Postmodern negotiations with medical technology: the role of midwifery clients in the new midwifery in Canada.

In 1994, after more than a century of uncertain legal status, the Province of Ontario legalized midwifery and incorporated midwives into the formal health care system. Midwifery is now accessible and publicly funded for all women experiencing "normal" uncomplicated pregnancy and birth. Yet midwifery's move from the margins into the mainstream health care system has brought many new challenges. Midwives must now contend with an expanded scope of practice; they use more medical technology both to fulfill their professional obligations and to respond to the choices of women. This and an increased accessibility to a wider clientele seem to work against midwifery as a critical, low-tech alternative to "technocratic birth." In this article, through re-telling and analyzing women's narratives of pregnancy and birth, I explore the role of midwifery clients in re-shaping midwifery's relationship to medical technology. Steering away from essentialist explanations that hold that women are either inherently opposed to technology by virtue of their closeness to nature or wholly oppressed by technology and the systems within which it is imbedded, my analysis focuses on women's agency (on what women do rather than on what is done to them). My study suggests that women act pragmatically both with regard to biomedical technology and to midwifery. I argue that women's negotiations with medical technology have been instrumental in re-shaping midwifery as a postmodern phenomenon.