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    Midwife Rituals: Anti-Science Or Just Symbolism?
    By Hank Campbell | December 19th 2011 02:14 PM | 53 comments | Print | E-mail | Track Comments
    About Hank

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    A number of midwives believe modern births rely too heavily on medication and technological intervention and they instead have created 'birthing rituals' to send the message that women's bodies know best and that birth is about female empowerment.

    It's no surprise the Pacific Northwest, home of progressive anti-vaccine efforts, is also on the vanguard of this latest fad in anthropology. In Medical Anthropology Quarterly, Melissa Cheyney,  assistant professor of medical anthropology at Oregon State University, documented rituals used by midwives and conducted interviews with midwives and new mothers.

    Conclusion?  Cheyney believes that because midwife deliveries have fewer Cesarean sections, the rituals may be the reason - not surprisingly, she is a midwife herself. The hallmark of any great study is throwing out objectivity and being a participant. "This is about invoking the mind-body connection. We know, for instance, that midwives have better health outcomes in some areas, such as reduced rates of surgical delivery and labor induction, than hospitals. But I wanted to examine how ritual might play a part in producing these positive health outcomes."

    More likely; only the lowest risk births take a chance on home delivery.  Yes, hospitals perform too many c-sections but we can thank get-rich-quick experts like former Sen. John Edwards for making c-sections required at the first sign of trouble, lest the hospital face a lawsuit for not doing a c-section. The infant mortality rate since midwives were the only option is also drastically down so mothers who go that route still have access to advanced medical care.  If things are okay, the delivery ritual helped.  If they do not, it was just bad luck.

    That's not a knock on midwives; many of them are pretty good and midwives do most of the prenatal checks a doctor or nurse would; this is a knock on an anthropologist claiming magical 'woman-centered rituals' are safely delivering babies that would otherwise not be delivered safely in a hospital and require surgery. Do these rituals work, provided we don't read too much into them?  Sure.  Cheyney noted that mantras like  "don't fight it", "let your body do it", "open" and "let it be strong" were reported to make women feel more involved than they had been during hospital births, where supposedly they just laid there.  But 50 anecdotes are not evidence.

    Cheyney makes no secret of her advocacy; she states up front that she wants to endorse midwifery - something sure to make obstetricians happy. "Just as women and their doctors who deliver in the hospital often feel convinced that their birth was the only safe and 'correct' way, women and midwives who deliver at home feel strongly that they have the solution," Cheyney said. "They believe it with every cell in their body because they have lived it."

    Is that science?  After the Fukushima nuclear plant incident, people in the Pacific Northwest also claimed radiation from Japan was immediately killing babies in America and their anti-vaccine beliefs are startling.  Stephanie Messenger suffered through the death of a child; the child was vaccinated and therefore the vaccines caused the death, she believes.  So now we have Melanie's Marvellous Measles, a book for kids about "about the ineffectiveness of vaccinations, while teaching them to embrace childhood disease, heal if they get a disease, and build their immune systems naturally." She's from Australia but would fit right into Seattle. She could just have easily blamed rice milk.

    To an anti-vaccine anthropologist, finding 50 more people who had a vaccinated child die is also a study because they just have to have 'lived' it.   This article seems to be more advocacy piece than medicine, despite the name of the journal.   She calls standard medical practices used in hospitals 'rituals' as well, a way to create false equivalence for these female empowerment rituals and endorse symbolism in place of science - "intentionally manipulated rituals of technocratic subversion", as she describes it.

    For low-risk deliveries, a midwife obviously works fine. Seeking to increase the number of non-hospital deliveries as part of a cultural agenda against "fictions of medicalized birthing care" is dangerous.

    Citation: Melissa Cheyney, 'Reinscribing the Birthing Body: Homebirth as Ritual Performance', Medical Anthropology Quarterly Volume 25, Issue 4, pages 519–542, December 2011 DOI: 10.1111/j.1548-1387.2011.01183.x

    Comments

    Gerhard Adam
    For low-risk deliveries, a midwife obviously works fine.
    Let's also keep in mind that despite the risks involved, humans actually had babies and survived before there were midwives or even the concept of medicine.  For some reason there seems to be a mindset (among some people) that human births didn't occur before the 20th century except by random chance.


    Mundus vult decipi
    Stellare
    "humans actually had babies and survived before there were midwives or even the concept of medicine"

    Exactly!

    Giving birth is something women are made to do (note, they can also do other stuff, like cook and wash...and some occasional science, hehe). It is a natural thing. Like in nature in general we have mishaps. This is were we can get help from medicine.

    My grandmother had twins at home, premature birth as is usual with twins, and they were so small they fit (and were actually put) in one shoe box. Both twins grew up just fine, strong and healthy without any kind of hospital.

    Personally, I hate doctors and hospitals and I am sure I would have benefited from having a fully equipped 'hospital' at HOME where I could then relax more (I guess this is part of the ritual thingy) as I would not be so exposed to the annoying doctors. I preferred to benefit from modern medicine though and used pain killers (epidural). And I have to say, I didn't feel less of a woman.  As opposed to some arguments I hear, perhaps from midwifes Hank are referring to. I, just felt smart. he!

    Seriously, each woman has her own preference. Too much pressure/manipulation in either direction is not good. And definitely not scientific.
    Bente Lilja Bye is the author of Lilja - A bouquet of stories about the Earth
    Hank
    It's off topic here but I wonder that a lot of scientists distrust hospitals and doctors, perhaps even more than the general public does - though in polls scientists don't seem to admit it.  I think there is general belief that in America there is not a lot of evidence-based medicine in medicine, we rely on some nameless FDA to determine whether things are okay; and the Four Horsemen of the Alternative in America (Chopra, Oz, et al) are all M.D.s.  Many doctors also seem to recommend whatever is newest because newer must be better, which isn't a comfortable feeling.
    Stellare
    Well, doctors are humans too! They make mistakes and each and every one of us have to take responsibility for our own health. Doctors are just advisers in my opinion. Many doctors are not happy with having that role; some kind of like the idea of being God-like. hahaha

    Although medicine, doctors and hospitals DO save lives, they also kill. I know of several cases in Norway where a perfectly healthy person that for instance just got a burn from warm coffee catch some disease and die in the hospital. Hospitals are also dangerous places to be. :-)

    When you actually need medical attention you rely on family and friends watching over you so that you reduce the chances of being exposed to those dangers and rather benefit from the help they can provide. I suppose it is this more nuanced picture of reality that the more educated population are having...

    As for medical science and what doctors recommend, I think that depends on whether the doctor at hand have focus on healing her patient rather than anything else...If one has tried all existing methods, trying the latest experimental medicine as a last hope of healing. Again, my grandmother, she survived several of the first experimental heart surgeries. If it hadn't been for doctors doing heart surgery experiments on her, her life would have been several decades shorter! :-)

    I also find it interesting that the views on traditional Chinese medicine has changed here in the West. It is (at least parts of it) more accepted by newer Western medicine now than say just a couple of decades ago.

