Licensed lay midwifery and the medical model of childbirth.

Previous research has tended to equate lay midwifery with demedicalized care. This paper analyzes how licensed lay midwives in Arizona have been pressured towards a more medical model of childbirth. Licensing has affected midwives' beliefs and practices through increasing their exposure to medical definitions of childbirth and making them legally accountable to the medically dominated State Department of Health Services. The midwives' cumulative experience with handling obstetrical problems has also affected their definitions of childbirth. The midwives have maintained a commitment to holistic care, but have moved towards a more hierarchical style of practice due to changes in their clientele, the need for efficient bureaucratic arrangements, and the desire to earn a living at midwifery.