Reading Birth and Death by Jo Murphy-Lawless (Bloomington and Indianapolis: Indiana University Press, 1998). 343 pages.

Reading Birth and Death is a multi-layered inquiry into the construction of obstetric knowledges, an inquiry which raises sceptical doubts about the ascendancy enjoyed by the medical model. With the disclaimer that her intention is not to prove the superiority of one conceptual approach over another, Murphy-Lawless gives us a rich and thorough history of the development of obstetric science, with particular attention to its consolidation of authority and the backgrounding of women's midwifery and other 'folk' knowledges around birth.

According to Murphy-Lawless, obstetric knowledges may be analysed in terms of their conceptual completeness and the degree of agency they acknowledge and accommodate in birthing women. The medical model, she alleges, has derived and preserved its authority by constructing its own efficacy as death-defying while simultaneously constructing the birthing subject as passive and needing to be rescued. While the risk of dying in childbirth is not to be dismissed, neither need it frame birthing knowledge by privileging the categories of 'norm' and 'risk'. Both terms, and the birth practices deriving from them, misleadingly suggest a uniformity, a predictability and a unanimity of judgment. In addition, the genesis of technical obstetric meanings reinforces the power of obstetric science even as it alienates women from a linguistic and social comfort and control over their own birthing.

Reading Birth and Death is a cornucopia of historical detail, taking the reader step by step through texts that paint a picture of birthing in history (the author focuses on Ireland) at the same time as it reveals the struggle over which knowledge will dominate. The book is explicitly a Foucauldian analysis - it shows that obstetric knowledge (like all knowledge) is a social construction, and that the relation between theory and evidence and between knowledge and its acceptance is neither static nor determined by epistemic norms alone. Obstetric science has a normalising thrust; and its subjects are constructed to be complicitous. Challenging the hegemony of the scientific approach, therefore, requires a revision of female subjectivity.This is not enough, however. Subjects exist in contexts which constrain the possibility of agency. For women to enjoy increased agency around birthing we need a critical engagement with the dominant discourses of obstetrics, an opportunity to redefine the key notions of 'risk'and 'norm', to embrace birthing technologies, where desired, on our own terms. This action and this talk amounts to the politicising of birth. As the author concludes, "If we re-position ourselves on the issue of no guaranteed outcomes, if we accept that there cannot be complete scientific knowledge but that we are valuable contributors to multiple knowledges, we can break up the power relations which maintain this closed discourse on risk and death." (263).

Jo Murphy-Lawless' book is not an easy read, but it offers much to a range of readers. It is a sophisticated history of obstetric medicine in Ireland (a history which doubtless parallels those in other Western countries). It is a provocative sociological analysis, offering another example of the epistemic empire-building Foucauldians have learnt to deconstruct. It is an inspiring feminist read (though chilling in its reporting of the conditions under which so many women have given birth, and the often bloodless narrative descriptions by medical attendants) in uncovering the birthing knowledge of early midwives, many of whose insights have been vindicated. And it is a moving read on a personal level, an opportunity for a backward-directed solidarity amongst birthing and birthed, a reminder, as the author says, that "Birth is a fateful moment, a reproductive moment of consequence that is far more than the static physicality to which obstetrics has reduced it" (262).

Elisabeth Boetzkes
Associate Professor, Philosophy