Barbara Katz Rothman

MIDWIVES IN TRANSITION: THE STRUCTURE OF A CLINICAL REVOLUTION*

of the birth process, a result of the social redefinition of birth. Through an analysis of the medical literature on birth, I compare the social construction of timetables for childbirth - how long normal labor and birth takes-by hospital and home-birth practitioners. I argue that, like all knowledge, this knowledge is socially determined and socially constructed, influenced both by ideology and social setting. This paper is based on interviews I conducted in 1978 with one subgroup of the home-birth movement: nurse-midwives certified by the State of New York to attend births. I located 12 nurse-midwives in the New York metropolitan area who were attending births in homes and at an out-of-hospital birth center. Nurse-midwives in the United States are trained in medical institutions one to two years beyond nursing training and obtain their formative experience in hospitals. They differ from lay midwives, who receive their training outside of medical institutions and hospitals. Once nurse-midwives are qualified, most of them continue to practice in hospitals. I use the term nurse-midwives throughout this paper to distinguish them from lay midwives. I discuss those parts of the interviews with these nurse-midwives which focus on their reconceptualization of birth timetables as they moved from hospital to home settings. This sample was selected for two reasons: first, because of the position that nurse-midwives hold in relation to mothers compared with that held by physicians; while physicians in hospital settings control the birth process, nurse-midwives in home settings permit the birth process to transpire under the mothers control. Second, because nurse-midwives have been both formally trained within the medical model and extensively exposed to the home-birth model, data gathered in monitoring their adjustment to and reaction to the home-birth model provide a crosscontextual source for comparing the two birth settings. Observation of the reactions of nurse-midwives to the home-birth setting demonstrates the degree to which their medical training was based on social convention rather than biological constants. The nurse-midwives did not embrace their non-medical childbirth work as ideological enthusiasts; rather, they were drawn into it, often against what they perceived as their better medical judgment. The nurse-midwives were firmly grounded in the medical model. Their ideas

Pregnancy, birth and risk: an introduction

In this introduction, I use my nearly 40 years of work in the area to reflect on the total medicalisation of pregnancy and childbirth that informs even the critical sociology that purports to examine the issue. The risks that are faced in pregnancy and birth are not only the inherent dangers that midwives have worked with across time and space but also those particular risks introduced by medicalisation itself. Medicalisation blinds us to those risks on the one hand, while it blinds us to the skills and knowledge that midwives and birthing women themselves have on the other. The women and midwives researched in these articles show us that in pregnancy and birth, as in most of life, it is not just a matter of ‘real risk’ versus ‘perceived risk’ as risk theorists (too) often describe it. There is rather an intelligent balancing of risks, weighing of risks and contextualising of risks. What we see in this issue is a glimpse into the ways in which people intelligently, creatively and determinedly balance risks.

The tentative pregnancy: then and now.

This paper examines the ways in which prenatal diagnosis changes womens experiences of pregnancy. The paper explores the role of patriarchal ideology in the development and use of prenatal diagnostic technology.

WOMEN AS FATHERS: Motherhood and Child Care Under a Modified Patriarchy

Although the modern American kinship system is nominally a bilateral system, the very definition of kin ties is based on the principles of patriarchy. Women do not gain their rights to their children in this society as mothers, but as father-equivalents, sources of genetic material. In child rearing as in childbearing, women may take on the role of fathers to their children, substituting poorer women to do the traditional mothering work. The resultant recasting of the classic Oedipal drama in terms of class and race rather than gender is described. This article argues that we must move beyond patriarchal definitions of the relations between parents and children, and beyond modifications that simply extend to some women, most often at cost to other women, some of the privileges of patriarchy.

Feminism confronts the genome: introduction

IntroductionContemporary genetics has generated both pervasive cultural transformation andconsiderable hyperbole. The notion that life has become and is increasingly beingrearticulated through genetification is evidenced amply by foundationaltransformations in everyday as well as professional vernaculars of kinship,health, personal and social identity, and in social–institutional practices crossingover the labours and economic futures of science and medicine, agriculture,pharmaceuticals, business marketing and policing, to name only a few. Theideological reach of genetics and the ideological work of the gene has beenindisputably profound and extensive. Interestingly this has occurred notwith-standing that genes and the science of genetics, in material terms, have for themost part not delivered on the extravagant claims attributed to them. Geneticshas not paid off in a transformation of curative medicine and genetic diagnosticinnovations have had little appreciable impact on either disease prevention orcare. The mapping of the human genome has not paid off significantly in theway of understandings, biological or social, of the human condition or the distinc-tions between or interrelatedness of species. Genetically modified foods have notredressed poverty or hunger; pharmacogenetics has not produced ‘smart’ drugs.So the spread of genetic ideas and investments in the possibilities of the genewould seem to owe much to their ‘fit’ with the times, to both comfortablecommon sense as well as uncomfortable points of social and cultural rupture,which genetification would seem to fill.One of the key achievements of feminist scholarship, and one of the centre-points of both feminist activism and feminist epistemology, has been the develop-ment of a critique of science. The advent of genetics and the purported geneticsrevolution has been articulated on a conceptual terrain in which critical ideas con-cerning reproductive rights, ecology, embodiment, bioethics, choice and agencyhave been reshaped by feminism, whether or not this is explicitly acknowledged

New breast milk in old bottles.

This paper identifies how the different ideologies of patriarchy, technology, capitalism, race and feminism shape how we see breastfeeding and the breastfeeding mother with child. Ultimately, while we can make good strong arguments for breastfeeding from the perspective of health, of outcome, of good scientific data, we need to appreciate that they are only rationalizations for a shared belief that the image of the breastfeeding woman with baby represents something precious and valuable. So while it may be important to make arguments that draw on what is valued in society, we need to think hard about what it is that we value so that as we move forward with our efforts to make breastfeeding safe, we can use but not be used by, the various ideologies or claims.

Alternative Modes of Reproduction: Other Views and Questions

The recent national impassioned debate generated by the Baby M case has dramatically increased the necessity of recognizing disparate voices in any feminist discussion of “third-party reproduction.” Indeed, the very language of “third-party reproduction” underscores tensions over the meanings of pregnancy and parenting when reduced to the realm of contract law. For many of us who participated in the Rutgers University Law School’s Project on Reproductive Laws for the 1990s, these tensions have been discussed fruitfully, but are not ultimately represented in the other position papers prepared for this book.

The Legacy of Patriarchy as Context for Surrogacy: Or Why Are We Quibbling Over This?

It probably is possible to envision circumstances in which wealthy people using surrogacy services from poor countries would not be “exploitative,” especially if we narrow our definition enough, as...

Where Are the Midwives

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