Rebecca R. Allen
HIST 411: History Seminar—Synthesis
Goshen College
April 12, 2004

Another transition began in the 1970s for Amish women, moving labor out of the hospital and back into the home. Midwives slowly surfaced to meet an ever-increasing demand for home birth attendants that physicians could not satisfy. New Eden Care Center, a birthing center established by and for the Amish, opened in 1997, offering families in the Nappanee and Elkhart-LaGrange settlements yet another choice in the childbirth market. Without debating which of these decisions offers the safest or most cost effective option, it is clear that Amish women in northern Indiana have a relative plethora of birthing options. Three months ago, the mother of the coughing baby probably debated the advantages and disadvantages of having her child at home versus giving birth at New Eden. Though her own mother probably delivered her in a hospital bed thirty years ago, this woman most likely considered a medical institution the last resort, a place reserved for expensive emergencies. Other differences distinguish this young woman from her own mother. Most Amish settlements have dealt with dramatic changes in the past century, and the Nappanee and Elkhart-LaGrange communities were no exception, witnessing shifts in occupation with definite effects on family and church life.

The move from hospital to home or birthing center corresponds with a noteworthy vocational trend. Though many Amish settlements in North America see the majority of their household heads finding work in non-farm employment, Amish men in Nappanee and Elkhart-LaGrange settlements have turned to factory work at a substantially higher rate than in most other communities. In both communities, the majority of Amish men since the late 1980s work at jobs other than farming. In Elkhart-LaGrange settlement, 52.9 percent of Amish household heads under 65 found employment in a factory in 2002; the Nappanee settlement showed even more dramatic numbers with 58.8 percent in factory work and only 11.7 percent farming in 1993. Other options for employment include carpentry, construction, and small, Amish-owned shops. This shift to industrial jobs began as early as the 1930s, but the percentage of men employed by non-Amish factories reached a majority level only in the past decade. Could a connection exist between Amish women’s increasing number of choices regarding birth and Amish men’s increasing tendency to work not with agriculture, but in industry?

A correlation may seem contradictory because both farm work and birthing at home fit a stereotypically "traditional" image, while employment in a factory and births using the latest medical advances in the hospital conjure notions of modernity. Yet Amish women move away from hospital births as their husbands seek employment in factories. Does nothing more than coincidence link these simultaneous shifts, or does a connection exist despite the apparent contradiction? Considering the Amish perspective, it seems appropriate to consider "progress" not as improving technology, but as improving community, church, and family life. The past century demonstrated that contrary to popular opinion, many Amish communities are in the throes of rapid change. Far from stagnant enclaves of stubborn, old-fashioned farmers, the Amish cautiously accept change after considering potential effects on the community. Amish women—more than the submissive, passive wives that many non-Amish may envision them to be—have started to actively choose their preferred birth location in response to their husbands’ increased role in production. Within the Amish cultural context, a transition that appears incongruous to an English observer actually follows from logical cultural patterns. In this case, we will examine why mothers return to "traditional" birth settings such as the home in response to changing work patterns.

Linking reproduction with production invites a careful consideration of gender roles and relationships within Amish culture. The religiously-based patriarchy of the Amish community invokes images of subdued women confined to the domestic sphere while men work to produce sustenance for the family. In this stereotypical and over-simplified version of what actually occurs, wives bear and raise children while men work. In reality, studies show numerous accounts of Amish couples who share tasks; on a farm, work must be done by someone, and both husbands and wives come to the other’s aid when necessary. Women and men both contribute to the family’s survival, producing different but equally vital contributions to the family’s well-being. Yet with the current shift to wage labor, Amish women find themselves increasingly relegated to the home and separated from production, or, to use a term implying action, productive agency. Perhaps in a quest to regain some power lost in the occupational shift, Amish women have sought out new forms of reproductive agency, or the ability to affect decisions about childbirth, contraception, and child rearing.

Elkhart-LaGrange and Nappanee settlements recently emerged from a socio-economic transition that changed the community from an agricultural society to a wage-earning, industrial culture. In the farm-based society of the past century, Amish couples shared work and developed reciprocal, interdependent gender roles. Women had productive agency, or the ability to influence actions regarding the production of goods for her family’s survival. However, with the shift away from the farm and toward wage work came an increase in the number of birthing options available to Amish women concurrent with a decline in their productive role. If the ability to choose indicates agency, then Amish mothers now enjoy a higher level of reproductive agency and a lesser role in the productive realm.

Despite significant and drastic changes in the Amish communities of Elkhart-LaGrange and Nappanee, much remains the same. For almost six centuries, the Amish (or their Anabaptist predecessors) have lived a faith "in but not of the world" (I Pet. 2:11). Belief in this complex two-kingdom theology requires devotion to the Ordnung, a set of dynamic guidelines that structures community life. Unlike other Amish settlements around North America, the Amish in Nappanee and Elkhart-LaGrange counties do not obey a single Ordnung; rather, congregations decide on their own set of mandates. This allows for a church cautiously in flux and enables shifts such as the current one from an agricultural economy toward a wage-labor system.

