Most women in the United States, my daughter among them, expect a dramatically different birthing experience from Charlotte's. And yet the country that spends the highest percentage of its GNP on health care also, according to [Jessica Mitford] in "The American Way of Birth," ranks 24th among industrialized nations in infant mortality. Mitford's curiosity was aroused by the case of a young lay midwife in California facing "criminal prosecution for allegedly practicing medicine without a license," and her experienced nose "scented the familiar aroma of a bureaucracy in the service of special-interest groups, hunting easy prey." She set out to investigate "the whole vast, intricate American birth scene," visiting hospitals and birthing centers from rural Tenessee to East Oakland and the South Bronx. Although her reach has exceeded her grasp, she has furnished an informative, highly readable, and often appalling account of her findings.

Obstetricians may similarly despise "The American Way of Birth." But babies will go on being born, and some of them, alas, will be in trouble. In such instances, obstetrical care will always be essential, and every woman, Mitford argues in her epilogue, must be provided access to it. But for the majority of women, who enjoy healthy pregnancies and uncomplicated deliveries not requiring medical supervision, safe and economical alternatives exist, and women must be provided access to these as well. Owing to "the lucrative partnership of fee-for-service medicine and private insurance," the universal access that national health insurance on the Canadian model would guarantee has been systematically forestalled, and Mitford seems less than sanguine that relief for the "37 million" or more uninsured Americans will arrive any time soon.

Mitford's presentation, though less than thorough, is invariably entertaining. She has a gift for telling details and amusing anecdotes: "My mother," she recounts, "asked what it felt like to have a baby, was hardly reassuring: `Like an orange being stuffed up your nostril,' she said." Mitford's treatment of reproductive issues tends to be spotty and superficial, omitting altogether questions regarding spontaneous or induced abortion, infertility, surrogacy, and neonatalogy, for example. Nevertheless, it serves as a sprightly introduction to matters that ought to lie, like babies themselves, very near our hearts.