OBSTRUCTED LABOUR:
Race and Gender in the Re-Emergence of Midwifery
false
Based on her analysis of documents generated by the midwifery movement and government, as well as interviews with
predominantly immigrant midwives of colour, [Sheryl Nestel] identifies three
"technologies of exclusion." "The first and most
indispensable" of these narratives was "the heroic tale" in
which midwives were represented in part as dedicated, benevolent individuals
whose actions would benefit all women ("the means justifies the end"
argument) while simultaneously midwives were presented in a mighty struggle
against primarily the medical professions ("the forces of evil"
argument). In practice, exclusion was realized through "white
solidarity" or "white racial bonding" in which the appointment
of leaders and representatives to committees both within the midwifery movement and in government was restricted
to a relatively, few trusted individuals who became "ambassadors" for
midwifery. This new professional midwife
projected an image that would distinguish her from the "disreputable"
image of the harridan Sarey Gamp of old, the more contemporary
"hippy" midwife of the 1960s and 1970s, and the now
"obsolete" foreign-trained midwife.
Although racialized immigrant women were largely excluded from practice, it
is "profoundly ironic," as Nestel observes, that the bodies of Third
World women provided practice experience which allowed white midwives to
qualify for registration (p. 69). Travelling primarily to clinics located on
the United States/Mexico border, these "midwifery
tourists" were able to translate the experiences of "the Third World
mother" into different kinds of knowledge currencies upon returning to
Canada. Attending high risk births earned these midwifery
tourists grudging respect from medical professionals while knowledge of the
"traditional" and "authentic" birth practices enhanced
their credibility among midwifery supporters.
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OBSTRUCTED
LABOUR: Race and Gender in the Re-Emergence of Midwifery
Sheryl Nestel Vancouver/Toronto: University of British Columbia Press, 2006;
200 pp.
Before 1991,
Canada had the dubious honour of being one often industrialized nations that
did not legally sanction the practice of midwifery.
On December 31, 1993, the Ontario government passed legislation regulating the
practice of midwifery. Since that time, midwifery has been legalized in Alberta (1994),
British Columbia (1995), Manitoba (1997), Quebec (1999), Northwest Territories
(2005), Nova Scotia (2006), and Saskatchewan (2008). Hailed as a "victory
for women," the regulation of midwifery
in these jurisdictions as well as the expansion of midwifery
scopes of practice in many parts of the world, envisioned a new model of
maternity care in which women could choose both the providers of their care and
the place of their birth(s). Canadian women could expect to have continuous
care throughout their pregnancies, labour and delivery by one midwife (or a
member of her practice).
For
predominantly white middle-class women, the legalization of midwifery in Ontario was a cause célèbre. The
regulation of midwifery represented a
significant improvement in women's experience of birth, as well as establishing
a high-powered and relatively well-paying new occupation for a select few. But,
as Sheryl Nestel has shown in her book, Obstructed Labour: Race and Gender in
the Re-Emergence of Midwifery, the costs were
high. Although many immigrant women of colour had trained and worked as
midwives in their home countries, and continued to work as labour and delivery
nurses in Canada, just 12 percent of practising midwives were, at the time of
the writing of the book, immigrant women of colour (p. 7). Given the multiracial
and multi-cultural diversity of Ontario (particularly in Toronto), and that
"racialized minority women represented nearly half of the hundreds of
women who had inquired about having their prior midwifery
training recognized" immediately after legalization, why are racialized
immigrant women so underrepresented in this new profession?
Nestel
demonstrates that the articulation of midwifery
as a feminist initiative to address "the universal needs of women"
(read gender oppression) failed to engage with race-blind epistemologies. The midwifery movement was blind to its privileges
articulated through geographic location (urban, southern Ontario), educational
attainment, the requirement for Ontario experience, proficiency in the English
language, and the financial costs and time associated with prior learning
assessments. As a result, the white midwifery
movement reinscribed racial hierarchies among midwives (since racialized
immigrant midwives were largely excluded from practice) and between midwives
and their clients, many of whom probably would have preferred attendants from
the same cultural and linguistic background. Nestel demonstrates that in its
desire to be respectable and having unprecedented access to power and
influence, the white feminist midwifery
movement used a variety of discursive strategies that effaced the skills,
knowledge and credentials of racialized immigrant midwives.
