The politics of representation: Doing and writing "Interested" research on midwifery.

Mackintosh, Margaret ; Bourgeault, Ivy Lynn

In this paper, we explore the personal, political and methodological issues raised by doing and writing social science research on the newly regulated profession of midwifery in Ontario. We focus on two key issues: first, the problem of constructing an account out of divergent and conflicting stories and second, the potentially paradoxical effects of raising awareness of important social and cultural phenomena through scholarship. The question of how we might represent other women, in this case midwives and midwives' clients, without betraying their political interests is critical in both issues.

A travers cet article, nous examinons les questions personnelles, politiques et methodologiques issues des recherches en sciences sociales sur la profession nouvellement regulee de la sage-femmerie en Ontario. Deux questions principales nous preoccupent, soit le probleme do la construction d'un recit partir d'histoires divergentes et contradictoires, et les effets potentiellement paradoxaux de la sensibilisation d'importants phenomenes socio-culturels. Lie a ces questions est le probleme crucial suivant : savoir comment representer les autres femmes, soit les sages-femmes et leurs clientes, sans pour cela trahir tours interets politiques.

Introduction

Feminist theory and methodology in the social sciences has long encouraged "interested" or advocacy positions vis-a-vis our subjects of study (Stanley and Wise, 1990; Harding, 1987). Indeed, one of the main projects of feminist ethnography in the last several decades has been to challenge ethnographic authority based on the premises of objectivity and distance. Such relations are argued to produce and reproduce a kind of colonial encounter between the ethnographer and his/her anthropological other/subject (Visweswaran, 1994). The move in feminist social science has been towards developing collaborative relationships in the field, and also towards openly situating ourselves personally and politically with the individuals and the communities with whom we work (Maguire, 1987).

While being an interested researcher/advocate is in many ways advantageous at the time of doing qualitative research, it is not always the case. Indeed, the idealized egalitarian relations that some feminists envision between themselves and their research participants are often elusive and sometimes illusory (Visweswaran, 1994). Moreover, the practice of feminist ethnography gives rise to several serious methodological and ethical questions. The implications of such a methodology have only begun to be explored in the social science literature. Judith Stacey, in her essay, "Can There Be a Feminist Ethnography?" (1991), suggests that feminist ethnography or interested research may have paradoxical effects. The potential closeness between the researcher and research participants, she argues, may be even more exploitative than traditional forms of social science research that assume and maintain social distance and hierarchical power relations:

Precisely because ethnographic research depends upon human relationships, engagement and attachment, it places research subjects at grave risk of manipulation and betrayal by the ethnographer. (Stacey, 1991, p.113)

Barry Thome's (1979) description of her experiences as a political activist and participant observer in the draft resistance movement of the 1960s is illuminating in this regard. She describes how her role as researcher became a retreat, limiting her involvement, particularly her risk-taking. Ultimately, she experienced a conflict between being a committed political participant and an observing sociologist which culminated in a sense of having betrayed the movement through the use of the knowledge she produced. Thorne's work points to the problematic process not only of doing interested research, but also of writing it up, when, in the end, it is the researchers' interpretation that is privileged over those of. the research participants. Anthropologist Aihwa Ong poses the critical question of how we might, as feminist social scientists, represent other women without betraying their personal and political interests (1995, p. 353). (1)

In this paper we explore the politics of representation in feminist social science through reflections on the personal, political and methodological issues raised by doing and writing "interested" research on midwifery in Ontario. (2) We begin our exploration with a brief history of the relationship between social science and midwifery as a social movement as it developed in the 1970s and 1980s. This discussion helps to situate our own descriptions and reflections on doing and writing midwifery research. We argue that while being an interested social scientist holds some clear advantages at the time of doing qualitative research, it also presents a number of methodological and theoretical problems. The politics of representation become particularly significant when it comes to writing up our research. In this regard, we focus on two key issues: first, the difficulties of constructing an account out of divergent and sometimes conflicting stories and second, the potentially paradoxical effects of raising the v isibility of important social and cultural phenomena.

