Unnecessary epidurals? Maybe on Planet Midwifery, but not in the real world.

extrasolar planet on star background

Good, old Hannah Dahlen. I can always count on her to say something idiotic that gives us insight into hijacking of midwifery by biologic essentialists. Those are the women who think a woman’s vagina, uteri and breasts are more important than her intelligence or her comfort.

You remember Dahlen? She’s the spokesperson for the Australian College of Midwives who has given us such gems as:

A common concern with water birth is that the baby could try to breathe underwater and drown. But healthy babies have what’s called a diving reflex (or bradycardic response), which causes the infant to hold his breath when under water. The reflex is stimulated via the the infant’s facial skin receptors, which detect the water and inhibits breathing.

Sorry, Hannah, the diving reflex works only in COLD water. Anyone with a modicum of obstetric knowledge knows that babies are happy to aspirate warm fluid. That’s why they do in utero to expand their lungs and practice breathing before birth.

And, my personal favorite:

While the birth of a live baby is of course a priority, perinatal mortality is in fact a very limited view of safety.

Really? On what planet would that be?

Apparently that’s the way it is on Planet Midwifery where Dahlen and her colleagues reside, a through the looking glass world, where the acme of childbirth is not a healthy mother and healthy baby, but, rather, an unmedicated vaginal birth.

What’s Hannah come up with today?

Dahlen is incensed that any woman might value avoiding a lifetime of urinary and fecal incontinence over the ultimate achievement of unmedicated vaginal birth.

Dahlen, in a comment to the Australian newspaper WAToday, is responding to speech by Dr. Peter Dietz who is a urogynecologist. That means that he spends his professional life in large part repairing the damage from vaginal births. Dr. Dietz told a recent meeting the Royal Australian and New Zealand College of Obstetricians and Gynaecologists that women are suffering substantial pelvic floor damage in the quest for natural birth, because vaginal birth carries a risk of 30 per cent to 50 per cent of substantial pelvic floor damage.

Major pelvic floor damage can result in years, if not a lifetime, of misery. It can mean being unable to hold urine and feces, being unable to leave the house because of embarrassment and being unable to have sex.

But apparently on Planet Midwifery, that’s far less important than having a baby transit your vagina.

According to Dahlen:

There is no doubt pelvic floor injuries are a threat to the health of child-bearing women. It is imperative we continue research in this area and work to make birth safer. But women need comprehensive information that goes beyond the pelvic floor when considering the pros and cons of vaginal birth versus caesarean section.

Umm, Hannah, you apparently do not realize that we have “done research” in this area and the research shows that vaginal birth is the single biggest risk factor for pelvic floor damage.

But who cares about something as trivial as incontinence, right?

Dr. Dietz also criticized the effort to reduce epidurals, calling it, correctly, “reprehensible and anti-Hippocratic.”

Dahlen responds with this bit of nitwittery:

There is no intent to deny a woman an epidural if she wants one; we need to ensure they are not used unnecessarily.

Wait, what? They’re giving epidurals to people who aren’t in pain?

That can’t be what Dahlen means. After all, epidurals are widely used in other areas of medicine like general surgery, orthopedic surgery and management of chronic pain. Dahlen doesn’t mean those people. I’m sure she thinks it’s just fine to use epidurals ease surgical pain or cancer pain. No, Dahlen thinks it is “unnecessary” to treat childbirth pain.

Why? Because it might lead to something other than the pristine unmedicated vaginal birth so valued on Planet Midwifery.

And then there’s this, infinitely more revealing about contemporary midwifery than it is about anything else:

Dr Dietz’s statement that ”human childbirth is a fundamental biomechanical mismatch, the opening is way too small and the passenger is way too big,” provides a real insight into why the caesarean section rate may be so high in this country.

If health professionals truly believe this, then what chance do women have to feel confident in their bodies and their capacity to give birth?

Because on Planet Midwifery, the most powerful force isn’t gravity, it’s magical thinking.

Earth to Planet Midwifery: do you hear me?

Listen carefully:

There is NO SUCH THING as an unnecessary epidural. Childbirth epidurals are always and only given to women who have so much pain that they want one.

A midwife has NO BUSINESS deciding whether a woman “deserves” to get an epidural. We have a word for that behavior; it’s paternalism, and it’s reprehensible and un-Hippocratic.

Confidence has no more impact on a woman’s ability to have a vaginal birth than it has on her ability to have a child of a desired gender.

Women need to understand that midwives like Hannah Dahlen do not have their interests at heart. How could they when they don’t care if babies die, when they don’t care if women become incontinent and when they don’t care if women are in agonizing pain? Midwives like Dahlen care about one thing only: themselves and their associated ability to maintain control over patients.

Midwives aren’t as capable of obstetricians at saving babies lives; hence “perinatal mortality is in fact a very limited view of safety.”

Midwives can’t prevent pelvic floor damage by performing C-sections; hence incontinence pales in importance to vaginal delivery.

Midwives can’t perform C-sections to save the lives of babies in distress or deliver babies who are too large to pass through the pelvis; hence they pretend that it is doctors’ and patients’ “lack of confidence” in women’s bodies that keep midwives from ensuring a vaginal birth for every patient.

The questions for women are these:

Do you want to give birth on Planet Midwifery, where your vagina is more important than your brain, where your pain is ignored and where you are blamed if you do not achieve the ideal unmedicated vaginal birth? Or do you want to live in the real world where people care about whether your baby lives or dies, whether you are rendered incontinent, and want to ease your agony, not celebrate it? It’s up to you to decide.