Is contemporary midwifery merely unreflective defiance of obstetrics?


Why have midwives hit out with such vehemence at the ARRIVE Trial that found elective induction at 39 weeks lowers the risk of C-section? Because they recognize that this represents a crossroads for contemporary midwifery.

The foundation of contemporary midwifery is:

1. The belief that childbirth interventions inevitably lead to more interventions, often culminating in a C-section and therefore a bad ‘experience.’

2. The quest for a better childbirth experience is justified by the fact that “scientific evidence shows” that it is also a safer experience.

The ARRIVE Trial demonstrated the opposite; childbirth interventions can actually be safer even when performed without a medical indication.

Hence the crossroads. One direction would confirm the claim that midwifery is about adherence to scientific evidence; the other would represent a rejection of scientific evidence in favor of doctrine. Sadly, it looks like midwifery leaders are searching desperately for any fig leaf that would cover a naked rejection of high quality science in favor of doctrine.

When there’s a choice between scientific evidence and power over women, midwives don’t hesitate to abandon science in order to preserve their power.

This struggle is not surprising if you recognize that contemporary midwifery (midwifery as practiced in the past 50 years) isn’t a medical discipline. It’s just unreflective defiance of obstetrics. And it seeks to rescue women from the purportedly patriarchal hegemony of technology not to free them, but to oppress them under an matriarchal hegemony of midwives.

This assessment of midwifery was made by two influential feminist scholars in a 1996 landmark paper, What is gender? Feminist theory and the sociology of human reproduction. The paper is long and filled with academic jargon, but its central claim is:

… [T]he lived experience of midwifery … is revealed only as the largely unresearched antithesis of obstetrics. An alternative is called into existence in powerful and convincing terms, while at the same time its central precepts (such as ‘women controlled’, ‘natural birth’) are vaguely drawn and in practical terms carry little meaning.

Why? To take power over women from male obstetricians and transfer it to female midwives:

If we conceive of power as a fundamentally male preserve we are led to gloss over ways in which women may exert power over others, including other women.In these terms, as recent institutional reforms stimulate community midwifery midwives may begin to consider the notion of affinity with women embedded in such concepts as ‘continuity of care’… as masking the potential exploitation of midwives by their clients.

The ARRIVE Trial strikes at the heart of midwifery doctrine in two ways. First, it shows that the claim that interventions should be avoided because they lead to more interventions is wrong. Second, and more importantly, if midwives continue to demonize interventions even when safe or safer, they make it clear that their recommendations were never about what is best for babies and mothers, but what is best for midwives.

It’s hardly surprising then, with so much at stake, that they have panicked.

1. They’ve advanced a series of reasons to ignore the results of the ARRIVE Trial, some nonsensical, and most equally applicable to studies that they have embraced such as The Birthplace Study of homebirth.

2. They’ve claimed, with no justification whatsoever, that studies done with obstetricians as primary providers aren’t applicable to midwives though they had absolutely no trouble accepting the results of studies using obstetricians as primary providers that demonstrated the risks of episiotomy.

3. They’ve insisted, with no justification whatsoever, that the study — which is nothing more than the scientific evidence on the risks and benefits of elective induction — will disempower women by “forcing” them to have elective inductions.

4. And led by Milli Hill, they’ve claimed that science is some sort of anti-feminist plot.

Hill’s post is a masterpiece of propaganda that would make a certain American President proud.

Step 1: Demonize the opposition by misrepresenting their views.

If we start from the standpoint that women’s bodies are entirely unfit for purpose …

Step 2: Portray freedom for others as oppression for you.

… then the obvious mental leap from the results of the ARRIVE trial is to recommend it as standard across the board.

Step 3: Insist that only those who are arrogant would dare disagree.

There is an arrogance about the ARRIVE trial that has long pervaded maternity care, a patriarchal approach that never stops to question whether there is a limit to ‘doctor knows best’.

Step 4: Invoke the specter of a police state.

To use Margaret Atwoods analogy from The Handmaid’s Tale, “Nothing changes instantaneously: in a gradually heating bathtub you’d be boiled to death before you knew it.”

Step 5: Do not, under any circumstances, address the facts.

It’s all done for the same reason the American President does it: to whip followers into blinding anger over their “oppression” so they can ignore unpalatable truths.

The reaction of midwifery leaders to the ARRIVE Trial reveals that contemporary midwifery is largely unreflective defiance of obstetrics. Its purpose is to wrest power over women from obstetricians so that midwives can enjoy that power instead. Sadly, when there’s a choice between scientific evidence and power over women, midwives don’t hesitate to abandon science in order to preserve their power. If that’s not anti-feminist, I don’t know what is.