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Tuesday
Feb092010

Monstrous rumors, evidence, and educating feminist allies

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By Emjaybee

Ok, here’s the deal: Jezebel picks up a story about a highly disturbing and inflammatory article that maintains that two pioneers of British obstetrics, William Hunter and William Smellie, may have committed murder in order to get enough pregnant corpses to practice on in the 18th century.

Lindsey Beyerstein at Majikthise finds the whole thing doubtful and tell us why. (watch for the infamous Dr. A to weigh in in her comments).

Feminist blogger Amanda at Pandagon picks up the story and worries about anti-science approaches to obstetrics (she is not a big fan of the anti-vaccination movement either).

(and of course I shoot off my big mouth a bit in Amanda’s comments, too).

Amanda is one of the newest and youngest feminist bloggers out there, and has a wide audience, well-deserved; she’s a sharp, fierce, and funny writer. But if you read her piece, you might feel as I do that there’s a lot of feminists who still don’t understand the connections between autonomy in a woman’s day-to-day life and autonomy in birth. Maybe because they’re young and haven’t had to deal with the birth-industrial complex yet (though Miriam at Feministing consistently posts excellent bits on midwifery and obstetrics).

And underneath all that is maybe also a fear of not being taken seriously if they ally themselves too closely to the midwifery types. This is understandable; when you pick up an issue of Midwifery Today, you can’t notice that, well, it looks like it was designed in 1975; among all the many excellent articles are also spiritual essays and advertisements for various herbal, homeopathic, and other remedies that owe much more to folklore and culture than to science. And discussions of natural birth online frequently include some mention of women and/or midwives who employ these practices.

This is touchy territory. I myself do not believe in homeopathy or many other birth-related practices that fall into this camp. However, I also know that the hippie, crunchy, spiritual types largely kept midwifery alive in the 20th century long enough for other women to find it again when they began to protest their mistreatment under the “scientific” regimes of obstetrics. We cannot deny the tremendous service they performed by doing so, even if we move on to advocacy for midwifery and other practices based on evidence, not religion or folklore.

Those of us who grew up in the 70s and 80s are in that middle ground, between the joyful reclamation of the self symbolized by Ina May Gaskin and her followers, and the fierce insistence on scientific truth demanded by younger feminists like Amanda. Maybe it’s part of our job to be the middle link, to transmit the memories and knowledge of the generation before us to the energetic and talented young women coming up after us.

 

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Reader Comments (37)

I'm young. Well, 29, but I've seen the complete insistence by some that doctors are always, absolutely right. That science is always good. That to not trust is "quackery". I wonder how they never learned of the scandals of the past. Times when women were sterilized by doctors based on race or mental abilities. When some doctors infected groups of Afro-Americans with deadly diseases to study the results.

Power over another can bring great harm, especially when steeped in our patriarchal society. Who has more power in many cases than a medical doctor? The more we tell women to be quiet and trust, the more power we give them.

February 9, 2010 | Unregistered CommenterSummer

Great post, Jill - I like your thoughts on middle ground.

I've also been frustrated that the "official" women's movement doesn't champion the cause of maternity care and women's autonomy to make decisions about birth. These influential organizations support women's reproductive rights, but that seems to only cover my choices about family planning and whether to *be* pregnant. If I own my body when I make those decisions, shouldn't I also own my body when it comes to decisions about birth too?

Jennifer Block's "Pushed" makes this point excellently in one great chapter - she used to write for "Ms." magazine. Then when she decided to research and write about maternity care her eyes were opened and she wondered why the heck this stuff wasn't getting more attention from her fellow feminists. I agree Jill, in part its because you have to go through it to understand.

February 10, 2010 | Unregistered CommenterMegan

Well, I'm not anti-science in the least, but I do realize its limitations. We cannot possibly know how everything we do truly affects human development before and after birth. As I've grown into adulthood and taken responsibility for raising my own humans it amazes me to witness how much medicine is based on coincidence, guess work and "We don't know why it works, but it does for some reason, so we're prescribing it". So I don't see a big difference between the earth knowledge that has been passed down through generations of midwives and lost somewhat and is now being rediscovered and protocols that are subjected to very limited trials that cannot determine effects over a lifetime. Actually, after typing that out, I will take generation tested "folklore" not invented to generate a profit over relatively recent pharmaceuticals on which shareholder wealth depends...