Throughout the United States, small farmers during the last century faced low crop prices and increasing competition from massive agribusinesses. National agricultural trends forced Amish farmers to find new employment. However, the primary concern for most Amish families was a lack of land for a constantly growing population. In traditional farm-based families, Amish parents bequeath the farm to one of their children and move into a smaller house on the same property. They expect their other children to marry and purchase or inherit land with their spouses. However, beginning in the late nineteenth century, those who could not find or afford land in northern Indiana often moved to new "daughter" settlements in Oregon, North Dakota, Michigan, and other states with available and affordable farmland. But by the 1930s and the Great Depression, many of these migrants returned to Indiana, suggesting that a change in location threatened community life more than a nonagricultural job might. Northern Indiana offered plenty of work in industry, and as early as the 1940s, men began to accept these positions. The number of Amish men who leave their plows for the assembly line continues to grow, and this occupational shift influences far more than the pocketbook. The transition to wage work from farming has modified women’s work in significant ways, changing Amish wives’ duties from both productive and reproductive to primarily reproductive.

Shifting Gender Roles

Distinct gender roles define even young children’s place in the community. Birth announcements often proclaim the infant’s sex with phrases like "little woodchopper" to describe a boy and "little dishwasher" to denote a baby girl. However, the Amish patriarchy should not necessarily conjure images of misused power and wives cowering before their domineering husbands. As in any population, some people do abuse their authority. Yet on the farm, numerous tasks must be done; each person becomes an expert at their specific responsibility. Women generally work within the household, preparing meals, washing and sewing clothes, cleaning the home, and caring for children. Men tend to do heavy, outdoor labor, including planting and harvesting crops, feeding animals, and maintaining equipment. Yet more important than relegating a specific gender to each of these tasks is the genuine need for the work to be done and done efficiently. A family recognizes every member’s duties as vital for their survival as a unit; ideally, each person’s work receives equal acknowledgement. In an agricultural society where people view labor as a calling and willingly mingle work with all aspects of life, men and women must and do appreciate the work done by the other. The farmer relies on meals ready at noon to give strength for work ahead, and the cook depends on food produced by the farmer’s daily toil.

Recognizing the Amish ability to share work across gender boundaries complicates the conventional imagining of Amish couples as strict participants in a distinctly absolute and inflexible system. Research by Steven D. Reschly and Katherine Jellison examines Amish families from the 1930s and 1940s who routinely challenged the predominant cultural norm with women who functioned not only as reproducers, but as viable and valuable producers. Examples of essential women’s work include sewing clothing, growing vegetables both for retail and consumption, work with poultry, and feeding hired hands. In addition to this worker role, women were mothers. Not only did they give birth to an average of seven children, but these busy women acted as primary caretakers for their offspring while continuing in their role as producers. Without question, maintaining the labor intensive work of farming would not be possible without many capable hands, including that of the typical Amish wife.

To those who assume that Amish men and women learn only the roles mandated by their sex, learning that work directly linked to survival often requires both men and women to cross supposedly well-defined boundaries may come as a surprise. A 25-year-old Amish woman with three children acknowledged that "if there’s a family of mostly girls, some help outside on the farm and neglect housework. Farm kids probably do the biggest variety of jobs." Another Amish woman from an earlier generation noted that her father needed her help in the field, and when hired as a maid at age fifteen, she felt nearly helpless in the kitchen. Couples explain that they help each other do the work that must be done, regardless of who may be expected to fulfill the task. Karen Johnson-Weiner explains the paradox of role-sharing within an explicitly patriarchal system as "both genuine hierarchy of authority and genuine sharing of power." As agriculture becomes a less sustainable option for a single family, the symmetrical beauty of such a relationship faces challenges that force families into new employment situations and new gender roles.

Factory work impacts diverse aspects of life ranging from a decreased reliance on mutual aid to increasing leisure time to more interaction with non-Amish people. Additionally, the Amish have noticed a transformation of gender roles that impact traditional divisions of labor, childbirth choices, and parenting practices. A 49-year-old mother of five explained that a farm-oriented family gets up together each morning to "go choring. They milk, the husband and wife together [with the kids], then get the kids off to school. If the husband does factory work, then the wife gets the husband off to work early. There’s no reason to get the kids up ‘til later, so it’s the wife’s responsibility to get the kids to school." The father’s early departure for the factory separates him from his children; the choring ritual requires every person to contribute together. Factory families who teach their children to value work must be more conscientious and creative to involve their youth in meaningful daily chores. In addition, a father who leaves in the early morning and does not return until mid-afternoon cannot share parenting responsibilities with his wife as fully as a farmer with a flexible schedule could. Amish historians Donald B. Kraybill and Steven M. Nolt echo the words of Amish women who maintain that factory work changes how they relate to their husbands, claiming that "as work leaves the farm, gender roles become more sharply defined and differentiated." Unlike the traditional and shared gender roles of the past, factory work creates impermeable boundaries that separate the man’s work from the woman’s. Her work becomes increasingly domestic and tied to childcare, while his work obviously connects with the family’s survival because he brings home a paycheck. Husbands, intentionally or not, dominate the productive role, leaving their wives with no choice but to focus on reproduction. With this increasing division of labor, mutual appreciation for the other’s vital role in familial well-being easily dissolves.

