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 in recent years midwifery has been pervaded by distinctive forms of feminist philosophy that rejects 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 theorist 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 purportedly have the same needs and desires. They simply assume that they represent non-Western women and women of color, but have never bothered to ask them. 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 “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 biological 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 authoritative merely because it is male. To the extent that science supports their beliefs, they are willing to brandish scientific papers as “proof,” but explicitly 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 the Midwives Alliance of North America (MANA), which is in part 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 scientists.
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.
This piece first appeared in December 2010.