Yesterday I wrote about recent research in midwifery that is either horrifying or horrifyingly stupid. It ranged from a paper on midwives’ clinical reasoning that concluded that a substantial proportion of midwives don’t use clinical reasoning, to a paper on midwives’ self-confidence that showed that it depended on the good opinion of their colleagues, not on objective outcomes, to a napalm grade stupid piece on midwives and knitting.
I noted that the papers cover disparate areas, but were united by the fact that the focus is not on patients and not on outcomes and that they are not quantitative, merely descriptive. Most importantly, they are not based on objective measures, but rather, on the midwives’ feelings about … themselves. In the world of philosophy, midwives would be described as devotees of metaphysical solipsism.
Wikipedia describes metaphysical solipsism as:
“the philosophical idea that only one’s own mind is sure to exist. As an epistemological position, solipsism holds that knowledge of anything outside one’s own mind is unsure; the external world and other minds cannot be known and might not exist outside the mind. As a metaphysical position, solipsism goes further to the conclusion that the world and other minds do not exist.”
In other words, the only thing that matters to many contemporary midwives, particularly midwifery theorists, is what they think and feel. They behave as if mothers and babies don’t have an independent existence. Their only purpose is as props for the midwife’s self-image. There is no objectivity, only the midwife’s subjective experience. To the extent that mothers and babies fail to follow the midwife’s plan to glorify herself or be lauded by her friends (by having a serious complication or dying), it’s always the patient’s fault or “meant to happen.” It is never the midwife’s responsibility since her only responsibility is to feel good about herself.
There is no objective reality, only the midwife’s feelings. Even the mother’s feelings are irrelevant since her mind and feelings don’t actually exist outside of the midwife’s mind. Baby dies? That doesn’t matter; all that matters is what the midwife thinks about the death. If she thinks it isn’t her fault, then it isn’t, because all that matters is what she thinks. Mother is dissatisfied by the midwife’s care? So what? She needs to adjust her thinking to comport with the midwife’s beliefs. There are no safety standards for homebirth midwifery? Who cares? Safety standards are predicated on an objective reality and contemporary midwifery is primarily concerned with the midwife’s subjective experience.
The authors of the paper on midwifery clinical reasoning implicitly acknowledge this focus when they report that their study was conducted using post structural, feminist methodology. What’s that?
Wikipedia comes to our rescue again.
A major theme of post-structuralism is instability in the human sciences, due to the complexity of humans themselves and the impossibility of fully escaping structures in order that we might study them…
The movement is closely related to postmodernism… Some commentators have criticized post-structuralism for being radically relativistic or nihilistic; others have objected to its extremity and linguistic complexity. Others see it as a threat to traditional values or professional scholarly standards.
emphasizes “the contingent and discursive nature of all identities”
Or as MJ Barrett writes:
Poststructural theorizing questions that which is assumed to be normal or common sense. Embedded within discourses of postmodernity, poststructural theorizing helps make visible the constitutive force of discourses and their relations with subjection and desire. It is a “mode of analysis [that] shifts attention from individualism to subjectivity, from text to discursive practices, and from signifier to signifying practices… Discourse and the ways in which it produces subjects, is a central focus of poststructural theorizing, and as such, so is an analysis of power.
What does this have to do with midwives’ clinical reasoning? Nothing, so far as I can tell, but it sounds really cool. Most importantly, it rationalizes turning the focus of midwifery away from what happens to women and babies toward midwives’ feelings. Hence we have midwifery papers like Including the nonrational is sensible midwifery written by one of the authors of the paper on midwifery clinical reasoning:
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.
Because it’s all about the midwife’s feelings:
Being open to the nonrational in midwifery practice makes room for midwives to self-reflexively acknowledge aspects of themselves, such as their fears, in a way that does not interfere with their practice. During birth, making room for the nonrational broadens both midwives’ and women’s knowledge about trust, courage and their own intuitive abilities including the changing capabilities of bodies. And by including the nonrational midwives can then most honestly be with the woman’s own fears as she opens her embodied self to her own unique process of childbearing.
What’s the problem with metaphysical solipsism?
It is often considered a bankrupt philosophy, or at best bizarre and unlikely… It also goes against the commonly observed tendency for sane adult humans in the western world to interpret the world as external and existing independently of themselves.
So midwives have adopted a bizarre and unlikely philosophical construct in order to rationalize their relentless insistence that the most important aspect of contemporary midwifery is the midwife’s feelings about herself. Not only are perinatal and maternal outcomes irrelevant, but babies and mothers have no existence independent of what midwives think about them. How very convenient!
Is contemporary midwifery losing touch with reality? It seems that way, especially when it comes to midwifery theory. It might be more accurate to say that contemporary midwifery refuses to acknowledge reality, which is that midwives have a fiduciary obligation to place the wellbeing of babies and mothers above their own interests. Instead they have a adopted a form of metaphysical solipsism, which places the midwives’ feelings and the midwives’ subjective experience, above all else.
Healthy babies and mothers are no longer the objective of many midwives; they’re merely the props in the midwife’s world, which is apparently the only world that counts.
The sad results is that it’s the midwives’ world. Babies and mothers just live (or die) in it.
In a UK hospital these were the words used by the midwife following the delivery of a flat baby now in SCBU on life support, “WE are all still in shock over what happened”. Not a single word to the mother how she was feeling. Solipsism reigns supreme!
Sadly, nursing research in general is like this.
A little OT: on January 2-nd, I gave birth to our beautiful son Israel. I’m recovering well and in fact felt remarkably well after having given birth, but the labor itself was very intense, and my pain/discomfort weren’t taken seriously enough. It started with me being admitted for monitoring, I was dismissed just because my contractions weren’t close enough (ignoring how I felt during each one), told I’m not in active labor, and left lying on my back (which caused excruciating pain) for a long time. Then of course… dilation check, oops, we would have offered you an epidural but now it’s too late!! (I didn’t plan on getting one, but I thought I had options!). Afterpains – sorry, not much we can offer you except for some paracetamol. Overall I’d label it all as inadequate pain management.
Congratulations on the new baby, and glad to hear he arrived safely!
