Rich, personal stories shed light on midwives at the frontier of women's reproductive rights.
Midwives in the United States live and work in a complex regulatory environment that is a direct result of state and medical intervention into women's reproductive capacity. In Birthing a Movement, Renée Ann Cramer draws on over a decade of ethnographic and archival research to examine the interactions of law, politics, and activism surrounding midwifery care.
Framed by gripping narratives from midwives across the country, she parses out the often-paradoxical priorities with which they must engage-seeking formal professionalization, advocating for reproductive justice, and resisting state-centered approaches. Currently, professional midwives are legal and regulated in their practice in 32 states and illegal in eight, where their practice could bring felony convictions and penalties that include imprisonment. In the remaining ten states, Certified Professional Midwives (CPMs) are unregulated, but nominally legal. By studying states where CPMs have differing legal statuses, Cramer makes the case that midwives and their clients engage in various forms of mobilization-at times simultaneous, and at times inconsistent-to facilitate access to care, autonomy in childbirth, and the articulation of women's authority in reproduction. This book brings together literatures not frequently in conversation with one another, on regulation, mobilization, health policy, and gender, offering a multifaceted view of the experiences and politics of American midwifery, and promising rich insights to a wide array of scholars, activists, healthcare professionals alike.
Contents and AbstractsIntroduction: Knowing About Legality and Illegality in Midwifery Care in the United States chapter abstract
The introduction tells the story of Gina, a midwife working illegally at the time of our interview. Using Gina's story as a frame of reference, the introduction explains the varying legal status for midwives in the United States and distinguishes certified professional midwives from other professionals who attend labor and delivery. The introduction also provides the theoretical and scholarly context for the rest of the book, focusing on legal pluralism, legal consciousness, legal mobilization, and the limits of law as it is implemented. Finally, the introduction explains my methodology in both researching and presenting the data and argues that we need to tell stories about law and society that are embodied, integrative, and holistic-much like the care provided by midwives to their clients.
1History and Status of Midwives in the United States chapter abstract
Chapter 1 begins with a story from Missouri after Ophelia, a certified professional midwife, attends a birth that brings her to the attention of the police. The chapter asks how we got to a place where a safe, qualified, trained birth attendant can fear prosecution for a good-outcome birth. The history of midwifery in the United States is one that combines medicalization and professionalization of birth, imperatives of nation-building through reproduction, and a renaissance in care that brought the profession of non-nurse midwifery back from the brink of extinction. Chapter 1 provides a version of that history, stressing that this version is the one told by advocates and midwives as they seek to expand access to care.
2Modern and Professional: Legitimating, Marketing, and Reimagining Midwives chapter abstract
Chapter 2 demonstrates that, in the name of professionalization, midwives have engaged in seeking legitimization of non-nurse midwifery via national organizations,
3Mostly Happy Accidents: Successfully Mobilizing for Legal Status chapter abstract
Chapter 3 explores the multiple ways that midwives and advocates use politics to mobilize for legal status. Focusing on the success stories in South Dakota and Missouri, it highlights how the long-term activism in both states, combined with "happy accidents" or contingencies, facilitated the passage of legalization bills. Midwives and advocates use traditional and social media, letter-writing to legislators, and consistent presence in the statehouse to get their bills passed. They also engage in novel attention-seeking activities like making quilts and calendars, designing T-shirts, and handing out M&M cookies (for "moms and midwives").
4Rights, Rules, and Regulation chapter abstract
This chapter begins with the unusual story of how lawyers needed to defend the constitutionality of the Missouri bill against claims by the Missouri Medical Association, as a way to frame the examination the legal mobilization undertaken on behalf of midwives nationwide. This mobilization includes criminal defense of their practice and lawsuits brought on behalf of victims of obstetric violence. It also includes seeking regulatory governance in rulemaking, defining the scope of practice for midwives, and articulating access to the state as a goal for the movement.
5Catching Babies and Catching Hell: Constitutive Interactions in the Limits and Shadow of the Law chapter abstract
Chapter 5 examines the various ways that midwives experience their daily practices and finds that, even in states where they are legal and regulated, the law limits and shadows how CPMs work. This limiting of the law is related to cultural disapprobation of out-of-hospital birth and the ways that that disapprobation is reinforced by friends, family, and hospital staff. Chapter 5 shares the stories of midwives who find constraints on their practice from the expressions of these norms and details the difficulties they have finding insurance, finding back-up physicians, and even knowing what the law is. It also shares stories of midwives and mothers who "catch hell" when they discuss their out-of-hospital birth plans or must transfer a client to the hospital for emergency care.
6Deep Transformations, Deep Contradictions: Changing Birth Culture One Movie, One Picnic, One<3.>Tiny Little Epistemological Shift at a Time chapter abstract
This chapter examines the multiple ways that midwives and advocates seek to change birth culture in any given locale, from hosting movies and picnics to thinking through the proper role of hospital and state in labor and delivery. It moves from eco-feminist midwifery advocacy in Berkeley, California, to emergency childbirth classes in rural South Dakota, highlighting the ways that locale shapes approaches to thinking about midwifery care. Chapter 6 also focuses on the contradictions and tensions within the pro-midwifery movement-around issues like abortion, vaccination and homeschooling, rights-seeking, partisan politics, and the decision to seek government intervention and approval at all. The goal in all of these conversations is to facilitate expanded access to midwifery care and the extension of reproductive justice to all who labor and deliver.
Conclusion: Attending to Birth in Sociolegal Scholarship: Embodied, Interdisciplinary, and Authoritative Knowledge chapter abstract
The conclusion offers closing thoughts on the relationship between disciplinarity and regulation-seeing both as simultaneously emancipatory and constraining. The conclusion examines the tensions within midwifery communities, and within sociolegal scholarship, and argues that sitting with those tensions in an embodied, interdisciplinary, authoritative epistemology is the way to do good work in both settings.