There are lots of promising-looking articles on the website of the Association of Radical Midwives. Here are some thoughts about the first one to catch my eye, “Trapped by thinking in opposites?” This is one of those dense articles that you feel must be saying something important, if only you could work out what it was.

Here is my take on it:

The authors argue that our way of thinking about issues in childbirth suffers from an unhelpful dualism – something is either safe or unsafe, good or bad, normal or abnormal. For example, if hospital birth is seen as safest and so best, then home birth is viewed as dangerous and bad. If home birth is promoted as normal and desirable, then birthing in hospital is characterised as aberrant and a cause for shame.

This dualism, a habit of seeing the world in dichotomies, is inherited from the patriarchal world view. (To control people you have to tell them who and what they are, and for that you need pigeonholes: male-female, good-bad, virgin-whore, black-white, acceptable-other.) This world view leaves little space for grey – or, as the article puts it, for rainbows – and promotes narrowmindedness. It is an institutionalised form of patriarchy from which even the most radical midwives suffer.

The effect of this dualism is manifold.

One key problem is that it leads to inappropriate judgements. For example, instead of asking Is this safe? and coming up with a judgement (yes/no) we should be asking How safe is this? and coming up with a more complex, more useful answer that puts the situation in its rightful place on a continuum of risk. To do so gives the patient the tools she needs for genuinely empowered decision-making.

Dichotomous thinking can also force people into sub-optimal choices. For example, by asking Breast or bottle? you might force a woman who finds that she is unable to do the “right” thing (breast=good) into doing the “wrong” thing (bottle=bad). For that woman, and for that child, it would almost certainly be better and more helpful to come up with a more flexible range of creative mixed feeding options. Again, to do so would enable the mother to make a truly informed and empowered choice.

In other words, dualism places decision-making power firmly in the hands of the person positing the dichotomy and making the judgement. It renders the patient powerless, a mere passive recipient of treatment that someone else has determined.

This illustration explains, I hope, what I mean:

A doctor says: “Having a C-section would be the safest thing; trying to deliver your babies naturally would be dangerous.” He sets up a safe-unsafe dichotomy and the mother has no power now to opt for a vaginal birth. But what if, instead of imposing his own judgement, the doctor gave the mother the information she really needs, to think about her options on a continuum of risk? Then, she has the power to make her own decision and exercise her own judgement.

The article concludes that “the narrowness of thinking in opposites and the danger of being defined as ‘other´… is… destructive of both individuals and of relationships“.

Midwives, as providers of healthcare, can begin to move away from this patriarchal dualism only when they start to become aware of it, to question their own thought processes, and to ask what they are “implicitly devaluing” by treating it as the polar opposite of what they explicitly promote.

PS The more hyphens I use in a post, the more scared I get that I am turning into one of those people who writes articles that might be saying something important, if only you could work out what it was. Apologies. But now you’re watching for this weakness of mine I will have to start being vigilant against Hyphen Invasion, won’t I?

PPS Hah, just deleted six of the little beasts. There are still too many. Oh well.