Did midwifery merely replace the patriarchy with the matriarchy?

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I’ve written extensively about the misogynistic views of Grantly Dick-Read, the father of natural childbirth. Dick-Read was deeply concerned that white women of the “better classes” were forsaking childbearing for political and economic rights. He viewed childbirth pain as one of the reasons, and strove to convince women that the pain of childbirth was in their heads, arguing that “primitive” women have painless births, an utter lie.

The philosophy of Lamaze birth began in the postwar Soviet Union when leaders tried to make a virtue of necessity. As Paula A. Michaels relates in her excellent book Lamaze: An International History, they could not afford to purchase the pain relieving mediciations available in the West, so they conjured a method of abolish the pain of childbirth by psychological conditioning. Soviet obstetricians believed that women were weak and had been “conditioned” to believe that childbirth was painful. Therefore, through patterned breathing and other exercises, they could be conditioned in Pavlovian fashion to have no pain at all. Lamaze was imported into France for political reasons. It was first used at hospitals run by the Communist Party of France as an example of the superiority of Soviet science over American science.

Therefore, both major forms of natural childbirth were based on deeply sexist and retrograde views of women, and scientific claims that were never true. They also shared another important characteristic, one that is rarely acknowledged among contemporary natural childbirth advocates. The practice of natural childbirth was deeply and deliberately paternalistic. It explicitly depended on the laboring mother trusting the doctor to take charge of childbirth. By convincing the mother that the pain of childbirth was in her head, doctors hoped to shame women into being more docile patients. Indeed, Lamaze and his Soviet and French colleagues graded women on their performance in labor. Women could be given and were given failing grades for exhibiting signs of pain.

Interestingly, neither Dick-Read nor Lamaze opposed the use of pain relief in labor. However, it was the doctor who decided, based on a woman’s performance, whether or not she needed or deserved pain relief. At no point were laboring women asked about their preferences or needs.

As Michaels notes:

… American obstetrician shared the value that European doctors put on psychoprophylaxis as a means to impart — as Soviet obstetricians liked to put it — discipline. The laboring woman who willingly and quietly relinquished control of the process to her obstetrician, while playing an active roll in assisting him to deliver her baby, was characterized as successful.

So the philosophy of natural childbirth is and has always been deeply sexist, unscientific, and patriarchal. How, then, did it come to be seen as feminist? The primary reason is that in contemporary incarnations, women, in the form of midwives, doulas and childbirth educators, replaced men as the people who manipulated women into behaving in ways that were convenient for them.

Simply put, natural childbirth has exchanged the matriarchy for the patriarchy.

That doesn’t mean that contemporary female arbiters don’t believe completely in their view of childbirth. Grantly Dick-Read, Lamaze and the other male originators of natural childbirth philosophy also deeply believed that what was convenient for them, a docile patient who refused pharmacological pain relief, was in the best interests of women. But natural childbirth, in its current incarnation, is still about convincing women that what’s actually in the provider’s best interest is in the woman’s best interest.

It is in the interest of midwives, doulas and childbirth educators to convince women not merely that they can control the pain of childbirth by preparation, but that experiencing the pain of childbirth is in itself a necessary, valuable and healthier choice. Contemporary natural childbirth is, in large part, about what midwives can and cannot do. If a midwife can do it, it is an acceptable practice. If a midwife can’t do it, it is an “intervention.” Hence epidurals, fetal monitoring and inductions are “interventions,” while waterbirth, cranio-sacral therapy, and herbal supplements are not.

But most importantly, and most apparent in countries where midwives are gate keepers of maternity care, it is the midwife who determines whether a patient needs pain relief and whether she gets it, not the patient. It is the midwife who determines whether a woman’s performance in labor is successful, not the patient. Both midwives and doulas appear to view pharmacologic pain relief as evidence of “giving in” and failure on the part of the mother. Both midwives and doulas appear to believe that they are more capable of judging whether a laboring woman “needs” pain relief than the woman herself. They have perfected delaying tactics (“You don’t really need it.””You’re doing great.” “You’re almost there.”), shaming tactics, and don’t hesitate to resort to simple obstruction by refusing to call for an anesthesiologist when the patient requests it.

The mantra of natural childbirth is “choice” but the meaning of choice within the world of natural childbirth is deeply circumscribed. When midwives, doulas and childbirth educators use the word choice, they don’t mean all possible choices that a woman might make. They mean one choice and one choice only, the choice to have a “normal” birth.

Midwives have replaced the obstetric patriarchy with the matriarchy. Some wield their power for the mother’s benefit, but more often that power is wielded for the midwife’s benefit. Midwives want to have complete control over childbirth and to that end, they lie to women about the risks of interventions, the dangers of refusing interventions, and the purported value of forgoing pain relief. Midwives do exactly what they abhorred about obstetricians, insisting that they know better than the patient herself what’s good for her.

Natural childbirth advocates have not overthrown the “authoritative knowledge” of obstetricians, they’ve simply promoted themselves to the role of the authorities.

  • Land of the Seven Horizons

    Matriarchy means egalitarian, not the patriarchy reversed.

  • MJB2005

    Great post. This sums up so much of the wrong-headed thinking inherent to the natural childbirth philosophy.

    I had my first child in the UK under the NHS system and, as a result, became more familiar than I wanted to be with the natural childbirth movement. Our ante-natal classes were ridiculous. We were constantly told that our midwife was there to be our advocate in labor and that our choices as birthing mothers should be respected.

    When I asked whether the choice of a woman who wanted an elective C-section without medical grounds would be respected to the same degree as a woman who wanted a drug-free labor at home, the instructor just stared at me open-mouthed, as if it had never occurred to her that a woman would choose a C-section and that, if she did, her choice should be respected the same as any other.

    When push came to shove, so to speak, the midwives who attended my labor used exactly those shaming tactics mentioned in this post (‘did you not know that labor would be painful?’ in a mocking tone and intense irritation when I asked for an epidural after 24 hours of a non-progressing labor).

    The sad thing is that here in the US, I now see the natural childbirth dogma is spreading like wildfire. I am due to have my second child here soon and when I asked friends for recommendations on OB-GYNs, I got recommendations for birth doulas and midwives and hospitals with low C-section rates. No-one understands me when I tell them that I want to stay as far away from midwives and doulas as I can and just find a good, well-trained obstetrician who has a solid track record on delivering healthy, living babies!

  • Votre

    Like the Who song said: “Meet the new boss. Same as the old boss…”

  • Daleth

    Interesting study that’s relevant here:

    “Controlling pain during childbirth and post delivery may reduce the
    risk of postpartum depression, writes Katherine Wisner, M.D., a
    Northwestern Medicine® perinatal psychiatrist, in a July 23 editorial in
    Anesthesia & Analgesia.

    Wisner’s editorial is based on a new Chinese study that found women
    who had pain control with epidural anesthesia during a vaginal delivery
    had a much lower risk for postpartum depression than women who didn’t
    have the epidural.”

    http://www.sciencecodex.com/controlling_childbirth_pain_tied_to_lower_depression_risk-138083

    • fiftyfifty1

      I found the following quote interesting:

      “Managing acute postpartum pain supports the new mother’s ability to emotionally attach and care for her infant, Wisner points out.
      “Pain control gets the mother off to a good beginning rather than starting off defeated and exhausted,”

      I am so glad that both delivery pain AND postpartum pain are being addressed because both do matter. After my first birth (difficult vaginal) I had so much pain from my injury that caring for myself, not to mention an infant, was very difficult. I couldn’t sit at all, I could barely stand. In retrospect I really should have been on narcotics, but as it was “just a vaginal birth” these weren’t offered and I didn’t think to insist. When I made the decision to schedule a C-section for the 2nd to preserve what was left of my pelvic floor I did so despite my belief that it meant that I would likely have uncontrolled pain in the postpartum period. When my recovery ended up being completely pain free it was like the sun was shining on me and birds were singing! I got to enjoy the amazing experience of getting to be the mom of my newborn, whereas with the first it was all gritted teeth and catching my breath and tears involuntarily coming to my eyes from the pain. I didn’t have depression with either, but I sure was miserable with the first and all the pain was really emotionally defeating.

      p.s. thanks OB and anesthesia for making some of the happiest memories of my life possible.

