Challenging Medicine: Law, Resistance, and the Cultural Politics of Childbirth

Whereas most sociolegal studies concerned with hegemony and resistance focus on the resistances of ordinary citizens in everyday life, this article focuses on the development of a particular social movement-the alternative birth movement-and analyzes the process by which this movement emerged and has achieved significant legislative victories. The analysis makes several contributions to the literatures on hegemony, resistance, and the law. First, by demonstrating the importance of medicine's assertion of its authority for the expansion and mobilization of the alternative birth movement, we show that the mobilization of the law by a dominant group may trigger the emergence of social movements seeking to resist hegemonic understandings and arrangements. At the same time, by examining how birth activists' organizational resources developed over time and were rendered meaningful in legislative debates, our study demonstrates the importance of avoiding dichotomous conceptions of structure and culture. In addition, by analyzing culture as a process of meaning-making rather than an independent and hierarchical set of values, the analysis shows how cultural and legal hegemony-even that of modern medicine - may be destabilized, even as it sets the terms of the effort to destabilize it and shapes the nature of the hegemony that will replace it. Much recent sociolegal scholarship focuses on hegemony and resistance to it. In this scholarship, hegemony is broadly understood as power that maintains and naturalizes existing social structures; resistance refers to actions that lay bare the historical and constructed nature of these social arrangements and the inequalities they generate and sustain (see especially Lazarus-Black & Hirsch 1994). This literature has generated many important insights regarding law as a source of both hegemony and resistance; yet, as McCann and March (1997) have argued, most such studies focus on everyday acts of resistance or the resistance of ordinary citizens in administrative settings such as courtrooms and welfare offices. As a result, the role of social movements as sources of resistance and sociolegal change is less well-understood. Furthermore, because individual acts of resistance are arguably less likely to have long-lasting or institutional effects, social actors' capacity to challenge hegemonic understandings, alter power relations, and effect sociolegal change may be underestimated. This article analyzes the development and recent legal victories of a particular social movement-the alternative birth movement-in order to explore this possibility. Part I, "Getting Organized: Law and the Emergence of the Alternative Birth Movement," draws on interview, archival, and secondary data sources to analyze the conditions under which members of alternative birthing communities have become part of an alternative birth movement. This analysis shows that the capacity of a dominant group (i.e., organized medicine) to mobilize the law on its behalf was the impetus for the emergence of a social movement that now endeavors to undermine medicine's cultural and professional authority over childbirth. In particular, the threat of legal harassment has stimulated the expansion and organization of alternative birthing communities; the establishment of local, regional, and national ties between these groups; and, later, the emergence of national and international organizations dedicated to the protection of birthing alternatives and midwifery. This analysis thus demonstrates that the assertion of power through law may trigger resistance to the social and legal hegemony upon which that power rests. Over time, birth activists' resistance to medical hegemony has centered on the need to secure midwifery licensure, and some of these efforts have resulted in the passage of relatively favorable midwifery statutes. These victories are surprising, for several reasons. First, the alternative birth movement does not enjoy the institutional or financial resources of its medical opponents, and midwives lack the formal educational and professional qualifications touted by medical practitioners. …