I wouldn’t discount the effect of a politely but firmly worded letter to the head of the maternity department. it can be framed as a letter of concern rather than a formal complaint, but is definitely worth considering.
Congratulations on his safe arrival! I wish you’d had a better, more comfortable time.
Congratulations!
Have you thought of letting the management know how they failed at providing you with adequate pain relief?
This is a good idea. Maybe send them something in writing. It’s been mentioned here before and also on the BBC that the new NICE guidelines are NOT taking pain management seriously.
Semi-OT: Another death at the Fort Mill, SC birth center, a little over a year since the last one. http://www.heraldonline.com/2015/01/22/6727913/baby-who-died-at-fort-mill-birthing.html
Oh that’s not good.
And this wasn’t a stillbirth, it was a baby that died after delivery.
Given that this is an accredited birth centre, do you think that this data will be collated into any statistical analysis of perinatal mortality in birth centres?
I do believe that the accreditation body collects data and statistics, and in general accredited birth centers have better outcomes than, say, CPMs at home. It is concerning that a birth center that’s had two deaths in a little over a year and whose midwives perform illegal home births in the neighboring state has continued to maintain accreditation.
TL,DR – “poststructural feminist” analysis CAN actually be a useful tool for this agenda: at the least, for critiquing NCB arguments more incisively; at most, to offer alternative explanations that neither lionize nor demean science and medicine.
Ok, so I’m going to show my cards here and come out as someone who studies and uses poststructuralist and feminist theory, in my own scholarly work. Like most theoretical frameworks, not all of their applications are well-executed, free of problematic bias, or worthwhile. But there is more to it than sounding cool (or sounding ridiculous, as some readers may complain) and it does take time and study to understand how to read it, what it is saying and trying to do, and its social, political, and philosophical underpinnings. I don’t really care to defend it more than that, since those who think this kind of thing is bullshit are unlikely to change their minds. But I do want to use my understanding of this work, (particularly as it has been applied to social studies of science, technology and medicine,) to respond to parts of the argument in this post.
Post-structuralism has for a long time been associated subjectivism and with social constructivism, which, at its most extreme, can entail a kind of radical doubt of the reality of the outside world (the metaphysical solipsism that Dr Amy talks about, which has its own long history in Western thought – see Plato or Descartes – and is not the invention of feminists or poststructuralists). However, there have been and continue to be different kinds or degrees of constructivism. In my opinion, the more radical elements in the midwifery debate believe not in metaphysical solipsism, which would doubt or even deny the existence of the outside world, but instead a radical constructivism which says that human beliefs, cultures and practices are what define and shape reality and not the other way around. It’s less the belief that nothing outside the self exists or matters, and more the belief that everything in “reality” is malleable and is in a sense re-invented by looking or thinking about it differently. I think this is especially relevant for cultural critics of the NCB model, because in this model it is not that the mother and baby don’t exist, but that the midwife’s feelings, affect, and other non-systematic or non-rational actions or characteristics have an effect on the reality of the birth process. Likewise, in this philosophy, from the birthing mother’s perspective, it is not that the reality of risks and complications does not exist, but that it can be manipulated by her own feelings, affects, beliefs, and non-rational or systematic actions. In this case, they are making an argument for a causal determinism from the subjective onto the objective. On the flip side, they make the argument that the medical model “constructs” the birthing mother pathologically, for instance. In my view they give far too much power to language, culture, and belief and not enough power to materiality/biology.
Radical constructivists privilege culture and the subjective in this causal relationship. Strong realists (and there are many on this page) take the opposite view, that the objective world exists completely separately from our beliefs about it. Our beliefs about the world come FROM the world directly – and science is our best tool to get at the world. In this view, science’s job is to uncover the reality that is there. The conflict between constructivists and realists actually reached its peak in the 1990s during what was called the “Science Wars” (http://en.wikipedia.org/wiki/Science_wars), and many philosophers and theorists since have attempted to resolve the debate with a kind of middle road (some of these attempts might be found under the rubrics of posthumanism, new materialism, agential realism, standpoint theory, actor-network theory, and so on.)
I myself, and many other contemporary thinkers (many of whom would identify themselves as part of the post-structuralist, feminist intellectual lineage), fall somewhere in between a strong realist position and a social constructivist position (as do many scientists I have spoken to, when pressed). In contrast to the radical constructivists, we think that the material world is not passive, and is actively involved in determining how it comes to be known. However, in contrast to the strong/scientific realists, we believe that nature and culture are firmly entangled, and that the beliefs, technologies, and knowledge systems that we use actively shape how and what we can see, manipulate, and understand, and as well, how we can choose to act in and on the world.
When it comes to childbirth, this is how I see my position play out: I’m not willing to rule out the possibility that “subjective” things like expectations, instinct, caregiver affect, birthing mother’s fear or tension, and other “wishy washy” sounding things have some kind of real effect in the process. However, I don’t think we have a good understanding of how these effects might work, and thus, I’m not willing to cede all, or even that much, causal power to them. I don’t think belief or wishing can make risks disappear or bring a dead baby back.
If you are a middle of the road constructivist like me, you might say, ok, if we co-construct the world (the world of course is a partner in this) what kind of world do we want to construct? If science and medicine are practices of understanding and thus re-making the world, they can and should be studied as systems that have real material effects: If medicine has “constructed” a world where fewer babies die, sign me up. Like with other science-denial movements, certain strains of constructivism have been taken up with very troubling results. I think it’s important to counter those, but if you claim that culture is irrelevant, you throw the baby out with the bathwater. Post-structural feminism and its descendents can actually be helpful in understanding the debate as a whole and for making counter-arguments that bridge the realism/constructivism gap, should you choose to attempt such a bridge.
Thanks for the fabulous explanation!!
I understand your point about falling in between a strong realist position and a social constructivist position (at least I think I do), and that would explain the NCB obsession with the mother’s thoughts, feelings, etc. The midwifery position seems to go beyond that, privileging the midwife’s thoughts and feelings over everything else, including those of the mother. That’s the part that suggests solipsism to me. I may not be explaining myself properly, but do you see what I’m trying to get at?