The Re-emergence of Midwifery and the Role of Feminist Social Science

In two decades, midwifery has gone from being a structurally marginal social movement to a fully-integrated and publicly-funded health profession in Ontario. The new midwifery in Canada (as in the rest of North America) grew out of sweeping social changes in the 1960s and 1970s. Women were increasingly dissatisfied with the medical and institutional management of birth; some were seeking more "natural," family-centred, and fulfilling birth experiences (Barrington, 1985). Spiritual values and "family values" (in both conservative and non-conservative strains) were also important to midwifery ideology (Rushing, 1993). One of the main goals of midwifery as a social movement was to de-medicalize and de-institutionalize childbirth, and ultimately place control of the process back into the hands of the woman giving birth (Barrington, 1985; Kay et al., 1988; Sullivan and Weitz, 1988; Peterson, 1983; Rushing, 1993). The development of community midwifery sparked the interest of social scientists, particularly those w ith a feminist perspective. For some feminist scholars, midwifery came to be seen as a symbol of women controlling the reproductive process (Arms, 1975; Corea, 1977; O'Brien, 1981; Rothman, 1982), as "subtle feminism" (Rushing, 1993) and as "feminist praxis" (Rothman, 1989). The fate of midwives, particularly vis-a-vis the predominantly male medical profession, also came to typify the broader struggle of the women's movement (Ehrenreich and English, 1973). Canadian feminist activist and social scientist, Mary O'Brien, for example, asserted:

Midwifery is integral to the women's movement. Its revival is a triumphant affirmation of women's tight to choose (as cited in Barrington, 1984, p. 7).

Arguably, the positive analyses of midwifery written by feminist social scientists helped propel midwifery along as a social movement. One of the earliest and most important works was the pamphlet written by feminist sociologists Barbara Enrenreich and Deirdre English, Witches, Nurses and Midwives (1973) which sought to reinterpret the healing roles of women throughout history in a positive light. Historians, too, have worked to expose the "wrongs" of history against midwifery and to raise awareness of this important profession which until recently had been "missing" from the history of maternity care and from historical accounts of women's lives (Biggs, 1983). Anthropologists, meanwhile, have supplied ethnographic portraits of midwifery and childbirth practices in non-western places. This cross-cultural perspective on midwifery and childbirth figured usefully in the critique of biomedical birth in the west, and helped feminist scholars, popular writers and childbirth activists envision alternatives to the b iomedical management of birth (Jordan, 1978; Laderman, 1983; Romalis, 1982). (3) Social scientists in general have argued for the validity of midwifery as a socially, culturally and clinically significant practice, and have supported its legal and political recognition in Canada and the United States through activism, writing and teaching. Thus, the relationship between feminist social science research and midwifery has been a symbiotic one.

Midwives in Ontario began to organize themselves around the goal of integration into the health care system in the early 1980s (Bourgeault and Fynes, 1996/7). Midwives who wanted to pursue regulation and public funding did so for a number of reasons: many were tired of being marginal and poorly remunerated for their work; others were tired of being seen as radicals; and many were committed to greater access to midwifery care that legitimacy and public funding would provide (Van Wagner, 1988). Several key events in the 1980s served to further midwifery's move towards seeking professional status and also solidified broad-based feminist support for this goal. (4) First, two high profile inquests into infant deaths after midwife-attended home births in the 1980s recommended that midwifery be regulated and integrated into the provincial health care system. It was also at this time that the College of Physicians and Surgeons of Ontario issued a statement strongly discouraging physicians from attending home births (CPSO, 1982, p. 2). (5) Another significant event in the move towards midwifery integration was the establishment of the Health Professions Legislation Review (HPLR) by the provincial government m late 1982 which invited proposals for establishing midwifery within the formal health care system. (6)

The decision to seek integration, however, was contested, and divisions within the midwifery community intensified as the process gained momentum. On the one hand, legal recognition of "lay" midwifery by the province would validate midwifery philosophy as well as the clinical skills and experience midwives had worked so hard to acquire outside the system. On the other hand, legal recognition would mean a process of exclusion: legitimation within the system for some, and loss of status and livelihood for others. (7) As the prospect of regulation grew closer, matters of training, experience, and scope of practice, which had been more flexible and varied by region and community, became more contentious. Furthermore, state regulation of training and practice seemed, to some midwives and birthing women, antithetical to midwifery's anti-authoritarian roots. Betty-Anne Daviss distinguishes between midwifery as a social movement which only much later broadened its concerns to include the goal of midwifery as a health profession (1999). The promise of legislation, however, has also been suggested by some midwives as one of the key reasons that midwifery as a social movement gained such momentum in the 1980s at all.

