Thank you,
Erin Schartner
The
Rhetoric and Ideology of Canadian Midwifery
Presentation
By Erin
M. Schartner
Slide
One:
In my
research paper The Rhetoric and Ideology
of Canadian Midwifery I ask the question, “How has the rhetorical discourse
surrounding the genres of midwifery helped to shape the current status of
midwifery, and what does the current discourse of midwifery reveal about what
can be expected of both its status in the near and distant future?” With this
question in mind I apply rhetorical theory to the discourse pertaining to
midwifery both historically and presently in order to see how the current
discourse is providing information on what to expect the future of midwifery to
look like. I am convinced that it is worth discussing the rhetoric that
is included in the discourse of Canadian midwifery as a means of presenting its
ideologies to society. In addition I realize that it is imperative to take a
look at the rhetorical discourse surrounding different genres in order to
reveal the ideology of the historical periods themselves and how these
ideologies influenced the perception of midwifery during these times.
Slide
Two:
For instance, on this
slide we have two pictures that were found in the genre form of newspapers.
These pictures were printed in the mid 1900’s and have a clear rhetorical
agenda. The
first picture depicts an old woman, who is a foreigner without education. The second
picture depicts a woman who is quite large and rough looking. The background is
dark and there are shady figures in the background suggesting that a midwife is
also a shady figure and someone to be feared.
However, compare this to a video clip broadcasted last year in 2011.
RHETORICAL HISTORY
2011: A PART OF OUR HERITAGE MOMENT
This is a
dramatization of the heroic midwife who, against the odds, is dedicated to
attending women in birth.
Even at quick glance this image clearly
supports and encourages midwifery.
Slide Four:
A comparison between
the written rhetoric is also very indicative of the ideology of the times. The
commentary on the first image states:
“A typical Italian
midwife practicing in one of our cities. They bring with them filthy customs
and practices.”
Whereas the commentary
at the end of the dramatization states:
“Well into the century
many of us were born where we lived, and the only professional hand guiding our
arrival into the world was theirs’ – the midwife.”
Slide Five:
Slide Six:
Yet, in the short clip, Midwives aren’t depicted as
foreign invaders, but rather are part of “our heritage” where many of “us” were
born and where “we” lived, and “our” arrival into the world was also into the
community in which midwives were major participants.
Also, rather
than a “filthy’ practice, midwives were the only “professional” hands “guiding”
our arrival.
Through the
rhetoric used in these examples, we can see that the perceptions and beliefs of
society vary depending on the rhetoric presented through the information that
is accessible; therefore, we can also see how society’s ideologies and thus
their actions are shaped by these encounters.
In my
paper, it was through using genres, such as these, in a combination of others
that I hoped to discover rhetorically what it was and is about Canadian
midwifery that would give me an indication of what I could expect it to look
like in the upcoming decades. Yet, however much I have learnt through this paper,
the research remains incomplete because as Miller describes it genre is a form
of social action, and as an action it generates change; therefore, as the
discourse surrounding Canadian Midwifery continues to engage in different genres,
the genres cannot help but influence and change the ideologies and thus the
practices of midwifery here within Canada.
It was with the understanding that it is the act of
engaging within discourse that helps to construct and reconstruct ideologies
within society, which in turn influence social action, and thus the different
genres used within the discourse, that I was particularly interested in gaining
an insight to current discourse surrounding midwifery. I was particularly
interested in obtaining a snapshot of the public discourse as well as the input
from a recognized as a member within the Canadian midwifery community. Thus,
from the start I proposed to use two specific genres in order to gain these
insights of verbal discourse. The first genre I used was in the form of a
student demographics survey. The second form of genre I used was a qualitative
interview conducted with a midwife who was currently practicing within the
Lower Mainland of BC. I used these two genre forms for two reasons. First, the
student demographics survey allowed an insight into what the public discourse
is actually saying and what knowledge about midwifery it actually contains.
From here I was able to ascertain what influence midwifery actually has within
the ideology of society. Second, the interview gave me a perception of the
position that midwifery plays within Canadian society, the ideologies that
midwifery itself adheres to, and an idea of what direction the interviewee
perceives the ideology, and therefore the practices of midwifery, following.
Canadian statistics state the 8% of women here in Canada
utilize their right to the access of midwifery care for their maternity care.