    Bente Lilja Bye is the author of Lilja - A bouquet of stories about the Earth
    "humans actually had babies and survived before there were midwives or even the concept of medicine"

    Safe human birth DIDN'T occur before the 20th Century.

    No one made the claim that EVERYONE died in childbirth prior to the advent of modern obstetrics, merely that massive numbers of women and children died in childbirth prior to the advent of modern obstetrics. That's because childbirth is inherently dangerous. In every time, place and culture it has been a leading cause of death of young women and the leading cause of death in the 18 years of childhood.

    The "natural" rate of neonatal mortality is approximately 7%. With modern obstetrics, it is now 90% lower. The "natural" rate of maternal mortality was approximately 1%. It is now more than 99.9% lower.

    In fact, as Atul Gawande has pointed out, no area of medicine has saved a greater proportion of lives than obstetrics.

    Gerhard Adam
    So, why is the U.S. ranked so low?

    In any case, the point of that statement was just to indicate that regardless of the risks, it is obvious that humans gave birth and survived, therefore regardless of who is in attendance, there is some percentage of women that would survive and have a successful childbirth.
    Mundus vult decipi
    Hank
    Low in what?  America doesn't abort at the first sign of prenatal trouble, like hyped-up medical institutions like the supposedly awesome Cuba do, doctors here are out to save as many lives as possible, so our infant mortality rate looks worse because our abortion rate is lower.
    Homebirth advocates like to claim that the US ranks low in infant mortality. What they neglect to mention is that infant mortality (death from birth to one year) is a measure of pediatric care, NOT obstetric care.

    According to the World Health Organization, the best measure of obstetric care is perinatal mortality. According to the WHO, the US has one of the LOWEST perinatal mortality rates in the world.

    Moreover, African descent (independent of economic status) is a risk factor for both perinatal and maternal mortality. The countries that do better than the US in perinatal and maternal mortality are all considerably "whiter."

    One of the most distressing things about homebirth advocacy is how much of what passes for "knowledge" among advocates in not true or is deliberately misleading, such as deliberately quoting the wrong mortality statistic and failing to mention that the countries that rank higher than the US in perinatal and maternal mortality have a lower risk population.

    mhlongmeyer
    We (meaning my wife and me) (meaning, mostly my wife) researched this quite a bit before having our first child.  The way to minimize risk is to give birth at a hospital, but politely refuse the epidural and/or induction drugs (i.e., pitocin, cervix "ripeners").  

    Because they interfere with what the laboring woman's body is trying to do, the epidural and induction drugs dramatically increase her odds of getting a C-section.  In turn, the C-section adds a layer of surgical risks that she would not have faced otherwise.  About 80% of women can make it through labor without an epidural after preparing with simple targeted exercise and relaxation techniques--no midwife-specific rituals required. 

    Of course, if you are trying to go without the labor drugs and a genuine medical problem occurs, well, there you are at the hospital.  The surgical risks of a C-section are nothing compared to a transverse lie.
    This is a pretty nasty hatchet piece by someone who appears to have done no research before writing.

    In response to "This is about invoking the mind-body connection. We know, for instance, that midwives have better health outcomes in some areas, such as reduced rates of surgical delivery and labor induction, than hospitals. But I wanted to examine how ritual might play a part in producing these positive health outcomes," Mr. Campbell says, "More likely; only the lowest risk births take a chance on home delivery." Nope, try again. The research doesn't support that statement at all and even a cursory examination of studies of midwife-assisted home births would have shown that (here's one just for starters ). So Mr. Campbell is countering research with his opinion. Is that science?

    The bizarre paragraphs on people fearing nuclear radiation and anti-vaccine activists seems thrown in there just to get the reader going. As far as I can tell, there's absolutely no connection between the folks with nuclear paranoia, the anti-vaccine folks and the anthropologist Mr. Campbell is targeting.

    Is the language in the study in question a little womens' studies/anthropology-ish? Well yeah, it was an article in an anthropology journal. If a medical article called the "rituals" something else, deep relaxation, or self hypnosis, perhaps, maybe Mr. Campell would be more comfortable? The facts are that the mind-body connection matters, the midwifery model of care does a better job addressing this than the conventional medical model of care, and that the midwifery model of care gets better results (even when adjusted for risk level).

    Gerhard Adam
    If a medical article called the "rituals" something else, deep relaxation, or self hypnosis, perhaps, maybe Mr. Campell would be more comfortable?
    I doubt it, and unfortunately if those terms sound sufficiently "scientific" to you, then there's more to be concerned about than a simplistic view of "rituals".
    Mundus vult decipi
    All you have to do to see the connection between the anti-vaxxers, the homebirthers, and the nuclear radiation paranoia is spend about five seconds on mothering.com.

    Also, it is absolutely not the case that the midwifery model Ms. Cheyney is writing about gets better results. Poorly trained homebirth midwives (CPMs) have horrific mortality numbers. The research DOES NOT support that homebirth midwives in the United States is safe, and all the research that has been done (in Canada, the Netherlands, and the UK) used very stringent criteria in choosing the subjects in their homebirth categories -- the lowest of the low risk! CNMs attending low-risk women at home do have good outcomes, but hardly better than those in the hospital. Finding that they have lower rates of epidural use, surgical delivery, and labor induction is worthless unless you can show that epidural use, surgical delivery, and labor induction are harming women.

    Many people are unaware that there are two types of midwives in the US, certified nurse midwives (CNMs) who are comparable to the midwives of Europe, Canada and Australia, and certified professional midwives (CPMs) like Melissa Cheyney) who exist in no other first world country.

    In contrast to CNMs who have college and masters degrees and extensive in hospital experience, and European, Canadian and Australian midwives who have college degrees and extensive in hospital experience, CPMs are high school graduates who have completed an certificate training program.

    CPMs do not do not meet the education and training standards of midwives in the Netherlands, Great Britain, Canada or Australia, or anywhere else. Indeed, American homebirth midwives (CPMs) do meet the standards for licensing in ANY industrialized country in the world. Simply put, they are "birth junkies" who couldn't be bothered to get a real midwifery degree.

    Not surprisingly, they are devotees of pseudoscience including the ridiculous self serving "rituals" Cheyney describes in her latest paper. One aspect of birth --- safety --- is almost entirely absent from her discussion. Homebirth is not about birth and it is not about babies, so safety is irrelevant. It's all about counter hegemonic empowering values! Actually, what it is really about is self-proclaimed midwives making themselves stars of the ritual "performance."

    It would be amusing except for the fact that Melissa Cheyney is the head of the Board of Direct Entry Midwifery in Oregon and therefore responsible for regulating homebirth midwives. This paper is Exhibit A in why she is unqualified for that job. For her, homebirth is all about three things: the midwife, the midwife's beliefs and the midwife's "performance." Birth, babies and safety have little or nothing to with homebirth, and science has nothing to do with it at all.

