| Reviews / Comptes Rendus | Labour/Le Travail, 60

REVIEWS / COMPTES RENDUS

Sheryl Nestel, Obstructed Labour: Race and Gender in the Re-emergence of Midwifery (Vancouver: UBC Press 2006)

OBSTRUCTED LABOUR is a brilliant and cogent case study of the profession of midwifery's attempt to legitimize itself in the province of Ontario in the late 20th century. The basic argument is that in an effort to gain institutional and legal status for their profession, elite white midwives both excluded and ignored the issues of women of colour and immigrant women of colour with respect to developing educational and training standards, and opportunities, and establishing licensing procedures. Nestel presents an "alternative telling" of Ontario midwifery's "heroic" story. She claims that white middle-class women practicing midwifery were "unable to see past their own oppression and chose systems that marginalized other women," thus reproducing relations of domination based on race. Some Ontario midwives also reproduced these relations of domination through their strategic use of cross-border maternity clinics utilized by Mexican women, to expand their own expertise and obtain credentials for practice standards set in Ontario.

Evidence was gathered through interviews with 23 women of colour who were immigrant midwives, midwifery students, and midwifery board members; and through interviews with a handful of white women involved in the initial Task Force, the Interim Regulatory Council, and the College of Midwifery. In addition, '"hundreds of documents and publications linked to the development of midwifery in Ontario between 1981 and 1996" were reviewed.

Nestel states in her introduction that the processes that created exclusivity in the midwifery profession resulted from both "deliberate choices" and "seemingly benign inertia," neither of which were necessarily intended to enact racism, but simply are a part of "race-blind" epistemologies which guided action. Nestel makes clear that it was the omission of consideration of relations of domination between women that creates a profession that is non-inclusive. This situates the Ontario midwifery profession's development historically, as its processes parallel the same processes of major organizations of the Canadian feminist movement through the same decades.

The chapter on "Midwifery Tourism" is a fascinating analysis of relations of exploitation and hierarchy among women, under the disguise of a universal global sisterhood. It focuses on the experiences of Ontario midwives working at maternity clinics for Mexican women in the United States, and demonstrates the author's skill at theoretical analysis of complex and contradictory phenomena. At the same time, I would like to have seen richer data presented in this chapter to support the analysis.

While Nestel's counter-narrative makes a convincing case for race-blindness, I wondered why issues of language and economic class, both of which block educational and credential attainment, and which proved to be the two major barriers to the midwifery profession for most women, were not analyzed in intersection with race but instead presented as subordinate to it. The absence of data on white immigrant women in the study confounds the argument about race blindness. I would like to know more about the issues of economic status, language proficiency, and cultural knowledge as barriers to accessing basic information, following required administrative procedures, or meeting admission and licensing criteria as experienced by both white immigrant women as well as immigrant women of colour. And because not all women of colour were immigrants, or all immigrants women of colour, we need a clearer understanding of the different constellations created by multiple barriers and discriminatory practices: the individual experiences are often collapsed in this study and the overall complexity of the concept of "other" is not fully explored in the choice to prove race blindness. Informants' accounts describe "otherness" in relation to the expectations for a midwife in terms of sexuality, dress, gender norms, skin colour, social class, language, culture, poverty, and religion. But women's narratives have been pulled apart, partly I am sure from a concern for privacy and confidentiality. The study would be well served by fuller narrative accounts which illustrate this complexity and the impact of the attribution of diversely constituted "other" labels on individual lives and aspirations.

Nestel claims that in the push to gain credibility for midwifery as a licensed profession, the ideal midwifery candidate became a white, middle class, English-speaking, well-dressed and impassive female professional who behaves like a medical doctor. There are also echoes in the study of normative gender requirements for midwives similar to those found in the early twentieth century opposition to European women as midwives, openly expressed then through concerns about their lack of refinement and cleanliness. Skillfully describing how race-blindness works in this specific case, and respectable midwifery is constructed, Nestel is actually demonstrating more: how both xenophobia and gender conformity are operative in a late 20th century multi-cultural society; and how they are so embedded in Canadian culture and the psyches of Canadian women that they have become invisible instruments of both domination and exclusion at individual, organizational, and institutional levels.

Nestel intends this study to be instructive, particularly to the midwifery profession, of which she was a committed member. And it could be, if the book was made more accessible through its use of language and a careful re-organization. The challenge of turning a dissertation into a book is evident. The experiences and insights the midwives and students have to share are rich and important and could be an organizing focus for a future publication if the goal is to share these findings beyond an academic audience. Still, this book is compelling and brave, and once I started it I couldn't put it down.


NANCI LANGFORD Athabasca University

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