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This chapter examines how missionary education feminised medical learning outcomes in India. Male medical colleges in each major Indian province were citadels that were cleverly infiltrated by female medical activists. The activism of these European females was still driven by a largely unremitting Western feminine discipline that enshrined a strong belief in the sanitation procedures of the West, which offered remedies for an ‘unclean’ Indian East. This approach was especially apparent when large numbers of Indian nurses and dais (midwives) entered into some form of Western training, even though this training also broke down some of the race barriers still strongly in place concerning female teaching. Feminist doctors in India contested the operation by males of large funding bodies like the Lady Dufferin Fund. Yet they were to keep their struggle against colonial men within the bounds of their colonial European communities, rather than attempting to instil a similar brand of feminism in their Indian female counterparts.

This chapter explores the strengths of modern midwifery and identifies areas of concern for the future. A strong interconceptual role is vital to improving women’s health but the lack of diversity in the profession is hindering its potential. The chapter focuses on the work of the American College of Nurse-Midwives’ Midwives of Color Committee, the United States Midwifery Education, Regulation, and Association, and the International Center for Traditional Childbirth to explore the ways in which midwifery can stake a permanent claim in the lives of American women and maternity health.

The epilogue brings hope of positive change as the American College of Nurse-Midwives and the American Congress of Obstetrics and Gynaecology work on common ground to solve the pressing issues of American maternity care. A reassessment of the essential inclusion of both macro-level and micro-level components of care leads to the conclusion that Dr. J. Edward Hill subscribes to: good health care is local and when community activism is supported by state and federal funding and integrated into the structures of medicine and politics change will happen.

Chapter 5, “From El Paso to Lexington: The Formation of the Midwives Alliance of North America,” closely tracks the push to organize direct-entry midwives, beginning with the first international conference of practicing midwives in El Paso in 1978 and ending with the formation of MANA. Ideologically, many of them viewed midwifery as a feminist endeavor that enabled women to reclaim their bodies, rather than a medical profession. Barred from membership in the already established American College of Nurse Midwives, they sought to create a more inclusive organization that could provide them with the protection, legitimacy, and visibility needed to sustain and grow their trade. This would turn out to be an enormously challenging task.

Despite their recognized importance to maternity care African American nurse-midwives experienced both racial and professional discrimination. This chapter underscores the unyielding obstacles of racism. Issues of segregation, unequal pay for black nurses, and lack of funding led to the closure of the Tuskegee School of Nurse-Midwifery, and the American Association of Nurse-midwives determined that whiteness was central to its concept of the professional midwife. Physician-centered maternity care was advocated as a solution to what was termed racial dualism in health care and ultimately the implementation of the wartime Emergency Maternal and Infant Care accelerated the shift toward hospital birth.

In competition with a powerful medical establishment nurse-midwifery has struggled to gain legitimacy and carve out a space in which to practice. This chapter provides some historical background of the American College of Nurse-Midwives, the importance of “whiteness” to the preceding professional body, and the effect that state legislation has on the growth of the profession. The experience of Dr. J. Edward Hill demonstrates the benefits of a collaboration between physicians and nurse-midwives.

This chapter examines the ways in which policy agendas and contemporary notions of the ‘good mother’ frame infant feeding practices, rendering them a site of moral and interactional trouble. Drawing on analysis of mothers’ talk with midwives during the first days of motherhood, the chapter explores the ways in which breastfeeding confers a positive maternal identity, while choosing not to do so is associated with a deficit identity against which mothers struggle to present themselves as good parents. The chapter suggests that mothers’ interactions with professionals are important places for exploring the ways in which ‘ordinary’ family practices may be troubled by professional and policy agendas which may conflict with women’s embodied experiences and cultural beliefs about what constitutes a healthy, well-fed baby. A focus on these encounters makes visible the rich texture of maternal labour and its complex and troubling relationship with policy.

With the help of Mary Breckinridge, Lovie undertakes midwifery training at the Simpson Memorial Maternity Pavilion at the Royal Infirmary of Edinburgh, Scotland, an almost unheard of ambition for an American woman of her generation. Her instructor is Margaret “Maggie” Myles, one of the best-known teachers of midwifery from any era and the author of the Textbook for Midwives, the first midwifery text by a midwife for midwives. Lovie’s classmates came to call her “Sister Carolina” after her home state. In this chapter Lovie discusses her training: she spent the first six months observing and attending births at the Simpson and the second six months attending home births in Edinburgh. Lovie also describes her affection for the Scots and the lasting influence on her of Myles and the training program.

