Is the new midwifery merely unreflective defiance?

Years ago I wrote a brief piece about homebirth midwifery entitled Whatever the scientific evidence shows, do the opposite. It turns out that I was echoing a feminist criticism of the “new” midwifery.

Among the most influential commentators on the subject are Ellen Annandale and Judith Clark, authors of the widely quoted paper, What is gender? Feminist theory and the sociology of human reproduction published in Sociology of Health & Illness Vol. 18, No. 1, 1996. The paper is long and filled with academic jargon, but has important insights that have created controversy among feminist theorists. The heart of Annandale and Clark’s criticism of the new midwifery is almost exactly the same claim that I made:

… the lived experience of midwifery … is revealed only as the largely unresearched antithesis of obstetrics. An alternative is called into existence in powerful and convincing terms, while at the same time its central precepts (such as ‘women controlled’, ‘natural birth’) are vaguely drawn and in practical terms carry little meaning.

This is a stunning criticism. Midwifery is described as unscientific and based on reflexive defiance. How did the new midwifery get to this point? Annandale and Clark believe that it starts with biological essentialism. They approvingly quote the work of a colleague:

… what both feminists and phallocentrists see as hegemony based on masculine perceptions of domination, performance, hierarchy, abstraction, and rationality, finds its antipode in a woman’s community proclaiming itself as naturally nurturant, receptive, cooperative, intimate, and exulting in the emotions . . . [feminists] assume that such principles exist and that they have been fixed and dichotomous since the dawn of patriarchal history. . . . Thus it is that the dominant culture and the counterculture engage in a curious collusion in which . . . a rebellious feminism takes up its assigned position at the negative pole.

Peeling away the jargon leaves us with the basic point, biological essentialism perpetuates women’s oppression by validating men’s belief that women are emotional and irrational. Or as Annandale and Clark write:

… Thus … reproduction is still centred for women and put on the agenda as if it were central to all women’s lives. This may serve to lock women into reproductive roles which may be politically problematic since the centrality of reproduction, contraception and childbirth to biomedicine is transferred to women’s experiences. This may be the reality of their experience, but equally importantly, it may not. To a certain extent this may be seen as an unavoidable consequence of a critique which appears as if it must engage the dichotomies of biomedicine to develop its own narrative.

The authors identify Sheila Kitzinger as an exponent of this false dichotomy.

‘Altematives’ to male-biomedicine were heavily valorised in research in the 1970s and 1980s. This was particularly evident in suggested alternatives to mainstream gynaecological and obstetric care. Sheila Kitzinger, for example, wrote that
the new midwifery has a vital part to play in the woman’s movement and is at the very centre of the great creative upheaval which is taking place as we reclaim our bodies and come to learn about, understand and glory in them. This new midwifery gives vivid expression to the way in which women are discovering strength and sisterhood as we turn to help and support one another during the intense, exhilarating and powerful experience of childbirth (1988:18).

A clear line of demarcation tends to be drawn in the literature between obstetrics and midwifery: each is portrayed as a unitary and intemally coherent body of thought and practice which is at odds with the other. The ‘alternative’ female-midwifery is clearly put forward as the better model…

Not only are such assumptions wrong, they are also elitist:

… The charge of elitism evidenced in the privileged white middle-class voice of much research, and the silence around differences between women, applies well to Barbara Katz Rothman’s influential 1982 work … which ends with an implicit call for a home-based natural birth experience …. This is made in joyous terms with little recognition that many women may not be in the position to avail themselves of such an ‘alternative’ even if they wanted to.

Annandale and Clark ask a critical question about the new midwifery. Are midwives “with women” or exploiting women for their own ends?

If we conceive of power as a fundamentally male preserve we are led to gloss over ways in which women may exert power over others, including other women . In these terms, as recent institutional reforms stimulate community midwifery midwives may begin to consider the notion of affinity with women embedded in such concepts as ‘continuity of care’ … as masking the potential exploitation of midwives by their clients.

Who, after all, is being served by this concept of midwifery?

In my view, the ultimate irony of the new midwifery is that the very people who bemoan the supposed inability of modern obstetrics to cooperate with midwifery are the very people who have made such cooperation impossible.

By insisting that all women are the same, that childbirth has a biological “essence” that must be preserved and, especially, that midwifery is defined by its opposition to modern obstetrics, midwifery theorists have created a false dichotomy that is by definition unbridgeable. Midwifery theory ignores the interests of many, if not the majority of women. Indeed, the new midwifery goes beyond ignoring women who refuse to subscribe to the theory of biological essentialism and questions the very “authenticity” of their womanhood and motherhood.

Most women in contemporary first world countries have rejected essentialism, embrace technology, and have no use for a philosophy that presumes that midwifery exists only insofar as it rejects defies modern obstetrics. If midwifery is to survive, midwifery theorists had better wake up to that reality and stop pretending that unreflective defiance is a virtue.