Midwifery as mediation: birthing subjects and the politics of self-determination
The dissertation compares the emergence of midwifery in Quebec with the renovations of midwifery practice in France. Midwifery, I argue, is implicated in new technologies of citizenship that take women's desires for self-determination and reproductive autonomy as their goal and target. In both Quebec and France, the neoliberal restructuring of health care systems solicits greater responsibility for pregnancy and birth from individuals.The dissertation demonstrates, however, that these new responsibilities are also experienced as burdens. The emergence of a "new" midwifery in Quebec formalizes the role of the midwife as mediator in the changing relationship between the birthing subject, her body and the state. In France, midwives' affective labor in France is implicated in new forms of regulation. The exercise of reproductive self-determination, framed as a right by associations of health care "users," is also increasingly posited as an obligation. Midwifery thus permits the expression of a desire for a fully autonomous relationship to the body, acting on the capacities and the will of the woman to cultivate her own practices of self-reflection and self-government.Scholarship on midwifery has tended to explain changes in midwifery practice and policy through the lens of gender and professional power, with struggles over the status of midwifery linked to the devaluation of women's caring work. Recent work on midwifery, however, suggests that these dynamics are no longer adequate to the task of understanding the complexity of practices and policies surrounding pregnancy and birth. While it is clear that the pressures to rationalize health care in Quebec and France are changing the nature of midwives' labor, a thesis of the devaluation of gendered labor and of professional competition among doctors and midwives cannot fully explain these transformations. The emergence of midwifery in Quebec and its renovations in France can be more fully understood by considering the rationalities informing health care and reproduction that become powerful in particular places and times.
- Geography