I just read this article that debunks the construction of Somali pirates as robbers at sea and it got me thinking about midwives.
What struck me first in reading this article was the gap between the perspective of this author (that the Somali pirates are local patriots, protecting their people) and authors of more mainstream press who portray them as “shrewd businessmen and daring opportunists.”
Similar is the gap between home birth activists/practitioners and medical practitioners like members of the the American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA). During the “Midwife Debate” that went on from 1916-1935 midwives were called “poor, black, dirty, illiterate, immoral, immigrants, drunken, ignorant, superstitious, callous, rough, criminal, relics of barbarism.”
Today it’s not much different. These groups portray midwifery like the American press portrays the Somali pirates: through imperialist eyes. To them, midwives are the enemy, the “other,” and they have to be diligent in the protection of their interests. For over a century the AMA has worked hard to police the boundaries of their profession, making sure that those boundaries are ever expanding, include the most profitable territories, and are unsurpassed in power. In the summer of 2008 these groups even passed resolutions proposing that home birth be outlawed.
On the flip side, midwives, and their clients have found their boundaries constrained, their territory occupied, their indigenous vilified (or worse) and their power limited to guerilla tactics - like the Somali pirates. Especially in this country and especially among people of color and immigrants (among whom today, you will find very few midwives). Imagine if, among the trials that new immigrants in this country faced, they at least knew that they had the power, authority, and wisdom to take care of their new families, to usher in new life in their own culturally relevant ways.
One hundred years ago, they did. Most of the midwives in this country were immigrants, and in fact, many of the American born doctors learned from these immigrant midwives about birth. I could go on and on and you can read more about this history in Judith Pence Rooks encyclopedic Midwifery and Childbirth in America, the point is that the European-Medical expansion into this territory - serves the same imperialist purpose as the European exploitation of African resources.
Linda Tuhiwai Smith in Decolonizing Methodologies defines imperialism as having several interlocking parts: economic expansion, subjugation of others, a discursive field of knowledge, and a spirit that gets represented in myriad ways. This expansion into the realm of childbirth has all of these elements, as does the recent piracy example.
Economic expansion: the newly professionalizing doctors had an economic imperative to define and protect their turf. Subjugation: today 99% of the people born here are born in a hospital, 98% of them under the care of a doctor - that’s almost a complete power reversal. Discursive knowledge: in addition to the resulting power shift, entire fields of knowledge have been written over, today the vast majority of birth is medicated, few people even know what an unmedicated natural birth is like. And the spirit: today, immigrants feel it is a mark of progress to be born in an American hospital (although health stats make such high regard questionable), midwives and pirates alike are seen as archival, mythological, backward…
This is why the political stakes are the same, it has to do with territories and resources, dignity and humanity. The contested sites differ, the discursive knowledges too, but in the end, we will have no justice without addressing imperialism in all of our labors.
Post-Post Thought: A midwife friend of mine in response to this provacative comparison asked “what are we stealing?” And I appreciated the challenge to my little analogy. As I have thought about it I really don’t think there is anything midwives are stealing in a way that makes for a good addition to the analogy. Do you?
I used this analogy because there are otherwise progressive folks who can understand the dynamics at play between these Somali pirates and the United States - but who don’t understand the dynamics at play between midwives and doctors or between hospital and home births. I am hoping that the analogy will illuminate that birth is an issue with political ramifications and context as profound and complex as piracy. Beyond that it is not necessarily an analogy I will take up again (though I do have a soft spot for both midwives and pirates). Let me know what you think.
The interesting point is that the U.S. thinks there is something really important to protect from these pirates, and the pirates also think they have something really important to protect but they each think the actions of the other is “criminal.” Midwives think they have something important to protect: natural labor or the confidence of families to birth themselves. And doctors think they have something important to protect: the well being of their patients. They each (often but not necessarily) think the other is “criminal” in their approach.
While midwives aren’t stealing things - many doctors (and others who are medically trained including some patients) do think they are being “bad” in many ways. Plus, legal structures are set up to criminalize and punish midwives with a rule of law that privileges doctors (like the rule of law privileges the U.S. against the pirates). This is what makes the difference of perspective not just a simple matter of agree-to-disagree because there are differences in power at play: current, historical, and structural.
The article is usefull for me. I’ll be coming back to your blog.
I’m so glad, thank you!
Where did you take from such kind of information? Can you give me the source?
Yes, of course here are some of my main sources: Judith Pence Rooks, Midwifery and Childbirth in America 23 (Temple University Press 1997); Leslie Reagan, “Linking Midwives and Abortion in the Progressive Era,” Bulletin of the History of Medicine, Winter 1995; Wendy Simonds, Barbara Katz Rothman & Bari Meltzer Norman, Laboring On: Birth in Transition in the United States (Routledge 2007). These will lead you to others…