    Hank
    It's certainly good to hear from someone whose interest is babies and not empowerment or ritual.  And your site has this Onion piece I knew nothing about - bonus!   Upon Reflection, I May Have Exaggerated My Skills In Midwifery
    "Homebirth is not about birth and it is not about babies, so safety is irrelevant."

    I can't imagine the level of arrogance it would take to express a personal bias with wording that implies that it's objective fact. Unless you're God, I'm assuming that you can't see into the hearts and minds of the women who wish to give birth outside of an institutionalized setting that is full of its own myths, ritualistic traditions, and pseudo-science. To use such an accusation to further your agenda, to appeal to emotion with a dirty falsehood, is disgusting and it certainly has nothing to do with reason. I don't know what your particular brand of crazy is, but it really scares me that there are people like you in the world.

    Hank
     I don't know what your particular brand of crazy is, but it really scares me that there are people like you in the world.
    Well, you think sane is people who believe chanting and voodoo results in healthy babies. So whatever the opposite of that is, we all want to be it.
    Gerhard Adam
    ...that is full of its own myths, ritualistic traditions, and pseudo-science.
    Oh, do tell.  I'm waiting to see your illustrious set of examples to back up such a claim.


    Mundus vult decipi
    There seems to be a lack of understanding of what Cheyney's paper was even about. This is an anthropological piece, an attempt to describe the context of midwifery care and birth outside of the hospital setting and the ways in which it differs from the medical model (which it clearly does in many ways). It's not an article about the qualifications of midwives or the safety of home birth, nor does it profess to be. It's "medical anthropology", folks. And who better to write about homebirth and midwifery care than someone who has actually observed it. Most OBs and anthropologists have never seen a homebirth, yet feel free to critique it as if they know what they're talking about.

    Hank
    There seems to be a lack of understanding of what Cheyney's paper was even about. This is an anthropological piece, an attempt to describe the context of midwifery care and birth outside of the hospital setting and the ways in which it differs from the medical model (which it clearly does in many ways). 
    There is increasing recognition that anthropology is no longer science, I agree. As I said, this was an advocacy piece masquerading as an attempt to science-y up an agenda.  It had little to do with science or medicine and simply conveniently mapped some data (interviewing midwives and mothers who like midwives) to that cultural topology.
    Not only do these comments reflect little familiarity with the article in question, Hank Campbell imposes an interpretation on it that is not consistent with the intentions or conclusions of the author, Melissa Cheyney. Cheyney notes, at the end of her article, for example, that home births do “go awry”, and she acknowledges that one of the limitations of her article is that it does not take up this side of the dichotomy of ‘nature’ versus technology. With regard to sampling bias, Cheyney herself writes “a major limitation of this study is the voluntary nature of sampling, which increased the likelihood that women who had successfully completed home-births would seek out participation” (page 537). Did Campbell miss that part?

    Cheyney’s perspective seems valid: people who elect home birth construct it around a ritual model. Cheyney teases out how that is, and what it means, and why. I saw nothing in her article that advocated any form of childbirth at all. If I write that “the Nacirema” believe that babies are delivered by storks” would Hank Campbell complain that I am anti-science?

    Hank
    I have no issue with symbolism.  Symbolism clearly has value - without symbolism, for example, there would be no voodoo and we would be without some terrific movies. My argument is that this attempts to be science and makes silly claims about how not using a doctor is female empowerment. Those kooky sentences are in quotes because she states them.
    Cheyney's article attempts to be observation and analysis -- not a how-to on childbirth. When she writes about what her informants believe -- including claims about female empowerment -- she is simply reporting and analyzing what her informants believe. They may be "silly" and "kooky" beliefs, but to confuse Cheyney's analysis of them with advocacy is itself silly and kooky.

    Much anthropology of this sort simply does not presume or claim to be "science" and criticizing it for not being something that it does not purport to be is surely unfair. Anthropologists have often been drawn to the bizarre and exotic, but describing, analyzing and interpreting the bizarre and exotic is perfectly legitimate and interesting -- and I often think that the odd critics who insist that it is or must be something else and then then reject it for not being exactly what they want are equally bizarre and deserving of analysis and interpretation...

    Hank
    They may be "silly" and "kooky" beliefs, but to confuse Cheyney's analysis of them with advocacy is itself silly and kooky.
    Endorsing, rationalizing and justifying personal beliefs actually is part of the definition of advocacy. Unless she is a paid lobbyist for Big Midwifery, then maybe those are not her personal beliefs wrapped in a cocoon of pseudoscience. You can't use interviews of people you want to endorse as proof that these 'rituals' they use led to better deliveries of babies than a doctor would have and call it anything but advocacy.
    OK, now I understand. We apparently read different articles. Cheyney's MAQ article -- I just went through it again -- doesn't "endorse" anything and doesn't claim to prove anything. She is trying to understand why people make one set of choices about childbirth, and I saw no endorsement of anything. Rather, her article reminds me of work done on that fascinating variety of issues that I'll group together as "why otherwise intelligent people do such odd things, don't follow their doctors' orders, reject climate science, go to Sedona for spiritual health, etc, etc" For Cheyney's informants, apparently, the benefits of psychological satisfactions such as "empowerment" exceed the risks of childbirth, and I would imagine that obstetricians would actually want to understand how and why their patients are making such choices; there's a whole sub-field that studies compliance (and compliance failures) in medicine, and it's full of interesting examples such as Cheyney's. Again, as I read Cheyney's article, she is not claiming to be doing science -- so please stop criticizing her for not doing science -- and she is not advocating any form of childbirth. She is trying to understand how and why people who make one kind of choice do so, and that question is interesting because it is already acknowledged that it is a problematic choice.

    Actually, she effectively IS a paid lobbyist for Big Midwifery, as director of "research" for MANA, as well as the chair of the Oregon Board of Direct Entry Midwifery, which is in and of itself a huge conflict of interest.

    >The hallmark of any great study is throwing out objectivity and being a participant

    LOL. That is the same recipe that elected this stinking pile of failure, Ovomit!

    Bravo! GREAT article. The only addition I'd make is to this:

    "... many (midwives) are pretty good and midwives do most of the prenatal checks a doctor or nurse would;"

    Let's see some statistics before we surmise that many midwives are pretty good. MANA might help us with that ... someday. And yeah, CPMs do the checks if you want them, but also readily dismiss them as unnecessary. At least my certified professional midwives did.

    I'm so thrilled Cheyney's spending her time pushing the agenda that encouraged certified professional midwives to ignore (and keep secret from me) the warning sign that would have risked me out of OOH birth, and to perform operations they didn't know how to do on me, resulting in the pelvic reconstruction surgery and hysterectomy I had several weeks ago. That's MUCH more important than, oh, say, making sure justice is done (not holding my breath on this one) in my ongoing (endless) Oregon Health Licensing Agency investigation.