      • araikwao

        Agreed on the post-partum pain relief. I had awful awful pain, and I remember my second night in hospital, desperately fatigued, not even able to turn myself in bed, (an easy recovery after a VBAC, right?!) and at one point I just started shaking uncontrollably, like I was having a rigor. No amount of breathing and relaxing would stop it, and I didn’t understand why. The lovely lovely MW on that night looked at me and said, “I think it’s from pain, and I am going to get you a dose of (can’t remember what opioid analgesia).” Bless her, she was right. Shame none of the other MW’s could understand I might need more than regular paracetamol. It was awful.

        • toni

          I found it a bit puzzling that each nurse had different ideas about how often and how much pain medicine I should be given in recovery for the afterpains. The first one gave me one percoset and a motrin every six hours which worked fine, the next changed it to one percoset and then four hours later a motrin and then another four til the next percoset which didn’t help me much at all, a different nurse gave me two percoset and a motrin every five hours which took away every twinge of pain but made me dizzy. I forget how much the others nurses gave me but you the idea.. the amount and intervals between doses kept changing. I didn’t question it at the time but afterwards I thought that was rather strange.. surely the doctor prescribes a dose and the nurses have to stick to it but apparently they have the authority to just give you what they think you need

          • araikwao

            Probably differs between countries – I’m not even sure what Percocet and Motrin are, tbh, I think we have a different range of opioids! I am not sure whether the doc had just written up a prn dose that she gave me,or whether she was able to initiate a stat dose herself, and even less idea for your situation. I’m surprised there isn’t a guideline for them to stick to.

          • toni

            well you spelt it correctly and I didn’t lol. Percocet is some kind of opioid and paracetamol/acetaminophen and Motrin is Ibuprofen.

  • Reality Check

    After reading this, I have to wonder how things might change if US hospitals legitimized the use of midwives within the scope of practice. As you say, contemporary natural childbirth views consist largely of what a midwife can and cannot do. It would be interesting to see what the environment is like, what procedures are performed, what rate of c-section and what the mortality rate is between hospitals with and without midwives.

    • Daleth

      I’m not sure what you mean by hospitals legitimizing midwives. Many hospitals have midwives (all CNM’s, of course, not so-called “lay midwives”). And the mortality rate for hospital midwives has been studied–see the Cornell study. It’s much lower than the rate for home birth midwives, and slightly lower than the rate for OB’s because hospital midwives only attend low-risk births.

  • Daleth

    I love this:
    “If a midwife can do it, it is an acceptable practice. If a midwife can’t do it, it is an “intervention.””

  • Anna T

    I find this post a little confusing. Does it mean that every woman who wants to have unmedicated birth is actually influenced by some freaky ideology? I had unmedicated births (by choice) and I never even heard of Dick-Head or Lamaze before I stumbled upon this blog.

    • KarenJJ

      “Dick-Head”
      *juvenile giggle*

      You’re lucky if you chose your preference without being exposed to NCB. I was exposed to it very early with my family already and having access to Dick-Read’s book as a teenager – prior to NCB being as mainstream as it is and prior the internet. For me, knowing about NCB and the rest just added a whole layer of anxiety to do pregnancy and childbirth “right” that was largely unnecessary and largely went against my own personal preferences (ie science and healthy baby).

      Thankfully I muddled through it without significant consequence and when the mec did hit the fan I was in a hospital with an obgyn saying he’d slot me in for a c-section and I was perfectly fine with that.

      • Anna T

        Also, I have to add that I find this idea, of childbirth pain being The Factor to determine family size, absolutely ridiculous. If it were true, epidurals would cause a population boom. Women choose to limit their family size for a variety of economical, social and health-related reasons.

        I’m due in January, and I think a lot more about the outcome of the birth (healthy Mom and baby), how we’ll adjust to being a family of 5, etc, than about how much it will hurt.

        • Heather Dalgety

          Sorry but I have to say I know several women who found childbirth so difficult that they weren’t prepared to go through it again.

          • Anna T

            I have heard of such cases too; what I meant to say was that it’s not like women decide, “oh well, since childbirth was a breeze, I’ll have ten kids”. Many women delay motherhood altogether until their mid-thirties, without even knowing how pregnancy and childbirth will go for them. They do it not because they are concerned about pain in childbirth, but because they are pursuing a career or just marry later than was common a generation or two ago.

        • Dinolindor

          I would venture to guess that this varies based on where people commenting on this blog live. It’s not an uncommon refrain to hear “my second pregnancy/birth was so difficult that we’re no longer going for a third” around here in the US. I think your points also factor into the decision, but the pregnancy and/or childbirth itself are frequently referred to as the reason why not to pursue their original intent to have a larger family – even among women who had epidurals.

          • Anna T

            Of course if I had an absolutely horrendous, traumatic pregnancy/birth, it might be a factor against another pregnancy. Especially so if the pregnancy was high-risk and/or if my own life or health jeopardized.

            But the argument of “let’s just convince women that childbirth pain is all in their heads and then they’ll pop out one baby after another”… only a lunatic can come up with something like that.

          • Dinolindor

            I agree that it’s lunacy to go for that angle as a way to encourage women to have more children. However, my point isn’t about that at all. I’m just pointing out that many women in the US decide that even after a couple regular/low risk pregnancies and non-extreme deliveries decide that that’s all for them. I mean, I have often declared that I love being pregnant, but as I’m closing in on week 38 on baby #2, I am keeping a critical eye to whether we truly want to go for a third like we had always planned or not. It’s hard being pregnant and caring for a 3 year old, especially with zero family nearby and I’m not getting any younger.

          • Anna T

            I certainly agree that it’s hard to care for a baby and a toddler. My first was only 20 months when my second was born; I came home from the hospital and I couldn’t even lift her (to her high chair, bath, car seat, etc). Like you, I had zero family around, except my husband.

        • Durango

          Who said that? (asking sincerely, not snarkily, since KarenJJ didn’t say anything about family size)

          I do think that you’re mischaracterizing the argument, though. I’m not sure anyone thinks that the sole factor in determining family size is the pain or not of the labor. It’s just one more thing, especially if you were on the fence about having more.

          • Anna T

            I thought Dick-Read said that. But then perhaps I should go and read his writings on my own.

          • auntbea

            He did say that…or at least that is Dr. A’s characterization of what he said. (Haven’t read him myself.) I agree with you that the premise is faulty is on its face. But so is a lot of the NCB movement.

          • Durango

            Ah, got it. Thanks. Just one more way GDR made stuff up.

        • theadequatemother

          There are other social movements that affect family size that occurred at the same time that epidurals were more available so there are confounders that muddy any conclusion you can draw there. Examples would be more women expecting to return to the workforce after having children, a rising cost of living outstripping rising wages, concerns over finite world resources etc. I have met many woman who have chosen not to have more children after a traumatic birth experience and unrelieved severe pain is one cause of birth trauma and associated with postpartum mood and anxiety disorders including PTSD.

          Edit: the correlation between poor grammar and low caffeine intake is real

          • araikwao

            ^^ pretty sure there’s a causal link, even

    • Sue

      Hi, Anna T. As is usually the case, Amy’s blog uses the term ”NCB” as an abbreviation to refer to the radical-anti-obstetrics movement, where rejecting any form of ”intervention” is an act of faith.

