Midwives, women and abuse

Abuse word on wooden cubes. Abuse concept

Lawyer and birth rights activist Bashi Hazard refuses to answer the question I posed:

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?

The ugly truth is that Hazard and Hill aren’t interested in what women want; they’re only interested in what they and their friends want.

In the meantime, journalist Milli Hill, always desperate for attention, has joined the fray.

Hill:

I don’t really understand who ultimately gains from all the effort though? What is their goal – or who is getting their pockets lined – or both?

Hazard:

Well, take the NRA for example. How do you manage to keep selling guns to teenagers when your community is coping with 30-40 school mass shootings a year? By keeping the public on side through floods of “emotional messaging”: (1) Affirm their outrage (2) Tell them what to think

They seem to be under the mistaken impression that the bullshit with which they baffle their gullible followers will work on me.

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Feminist academics have been exploring midwifery abuse of power for decades.

Among the most influential commentators on the subject are Ellen Annandale and Judith Clark, authors of the widely quoted paper, What is gender? Feminist theory and the sociology of human reproduction published in Sociology of Health & Illness Vol. 18, No. 1, 1996. The paper is long and filled with academic jargon, but has important insights that have created controversy among feminist theorists:

…[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.

In other words, contemporary midwifery is unscientific and based on reflexive defiance. How did the it get to this point? Annandale and Clark believe that it starts with biological essentialism. Biological essentialism perpetuates women’s oppression by validating men’s belief that women are emotional and irrational. Or as Annandale and Clark write:

… Thus … reproduction is still centred for women and put on the agenda as if it were central to all women’s lives. This may serve to lock women into reproductive roles which may be politically problematic since the centrality of reproduction, contraception and childbirth to biomedicine is transferred to women’s experiences. This may be the reality of their experience, but equally importantly, it may not. To a certain extent this may be seen as an unavoidable consequence of a critique which appears as if it must engage the dichotomies of biomedicine to develop its own narrative.

Not only are the assumptions of biological essentialism wrong, they are also elitist:

… The charge of elitism evidenced in the privileged white middle-class voice of much research, and the silence around differences between women, applies well to Barbara Katz Rothman’s influential 1982 work … which ends with an implicit call for a home-based natural birth experience …. This is made in joyous terms with little recognition that many women may not be in the position to avail themselves of such an ‘alternative’ even if they wanted to.

Annandale and Clark ask a critical question about the new midwifery. Are midwives “with women” or exploiting women for their own ends?

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.

This is what Bashi Hazard and Milli Hill refuse to acknowledge. And because they cannot accept that midwives could abuse their power, they feel free to ignore the women who are abused by midwives.

One Twitter commentor wrote:

This happened to me and it certainly felt like assault. Midwife/doctor whoever is denying the pain relief, there needs to be serious concequences, it is a human right to have pain relief during childbirth, and in denying pain relief they are deliberately violating a human right.

Another wrote:

I’d also like to see them pulled up for ‘too early to have an epidural’ or the ‘let’s see how it goes’ routine. It’s nonsense- childbirth will generally get worse before it gets better and these tactics are designed to get the woman past the point of being able to have one.

The ugly truth is that Hazard and Hill aren’t interested in what women want; they’re only interested in what they and their friends want. And they’ll say and do anything — no matter whom they hurt in the process — to get it.

They know their position is indefensible so they try to divert with name calling and lies. That won’t work any more.

  • RudyTooty

    There is a cruelty in denying a woman’s request for an epidural in the middle of labor. But there is another type of cruelty that revolves around the months of grooming women to believe that they will be ’empowered’ by the agony and torture of birth, that they should want to avoid an epidural at all costs, and that a birth with an epidural is somehow a failure to experience the raw glory and awesome power of vaginal unmedicated birth.

    I mean, if a midwife has done her grooming correctly over months of the hour-long prenatal appointments, the chance that the patient will even request an epidural during labor go down considerably. So it will appear that the midwife is honoring the patient’s wishes in supporting her ‘natural’ birth.