At its most extreme, feminist theory argues that the beliefs and experiences of women are sufficient evidence to make a theory of reality. It is inherently solipsistic as it makes no attempt to account for reality separate from a woman’s perceptions of it. It also necessarily prioritizes the reality of the woman being studied over the reality of everyone else not included in the study. If you study midwives through this lens, midwives’ reality IS reality.
The subjectivism seems in some sense instrumental, a way to rationalize predertermined beliefs. That’s why the only thing that counts is what the midwives believe and what they allow patients to believe, not what individual women believe.
The irony is that feminist theory and its intellectual brethren claim subjectivism as a way to stand up for subjugated and oppressed people. They have upheld subjectivism as a way to challenge dominant subject positions and ask, whose subjective experiences and beliefs count? In reality, many of these NCB/midwifery advocates stand for the beliefs and subject experiences of a majority of white, privileged women at best, and even then, only when your experience aligns with the party line. “Subjectivism – you’re doing it wrong”.
Yes, I see what you are trying to get at. I think that what you are you are describing could arguably be called solipsistic, but I think it’s a bit off for a couple of reasons. First, metaphysical solipsism involves not only doubting the existence of anything outside one’s own mind, but the denial of its existence. Thinking your own thoughts and feelings are the only or most important ones might be behaving “as if the rest of the reality doesn’t exist”, but it’s not the same as denying it’s existence. I feel like true solipsism would imply some kind of apathy. Second, characterizing them as solipsists implies a radical individualism that fails to encompass how midwifery and NCB, as social movements and worldviews, position themselves against the “dominant” medical worldview. The feminist foregrounding of subjective experience is a political move, and in my understanding, is part of a broader constructivism and an attempt to take control of the “construction” under way.
So I guess in the end it might be called solipsistic, but I don’t think it’s grounding is an adherence to solipsism as much as an attempt to re-make reality – which is a social project.
I agree that it’s not a perfect fit, and I agree that it has a social dimension, but it seems to me it goes beyond the constructivism of insisting that a specific cultural construction of birth should be privileged to insisting that their thoughts and feelings are reality. I would also say that the social dimension of natural childbirth theory is more a matter of deriving support for one’s own reality than supporting the belief that all women are entitled to their own reality.
I’ve written in the past about narcissism, and the belief that the needs of the mother (or the midwife) take precendence over the needs of the baby, but narcissism doesn’t seem strong enough for the belief that reality is what you think it is and what anyone else thinks is irrelevant.
The concept of “birth rape” is paradigmatic. It’s supposedly rape if a woman says it’s rape and the doctor’s intentions, as well as the understanding of the observers, is utterly meaningless to those who insist that they are victims of “birth rape.”
In contrast, when a dissenting women insists that her homebirth experience was traumatic, advocates immediately discount her perception of the experience and replace it with what they believe they would have felt in her position, going so far as to insist that her view of her own experience is wrong, while their views of HER experience are right.
Natural childbirth advocates (especially midwives) feel confident in asserting not merely that their feelings are reality, but that other people’s feelings are not.
Hmm. I think these examples are the result of a flawed dogmatic ideology, but not necessarily the result of a philosophical commitment to solipsism. In this sense, I see what you are describing as solipsistic (as a way of having a stronger descriptor than narcissism) is a symptom rather than a cause.
I probably haven’t always been clear here, but I think what I’m trying to get at is that the commitment to subjective experience, in midwifery and in midwifery theory/scholarship, is not in itself the problem or the cause of the problem. I think it’s the dogmatism that can make their subjectivism hypocritical and one-sided, rather than actually making room for a diversity of womens’ experiences of pregnancy and birth.
It may look like a solipsistic duck, but it sings like a cuckoo and flies like a crow?
You can call it solipsism, but maybe plain old selfish is better.
I thought about writing that in my reply. And Dr. Amy has done, numerous times!
This may be the most fascinating and educational comment I’ve ever read. Wow!
Thanks, what a nice compliment!
“On the flip side, they make the argument that the medical model “constructs” the birthing mother pathologically, for instance. In my view they give far too much power to language, culture, and belief and not enough power to materiality/biology.”
But even a serious social constructivist will all of a sudden be willing to give weight to materiality/biology and those nasty pathologizing OBs when the shit hits the fan. Oooh save me, save me! Do that constructed medical stuff you do and save me!
“When it comes to childbirth, this is how I see my position play out: I’m not willing to rule out the possibility that “subjective” things like expectations, instinct, caregiver affect, birthing mother’s fear or tension, and other “wishy washy” sounding things have some kind of real effect in the process.”
Agreed, and the true hypocrisy of their supposed feelings-centered interpretation comes into play with so many examples of lay midwives ignoring mother’s feelings during birth, or dismissing the feelings of homebirth loss mothers.
Their ideology only cares about feelings of women in childbirth as long as those feelings are directly in its favour.
Your final paragraph is a beautiful explication of what I was trying to explain to someone a few months ago but couldn’t get the words to do it (at all) clearly.
Well thought and well said.
Thanks!
This is a odd characterization of realism. At least in the social sciences, I don’t know anyone who argues that attitudes and beliefs don’t shape outcomes. In fact, learning how “wishy-washy” things cause and respond outcomes is pretty much whasocial science IS. I don’t see how that is in conflict with an assumption that feelings are separate from an objective and constant true state of the world (an assumption that is required for any type of statistical analysis). I could argue that your middle of the road approach is pretty garden variety realism.
In my field, Science Studies, this kind of scientific or strong realism does often get invoked, since our work troubles the boundary between the natural and social sciences.
One kind of popular garden-variety realism entails a kind of division of the goods between “social/cultural” stuff and “natural” stuff, with the social and natural sciences working unproblematically alongside each other on their own “stuff”: what business does a philosopher or sociologist have with molecules, particles, RNA, neuron assemblies, etc? Whereas in Science Studies/STS, we want to understand science AS a social (human, cultural) practice and some of us want to be able to include the “objects” of science in our analysis. So the kind of resolution to the realism-constructivism debate that I am referencing is not a divvying of the world into “natural” and “cultural”, but the theory that all of reality is natural-cultural, that one does not necessarily have dominance over the other, and that one part of our job is to try and describe the character of that entanglement. (We aren’t generally quantitative social scientists, but that doesn’t mean we can’t believe statistical arguments.)