In BC this percentage is slightly higher at 10%. The reason for which I
conducted both the survey and the interview was to gain an insight as to why
this number is so low, especially since in BC midwifery care is an option that
is fully funded. I was curious to see if this percentage was due to a lack of
knowledge about midwifery as a vocation in general, or about the actual type of
care midwifery offers? Or, in complete contrast, if the rhetoric of science had
specifically dictated a medicalized maternity care through the ideology
represented in their discourse? In addition to the question of why, is the question of what? By this I mean what is society’s
perception and opinion towards midwifery, or what Freadman describes as their
“uptake” on midwifery, which is based on the information that has been
presented. In essence, the opinion, or uptake, determines the choices they
choose and the action they take, which reflects, while also shaping, the
ideology that society adheres to.
For this reason, the student demographics survey was
helpful in that it acted as a gauge in the uptake of midwifery within society.
Through the various genres of information the surveyors had access to, such as
conversation, education, media, pamphlets, doctor-patient interviews, or even
this survey they were participating in, each surveyor has an opportunity to
gain information, to analyze, to accept and or reject the information.
Regardless, the perception they formed on midwifery was based on their uptake,
or what they retained through these genre sources. As a result, based on their
uptake, these surveyors have indicated the social action they will take when,
or if, they choose midwifery care. Whatever their choice may be, one thing is
for sure: their choices, and in regards to the survey, their answers, indicate
the current in which the ideology of society is following.
A reason for conducting a student demographics survey is
that this particular population is a gauge for the immediate future as they,
the ones who strive for knowledge, are the ones most likely to take action to
either change the current ideology or to maintain it. However, although they
are more likely to represent the leaders of social action in the near future,
there is a gap as they also represent the “privileged to be educated”. In The Rhetoric and Ideology of Canadian Midwifery
I explore the fact that education has historically been a major contributor to
the ideology of society, and thus has played a significant role in determining
the social action – especially in regards to midwifery in Canada. In the past,
it was the access to education that helped form a strong belief in science, and
thus the medical system, and the near destruction of midwifery throughout
Canada. In fact, those without or with limited access to education, oddly
enough were denied medical care and forced to continue with the type of
maternity or midwifery care their community provided. This is particularly true
for the native population who were most affected and denied access to both
education and medical care. And, as it would turn out, they are still the most
vulnerable population within Canada as many native communities are faced with
challenges, such as rural setting, that prohibit full access to education and
care. Ironically, midwifery care is now more accessible to those who are
educated in their options of maternity care; so, those who are denied, or have
limited access due to lack of information, education, or rural setting, are
more likely to have limited choices, and therefore are far more likely to have
medicalized maternity care.
Slide
Seven:
Although
the student demographics represent a narrow view of society, it is often the
educated that start implementing a change in ideology, while it is the rest of
society that takes the new ideology and puts it into action. Thus, it is
beneficial to take a look at the student demographics in order to get a sense
of what direction they are leading the current ideology. The results of the survey
that I conducted were quite interesting. (Refer to slide for results). To
begin with, most of the surveyors seemed to at least be familiar with the term
midwife, yet very few seemed to actually know exactly the type of care that
midwives do offer. However, although half of the surveyors originally noted
that they’d prefer an obstetrician, when asked, “if given more information
would by more open to the use of midwifery?” as we can see over three-quarters
indicated that yes they would.
Slide
Eight:
The midwife interviewee made mention of some
basic benefits that a woman could expect.
(Refer
to slide for quote). To begin with midwifery is holistic in both its nature and
in the care it offers. As a result, midwifery is dedicated to optimal and high
quality care that is primarily focused on the best possible outcomes, with the
least interventions, for a healthy mother and baby, and this is true right from
the beginning of prenatal care, at the onset of labour, throughout the birth,
and up to six weeks postpartum. As a result, from the beginning there is
continuity of care which fosters a relationship of trust and openness between
the woman and her midwife. This in turn, as the midwife interviewee states,
results in mothers having less to deal with as they are assured that they can
rely on their midwife throughout the entire process. And, because they have
someone to rely on they are more relaxed, which means they are less
traumatized. As a result, women are more likely to be satisfied with the
process as a whole, and her satisfaction, in turn affects her family’s well
being. Therefore, if over three-quarters of those surveyed stated they’d be
more willing to choose midwifery care if
they had more knowledge, this raises the question of where are they getting
their information? And, of the information they do have access to, what does it
contain? In order to answer these questions, I realized that I first had to
understand the rhetorical history of Canadian midwifery in order to understand
the current ideology that surrounds it.