    Both methods of controlling women are cruel. The pre-meditated and calculated one is rather disturbing, though. And yes, this is a lot of what contemporary midwifery is – this grooming of patients for a certain method of labor and birth – the type the MIDWIFE prefers. :-/

    • fiftyfifty1

      Yep. Women are repeatedly given the message that epidurals are for weak losers who are brainwashed. That they will drug the fetus and prevent bonding. That being able to manage the pain is the sign of a good mother essentially. Then if a woman does get an epidural and struggles with guilt or postnatal depression the midwives accept no blame, they say it’s because the woman didn’t meet HER OWN goals. Same sort of thing with breastfeeding–the woman is upset because she failed to meet HER OWN breastfeeding goals. It’s gaslighting.

    • Cristina B

      That’s a really disturbing way of putting it, but sounds accurate. I always wondered why they needed hour long prenatal appointments when my GP ones were like 15 mins. And why they needed to do so “research” when the midwife is already supposed to know what’s going on.

      • AnnaPDE

        I’m not sure what the midwives do in that time, but with my OB it was:
        * Checking the standard stuff, such as blood pressure, fundal height, baby position, heartbeat etc.
        * Discussing any possible symptoms (including her asking about stuff I may not have mentioned but she considered worth knowing yes/no)
        * Detailed US scan, in part for the fun factor of seeing bub, but also for measuring if and how he’s growing (his head was pretty big), how my cervix is looking, and a check of the placenta.
        * Plus planning with regards to how to get bub out (planned CS, and detail questions around that), going over results from blood draws or similar, etc.
        * Some of the time, a med student would be there and get to practice a bit as well.

        This usually took 30-45min. A bit of extra time may have been spent on indulging our shared biking passion, but she had her appointments set up with 1hr intervals anyway to be able to fit patients in on short notice and be able to pop down to L&D a few corridors away, and in her words, “The fee is the same whether we just do the minimal stuff or go the whole hog, so why not do it properly and look at cute baby photos?”

    • Griffin

      “grooming” is an excellent term for what pro-NCB midwives are doing!

  • fiftyfifty1

    You say Annandale and Clark’s paper is “widely quoted” and it may be, but I keep wondering why their viewpoints are so underrepresented in mainstream discourse. I mean the vast majority of women choose to deliver in hospitals, under OB care, with epidurals and other interventions. And yet when you look in the media the conversation overwhelmingly favors the idea that “natural birth” is best, that doulas can reduce epidurals (as if that should be a goal), and that midwifery care is more feminist. I can’t figure it out.

    • mabelcruet

      It’s the silent majority-I think the majority of women are sensible, practical, and risk averse. No matter how much homebirth is pushed in the UK by the Royal College of Midwives, I think most women seem happy enough to deliver in an along-side midwife-led unit with the fancy machines and operating theatres right next door. The ones who push for homebirth, unassisted, hands-off, non-medicated births tend to be very vocal, but in the UK at least, they aren’t swaying public opinion very much at all, no matter how many column inches they get in the Guardian. If you look at the comments to this article, the majority are basically ‘stupid woman, why take those risks?’ I actually think that’s why the homebirthers/natural birthers are getting more and more aggressive and strident, they know they are making no inroads at all and that most women aren’t prepared to risk their health and certainly not their baby’s health and life, simply for bragging rights, and its frustrating for them.

      https://www.theguardian.com/lifeandstyle/2013/sep/14/freebirthing-birth-without-medical-support-safe

      • Ozlsn

        I agree. The amount of money that is being thrown at homebirth in the public system here is ridiculous – and it’s still a very tiny (but vocal!) minority who want it. The Canberra trial is having trouble getting enough eligible women who want to enrol (and are being pressured to relax the criteria which are “too restrictive”). Even with the new study that came out allegedly showing that planned homebirth was as safe as planned hospital birth in Australia the numbers are still under 1% of all births.

