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Obstructed Labour: Race and Gender in the Re-Emergence of Midwifery.

OBSTRUCTED LABOUR: Race and Gender in the Re-Emergence of Midwifery

Sheryl Nestel

Vancouver/Toronto: University of British Columbia Press, 2006; 200 pp.

Before 1991, Canada had the dubious honour of being one of ten industrialized nations that did not legally sanction the practice of midwifery. On December 31, 1993, the Ontario government passed legislation regulating the practice of midwifery. Since that time, midwifery has been legalized in Alberta (1994), British Columbia (1995), Manitoba (1997), Quebec (1999), Northwest Territories (2005), Nova Scotia (2006), and Saskatchewan (2008). Hailed as a "victory for women," the regulation of midwifery in these jurisdictions as well as the expansion of midwifery scopes of practice in many parts of the world, envisioned a new model of maternity care in which women could choose both the providers of their care and the place of their birth(s). Canadian women could expect to have continuous care throughout their pregnancies, labour and delivery by one midwife (or a member of her practice).

For predominantly white middle-class women, the legalization of midwifery in Ontario was a cause celebre. The regulation of midwifery represented a significant improvement in women's experience of birth, as well as establishing a high-powered and relatively well-paying new occupation for a select few. But, as Sheryl Nestel has shown in her book, Obstructed Labour: Race and Gender in the Re-Emergence of Midwifery, the costs were high. Although many immigrant women of colour had trained and worked as midwives in their home countries, and continued to work as labour and delivery nurses in Canada, just 12 percent of practising midwives were, at the time of the writing of the book, immigrant women of colour (p. 7). Given the multiracial and multi-cultural diversity of Ontario (particularly in Toronto), and that "racialized minority women represented nearly half of the hundreds of women who had inquired about having their prior midwifery training recognized" immediately after legalization, why are racialized immigrant women so underrepresented in this new profession?

Nestel demonstrates that the articulation of midwifery as a feminist initiative to address "the universal needs of women" (read gender oppression) failed to engage with race-blind epistemologies. The midwifery movement was blind to its privileges articulated through geographic location (urban, southern Ontario), educational attainment, the requirement for Ontario experience, proficiency in the English language, and the financial costs and time associated with prior learning assessments. As a result, the white midwifery movement reinscribed racial hierarchies among midwives (since racialized immigrant midwives were largely excluded from practice) and between midwives and their clients, many of whom probably would have preferred attendants from the same cultural and linguistic background. Nestel demonstrates that in its desire to be respectable and having unprecedented access to power and influence, the white feminist midwifery movement used a variety of discursive strategies that effaced the skills, knowledge and credentials of racialized immigrant midwives.

Based on her analysis of documents generated by the midwifery movement and government, as well as interviews with predominantly immigrant midwives of colour, Nestel identifies three "technologies of exclusion." "The first and most indispensable" of these narratives was "the heroic tale" in which midwives were represented in part as dedicated, benevolent individuals whose actions would benefit all women ("the means justifies the end" argument) while simultaneously midwives were presented in a mighty struggle against primarily the medical professions ("the forces of evil" argument). In practice, exclusion was realized through "white solidarity" or "white racial bonding" in which the appointment of leaders and representatives to committees both within the midwifery movement and in government was restricted to a relatively, few trusted individuals who became "ambassadors" for midwifery. This new professional midwife projected an image that would distinguish her from the "disreputable" image of the harridan Sarey Gamp of old, the more contemporary "hippy" midwife of the 1960s and 1970s, and the now "obsolete" foreign-trained midwife.

Finally, white midwives were able to inoculate themselves from charges of discrimination/racism by pointing to their inclusive efforts of establishing equity committees and various forms of outreach. Nestel argues that the white midwifery movement engaged in strategies which idealized Aboriginal people while positioning white midwives as their saviours (p.48). In contrast, immigrant and racialized women were represented, by virtue of their subordinate position, as "needy"--the role of white midwives was to provide services that would protect and/or guide these women who faced linguistic and cultural barriers and/or who were victims of racism and violence.

Although racialized immigrant women were largely excluded from practice, it is "profoundly ironic," as Nestel observes, that the bodies of Third World women provided practice experience which allowed white midwives to qualify for registration (p. 69). Travelling primarily to clinics located on the United States/Mexico border, these "midwifery tourists" were able to translate the experiences of "the Third World mother" into different kinds of knowledge currencies upon returning to Canada. Attending high risk births earned these midwifery tourists grudging respect from medical professionals while knowledge of the "traditional" and "authentic" birth practices enhanced their credibility among midwifery supporters.

The production of white dominance through professionalization did not go unchallenged in the midwifery movement either by a small minority of white midwives or by a larger contingent of racialized immigrant midwives. However, the majority of racialized immigrant midwives did not seek registration even though many had government-approved credentials from their country of origin and had good jobs as labour and delivery nurses. This group could not afford to risk their immigrant status if they were charged with illegally practising medicine, or worse, if a baby died. They recognized that their practices would be carefully scrutinized through racial and colonial eyes.

Nestel's book is "a counter history" to "the heroic tale" of the new white midwifery movement, and should be read alongside Ivy Bourgeault's, Push! The Struggle for Midwifery in Ontario, an excellent account of the legalization and regulation of midwifery in Ontario. Meticulous in its detail, rich in its theorizing of colonialism, globalization and postcolonialism, Nestel's book attends to the microprocesses and practices involved in producing relations of dominance. She demonstrates that the international migration of labour and capital, institutional strategies of exclusion, and personal expressions of racism all played a part in the production of white midwives' subjectivities which were contingent upon and constituted through the construction of Third World/Aboriginal women as "Other" mothers.

Could the situation have turned out differently? Nestel says yes, but not without a high degree of self-consciousness on the part of those of us who have privilege; grappling with relations of dominance and subordination would require active listening to what is being said, resisting the desire to proffer our views and advice first, and a willingness to relinquish positions of governance which grant access to the corridors of power.

Nestel's book is a cautionary tale, and should be read not only by those interested in midwifery, but by all of us who continue to be engaged in feminist projects, and anyone else who wants to understand how racism works in the everyday practices of policy-making.

References

Bourgeault, Ivy Lynn. Push! The Struggle for Midwifery in Ontario: Montreal, Toronto, London, Ithaca: McGill-Queen's University Press, 2006.

Reviewed by Lesley Biggs

Department of History

University of Saskatchewan

Saskatoon, SK
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Author:Biggs, Lesley
Publication:Resources for Feminist Research
Article Type:Book review
Date:Sep 22, 2010
Words:1197
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