Delivering Subjects: Race, Space, and the Emerqence of Legalized Midwivery in Ontario

Canadian Journal of Law and Society

Volumn 15, Issue 2, 2000, Pages 187-215

  Nestel, Sheryl ^a  

^a NONE   (Canada)

Author keywords

[No Author keywords available]

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EID: 85010123837     PISSN: 08293201     EISSN: 19110227     Source Type: Journal    
DOI: 10.1017/S0829320100006414     Document Type: Article

References (109)

1. D. L. Martin, “The Midwives Tale: Old Wisdom and a New Challenge to the Control of Reproduction” (1992) 3:1 Columbia J. of Gender & Law 417 at 417.
2. See especially V. Van Wagner, “Women Organizing for Midwifery in Ontario” (1988) 17:3 Resources for Feminist Research 136.
3. See R. E. Davis Floyd, Birth as an American Rite of Passage (Berkeley: University of California Press, 1992);
4. A. Oakley, The Captured Womb: A History of the Medical Care of Pregnant Women (Oxford: Basil Blackwell, 1984);
5. B. K. Rothman, In Labor: Women and Power in the Birthplace (New York: Norton, 1991)
6. D. Scully, Men Who Control Women's Health: The Miseducation of Obstetrician Gynecologists (New York: Teachers College Press, 1994).
7. Canadian Journal of Law and Society / Revue canadienne droit et société, 2000, Volume 15, no. 2, pp. 187–215.
8. Bill 56, An Act Respecting the Regulation of the Profession of Midwifery, lst Sess., 35th Leg., Ontario, 1991 (assented to 25 November 1991. S.0.1991, c. 31).
9. The term “women of colour” in its various forms is a problematic but indispensable one. While this phrase represents an act of self-definition and resistance to racist terminology by groups which have been subjected to racialized definitions and exclusions, it nonetheless fails to capture the multiple subject positions occupied by these women, eliding axes of difference along which women who share racialized status are positioned. In some senses the term represents the inadequacy of modernist language in representing multiply-constituted identities - what Ali Rattansi has called “a perennial excess of things over words.” A. Rattansi, “Western Racisms, Ethnicities, and Identities in a ‘Postmodern’ Frame” in A. Rattansi & S. Westwood, eds., Racism, Modernity, and Identity on the Western Front (Cambridge: Polity Press, 1994) 56 at 59.
10. For a statistical accounting of “visible minority” residents of Ontario see Statistics Canada 1996 Census Nation Tables online (. Accessed April 22, 1999. On “visible minorities” in the City of Toronto see M. Ornstein, Ethno-racial inequality in the City of Toronto: An Analysis of the 1996 Census (Toronto: Access and Equity Unit, Strategic and Corporate Policy Division, City of Toronto, 2000).
11. P. Essed, Understanding Everyday Racism (Newbury Park, N.J.: Sage, 1991).
12. The use of the term “Third World” continues to demand explication on the parts of those who use it. While acknowledging the assertion of Theo David Goldberg that “Third World” is one of three “conceptual schemata hegemonic in the production of contemporary racialized knowledge that now define and order popular conceptions of people racially conceived” and that of Ella Shohat and Robert Stam that “First World”/ ‘Third World” struggles take place not only between nations but also within them, I will adopt this term here as a provisional one. As Shohat and Stam argue, “Third World” can signal “both the dumb inertia of neo-colonialism and the energising collectivity of radical critique but with the caveat that the term obscures fundamental issues of race, class, gender and culture”. E. Shohat & R. Stam, Unthinking Eurocentrism: Multiculturalism and the Media (London: Routledge, 1994) at 26.
13. D. T. Goldberg Racist Culture: Philosophy and the Politics of Meaning (Oxford: Blackwell, 1993) at 155.
14. Ministry of Citizenship of Ontario, Access!: Report of the Task Force on Access to Professions and Trades in Ontario (Toronto: Ministry of Citizenship, 1989). For a historical perspective on this dynamic see A. Calliste, “Women of ‘Exceptional Merit’: Immigration of Caribbean Nurses to Canada” (1993) 6:1 Can. J. of Women and the Law 85.
15. See especially in the Canadian context A. Bakan and D. Stasiulis, “Making the Match: Domestic Placement Agencies and the Racialization of Women's Household Work” (1995) 20:2 Signs 303.
