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:

• Village Midwife of Australia remarks that labor IS a rite of passage
• Lisa Barrett, another Australian midwife, writes about Denis Walsh and Andrew Lavender at Homebirth: Midwifery Mutiny.
• Bellies and Babies writes about Pain in Labor
• MedGuru reports that It’s good for women to undergo labour pain: Professor Denis Walsh
• The Times says: Pain in Childbirth. Professor says endure it!
• 'Embrace the pain' of birth, mums told, reports Northern Territory News of Australia

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.