    If she didn't keep busy educating the public with articles like these, the chair of the Oregon Board of Direct Entry Midwifery might actually have to look at the mess that is midwifery in Oregon and, oh, I don't know ... do something about it.

    Campbell seems to fail to understand certain things about anthropology, like the fact that participant-observation is a dominant method of anthropological research. He also calls her analysis of her research "advocacy" when she says "Just as women and their doctors who deliver in the hospital often feel convinced that their birth was the only safe and 'correct' way, women and midwives who deliver at home feel strongly that they have the solution." This is her analysis statement, not a bashing of obstetricians. Additionally, calling aspects of biomedical care "rituals" is not meant to "create false equivalence for female empowerment rituals," as Cambell states, it is a true anthropological concept and theoretical analysis method which has been studied extensively, not simply made up for Cheyney's convenience.

    It is a true concept that the female reproductive body has become medicalized in all aspects - menstruation, pregnancy, birth, breastfeeding, menopause, and so forth. The concept that American medicine has of the birthing body is encompassed in the culture of biomedicine and the beliefs of our society. We like to think that it is objective, evidence-based, and the One Truth, but in fact it is only one reality. Robbie Davis-Floyd explored how medicine, obstetrics, and birth in the U.S. is a ritual; a socially constructed rite of passage. If Campbell had read the article carefully, he would have noted that the reason that Cheyney used ritualization as a lens through which to explore homebirth is because it has been a useful tool for reproductive anthropologists in the past. (Rites of passage and rituals have been studied extensively in other areas of anthropology as well). Davis-Floyd showed that birth is "a reflection of a larger patriarchal and technocratic society." Davis-Floyd examined the rituals associated with hospital birth, and Cheyney examined the rituals associated with home birth midwifery. Both are valid anthropological research and theory.

    So while, yes, home birth is party about a rejection of the dominant biomedical tenants about birth and certain types of authoritative knowledge, it is also about embracing a different point of view regarding the way both is or should be. Biomedicine is only one example of the way birth is or can be. Differing views are not wrong, they are just different, and exploring them for a deeper understanding is what medical anthropologists do best.

    The point of this article is not to add to the "which is better, home birth or hospital" debate. The purpose is to explore the rituals involved in home birth midwifery and what they mean. Cheyney believes that what she calls rituals in home birth are intentionally subverting technocracy, and are meant to "reinscribe pregnant bodies and reterritorialize childbirth spaces and authorities." What this means is that home birth midwives are doing the things they do and saying what they say in order to purposefully go against the hegemony of biomedicine and all it says about bodies and where birth should take place and with whom. She says that midwives are, like obstetricians, taking advantage of this liminality of birth to create a certain meaning of childbirth (in the midwives' case, that nature is sufficient; in the physicians', that technology is supreme).

    I've written more on my response to the article here: http://anthrodoula.blogspot.com/2011/12/comment-turned-post-medical.html

    Hank
    Hi Emily,

    Nice post.   But you wrote "Unfortunately, the comments on the Science 2.0 article do not tend to focus on the fact that Campbell's understanding of anthropology is flawed and his analysis of Cheyney's piece is incorrect."

    Well, that is because neither is true.  Only the surest partisan in anthropology or medicine would regard Cheyney's piece as even remotely scientific or contend I somehow did not understand it.  Rationalizing as you did earlier in your piece that surveys of advocates is common practice in anthropology does not make anthropology more scientific, it makes it consumer research, the same way surveying people who buy Brand X detergent tells us little about why people wash clothes.
    Considering this conversation seems to be both a debate about the question of what is 'science' and to what degree anthropological research should be categorized within the Campbell and Tuetur's homogeneous notion of the concept, perhaps the discourse could be shifted back to what you are both really talking about. Which, in my view, generally prescribes the extension of biomedical discursive power through the legitimization and unquestioning deployment of "science" to manage female bodies and health care spaces. Since this article seems to include very little actual background research regarding anthropology and/or the research methodologies it deploys, perhaps its worth considering that methodologically, medical anthropological research engages with both systems and structures at the level where they shape the lives of individuals, comprehensively examining the process and influences that sculpt a patients reality. Yes, that involves interviews, participant observation and focus groups. Yes, that means asking individuals questions directly related to the topic of study to articulate their experience. And, in the same vein, it can involve the collection of quantitative data, all of which contributes to a dynamic understanding of a social issue. So, I suppose if your definition of science is a reductionist measurement of medical experiences that completely ignores patients and their relationship to that system, ok. Or, if your critique of anthropological research is that it isn't science because it deploys methodologies that engage with the multifaceted experience of the body, particularly the reproductive body, fine. However, perhaps you might consider utilizing at least one useful methodology before you continue on with this writing venture--the literature review. This actually requires you to both read and understand an issue fully before commenting on it in a public blog.
    So--give it a try. You'll be amazed at how much more informed you will become about an issue. Then you can try writing about it.

    Gerhard Adam
    Wow ...
    Which, in my view, generally prescribes the extension of biomedical discursive power through the legitimization and unquestioning deployment of "science" to manage female bodies and health care spaces.
    I'm impressed.  What exactly is that supposed to mean? 

    Well, when I see a phrase like "unquestioning deployment of 'science'" ... I can see an agenda on the horizon.  Usually allegations of dogma are the first arguments advanced by those with little or no evidence.
    Mundus vult decipi
    Hank
    This actually requires you to both read and understand an issue fully before commenting on it in a public blog.
    Is it necessary, in your postmodernist view of science, that I became a midwife or an anthropologist to determine whether or not that using midwives as "intentionally manipulated rituals of technocratic subversion" is made up nonsense?  Because any gas station attendant could figure it out.
    Cheyney is not the only anthropologist of birth. There are others whose work is not colored by the need to justify the beliefs of the natural childbirth/homebirth subcultures. Consider the chapter The Dialectics of Disruption: Paradoxes of Nature and Professionalism in Contemporary American Childbearing by Caroline Bledsoe and Rachel Scherrer. It appears in the book Reproductive Disruptions: Gender, Technology, and Biopolitics in the New Millennium.

    Unlike Cheyney, who so eagerly accepts the meanings and meaning-making of contemporary NCB/homebirth advocates, Bledsoe and Scherrer examine why meaning-making is so important within the subculture.

    Homebirth midwives (such as CPMs like Cheyney) are obsessed with "disruptions" of the natural process of birth, because they lack a basic understanding of the purpose of and need for these "disruptions":

    "Whether we look at birth through an African cultural vision, our own historical impetus for the rise of obstetrics as a medical specialty, or even through the lenses of international metrics, what emerges is a vision of birth as an event of potentially mortal consequence. The conviction among middle-class US women that birth is an event to be experienced to the full, freed from any external attempts to regulate or disrupt it, inverts this image. As we turn to the disruptions that preoccupy US middle-class women as they contemplate the birth of a child, it is vital to keep in mind both the dangers that reproduction can entail and the science that has allowed us to imagine as common sense a safe, uninterrupted. reproductive life trajectory." (my emphasis)

    Simply put, the understanding of what is natural, and therefore the understanding of what is disruptive to the natural process is based on a false premise.