16. See E. Said, Culture and Imperialism (New York: Alfred A. Knopf, 1993)
17. and A. L. Stoler, Race and the Education of Desire: Foucault's History of Sexuality and the Colonial Order of Things (Durham: Duke University Press, 1995).
18. R. J. Johnston et al., The Dictionary of Human Geography (Oxford: Blackwell, 2000) at 546.
19. A. Burton, Burdens of History: British Feminists, Indian Women and Imperial Culture, 1865–1915 (Chapel Hill: University of North Carolina Press, 1994) at 1.
20. See E. Soja, Thirdspace: Journeys to Los Angeles and Other Real-And-Imagined Places (Cambridge: Blackwell, 1996).
21. See A. Bailey, “Despising an Identity They Taught Me to Claim” in C.J. Cuomo & K.Q. Hall, eds, Whiteness: Feminist Philosophical Reflections (Lanham: Rowan and Littlefield, 1999) 85.
22. S. Nestel, Obstructed Labour: Race and Gender in the Re-emergence of Midwifery in Ontario (Ph.D. Dissertation, Department of Sociology and Equity Studies, Ontario Institute for Studies in Education of the University of Toronto 2000) [unpublished].
23. These interviews were conducted in three urban centres in Ontario between December 1997 and February 1999. The interviews lasted between two and four hours each. They were transcribed and then coded using QSR NUD∗IST software. The interview questions posed probed issues beyond the subjects' experiences of midwifery tourism. However, this topic came under discussion for at least half of the interview session in most cases. B. Pateman, “Computer-aided qualitative data analysis: The value of NUD∗IST and other programs” (1998) 53:3 Nurse Researcher 77.
24. See M. Enkin, et al., eds., A Guide to Effective Care in Pregnancy and Childbirth (New York: Oxford University Press, 1995)
25. and J. Kaczorowski et ai, “A National Survey of Use of Obstetric Procedures and Technologies in Canadian Hospitals: Routine or Based on Existing Evidence” (1998) 25:1 Birth 11.
26. see J. P. Rooks, Midwifery and Childbirth in America (Philadelphia: Temple University Press, 1997) at 8.
27. For a discussion of the early midwifery movement in Ontario, see M. T. Fynes, The Legitimation of Midwifery in Ontario 1960–1987 (Master's Thesis, Graduate Department of Community Health, University of Toronto 1994) [unpublished].
28. While some of the goals of traditional and feminist women's health movements converge, including humane and respectful medical care, appropriate use of medical technology, and informed choice in health care decision-making, their ideological positions on a variety of issues, including access to abortion and women's relationship to the family, differ widely. For critical perspectives on traditional women's health movements see D. Gorham & F. K. Andrews, “The La Leche League: A Feminist Perspective” in K. Arnup, A. Lévesque & R. R. Pierson, eds., Delivering Motherhood (London: Routledge, 1990), and
29. J. D. Ward, La Leche League: At the Crossroads of Medicine, Feminism, and Religion (Chapel Hill: University of North Carolina Press, 2000). On feminist women's health movements in Canada
30. see N. Kleiber & L. Light, Caring for Ourselves: An Alternative Structure for Health Care (Vancouver, B. C.: School of Nursing, University of British Columbia, 1978), and
31. E. Dua, el al., eds., On Women Healthsharing (Toronto: Women's Press, 1994). On the 1960s counterculture's effects on the childbirth reform movement
32. see L. Umansky, Motherhood Reconceived: Feminism and the Legacies of the Sixties (New York: NYU Press, 1996). For an excellent chronology of childbirth reform in the U.S.
33. see M. Shearer, “Maternity Patients' Movements in the United States, 1820–1985” in Enkin, Motherhood Reconceived: Feminism and the Legacies of the Sixties. For an examination of 1970s and early 1980s childbirth reform in Canada
34. see S. Romalis, “Struggle Between Providers and Recipients: The Case of Birth Practices” in V.Oleson & E. Lewin, eds., Women Health and Healing (New York: Tavistock, 1985) 74.
35. While the Canadian Medical Association announced its official position opposing the licensing of midwives in 1987, Ontario physicians did not endorse this stance. They were, however, unequivocally opposed to home birth, a practice which Ontario midwives considered the foundation of alternative childbirth and one which they categorically refused to abandon in the struggle for legalization. See H. A. Davidson, Territoriality Among Health Care Workers: Opinions of Nurses and Doctors Territoriality Among Health Care Workers: Opinions of Nurses and Doctors Towards Midwives (Ed. D. Dissertation, Graduate Department of Education, University of Toronto, 1997) [unpublished].
