Do obstetricians ignore scientific evidence?

Natural childbirth advocates love mantras. They spread through the community, are quoted over and over, and become received wisdom as though by saying something enough times it might make it true. Classic NCB mantras include “pain is caused by fear” and “animals need privacy to birth successfully; so do humans.” And let us not forget the infinitely stupid “trust birth.”

Mantras change with time and in response to cultural values. In an age in which science is greatly respected, the most popular mantra is “obstetricians ignore the scientific evidence.” All the celebrity natural childbirth advocates insists that this is so, and some of them might even believe it. Lamaze has taken the mantra to new heights, by renaming their blog Science and Sensibility, presumably to imply that NCB is based on science and common sense, though it is based on neither.

Barry Beyerstein, a professor of psychology at Simon Fraser University, wrote about the technique of applying a veneer of scientific respectability as a way to improve the status of pseudoscientific beliefs. As Beyerstein explains:

The prestige and influence of science in this century is so great that very few fields outside of religion and the arts wish to be seen as overtly unscientific. As a result, many endeavors that lack the essential characteristics of a science have begun to masquerade as one in order to enhance their economic, social and political status. While these pseudosciences are at pains to resemble genuine sciences on the surface, closer examination of the contents, methods and attitudes reveals them to be mere parodies. The roots of most pseudosciences are traceable to ancient magical beliefs, but their devotees typically play this down as they adopt the outward appearance of scientific rigor. Analysis of the perspectives and practices of these scientific poseurs is likely to expose a mystical worldview that has merely been restated in scientific-sounding jargon.

And that almost perfectly captures the current public relations ploy of choice among NCB advocates. What could sound more impressive that shouting from every hilltop that obstetricians ignore the scientific evidence, while NCB advocates are slaves to scientific rigor? The fact that the claim is a lie is beside the point. NCB advocates neither know the truth, nor care.

Let’s examine the claim on the two levels apparently favored by Lamaze: sensibility and science.

If you say “obstetricians ignore the scientific evidence” fast enough, people won’t stop to consider if it makes sense. But if we do stop to consider it, we might amplify it as follows:

We are supposed to believe that obstetricians (with 8 years of higher education, extensive study of science and statistics, and four additional years of hands on experience caring for pregnant women), the people who actually DO the research that represents the corpus of scientific evidence, are ignoring their own findings while NCB advocates (generally high school graduates with no background in college science or statistics, let alone advanced study of these subjects, and limited experience of caring for pregnant women), the people who NEVER do scientific research, are assiduously scouring the scientific literature, reading the main obstetric journals each month, and changing their practice based on the latest scientific evidence.

See what I mean? That makes no sense at all.

Consider someone like Amy Romano, the CNM who writes Science and Sensibility. It seems like Ms. Romano is a nice person; her heart is definitely in the right place. Nonetheless, she repeatedly presents her opinions as scientific facts, and routinely misrepresents the scientific literature. That’s not surprising since she doesn’t read it and, because of her deficits in basic science knowledge and understanding of statistics, is literally incapable of interpreting it on her own. She needs someone to tell her which papers are “important” and what they supposedly “mean.” She does not review the literature before writing, she just assembles the papers that she likes, never bothers to read them, let alone analyze them. She makes this clear every time she is pressed to substantiate her claims; she can’t do it, so she falls back on refusing to discuss anything with anyone who is “disrespectful” as if challenging her claims is a sign of disrespect.

And what does the scientific evidence on childbirth really show? There is virtually no support for ANY of the central tenets of NCB advocacy. Let’s start with a favorite NCB claim that “lots of scientific papers show that homebirth is safe.” When it comes to homebirth in the US, ZERO scientific papers show that homebirth is safe. Indeed EVERY paper written on the subject shows that homebirth increases the risk of neonatal or perinatal death, even the Johnson and Daviss BMJ paper that claims to show otherwise. National statistics on homebirth collected by the CDC from 2003-2005 (the only years published thus far) show that homebirth with a non-CNM midwife triples the rate of neonatal death, and homebirth with a CNM doubles the rate of neonatal death.

Consider other, easily verifiable claims:

Proper position speeds labor? No, no evidence for that.

Eating in labor gives women “strength” and improves outcomes? No, no evidence for that.

Babies won’t breathe if delivered under water because of the diving reflex? The diving reflex works in cold water, not warm water.

Epidurals are dangerous? No, no evidence for that, either.

Indeed, I am hard pressed to come up with even a single NCB tenet that is based on scientific evidence. Oh, wait. I can think of one: breastfeeding is beneficial for your baby. But even that scientific evidence is misrepresented by NCB advocates, since the benefits are actually quite small.

The bottom line is that the NCB claim that “obstetricians ignore the scientific evidence” is a big lie. NCB advocates seems to think that if they say it loud enough and long enough everyone will believe. Unfortunately for them, both “Science” and “Sensibility” demonstrate that obstetricians follow the scientific evidence and NCB advocates don’t even know what the evidence shows.