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Delivering Subjects: Race, Space, and the Emerqence of Legalized Midwivery in Ontario

Published online by Cambridge University Press:  18 July 2014

Sheryl Nestel
Sheryl Nestel
Affiliation:
50 Ellsworth Avenue, Toronto, Ontario M6G 2K3,[email protected]
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Abstract

While widely regarded as a victory of grassroots feminist organizing and as part of the ongoing struggle for gender equity and female reproductive autonomy, the movement to legalize midwifery in Ontario has, in fact, derived considerable benefit from hierarchical rather than equal relations among women. This article describes the practice of “midwifery tourism” whereby Ontario midwives traveled to “Third World” maternity clinics in order to obtain clinical experience unavailable to them in the period that preceded the legalization of the profession in the province. Many traveled in order to garner the requisite number of births for participation in provincial programs designed to integrate practicing midwives into the health care system. In addition to this very quantifiable benefit, midwives were also able to enhance their professional prominence through a claim to first-hand knowledge of the birth practices of “Third World” women, a group mythologized within natural childbirth discourse as possessing innate feminine birthing knowledge as yet uncorrupted by Western medical practices. The re-emergence of midwifery in North America provides a cogent example of how, through epistemological claims about women's shared identity, “Third World” space, and those who occupy it, come to constitute a commodity for first world women's consumption and social advancement.

Résumé

Cet article décrit la pratique du «tourisme de la profession de sage-femme» par laquelle, les sages-femmes en Ontario ont fait des stages dans des cliniques de maternité de pays du Tiers-monde en vue d'obtenir l'expérience clinique qu'elles ne pouvaient pas obtenir ici avant la légalisation de la profession dans la province. Plusieurs sages-femmes ont aussi pu mieux se faire reconnaître sur le plan professionnel pour leurs connaissances directes des méthodes obstétriques utilisées par les femmes du Tiers-monde, c'est-à-dire par des femmes qui, selon une mythologie soutenue dans le mouvement pour l'accouchement naturel, posséderaient, en ce qui concerne les accouchements, des connaissances féminines innées qui n'auraient pas encore été corrompues par les pratiques médicales des pays de l'Ouest. L'émergence nouvelle de la profession de sage-femme en Amérique du Nord est un exemple convaincant de la manière dont, par des affirmations épistémologiques sur l'identité partagée des femmes, les régions du Tiers-monde et les personnes qui les occupent en sont venues à constituer un produit de consommation et de progrès social pour les femmes des pays industrialisés.

Type
Law, Race and Space/Droit, espaces et racialisation
Information
Canadian Journal of Law and Society / La Revue Canadienne Droit et Société , Volume 15 , Issue 2 , August 2000 , pp. 187 - 215
Copyright
Copyright © Canadian Law and Society Association 2000

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References

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6 The term “women of colour” in its various forms is a problematic but indispensable one. While this phrase represents an act of self-definition and resistance to racist terminology by groups which have been subjected to racialized definitions and exclusions, it nonetheless fails to capture the multiple subject positions occupied by these women, eliding axes of difference along which women who share racialized status are positioned. In some senses the term represents the inadequacy of modernist language in representing multiply-constituted identities – what Ali Rattansi has called “a perennial excess of things over words.” Rattansi, A., “Western Racisms, Ethnicities, and Identities in a ‘Postmodern’ Frame” in Rattansi, A. & Westwood, S., eds., Racism, Modernity, and Identity on the Western Front (Cambridge: Polity Press, 1994) 56 at 59.Google Scholar