      • Anna T

        I see. I always thought that NCB refers to people who like to give birth without drugs. In her context, I guess that’s a different thing.

        • Carrie Looney

          The issue, I think, is that everyone planning a birth would _like_ to have such an easy and pain-free birth that drugs are unnecessary – but lots of people aren’t lucky enough to have such a birth, and then the question comes down to if people are scared into rejecting pain relief unreasonably, based on poor quality information.

    • The Bofa, Being of the Sofa

      Let’s explore it. Why was an unmedicated birth important to you?

      • Anna T

        I’ve read about how epidurals are done and said, “yikes, I’d rather avoid it. If I can.” Turned out, I could, and with no problems at all. I actually thought I wasn’t progressing, because the pain was much less than I expected. I liked how it worked so I did the same a second time. No ideology whatsoever.

        • Guesteleh

          This isn’t a criticism of your choice whatsoever, but I’m guessing what you read about epidurals was exaggerated, misleading and maybe even downright untrue. It’s very hard to get objective information about epidurals online. You may not have been overtly influenced by NCB ideology but there is NCB ideology underlying a lot of what’s written about pain relief in childbirth.

          But I’m very glad you didn’t find childbirth horribly painful. The worst stories are the women who are in agony but forego pain relief because they’ve been brainwashed into thinking it’s harmful.

          • Rabbit

            I don’t think it is a fair to assume that because someone opted against an epidural, they must have read only or mostly exaggerated or untrue things about them. Totally true thing about epidurals: the anesthesiologist places a needle into the epidural space along your spine, then usually threads a catheter that will remain to deliver more medication as necessary. Bam, right there my discomfort with needles has me predisposed to not want an epidural. It may be an irrational fear, but its being irrational does not make it any less real. I’ll push it aside to get the IV (I don’t go into labor on my own, and have always been induced), have blood tests, get vaccinations, and give blood at the blood drive every 10 weeks, but for me, there was no compelling reason to get over it for labor. I have easy labors though.

            I chose, with all three births, to see how things went, and if/when the discomfort and pain of labor outweighed the mostly mental discomfort I had regarding the epidural needle, I’d get an epidural. As a grown up adult person, I get to make that choice. Fortunately for me, I have incredibly easy, fast labors.

          • Young CC Prof

            And that’s totally reasonable. There are valid reasons not to get an epidural, and needle-phobia combined with relatively easy labor is a really good one.

          • Guesteleh

            Agreed! I’m not telling anyone to have an epidural. It’s just in general very difficult to get objective info on epidurals, even on mainstream websites. So when someone says they read up on the procedure and opted against it, I think there’s a good chance they read something that exaggerated the risks. Like I said above, if you tolerate labor well, great! But I’d hate for someone to go through agony because of anti-epidural scaremongering.

          • guestss

            I couldn’t be bothered to have one either Guesteleh. Not saying labour didn’t hurt, just that by the point I thought it was getting unbearable the baby was pretty much already out (both times) so an epidural would take longer to get/recover from than the rest of the birth!

            Also, I was shown the process of receiving an epidural and thought the same, I’d rather not have something that close to my spine if I can possibly avoid it.

            Couldn’t care less what other women choose to do about their pain relief as long as they are listened to and have access to what they need.

          • The Bofa, Being of the Sofa

            Totally true thing about epidurals: the anesthesiologist places a needle into the epidural space along your spine, then usually threads a catheter that will remain to deliver more medication as necessary. Bam, right there my discomfort with needles

            a) you don’t see it, so your “discomfort with needles” is, to an extent, your imagination of what the needle is doing. Personally, the sight of a needle entering skin makes me queasy. However, close my eyes and it’s not the same.
            b) given that the needle is being placed into the epidural is done very differently from other types of needle sticks you’ve encountered, it’s not fair to compare them and say, well, I don’t like needles used for X so therefore I won’t like an epi
            c) If you don’t like needles, how is an IV any better? I realize there are irrational fears, and that kind of accounts for parts a and b above sure, but if you want to proclaim needle phobia, why single out epidurals? I don’t understand that.

          • Rabbit

            a) totally know it is my imagination, but I have a vivid one, and telling myself it is just my imagination doesn’t seem to help. I acknowledge that this is not rational.

            b) I don’t know what getting an epidural feels like, so I don’t have that apple to compare. The only thing I can do when making my personal choice is to draw from the experiences I do have with needles.

            c) An IV isn’t any *better* it was just necessary. While I’m not totally rational on the issue of needles, I’m not totally irrational either. IV of pitocin > baby dying because I don’t go into labor on my own. Vaccine > contracting measles.

            And really, I have incredibly easy labors. In a way, it is a good thing that I have to be induced, because if my body labors on its own the way it does with a Pitocin drip, I’d never make it to the hospital on time because by the time I’d realize I was in labor, it would be time to push. With all three, the only way I could tell I was having contractions before my water broke was if I looked at the monitor. After my water broke they became uncomfortable, but never really painful. As the person experiencing the labor, I get to choose when my discomfort with labor outweighs my discomfort with needles.

          • Kerlyssa

            Makes sense to me. It’s not like you were holding out against an epidural even whilst passing out in agony- apparently you just didn’t need OR want one.

          • Anna T

            Exactly exactly exactly!! Severe UTI? Antiobiotics, pain meds. Debilitating migraine during pregnancy? Pain meds. Labor? Doesn’t hurt enough to warrant pain meds.

          • Cobalt

            Totally with you on the needles. IV to manage emergencies? Absolutely. Vaccines to prevent the spread of illness? Yes. Needle in spinal area for a few hours of moderate pain relief? Nope.

            People have died because of a lack of those other kinds of needle sticks. No one has died of my subjective experience of my labor pain.

          • attitude devant

            That’s just the point: it was YOUR subjective experience of YOUR labor pain. Which obviously was not severe enough for you to want regional anesthesia. For other people, it’s severe enough. Either because they are wired differently, or their labors or longer, or whatever. Pain is not trivial. Just because yours was bearable doesn’t mean other people don’t need the option of regional anesthesia.

          • Cobalt

            I know. I also get tired of having to justify my decision to bypass an intervention that neither I nor my baby needed.

          • attitude devant

            I don’t think you have to justify it to anyone!

          • Anna T

            ” the anesthesiologist places a needle into the epidural space along your spine, then usually threads a catheter that will remain to deliver more medication as necessary. Bam, right there my discomfort with needles has me predisposed to not want an epidural.”

            Same here. I read about the procedure, decided it doesn’t sound very nice. Of course, I can totally imagine myself being in the kind of pain when I wouldn’t care anymore about anything but stopping the pain. I remember myself sprawled out on the bed with a pregnancy headache which was A LOT worse than any contractions (not exaggerating), unable to move, get up, care for my toddler who was crying. All I could do was moan and drool from the pain. If someone offered me an epidural for headaches, I’d sure take it.

            But in labor? I was feeling fine. I remember afterwards, I was glowing and saying, “I could do this again right now!” So why do I, personally, need to opt for something just because it’s a common procedure?

          • Box of Salt

            Anna T “But in labor? I was feeling fine.”

            If I award you a gold star now, would you – pun intended – quit belaboring the point?

          • Anna T

            Nope, no need of gold stars. An easy labor is a reward in itself.

          • Box of Salt

            Anna T “An easy labor is a reward in itself.”

            And what do you like to share with those of us who didn’t get one?

          • Anna T

            I sincerely hope that all those who needed pain relief during labor got it in a swift, safe and efficient manner. I hope for the same thing for myself, should I ever need pain relief in future births or after a C-section (I don’t have a crystal ball and two easy deliveries do not guarantee a third).

