In yesterday’s post Do obstetricians ignore the scientific evidence? I discussed the current natural childbirth public relations ploy of choice, the claim that there is a vast body of scientific evidence that obstetricians are ignoring. I focused on Amy Romano in her role as editor of the Lamaze blog ironically titled Science and Sensibility and the fact that she lacks an understanding of the true depth and breadth of the obstetric literature, not to mention and inability to critically analyze that literature. But she is not the originator of that public relations ploy. That honor goes to her colleague Henci Goer who has staked her professional life on the bizarre claim that obstetricians ignore the scientific literature that they create and that only NCB advocates assiduously scour the literature and change their recommendations based on research.
So who is Henci Goer? And who believes what she has to say?
According to Goer:
You may be wondering about my credentials to write this book since I am not a doctor — either M.D. or Ph.D — a midwife, or a nurse. I am a certified childbirth educator with a degree in biology from Brandeis University. Beyond that, I am self-taught.
So Henci Goer is not a medical professional and has no experience in the field of obstetrics. That, in itself is not a complete bar to understanding the obstetric literature if it is replaced by a PhD in a hard science or statistics. But, Goer doesn’t have those qualifications, either. In other words, Goer is a teacher of childbirth classes who reads the scientific papers that she likes, but has no independent way of assessing the full depth and breadth of the obstetric literature.
I will say that Goer, in contrast to the other self-appointed “experts” in the scientific literature does have a real grasp of the literature that she reads and a real understanding of statistics. That makes her false claims less understandable. Amy Romano actually believes what she writes. Someone told her it was true and she is repeating it. Henci Goer, on the other hand, knows better.
Goer’s typical modus operandi is the smear campaign. She tries very, very hard not to be pinned down on specifics, but instead hurls insults.
Ask Goer whether the Johnson and Daviss 2005 BMJ study shows homebirth to be as safe as hospital birth, and she will refuse to answer, because she knows that it is a bait and switch. Instead she will launch into a riff about comparing apples and oranges in order to divert attention from the factual question.
Consider Goer’s response to Atul Gawande’s excellent article on the success of modern obstetrics:
Gawande applauds doctors for trying whatever appeals to them without “wait[ing] for research trials to tell them if it was all right.” It is sufficient that obstetric innovators “looked to see if results improved,” although how they would know this without a controlled evaluation of safety and effectiveness, he does not say. Neither does he bring up the obstetric disasters that have followed in the wake of this approach. DES, thalidomide, retrolental fibroplasia (blindness in premature newborns), and misoprostol (Cytotec) inductions come to mind …
Instead of addressing Gawande’s factual claim that modern obstetrics has saved more lives than any other branch of medicine, Goer resorts to the smear. Not only does she favor the smear, but she doesn’t trouble with the truth of her claims, either. The implication is that obstetricians deliberately created tragedies by foisting unrested medications on unsuspecting women. Yet that is a lie.
Thalidomide is a medication was used in Europe during the early 1960’s. It was prescribed as a sedative. Thalidomide taken in the early weeks of pregnancy causes limb defects. Typically, the babies were born with flipper like appendages instead of fully developed arms.
Was thalidomide use promoted by obstetricians? No. Furthermore, thalidomide was never used in the US. An official in the Food and Drug Administration refused to allow the drug to be used in the US because she had read the case reports in the European literature. As a result of the European experience, the FDA instituted studies to see if other medications could cause birth defects. So the reality is that thalidomide was never used by obstetricians and was never even allowed in this country.
How about retrolental fibroplasia? Oxygen supplementation for prematurity was instituted in the 1940’s. Thousand of lives were saved by it. The side effect of blindness (retrolental fibroplasia) was noted almost immediately thereafter in the survivors. It was not until the early 1950’s that it was recognized that the cause was high concentrations of oxygen.So retrolental fibroplasia has nothing to do with obstetricians. No matter, Henci Goer is not bothered by a trivial matter like the truth of her claim.
Goer has attempted to use this smear tactic recently in response to my claims that obstetricians do follow the scientific evidence and it is NCB advocates who don’t even know what the scientific evidence shows. In the comment section of Science and Sensibility, Goer writes:
“Amy Tuteur, MD: Obstetricians are following the evidence, and it is bizarre for NCB advocates, who don’t have a clue as to the entire depth and breadth of the scientific evidence, to suggest otherwise.
Obstetricians are following the evidence? Really? Let’s just list a few routinely and commonly used obstetric management practices about which there is NO controversy in the obstetric research that they are ineffective, harmful, and generally both when used routinely or frequently and in some cases, with any use at all:
* induction for suspected big baby
* artificial rupture of membranes
* no oral intake other than ice chips
* I.V.
* continuous electronic fetal monitoring
* confinement to bed
* active management of labor (treating labor progress slower than average with high-dose oxytocin)
* directed pushing
* pushing on one’s back or in a semi-reclined position
* episiotomy (Episiotomy is on the decline, but it was still used in 1/4 of women having vaginal birth in 2005.)
* immediate umbilical cord clamping
* separating newborns from their mothers shortly after birth
* cesarean surgery (The research literature supports a rate of no more than 15%. At rates higher than this, maternal and perinatal morbidity and mortality rates begin to climb.)I’m sure I’ll think of others after I submit this, and, of course, this list does not include anything from the much longer list of practices and policies about which there is controversy but a good case can be made against them for routine or frequent use.
