(Disclosure: I received a copy of the book to review. And I'm giving it to someone else after I'm done. So as far as the ads go, we're all good.)
When I first found out about The Blue Cotton Gown: A Midwife's Memoir, I assumed it was going to be chock full of birth stories and pregnancy lore. (The author, Patricia Harman, is a Certified Nurse-Midwife in practice with her husband, an OB.) I was wrong about that -- but what the book actually is is far more revealing of the state of midwifery and medicine in general than any compendium of birth stories seen through a midwife's eyes.
Harman's clinic has stopped doing births, we learn, because the insurance payments are too much. Indeed, the thread of financial pressures on health practices runs through the book, and by the end it's evident that if anything is the undoing of health care in the U.S., it's the deeply screwed-up system of malpractice insurance and finance in general. Small practices in particular are vulnerable, yet those are often the places that give the best, most personal care. Not to mention the growing numbers of doctors unable to pay the malpractice insurance that lets them attend births...sigh. Here in the book, the problem is rendered in microcosm, on a personal, one-practice level, and the consequences to patients and providers alike are disheartening.
Another issue that surfaces in the book on a personal level is the issue of lawsuits against providers -- again, part of a larger societal shift, but here we see how the threat of being sued affects both a provider's willingness and ability to take on certain types of cases, and what it does to the provider herself (or himself). We ask a lot of our health care providers, especially the ones who are really in the trenches providing ob/gyn care, midwifery services, and (one imagines) general and family practice care; often the payoff for countless hours of exhaustion is numinous as a patient's success. Of course that's the story we as a society tell ourselves about medicine and midwifery -- hey, we're in it because we just LOVE the PATIENTS -- and while that's a beautiful thing, it's not always enough, while insurance companies (both patient and malpractice) are devouring most of a practice's profit.
Unless you're really passionate about the cause, the above issues might seem a little dry and removed -- but in this book they're vividly rendered in an unassuming way.
The most compelling aspect of the memoir, however, is the overarching story of how Harman relates to her patients. We watch them reveal their stories to Harman over the course of visits, we see how the consequences of their actions play out, we wince and hope along with Harman (and are eventually uplifted or crushed, right along with her). In contrast, birth stories look tidy, with a time-limited arc, obvious crescendo, and relatively predictable endpoint -- the stories of lives told here are messy and even shocking, depressing and sometimes surprisingly hopeful. And Harman herself is far from exempt. The story of her life is revealed here too, and she does not shy away from the uglier parts: grown children who screw up their lives, a marriage on the verge of collapse, demoralization and exhaustion. In all it's a frank and unflinching look at the world, and left me wondering if there was any hope for my eventual teenagers. Or my eventually older self.
Stylistically the writing often fades into the background, which works well in a memoir like this; you don't want to be noticing the writing so much as the story. Harman inserts stories of her dreams, relevant, of course, to the unfolding drama, but the effect is somewhere between tiresome and jarring. It takes you out of the immediacy of the real story and deposits you in a place where symbolism is obvious and heavy-handed.
The strength of Harman's writing is in her honest and realistic rendering of life as a CNM. We can interpret the larger significance of events best when we are seeing them unfold on the small stage of one medical practice in West Virginia; we understand the bafflement of how to care for the woman with cancer, chronic pain, an abusive relationship, best when Harman brings us along with her into the exam room.
It's not what I'd call great literature, but in all I'd say it's worth a read, especially if you're at all interested in what's going on with medical and midwifery care in the U.S. today. Even if you don't have a dog in that race, even if you read it from the perspective of a patient, it's worthwhile. What I'd really love to know is what health care providers think about the book. Anyone able to oblige?
