Wednesday, October 17, 2007

Who has the right to criticize?

Direct entry midwives spend an inordinate amount of time criticizing doctors and "medwives". Yet they do nothing to improve patient care or outcomes. Do they have a right to criticize if they are doing nothing to solve existing problems?

I'm not talking about the legal right to criticize. Obviously, they are free to say whatever they want about modern obstetrics, doctors and CNMs. I am asking about their moral rights and moral obligations.

What function is their criticism supposed to perform? Clearly, it is a means of expressing their frustration that things are not to their liking. Also, it is a means of advertising themselves and their beliefs. Ostensibly, criticism of the existing practice of medicine is meant to improve care for people, but direct entry midwives appear to feel they have no obligation to patients who do not share their philosophy. Unlike doctors and CNMs who are ethically obligated to provide care to everyone and to attempt to meet patient needs whether they agree with them or not, direct entry midwives never consider or mention women who do not agree except to criticize them, too.

Most importantly, direct entry midwives make no effort to improve anything. Take the C-section rate, for example. They are shrill in their condemnation of the C-section rate, yet I have never heard even one remotely practical suggestion from them for reducing the rate. "There are too many unnecessary C-sections," they say. Okay, if that's how they feel, they should tell us speficially which ones are the unnecessary ones. What tests or techniques are we to use to limit C-sections to only those that are necessary? Do those tests or techniques actually work to lower the C-section rate without raising the neonatal mortality rate? They don't know and they don't care; they don't even give it any thought.

So here's my question: if you never make any effort to devise improvements in obstetric care, if you never make any effort to lower mortality rates, if you research nothing, and if you refuse to have anything to do with any patient who isn't just like you, do you have any right to criticize the obstetricians, CNMs and midwives who are constantly working, assessing and changing in an effort to improve outcomes?


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