36. For discussions of racialized images in the campaign to eliminate midwifery in the U.S. at the beginning of the last century see B. Ehrenreich & D. English, For Her Own Good: 125 years of Experts' Advice to Women (New York: Doubleday, 1978) at 96, and
37. R. D. Wertz & D. Wertz, Lying-In: A History of Childbirth in America (New Haven and London: Yale University Press, 1989) at 216.
38. At the turn of the last century both nurses and physicians employed rhetoric which associated midwives with “dirt, ignorance and danger.” See B. Boutilier, “Helpers or Heroines? The National Council of Women, Nursing and ‘Woman's Work’ in late Victorian Canada” in D. Dodd and D. Gorham, eds., Caring and Curing: Historical Perspectives on Women and Healing in Canada (Ottawa: University of Ottawa Press, 1994) 34.
39. As recently as 1995, physicians in Sudbury, Ontario published an advertisement in which they denounced proposed midwife-run birth centres. Utilizing a discursive strategy with unmistakably racist overtones, the ad claimed that “the only model for this is Somalia (no doctors or nurses there anyway).” Northern Life (Spring, 1995) at 5.
40. J. Winkup, Reluctant Redefinition: Medical Dominance and the Representation of Midwifery in the Canadian Medical Association Journal 1967–1997 (Master's Thesis, Department of Sociology and Anthropology, University of Guelph, 1998) [unpublished] at 122.
41. See, for example, E. Shorter, Women's Bodies (New York: Basic Books, 1991).
42. H. Tyson, “Outcomes of 1001 Midwife-Attended Home Births in Toronto, 1983–1988” (1991) 18:1 Birth 14.
43. The practice of midwifery was never proscribed by law during the recent period of its re-emergence in Ontario. Unlike in other provinces where midwives had faced charges of criminal negligence causing bodily harm, in Ontario no midwife had been charged with a criminal act related to the practice of midwifery. The threat of legal action did, nevertheless, overshadow midwifery practice in the form of coroner's inquests. Ontario midwives found themselves testifying in the pre-legislation period in a number of high profile coroner's inquests related to infant deaths at midwife-assisted births. See B. Burch, Trials of Labour: The Re-emergence of Midwifery (Montreal: McGill-Queen's University Press, 1994).
44. Government of Ontario, Report of the Task Force on the Implementation of Midwifery in Ontario by M. Eberts et al., (Toronto: Government of Ontario, 1987).
45. For a discussion of the North American childbirth reform movement's engagement with racist discourses of “Third World” women's bodies see S. Nestel, ‘“Other Mothers: Race and Representation in Natural Childbirth Discourse” (1995) 23: 4 Resources for Feminist Research 5.
46. N. Alarcon, “Anzaldua's Frontera: Inscribing gynetics” in S. Lavie & T. Swedenburg (eds.) Displacement, Diaspora and Geographies of Identity (Durham and London: Duke University Press) at 45.
47. Candidates for the Michener Institute Pre-Registration program, which assessed midwives practising in the province prior to legislation and “grandparented” into practice those whose assessments were deemed adequate, required midwives to have attended 60 births, 30 of which could have taken place outside of Ontario and 20 of which could have been attended in the capacity of observer/assistant. While a short stay in a border clinic would not have yielded the requisite experience for admission to the program since a candidate needed to have provided care for an entire pregnancy in 30 out of 60 births, such a stay could have been helpful in allowing a candidate to fulfill at least some of the pre-requisites. D.M. Schatz, Report on the Admission process, Pre-Registration Program Midwifery (Toronto: The Michener Institute, November 30,1992) at appendix 2.
48. L. Mani, Contentious Traditions: The Debate on Sati in Colonial India (Berkeley: University of California Press, 1998) at 3.
49. For examples of this literature see, M. L. Pratt, Imperial Eyes: Travel Writing and Transculturation. (London: Routledge, 1992)
