CECILIA BENOIT's exploratory study of the working lives of midwives in Labrador and Newfoundland, Midwives in Passage (ISER, 164 pages, $24-95 cloth), sketches the history of the profession and connects changes in sites of practice and working conditions to the development of a powerful medical establishment that blocked its legalization.
Benoit interviewed retired traditional midwives, or "grannies," as well as midwives who practised in cottage hospitals and modern teaching hospitals. The rich first-hand accounts of "granny" midwives are a treat to read. They provide a vivid picture of women's reproductive histories and debunk idealized notions of traditional lay midwifery. Independent in only the narrowest sense, the "granny" midwife had little control over a gruelling workload, 24-hour access by clients, helplessness in the face of obstetrical emergencies, and an unreliable and inadequate income.
Nurse-midwives working in large, bureaucratic hospitals described a lack of control in their work comparable to the "granny" midwife. They complained of alienation from patients and an inability to utilize their expertise because physicians, who in general view birth as a medical event, maintain control over pregnancy, labour, and delivery. Only midwives employed in small cottage hospitals enjoyed a measure of control over their work activities. Cottage hospitals, now largely phased out in favour of large, centralized institutions, provided physician support and technical back-up in emergencies but were not large enough to generate bureaucratic or physician control.
Further support for a return to small, midwife-centred maternity units is found in Benoit's examination of published research on the present-day practice of midwifery in Sweden, the Netherlands, the United States, and Canada. Sweden, which has the lowest infant/maternal mortality rate in the world, provides health care to pregnant women in local mothercare clinics where nurse-midwives provide both pre- and post-natal care and perform all normal deliveries. Benoit concludes that only the Swedish system meets the labouring woman's safety and psychosocial needs, and at the same time permits occupational autonomy for the midwife.