Date of Award


Document Type

Campus Access Dissertation



First Advisor

Erica Gibson

Second Advisor

Tom Leatherman


This research is based on a little over a year's worth of ethnographic fieldwork with the South Carolina midwifery community. The goals of the research were to understand how the dominance of medical discourse and midwifery participant's practical accommodation of medicine has transformed ideologies and practices of midwifery and explore why individuals would participate (as providers or clients) in an "alternative" form of maternity care and what strategies they use to validate and legitimate this participation. I was interested in exploring what discursive practices midwifery participants utilize to legitimate the practice of midwifery and how and why midwifery participants vary in terms of the discursive practices utilized. I wanted to know how medical accommodation, which in turn is shaped by historical, political, economic, and social, factors, was related to differences in discursive practices. Medical accommodation means midwifery practice is defined by medical definitions of risk and midwives must abide by medical policies and procedures in order to practice legally. It also means that midwives and their clients choose to or are pressed to incorporate medical technologies into midwifery.

To answer these questions I conducted semi-structured interviews with 65 midwifery participants. These participants included licensed midwives, licensed midwife apprentices, doulas, natural childbirth educators, certified nurse midwives, and midwifery consumers who had either given birth at home, in a free standing birth center, or at the hospital. In addition I strived to situate these participant ideologies in the context of South Carolina midwifery. Midwifery in South Carolina is similar in many regards to midwifery all over the U.S. but it is important to understand its unique history, especially in regards to medical accommodation.

I found that certified nurse midwives and their clients used medical technology and medicine as a discursive resource to legitimate their choice of midwifery more than LMs and their clients did. This means that medical accommodation and related political, economic, and social factors impacts the discourse, ideologies, and practices of midwifery participants.


© 2012, Christy Kollath