Okay, but whether nature and culture are separate or intertwined has nothing to with whether reality exists or not. They are separate debates.
Well, it’s a debate about the character of reality versus a debate about its existence. I disagree that they’re separate debates – that’s not the case in the history of philosophy or philosophy of science. If on one extreme end of the constructivism spectrum, you have solipsism (doubt or denial of the existence of anything but your own mind) and on the other end you have an acknowledgement that minds exist but are fully independent from objective reality, then in the “middle” you can have both views about entanglement and views about “kinds”/categories of reality which are variably dependent or independent from “social” factors.
Anyway, the argument I’m making here is that midwives don’t actually doubt, deny, or debate the existence of reality. Instead, they think (in a reactionary, politicized, restorative sense) that they are the rightful arbiters of it.
Very interesting! My personal theory (and I am not any kind of philosopher or social scientist) is that the rise of NCB in the US responds to a lack of cultural and economic support of women and mothers more broadly: no ability to depend on a male wage earner during childbearing years, no paid maternity leave, extreme difficulty finding good childcare, reduced job stability when you have to juggle work & family, no close-knit female relatives to share care with, no religious or cultural traditions to care for the new mother like the cuarentena.
Into this vacuum, NCB and midwifery seem to promise a needed structure of support for the woman, which goes beyond what the “medical model” can provide. It gives an ideology to hold onto and a series of rituals to navigate the intense and scary transition to motherhood. Some of the precepts are actually helpful — like the idea of post-partum doulas, the creation of social networks between new mothers who ascribe to similar beliefs and can provide support to each other (eg Bradley class attendees), and *accurate* support for breastfeeding if it doesn’t go overboard. But as we have also seen on this board, the flip side is rigid ideology that can harm more than it hurts.
Not sure what kind of analysis I would be doing here – is it sort of Marxist?
And also, I think a huge part of the problem is that NCBers actually believe they have a superior grasp on reality than the “medical model.” I’m not sure that they really construct the world differently – it’s just that they believe that they know better.
Interesting points – and a way to understand a function that NCB has for women who are otherwise and comparatively quite privileged. Seeing how NCB actually fills a need goes beyond criticisms that cast mothers as selfish. But in our context, I think the regulatory context is equally important in explaining how homebirth midwifery, in particular, has gained such a foothold here. I wonder if anyone has done any research on how the NCB philosophy and practice has changed in the last 40 years or so.
As for your last point about reality, I agree in some ways. There are competing claims on who gets to define the reality of birth and NCBers think theirs is better. At the same time, there are these entrenched beliefs about how powerful thoughts, moods, and feelings are in the birthing process, all bound up with language of empowerment and taking back birth. They believe their theory of reality has got it right, but this theory of reality includes problematic and contradictory ideas about how subjective feelings can shape and control it.
I can think of situations where post-structural feminist methodology would be useful in studies of the medical profession; they would be surveys of the attitudes of, or towards, health care providers. This would be important work, as it’s possible sexism may affect clinical care (for example, if other HCP are more likely to refer to a specialist if it’s a man).
But in a study of whether purported HCP use clinical judgement??? Nah bro, that needs scientific empiricism.
Why would anyone want to use a health care provider who doesn’t use clinical judgement?
In case they don’t get told what they are hoping to hear?
I think a disconnect between people who produce theories and people who do hands-on-work in the field is pretty common since I’ve seen it for years in secondary education, am seeing first hand in post-secondary education and in ecology and evolutionary studies.
The problem in midwifery is that the people working in the field drink the Kool-Aid of theories. Using a philosophical construct to help a midwife understand her feelings and the mother’s feelings is all well and good during a time where everyone is healthy and stable. The construct needs to be placed aside rapidly when the mother develops postpartum hemorrhage until the mother is stabilized.
Well-said.
In my view, both the affective (emotional) and physical aspects of science-based midwifery/obstetrics care can be the subjects of empirical research.
Competent pregnancy and labor care involves attention to both physiological/structural issues AND well-being/state of mind/psychologocal issues.
It is just as relevant to study the influences on mental health and well-being empirically as it is to study the patho-physiological aspects of care – all aspects can be improved with well-designed research.
HBMWs should no more be amateur psychologists/counselors than amateur acoucheurs.
Holy fucking shit to that paragraph about managing the third stage. And it was published in the Professional Journal of the Australian College of Midwives! Not Lamaze or a CPM rag. Like, a legit journal! This is madness.
Sadly, this solipsism isn’t an uncommon worldview these days, where even talking about basic biology can often bring death threats (dare to say a penis is a male organ organ?…watch out) . Solipsism is totally out of control, with its partner postmodernism.
That these MWs have fallen head first into it is utterly disappointing; they should have been a bulwark against such nonsense, being so immersed in such a serious part of reality. Instead they went off the deep end, and following MEN, instead of evidence and wise womyn, was their demise.
From the NCB cult of Grantly-racist-as-fuck-Dick-Reed, Michael-knitting-needle-Odent, Bob-women-in-the-kitchen Sears, to the pied pipers of structuralism and postmodernism- Foucoult, Derrida, Lacan, etc., these are ideas created by men, promoted by men, in the service of men. (The one famous female philosopher in this school of thought, Judith Butler, also did more harm than good to women.)
None of these ideas should ever have had anything to do with women and their needs, let alone in such a critical field as MWery, but they all spread the infection of essentialism.
The sad irony is that many MWs talk about how doctors, hospitals, technology, and obstetric science as the cause of the “death” of MWery. They are always talking about how they are being marginalized, persecuted, disregarded. But they seem to have missed that while the tradition of MWery (and wise womyn) have been under attack for ages, in this modern time, the opponents have destroyed MWs from within. They no longer need the spectre of science and hospitals, they have successfully used this destructive philosophy to ruin the very foundation of MWey itself.
There IS a crisis in MWery! but ita not what they think it is.
IMO, Postmodernism destroys everything it touches. Its a fun theory to use to critique art, or literature, and for philosophical discussions with your freshmen friends, but thats it.
