Alleging c-sections go down if midwives chant is silly. Hank Campbell

Hank Campbell, author of the Science 2.0 blog picked up and ran with a story about midwives published in the December edition of the Medical Anthropology Quarterly.  In the article anthropologist Melissa Cheyney argues that the rituals used by midwives leads to better birthing outcomes – that is, fewer caesarian section deliveries. Cheyney, herself a practicing midwife, argues strongly that the chanting and related rituals are about invoking a “mind-body connection” which, according to Cheyney leads to a “better health outcomes” then in hospital.

It’s not clear that Cheyney has examined the underlying risk factors that influence which birthing situation an expectant mother chooses.   High risk pregnancies will be more likely to have health complications.  Lower risk pregnancies will have few irrespective of the birth rituals or practices.  If the sample of midwifery births Cheyney observed were in fact lower risk than those for the hospital birth data she compares them to then there is a problem with the study’s assertions.

Here’s an education parallel. French Immersion public schools in Vancouver, BC, typically score higher on standardized tests administered by the government than do their neighbourhood mainstream neighbourhood schools.  Schools in wealthier areas also score higher, overall, then schools in poorer areas.  For certain commentators the testing data ‘proved’ that the higher scoring schools had better teaching.  Yet, detailed examination of a wider range of factors shows us that the higher testing results is an artifact of something totally independent of the teaching.

The french immersion schools included a self-selecting pool of parents who actively engaged with the school. This parental involvement combines with an internal process of quietly advising parents to remove children from the program when they weren’t doing well.  End result, by the time the testing hits the school there is a population of high achieving, relatively problem free children who will do better in spite of how they are taught.

A series of studies by UBC education faculty (and other studies from across North America) have shown that educational attainment is strongly influenced by parental education and socioeconomic status.  Thus, one finds a gradient of school outcomes that varies in direct relation to these sociological factors.  This is not to say that individual teaching factors don’t make a difference.  It is, however, to point out that the underlying factors related to school success are social class based.  But, any study that only focused upon teaching practices in the classroom (or midwifery practices in the birthing room) would not be able to tell us the full story nor would it be able to make conclusions about causal factors of education outcomes.

There’s a lot of anthropology that goes forward these days that has made the swing toward the emic view so hard as to take a leap from reality. It is not unusual these days to hear a conference presentation comprised almost entirely of quotes from people the anthropologist interviewed with little or no commentary or analysis – the words speak for themselves. But that’s rarely the case.  In his wonderfully titled book, They Lie, We Lie,  Peter Metcalf pulls apart the ways in which research is in some sense a struggle over partial truths and half truths  and writing about it is also an engagement in the construction of meaning itself.  While Metcalf is influenced by the post-modernist nihilism of our times he is clear that words don’t just speak for themselves.  In the same sense, simply finding better health outcomes for middle-class white americans who employed a midwife doesn’t prove that chants and rituals connecting mind and body lead to healthier births.

The article in MAQ has become another touchstone in the large-scale social cynicism that everything establishment and ‘scientific’ is wrong.  Or, at least no more right then, say, middle class white amercian belief’s about home birthing or vaccinations. Since being picked up by Hank Campbell’s Science 2.0 webpage a minor twitter and blogosphere flurry has emerged.  The usual sorts have chimed in with either pro or anti commentary.

Leaving aside the question about what makes for safer childbirth, the original comment by Campbell and article by Cheyney raises a critical methodological issue – what can anthropologists claim about their reserach?  Can a method that, in the MAQ case, is primarily oriented toward eliciting the construction of meaning for participants actually say anything about medical practices?  It would make sense that such an approach can tell us much about the sentiments and beliefs of both midwifes and their clients; but whether or not it can tell us anything about the efficacy of their methods and ‘rituals’ in terms of safer childbirth I have serious doubts.

Anthropologists need to be clear about their methods and the scope of their potential findings and conclusions.  We need to know the details about how and what was studied, what limitations are there, on what basis is an author making their claims.  Evan-Pritchard’s comments about Azande witchcraft or Bronislaw Malinowksi’s comments on Trobiraind garden sorcery are worth revisiting when one examines contemporary American midwifery rituals.  Emic explanations are important, but rarely do the words of interviewees speak for themselves.