Midwives objections to technology: philosophical or practical?
We have seen how midwives' objection to technology is based in part on classical philosophical issues like the relative merits of technology vs. nature. However, I wonder how much of midwives' antipathy to technology is based on a simple practical motivation. They don't know how to use it. Since they can't use it, acknowledging the need for it would leave them unemployed.Natural childbirth advocates often accuse doctors of being to eager to use technology. A typical riposte is: "If you are a hammer, everything looks like a nail". I don't think that this is an especially valid criticism, but if you believe that it is true, then you must ask the converse: "If you are not a hammer, could you recognize a nail, and would you acknowledge it even if you recognized it?"
We know from medical care, that doctors may recommend what they know how to do. For example, for particular cancers, surgeons may be more likely to recommend surgery, radiation oncologists may be more likely to recommend radiation, and medical oncologists may be more likely to recommend chemotherapy.
In the case of childbirth, obstetricians have a wide array of interventions, procedures, and pain medication options at their disposal, in addition to the option of doing nothing at all. Direct entry midwives have essentially no knowledge in the use of technology, whether in normal labor or for complications. It's not suprising that they recommend against the use of technology, since they would almost certainly have to recommend a different care provider. Does the opposition of direct entry midwifery to technology reflect the patient's medical interest or simply the economic interest of midwives?
Aren't obstetricians freer to give a more objective assessment of what interventions a woman might or might not need because they know how to use all of them? A large proportion of obstetricians are salaried, or work in states like mine where obstetricians are reimbursed the exact same amount regardless of whether any technology is used. Therefore, there is no economic incentive to recommend an intervention over doing nothing at all. In contrast, a DEM has a strong economic incentive to insist that interventions are not needed or are actually harmful.
Labels: midwifery, philosophy
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