Thesis (Ph. D.)--University of Wisconsin--Madison, 1989. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 495-515).

This thesis explores the newly established role of midwife practitioner (MP) and its impact on midwives and obstetricians in a maternity unit in Wales. MPs manage the care of women at high obstetric risk and carry out aspects of care, such as assessment, diagnosis and the development of management plans, which in the past were predominantly performed by obstetricians. This qualitative study employs a focused ethnographic approach and uses a purposive sample. Phase one consisted of seven focus groups, which were held between May and August 2004, with midwives (n=48) from maternity units in Mid and South Wales. In Phase two, participant observation was undertaken with MPs (n=3) over a two-week period encompassing eight 12-hour night shifts, during November and December 2004. For Phase three, semi-structured interviews were conducted with midwives (n=10), clients (n=10) and obstetricians (n=7), between July and December 2005. Phases two and three were carried out in a maternity unit in South Wales. The key findings of this study demonstrate that the lack of planning for the MP role inadvertently resulted in the creation of a distinct health care role, which encompasses positive aspects of both midwives' and obstetricians' work to provide safe and acceptable care for clients. The MPs in this study are committed to providing holistic care that takes into consideration the emotional and social needs of women and their families. In addition, these MPs are developing confidence and analytical skills, normally demonstrated by medical staff. However, further initiatives such as allowing MPs to prescribe, or to refer to other specialties, have not yet been adapted to support these new roles. It is too early to see the full impact of this role, but it is argued that it will have no significant effect on the work of the other midwives. MPs, however, do have the potential to impact upon the work of the obstetricians. This study contributes to the current body of knowledge concerning policy and practice for maternity care by examining a new role early in its genesis. This study makes a number of recommendations, including extending the number of MPs employed in Wales, the need for careful planning of future extensions to the midwives' role and further research into the safety and effectiveness of the MP role.

Listening to Birth asserts that structures of power reproduce themselves by instituting particular modes of listening and sound production. Situating my research within feminist sound studies, I argue that meanings conjured around the audible, material bodies of women were carefully crafted by elites in antiquity, in order to construct gendered ideologies of kingship, civilisation, and nature. I examine these power dynamics as expressed in mythic and magical texts and iconographies, dating from the Bronze Age to later Roman antiquity. Throughout the thesis, I examine the development of symbolic systems and narrative tropes that linked mining and metallurgy with reproduction and vocality. My analysis emphasises how the invention of nature was accomplished, in part, through a metallurgical reclassification of the voices and sexualities of women as indiscrete phenomena: womb, mouth, and voice were elided with mining and smelting to form a unified semantic realm. I argue that this invention of ‘vulvar vocality’ reclassified female sounds as illicit, providing a plaform for the removal of women from the public sphere. I attempt to connect the gendered discourse found in myths and magical rituals to the political and economic domain of state-craft, to demonstrate the importance of hegemonic mythopoeic control of audible female reproduction for establishing ideologies of colonisation and extraction. I link analyses of texts and iconographies from the Bronze Age Mesopotamians, Hittites, Canaanites, Minoans, and Egyptians to later materials from the Iron Age Greeks, Israelites, and Romans—my goal is to demonstrate both the ubiquity and the continual reproduction of metallurgical ideology across the ancient world. I also present my preliminary research into the lasting impact that antique notions of vulvar vocality had on later state-craft. I begin to trace the preservation and elaboration of antique metallurgical literature by Byzantine and Islamic scholars, who in turn exerted strong influence on the Ottomans and late medieval and early modern Europeans. I outline future work to investigate the exponential rise of entrepreneurial metallurgy in late medieval and early modern Europe, arguing that this metallurgical discourse provided symbolic re-enforcement for the rapidly-accelerating mining and metal trade that formed the core of European colonial expansion. I suggest that vulvar vocality was central to early modern metallurgical, demonological, and colonial discourse, and that specific female vocalities and silences were purposefully crafted into the colonial project in order to forcibly redefine women, along with the lands and children stolen from them, as mere natural resources.