Is contemporary midwifery the ugly stepsister of obstetrics?
Everyone knows the story of Cinderella. Enslaved by her stepmother, bullied by her stepsisters, Cinderella manages (courtesy of her Fairy Godmother) to attend a ball where she meets the Prince. Rushing to leave, she loses her petite glass slipper. The bereft Prince vows to find her again by searching for the woman who can wear the shoe.
Cinderella’s stepsisters know the shoe is not theirs; no matter. When the Prince’s aide attempts to put the shoe on Drizella, she jams her much bigger foot into it and announces, to obvious disbelief, that it fits. She is so desperate to claim the reward, that she will say whatever it takes, even if it is obviously nonsense.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Claiming personal experience is a form of scientific evidence is the rhetorical equivalent of jamming a big foot into a tiny shoe, and declaring, “It fits!”[/pullquote]
Similarly, contemporary midwives are so desperate to claim the reward of financial compensation and professional autonomy that they will say whatever it takes, even if it is obviously quackery. To wit, the new medical anthropology paper by Andrea Ford, Advocating for evidence in birth: Proving cause, effecting outcomes, and the case for ‘curers’ that I wrote about on Friday. Ford attempted to rebut my longstanding critique that midwifery is not based on scientific evidence by insisting that personal experience is scientific evidence. It’s the rhetorical equivalent of jamming a big foot into a tiny shoe, and declaring, “It fits!”
For example, according to Ford it doesn’t matter whether spicy food can be proven to induce labor so long as the midwife and patient believe it can. In this way, midwifery theorists assert with a straight face that what the patient believes has happened is “scientific evidence” on the same footing with objective evidence of what actually happened.
Though Ford imagines she is rebutting my criticism of modern midwifery, she is both corroborating and bolstering it. She is demonstrating that contemporary midwifery theory is quackery because the foundational principle of quackery is that personal experience is evidence.
I first explained this exactly ten years ago. I quoted the paper The Persuasive Appeal of Alternative Medicine:
The person-centered experience is the ultimate verification and reigns supreme in alternative science… Alternative medicine makes no rigid separation between objective phenomena and subjective experience. Truth is experiential …
In other words:
- You don’t have to listen to experts; everyone is an expert in her own body.
- It doesn’t matter what studies show; the only thing that matters is how you feel about scientific claims.
- Your personal experience isn’t irrelevant to determining causation or cure; it is the central, perhaps the only, thing you need to know to make a determination.
These are the guiding principles of quackery, whether it is homeopathy, anti-vaccine advocacy or bogus cancer cures. The goal is to undermine the standard of reasoning so that rational debate is impossible.
As this paper on pseudoscience notes:
…[I]n discussions about alternative medicine one often hears the claim that each person or patient is “radically unique”, thus frustrating any form of systematic knowledge about diseases and treatments. Of course, advocates of unproven medical treatments use this argument as a way to deflect the demand for randomized and double-blind trials to substantiate their therapeutic claims. If each patient is radically unique, there is no point in lumping patients together in one treatment group and statistically comparing them with a control group… The argument is so convenient that it has been borrowed as a … strategy by countless alternative therapists …
It is offered as a way of making pseudoscientific claims invulnerable against both empirical evidence and rational argument. That is precisely what Ford is doing in her paper.
Again referencing philosopher Isabelle Stengers, Ford writes:
…[W]hat if evidentiary practice were expanded to include the non-rational? Stengers also has a category into which midwives who do not seek belonging via rationality might fall, a third category of ‘curers’ who ‘are not haunted by the idea of being able to disqualify others, but rather who have cultivated an “influencing practice”’ Such curers are not concerned with being rational (as a charlatan is), much less with proving (as a doctor-scientist is); Stengers asks if modern medicine does not indeed have something to learn from them.
One of the older midwives I spoke with during fieldwork, who was a pillar of the local birth community and the natural birth movement in the 1970s, explained to me that ‘pre-stats’ she and her cohort just had a feeling that home birth was ok, they didn’t feel the need to prove it, nor to consolidate a best practice, as ‘the nature of midwifery appeals to independent minds, and there will be diverse opinions… We practice from our own innate wisdom, not protocols’…
You know you’re in a bad place when you insist that charlatans are more concerned with being rational than midwives are! Ford seems oblivious that she is situating midwifery securely within quackery.
The sad reality is that midwifery theorists from Soo Downe, to Sheena Byrom, to Hannah Dahlen are the basest form of quacks. That’s doesn’t mean they don’t believe what they say; many quacks believe they are making people healthier when they are actually making them sicker, as well as making themselves wealthier and more influential. But they are quacks nonetheless and they are harming women and babies.
Why have we allowed this to happen?
Because midwifery, like most forms of quackery, is cheaper than evidence based medicine and saving money is more important to government and hospital bean counters than saving lives. It’s as if the Prince determined that searching for Cinderella was too expensive and it was cheaper to settle for the ugly stepsister instead.
That’s not a happy ending … but there can never be a happy ending when you insist quackery is deserving of the same respect as science.