Like most American women, Amish mothers delivered their babies at home until the 1930s and ‘40s. A great-grandmother from the Nappanee settlement that grew up in North Dakota 90 miles from a hospital was born in 1915. Her mother gave birth to one of her ten children in the hospital following a miscarriage with severe hemorrhaging, but she delivered her other nine children at home. Using the hospital as a last resort in emergency situations would have been typical for many women of that generation, but especially for the Amish who tended to separate themselves from the latest medical advances. Doctors delivered most babies at home, often with the mother’s female relatives or neighbors in attendance. However, within the next twenty years, physicians led the transition to the hospital. In the 1930s, a doctor and a nurse came to most home births and charged about $40; before long, physicians came to prefer the routinized, medicalized births of the hospital setting. One Amish woman delivered her first six children at home in the 1930s and the last three in the hospital; her personal transition from home birth to hospital birth reflects a broader movement directly related to the doctors’ locational preference. Another woman recalls her mother’s experience with eight births in LaGrange County during the 1940s and ‘50s. After five successful, uncomplicated births at home, her doctor suggested she start laboring in the hospital. As expected of an obedient Amish woman, she took the expert’s advice and had three more babies in the hospital. An Amish midwife reported that Amish women went to the hospital between 1935 and 1940 because "the doctors didn’t want to go to the home anymore." Further research with this older generation would be necessary to determine if Amish women grudgingly accepted the medical mandate to move birth to the hospital, or if expectant mothers wanted medical care and actually exercised agency in this transition.

This all changed as women across the nation reacted to the lure of mysterious scientific advances and supposedly safer outcomes proffered by the medical profession. The hospital setting negated the need for and prohibited the presence of supportive, knowledgeable females at a birth, making hospitals an increasingly male-focused option for care. Doctors willingly stepped into their newfound positions of power within the hospital hierarchy, accepting that "the relocation of obstetric care to the hospital provided the degree of control over both reproduction and women that would-be obstetricians needed in their ascent to professionalized power." Having already replaced midwives within the home, physicians considered the move to the hospital to be progressive and safe. Many mothers agreed despite the fact that it took doctors well into the 1930s to substantially reduce the infant and maternal mortality rates in the hospitals, where women and children faced the dangers of puerperal fever, concentrated infection, unnecessary interventions, and psychological trauma. In a sense, women did choose to go to the hospital for labor; they believed their doctors when promised safer care. However, due to steadily decreasing numbers of midwives and obstetricians’ increasing refusals to deliver outside of a hospital setting, options rapidly channeled into only one potential selection: a hospital birth attended by an obstetrician.

Amish women in Nappanee and Elkhart-LaGrange settlements followed their "English" peers into the hospital, and delivered nearly all their children there between the 1950s and the 1970s. Mothers who delivered children between those years related generally positive experiences in the hospital, though further research would allow for a more thorough examination of this generation’s birthing stories. Though most women labored in hospitals, one potential deterrent for uninsured Amish families was the high cost of a hospital birth; the Amish church forbids the purchase of commercial indemnity with the intent of maintaining a closely knit community non-reliant on worldly methods of insurance. However, farming in the mid-twentieth century ensured a decent middle-class income, especially for frugal Amish families. Hospital bills, though pricier than $40 doctor visit to the home, were not impossible for a farmer (even a farmer with seven children) to pay. Church members helped each other with larger bills; however, the climbing costs of birth in the 1980s challenged the pocketbooks even of entire settlements. Rising costs contributed to changes within the system that corresponded with an occupational transition toward wage labor and away from farming.

Impacting this change quite significantly was the cost of childbirth, which, especially for the uninsured, rose at a rapid rate. Care for each mother and newborn pair in the United States cost about $6,850 in 1989. For an uninsured family that welcomes a new child every year or two for about 15 years, such a price tag seems not only unreasonable, but impossible. An Amish mother of five (four of these by Cesarean section in a hospital) paid $2800 for her baby’s surgical delivery in 1983, and her total bill included additional fees for room, board, and staff care. Her assessment over twenty years later was that the hospital was "doing a good job, but it cost way too much." Partially as a result of these economic pressures, the Amish began looking for other caregivers.

Enabling such a transition back into the home were midwives, who reappeared in the community to offer safe perinatal care at affordable prices. Rising hospital costs created a tempting market opportunity for midwives. The same mother mentioned above observed Goshen General Hospital’s sincere attempts to provide appropriate care for their valued Amish customers, "but the pendulum had already swung too far. By the 1980s, home births [for the Amish] caught on like a snowball rolling." Mothers who liked the care they received from a midwife told their friends and sisters, and the number of women birthing in a "traditional" fashion grew steadily in the past decades. At least one Amish midwife started a small practice in LaGrange County after shadowing a non-Amish, direct-entry midwife popular among her Amish peers. Though she now teaches school to the children she once caught in labor, this former midwife did about twenty births a year for over a decade. Mothers often told her how much more they liked her care than that they received at the hospital; one neighbor especially appreciated a caregiver who spoke Pennsylvania Dutch because her limited English skills made communication at the hospital a frustrating challenge.

