Friday, July 17, 2009

Burn the male midwife!

A British midwife and PhD recently submitted an article to Evidence Based Midwifery, a publication of the Royal College of Midwives. Some of his viewpoints were featured in an article in The Observer. Its headline proclaimed: It's good for women to suffer the pain of a natural birth, says medical chief. The midwife argued that epidurals are overused and that having an unmedicated birth can be beneficial to women by helping them bond with their baby, preparing them for the demands of motherhood, and serving as a significant rite of passage. Instead of routinely offering epidurals, the midwife wrote, hospitals should encourage non-pharmaceutical forms of pain relief, such as yoga, hypnosis, and birthing pools. Any article discussing pain relief--whether epidurals are over- or under-utilized--is bound to be controversial. But this midwife's perspective has elicited an outpouring of what can only be described as mass hysteria.

Why? Because the midwife, Dr. Denis Walsh, is a man.

The outcry has been fierce and swift. Newspapers (mostly in the UK, Australia, and New Zealand) and bloggers quickly joined in the debate. Most simply repeated what The Observer reported, but with increasing levels of embellishment, outrage, and indignation. A sampling of headlines from various media reports about Dr. Walsh's paper:

The Mail Online's headline announced: Why mothers should put up with pain of childbirth - by a male expert in midwifery. A companion article in the same publication began with these words: "Obviously, it was a man who said it. A man who will never know the intense fury of a contraction, the hours of desperation or the waves of fear as a baby makes its painful way into the world," wrote Laura Kemp in I dare you to say that to a woman in labour.

Momlogic's headline asserted that "Midwife Says Childbirth SHOULD Be Painful." The first line of the article shouted (emphasis theirs): "When he pushes a baby out of HIS body, maybe we'll give a damn what he has to say!...Of course, this would be A GUY who says this ... a guy who has never had to go through the pain of childbirth himself!"

British midwife calls for end to pain relief during childbirth, says Australia's 3News. `

From the UK's Marie Claire: Male Midwife: Women Should Endure Labor Pains.

Medical News Today announced that More Women Should Endure Labour Pains Says Leading UK Midwife.

This is a classic case of telephone--each article reporting what another article said, each step away from the source becoming more extreme and distorted. For example, you'd think that Dr. Walsh were saying that no one should ever have the option of any pain relief and that all women should just suffer in agonizing pain. However, he did not say that at all. In fact, he strongly advocated the use of other techniques that reduce the pain of labor, including hypnosis, yoga, and water immersion. (Hydrotherapy in labor is the second-most effective form of pain relief, eclipsed only by the epidural, and was rated as the safest form of pain relief by Britain's National Institute for Health and Clinical Excellence.)

Even the original article in The Observer probably distorted Dr. Walsh's intended message. I have been interviewed multiple times for magazines, newspapers, and television. Most of the direct quotes attributed to me were, in fact, inaccurate. I never actually said those things verbatim. Instead, the people interviewing me made up quotations approximating what I said. In addition, the process of writing an article necessitates emphasizing some points and omitting others--further changing the interviewee's original message.

I doubt that any of the authors actually read Dr. Walsh's original article about "Epidural Culture." Why? Because it does not yet exist! If the authors and readers submitting comments had actually taken a moment to do some research, they would have discovered that his paper has not even been published yet! (It is currently undergoing peer review.) Nevertheless, many of the articles assume the article has been published, and that Dr. Walsh's quotes are taken from the article, because of the wording in The Observer:
He has set out his controversial views in an article for the journal Evidence Based Midwifery, which is published by the Royal College of Midwives (RCM). In a sharply worded critique of the rising popularity of pain-free labour, Walsh warns that normal birth is in danger of being "effectively anaesthetised by the epidural epidemic" in the NHS. A widespread "antipathy to childbirth pain" has emerged in the past 20 years and combined with increased patient rights and risk-averse doctors to create a situation where almost all hospitals now offer epidurals on demand, even if that is not in the mother's or baby's interests.
It sure sounds like those quotes are coming from the article, right? But they aren't, and the article doesn't yet exist.

