Is contemporary midwifery merely unreflective defiance of obstetrics?

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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.

  • RudyTooty

    I’m currently reading the book _More Harm Than Good?_ by Edzard Ernst and Kevin Smith.

    I came across this section where they describe how CAM (complementary and alterative medicine) practitioners respond to scientific research that challenges their practices/ideology. So. Fitting. For. Midwifery.

    “1. They will state there is evidence to the contrary.
    2. They will suggest that the existing evidence has been misquoted.
    3. they will say that medical research is generally so flawed that it cannot be trusted.
    4. They will claim that scientific evidence is overruled by centuries of experience.
    5. They will reverse the burden of proof.
    6. They will say a new scientific paradigm is required to explain why CAM works.
    7. They will claim that scientific evidence and reasoning are not applicable in CAM.
    8. They will point how how safe or inexpensive CAM is compared to conventional evidence.
    9. They will suggest that the critic is paid by big pharma to defame CAM.
    10. They will launch personal attacks on their critics. ”

    Midwives, CNMs too!, have clearly made claims 1, 2, 3, 4, 5, 8, 10 in response to the ARRIVE study.

    • Sue

      Great list!

      I’ve found this when arguing with anti-vaxers:

      AVer: There have never been any safety studies done on vaccines.
      Me: Here are a bunch of safety studies.
      AVer: But they’re probably all funded by Big Pharma
      Me: Here are some independently-funded ones
      AVer: You are a lying paid shill!!

      • RudyTooty

        Yeah. It’s an underlying theme that spans multiple ideologies.

        I didn’t have time to expound when I first posted, but here’s what I’ve been seeing/hearing from midwives in response to the ARRIVE trial.

        1) “Natural birth and spontaneous onset of labor reduces the cesarean rate!” (not IOL).
        2) “The ARRIVE trial ignores all the other evidence that shows the benefits of the Midwifery Model of Care.”
        3) generally tossed around among other comments “This is a so-so study.” “This is a flawed study.” “This study was unethically conducted.”
        4) “Women have been having babies naturally for millenia, do we really believe that we can improve on what nature designed?”
        5) “There are harms from induction of labor that may negate the benefit of reducing the cesarean rate. Those potential harms (breastfeeding, magical hormones, feelings of ‘confidence’ and ’empowerment’) need to be examined before recommending IOL just to reduce the C-section rate.” [Is this reversal of proof? Eh. I know they do it. -RT]
        6) “We need to do our *own* studies!”
        7) [This one is probably folded into the women’s-wisdom mythology, and the adherence to nature is perfect, and don’t mess with nature.]
        8) “How much money is going to be spent on staffing for elective IOLs!?!?!?!”
        9) [not sure what the ob/gyn equivalent is of Big Pharma]
        10) [anything midwives say to Dr Tuteur is usually a personal attack, they rarely engage in discourse on the issues at hand.]

  • attitude devant

    You know, I spent a lot of my career feeling bad about a lot of what I do. I worried about harm from interventions, I worried about epidurals, I worried. A lot. As a counterpoint to my worry was the midwife chorus that everything I do messed up everything about birth, that I was interfering with vital processes disrupted by the tools I was using. They claimed they had better outcomes at home and happier healthier patients. They claimed they had ‘different ways of knowing.’

    But everything, everything that the literature tells me these days is reassuring. Hospital birth? Less stillbirth and less neurologic injury. Epidurals? Shorter labor, better APGARs, and no change in c/s rates. C/S? Remarkably safe. Induction? Lowers trauma and c/s rates and stillbirth. Aggressive management of hypertension in pregnancy? Saves lives!

    The ARRIVE trial is the final answer to every piece of crap the midwifery community has tried to feed me. Hey, if someone wants to labor spontaneously and without meds, fine by me. But don’t tell me I’m ruining women’s lives by offering them what investigation clearly shows is optimal care. I’m wise to their lies now. Their fantasy birth world is just that–fantasy.

    • Daleth

      If you want to really drive them mad, talk to them earnestly about “evidence-based care.” They love that phrase, or they used to love it until the evidence started showing they’re wrong.

      • attitude devant

        I know, right? I was literally HOWLING with laughter watching the ‘Evidence Based Birth’ lady try to evade the evidence.