In 1994 midwifery was legalized in the province of Ontario and became a self-regulating and publicly funded health profession. (8) It was widely bailed by midwives, midwifery consumers and supporters as a victory for women's choice in maternity care in Canada. Arguably, it also had much to do with the relative preoccupation of the medical and nursing professions in other political issues, as well as significant support for midwifery as a women's issue and as a potential cost-saving strategy by the provincial Liberal and NDP governments (Bourgeault & Fynes, 1996/7). The transition from a social movement to a health profession was not necessarily an easy one. In the years following integration a relatively small number of newly registered midwives were grappling with the huge demands of setting up a new profession and a new midwifery education program. Furthermore, the established educational and health care institutions were not always welcoming, and sometimes openly hostile. Uncertainty and conflict were sig nificant features of midwifery during this time. Overall a sense of vulnerability vis-a-vis the state and its institutions permeated the community. (9)

Midwifery's relatively rapid movement from the margins to the mainstream gave rise to a number of critical debates with regard to training, clinical practice, and funding within midwifery. In the years leading up to and surrounding midwifery integration in Ontario, the efforts of scholars, midwives, and interested individuals and groups to represent midwifery -- to say what it is, and equally important, to say what it stands for -- have intensified. What gets spoken and recorded about midwifery is increasingly critical and contested compared to earlier accounts. And the relationship between the midwifery community and social science has never been more fraught. For these reasons this discussion is both timely and important. How this climate of uncertainty, internal contest and sense of vulnerability influenced the doing and writing our respective research is the topic to which we now turn.

Doing Interested Research on Midwifery

We began studying midwifery in Ontario for our doctoral dissertations in the mid-1990s. at the time when midwifery was in its busiest transition phase. In this section, we begin with Bourgeault's reflections on doing sociological research on the process of midwifery professionalization, and follow with MacDonald's account of doing anthropological research on cultural conceptions of the body in midwifery discourse. (10)

Bourgeault: Doing Research On Midwifery Integration

I began my research following the midwife-attended birth of my daughter in 1990. Being a midwifery consumer meant that I was identified as an "interested" observer within the midwifery community from the outset. My position was made even more explicit when in 1992, I became politically involved in the broader midwifery movement by becoming a board member of a committee lobbying the provincial government to establish a free-standing birth centre in Toronto. As I defined my thesis topic, my position within the midwifery community became even more complex. In collaboration with my thesis committee, I decided to examine the professionalization of midwifery; that is, how midwifery had changed through its integration into the formal health care system. While my participation in the midwifery community was instrumental in the conceptualization of my thesis research, my choice of thesis topic altered my role as a participant in the midwifery community. My immersion in the midwifery movement in Ontario helped contextu alize the social and political issues that were directly related to my thesis research. Through my participatory work, I developed important research contacts which proved useful in securing interviews with the overwhelming majority of key informants I contacted for my thesis (i.e., midwives, midwifery consumers and supporters, and midwifery policy-makers). In addition, because of my involvement with the birth centre committee, I had relatively unrestricted access to documents and archival material which were key sources of data for my thesis.

At the same time, however, I quickly came to realize that having "professionalization" as the focus of my research recast my relationship to the midwifery movement. I was now not just potentially doing research for the midwifery movement as other feminist social scientists had done, but about it. Professionalization was a particularly sensitive issue for midwifery, given its anti-authoritarian roots. As a result, my continuing participatory work may have indeed been construed, in part, as a kind of undercover work. This became particularly salient when another member of the birth centre committee expressed the view that talking to me was like "talking to the press." The more involved I became in my research the more removed I became from the midwifery community, as my observer role came to supersede my role as a participant in the community. By the time I started to conduct the key informant interviews in 1994 and 1995, I felt very much like the academic outsider, or "the press."

MacDonald: Doing Research On Cultural Conceptions Of The Body

I conducted ethnographic research with midwives and their clients in Ontario over an extended period in 1996 and 1997. As a feminist scholar, with a long history of personal, political and academic engagement in issues of women's health, and women's reproductive health in particular, I saw in community midwifery an exciting affirmation of women's social and political will. Though I had not been involved directly in the midwifery movement, I was supportive of its philosophical and political goals, including seeking professional status. As a medical anthropologist, I saw in midwifery a compelling site of cultural analysis. I wanted to explore the ways in which midwives and birthing women conceived of and enacted pregnancy and birth as metaphors for broader cultural processes occurring in contemporary Canadian society (MacDonald, 1999). My methods consisted of participant observation at midwifery clinics across the province, and also formal in-depth interviews with practicing midwives and with women who had had midwifery care.

