Expectations of motherhood: Citizenship and political mobilization for midwifery in Virginia

What prompts women to become politically mobilized around healthcare issues? And how do their resultant expectations and strategies influence the outcome of their mobilization? In this study, I explore women's support of midwifery and homebirth in the context of political and economic changes around healthcare and shifting cultural meanings of motherhood and citizenship in the United States. The recent grassroots organization among homebirthers in Virginia to enhance local midwifery services is the subject of this inquiry. First, I demonstrate historically how women's political mobilization around past healthcare initiatives---such as the movement to improve infant and maternal health in the early 1900s and the Natural Childbirth Movement during the mid- to late 1900s---has further stratified, rather than ameliorated, women's uneven access to healthcare services. Most often, these movements have enhanced reproductive options for white, middle-class and affluent women, but have continued to restrict the reproductive choices of women of color and poor women. In this context, the contemporary political organizing for homebirth midwifery in Virginia---primarily among white, educated women who represent a variety of political, religious, and class backgrounds---further illustrates the diverse expectations and experiences of motherhood, citizenship, and political action among different constituencies of women. In response to medical and state characterizations of homebirthers as pathological mothers, many midwifery supporters have denied participation in political activity---although they continued to perform actions that they defined as political. This seemingly paradoxical strategy is one way that some homebirthers understood themselves as political actors, but only in their capacity as "respectable," apolitical mothers. Additionally, some midwifery advocates have begun to define themselves as "consumers" of healthcare services---particularly in conversation with government officials---reflecting a neoliberal definition of citizenship under which the state prioritizes "consumer rights" over the social, economic, and political rights of its citizens. In this dissertation, I explore the consequences of these strategies for midwifery supporters. I highlight the contradictions between most midwifery supporters' aspiration to support low-cost, community-based reproductive care for all women and the increasing commercialization and stratification of alternative healthcare in the U.S., including midwifery services.