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As Puerto Rico rapidly industrialized from the late 1940s until the 1970s, the social, political, and economic landscape changed profoundly. In the realm of heath care, the development of medical education, new medical technologies, and a new faith in science radically redefined childbirth and its practice. What had traditionally been a home-based, family-oriented process, assisted by women and midwives and "accomplished" by mothers, became a medicalized, hospital-based procedure, "accomplished" and directed by biomedical, predominantly male, practitioners, and, ultimately reconfigured, after the 1980s, into a technocratic model of childbirth, driven by doctors' fears of malpractice suits and hospitals' corporate concerns.

Pushing in Silence charts the medicalization of childbirth in Puerto Rico and demonstrates how biomedicine is culturally constructed within regional and historical contexts. Prior to 1950, registered midwives on the island outnumbered registered doctors by two to one, and they attended well over half of all deliveries. Isabel M. Córdova traces how, over the next quarter-century, midwifery almost completely disappeared as state programs led by scientifically trained experts and organized by bureaucratic institutions restructured and formalized birthing practices. Only after cesarean rates skyrocketed in the 1980s and 1990s did midwifery make a modest return through the practices of five newly trained midwives. This history, which mirrors similar patterns in the United States and elsewhere, adds an important new chapter to the development of medicine and technology in Latin America.

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• Map and Tables(p. ix)
• Acknowledgments(p. xi)
• Introduction(p. 1)
• Chapter 1 Phase One: Midwife-Assisted Home Births, 1948-1953(p. 16)
• Chapter 2 Phase Two: Transitioning toward Hospital Births, 1954-1958(p. 49)
• Chapter 3 Phase Three: Physician-Assisted Hospital Births, 1959-1965(p. 84)
• Chapter 4 Phase Four: Medicalized Births, 1966-1979(p. 107)
• Chapter 5 Phase Five: Novoparteras and a Technocratic, Litigation-Based Model of Birth, 1980-2000(p. 138)
• Conclusion and Epilogue(p. 172)
• Notes(p. 181)
• Bibliography(p. 205)
• Index(p. 223)

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CHOICE Review

Córdova (Nazareth College) offers a compelling analysis of the transformation of birthing practices in Puerto Rico in the 20th century. She traces how these practices evolved from the 1950s--when the majority of Puerto Rican births were facilitated by midwives and took place in the home--through the present day, in which doctors have replaced midwives alongside technocratic, hospital-based procedures. Of course, this shift echoes a similar trend elsewhere in the world where the Western medical paradigm is employed as populations have urbanized and technology has advanced. Córdova structures her chapters around five phases, introducing each with poignant first-person vignettes recounting the experiences of mothers, midwives, and doctors. Home births were the norm prior to 1953; the next decades saw a marked rise in hospital births while home births gradually decreased and disappeared. Over time, the process became increasingly institutionalized and brought under more rigorous regulation. In recent years, litigation became widespread as doctors were blamed for complications and cesarean rates escalated. This helped drive a new trend: novaparteras (certified midwives) have begun to offer women in search of alternatives a more personalized home birthing option. A thoughtful analysis of birthing practices in Puerto Rico, written from a historical, multifaceted perspective. Summing Up: Recommended. Upper-division undergraduates through faculty and professionals. --Debra E. Bill, West Chester University

Notas de autor provistas por Syndetics

Isabel M. Crdova is an associate professor in the Department of History and Political Science at Nazareth College in Rochester, New York.