Yesterday I asked:
What’s the difference between a doctor who performs a painful exam over a woman’s protests and a midwife who denies an epidural over a woman’s protests?
Hazard’s pious appeals are not about women; they’re about midwifery market-share.
I was responding to the claim by human rights lawyer Bashi Hazard that an increasing number of women are likening their experience of childbirth to assault by doctors.
I also posed the question to her directly on Twitter and she “responded” in the fashion typical of those who have been caught in hypocrisy — with a desperate effort to deflect:
I have arrived. A US RWNJ troll who claims to be an obstetrician has thrown down an imaginary gauntlet at me!
Is this woman really a lawyer? Most lawyers I know do research before responding so they won’t be caught uninformed. Hazard clearly didn’t bother.
I asked again:
If you care about women, you would be concerned about the widespread problem of midwives denying women epidurals. It seems you don’t.
Once again she tried to deflect:
Its you I dont care about. You are not an obstetrician. You are a troll and a RWNJ and a hired gun coming out of a country with a leader who bullies, trolls, lies and manipulates facts much like you. Your white self importance and entitlement is offensive. I waste no time on it.
Sure! If she didn’t care, she wouldn’t have responded, but apparently she was stung … as I intended.
The ugly truth — which Hazard is desperately trying to obscure — is that efforts to claim obstetricians commit assault/violence/birthrape have little if anything to do with women’s wellbeing and everything to do with midwives’ desperation to claw back market share.
Midwifery is an industry and midwives demonize their competitors. Indeed, much of midwifery philosophy is just reflexive (and unreflective) defiance of obstetricians:
Since obstetricians medicalize childbirth to make it safer, midwives de-medicalize it to make it more enjoyable, and, for added impact, declare childbirth was safe before obstetricians got involved.
Since obstetricians offer pain relief, midwives proclaim that pain improves the experience, simultaneously testing one’s mettle and making childbirth safer.
Since obstetricians whisk babies off to pediatricians to be sure they are healthy, midwives claim (without evidence) that skin to skin contact between mother and infant in the first moments after birth is crucial to creating a lifelong bond.
Since obstetricians placed the highest value on a healthy mother and a healthy baby, midwives place the highest value on a fulfilling birth experience.
In other words, no matter what obstetricians offer, midwives insist that it is unnecessary, disempowering and harmful. Midwives can thereby wrest childbirth back from doctors and give it to those to whom they believed it rightly belongs … the midwives themselves.
Wait, what? You think childbirth should belong to women? How naive. That would require holding midwives to account for their egregious behavior and apparently that’s not allowed.
A recent incident in New Zealand is emblematic of midwifery assault on women: Midwife disciplined after pretending to give woman pain relief during labour.
…[I]nstead of giving the woman the agreed pain relief of pethidine, the midwife gave her intravenous saline as a placebo but told her it was the pethidine.
…[T]he midwife said she “believed in the placebo effect”.
It gets worse. According to the midwife:
The way [the woman] was presenting led me to believe that she was transitional. Knowing this, I felt it was in the best interests of the baby not to give pethidine,” the midwife said.
“However, in the best interests of [the woman], I was to give her a sense of support and help in a difficult time, therefore I administered normal saline, leading her to believe it was Pethidine.
“I knew it would do no harm, and that pethidine could still be administered at any stage.
What did Bashi Hazard and her organization have to say about that? As far as I can determine, absolutely nothing!
Hazard has revealed her true goal — clawing back turf — in an article she wrote for Midwifery Today entitled Equality for Midwives:
Despite the knowledge and skills that traditional midwives have always used to serve their communities, there were medical emergencies that could arise in childbirth that they could not solve. Antibiotics, anti-hemorrhagic medicine, assisted and surgical deliveries and other medical technologies can prevent many of those deaths, and access to such technologies has saved many lives and massively reduced maternal and neonatal loss since their invention. But the terms on which these tools were offered to women, in the US and in many other places, created new forms of risk as all women were asked to place themselves in the care of medical professionals for pregnancy and birth, whether or not they needed medical treatment. Midwives were often disempowered (my emphasis)…
Midwives lost turf and income and they want it back:
Inequality exists in economics when doctors are rich, while midwives are poor. The valuing of, and compensation for, midwifery services should appropriately recognize their contribution to maternal health, enable midwives to continue in the field and develop experience and skills and construct midwifery as a stable profession that enables a woman to support her family, as doctors are able to support theirs.