On top of playing telephone, most of the commentary about Dr. Walsh's views suffers from a classic case of killing the messenger. Notice how quickly so many of the authors and bloggers and comments are quick to discredit his viewpoints, simply because he is a man and has therefore not given birth. Because if we can dismiss anything a male midwife says, simply because of his gender, then we surely must also discount any viewpoints on pain relief from male OBs. And we must also dismiss anything from any female midwives or OBs who have not had children. And, for that matter, any female birth attendants who have had a baby by cesarean--since they would not know what giving birth feels like, right? What we have is a reductio ad absurdum argument: if you have not given birth and experienced exactly what I felt, you have no right to have an opinion, research-based or not, about the value of labor pain.

There is a serious case of gender bias going on here. Not only is he male, he is a male midwife. Almost as weird as a male nurse. Note how many of the articles mentioned his gender. However, if the author had been a female midwife, they would not have emphasized her gender and mentioned it alongside her profession. I wonder if the response would have been as dismissive if it had been a male OB, rather than a male midwife, voicing the same ideas.

I also sense a lot of defensiveness about the use of pain relief, as if people feel threatened or personally attacked because this particular midwife feels epidurals are used too commonly and that there is value to feeling the sensations of labor. If having an epidural was the right choice for a woman, why the need to be defensive about it? (Besides the obvious reasons--1) he is a man and 2) most authors and readers were reacting to someone else's perception and interpretation of Dr. Walsh's message.)

More posts about Dr. Denis Walsh, Male Midwife:
If you only have time to read one link, be sure to visit the commentary at Feminist Philosophers: A Brief Defense of My Current Hero, Denis Walsh. Here is an excerpt:
SO, big dumb MALE midwife versus women just trying to do the best they can to cope with horrible pain, right? No. Not at all. Denis Walsh has made it his mission to write about and try to put into practice good, well-designed midwifery and obstetric research, with a particular emphasis on respect for the woman as a dignified person in a highly vulnerable and difficult circumstance. I know this because–in preparation for a second delivery, of which I was formerly shitless on account of a *terrible* first–I happen to have recently read Walsh’s midwifery text Evidence-Based Care for Normal Labour and Birth. Here is a brief run-down of what I took from his text wrt epidurals:

* epidurals interfere with, slow, and generally throw off the body’s efforts at expelling the fetus, thus greatly increasing the instance of assisted delivery. (For those not in the know, “assisted delivery” means they slice into your genitals with a sharp knife and then shove heavy metal tongs up your vagina to yank the baby out. It is not fun, and even if it’s “simple” (as you’ll hear in the interview linked below), it is certainly not nice–nor are the lasting pain and disfigurement caused by it. And charmingly, in many instances of use (take my experience, for example) it doesn’t even seem to be medically indicated.)
* Midwives (a) have in some delivery ward contexts become so accustomed to routine intervention and pain relief that they’ve simply lost the ability to accurately judge ‘how it’s going’: they see a woman screaming in labour pain and think something’s gone wrong, when in fact she’s simply in labour. Because of this, midwives are quite often quick to try to “fix” the situation by offering epidural; (b) are sometimes simply not willing to take part in helping women to manage pain; in a nutshell, they simply don’t like putting up with screaming patients; and so they like for their patients to receive epidural as quickly as possible.
* Childbirth is a frightening experience, especially for women who aren’t well-educated about it, and as such, midwives tend to influence very heavily what decisions women make for themselves in childbirth.


  1. Great write-up, Rixa.

    I read about this earlier in the week at and I was shocked that all the women at Salon (a liberal minded free-thinking news website) gathered around to throw stones at Dr. Walsh. All of the various (female) staff got on and left comments that epidurals were the only way to go, and many called him narcissistic. Pretty sad.

    I'm glad you wrote a very well-rounded and even-handed piece about it.

