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Negotiating Public and Professional Interests: A Rhetorical Analysis of the Debate Concerning the Regulation of Midwifery in Ontario, Canada

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Abstract

This article investigates the uneasy process of integrating midwifery’s alternative, women-centered model of childbirth care within the medically-dominated healthcare system in Canada. It analyses the impure processes of rhetorical identification and differentiation that characterized the debate about how to regulate midwifery in Ontario by examining a selection of submissions from diverse health care groups with vested interest in the debate’s outcome. In divergent ways, these groups strategically appeal to the value of the “public interest” in order to advance professional concerns. The study considers the implications of this rhetorical process for re-defining midwifery’s distinctive professional identity in relation to other health professions, to the state, and to the women for whom midwives care. Likewise, it suggests the relevance of rhetorical analysis for understanding the discursive formation and re-formation of health models, values, and professions in Western culture.

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Notes

  1. Relevant scholarship in this area includes Martin, The Woman in the Body; several key articles by Davis-Floyd, including “The Technocratic Body: American Childbirth as Cultural Expression,” “The Technocratic Body and the Organic Body,” and “The Technocratic Model of Birth”; Duden, Disembodying Women; Rothman, Recreating Motherhood; Oakley, The Captured Womb; and Stabile, “Shooting the Mother.”

  2. See, for example, Marland et al., “Midwives, Society, and Childbirth”; Barrington, Midwifery is Catching; Schroff, The New Midwifery; Bourgeault et al., Reconceiving Midwifery; and Lay, The Rhetoric of Midwifery.

  3. For discussion of the U.S. context of midwifery regulation, see Devries, Making Midwives Legal; Weitz and Sullivan, “Licensed Lay-midwives and the Medical Model of Childbirth”; Lay, “The Law and Traditional Midwifery”; and Bourgeault and Fynes, “Integrating Lay and Nurse-Midwifery into the U.S. and Canadian Health Care Systems.”

  4. See Schroff, The New Midwifery; Bourgeault, “Delivering Midwifery”; and James, “Regulation: Changing the Face of Midwifery?”

  5. Wagner, “Why Legislation?: The Regulation of Midwifery,” 73.

  6. See Burke, A Rhetoric of Motives.

  7. Burke, A Rhetoric of Motives, 19.

  8. See Perelman and Olbrects-Tyteca, The New Rhetoric; Witz, Professions and Patriarchy; two articles by Coburn, “State Authority, Medical Dominance, and Trends” and “Professionalization and Proletarianization”; Coburn et al., “Decline vs. Retention of Medical Power through Restratification”; Bourgeault, “Delivering Midwifery”; Bourgeault and Fynes, “Integrating Lay and Nurse-Midwifery”; and Suschnigg, “False Labour?”

  9. Burke, A Rhetoric of Motives, 20–21.

  10. Ontario Health Professions Legislation Review, Striking a New Balance, 16–17.

  11. Bourgeault and Fynes, “Delivering Midwifery in Ontario,” 229. This situation contrasts with Lay’s findings in her rhetorical analysis of Minnesota’s public hearings during the early 1990s concerning the licensing of lay midwifes. According to Lay in The Rhetoric of Midwifery, the ultimate failure of these hearings to produce licensing rules acceptable to all parties was due, at least in part, to the dominant role played by the medical professions in shaping the terms of the discussion (169).

  12. Bertilisson, “The Welfare State,” 115.

  13. Coburn, “State Authority, Medical Dominance, and Trends,” 135–137.

  14. Burke, A Rhetoric of Motives, 118.

  15. Ontario Health Professions Legislation Review, 2.

  16. Fynes, “The Legitimation of Midwifery in Ontario,” 76, 122.

  17. Ibid., 75.

  18. Although the majority of practicing midwives at the time supported state regulation and the AOM’s efforts to achieve this, a significant minority of lay midwives “expressed serious misgivings about becoming integrated into the mainstream health care system, wishing instead to remain an underground, alternative movement.” Bourgeault and Fynes, “Delivering Midwifery in Ontario,” 235.