Slide
Nine:
Throughout The Rhetoric and Ideology of Canadian Midwifery I begin by
analyzing different theories of rhetoric and genres that particularly pertain
to midwifery. Then I looked at how these theories were used throughout the
history of Canadian midwifery discourse in order to shape the ideologies that
society adhered to, and how this resulted in social action. (Refer to slide for
timeline). Unfortunately,
through the use of terminology, or “terministics” as Burke has coined it,
society was educated and persuaded in the merits of medicalization and the
dangers of midwifery. As a result, the ideology of society came to fear
midwifery seeing it as old and backwards, a vocation and practice to be feared.
Thus, society quickly accepted the ideology of science and turned to
medicalized care. However, while science used terministics within their genres
of medicalization to define and uphold their mores and protect against their
taboos, what science unintentionally did was become so exclusive that in its
genres of medicalization they actually alienated the very women they were
trying to protect. As a result, the women in society began to look for alternative
means of care in which they were respected. It is with this history that the
discourse of midwifery began to reemerge and take hold of its own kairotic
moments in the late 1960’s-70’s. As we can see in the slide there is a much
more relaxed, peaceful and confident depiction of a birth. Thus, the uptake
from this discourse really began to shape the ideology of Canadian midwifery
within society in the 1980’s. Which brings us to the rhetoric currently being
used in relation to midwifery, here we see words such as: relationship,
pregnancy, wellbeing, breastfeeding, professional, amazing, special, able,
wonderful, labour, baby, mother, life, listening, trust, understanding,
inspiration, reassuring, confidence and family.
Slide
Ten:
Yet,
now in 2012, we can still see the rhetorical power that the discourse of
medicalization still maintains as only 10% of BC women use midwifery care.
However, as the survey suggests, more than three-quarters of those surveyed are
receptive to learning more. In
addition, this survey reveals that within society the discourse of midwifery is
prevalent as 88% of those surveyed knew about midwifery (and therefore had
engaged in the conversational genre of discourse about midwifery), and of this
over ½ indicated their source of info being from family and friends – not from
the professional or even educational genres of discourse.
This
indicates a gap within the information that is available, and therefore it is worth
investigating. For example, midwifery both saves money while promoting the
health of society. Thus, as it benefits financially, socially and economically
to society, the question must be raised, why isn’t midwifery being more
thoroughly promoted by BC Health? (Refer to slide for survey results). Why in
collaboration with the medical professions is BC Health reaching less than a
quarter of the student demographics and why aren’t they educating the public
about midwifery? In fact, of the 8, 5 sourced BC Health, while only 3 source
their doctors. Interestingly enough, besides family and friends, education was
the next biggest source of information covering just over a quarter of those surveyed
(and 5 of them gained their information from this survey). Thus, as already
indicated, education is a major factor in changing society’s perceptions and
ideologies, and therefore a major factor in contributing to choices and social
action. With that in mind, the discourse of Canadian midwifery continues to
grow and is becoming prevalent within the conversation of society.
Slide
Eleven:
What The Rhetoric and Ideology of Canadian
Midwifery has helped to reveal is that by learning from its past and using
rhetorical discourse, not only has Canadian Midwifery been able to firmly
establish itself as a growing ideology within society, but by educating the
public it will continue to grow, to form, and be reformed in order to meet the
needs of society. However, it is through educating the public that this growth
will occur. Thus, I will end this presentation with a quote from the midwife
interviewee and a few thoughts that I conclude The Rhetoric and Ideology of Canadian Midwifery with, “I would love
to see information that states what are the benefits
and how can it affect community, a
different type of information.”
Slide
Twelve:
In
fact, this paper I am here to present, as a form of discourse genre, is itself
a source of information helping to direct the course of action while shaping
how the genres of midwifery will look like in the near future. Like Bourgeault
and Benoit comment about Reconceiving
Midwifery, if nothing else, this paper “has shown reader [and me] that
midwifery is in fact alive and well in this country, and there is promise of further
growth in the years to come” (308).
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