Ideological battlefield of the labour ward

WHEREVER we are in medical practice now, most doctors will remember their experience on the labour ward – whether it was as a medical student or junior doctor.

Labour ward has a culture of its own. It’s a place where life begins, but also, rarely, ends. Where healthy young women endure severe pain. Where babies negotiate a potentially hazardous entry into the world. Where there is joy but risk of tragedy.

Pregnancy and delivery care involves a unique collaboration between midwives and obstetricians. The relationship is inextricably linked, but also potentially fraught. At its best, this is teamwork par excellence. Lurking in the background, however, are serious differences in culture and ideology.

It’s on this background that the story emerged recently of the endorsement of the Australian College of Midwives (ACM) of training in “alternative” therapies. The comments of Emeritus Professor of Obstetrics and Gynaecology, Alastair MacLennan, reached the international news. Professor MacLennan, an executive member of Friends of Science in Medicine, which promotes the adoption of scientifically based principles in all health and medical courses, expressed concern about continuing professional development points for certain courses offered by the ACM in areas including moxibustion for “turning” breech babies, and in the use of “acuneedling”. Both of these are practices derived from traditional Chinese medicine, and are described by Professor MacLennan as “dark arts” and as having “no scientific evidence of safety”.

Moxibustion involves burning a herbal preparation of Artemisia vulgaris (mugwort) close to the skin of a specific acupuncture point until the heat produces redness. To promote version of a breech presentation, moxibustion is applied to the acupuncture point bladder 67 (located on the outer corner of the fifth toenail).

Such a mechanism is, frankly, implausible.

Midwives are well trained in the physiology and natural course of labour and birth, and routinely use drugs and procedures to modify these processes. Midwives were one of the first groups of specialised nurses to adopt advanced practice, applying medical interventions that save lives. In Australian public hospitals, most uncomplicated births are entirely managed by midwives, including monitoring, analgesia, use of medications and suturing.

In defending the moxibustion courses, the ACM argued that “in order to provide appropriate advice it is essential that midwives have an understanding of practices that women are interested in, including complementary therapies”. The spokesperson opined that “all health professionals, including midwives, have the critical thinking skills to enable them to suitably analyse and assess any practice or research to determine whether it can be incorporated into their evidence-based practice”.

This explanation doesn’t ring true, however, when details of the courses reveal that they are not a review of the valid evidence but teach participants to deliver the “therapy” itself. Courses endorsed by the ACM can be reviewed here.

It’s difficult to understand how a clinician with an expert understanding of pregnancy and birth could suspend disbelief long enough to seriously offer such a service to patients. The stated stance of the ACM cannot justify the endorsement of courses in unscientific practice. It’s likely that many midwives would be appalled by this, but, so far, they have not been publicly vocal.

And so, it appears that these ideological battles over the labour ward remain.

Dr Sue Ieraci is a specialist emergency physician who has also held roles in departmental management and medical regulation. She is an executive member of Friends of Science in Medicine. She can be found on Twitter @SueIeraci.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.

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