Hazard’s pious appeals about assault in childbirth are not about women; they’re about market-share. Her goal is not the empowerment of women, but the enrichment of midwives.
That’s why Hazard has no interest in protecting women from assault by midwives, and was stung when I pointed out her hypocrisy. She felt compelled to respond, but her response merely confirmed my claims.
She thinks you’re right-wing? Anyone who’s read your blog for any amount of time knows that’s not true. In fact, it was our shared politics, and your criticisms of the natural birth movement as racist and anti-feminist that led me to reconsider my own beliefs about birth and parenting.
“You are a troll and a RWNJ and a hired gun coming out of a country with a leader who bullies, trolls, lies and manipulates facts much like you. Your white self importance and entitlement is offensive”
Nice example of ad hominem
“Ad hominem (Latin for “to the person”), short for argumentum ad hominem, typically refers to a fallacious argumentative strategy whereby genuine discussion of the topic at hand is avoided by instead attacking the character, motive, or other attribute of the person making the argument, or persons associated with the argument, rather than attacking the substance of the argument itself.”
According to her and her discussion with Milli Hill, you’re not a person, but a shady PR team funded by the Catholic church to push a right wing agenda. Let me guess-she also believes in chem trails, vaccinations and mass medication via fluoridating water is being used as a weapon of public control, and that Queen Elizabeth is actually a 7 foot tall blue lizard from outer space.
To be fair to Ms Hazard, the right wing types are very much in evidence here in Oz at the moment, and the Catholic Church is trying to redeem its authority, and ride on the coat tails of a ‘religious freedom’ Bill in federal parliament.
It’s lazy thinking, but unfortunately a common conclusion to hastily jump to.
On the Birth Time movie website under “experts” theres a video of her speaking at a Human Rights in Childbirth Seminar. Its an hour long rant. The usual shit about how Drs took over birth so they could dehumanise women for fun blah blah. About half way in she talks about her 3rd birth (NCB types dont have babies, they have births!) and it sounds like an HBA2C transfer. She uses the word transfer and says they wouldnt let her partner or midwife in at first. Maybe they were kicking up a stink and being threatening? No way of knowing but its unusual for partners not to be allowed in. Anyway its like shes reading off the “obstetric violence” script – they kept pushing me down (theyre trying to get a trace on your babys FHT?), theyre trying to get me to sign a consent (your baby is in distress?) my midwife whispers to me “you need to push this baby out right now” (further suggestion baby is in trouble?), zero concern about baby from Hazard but a brag about the size of her “successful VBA2C”. She blames her tear on the Dr rushing her and is shirty he isnt immediately at her service to stitch her up. In summary, high risk homebirth transfer, me me me and now she decries the system that most likely saved her babys life. If she thinks hospital is so dangerous why did she go there? Why not stay on the side of the road or at home?
Im wondering if she is really know in human rights law outside of NCB? I believe she has done activism/advocacy work in developing countries but not much detail available apart from articles in midwifery rags and speeches given at natural birth conferences.
The NCB groups always claim they dont read here and discourage the rank and file minions from reading here so it’ll be interesting to see how quickly they start swooping.
Somewhat off-topic, but Al-Jazeera had a great article about a midwife in Malawi, a country with some of the highest maternal and infant mortality rates in the world, who is having brilliantly successful outcomes by making basic prenatal medical care and interventions available to rural women who would otherwise give birth unassisted.
https://www.aljazeera.com/indepth/features/charity-nature-malawi-extraordinary-midwife-190827114801234.html
A quote from the article: “As far as delivery is concerned, we always monitor the pregnancy of the woman. When the situation is tough and beyond our control, we then refer them to Bwaila District Hospital right away with no delays, because we are dealing with two lives – the life of the baby and the life of the mother”
How different of an attitude from midwives and lay birth assistants in countries like the United States and Australia!
It is an attitude of working cooperatively with doctors and surgeons to improve and protect the lives of mothers and children wherever possible. It is an attitude that women need more options and access to care, not less.
Ms. Hazard doesn’t understand much about the dangers of delaying treatment for massive blood loss and labors where the mother or infant is not doing well.
Most women deliver with OBs because they understand that being at a fully staffed hospital with access to a blood bank and surgical delivery options massively reduce the risk of death or severe injury for the mom and baby.
Bashi Hazard: Birth rape is accomplished by OBs!
Dr. Amy: Sometimes. And equally or more frequently by midwives who withhold pain meds to laboring women.