        • RudyTooty

          Rebecca Dekker.

          All I can do is shake my head.

          But I think she’s dangerous, because she’s educated, and she bandies her advanced degrees and credentials about as if it grants her authority on the subject (APRN specializing in cardiology right?). And people trust and believe her.

          Sure she has a PhD, but she is a birth hobbyist like the rest of them.

          • attitude devant

            You know, I have a big bad MD and I collaborate with cardiologists ALL THE TIME but I would NEVER presume to speak authoritatively or give advice on cardiology topics.

      • Anna

        They love to bang on about “evidence based”. Their evidence being Sara Wickhams cherry picking, Henci with her BA, and ridiculous feels based observational studies done by midwives using their friends and homebirth groups on FB to garner the sample group.

        • Mari

          ‘Feels based’!! I love it, and am totally going to use that on Twitter.

      • Mari

        Nobody ever talks about ‘evidence’ when they actually have it. It’s a fact of life that definitely holds true here.

    • swbarnes2

      It seems that now the crunchy midwives are in the position of disapproving both of wanting a C-section, and of trying to avoid a C-section through induction.

  • mabelcruet

    Milli Hill is now getting her arse handed to her on a plate over on Twitter by Prof Kenny (Irish obstetrician who runs a home birth service, so she could hardly be called biased). Milli is dragging in a moronic ‘critique’ of the ARRIVE trial by Henci Goer teacher up-it’s like Dumb And Dumber over there.

    • Sarah

      Her replies are so laughably pathetic too. Sorry you’re offended it’s how I feel. It’s hilarious. She didn’t try and argue though!

      https://twitter.com/millihill/status/1028957524920291329

      • mabelcruet

        She is such an idiot. The authors of the report specifically say that knowing early induction is safe will give women more choice and more control. This is precisely what Hill and the like keep hammering on about! But obviously, the only choices they want to offer women are the choices that they deem to be the right ones.

        • attitude devant

          That is it in a nutshell.

  • Amazed

    OT but hell, it hurts and tomorrow, it isn’t a working day, so I’m gonna ask anyway.

    I had an accident in the playground. One of the kids jumped high and back to catch a ball. Instead, he got me in the throat. A header that the football teams at the WC would be proud of. It’s been a while and it still hurts like two pneumonias combined. Literally feels like the right part of my throat is burning and it is getting worse. Is a pill about trauma going to work, or should I pretend that I have a sore throat and take something about this? A gel that was supposed to remove the pain somewhat failed in a most spectacular way.

    The irony is, I a few minutes before the accident, I did think to tell these kids that they should really look for another place to play volleyball since the playground was tiny and equipped for toddlers alone but I thought, “Well, there are so many mothers of kids who are even younger than Amazing Niece and no one is saying a thing. I must be paranoid or something.” It does feel weird when I’m one of the few people who never leave the kid they are with to go more than five meters away from me if she isn’t clearly occupied with playing in a safe way – she isn’t this cautious BUT she is up to no good all the time. So, this time I kept my silence and I got my just rewards, I suppose.

    I am not complaining, though. Amazing Niece was out of the way only because I kept her on the safe side of me and behind me, there was an even younger kid. If I had not been there at this moment, the older boy would have flattened him right there. I still have no answer where the hell the adult with him was if he was wandering and toddling around older boys with a ball.

    • demodocus

      If you’re still hurting, might be good to go see a doc. It’s been half a day.

      If you’re concerned about the toddler, it could be that their big person was dealing with a sib at that moment (It’s damn near impossible for me to keep both of mine in sight at all times. Usually I’m with the younger, but sometimes I have to deal with my elder)

      If you’re concerned about the big kids’ vigorous game, it’s totally appropriate to remind them that this playground is geared more to little kids and to remind them that they can be intimidating to the babies.

      • Amazed

        It’s better now, thank God. I will survive.

        Yeah, the big person was clearly otherwise occupied – either by a sib, or a conversation at the benches with other moms/dads/aunts/grandparents. I’m afraid I’ve become quite judgy in the last few months since I started frequenting such places. A few last-minutes saves of the same kids with no one looking at us and no one occupied with other kids have made me as skeptical of free-range parenting as I am of helicopter parenting. I mean, I’m all for letting kids learn by experience but not if said experience includes falling on the hard ladders meant for older kids. So now I automatically assume that when no one is around and I see no one look at the kid, I’m dealing with a free-range parent. Which is very unfair.

