The classic natural childbirth advocate: completely fabricated, completely false
Below is an excerpt from Henci Goer's book, The Thinking Women's Guide to a Better Birth. Outright fabrications and lies are highlighted for discussion purposes."Obstetric practice does not reflect the research evidence because obstetricians actually base their practices on a set of predetermined beliefs. If you start from this premise, everything about obstetrics, including the inconsistencies between research and practice, makes sense.
There is nothing unique in shaping the care of childbearing women according to what one believes. Every culture does it. The problem is that obstetric beliefs don't fit the realities of pregnancy and childbirth. Obstetrician-gynecologists are surgical specialists in the pathology of women's reproductive organs. The typical obstetrician is trained to view pregnant and laboring women as a series of potential problems despite the fact that pregnancy and childbirth are normal physiologic processes that are no more likely to go seriously wrong than, say, digestion. Obstetric belief tends to become a self-fulfilling prophecy. It has been said that a healthy person is someone who hasn't undergone enough testing by specialists.
Obstetricians work within the medical model, a model that says drugs and procedures are the answer to whatever goes wrong. However, labor difficulties usually resolve themselves with tincture of time or simple remedies. Sterner, riskier measures are rarely required.
Obstetricians are also influenced by the broader culture in which it is believed that technology is superior to nature and machines are more reliable than people. This explains why they will not back off from technologies that have proven to be failures except to replace them with the next new and untested expensive technology that comes down the road. It also explains why not intervening has the burden of proving itself rather than the other way around.
Finally, until recently nearly all obstetricians were male, and even today, women obstetricians train in curriculums devised by and mostly supervised by men. This means gender bias permeates the system as indeed, it permeates all of medicine, only here all the patients are women, which intensifies its effects. One tenet of gender bias is that womens bodies are weak and defective and cannot be trusted to do what they are supposed to do. Little wonder, then, that the foundation of obstetrics is that obstetricians are needed to rescue babies from their mother's bodies. Little wonder too that obstetric remedies rarely involve the mother's actions but are things done to her. If you see the mother as the problem, you don't see her as the solution. Gender bias also values the masculine qualities of control, efficiency, and predictibility. This explains why obstetricians define normal within ever tighter limits around average, although as with any bodily process, normal, covers a wide range. It values action over inaction, hence the obstetric inclination to do something -- anything -- rather than nothing, even when nothing is the best thing to do. And it values top-down relationships, which explains why many obstetricians treat any questioning of their actions as a challenge to their authority and why they will not learn from any other source -- midwives or nurses, for example -- besides each other.
Returning to the question, "Why the gap?" one characteristic of beliefs is that they unconsciously color what those who hold them think and do. Believers know that their way of thinking and doing is the only right way. This means obstetrics lacks a self-correcting mechanism. Research doesn't change practice because a primary characteristic of belief is that evidence to the contrary makes no difference: My mind is made up; don't confuse me with the facts. For this reason, anything that doesn't fit with the obstetric belief system will be denied or explained away while anything that fits will be accepted without question. This prevents the recognition that obstetric management frequently doesn't work, that alternative strategies do, and most important, that obstetric management can cause harm. In other words, science and logic can have no effect unless obstetricians first change their beliefs, which is unlikely because they are the underpinnings of obstetrics."
The introduction to Henci Goer's book, The Thinking Women's Guide to A Better Birth is a classic in natural childbirth literature. Almost everything is either fabricated or an outright lie. In fact, virtually the only words that appear to be true are "and" and "the".
I have highlighted some of the more egregious fabrications, but, in truth, almost everything should be highlighted. The only thing I agree with applies to natural childbirth advocates, not obstetricians: "one characteristic of beliefs is that they unconsciously color what those who hold them think and do. Believers know that their way of thinking and doing is the only right way." That's a pretty good description of natural childbirth advocates.
Lie #1: Obstetric practice does not reflect the research evidence because obstetricians actually base their practices on a set of predetermined beliefs.
That's an outright lie and doesn't really require much further comment.
Lid #2: The problem is that obstetric beliefs don't fit the realities of pregnancy and childbirth.
The reality of pregnancy and childbirth is that it is one of the leading causes of death of infants and young women and has always been.
Lid #3 Obstetrician-gynecologists are surgical specialists in the pathology of women's reproductive organs.
Obstetrician-gynecologists are specialists in women's reproduction in both health and illness. This definition is made up by and held solely by natural childbirth advocates.
Lie #4: pregnancy and childbirth are normal physiologic processes that are no more likely to go seriously wrong than, say, digestion.
This is the central lie in what is essentially a collection of lies. Pregnancy and childbirth are and have always been leading killers of infants and mothers. The most dangerous time in a child's life is the day he is born. Pregnancy and childbirth are still leading killers of young women throughout the world despite the fact that maternal mortality has already been dramatically reduced. If you don't start from that factual premise, all your conclusions will be wrong.
Lie/fabrication #5: However, labor difficulties usually resolve themselves with tincture of time or simple remedies. Sterner, riskier measures are rarely required.
The leading causes of maternal death include postpartum hemorrhage and eclampsia/pre-eclampsia. They don't resolve themselves. It is estimated that in Africa alone, some 40,000 women die each year of obstructed labor (the baby doesn't fit). Clearly that does not resolve until both the woman and baby are dead. It usually takes three days of agony.
Classic sexist statement: even today, women obstetricians train in curriculums devised by and mostly supervised by men. Gender bias also values the masculine qualities of control, efficiency, and predictibility.
Evidently women cannot be trusted to have the intelligence to reach their own conclusions. Although women obstetricians agree with their male colleagues, it must be because they have been pressured into doing, not because they are capable of making their own assessments. Women are not capable of having "masculine" qualities or understanding efficiency and predictibility
Lie/fabrication #6: If you see the mother as the problem, you don't see her as the solution.
Obstetricians don't see the mother as the problem, they see death as the problem. Everything they do devolves from that.
Lie/fabrication #7, the crowning lie: This means obstetrics lacks a self-correcting mechanism.
Williams Obstetrics, the classic text in the field, has been through more than 20 editions. The most recent one is very different from the first or the tenth or the fifteenth. Why? Because techniques that did not work were replaced by those that did; need discoveries changed the fundamental knowledge in the field; and the spectacular successes of obstetrics have caused obstetricians to research and discover ever more life saving techniques and technologies.
I'd be very happy to see whatever evidence Henci Goer would like to present to show that these claims (and others) are not completely fabricated and have any basis in fact.
Labels: "natural" childbirth, Henci Goer
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