The Making of Informed Choice in Midwifery: A Feminist Experiment in Care

Abstract

This paper is about the clinical principle of informed choice-the hallmark feature of the midwifery model of care in Ontario, Canada. Drawing on ethnographic history interviews with midwives, I trace the origins of the idea of informed choice to its roots in the social movement of midwifery in North America in the late 1960s and 1970s. At that time informed choice was not the distinctive feature of midwifery but was deeply embedded what I call midwifery's feminist experiment in care. But as midwifery in Ontario transitioned from a social movement to a full profession within the formal health care system, informed choice was strategically foregrounded in order to make the midwifery model of care legible and acceptable to a skeptical medical profession, conservative law makers, and a mainstream clientele. As mainstream biomedicine now takes up the rhetoric of patient empowerment and informed choice, this paper is at once a nuanced history of the making of the concept and also a critique of the ascendant 'regime of choice' in contemporary health care, inspired by the reflections of the midwives in my study for whom choice is impossible without care.

‘Normal birth’: Time to change our tune?

“…In the 1960s, the women’s health movement in North America began to influence how women approached birth and its attendant risks 5 . Promotional material was circulated in the 1970s urging women to learn about, and reclaim responsibility for, their birth experience 5 . At this time, medicine was dominated by men, and paternalistic in practice 5 .…”

“…Promotional material was circulated in the 1970s urging women to learn about, and reclaim responsibility for, their birth experience 5 . At this time, medicine was dominated by men, and paternalistic in practice 5 . The concept of patient consent, as we know it today, did not exist 5 .…”

“…At this time, medicine was dominated by men, and paternalistic in practice 5 . The concept of patient consent, as we know it today, did not exist 5 . Birth in hospitals occurred without husbands, support persons, or information, and was considered by the women’s movement to be unsafe 5 .…”

“…The concept of patient consent, as we know it today, did not exist 5 . Birth in hospitals occurred without husbands, support persons, or information, and was considered by the women’s movement to be unsafe 5 . Midwifery was at the heart of a radical grassroots social movement which aimed to protect women from the dangers of paternalistic obstetric practice 5 …”

“…There was an emergence of natural childbirth literature in the 1980s and 1990s as the women’s health movement gained momentum 5,6 . Birth centres also came into existence around this time, offering a cost‐effective birthing environment, staffed by midwives 5,6 . However, birth centres contained certain dichotomies.…”