            The way your body works during labor is not an accomplishment. The way you experience pain is not a “pass” or “fail” (that’s why I found your “gold star” comment condescending and offensive. I am not a child waiting for affirmation for “doing good”). If there are things that make you feel good in labor (water, movement, birthing ball), they might not work for others. It’s just different for every mother. That’s why it’s so great we have this marvelous thing called CHOICE.

          • Cobalt

            THANK YOU Anna T. Flip side of this is not judging someone for declining an intervention they didn’t need. I have no desire to get an epidural just to prove my science cred.

          • Cobalt

            If you got a gold star would you quit needling her about it? I mean really, get off her back about her epidural choices.

        • atmtx

          This was my exact thought process as well. However, with #2, I went into labor and was like “forget this, give me the epidural.” Best decision. I had so much more energy to enjoy and care for my baby. I also look back very positively on that birth, and am ambivalent with the first. The needle hurt significantly less than contractions, and was more a weird sensation than anything. I’m not planning any more kids, but if it happens, I’m totally on team epidural.

        • Cobalt

          This is similar to my thoughts going into labor. I never felt like I needed an epidural, so I never got one. It just wasn’t that bad. I also have a generous pelvis and no babies (so far) over 7 pounds, so maybe that helps.

          Going without the epidural wasn’t the important part. Aside from the health related priorities (which I left to the doctors and hospital staff, that’s the whole point of hiring a medical team) want I wanted was to hold my baby. An epidural didn’t seem helpful with that.

  • Sue

    Interesting thoughts – and consistent with what I have been thinking in relation to a range of ”alt med” providers – who I call the “New Paternalists”.

    In my model, the rise of New Paternalists parallels the reduction in paternalism in medical practice. It is no longer PC to see your physician as the provider of simplistic, directed advice – the culturally appropriate model in our societies is the therapeutic partnership. In our post-modernist world, everyone’s point of view is innately valid, and we scorn (and are suspicious of) “The Expert”.

    In this context, there appears to be an innate human need for some simplicity and certainty. it’s not PC to get this from authority figures (”experts”), so we get it by consulting non-mainstream providers, who give us the simplistic, directed advice we want (you have (x), take this remedy) under the guise of choice and rebellion against conventional authority.

    Significantly, conventional authority is seen as The Man (male), while female-ness in providers is seen as more feeling-intuitive-holistic. Many homeopaths and naturopaths, for example, are women.

    Enter the HB midwife. Female, rebelling against The Man (female obstetricians are just men in disguise), promoting touch-feely intuition while telling you what to do and what is acceptable.

    It all fits.

  • KarenJJ

    I really enjoyed this post. If midwives were truly about empowering women to make their own decisions that are best for them, they’d care a lot more about the facts surrounding epidurals, maternal choice c-sections, poor outcomes at homebirth etc. And they’d care a lot less about the “sisterhood” of midwifery – ie conforming to a certain “ideal” set by the midwifery leaders such as Hannah Dahlen, Cathy Warwick and Melissa Cheyney.

  • CanDoc

    Well said.

  • David Whitlock

    It is a Kyriarchy:

    http://en.wikipedia.org/wiki/Kyriarchy

    A top-down social power hierarchy that assigns social power based on position in the social power hierarchy. It is position in the hierarchy that matters, not expertise or being correct. The social power of hierarchies is zero-sum. The only way that someone can move up the social power hierarchy is if someone above them moves down.

    It really is only about power. Truth doesn’t matter, outcomes don’t matter, maintaining the social power hierarchy that gives people at the top their current power is all that is important. That is why those at the top are completely resistant to change.

    • Amy Tuteur, MD

      I really like that description!

    • Deena Chamlee

      Yes BINGO you got it!

    • Deena Chamlee

      And in order to address the pressing issues within the profession it means they would not be able to remain in power. Others, colleagues, who have known about the heiarchy assume the role of sycophants due to fear and some due to loyality all the while accepting the oppression. As one midwife puts it, ” in order to practice you can’t go against the heirarchy. So the professional moto is “Dont ask, don’t tell.”

      Otherwise if you tell about the opprssive abuse you are booted out and intimidated through violence, stalking, harrassment and psychological warfare. Sad crazy sick.

      • Renee

        Sounds like time for a split, and a new break off group.

        • Guest

          midwife?

        • Deena Chamlee

          Midwives have to WANT to free themselves. I have by a forced elimination and then a realization that in order to truly love myself and care for myself I must not give MY power away any further by feeding others needs at my expense. I cannot place other’s needs above my own in order to practice. And then one must ask themselves how does such a hierarchy rise to power. This hierarchy rose by self selection beginning in 1994, so the social structure is highly narcissistic by selection. And those who are non narcissistic are codependent.
          From what I have observed when I was affiliated with ACNM is no movement against the hierarchy. People want to keep their jobs and not become a target for destruction and many are narcissistic I just don’t see any change that is required for social protection occurring.

      • Sue

        There we may have the answer as to why the mainstream of rational hospital-based MWs aren’t taking the high moral ground and calling out the renegades – because they hold the SOCIAL power – which appears to be stronger than professional power.

        Something similar appears to exist within the Chiropractic community. There is a largely-quiet rational group who work somewhere between physiotherapy and sports medicine, but the vocal ”vitalistic” group still evoke the grand history of the profession when Subluxation ruled, and the “spinal cord controlled every cell in the body.” The “vitalistic” group hold the social power, seeing themselves as special and distinct from other health care disciplines (in fact, superior, because they have the true model and don’t use drugs or surgery – because they CAN’T).

        The social power in these examples comes from distinguishing yourself from the mainstream, and holding the rationalists as being ”conformist” and therefore beholden to the mainstream.

        Fascinating stuff! More exploratory essays required.

        • KarenJJ

          Interesting ideas on social power vs expertise power. So does second wave feminism have a role for expertise power or is it more based on social power? Or am I wayy off course on this?

          • Sue

            Good question. Just off the top of my head, I think second wave feminism is ALL about expertise power and not about social power at all. In that sense, layMWery is structured in the opposite way to second wave feminism – all about what you represent and your authority as a person rather than what you can do.

            I think this may be manifested in young women and ”raunch” culture. It is accepted that young women can join any profession, but they are socially subjugated – there is something of a return to the whores-and-madonnas dichotomy.

            Then there is the educated, professional young woman who is subject to woo. Are they somehow trying to re-claim some sort of ”feminine” side (intuitive/feeling vs training/competence)?

            Is there something here, or am I off course?

          • KarenJJ

            “Then there is the educated, professional young woman who is subject to woo. Are they somehow trying to re-claim some sort of ”feminine” side (intuitive/feeling vs training/competence)?”

            That was definitely part of what I was doing I think. I admire my grandmothers a lot but trying to emulate their lives doesn’t work for me. I since found out that one of them was taking valium for depression back in the days too – so I think they also found babies and motherhood psychologically tough like I did it just wasn’t talked about as much.

            At least it was more socially acceptable for me to go back to work and use childcare and hire a cleaner and at least I had the ability to do so with regulated and subsidized daycare and maternity leave that kept my job for me for the first 12 months. And I was able to obtain qualifications that enabled me to get a well-paid career (at my uni graduation the speaker was a female physicist around my grandmother’s age that had not been allowed to enrol in engineering at the university back in the 50s due to there being no female toilets).

        • http://www.europeanmama.eu/ Olga Mecking

          Great explanation! I am reading a book (A pleasing birth by Peter de Vriees) about midwifery in the Netherlands. In the NL it’s midwives who have the power and doctors who are the counter-culture. I am not sure if it’s still like that but he intreviews one of the midwives and she says, oh well, if we don’t like the doctors in the hospital, we’ll transfer the women to another one and then the other hospital comes back to us and asks, what should we do to get you to transfer patients to our hospital again? And the midwives say, oh well you have to do this and this and this and this. It’s ridiculous to be honest.