Just saying... but I suppose I might be classified as "hippy" by some, even though I live a rather mainstream, suburban life and am good friends with a female PB whose practice I personally use for my medical gyne needs. And I'm not a conspiracy theorist... I swear! Just somewhat skeptical.

February 10, 2010 | Unregistered CommenterVanessa Manz

Megan, thanks, but this was Emjaybee's post. :)

February 10, 2010 | Registered CommenterJill

Emjaybee, holy crap. Where do I even start?

In general, a lot depends on what type of education, knowledge and information flow that people privilege. White coats do sound more convincing that non-white coats to the average white, middle and upper class American. I guess if the medical industry has always served you well (as it did me), why look at it critically? Why not just assume that it is a benevolent, altruistic industry? Why not just ignore that it is an *industry* and driven as much by profits and fear of lawsuits like anything else? I didn’t think twice until it became relevant to me. It doesn't devalue the positive practices to look critically at all of the factors influencing patient care that have little to do with the patient.

The issue of appreciating the activists that came before who fought for civil rights, patients’ rights, consumer rights, women’s rights, etc., is relevant here, too. Enjoy voting Republican in elections? Thank one of those feminists that you think are gross. Enjoy participating in your health care? Thank a patient advocate. Happy that you were encouraged to breastfeed? Thank all of the activists who worked their asses off to shift away from the formula-for-all, bound breasts in hospitals, hormone shots to suppress milk and change cultural attitudes. They seemed anti-“science”, too.

“And underneath all that is maybe also a fear of not being taken seriously if they ally themselves too closely to the midwifery types.”

I don’t know. Depends on one’s vantage point. I’m pretty comfortable moving back and forth between paradigms (both in general and in this example), but it’s obvious that maternity care issues get polarized into doctors vs. midwives, which is distracting at best. Remember, my experience was Opposite World from my previous view on things… the doctor/CNM that recommended the cesarean that I ultimately refused had no scientific ground to stand on and the home birth midwife (CPM) with whom I spent several hours at the insistence of a friend had accurate research and stats. Ultimately, Midwifery Today became relevant to me. Sure, what they said in the hospital appeared more scientific because of the way it was presented, but nothing matched up with journals.

I gave up on giving a shit about the red herring about “natural.” Or the whole supposed “metaphysical” reasoning behind refusing a cesarean. It’s garbage… for me, anyway. It’s a defense mechanism to try to make the patient look like a freak instead of acknowledging that there are some seriously unscientific practices (habits) going on in hospitals along with the really awesome services available to patients.

February 10, 2010 | Registered CommenterJill

For some reason, I don't doubt at all that this could have happened. I'm not familiar with their work (although who can forget the name William Smellie?) and since grave robbing was a popular means of cadaver acquisition during the day, I don't doubt that murder was, either. Mary Roach talks about this (although not on pregnant women) in her book "Stiff: The Curious Lives of Human Cadavers" and I believe does talk about how certain 'expendable' patients would often be knocked off. Like one of the commenters on Lindsay's blog, I also doubt that pregnant women were all that healthy then, either, given what we know about the general conditions of London during that time. Not a very fun place to live.

Although I'm not sure it applies to this time period, after reading some of Jennifer Block's book I wouldn't be surprised if some of the neonatal deaths that were "so common" weren't due in part to interventions. The use of Pitocin and similar induction agents was not uncommon in the early 19th century and were no doubt regulated poorly and their efficacy unknown. Knowing what we know about Pit today, the same risks would have applied in 1800 as much as they do now, maybe even more so.

