Reconceiving Midwifery

Reconceiving Midwifery

Ivy Lynn Bourgeault
Cecilia Benoit
Robbie Davis-Floyd
Copyright Date: 2004
Pages: 352
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  • Book Info
    Reconceiving Midwifery
    Book Description:

    The authors - social scientists and midwifery practitioners - reflect on regional differences in the emerging profession, providing a systematic account of its historical, local, and international roots, its evolving regulatory status, and the degree to which it has been integrated into several mainstream provincial health care systems. They also examine the nature of midwifery training, accessibility, and effectiveness across diverse ethnic and socio-economic groups, highlighting the key issues facing the profession before, during, and in the immediate post-integration era in each province.

    eISBN: 978-0-7735-7180-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Acknowledgments
    (pp. vii-viii)
  4. Foreword
    (pp. ix-2)
    Robbie Davis-Floyd

    This book tells the story of the midwifery renaissance that began in Canada during the 1970s and continues today: its chapters describe and analyse how Canadians came to “reconceive” midwives and midwifery and generate a new model of midwifery care, funding, and education – one that is unique in the Americas and rare in the world – and how that new model has integrated into the various provincial health care systems known collectively as medicare. To their credit, many of the book’s contributors have been there from the beginning, documenting, describing, recording, analysing, and supporting the remarkable developments to date,...

  5. INTRODUCTION Reconceiving Midwifery in Canada
    (pp. 3-14)
    Ivy Lynn Bourgeault, Cecilia Benoit and Robbie Davis-Floyd

    Midwifery today is in a state of ferment and change. The phenomenon referred to as thenew midwifery– which denotes a critical shift in thinking and action by midwives, birthing women, and sympathetic supporters in regard to the significance of midwifery for the health and well-being of mothers and infants – is emerging increasingly around the world (Burtch 1994; Bourgeault 1996, 2000; Bourgeault and Fynes 1996/97, 1997; Shroff 1997; Page and Percival 2000). Perhaps in no other country is this change in maternity care organization more apparent than in Canada.

    Until the 1990s, Canada held the dubious distinction of...

    • [PART ONE Introduction]
      (pp. 15-16)

      To best understand the stories that make up the process of reconceiving midwifery in Canada in the contemporary era, it is important to situate midwifery within a historical as well as cultural context. Our first chapter in this section is by sociologist Lesley Biggs, entitled “Rethinking the History of Midwifery in Canada.” In this paper, Biggs questions the universality of the “neighbour midwife,” which emerged as the dominant motif that many scholars and the popular press have drawn upon to articulate the history of midwifery in Canada. She argues that, rather than being a universal form, the neighbour midwife emerged...

    • 1 Rethinking the History of Midwifery in Canada
      (pp. 17-45)
      Lesley Biggs

      Beginning in the 1970s, feminist historians and social scientists turned their attention to the history of midwifery and childbirth. Inspired by critiques emanating from the women’s health movement and from a resurgence of midwifery and natural childbirth, feminist scholars strived to uncover the work of women who were formally trained as midwives or who offered assistance as neighbours and relatives of labouring women. Little was known about midwives or the practices of childbirth. The received knowledge was based on the history of obstetrics, in which physicians armed with scientific knowledge and new technologies were portrayed as champions of women’s health...

    • 2 Tradition as a Political Symbol in the New Midwifery in Canada
      (pp. 46-66)
      Margaret MacDonald

      A midwife travels by horse and sleigh and then on snowshoes across a frozen lake to attend a woman in labour at her log cabin home. The baby is delivered by lamplight as the voice-over is heard: “Until well into this century most of us Canadians were born where we lived. And the only professional hands guiding our arrival in the world were theirs: The Midwife.” This brief but moving vignette is called “Midwife. A Heritage Minute.” It is one of several dozen vignettes broadcast on television across the country that depict important events and characters in Canadian history and...

    • [PART TWO Introduction]
      (pp. 67-70)

      Following on the heels of the critical and reflective analyses of the historical context and notion of tradition presented by Biggs and MacDonald respectively, the chapters in Part II address the key contemporary issues of legislation and integration and the challenges that these both pose for midwifery as a social movement, for the way that midwives practise, and for the manner in which midwives are compensated for services rendered to clients. We begin with practising midwife, midwifery educator, and social scientist Vicki Van Wagner, who writes on the complicated decision to seek legal regulation of midwifery in Ontario in the...

