Sunday, March 11, 2007

No knowledge necessary

One of the most attractive things about "alternative" medicine is that no particular knowledge is necessary to declare yourself an expert. Homebirth and "natural" childbirth advocacy share this appealing trait.

As Kaptchuk and Eisenberg point out in their 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 and is ultimately accessible to human perceptions. Nature is not separate from human consciousness. Instruments that extend the senses or objective diagnostic or laboratory tests that discern what cannot be felt never replace human awareness... [A]lternative medicine, unlike the science component of biomedicine, does not marginalize or deny human experience; rather, it affirms patients' real-life worlds. When illness (and, sometimes, biomedicine) threatens a patient's capacity for self-knowledge and interpretation, alternative medicine reaffirms the reliability of his or her experience.
One of the foundational premises of homebirth and "natural" childbirth advocacy is no particular knowledge of birth is necessary. This is expressed in a variety of ways, some of them actually contradictory to other claims of homebirth and "natural" childbirth advocacy. These claims fall into three general groups: no special knowledge is necessary, science cannot provide the knowledge that is necessary and specific knowledge is necessary but such knowledge can be accessed by personal experience. These claims about the nature and value of knowledge are invariably held by people who have limited or no understanding of the scientific method or statistical analysis. Indeed, they are puportedly a defense of deficient knowledge.

The first claim is that no particular knowledge of birth is necessary: This undergirds all aspects of homebirth/"natural" childbirth advocacy, but it is a particularly prominent feature of unassisted childbirth advocacy. It is expressed in a variety of ways including:

Childbirth is natural.
Women are "designed" to give birth.
We wouldn't be here if childbirth were not safe.
"Trust" birth.
Women "know" how to give birth and babies "know" how to be born.
Childbirth is like any other natural body function. Just like you don't need assistance to have a bowel movement, you don't need assistance to have a baby.

These claims are simultaneously a reflection of ignorance of basic knowledge about childbirth in nature and a celebration of such ignorance. These claims are made by women who live in first world countries and therefore have no experience or knowledge of the inherent dangers of childbirth in nature, and the high neonatal and maternal mortality rates. These claims are never made by women who have direct and extensive experience of childbirth in nature. What is especially ironic is that these claims reflect both ignorance of nature AND ignorance of science.

The second set of claims are meant to be an indictment of science. These claims also perform two functions simultaneously. They are justification for lack of understanding of science and statistics and they are a defense against scientific evidence that does not comport with pre-existing beliefs. In contrast to claims about basic knowledge of birth, which are claims that are only made by people in first world countries, claims about the value of science are very primitive indeed. They are claims make by people who feel threatened by knowledge. Such claims include:

There are areas of knowledge that are not accessible to science.
Statistics cannot tell us everything about what happens.
Science tells us something different than experience tells us.
Science does not tell us the truth because it is manipulated by scientists for their own ends.
There is no such thing as scientific truth.

These claims have been invoked by flat-earth theorists, by creationists and by purveyors and supporters of "alternative" medicine.

The final set of claims posits that specialized knowledge may be required but science is not needed to access such knowledge. These claims include:

Women have different ways of knowing.
Intuition is an equally valid way of accessing knowledge about childbirth.
Experience is more valuable than scientific knowledge.

These claims are not just a justification of lack of knowledge, they are an affirmative celebration of ignorance. Moreover, they are sexist in the extreme. Science is considered a "way of knowing" that is inherently male. This has two important implications. Science supposedly cannot tell us much about female subjects like childbirth, and women, by virtue of their sex, supposedly cannot "do" science. This is mitigated by the fact that women supposedly have other ways of "knowing". They don't have to learn things, they can simply intuit them.

Homebirth/"natural" childbirth advocacy is not simply based on factual errors and a pervasive failure to understand the scientific method and statistics. It is also based on an explicit denial of the need for specific knowledge and a disparagment of such knowledge.


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