More goofy midwifery theory


You can’t make this stuff up.

If you want a good laugh, try reading some of what passes for midwifery “philosophy” these days. I’d particularly recommend Normal Childbirth: Evidence and Debate by Soo Downe. It has certainly provided me with hours of entertainment.

As I detailed in a previous post, midwives are having a serious problem with scientific evidence. It seems that the scientific evidence does not support their beliefs. The obvious response is to modify their beliefs, but that’s not the course they have chosen. Instead, they are challenging the concept of scientific evidence. And like many other purveyors of pseudoscience, they have latched on to the language of quantum mechanics.

Of course, its midwifery advocates, like all its pseudoscience advocates are utterly ignorant of theoretical physics and the concepts of quantum mechanics. It sounds so good, so very scientific, and in pseudoscience, how it sounds is much more important than what it means.

Let’s back up a bit and look at the way that pseudoscience works. Wanda Mohr, writing for an audience of nursing students, explains the difference between science and pseudoscience:

Perhaps the most important characteristic that sets pseudoscientific practices apart from genuine scientific practices is the lack of concern with valid evidence. Practitioners of pseudoscience rely on eyewitness testimonies and personal anecdotes rather than well controlled and publicly verifiable studies…

Pseudoscientists operate from a set of assumptions, or assertions taken for granted or supposed that may be either explicit or hidden…

Professor Downe is quite open about her assumptions. In fact she lets Robbie Davis-Floyd leads with them in the preface, in the very first line of the text:

Let me be very clear. As the chapters in this book illustrate, the Western technocratic approach to birth, which has become the global technocratic approach to birth, is wrong. Simply and fundamentally wrong…

But Professor Downe has a problem. The scientific evidence does not support her pre-existing beliefs, so she sets herself the task of substituting scientific evidence with, in her words, “alternative ways of seeing.”

Downe accurately describes the concept of scientific evidence:

The currently held authoritative scientific and practice paradigm in most Western countries is based on the belief that the best, most certain evidence is gained from research based on the study of specific elements of the system, with enough individuals to be fairly sure that the results can be generalized to whole population. The ideal has been termed ‘large trials with simple protocols’. It is believed that this model increases certainty and that the findings from such trials, if they are carried out well, should be applied wholesale to individuals.

But this is precisely the paradigm that produces the scientific evidence that does not comport with Prof. Downe’s ideological assumptions. Since the assumptions must be right, it follows that the definition of scientific evidence must be wrong. Prof. Downe could make that simple assertion, but she knows that everyone would laugh. So instead she opts for what seems to her a more sophisticated assault on scientific evidence.

Mohr, writing about pseudoscience in nursing, anticipates this approach:

Most recently, several quacks have defended themselves using concepts from postmodernism… Postmodernists have applied such ideas and concepts as Gödel’s theorems, relativity, quantum mechanics (particularly the uncertainty principle), chaos theory, and catastrophe theory to literature and psychoanalysis.

The postmodern movement has infiltrated health care and nursing. This approach encourages people to believe that healthcare advice based on scientific research is of no more value than any other healthcare advice… Some authors borrow terms from theoretical physics without regard for what those terms actually mean… Many readers have little understanding of the scientific theory being invoked or the philosophical implications of what is being said. They may assume that if an author has a PhD, he or she should be believed without question.

Soo Downe, PhD faithfully follows this pseudoscientific approach:

Maxwell’s laws of thermodynamics represented an important shift in concepts of nature from those that pertained previously. While his first law described the principle of conservation of energy, the second described its dissipation (such as by movement producing heat). This implied a shift from order to disorder and led to the concept of entropy (that matter breaks down over time). Einstein’s relativity and quantum theories built on this work…

Never mind that Einstein was not the originator of quantum mechanics, Heisenberg and Schrodinger were. Never mind that Einstein was a vociferous critic of quantum mechanics. Never mind that Einstein famously retorted “God does not play dice” in response to the implications of quantum mechanics. (And those who are familiar with physics know that Maxwell’s equations are about electromagnetism, not thermodynamics.) Einstein was smart and he had something to do with quantum theory so that must make it true and relevant to midwifery.

The implication of the new subatomic physics was that certainty was replaced by probability, or the notion of tendencies rather than absolutes: ‘we can never predict an atomic event with certainty; we can only predict the likelihood of its happening’… This directly contradicts the mechanistic model we explored above, and it implies that a subject such as normal birth needs to be looked at as a whole rather than its parts…”

Wait one moment while I picked myself up off the floor from laughing so hard. Prof. Downe seems to have missed the most basic, most important fact about quantum mechanics, which is not surprising since she doesn’t have a clue as to what it means. Quantum mechanics is an explanation of events at the atomic level, not on at the level of objects in the world. So unless Downe would like to discuss the individual atoms that make up the molecules that make up the cells of the fetus, quantum mechanics has no applicability.

Never mind. It sounds so cool and so scientific.

When we turn to the implications of this paradigm shift for our understanding of health, it becomes clear that the benefit or harm of an intervention for an individual can only be established with reasonable certainty by identifying and taking into account all the relevant “noise”. This includes environment, carer, attitudes, skills and beliefs, and the expectation of the woman and her family. Similarly, the appraisal of research and evidence needs to consider the concept of attitudes and roles of researchers and how these may have framed or influenced the process of generating evidence…

Prof. Downe has managed a stupidity trifecta: she used the wrong theory, from the wrong field, wrongly interpreted to reach the ideologically predetermined result.

It’s not as though Downe wasn’t warned about this approach, as she acknowledges:

… [A] number of authors have cautioned against oversimplistic generalization of the seductive post-modernists aspects of multipliticy and connectivity that are expressed in these theories. Carol Haigh, writing from a nursing perspective, sees the misuse of chaos theory as being particularly prevalent within nursing and research and philosophy. She cautioned that application of the chaos contruct is not relevant without a thorough understanding and use of the mathematical underpinnings of the theories…

The same warning applies equally to the misuse of the quantum mechanics. But Downe airily dismisses this criticism. She doesn’t quibble with the idea that she lacks a thorough understanding of the mathematical underpinnings of the theories, but:

While we accept her thesis to some extend, we depart from her apparent rejection of the potential for the insights of complexity and chaos to provide new ways of seeing at the macro level…

Of course, this is that view that is the problem. Quantum theory has no applicability to midwifery or to the concept of scientific evidence. If Downe understood quantum mechanics, and the mathematics that underpins it, she wouldn’t dare apply it to midwifery. It is precisely because she hasn’t a clue as to what it means, that she thinks it is “relevant.”