Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, February 2, 1993 TAG: 9302020116
SECTION: EXTRA PAGE: 6 EDITION: METRO
SOURCE: ELIZABETH KASTOR THE WASHINGTON POST
DATELINE: WASHINGTON LENGTH: Long
JESSICA MITFORD'S LATEST BOOK GOES AFTER THE MEDICAL SYSTEM
She spent three long years at it, equipped with cane, heavy brown shoes and a notebook. Forcing down tofu prepared by politically correct midwives. Slogging through medical terminology. Confronting an obstetrician here, a state medical official there. Finding a new subject to arouse the muckraking outrage in her mid-seventies.It had a long gestation, "The American Way of Birth," and Jessica Mitford is both wearied by that and a little bit embarrassed.
"Look at these monstrous chapters," she is saying, as she riffles through the book. "They're so long and technical. But the reviewers seem to find them amusing anyway. All you like to do is make people laugh in the end."
Amusement - a modest enough goal. Deceptively modest, perhaps, for an author best known for her acidic 1963 attack on the funeral industry, "The American Way of Death."
That witty, eccentric and wildly opinionated book gave amusement a stiletto edge. Her new book, a journey through birthing rooms and obstetrical offices, is a personal assault on the inequities and technological obsessions of the American medical system.
She speaks about the subject passionately, and in the midst of her passion says she hopes to have some effect on the national debate over health care: "After you've written a book, the one thing you hope to do is have some influence on legislation." There is behind this much more than the desire to amuse.
Yet despite her political passions and half a century of life in America, Mitford still retains that British way with a supremely sensible, dismissive aside. And that tone keeps her book amusing, in her casually wry, trademark style.
How many other investigative writers would quote a policy reversal by the American College of Obstetricians and Gynecologists and then comment in print, "Well I never"?
She is helped stylistically (although somewhat hurt substantively) by the fact that she began her research for the book in a state of utter ignorance. "An awful lot of these terms are completely unknown to me," she says. "I didn't know what an episiotomy was."
(Note to any naifs out there: Webster's New World Dictionary defines episiotomy: "an incision of the perineum, often performed during childbirth to prevent injury to the vagina." If any questions remain, look up perineum yourself.)
Mitford is sitting right now in a Washington hotel bedroom that has opted for pseudo-English charm over size. She is unfailingly gracious, repeatedly apologizing for the clutter of the room ("It's partly me and partly because the room is too small").
Within her decorous blue silk dress she looks rather frail, but she pages through her book with energy, searching for a certain quote or statistic.
The daughter of a well-documented and notoriously eccentric aristocratic English family, she lives in Oakland, Calif., as she has for decades. Her well-received memoirs are behind her, and she insists she will retire after this book, but "my editor says I say that after every book. It's like when you have a baby. You don't think you'll start another right away."
Having retired from childbearing more than 40 years ago, Mitford lacked firsthand knowledge of most of the fads and techniques that have shaped childbirth in the intervening years, from doctrinaire natural childbirth to the electronic fetal monitor. She comes to modern-day obstetrics with the amazed skepticism of Rip Van Winkle in Silicon Valley.
In the book there are the interviews with young obstetricians conducted in the mid-'70s by an anthropologist in which the doctors reveal themselves to be callous toward poor clinic patients, using them merely as tools in their education. There are the programs designed to bring adequate prenatal and obstetrical services to poor women in Alabama and the Bronx. And there are the midwives.
Mitford spends much of her time examining the travails faced by "lay midwives," who are trained to deliver babies at home. Her desire to write this book began with the tale of one such midwife, who was being investigated by the California Board of Medical Quality Assurance for practicing medicine without a license.
In the course of her research she became a fierce advocate of midwife-assisted births and now believes the investigations of lay midwives (who, unlike "certified nurse-midwives," do not have nursing degrees in addition to their midwife training) are an example of the medical establishment's desire to keep control over the lucrative birth business.
A few reviewers, however, have pointed out that some of what Mitford found during her work is not as surprising to many as it is to her. The belief that there are too many Caesarean births in this country, and that doctors' fears of malpractice may cause them to deliver babies surgically when it is not truly necessary, has prompted troubled conversations among mothers-to-be for years.
She says, "The theme of my book is freedom of choice," something she believes many women are denied because they lack the knowledge to question the pronouncements of their doctors or the money to pay for adequate care.