Based on her
analysis of documents generated by the midwifery
movement and government, as well as interviews with predominantly immigrant
midwives of colour, Nestel identifies three "technologies of
exclusion." "The first and most indispensable" of these
narratives was "the heroic tale" in which midwives were represented
in part as dedicated, benevolent individuals whose actions would benefit all
women ("the means justifies the end" argument) while simultaneously
midwives were presented in a mighty struggle against primarily the medical
professions ("the forces of evil" argument). In practice, exclusion
was realized through "white solidarity" or "white racial
bonding" in which the appointment of leaders and representatives to
committees both within the midwifery movement
and in government was restricted to a relatively, few trusted individuals who
became "ambassadors" for midwifery.
This new professional midwife projected an image that would distinguish her
from the "disreputable" image of the harridan Sarey Gamp of old, the
more contemporary "hippy" midwife of the 1960s and 1970s, and the now
"obsolete" foreign-trained midwife.
Finally,
white midwives were able to inoculate themselves from charges of
discrimination/racism by pointing to their inclusive efforts of establishing
equity committees and various forms of outreach. Nestel argues that the white midwifery movement engaged in strategies which
idealized Aboriginal people while positioning white midwives as their saviours
(p.48). In contrast, immigrant and racialized women were represented, by virtue
of their subordinate position, as "needy" - the role of white
midwives was to provide services that would protect and/or guide these women
who faced linguistic and cultural barriers and/or who were victims of racism
and violence.
Although
racialized immigrant women were largely excluded from practice, it is
"profoundly ironic," as Nestel observes, that the bodies of Third
World women provided practice experience which allowed white midwives to
qualify for registration (p. 69). Travelling primarily to clinics located on
the United States/Mexico border, these "midwifery
tourists" were able to translate the experiences of "the Third World
mother" into different kinds of knowledge currencies upon returning to
Canada. Attending high risk births earned these midwifery
tourists grudging respect from medical professionals while knowledge of the
"traditional" and "authentic" birth practices enhanced
their credibility among midwifery supporters.
The
production of white dominance through professionalization did not go
unchallenged in the midwifery movement either
by a small minority of white midwives or by a larger contingent of racialized
immigrant midwives. However, the majority of racialized immigrant midwives did
not seek registration even though many had government-approved credentials from
their country of origin and had good jobs as labour and delivery nurses. This
group could not afford to risk their immigrant status if they were charged with
illegally practising medicine, or worse, if a baby died. They recognized that
their practices would be carefully scrutinized through racial and colonial
eyes.
Nestel's
book is "a counter history" to "the heroic tale" of the new
white midwifery movement, and should be read
alongside Ivy Bourgeault's, Push! The Struggle for Midwifery
in Ontario, an excellent account of the legalization and regulation of midwifery in Ontario. Meticulous in its detail, rich
in its theorizing of colonialism, globalization and postcolonialism, Nestel's
book attends to the microprocesses and practices involved in producing
relations of dominance. She demonstrates that the international migration of
labour and capital, institutional strategies of exclusion, and personal
expressions of racism all played a part in the production of white midwives'
subjectivities which were contingent upon and constituted through the construction
of Third World/Aboriginal women as "Other" mothers.
Could the
situation have turned out differently? Nestel says yes, but not without a high
degree of self-consciousness on the part of those of us who have privilege;
grappling with relations of dominance and subordination would require active
listening to what is being said, resisting the desire to proffer our views and
advice first, and a willingness to relinquish positions of governance which
grant access to the corridors of power.
Nestel's book
is a cautionary tale, and should be read not only by those interested in midwifery, but by all of us who continue to be
engaged in feminist projects, and anyone else who wants to understand how
racism works in the everyday practices of policy-making.
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