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.
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Notes
This research was reviewed and approved by the Human Participants Review Sub-Committee at my institution’s Ethics Review Board and conforms to the standards of the Canadian Tri-Council Research Ethics guidelines. Informed consent was obtained from all participants included in the research. The interviews were transcribed by a professional transcription service. I have used pseudonyms for all research participants, except in the case of one midwife who wished to be identified by name.
References
Allemang, Elisabeth 2013 Alegal Midwives: Oral History Narratives of Ontario Pre-Legislation Midwives MA thesis, University of Toronto, Toronto.
Association of Ontario Midwives 2007a Benefits of Midwifery to the Health Care System, http://www.aom.on.ca/Communications/Government_Relations/Benefits_to_Women_Needing_Obstetrical_Care.aspx, accessed April 15, 2016.
Association of Ontario Midwives 2007b Benefits to Women Needing Obstetrical Care: A Case for Sustaining Midwifery, http://www.aom.on.ca/Communications/Government_Relations/Benefits_to_Women_Needing_Obstetrical_Care.aspx, accessed April 15, 2016.
Beckett, Katherine 2005 Choosing Cesarean: Feminism and the Politics of Childbirth in the United States. Feminist Theory 6(3): 251–275.
Bourgeault Ivy Lynn 2006 Push! The Struggle for Midwifery in Ontario. Montreal: McGill Queens University Press.
Bourgeault, Ivy Lynn, Cecilia Benoit and Robbie Davis-Floyd, eds. 2004 Reconceiving Midwifery. Montreal and Kingston: McGill-Queen’s University Press.
Burtch Brian 1994 Trials of Labour. The Re-emergence of Midwifery. Montreal: McGill Queens University Press.
Beauchamp, Thomas 2011 Informed Consent; Its History, Meaning, and Present Challenges. Cambridge Quarterly of Healthcare Ethics 20: 515–523.
Canadian Medical Association 2010 mHealth care transformation in Canada: change that works, care that lasts. Ottawa, ON: The Canadian Medical Association.
Canadian Association of Midwives 2015 Informed Choice Practice Standard. Toronto: Canadian Association of Midwives.
Childerhose, Janet and Margaret MacDonald 2013 Health Consumption as Work: The Home Pregnancy Kit as a Domesticated Health Tool. Social Science and Medicine 86 (June): 1–8.
Craven, Christa 2010 Pushing for Midwives: Reproductive Rights in a Consumer Rights Era. Atlanta, GA: Temple U Press.
Committee on the Quality in Health Care in America 2015 Crossing the Quality Chasm: A new health system for the 21st Century. Washington DC: National Academy Press.
Davies, Megan 2014 Women unafraid of blood: Kootenay Community Midwives 1970 -1990. BC Studies 183: 11-36.
Daviss, Betty Anne 2002 Reforming Birth and Remaking Midwifery in North America. In Birth by Design: Pregnancy, Maternity Care and Midwifery in North America and Europe. Raymond De Vries, Sirpa Wrede, Cecilia Benoit, and Edwin van Teijlingen, eds., pp. 70–86. London: Routledge.
Davis-Floyd, Robbie 2004 Home Birth Emergencies in the United States: The Trouble with Transport. In Arauchu Castro and Merrill Singer, eds. Unhealthy Health Policy: A Critical Anthropological Examination. Pp. 329-350. Lanham, MD: Altamira Press.
Puig de la Bellacasa, Maria. 2011 Matters of care in technoscience: Assembling neglected things. Social Studies of Science 41: 85–106.
Dick-Read, Grantly 1959 Childbirth without Fear. New York: Harper and Row.
Epstein, Stephen 1995 The Construction of Lay Expertise: AIDS Activism and the Forging of Credibility in the Reform of Clinical Trials. Science, Technology, & Human Values 20(4): 408-437.
Fannin, Maria 2012 The burden of choosing wisely: biopolitics at the beginning of life. Gender, Place and Culture. 1-17.
Flood, Colleen M and Katherine May 2012 A patient charter of rights: how to avoid a toothless tiger and achieve system improvement. CMAJ 184(14): 1583-1587.
Fontaine, Corinne 1989 Midwifery task force replies. Canadian Family Physician 35: 1736-1738.
Foucault, Michel 1975 The Birth of the Clinic. New York: Vintage
Foucault, Michel 1977 Discipline and Punish. New York: Vintage.
Foucault, Michel 1980 The History of Sexuality. New York: Vintage.
Gaskin, Ina May 1977 Spiritual Midwifery. Summertown, PA: The Book Publishing Company.
