In Birthing a Movement: Midwives, Law, and the Politics of Reproductive Care, Renée Ann Cramer provides a captivating, scholar-activist account of the development of the midwifery movement in the United States. The book specifically highlights Certified Professional Midwives (CPMs) and direct-entry midwives, who are not nurses and exclusively attend births out of hospitals. The book is “at its core an argument about the need for holistic, embodied, and integrative sociolegal research” (Cramer, 2021, p. 4) and makes use of classic interpretive methodological techniques, including participant-observation, ethnographic fieldwork, formal semi-structured interviews, and informal conversations. Cramer also uses case study methodology, with a focus on the development of the midwifery movement in Iowa, South Dakota, Missouri, and California. Through a compelling narrative, Cramer examines how midwives mobilize through the law in order to expand access to reproductive care and explores the contradictions within a movement that simultaneously craves and scorns the prospect of state regulation.
Birthing a Movement is divided into six main chapters, with each chapter centering the experiences of midwives in the law in the service of a broader narrative that sheds light on law's power in society. Chapter 1 is a history of midwifery in the United States, from the perspective of midwives. Cramer relates how the professionalization of obstetrics and gynecology combined with the consolidation of hospitalized births virtually eradicated midwifery in the United States by the mid-20th Century. Since the 1970s, a midwifery renaissance has emerged, driven by movement activists who seek to undo the mechanical and industrialized childbirth that occurs in hospitals in favor of at-home births, which have better outcomes for babies and pregnant people. Chapter 2 relays the rise of the renaissance of midwifery in the United States and the role midwives have played in mobilization campaigns that led to state legitimation. The chapter shines the most through Cramer's rich interviews, which beautifully depict activist stories of empowered women radicalized by tragic experiences of medicalized childbirth. Chapter 3 examines the tactics and mobilization strategies midwives employed in order to achieve legalization. The chapter opens with a narrative of the “happy accidents” within the Missouri legalization campaign, which ultimately ended the criminalization of midwifery by replacing the word “midwifery” in legislation with “tocology.” The language swap successfully kept the bill under the radar of the lobbyist for the opposition.
The final three chapters deepen Cramer's midwifery movement story through analyses of how midwives engage in legal mobilization, of their legal consciousness experiences, and of the cultural representations that shape and are influenced by midwifery. Chapter 4 focuses on heart-wrenching cases of over-zealous prosecution that follow tragic births. Cramer discusses how midwives use legal mobilization to challenge prosecution, to seek redress against obstetric violence, and in the pursuit of government regulation. Chapter 5 examines the complications midwives face in California as a result of legalization and their legal consciousness. These complications include difficulty attaining malpractice insurance and meeting legal requirements like working under a doctor's supervision. The final chapter examines cultural representations of midwifery and birth and how culture influences contradictions within the practice of midwifery. One particularly interesting section focuses on midwives who oppose regulation, further contextualizing the contradictions within the movement.
The book has an array of strong points. It tells a compelling narrative through the lens of midwives like Gina, a grandmother midwife, who spent 30 days in jail after illegally attending a traumatic birth in the middle of a blizzard. Birthing a Movement forcefully demonstrates how scholar-activism can advance the field through an absorbing narrative that is grounded in the experiences of activists themselves. At one point, Cramer relates her own traumatic birth story in a remarkable example of how qualitative and interpretivist ideologies can best integrate researcher positionality. The book is an excellent example for researchers who are invested in feminist ethnographies and conducting holistic studies that fully integrate activist narratives. Finally, the book comes at a crucial moment, when reproductive care in hospital settings has taken a hyper-medicalized turn due to the exigencies of the pandemic, and pregnant people have been forced to labor alone, in masks, and in settings that place them at greater risk of a COVID-19 infection. Cramer's story of the formation of the midwifery movement in the United States imagines alternative possibilities, where birth and labor are empowering experiences with reduced maternal and infant mortality rates.
Birthing a Movement is such a rich and well-written narrative, that it is difficult to find criticism. Yet, with midwives at the center of the story, it was not always clear what communities have benefited the most from the midwifery renaissance that has taken hold of the United States since the 1970s. That is, the book sometimes left the reader wanting to know more about those who use and seek to use the services offered by midwives in today's world. The book does touch upon this at various points, particularly at the beginning of Chapter 6, where Cramer describes critiques of “capitalism, colonialism, and imperialism” (Cramer, 2021, p. 170) at a BirthKeepers Summit. This meeting of midwives very consciously highlighted the contributions of women of color, indigenous midwives, and the queer and trans communities (which frequently prefer midwifery because of previous experience of medical racism, homophobia, and transphobia). But this is perhaps indicative of ways in which research on this topic might expand in the future rather than a systemic flaw with the book. Birthing a Movement will be of interest to any sociolegal scholar interested in law and social movements, legal pluralism, legal mobilization, legal consciousness, and the contradictions of legal implementation. It will also be of interest to undergraduate students and anyone curious about the politics of reproductive justice—and how much more there is left to do before justice can be achieved.
