Tuesday, July 24, 2007

Intuition: pretending that ignorance is a virtue

When it comes to science and other forms of formal knowledge, direct entry midwives have a conflict of interest. Direct entry midwives lack scientific knowledge and have minimal understanding of evidence based medicine and statistics. Indeed, they have less education and clinical experience than any midwives in the industrialized world. Moreover, science and scientific evidence show that many claims of direct entry midwifery are factual false.

There are two possible strategies in the face of such a conflict. Direct entry midwives could increase the requirements for formal learning; they could conduct scientific research; and they could subject the claims of direct entry midwifery to scientific scrutiny. That's hard. The alternative strategy is much easier. They simply claim that scientific knowledge is unnecessary.

Attempting to make a virtue of necessity, direct entry midwives have adopted a variety of strategies that serve to de-emphasize formal knowledge and water down the concept of expertise to the point that anyone can be an "expert". These strategies include:

Minimal formal knowledge requirements in training.
Ability to forgo formal education altogether and become certified on the basis of a "porfolio".
Replacement of scientific knowledge with inanity such as homeopathy, flower essences and vibrational energy.
No requirement for any kind of evidence before methods are employed in practice.
Claims of being "experts" in normal, as if such a thing even exists. It's like claiming to be a meteorologist who is an "expert" in good weather.

One of the more subtle strategies is the elevation of "intuition" to a place of primacy. Anyone can have intuition, of course, and there is no way to objectively compare intuition among practitioners. Intuition fills its role perfectly in midwifery. Anyone can have it. No one can test it. There is no objective way to measure it.

The problem is that "intuition" in direct entry midwifery is just another word for ignorance. It is important to be clear that intuition in direct entry midwifery means something entirely different than it means in medicine or law or other disciplines. Intuition in those realms means non-linear thinking which draws unconsciously on funds of formal knowledge and experience. In other words, it is pattern recognition.

Lay people do it, too. So if your child develops a low grade fever and pox-like lesions after being exposed to chicken pox, you "intuit" that the child has chicken pox without going through a formal diagnostic procedure. Your "intuition" relies on what you already know about what chicken pox looks like, how it presents, and any recent exposures.

The concept of "intuition" in direct entry midwifery does not mean drawing on a fund of formal knowledge and clinical experience to recognize patterns and therefore make judgments quicker than might occur with formal linear thinking. In direct entry midwifery, "intuition" means internal feelings that are independent of prior education and clinical experience.

Simply put, a medical student who lacks formal education and clinical training in endocrinology is not able to "intuit" Hashimoto's thyroiditis by looking at a patient. Since the medical student has no prior knowledge of the clinical pattern of Hashimoto's thryoiditis, he will not recognize the pattern when he sees it. In contrast, an inexperienced direct entry midwife is encouraged to trust her "intuition" on how to handle various occurances in labor. Without formal background and clinical experience, she cannot recognize patterns either, so her "intuition" is nothing more than an uneducated guess.

Direct entry midwives are not midwives who rely on a different fund of knowledge and experience than other midwives (CNMs or European midwives). They are midwives who have less education and less experience and who are trying to convince people that when it comes to knowledge, less is more and feeling trump all.

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