50. N. Chaudhuri & M. Stroebel, eds., Western Women and Imperialism: Complicity and Resistance (Bloomington: Univ. of Indiana Press, 1992)
51. I. Grewal, Home and Harem: Nation, Gender, Empire and the Cultures of Travel (Durham: Duke Univ. Press, 1996) and
52. V. Ware, Beyond the Pale: White Women, Racism and History (London: Verso, 1992).
53. S. Razack, “Race, Space and Prostitution: The Making of the Bourgeois Subject” (1998) 10 Can. J. of Women & the Law 338.
54. B. Heron, Desire for Development: The Education of White Women as Development Workers (Ph.D Dissertaton, Department of Sociology and Equity Studies in Education of the Ontario Institute for Studies in Education of the University of Toronto, 1999) [unpublished].
55. Desire for Development: The Education of White Women as Development Workers at 186.
56. Desire for Development: The Education of White Women as Development Workers at 189.
57. Some forms of feminist travelling endeavour to work against the reconstitution of imperial subjects. Feminist ethnographers and others have travelled in order to pursue scholarly inquiry which interrupts gendered colonial narratives. The most successful of these attempts assiduously account for the positionality of the researcher and strive for accountability to the subjects of their research. While such projects may ultimately yield a greater benefit to the researcher than to the researched, politically-engaged scholars must continue to struggle to produce representational texts which are grounded in dialogic practices and which pursue accountability. For an example, see L. Peake and D.A. Trotz, Gender, Ethnicity and Place: Women and Identities in Guyana (London: Routledge, 1999).
58. Grewal, Gender, Ethnicity and Place: Women and Identities in Guyana 43 at 2
59. J. Jacobs, Edge of Empire: Postcolonialism and the City (London and New York: Routledge, 1996) at 142.
60. G. Pollock, “Territories of Desire: Reconsiderations of an African Childhood” in George Robertson et al. (eds.), Traveller's Tales: Narratives of Home and Displacement (New York: Routledge, 1994) at 72.
61. C. Kaplan, Questions of Travel: Postmodern Discourses of Displacement (Durham: Duke University Press, 1996) at 35.
62. Quoted in A. McClintock, Imperial Leather: Race, Gender and Sexuality in the Colonial Contest (New York: Routledge, 1995) at 130.
63. See M. Mead, Male and Female: A Study of the Sexes in a Changing World (New York: William Morrow 1967 /1949) and
64. S. Kitzinger, Ourselves as Mothers (London: Doubleday, 1992).
65. B. Jordan, Birth in Four Cultures (Montreal: Eden Press, 1983) at 3.
66. B. Jordan, “Preface to the 4,th edition of Birth in Four Cultures,” quoted in “Introduction: The Anthropology of Birth” in R. E. Davis-Floyd and C. F. Sargent, eds., Childbirth and Authoritative Knowledge: Cross Cultural Perspectives, (Berkeley: University of California Press, 1997) at 1.
67. The film, Birth in the Squatting Position, was produced in 1979 by two Brazilian physicians, Moyses and Claudio Paciornik in their hospital in Curitiba, Brazil. In the summer of 1982 the Paciorniks published an article which elaborated on the film. The article describes how the patients in their clinic follow the example of “our teachers, the Indian women out of the woods”. Moyses and Claudio Paciornik, “Rooming-in: Lessons Learned from the Forest Indians of Brazil” (1982) Birth: Issues in Perinatal Care and Education 16.
68. G. C. Spivak, A Critique of Postcolonial Reason: Toward a History of the Vanishing Present (Cambridge: Harvard University Press, 1999) at 60.
69. G. Anzaludua, Borderlands/La Frontera: The New Mestizo (San Francisco: Spinsters/Aunt Lute, 1987) at 2–3.
70. L. Salzinger, “From High Heels to Swathed Bodies: Gendered Meanings Under Production in Mexico's Export-Processing Industry” (1997) 23:4 Feminist Studies 549 at 569.
71. D. Nathan, “Death Comes to the Maquilas: A Border Story” in R. Kamel & A. Hoffman, eds, The Maquiladora Reader: Cross-border Organizing since NAFTA (Philadelphia: American Friend Service Committee, 1999) at 27.
72. R. Moure-Eraso, et al, “Back to the Future: Sweatshop Conditions on the Mexico/U.S. Border” (1995) 31 Am. J. of Industrial Medicine 587 at 597.
73. For a discussion of gender and global economic formations see S. Mitter, Common Fate, Common Bond: Women in the Global Economy (London: Pluto Press, 1986).
