A Brief Defence of My Current Hero, Denis Walsh

J-Bro sent us a link to an article in yesterday’s Daily Mail entitled “top midwife says labour agony is a ‘rite of passage’ and pain relieving epidurals weaken the mother’s bond with babies”. In it, we learn that

Dr Denis Walsh, an influential midwife, said the agony of labour should be considered a ‘rite of passage’ and a ‘purposeful, useful thing’.
He criticised the ‘epidural epidemic’ sweeping the NHS, saying maternity units should abandon routine pain relief and instead embrace a ‘working with pain’ approach.

And later

Dr Walsh said labour pain was a timeless component of motherhood. ‘Over recent decades there has been a loss of rites-of-passage meaning to childbirth, so that pain and stress are viewed negatively,’ he said.
But Sally Russell, of the Netmums website, said he was talking ‘absolute rubbish’.
‘What he is promoting suggests to me that women who can’t go through normal birth for whatever reason find they are stigmatised and made to feel they have let themselves down, and that’s very damaging.’

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 vangina 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 releif 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.

Walsh’s recomendations are aimed at midwives. And what they amount to is “hey midwives, instead of setting these women up for almost certain genital mutilation because you can’t be bothered (or you don’t know how) to support them through their pain, let’s all reeducate ourselves on being an effective support for labouring women; let’s try to save a few women from the knife–truly give them all the options by making labouring without epidural back into a real choice”. Walsh is deeply concerned that women’s bodies–and indeed women–should be respected in the process of delivery; that the midwifery and obstetric communities not behave as if anything and everything to yank the fetus out quickly is fair game; and that delivery be conducted in positive, effective ways identified by good research. Another example of this concern is Walsh’s writing about “coached” second-stage labour (where midwife shouts at you to PUSH! PUSH! -which btw, seems to be totally ineffective and even dangerous in some cirsumstances):

One wonders how women delivered babies over the centuries without the stern, exhorting voice of the midwife, coaching them every step of the way. In twenty years of practice I have yet to hear a woman say ‘Thank you so much for shouting at me at the end there. In fact, I am so grateful to all of your for aggressively telling me how to do that pushing bit. your volume 10 instruction made all the difference…’ … There is little doubt in my mind that this style of care could be construed as bullying…It is quite simply no way to talk to another human being regardless of setting or context. (From EBCfNLB, pp.94-94)

Denis Walsh is not the slimy pig-man who’s out to demonize women who choose pain relief, as the Daily Mail (or the BBC, for that matter) would have us believe. He’s a midwife who wants midwives to act as advocates for women: to put the needs of the labouring woman on the map, rather than letting the midwive’s own needs as professionals or the the baby’s (purported) needs push all mention of the woman’s well-being out the window. I, for one, am very thankful I’ve read his work in preparation for the birth of my second child.

(The bit about ‘preparing for the responsibility of motherhood’ by experiencing pain, btw is also Mail spin. There’s evidence that the hormone rush one experiences from the intense pain of labour is actually the cause of the “love at first sight” that some women experience at the birth of their babies. Walsh thinks a further reason to value normal delivery is that this hormone-induced intense love probably helps the women who experience it to cope with those grueling first few weeks with newborn. He does not claim that being in pain makes one more responsible, nor does he claim that pain relief in childbirth makes you a less-good mother!)

You can listen to a six minute interview with Walsh and a (female; just to stir the pot) obstetrician set up as his adversary on bbc online. Or if you’re interested, I highly recommend Evidence-based Care for Normal Labour and Birth.

Regina Benjamin for Surgeon General


Obama’s Surgeon General nominee sounds fantastic so far:

A decade ago, the New York Times called her “angel in a white coat,” a country doctor who made house calls along the impoverished Gulf Coast, paid whatever her patients could scrounge.

From those early days she has emerged as a national leader in the call to improve health disparities, pushed by the need in her own fishing community of Bayou La Batre, Ala., and its diverse patient mix _ where immigrants from Vietnam, Cambodia and Laos make up a growing part of the population.

Her nonprofit clinic was rebuilt by volunteers after being destroyed by Katrina, only to burn down months later. Benjamin later told of her patients’ desperation that she rebuild again, recalling one woman who handed her an envelope with a $7 donation to help.

“If she can find $7, I can figure out the rest,” Benjamin said last fall as she received a $500,000 MacArthur Foundation “genius grant,” money she dedicated to finishing that job.

Benjamin became the first black woman and the youngest doctor elected to the American Medical Association’s board. She also received the Nelson Mandela Award for Health and Human Rights in 1998, and Pope Benedict XVI awarded her the distinguished service medal Pro Ecclesia et Pontifice.

But you can bet forces will mobilise against someone who really cares about poverty and inequalities in health care, so get ready for the fight…

AAP on Women in Philosophy

I’m later to this than I should be (in fact, I keep worrying I may have already blogged on it!), but far better late than never. The Australasian Association of Philosophy has put together an enormously impressive, very thorough report on the state of women in Australasian philosophy. But there’s more going on than just the report. There’s the fact that the committee behind it included not just women philosophers, but men, including very senior men. There’s the fact that *every* Australasian Head of Department has formally committed to supporting it. And there’s the fact that there was funding from the AAP and a University of Wollongong grant to support it. This sort of widespread institutional support is a rarity in efforts of behalf of women in philosophy, but it really shouldn’t be.

Anyway, it’s well worth a look. You might start with the executive summary. It’s apparently going to be discussed at a department meeting of every Australasian philosophy department (recommendation 8, on page 14). Just this level of engagement with the issues is an amazing thing, and hopefully it (and the other recommendations) will have a significant effect. (Thanks, Rae!)