Women's health and social change: the case of lay midwives

Abstract

One reaction to the medicalization of birth has been the comeback of lay midwives in the past 10 years. While many practice alone as did midwives 80 years ago, now midwives are networking and organizing in regional and statewide groups, an important new distinction in the light of increasing regulatory policy formation by many states. Are these groups the beginnings of traditional bureaucratic health professional organizations or are they better described as alternative women's health groups that espouse nonhierarchical philosophies of women's health? In this article, we describe an empirical study of one such group, the Michigan Midwives' Association, and explore the philosophies and practices of individual members as well as the internal organization of the group and its influence on members. Data were collected using individual telephone interviews with 48 of 50 members, group newsletters and documents, and two spokespersons who developed an oral history of the Association since its origin in 1978. Results suggest that the group plays an important role in reinforcing individually held philosophies about women-controlled birth and in providing social support to health workers practicing outside the traditional system.

PIP: An empirical study of the Michigan Midwives Association (MMA), a lay midwife group, was undertaken, and a oral history was developed; interviews were conducted with 48 of the 50 members. Their ages cluster in the 30s. 27 (56%) of these women considered themselves full-time midwives. They usually meet their clients by word-of-mouth. Their practice patterns are characterized by client-centered care and continuity of care. The midwives' socioeconomic backgrounds are similar; but their political attitudes include many views. The words "natural" or "normal" were used by the midwives to describe birth. The MMAs origin was informal. Originally there were 8 members, but the group grew rapidly. Currently there are 50 members. Authority is shared equally among members. Work is done through committees. MMA members share common views about birth and women's right to make decisions about it. Members are spread out geographically all over Michigan, so frequent meetings are impossible. Many members have changed their practice ways since they started midwifery. About 75% of the midwives thought that client relationships had changed since they began practicing. Several felt that their attitudes toward their profession had changed. The MMA holds peer review sessions whenever a midwife requests it. An internal certification process has been developed.