Recent issues of the Skeptic have contained expressions of puzzlement at some subjects being taught to tertiary students in New Zealand. The worst example is the Degree in Naturopathy planned for Aoraki Polytechnic. But is this really all that surprising?
Currently, health courses in polytechnics are including all manner of “alternative” medicine instruction as part of core courses. In my experience, the worst offenders are courses in midwifery.
Most midwives in New Zealand train for one year at a polytechnic, having previously completed a three-year course in nursing. There are three-year direct entry courses, but these are quite new and their first students have not yet graduated.
I teach anaesthetics in the one-year course at Wellington. The time allocated to me is one hour. The senior tutor also teaches this topic for one hour, a total of only two hours’ formal instruction in the whole course.
How relevant is anaesthetics to midwifery? I agree that the amount of knowledge needed by a midwife in this area is limited, but it is not generally recognised just how dangerous anaesthesia can be in the pregnant female. General anaesthesia is the third or fourth commonest cause of death in labouring women in the developed world. The situation is worse in Japan, where it ranks first or second. (The “or” is included because figures change from year to year. The United States has pushed anaesthesia down a slot as a cause of death in pregnant women by bringing gunshot into the top three.)
The point I am hoping to make is that anaesthesia can have a major impact in obstetrics, and I, for one, think that anyone involved in the care of pregnant women should have a sound background in the principles of anaesthesia, and why it can be so dangerous.
So is two hours enough? An open question, but homeopathy gets more than twice as much formal teaching time, and I assume the tutors are paid out of taxpayers’ money and student fees.
Midwives as a group seem to have a fascination with homeopathy. When challenged, defences range from “scientific proof” to “patient choice”. I will disregard the first of these, except to say that I have yet to be offered science or proof in any discussion of homeopathy with a midwife. (As an aside, the weakest defence I have heard is that the Queen is interested in homeopathy, so there must be something in it. These days, one would have thought that royal patronage of anything was guaranteed to ensure its failure, but I digress.)
“Patient choice” is fast becoming the defence of scoundrels. Should patient choice be the final arbiter in medical practice? It is a nice, politically correct idea, but choice is limited to what is realistically available. To defend the inclusion of something in a professional curriculum purely because the students or the patients are interested in it is lacking in sense and responsibility. I would guess that midwifery students might also be interested in skiing and wine tasting, and their potential patients may express an interest in Fascism or safe-breaking. Following along the lines of “choice” may lead to a more entertaining course, but would it advance the care of mothers and babies?
The whole question of choice leads onto the matter of informed consent. Does a midwife who uses homeopathy fully inform her patient (sorry, sorry; I should say her “client”) that she is using something that is unrecognised as a form of scientifically proven medicine, and that its use may put the patient (“client”; there I go again) beyond compensation by ACC should something go seriously wrong? Like hell she does.
Homeopathy is not the only intruder of its type in midwifery. Acupuncture is praised not only for its analgesia, but also as a means of inducing labour, stopping early labour, and turning breech babies the right way up before delivery. Aromatherapy has its advocates, and I have attended a labouring mother whose midwife insisted on having a lighted candle in the room as part of her client’s care. (Delivery rooms are oxygen-enriched environments, and she was not happy when I refused to proceed until the flame was extinguished. The hospital fire officer was even less impressed when I referred the matter to him.)
I was horrified recently to hear of the advice offered to the wife of one of my junior colleagues. She is expecting her second baby, and the baby has turned breech — i.e. bum first instead of head first. A midwife told her that she should lie flat on her back with her feet up until she felt dizzy and breathless, then walk around for a while. This was to be repeated several times a day, and would turn the baby back to present in the proper manner.
Anyone with the slightest knowledge of the physiology of pregnancy should know that if the mother is becoming breathless and dizzy, the baby is likely to be in an even worse state. In late pregnancy, lying flat can pose a significant risk to mother and baby, as the weight of the uterus can press on the aorta, reducing the blood supply to the placenta, and also on the vena cava, reducing the blood flow back to the mother’s heart.
Needless to say, the advice was ignored and the prospective parents are due to see a consultant obstetrician.
Pseudoscience is alive and well in the midwifery world, and is being taught to midwifery students.