Exploring Legislated Ontario Midwifery: Texts, Ruling Relations and Ideological Practices

Most babies in the world are born into the hands of midwives. Until recently Canada was one of the few countries in the world where midwives were not legally recognized. However, with the enactment of the Midwifery Act in 1994, Ontario midwives began to practise as regulated health professionals, and midwifery, long marginalized by the medical establishment, moved into the mainstream of the Ontario health care system. In this article, I examine some of the changes to work structure, processes and relationships, with particular attention to the role of written texts in the working lives of midwives.La plupart des enfants du monde sont nes a l'aide de sagesfemmes. Il y a peu de temps, le Canada constituait l'un des seuls pays au monde qui ne reconnaissait pas les sagesfemmes de jure. Cependant, suite au texte legislatif de la Loi de 1994 sur les sages-femmes, les sages-femmes de l'Ontario sont reconnues comme des professionnelles de la sante reglementees, et la profession de sage-femme, qui s'est longtemps vue marginalisee par le corps medical, s'est trouvee une place dans le cour ant dominant du systeme de sante de l'Ontario. Dans cet article, j'examine certains des changements apportes a la structure du travail, des proced es et des rapports, en portant surtout attention au role que jouent les textes dans la vie des sages-femmes.On January 1, 1994, with the implementation of the Midwifery Act,(f.1) Ontario midwives began to practice as autonomous, regulated health professionals. Midwifery, long considered peripheral to traditional medical practice, became legally integrated into the Ontario health care system. This Act altered the status of the Ontario midwife and required the establishment of new work structures, processes and relationships. In this paper, I examine the role that texts have increasingly played in midwives' work.(f.2) I do this through interviews with newly legislated midwives and through personal reflections of twenty years in Ontario: as a lay midwife, as a registered midwife and as my daughter Jenny's midwife. I conclude that the texts midwives use frame women's experiences in particular ways that both limit and support care; these texts also protect women, midwives and the profession of midwifery.Historical preface(f.3)Many generations of women have helped other women with birth. Neighbor women(f.4) and midwives(f.5) working within their ethnic communities were usually specially chosen and respected as the primary helpers at births. Many women, out of choice or necessity, gave birth alone or with members of their families. The work of these women helpers/midwives was undermined by the gradual medical takeover of birth(f.6) and by the transportation of women to hospitals where anesthesia and obstetrical instruments were available.(f.7) By 1960, women's choice of caregiver at birth was largely limited to male physicians and the choice of place of birth to the hospital. Home births, especially in the north or in rural areas where physician services were scarce, were occasionally attended by aboriginal or nurse midwives.(f.8) Within two generations, midwife-attended births had almost completely disappeared in Ontario.(f.9) Some women began to critique the increasing medicalization of childbirth in the 1940s and by the 1970s the women's movement and health care activists were attempting to make changes in obstetrical practices and work towards the re- establishment of the occupation of midwifery.Inquests into baby deaths following lay midwife-attended home births in 1982 and 1985 were catalytic events in the direction towards legalized midwifery in Ontario. In 1982, the Ontario Minister of Health formed the Health Professions Legislative Review. In the same year, the Midwifery Task Force of Ontario, comprised primarily of midwifery clients, and the Association of Ontario Midwives began to lobby for legalization of a particular model of midwifery care. In 1982 and 1985, Ontario juries recommended the regulation of midwifery in order to protect the safety of the public. …

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