        • Deena Chamlee

          Sue I think the profession is highly narcissistic pathologically, thus, the fragile egos receive narcissistic supply by being a part of the narcissistic group. Kyarchies which consist of malignant narcissist/psychopaths rise to power in narcissistic societies.
          The thing is many of my colleagues are willing to forgo oppression because their narcissistic supply is being met by being a part of a large narcissistic family or “tribe”. I just became aware of the hierarchy by debating with the fellows in February. Many have known about the profession because they are narcissistic
          So you are either a part of the “club” or you end up like me horrified at your reality and become PTSD.

          • Deena Chamlee

            Thus, I think the answer is to remove the kyarchy, address the atrocities against society that have and are occurring by barring NACPM/MANA from any further existence this may include criminal charges against those in the kyarchy , institute leaders who are “sane” and implement an anti-bullying campaign throughout midwifery. Change the name to American College of Midwives and license CMs in every state. And eventually move away from the CNM.

    • KarenJJ

      Wow – that’s describes a lot of my thoughts around it. Thanks for that – it’s given me some more to think about.

  • Beth S

    I remember when I was a kid in the late eighties and early nineties where every woman you saw in the movies was doing that freaky Lamaze breathing. I remember even back then wondering just how the heck that breathing was going to keep a woman from feeling pain. I also wondered why with drugs women would even want to feel the pain.
    Now I understand that back when the NCB advocates start out they were fighting for choice, not for one specific way for a woman to give birth.
    I saw Bill Cosby do a bit about how he had to take NCB classes in order to be at the birth of his first child, and how he used his sports background to be a cheerleader for his wife. In an unrelated though, DH and I do the “push ‘em out shove ‘em out wayyyyy out” chant some nights when we’re talking about what he’s supposed to do for me. I always felt his take on it was the best view of what a man, or a doula was supposed to be, an advocate for the woman’s wants and needs during childbirth. Now it seems that the pendulum has swung the other way.
    Some unethical Doulas, midwives and even husbands are no longer advocating for choice above all. They are advocating for that one way they feel is the perfect way to give birth. Now it’s perfectly okay with them to withhold pain medication for a mother who’s begging for relief, it’s okay for them to shame a woman because she had to have a C-section. God forbid you have a reason not to breast feed that doesn’t include what they consider a legitimate medical reason. They themselves are now taking away a woman’s right to choose, but they don’t feel at all guilty about it. It’s like NCB advocates feel that since they had to struggle in the early days, it’s their right to make a woman’s choice for her, instead of letting the woman make her own choice.
    On the other hand there’s all those father’s who’s voices are silenced by the community. Their right to speak up for the needs of their child has been taken away and that’s not fair either. Sure women should have the right to choose how and when they give birth, but shouldn’t fathers have the right to have a say in what happens in the life of his child. It’s the NCB fallacy that’s making it easier and easier for some of the creepier Men’s Rights Advocacy groups to not only survive but thrive in a world where all things are supposed to be equal.

    • theadequatemother

      My mother tells me that she had some classmates that would try to get out of gym class in middle school by having a partner hold them tight around the chest while they hyperventilated. Rapid shallow breathing leads to HYPOventilation because the majority of the breath is just ventilating the anatomic deadspace of the resp system (the pharynx, trachea, bronchi and bronchioles where gas exchange doesn’t occur). The result is dizziness and in extreme cases, fainting. I always assumed Lamaze breathing would work in the same way – result in dizziness which would be a distraction and possible reduce the perception of pain.

      But regardless that kind of breathing is bad for placental gas exchange and can decrease the fetus’ ability to cope with contractions and is pretty ineffective for pain control. So it has zero benefits. Ineffective for mom and bad for baby.

      • Mishimoo

        My dad taught me to concentrate on taking deep, slow breaths in order to deal with pain and avoid freaking out (I was rather accident-prone and anaesthetics don’t really work for me), by telling me a similar story. He was working on a house with another electrician. The other guy was pretty heavy and managed to get stuck under the house. He understandably freaked out, couldn’t follow directions or communicate his situation so others could assist him, hypoventilated due to his chest being compressed, and passed out. After which, they were able to drag his limp body out and get him some medical attention. The moral being that no one can help you if you are too upset to communicate, so breathe + calm down in order to try and avoid ending up in a serious situation.

    • Zornorph

      Funny you mention that – I was just remembering a TV show that starred John Ritter as some type of cop and he had to help this biker woman give birth and he asks if she’s had any Lamaze classes and she just looks at him and says ‘Are you kidding?’ So for some reason I don’t pretend to understand, he gets her to sing ‘Wooly Bully’ with him while she is giving birth.
      I have to say, I had always assumed that Lamaze was a legit thing – that this was what women in labor were supposed to do. It was just in the media so much, it seemed normal. I was actually surprised when I was expecting that nobody mentioned it.

      • Amy M

        My impression, from the media (back before I had children), was that Lamaze classes were synonymous with childbirth classes—any childbirth classes, even if no breathing techniques were ever mentioned.

        Personally, I assumed the breathing thing was to act as a distraction.

        I’ve seen some birth videos and I don’t recall seeing any of the women using the Lamaze panting thing, but I’m pretty sure we’ve seen some homebirth videos even posted here where the midwife is saying “breathe, breathe” or “breathe your baby down” or something like that.

        • The Bofa, Being of the Sofa

          I always assumed the breathing thing was to account for the fact that the most common way to deal with something is to hold your breath, and they want to you keep breathing regularly to avoid holding your breath too much.

          • attitude devant

            Many spiritual disciplines use some kind of directed breathing or mindful breathing to alter attention or the sensorium.

          • Trixie

            It is true that they had to keep reminding me not to hold my breath during contractions.

      • Dinolindor

        My mom used Lamaze and swore by it for all 3 of us, and so I assumed it would be good for me (nope, not in the end, which was fine. I just got an epidural). She did say that in her experience it only works if you really practice it before you’re in the throes of labor.

        It can be a useful skill to be able to call on if no pain relief is in sight for non-labor situations too. Plus, she taught me how to apply it for other things too – falling asleep, having an anxiety attack, etc. In my experience, it is purely a distraction technique that can help you relax.

        Now that I’m in pregnancy #2 and getting very, very close to my due date, she asked if I’ve been practicing Lamaze. Nope (although I should – what if I’m in a situation where I can’t get to the hospital, and therefore the epidural, quickly enough?), and she was surprised. But she agreed that now that we know that epidurals really are safe, why wouldn’t you get one!

        • fiftyfifty1

          “She did say that in her experience it only works if you really practice it before you’re in the throes of labor.”
          How did she come to that conclusion, do you know? Because that for sure is the propaganda. If it doesn’t work for a woman, the Lamaze people say it was because she must not have practiced often enough or hard enough. So do you think your mom is just unconsciously passing on the party line that she was taught or does she have actual experience that supports it? I wonder how a person even could get personal experience. I mean you could say “I didn’t practice much with my first and it didn’t work but I practiced before my 2nd and it helped”, but 2nd labors are almost always easier than 1st labors.

          • Dinolindor

            I’m not sure if it truly was her experience, now that you point it out. I’ll have to ask her because I’m curious how she came to the conclusion, or if I just assumed that’s what she meant. She did also say that it was important that your partner practice and be on board – my dad was not for the first time around (the story goes that once he saw how much pain she was in, *he* couldn’t take it and fled the room. In his defense, he grew up in the 1930s in India. The idea that he would be in the delivery room with my mom was really bizarre for him even if it was the mid-70s in the US by then). He did better in the subsequent births, most likely since they were not my mom’s first birth. But my mom always gave me the impression that while the 2nd and 3rd births were shorter, they weren’t necessarily easier than the first. So I’ll have to find out if I just conflated her advice that the partner has to be on board with the mother having to practice in order for it to work.