    • Casual Verbosity

      Anything that’s “too academic” generally won’t make it to mainstream media. I speak fluent Academic and some of those paragraphs were still a bit difficult to wade through and extract meaning from. So I think that the message could stand to be presented in a more accessible way. More so, however, I think that criticising “medicalised” birth is the dominant social narrative at present, at least in Australia, where we have a midwife-led approach in the public health system. The predominant discourse, not only online and in the media, but also amongst women on the streets, is that “natural” birth is best. There’s a lot of anti-medical sentiment, even amongst women who have had “medicalised” births. Despite acknowledging it was necessary to save themselves of their babies, they often feel the need to express how hard they tried for a vaginal birth and that next birth they’re going to be “educated”.

      • AnnaPDE

        The scary bit is that even well meaning people with influence — e.g. our local MP, a lovely progressive guy, dad of three, newest baby a few months old — are falling for this crap and supporting the NCB-as-standard political agenda in a belief they’re doing the right thing by women. And they get vocal support for it, at least initially.

        In this specific instance, I commented on his “I’ll support this in parliament, OK?” post that many women shell out for private care, because we do want access to an actual specialist doctor’s skills, plus an epidural or elective CS. Not just a midwife, as the gatekeeper for both “nice” stuff like epidurals, and “life or death” stuff like calling in doctors if things look a bit funny, especially when there are numerous examples of them putting ideological preferences over their patients wishes and well-being. And suddenly, there came a bunch of likes and “yes, same for me”s out of the woodworks.
        .
        With the current language and position of NCB, speaking up against it as the mandatory standard, and its proponents take full advantage of that.

    • Anna

      What they both said below. The average Joanna Citizen isnt all that bothered. The maternity lobby groups are mostly doulas and homebirth Mamas(as mouthpieces for their midwives). They have their academics, journalists, photographers, image makers and now social media managers to make it seem like every woman wants a forest birth with a deer doula (alongside the $2000 human one) when reality is most women want a hospital birth and access to pain relief. The Millis and Bashis of the world can make money bleating to the choir and despite all the bruff about feminism and sisterhood they really think women that want epidurals and accountability are just stupid.

    • Mel

      I think there’s a few reasons that NCB is over-represented in media.

      First, journalism favors the unique and vocal. “Mom has comfortable labor where OB prevents a common, but treatable, issue from endangering baby” is less attractive than “Giving birth at home: all the dramas!”

      Second, humans respond differently to reading about other people’s choices than they do their own choices personally. I enjoy reading about high altitude mountain climbing and deep shipwreck penetration SCUBA diving – a lot. At the same time, there is NO way in hell I’d ever do either of those.

      Third – and I do think this one is underappreciated by the NCB crowd – for every woman who reads about a homebirth and thinks “Oh, I’d love to do that!”, there are at least 50 women who say “Jesus H. Christ, what a hot mess! Who would do that!” I think of this as the Duggar phenomenon. The Duggar Family justifies their TV shows (and the way it corrupts their lifestyle away from the ideal CP/QF type) as exposing more people to their beliefs – therefore it’s a form of evangelicalization. The bit they miss is that most people who watch the show either say “Wow, the way they live is so sweet” or “Wow, these people are nuts” – but both groups proceed to turn off the show at the end and go on living like they did before.

      • fiftyfifty1

        I agree with everything you are saying. But it’s such a pity that train wrecks attract over prevented train wrecks.

        “Mom has comfortable labor where OB prevents a common, but treatable, issue from endangering baby.” –I mean how amazing is this? In all of human history except the last ~100 years this was impossible. It’s a miracle and people barely notice.

        • Mel

          Oh, I agree. I much prefer reading about deep diving expeditions where everyone comes back alive over ones where people die.

          I do think most people notice, though. After all, that’s where most women give birth – including women with the money and connections to give birth at home.

        • Shawna Mathieu

          You won’t see anything like “Breech Baby Saved By C-Section”. – just stuff about how the C-section rate is too high.