Thesis Defense by Anne-Sophie Pilarski

Ms. Anne-Sophie PILARSKI publicly defended her thesis entitled "The midwifery profession or the art of calculated risk. A sociology of pregnancy management in France,"supervised by Laurent Visier and François Buton, on Friday, December 13, 2024, at 9:00 a.m., at the Faculty of Law and Political Science of Montpellier, Justitia Room.

Composition of the proposed jury

Mr. Laurent VISIER – University of Montpellier – Thesis supervisor

Mr. François BUTON – CNRS ENS de LYON – Thesis co-supervisor

Mr. Philippe CHARRIER – Nantes University – Rapporteur

Ms. Priscille SAUVEGRAIN – Sorbonne University – Rapporteur

Ms. Laura MICHEL – University of Montpellier – Examiner

Ms. Anastasia MEIDANI – University of Toulouse – Jean Jaurès – Examiner

Keywords:midwifery, prenatal care, professionalization, empowerment, technicization, care/cure

Summary:

This sociological investigation of midwives' work in the context of prenatal care in France sheds light on the mechanisms of professional appropriation of this activity. The methodological approach, rooted in a multidimensional perspective, combines the contributions of the sociology of work and professions and "bottom-up" public action, based on a multi-situated ethnographic approach. The socio-historical analysis of the profession since the 18th century reveals a non-linear trajectory, alternating between jurisdictional expansion and restriction. After consolidation in the 19th century, the 20th century saw an erosion of prerogatives in favor of emerging medical specialties. The beginning of the 21st century marked the start of a reappropriation of skills, in a context of medical demographic tension and collective mobilization. The professional identity of midwives is characterized by an interstitial position between cure/care and medical/paramedical. Bureaucratization and the development of research in midwifery are seen as strategies for legitimization. The study of midwife/patient interactions, through the concept of agency, shows how professional evolution promotes the empowerment of users. "Proximity" emerges as a characteristic feature, attenuating the expert-layperson asymmetry. Analysis of practices reveals a cure/care articulation and a critical integration of probabilistic reasoning and technicization. The prudential nature of the activity is emphasized, characterized by adaptation to singularities and careful risk management, positioning midwives as professionals of vulnerability rather than mere guarantors of physiology. The contributions of this research include an analysis of the specific position of midwives in the professional ecology of the healthcare system, an examination of the extension of their jurisdiction, and their nuanced approach to the technicization of care. This study helps to shed light on the dynamics of transformation in the health professions and highlights the relevance of understanding the midwifery profession as an analytical prism for contemporary public health issues and the reconfiguration of the medical field.