The Rhetoric of Midwifery: Gender, Knowledge, and Power (review)

The Rhetoric of Midwifery: Gender, Knowledge, and Power . By Mary M. Lay. New Brunswick, N.J.: Rutgers University Press, 2000; pp. x + 239. $24.00.

A book on midwifery is not apt to attract the attention of communication educators. Yet in Mary M. Lay's capable hands, this seemingly benign topic serves as a conduit for how rhetoric functions in society to create a presumed knowledge, to shape attitudes, and to sustain embedded power differences within a particular culture.

Using the 1991-95 Minnesota Department of Health and Board of Medical Practices public hearings on the status of direct-entry (nonacademically trained) midwives as the basis for an in-depth case study, Lay's rhetorical examination uncovers the arguments used to support or subvert this longstanding practice. Additionally, the author provides an overview of a 300-year legacy of midwifery to demonstrate how concerns related to the profession have persisted over time. Four basic questions undergird her study: (1) What are the similarities and differences between the medical community and the home birth community and how were these views articulated publicly during the hearings? (2) What rhetorical strategies were employed by direct-entry midwives to legitimate their knowledge about birth and to gain professional status? (3) How did the medical community use the genre of licensing rules to maintain control over the birthing process and to negate competing knowledge systems proffered by midwives? and (4) What types of communities were created by midwives on the Internet and what did these communities reveal about women's experiential knowledge and their sense of home birth?

Although midwives and health-care practitioners are ostensibly united by their concern for the health of mothers and their newborns, festering beneath the surface are issues that serve to disempower direct-entry midwives. The major issues Lay examines are: Who defines appropriate knowledge of safe-birthing practices? Does such knowledge inhere solely through formal (institutional) learning (the view of the medical and nursing field) or can it be obtained, as well, experientially via at-home apprenticeships (the view of the direct-entry midwives)? A related issue concerns how (and who) has the power to define a "normal" birth versus one that is deemed medically problematic and requires external intervention. Power is the crux of Lay's analysis, for it is through the testimony of midwife practitioners and their Internet conversations that their struggle to obtain legitimate and legal status as a profession (as well as to determine whether such recognition is desirable) is revealed.

Her work provides a fascinating account made all the more powerful by the women's voices on both sides of the issue that pervade the book. Here is one example that exemplifies the perceived tension between the medical field's and the midwife's perspectives on pregnancy and childbirth:

Moreover, the very language that medical health care providers used seemed to the midwives on the listserv to denigrate their practices and have differing effects on their clients. For example, Ida cautioned another midwife that the words doctors used had linguistic capital:

"You said words communications etc cannot disempower anyone—they do it themselves (women disempower themselves). I can't go along with that. At all. Words are powerful and can wound, stop, wither—or they can nourish, open, soothe. Witness any labor. See the difference in a newly pregnant Mom who's told about her pelvis, 'I don't know, you're kind of small there, but we'll see.' Versus 'Wow, great bones—made for babies, feels wonderful.'" Witness, "Shut up and stop screaming" versus "Let it out, let it be low in your throat, you're so strong." Witness "Mother and baby" versus "Maternal-fetal unit" (listserv communication, August 30, 1996). (116)

This example typifies the integration of analysis and vibrant passages that recur throughout the book. The scholarly integrity of the work is evidenced by Lay's ability to draw from an impressive breadth of field, although Foucault's...