Professional Documents
Culture Documents
In order to fully understand childbirth care options in the United States, and to look ahead
at how women will view these options America¶s changing health care environment, we as
health care consumers need to understand the two distinct discourse communities speaking to
expectant mothers: midwives (the natural childbirth community) and obstetricians (the medical
comparative discourse analysis of the Codes of Ethics of the Midwives Alliance of North
America (MANA) and the American Congress of Obstetricians and Gynecologists (ACOG),
which should reveal the values most important to each group and the language used to express
those values.
My interest in this topic is indeed personal. Inspired by a women¶s studies class I took in
college, I began researching childbirth options when I was pregnant with my first child. I read
books and online forums, met with a midwife and an obstetrician, and made my decision: I chose
to give birth at a free-standing birth center staffed by three direct-entry midwives. When the time
came, I labored in a tub of warm water, received no drugs or other interventions, and delivered a
healthy baby girl. I am thankful that I had the ability to choose this type of care. I gave birth in
South Carolina, one of only 26 states in the U.S. where direct-entry midwives are legal and
After having such a positive experience with my own birth, and after having had
countless conversations with other women who did not understand my choice, blamed me for
putting myself and my child ³in danger,´ or confessed that they had no idea that there were even
options in childbirth care, I decided to research the topic further. There are many key issues in
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the discussion of childbirth care in the U.S., ranging from the current state of the health care
industry, to insurance companies and malpractice suits, to a society motivated to medicalize and
treat with prescription drugs anything perceived to be an abnormality; however, I plan to analyze
the subject from a rhetorical point of view. The language and rhetorical strategies used by
midwives and obstetricians are markedly different, forming two distinct discourse communities.
One could say that the two groups, even as they serve the same patients, aren¶t even speaking the
same language. If we can understand this language, we can better understand the type of care
LITERATURE REVIEW
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To understand the current rhetorical situation, we need to first understand the history of
childbirth care in America. Until modern times, childbirth history was the story of one central
character: the midwife. The term comes from the Old English word meaning ³with
woman,´ but she is also known as ³grandmother´ or ³granny´ in languages around the globe
(Cassidy). Today, there are two main types of midwives: the direct-entry midwife (also known as
a lay, independent or traditional midwife), who is trained mainly by apprenticeship but also often
in a school of midwifery and usually delivers at home or in free-standing birth centers; and the
nurse-midwife, who is trained in nursing school and usually works in hospitals, reporting to
physicians (Lay). For this proposal, I will use the term ³midwives´ to refer only to direct-entry
midwives.
For centuries, midwives were the primary ± and usually only ± option to assist a mother
in childbirth. Starting in the early 1800s, doctors began pitching their services to deliver children,
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campaigning that their medical educations set them apart from ³ignorant´ midwives (Cassidy).
«launched public education campaigns promoting the ideas that birth was painful and
should be treated like a disease, and that male attendants were best qualified to handle
deliveries. These early campaigns were brutally effective. By and large, midwives were
left to care for those who could not afford ± or did not live near ± a doctor. (Cassidy 39)
Thus, after being the dominant option for childbirth care for centuries, midwives delivered only
half of all babies in the U.S. by 1910 (Cassidy). As concerns about infection and disease grew,
and as the U.S. government began to forbid midwifery education, the medical community
became the dominant choice for expectant mothers. By 1930, midwives delivered 30% of
American babies, and those were mostly in the rural South to poor women. By 1973, direct-entry
The midwife was saved from obscurity by the women¶s liberation movement of the late
1970s. Turned off by the isolation of delivery rooms, the routine treatments (like enemas and
shaving) and the clinical approach of doctors and hospitals, women began requesting more
natural methods of childbirth, often choosing to deliver at home, even in states where it was
illegal. By 2006, midwives delivered 10% of vaginal births in the U.S., a number believed to be
As the favor of doctors and midwives has risen and fallen, other factors have influenced
women¶s options. Politics have come into play, as states regulate midwives differently, with
some offering education and licensing for midwives while others strictly forbid the practice all
together. Insurance, specifically malpractice insurance, has become such a burdensome cost that
many midwifery practices and free-standing birth centers have had to close (Cassidy). The
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medical community has been split on the health and safety of midwives, offering plenty of
studies that show that home births attended by midwives are ³as safe as´ or sometimes even safer
than hospital births (Cassidy), but also continuing to assert that hospital births are the safer
choice for mothers and babies (³Position Paper on Midwifery Licensure´). Clearly, the
discussion of childbirth care in America has become passionate, often leading to heated, divisive
rhetoric.
