Tag Archives: science

Choosing Midwives: Science Is Not Exclusively Male

Laurie and Debbie say:

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One of the many ways male hierarchies keep women’s skills at bay is by associating myths with women, and facts with men, magic with women and science with men. In this context, Therese Oneill detailed and informative essay at Jezebel on the tension between doctors/men and midwives/women tension helps reveal the persistent and culturally accepted myth which associates men, science, doctors and hospital births with cleanliness, safety, and infant survival.

There was nothing wrong in wanting those who attended birthing to be clean, educated and accountable, but the doctors were going for self-interested gatekeeping. Requiring official licensing was the first step in shoving women out of the field all together. You couldn’t get licensed from just an apprenticeship, which was the norm for midwifery. Official training and state licensure cost money, an expense passed on to clients. It undermined the centuries-old purpose of the midwife as an affordable option to assist births. Instead, went the parallel argument, physicians wanted the poor to give birth in charity hospitals—where tired, apathetic attendants and untold diseases and infections awaited them. …

[The 1906 study of 500 interviewed New York midwives, described in Oneill’s article] included only one, one, “West Indian Negress.” It seems unlikely that an urban population the size of New York had so few black mothers as to warrant only one midwife. It is possible that white midwives served black mothers, but highly unlikely in an era and place where ethnocentricity was king. It is more likely that black society, North and South, experienced far less interference from campaigns intended to improve society.

Women could, of course, go to medical school to become fully licensed obstetricians. But the number was minuscule clear into the 1980s. According to the Journal of the American Osteopathic Association, in the 1970s, only 9 percent of enrolled medical students in any field were women.

[Side note: Lots of factors kept women out of medical school. Debbie’s mother was admitted into medical school in the 1930s, defying quotas on both women and Jews. But her parents, who could easily afford it, refused to pay for it, reserving the money “to educate their two sons,” one of whom never went past high school. ]

But that changed, and it changed fast. According to The US National Library of Medicine, female residency in Obstetrics and Gynecology quadrupled from 1978 to the present. Women now account for 71.8 percent of OB/GYN residents….

It’s not just that there are more female obstetricians, either. Midwifery, far more sanitary and scientific than its ancient ancestor, is booming again after a near 200-year lag. The difference between the two is most salient in terms of their technical training: obstetricians have gone through medical school, are able to perform C-sections, suturing, circumcision, and are skilled in handling high-risk pregnancies. Midwives come in different flavors, but the majority are medically trained and licensed in all things related to normal pregnancy and birth.

None of this is new information to people who follow this kind of history. The persistent, deep belief that doctors are better than midwives is not just about pregnancy  and birth (so much of history is about men trying to figure out how they can own children!), but about how Western science was created and defended as a male domain. Science was developed (mostly) by men, promulgated (mostly) by men, and made available (almost exclusively) to men. Thus science became male, despite the fact that there are no “insert penis here” slots in any scientific test or accomplishment we’ve ever heard of.

In the last few decades, the presence of women in the sciences has shifted substantially (though we may be losing ground). In the same period,  the perception of science as male has shifted less.

If men “own” science, then whatever women do, by definition, isn’t science. That’s how you get to Teresa Oneill’s husband’s reaction:

“Yes! A midwife!” … “Because I was thinking to myself, ‘Who are we going to get to wave burning sage over your stomach and chant to Gaia while the baby dies?’ CLAP IF YOU BELIEVE!!”

While it seems very likely that some significant percentage of early midwives worked in filthy conditions, as Oneill points out, hospitals were filthy then also. Yet, the discussion implies men=science=clean and women=ignorance/magic=dirty.  We’d bet the rent that a good history of midwifery would point out many instances where midwives figured out sanitation and disinfection issues on their own, through experience and observation.

The association of women solely with magic and myth is one way that male culture uses its own myths to denigrate and trivialize those who work outside it. Let’s hope that this one remains dead for two centuries and more, while midwives continue to use science and intuition, caring and disinfectant to combat the risks of pregnancy and birth.

Want to Reduce Risk of Dementia? Don’t Diet!

Debbie says:

I know I’m not alone in being more frightened of old-age dementia than any other thing that could happen to me. Everyone is different about these things, but for me, my mind is me, and without it I do not want to survive.

That fear, a lifetime of body image activism, and my hatred of junk science combine to make this the best science news possible.

The analysis of nearly two million British people, in the Lancet Diabetes & Endocrinology, showed underweight people had the highest risk. …

Dementia is one of the most pressing modern health issues. The number of patients globally is expected to treble to 135 million by 2050.

At least by basic criteria, the science is impeccable. There were 1,958,000 subjects.

Compared with people of a “healthy weight,” underweight people (BMI <20 kg/m2) had a 34% higher (95% CI 29–38) risk of dementia. Furthermore, the incidence of dementia continued to fall for every increasing BMI category, with very obese people (BMI >40 kg/m2) having a 29% lower (95% CI 22–36) dementia risk than people of a “healthy weight.” These patterns persisted throughout two decades of follow-up … [quotation marks added]

In other words, it’s not just that low BMI correlates with greater dementia, but higher BMI, well into the categories that modern medicine continues to describe as “morbidly obese,” correlates with even less dementia. The difference between having an “underweight” BMI and an “obese” BMI is a 54% (!) reduced risk of dementia. That’s a gigantic number.

Of course, BMI is and always has been a bullshit benchmark. Also of course, the scientists are thrown for a loop by their own findings, because they went in assuming that fat would fry your brain, just as their counterparts continue to insist (against evidence) that fat destroys your body. They really have to grasp for their “faith sentence” here, and what they came up with is:

… the findings were not an excuse to pile on the pounds or binge on Easter eggs.

“You can’t walk away and think it’s OK to be overweight or obese. Even if there is a protective effect, you may not live long enough to get the benefits,” he added.

We know from other large-population studies and analyses that this isn’t true.

Of course,  no one is suggesting that these results suggest that low-BMI people should try to gain weight. Just to be clear, I’m not suggesting that either; people find their own weight and everything, including dementia risk, has multiple complex factors. But you do know what they would be saying if the study had gone the way they expected!

For me, I will continue to live the way I live, to follow my doctor’s advice (“Whatever you’re doing, keep doing it”), to appreciate my fat body, and I will breathe just a little easier when fear of dementia sneaks up and ambushes me.