Gaskin, Stephen 1977 Forward. In Spiritual Midwifery. Ina May Gaskin. pp. 14-15. Summertown, PA: The Book Publishing Company.
Hacking, Ian 2007 Making up People. In Margaret Lock and Judith Farquar, eds. Beyond the Body Proper. Pp. 150-163. Chapel Hill, NC: Duke University Press.
Handa, Manavi and Mary Sharpe 2015 Shifting Paradigms in Women’s Health Care: From Informed Consent to Informed Choice. Women’s Health Bull. April 2(2):e28194.
Hindley, Carole and Anne M Thomas 2005 The rhetoric of informed choice: perspectives from midwives on intrapartum fetal heart rate monitoring. Health Expectations 8: 306–314.
James, Susan G. 1997 With Woman: The Nature of the Midwifery Relation. PhD Dissertation. Edmonton: University of Alberta.
Janssen, Patricia, Shoo K Lee, Elizabeth M Ryan, Duncan J Etches, Duncan Farquharson, Donlim Peacock, and Michael C Klein 2002 Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ 166: 324-326.
Janssen, Patricia, Lee Saxell, Lesley A Page, Michael C Klein, Robert M. Liston and Shoo K Lee 2009 Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Canadian Medical Association Journal 18: 6-7.
Johnson, Kenneth C and Betty Anne Daviss 2005 Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 330: 1416-1423.
Kaufert, Patricia and John O’Neil 1989 Biomedical Rituals and Informed Consent: Native Canadians and the Negotiation of Clinical Trust. In Weisz G. ed. Social Science Perspectives on Medical Ethics. Pp. 41-63. New York: Kluwer Academic Publishers.
Klassen, Pamela 2001 Blessed Events. Religion and Home Birth in America. Princeton: Princeton University Press.
Kaufman, Karen, J. Hogenbirk, R. Pong, and L. Martin 2001a Midwifery Care in Ontario: Client Outcomes for 1998, Part 1: Maternal Outcomes. Association of Ontario Midwives Journal 7(2):56-64.
Kaufman, Karen, J. Hogenbirk, R. Pong, L. Martin 2001b Midwifery Care in Ontario: Client Outcomes for 1998, Part II: Fetal and Newborn Outcomes. Association of Ontario Midwives Journal 7(4):147-153.
Lamaze, Fernand 1958 [1956] Painless Childbirth. Trans, London: Burke.
Lang Raven 1972 The Birth Book. Ben Lomond, CA: Genesis Press.
Leboyer Frederic 1978 Birth without Violence. New York: Alfred Knopf.
MacDonald, Margaret 2007 At Work in the Field of Birth: Midwifery Narratives of Nature, Tradition, and Home. Nashville: Vanderbilt University Press.
MacDonald, Margaret 2011 The cultural evolution of natural birth. The Lancet 378(30): 394-395.
MacDonald, Margaret 2014 Seizing the Means of Reproduction by Michelle Murphy (Duke University Press, 2012, 259p). Somatosphere. Science, Medicine and Anthropology. (May 28) http://somatosphere.net/author/margaret-macdonald
MacDonald, Margaret 2016 The Legacy of Midwifery and the Women’s Health Movement in Contemporary Discourses of Patient Choice and Empowerment in Canadian Journal of Midwifery Research and Practice 15(1): 43-50.
Aryn Martin, Natasha Myers and Ana Viseu, 2015 The politics of care in technoscience. Social Studies of Science 45(5): 1-17
McDonald, Susan J., Philippa Middleton, Therese Dowswell and Peter S. Morris 2013 Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews Issue 7: CD004074.
Mol, Anne Marie 2008 The Logic of Care. Health and the Problem of Patient Choice. New York and London: Routledge.
Mol, Marie Anne, Ingunn Moser I and Pols Jeanette 2010 Care: Putting practice into theory. In Annemarie Mol, Ingunn Moser and Jeanette Pols, eds. Care in Practice: On Tinkering in Clinics, Homes and Farms Pp. 7-25. Bielefeld: Transcript Verlag.
Mason, Jutta 1990 The Trouble with Licensing Midwives. Ottawa: CRIAW/ICREF.
McLain, Carol, ed. 1989 Women as Healers. New Brunswick, NJ. Rutgers University Press.
Morgan, Sandra 2002 Into Our Own Hands: The Women’s Health Movement in the United States, 1969 to 1990. New Brunswick, NJ: Rutgers University Press.
Murphy, Michelle 2012 Seizing the Means of Reproduction: Entanglements of Feminism, Health, and Technoscience. Durham and London: Duke University Press.