    "American women's assumptions of a healthy, surviving mother and child make the possibility of apprehending birth as a pathological event a challenging stretch. The popular sources now overwhelmingly depict birth as a peak life experience of physicality for women, bringing a sense of achievement at fulfilling a natural act, so much so that the baby seems to play a secondary role. The failure to achieve all the elements of this experience is viewed as personal failure..."

    In fact, homebirth midwives know so little about childbirth that they actually believe that efforts to prevent "disruptions" are what makes childbirth safe.

    " ... In the US, where the default assumption of pregnancy and birth is normality, a natural lifestyle during pregnancy and an intervention-free, natural birth are often described as the cause of a normal outcome: healthy mother and baby."

    Since the safety of childbirth is assumed, NCB and homebirth advocates turn their attention to "disruptions" that they believe can lead to the two most feared outcomes.

    1. The "suppressed birth experience"

    "While birth is seen as a natural process that should transpire at a pace and in a manner set by a birthing woman ... birth is removed to the hospital, where ... birth becomes subjected to ... systematic management... [W]hat [NCB and homebirth advocates] most fear is losing control over the birth event and with it, the chance of achieving what they see as a natural birth... In this context, then, disruptions refer less to unpredictable events that can spell health risk ... than to the disruptions that the loss of control to medical authority may spawn."

    2. The failure to bond with the baby

    "Bonding has a deep emotional pull in the contemporary US... [Homebirth and NCB advocates believe that] [t]he faster the mother and baby ... can establish dose contact-the mother receiving the infant immediately after birth, wet and crying, umbilical cord attached, placing it on her chest and beginning to breast feed-the better the chances of selling the child securely on a healthy emotional course in life ... [T]he loss of the smallest window of bonding opportunity after the birth may set the stage for future pathology for both the infant and the new family unit."

    Unbeknown to homebirth midwives, it is the "disruptions" that have allowed homebirth midwives the luxury of pretending that facilitating experience of childbirth and "meaning making" about childbirth are the most important services that can and should be offered.

    " ... the explicit goal of childbearing in the US in the past was health normality. and in much of the developing world it remains the same. Today in the US, as long as health normality remains the predicted outcome, the goal shifts to the experience itself of childbirth, and the interventions that can save lives are [barely mentioned] in pursuit of the goal of naturalism and the control that is seen as the key to achieving it."

    One of the most remarkable things about Melissa Cheyney's paper Reinscribing the Birthing Body: Homebirth as Ritual Performance is the virtual absence of any discussion on safety, either of homebirth or of birth itself. The paper has 156 mentions of midwives/midwifery/providers, but only 13 of safe/safety. Safety is assumed to be a given. It is precisely this assumption, belied by everything we know about childbirth in nature, that is the fatal error at the heart of homebirth midwifery. Fatal because it renders the entire philosophy incoherent and nonsensical and fatal to the babies whose mothers have been misled by an incoherent and nonsensical philosophy.

    One of the problems that anthropologists often create emerges from a naive take at face value approach to the people we work with, observe, and interview. The midwifery paper reviewed above seems to stray into this problematic realm.

    As an anthropologist I need to recognize the limitations and the advantages of my method. But, I also need to be clear about my method. Who am I speaking with and observing? How have I come to select these people. If I've worked with 50 individuals who are engaged in home-birthing - that doesn't mean I have 50 anecdotes. Campbell seems to make that misunderstanding of anthropological methods. However, the author of the paper that Campbell is critiquing does seem to fall prey to the other side of the problem, assuming that her observations and interviews can 'prove' that there is some sort of advantage to the 'rituals' of midwifery. The medical anthropologist thus appears to misunderstand the limits to her methods and analytic frame.

    Anthropology tells us a lot. At first blush, we can learn about the meanings and values that groups of people hold and we can do so in highly nuanced ways. It can also provide understandings of the ways in which ours and other societies are organized at levels that sometimes contradict what our immediate reserach participants might say. Anthropology (especially cultural/medical anthropology), however can't 'prove' which method of childbirth or what medicine etc works best. That's not something that an anthropological method is set up to do. For that we need a form of science best practiced by healthcare professionals. Anthropology can lead the way to making changes in what healthcare reserach focuses on but it shouldn't be seen as a method that can resolve debates over these same issues.

    Hank
    Hi Charles,

    Well put.  It's a common technique for someone in pseudoscience to try and attach themselves to a more legitimate field and this paper is an example - I have no issue with anthropology, though some participants have edged into advocacy-based work in recent years (as have a lot of the social sciences and a few of the earth ones), there is an anthropology section here on Science 2.0 so we clearly respect it.  This work diminishes the field, though, especially if people doing serious work don't call it out and instead defend it because it claims to be anthropology.
    Hey Hank! I appreciate your engagement with the discipline of cultural anthropology. Your interest in the “scientific” claims that social scientists make is heartening and opens the lines for a great dialogue about the unique methodologies and perspectives that cultural anthropologists utilize to gain a greater understanding of the human experience. As a doctoral student in anthropology, I often grapple with these issues as well. While I wish your tone had been less condescending, your concerns are not new, and I worry that anthropology as a discipline has failed to educate the public about the scope of our research and methods.

    Your first gripe with Dr. Cheyney’s article appears to be a suspicion regarding the use of the emic perspective—where an insider engages an issue within her/his own community. It has become a truism in science that the only persons qualified to “objectively” evaluate a phenomena are those that remain on the outside of some ephemeral boundary that exists around an experience—keeping the objects of our study separate from ourselves, leaving ourselves without bias and our participants unchanged by our study or analysis. Yet, anthropologists as a discipline [yes, it was the post-modernists!] began to understand that this boundary was merely a construct and that its arbitrary construction and subsequent division between researcher and researched merely served to reinforce and obscure power dynamics. First, in denying that even as an outsider we remain biased in our situated knowledges, we are at risk of marginalizing already marginalized populations with our inherent bias as the “other,” gazing with the power that the role of researcher affords us. Second, in assuming an absolute objectivity that anthropologists acknowledge to be a fiction, we deny that our own lens inevitably affects our research. This does not absolve us of attempts at objectivity, but it does allow us permission to engage research questions that we admit to having a personal stake in. If anthropologists “are necessarily and partly positioned in the phenomenon [we] seek to understand,” this can be seen as a benefit, especially when working with difficult to access populations, such as direct-entry midwives (Rapp 1999:14). I feel that what would be “anti-science” would be to pretend an objectivity exists where there is none. There are not many researchers who do not promote an agenda, whether it is anti-vaccine, pro-vaccine, anti-homebirth or pro-homebirth. It is denying that this bias exists that undermines a methodology.

