Thursday, March 20, 2008

And they wonder why no one takes them seriously

You can't make this stuff up.

This piece of psychobabble is what passes for research in the world of midwifery, Including the nonrational is sensible midwifery, by Jenny A. Parratt, and Kathleen M. Fahy, was recently published in the Australian midwifery journal Women and Birth. This piece has a very simple premise and conclusion: Many principles of midwifery are not supported by science. Rather than modify midwifery to reflect scientific knowledge, it is personally more satisfying to midwives to justify and celebrate their ignorance. Hence, we celebrate!

In many ways, the article resembles religious rationales for maintaining belief in creationism in the face of the overwhelming scientific evidence that creationism is nothing more than wishful thinking. It is striking how the language of the article resembles that used in justifications of religious belief:
Much of life cannot be apprehended or comprehended on a purely rational basis... Consider, for example, the sensations that may arise when watching a sunset, hugging a loved one, hearing a bird's song or delighting in a sense of bodily capability... Similarly a midwife's ordinary practice of being with the woman can be experienced by the midwife in quite extraordinary — nonrational — ways...
The centrality of emotion is similar; the nonrational beliefs must be good because they help people feel better about themselves; interestingly, the "people" in question are not laboring women, they are midwives. This article is a justification of irrational midwifery beliefs on the basis that they make midwives feel good about themselves.
Experiencing the nonrational may include sensations of inner power and/or inner knowing... These experientially grounded, nonrational aspects of life have been described variously as mysterious, sacred, spiritual and intuitive... Experiences that are nonrational are experiences of unity and wholeness; ...
And, of course, no discussion of religious justification is complete with reference to the "soul".
Our soul is our own particular organic expression of the spiritual milieu of nonrational power. The soul moves in parallel with spirit: thus soul is nonrational, ethically neutral and idiosyncratic... Through our soul we may interpret and experience the power of spirit in diverse and contrasting ways: e.g. liberating, oppressive, joyous, peaceful or challenging...
The central claim of the paper is that the inclusion of the non-rational is midwifery "enhances safety", although the authors' explanation seems to show nothing of the kind.
When the concept of 'safety' is considered in childbearing it can illustrate how insensible rationality can be and how negative consequences can occur. Safety is an abstract concept because it is difficult to define and can only be considered in general terms. Rational dichotomous thought, however, provides 'safety' with the following defining boundaries:

- 'safe' has a precise opposite called 'unsafe',
- every situation/person/thing must be either be safe or unsafe,
- a situation/person/thing cannot be both safe and unsafe,and
- it is not possible for a situation/person/thing to be anything
other than safe or unsafe.
The authors have created a straw man. Perhaps they understand safety to be an either or dichotomy, but real medical professional recognize safety as existing on a continuum. Some techniques, treatments and situations are safer than others, but there is no single technique, treatment or situation that is "safe", rendering everything else "unsafe". The authors complain:
... What is deemed as safe is aligned with what is rational and what is unsafe is aligned with what is irrational. As irrationality is not acceptable this essentially forces the definition of safety to be thought of as 'true' even though it may not fit with personal experience and all situations... As the standard birth environment is the medicotechnical environment of the hospital this is presumed to be the safest. Its 'opposite', the home environment, is therefore rationalised to be unsafe. To argue otherwise would define the rational person as irrational... In the purely rationalist way of thinking there is no other option except to consider that honouring the nonrational variabilities of individual bodily experience is irrational and unsafe.
The authors end with a flourish of outright stupidity:
For example, when a woman and midwife have agreed to use expectant management of third stage, but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking. Depending upon all the particularities of the situation the midwife may focus on supporting love between the woman and her baby; she may call the woman back to her body; and/or she may change to active management of third stage. It is sensible practice to respond to in-the-moment clinical situations in this way... Imposing a pre-agreed standard care protocol is irrational because protocols do not allow for optimal clinical decision-making which requires that we consider all relevant variables prior to making a decision. In our view all relevant variables include nonrational matters of soul and spirit.
Evidently, even if the woman bleeds to death for lack of pitocin, the decision to "support love between the woman and her baby" is still the correct one because her "soul" is "safe".

And, of course, the central focus: how does this make the midwife feel:
Being open to the nonrational in midwifery practice makes room for midwives to self-reflexively acknowledge aspects of themselves, such as their fears, in a way that does not interfere with their practice. During birth, making room for the nonrational broadens both midwives' and women's knowledge about trust, courage and their own intuitive abilities including the changing capabilities of bodies. And by including the nonrational midwives can then most honestly be with the woman's own fears as she opens her embodied self to her own unique process of childbearing.
At least these people are honest, even if completely inane. A fundamental (perhaps, the fundamental) goal of midwifery is to make midwives feel good about themselves. Coming face to face with their own ignorance makes midwives feel bad about themselves. Fortunately, there is a way to pretend that there is no such thing as ignorance. If a midwife thinks it or "feels" it, it automatically becomes knowledge. If the ultimate goal of midwifery is to make midwives feel good about themselves, then the inclusion of the nonrational is indeed "sensible".


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