Are midwives with all women or just some women?


Apparently my book PUSH BACK: Guilt in the Age of Natural Parenting made Professor Laura Freidenfelds feel stung. Unfortunately it did not make her feel curious enough to reexamine her assumptions about midwifery and childbirth.

In Nurse-Midwives are With Women, Walking a Middle Path to a Safe and Rewarding Birth, Freidenfelds writes:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Freidenfelds piece is profoundly disappointing because when challenged on her personal beliefs she responded as a partisan, not as a person interested in the truth.[/pullquote]

Recently, obstetrician and blogger Amy Tuteur published Push Back: Guilt in the Age of Natural Parenting, in which she made fun of women stupid enough to believe that they might have a better birth experience without an epidural, and excoriated anyone who would refuse any of the bells and whistles of modern obstetrics.

Her title was a response to journalist Jennifer Block’s, Pushed: The Painful Truth about Childbirth and Modern Maternity Care, an exposé of callous obstetricians who damaged women and their babies with the thoughtless overuse of standard obstetric interventions such as the induction agent cytotec and the drastic overuse of major abdominal surgery (cesarean section).

Made fun of women?
Stupid enough to believe they might have a better birth experience without an epidural?
Bells and whistles?
Callous obstetricians?
Thoughtless overuse?

In other words, instead of giving some thought to the idea that privileged, white women swallowed wholesale the fake news and propaganda of the natural childbirth industry, Freidenfelds decides to double down by repeating it all and insisting it’s true.

Curiously, Freidenfelds doesn’t deign to provide any scientific evidence to rebut my scientific claims. She seems to find truthiness of natural childbirth propaganda more persuasive than the truth of historical and scientific evidence.

Instead she offers an intellectually lazy compromise: a highly romanticized view of nurse midwives as a middle way:

In fact, there is someone ready and willing to escort birthing women along that middle path: the nurse-midwife. Calm and sensible, evidence-based and gentle, she is too easily effaced by the competing romantic dreams of natural bliss and technological perfection. We need to notice that she’s there, and we need to figure out how to connect her services to more women.

Seriously, Professor Freidenfelds? Calm? Gentle?

Freidenfeld then proceeds to regurgitate the fake history of midwifery as turf war in which evil obstetricians sought to steal the livelihood of “calm, gentle” midwives.

Sadly, Freidenfelds doesn’t bother to address the questions I raise in PUSH BACK regarding the racist, sexist origins of the philosophy of natural childbirth, the implicit biological essentialism and the remarkable elitism of the movement.


What distinguishes midwifery from obstetrics? Is it truly a difference in outlook or merely midwives clawing for market share

In the paper What is gender? Feminist theory and the sociology of human reproduction sociologists Annandale and Clark criticize contemporary midwifery:

…[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.

Should women be reduced to their reproductive organs and does reproduction mean the same thing to every woman?

Annandale and Clark explain that much of contemporary midwifery imagines that:

… 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…

Are midwives with all women or just privileged white women?

Apparently the only women who count in Freidenfeld’s world view are privileged white women. Natural childbirth advocates are overwhelmingly Western, white, and well off. Certified nurse midwives are overwhelmingly Western, white and well off. I find it quite shocking that in a country that struggles with high black perinatal mortality and high black maternal mortality, Freidenfelds doesn’t even bother to give lip service to the many women of color, women of other nationalities, and women with pre-existing medical conditions and pregnancy complications whose have no interest in and cannot be helped in any way by the philosophy of natural childbirth.

Instead of addressing these fundamental issues of gender, race and class Freidenfelds expresses her surprise that despite my support for nurse midwives (the most highly trained, best midwives in the world), I don’t see them as the solution to all obstetric problems:

If Amy Tuteur and I can agree on the value of nurse-midwives’ practice, why aren’t we both looking to nurse-midwives as model practitioners? In her book and in our conversation, Tuteur insisted that the high false positive rate from obstetricians’ use of continuous fetal monitoring, which leads to a high c-section rate, is unavoidable if we want to save babies. I suggested that it is, in fact, avoidable: all she and her obstetrician colleagues have to do is walk down the hall and ask the nurse-midwives to teach them how to use intermittent monitoring effectively. Tuteur chose to ignore me, and simply insisted that obstetricians know best. She was not about to give ground in public to anyone called a “midwife,” even someone she privately recognizes is fully competent.

Why aren’t nurse midwives model practitioners?

Because not everyone who needs care is a healthy, privileged white woman. Indeed nurse midwives can’t “be with” and can’t care for the many women who are most in need — women with serious medical issues.

Because most women consider a healthy baby more important than avoiding a C-section or treating birth as a piece of performance art.

Because while Freidenfelds may blithely ignore the risks of childbirth, childbirth is inherently dangerous.

Because it is laughably easy to tell obstetricians what they should and should not do when you bear no responsibility for dead babies and dead mothers.

It seems obvious to me that not every woman is a member of the white elite. It seems obvious to me that the white elite should not assume that their needs and desires are the model that all other women seek to emulate. It seems obvious to me that a movement based on biological essentialism is deeply anti-feminist. And as a physician it seems obvious to me that the steep declines in perinatal and maternal mortality is due to the liberal use of obstetric interventions not midwifery, which had existed for millennia before the advent of obstetrics and presided over astronomical rates of perinatal and maternal mortality.

Freidenfelds piece is profoundly disappointing because when challenged on her personal beliefs she responded as a partisan, not as a person interested in the truth.