Thesis Defense by Anne-Sophie Pilarski

Ms. Anne-Sophie PILARSKI publicly defended her dissertation, titled“The Midwifery Profession, or the Art of Calculated Risk. A Sociology of Pregnancy Governance in France,”supervised by Mr. Laurent Visier and Mr. François Buton, on Friday, December 13, 2024, at 9:00 a.m., at the Faculty of Law and Political Science in Montpellier, Justitia Hall.

Proposed jury composition

Mr. Laurent VISIER – University of Montpellier – Thesis Advisor

Mr. François BUTON – CNRS ENS de LYON – Thesis Co-Advisor

Mr. Philippe CHARRIER – University of Nantes – Rapporteur

Ms. Priscille SAUVEGRAIN – Sorbonne University – Rapporteur

Ms. Laura MICHEL – University of Montpellier – Examiner

Anastasia MEIDANI – University of Toulouse – Jean Jaurès – Examiner

Keywords:midwifery profession, prenatal care, professionalization, empowerment, technicization, care/treatment

Summary:

This sociological study of midwives’ work in the context of prenatal care in France sheds light on the mechanisms through which this practice has become a recognized profession. The methodological approach, grounded in a multidimensional perspective, combines insights from the sociology of work and professions and from “bottom-up” public action, drawing on a multi-sited ethnographic methodology. A sociohistorical analysis of the profession since the 18th century reveals a non-linear trajectory, alternating between jurisdictional expansion and restriction. Following a period of consolidation in the 19th century, the 20th century saw an erosion of their prerogatives in favor of emerging medical specialties. The early 21st century marks the beginning of a reappropriation of competencies, against a backdrop of medical workforce shortages 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 viewed as strategies for legitimization. The study of midwife-patient interactions, through the concept of agency, demonstrates how professional evolution promotes the empowerment of service users. “Proximity” emerges as a defining trait, mitigating the expert-layperson asymmetry. An analysis of practices reveals an interplay between cure and care and a critical integration of probabilistic reasoning and technicization. The prudential nature of the profession is highlighted, characterized by adaptation to individual circumstances and nuanced risk management, positioning midwives as professionals of vulnerability rather than mere guardians of physiology. The contributions of this research include an analysis of midwives’ specific position within the professional ecology of the healthcare system, an examination of the expansion of their scope of practice, and their nuanced approach to the technicization of care. This study helps shed light on the dynamics of transformation within the health professions and highlights the relevance of viewing the midwifery profession as an analytical lens through which to examine contemporary public health issues and the reconfiguration of the medical field.