Is contemporary midwifery just another form of quackery?

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Is contemporary midwifery the ugly stepsister of obstetrics?

Everyone knows the story of Cinderella. Enslaved by her stepmother, bullied by her stepsisters, Cinderella manages (courtesy of her Fairy Godmother) to attend a ball where she meets the Prince. Rushing to leave, she loses her petite glass slipper. The bereft Prince vows to find her again by searching for the woman who can wear the shoe.

Cinderella’s stepsisters know the shoe is not theirs; no matter. When the Prince’s aide attempts to put the shoe on Drizella, she jams her much bigger foot into it and announces, to obvious disbelief, that it fits. She is so desperate to claim the reward, that she will say whatever it takes, even if it is obviously nonsense.

Claiming personal experience is a form of scientific evidence is the rhetorical equivalent of jamming a big foot into a tiny shoe, and declaring, “It fits!”

Similarly, contemporary midwives are so desperate to claim the reward of financial compensation and professional autonomy that they will say whatever it takes, even if it is obviously quackery. To wit, the new medical anthropology paper by Andrea Ford, Advocating for evidence in birth: Proving cause, effecting outcomes, and the case for ‘curers’ that I wrote about on Friday. Ford attempted to rebut my longstanding critique that midwifery is not based on scientific evidence by insisting that personal experience is scientific evidence. It’s the rhetorical equivalent of jamming a big foot into a tiny shoe, and declaring, “It fits!”

For example, according to Ford it doesn’t matter whether spicy food can be proven to induce labor so long as the midwife and patient believe it can. In this way, midwifery theorists assert with a straight face that what the patient believes has happened is “scientific evidence” on the same footing with objective evidence of what actually happened.

Though Ford imagines she is rebutting my criticism of modern midwifery, she is both corroborating and bolstering it. She is demonstrating that contemporary midwifery theory is quackery because the foundational principle of quackery is that personal experience is evidence.

I first explained this exactly ten years ago. I quoted the paper The Persuasive Appeal of Alternative Medicine:

The person-centered experience is the ultimate verification and reigns supreme in alternative science… Alternative medicine makes no rigid separation between objective phenomena and subjective experience. Truth is experiential …

In other words:

  • You don’t have to listen to experts; everyone is an expert in her own body.
  • It doesn’t matter what studies show; the only thing that matters is how you feel about scientific claims.
  • Your personal experience isn’t irrelevant to determining causation or cure; it is the central, perhaps the only, thing you need to know to make a determination.

These are the guiding principles of quackery, whether it is homeopathy, anti-vaccine advocacy or bogus cancer cures. The goal is to undermine the standard of reasoning so that rational debate is impossible.

As this paper on pseudoscience notes:

…[I]n discussions about alternative medicine one often hears the claim that each person or patient is “radically unique”, thus frustrating any form of systematic knowledge about diseases and treatments. Of course, advocates of unproven medical treatments use this argument as a way to deflect the demand for randomized and double-blind trials to substantiate their therapeutic claims. If each patient is radically unique, there is no point in lumping patients together in one treatment group and statistically comparing them with a control group… The argument is so convenient that it has been borrowed as a … strategy by countless alternative therapists …

It is offered as a way of making pseudoscientific claims invulnerable against both empirical evidence and rational argument. That is precisely what Ford is doing in her paper.

Again referencing philosopher Isabelle Stengers, Ford writes:

…[W]hat if evidentiary practice were expanded to include the non-rational? Stengers also has a category into which midwives who do not seek belonging via rationality might fall, a third category of ‘curers’ who ‘are not haunted by the idea of being able to disqualify others, but rather who have cultivated an “influencing practice”’ Such curers are not concerned with being rational (as a charlatan is), much less with proving (as a doctor-scientist is); Stengers asks if modern medicine does not indeed have something to learn from them.

One of the older midwives I spoke with during fieldwork, who was a pillar of the local birth community and the natural birth movement in the 1970s, explained to me that ‘pre-stats’ she and her cohort just had a feeling that home birth was ok, they didn’t feel the need to prove it, nor to consolidate a best practice, as ‘the nature of midwifery appeals to independent minds, and there will be diverse opinions… We practice from our own innate wisdom, not protocols’…

You know you’re in a bad place when you insist that charlatans are more concerned with being rational than midwives are! Ford seems oblivious that she is situating midwifery securely within quackery.

The sad reality is that midwifery theorists from Soo Downe, to Sheena Byrom, to Hannah Dahlen are the basest form of quacks. That’s doesn’t mean they don’t believe what they say; many quacks believe they are making people healthier when they are actually making them sicker, as well as making themselves wealthier and more influential. But they are quacks nonetheless and they are harming women and babies.

Why have we allowed this to happen?

Because midwifery, like most forms of quackery, is cheaper than evidence based medicine and saving money is more important to government and hospital bean counters than saving lives. It’s as if the Prince determined that searching for Cinderella was too expensive and it was cheaper to settle for the ugly stepsister instead.

That’s not a happy ending … but there can never be a happy ending when you insist quackery is deserving of the same respect as science.