    • 3 Why Legislation?: Using Regulation to Strengthen Midwifery
      (pp. 71-90)
      Vicki Van Wagner

      This paper was originally written in 1994, just months after the legal recognition of midwifery in Ontario, to explore and explain the reasons why midwives like myself became strong advocates for midwifery legislation. The idea of including the paper in this book has given me the opportunity to reflect on the paper from the perspective provided both by the years that have passed since the passing of the Midwifery Act in Ontario and through discussion with other Canadian midwives who have worked towards midwifery legislation in their provinces.

      In the late 1970s I was a young and idealistic pregnant woman,...

    • 4 Delaying Legislation: The Quebec Experiment
      (pp. 91-110)
      Hélène Vadeboncoeur

      Among the provinces that answered women’s requests to legally recognize midwives, Quebec is the only one that decided to experiment with the practice of midwifery, in order to see, first, if legalization was indicated and, second, how midwifery could be organized and integrated into the health care system. In this chapter, I describe the experiment and the circumstances that led to this decision, the outcomes of the experimentation, and why the decision to experiment was made and the reactions to its outcomes. I also describe the subsequent announcement by the government to legalize midwifery in 1999 and the terms of...

    • 5 Challenges to Midwifery Integration: Interprofessional Relationships in British Columbia
      (pp. 111-130)
      Jude Kornelsen and Elaine Carty

      On 1 January 1998 midwives in British Columbia began legalized practice. Regulation was the culmination of an arduous struggle for legitimization by some midwives – through their professional association, the Midwifery Association of B.C. (mabc) – and consumers – through the Midwifery Task Force (mtf) – that began in the mid-1970s. Similar to other provinces in Canada, not all practising midwives supported legalization, and fissures developed within the community between those working for official status and those who preferred to continue to provide care outside of a regulatory system (see also Van Wagner, this volume). Despite this, the move toward...

    • 6 To Fund or Not To Fund: The Alberta Decision
      (pp. 131-149)
      Susan James and Ivy Bourgeault

      Given the particular organization of health care in Canada, the integration of midwifery has to occur within various, somewhat disparate, provincial health care systems. One of the key issues to be decided, apart from regulation, is whether to include midwifery in the system of public funding for maternity care services. Both are provincial jurisdictions. Public funding is a critical issue in levelling the playing field between midwives and physicians and for fostering greater accessibility to midwifery care. Public funding is one of the prime reasons Van Wagner notes in chapter 3 why legislation was pursued in Ontario. But regulation does...

    • 7 Exploring Legislated Midwifery: Texts and Rulings
      (pp. 150-166)
      Mary Sharpe

      On 1 January 1994, with the implementation of the Midwifery Act, Ontario midwives began to practise as autonomous, regulated health professionals. Midwifery, long considered peripheral to traditional medical practice, became legally integrated into the Ontario health care system. The act altered the status of the Ontario midwife and required the establishment of new work structures, processes, and relationships.

      In this paper, I examine the role that written documents, official language, structures, and institutionalized processes (henceforth referred to as texts and/or rulings), have increasingly played in midwives’ work through the integration process. To do this, I draw upon the theoretical work...

    • [PART THREE Introduction]
      (pp. 167-168)

      Midwifery education and training have been highlighted as critical issues in the chapters on midwifery history and legislation in the precedings two sections. Part III delves more fully into the specific models of education for midwives and other entry-to-midwifery-practice issues. Sociologist Cecilia Benoit and anthropologist Robbie Davis-Floyd begin by describing the three basic models of midwifery education – apprenticeship, vocational, and university training – that have been adopted by midwives in altered forms in different times and places across Canada. They argue that each model has its strengths and weaknesses but at the same time needs to be contextualized within...

    • 8 Becoming a Midwife in Canada: Models of Midwifery Education
      (pp. 169-186)
      Cecilia Benoit and Robbie Davis-Floyd

      How should aspiring midwives be best prepared for their future service role? What types of knowledge should be transmitted, and who are the ideal teachers to transmit this knowledge? Where should such preparation take place? There were no definitive answers to these questions in the past, nor are there in the present. Each educational model that has been developed for midwifery has its strengths and weaknesses, as does the diversity of their applications in Canada and other countries.

      Characteristic of Western technocratic societies in general is a marked trend toward requiring ever higher levels of education and ever more advanced...

    • 9 Midwifery Education in Ontario: Its Origins, Operation, and Impact on the Profession
      (pp. 187-203)
      Karyn Kaufman and Bobbi Soderstrom

      On 7 September 1996 the first eighteen women to graduate from the Ontario Midwifery Education Programme stood in front of their families, midwife teachers, and fellow students and read aloud their promise:

      This is our promise to all of you, our way of thanking you for what you have done for us.

      This is our affirmation to our community.

      We Promise

      To serve and attend to the women in our community;

      To protect the sanctity of the birth process as a normal and profound life event;

      To respond to the psychosocial, physical, emotional, and spiritual needs and choices of women;...

