Who hijacked childbirth?

There have always been midwives.

Ever since our ancestors acquired the ability to walk upright, human childbirth has been fraught with extreme risk to both mother and baby. The first midwives were those who recognized that assistance in childbirth can minimize those risks.

They understood that something as simple as massaging a woman’s uterus after childbirth could prevent life threatening hemorrhage and that different fetal positions like breech posed specific problems that could be overcome with specific maneuvers. Over time they acquired knowledge of the pharmacologic properties of certain plants and gave extracts to women with the intention of starting labor or stopping bleeding.

Above all, ancient midwives were empiricists. Their very existence was predicated on the inherent dangers of childbirth and everything they did was devoted to preventing death and injury. They abjured magic incantations in favor of empirical observation. They noted what worked and what did not and faithfully strove to incorporate those scientific observations into practice.

Despite profound changes in the human condition, midwifery changed very little. Midwifery knowledge grew, of course, and that knowledge was supplemented by appeals to whatever forces were deemed to be in charge at the time (nature, gods, the Church), but the purpose always remained the same. And the faithful adherence to empiricism (as opposed to the often outlandish theories held by doctors up to the 19th century), ensured that midwives provided the best possible care to the women they served.

That was certainly what I understood midwifery to be when I entered medical school, and that view was reinforced by working extensively with certified nurse midwives in the hospital setting. I found them to be highly educated, very experienced and capable of providing a more personalized form of care. But gradually I came to understand that midwifery has been pervaded by distinctive forms of feminist philosophy that rejected the traditional empiricism of ancient midwives in favor of philosophical theories. In fact, I think it is fair to say that childbirth in general and midwifery in particular have been hijacked by radical feminists.

These feminists were part of the second wave of feminists, who moved from insisting that women are equal to men (and therefore have the same rights) to insisting that women are different from men, and that those differences make women superior. Among the second wave feminists were two types of radical feminists that have profoundly changed the way that childbirth is understood. These two groups of feminists are biological essentialists and feminist anti-rationalists.

Broadly speaking, the biological essentialists are characterized by a belief that women are defined by their biology and that their biological differences should be celebrated; the premier biological essentialist in the natural childbirth movement is Sheila Kitzinger. The anti-rationalists are essentialists with a twist. In their view, empiricism and rational thought are the preserves of men, and that women have “different ways of knowing.” The premier anti-rationalist in the childbirth movement is Robbie Davis-Floyd.

The essentialists and the anti-rationalists share quite a few characteristics. Almost exclusively Western, white women of privileged classes, they believe that they speak for all women because all women have the same needs and desires. They simply assume that they represent non-Western women and women of color. They are sociologists and anthropologists. Curiously, they have little or no practical knowledge of childbirth or modern obstetrics, but don’t view that lack of knowledge to as a problem.

You can recognize them by what they say. The biological essentialists are fond of catch phrases like “trust birth” and “pregnancy is not a disease.” They insist that obstetrics has “pathologized” childbirth and they can display a shocking and callous fatalism by dismissing deaths with the dictum that “babies die, that’s just the way it is” or “some babies are not meant to live.”

The anti-rationalists are distinguished, not surprisingly, by their anti-rationalism. They dismiss science as a male form of “authoritative knowledge” on the understanding that there are “other ways of knowing” like “intuition.” Many are post modernists who believe that reality is radically subjective, that rationality is unnecessary and that “including the non-rational is sensible midwifery”

How do professional childbirth advocates line up? To some extent, all are biological determinists who deliberately conflate the is/ought distinction. Since childbirth in nature IS a certain way, it OUGHT to be allowed to proceed in exactly in that way at all times. Natural is understood to be superior and technology is automatically inferior.

The difference between biological essentialists and feminist anti-rationalists is primarily in their view of rationalism. Among the true biological essentialists are Henci Goer and Amy Romano. The biolgical essentialists are represented by organizations like Lamaze and the American College of Nurse Midwives (ACNM). They worship the “natural” on the assumption that biology determines what is best for all women. Nonetheless, they believe that science is non-gendered, valuable and the standard by which claims about childbirth should be judged. They freely quote scientific papers and insist that their views of childbirth are “evidence based” even when they are not. They value empirical knowledge and advanced education.

The non-rationalists reject science as male, and unfairly regarded as authoratative merely because it is male. To the extent that science supports their beliefs, they are willing to brandish scientific papers as “proof,” but explictly reject rationalism when it does not comport with their personal beliefs, feelings and opinions. They do not value empirical knowledge and reject rigorous education.

The grandmother of anti-rationalism among childbirth advocates is Ina May Gaskin and MANA, which is her creation, is the primary organizational exponent of anti-rationalism in childbirth. Radical midwifery theorists like Soo Downe and Jenny Parratt provide the ideological underpinnings of anti-rationalism within midwifery. Also included under the anti-rationalist umbrella are the “freebirthers” like Laura Shanley and Janet Fraser, and the Quiverful movement that rejects rationalism in favor of religious belief.