Though I was not, for the most part, explicit about my political opinions, the women with whom I worked generally assumed that I was supportive of midwifery. Rapport was relatively easy to build in this community. Midwifery clients received me warmly into their homes, and spoke to me openly and enthusiastically about their pregnancy and birth experiences with midwifery care. And many midwives, though weary with the demands of their new careers, welcomed me into their clinics and homes to talk about midwifery. However, this was not uniformly the case. In fact I was carefully screened by several midwives on the basis of my specific interests as a researcher. What did I want to know? What would I say or write about midwifery? And to whom? Not far into my research, my growing awareness of the controversial issues within midwifery found me prefacing my requests for meetings and interviews with statements like: "My research is not about the process of professionalization." Nevertheless, I vividly recall one exchan ge with a midwife in which I was told that if I was interested in showing how regulation destroyed the dream of an independent midwifery in Ontario then she would not speak to me.

Reflections On Doing Interested Research

The politics of representation, already apparent in the process of choosing and refining study questions about midwifery in Ontario, continued to be significant during the participant observation and formal interviews that comprised our data collection. Our positions as "interested" researchers not only helped to develop rapport with our community informants, our "interestedness" made us sympathetic audiences for the data that we were collecting. Midwives, and the women they care for are, of necessity, sophisticated political strategists, frequently engaged in the politics of representation -- be it a carefully written rebuttal in the national newspaper, or the way a woman explains her choice of midwifery care and home birth to skeptical family members, co-workers and friends. On many occasions during the data collection phase it was our informants who directed encounters, conversations, and formal interviews. The midwifery clients MacDonald interviewed gave long glowing reports about the caring, knowledgeabl e, and tireless midwives who attended them. Midwives often used our interviews to air their views on controversial issues or incidents and to tell us what they thought we should know about midwifery. It is important to note that in the case of both our research projects the power relationship between ourselves and our research participants was not clearly nor consistently hierarchical. As our experiences illustrate, ethnographic subjects exercise power too; they refuse, deny, omit, redirect, insist, opine. In other words, our informants are active "cultural producers" (Ong, 1995). In this sense, we both experienced our research projects as collaborative. For Bourgeault, the views of key informants were integral to the telling of the "story" of the integration process -- particularly what had happened "behind closed doors" and what was never formally documented. MacDonald enjoyed intellectual collaboration with many informants who were interested in engaging in theoretical discussions central to her studies. T he vast majority of her informants, from the most experienced and politically active midwife to the birthing woman using midwifery services for the first time, had given midwifery a lot of thought. Many of our midwife informants were themselves pursuing graduate degrees and seeking academic credentials while continuing to practise and do political work. In sum, the experience of being an "interested" researcher was largely positive and supportive in the doing phase of our research, and yet foreshadowed some of the challenges we would encounter in the writing phase.

Writing Interested Research an Midwifery

One of the fears and frustrations expressed by a number midwives in the course of our respective studies has been that they have been, and will be again, "misrepresented" in social science research; that "their" story is not being written by "them." Negative analyses of midwifery that persist in the media (11) as well as the on-going debates about the safety and appropriateness of midwifery and home birth in the medical literature (12) are perhaps familiar, if vexing, to the midwifery community. Critical social scientific analyses that appear in the academic literature, however, are perhaps more troubling (Benoit, 1987; Bourgeault, 1996; Mason, 1990; Nestel 1996/97, MacDonald 1999). Two assumptions underlying this fear are worth addressing here: first, that the legitimacy of social scientists who are not midwives conducting research on midwifery; and second, that there is only one real story of midwifery in Ontario to be told. Despite openly taking positions as midwifery supporters, we have both have been rem inded at times throughout the research process of our outsider status -- a position of limited understanding and legitimacy. Yet, as scholars, we do hold power and responsibility in the form of textual representation (see Schatzman and Strauss, 1973).

