THE POLITICS OF CHILDBIRTH: THE RE-EMERGENCE OF MIDWIFERY IN ARIZONA*

Interviews with 27 licensed lay midwives in Arizona demonstrate the continuing macroand micro-political struggles over definitions and control of childbirth. Physicians define childbirth as a potentially pathological process requiring active medical intervention. They also continue to regard lay midwives as dangerously unqualified and home birth as unnecessarily risky despite state licensure of midwives who attend home births. On the other hand, midwives define childbirth as a safe, normal process in most cases, and see physician opposition as self-serving and misinformed. They also stress the advantages of their holistic, family-centered care. Although state licensure gives lay midwives some protection from legal risks, physicians' continuing dominance in the health care arena has powerful, adverse consequences for both midwives and their clients. A cornerstone of the feminist health movement is the belief that women must take charge of their own health care if they are to liberate themselves from men's control (Boston Women's Health Book Collective, 1984; Corea, 1985; Ruzek, 1978). The male-dominated medical profession has maintained control over women by defining menstruation, menopause, childbirth, and other female physiological processes as dangerous and pathological - requiring medical treatment. Contrary to this definition, feminists argue that these processes and the wide variation in women's experience of them are normal, while many "routine" medical procedures that physicians use to treat women's health care "problems" either endanger women's health or are simply unnecessary. For example, they view the historical use of medical practices such as ovariotomy and clitoridectomy to treat hysteria, frigidity, and masturbation, as well as recent restrictions on birth control and abortion, and denial or imposition of sterilization, as helping men to maintain their dominance over women (Barker-Benfield, 1976; Corea, 1985; Ehrenreich and English, 1973; Gordon, 1976; Koumjian, 1981). Moreover, they see the current rates of cesarean sections, hysterectomies, and mastectomies -rates which are unnecessarily high (Dicker et al., 1982; Mueller, 1985; Roos, 1984; U.S. Department of Health and Human Services, 1981)- as further evidence that physicians neither understand nor have sympathy for women's health problems, and that they do not exercise sufficient caution in subjecting women to new or radical treatment regimens. Feminists are not alone in their opposition to standard practices of the male-dominated medical profession. Both feminist and non-feminist women are united in their concern over the widespread medicalization and medical control of childbirth. Both groups fear that routinized medical intervention may do more harm than good to women and their babies. Additionally, non-feminists fear that such medicalization and medical control pose a threat to family bonding and the family's control over decision-making. They criticize hospital procedures which isolate women in labor from their families, separate newborns and their mothers, and discourage breast-feeding (see for example, the journals Birth and Mothering). The recent re-emergence of lay midwifery in the United States is one example of how women are attempting to regain control over their own health care by demedicalizing the childbirth process. A number of excellent historical analyses of midwifery exist (e.g., Devitt, 1979a,b;