Monday, September 10, 2007

Evidence "informed" midwifery: a celebration of ignorance

You'd think that direct entry midwives would be embarrassed by their lack of knowledge. Instead, they positively celebrate it. What better way to demonstrate grossly inadequate knowledge of obstetrics, science and statistics than to proudly announce that evidence is optional?

Sara Wickham, a registered midwife in the UK, writes about her belief that midwives are free to ignore scientific evidence:
One of the major criticisms of the concept of evidence-informed practice is that it is seen as reductionist, positivistic and based in the medical scientific paradigm. ... this does not have to be the case... there are as many different forms of evidence as our understanding of midwifery and women will allow us to see. Some of these are listed below.

There is also an important distinction between the words 'based' and 'informed' - the latter is preferred by those who realise that midwifery is a process which is about far more than evidence...

What Constitutes Evidence?

Woman's choice / philosophy * Intuition (woman / midwife)
Women's experience * Research
Midwifery experience * Body knowledge
Life experience * Physiology
Insight * Philosophy
Common-sense reasoning * Policy and practice
Now I'll try to stop laughing so we can dissect this travesty of "reasoning".

Unfortunately for direct entry midwifery, Ms. Wickham, evidence is not optional. It is simply impossible to show that something is safe or effective without evidence. Not "challenging", not "difficult", but impossible. Evidence is not one way of "knowing", it is the ONLY way of knowing. Everything else is wishful thinking and misapprehension.

The appeal of dismissing evidence is obvious. First, it is difficult to become educated in science and statistics. Learning is hard, ignorance is easy. It is so much easier to pretend that you don't need to know it, than to make the effort to actually learn it. Second, midwives don't do research, because they don't have the education or training to do so. Research is hard, ignorance is easy. Why bother doing research when you can simply pretend that it isn't necessary? Third, (and most importantly) the scientific evidence demonstrates that many claims of homebirth midwifery are false. Well, then, let's just pretend that it doesn't count! According to Wickham herself, only 12% of direct entry midwifery is based on science. Isn't that what I have been saying all along?

Evidently, Ms. Wickham does not think it is enough to excuse ignorance. She positively celebrates it. Women don't need science or scientific evidence because they have special powers that allow them to create their own brand of "evidence" (otherwise known as wishful thinking). Sorry, Ms. Wickham, but women are no longer reduced to bleating pathetic excuses when confronted with science. Women are biologists, chemists, physicists, statisticians and mathematicians. They work at the frontiers of knowledge and do cutting edge research. Just because direct entry midwives can't understand science does not mean that the rest of us are incapable of understanding it or that we wished to be lumped in with those who praise their own lack of knowledge.

Advocates of midwifery like Ms. Wickham do more to damage their cause than opponents ever could. Ms. Wickham acknowledges that midwifery is not based on science, that midwives don't understand science or statistics, that midwives feel free to ignore scientific evidence, and that they are proud of themselves for doing so. I couldn't have said it better myself!

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