Since its opening in 1997, New Eden has bustled with business, demonstrating the bishops’ astute grasp of their community’s needs. Amish mothers with high-risk pregnancies still patronize area hospitals, and other women prefer the opposite extreme of home birth. However, a significant percentage of Amish women in Elkhart-LaGrange settlement (and, increasingly, those from Nappanee) use New Eden Care Center for their childbirth needs. Formal impetus for establishing New Eden came from a group of Amish men who traveled from Elkhart-LaGrange settlement to Holmes County, Ohio to visit an Amish-run birth center called Mount Eaton in August of 1995. Upon returning to Indiana, they initiated the formation of a committee to discuss a local version of the birth center. This group of men (three Amish, one Beachy Amish, and one Mennonite) met for eight months to coordinate efforts of all 114 church districts in the Elkhart-LaGrange settlement. In that time, they raised approximately $500,000 from potential Amish customers and adopted a mission statement:

A board member pared down the reasons for opening New Eden to two: safety and cost. He wished to provide what he felt was a safer option than home birth for the growing number of women deterred by the rising cost of hospital birth to stay at home. Amish women and their non-Amish midwives frequently sited these same two factors as influences in their decision about where to labor. Though the preservation of cultural integrity may seem a more viable concern to us non-Amish, the practical, concrete impact of safety and cost are sensible motivations within this particular cultural context.

For many, considering a location other than the hospital indicated concern about cost tempered by a strong desire for safe deliveries and healthy babies. Amish women did express some discomfort with the hospital setting, but many others liked the care they received at Goshen or LaGrange hospitals. A 49-year-old Amish woman reported that many women approved of the hospital’s services and switched to a home or New Eden birth only because of cost. For a post-delivery, one-night stay at Goshen General Hospital, an uninsured client must pay $2500 in addition to the doctor’s or midwife’s fees. New Eden charges $700 for a three-night stay, though this fee does not include board and the family must pay the doctor or midwife, too. A birth at home offers the least expensive option; the only fee is $1000 to $1200 owed to the midwife.

However, Jeannie Stanley, a certified nurse midwife at New Eden, hoped her clients do not consider her "a cheap way out. We come to their house, and the women love it—they never want to go back to the doctor. I get cards saying, ‘I was never so educated before.’" Midwives provide extra services like prenatal visits at home and the option to deliver at home; though Stanley does 90 percent of her births at New Eden, another CNM employed by New Eden, Mary Doezema, does far more home births than New Eden deliveries. Stanley also commented that if she recommends the hospital to a client for medical reasons, the family will go to the hospital, regardless of cost. An Amish woman echoed this sentiment, claiming that "if home births weren’t safe and we were losing babies, we’d go to the hospital." The transition to other birth locations seems motivated less by an ideological shift than by practical concerns for maternal and infant health at a reasonable cost.

Of course, certain procedures require medical attention best provided by professionals in the hospital. A large portion of a midwife’s training involves learning how to assess risk; if a midwife foresees complications, she must recommend that the client labor in the hospital. This increases the likelihood that Amish women giving birth in the hospital will be higher-risk clients who incur large bills. Dr. Norm Waggy, a family practice physician who delivers babies at both Goshen General and New Eden Care Center, noted that he can provide a higher quality of care in the hospital. At a recent New Eden birth, a mother surprised him by carrying twins; after the first baby’s birth, he knew that the mother needed to dilate further before she could birth the larger twin. Typical procedure in the hospital would be to initiate a Cesarean section immediately following the first infant’s delivery. However, Waggy could not perform surgery in the birthing center and did not have time to transfer the mother to the hospital. Instead, he administered Pitossin, a drug designed to induce labor. The Pitossin pump broke, requiring that an assistant give the medication manually. The umbilical cord wrapped around the infant’s neck, adding the pressure of time to the already tense atmosphere of the birthing room. At Waggy’s urging the mother pushed harder than she had ever pushed before and birthed the second infant; both twins survived the ordeal. Waggy admitted that having the birth at New Eden saved this family several thousand dollars and an invasive surgical procedure, but their decision to avoid the hospital also put their children’s lives in temporary danger. However, midwives might respond that the doctor’s assumption that a Cesarean section was necessary affected the quality of care given. A midwife trained to deliver twins without a waiting surgical team backup could possibly provide more confident, more empowering, and less fearful care.

That said, New Eden Care Center operates imperfectly as well. Like any institution trying to offer an alternative to the norm, New Eden receives critiques from practitioners at either end of the birth care spectrum. Dr. Waggy compared deliveries at New Eden to building cabinets for a customer who expects a perfect outcome despite allowing the carpenter to use only half his tools. Dr. Waggy also acknowledged that his Amish clients may be more willing than most English to accept the consequences of choosing an alternative method of care, perhaps related to their deep faith in God. A nursing assistant with experience at New Eden alluded to this Amish tendency toward acceptance of both advice and outcome, stating that most clients do not have the resources they need—such as education that encourages questioning of the status quo—to voice any concerns in the presence of a medical authority. In addition, Amish teachings forbid the faithful from filing lawsuits, which the church considers to be against the Biblical teaching of nonresistance. Knowing this potentially influences the care given, either by making practitioners more reckless (as their clients are less likely to sue for malpractice) or by helping caregivers to relax and provide less fearful care.