As far as I (and most women) are concerned biological essentialism and feminist anti-rationalism are two radical theories that have come and gone. Women are not determined by their biology and women differ in their needs and desires even if they share common biology. Anti-rationalism is the preserve of educated social theorists and uneducated laypeople. It is a doctrine of sour grapes. Rationalism does not support their opinions and rather than changing their opinions, they prefer to reject rationality itself. Anti-rationalism cannot account for the fact that some women not only believe in science, but they are scienttists.

Ultimately, the natural childbirth movement is wrong, not merely in its scientific and historical claims, but especially in its underlying philosophy. Most women no longer accept that they are supposed to be defined and determined by their biology. They believe that just because something is a certain way in nature, it does not mean that it ought to be that way today. In nature “some babies aren’t meant to live,” but that doesn’t mean that we should withhold our technological expertise and let those babies die. In nature, women give birth in agony, but that does not mean that women ought to give birth in agony or that it is an “achievement” to do so.

Most women are not, and never were anti-rationalists. They do not view reality as radically subjective; they embrace science and become scientists and doctors themselves. They value knowledge and respect advanced education.

Midwifery has been pervaded and in some sense perverted by the biological essentialists and the anti-rationalists. Childbirth has been hijacked by radical feminist theorists, and it is time for the rest of us to take it back.

  • Captain Obvious

    From one of Amy’s posts…
    “Ina May Gaskin

    Would you hire this midwife?

    Don’t let the head suddenly explode from the mother’s puss. Coach the mother about how much and how hard to push. Support the mother’s taint with your hand during rushes. It helps the mother to relax around her puss if you massage her there using a liberal amount of baby oil to lubricate the skin. Sometimes touching her very gently on or around her button (clitoris) will enable her to relax even more. I keep both hands there and busy all the time while crowning … doing whatever seems most necessary.

    And:

    Sometimes I see that a husband is afraid to touch his wife’s tits because of the midwife’s presence, so I touch them, get in there and squeeze them, talk about how nice they are, and make him welcome.

    And:

    I might want to have a cunt one day and a twat the next. On the third day I might decide that pussy is my favorite word.

    Would you hire this midwife?

    Her quotes make her sound immature, foul mouthed, and sexually inappropriate.

    Plenty of women have hired her. Her name is …

    Ina May Gaskin.
    The quotes come from Spiritual Midwifery, 3rd and 4th Editions”

  • ron

    You’re really missing the point. It’s not a pissing contest about medical hierarchies. OBs are trained to handle complications that require technology, surgery etc. They rarely involve themselves in the psychology and human side of birth. Midwives (mostly female) are much more effective than doctors when nothing goes wrong. However OBs (mostly male) seem to need to make themselves relevant where they wouldn’t be otherwise.

    • Captain Obvious

      Most OBs nowadays are female! A midwife is taking on all responsibility by herself, foolish. Yes, sometimes a smart one will have a second midwife help. A doctor has a trained L&D nurse to be with the patient, a nurse anesthetist available if needed. An OR is available and any medicine or assistance. I hate when people say OBs are surgeons. We are primary care doctors caring for women from teens til death. I love the routine fun delivery. Hand the baby to mom right away,, take photos, DCC for a minute or two. Unfortunately, that is the exception. With fetal HR issues, meconium, fatigue or whatnot, most deliveries need supervision. Would you ever start a project or surgery that you couldn’t Handle all the possible complications or outcomes? Midwives do! A doctor and his/her nurse and staff can start with your delivery and finish with it. A midwife has to recognize her limits first and than transfer.

    • Young CC Prof

      That’s funny. I just got back from a routine appointment with my OB, a great lady around my mom’s age, and we discussed actual delivery issues for the first time. She loves birth, loves babies, and her office is filled with bulletin boards full of the babies she’s delivered. Every time she hears my baby’s heartbeat, she smiles.

      She believes in walking to speed labor, perineal massage to prevent tearing, and letting babies come in their own time unless there’s a good reason not to. We also discussed contingency plans for not-natural birth. I like being in the hands of someone who will let things proceed naturally if possible, but who also knows when intervention is necessary, because she’s seen so many deliveries, both easy and complicated.

      That being said, a midwife with doctor as backup is also a great option. The only time a midwife is not so great is if the midwife starts to think her job is to prevent interventions, rather than helping women deliver healthy babies, or if the midwife starts deliberately promoting solo out-of-hospital deliveries.

  • Ron

    This was exactly my experience except they wouldn’t let me get up. I felt like if i could just get on to my knees, or squat that i would lose control. instead they forced me into over an hour of ineffective pushing on my side and in stirrups (utterly degrading) then finally gave me oxytocin. A few more pushes and we had slow heart rate and I was told his head wasn’t straight so we moved to vacuum. They essentially made me push on his head while telling me there was something wrong with my body. I got through non-anaesthetised labour just fine but didn’t get the pay-off of having some control during pushing. It was horrible.

    • Captain Obvious

      A healthcare professional, doctor or midwife, is recommending you to try different positions to help resolve the asynclitic position based on their years of experience and all you take out of it is that the doctor is telling you something is wrong with your body? Your baby’s head was asynclitic in your pelvis. Next, you will be telling us when doctors try to treat your HTN or DM or perform surgery on your appendix or gall bladder that all you remember is that the doctor was yelling at you that something is wrong with your body.

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