7 While “visible minority” people comprise approximately 15 percent of Ontario's total population, in Toronto, the historical centre of midwifery activism, they account for nearly 40 percent of all residents. However, the number of midwives of colour expressing an interest in having their credentials recognized in the province has, since 1986, outstripped their proportion in the population at large, accounting for nearly half of those who, by 1994, had sought information from the College of Midwives and its predecessors about credentials assessment. Relatively few of these women, however, have succeeded in becoming registered as midwives. The College of Midwives of Ontario has not collected statistics on the ethnic/racial group identification of its members. Consequently, any claims about the numbers of racialized minority women who are registered midwives represent estimates. In June, 2000, I asked four individuals who are intimately involved with midwifery in Ontario to review the most recent lists of registered midwives issued by both the Association of Ontario Midwives and the College of Midwives of Ontario. These women were able to identify 17 women of colour and two Aboriginal women, who, in total, represented just over ten percent of the approximately 180 midwives listed as registered in the province. Three of the women of colour identified were known not to be practicing. While I must emphasize that this is not an official accounting, this estimate is likely highly accurate. For a statistical accounting of “visible minority” residents of Ontario see Statistics Canada 1996 Census Nation Tables online (<http://www.statcan.ca/english/Ogdb/People/demo40b/jt>. Accessed April 22, 1999. On “visible minorities” in the City of Toronto see Ornstein, M., Ethno-racial inequality in the City of Toronto: An Analysis of the 1996 Census (Toronto: Access and Equity Unit, Strategic and Corporate Policy Division, City of Toronto, 2000).Google Scholar

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12 The end of European political rule in these areas has by no means signalled the end of foreign political and economic domination. Indeed, any attempt to mark a temporal border between the colonial and post-colonial periods must be viewed as highly problematic given colonialism's numerous successor projects - economic, political and representational - that serve to keep former colonies and their occupants under the dominance of both powerful industrialized countries and global financial markets.

13 See Said, E., Culture and Imperialism (New York: Alfred A. Knopf, 1993)Google Scholar and Stoler, A. L., Race and the Education of Desire: Foucault's History of Sexuality and the Colonial Order of Things (Durham: Duke University Press, 1995).Google Scholar

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17 I wish to thank Margot Francis for suggesting the use of the term “midwifery tourism.”

18 In identifying myself and other women here as “white” I am signalling our positionality as the beneficiaries of numerous social privileges which accrue to those whose appearance, comportment, habits and behaviours are construed as white in the wake of specific historical processes. Whiteness is not an essential, immutable identity, but rather a relational one. Its privileged status can be compromised and it's attendant privileges diminished when its bearer transgresses the boundaries of gender, class, sexual, religious or bodily normativity. It is nearly impossible, however, to divest oneself of white privilege in an environment highly structured by racial meanings and hierarchies. While I believe that radical versions of whiteness, wherein white racial privilege is contested and refused are possible, few examples of this have emerged in my study of midwives. Rather, I have encountered abundant data about how white midwives utilized race privilege to mitigate gender oppression thus reinforcing rather than challenging racism. See Bailey, A., “Despising an Identity They Taught Me to Claim” in Cuomo, C.J. & Hall, K.Q., eds., Whiteness: Feminist Philosophical Reflections (Lanham: Rowan and Littlefield, 1999) 85.Google Scholar

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20 These interviews were conducted in three urban centres in Ontario between December 1997 and February 1999. The interviews lasted between two and four hours each. They were transcribed and then coded using QSR NUD*IST software. The interview questions posed probed issues beyond the subjects' experiences of midwifery tourism. However, this topic came under discussion for at least half of the interview session in most cases. Pateman, B., “Computer-aided qualitative data analysis: The value of NUD*IST and other programs” (1998) 53:3 Nurse Researcher 77.CrossRefGoogle Scholar

21 Indeed, the small sample size of white midwives interviewed and from whom data on midwifery tourism could be culled reflects the theoretical and methodological commitments of the dissertation project from which this article is derived. I interviewed relatively few white women who participated in the movement to re establish midwifery in Ontario inasmuch as their ideologies and political positions were widely circulated and documented. Rather, I sought to document exclusionary measures, relying largely on archival materials (see note 37 below), and to counterpose these with testimonies – largely from women of colour – about the impact of exclusionary practices. While nearly half of the 47 women interviewed for the dissertation were white, only about a third of these were from the group of iconoclastic/traditional midwives described above (the remaining white interview subjects were midwifery students, activists and members of midwifery boards).

22 I have begun collecting additional data from midwives in Manitoba, Saskatchewan and British Columbia as part of my postdoctoral research project funded by the Social Sciences and Humanities Research Council of Canada.