Thus far, New Eden’s birthing statistics indicate a high quality of care resulting in safe deliveries for both mother and child. Any concerns from staff relate more to procedural mandates for possibly unnecessary intervention with medication or technology rather than to issues of safe care. One nursing assistant wondered why New Eden allowed doctors to use stirrups and special spotlights to do vaginal exams while midwives perform the same exam less intrusively using a recliner and a soft incandescent lamp. She also speculated that some New Eden nurses rely too heavily on charts, having received little training about direct examination of the client. Other concerns pertained to the care given to the infant, especially if the procedure in question required taking the baby away from the parents; some staff question if it is truly necessary to weigh the child, administer medications (such as Erythromycin and Vitamin K), and feed the infant immediately after birth. To offer culturally appropriate care, the New Eden staff must remember that their Amish clients may not readily assert their client rights even if dissatisfied.

More research is necessary to determine where clients receive the best possible care for their particular needs; regardless, New Eden continues to attract large numbers of Amish mothers. Women in various stages of labor or what many coyly call "my vacation" often fill all ten rooms, an indicator that the center meets a critical need in the community. The same nursing assistant who offered her constructive critique of New Eden volunteered that her clients "labor well at New Eden," and the popularity of the center among its constituents demonstrates that she is correct. New Eden continues to draw clients from as far as Nappanee; for a frugal people with distinct cultural needs and a strong interest in safe births, an Amish-owned birthing center fills a niche in the Elkhart-LaGrange and Nappanee communities.

For women with a reduced role in production, finding a secure, comfortable location in which to deliver babies may have more significance attached than we "English" first believe. Most healthy human beings need to exercise control over some aspect of their lives; Amish women are no exception. As husbands accept jobs away from home with guaranteed regular paychecks, wives cannot contribute to the family’s sustenance to the same degree that farm wives once did. Instead of tending a garden and preserving that garden’s yield like a typical farm wife would, factory wives spend money earned by their spouses at Wal-mart or Aldi. This shopping trip represents a potentially disempowering transition that robs Amish women of their productive agency. In response, many Amish mothers and wives of Elkhart-LaGrange and Nappanee settlements found a remarkable agency in their control of childbirth. Instead of continuing to join the vast ranks of women who labor in the hospital, the recent generation of Amish women created several new birthing options. The current availability of multiple childbirth choices confirms this generation’s increased reproductive agency within an androcentric, patriarchal context.

Though Amish men formally instigated the construction of New Eden, women asserted their voices of support from their kitchens and gardens. Empirically measuring the pointed comments, fervent prayers, and explicit suggestions of wives, daughters, and sisters of the New Eden founders (all male) is impossible, but examination of multi-layered Amish doctrine regarding gender roles hints not only at who conceptualized the birth center, but who controls decisions surrounding birth. 1001 Questions and Answers on the Christian Life, an Amish publication intended to outline Amish doctrine with Scriptural support, states that a husband must "provide for the material and spiritual welfare of his wife and children." A model Amish husband must be responsible for making decisions, though he should always consider the opinions of his wife. This model of power may seem hopelessly patriarchal to conventional Westerners, but may actually generate a reciprocal method of communal decision-making beneficial to both women and men. Within these seemingly rigid relationships, Amish wives report confidence and contentment with their ability to make decisions. Assuming this is the case in some, even many, Amish homes, then Amish women—not Amish men—ultimately make decisions about birth in a demonstration of reproductive agency.

Birthing choices often settle into two categories: where and with what type of attendant to have the birth, and decisions made during labor regarding body position, pain medication, and level of professional intervention. During interviews, Amish women in Elkhart-LaGrange and Nappanee revealed significant levels of control prior to the birth, and perhaps less during the actual labor. When a Middlebury physician refused to deliver a young woman’s first child at New Eden Care Center, the soon-to-be mother asked friends and a sister-in-law for recommendations. Positive reviews of New Eden and Mary Doezema prompted her to change providers and deliver her child at the care center, an environment she soon abandoned for the comfort of her own home for her second and third births. At home, the industrious young woman kept doing housework and even hosted her brother’s family for dinner during the early stages of one labor. Though still quite young and inexperienced in the practice of having babies, this mother not only rejected a doctor’s suggestion, but kept seeking other options even after a fairly positive experience at New Eden. Her willingness and ability to explore new options exhibits reproductive agency lacking in many "liberated" English women of the same generation and educational level.

Older women, the majority of which lived and worked on the farm, appeared to submit to a given birthing place more willingly than their daughters and granddaughters; however, they did remember having some control during the labor. A mother, age 49, spoke wistfully of her four births by Cesarean section; her one natural birth was followed by a breech baby delivered surgically. Her doctor explained that she was allowed three more children, and only via Cesarean section. Instead of relocating to a birthing location other than the hospital or finding a new childcare professional, she proceeded with the three Cesarean births and then stopped having children. She and her husband "accepted it but we always lamented that it was that way." Some direct-entry midwives now offer women with healed, horizontal Cesarean incisions the option of a vaginal birth, a still-controversial procedure among midwives and one roundly rejected by obstetricians. This mother’s experience from the hospital-bound years of Amish women seems to demonstrate a penchant for accepting the authoritative suggestions of medical professionals regarding general birthing decisions.

