Midwifery professors respond


Several months ago, I discussed a bizarre paper in the midwifery literature. In Homebirth midwives wonder why no one takes them seriously:

Including the nonrational is sensible midwifery, by Jenny A. Parratt, and Kathleen M. Fahy, was recently published in the Australian midwifery journal Women and Birth. This piece has a very simple premise and conclusion: Many principles of midwifery are not supported by science. Rather than modify midwifery to reflect scientific knowledge, it is personally more satisfying to midwives to justify and celebrate their ignorance. Hence, we celebrate!

As an example of the inanity promoted by the authors, I quote this:

For example, when a woman and midwife have agreed to use expectant management of third stage, but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking. Depending upon all the particularities of the situation the midwife may focus on supporting love between the woman and her baby; she may call the woman back to her body; and/or she may change to active management of third stage. It is sensible practice to respond to in-the-moment clinical situations in this way… Imposing a pre-agreed standard care protocol is irrational because protocols do not allow for optimal clinical decision-making which requires that we consider all relevant variables prior to making a decision. In our view all relevant variables include nonrational matters of soul and spirit.

I referred to the paper in a post earlier today, Midwives have a problem with scientific evidence. It came to the attention of one of the authors who has written in defense. This appears to be a genuine comment from Kathleen Fahy:

I find your rudeness and arrogance breathtaking. You seem to have a very clear view that body and mind (let alone soul) are separate. You are not up to date with the research in neurobiology and psychophysiology which demonstrates clearly the effect of thinking and feeling on human physiology. You might think it is ridiculous that skin to skin contact between a woman and her baby is seen as important in midwifery: it IS important for the woman’s natural oxytocin to be released which does at least two important physiological things; one contract the uterus and two assists with breastfeeding. Is it really your view that without the drug pitocin then women would all be having postpartum haemorrhages? Amy, you sound like a fundamentalist; you need to open you mind to knowledge and critically appraise new research rather than resort to selective reporting and ridicule. Kathleen

The defense is as illogical and unconvincing as the original paper.

1) There is no scientific research in neurobiology or any other field that supports the use of nonrational treatments.

2) There is no evidence that postpartum hemorrhage can be prevented or treated by skin to skin contact between a woman and her baby.

3) Rather than address the scientific evidence on postpartum hemorrhage, Fahy prefers to put words in my mouth. I did not say that all women will have postpartum hemorrhages without pitocin. I said that recommending “supporting love between the woman and her baby” is a flourish of outright stupidity, and Fahy has offered no reason to change that claim.

Caroline Hastie, another Australian midwife and co-author with Fahy and Maralyn Foreur of the new book Birth Territory and Midwifery Guardianship submitted this comment:

In regards to ideas about rationality and the non-rational, you may like to read this book on your journey to start understanding these concepts and why they are so important to supporting birthing women and midwives. Body and soul: a social history of the self

Ms. Hastie’s own book includes such gems as:

During women’s experience of childbirth, midwives also have the capacity to become aware of nonrational power and knowing… Being open to the nonrational can teach midwives about trust, courage and their own intuitive abilities.

And (I’m not making this up):

Nonrational power is inexpressibly unique, diverse and whole at the experiential level…

Spirit is power… Spirit is nonrational, ever moving, and acts in sometime idiosyncratic ways as it is free of what we rationalize as possible and impossible. The direction, force and flow of spirit extend beyond rational boundaries of time, space and matter…

The power of the spirit is the energy underlying all that in the world and the cosmos; it has been given other names, for example Universal Energy and the subtle yet vital energy called qi…

The effort to promote and defend the use of the nonrational in midwifery is astounding. Including the nonrational is not sensible midwifery; it is immature, self-absorbed, dangerous behavior. It reflects the unfortunate obsession among many midwives with their own feelings and need for validation.

Australian midwives are currently protesting the governments plan to bring them under the supervision of physicians. Frankly I regard any attempt to promote the nonrational in midwifery as evidence that midwives cannot be trusted to care for women without direct and continuous supervision by physicians.