One of the main problems we experienced in writing up our respective research was dealing with conflicts or tensions between our various informants' accounts (i.e., between midwives and between midwives and clients). This was particularly the case around controversial issues, or what Jo Anne Myers-Ciecko (13) calls the "shadow stories" of regulating independent or community midwifery (1997, personal communication). In Ontario, and elsewhere, regulation and integration brought some inevitable and unwelcome changes to midwives used to practising outside the system, and to women who had previously chosen midwifery precisely because they did not want to participate in the health care system. Among these shadow stories of midwifery legislation in Ontario are the stories of midwives who were not included in the pre-registration program and lost their livelihoods the instant midwifery was regulated; long time rural midwives who, without sufficient numbers of births per year to qualify, ceased to practise, leaving m any rural women without midwives in their communities; radical midwives who resisted adopting what they considered "medical model" practices and consequently bore the disciplinary power of the new system; and many foreign-trained nurse midwives working within the health care system as obstetrical nurses felt they were left out and discriminated against in the process.

In doing research on midwifery in Ontario, both the shadow stories and success stories surface quickly and with passion. Not everyone in the midwifery community was for the integration of midwifery within the system in Ontario, nor did everyone feel they benefitted as a result. Midwifery in Ontario, in many ways, thrived in a state of marginality; many midwives and birthing women wish it had never been regulated. The story of the integration of midwifery in Ontario is multi-layered--both the stories of success and the stories of loss are remarkable and compelling. The challenge for us as interested social scientists was how to interrogate and represent some of the stories and critical debates -- including the shadow stories -- while still supporting the political agenda of midwifery.

Bourgeault: Writing About Midwifery Integration

In my thesis on midwifery professionalization, I sought to resolve the dilemma of what and how much to write about midwifery, first by adhering to a strict theoretical focus on professionalization, and second by defining my audience. Having a focus on professionalization meant that I explored the controversies and shadow stories of regulating midwifery that were pertinent to my thesis. These included dissent within the midwifery community regarding the content and process of making key decisions around organizational objectives, regulation and practice standards, and educational qualifications exemplary of the exclusionary social closure strategies that are part and parcel of professionalization projects (Witz, 1992). Nevertheless, I feared that foregrounding the shadow stories in great detail at that particular point in time would not only have detracted from the focus of my thesis, but would also have reinforced some of the more negative outsider views of the midwifery community. Refining the focus of my th esis may have resolved some dilemmas of which stories to focus on, but the challenge of the many and varied audiences to which my thesis would be addressed remained.

I considered one of my major audiences for my thesis to be my informants and the broader midwifery community in Ontario. Acknowledging this influenced my writing. Being part of the midwifery community and realizing how small it was, I was particularly attentive to the issue of confidentiality. I dealt with this concern by forwarding to each of the informants their quotes I had used in the text of my thesis. Although for the most part informants either approved the quotes used or made minor editorial changes to them, some informants asked that their quotes not be attributed to them (i.e., that they remain anonymous). Another informant asked me to omit some key quotes around the funding of midwifery because she felt her words could be used to the detriment of the profession. She felt this to be particularly critical given the then newly elected provincial Conservative government's penchant for cuffing "waste" in health care.

This informant's concerns made even more significant for me the possible political ramifications of what I was writing, not just within the midwifery movement, but also within the broader health care community. These concerns were made even more apparent when the funding for the Toronto Birth Centre I had been lobbying for was abruptly cut by the Conservative government in 1995. At this juncture, the possibility that midwifery might also lose its funding felt very real. Being a "connected critic" (Walzer, 1987, p. 39), I did not wish my words to be used as justification for the discontinuation of funding for midwifery services. Once my thesis was "out there," I realized that I would have little control over its use. This resulted in a more cautious mind set which had a strong impact on the subsequent revisions of my thesis. I found that I was less critical of the midwifery integration process (particularly around the issue of funding) than I might have been had I not been a participant in the movement. In th is sense, I was practising a form of "self-censorship" (Adler and Adler, 1989) because I was both interested and a part of the community I was researching.

Knowing that another key audience for my thesis was my examining committee, I felt justified in my decision to limit myself to the data that were most relevant to my professionalization thesis. While this decision had emerged, in part, through a consideration for the political goals of midwifery, it had the effect of limiting the breadth of my examination of the integration of midwifery. Limiting my analysis of the process and outcome of the integration of midwifery for one audience (the midwifery community) had significant consequences, however, for the reception that my thesis received from my other audience -- the examining committee at my defence. Although my thesis passed with minor revisions, some of my examiners thought that I focussed on the positive aspects of the midwifery integration process, glossing over some of the "shadow" stories and, overall, not being as critical as I could have been perhaps because of my community involvement. The midwifery community was split in terms of their reaction to my thesis but for different reasons. My thesis was seen as being informative because of the detailed descriptive content; however, some felt I was too critical in my conclusions.