  • MaineJen

    How much do you want to bet that the “older midwife” Ford consulted was none other than our old friend Ina May? We already know she doesn’t care about evidence or best practices.

    • rational thinker

      Ina didn’t even seem to care about her own baby dying a preventable death.

    • fiftyfifty1

      I doubt it was Ina May, both because Ford’s doula business (and thus research study) are in the Bay Area, but also because there any number of revered older midwives, pillars of their NCB community etc types. And they pretty much all believe the same thing (they have to of course.)

  • Mel

    I think Ford got so wound up that she missed the obvious:

    Of course you can expand midwifery to include “curers” who use “different ways of knowing” including a worldview that stifles learning by reinforcing group/personal norms as the best form of knowledge. People do that all the time in various groups by changing inclusion guidelines.

    Just understand that that expansion places the new curers outside of science, rationality or medical practice.

    As such, they need to be very clear that any payment they accept is as a religious guru without any promise of medical-grade outcomes for child birth. And – obviously – this places them way-outside of the insurance model of reimbursement since that’s based on actuarial science – so they’ll remain in a fee-for-service model outside of hospitals.

    • fiftyfifty1

      As most of you here know, I grew up in a homebirthing family, so I have had an inside look at the way they think, and I can confirm it is a religious/cult/quackery type thinking. I can confirm it is neither heroic nor “free thinking.”

      That said, I am not “against” homebirth. Unlike anti-vax, it is quackery that can hurt nobody other than the woman who chooses it and the fetus that exists inside her. I support bodily autonomy in choice of birth location both because it is right and because any alternative is horrific. That does NOT mean I have to pretend that all “ways of knowing” are equal, or that any charlatan should be able to lie about the evidence and charge money to practice her birth hobby.

  • KQ Not Signed In

    I honestly thought a couple of those quotes were written by someone who was writing a logical critique of midwifery theory. But it was written as a rebuttal to same? Jesus wept.

  • mabelcruet

    Given that Cinderella’s glass slipper was thought to symbolise her purity and virginity, the phrase ‘jamming a big foot into it’ brings a whole new angle to this column!

    • Christine O’Hare

      LOL – just about did a spit-take all over my desk at work!

    • MaineJen

      Not to mention her “smallness.” Much has changed about the ideals of female beauty, but it seems women are always valued for being as small, unobtrusive and compliant as possible.

  • Contemporary midwifery theory does seem prone to quackery, not to mention an ignorant sort of paternalism (maternalism?) in which patient preferences can be ignored. That said, in the practice of midwifery there are plenty of good, evidence-based midwives whom I’d trust; my previous and current ob-gyn providers included midwives, and they never gave less than excellent care.

  • fiftyfifty1

    In her graduate thesis, Ford compares Bay area NCB proponents to LGBT activists. In her mind, both are brave pioneers showing the larger world that there is an alternative to the conventional way. I agree that Bay area LGBT activists were heroes. But to me NCB proponents seem to have much more in common with another Bay phenom–cults. LGBT people aren’t trying to convert or control anyone, they just want normal human rights/legal protections and to be left alone. But NCB is like a religion. Ask anyone who dares question the party line, ask any homebirth loss mother who has dared ask questions. Dr. Ford is too close to the NCB world for it to be her anthropology subject. She is unable to ask the right questions.

  • wildemoose

    This stuff has increasingly terrified me since I’ve been pregnant. I am really scared of decisions being made about my care that aren’t evidence-based. The other day we got some bottles in a sample box and the tagline printed on them was “The most natural way to bottle feed”. I don’t want the most natural way of doing anything! I want the scientifically proven BEST way. As my husband pointed out, the natural way of dealing with measles is to die from them.

    • Eh, don’t worry about the bottles too much. The cheapo nipples the hospital used turned out to be very popular with our kids; otherwise, just get an assortment and see which ones make them the happiest. I don’t know that there’s a proven scientific kind of bottle that’s best for most babies (though you do want slower flow for newborns).

      • wildemoose

        For sure, it was the sentiment more than the bottles that worried me. There is this assumption that the “natural” way is best when in many cases it’s dangerous, unnecessarily painful, or both.

        • PeggySue

          I’ve said this on here before, but my favorite response to “It’s natural!” is, “So is smallpox.”

          • EmbraceYourInnerCrone

            It’s gotten so annoying I will actuall walk BY something in the store that has “Natural, Organic, GMO free” on it becuase those words don’t mean it’s healthier and those words usually mean its more expensive.

          • MelJor

            It kills me with babyfood—I am basically forced to buy non GMO and often organic varieties because they are what meet my needs, and most babyfood is both of those things. The alternative would be to make my own, which is just not gonna happen as a household with two working parents.

      • Christine O’Hare

        yep, babies can’t read and don’t know what they are “supposed” to do. They will decide if they like a bottle, whether or not its the most “natural”

    • Cristina

      Honestly, that language makes me think it’s geared towards people who wanted to breastfeed but need bottles for whatever reason. The most scientifically proven best way to feed a baby is to just feed the baby. My oldest didn’t even like being burped halfway and would get pissed at being interrupted, so just go by what your baby likes, whether temperature, nipple flow, hold position, etc.