Pushing in Silence

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.

A thoughtful analysis of birthing practices in Puerto Rico, written from a historical, multifaceted perspective., It’s more important than ever to restore a sense of [Puerto Rico] as a complex place with a rich history—as much more than a disaster. This book certainly gives us that., Pushing in Silence eloquently narrates the complex experience of birth in Puerto Rico over the course of the second-half of the twentieth century to illustrate how medicalized birth arose due to a cultural value change rather than a vis-á-vis state imposition., Whereas traditional historical accounts have focused on the purely economic and political forces at lay in the institutional development of biomedicine in Puerto Rico, Córdova astutely illustrates the inherent intersectionality in these dynamics. She works to explore the entangled relationship of class, gender, race, politics and power that imbue childbirth and medicine more broadly., Córdoba’s writing is clear, her story is compelling, and she makes excellent use of historical documents and the interviews that she conducted with midwives, mothers, and doctors...This book is important reading for those interested in medical history, recent Puerto Rican history, and gender studies, as well as for medical professionals.

Isabel M. Córdova is an associate professor in the Department of History and Political Science at Nazareth College.