    So, maybe your problem is qualitative methodology in general? What you derisively call “anecdotes” are in fact a well-established methodology where the researcher seeks “depth more than breadth”, attempting to gain a holistic understanding of a phenomena, allowing the themes to emerge organically over the course of many time-intensive interviews and hours of participant observations (FHI 2002:57). As previously mentioned, you are not the first to call this methodology soft or unscientific, but the goal of qualitative research is different from the goals of quantitative research. By engaging research subjects through their “anecdotes,” ”researchers may examine the “how the person copes with society rather than how society copes with streams of individuals” (Mandelbaum 1973: 177). Rather than filling out a survey that assumes a quantifiable aspect of each phenomenon in which a p-value can inform us of the “importance” of a person’s experience, qualitative research can allow us to understand the experiences of individuals as they are defining it, which is precisely what Cheyney was attempting to do here. She was asking, what are the experiences of these women? She found that these experiences are experiences of power. Why are they experiences of power? She proposes that this is due to the ritual.

    Maybe your issue is a combination of both qualitative methodologies using an emic perspective? You feel that allowing the themes to emerge organically will inevitably be influenced by her insider perspective as a midwife? They probably are. Yet, would the conclusions she came to be more valid if she was not a midwife but a homebirth supporter? What about if she was a physician who opposed homebirths? What if she was someone who had never heard of homebirth until she met these women and then decided to interview them? Then, she interviewed them and decided she still had absolutely no opinion of them whatsoever? Have you ever met a researcher who was engaging human subjects and didn’t either have some personal interest in the subjects or at the very least was impacted by these interactions? As anthropologists, qualitative methods engender subjectivity because we are inevitably personally interested in or affected by our research. Rather than discussing this as a weakness, we attempt to inform the reader of our subjectivities and our intentions. Then, we use rigorous methodology to answer our research question without ever pretending that we are somehow, magically not people every time we put our researcher hat on. I understand that this methodology would be shit when trying to analyze canine fossils from 30 kya or when examining guppies preference for companionship (since you refer to the other articles on this site), but the question must determine the methodology. Our questions, as cultural anthropologists are very different from the questions you seem to think Cheyney is asking. If she was trying to quantify cortisol levels associated with home v. hospital births, her methodology would have been very different. Instead, she was asking about experience and how experience affects birth outcomes. Thus, her methodology must speak to the intricacies of experience, something other methodologies are ill equipped to examine.

    I do not feel that this article or any other theory-based article in cultural anthropology is attempting to define a discrete experience within the span of one article. This article provides researchers with another piece of the birth puzzle. If the biomedicalization of birth has become the accepted method of birth and the majority of the public accepts this ideology as inevitable, then what is occurring in this subculture that has traditionally been viewed as radical and dangerous? Do they deserve a voice, a perspective, a picture of themselves in the imagination of the public? I think they do. Cheyney’s piece offers us that picture, and I am more informed and challenged for seeing this picture.

    Halliday

    So, Susanna, are you telling us that sociology is not to be taken as a science?

    I can live with that.  After all, the "-ology" suffix means a "study", of some sort, and need not be any form of scientific "study".  There's no shame in admitting that one's discipline is not a science.  I believe the world would be well served if more non-scientific disciplines would admit to being such, rather than trying to cloak themselves with the "mantel of respectability" that is afforded the label of "science".

    David

    Well, Cheyney is an anthropologist, but no, that's not what I'm saying. This debate is pretty intense even within our own field. Not to air our own dirty laundry, but here is a link to a number of article from our professional meetings this year, which had a session discussing this very question:

    (http://blogs.plos.org/neuroanthropology/2011/11/22/the-montreal-anthropo...

    Since the people at the meeting discussing this are far more intelligent than I am and since they could not come to a conclusion, I will only weigh in briefly. First, I must specify that I am discussing qualitative research here--a tool used by different social scientists. I am not discussing biological anthropology or other aspects of the discipline of anthropology that are absolutely rooted in the "hard" sciences (though many anthropologists hate that term because it implies the science I am discussing is "soft").

    How are we defining science? I feel there are some ways in which we absolutely meet the criteria. For example, we use the scientific method--we ask a question, perform background investigation, make a hypothesis, design and implement a research design that speaks to our hypothesis, analyze results and publish.

    But, there are also some criteria that are more problematic to meet due to the precarious work of dealing with human subjects. For example, testing reliability when working with qualitative data is not always straightforward.

    I suppose, personally, I never call myself a "scientist." I call myself a social scientist, and I assume inherent in that statement is the understanding that I use a rigorous and well-respected methodology, that is akin to the "science" you think affords your hard sciences the "mantel of respectability." Thus, I do take umbrage at you thinking that recognizing differences between the two means that I am acknowledging that the way you are defining science is respectable and the way I am defining science is not. We're asking different questions, so why would we use the same techniques to answer these questions?

    Hank
    Sure, the fact that there was a "Science in Anthropology" shows that some recognize that it isn't science (and doesn't need to be); but Cheyney is attempting to make evidence-based claims using a subjective social approach, which doesn't really work.

    It's unclear why so many in these social fields want to lay claim to being science but not actually be bound by the rules of what science does.  The fact that so many feel there is some subjective, personal definition of science is telling.
    Halliday

    Thank you, Susanna, for responding.

    I don't know why I said "sociology", since it is a subset of anthropology that we are discussing.  :/

    I found your linked article on "The Science Controversy" quite interesting.  However, as far as I can tell, the question was less about whether Anthropology, as a whole, is or is not a science, but appeared to revolve more around the inclusion or marginalization of scientific approaches to Anthropology within the whole (at least within the American Anthropological Association [AAA]).  In fact, it looks like the association acknowledges that certain parts of Anthropology are more "science-y" than others.

    About a decade and a half ago, I had long debates with others on "what should and should not be considered to be a science".  Of course, I did not truly recognize that philosophers of science have been debating this question for centuries, without much resolution.  :/

    One long debate was with an individual who contended that unless one accomplishes their investigations by way of "controlled experiments", one cannot be doing science.  Of course, this would exclude Astronomy, Cosmology, Paleontology, and most any other discipline that investigates the past.*

    On the other hand, it has always been my contention that a discipline can be a science so long as one faithfully adheres to "the scientific method".

    Little did I know that the definition of "the scientific method" is so nebulous, and that some (like your post, above) "define" "the scientific method" in such a way as to be applicable to practically any "method of investigation".  :/

    In fact, when I read Richard P. Feynman's 1974 Caltech commencement address entitled "Cargo Cult Science" I came to recognize that one can "follow all the apparent precepts and forms of scientific investigation, but [still be] missing something essential":  "[T]he planes don't land", as he puts it.