Bashi Hazard: I can’t use the internet to check credentials! The US sucks compared to my country! You love Trump! White people suck!
That’s doubly funny once you run an internet background on her.
Average legal background in Big Law. Bailed on Big Law for non-profit advocacy of midwifery.
She’s from the highly racially tolerant land of Australia.
She has deep talks with other midwifery-adjacent professionals in several countries and may even make money doing so. (I don’t know who wrote up her blurb on the HRCMC – but someone didn’t realize that the Netherlands is included in the larger term Europe.)
My only hope is that one day this asshole is blessed with the miracle of pregnancy and then finds herself a midwife that does everything she can to help her have a natural empowering birth experience.
Then a few hours after labor starts when she realizes she miscalculated how painful this would actually be and every contraction is worse than the last she will break down and ask her beloved midwife for the epidural.
If karma does its job then after asking for that evil epidural the midwife will go to her and hold her hand and gently say ” I dont think that would be the best thing for you. Do you really want to harm your baby because you are uncomfortable? You will thank me later I know what is best for all moms and babies.”
Oh, she had a homebirth not working out already and reframed the ensuing emergency transfer and not ending up with a dead baby (or dead herself) as obstetric violence. I guess that pretty much sums up the level of entitlement.
She probably only went because her own life was in danger. I bet she did not even thank the doctor or any other staff for saving both their lives. Then again she is probably the type who would have been happier if she stayed home birthed vaginaly and ended up with a dead baby. She is just a disgusting excuse for a human being.
Ay-yi-yi!
She ends on the argument that doctors get paid more than midwives, and that’s unfair.
The obvious response is “If you want to get paid as much as a doctor – become a doctor.”.
I value midwives. I value doctors. I understand that someone with more education, more experience, more skills should get more compensation.
This idea that midwives do almost everything that a doctor does and should get paid almost as much as a doctor does doesn’t stand up to scrutiny. It’s not as if you can give midwives one course in obstetric surgery and you can replace OBs/consultants/doctors with midwives in L&D.
If you want to get paid as much as a doctor, study for as long as they do, pay the same registration fees, and accept the same level of accountability when you screw up … *crickets*
Yeah, it’s funny how even the crunchiest midwives get that a “backup” OB is a good idea for emergencies, whereas they don’t think that doctors need a backup midwife for the same purpose, but then continue pretending that their qualifications are “just the same”.
If you look at starting salaries, there is very little difference. In the UK, doctors and nurses working in the NHS are all paid according to fixed pay scales. A junior doctor, the year after qualification, starts on £26,610 per year, a first year nurse starts on £23,000. Added to that, up until 2018, student nurses received bursaries for tuition costs-its only very recently that nursing students have had to pay for tuition. Most medical students come out of the end of their student years with an average debt of around £69,000. There is less chance for them to earn whilst studying because medical students have longer working weeks and longer terms with shorter vacations than other students. Currently, most nurses don’t have anywhere near this sort of debt at the start of their career.
In my lab, the trainee pathologists, who have been qualified for 3+ years, earn less than the lab staff (biomedical scientists). Ward based doctors earn more because they do many more hours-most nurses do a 37.5 hour week, most ward based doctors do a 48-50 hour week.
Over the course of a career, doctors will earn more, but that needs to be offset against outgoings-before I do a tap of work, I currently have to pay out approx £12,000 per year in membership fees, medical insurance, registration fees and so on. People working in higher risk areas (like obstetricians who are far more likely to be sued than me) obviously pay out many 10s of 1000s for their insurance. It’s not a cost nursing staff generally need to consider. In addition, look at the cost of conferences-many of the conferences that are multi-disciplinary often have a range of fees-nurses invariably are charged less to attend the same conference than a doctor would be charged, even a junior doctor on a lower salary.
In our lab, we have some biomedical scientists who are taking over roles which were previously medical (specimen dissection mostly). They get paid on a salary scale from about £37 000 to £50 000 depending on seniority. But they don’t have to pay for their training (that’s provided free via the hospital), they don’t have to pay for exam fees (ditto), and they don’t have to take on additional insurance (ditto). Unlike medics-we have to pay for all exams that we take, tuition costs, everything.
If you want to be paid the same as a doctor, you have to be prepared to take on the same risk, the same responsibilities, the same culpability and liability and the same answerability. The buck stops with me-I cock up and a patient is harmed, I am the one at fault.