        Yes, I should have reminded the big kids that it wasn’t a playground suited to their needs. This idea that “mommy knows best”, in this case “many mommies surely know best” bit me right in my behind, I’ve always been wary of balls flying all over the place and clash of body against a body but hell, I had no idea that headers could be this painful for the recipient.

        I think I’ll be as good as new by Friday when I’m taking the kid… to the playground, as you might have supposed.

        Funny thing from that day: kid was wailing for chocolate. I gave her a bar, she wanted more. I said no, she started wailing. I still said no. She wailed, “I want chocolate. But, but, but I WANT chocolate!” Still didn’t get it. “I want Mommy. I want Mommy. I want Mommyyyyyy! I want chocolate. I want Mommy.” Finally, I got tired and asked, “Well, kid, what is it? Do you want mommy, or do you want some chocolate?” She did not hesitate. “I want chocolate!”

        I guess I am not an attached aunt. I still didn’t give her any.

      • Amazed

        Demo, I thought you might find this interesting.

        https://www.livescience.com/60678-thracian-chariot-on-reddit-explained.html

        Unfortunately, since there is too much money for some people’s private “economics”, there isn’t nearly enough for maintaining precious artefacts. We’re going to lose this one as well, just wait and see. Things were bad enough when I was at the university and they have been escalating ever since. I almost wish treasure-hunters reach such treasures before archaeologists. At least this way, they are going to be saved and solved.

        Sad thing is, this chariot was saved by the villagers themselves. They drove the treasure-hunters away and called the local archaeological museum… and now, we’re going to lose the chariot. WTF?

        I adore Thracian tombs. Their art is amazing. And I heartily approve the practice of making replicas, so we can keep having the originals and not ruining them, although each time I visit one, there is at least one visitor complaining that hhe was cheated of seeing the real thing and how disappointed he was.

        BTW, I made it to the doctor yesterday, a good week after the accident. The woman was stunned at the size of the oedema and turned pale when she felt my throat. Told me than an inch left, with the same strenght, would have left me suffocating right upon the spot and unless the ambulance came really fast which it wouldn’t have…

        I can see many older kids who won’t be allowed to play dangerously around the babies in my future…

        • demodocus

          oh neat article!

          Getting your doc to turn pale is never a good sign. Glad it got looked at.

    • mabelcruet

      Bear in mind I’m a pathologist and only do dead people, so my view of injuries is fairly skewed. If you touch the skin over your neck, is it making crackle noises? Subcutaneous emphysema can happen after blunt trauma to the neck through fracturing bits of your larynx and associated structures. If you’ve got a leak, the pressure in the tissues will be increasing and the pain getting worse. Probably a worst case scenario, you’ve probably just got bad bruising, but if it’s still sore, go see a proper doctor.

      • Amazed

        Thank you! It looks like bad bruising indeed. The pain has lessened over the last 24 hours and is quite tolerable, although a few hours after my initial post, I had to take some pills. Kind of opiates, I suppose you may call them. But it’s better now. Just a sore throat. Not like a pneumonia or two combined. And I can tilt my head upwards without problems now. If it gets worse, I’m off to the doctor but I think it’ll get better.

    • PeggySue

      Gosh, I would go to the doctor. This sounds awful.

      • Amazed

        It was awful. It’s better now. If it wasn’t a non-working day, I would have gone, though.

  • attitude devant

    I was glad to see that ACOG released a preliminary position paper. A full Committee Opinion will follow. Their take: we can counsel patients that induction will not increase their risk of cesarean or complications, and that 39 week elective induction is a reasonable choice. Of course, since we live in the real world, they also remind us that our care partners (the hospitals) have limited beds and limited nurses and induction does increase the number of hours of labor that are spent IN the hospital, so there are some natural restrictions on what we can do.

    But still. This is so awesome. I haven’t been smiling so much since the report last year that upright birthing takes longer and leads to more lacerations. Will wonders never cease!