However, perhaps on a smaller scale, this older generation of women managed to wield some power during labor. This farming generation of mothers still enjoyed a high level of productive agency and therefore, they may have tended to de-emphasize their reproductive role. The 49-year-old mentioned above rejected conventional pain medication during her third planned Cesarean, but chose instead to use acupuncture and request the supportive presence of her husband by her side. This Amish woman resigned herself to the discomfort and expense of surgery mandated by professionals, but took seemingly small measures to protect her autonomy. An 88-year-old Amish woman from Nappanee told of delivering her sister’s baby as the husband went for the midwife. "My sister said to help, and I said, ‘I can’t.’ She said, ‘You’ve got to.’" The sister, an Amish woman giving birth in 1933, probably did not have a choice about where she delivered; yet left alone with her 18-year-old sister, she took charge of the situation despite the contractions and probably some apprehension (considering the prolonged absence of her husband and the midwife). The newborn failed to breathe immediately, and the new mother explained to her sister how to cut the umbilical cord and slap the child. The baby lived, owing his life to his mother’s strength, intuition, and determination. Amish women of the farming generation display a marked and vibrant sense of their power in the birthing realm despite the patriarchal backdrop.

Despite evidence of women’s agency, images of Amish patriarchy linger. Is Amish society dominated by men? 1001 Questions asks "Who is the head of the home?" and answers "The husband." This clear statement seems to indicate that although Amish women appear to control some elements of their bodies and births, their husbands actually dominate the childbirth procedure. Indeed, women freely admit that birthing decisions are not theirs alone, and a New Eden midwife noticed this balance of power; Stanley commented that most of her clients make decisions as a couple, though she recalled a few husbands with overbearing opinions. Most couples ask her opinion, prompting her to offer multiple choices. Two Amish women confirmed Stanley’s observation, noting that they share decisions with their husbands. One couple chose to stay at home because her labor progressed so rapidly that a trip to the hospital took too much time. Another mother commented that she and her husband "decide everything together, but the final decision is always up to me. He always says, ‘Whatever you think is best.’ I really feel loved and respected when he says, ‘Wherever you’re most comfortable.’" Her comment indicates that to truly understand an Amish marital relationship, one must consider an unusual ability to share authority and care for one another’s well-being. Each partner in the relationship must submit to the other’s needs, illustrating the true essence of Gelassenheit.

Perhaps a balanced marriage in which neither husband nor wife yields significantly more power is idealistic and romanticized, but is it unreasonable to presume that beneath the surface patriarchy of the Amish community, a different partnership model than that of the world exists? In my interviews, no Amish women from any generation told of husbands ready to control their wives, especially in a realm recognized as feminine, such as childbirth. Instead, one woman said that mothers tend to decide where to give birth, and her husband immediately chimed in from the kitchen, saying "If the husband is responsible, he’ll listen to his wife." Listening implies yielding, a concept explained in Johnson-Weiner’s article regarding Old Order, Beachy, and Fellowship church women; she writes that "a woman’s equality as a Christian overrules her subordination to men in the earthly hierarchy." The very notion of applying the term "patriarchy" to relationships emphasizing joint decisions and shared work betrays a cultural bias unfair to the Amish community. Midwives working with Amish families in Elkhart-LaGrange and Nappanee settlements expressed delight at the number of supportive, attentive husbands they see during prenatal care, delivery, and postpartum care. These men dedicate their lives to providing for their families’ comfort and nurturance; this is demonstrated by one midwife’s observation that most Amish husbands make a special request for a prenatal visit at the end of the workday, allowing them to meet the caregiver for their wives and unborn children. Most often, the wife chose the caregiver, but even if the decision was shared (or, in a rare case, solely the husband’s), Amish husbands generally seek to provide the best possible care for their families. Of course, financial concerns always affect decisions, but seeking the simplest assurance that a wife and mother will be comfortable often prompts Amish men to let women arrange the details of birth.

Husbands offer only one of several potential threats to women’s reproductive agency. Can midwives and physicians allow pregnant women the same liberty to choose that Amish husbands seem ready to offer? Medical professionals bear a responsibility to their clients, requiring them to use their education to teach their clients; especially in medical emergencies, it is the professional’s role to gently but firmly prescribe the safest option. One mother who gave birth in early January of 2004 explained that she initially wanted to stay at home for the birth, but the midwife suggested New Eden because of the mother’s age (44) and the knowledge that the mother carries the gene for hemophilia. These increased risks made a birth center a safer option, and the mother agreed to labor there. However, high-risk clients are rare exceptions, and most professionals working with Amish mothers reported giving ample choices to the mother or family. A former Amish midwife of Elkhart-LaGrange settlement said many mothers "studied their own path" and only needed her manual assistance. Unlike the other midwives, she shares her clients’ faith, and felt most comfortable during a birth when "the woman put her faith in God and asked me to come help. I didn’t care to make the decisions." With confidence in God’s presence and assistance, this midwife provided her best quality of care and allowed the mother to make decisions based on their intuition.