There is a very dark joke in obstetrics looking at the difference between midwives and obstetricians. It goes: ‘How do you know when the shit has hit the fan? It’s when ‘my client’ becomes ‘your patient’.
She sounds like a winner.
A serious question: How should we frame the grey area for women who, going into childbirth, value a ‘natural delivery’? How do we get them, and their midwives to look out for the women and babies and understand that changing one’s mind is FINE?
I know you can’t train for childbirth like a race, but let’s go with that analogy for now. Assume I train for a marathon, and ask someone to support me on race day help me finish the marathon (another runner? it doesn’t matter.). Then, on race day, I am winded at mile 16 and want to stop. It is reasonable to expect my support person to tell me “you got this, you trained for it, keep going”. I still want them to back off if I am adamant I am stopping, but I did want to do this and I did ask them for encouragement in this goal. Yet, if I slip on a rock and break my ankle, I expect them to tell me to stop the race, and not be stupid. Even more so if I have a heart attack. But we don’t see this in the grey area of childbirth. Sure, mostly we do if the shit hits the fan and there is no question that the laboring mother needs medical attention. So, where does the grey area extend? How do we get mothers and doulas and midwives (and fathers, and the mother’s mothers..) to see pain or exhaustion as new information and a reason to reevaluate labor goals instead of “giving up”?
I like this analogy of childbirth like a race (and It’s one that natural birth pushers use), and I think about how if labor is like a race, sometimes the finish line gets moved. Say you trained for a marathon that’s 26.2 miles long, and the course ended up being 52.4 miles long? And uphill the whole way? And it was snowing that day? Would your training and your mantras and your special doula really matter or make a difference? No. Would some additional tools of modern medicine and technology help make the process less traumatic and less harmful? YES.
And yes, there is so much to overcome when a patient has idealized the notion that ‘natural birth’ as best – despite the trauma and horror of they might be experiencing during their labors. I don’t plant those seeds in patients, but I find it a challenge to help them deal with not only what they are physically experiencing, but what they are mentally clinging to as an idea of ’empowering’ birth – ie no drugs, no anesthesia, no help – when they being tortured by it.
I find myself often saying to patients: “I am happy to support a natural birth, but let’s remember that no one knows what kind of birth they are going to get.”
Natural birth is easier to achieve with short and normally progressing labors, but that doesn’t happen all of the time. And having a long, dysfunctional, abnormally progressing labor without intervention is too often blantantly torturous instead of empowering. I won’t do anything to a patient (in a non-emergency situation) against their wishes, but it is very hard to watch them cling to their idealism in some of these circumstances.
For people who have it in their mind that a non-epiduralized birth is something akin to rapture, telling them that getting an epidural during a hard labor is like blaspheming – but the truth is that epidurals can be lovely, lovely restful tools for long and hard labors. (Or for short ones, if that what the labor patient wants!)
We need more grey area, and conversations in these grey areas. Because promoting natural birth to the point of torture, exhaustion and injury is not reasonable.
I see one major difference between running a marathon and giving birth – when running a marathon, you get to decide if you are done; when giving birth, someone else gets to decide if you are done. No matter how much your race buddy cajoles you, if you don’t want to run anymore, you can step outside the tape and sit down. But in birth, your race buddy is riding ahead of you in a golf buggy, you’re attached to that golf buggy by a chain around your neck, and you have no choice but to keep running until your race buddy stops the buggy. That level of control is what makes marathon running potentially empowering and birth potentially disempowering. It’s the level of control that means giving birth itself can, under certain circumstances, constitute a traumatic event, whereas the act of running a marathon itself would not be.
For those women who go into birth wanting to attempt an unmedicated vaginal delivery, I think midwives would do well to recall the lessons of sexual consent:
– If someone starts out doing something with you and then decides they don’t want to do it, stop doing it.
– It’s important to communicate, but if you need to persuade the person to do something, they haven’t really consented.
– If you’re in a position of power over someone or their judgment is impaired in some way (read: extreme pain), they may not be able to give consent.
That’s why I prefer the comparison to traversing down a mountain (like, on the ski slopes). If you work very hard with good management, you can get your way down the hill relatively smoothly, although you never know about dropoffs and other hazards. Or, if you are like me, you can fall and bounce your way down the hill. In the end, you are going to hit the bottom, hut if you do carefully, you can avoid serious issues.
Maybe going down a cliff is even better. You can try to climb down, but even when you do, you still have a belay line for safety. My wife would rather rapel. You could try to climb down without a safety rope, but if you slip and fall it’s bad news.