there is more emphasis on safety than on consent in the birth world, which is in part why i just dont interact with it much anymore.
i wrote this a couple of days ago to ash. and then i wanted to expand on it a bit…
consent is so primary in birth work.
online i read way too often of midwives touting safety as being the primary consideration in terms of how one treats another. even to the point of saying that mamas hire midwives to make sure that the birth is safe. this idea of safety is so ubiquitous that even the controversial ‘trust birth‘ movement says, birth is safe, interference is risky, as if the question on the table is, how do we have the safest birth possible? do we follow medical protocol, mainstream midwifery protocol, more ‘hands off’ protocol…which one is safer?
but i want to question, why is safety the goal? why do we first tout how safe a procedure, before we talk about whether the mama has given informed consent? and why when we talk about informed consent, we often boil down to whether or not the mama consented to this procedure, despite or because of the risk or safety of the said action? feel me?
what is safety? being alive? fitting into the normative ideas of healthy and average?
and how do we determine safety? through clinical studies? medical tradition? anecdotal evidence? expert opinion?
my problem with evidence midwifery is that for any position that a midwife advocates for there is an abundance of evidence upholding and illustrating her position. is circumcision safe or harmful? is pitocin dangerous or helpful? what foods are the best to eat during pregnancy? how much weight is proper to gain during pregnancy? etc.
all of these and more questions i have seen being debated with both sides having a stackful of decent studies and theories backing them.
and then the question turns to: what is the appropriate and proper criteria that we should use to determine which studies are stronger evidence?
all the while ignoring that the big studies, the double blind ones, the years-long ones are the ones that get government and major university funding and support. and so we are allowing the powers that be to decide what scientific claims have the most validity. at the heart of it, money, how much money a study receives, determines what is considered proper evidence based midwifery.
and i am too much an ancient cynic to trust the powers that be, the ones with the most privilege and the least amount of accountability, to determine what is best for me, my body and my child’s body.
and i love dr john stevenson’s take:
Thirdly, prospective randomised controlled trials are useless, as I shall show later. George Bernard Shaw (or was it Mark Twain?) was spot-on when he said “There are lies, there are damned lies, and there are statistics.” Statisticians can lecture plausibly, even convincingly, that they are aware of all the pitfalls in interpretation of research findings and know how to dredge up the facts infallibly, especially when applied to prospective randomised controlled trials which are regarded as the ultimate in fail-safe research. But what the statisticians are expert at is dredging up the ‘facts’ that the researcher wants to prove, (possibly more subconsciously than deliberately).
i guess it is because i think of safety/security as an illusion. there are no guarantees in life. and playing the statistics game (deciding ones protocol based on what has proven to be statistically safest or most effective) is a fools errand. because you can easily find yourself in a situation where you do all the right things and the outcome is horrible. and you can do all the wrong things and in the end everything turns out just how you wanted.
and if something is 99 percent effective, and you turn out to be that 1 percent, do you really care that 99 other people had difft outcomes? and what if you are the mama and you lose your babe, because you are the 1 percent? is your grief any less? probably not.
but yr grief probably is harder if you were told to go against your own motherwit, because the stats said xyz.
and if you did follow your intuition, and the outcome is not what you expected, then at least you can take responsibility for what happened. rather than blaming mw’s and obgyns etc, ppl who have little accountability to you, and will go on doing their jobs barely remembering you existed a couple of weeks or months later.
i dont know. i tell mamas, look, everything will not be perfect. but if you follow your own sense of what to do, then you are taking responsibility for your own life and choices. everybody has to be who they are.
and from what i have seen if you follow your own sense of what to do, then you will have more self-respect, self-love, self-empowerment. and the more that we value ourselves, the more we are able to value others around us, including/especially our children.