Medicine as discursive resource: legitimation in the work narratives of midwives

This article examines the work narratives of midwives practicing in the United States, specifically in the State of Florida. We focus analytic attention on how the discourse of medicine is used as a resource in constructing a sense of legitimation for midwifery. Data are drawn from in-depth interviews with 26 direct-entry, licensed midwives and certified nurse-midwives. Historically, social scientific literature on midwifery has placed a midwifery, or a holistic, model of childbirth in polar opposition to a technocratic or medical model. In practical work, however, midwives demonstrate knowledge of, and make use of, a discourse of medicine to serve their purpose-at-hand. In these 'narratives of legitimation', the medical model does not emerge as an entity definable as separate and necessarily at odds with the midwifery model. Rather, the medical model is a resource through which midwives work narratively to construct the validity of their profession. The midwives interviewed use the discourse of medicine in three specific ways. First, they draw upon it as a contrast device, setting themselves and their work apart from the medical establishment. Second, midwives use the medical model to communicate necessary daily aspects of their work. Finally, they construct a story of medical collaboration to equate their work with that of physicians.