I began to wonder: Can a male really fulfill a role that is so strongly associated with the female sex? What is the relationship between the norms of gender which we associate with each sex and the requirements of a midwife? In the broader view, how do male midwives figure into modern American gender relations?
In order to explore these questions, I posted a survey on an internet newsgroup dedicated to midwifery (sci.med.midwifery) asking people to send me their thoughts, experiences and opinions via electronic mail. I expected the majority of the respondents to criticize the notion that men can be satisfactory midwives, with a minority of responses defending male midwives. In fact, my informants split about half and half. Five responses supported the argument that female gender is not intrinsic to midwifery, while only four women insisted that there is a crucial difference between men and women, and that only women can fulfill the role of the midwife.
Of my informants, two midwives were the most vociferous: Helena and Michael. Each of them wrote long responses to my survey, with thorough comments on all of the applicable questions, and they expressed a strong interest in my project. As I worked with all of the survey responses, these two people emerged as the primary speakers for their respective sides of the "debate." Phrases and ideas from Helena's commentary were echoed by the other women who expressed opposition to male midwives, while in my mind Michael, as the only actual male midwife to respond to my query, came to represent those who argued that men's gender does not necessarily compromise their ability to act as midwives. I will now elaborate on the results of my survey, using quotations from Helena, Michael, and all of the other respondents to describe each of the two opposing points of view.
Helena was joined by three other women (none of them midwives), who also argued against male birth attendants. To begin with, they personally rejected the idea of employing a male midwife. "I would not, nor would I ever have hired a male midwife," said Helena. The others agreed. One commented, "I absolutely would not consider a male midwife. . . . Out of the question." Another claimed, "I would have to know a male midwife very well [but] probably even then wouldn't use him." A sense of modesty was cited as one reason for avoiding male midwives, but the women's sensitivity to gender extended well beyond personal modesty to encompass the philosophy of midwifery as well as social concerns. One woman asserted, "I know very few men who would have the emotional wherewithal to get out of the way, to let a woman's body give birth in its own way and time." Beyond this personal observation, she added a historical note; in her words, "the politics of labor and birth are such that male m.d.'s have taken a great deal of power away from laboring and birthing women. Men are still, unfortunately, greatly overly powerful in our culture." Another woman wrote, "I am somewhat of a feminist, and knowing and experiencing the male attitude of wishing to control women's knowledge and lives makes me very skeptical about the idea of men being midwives." Helena also alluded to male domination; she seemed to see male midwives as a potential threat to women's power. "I am no feminist per se," she said,
but I do believe that men should "butt out" of the babyhaving business. . . . Haven't they got enough to do, running the rest of the world? . . . Men are not women and from what I've seen, they tend to be a bit (to put it mildly) on the, "let me tell you what to do" whether they are doctors or "midwives."Clearly Helena possesses a strong awareness of social gender relations, and she sees gynocentric birth practices as one way of resisting, or at least avoiding, patriarchal control.
Though they addressed social themes, these four women did not limit their understanding of gender to a social construction. They indicated that, in their view, there are intrinsic differences between men and women -- differences which are crucial to midwifery. Physiology was one key issue: the idea that part of a woman's qualification as a midwife is the capacity to empathize with the parturient's physical experiences. "Men do not experience the birth process," explained Helena, "and therefore they cannot know what it is to labor and give birth. Therefore, they simply do not know anything about the subject." Another informant agreed: "birth is women's work. Men can help, but it is women's work." All four women alluded to an ineffable but essential link between women: some emotional, spiritual, or intuitive characteristic which is uniquely female. This characteristic connects women to one another and constitutes one of a midwife's qualifications. One respondent wrote, "I feel that women know women better . . .." Another asserted that a man could not fulfill "the essential role of a midwife [which is to] remind the woman that she is POWERFUL." Helena explained, "I believe midwives are born, not taught. I was born to be a midwife and one reason is my very femaleness." By choosing the word "femaleness," Helena refers to not only her sex but also some innate personal characteristic. For at least one of my infomants, the requirement that midwives be women was so absolute that she could not conceive of a man in that role: "In my world," she wrote, "there is no place for a male midwife."
The idea that one sex is intrinsically better suited to a particular activity than the other brings to mind the ideology of separate spheres. Historically, before the rise of male-dominated medical obstetrics, childbirth was considered "women's work," almost universally. Historian Laurel Thatcher Ulrich describes colonial births where "the badge of entry was sex" and even husbands were excluded (127). As "man-midwives" and male obstetric specialists became more common, some women resisted their invasion into the female realm of the birthing room. By the mid-twentieth century, however, hospital birth with a (usually male) obstetrician was the accepted norm. My understanding of the contemporary resurgence of midwifery is that the movement attempts to reclaim birth as a gynocentric event, empowering for women. In imitation of the colonial tradition, the modern ideology rejects male-identified medicine in favor of female-identified midwifery. Could this tendency be considered an attempt to return birth to a "separate sphere" belonging to women? Does contemporary midwifery relate to the historical concept of separate, sex-defined, gender spheres?
