Gabrielle Robilliard's new book, Tending Mothers and the Fruits of the Womb, is an impressive analysis of the intricacies of the world of Leipzig's midwives and other medical professionals involved in obstetrics. Scholars of early modern women, medicine, and local governments will find this study useful for its level of detail and its new perspectives on the relationship of midwives to city governments.

Robilliard's most impressive feat is how she carefully parses the intricate relationships between midwives and the city's other medical professionals. Robilliard uncovers and carefully traces what she calls the “grey landscape” of midwifery, which included officially sanctioned midwives and their assistants as well as a great number of unofficial actors within the medical community. Robilliard has discovered that there was not always a clear distinction between regulated and unregulated midwifery, as these medical practitioners could move from unofficial positions to official, regulated positions in a number of ways. If it makes for a tedious read, it is not without the reward of a much deeper understanding of the medical community

Robilliard also addresses the ability of midwives’ clients to dictate their own medical care. She emphasizes the role that clients played in shaping the medical landscape: clients might flout regulation or tradition by insisting on a preferred midwife or by retaining the services of a Stadtaccoucheur in expectation of a difficult delivery. This is perhaps an area of the text which could be expanded. Robilliard spends a great deal of effort detailing the complex networks of midwives and their helpers, but relatively less on this intriguing agency of the patients and their families.

An analysis of the transition from the predominance of midwives over obstetrics to the predominance of the male physician is particularly fruitful in that Robilliard demonstrates clearly that the familiar narrative of elite-male intervention and eventual domination in eighteenth-century obstetrics does not apply to Leipzig, and much of Germany. A transition that was so central to English obstetrics in the eighteenth century only came about in the nineteenth for Leipzig. According to Robilliard, this is more than a matter of timing, indicating, rather, the city's general satisfaction with the work and place of the midwives. In early modern Leipzig, unlike early modern England, there was no perceived competition between male and female medical practitioners in the world of obstetrics, because the limited male role in obstetrics did not directly threaten the economic situation of the city's midwives. Male surgeons and physicians were eager to retain a restricted teaching and advisory role.

This did not mean Leipzig did not attempt to reform midwifery or medical practice. Robilliard argues that attempts at reform within the city were driven by cameralist policies and intended to address concerns about depopulation, especially in the wake of war, and were also instigated at the local level and not mandated by the Saxon state, which allowed the city to assert its civic power. Yet even when the city enacted reforms in the late seventeenth and early eighteenth centuries, it changed very little about what Robilliard labels the “culture of urban midwifery.”

One other area that Robilliard might have explored further is the actual practices of midwives and their helpers. While she clearly discusses the relationships between medical practitioners, a level of detail about their activities is missing. This is perhaps a personal preference of the reviewer, but the title and subtitle—“tending mothers” and “the work of the midwife”—set up an expectation of a deeper picture of the immediate situation in the birthing chamber and the detailed actions of the midwives. Likewise, while the bureaucratic detail is key to her conclusions about the agency of midwives in relation to male practitioners and the city's power, Robilliard's diagrams of networks are sometimes more dizzying than helpful.

Yet these minor complaints do not detract from the importance of her argument for a more independent and consistent midwifery practice in early modern Leipzig, which undermines long-held presumptions about medical practice, gender, and expertise.