Nestel, Sheryl 2006 Obstructed Labour: Race and Gender in the Re-emergence of Midwifery. Vancouver, BC: University of British Columbia Press.
Nicholson, Kathryn 2009 Patient Empowerment: The Key to Renewing Canada’s Health Care System. Using Electronic Health Records and a Client Response Tab to Improve and Sustain the Health of Canadians. Submission to the Health Council of Canada.
Ontario Ministry of Health and Long Term Care (MOHLTC) 2005 McGuinty government increases access to midwifery. http://ogov.newswire.ca/ontario/GPOE/2004/08/13/c1159.html?lmatch=&lang=_e.html, accessed April 15, 2007.
Osuch, Janet, Kami Silk, Carole Price, Janice Barlow, Karen Miller, Ann Hernick and Ann Fonfa 2012 A Historical Perspective on Breast Cancer Activism in the United States: From Education and Support to Partnership in Scientific Research. Women’s Health 21(3): 355–362.
Paterson, Stephanie L. 2004 Ontario Midwives: Reflections on a Decade of Regulated Midwifery. Canadian Woman Studies 24(1): 152.
Paterson, Stephanie L and Cherry Marshall 2011 Framing the New Midwifery: Media Narratives in Ontario and Quebec during the 1980s and 1990s. Journal of Canadian Studies/Revue d’études canadiennes 45.3: 82-107.
Rabe, Heike, Jose Luis, Diaz-Rossello, Leila Duley and Therese Dowswell 2012 Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews. Issue 8: CD003248.
Robertson, Kathleen J 1999 Patient Empowerment in the United States: A critical Commentary.” Health Expectations. 2: 82-92.
Ruzek, Sheryl J 2007 Transforming doctor-patient relationships. Health Services Research and Policy 12(3): 181–182.
Sagady, Mayri, Leslie, Debra Erickson-Owens and Maria Cseh 2015 Is it the evidence? The evolution of Maternity Care Providers to Delayed Cord Clamping. Journal of Midwifery and Women’s Health 90: 1–9.
Sherwin, Susan 1998 The Politics of Women’s Health: Exploring Agency and Autonomy. Philadelphia: Temple University Press.
Shroff, Farah M, ed. 1997 The New Midwifery: Reflections on Renaissance and Regulation. Toronto: Women’s Press.
Silverman, William A 1989 The Myth of Informed Consent in Daily Practice and in Clinical Trials. Journal of Medical Ethics 15: 6–11.
Spoel, Philipa 2004 The Meaning and Ethics of Informed Choice in Canadian Midwifery. Oral presentation at Laurentian University, Canada.
Spoel, Philipa 2013 Standards and Stories the Interactional work of Informed Choice in Ontario Midwifery Care. Health Care Policy 9: 71-85.
Stevenson, Lisa 2015 Life Beside Itself. Imagining Care in the Canadian Arctic. Berkeley: University of California Press.
Thacuk, Angela K. 2004 Midwifery, Informed Choice and Reproductive Autonomy: A Relational Approach. Honours Thesis. Burnaby: Simon Fraser University.
Weinberg, Stephen 2015 Eye on the Present. The Whig History of Science. New York Review of Books. Dec 17: 13–15.
Wells, Susan 2008 Our Bodies Ourselves: Reading the Written Body. Signs: Journal of Women in Culture and Society 33(3): 697-722.
van Esterik, Penny. 1995 Care, caregiving and caregivers. Food and Nutrition Bulletin 16(4):70-74.
van Wagner, Vicki 1988 Women Organizing for Midwifery in Ontario. Resources for Feminist Research. 17(3): 115-118.
van Wagner, Vicki 2004 Thinking Through the Debate about Cesarean Section on Demand. Canadian Journal of Midwifery Research and Practice 3(1): 12–28.
Acknowledgements
I would like to thank the midwives and clients who have contributed their time and interest to my research on midwifery and health consumption over the years. I am also very grateful to a number of colleagues and academic interlocuters with whom I have had the pleasure to share and discuss this work at various stages of refinement, including Janet Childerhose, Christa Craven, Megan Davies, Todd Foglesong, Pamela Klassen, Ana Ning, and Natasha Pravaz. This paper has also benefited from the constructive comments of two anonymous reviewers. This work was supported by a York University Research Release Award in 2013–2014.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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MacDonald, M.E. The Making of Informed Choice in Midwifery: A Feminist Experiment in Care. Cult Med Psychiatry 42, 278–294 (2018). https://doi.org/10.1007/s11013-017-9560-9
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DOI: https://doi.org/10.1007/s11013-017-9560-9