Evidence-based paradigms and contemporary midwifery

Midwifery and maternity care are fields of community health where the use of evidence is, at best, contested and at worst highly divisive. The process of childbearing elicits strong opinions and views within Australian communities and in popular culture and there is often little evidence per se underpinning such debates. As a profession, midwifery is traditionally dominated by women and has strong links with feminist thought and community activism. At various points in time midwifery has had an antagonistic relationship with medicine, a profession histOlically dominated by men. This has resulted in a long period of inter-professional negotiation and conflict, although in more recent times there has been some convergence. Despite the increasing prominence and legitimacy of midwifery in maternity care, questions around what is safe, and who should provide care in the context of birthing, remains contentious. The evidence-based paradigm is influential in delineating what is safe and risky in the context of maternity care and thus shapes the relationship between midwifery and medicine. The challenges that have occurred in development, use and interpretation of evidence in contemporary midwifery are exemplified in the practice ofhomebirth. In this chapter we investigate the politicising ofevidence, focusing on how diverse philosophical and political perspectives have challenged the conventional evidencebased paradigm in the case of homebirth. Furthermore, through this analysis we examine the relationship between midwifery and evidence-based health care. Homebirth presents a contentious example of the problematic of evidence-based practice for midwifery. That is, how midwifery as a profession has attempted to negotiate the demands of integration (with obstetrics) vis-a-vis remaining distinct and retaining core values. Here we explore the politics of birthing in Australia the role of 'evidence' and evidence-based social movements therein