What’s this about Bob-women-in-the-kitchen Sears? I don’t think I’ve heard that criticism of him before.
I feel like he can be paraphrased as “I’m not saying you should stay home, I’m just saying that the mother (and only the mother) needs to fulfill this exhaustive list of requirements that just so happen to be incompatible with work outside the home or the kid will be destroyed for life”
If your gospel is that a baby needs constant contact from its mother in order to thrive going to an office job for eight hours a day is pretty much off of the table.
I think you must be thinking of William Sears then.
Not to mention nursing every 5 minutes all night long. Good luck going to work the next day!
Actually, I’d like to correct Staceyjw. It’s William-women-in-the-kitchen-holding-their-babies-Sears.
His son is Bob-don’t-bother-vaccinating-your-children-because-measles-is-no-big-deal-(but-don’t-tell-anyone-you-didn’t)-Sears.
Any discussion of post-modernist disdain for formal training and ”expertism” is always an opportunity to re-post this most relevant article by Aussie academic philosopher (and stand-up comic) Patrick Stokes:
https://theconversation.com/no-youre-not-entitled-to-your-opinion-9978
That one is a classic. “You are not entitled to your own opinion. You are only entitled to what you can argue for.”
I don’t think it’s just midwives that have adopted a form of metaphysical solipsism that values feelings and subjective experience foremost.
I’ve seen lots of NCB advocates that seem to believe this very same thing. Like the ones that say they had a wonderful healing home birth, even though their baby died, or those that get so fixated on minor points of a birth experience (eg the lights in the hospital room were too bright, the monitor was uncomfortable, etc.) that they complete forget about their healthy baby.
Absolutely!
I’m already working on a post about that.
“Like the ones that say they had a wonderful healing home birth, even though their baby died”
I just threw up in my mouth a little.
Yes, do call your dying patient back to her body. That always works. Because you can prevent somebody’s death by simply telling them not to die. Kinda like that “Don’t you dare die on me!” moment in films… Wait, the character usually dies… Mmm… Maybe more like in Dora the Explorer, where the phrase “Swiper, no swiping!” works every single time? I totally didn’t know it was actually about midwives.
Sometimes telling Swiper not to swipe doesn’t work, if you don’t say it three times before he reaches the object of his inexplicable lust. Dora’s simply utilizing her understanding of Swiper’s pathology (serious obsessive/compulsive tendencies, possible “manic” episodes relating to likely bipolar disorder and adult ADHD and manifesting in hoarding and kleptomania–likely complicated by a drug dependency and housing difficulties), with generally good results for the community. She seems, however, to have given up on saving Swiper from himself.
You’ve been watching Dora the Explorer too intensely! Deconstructing Dora the Explorer…potential topic for a day long seminar…you can charge a fee and give Continuing education credits for doulas or LC’s.
At last, I can use my excessive verbosity and mediocre parenting skills for fun and profit!
Oh, man!
Snap
So what’s Dora’s problem? Some kind of brain damage? Or do you think maybe she’s like that traumatized kid in I Am The Cheese and everything we see is just a product of her imagination/hallucination? I wonder what traumatized her?
Well, she’s obviously neglected by her family, lonely, and seriously codependent. But from what I can tell, a solid case of codependency drives a lot of people toward careers in medicine, so I think if she can get through this (and not end up living in the woods, engaged in a creepy pseudo-marriage with a partially clothed monkey), her future could be bright.
Based on the episode where her mom had surprise twins, I also think her mom is into NCB and probably deep in the woo. That’s got to make it hard — when you are the smart one in the family.
You’ll never find it now!
Did you see the Christmas episode where they did a kind of “It’s a Wonderful Life” for Swiper, taking him all the way back to his babyhood and the first time he ever swiped? They really got the guy to open up, and he seemed to show genuine remorse for his behavior.
Of course, by the next episode, he was back to his old tricks.
I did not, but that’s so typical (and a perfect example of the limits of regression therapy).
They really go off the rails when they include non-rational matters in the relevant variables categories. No sane person, let alone a health care provider would do that because its totally ridiculous. How they can even claim that their thoughts about birth goddesses are relevant when someone is bleeding to death is mind-blowing and the fact that they put it in print should be career-killing.
I can only conclude that 1)the majority of potential homebirthers /woo-padawans have not seen that papers and others like it and also 2)if they have, they in a subset that are so far off the deep end that they would agree with it.
I’ll take it out the homebirth context even. A person is discussing an upcoming surgery with the anesthesiologist and the doctor mentions the risks of general anesthesia, including heart attack. The person asks what the doctor would do if that happened. The doctor says: “Well, first I’d close my eyes and listen to my spirit. It might suggest I hit the code button and summon help, or might suggest I gently call you back to your body. Whichever option feels the most calm to me, is what I go with. We don’t like to instill an atmosphere of panic in the OR, afterall, and if a bunch of people rushed in, we wouldn’t even be able to hear the Enya playing.” Is anyone going to stick with this doctor?
I understand how American CPMs get away with this nonsense because they are totally unregulated, but what about the real midwives in the UK, Canada and Australia/NZ? How does this get past their superiors? Don’t patients complain?
Well, there *is* some merit to not instilling an atmosphere of panic in the OR. Not because of anyone’s feelings or being able to feel the vibrations of the New Age music, but because it decreases likelihood of errors and miscommunication. I would like to hear that the provider is calm, cool and collected and acting appropriately and methodically – panicking is never a good option.
But clearly these articles are about romanticizing “other ways of knowing.” I do, however, strongly value not panicking in the OR.
Oh me too! But the NCB crazies think that by even considering a negative possibility, that’s inciting panic and fearmongering. I would hope that doctors in an OR wouldn’t actually panic if someone codes during an operation! 🙂
They’re big on “thought crime” in NCB land. Affirmations, avoiding “negative” information, “trusting” birth/body/baby… and any bad outcome is blamed on the bad thoughts…
Good insight. This is so true in my experience with NCB ideology. I have also noticed NCB ideology has a lot in common with some toxic religious beliefs. Trusting more would make for a different outcome so it is all my fault.
Life is not perfect no matter how hard I try to believe/affirm that it is.