    • RudyTooty

      “…39 week elective induction is a reasonable choice.”

      Wait, wait. The midwives and NCB nutters are saying you want to induce everyone at 39+0 now. Because you’re evil and you’re ‘afraid of birth’.

      Offering IOL at 39 weeks as a ‘reasonable choice’ sounds so much different.

      Why are midwives’ hair on fire over this?

      And honestly, if I didn’t have patients requesting inductions Every. Day. I might wonder why create the option. But for crying out loud, this is what they are asking for. (Ok. I’ve also encountered patients asking for elective inductions at 34 weeks. Hard no from me on that one.) But at 39 weeks? Why not. And yeah, the 39 week elective IOLs will be bumped after the medically-indicated IOLs, and the 41 wk IOLs. But at least it could be an option.

      • attitude devant

        re:34 weeks, I know right? “Please Nurse Tooty! My baby will be fine! I’ll know she’ll be fine!”

      • Heh heh. I’d just like to get an epidural for, approximately, my last trimester.

      • swbarnes2

        I suppose they are against it for the same reasons the crunchies are against elective C-sections and bottle feeding…they don’t want anyone making choices they don’t want them to make.

        • RudyTooty

          Yes. That. And they hold their beliefs with a sort-of religious ferocity.

          Their way is Earth-goddess-divinely superior and The Only Truth And The Only Way Amen.

  • Cat

    Totally OT, but does anyone know how strong the evidence actually is for baby-led weaning? Last time I checked (about 6-9 months ago), the evidence for a pure “baby-led” approach being better than any other weaning method seemed pretty thin. However, a family member who was planning on weaning using a mixture of purees and finger foods has been frightened out of that approach by the teacher at a parenting class that she attends (she was told using purees would make her baby fat). How good is the science behind this?

    • Can’t help you, but my unscientific opinion is that this is one of those areas where parents should just do what works for them. Purees might add unnecessary calories if the baby’s gulping them down repeatedly after, like, age one, but mashed peas honestly don’t seem all that fattening. We just did whatever required the least work.

      • Cat

        “We just did whatever required the least work.”

        The longer I’m a parent, the more I wonder why the hell everyone doesn’t follow this approach!

    • demodocus

      i don’t know if there’s any kind of research. I did find this blog back when I had my first
      http://breastfeedingwithoutbs.blogspot.com/2011/11/bullshitometer-baby-led-weaninggill.html
      God knows my puree fed 4 yo is a bean pole. They turn their heads and/or spit food out when they’re done. ‘Course some kids don’t like purees

      • KQ Not Signed In

        My little man didn’t want anything to do with purees. I only got to feed him a few times, he skipped right to finger foods.

        I will, however, recommend frozen peas for teething. They were the most helpful thing ever. And he *still* eats frozen peas straight out of the freezer at almost 8.

        • Cat

          Frozen peas have all kinds of uses. Although I managed to give my self a nasty ice burn as a teenager trying to use a pack of frozen peas to relieve severe menstrual cramps when I was stranded without painkillers. Not a good call.

      • Cat

        Thanks! That was a very interesting read. On the picky eating front, I’ve come to the conclusion that, by the time you get to aged 2-3, ALL kids are fussy some of the time. Example: earlier in the summer, I went out for a picnic with an old friend and was filled with mummy guilt and self-doubt when her toddler (who was weaned using the BLW method and the River Cottage Baby and Toddler cookbook) sat eating her lunch beautifully while my toddler cadged crisps off the grown-ups and refused to eat anything else. The following month, her toddler ate precisely two chips and a mouthful of baked beans, while mine stared at her with big shocked eyes whilst eating linguine with a fork (and didn’t even make a mess).

        (Short version: irrespective of weaning method, toddlers are capricious little sods.)

        • Heidi

          My kid ate 3 servings of Takis Fuego (they’re like super spicy rolled up Doritos) yesterday. He barely touched his lunch and I found myself out with a screaming hungry toddler at the checkout line so I grabbed them. I didn’t see the Extreme Chili Pepper on them (oops), but I’m sure a lot of people were thankful that I got him to quit screaming! He handled the heat fine (I’ve caught this kid licking hot sauce out of a bowl). I know some parents would have been aghast that I let him eat processed corn products with artificial coloring and a sprinkle of MSG and are sure my kid will be obese next week or something. But today he’s had multigrain toast, avocado, seitan sausage, hemp seeds, black-eyed peas, carrots, brown rice, broccoli, and pasta. He still looks slim and he isn’t robbing my purse to fuel his junk food habit. LOL.

