The prospect before her: a history of women in western Europe, volume one, 1500–1800

struggle of medical practitioners to assert their new authority as scientific professionals between 1870 and 1930. The shift towards the hiring of physicians rather than midwives, however, had little to do with an improved scientific training of physicians. As Borst points out in the case of Wisconsin, medical school training in childbirth was often no more "scientific" than, and indeed was frequently inferior to, the education offered to midwives. Furthermore, many of the first physicians attending maternity cases "were rural physicians, who practised in places that never built institutions, such as hospitals or medical schools, that would come to define the essence of scientific, laboratory medicine in the twentieth century" (p. 6). As Borst points out, many women's acceptance of the male physician attendants in the birth chamber and the scientific ideals that they brought with them was linked to the fact that these men were familiar, powerful figures in the community who, like midwives, shared the ethnic background of their patients. In the final part of the book Borst shows that issues of gender and culture were just as important in the rise of the specialist obstetrician. Many of the first doctors to specialize in obstetrics gained their reputations by building large practices through their communal connections and by reliance on the traditional face-to-face relationships expected between doctors and patients. By comparison with these specialist doctors, the later hospitalbased obstetricians achieved their professional status not through communal and cultural ties but rather through their institutional ties and academic affiliations. By the 1920s most births were taking place in hospitals, and even small rural communities were building hospitals to accommodate maternity cases. For anyone interested in the professionalization of medicine and the rise of obstetrics in childbirth Borst's book provides much food for thought. Using census material and a host of other quantitative and qualitative data, her study not only provides a rich account of the changes in midwifery and obstetric training but also highlights the importance of looking at local communal and neighbourhood networks in shaping the acceptance of "scientific" ideas in medicine and determining the types of birth attendant.