    • Smoochagator

      I loved Bill Cosby’s assessment of NCB classes: “My wife and I are educated people, so of course we went to a class to learn how to do something that people have been doing for millions of years.”

    • guest

      I might be completely wrong, as I’ve never taken anything Lamaze related – however, my mom taught me the breathing technique that I thought was Lamaze (three short breaths out, one long breath in) and it helped immensely in keeping me from hyperventilating, which I tend to do when I’m in a ton of pain. It got me through a failed epidural when I was starting to see stars from breathing too fast. Is that not Lamaze? (I have no ideological affiliation there, I’m just curious).

  • Young CC Prof

    Our mothers, the original natural childbirth advocates, fought for patient autonomy and choice, real choice. (This also came at a time between Twilight Sleep and epidurals, so natural coping techniques were just practical.) At the same time, these women fought for choices in the larger world. They demanded employment opportunity, educational opportunity, and many pushed forward into nontraditional careers without role models. The women who rose to positions of authority in the 1970s and 1980s were told repeatedly, “girls can’t do that,” and simply refused to listen. These were the second-wave feminists.

    Their daughters grew up in a very different world. Overt sexism was far less common, and those girls, especially the ones born to privileged families, found ample educational and career opportunities. Their parents and teachers said, “Of course you can,” and the girls believed it. Sexism still existed, but it was far far less common.

    And then those girls grew up, and moved into the world, and discovered something interesting. They enjoyed equal opportunity only as long as they didn’t want to be mothers. Oh, yes, you can certainly have a high-powered career and be a mother, as long as you can work at your previous pace up until the day you go into labor and return six weeks later ready to do it all again. But many women physically cannot do that, and many who can don’t want to.

    Make no mistake, this is not proof that the second-wave feminists failed. It’s proof that their work is not yet finished. When paid family leave is universally available and expected to be used, when part-time work is available at the same effective hourly wage as full-time work, when health care is decoupled from employment, when affordable high-quality day care is open to all families, then and only then will women have equal economic opportunity.

    But that day is a long way off, and we’ve got to live in the world as we find it. And for many women, that means reproducing old-fashioned gender roles. Now, there’s nothing wrong with this! If husband as primary breadwinner works for your family, great. But these women who expected to achieve outside the home find themselves disappointed.

    Many of them fight the tide. Others decide, “What does it matter if I had to quit my job because I couldn’t
    find day care, and now it seems I can’t go back without starting at the bottom
    of the ladder again? I’m the world’s best mommy, and that’s good
    enough for anyone. I just need to prove it on the Internet, and then everything will be fine…”

    This is where the mantle of feminism got lost. This is how it was stolen by reactionaries. Women who enjoyed full status in society until they wanted children were seduced by NCB’s promises that excellence in motherhood is valuable, and by extension, that bearing children easily and “naturally,” breastfeeding successfully, and making every possible sacrifice to produce healthy and excellent children, is in itself proof of one’s merit as a human being.

    • Amy M

      And these same women denounce feminists and feminism–associating it with man-haters, lesbians and child-haters. They poo-poo women who try to “have it all” by going back to work after having children. Instead of working to reach the solutions you’ve outlined above, they merely tell us that it’s impossible to be 100% a mother or 100% a worker, so pick one, or one of those will be getting short shrift. (Funny how it is possible to be a worker and a dad!)

      Should women (and men too!) have the choice to stay home and raise their children? Absolutely. Realistically though, how many truly have the choice, as opposed to having the choice made for them based on economic circumstances? Family leave and health care policy changes would go a long way towards making this a choice for more people, but it would not completely negate the roles that SES and educational background have in determining family structure.

      • Beth S

        I wish I had the ability to go back to work. I’ve been stuck at home for five years and am looking at yet another five because for our family the expense of child care makes me working unfeasible. Do I love my kiddos, yes, but I miss working. I liked working and feeling as if I were contributing to my own household. I will work once the baby starts school.
        My husband on the other hand would love to be able to be home more with our kids, however he has to work ten hour days to make ends meet. He’s also a great caregiver, he proves it time and again when he gives me days off.

        • Young CC Prof

          Yup. For a lot of families, two parents working 30 hours a week would be a better solution than one person working 60 hours and the other staying home all the time. But very few families are able to find work situations that permit it.

          • Amazed

            I remember my mom’s boss (a school principal, and female if that matters). She was furious whenever my mom and her colleagues had to take a sick leave because of the children. “Have your husband take a sick day!” she insisted. Ha! 30 years ago, it would have just flown SO marvelously with men’s employers.

            The ladies’ reply? “Come on, boss, let’s be real. Have you ever encountered a sick toddler who whines “Daddy!”? They all want Mom.”

          • Amy M

            Mine usually whine for Daddy first. Of course, this is modern day, and my husband has been a part time stay at home father for their whole lives.

          • Amazed

            Yeah, amazing what 30 years can do to a mindset.

            In defense of the woman, I have to say that she wasn’t all bitchy or anything. At the end, they all had their sick leaves (one of the benefits of being a mother in a communist state, along with a long paid maternity leave). Plus, she never yielded to emotional manipulations like, “Do you know how long I have been waiting for my child’s arrival!” She always said, “Ms Smith, I understand you perfectly (I think she actually did, her kid was my age and she was waaay older than my mom). But this is no reason to let your special awaited snowflake brutalize other students.” No amount of complaints of this sort could move her. And yes, some parents actually complained of her because she didn’t address their children’s special needs (express themselves through bullying, pass tests with flying colours without showing the knowledge required and so on). None of the investigations against her actually led to anything.

          • KarenJJ

            Thank heavens it’s improved somewhat – my husband takes at least as many sick days for the kids as I do. That doesn’t work well with all employers unfortunately, but we’ve been lucky there.

          • guest

            Oh man, this exactly. My husband and I would love to each work 25-30 hours a week, but finding jobs that support that and pay well (I’m an attorney and he’s an artist). We’re batting zero. We have two very small kids (1 and 3) and would like to have another, but I’m really not sure how to do so without being a weekend parent OR totally giving up on a career that I worked very, very hard for. I feel like I’m banging my head on a wall every single day, there’s just no options out there.

          • KarenJJ

            We want to aim for this in the future – husband and I working 30 hours a week. But we’re not sure we’ll get there at the moment. There’s some precedence in his company – a manager that works 4 days a week to play golf on Wednesdays – so it might be possible – but times are also tough and programming roles can be simple to outsource these days so we’re not rocking the boat at the moment.

          • Anna T

            That’s because in many, many fields a part-time job is virtually impossible to obtain. Part-time work almost always pays less (per hour) than full-time work.

    • Carrie Looney

      I wish I could +1 this more. Especially this:

      “When paid family leave is universally available and expected to be used, when part-time work is available at the same effective hourly wage as full-time work, when health care is decoupled from employment, when affordable high-quality day care is open to all families, then and only then will women have equal economic opportunity.”

      And this would benefit _everyone_. Yes, this would allow a woman to be a mother and still have a career. And suppose the woman wants to be the primary breadwinner and the man wants to work part-time and care for the house/children/dogs? That should be as good and supported as vice-versa.

      I’ve heard women who have bought into the NCB say that the man cannot be a proper co-primary care-giver to the child because he can’t breast-feed, and so she HAS to quit her job to be on-call for the baby through toddlerhood.

