Is the New Zealand academic community too small for critical reviews?
Writer and historian Kerryn Pollock was initially surprised to be commissioned by the New Zealand Journal of History (NZJH) to review The Best Country to Give Birth? Midwifery, Homebirth and the Politics of Maternity in Aotearoa New Zealand, 1970-2022 by Linda Bryder, but was even more surprised when her review was then rejected by the journal on the grounds of legal risk. Pollock was especially alarmed given the co-editor of the journal is Linda Bryder herself.
Bryder’s book was published in November 2023 by Auckland University Press. The Best Country to Give Birth is Bryder’s fourth publication with the press, including the 2009 book, A History of the ‘Unfortunate Experiment’ at National Women’s Hospital, which was vehemently debated at the time it was released.
Pollock was commissioned by the NZJH’s reviews editor David Littlewood to review Bryder’s book because, though maternity was not her area of interest, Pollock wrote the entry on Pregnancy, Birth and Baby Care for the online encyclopedia, Te Ara, so was somewhat familiar with the broader subject.
However, when Pollock submitted her work, she was informed by the co-editor of NZJH, Dr Lyndon Fraser, that her review couldn’t be published because it posed a threat of “possible legal action” against the journal, and they (the NZJH) had to ensure that “standards are maintained”. Fraser explained that his and Littlewood’s reasons were that Pollock’s review was “unfair and inaccurate” and at times “read like a personal attack on the writer”.
In response, Pollock denied that her review was in any way unfair or inaccurate or that it personally attacked Bryder. She agreed that the review was critical but noted that it is a reviewer’s prerogative to take a critical approach when warranted. Pollock voiced her own surprise at being asked to review the book in the first place, listing other writers with more interest in the topic who she’d have expected to review it instead. When Pollock asked Fraser how the review was legally risky, she didn’t receive a reply. It was not specified where, or who, the suggested legal threat could come from.
In signing off her email, Pollock stood by her review despite predicting the outcome. “I knew NZJH would be unlikely to publish my review but I couldn’t in good conscience have written anything else.”
Pollock’s review of Bryder’s book was not the only one to be critical. In the Social History of Medicine Journal, Volume XX, former CEO of the College of Midwives, Karen Guililand, begins her appraisal with this: “Bryder’s perspective of the New Zealand (NZ) environment leading up to and following the 1990 Nurses Amendment Act that recognised midwifery as an autonomous profession is deeply flawed and challenging. Bryder’s referencing of documents recording the decades of political changes to maternity services is vast. However, it is the revisionist analyses and omissions that makes it difficult reading.”
It’s unclear why Pollock was asked to review Bryder’s book, and is equally unclear why a review of it was commissioned at all given Bryder’s position as co-editor of NZJH. Reviews editor Littlewood told The Spinoff that as the NZJH is published by the University of Auckland it is subject to the University’s conflict of interest policy, but didn’t respond to questions about how that policy was applied in this scenario. The Spinoff does not know whether Pollock’s review would have been published if it was glowing rather than critical.
The Spinoff understands that former contributors to the NZJH are disturbed by Pollock’s experience and considering withdrawing reviews from the publication, or refusing to review for NZJH altogether.
New Zealand is a notoriously difficult country to produce critical responses to any text, art work or performance. It’s practically impossible to find reviewers who aren’t conflicted or who are willing to risk potentially frequent awkward encounters (or even personal and direct admonishments) should their appraisal be critical.
However, by and large the assumption has been that the academic realm at least upholds, and is built to thrive on, critical response.
Pollock’s review of Bryder’s book as submitted to NZJH, is printed in full below.
Note: a review is, by its nature, the reviewer’s opinion.
The Best Country to Give Birth? Midwifery, Homebirth and the Politics of Maternity in Aotearoa New Zealand, 1970-2022 by Linda Bryder, reviewed by Kerryn Pollock
Maternity and childbirth are personal and political. Historian of medicine Linda Bryder begins The Best Country to Give Birth? with a coronial inquest into the death of two babies during birth in 2012, a highly public legal exploration of personal tragedy. This sets the tone of her book. The author acknowledges that she is dealing with “a highly politicised area of healthcare…in which the stakes are high” (p.4). This is not, however, a detached, dispassionate study. Bryder is highly critical of New Zealand’s midwifery-led maternity system, instituted by the Nurses Amendment Act 1990. While she is careful to note that most births “proceed without mishaps” (p.4), there’s an inference of a correlation between avoidable adverse and tragic outcomes and the primacy of midwives. Bryder infuses her critique with a cumulative antipathy towards leading midwifery figures and the influence of the women’s liberation movement in the two decades leading up to the law change.
