I appreciate this so much. Once again I feel like you're able to put into words what I'm always attempting to articulate when talking about birth and evidence. I teach Evidence Based Birth Childbirth classes and one week we talk about failure to progress and Freidman vs. Zhang. That section is hard to teach because ultimately the takeaway should be "failure to progress is a lie" but the way EBB lays out Zhang as revising Freidman doesn't actually get you to that conclusion. The couples in my class usually struggle to understand what the material is saying, and I struggle to articulate how to interpret the information without sounding like I'm "anti-evidence".
I am (finally, excitedly) in the process of applying for midwifery school and have been tasked with the reflective questions of why I want to become a midwife and how midwifery differs from medicine. If I could answer both in one word: THIS! Thank you, as always, for your beautiful, fiery, eye-opening writing.
I read most of this piece and was particularly enraptured by the last three paragraphs where you brought everything together. Earlier in my midwifery career, I felt less than because I was exclusively trained out of the hospital setting and was not taught what is considered the gold standard in contemporary patriarchal society in maternal care. As I have grown from being a baby midwife, the deep knowledge I carry in my body, spirit, and hands has erased that doubt. Teaching the history of midwifery course has brought me to the same conclusion you reached here; something I tell my students every semester is that empirical evidence is what I believe to be the basis of midwifery and that is just as valuable (if not more) as the evidence we have been told needs to be the law and guide of our practice. I find it interesting that there was a point in time when midwifery was the unrefuted expert in all this and American obstetrics was a burgeoning profession with patriarchal and racist underpinnings. It is infuriating to me what violence obstetrics in this country was built on and the ends it has reached currently. Moreover, American obstetrics and probably European obstetrics did not peer long enough to the Egyptian and other Middle Eastern iterations of obstetrics and midwifery to understand and build on the relationship fostered between the two. In any case, I always look forward to getting your writing in my inbox
“We seem to have equated the simple use of technology we have at our disposable — whether or not it’s actually effective or beneficial — as scientific.” Yes…it’s like the medical providers need a whole wall of numbers and data to gesture at vaguely while they insist on more interventions. But when you inspect the numbers, the data, as you said, there’s no “there” there. It’s just…noise.
In my first labor watching the provider and my partner stare at the computer screens and reacting only to the screen. They would “cheer” me through contractions one minute late, “warn” me of waves I was already cresting. Americans do love gadgets. It was like they were watching a video of me giving birth, one minute after the fact. Idiotic.
Imagine if the obstetric world actually observed physiological birth. It’s difficult to picture an ob doing that. Would it be worth it? Is there anything that obstetrics could offer a birthing person? (Obstetrics in particular, not just western medicine with vaccines, antibiotics, blood pressure meds, etc).
As a young midwifery student, I remember being astounded watching a resident an attending OB push with a client whose care they hip-checked me out of (for "failure to descend") -- the resident, eyes on the tracing, fingers in the patient's vagina, would bark "is it starting? Can you feel it? Is it starting?" or "Is it over?" aggressively when it was completely obvious what was happening if he had just turned his attention to the actual human in front of him.
Your last question is worth asking. I think yes in that there will always be some births and gestations that are complicated and would benefit from a surgeon or a high-risk specialist. But I think the task of those parameters shouldn't left to the surgeons and high-risk specialists who have been taught that all gestations and births are potentially pathologic until proven otherwise. In a perfect system, midwives would be managing most everything, including deciding when to bump up the care. One thing I did learn from the public hospital in which I worked, for all its problems, was that birth, even for people who had "high risk" pregnancies (assuming co-management of the complication during pregnancy), was best attended by midwives in almost all cases.
I appreciate this so much. Once again I feel like you're able to put into words what I'm always attempting to articulate when talking about birth and evidence. I teach Evidence Based Birth Childbirth classes and one week we talk about failure to progress and Freidman vs. Zhang. That section is hard to teach because ultimately the takeaway should be "failure to progress is a lie" but the way EBB lays out Zhang as revising Freidman doesn't actually get you to that conclusion. The couples in my class usually struggle to understand what the material is saying, and I struggle to articulate how to interpret the information without sounding like I'm "anti-evidence".
so grateful for your words on this <3
I am (finally, excitedly) in the process of applying for midwifery school and have been tasked with the reflective questions of why I want to become a midwife and how midwifery differs from medicine. If I could answer both in one word: THIS! Thank you, as always, for your beautiful, fiery, eye-opening writing.
Congrats on taking the leap!! I hope the writing goes well and I'm glad to have helped in any little bits of inspiration!
I read most of this piece and was particularly enraptured by the last three paragraphs where you brought everything together. Earlier in my midwifery career, I felt less than because I was exclusively trained out of the hospital setting and was not taught what is considered the gold standard in contemporary patriarchal society in maternal care. As I have grown from being a baby midwife, the deep knowledge I carry in my body, spirit, and hands has erased that doubt. Teaching the history of midwifery course has brought me to the same conclusion you reached here; something I tell my students every semester is that empirical evidence is what I believe to be the basis of midwifery and that is just as valuable (if not more) as the evidence we have been told needs to be the law and guide of our practice. I find it interesting that there was a point in time when midwifery was the unrefuted expert in all this and American obstetrics was a burgeoning profession with patriarchal and racist underpinnings. It is infuriating to me what violence obstetrics in this country was built on and the ends it has reached currently. Moreover, American obstetrics and probably European obstetrics did not peer long enough to the Egyptian and other Middle Eastern iterations of obstetrics and midwifery to understand and build on the relationship fostered between the two. In any case, I always look forward to getting your writing in my inbox
I enjoyed this article immensely, as always. Thank you
Wonderful writing
Thank you so much! I never get QUITE the amount of time I want to devote to my newsletter (or editing it), so I'm glad it resonates nonetheless.
“We seem to have equated the simple use of technology we have at our disposable — whether or not it’s actually effective or beneficial — as scientific.” Yes…it’s like the medical providers need a whole wall of numbers and data to gesture at vaguely while they insist on more interventions. But when you inspect the numbers, the data, as you said, there’s no “there” there. It’s just…noise.
In my first labor watching the provider and my partner stare at the computer screens and reacting only to the screen. They would “cheer” me through contractions one minute late, “warn” me of waves I was already cresting. Americans do love gadgets. It was like they were watching a video of me giving birth, one minute after the fact. Idiotic.
Imagine if the obstetric world actually observed physiological birth. It’s difficult to picture an ob doing that. Would it be worth it? Is there anything that obstetrics could offer a birthing person? (Obstetrics in particular, not just western medicine with vaccines, antibiotics, blood pressure meds, etc).
As a young midwifery student, I remember being astounded watching a resident an attending OB push with a client whose care they hip-checked me out of (for "failure to descend") -- the resident, eyes on the tracing, fingers in the patient's vagina, would bark "is it starting? Can you feel it? Is it starting?" or "Is it over?" aggressively when it was completely obvious what was happening if he had just turned his attention to the actual human in front of him.
Your last question is worth asking. I think yes in that there will always be some births and gestations that are complicated and would benefit from a surgeon or a high-risk specialist. But I think the task of those parameters shouldn't left to the surgeons and high-risk specialists who have been taught that all gestations and births are potentially pathologic until proven otherwise. In a perfect system, midwives would be managing most everything, including deciding when to bump up the care. One thing I did learn from the public hospital in which I worked, for all its problems, was that birth, even for people who had "high risk" pregnancies (assuming co-management of the complication during pregnancy), was best attended by midwives in almost all cases.