    • 10 Midwifery on the Prairies: Visionaries and Realists in Manitoba
      (pp. 204-220)
      Pat Kaufert and Kris Robinson

      Discussing issues of language and childbirth, Paula Treichler argues that definitions “are social, cultural and political as well as linguistic and they are constructed by specific speakers with specific aims and interests.” She continues: “Thus a definition is not, as conventional wisdom assumes, the set of necessary and sufficient conditions that constitutes a fixed starting point for political, economic and ideological struggle. Rather a definition represents the outcome of such struggles – an unstable, negotiated and often quite temporary cultural prescription” (1990, 133).

      This paper deals not with childbirth but with midwifery. Like Treichler, however, our concern is with issues...

    • [PART FOUR Introduction]
      (pp. 221-224)

      As Pat Kaufert and Kris Robinson’s paper in the last section describes, equity and accessibility are important issues for both midwives and birthing women that have yet to be fully resolved. We take aim at these two issues more fully in this section. Concerns with equity and accessibility are particularly salient in the description of the experiences of women with unregulated midwifery care in Nova Scotia from 1975 to mid-1998 by Denise Marion. In this chapter, Marion documents 169 cases of experiences with midwifery care in a retrospective, descriptive study that involved mailed questionnaires to former midwifery clients and selected...

    • 11 Unregulated Midwifery: Experiences of Women in Nova Scotia
      (pp. 225-243)
      Denise Marion

      The case of midwifery in Nova Scotia offers an interesting contrast to many of the provinces discussed in this volume in terms of access and regulation. Although there has been a slow surge of interest in midwifery care since the late 1970s similar to other jurisdictions, midwifery in Nova Scotia is not (at the time of writing) a regulated health profession. Therefore when women in Nova Scotia choose midwifery care, they usually pay for the service out of pocket, according to a sliding scale determined by their financial means or by negotiating barter agreements with their midwives. Some women also...

    • 12 Access to Midwifery: Reflections on the Ontario Equity Committee Experience
      (pp. 244-262)
      Anne Rochon Ford and Vicki Van Wagner

      Access to health care services is viewed as a universal right in Canada. However, it appears that some groups have better access than others. Over the past two decades, many members of marginalized communities have taken issue with federal and provincial governments and with specific health services about inequality of access to basic services and about unfair treatment within those services.

      In the late 1980s and early 1990s, we were fortunate to be part of a process where we were able to hear first hand what lack of access looks like for a number of population groups in the Canadian...

    • 13 Aboriginal Midwifery in Canada: Merging Traditional Practices and Modern Science
      (pp. 263-286)
      Dena Carroll and Cecilia Benoit

      In this chapter we present an alternative narrative of Canadian midwifery, with a particular focus on how government legislation is being applied to help revitalize Aboriginal midwifery practices in Canada. For many centuries, Aboriginal women have faced social and cultural changes that have negatively impacted their health, cultural identity, social structures, and traditional values. Several studies have examined the damaging effects of government policies, including the denigration of early healing practices and the removal of pregnant women from their communities and evacuation to southern hospitals (O’Neil and Kaufert 1990; Linehan 1992; Kaufert and O’Neil 1993; Lowell 1995). More recently, government...

    • 14 The Boundaries of Professional Belonging: How Race has Shaped the Re-emergence of Midwifery in Ontario
      (pp. 287-305)
      Sheryl Nestel

      In the summer of 1995, the interdisciplinary childbirth educator’s training program that I had taught for several years – a collaboration between a suburban college and an urban hospital – received nearly triple its usual number of applications for the coming academic year. Even more unusual was that half of the students applying were women of colour, most of them trained midwives from Asia, Africa, Latin America, or the Caribbean. Childbirth education has been an overwhelmingly white avocation in Ontario (and elsewhere in North America) and the opportunity to develop a more diverse pool of childbirth educators was decidedly welcome...

  10. AFTERWORD Missing Pieces and New Developments: Challenges and Opportunities
    (pp. 306-310)
    Ivy Lynn Bourgeault and Cecilia Benoit

    In the introduction to this volume we described how our collection of chapters represents a snapshot in the continuing dialogue about the socalled “new midwifery” in Canada. Several important issues have been addressed in the preceding pages, including the historical roots of what we argue are not one but a variety of emerging models of midwifery care in different parts of the country. The volume also traces the international antecedents of these emerging models, the pivotal role played by legislators and other stakeholders, and the impact of subsequent legislation in the different provinces discussed. Other chapters have focused much-needed attention...

  11. Contributors
    (pp. 311-318)
  12. Index
    (pp. 319-336)