Narrator Lisa Yarger asks Lovie about the possibility of accompanying her to a birth. Lovie tries and fails to get one of her Mennonite clients to meet Yarger. Yarger gives Lovie Chris Bojalian’s novel Midwives, which Lovie mistakes for nonfiction. Lovie hits upon the idea of introducing Yarger to her newest client, Joy Mitchell of Pantego, who grew up in the Dutch-American community of Terra Ceia in northern Beaufort County. This chapter includes the story of how Joy and her husband Kenny Mitchell decide on a home birth for the delivery of their fourth child after three dissatisfying hospital births.

This chapter explores the resurgence of interest in home birth and midwifery (primarily among college-educated white women) as a result of second-wave feminism. Midwives such as Ina May Gaskin begin challenging the physician-controlled model of birth seen by many women as oppressive. Midwife-attended home birth also becomes popular among conservative Christians, who provide a new client base for Lovie. This chapter examines the response of the medical establishment to women's demands for more personalized care and details the political showdown in the early 1980s in which the North Carolina Medical Society pressured legislators to oppose home birth, despite Midwifery Study Committee findings about the safety of planned, attended home births. House Bill 814, passed in 1983, recognizes certified nurse-midwives for the first time and ends the licensing system for lay midwives. The bill also provides a “grandmother clause” for midwives who have practiced at least ten years. Lovie is one of two women to benefit from the exemption: although trained as a nurse-midwife, she did not maintain membership in the American College of Midwifery or seek to fulfill updated membership requirements. The other, Lisa Goldstein, becomes legendary among a new generation of midwives who have no idea of Lovie’s existence.

This chapter explores how, unknown to Lovie, an underground home birth movement has quietly thrived in North Carolina in the several decades since the passage of the 1983 midwifery bill outlawing the practice of lay midwifery. This chapter also chronicles the founding in 1992 of a master’s level midwifery training program at East Carolina University in Greenville, a program that brought certified nurse-midwives (CNMs) into the eastern part of the state to train, teach and work. Two CNMs, Laurie Irwin-Pinkley and Maj-Liz Downey, befriend Lovie and facilitate her connection to the North Carolina chapter of the American College of Nurse-Midwives (ACNM). Lovie is flattered by their recognition of her as a pioneer but befuddled by the changes in her profession that make it difficult for her to identify completely with the younger nurse-midwives. Lovie tries and fails to understand her place in the new midwifery landscape.

While pregnant, the narrator visits Lovie (who is still living with her daughter Nancy while her house is being repaired post-fire) and ponders how Lovie’s life looks like a stretched out version of the Book of Job. The narrator meets and interviews younger midwives around North Carolina (including CNMs at a North Carolina chapter meeting of the American College of Nurse-Midwives) to help her put Lovie's career in context. Influenced both by these women and by her relationship with Lovie, the narrator considers delivering at the Women’s Birth and Wellness Center in Chapel Hill, a free-standing birth center, and ultimately decides to have a home birth with nurse-midwife Nancy Harman in attendance. This chapter also unfolds the story of the narrator’s home birth. Before moving with her husband and daughter to Munich, Germany to open a bookshop, the narrator visits Lovie with her baby and realizes she knows everything she needs to know to finish the book on Lovie.

This chapter, like the entire volume, is dedicated to the memory of Channi Kumar. I first met Channi in August 1984 in Oakland, California, at the biennial meeting of the Marcé Society, hosted by James Hamilton. I had already been impressed by Channi’s research but knew him only through his published work. In person, the man did not disappoint. He was elegant and kind, a man who treated everyone with respect. Over the years, my affection and admiration for Channi grew through many stimulating discussions and delightful social occasions. Even our last series of meetings focused on a new, exciting initiative of Channi’s: the ‘Transcultural Study,’ which he envisioned as a way to harmonize the detection, assessment, and treatment of perinatal mood disorders, across western Europe and even the United States, Asia, and Africa. Through experiences like these, Channi made my life richer, personally and professionally; and I greatly miss him as a mentor and a friend, and feel privileged, along with my colleague Lisa Segre, to contribute a small piece to honor this great psychiatrist and humanitarian. Michael W. O’Hara Perinatal depression is a significant mental health problem that afflicts women around the world at a time when they are highly vulnerable—pregnant or managing a new infant. In one form or another, perinatal depression has been recognized for thousands of years; however, only in the past 50 years has there been a sustained focus on the non-psychotic mental illnesses experienced by some during pregnancy and the postpartum period. The literature of the 1960s contains only a few papers with the words postpartum depression, postnatal depression, or perinatal depression. Not until the 1970s did these terms come into common use. Indeed, a search for at least one of these terms on the PsycNET database (from entries catalogued between 1884 and 9 September 2012) revealed the vast majority (2,743 or 75%) of 3,651 papers, books, and book chapters on perinatal depression were published after 2000. These findings show how work in the field of perinatal mental illness has expanded exponentially.