February 10, 2010 | Unregistered CommenterThe Deranged Housewife

I think the whole science versus midwifery thing is a false dichotomy. Much of what I read and learned while I was pregnant was scientific, it was just coming from outside of mainstream western medicine. Look at the kind of stuff Henci Goer does, for instance. Look at the evidence-based practices in many western European countries, which are sometimes completely the opposite of American practices. The question is often not whether it's science-based, but which science, whose science? What interests me is how many of the traditional practices of midwives have proven to be effective when scrutinized using standard research methods. For instance, maybe it's true that old-time and indigenous midwives didn't know why they waited to cut the cord until the blood stopped pulsing. This was just a practice that had been passed down to them with no understanding of the underlying mechanism. My aunt tells me that my great grandmother, who birthed 13 healthy babies with no doctors around, told her that babies are "more robust" if you wait to cut the cord. Now it's been well-established through standard research methods that babies who get all the cord blood have an easier time breathing for the first few minutes and do not become anemic if they're exclusively breastfed for the first six months, and back when my great grandma was having 'em they were all breastfed. So now science has revealed the reason behind this old practice, and the huge benefit it provides, but if you specify in your birth plan that the cord not be cut right away, all you get is deep sighs and eyerolling from medical professionals. Because they absolutely do not want to know about any scientific information that interferes with their routine and their control and unquestioned authority over the new parents, and waiting 7-10 minutes to cut the cord is just really asking too much. And the list of traditional midwifery practices that have been confirmed by scientific research goes on and on. So I think that in many cases we have to question this dichotomy to begin with.

February 10, 2010 | Unregistered CommenterRachel_in_WY

This is probably one of my biggest struggles when it comes to my thoughts on birth. I am an LCCE and am constantly trying to be "current" so that I can pass along good information to my clients. But the more I read, the more I feel hopeless about the quality of research out there. There always seems to be some bias, some motive, or some philosophy which drives research or the interpretation of said research. This falls on both "sides" of the debate. I keep reading articles about this doctor or that doctor who got a huge payout to publish sketchy stats on some drug from a pharmaceutical company. How can we trust that? Things like this call into question (for me at least) almost anything I read!

However, there are some things on the "natural" side which I feel flabbergasted at when I read them. How can we expect the average American woman to wade through everything and try to make an "informed decision"? It is no wonder, in my mind, why women are just usually more content to trust their care provider's philosophy (be they midwife or OB, or any other doctor for that matter).

February 10, 2010 | Unregistered CommenterAugusta

And for the record, I thought that original article about the OBs seemed a little too implausible for me to believe.

February 10, 2010 | Unregistered CommenterAugusta

I think I should qualify that while I do in fact trust *science* (as in the process of gathering evidence, experimenting, and observing results as objectively as possible) I do not think *scientists* (or doctors, or any human) are trustworthy just by nature of what they do, however noble their stated intentions.

Of course, human beings often claim to be using the principles of science while still being blinded by prejudices/their own interests (which explains many of our problems in healthcare, as well as in other areas). And science itself is complex enough that nonscientists are forced to have some trust in those who use it simply because we don't have the knowledge to refute them. And since most scientists and/or doctors are regular and decent human beings, we don't have to treat them like enemies.

However, when it comes to medicine we *can* point out things you don't need a medical degree to see, like prejudicial attitudes, or practitioners refusing to accept research from their peers for reasons that have nothing to do with good practice. Said practitioners might retreat behind their degrees and terminology (or roll their eyes, or dismiss us as anti-science cranks) but the more research we gather for our point of view, the less credible they look.

And actually, I think it's quite scientific to look at midwifery practices--which are, after all, the result of experimentation and midwives who killed off lots of mothers were not likely to stay in business long. One of the biggest mistakes early obstetrics made was driving skilled and experienced midwives out of business instead of learning from them and bringing them into obstetrics itself. How much knowledge of pain managment, safe labor, and delivery techniques was lost because it was never written down and practitioners were silenced? What we have now may only be a remnant of what was actually known and lost forever, and now has to be rediscovered.

How idiotic is it that we have two groups fighting over best birth practices anyway? They have the same stated goals, and each has a vast pool of knowledge that can benefit women, but are split apart by prejudices and power struggles (mostly on the OB side) going back centuries, and women lose out. Nothing logical about that whatsoever.

February 10, 2010 | Unregistered Commenteremjaybee
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