Is midwifery one of the last bastions of evidence-free practice?
That’s what Edzard Ernst wants to know. Who is Ernst? As I wrote last year when discussing the evidence double standard in “alternative” health:
Edzard Ernst MD, PhD, FMedSci, FSB, FRCP, FRCPEd … is the bete noire of “alternative” health. His credentials are impeccable. He was the first Professor of Complementary Medicine in the UK. Born and trained in Germany, he began his career at a homeopathic hospital. His belief in “alternative” health was so complete, he set out to show that its various remedies are both safe and effective.
But what he found apparently shook him to the core. His 700 published papers represent a lifetime of research that led him to conclude that only 5% of “alternative” medicine is backed by scientific evidence. The other 95% has either not been studied or has been definitely shown to be ineffective, unsafe, or both. Not surprisingly, Dr. Ernst is now viewed as “the scourge of alternative health.”
Writing in a British medical journal last week, Prof. Ernst notes:
… Numerous surveys have shown that, in most countries, including the UK, midwives employ CAM liberally and usually without the supervision or knowledge of obstetricians. Recently published data from Sweden add to this picture.
Ernst pointed to a recent study in the journal Midwifery, Martensson et al., national survey of how acupuncture is currently used in midwifery care at Swedish maternity units. Midwifery 2011; 27:87-92.
The study found that 60% of Swedish midwifery units prescribe acupuncture for “milk stasis” and afterpains; more than 80% prescribe it for retained placenta; and fully 97.8% prescribe it for both relaxation and pain relief in labor.
Ernst explains:
There is some trial data supporting the use of acupuncture for reducing the types of pain listed above. Yet this evidence is far from being uniformly positive and is therefore not convincing. With all other conditions listed above, there is no good evidence at all.
Prof. Ernst bemoans the willingness of midwives to prescribe “alternative” remedies in the absence of supporting evidence, but this is hardly surprisingly when you consider that almost every recommendation exclusive to midwifery was instituted in the absence of scientific evidence or in direct contravention to scientific evidence that shows it doesn’t work.
This behavior is not restricted to the grossly undereducated and grossly undertrained American homebirth midwives (CPMs). Obviously it is only to be expected among a group that shuns formal learning and practice standards in favor of “intuition.” Unfortunately, as the Swedish study shows, better trained midwives (particularly those in the UK and Australia, havens of midwifery “theory”) have no problem ignoring scientific evidence or issuing recommendations in the absence of evidence.
Not only do they ignore scientific evidence, they clumsily try to justify their behavior. Consider the paper Including the nonrational is sensible midwifery, by Parratt and Fahy:
… Our thesis is that midwives and women need to take conscious account of nonrational knowledge and power during the childbearing year. We argue that pure rational thinking limits possibilities by excluding the midwife’s embodied ways of knowing along with the ways of knowing embodied by the woman. The inclusion of women’s and midwives’ nonrational ways of knowing in childbearing situations opens us up to knowledge and power that provides for a more complete, and therefore a more optimal, decision-making process.
English to English translation:
Science is hard. We don’t want to learn it and we certainly don’t want to follow it.
In other words, midwifery does appear to be the last bastion of evidence-free practice.