    In fact, he even gives examples where one is (supposedly) doing "controlled experiments", while actually only doing "Cargo Cult Science".

    Now, lest one think that he, or I, hold the "hard" sciences as pristine, he even warns that his "beloved" physics can slip into being "Cargo Cult Science", if we don't watch out.

    So, like I said, I believe it is far better for non-scientific disciplines (or sub-disciplines) to simply admit that their methods, and/or the "objects" of their investigations are not conducive to "scientific methods and approaches".

    After all, if we don't hold all disciplines (or sub-disciplines) that claim the "science" monicker to the required level—so they are not "missing something essential"—then all of "science" will suffer from a degradation of any supposed "mantel of respectability".

    David

    *  Warning:  I am not saying that Astronomy and/or Cosmology only investigate "the past".  The last phrase is to include "most any other discipline that investigates the past."

    Bonny Bonobo alias Brat
    David, I don't think that Susanna is telling us that sociology is not to be taken as a science, she is saying that in some sciences such as sociology and anthropology the sociologists/anthropologists should be capable of admitting that total objectivity is not their primary objective or even possible, however the additional knowledge contained in the sociological/anthropological study can still be extracted and analysed in a scientific manner. I wish that more 'scientists' could see how lacking in objectivity they have also often become in many fields of 'scientific study', the Large Hadron Collider Higg's boson experiment and Gran Sasso's superluminal neutrinos and even the possible varying laws of physics and constants throughout the universe obviously spring to mind. I think Susanna worded this problem very beautifully when she said:-
    What would be “anti-science” would be to pretend an objectivity exists where there is none. There are not many researchers who do not promote an agenda, whether it is anti-vaccine, pro-vaccine, anti-homebirth or pro-homebirth. 
    It is denying that this bias exists that undermines a methodology. It has become a truism in science that the only persons qualified to “objectively” evaluate a phenomena are those that remain on the outside of some ephemeral boundary that exists around an experience—keeping the objects of our study separate from ourselves, leaving ourselves without bias and our participants unchanged by our study or analysis. 
    Yet, anthropologists as a discipline [yes, it was the post-modernists!] began to understand that this boundary was merely a construct and that its arbitrary construction and subsequent division between researcher and researched merely served to reinforce and obscure power dynamics. First, in denying that even as an outsider we remain biased in our situated knowledges, we are at risk of marginalizing already marginalized populations with our inherent bias as the “other,” gazing with the power that the role of researcher affords us. Second, in assuming an absolute objectivity that anthropologists acknowledge to be a fiction, we deny that our own lens inevitably affects our research. This does not absolve us of attempts at objectivity, but it does allow us permission to engage research questions that we admit to having a personal stake in.
    My latest forum article 'Australian Researchers Discover Potential Blue Green Algae Cause & Treatment of Motor Neuron Disease (MND)&(ALS)' Parkinsons's and Alzheimer's can be found at http://www.science20.com/forums/medicine
    Halliday

    Helen:

    First off, it will probably help you to read my reply to Susanna, above, since I will not be repeating myself here.

    Secondly, I especially recommend that you read Richard P. Feynman's 1974 Caltech commencement address entitled "Cargo Cult Science".

    While you may not get all that I have out of Feynman's talk, I do expect that you will catch his repeated admonitions concerning "a kind of scientific integrity, a principle of scientific thought that corresponds to a kind of utter honesty—a kind of leaning over backwards."

    You see, especially the example of "Gran Sasso's superluminal neutrinos" is a good example of the researchers, there, exercising this form of "scientific integrity".

    Now, if you are trying to imply that the "rest" of the "scientific community" (or "scientific establishment") is "lacking in objectivity" "in many fields of 'scientific study'", you have something to learn about the (supposed) "objectivity" within science.

    I would hope that you would see, in Feynman's talk, that it's not about some sort of "objectivity", but about "leaning over backwards" to show all the possible reasons one can conceive of for doubting one's experimental/observational results, or even one's theory.

    Additionally, science is not about validating or invalidating theories/hypotheses/etc. based upon single experiments, regardless of how good or compelling such may be.  It's about evaluating multiple lines of evidence.

    As Feynman points out, one of the dangers physics faces—that could determine whether physics remains a "true science", or slips into becoming a "Cargo Cult Science"—is the principle of independent replication of results.  Especially High Energy Particle physics, where experiments and equipment can be so extraordinarily expensive, has the propensity for slipping down this slope of avoiding "the waist of time and resources" in replication of others' results.

    No, it's not about some air of "objectivity", but a more full "scientific integrity", including the need for independent replication of results, in addition to the pursuit of new and interesting—even challenging—results.

    David

    P.S.  I could go on and on about how important independent replication of results is, and how the lack thereof has lead to many a "scientific fiasco".  However, I shall restrain myself, at this time.  ;)

    "She calls standard medical practices used in hospitals 'rituals' as well, a way to create false equivalence for these female empowerment rituals and endorse symbolism in place of science - "intentionally manipulated rituals of technocratic subversion", as she describes it."

    Actually, the ritualistic nature of hospital births is well documented in Dr. Robbie E. Davis-Floyd's work, "Birth as a Rite of Passage in America," first published in 1993.

    "For low-risk deliveries, a midwife obviously works fine. Seeking to increase the number of non-hospital deliveries as part of a cultural agenda against "fictions of medicalized birthing care" is dangerous."

    There's nothing fictional about the extremely high rate of unnecessary c-section and other forms of medical intervention currently being used in US hospital births (32.8% rate of c-section in the US in 2010, according to the Center for Disease Control). A c-section is a serious and invasive surgery, not be taken lightly as it is potentially dangerous to the life or health of mother and/or child.

    Hank
    There's nothing fictional about the extremely high rate of unnecessary c-section and other forms of medical intervention currently being used in US hospital births (32.8% rate of c-section in the US in 2010, according to the Center for Disease Control). A c-section is a serious and invasive surgery, not be taken lightly as it is potentially dangerous to the life or health of mother and/or child.
    Agreed, except that has nothing at all to do with midwives or medicine, it has to do with malpractice.  As I noted, former Sen. John Edwards became a billionaire suing hospitals for not doing c-sections more, so we need tort reform, not fewer hospital deliveries.   Alleging c-sections go down if midwives chant is silly.
    I've added my own blog post on this matter on my anthropology blog:

    http://blogs.ubc.ca/anth100/2011/12/23/chanting-rituals-midwives-and-the...

    Charles

    Hank
    That's terrific.  What we need are more anthropologists helping provide context for how the field itself looks at certain kinds of studies. Physics is so arcane it is rarely a problem when woo gets a preprint in the arXiv but a study claiming that midwives and rituals mean healthier deliveries than hospitals can have real repercussions - no one dies if a theoretical physicist uses mathematical sleight of hand to try and contend we can travel through time.