  2. Love it! Some of the best midwives I have worked with were males and some of the worst obstetricians were women!

    They both have something to prove. Female obstetricians are often proving they are as smart and tough as their male associates and male midwives are proving they are as sensitive and empathetic as their midwifery associates.

    I have encouraged male nursing students to pursue midwifery when I thought they had talent and one is now in midwifery school. I would also be more than happy to hire a male birth assistant in my homebirth practice, and have had a few interested, although couldn't make the commitment. Our field would move forward at a speedier rate if we had more male presence, IMnshO.

  3. I read all of those articles and editorials as they came up and purposely avoided comment sections because of the sensationalism. When I saw the RCM's statement that the paper is still in peer-review, I knew it was just link bait. You can feel all of the caps locks keys as women prepare TO UNLEASH THE FURY! MAN MIDWIFE, OMG! If pain is good, then no pain must be bad, so he must be saying that I did something bad.

    Here's something interesting that a commenter noted when I wrote about Denis Walsh the other day. You could use reverse psychology to ignite public support for complete and total medicalization of childbirth. Suggest that epidurals be limited and let people come out of the woodwork to sing the praises of epidurals. In lauding the delights of epidural anesthesia, you would be simultaneously giving a thumbs up to the medical assistance needed to move birth along while having the elective procedure of epidural anesthesia. It takes a team of people to take care of a patient with an epidural (anesthesiologist, nurse, doctor) and the terms of the hospital stay change the minute that needle goes in.

  4. Also, I think much of the furor had to do with the idea that a man was moralizing about how to be a good mother.

  5. Hi Rixa,
    I find it amazing, but not surprising, that the media runs away with an unpublished study. How did they get their hands on any of it I wonder? Also, there is not any bias against a male OB, why is there hatred for a male midwife?

    I just wrote a post on providers not preparing women for the fact they are not "guaranteed" an epidural when they are in labor, even if they want one. We are doing a disservice to these women by not preparing them at all for the sensations of labor, without a needle in their spine. I would love your input.

  6. I don't think we have to burn him. Tarring and feathering will do just fine.

  7. RR--I saw your post and hope to link to it soon. And Pinky, you always make me laugh!

  8. I like your bit about the fact that if we write him off, we also write off male OBs, anyone who has given birth by caesarean and any female OB/midwife who has not yet given birth. I've gotta say, I originally thought "hmmm ... kinda not sure abut a male midwife writing about that", but once you said that, it made a lot of sense to me. My secondary midwife at my daughter' birth has not yet had children and she was a fantastic birth professional!

  9. I say, all hail the chief!

    Interesting topic here. I have not read any of this stuff, seeing that my new life as a CNM has taken over and leaves little time for much else. But, frankly, I am glad. This would piss me off (the backlash at the article/male midwife) and the comments would surely infuriate me. Having not read the artice, but your assessment of it as well as the chatter about it makes me think what he is trying to say (scholarly) is that pain in labor is normal, physiologic, natural, and there for a reason. Women should not be so quick to disregard that. There needs to be a major swing in the direction of understanding that pain in labor is not bad and not to be feared. Perhaps if this shift could occur in the mass mind, then we wouldn't see so much reliance on medical technology and anesthesia for a normal physiologic process.

    And the bashing for him being male is no different, in my mind, than being a female midwife being judged on her birthing status (see: My Barren Uterus post).

  10. I read about this the other day on a blog I normally love, FREAKING OUT that a man dare tell them the pain was useful. Because, you know, he doesn't have a vagina. I kept thinking, neither does any male OB that pushes drugs like candy and yet we listen to them don't we? If we can get past the OMG A MAN! he's actually got a couple good points.

    But then, I guess as an owner of a vagina I can say that.

  11. Thank you for this! I have been watchign this kerfuffle unfold and not being quite sure what to make of it. I am dismayed at the bias against him because of his sex...wasn't there the same outrage over Odent when he said that (some) fathers shouldn't be in the delivery room? All of a sudden people forgot all his fantastic teachigns and beliefs and slapped him as some idiot MAN, how DARE he. Sigh.

