All that’s wrong with midwifery in two sentences

The folks over at the Journal of Midwifery and Women’s Health have a problem. They are obsessed with labeling birth. They are absolutely, positively certain that their view of birth is THE TRUTH, and want to give their view an adjective that proclaims to everyone (most especially themselves) that their view is the safest, best, healthiest way to have a baby. First they called it “natural” birth as if everyone who deviated from their prescription were somehow having artificial births or producing plastic babies.

In addition “natural” birth is a problematic description because the philosophy of “natural” childbirth bears absolutely no resemblance to childbirth in nature. Last I checked, childbirth in nature did not involve prenatal visits, blood pressure checks, periodic weighing. It also didn’t involve intermittent fetal monitoring, kiddie pools and neonatal resuscitation.

So midwives invented a new description used only by them and their acolytes: “normal” birth. But as Holly Powell Kennedy recognizes in an editorial in this month’s issue, calling their view of “normal” implies that anyone who doesn’t do it their way is abnormal.

… It is a word that dichotomizes—if you are not “normal,” then you must be abnormal, atypical, disordered, unhealthy, or irregular—and who wants those labels?

This issue doesn’t present much of problem for most of us. Normal birth is pretty simple: the baby that was once inside is now outside, and most importantly, the baby is healthy. That’s all there is to “normal” birth for most women. But that’s unacceptable to midwives like Kennedy, who in the tradition of birth activists, is obsessed with the process and considers the outcome almost irrelevant.

I propose that “normal” is commonly used by midwives as a way to describe a process that counters the common and escalating interventions in many birth settings. A more fitting term might be “physiologic”— that which reflects the innate capacity of a woman’s body to reproduce without intervention—and which most women would be able to achieve when left alone to find their strength, and supported as needed in the process.

There you have it: everything that is wrong with contemporary midwifery wrapped up in two somewhat clumsy sentences. Why is this sentence appalling? Let me count the ways.

1. “commonly used by midwives”

The definition that counts is the one that midwives select. There are no objective criteria.

2. “counters”

The correct views of midwives are oppositional. Whatever is common in current obstetrical practice is to be opposed. Do common practices save lives? Who cares? It’s about the process, not the outcome.

3. “innate capacity”

What is that supposed to mean? Every woman has the “innate capacity” to get pregnant, but that doesn’t mean that she can. Every women has the “innate capacity” to carry a pregnancy to term but that doesn’t prevent miscarriage. Every woman has the “innate capacity” to have a vaginal delivery, but that doesn’t mean that the baby will fit or that the baby will live through the process.

4. “reproduce without intervention”

Ahh, there’s that obsession with process again. And what’s wrong with interventions anyway? It’s as if Kennedy and other midwives oppose any interventions on the principle that they are inherently bad. No attempt is made to discern if the interventions are helpful or even if they are requested by a woman herself.

5. “most woman would be able to achieve”

Would the baby be alive at the end of this achievement? Would the mother be alive? Kennedy doesn’t say. It’s the process that counts, not the outcome.

6. “strength”

Oh, please, please stop the bullshit! Strength? Birth has precisely NOTHING to do with strength, either physical or spiritual. It depends on three things: the pelvis, the passenger (the baby) and the power (strength of uterine contractions). If the pelvis is too small, the baby won’t fit, and all the “strength” in the world won’t make a whit of difference. If the baby is too big, won’t fit and all the “strength” in the world is useless. If the uterine contractions are not forceful enough, the baby won’t come out and both mother and baby will die in the process, and, you guessed it, strength is irrelevant.

The stupidity doesn’t end there.

I suggest that our culture has situated childbirth fully in risk …

How sad for all those women and babies buried in graveyards around the world. They didn’t die because of the risks of childbirth. They were tricked!

Fear of birth has become the foundation of childbearing in US culture. We do not usually fear things that are normal …

Last I heard, most people fear death and there’s nothing more normal than death. Childbirth is one of the top 10 causes of death of young women in EVERY time, place and culture, including our own. Out of the 18 years of childhood, the day with the highest risk of death is the day of birth. Stop pretending that women fear birth and acknowledge reality: women fear that they or their babies could die and that fear is completely justified.

We live in … a culture that deifies technology and control, with no room for uncertainty of any kind or for less than perfect outcomes.

Yes, we live in a culture where we don’t like to wonder whether our babies will live or die and we certainly don’t like them to die or be rendered brain damaged. Evidently people like Kennedy, for whom the process is more important than the outcome, are willingly to risk “less than perfect outcomes” so they can brag out their “normal” births.

The problem here is not birth, it is midwives. This piece unwittingly reveals the profoundly unscientific, biased and self aggrandizing nature of contemporary midwifery. Midwifery is obsessed with labeling women, dividing them into those who give birth following the preapproved directives and those who do not. Midwifery is obsessed with insulting women who do not adhere to its principles. The language used, words like “natural” and “normal,” is deliberately and profoundly judgmental. Midwifery is obsessed with process; the outcome is virtually irrelevant and never even mentioned in the editorial. Midwifery is based on opinion, not science; in the entire editorial scientific evidence is not mentioned even once.

Midwives have appointed themselves arbiters of birth. They define, they judge, they pontificate. They are mean and they are wrong.

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