    I liked your parallel to education studies, since people can obviously see how to 'control' a study like that (a wealthy private school doesn't take everyone whereas public schools have to take all students) but on a midwife study like this, they don't know how to mentally calibrate babies being born.  "Emic explanations are important, but rarely do the words of interviewees speak for themselves" is as good a way to phrase it the weaknesses of the Cheyney paper as any.
    I want to say something for midwifery here. This article hits home with me. I'm a father of four and midwives were involved in three of these births. For the first birth, the midwife was a no-show. We went to he hospital and had a Ceasarean after a long and unsuccessful attempt to birth her vaginally. Number two was managed by the local OBGYN doctor at the local hospital who assured us we could still have a vaginal birth after having had a C-section. Timing is everything. It being late in the day when the water broke, the doctor called for a C-section and was out of the building by 4:30. I think he was a good doctor, we were just disappointed.
    Number three was managed by the earlier mentioned midwife. Now this birth, as luck would have it, was truly problematic. We lived rurally 35 miles from the hospital and we never could get the baby to turn over towards the end of the gestation period. But we perservered, nervously on my part, anyway. So, this little boy was breached. After stuggling to get the baby down a while the midwife concluded he was stuck butt end first down in the canal.
    Now I want to talk about ritualism and midwifery. She and her assistant had their little sort prayer/contemplation intervals during which, I think they were thinking pretty hard. The rest of the time they were working hard and paying strict attention to the mom and her condition.
    But outward signs can only say so much and merely performing rituals does absolutely nothing. So she reached up the birth canal, around my boy's butt, up his back and felt around to find the umbilical cord wrapped around his neck. So he wasn't just stuck, he was getting hanged. So she manipulated the cord with her fingertips and got, not just one but three loops of the cord unravelled from his neck. Then with the usual pushing and screaming his butt crowned and out he came. Started crying and everything. That was twenty five years ago. Today he is an avid rock climber, a musician and likes reading various science writers. He also got his vaccinations. I am a science guy.
    The fourth child's birth, by a later wife, was managed by the midwife who trained the one at my boy's birthing. That all went normally, no big drama. She just did a great and professional job.
    What I'm driving at with this account is that the ritualism aspect of mid-wifery is overstated and a bit condescending I think. My experience with them, anecdotal, I know, is that hey are very talented, knowledgeable and do great work.

    Hank
    What I'm driving at with this account is that the ritualism aspect of mid-wifery is overstated and a bit condescending I think. My experience with them, anecdotal, I know, is that hey are very talented, knowledgeable and do great work.
    As you note, anecdotes are not evidence yet the anthropologist I am critical of attempted to do just that.  I never said midwives had no value but claiming because they do a low risk birth as well as anyone, and therefore mostly do those, means their chanting results in safer deliveries is quackery and needs to be called out because it is dangerous to foist that off as science. 

    Obviously birthing occurred before there were doctors and before there were midwives - but more deaths occurred.  Midwives reduced deaths because they became experts at birthing issues and so were the doctors of their time - not because they chanted - and doctors reduced deaths even more because they had a standard to get a title, unlike midwives. Going backwards and claiming the rituals are medically valid is just goofy.   Athletes have all kinds of pre-game rituals and superstitions but it is the thousands of hours of preparation that make success possible, not the ritual.
    Thank you , Hank.

    I agree with that completely. I just didn't want your readers to come away thinking the converse is true, ie that midwives are a goofy bunch of mystics. I think any great athlete will point out that far all their hours of practice and hard work, it's often a great coach who gets them to the very top of their game. Likewise, the midwife coaches the whole pregnancy, builds trust and understanding, has a skill set for getting the babies to come down and recognizes troubling signs early on. It's been my perception that aspirants who cling to notions of ritualism and magic just don't get very far.

    Hank
     It's been my perception that aspirants who cling to notions of ritualism and magic just don't get very far.
    Well, they can become a professor at OSU and write in a 'peer reviewed' journal, which is farther than is comfortable.  :)
    While a few commentators have mentioned this fact in passing it really needs to be made clear that most midwife births, in the US and in Europe, are not home births. Why is that important to remember? Because the types of birthing practices that MOST midwives are involved with are, by all indicators I've seen, better for the average mother and child than the dominant American OB model is. I'm not an expert in this area, but it is my understanding that public health researchers have been saying that for years (e.g. http://www.ncbi.nlm.nih.gov/pubmed/3235680). It is truly sad to see the debate over midwife vs. OB birth get so wrapped up in the extremes. To Hank Campbell specifically I would also like to point out that while you accuse others of being unscientific and of trafficking in anecdotes, you do no better yourself when you make claims about the rise of cesarean rates in the US which at best hang upon a correlation (though I am not at all convinced that even that correlation has been measured "scientifically"). Tort reform is of course sorely needed in our country, but it is absolutely not the only piece in puzzle of how our national health has managed to reach the crisis it is in (something that goes well beyond birth practices). We've had lawyers, doctors, hospitals and patients in this country for quite some time now. It is naive to think that our current epidemic of lawsuits is caused by the legal system alone. For patients to believe that suing medical providers is the right option, for lawyers to agree and for juries and judges to reward their efforts requires much more than a few laws. Ironically what we sorely need are social scientists to start digging into what about our culture and our social institutions and practices enables this type of behavior. It wouldn't surprise me in the least if such studies found direct connections between the culture of medicine that we have created over the last few decades and the rise of medical lawsuits (among other things).

    I can't access the article, so can't see for myself what Cheney's intended message is. However, just going on the information provided by you here ("This is about invoking the mind-body connection", "'magical 'woman-centered rituals' are safely delivering babies that would otherwise not be delivered safely in a hospital and require surgery", the first a direct quote, the second your disdainful paraphrase) it sounds to me her point is that mental state affects bodily function. That, I hope, is something that someone who supposedly knows something about science, should know. Do you really believe that Ms. Cheney, if you asked her, would agree, "Oh yes, it's magic. All I have to do is say "bippity-boppity-boo", and it makes the baby come out. Really? Doesn't it seem more likely that she is describing a real psycho-physical phenomenon, and how it is treated in this particular subculture? If you truly believe that the birth process happens in a physiological vacuum and that environment has no effect on it whatsoever, please go back to your science books. Please.

    Gerhard Adam
    Doesn't it seem more likely that she is describing a real psycho-physical phenomenon...
    Once again, I'm all ears about what this "real psycho-physical phenomenon" is. 

    Actually you can read the abstract to see that science has little involvement in this piece.
    Homebirth practices are, thus, not simply evidence-based care strategies. They are intentionally manipulated rituals of technocratic subversion designed to reinscribe pregnant bodies and to reterritorialize childbirth spaces (home) and authorities (midwives and mothers).[homebirth; midwifery; ritual; childbirth]
    http://onlinelibrary.wiley.com/doi/10.1111/j.1548-1387.2011.01183.x/abstract
    Mundus vult decipi