Other midwives and physicians may not share their Amish clients’ faith, but they often share the policy of offering assistance to a mother in control of her own birth. Doezema said she tells women that "it’s their family, their baby—not ours." Stanley called herself the "overseer" responsible for offering options like taking a shower, walking, resting, eating, or sitting during early labor and later, alternatives such as birthing chairs, beds, birthing tubs, or stools for the actual delivery. Both women catch babies in the home and at New Eden. Dr. Waggy, a physician who prefers hospital births but also attends births at the care center, recited the speech he typically delivers to mothers: "I say, ‘You do whatever you want to do. I’ll make some suggestions, but you can tell me to go jump in a lake. If I see the baby is in trouble, I’m going to tell you right away and I want you to listen to me.’" There again is the medical mandate to direct care in crisis situations meshed with the explicit statement that the mother is in control of her labor. She may listen to suggestions, but ideally it is she—not the midwife, the doctor, nor her husband—who ultimately decides how to birth her child.

The motivation for keeping the pregnancy so private may relate mostly to a strong Amish desire for discretion. After the child is born, parents can show pride in this gift of God, but until then, little public discussion revolves around the upcoming birth. Another reason that Amish parents refrain from publicizing pregnancy and inviting many people to the actual labor relates to the frequency of childbirth in Amish settlements. Unlike English parents, who generally have two or three pregnancies, Amish families become accustomed to birth. Birth can never be called commonplace, but when most women deliver seven babies, communities certainly become familiar with the process. Of course, exceptions abound; the 88-year-old living in Nappanee who caught her sister’s baby unassisted at age 18 and later attended her daughter’s water birth in 1979 provides a counter example to the norm. After birth, this desire for privacy soon falls away to the need for household help; postpartum care comes from hired maids, young Amish women who move into the new parents’ home to help cook, clean, and care for other children for a week to a month after the infant’s birth. Most important to the broader story is this wage-earning generation’s increased ability to make decisions about birth, regardless of the setting, the attendants, or external influences. Making choices related to childbirth demonstrates Amish women’s ability to control their own bodies, an aspect of feminine power vital to women’s sense of agency.

Amish women birth more babies than most American women and therefore, may consider birth a normal life process rather than a pathological event to confine to the medical realm. How does this cultural context change the quality of an Amish woman’s birth? Studies show that the mother’s sense of control contributes significantly to the well-being of both mother and child. The term "control" indicates many things, including control of staff and their actions, control of self, and control of environment. The interviews suggest that Amish women who feel in control have "better" births than Amish women who have decisions made for them or rely on others for advocacy and action on their behalf. Stanley, a midwife for the Amish, agreed that women in a location of their choosing "tend to do better. Things just flow." For most Amish women in the Elkhart-LaGrange and Nappanee settlements, that location is home or New Eden Care Center. Some continue to use the hospital, but certainly a smaller percentage than in the 1950s when the hospital was women’s only option.

Perhaps this shift reflects nothing more than an increase in the number of midwives in the past twenty years. However, nothing forced Amish women to change providers; they did so of their own volition in response to a changing occupational climate, increased birthing costs, and the presence of safe alternatives to the hospital. Issues such as cost certainly affected this transition to alternative locations, but the demeaning, powerless position some women reported facing during labor in the hospital also has some influence. Stanley mentioned that she purposefully asks her clients at week 36 of their pregnancy about their vision for labor. She believes that the pain which accompanies labor puts women into a vulnerable place. Unless women have advocates whom they absolutely trust to guide the labor according to their wishes, then some nervousness and tension about the provider or the possibility of intervention is likely to influence the actual physical process of birth. She agreed with other midwives that the safest place for a birth is where the mother feels safe. One Amish woman who had four children in the hospital, four more at home, and one at New Eden Care Center felt some apprehension about giving birth at home. Concern about how to reach her husband when labor began mingled with worries about her other children; these distractions certainly impacted her labor. She claimed that her second birth was the most satisfactory, and it took place in a Kansas hospital before the family moved to Elkhart-LaGrange settlement. Thus, Amish women with a definite sense of their reproductive preferences and needs should have more satisfactory—and possibly safer—births than those who lack conviction about pregnancy and labor.

Fear in the childbirth process does not benefit the mother or the child; therefore, medical caregivers working with Amish women must provide extra education in order to give culturally appropriate care that eliminates or reduces anxiety. Dr. Waggy observed a difference between his Amish and his "English" clients; noticing that the Amish were more likely to unquestioningly accept unfortunate outcomes, he explains to his clients that "by our choices, we accept certain givens, and we have to be aware of those." For example, a nursing assistant at New Eden explained that nurses often administer standard medications to the infant without asking for the parents’ consent. Many Amish women may not realize that the decision is theirs to make, not the nurse’s. However, formal education does not offer a perfect solution granting women agency and voice; many non-Amish women with high levels of schooling never even consider alternate birthing options. Also, many Amish women demonstrate substantial control during or after birth by changing some aspect of labor. Mothers in subsequent pregnancies make choices demonstrating how maternal learning occurs with each birth experience. Four of four Amish mothers interviewed in Elkhart-LaGrange and Nappanee settlements amended the site of their births to better suit their preference. However, such evidence of agency does not negate the absolute necessity of providing thorough prenatal education for every mother (and, ideally, father). Possessing knowledge generates agency and dissipates uncertainty and fear that could easily harm mother or child.

