Towards an ‘optics of power’: technologies of surveillance and discipline and case-loading midwifery practice in New Zealand

Abstract

Midwives in New Zealand achieved professional autonomy in 1990 with an amendment to the Nurses Act 1977. Predicated on a natural approach to childbirth it was envisaged that midwifery would counter the trend of increasing medicalisation of childbirth. Some 20 years later, we continue to be concerned by increasing rates of intervention in childbirth including caesarean section operations. Midwifery practice is no longer supervised in a hierarchical arrangement with the obstetrician at its peak, however, we suggest that new and more subtle disciplinary mechanisms have come to the fore post-1990. Drawing on Foucault's concepts of the ‘medical gaze’ and the ‘panopticon’ we describe the ways in which midwifery practice (and through them the bodies of childbearing women) continues to be disciplined to conform to obstetric norms.

Las parteras en Nueva Zelanda lograron la autonomía profesional en 1990 con una enmienda a la Ley de Enfermería 1977 (Nurses Act 1977). Predicada sobre un enfoque natural hacia el parto, se esperaba que la partería contrarreste la tendencia de la creciente medicalización de los partos. Veinte años después, continúa nuestra preocupación por las crecientes tazas de intervención en los partos incluyendo las cesáreas. La práctica de la partería ya no es supervisada en un diseño jerárquico con obstetras en su cima; sin embargo, sugerimos que nuevos mecanismos de disciplinamiento, más sutiles, han surgido desde 1990. Basándonos en los conceptos de Foucault de la “mirada médica” y el “panopticón” describimos las formas en que la práctica de la partería (y a través de ellas los cuerpos de las mujeres embarazadas) continúa siendo disciplinada para ajustarse a las normas de la obstetricia.

在增修1977年制定的护士法后, 新西兰助产士于1990年代取得专业自主权。社会预期助产士将支持自然产, 因而得以对抗逐渐增加的生产医疗化趋势。然二十多年后, 我们仍持续担忧如剖腹产手术等比例渐高的介入性生产。助产实作不再受到颠峰时期妇产科医师的阶层性督导, 但我们主张, 更为新颖、细致的规训机制已于1990 年代后期悄然降临。我们将运用傅柯“医学凝视”与“圆形监狱”的概念, 描绘助产实作(及其所处置的分娩女体)如何持续受到规训以服膺妇产科规范的方式。

Keywords:

• midwifery
• autonomy
• discipline
• Foucault
• medicalisation
• childbirth

Keywords:

• partería
• autonomía
• disciplina
• Foucault
• medicalización
• parto

Keywords:

• 助产
• 自主权
• 规训
• 傅柯
• 医疗化
• 分娩

Acknowledgements

The authors would like to acknowledge the contributions of the New Zealand midwives participating in this research and the editor and reviewers of this journal for their careful reading of our manuscript and helpful feedback.

Notes

 1. The terms ‘natural’ and ‘normal’ are frequently used to describe vaginal birth without obstetric intervention, though these terms are problematic. For example, there is no agreement as to what constitutes intervention in childbirth. Some would argue, for example, that hospitalisation is an intervention. These terms also invoke their binary partners ‘unnatural’ and ‘abnormal’ both of which have pejorative connotations. These terms, however, are used extensively in the midwifery and childbirth activism literature. Natural childbirth and midwives as guardians of normal birth are constructs that featured heavily in the rhetoric supporting regulation to promote midwifery autonomy in New Zealand.

 2. Midwives who carry a caseload may be employed or self-employed and provide continuity of care to a group of women from the antenatal period through labour and birth to up to six-weeks post-partum.

 3. The rate of caesarean section operations, for example, in New Zealand was approximately 23.7% in 2004 (the latest available figures) while in Australia was 30.9% in 2007. (Australian Institute for Health and Welfare, http://www.aihw.gov.au/mediacentre/2009/mr20091210.cfm) (accessed September 17, 2010).

 4. While these data were collected from 2001 to 2003, Davis has been continually engaged in midwifery since this time and the data and our analysis are as relevant now as they were then.

 5. ‘Section 88 Primary Maternity Services Notice 2007’ is a service contract between health professionals providing primary maternity care and the Ministry of Health in New Zealand. This contract specifies the services that must be provided in the primary maternity care context.

 6. Midwifery practice may come under the scrutiny of a number of legal entities including the regulatory authority, the Midwifery Council of New Zealand, the Accident and Compensation Corporation (ACC) and the Health and Disability Commissioner. The Midwifery Council has the authority to suspend or impose conditions on a midwife's practice and they may instigate proceedings acting on their own information or on that provided by such entities as ACC and the Health and Disability Commissioner.

 7. A polycose test is a screening test for gestational diabetes.

 8. Since the data for this study have been collected, the Midwifery Council was formed as the new regulatory authority for midwifery in New Zealand.

 9. Stretch and sweep of the cervix involves a vaginal examination where the practitioner inserts one or two fingers into the woman's cervical opening, stretching the cervix and sweeping their fingers between the cervix and the amniotic membranes. This procedure results in a release of prostaglandins, which can help stimulate labour.

10. The ‘wheel’ refers to a disc-shaped tool that enables the practitioner to quickly calculate the woman's current gestation based on her EDD.

11. Stretch and sweep of the cervix involves a vaginal examination where the practitioner inserts one or two fingers into the woman's cervical opening, stretching the cervix and sweeping their fingers between the cervix and the amniotic membranes. This procedure results in a release of prostaglandins, which can help to stimulate labour.