The first five chapters are contextual. A few pages of chapter one traverse the shift from predominantly home births in the nineteenth and early twentieth century to majority hospital births from the 1930s; improvements in birth hygiene practices; technological developments; and maternity care training. After a brief mention of the decline in maternity mortality from the 1930s, the focus shifts to the rise of modern midwives and the influence of the feminist- and counter culture-driven home birth movement. Bryder’s thesis is that a minority movement underpinned by anti-establishment values co-opted New Zealand’s maternity system.
While there is no disputing the change from general practitioner to midwife-led care, which bears the imprint of vigorous feminism, Bryder’s narrative is threaded with an almost conspiratorial tone. Chapter one ends with a dramatic promise to “reveal” how New Zealand’s small group of home birth practitioners of the 1970s were “part of a powerful international movement” (p.29). Trans-national relationships forged between local midwives and their counterparts overseas are suspect. New Zealand is described as “an attractive destination [on] the international circuit for campaigners” (p.46). Visits by midwife Ina May Gaskin, obstetrician Michael Odent, social anthropologist Shelia Kitzinger and the World Health Organisation’s Marsden Wagner, are looked upon askance. “The homebirth movement had gained some powerful international allies” (p.47) as a stand-alone sentence is innocuous enough, but in the context of this book it reads as if a cabal of women made unholy alliances. Another interpretation is that they were simply acting like all participants in successful social movements, making international connections. While the experts cited above are not immune from criticism, neither are they fringe-dwellers that inherently warrant suspicion.
The counter-cultural practices of home birth midwives are excellent fodder for Bryder. Their penchant for living in communes (including the now-notorious Centrepoint), eschewing alcohol and cigarettes for marijuana, prescribing raspberry leaf tea, blackstrap molasses and homeopathic remedies, and holding anti-vaccination views are rightly traversed. It would be remiss not to explore the lifestyle choices, values and beliefs of home birth practitioners, some of which are highly problematic (e.g. vaccine denial). It is however, necessary to articulate that such practices and views did not, aside from alcohol and tobacco, gain mainstream traction, which Bryder does not do, though she correctly points out that home birth did not take off as its practitioners assumed it would. This demonstrates the importance of not overstating, even implicitly, the influence of counter-cultural practices on New Zealand’s maternity system.
A curious feature of Bryder’s work, which also marked her revisionist account of the ‘Unfortunate Experiment’, is the absence of oral history interviews. Many of the midwives who feature in this book, and whose published and unpublished work is used as source material, are still alive, and some remain active in their profession or allied fields. It is difficult to understand why they were not interviewed, at the very least as a courtesy. Joan Donley (1916–2005), a critical figure in New Zealand midwifery, is correctly singled out but in an almost demonising fashion. Donley was clearly an energetic, dynamic woman with phenomenal organising abilities. Bryder’s use of words and phrases such as “orchestrated” (pp.89, 111), “exhorted” (p.94) and ”very determined, persistent and effective campaign”, while encapsulating the necessarily robust tactics of political movements, leave the reader feeling as if the raspberry leaf-wielding Donley was possessed of occult powers, such that she swayed the influential politicians Marilyn Waring and Helen Clark to her cause.
The book’s overall tenor is that midwife-led maternity care has compromised the safety of mothers and most particularly, babies, even if Bryder is careful not to make such bald statements. She makes extensive use of coronial inquests to support her thesis. This qualitative information, along with the quantitative evidence derived from Perinatal and Maternity Mortality Review Committee reports, is not situated within a wider context. Readers are not provided with a baseline analysis of maternal and infant mortality trends prior to 1990, data issues acknowledged. There is no comparative information from inquests and disciplinary investigations into other health service-related avoidable deaths or injury. Midwifery cases are treated in unhelpful and unjust isolation. Context is critical, especially when working with delicate subject matter. While Bryder has provided a usefully detailed exploration of the recent history of maternity and birth in New Zealand, The Best Country to Give Birth? is simply another voice in the “maternity row” recounted on the first page.