MacDonald: Writing About Cultural Conceptions Of The Body

When it came to the writing stage of my thesis, my initial instinct with regard to the known controversies around the professionalization of midwifery was to steer clear. The subject had evoked strong reactions in some of my study participants and I was also aware of the mixed reception of recent sociological critiques of midwifery in Ontario -- including Bourgeault's -- by the midwifery "audience." Initially I believed that my thesis question was relatively uncontentious. My anthropological focus, however, did not bracket out the debates around training, funding, and scope of practice that were brought to bear on midwifery by its new context within the health care and education systems. Nor did my specific interest in cultural conceptions of the pregnant and birthing body bracket out embedded and emerging differences within the midwifery community, a situation which was exacerbated by an increasingly diverse midwifery clientele. My cultural focus proved to be, after all, inseparable from the politics of midw ifery in Ontario in the 1990s. In fact, I found that many of the shadow stories and political debates within midwifery were played out at the level of clinical knowledge and practice, and also at the level of women's embodied experiences of pregnancy and birth. Specifically, in my thesis I explored differences between midwives, and between some midwives and some birthing women with regard to what is considered appropriate use of medical technology during pregnancy and birth. Some feel that integration within the system has brought too much medical technology to impinge upon "the natural process of birth" -- a situation which they feel threatens the very essence of midwifery. (14) The potential problem lies in that I did not frame the changing relationship of midwifery to medical technology -- specifically what I observed and heard recounted as a trend towards increased use and acceptance of medical technology -- as a cautionary tale. (15) Rather, I suggest that midwifery is making room for technology, the mea ning of natural birth is being redefined by the pragmatic -- but not necessarily apolitical -- choices of midwives and birthing women to include some medical technology. (16) My analysis is underpinned by theory in the "anthropology of the body" which assumes the cultural constructedness of the body; that is, the relationship between social and political context and what we construe and experience as natural about our bodies. (17) The debates about the changing meaning of natural birth that I explored in my thesis mirror broader debates about the changing meaning of midwifery itself, and even more specifically, the validity of the professionalization project and the existence of the shadow stories.

Though my thesis committee was quite satisfied with my description and analysis, I was nevertheless concerned that part of my midwifery audience might feel betrayed by my critique of natural birth given its symbolic importance to midwifery as a social movement. Additionally, I wondered if my discussion on diversity within midwifery rather than unity would be seen to threaten midwifery's strategic representations of itself as a strong and unified movement underpinned by a set of clear ideals and practices? The resolution of these dilemmas emerged in how I chose to theorize the midwifery ideal of natural birth. Specifically, I teased out the symbolic power of the concept of natural birth from any claims of its existence "in reality," and yet argued for its value and validity as an organizing cultural and political symbol. At the same time I was committed to bringing some of the new stories of midwifery in the post-legislation era to light for both scholarly and political reasons that we elaborate below.

Reflections of Writing: Midwifery and the Politics of Representation

In conclusion, our experiences of writing interested qualitative research on midwifery may have initially been influenced by our unique approaches to the topic of midwifery -- Bourgeault was researching and writing about midwifery through the use of the sociological concept of professionalization and MacDonald was researching and writing about cultural conceptions of the body, an anthropological concept, through midwifery. Our relative involvement within the "researched" community also affected our work somewhat differently . We nevertheless experienced similar dilemmas in terms of the legitimacy of our positions as academic outsiders, (yet ones interested in the aims of the midwifery movement) and the problem of constructing our accounts out of divergent and conflicting stories and then presenting them to audiences with different agendas.

Another key issue that arises from our analyses is the responsibility that the "interested" researcher has for increasing the visibility of certain issues -- whether they are deemed to be positive or negative for the "researched" community. One of the main thrusts of feminist social science research on midwifery and childbirth has been to make women -- as both birthers and attendants -- visible. Anthropologists studying pregnancy and birth in nonwestern settings, for example, have often sought to validate traditional or indigenous birth attendants through revealing the cultural and clinical logic of their beliefs and practices (Jordan, 1978; MacCormack, 1982; Laderman, 1983; McClain, 1989; Sargent, 1989). Anthropologists studying pregnancy and birth in western settings have also endeavoured to combat the invisibility of women in biomedical birthing systems by recounting the embodied experiences of pregnant and birthing women (Davis-Floyd, 1992; Klassen, 1996) and the knowledge of attending women (Fraser, 1988; Davis-Floyd, 1996). An important part of the task of feminist social science has been to tell women's stories; stories that serve as counterpoints to heg emonic stories about pregnancy, birth and birth attendance in the medicalized West; stories of a female-dominated profession that does not begin or end in subordination. Indeed the knowledge that these stories would be written was often the explicit reason women gave for participating in our studies. Thus bringing new stories to light is both a scholarly endeavour and a political act, central to the project of challenging and resisting the normative order of reproduction (in the case of MacDonald's work), and of women's work (in the case of Bourgeault's work). Bringing new stories to light about midwifery, pregnancy and childbirth in Ontario is one way, to paraphrase Sandra Harding, that we as social scientists can work "to change its condition...to win over, defeat, or neutralize those forces arrayed against its emancipation" (Harding, 1987, p.8)