    There is indeed a value in having birthed yourself, it gives you a perspective that nothing else can. But it certainly doesn't completely discredit you if you haven't done it.

  12. I wasn't going to read much about this, but was intrigued by the Feminist Philosophers link you gave. Thank You! I had a HUGE laugh reading the comments where the able minds there put Dr. Amy the troll in her place. Here were people who really weren't infused in birthy stuff seeing her for what she is and calling her out for her refusal to acknowledge facts and evidence.

  13. glad you enjoyed the post! it's criminal the was the press have covered walsh's publication; i sincerely hope they pick up on the talk that's gone on on the blogosphere and set things straight. (btw where'd you get the fab maple leaf real nappies?)

  14. I made the Canadian flag diapers myself. For a tutorial, search "canadian diaper tutorial" on my blog and it will come up.

  15. Thanks for this, Rixa. I've been mulling over your post all morning.

    Here's what I don't get... why do women tear down the man who thinks they're strong, that their bodies aren't broken, that they don't need the trappings of the highly-male medicalized world to birth their children? And instead women put their trust in the men who espouse the opposite philosophy??

    Shouldn't we, as women, cheer to find a male birth attendant who recognizes our innate strength and mother nature's wisdom?

    I know I'm cheering him!

  16. Goddess thank you for this post. I was so frustrated when I read the comments on one of the articles (Time?) the other day.

    Women need to take responsibility for their bodies which would include educating themselves about its processes.

    If we want rights, we got to take them!

  17. Great post.
    It's all very ironic, isn't it.

    One part you wrote rang a bell with me because I have had two scheduled c-sections but in this past year have become a doula and a huge advocate for natural childbirth. (mainly because of my anger at my c-section and wanting to help women avoid that). I think I am still a good birth attendent, even though I haven't been through labor. (I plan to someday and I think that will make me even better). But I don't often talk about my natural childbirth views with church friends who've all had epidurals because I feel like they might think "You haven't even experienced labor pain, don't talk to me about going natural".

  18. Hello all
    I have had the pleasure of hearing Denis Walsh speak, and have read a lot of his stuff. In that context, I can confirm that all of the positive speculation set out here re his views are spot on.
    His slides/references - fairly intelligible without a text - can be found at:

  19.'s SOO easy to discount someone;s experience OR lack of experience when it doesn;t jibe with your own opinion. working as a volunteer doula in a program that provided borth support to moms on MEdi-Cal at a local clinic, I ran into this a lot. there wer nurses and doctors at the hospital where these women birthed who thought "natural childbirth advocates are sadistic and crazy!" and I learned that there was no point to saying, :well, I DID have a baby without medication, so I might have some insight into this woman's situation!" when everything you have learned in school is about puching frugs in one form or another to make "undearable" pain ebarable, you tend to see anyone who suggests an alternative as either naive or delusional. not having had a baby (or not having the oportunity to do so, like this man who is a trained midwife) means he doesn;t know what he is talking abot, in that orientation, but having actually found alternatives to pain mdication while having a baby means that you are some kind of cukltist out to impress your views on the world.

    I oly occasionally visit Salon and have fond that much of their "Mothers WHo Think" stuff seems aimed at debunking natueal childborth. I'm not relly clear on why that is, nor is it new to me - I ws born in 1956, and my mother wrote a rather entertaining but biting magazine article called Nuts to Natural CHildborth that said pretty much what it;s current to say now - that women who didn;t want to be anesthetized were being silly and cultish. kind of ironic I wond up being a antral birth advocate by age 14...

  20. Great post. Denis Walsh is one of my midwifery heros - he writes a lot of good sense.

    But as well as being a gender thing, I wonder if it's also a professional bias. If a male doctor came out with similar comments, would he be as reviled as Denis?...or get even as much as a sentence attributed to him in the media?

    I love this whole debate...anything that gets us thinking has got to be good. really made me laugh, Pinky!! :)


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