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This chapter is concerned with the varied legitimizing discourses used by midwives to frame their identities in relation to their work. This sociological issue is particularly important in the context of an occupation, such as this one, that exists at the border of competing service claims. Drawing on 26 in-depth interviews, I use narrative analysis to examine the stories that midwives tell about their work. Through these women’s work narratives, I show the complex intersection of narrative, culture, institution, and biography (Chase, 1995, 2001; DeVault, 1999).

This research studied the integration of Ontario midwives into the hospital system, through analysis of 15 semi-structured interviews with midwives throughout the Canadian province. In 1994, following activism from parents and families who wanted “alternative” choices for childbearing, Ontario became the first Canadian province to legislate and publicly fund midwives. This followed nearly a century in which midwifery had all but disappeared in Canada, in part due to deliberate campaigns to discredit woman-centered health care and knowledge. The findings from this research were considered through the lens of Foucault’s concept of power/knowledge, to identify the ways in which medicalized norms have been privileged in Ontario birth care, and to demonstrate how pregnant people¹ and midwives have struggled against the power/knowledge of hospital environments. This research looked at the ways that midwifery, as a social movement born of feminist and countercultural activism, offers possibilities for resisting disciplinary power. Midwives in Ontario offer an alternative to medicalized childbirth which recognizes that a birth caregiver’s role is not only the physical care of parents and babies, but guidance for families during a liminal experience – the birth of a new child, which changes a family permanently and profoundly.

Unassisted childbirth, also known as “freebirth,” is when a person intentionally gives birth at home with no professional birth attendant. The limited research on unassisted birth in the United States focuses on women’s reasons for making this choice. Studies suggest women are committed to birthing without a professional and that this choice is rooted in religious or natural-family belief systems. These studies do not adequately account for the ways a framework of “choice” obscures the role structural barriers play in decision-making processes. International research on unassisted childbirth finds that it is not always a first choice and may be a last resort for women who have had negative experiences with maternity care. More research on unassisted birth in the United States is needed to better understand if people face similar structural barriers. In this paper I examine how structural limitations of the US healthcare system intersect with values in decision-making processes about childbirth. Drawing on in-depth interviews with nine women who gave birth unassisted in the United States, I examine the women’s shared ideological commitments, negative experiences with health care, and barriers faced seeking care. I discovered that unassisted birth may not be a first, or even positive choice, but rather a compromise informed by ideological commitments and constrained choices. Structural barriers in the US healthcare system prevented women from having a professional birth attendant who they felt was acceptable, available, and accessible. I conclude by discussing the implications of these findings for debates about birth justice and health policy.

Language is a fundamental and yet extraordinarily powerful medium. Language is more than the primary feature distinguishing humans from other species. As our principle means of communication, language links us to culture, and in so doing, shapes our perceptions and determines the way in which we think (Clark, Eschholz & Rosa, 1981; Thorne, Kramarae & Henley, 1983). Language is inseparable from social life. Through language, individuals learn cultural patterns and political and social values (Mueller, 1973). Language also reflects the prejudices of society, with assumptions about relative status, power or appropriate behavior often built into the words we use to talk about different groups of people. As Frank and Anshen (1983) note, ageism, racism, and most importantly for this discussion, sexism, are all perpetuated by our language, even among those who consciously reject those prejudices.

This chapter reports on an action research case study of integrated obstetric care in the Netherlands. Efficient and patient-friendly patient flows through integrated care networks are of major societal importance. How to design and develop such interorganizational patient flows is still a nascent research area, especially when dealing with a large number (n>3) of stakeholders. We have shown that a modification of an existing method to support interorganizational collaboration by system dynamics-based group model building (GMB) (the Renga method, Akkermans, 2001) may be effective in achieving such collaboration.

In this chapter, I bring a rhetorical genre theory lens to the study of two sets of information activities: information seeking and informing in a clinical setting, and personal information management in the household.

I begin by characterizing each candidate genre and show how it is constituted, created, repurposed, and used. I then show how that genre is embedded within a local genre set. This analysis maps the institutional, interactional, and intertextual connections, showing how generic forms interact with other oral and textual genres within the setting. Finally, I situate the single genre and genre set within the broader genre system to show how individual genres are both socially and intertextually connected with institutions and organizations beyond the local setting.

A genre analysis shows how “information” is accomplished out of the social and documentary practices of participants in particular settings and elucidates the shifting and complex nature of contexts in which information actors operate. Combining three levels of analysis shows how the actions of individuals are locally negotiated but also situated within broader structural constraints and discourse communities. A genre approach therefore offers a window on the elusive concept of “context” in information needs, seeking, and use research.