Media Reviews – Issue 139

Midwifery Today, Issue 139, Autumn 2021.
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For Generations: A Midwife’s Tale of Hope and Help for Drug Addicted Pregnant Women and Their Families, by Mary Earhart. 2018. (CreateSpace Independent Publishing Platform, $5.95, 122 pages, paperback)

Addiction recovery meets midwifery care in For Generations, written by a licensed midwife and public health nurse in Southern California. Readers will enjoy a book of learned wisdom that focuses on drug-addicted pregnant women and their stories of managing both pregnancy and the problems of life in early recovery.

Case histories in the book supplement midwifery best practices for helping mothers with special needs, such as childhood sexual abuse and rape—major factors in many cases of chemical dependency. The book details how to avoid trauma triggers in a way that facilitates bonding and can break intergenerational patterns of abuse and neglect.

The author tells her own story of drug addiction and being unable to access residential care because no facilities were open to pregnant women at that time. Getting clean and going back to school were her paths to creating the program she wished had been there for her, an award-winning, 12-step-based, peer-oriented, midwife-run social model perinatal program that Ms. Earhart facilitated for nearly 20 years. Between primary care and sober living, many of her clients remained in supportive environments for up to two years, allowing for thorough follow-up. For Generations provides eye-opening scenarios and thought-provoking insights written in a warm, inviting format that welcomes readers to a world of healing.

While many of the women delivered naturally in their own bedrooms, there were also circumstances that required collaboration with other healthcare professionals: Sometimes fear and self-centeredness lead to decisions that don’t turn out the way we would like in childbirth. When that happens, I am happy for the quick thinking of a good pediatrician, and I try to stay objective and focus on the present: a baby and mother desperately needing to bond so that things have a second chance at a good start. Sometimes we get lucky.

Illustrated with charts comparing models of care and sidebars of dos and don’ts, the blend of practical advice for midwives, doulas, and families; psychological and physiological insights; and a midwife’s challenges when helping her clients face addictive processes makes for a unique approach to pregnancy and postpartum care in this population. For Generations is recommended for anyone seeking an understanding of drug-addicted pregnant women. This is a fine, much-needed book. The late Jeannine Parvati Baker, author of Hygieia, a Woman’s Herbal and Conscious Conception, called For Generations “an incredibly important contribution to a more compassionate and sane society.”


Birthing Outside the System: The Canary in the Coal Mine, by Hannah Dahlen, Bashi Kumar-Hazard, and Virginia Schmied. 2021. (London: Routledge, $48.95, 484 pages, paperback).

I have been waiting for this book for so long. I saw reviews online, but could not really warrant the price of hardback copy, so was pleased when the paperback was available.

I knew that there would be some uncomfortable moments when reading this book. At the beginning the reader is informed that we will be shocked and at times distressed. This will inspire us to join the revolution in humanizing childbirth.

I will come back to this quote several times but “The question should not be why do women not accept the service that we offer, but why do we not offer a service that women will accept?”–Mahmoud Fahthy Fathalla, 1988.

There are several chapters reviewing the current practice and studies about birthing outside the system. This includes freebirthing, HBAC, and women who do not “fit” the organizations’ criteria. Similar stories exist from the US, UK, and Australia. While there are exceptions, as shown in the homebirth rate in the Netherlands of 12.7% (2017) and midwives working in groups rather than solo (80% vs. 5%, 2015). The Netherlands also have challenges to their own system.

As the book continues with birth expectations and actual experiences in the Middle East, Eastern Europe, and India, it unfolds into worrying interventions and coercion. There are interesting discussions about the role of TBAs (traditional birth attendants) in India and their role in areas that have limited access to professional midwives and doctors. The book references “unregulated birth workers in Australia.” With the rise in “freebirthing,” especially during the pandemic, it encompasses how we can work together and reiterates that “[t]he question should not be why do women not accept the service that we offer, but why do we not offer a service that women will accept?”

Chapter 11 discussed the legal rights and challenges from many parts of the world, including Australia and the US, about women being coerced into procedures which are against their wishes. Discussion of the modern-day witch hunt is shared by Hannah Dahlen and Jo Hunter, from the middle ages to “modern” Norway, US, Iceland , Australia, and Eastern Europe.

This is an amazing book to read. It is easy to dip in and out of the chapters and is thought-provoking and challenging. I highly recommend it to every birthworker.

Thank you to the authors for publishing this wonderful, eye-opening book.

About Author: Dianne Garland

Dianne Garland, FRCM, SRN, RM, ADM, PGCEA, MSc, developed a passion for midwifery in 1983. Her subsequent energy and enthusiasm for developing and expanding a new practice led her to teaching about waterbirth in 1989; a subject which has remained extremely close to her heart ever since. Dianne works clinically in a local hospital supporting low- and high-complex mothers and babies through childbirth.

After over 40 years in the NHS, she started her own company, MidwifeExpert, in 2005. In this role, she lectures and consults internationally, as well as offering other specialist services such as Expert Legal Witness and Care Quality Commission Inspections. She currently holds professional roles within respected public and private bodies including APEC (Action on PreEclampsia), NICE UK, Gentle Birth Guardian Education, Waterbirth International (USA), Wenzhou Oriental Maternity Unit (China), Wellness Mother and Baby Hyderabad (India), and advisory panel for MMF.

Dianne has published four books on waterbirth. In 2019, she was awarded RCM fellowship for her worldwide contribution to waterbirth research, teaching, and clinical work.

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