    • BeatriceC

      I am unaware of any rigorous science on the topic. The people spouting such nonsense are no different than any other ideologue spouting nonsense on any other topic. They use big words and sound all sciencey and stuff, but in the end it’s just unsupported hypothesis without any real basis in reality.

      If BLW works for you, then great. I purees work, that’s wonderful. If a combo approach works, that’s fantastic. Feed the baby however it works best for your child and your family.

      • Cat

        “but in the end it’s just unsupported hypothesis without any real basis in reality.”

        That was my impression, too. There seem to be a lot of assumptions made about how it *ought* to work (a friend once told me that it stands to reason that BLW is better because cavepeople wouldn’t have had blenders) and very little actual data. But it’s great to hear other, more informed views – thanks!

        • Madtowngirl

          Lol what? I’m sorry, the cave people reference cracks me up..sure, they didn’t have blenders, but they had hands and fists and other rudimentary tools. There’s no reason to assume they didn’t mash up food, whether for a baby or an adult.

          • Sarah

            Another thing they had is teeth…

          • momofone

            This makes me think of my mom and grandmother. We never had fish when I was growing up, because my mom strongly disliked it and everything about it–the odor, the taste, the texture, you name it. A few years ago, when one of my aunts came to visit, the subject of fish came up, and she explained how my grandmother always pre-chewed fish for them to make sure there were no bones (no wonder she had such an aversion!).

          • Sarah

            Ewwwww.

    • EmbraceYourInnerCrone

      Purees are not going to make her kid fat. My kid loved purees and is a 24 year old skinny mini(always has been). Which is mostly due to luck of the genetic draw and that she likes to hike. She love purees because until she was 9 months she had no teeth…she got the first 4 teeth the same week she learned to walk. babies are all different, some hate one texture some like another.

      • Cat

        Yup – I know some kids who would have starved by the age of one year if they’d only been allowed to eat what they could pick up, put in their own mouths and chew. I know others who couldn’t stand mushy textures from the very start. It’s almost as though they’re actual people with their own tastes, right?

    • Heidi

      My 2.66 year old still likes purees (the pouches) and is not a bit overweight. I suspect childhood obesity is a lot more nuanced than parent didn’t BLW or baby got formula. In fact purees allowed us to give him tastes if veggies and fruits that he would have likely rejected if it was all up to him. Now I have a toddler who eats his broccoli.

      • Cat

        Mine too! Well, today, at least. Might be a coincidence but my godson is crazy about broccoli (his mum used to bribe him with broccoli to eat some of his chips) and he was introduced to it in pureed form at an early age too.

    • seenthelight

      Check out this book: https://www.amazon.com/Secrets-Feeding-Healthy-Family-Eaters/dp/0967118921?crid=2B16N833A07WY&keywords=secrets+of+feeding+a+healthy+family&qid=1534291459&sprefix=secrets+of+fee&sr=8-1&ref=mp_s_a_1_1
      I believe she has a book regarding only infants, but I could be wrong. This book covers the whole picture, from birth to death, and I’ve thoroughly enjoyed getting my family on the structured-feeding method. I had been letting them graze, and ended up with one kid who’s probably too heavy, and another who’s probably too light, and this book provides a wonderful solution. I highly recommend it for everyone.

  • In the fairly near future more OB/GYNs are going to be women than men. It’s going to be difficult for midwives to rail against obstetric patriarchal oppression then.

    • attitude devant

      They already are. And the midwives hate us.We’re nasty bitches.

      • MaineJen

        “Such a nasty woman.” Sounds familiar…

  • Anna

    I wonder what Milli Hill thinks a woman’s purpose is? Sounds a lot like it boils down to vaginal birth and breastfeeding! That sounds a lot more like Gilead to me. I keep seeing natural birth at all costs proponents trying to compare modern maternity care and safety to the Handmaids Tale but they have it backwards! They probably all think June must be thrilled with her wolf midwifed free-birth complete with haemorhage! Nobody died right! So its safer than hospital cos if she’d gone to hospital she probably would have had a c-section! Thats honestly their way of thinking!