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The history of and present-day situation of midwives and obstetricians puts these two
camps at opposite ends of a long spectrum. The medical option of childbirth is clearly dominant,
but the natural childbirth camp is slowly gaining attention. As the groups wrestle with their
current status, and as expectant mothers make choices (if they are aware of having a choice) for
their childbirth care, it is important to understand the values and ethics of each organization.
Midwives may not identify themselves as medical practitioners, but they are caregivers
and likely have a similar set of values to medical caregivers. To better understand the ethics used
by all caregivers of expectant mothers, I will explore the general values of medical ethics and
how they are followed and interpreted by midwives and obstetricians. According to Steinberg
and others (so many others that this is considered common knowledge on Wikipedia), there are
treatment
2.c Beneficence (ë ) ± caregivers should act in the best interest of
the patient
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4.c ustice ± values concerning how to distribute resources and choose fairly which
5.c Dignity ± patients and caregivers have a right to be treated with dignity
I plan to further explain each value so that in my discourse analysis, I can discuss how the
professional codes of ethics written by the leading associations for midwives and obstetricians
Both the Midwives Alliance of North America (MANA) and the American Congress of
Obstetricians and Gynecologists (ACOG) spell out their ethics clearly in their organizational
Codes of Ethics. Most businesses today have written codes of ethics that function to ³influence
the decisions which individuals make so that the resulting behaviour [ Ë is acceptable to the
organisation [ Ë´ (Farrell and Farrell 588). Codes of ethics are their own unique genre. They
mostly operate the same way: to identify the values important to the associations and their
values (Farrell and Farrell). I¶ll review how a code of ethics reflects the values of an organization
incorporating research from Davis, Frankel, Farrell and Farrell, and Tucker et al on the
importance of codes of ethics and the role they play in professional organizations.
In ³The Discourse on Language,´ Foucault argues that groups are formed and divided
through language and discourse. The truth and collective knowledge of a group can be found
through its discourse²by what the members say, as well as by the discourse they exclude.
Foucault even uses a medical example to illustrate how the power of language and discourse
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within the medical community can create Truth about how the body works (even if that idea is
later proven false). This concept directly applies to the language used by midwives and doctors
and the ³truths´ about childbirth and maternal care created by such rhetoric. Therefore, if I can
provide a better understanding of the language and rhetoric used by MANA and ACOG in a
document like the Code of Ethics, I can better understand what defines and differentiates these
two groups and can perhaps even uncover an underlying truth to which they both subscribe.
employ a discourse analysis of text, in this case, specifically interpreting the language and
phrases employed in their Codes of Ethics. Discourse analysis is, according to Kinneavy,
the study of the situational uses of the potentials of the language. [ «Ë The particular
province of discourse study « excludes, on the one hand, merely linguistic or semantic
analyses and, on the other, aspects of the situational context and cultural context. But
whenever either the linguistic or the metapragmatic considerations can throw light on text
as such, they become subordinately relevant to discourse analysis (22-24, qtd. in Kaplan
Per Kinneavy¶s suggestion, studying the specific language used in a written document
can help us understand the full meaning of a text. Farrell and Farrell performed a discourse
analysis of corporate codes of ethics, revealing that writers of codes of ethics tend to employ five
specific linguistic features, which display the power of the organization and prevent the reader
from making independent decisions. Following their method, a discourse analysis of MANA¶s
and ACOG¶s Codes of Ethics should reveal the power dynamic of each group over their
membership. Furthermore, a discourse analysis of the specific words chosen will likely reveal
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important information about the values of each organization and the type of care they offer when
My discourse analysis would not be complete without also employing the works of Bitzer
and Burke. Clearly, the two Codes of Ethics were composed in different rhetorical situations
(Bitzer); the documents have very different audiences and were written within different
exigencies, and these differences should help shed light on the underlying values of each
organization. Furthermore, the language used by each group helps create a terministic screen
through which they interpret the world (Burke). Midwives and obstetricians view a laboring
mother differently ± either as a natural process or a medical situation ± and that screen affects
how they react to the mother. An analysis of Burke¶s application to these discourse communities
should help to further illuminate how they developed their ethics and values, and why each group
PROECT PLAN
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In order to analyze and discuss the differing rhetoric of these two groups and better
understand their values, I will write a thesis employing a comparative discourse analysis of the
Codes of Ethics for the Midwives Alliance of North America (MANA) and the American
organizations representing natural and medical childbirth options. I will begin by analyzing the
type of ethical appeals that each Code is making. I expect to find that both groups appeal to the
same major values of medical ethics, but use different rhetorical strategies to make those appeals.
