Expectations: The cultural construction of nature in midwifery discourse in Ontario

This is a study of midwifery in the province of Ontario, Canada. Specifically, it is an ethnographic study of the cultural construction of nature in midwifery discourse and its impact on the spatial and embodied experiences of pregnant and birthing women. I examine two central questions: What constitutes a natural birth from the perspective of midwives and women who have had midwifery care? How are midwifery spaces, including clinics, homes, and hospital rooms, produced by midwives and birthing women as natural locations for maternity care and giving birth?

In 1994 the province recognized midwifery as a health profession and incorporated it into the formal health care system. Prior to this time midwifery in Ontario existed as a structurally marginal social movement opposed to the medicalization and institutionalization of pregnancy and child birth. Significantly, midwifery has maintained important aspects of its philosophy as a social movement and enshrined them in its current model of care, specifically, the principles of continuity of care, informed choice, and choice of birth place.

My analysis is theoretically underpinned by the critical-interpretive approach in medical anthropology which assumes that “all knowledge relating to the body, health and illness is culturally constructed, negotiated, and renegotiated in a dynamic process through time and space” (Lock and Scheper-Hughes 1990: 49). This theoretical approach allows me to expand upon feminist analyses that identify reproduction as a site of women's oppression. By examining midwifery narratives—the stories and experiences of midwives and birthing women—I show how midwifery in Ontario both reflects and informs the emergence of spatial and embodied experiences of the pregnant and birthing body that challenge biomedical versions. I argue that nature in midwifery is being redefined and relived by the political and pragmatic choices of women as both birthers and midwives. New expectations of pregnancy and birth give rise to new performances that are deeply personal and yet highly political. In this way midwifery generates positive gendered identities for women that are naturalized in the body.