  19. Ibid., 234.

  20. Fynes, 114.

  21. See, for example, Mason, “The Trouble with Licensing Midwives”; Spoel and James, “The Textual Standardization of Midwives’ Professional Relationships.”

  22. Bourgeault, “Delivering Midwifery,” 106.

  23. Fynes, 93-95. Although the name of this organization implies that its members were all consumers, the MTFO was open to “anyone who supported midwifery.” Suschnigg, 11.

  24. See Bourgeault and Fynes, “Delivering Midwifery in Ontario,” 252–253.

  25. Bourgeault, “Delivering Midwifery,”105.

  26. Perelman and Olbrechts-Tyteca, 74–76.

  27. Ibid., 77.

  28. Ibid., 85–89, 93–94.

  29. Burke, Language as Symbolic Action, 50.

  30. Perelman and Olbrechts-Tyteca, 116–117.

  31. Association of Ontario Midwives (AOM), Creating the Midwifery Profession in Ontario, 2.

  32. Perelman and Olbrechts-Tyteca, 362–368.

  33. Midwifery Task Force of Ontario (MTFO), A Brief Presented to the Task Force, 1.

  34. See Lay, The Rhetoric of Midwifery and Spoel and James.

  35. MTFO, 1.

  36. Ibid., 4–5.

  37. Ibid., i.

  38. Even though the OMA was (and is) the official professional body for all physicians in Ontario, its views did not represent the positions of all physicians concerning midwifery.

  39. Ontario Medical Association (OMA), Letter from John Krauser to Mary Eberts (1986).

  40. Perelman and Olbrechts-Tyteca, 97, 93, 98.

  41. Ontario Medical Association, Letter from John Krauser to Mary Eberts (1987).

  42. Coburn, Rappolt, and Bourgeault, 18.

  43. College of Family Physicians of Cananda (CFPC), 7. At the time, the number of family physicians providing obstetrical care was decreasing dramatically for a variety of reasons including lack of financial motivation, lifestyle concerns, and pressure from obstetricians.

  44. Ibid.

  45. Ibid., 6.

  46. Perelman and Obrechts-Tyteca, 415–420.

  47. Registered Nurses Association of Ontario (RNAO), 3.

  48. For more on healthcare consumerism, see Henderson and Petersen, Consuming Health and Spoel, “Midwifery, Consumerism, and the Ethics of Informed Choice.”

  49. Ontario Nurses’ Association (ONA), Submission to the Task Force, 1.

  50. Midwifery Task Force of Ontario, 8.

  51. Ibid., 10.

  52. Association of Ontario Midwives, 7.

  53. Perelman and Olbrechts-Tyteca, 97, 93.

  54. See, for example, Bourgeault, “Delivering Midwifery”; Bourgeault and Fynes, “Delivering Midwifery in Ontario”; and Suschnigg.

  55. Witz, 46,47.

  56. Ibid., 48.

  57. Ibid., 47.

  58. Perelman and Olbrechts-Tyteca, 234–235.

  59. Coburn, “Professionalization and Proletarianization,” 154.

  60. James, 183, 196.

  61. Burke, A Rhetoric of Motives, 26.

  62. Ibid.

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Authors and Affiliations

  1. Department of English, Laurentian University, Sudbury, Ontario, P3E 2C6, Canada

    Philippa Spoel

  2. Midwifery Education Program, Laurentian University, Sudbury, Ontario, P3E 2C6, Canada

    Susan James

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  1. Philippa Spoel
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  2. Susan James
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Correspondence to Philippa Spoel.

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This research has been made possible with support from the Social Sciences and Humanities Research Council of Canada.

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Spoel, P., James, S. Negotiating Public and Professional Interests: A Rhetorical Analysis of the Debate Concerning the Regulation of Midwifery in Ontario, Canada. J Med Humanit 27, 167–186 (2006). https://doi.org/10.1007/s10912-006-9016-7

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