If all it took was pure hearted belief, my daughter would ride a unicorn to school instead of a bus.
Ha! When I was a kid and someone said to me “You can do anything you want if you [just believe in yourself/work hard/etc]” my answer always was “Well how come I can’t fly then?”
Deep down, Amy, you don’t really want it bad enough.
Yes, clearly she has hang-ups. Probably needs her breasts squeezed by Ina May.
ETA: I take it back. I just gave myself the willies even writing that.
There’s such a big difference between maintaining a calm atmosphere because it helps with clear communication when solving problems vs. maintaining a calm atmosphere because being afraid actually causes the problems.
Oh, hell no! I can’t stand Enya!
Yep…women can complain colleagues can lodge concern, the Health and disability people can look at whether Midwifery Standards of care have been met or not and the outcome for the health practioner can be suspension, supervision, re training in areas where standards have not been met…..the Standards are comprehensive and then we have referral requirements and a list of conditions that require a midwife to refer…..we have emergency day updates that address pph protocols…..it is frustrating, for want of a better word that standards, protocols not adhered to, especially for the women on the end of care that is inadequate.
“Being open to the nonrational in midwifery practice makes room for
midwives to self-reflexively acknowledge aspects of themselves, such as
their fears…”
That is what therapy is for.
Do you think they have _any_ fears that the mom or baby could die? Or are they both naive and caught up in the mantra that a NCB death is one that was truly destined to mom or baby?
I don’t know…if I were responsible for a childbirth without any proper training, I’d be scared out of my mind. Even my yoga/meditation practice wouldn’t help me through that one.
How many mothers have worried about their midwives’ feelings too? A common event in stories about Homebirth loss and injury is the poor mother feeling initially that she let her midwife down or her fear that the midwife won’t like her. How interesting that pleasing the midwife is also seen as a goal by the mothers.
It’s the cult mentality..
I wonder if there is any connection between highly narcissistic women who value the “birth experience ” more than the baby, and narcissistic midwives who think a birth is all about their feelings.
Tell me more
The solipsism of midwifery extends to natural childbirth and homebirth advocates as well. That’s why they believe that how they feel about what happens is more important than what actually happens.
OT: Not sure if this one is on your radar yet.
http://www.readytopopdance.com/rtp-blog/2015/1/19/7cuymu6xylf22nnzttowb8dnaesdz0
I left a comment.
Ah, yes. It must truly have been the homebirth that saved this baby’s life. At 37.4 weeks this baby had a growth at less than the 1st percentile with an IUFD risk of 58/10,000. Silly me, sitting here diagnosing IUGR, consulting perinatologists, doing doppler flows and biweekly antenatal testing, giving betamethasone injections whilst holding my breath for parameters to prompt delivery or reaching 37 weeks with continuous EFM and a neonatology team in attendance. All those sleepless nights I have and the relief of healthy birth outcomes, the certainty of IUFD risks and the uncertainty of impending occurence when all I have to do is delay diagnosis, recommend bedrest, await onset of spontaneous labor, attend a water birth and breathe a few puffs into an apneic infant in a living room. Who knew? I suppose I should put all these studies away and go back to having a life, sleeping nights and start attending homebirths in a swimming pool to save all these IUGR babies. Who knew I was just over thinking the whole process? This is a perfect story to put out there so all of my patients with IUGR fetuses can second guess whether all of this surveillance is really necessary and if the risks to their babies are really as significant as presented. Fortunately, outside the world of homebirth woo, most people really get it and don’t make pathetic excuses to justify the monstrosity of risk ignored and label it a victory or homebirth ‘save’. I’m going to self-medicate with a glass of wine before I throw something at her webpage. You just DON’T mess with IUGR.
Yeah, that post was truly epically horrible.
Just awful. I walked to refrigerator to pour a glass of wine after reading it. Realized the bottle must be at least 6 months old and that I really don’t like wine. I grabbed an obnoxious amount of dark chocolate instead, then sat and stewed over her post. I work with a high risk population of women; DM, HTN, AMA, ART, Multiples, Class III Obesity in a setting of collaborative care with obstetricians and perinatologists. What those women wouldn’t give to have a low risk normal pregnancy, far removed from the threats of increased maternal and fetal morbidity and mortality. What they wouldn’t give for prenatal appointments to consist of happy thoughts and good feelings, but that’s not why they come for prenatal appointments. They’re there because they want care to identify and mitigate the risks to themselves and their babies. They’re not looking for me to blow smoke up their orifices, to trust birth or to develop an unhealthy relationship for me to manipulate their thoughts and perceptions in the event a bad outcome occurs. They just want a healthy baby and they trust me to know and do what it takes to get there safely.
ETA: DM, HTN, AMA, ART, Multiples, Class III Obesity listed as common and known risk factors for IUGR. In other words, work with a significant population at risk for IUGR, which is why the failure to diagnose and act on IUGR in the OP Homebirth was just beyond infuriating to me. My apologies for ETA, was commenting quickly trying to get the house cleaned and left important point out.
I have some compassion for how this mother describes or defends her birth. She is clearly processing, and though she is spewing NCB rhetoric, she is also questioning the management of the complications of her pregnancy and her newborn. She’s weaving a story so she can feel good about her midwives – because she hired them because she trusted them. She has an inkling that her pregnancy and birth were mismanaged; she’s trying to figure it out.
My issue is with the midwives. The recount of this homebirth highlights example after example of negligence and incompetence. It would be a pretty clear-cut case for the parents if something untoward had happened to the baby or the mother. These midwives repeatedly ignored and/or minimized clinical signs of problems. Not sure what standards of care these midwives were following – except their own.
I know I’d said this was OT, but is it? Have midwives lost touch with reality? What was their clinical reasoning in this situation? Why, oh why, are they performing mouth-to-mouth resuscitation on newborns? Is that a standard of care? What made them forgo further follow up for a woman who had increasing blood pressure readings at the end of pregnancy? Did they just “feel” that everything was going to be ok? Why did they proceed with a homebirth at 37 wks with a newborn with IUGR? Did the birth goddess come to them in a dream and whisper to them that there would be no harm at *this birth*? Who are these midwives? How many midwives are practicing this way? How can women find midwives who truly put their health and their babies health before having some mythical birthing experience?
