Lay, Mary M. The Rhetoric of Midwifery: Gender, Knowledge, and Power. New Brunswick: Rutgers UP, 2000. Print.
This book is an extended rhetorical analysis of a set of hearings about licensing practices for direct-entry midwives (midwives who enter the profession without a background in medicine) in Minnesota that took place in the 1990s. Looking to the history of midwifery in the state, legal language surrounding midwifery, medical discourses of birth and pregnancy, testimonies given by midwives during the hearings, and communications between midwives, Lay highlights the various rhetorical strategies midwives use to assert their professional authority and knowledge of women’s bodies in the face of powerful medical discourses. Her analysis also explores the ways in which legal language has left Minnesota direct-entry midwives in a legal gray space and the ways in which these midwives attempt to negotiate this uncertain legal status.Theoretically grounded in corporeal feminism as it is articulated by Elizabeth Grosz, Susan Bordo, and Donna Haraway, as well as in Foucault’s discussion of bio-power, Lay’s analysis is primarily concerned with the way direct-entry midwives articulate an understanding of women’s embodied knowledge within discursive spaces that value scientific knowledge. Lay’s analysis, then, not only poses important epistemological questions but also important questions about power and agency.
Her rhetorical analysis of the hearings is arranged chronologically, focusing first on the public hearings and then on two later sets of hearings dedicated to the collaborative writing (of midwives and medical professionals) of licensing standards. In this rhetorical analysis, Lay focuses primarily on the rhetorical moves midwives made to increase their status as professionals but also on the ways in which the genre of licensing standards works to reinforce the professional jurisdiction of medical professionals over scientific knowledge of the body in ways that silence other practitioners like midwives or that negate the legitimacy of their practices. In her conclusion to the book, Lay argues that we need to understand the Minnesota midwifery debates as a gendered power struggle in which the knowledge claims of women, specifically those knowledge claims that emerge from experience as women and/or of caring for other women, have to fight for legitimacy against masculine medical discourses granted power and authority by the state and by much of public opinion.
“Whoever gets to define the body–and what makes it safe and normal–claims a great deal of authority and power to determine standards of practice among medical and alternative caregivers.” (23)
- “The Current Debate Over Direct-Entry Midwifery in the United States”: An introduction to the Minnesota debates and key players in the debate.
- “Rhetorical Analysis and the Midwifery Debates”: Describes the theoretical foundation of her analysis, as well as her methodology.
- “The Rhetorical History of Midwifery”: To provide some historical context for the MN debates, Lay provides a rhetorical history of four different moments, starting in the 17th c, when authoritative knowledge over birth was claimed or debated. Lay argues that throughout these different historical moments, as well as during the MN debates, one of the issues that continues to surface is that the professionalization of midwifery increases the status of practitioners, but decreases their autonomy as they come under increased medical oversight. Likewise, the professionalization of obstetrics (and the maintenance of its professional boundaries) requires a serious challenge to the expertise and authority of midwives.
- “The Minnesota Midwifery Study Advisory Group: Professional Jurisdictions and Boundary Spanning”: This chapter is focused on the first public hearing in the debate, and focuses specifically on the statements offered by two members of the MN midwives guild, as well as the statement offered by one medical rhetor. Lay argues that the guild rhetors worked to increase their professional status through boundary spanning (showing common knowledge, common practice, and cooperation with medical professionals), but that boundary spanning is also boundary work that reinforces high-risk pregnancy as the domain of medicine and separates guild midwives from “bad” or “less professional” midwives who do not follow the guild guidelines.
- “Licensing Rules and Regulations: Normalizing the Practice of Midwifery”: This chapter focuses on the first collaborative writing sessions of the rules and regulations for licensing direct-entry midwives. Lay argues that despite the guild rhetors success in raising their status, different knowledge systems came into conflict during the writing of the licensing guidelines, particularly because the licensing genre privileges the incumbent authority (medicine), forcing midwives to use its language and honor its hierarchy. The midwives resisted these genre conventions because they threatened their autonomy and because the discourse of licensing could not adequately capture the spirit of their practice.
- “Jurisdictional Boundaries: Claiming Authority over Scientific Discourse and Knowledge”: This chapter is focused on the second stage of the hearings, during which some of the midwives tried to give up attending the births of breeches and twins in order to be able to use certain drugs and medical interventions. This attempt at bartering deepened the split in the midwife community when other women weren’t willing to sacrifice attending breeches and twins because they felt is was an assault on their scientific knowledge and professional expertise. At the same time, this attempt at bartering for access to drugs and medical interventions was perceived as a direct challenge to the boundaries of medicine, which prompted greater medical backlash and effectively shut the licensing process down.
- “Issues of Gender and Power: The Rhetoric of Direct-Entry Midwifery”: Emphasizes the midwifery debates as a gendered power struggle and summarizes several other take-away points from her analysis about midwifery and women’s knowledge claims.