The organization of professions plays a significant role in the way care at birth is delivered. Because midwifery is “where the action is” in terms of professional “jurisdiction”—arguments about the most appropriate caregiver at birth—all four chapters in Part II put midwives at the center of their analysis: Midwifery is used as a way of illustrating the professional activity in maternity care systems.
Sandall and her colleagues open Part II with an examination of interprofessional rivalries among maternal health professions in the latter half of the twentieth century. Using case studies from Germany, the United Kingdom, Canada, and the Netherlands, Chapter 6 examines how the process of professionalization changes the nature of midwifery work, relationships with clients and colleagues, and the standing of midwives in society. These four countries were selected because they represent three different processes of professionalization. Midwifery in the United Kingdom exemplifies an occupation that appears to be strong but is struggling to find independence. Midwifery in the United Kingdom is state-funded; midwives are university-educated, and they attend the majority of all births. But as salaried employees of the National Health Service, most midwives work in a very hierarchical system and complain about long hours and poor pay. Midwifery in Germany has a long tradition, but today most midwives work under the supervision of an obstetrician. In the Netherlands midwives practice as private entrepreneurs at home and in the hospital. Dutch midwives benefit from legislation that limits competition from both family doctors and obstetricians, but their status is uncertain and their pay modest. Midwifery in Canada had largely vanished by the 1980s, but is now reappearing with the support of the state.
Chapter 7 analyzes midwifery education. Education is central to all professions, offering the training and socializing necessary to transform lay people into professionals. In “Designing Midwives,” Benoit et al. look at education in the widest sense of the word—ranging from informal unofficial hands-on training by apprenticeship to formal and official education that leads to a government-endorsed license. The authors discern three educational models and illustrate and analyze them with case studies from different countries.