I’m glad this mother and this baby are OK. I’m glad they were spared the heartbreak of losing one another in this process. I’m disappointed that this happened in NY where only ACMB-certified midwives are allowed to practice. This is frightening, and does beg the question: “Have midwives lost touch with reality?”
I have compassion for this mother in the sense her daughter’s life was gambled with by her midwives, but I have a very difficult time feeling compassion when she places the success of her daughter’s birth in the value of home birth and her midwives. Her midwives gambled with her daughter’s life by continuing to pursue a home birth in the setting of her self-described gestational hypertension (whether it was pre-eclampsia is unknown as there is no mention of whether it was evaluated for such), failure to obtain an earlier diagnosis of IUGR by obtaining a growth u/s at the 32-34 week onset of hypertension, failure to ensure delivery at 37 weeks in the setting of severe IUGR and HTN and most of all pursuing a home birth despite an obvious diagnosis of a high risk fetus. Her midwives failed her, the homebirth did not ‘save’ her daughter…they gambled, got lucky, nothing more.
It begs the question, what are these midwives doing during one hour prenatal appointments? If not for identifying and acting on risks, then what is their value? Certainly, the hypertension was identified during a preterm gestation, but the lack of further evaluation is appalling. Did no one recommend laboratory evaluation, fetal growth assessment, OB consultation, discussion to consider a hospital birth? For heaven’s sake, a lagging fundal height of a IUGR <1% was not identified until after 37 weeks and even then the midwives failed to follow standard guidelines of care once the information was received. Seriously, WHAT is being done during these lengthy prenatal appointments? Discussing feelings, birth tub rentals or elaborate birth plans does absolutely nothing to mitigate the obvious risks at play in this scenario.
You've asked a number of million dollar questions and I do not have these answers. I've asked the same questions here myself and no one has those answers. You've posed the question "Have midwives lost touch with reality?". I will pose to you…Can one lose something if they never really had it?
Same here. While I do have some compassion for her, it’s quickly wiped out when I look at her “midwives are angels” comment. Worst thing is, she’s a bloody doula promising “the birth you deserve” and reaching one’s “birth super powers”. In other words, she’s someone women would listen to since her doula certificate conveys that she knows what she’s talking about. Even when she blatantly doesn’t.
A not so tiny part of me wonders quite cynically shouldn’t I just follow the money. She’s desperately trying to create the impression that it was all great. Isn’t it partly because she stands to lose business and money if women see the reality of her situation?
And her comment to NICU nurse that the differences between hospital treatment and the one she deserved made her choice good and safe made me see red. I still have compassion but it’s a very tiny grain. It’s usually hard for me to sympathize with someone this dangerous.
I think a portion of the ideology of NCB is financially driven, but I think the greater portion is based on a warped sense of power and control with a failure or unwillingness to accept the uncertainty of pregnancy and birth as anything other than normal. NCB appears to cloak themselves in a shield in which if they say everything is normal or a variation thereof, then nothing bad can happen. In the OP case, they escaped morbidity without ever acknowledging how much had been risked. Going even further to purport it was the homebirth environment and midwifery care that saved a baby that in all actuality was nothing more than a near-miss. In order for NCB and HB midwives to acknowledge a higher level of care in a different care setting is demanded, they must acknowledge life is more than variations of normal, can be something to fear and they must release the power and control they have over such a situation. The financial motivation is there no doubt, but their inability to maintain a grasp on reality that birth is not as safe as it gets would show the vulnerability they try so hard to hide and deny.
One of my recent new births is a tiny tiddler born at 34 weeks’ gestation due to severe IUGR. When I first saw him at home, he looked like a doll. He then went on to double his birthweight in…wait for it…EIGHT WEEKS!! Normally we allow babies six MONTHS to do this. Fully breastfed too. Amazing little chap, who was definitely better off out than in.
Actually, doubling birth weight in 2 months is the expected growth curve for otherwise healthy term or near-term IUGR babies who are “catching up.” My son did.
Classic irresponsible NCB web site. She encourages other women to birth at home and makes statements that imply that homebirth will be helpful for conditions like IUGR, cord problems and shoulder dystocia…but then surprise surprise, if you scroll way to the bottom, she gives this disclaimer:
DISCLAIMER: THE INFORMATION AND OPINIONS PRESENTED BY READY TO POP DANCE FITNESS AND NACIA WALSH ARE NOT A SUBSTITUTE FOR PROFESSIONAL MEDICAL PREVENTION, DIAGNOSIS, OR TREATMENT. PLEASE CONSULT WITH YOUR HEALTHCARE PROVIDER BEFORE BEGINNING ANY FITNESS PROGRAM. ONLY YOUR HEALTHCARE PROVIDER, OBGYN, OR MIDWIFE CAN PROVIDE YOU WITH ADVICE ON WHAT IS SAFE AND EFFECTIVE FOR YOUR UNIQUE NEEDS.
For her it’s all about promoting her doula (and other) business by badmouthing hospitals. But damned if she’s going to take any responsibility for the bad outcomes of her advice.
One can be reasonably certain that the midwives were River&Mountain Midwives, in NY state. All 3 midwives are Licensed Midwives.
As a moment of levity, for the items clients must supply, among them is baby’s first outfit but the list specifies it CANNOT be only a onesie or tshirt.
Yes, the OP confirmed they are her midwives elsewhere. Am I mistaken in that S. Condon’s bio on her website lists an alphabet soup of credentials, none of which are APN or RN? However her bio lists her as an OB GYN Nurse Practitioner?
Susanrachel Condon has a current license in NY State for nurse practitioner–OBGYN as well as Registered Nurse. However, when I looked for “Midwife” she did not show up on the list.
” She is a licensed in New York as a Midwife and Ob-Gyn Nurse Practitioner.”
Strange, I used http://www.op.nysed.gov and did not find a Condon listed under Midwife.
Thanks for finding what I couldn’t seem to find. Why wouldn’t she list her nursing and advanced practice nursing education or title? I’d sure rather know my provider has those credentials than whether she is a licensed massage therapist or certified childbirth educator.
