Premature adoption and resolution of medical technology: illustrations from childbirth technology.

The first part of this article discusses four forces underlying the emergence, adoption, and routinization of medical technology: key societal values, policies of the federal government, reimbursement policies, and economic incentives. It also addresses a set of impacts resulting from increased reliance on medical technology. The second part of the paper assesses three examples of childbirth technology: electronic fetal monitor, obstetric ultrasound, and cesarean birth. The tendency toward premature and excessive use of technology is especially strong in the area of childbirth and technology.

Self-certification in lay midwives' organizations: a vehicle for professional autonomy.

The recent resurgence of lay midwifery in the United States has been intimately connected with the establishment of grassroots organizations which address women's health issues and make the reappearance of the lay midwife a different kind of phenomenon than was the case earlier in this century. This paper describes the organizational structure of 32 lay midwives' organizations and compares them to a model of alternative women's health groups as well as more traditional health professional organizations. Are lay midwives' groups the beginnings of new professional organizations which eventually will become part of the dominant system or do they model themselves more closely after alternative women's health groups? Voluntary self-certification in five lay midwives' groups is described in detail as a means of determining how a group handles the question of integration with or separation from the existing medical care system. Certification plays a critical role in promoting acceptance and credibility of midwifery practice and is seen increasingly as a mechanism to preempt regulation by another body.

Women's participation in health-care delivery: recent changes and prospects.

This article examines women's participation in health-care delivery by reviewing dissimilarities in employment patterns of male and female health workers with primary emphasis on roles, status, and earnings. Selective data pertinent to gender-typing of jobs and the hierarchical structure of the health workforce are presented. Recent shifts in women's entry into health occupations are reviewed and questions are posed about prospects for change.

State laws and the practice of lay midwifery.

A national survey was conducted to assess the current status and characteristics of state legislation regulating the practice of lay midwives. As of July 1987, 10 states have prohibitory laws, five states have grandmother clauses authorizing practicing midwives under repealed statutes, five states have enabling laws which are not used, and 10 states explicitly permit lay midwives to practice. In the 21 remaining states, the legal status of midwives is unclear. Much of the enabling legislation restricts midwifery practice often resulting in situations similar to those in states with prohibitory laws. Given the growth of an extensive grassroots movement of lay midwives committed to quality of care, this outcome suggests that 21 states with no legislation may provide better opportunities for midwifery practice than states with enabling laws.

Women's health and social change: the case of lay midwives.

One reaction to the medicalization of birth has been the comeback of lay midwives in the past 10 years. While many practice alone as did midwives 80 years ago, now midwives are networking and organizing in regional and statewide groups, an important new distinction in the light of increasing regulatory policy formation by many states. Are these groups the beginnings of traditional bureaucratic health professional organizations or are they better described as alternative women's health groups that espouse nonhierarchical philosophies of women's health? In this article, we describe an empirical study of one such group, the Michigan Midwives' Association, and explore the philosophies and practices of individual members as well as the internal organization of the group and its influence on members. Data were collected using individual telephone interviews with 48 of 50 members, group newsletters and documents, and two spokespersons who developed an oral history of the Association since its origin in 1978. Results suggest that the group plays an important role in reinforcing individually held philosophies about women-controlled birth and in providing social support to health workers practicing outside the traditional system.

PIP: An empirical study of the Michigan Midwives Association (MMA), a lay midwife group, was undertaken, and a oral history was developed; interviews were conducted with 48 of the 50 members. Their ages cluster in the 30s. 27 (56%) of these women considered themselves full-time midwives. They usually meet their clients by word-of-mouth. Their practice patterns are characterized by client-centered care and continuity of care. The midwives' socioeconomic backgrounds are similar; but their political attitudes include many views. The words "natural" or "normal" were used by the midwives to describe birth. The MMAs origin was informal. Originally there were 8 members, but the group grew rapidly. Currently there are 50 members. Authority is shared equally among members. Work is done through committees. MMA members share common views about birth and women's right to make decisions about it. Members are spread out geographically all over Michigan, so frequent meetings are impossible. Many members have changed their practice ways since they started midwifery. About 75% of the midwives thought that client relationships had changed since they began practicing. Several felt that their attitudes toward their profession had changed. The MMA holds peer review sessions whenever a midwife requests it. An internal certification process has been developed.

Gender hierarchies in the health labor force.

Rapid growth and increasing diversity characterize trends of the U.S. health labor force in recent decades. While these trends have promoted change on many different fronts of the health system, hierarchical organization of the health work force remains intact. Workers continue to be stratified by class and race. Superimposed on both strata is a structure that segregates jobs by gender, between and within health occupations. While female health workers outnumber males by three to one, they remain clustered in jobs and occupations lower in pay, less prestigious, and less autonomous than those of their male counterparts. What has prevented women from improving their economic and leadership status as health workers? Is work performed by men of higher prestige because men perform it? Would curative and technical fields have less status if dominated by women? Would health promotion be funded more generously if most health educators were men? In this article, two analytical constructs are presented to take a closer look at occupational categories, selected structural characteristics, differential rewards, and their relationship to gender segregation. Taken together, they demonstrate how women always cluster at the bottom and men at the top, no matter which dimension is chosen.