  • Mel

    It’s pretty clear in the middle of the blog post what Milli is really afraid of: informed pregnant women.

    “It could even be argued that pregnant women should be informed about this new evidence routinely, since, as the lead author of the report Professor William Grobman puts it, “This new knowledge gives women the autonomy and ability to make more informed choices that better fit with their wishes and beliefs.”

    The inconvenient flaw in this way of thinking is that women are people, not incubators. They are all different, with different wants and needs when it comes to their birth experience, as indeed every other aspect of their lives. Some, like the 6106 women who agreed to be randomised in the trial, may not mind if they become part of a wide scale medical and cultural experiment; others, like the 16,427 women who were approved for the trial but declined to take part, may indeed mind, very much. ”

    The medical-industrial-patriarchy complex that Milli grinds her teeth about recommends telling women that a 39 week induction increases the likelihood of a successful vaginal birth without increasing neonatal distress. The same medical-industrial-patriarchy complex had 16,427 women opt out of being involved in a RCT when offered the choice compared to the 6106 women who opted in. When presented a choice, 2% of women opted in; 98% opted out.

    Since the vast majority of women in the US receive OB/GYN or CNM supervised by OB/GYN care during pregnancy, an OB/GYN or CNM can run a great study on a 2% “yes” rate – and still provide services for the 98% “no” clients. NCB midwives, though, can’t afford to lose any of the less than 1% of women who are interested in giving birth in the absence of modern care. And, so, she recommends withholding pertinent information to influence the women to remain as her client.

    Sounds like she’s learned something from the worst practices of the medical-industrial-patriarchy complex, yes?

    • Sarah

      Milli is afraid of disagreement generally.

    • attitude devant

      I couldn’t get past the first paragraph, because of her reference to the “birth world”. Hello? I’m an obstetrician of thirty-plus years experience and the mother of two, and I don’t live in the “birth world.” I live in the world where birth is part of life and should be experienced in safety and with dignity…..and then you get on with living. Because Milli, seriously, focussing on this ONE biological function is just as weird as focussing on your defecation, although for all I know you do that too.

  • demodocus

    *snort* Part of me didn’t want to send my kid to preschool (which isn’t free and we don’t qualify for the sliding scale) because everybody was telling me he needs it. I’m contrary, but he’s schedule to start next week because he really could use a bunch of it, especially now that kindergarden is so academic.

    • swbarnes2

      IMHO (my kid is in pre-school), learning how to learn from other people is a very very important skill, and one a kid really can’t learn in the house.

      • EmbraceYourInnerCrone

        For my only child, preschool was about learning to get along in a group of other kids, learning about waiting her turn and yes, about following the rules. Her day care until age 2 was at home with one person who usually only had her to take care of. Pre-school made the adjustment to school a breeze. It didn’t hurt that she started learning her alphabet and numbers and simple addition in preschool.

    • Sarah

      I do think it’s good for them to get a few hours a week in, just to get used to it if nothing else. We have free hours at 3 in the UK and mine really benefitted from and enjoyed it. I think it’s a good call to do it.

      • demodocus

        It’s $200 per month so maybe 140 pounds? Not counting the list of school supplies we have to get. It’s going to take some very careful budgeting. This is as a public school, too, not some private place. sigh.

        Well, I am trying to get a few quilt commissions which will help.

        • Sarah

          Tough if you’re on a tight budget. It’s a crying shame the way some children who’d benefit from a few hours of nursery or other preschool provision can’t always access it because of cost. We have in the UK some free hours at 2 for people on the very lowest incomes, but the working poor don’t always meet the criteria and may miss out.

          • demodocus

            Yeah, we’re kind of in the middle spot where if you have one child and no medical concerns, you’re fine, but between our psych needs and DH’s ophthalmology needs, we have to pay way more in insurance than average. Even my moderate conservative husband is beginning to come around to the idea of health care being a national thing.