At the same time feminist ethnographers have been concerned with issues of responsibility and accountability to the groups and individuals they study and tell stories about, as well as with the social and political consequences of their work (Stacey, 1991). By writing about midwifery in Ontario at what must still be considered a vulnerable time it is possible that our descriptions and interpretation of midwifery in Ontario might, while making midwifery visible, also make it vulnerable. Midwifery in Ontario continues to be watched closely by both supporters and detractors in other provinces -- including those in positions of power and influence. The controversial allowance for choice of birth place including home birth is particularly vulnerable to scrutiny and attack. A recent article appearing in the Journal of the Society of Obstetricians and Gynaecologists of Canada by a Nova Scotian Obstetrician/Gynaecologist James Goodwin (1997) attacks home birth as a "dangerous, inappropriate and irrelevant" part of m idwifery. He writes, he says, in hope that the Atlantic provinces might be spared such "critical error" and recommends that home birth be disallowed. This is only the most public illustration of the vulnerability of midwifery as a social movement/emerging profession committed to choices in childbirth for women. Midwives, while giving of their time in the interests of the goal of visibility for their profession and their feminist social project are painfully aware of this. Social scientists writing about midwifery at this time must also attend to such concerns.

Another concern with regard to the paradox of visibility has to do with birthing women themselves. Jutta Mason, a long time midwifery supporter and critic of professionalization in Ontario warned, in her essay "The Trouble with Licensing Midwives" (1990), that professional midwifery will increase visibility of pregnant and birthing women, and that this is a double-edge sword. She predicts that midwives will be used to survey women in their own homes, on behalf of the state, and that as a result, women's choices in childbirth -- one of the central goals behind the midwifery movement -- will be eroded. In light of such public scrutiny and internal concerns, social scientists must ask themselves: Will social science accounts contribute negatively or positively to the visibility/surveillance of midwives and birthing women? Might social science descriptions and interpretations of home birth, for example, be misused as evidence of "dangerous, inappropriate, and unnecessary" behaviour on the part of birthing women and midwives, as Goodwin charges?

At the heart of social science accounts and critiques of midwifery in Ontario lie differences among midwives, and their community of clients, supporters, and chroniclers about what is good for midwifery -- including what is good for birthing women in Ontario. While many of these differences appear in the tension between midwifery's shadow stories and its remarkable achievements, ultimately both political and scholarly debates about midwifery are contests over the meaning of midwifery itself. In our view, they are contests of meaning that cannot be divorced from political strategy. While we as researchers are concerned not to contribute to the erasure of particular stories from the official accounts of midwifery in Ontario, we must also be concerned to balance critical exegesis with political strategy. Strategy includes timing. To lay bare certain stories and controversies in such a form that could be used to discredit the vulnerable enterprise of midwifery in Ontario at this time would represent a betrayal o f our respective informants' trust in us as listeners, interpreters, and supporters of midwifery, and betray, too, our respective intentions in telling some of these stories.

Midwifery will continue to attract the attention of feminist scholars of different theoretical and methodological perspectives. Will any one of these accounts ultimately constitute the real story of midwifery? On the contrary, just as midwifery in Ontario changes and grows with the pressures of its participants and regulators, so will the personal, political and analytical concerns of social scientists who study it. We have argued here for an understanding of the complex but important task of conducting interested research on midwifery in Ontario at such a critical time. We have also argued that knowledge of both positive and negative consequences of making midwifery politics and practices more visible is critical for the "interested" researcher. The hazards of feminist research methods and the inevitability of the politics of representation demand our ongoing and vigilant attention (Stacey, 1991). Nevertheless, we conclude that the feminist research ideals of interest, closeness and collaboration still hold the greatest promise in our efforts to construct good scholarly accounts -- however partial and incomplete -- of important social and cultural phenomena.