23 See Enkin, M. et al. , eds., A Guide to Effective Care in Pregnancy and Childbirth (New York: Oxford University Press, 1995)Google Scholar and Kaczorowski, J. et al., “A National Survey of Use of Obstetric Procedures and Technologies in Canadian Hospitals: Routine or Based on Existing Evidence” (1998) 25:1 Birth 11.CrossRefGoogle Scholar

24 The terminology surrounding the classification of midwives is complex and shifts depending on geographical and temporal location. The use of the term “lay” midwife here is meant to invoke the context during which that term was current. It is meant to identify midwives who may have been trained in formal training programs and through empirical means, but who are not affiliated with nurse-midwifery or directentry midwifery training in medical institutions. Its use has, however, for some time been considered to be disrespectful of the considerable expertise of midwifery practitioners educated outside of medical institutions and has come to be replaced by the term “direct-entry” midwife, a term I employ throughout the rest of this paper. Direct-entry midwifery in Canada and the U.S. largely refers to midwives who are institutionally-educated but who have not been required to undergo prior nursing training. For a discussion of the different usages of classificatory terms for midwives see Rooks, J. P., Midwifery and Childbirth in America (Philadelphia: Temple University Press, 1997) at 8.Google Scholar

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27 While the Canadian Medical Association announced its official position opposing the licensing of midwives in 1987, Ontario physicians did not endorse this stance. They were, however, unequivocally opposed to home birth, a practice which Ontario midwives considered the foundation of alternative childbirth and one which they categorically refused to abandon in the struggle for legalization. See Davidson, H. A., Territoriality Among Health Care Workers: Opinions of Nurses and Doctors Territoriality Among Health Care Workers: Opinions of Nurses and Doctors Towards Midwives (Ed. D. Dissertation, Graduate Department of Education, University of Toronto, 1997) [unpublished].Google Scholar

28 For discussions of racialized images in the campaign to eliminate midwifery in the U.S. at the beginning of the last century see Ehrenreich, B. & English, D., For Her Own Good: 125 years of Experts' Advice to Women (New York: Doubleday, 1978) at 96 Google Scholar, and Wertz, R. D. & Wertz, D., Lying-In: A History of Childbirth in America (New Haven and London: Yale University Press, 1989) at 216.Google Scholar

29 At the turn of the last century both nurses and physicians employed rhetoric which associated midwives with “dirt, ignorance and danger.” See Boutilier, B., “Helpers or Heroines? The National Council of Women, Nursing and ‘Woman's Work’ in late Victorian Canada” in Dodd, D. and Gorham, D., eds., Caring and Curing: Historical Perspectives on Women and Healing in Canada (Ottawa: University of Ottawa Press, 1994) 34.Google Scholar

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33 While I will use the term “Ontario midwives” to designate the predominantly white group which practised midwifery outside of the medical system and organised the profession's legalization campaign, I acknowledge the contradictory nature of the term. I would argue that midwives trained outside of the province who wish to practise but who are not registered, also need to be regarded as Ontario midwives (although legally proscribed from using that term) inasmuch as they have undergone formal training and are residents of the province.

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35 It must be stressed that this number is merely an average. In fact, some midwives attended 30 or 40 births per year in this period while others attended relatively few. Also, owing to family responsibilities, travel or study, midwives would often withdraw from practice for an extended period, during which other practitioners would take on larger case loads (personal communication with Christine Sternberg RM, May 25, 2000).

36 The practice of midwifery was never proscribed by law during the recent period of its re-emergence in Ontario. Unlike in other provinces where midwives had faced charges of criminal negligence causing bodily harm, in Ontario no midwife had been charged with a criminal act related to the practice of midwifery. The threat of legal action did, nevertheless, overshadow midwifery practice in the form of coroner's inquests. Ontario midwives found themselves testifying in the pre-legislation period in a number of high profile coroner's inquests related to infant deaths at midwifeassisted births. See Burch, B., Trials of Labour: The Re-emergence of Midwifery (Montreal: McGill-Queen's University Press, 1994).Google Scholar

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39 For a discussion of the North American childbirth reform movement's engagement with racist discourses of “Third World” women's bodies see Nestel, S., “'Other Mothers: Race and Representation in Natural Childbirth Discourse” (1995) 23: 4 Resources for Feminist Research 5.Google Scholar

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77 Rooks, supra note 24 at 268.

78 “Jamaica Clinical Trip Information Sheet” International School of Midwifery, Miami Beach, Fla. 1997.

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