Patronizing: midwives and lactation consultants emulate what they claimed to despise about doctors

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Is there anyone more patronizing then the doctor who visits an indigenous culture and — imagining himself as doing nothing but good — goes where he is not wanted, is a poor guest, allows personal goals to take priority over the goals of the natives, fails to match technology to the needs of the local population, neglects to create a follow up plan and leaves a mess behind when he departs? In other words, the patronizing doctor provides what he believes the benighted patient needs, leaving the patient without what she needs, and then decamps back to civilization congratulating himself on a job well done.

Amazingly it is possible that there are people who are even more patronizing than such doctors; they are midwives and lactation professionals.

They, too, believe themselves to be on humanitarian misssions to enlighten the natives and gift them with what they imagine to be their priceless services. But in their case, the “indigenous culture” is our own and the benighted patients are women who have not been captured by natural childbirth and lactivists ideologies. When their services are not greeted with the unalloyed gratitude they expected, they are shocked, angered and hurt. There is much they could learn from the mistakes doctors have made.

Apparently, the problem with patronizing medical professionals was not that they were patronizing, but that midwives and lactation consultants weren’t the patronizing professionals!

As a paper on the deadly sins of humanitarian medical missions by Welling et al. explains:

This article is in no way meant to denigrate the good works of those who participate in humanitarian missions. We salute all those in these sorts of activities, realizing that there often is real sacrifice made, including the sacrifice of time, money, and equipment… We have great respect for all who go forth to serve. Surely those who aspire to help others almost always do so with honorable intent, and almost never set out to satisfy selfish desires. However, despite our good intentions, mistakes continue to be made …

These same principles apply equally to many midwives and lactation professionals. They believe that by promoting “normal” birth and breastfeeding, they are engaged in a humanitarian mission of the highest order. They often make real sacrifices and they do so with honorable intents. Yet, in doing so, they make terrible mistakes that harm women and babies.

The authors highlight the dangers of patronizing behavior:

As to how one should conduct oneself when on a humanitarian mission, a dose of humility might get us off on the right foot as we begin. Anything that looks like boorish behavior, or condescension, or a patronizing attitude … is detrimental to our efforts and will leave an unpleasant memory of us for those who would be our patients and our colleagues… We should go with the desire to see a different way to render care, instead of insisting that our way is the only correct way possible.

This is good advice for doctors heading to developing countries and it is good advice for midwives and lactation consultants heading to maternity wards.

There is no place for boorish behavior (denying epidurals, grabbing women’s breasts without consent); there is no place for condescension (imaging women who don’t want unmedicated vaginal births or who don’t want to breastfeed as ignorant victims of the medical patriarchy); and there is no place for patronizing attitudes (“C-sections aren’t real births,” “Fed is Minimal”). They leave women with trauma, not gratitude. There are other ways to render good care than natural childbirth and lactivist ideologies.

Furthermore, in humanitarian missions:

Motives should be questioned. We ought to aggressively plan activities that will do the most good for our patients, and we ought to shun those activities that are more designed for our own personal aggrandizement…

Midwives and lactation professionals need to question their own motives. Are midwives promoting unmedicated vaginal birth because it is truly a “one size fits all” benefit or because it enhances midwives’ power relative to other medical professionals? Are lactation consultants aggressively pressuring women to breastfeed because breastfeeding is a “one size fits all” way to maximize infant and maternal health or because it enhances lactation consultants’ employment opportunities?

Most importantly, doctors on humanitarian missions should go to the patients who want to be treated, not to populations who don’t want their skills. They should provide the services that patients want, not the services that the doctors want to give.

Midwives should care for the patients who prize unmedicated vaginal birth, not force patients who want epidurals and C-sections to have unmedicated vaginal births. Lactation consultants should be providing their services to women who want to breastfeed, not forcing everyone to accept their services so that they can pressure everyone to breastfeed.

Doctors on humanitarian missions should respect local traditions, not seek to replace them with the values of industrialized societies. They should treat patients from developing countries as autonomous individuals fully capable of making decisions about their own bodies.

Similarly, midwives should respect the “traditions” of our culture where women are entitled to pain relief in labor and to infant formula to feed their babies, not seek to replace them with midwifery values. Lactation consultants should treat women who can’t or don’t wish to breastfeed as autonomous individuals fully capable of making feeding decisions about their own bodies for their own babies, not as ignorant dupes of corporate behavior. Otherwise, both will merely recapitulate the worst behavior of paternalistic physicians.

Sadly, the greatest irony of contemporary natural childbirth advocacy and lactivism is that its practitioners have become everything they claimed to despise in doctors. It turns out that the problem they had with patronizing medical professionals is not the fact that the professionals were patronizing, but the fact that they weren’t the patronizing professionals

  • no longer drinking the koolaid

    The sad thing is the number of women who wholly buy into this model of care, but fail to see that is also patronizing. When their midwife or LC does suggest a more medicalized and necessary approach they are suddenly demonized and said to be non-supportive of NCB and BF.

  • Notsigningupwithdisqus

    An foundation in my country promoting natural childbirth and breastfeeding (masquerading as a feminist foundation) organized a series of workshops/lectures(?), entitled “Time for midwives” 🙂 I always read it as “So far doctors have been the ones telling women what they need. From now on, midwives will do it.” 🙂

  • mabelcruet

    I’d imagine they’d use the ‘primum non nocere’ defence, and argue that they would be doing harm if they supported the woman’s decision to formula feed, given all the incredible benefits they believe it has for her (reduces her risk of breast cancer, cures post natal depression, best weight loss diet ever and so on). Or they’d argue that you couldn’t stand by and watch a ‘harmful’ practice without intervening. I think the behaviour of some of the more extreme lactivists that we’ve seen on here, like Jan Hocking and Anna Perch, is grossly unethical-they mandate giving the woman the information she needs to make the decision you want her to make, basically lying to her, giving her less than comprehensive information and undermining her autonomy. I haven’t seen that type of medical paternalism for very many years (the only time I can remember was in 1991, I was a very junior doctor and the consultant in the surgical unit was fairly elderly and close to retirement. He would not tell his patients if they had bowel cancer. He would tell they had an ulcer in their bowel, or use a term like ‘nodule’ or ‘neoplasm’ or ‘mitotic lesion’. He was of the opinion the patient would lose hope if you told them about cancer.

    I think this type of lactivist has a very loose grasp of professional ethics and think their good intentions excuse all sorts of abominable behaviour.

  • demodocus

    Reminds me of some missionaries I met once. They were heading to convert the heathen Icelanders to the True Faith. (Baptist, in their case.) At 13, I thought they were ridiculous; this opinion hasn’t changed.

    • Gene

      When I was a child, the (Baptist) church we attended was raising funds for a mission trip to Canada to convert the heathen Catholics. Seriously.

    • Ozlsn

      My current favourite “off to convert the heathens” Baptist missionaries are in Scotland. They are apparently trying to work out the local language and cuisine… I don’t think they’ve converted anyone but they’ve put on about 10kg.