Acknowledgements

Margaret MacDonald would like to acknowledge the financial support of the Social Sciences and Humanities Research Council of Canada through a doctoral fellowship. Ivy Bourgeault would like to acknowledge the financial support of the National Health Research and Development Program of Health Canada and the Social Sciences and Humanities Research Council of Canada through doctoral and postdoctoral fellowships. Both authors would like to thank Cecilia Benoit, Robbie Davis-Floyd, and Pamela Klassen as well as the anonymous reviewers for offering many insightful comments on earlier drafts of this paper.

Ivy Bourgeault is an Assistant Professor of Sociology and Health Sciences at the University of Western Ontario in London, Ont. She is currently doing research on the impact of gender and geography on the rationalization of the division of labour in health care, and has been active in the midwifery and alternative childcare movements for the past decade.

Margaret MacDonald is a medical anthropologist specializing in gender and health, with specific research intersts in midwifery in Canada. She is a Postdoctoral Fellow in the Department of Anthropology at the University of Toronto and lectures in the Department of Anthropology at York University.

Notes

(1.) Ong's question arises out of her concern about unequal relations of power between herself as a researcher and the migrant Chinese women with whom she works (1995).

(2.) The experience of finding oneself sharing a political agenda with one's research participants, or of advocating on their behalf in various public forums, is not unique to feminist research. "Advocacy anthropology" constitutes a specific theoretical and methodological approach to research in anthropology (see Harries-Jones, 1991 and Schensul, 1998).

(3.) The nostalgic tendency to portray non-western birth as natural in binary contrast with highly technological western birth in some of this literature, and especially in the popular works which draw on anthropological accounts, is problematic. See, for example, Arms (1975). For a critique of this tendency, see Nestel (1995). And yet by drawing on such images, midwifery successfully counters the construction and performance of the female body as inherently problematic (MacDonald, 1999).

(4.) The push for legislation was buoyed by organizations of committed and politically astute consumer supporters and advocates.

(5.) Consequently, midwives across the province who had previously practised with co-operative physicians were forced to continue alone.

(6.) See Bourgeault (1996) and Bourgeault and Fynes (1996/97) for a detailed account of this process.

(7.) See Nestel (1996/97) for a discussion of "radicalized exclusions" in the professionalization of midwifery in Ontario.

(8.) Since that time, midwifery legislation has been introduced or is pending in several other provinces, including BC in 1998, (with public funding), Alberta in 1998 (without public funding), and Manitoba in 2000 (with public funding).

(9.) For example, in 1995 the newly elected Harris Conservatives promptly cancelled funding for freestanding birth centres in Toronto and St. Jacob's, a rural community in Southwestern Ontario, that were both on the verge of opening.

(10.) The doing and writing of our research on midwifery was not as separate in reality as it seems in this paper. We use this distinction as a heuristic device to tease apart the key controversial issues within and between our two projects.

(11.) Articles and editorials about midwifery periodically appear in local and national newspapers that explicitly call into question the safety of midwifery care -- especially home birth -- and decry the choice of midwife attended home birth as selfish, foolish, and dangerous. See, for example, Mitchell (1991) who describes the argument for home birth as "anti-women" and "anti-child."

(12.) See, for example, Goodwin (1997)

(13.) Myers-Cieko is the Director of the Seattle School of Midwifery. She was speaking about a similar process of exclusion which took place in the political process that led to legal recognition for midwives in the state of Washington.

(14.) What constitutes a natural birth is a question around which midwifery has organized some of its central clinical and political goals. With this concept midwives, their clients, supporters, and chroniclers have distinguished midwifery knowledge and practice from male control and the medical model. Yet the nostalgic desire for birth as a natural event that takes place in the home, though strategic, is problematic, especially given the development of feminist and anthropological theory beyond such essentialisms -- even strategic essentialisms (Spivak, 1993).

(15.) It is important to stress that midwives still use considerably fewer pharmaceutical and technological interventions than do other maternity care providers in the province.

(16.) See Lock and Kaufert (1998) for an elaboration and examples of this concept of "pragmatism" in women's health choices.

(17.) For works in the anthropology of the body, see Lock and Scheper-Hughes (1990), Martin (1987, 1994) and Yanagisako and Delaney (1994).

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