I am sure that’s what you’d rather know but IMHO it’s entirely possible that a subset of clientele do not want a midwife who has experience in the medical system. Thus, “medwife” as a derogatory term in certain circles.
Ah yes, the derogatory term ‘medwife’. There are those who will fight the term and those of us that choose to embrace it, wear it as a crown. It speaks volumes that there is a subculture who specifically set out to find a less qualified provider for fear of a ‘medwife’ when the outcomes of one are so different from another.
Holy shit! So she’s not a CPM/lay midwife? She’s an actual advanced practice RN? And she ignores hypertension in that mom and then gets an ultrasound when she measures small and ignores the significant IUGR just because the fluid wasn’t low?! And then when baby is born at 4#6oz doesn’t transfer her and doesn’t even re-weigh her until day 3?! Absolutely negligent care pure and simple. That baby is damn lucky to be alive after “care” like that! My blood is boiling.
Blood boiling, hence my dark chocolate binge while reading this Friday night! If the risk factors were present and care was not transferred, in what situation would they be transferred? This goes beyond negligent and is an outright display of tempting fate with a baby’s life at stake, for the sake of a birth experience with the utmost faith misplaced in the hands of the midwife who obviously trusts birth too much or has a warped sense of her own reality.
“If the risk factors were present and care was not transferred, in what situation would they be transferred? ”
Yes, what exactly would it take for them to transfer care?! If this doesn’t cause them to transfer, I doubt anything would. Super, super high risk situation.
Also, the moment, Susanrachel Condon’s website indicating that she is a NY Licensed Midwife is false, per records lookup. So why did she let her license expire? And why is she saying she’s a current LM?
It’s there, under Balber as LM.
@Guest, yes, you’re right, she is a licensed LM, looks like she changed her legal name, probably due to marriage.
I was stunned that this wasn’t a birth out of Utah or Oregon or with some “underground” midwives in some “alegal” state. No, this was in NY – with licensed midwives. And to be a licensed midwife in NY, one needs to be a CNM or CM. Horrifying.
At this point I should be used to it, but I still can’t wrap my head around the fact that it isn’t just the lack of training that makes homebirth midwives dangerous. It’s that it’s a cult. Because the ones with training seem no better than the ones without. And CNM leaders refuse to call out their dangerous colleagues.
JMO, I theorize that the main problem with the rogue group of CNMs and LMs is that they perceive themselves as an inherently morally superior group. Other advanced practice providers such as USA Nurse Practitioners, Physician Assistants, CRNAs, and Anesthesia Assistants work as a team. There is no physician assistant operated that is only staffed by PA-s and touts the benefits of going to only PAs rather than physicians. Even at the academic medical center in my city, if I want to be attended by a CNM, the clinic is SEPARATE from the OBGYN clinic, there is a separate phone number to call and a separate location. I don’t think this is an ideal model of care. I think that the OBGYN services should all be one group, just like the other medicine departments. I think the division between these groups breeds insulated models of practice.
http://www.riverandmountain.net/about-us/
Two of them clearly claim they were trained as CPMs prior to becoming CMs.
Not sure about the 3rd (discussed elsewhere in this thread) does she have nursing experience, or not?
Education, ideally, should be able to weed out the cultists – don’t you think?
I wonder if this birth was the first baby with a new partner.
Even if you haven’t had pre-eclampsia previously, a first pregnancy with a new partner can trigger it, and it certainly sounds like pre-e with placental insufficiency.
Personally, if I had a lady with lots of amniotic fluid who was still measuring small for dates with High BP, I’d be sending her to the maternity hospital for 24hr urine protein collections and BPP.
Why couldn’t the midwives bring the oxygen to the baby, even if they didn’t want to cut the cord?
Why mouth to mouth with exhaled air (21%oxygen) instead of controlled BVM ventilation with 100% oxygen?
Why didn’t they transfer to hospital for further evaluation of a 37 weeker with IUGR and low APGARS?
None of it seems like acceptable practice.
Looking at the picture of her children and the older ages of the boys, I wondered also if it was a new paternity and hence the HTN.
NCB holds so much sacred with the placenta and delaying cutting the cord or using various methods of nonseverance, burning, lotus, artwork or placental consumption. I wish she would have made mention and photo of this wonderful placental unit she touts remaining intact with her apneic infant. I would love to see the story her placenta told of just how much it failed, scrawny, calcified and all. It’s an odd fascination I have with placentas, although I could never consume or attempt artwork with it. I really do enjoy a thorough in depth pathology report and a good strong cup of coffee after a high-risk pregnancy, usually makes for a hearty dose of reality and humility.
One of my fellow IUGR moms was mildly into the woo and is now a bit less in the woo. She had all her kids’ placentas encapsulated, including the IUGR one.
Then, with her baby still in NICU, she’s looking at this jar of placenta pills. And she’s like, wait, if it did that to my baby, do I really want to eat it? In retrospect she wishes she’d just had it dissected instead.
I have many mothers who choose to encapsulate, but I do insist on a placental pathology exam on any IUGR placentas. So often mothers come away from any complicated pregnancy with a sense of underlying guilt, but having a pathology report can usually serve reassure them that so much was outside their control. Makes them feel better than any placental placebo pills could and helps provide additional information in future pregnancy management. I’ve seen some crazy placentas that I can’t believe produced a live baby and often times I just tremble at the thought of what could have been.
Love your friends perspective on that jar of placental pills.
Mountain & River practice has also been accepted as a preceptor site for student midwives in the Frontier midwifery program. Sad to think these dangerous practices may be passed onto others during apprenticeship.
What are the odds that the baby will have long-term problems? Seems like it’s way too soon for mom to declare everything okay. And the photo of the baby as a newborn put a pit in my stomach. She looks so skinny and ill.G
so many blazing red flags! this birth should have been medically supervised from the moment the midwives detected that moms blood pressure was “creeping up” When do midwives risk a client out? When it is too late? Oy, I hope this baby doesn’t suffer due to all the educated people in her life willfully ignoring the benefits of being in an industrialized scientifically advanced era!
Well, you know what they say… “Birds of a feather…”
Such as Christy Collins and her reprehensible letter.