  • fiftyfifty1

    It’s easy to understand why CPMs oppose this study; they can’t do inductions. It’s harder to understand why CNMs oppose it. A CNM can place a Cervidil as easily as an MD, no?
    So it seems that Dr. Tuteur is right, it’s about opposing Obstetricians. I think it shows that CNM leadership is not content with the idea of CNMs being midlevel providers–providers who can do the first half of what an OB can but who can’t do the more advanced skills. So they have to pretend that they do the half that they CAN do in some special and better way. That their role is to speak truth to power or some such, not just deliver the easy catches and triage away complicated cases.

    • mabelcruet

      But Milli et al pretend that they have advanced skills and that they are evidence based and scientifically robust by throwing handfuls of sciency sounding words in-look at Hill waffling on about microbiomes and epigenetics. It sounds good, but they have absolutely no idea what it actually means. I don’t know a single obstetrician who talks about epigenetics or microbiomes-can you imagine the conversation ‘Your baby is showing signs of distress, we might need to do a section, but that might affect the microbiome, so we won’t’. Birth can be dangerous-you simply wouldn’t balance the very real risk of an immediate poor outcome with something that we can’t quantify and that may or may not turn out to be significant. But they throw in these concepts to scare women. Dahlen established an epigenetics working group and pontificates widely on it, but everything she’s written is virtually all unproven hypothesis with very little evidence.

      • Mel

        That’s the funny thing about medicine and informed patients – we often choose a treatment that prevents or corrects a severe condition that can cause morbidity or mortality in exchange for the risk of a lesser condition happening down the line.

        Like when women decide to give birth in a hospital in spite of the risk of the birth feeling less personal and more medical.

        • Who?

          Or even that just causes general misery. I am on HRT because days and nights of hot flushes, anxiety, horrible periods (a different kind of horrible from the 40 years of horrible I’d already had) and being starving all the time didn’t work for me.

          I’ve had all kinds of people tell me the risks, and of course my gp and I have had the conversations about it. Bottom line-I’m alive now, and I’d like to stay well, but that doesn’t include being exhausted, wracked with anxiety, and overweight. We monitor my health as we would do anyway. I’m not interested in two extra years in 30 years time as a tradeoff for several miserable years now.

        • FormerPhysicist

          I chose bilateral mastectomy and ooforectomy (along with surgical menopause) because my genes say I have a large chance of getting breast cancer. That’s even stranger – a large but lesser condition NOW, in exchange for lessening the risk of something worse down the line.

    • RudyTooty

      “It’s harder to understand why CNMs oppose it.”

      Me too.

      “A CNM can place a Cervidil as easily as an MD, no?”

      Uhhhhm…. YEP!

      Too many people in the upper echelons of the ACNM are spewing absolute nonsense in response to this study. I can’t figure out how having the same talking points as the Birth Hobbyists hasn’t raised their suspicions that they might be wrong on this one.

      • The Bofa on the Sofa

        “It’s harder to understand why CNMs oppose it.”

        Me too.

        Sometimes, maybe the easiest answer is the simple and obvious one, with a dose of Bofa’s Law.

        Instead of trying to twist yourself into a lot of contortions to try to understand it, why not consider the obvious and simple answer: CNMs are a bunch of loons.

        And, if your response is, “Not all CNMs are like that,” just refer to Bofa’s Law.

        I know, CNMs are supposed to be the “good ones.” But when push comes to shove, their true colors are shining through. And what we see isn’t good. It’s time to question the premise that the CNMs are the good versions of midwives (yeah, they are better than CPMs, but that is a low bar)

        We know the ACNM leadership has a bunch of problems with their over-entanglement and legitimization of CPMs, and, in the past, I’ve taken the CNMs to task for not speaking out against it. Maybe the reason they haven’t is because they actually agree with the leadership?

        With crap like this, they are losing the benefit of the doubt.

        • RudyTooty

          Hi Bofa

          Not sure what type of conversation you are (aren’t) trying to start.

          I am a CNM.

          Maybe I am a loon since someone in the internet comments told me as much. I didn’t know until now, so thank you.

          What is the evidence for your assertion? Beyond your personal opinion?

          Do you know CNMs? When you say you “take them to task” is this in conversation in real life? Or in internet comments?

          • The Bofa on the Sofa

            I didn’t start this conversation, I am responding to it.

