Trials of Labour: The re-emergence of Midwifery

Andrea Levan is an assistant professor and co-ordinator of the Women’s
Studies Program, Thorneloe College, Laurentian University.

This thorough scholarly review of contemporary debates surrounding the
re-emergence of midwifery in Canada pulls together various aspects of
scholarship and summarizes different viewpoints concerning midwifery.
For example, in Chapter 2 Burtch reviews theories of the state and
discusses how they might help to illuminate the challenge that midwifery
presents to the health-care system. In Chapter 3, he examines historical
and cross-cultural aspects of midwifery practice that contrast with the
current situation in Canada. Particularly useful are his succinct
summaries of landmark court cases involving midwives in Canada. Burtch
tries to be comprehensive and impartial in his approach by carefully
outlining the basis of some rivalries (for example, between community
midwives and nurse-midwives) and by examining the arguments of those
opposed to midwifery. However, it is clear that he supports the concept
of community midwifery. The actions of the state are perceived, by and
large, as inimical to the midwifery project and as protective of
established interests.

Burtch’s original research consists of interviews with practising
midwives and yields useful data on caseloads, fees, and the class,
medical history, and delivery patterns of clients. One problem with this
section is that it appears to conflate community midwifery with home
birth, even though in other sections of the book Burtch does mention the
practice of midwifery within hospitals and alternative birth centres.
Also, his emphasis is heavily on the experience of British Columbia. It
is particularly disappointing that he does not explore the compromises
that have been reached in Ontario and Alberta, both of which have moved
to legalize midwifery. The long and successful struggle of organized
midwives to influence the state in these provinces has particular
relevance to his thesis. Examining the programs they have put in place
would help to illuminate many of the differences in philosophy and
practice that he mentions.

Overall, the book is a very useful source of information on midwifery
debates and practices, though it captures little of the emotional tenor
and passionate commitment that has characterized them.