John Pendleton

Midwifery is one of the oldest recorded occupations and overwhelmingly mono-gendered. Historically only women who had given birth could be midwives because this embodied experience was necessary fo...

The professional title “midwife” is predicated on the understanding that people who access their services have a normative relationship between their gender and assigned sex. As trans and non‐binary people increasingly require access to midwifery services, this paper proposes an alternative professional title that is inclusive and liberates midwives from continuously reinscribing the sex/gender binary in their nomenclature. We work with Levitas's Utopia as Method framework to propose the title of Lead Perinatal Practitioner. Working through the archaeological, ontological and architectural modes, we explain the rationale for each component part of the title. “Lead” foregrounds the profession's relationship with autonomy, which is considered foundational but threatened by encroaching medicalization. “Perinatal” encompasses not just the birthing person but also the neonate and the physiological process and timeframe encapsulating pregnancy and birth currently absent. “Practitioner” captures the reflexivity, skill, and active engagement already inscribed in allied healthcare professions that use this title. We argue that when combined, they signal a trailblazing contribution towards the eradication of gender inequalities in the reproductive arena by uncoupling the profession from patriarchal oppression inscribed in the sex/gender binary, which has hitherto been positioned as the sine qua non of midwifery.

This chapter examines how the professional title ‘midwife’ is predicated on the understanding that people who access their services have a normative relationship between their gender and assigned sex and why this is problematic. As trans and nonbinary people increasingly require access to midwifery services, this chapter proposes an alternative professional title which is inclusive and liberates midwives from continuously reinscribing the sex/gender binary in their nomenclature. Using Levitas’ ‘utopia as method’ framework, this chapter proposes the title of ‘lead perinatal practitioner’. It is argued that this title signals a trailblazing contribution toward the eradication of gender inequalities in the reproductive arena by uncoupling the profession from patriarchal oppression inscribed in the sex/gender binary which has hitherto been positioned as the sine qua non of midwifery.

Effective communication in relation to pregnancy and birth is crucial to quality care. A recent focus in reproductive healthcare on “sexed language” reflects an ideology of unchangeable sex binary and fear of erasure, from both cisgender women and the profession of midwifery. In this paper, we highlight how privileging sexed language causes harm to all who birth—including pregnant trans, gender diverse, and non‐binary people—and is, therefore, unethical and incompatible with the principles of midwifery. We show how this argument, which conflates midwifery with essentialist thinking, is unstable, and perpetuates and misappropriates midwifery's marginalized status. We also explore how sex and gender essentialism can be understood as colonialist, heteropatriarchal, and universalist, and therefore, reinforcing of these harmful principles. Midwifery has both the opportunity and duty to uphold reproductive justice. Midwifery can be a leader in the decolonization of childbirth and in defending the rights of all childbearing people, the majority of whom are cisgender women. As the systemwide use of inclusive language is central to this commitment, we offer guidance in relation to how inclusive language in perinatal and midwifery services may be realized.

Upon starting midwifery training, students largely visualise a clinical career, working on the frontline of perinatal care. However, careers in midwifery span many disciplines, providing many career options for qualified midwives. In this special report, midwives from research, academic and consultancy positions discuss the importance of their roles, the challenges, benefits and relevance to clinical midwifery.

This discussion paper takes as its starting point the marginal existence of men in the seemingly mono-gendered arena of childbearing, both as midwives and as service users. It seeks to explore how their problematic presence can be both accommodated and rejected within the limits of existing language which manifests itself most rigidly in the word ‘midwife’. I argue that ‘midwife’ has multiple meanings which are mobilized in different situations to call upon either a seemingly stable etymological understanding or a more fluid and adaptable semantic meaning. I engage in the heuristic device of ‘orientations’ inspired by the work of Sara Ahmed to illuminate how these multiple meanings serve to exclude people who do not identify as female. Lastly, I illustrate how a recent focus on gender-neutral and additive language to accommodate men into a historically exclusively female discourses has further exposed the limitations of the gendered word ‘midwife’ to be able to include people of all genders and none.

Midwifery is an ancient profession that continues to be practiced almost exclusively by women. This paper explores the role that millennia of gender exclusivity has had in shaping the knowledge that informs the profession. Prior to the Renaissance this knowledge was exclusively female, largely oral, tacit and intuitive whilst recognising childbearing as an important transformative period in a woman’s lifecycle. Male scientific enquiry in the seventeenth century into human anatomy extended to women’s bodies and childbirth and disrupted the female ways of knowing. Their positivist ontology focussing on the mechanics of childbirth created an opportunity for intervening in a normal process and receiving payment for it. The perceived structural superiority of a male obstetric ontology of childbirth has posed an existential threat to the midwifery profession. This paper concludes by discussing how 20^th century professional regulation of midwifery has encouraged midwives to use patriarchal structures and frameworks of knowledge to co-exist within the hegemonic biomedical model advocated by the majority of their obstetric colleagues.

Evidence suggests that black and minority ethnic (BME) midwives are more likely to face fitness to practise hearings than white registrants and BME NHS staff are less likely to be in senior positions. This literature review critically evaluates the literature published since a systematic review on the topic was conducted in 2005. It found that BME nurses and midwives, especially those who registered abroad and subsequently came to live and work in the UK are ‘underemployed’ and consequently expressed feelings of loss of self-confidence. This was further compounded by accounts of excessive scrutiny and punishment. Many felt excluded from white networks of power and opportunities for staff development and promotion. The literature also describes experiences of covert as well as overt racism between the white majority and BME staff as well as ‘horizontal racism’ between BME staff of differing ethnicities.

After 30 years of men in the profession, John Pendleton wonders why do we still need to ask this question?