The transfer from an agricultural way of life toward a wage-based economy brings dramatic shifts in almost all aspects of life. Weddings, traditionally held on Thursdays, must move to Saturdays so factory workers can attend; a regular paycheck makes shopping at Wal-Mart for processed food an easier option than gardening and preserving vegetables; required Social Security payments tempt retired Amish men to collect, even though the church forbids the practice. This occupational transition even affects women’s experience with birthing in unexpected ways. One Amish woman, age 44, explained that she went to New Eden for her most recent birth to ensure that she got a rest; she usually hires a maid to help with housework, but now a maid who is sufficiently trained (usually because she was raised on a farm, not in a family with a factory worker at its head) charges too high a fee for a financially struggling farm family to afford. This woman fondly recalled her early childbearing years when most Amish families lived on farms, and maids were both capable and affordable. Fortunately, the economic transition corresponded with an increase in birthing options, which provide her with affordable, restful choices.

Birthing alternatives generated in the past two decades reflect an increase in women’s agency during and after a time of societal transition for the Amish of northern Indiana. Historically, women around the world gain power during times of uncertainty, economic instability, or social transformation. Amish women, too, gained power during the recent social transition from an agriculturally-based society in which men and women shared tasks to a more industrial-based economy that relegates men to the workplace and women to the reproductive domestic sphere. In the twenty-some years since Amish men moved into the factories en masse, Amish women simultaneously developed up to five birthing options to replace the doctor-assisted hospital birth of the past. Creating multiple birthing options increased agency for Amish women, and many construe this ability to act as a facet of power. Choices about childbirth may not seem noteworthy to a non-Amish woman concerned with the power of a lucrative career or education; however, for a woman expected to give birth to an average of seven children and for whom childbearing and rearing play a central role, the cultural context should explain why such a choice is significant.

From a non-Amish perspective, the simplicity of stereotyping lures us to categorize Amish gender roles into deceptively straightforward types. The Amish seem to adhere to the lifestyle of our "English" ancestors, who generally separated men’s and women’s tasks into well-defined boxes and then elevated the men’s work above the women’s. Therefore, assumptions about archaic marital relationships may overwhelm the more honest, complex reality of Amish marriage. Yet upon closer study, not all—and, indeed, not many—Amish women are passive homemakers who raise children and never leave the house; similarly, few Amish men dominate their wives while working impossible hours on the family farm. Teachings about yielding and submission affect husbands as well as wives to generate marriages based on mutual satisfaction, shared work, and joint decision-making.

Dismantling stereotypes of the Amish and constructing intricate, nearly paradoxical visions of a gendered Amish society requires careful historical work. Theoretically examining productive and reproductive roles of both men and women in the Elkhart-LaGrange and Nappanee settlements allows us to see new and perhaps unexpected patterns. After all, why would a relatively "modern" Amish father working in a factory support his wife’s seemingly "traditional" decision to give birth at home? And why, in a hierarchical, patriarchal culture, does the woman make the ultimate decision about where to give birth? The answers expose images of Amish farm wives working in the fields and producing goods vital for her family’s survival; they also reveal factory wives with little to no productive input who wield significant control over their children’s births.

Yet the transition to a wage-earning society has only just occurred in Elkhart-LaGrange and Nappanee settlements. Leaders in the Amish community currently express concern over the number of factory-oriented families in their settlement; one woman, age 49, articulated an explicit desire for young couples to buy a farm with factory-earned savings as soon as possible. Such apprehension betrays dissatisfaction with the existing occupational situation for the majority of Amish males. Potentially, this discontent could produce ultra-traditional reverberations impacting women’s agency. As Amish women find their productive capacity limited to that of homemaker, these mothers could become confined to the home and high expectations regarding childbirth. Ironically, if reproduction becomes women’s sole responsibility, a consequence of this development could be a reduction in the number of birthing options. If the choice between midwife or doctor and hospital, care center, or home birth depends on women’s agency, then limiting mothers’ decision-making power would decrease their birthing options again. Other reproductive issues may develop; will wage-earning, non-farm families require fewer children and eventually necessitate birth control? Will husbands or wives claim responsibility for contraception, or will they make decisions and act in tandem?

The coming decades will prove formative in the future of the Amish church as occupational shifts continue to impact Elkhart-LaGrange and Nappanee settlements. Ways in which Amish women build, maintain, or yield their reproductive agency will partially dictate the future of women in the Amish community. Giving birth bestows mothers with untold stores of power. Amish women access and exercise their birthing strength with regularity and grace, becoming admirable beacons of female force.

Works Cited

Armstrong, Penny, and Sheryl Feldman. A Midwife’s Story. New York: Arbor House, 1986.