HOMEBIRTH POLITICS: FEMINISTS, CONSERVATIVES, AND THE STRUGGLE OVER EXPERT KNOWLEDGE

Abstract

In recent years, some critics have proposed that we live in a “post-truth” world, or that expertise is dead. This dissertation argues that though the status of expertise and the professions is changing, it is not simply because professions are powerless, experts are no longer believed, or truth is no longer a relevant category. Instead, I focus on the rise of alternate forms of expertise. I examine what I term the counterprofession of homebirth midwifery in the United States. Contemporary homebirth midwifery arose from the convergence of late twentieth century challenges to medical authority by conservative off-the-grid and Christian communities, the feminist health movement, and back-to-the- land groups. A small but growing share of parents, many of whom wish to avoid the US’s distinctively dangerous medical perinatal care system, now seek perinatal care from providers who train and practice outside of medical settings. I argue that rather than avoiding experts in pregnancy and birth, these parents choose counterprofessionals as their care providers.

Counterprofessions, I contend, emerge when critics of an existing profession’s way of approaching a problem or task create an alternative body of expert knowledge and skill that they claim is better equipped to both understand and address that concern. They are fruitful sites from which to observe what I call a profession’s normative epistemology, or its organizing principles for how knowledge ought to be produced and deployed. My analysis shows how critical and social movement writings find purchase in homebirth midwifery’s normative epistemology, tracing the centrality of epistemic multiplicity and local expertise to the practice of informed choice. Practice guided by

this kind of normative epistemology leads a counterprofession such as home birth midwifery to a distinctive relationship with law. Counterprofessionals, I contend, must become active managers of law’s contradictions with their epistemic and normative commitments, facing its paradoxical abilities to both limit and protect choice. Demonstrating how politically disparate midwives often bracket disagreements in service of collaboration, I highlight the fragility of right-left convergences around challenges to expertise. Through close examination of contemporary professional midwifery, I aim to contribute to broad debates about the contemporary politics of expertise.