Helena and the other informants who agree with her apparently believe that midwifery does, in fact, belong exclusively to women's sphere. "I do believe men and women have their separate roles in life," Helena states plainly. Another respondent concurs: "when men step into a woman's realm without being able to fully experience the woman's position . . . it upsets a type of balance . . ." For these women, the separation of gender roles is not a mere social construction which can be dismissed as archaic. At least when it comes to midwifery, they view gender as a significant quality in an individual, inherently dependent on his or her sex.
The views expressed by Helena and the three other women whom I have quoted are almost completely opposed by Michael, with support from another group of non-midwife informants. To begin with, they offer evidence that not all women share Helena's categorical rejection of male midwives as personal birth attendants. Michael himself claims, "In over 20 years, I have had only 1 patient . . . ask that I not treat her." A married couple wrote to me jointly that although they employed a female midwife, they would not reject the idea of hiring a man. Some informants talked about having positive experiences with male birth attendants. A New Zealand woman who was assigned a male midwife for postpartum care after a cesarian section wrote, "I was initially surprised when he introduced himself as my midwife but I didn't feel embarassed as he soon put me at ease and was obviously good at his job." A registered nurse wrote to me about her experiences working in the labor & delivery section of a midwifery-oriented hospital. She spoke of a male nurse who assisted the female midwives: "After the initial shock of seeing him in a 'traditional' feminine setting, things always went well." Apparently gender does not matter to some women as deeply as it concerns Helena and her supporters.
Not surprisingly, Michael emphasized skill and caring over a midwife's gender. "[T]he most important thing is how each client is treated not necessarily the gender of the care giver," he wrote. "My patients see me for me and appreciate the care so there is no gender bias there." The New Zealand woman wrote about her midwife's skill: "He was very good. He was very gentle and spoke with a quiet voice." The nurse, too, noted of her male colleague that "He was very professional, caring, knowledgable. I do not recall anyone ever being disatisfied with his care." "The most relevent issue," stated another response, "is competence." Michael confidently stated, "I am probably the best Midwife, doula and feminist-oriented care giver in the US." Obviously female sex is not, in his opinion, a crucial qualification for midwives.
According to some of my informants, women do not own a monopoly on (in Helena's words) "the babyhaving business." In their view, birth involves men in a deep, ineffable way as well. A man named Trevor wrote a very personal account of his own experiences related to the birth of his daughter. He said, "I found the whole process deeply moving and quite fascinating, and asked one of our midwives about the possibility of my training to become a midwife." Michael alluded to a similar inspiration in his answer to the question, "Why did you choose to become a midwife?": "Can't think of a more rewarding field of medicine!" Others agreed that "the tremendous satisfaction derived from this work" could be enjoyed by women and men alike. This understanding of midwives' emotional experiences differs significantly from Helena's model where women are uniquely equipped to understand the most profound meanings of birth.
Interestingly, Trevor experienced firsthand a clash between these two points of view. The midwife with whom he spoke evidently had opinions similar to Helena's. He wrote that "She was *strongly* discouraging, saying in effect that no woman in her right mind would choose a male midwife, that midwifery is (in large part) an effort to remove men from the birth process." Trevor found himself an intruder in the women's sphere, even before he expressed a desire to study midwifery. "[M]y entire pre-natal experience was of exclusion, hostility, and of the 'matronising' behaviour and attitudes of not only the midwives, but of women in general." Trevor ended his e-mail message to me with bitter criticism of separate spheres. He wrote, "I look forward to the day when women are comfortable enough with themselves and with the expression of their power that they can support men in getting out of the gender box that we still find ourselves pushed into."
In a concluding note to my paper, I would like to address Trevor's notion of "the gender box." The debate over male midwives presents a problem for feminists. One argument states that women need to reserve a few spheres for themselves, areas where men do not intrude. These protected spheres -- such as women-only midwifery -- are regarded as essential for maintaining women's collective identity and power. In a world where we struggle daily under the hegemonic influence of a centuries-old patriarchal tradition, protected women's spheres appear as enticing havens, the vital sanctum sanctorum to which women may retreat.
The appeal of a women's sphere, however, must be reconciled with the history of gendered spheres. In the past century, feminism has focused on winning masculine priveleges for women, and bringing women out of the (seemingly) limited feminine sphere and into the (seemingly) much freer masculine sphere. It is evident, however, that the masculine "gender box" may be as limiting as the feminine one. New questions must be addressed: Can men assume a traditionally female role, such as that of the midwife, without imposing patriarchal domination? Is it imperative that feminists accept male midwives as part of the transformation of American gender norms which we have sought? Or should we protect the few areas of exclusively female activity, including midwifery, from erosion?
In my research I have collected enough data to illuminate these questions, but not enough to answer them. The area of midwifery offers a promising focus for a feminist discussion of issues related to the "gender box."