A midwife and an OB walked into a bar

Jill Arnold at The Unnecesarean wrote an interesting recap of a discussion that occurred on her blog between Ina May Gaskin and me. What’s most interesting about it is Jill’s conclusions.

Jill quotes two comments.

Ina May:

… I understand now that one reason that Dr. Tuteur has objected so strenuously to my ideas comes from the helplessness she and other staff members felt during her residency when those three mothers who did need obstetrical intervention refused it, unaware that their babies really could (and did) die for lack of it…

I didn’t make up the incident … in which repeating the traditional wedding vows made it possible for my friend’s cervix to dilate fully after she had been stuck at 7 cm for more than a day. She gave birth about an hour and a half after that impromptu ceremony. I realize, of course, how hard it can be for anyone who prides herself on being “rational” and skeptical to accept this, but I’m stuck with what did happen. There were witnesses…

I don’t find it at all hard to believe that he encountered tribal people whose experience told them that a labor could be prolonged when a mother had a sexual secret that she was keeping. It doesn’t mean that will happen with everyone, but it does happen sometimes. And no randomized controlled trial will ever demonstrate this…

And my response:

You don’t have to conjure up any secret motivations. I’ve explained why I object strenuously to your ideas: I find your philosophy of biological essentialism and anti-rationalism completely unpersuasive, and I have pointed out ad nauseum that most of your empirical claims are factually false. That’s more than enough reason to explain why I disagree with you.

In recounting those anecdotes, I was not describing my “helplessness” since I did not feel helpless. I recounted those anecdotes specifically to illustrate my claim that homebirth and NCB advocates don’t understand the risks of their choices because the NCB literature is silent or lies about those risks.

Let me make myself very clear, Ms. Gaskin, so you cannot twist or misinterpret what I mean. I disagree with almost everything you say because I think you are wrong. The scientific evidence does not support your claims, and your invocations of non-rational forces and energies is nothing more than quackery. (my emphasis)

Jill’s take on the discussion:

Amy has more or less placed the OB philosophy in the science category and NCB philosophy in the mysticism (or non-rational) category. Scientism holds science as superior and therefore will always trump any non-empirical philosophical explanations for phenomena…

I agree wholeheartedly that NCB philosophy, at its purest and as I understand it, is biological essentialism. It ranks unmedicated, vaginal birth as superior to all other ways to become a mother.

Unfortunately, Jill goes on to confuse the impact of the mind on the body (“psychosomatic aspects”) with anti-rationalism:

The source of contention seems to be whether or not there is a psychosomatic aspect to pregnancy and labor … This is the classic debate between the Cartesian view of the patient (edit: the patient’s body) and what psychosomatic medicine refers to as the “body-mind.” It bleeds through into discussions about alternative medicine … And if there’s anything on science blog …that will drive scientists and doctors up the wall, it’s claiming that a treatment works based solely on a personal experience.

But the impact of the mind on the body is a concept firmly embedded in science. Non-rationalism is the idea that there are OTHER forces, like spiritual forces, that come from outside the body to impact the body. It also invokes the idea of special powers such as intuition that give certain people secret knowledge.

Jill concludes:

Within the framework that Amy is working, I’d have to say (as a layperson, so who cares, right?) that most non-biological (i.e. psychological) claims about birth are unscientific, as they are yet unproven. Neuroscience appears like it might someday bridge that gap, but as of yet, it hasn’t.

She goes on to say

As far as correctness and being right is concerned, a cultural relativist (like me) will hold that separate philosophies are equal and can both lay moral claim to rightness, with none being superior to the other.

And that is the quintessential anti-rationalist claim. All ways of looking at things are equal. Empiricism and rationality shouldn’t be privileged. Women have other ways of knowing.

As I understand it, Jill is saying that it is her personal belief that vaginal birth is best even though that’s not what the scientific evidence shows. She has every right to that personal opinion as do other NCB and homebirth advocates, but they need to realize what Jill has acknowledged: the scientific evidence does NOT support the claims of NCB or homebirth advocates.