I will try to find specific mentions of the six values of medical ethics and discuss how explicitly
(or not) they are defined. This analysis will help reveal the import that each organization places
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in each major tenet of medical ethics. I may find that both groups make similar appeals, and thus
share the same ethics²or that they are divided by something as essential as their ethics.
I will then compare the rhetorical strategies employed in MANA and ACOG¶s Codes of
Ethics, specifically analyzing the audience and goals of each piece. The audience chosen by each
group reflects whom they want to persuade ± an expectant mother or a fellow in the profession.
This choice illustrates differences in the goals that each group may have had in publishing their
Codes; in other words, appeals to the audience indicate how each group seeks validation and/or
works to persuade new clients (or, in the case of the dominant community, there may not be a
Finally, I will identify, analyze and compare the language used by both organizations. I
plan to identify key words used by each group and discuss those words that appear most often.
For example, the ACOG Code of Ethics always refers to the ³patient,´ while MANA uses the
term ³woman´ or ³woman and child.´ This choice of words reflects the type of care each group
offers: ACOG views an expectant woman as a medical case (as is expected of their medical
school training), while MANA stresses the value of personal relationships between midwives,
women and their children. I will also identify the linguistic features displayed in each code,
following the work of Farrell and Farrell, and how these features empower (or not) their
By analyzing the ethical claims, rhetorical strategies and language utilized in MANA and
ACOG¶s Codes of Ethics, I hope to clearly identify the two discourse communities involved in
American childbirth. I then hope to be able to expand on this knowledge by reflecting on how
these groups are participating (and will continue to contribute to) the current healthcare debate in
the U.S. As more women become insured, money will not be as much of decisive factor for
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future mothers. How might this affect how women review their childbirth options? I may also be
able to make recommendations to MANA and ACOG to alter their rhetoric (co-opting some of
the opposing group¶s language, perhaps) to appeal to the growing number of women, armed with
insurance and education about their options, who will be having children in the future.
With a goal of graduating in December 2011 but completing most of my work by the end of
summer 2011, I propose the following schedule for the development of my thesis:
uc Assemble my committee and gain full topic approval in early Fall 2010
Because of my later graduation date, I can be flexible to work within my committee members¶
schedules. Even though I plan to do most of my writing during the summer, I will not expect my
CONCLUSION
Alliance of North America and the American Congress of Obstetricians and Gynecologists, I
hope to reveal the values most important to each group and the language used to express those
values. By uncovering the rhetoric and values of each group, we can better understand what
defines the two discourse communities and how they are communicating to their audiences. I
plan to employ and contribute to research in the fields of medical ethics, rhetoric, health
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contribute to a greater understanding of the choices women have in childbirth care, and equip
women to make more educated choices in America¶s changing health care environment.
I look forward to the opportunity to research and write a thesis analyzing these issues
important to professional communication. I have a passion for this research and hope to share
that excitement with a dedicated committee chair. Though I am delaying my graduation until
December 2011, I am eager to begin working together. I will contact you in late August to set up
a meeting to discuss this thesis proposal and your interest in chairing it. Thank you for your
consideration.
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BIBLIOGRAPHY
Burke, Kenneth.
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Davis, Michael. ³Thinking Like an Engineer: The Place of a Code of Ethics in the Practice of a
Farrell, Helen, and Brian . Farrell. ³The Language of Business Codes of Ethics: Implications of
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Foucault, Michel. ³The Discourse on Language.´ In
)
& A.M. Sheridan Smith, Trans. New York: Pantheon, 1972. 215-
237.
Frankel, M. S., ³Professional Codes: Why, How and With What Impact?´ '
. 8 (1989): 109-115.
ovanovic, Spoma, and Roy V. Wood. ³Communication Ethics and Ethical Culture: A Study of
Kaplan, Robert B., and William Grabe. ³A Modern History of Written Discourse Analysis.´
'
ë
"
11 (2002): 191-223.
Kinneavy, . . Englewood Cliffs, N: Prentice Hall
(1971).
Lakhan S.E., E. Hamlat, T. McNamee, and C. Laird. ³Time for a Unified Approach to Medical
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MEB1.1.asp. Dr. Falk Schlesinger Institute for Medical-Halachic Research. 1998. Web.
2 une 2010.
19 (1999): 287-300.
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(
$. Berkeley: University of California Press, 2006. Print.
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