UK midwifery, an alternate world of internal legitimacy

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Bravo to Milli Hill for being willing (at least temporarily) to engage outside her comfort zone of UK midwives and natural childbirth advocates.

She unblocked a number of midwifery critics in an effort to convince them of the rightness of her convictions. But like an anti-vaxxer, Milli appears to be utterly flummoxed that we aren’t persuaded by the “facts” as she understands them. Similar to the typical anti-vaxxer, she doesn’t understand that she has been living in an alternative world of internal legitimacy.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]UK midwives never having to face dissent, respond to real scientific evidence or acknowledge that most of what they claim is factually false.[/pullquote]

That phrase was coined by the author of The Legitimacy of Vaccine Critics: What Is Left after the Autism Hypothesis? by Anna Kirkland.

[They] have built an alternative world of internal legitimacy that mimics all the features of the mainstream research world — the journals, the conferences, the publications, the letters after the names — and some leaders have gained access to policy-making positions…


Journals: There are a plethora of midwifery and natural childbirth journals. For example, Birth: Issues in Perinatal Care, published on behalf of Lamaze International, is technically a peer review journal. It is made up in large part of papers written by editorial board, which includes such luminaries of the natural childbirth world as Eugene Declercq, Marc J.N.C. Keirse, Michael Klein, and Marian F. MacDorman. Birth is where you send your paper if you can’t get it published in a real medical journal, and it carries little influence in the world of obstetrics. Every country has at least one peer reviewed midwifery journal and many non peer reviewed “journals” like the Journal of Perinatal Education, another Lamaze production, and Midwifery Today.

Conferences: Midwives and natural childbirth advocates love conferences like the Normal Birth Conference, the Trust Birth Conference and conferences of midwifery trade organizations. Unlike traditional scientific conferences where all viewpoints are heard on vigorous disagreements aired, midwifery conferences are heavily censored to remove dissenting views with the express purpose of creating an echo chamber for non-scientific claims. Sure, some doctors are allowed, like Michel Odent, Marsden Wagner and now Neel Shah, but only if they’ve been vetted for ideological purity beforehand.

Moreover, you won’t find midwifery academics and theorists on the speakers’ list at obstetric conferences, first because they aren’t respected within the greater obstetric and scientific communities, and second because they wouldn’t dare appear at a place where they would be laughed off the stage for their fanciful claims.

Libertarian individualist account of health: Midwives and natural childbirth advocates like to invoke all sorts of made up rights, like the “birth as a human right,” and the “right” to be attended by the provider of one’s choice in the place of one’s choice. They decry government regulation, yet, ironically, spend a great deal of time lobbying for government involvement in promoting and paying for favored birth choices and providers.

As Kirkland explains about anti-vaxxers:

[They] share an internally bounded world in which both individuals and ideas enjoy legitimacy, but undercut the groups’ external legitimacy …(emphasis in original)

But preserving internal legitimacy is considered far more important, hence Sheena Byrom and her UK midwifery clique block everyone who might possibly disagree with them. They insist that they are blocking trolls but the definition of “troll” belies that claim.

According to Wikipedia:

…[A] troll is a person who starts quarrels or upsets people on the Internet to distract and sow discord by posting inflammatory and digressive, extraneous, or off-topic messages … with the intent of provoking readers into displaying emotional responses and normalizing tangential discussion.

But I and like minded midwifery critics aren’t trying to distract, provoke midwives into displaying emotional responses or normalize tangential discussions. We are trying to engage on the issues, analyze scientific evidence, and subject claims to thorough analysis.

Kirkland asks a question about vaccine rejectionists that can also be asked about UK midwives:

Under what conditions could we imagine leaders reporting back at a later conference that the right study had finally been done and proved them wrong?

The answer, of course, is never.

UK midwives occupy an alternate world of internal legitimacy, which means never having to face dissent, never having to respond to real scientific evidence, and never having to acknowledge that most of what they claim is factually false.

It remains to be seen what Milli Hill will do about her cognitive dissonance. Will she be motivated to read the scientific literature, analyze it and seek out the papers of those who disagree with midwifery claims? Or will she take the easy route and subside back into the comforting community of like-minded believers inhabiting an alternate world of internal legitimacy?

10 Responses to “UK midwifery, an alternate world of internal legitimacy”

  1. Wendy Budin
    September 13, 2018 at 10:00 am #

    PLEASE NOTE CORRECTION: The journal “Birth: Issues in Perinatal Care”, IS NOT published on behalf of Lamaze International. “Birth” is published by Wiley and has nothing to do with Lamaze. Also, The Journal of Perinatal Education (JPE) is the leading PEER-REVIEWED journal specifically for childbirth educators. Through evidence-based articles, the JPE advances the knowledge of aspiring and seasoned educators in any setting—independent or private practice, community, hospital, nursing or midwifery school—and informs educators and other health-care professionals on research that will improve their practice and their efforts to support natural, safe, and healthy birth.


    Wendy Budin, PhD, RN-BC, FAAN
    Editor-in-Chief, Journal of Perinatal Education

    • fiftyfifty1
      September 13, 2018 at 10:50 am #

      In terms of JPE, aren’t you just proving Dr. Tuteur’s point? Sure it’s a “peer reviewed” journal, but when all those peers have already made up their minds that “natural birth” is the goal, then it’s nothing more than an echo chamber.

    • Who?
      September 13, 2018 at 10:54 am #

      The JPE (of which you are Editor in Chief) is a Lamaze membership benefit.

      What is its relationship to ‘Birth: Issues in Perinatal Care’? And as Editor in Chief of the one, what is your relationship with the other?

      • Wendy Budin
        September 13, 2018 at 2:20 pm #

        I have absolutely no relationship to the journal “Birth.” I never have. See response to posts above.

    • September 13, 2018 at 10:57 am #

      It is indeed published by Wiley–on behalf of Lamaze. Most societies don’t have their own publishing arm, and so use Elsevier, Wolters Kluwer, or Wily (or another publisher) to put out their journal.

      • Wendy Budin
        September 13, 2018 at 2:02 pm #

        You are correct that many societies use other publisher for their journals. In fact, Lamaze International uses Springer Publishing to publish the Journal of Perinatal Education (JPE). However I want to clarify that the Journal “Birth” has absolutely no affiliation to Lamaze International. It is NOT published on behalf of Lamaze International. (see post above where this error was corrected).

    • Amy Tuteur, MD
      September 13, 2018 at 11:04 am #

      Really? So what happened since this in 2012? I wrote it about it then: and have mentioned in many times since and have never been contacted by Lamaze International to advise me otherwise.

      • Wendy Budin
        September 13, 2018 at 1:56 pm #

        I believe that Lamaze International did respond to correct this error way back when this was originally mentioned in an earlier post. The Journal “Birth” has never been published on behalf of Lamaze International. This was apparently an error on the Wiley website and has clearly has been corrected as you’ll see at this link –

        • swbarnes2
          September 13, 2018 at 3:08 pm #

          That’s a hell of a mistake to make. You really think they just made that up out of nothing? The fact that information has been omitted is not proof that it was incorrect. And you can see as well as anyone that the “Society information” page has nothing but a mention that Lamaze International members get a discount. No other group is singled out for that. Not LLL, or any midwife organization.

        • Heidi
          September 13, 2018 at 3:14 pm #

 Weird, Lamaze still gets a discount. I would call that affiliated.

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