      • Amy M

        I have heard that too (about the man being unable to be a proper caregiver)—not only that he can’t breastfeed, but that because he can’t breastfeed, he can’t bond properly. Uh huh. That’s insanely offensive on so many levels, and just plain wrong, to boot. Again, these crazies have us mixed up with ducks….we do not have the imprinting response like newly hatched ducklings, you know? Like the first thing a baby latches onto is what it bonds to? It doesn’t work like that.

        • Beth S

          I always offer to introduce them to my ODD who’s a total Daddy’s girl with both her Daddy and her Stepdaddy. when it comes to her heart I come in third lol.

      • Karen in SC

        Definitely! especially the same effective hourly wage for part-time work!

        As an adjunct instructor, my “contact hours” and number of students in class often exceeds those of the full time faculty, yet my pay is at best 20% of what they make, with no benefits but a parking sticker.

    • auntbea

      I’m not sure they were even seduced by NCB. The sacred calling of motherhood has ALWAYS been used as a way of keeping women from demanding more.

      • Renee

        They weren’t seduced. 2nd wave NCBers wanted to enable women to have value AS woman, instead of only being able to gain status copying men. Male roles were the ones with power, so it make sense to do those things for status. This left women that didn’t do those male jobs, who still had “pink” collar jobs or were mothers, stuck in the very same low position.

        Their solution was to empower women, as women, doing things women do. This is where the idea that birth is empowering comes from! Because prior to this, it was the lowest thing a human could do, and is what kept women in such a powerless position. It is a valuable idea, and was critical to feminism.

        That some decided to use ideas that are patriarchal is unfortunate, but unsurprising. I think this made sense when it happened, but those that went down that path took on all the negatives of patriarchy with them, including the hierarchy and judging of women. This use of patriarchal beliefs needs to end, so that the ideas behind NCB can be modernized, and used today.

        Because the idea that women can do things that only women do, and still have value, is a timeless and vital value. It does not need to be tied to NCB and all the negative patriarchy bullshit to be used today.

        • Guesteleh

          the idea that women can do things that only women do, and still have value,

          Except that literally the only thing women can do that men can’t is to get pregnant and breastfeed. When you carve out an area that belongs to women alone and promote women’s value in that sphere, the unspoken assumption is there are areas of achievement that belong to men alone. And that’s problematic.

          • Who?

            ‘Taking back’ the power and value in women’s fertility is powerful to the extent that a strong patriachy will take the babies it wants, and treat them, and the women who produce them, as valuable property, and dispose of the others.

            But yes, broadly it isn’t a good precedent to set.

        • auntbea

          I’m not sure I entirely understand your argument this but really? Until the second wave of feminism — so until the 1960′s — childbirth was considered the “the lowest thing a human could do”? And *childbirth* is what kept women down? I’m just really gonna need some examples.

          • Who?

            I think that what happened around fertility was the issue. Women had trouble controlling their fertility as contraception was either unreliable or at the whim of their partner. Once the contraceptive pill allowed women to choose ‘trying’ for a child rather than hoping not to have one, all sorts of things opened up.

          • auntbea

            Okay. But fertility ! = childbirth.

          • DiomedesV

            Except that whether or not a woman will be able to conceive and carry a pregnancy to term is still largely a matter of luck.

        • KarenJJ

          The problem I see is that second wave feminism still screens for male/female and tries to elevate the “female”. In my experience there’s a lot of “female” in science and technology and yet this has been labelled as “male” to be turfed aside for “other ways of knowing”. I want no part of that BS.

          Science and technology needs to open its doors to women and women also need to embrace science and technology and not feel that it is devaluing their “womanhood” by doing so. This is where second wave feminism falls in with traditional patriachy and has been a significant issue in my field and why I felt feminism was excluding women actually “at the coalface” in male dominated fields.

          • auntbea

            I have recently been struggling with a number of female students who have been pushing to make our department friendlier to qualitative methodology. They are insisting methodology is gendered and if we want to make the department friendly to women, we need to have less math. I just don’t even know what to do with that. I get that women are socialized from an early age to avoid building quantitative skills, and that therefore these women are at a disadvantage. And, until early training becomes more equal, we will lose more and more women as the field becomes more quantitatively sophisticated. But the answer can’t be to just make the whole field less rigorous. And it CERTAINLY can’t be that we will just make it less rigorous for the wimminz.

          • Young CC Prof

            “Methodology is gendered.”

            Headdesk.

            The QUESTIONS you ask in social science may be gendered, the things you consider important may be gendered. Methodology only determines what types of answers you can get. (And in my experience it isn’t just female students who want to hide from real math. I see students of both genders about to graduate but still lacking math.)

          • auntbea

            We also have men who don’t like the maths. But they are not demanding we teach less of it, because they have no way to justify such a request. They are either buckling down to learn it as best they can, or accepting of the fact they will always be “lower-tier” in the field.

          • Amazed

            That’s ridiculous! Sounds like high school me who insisted that maths hated me because well, I was a humanities person. Worked for some people, thanks to the preexisting belief that humanities and maths don’t mix well. Not for my maths teacher, though. She was well aware that I was simply lazy, didn’t like maths and used the most popular excuse for my laziness.

          • KarenJJ

            Wow, that’s so wrong.

            There are plenty of women willing to give it a go at maths. I’m a big fan of Carol Dweck’s work with the brain being a muscle and needing exercise when it comes to maths. I don’t think people are nearly as “maths vs humanities” as it is portrayed – a love for something and practice makes all the difference. I think maths anxiety (especially coming from the teachers in early childhood that are largely female and therefore role models for the girls) and cultural traditions play a huge part.

            When I was 9 I was chosen to be in a maths extension class with a dozen other kids in my year. We had a charismatic teacher who had a higher level of maths education (science degree) then most other teachers (who were primary school generalists). I think it got me at a crucial time, the maths class was hard work but interesting. We did some investigations (I still remember learning about Pi). I was in that class for three years and I believe that I wouldn’t be in the field I’m in today and wouldn’t have had the maths grounding to get through some mediocre high school teaching without that class. I wish all kids got that chance – especially girls at that age who think they “can’t do maths”.

            I’m going to paraphrase Neil DeGrasse Tyson a bit here, but until we can remove the cultural perceptions surrounding women and maths we can’t say that women are inherently “better” at qualitative vs quantitative methodologies.

          • Mishimoo

            I’m really hoping that our eldest will be picked for the Gifted and Talented program at her school next year (she’ll be old enough then) simply because I want her to keep enjoying maths. She’s definitely skilled with both Humanities and Maths/Science, so I want her to have the support and space to learn things she’s interested in at her pace, rather than having to wait for everyone else.

          • KarenJj

            I was a bit of an all-rounder but swung more to the maths/science side through high school – I think mostly due to the interest and grounding in maths I got in primary school. Maths/tech careers have definitely been better paid during my time working (on top of being more interesting in my personal experience) so no regrets there.

          • Who?

            This is just disturbing.

            As things get more sophisticated you will lose both men and women who can’t keep up, and will attract men and women who can. As long as what you are doing has integrity you won’t go wrong being exacting about who has the ability to do it.

          • KarenJJ

            I also think these women are also buying into a patriachal view of the history of science, technology and mathematics. Women have been involved in this field throughout history but have rarely (if at all) been credited for their work.

    • Who?

      All so true. My daughter is about to join one of the professions, and doesn’t believe she will meet sexism at work because she has never met it in her life before. Which means she is in for a shock.

      Children and families are family issues, not women’s issues. But we’re not there yet. Here in Oz it is all about getting ‘mums back to work’ not about getting both parents into the workforce, and this casual and sloppy assumption is the start of the slide into the ‘mummy track’, poorly paid casual work and the assumption that if you have children you can’t also be serious about your job.