74. Salzinger, Common Bond: Women in the Global Economy at 569.
75. V. S. Mills, Gender and Work in the Maquiladoras of Ciudad Juarez, Mexico (Master's Thesis, Department of Anthropology, McGill University, 1991) [unpublished].
76. For a discussion of border surveillance see M. Kearney, “Borders and Boundaries of State and Self at the End of Empire” (1991) 4:1 J. of Hist. Soc. 52
77. T. C. Brown, “The Fourth Member of NAFTA: The U.S. Mexico Border” (1997) 55 The Annals of the Am. Academy of Pol. and Soc. Sci 105.
78. Academy of Pol. and Soc. Sci, at 108.
79. N. Rodriguez, “The Battle for the Border: Notes on Autonomous Migration, Transnational Communities and the State” (1996) 23: 3 Social Justice 21 at 21.
80. S. Guendelmann & M. Jasis, “Giving Birth Across the Border: The San Diego Tijuana Connection” (1992) 34:4 Social Science and Medicine 419 at 419.
81. See also, H. Ortega, “Crossing the Border for Bargain Medicine: Findings of the Primary Health Care Review in Ambos Nogales” (1991) XXXV Carnegie Quarterly 1.
82. For an account of care in a Catholic maternity centre in Southern Texas see H. Boyer, “Holy Family Birth Services” (1992) 21:2 Midwifery Today 25.
83. Rooks, “Holy Family Birth Services” 24 at 153.
84. Maternidad La Luz Direct-Entry Midwifery Program, mimeo, n.d., postmarked 1997.
85. For one of the few early accounts of a highly influential border midwifery clinic see W. T. McCallum, “The Maternity Center at El Paso” (1979) 6:4 Birth and the Family Journal 259.
86. Rooks, “The Maternity Center at El Paso” 24 at 150.
87. Rooks, “The Maternity Center at El Paso” 24 at 268.
88. “Jamaica Clinical Trip Information Sheet” International School of Midwifery, Miami Beach, Fla. 1997.
89. Ortega, International School of Midwifery, 70 at 2.
90. Maternidad, International School of Midwifery, 73.
91. International School of Midwifery, at 16.
92. See J. Seabrook, Travels in the Skin Trade: Tourism and the Sex Industry (London: Pluto Press, 1996).
93. R. Bishop & L. Robinson, Night Market: Sexual Cultures and the Thai Economic Miracle (New York and London: Routledge, 1998) at 10.
94. Letter from Linda Arnold Milligan, Administrative/Clinical Director of Casa de Nacimiento, El Paso, Texas to prospective interns, n.d. (envelope postmarked 1997).
95. T. T. Minh-Ha, When the Moon Waxes Red: Representation, Gender and Cultural Politics (New York: Routledge, 1991) at 22.
96. Bishop & Robinson, When the Moon Waxes Red: Representation, Gender and Cultural Politics 83 at 126.
97. Van Wagner, When the Moon Waxes Red: Representation, Gender and Cultural Politics 3 at 137.
98. T. DeLauretis, Alice Doesn't: Feminism, Semiotics, Cinema (Bloomington: Indiana University Press, 1984) at 159.
99. H. White, “The Value of Narrativity in the Representation of Reality” in W.J.T. Mitchell, ed., On Narrative (Chicago: University of Chicago Press, 1981).
100. College of Midwives of Ontario, Philosophy of Midwifery Care in Ontario (January, 1994).
101. Maternidad, Philosophy of Midwifery Care in Ontario 73.
102. Casa de Nacimiento, pamphlet for prospective students, El Paso, Texas (postmarked, 1997).
103. B. Curtis and C. Pajaczkowska “ ‘Getting there’: Travel, Time and Narrative” in G Robertson et al., eds., Traveller's Tales: Narratives of Home and Displacement
104. O. Schutte, “Cultural Alterity: Cross-cultural Communication and Feminist Theory in North-South Contexts” (1998) 13:2 Hypatia 53 at 53.
105. C. F. Sargent & G. Bascope, “Ways of Knowing about Birth in Three Cultures” in R. E. Davis-Floyd & C. F. Sargent, eds., Childbirth and Authoritative Knowledge (Berkeley: University of California Press, 1997) 193.
106. B. A. Daviss, From Social Movement to Professional Project: Are We Throwing the Baby Out with the Bathwater? (Master's Thesis, Carleton University, 1999) [unpublished] at 107.
107. B. Goldman, “Home Birth: ‘We did it, all of us’” (1988) 139 Can. Med. Assoc. J. at 773.
108. M. J. Alexander, “Imperial Desire/Sexual Utopias: White Gay Capital and Transnational Tourism” in E. Shohat, ed., Talking Visions: Multicultural Feminism in a Transnational Age (Cambridge: The MIT Press, 1998) 300.
109. I. Grewal, “ ‘Women's Rights as Human Rights’: Feminist Practices, Global Feminism, and Human Rights Regimes in Transnationality” (1999) 3:3 Citizenship Studies 337 at 348.