            Yes, sit and defend it. But do you disagree with what I said? The ACNM leadership is horrid. That is obviously true. And as others have noted, see the CNMs response to this topic. You can pull the “not all CNMs are doing it” but that doesn’t change the point.

            We need to take a serious, HONEST look at what’s happening here. YOUR COLLEAGUES are making you look like a loon. THEY are the problem.here. You need to go after them.

          • Anj Fabian

            My shortest argument against CPMs is that I can’t tell you who is a good CPM (assuming they exist) and who is a bad CPM. Therefore I will not recommend any CPMs.

            If CNMs as a group are trending in that direction, then the same argument applies. If I can’t trust them as a group to practice responsible, ethical, evidence based care then I can’t recommend them.

          • fiftyfifty1

            I have a lot of sympathy for good CNMs like you, the ones who have no problem being “medwives.” Your ACNM leadership has gone off the rails, and the rank and file of practicing CNMs have sat by and let them! I would encourage you to “take back midwifery” from the loons, but I don’t think it will do any good. Too many of the rank and file support this NCB ideology.

            Sadly, it’s why I can no longer recommend CNM care to my patients. Sure, there are some great CNMs that deliver at my hospital, but I know for a fact that a few of them in their group practice support the woo (some quietly, some loudly.) The good ones, for whatever reason, have not purged the bad ones. So if I recommend CNM care to one of my pregnant patients and someone like you is on call, all is great. But what if one of the bad ones is on call? See the bind it puts me in? It’s really sad.

          • RudyTooty

            I’m not in need of any sympathy.

            And I understand why you don’t recommend CNMs – I understand completely. I know quite a few of them IRL. I’m not trying to persuade anyone here – just have a discussion.

          • attitude devant

            Rudy, we like you. Thanks for being here.

          • PeggySue

            What AD said.

      • Merrie

        Market share probably. CNMs appeal to the patients who want the more “natural” experience. If 39 week induction becomes more of the norm, and generally if the idea that interventions are great becomes more of the norm, potentially fewer women are going to choose CNMs.

        • RudyTooty

          I have many patients who are not looking for NCB, but they’ve chosen midwives. Neither the physicians nor the CNMs can offer elective IOL at 39 weeks – because they are effectively prohibited by hospital induction policies. If these policies change, and a subset of providers refuses to offer this based on their personal ideology, then women might choose another set of providers.

          I don’t know that elective IOL will become “the norm”, but it would be nice if it became an option. Because patients are already requesting this.

          • EmbraceYourInnerCrone

            I really do not understand why elective induction at 39 weeks is not an option the patients can choose if they want it…yes it means that women could plan the timing of their labors(a bit) and schedule them. So they could be sure they had child care, pet care, so they could schedule the grandparents if they plan to fly out and help the parents during the first weeks. So they could schedule their replacement at work. So their partner could schedule baby leave from their job.

          • fiftyfifty1

            I bet it’s at least partly due to cost. Inductions can take many hours, all of which needs to be closely monitored, and thus costly nursing staff.

          • LaMont

            Being able to schedule your labor is viewed as a bad thing in itself. The only proper labor starts at 11pm after a long day when you haven’t been able to sleep yet, and when the entire medical team is scrambling. How else will you prove you’re an earth mother goddess who trusts birth? Literally, statistics showing more births during weekdays are held up as proof of the anti-woman bias of doctors. The HORROR of women taking control is always the first port of call for anti-obstetrics people.

          • MaineJen

            You just described how my first labor started…at 11PM on a Friday night after a long day, right before I was about to crawl into bed. Earth mother goddess!!

          • seenthelight

            Wow! I’m in Alabama and was able to request a 39th week induction with no trouble. But I also had access to an overnight nursery at the hospital… Perhaps, besides home prices, this is one of the benefits of living in one of the worst states?

            I also had precipitous labor with my first, so maybe the doc was able to use that to persuade behind the scenes? But, as i recall, the paperwork was all labeled maternal-request.

      • attitude devant

        ACNM is crippled by the absolute fixation on ‘supporting all midwives everywhere.’ I cannot for the life of me understand why a group with REAL training and REAL expertise insists on institutionally aligning itself with the Birth Hobby Lobby.