      • Renee

        She may not see sexism at work. I haven’t experienced it in my career, or at least, haven’t perceived it, if it was there. But I work in a progressive industry, and was at a German company that recruited women, and that had a home office fully 50% female (engineering included). This is not the norm. But its possible. Lets hope for the best for her.

        • Who?

          Thankyou for that.

          She finds the whole idea inconceivable, which (in some ways) is great. Less great is that she and her peers think ‘feminism’ is a dirty word and the battle is won. It will be an interesting journey to watch over the next couple of years. I hope she’s right but think it likely she’s wrong.

          • KarenJJ

            I’ve encountered it. It’s annoying and frustrating but I keep telling myself that it says more about them then it does about me. And I’ve walked out of stuff that was just ridiculously over the top (being singled out in a male dominated office to stack the dishwasher for another guys’ cups). Early in her career she might get confused by it, later in her career she’ll just get cranky and say so. Some older blokes are 100% clueless. Hopefully she skips it completely. The openly sexist stuff is more straight forward to deal with and is dying out.

            The other stuff – trying to work part time in a career that is only done full time/juggle the needs of young kids – is much harder. I have a supportive company and manager and I am in a technical field (pay is decent) but there’s still stuff that is tricky to deal with (eg doing what is essentially a full time job in part time hours and needing to travel for work..). I’m still trying to figure this lot out… Hopefully we’ll have better policies in place for when she gets 15 years in.

          • Sue

            I can’t say I’ve encountered sexism directly from work colleagues, but I’ve seen in structurally.

            Amongst all my friends who are medical couples, I can’t think of one couple where the wife has pursued specialty training while the husband has done part-time general practice, but I’ve certainly seen it the other way around.

            (This hasn’t applied to me as my partner isn’t medical).

            I can happily report a recent work colleague, however, who broke the mould. Despite being a male from a conservative Moslem country, he recently worked part-time to care for his first child while his wife worked full-time (in another area of hospital medicine). There is hope!

        • Dr K Cairns

          IF ANYONE thinks the “battle is won”…Everyday Sexism on Twitter will put an end to that.

      • Aussiedoc

        I honest,y didnt. Until I gt pregnant. Then it was amazing, the most egregious example being that they would not renew my contract when I went on mat leave – promised me in writing it would be the same contract then when I returned – put me on a 30% lower pay schedule than my male colleagues.

        As I’m still under supervision I can’t fight it without losing my job.

        It’s been a rather unpleasant wake up call.

        • araikwao

          That’s outrageous! I thought we were better than that in Australia. Consider my bubble burst..

        • auntbea

          I mean obviously it would be a massive burden on you, but if a lawsuit cost you your job, you would be able to sue about that too. They don’t have the right to discriminate like that, whether you are under supervision or not.

          • Who?

            Australia is a small community in professional circles, and particularly within states. ‘Troublemakers’ get a reputation really quickly and may struggle to get future employment. It would be professional suicide to take it on, and a pyrrhic victory if a ‘success’.

          • Aussiedoc

            Yes, I’m already one of those ‘troublemakers’

            You stick your neck out – you pay. If I fought this I’d be done forever and they know it. Rock meet hard place.

            Medicine really hasn’t changed at all in 50 years – if you piss off the old guard ….

          • Who?

            It is the same in law; the comfort is the old guard move on eventually, and hopefully the new guard are a bit wiser, though at times it can feel a bit ‘Animal Farm’ where you can’t tell the pigs from the men.

            I’ve always stepped sideways rather than have a fight I can’t win-the result is good people notice and remember, bridges remain in place and drawbridges come down where least expected at times. If you do a good job and maintain your integrity you will find your networks will ultimately support you, when the fuddy-duddies have shuffled on.

            Good luck, and enjoy your family-they will grow up before your very eyes!

        • KarenJJ

          I know a few women “made redundant” while on mat leave.

        • Who?

          I’m sorry to hear that. ‘Re-classifying’ is pretty usual, along with finding that your former role no longer exists, despite someone doing a job almost exactly like it; or finding that you’re urgently needed for something less interesting/glamorous/remunerative.

          Learning that your workplace is not the kind of place you understood it to be can be shattering.

    • Renee

      Lol to this:

      “They enjoyed equal opportunity only as long as they didn’t want to be mothers.”

      You MUST be talking about well educated, middle or upper class, white women, with good families with progressive ideals, because this sure is not the experience of most women out there. Even those elite women that don’t feel oppressed are still making less money, being promoted less, etc. And we (Western world) have it better than most places in the world!

      This is a PERFECT description of why feminism is NOT about equality, and equality is NOT the goal- liberation from patriarchy is. Modern “equal opportunity” continues to be defined by male needs- we fit into their world, instead of having one that suits US. “Equality” is legally policed by institutions that are male dominated, and it smokescreen- when all choices and possibilities are defined by the patriarchy, equality is still serving male interests. We feel better about it, but its only HALF a revolution, and incomplete. If a TRUE true system of equality is to exist, or be gender neutral, it will only come after women are liberated.

      IMO-True freedom for women is the freedom from oppression, to make reality for ourselves, a reality that takes our wants and needs into consideration. THIS is 2nd wave, and its STILL relevant, and will be as long as patriarchy exists. You don’t get liberation from so called equality; you can have legal equality and still have plenty of misogyny and patriarchy.

      Sure, its a LOT better than it was, but the work isn’t near done.
      Even now 99% of all wealth is owned by men, and they get 90% of all income, but WE do 2/3 the work- sooooo equal!

    • Anna T

      Of course successfully raising a family is an important job, and a parent who has dedicated a large chunk of their life to doing this full-time is a worthy human being.

      However, this has nothing to do with how you birth, whether you breastfeed, co-sleep, cloth diaper, etc. It has everything to do with raising happy, healthy, well-adjusted children.

  • Dr Kitty

    Well said Dr T.

    In no other area of medicine is it considered to ethical to deny pain relief to a patient who is in pain and requests analgesia.

    “It wasn’t in your birth plan” or “but you had planned a natural birth, you don’t REALLY want that” are equivalent to telling a post op patient who requests pain relief that in the pre op discussion they had thought they could do without it, “so tough, no drugs for you!”

    • Beth S

      It would be like my doctor saying there’s no reason to give you good medication for a migraine, breath through it and everything will work out just fine.

    • araikwao

      But it’s”pain with a purpose”! *eyeroll*

  • Renee

    I would think this shows a serious misunderstanding of the nature of patriarchy, but I am pretty sure Dr Amy gets it.

    This is no example of matriarchy. Its proof that these women are tools of the patriarchy, nothing more.

    Otherwise, great points.

  • Deena Chamlee

    When I was practicing midwifery I never encouraged one pain relief method over another. I discussed benefits and risks (which my bias is pain can leave some with PTSD and trauma) and the patient not her family or anyone else made the decision. I made sure she knew that if she wanted fentanyl, and epidural she was not a failure at all. That in fact it is her basic human right for pain management.
    I have actually seen women post traumatic births who went all the way and definitely have PTSD symptoms and we discuss at length pain management for her current pregnancy to avoid recurrent trauma.
    I actually think that the ideology and back to nature is being seen to the extent it is because of pathology in narcissism. It is in fact known to be observed with the disorder. All I can do is pray for us all, because midwifery deserves to be healthy not only for the providers but more importantly for the patients we serve.

  • The Computer Ate My Nym

    I think you make a good case for the NCB style midwife not replacing patriarchy with matriarchy but simply being part of the patriarchy, Handmaid’s Tale style.

    • Anj Fabian

      If you look at The Farm and Ina May, she was in no way an equal with her husband who the de facto ruler.