Standard Goer smear tactics:
1. Evil is implied but Goer presents no evidence for her claims.
2. Goer deliberately and falsely implies that hospital policies are obstetric policies. Separation of mother and baby is a hospital policy. You can argue against it, but you certainly can’t claim that obstetricians said that scientific evidence showed that mothers and babies should be separated.
3. Goer does not consider herself constrained by the truth. A lie is fine if it serves the cause. Goer knows as well as I do that there is NO scientific evidence that a 15% C-section rate is optimal. The World Health Organization has even admitted that there is no scientific evidence for their recommendation and there never was any scientific evidence for that claim.
Goer presents herself as an “expert” on the obstetric literature, yet no one else seems to agree with her grandiose self-description. She is not called for expert testimony in court cases that turn on the obstetric literature. The government does not invite her to join expert panels on obstetric topics. In fact, the only people who consider Goer an “expert” on the obstetric literature are lay people who have no way to evaluate her self-proclaimed expertise.
Ms. Goer never appears in any venue where she can actually be questioned on her supposed expertise. She knows that her claims would be eviscerated in short order. She just continues to spread misinformation by flattering trusting women into believing that accepting her smears means that they are “thinking.”
Actually if you read the book, the studies are all sourced well in the bibliography. And yes, I was skeptical at first so I did read the abstracts and studies that I questioned the most. What’s funny is, I have given birth over a time span of 15 years and many things that she quotes have changed gradually to what her books suggest. For example, episiotomies. Do you still perform them on every patient routinely? My first ob did, but then I got transferred to a high risk hospital where they preferred a natural tear. That was nearly 18 years ago! Now it’s virtually unheard of!
Water birth? 18 years ago I was only allowed in the shower when my amniotic sac was intact, and I wasn’t yet dilated over a 4. 8 years ago, there was a tub available if I wanted to give birth in the tub. And I could choose my location of birth and I had the option of changing my mind.
Lithotomy position. There was no squat bar available and monitoring was continuous. 7 years later? I was allowed to use a squat bar during transition and practice pushing and I only needed monitoring once an hour. 9 years later, I was on a yoga ball until it was time to push!
I know it’s hard when a ‘non professional’ shows things in a harsher light than what the established profession accepts and was probably taught as gospel. I get that. You guys spent A LOT of money on your degrees and you studied very hard to be Doctors. Listening to laymen though doesn’t make you weak. It makes you stronger because you can choose to help patients have a better experience and a healthier outcome.
Dude, science has shown that water birth is dangerous, but even a lay person like Henci Goer could figure out that submerging newborns in fetid poop water is probably a horrible idea.
“Dude, like uh” there are water birthing suites in Columbia Missouri at the University of Missouri Hospitals and Clinics. I guess they must just be a pack of morons down there. (snark) And no the science hasn’t shown that. The science has shown that if the mother doesn’t have an active case of herpes, or Group B strep, and the doctor (or midwife, but I never had a midwife) is well trained, it’s just as safe as ‘dry’ births. In the UK, the NHS has midwives AND Obstetricians who have formed a coalition to promote the idea. http://www.waterbirth.org/assets/documents/rcog_rcm_birth_in_water.pdf
To be frank, I’ve never had one. I was always too high risk. But I don’t whine about those who can.
And this is why Goer has to write books. *shakes her head* Is continuing education a requirement for OBs or OB nurses? Because you’d ‘think’ it was. But from the comment here, hmmm.
And what exactly is Henci Goer’s education and CE requirements? What peer reviewed publications has seen appeared in recently? What conferences has she spoken at? What articles of hers have been referenced by OBs in other journals?
Mocksoup has a degree in electronics from a community college, so she’s every bit as qualified as Henci to write about birth!
http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Health-Experts-Determine-Water-Births-Have-No-Proven-Health-Benefits.aspx
Would you swish your newborn’s face around in the toilet after you emptied your bowels? When your toddler poops in the bathtub, do you let them sail the rubber ducky right through it, and keep on playing? I, personally, have always gone to great lengths to keep feces out of my children’s faces. You may have a different parenting style, however.
Water birth was introduced because women wanted it, and babies have been seriously harmed as a result. Hyponatremia, low Apgar, aspiration of contaminated water.
So the Royal College of Obstetricians and Gynaecologists. And, could you in that same breath say that those negative outcomes could have come from untrained or improperly trained doctors and staff? I just want to know if that is something you are comfortable saying.
RCOG’s position statement on water birth is from 2006, and it basically admits there was very little to no reliable safety data on the subject, but that there were anecdotal reports of drowning and infection. Not very reassuring. http://www.rcog.org.uk/womens-health/clinical-guidance/immersion-water-during-labour-and-birth
Interesting. That is the exact position of the ACOG/AAP. However, as a result, the American associations err on the side of caution. Apparently, the Brits throw caution to the wind…
Yeah, the whole thing is weirdly written.
“Birth in water
Informed choice on the benefits and risks of birth in water is clouded by the lack of good quality safety data. Although there is no evidence of higher perinatal mortality or admission to special care baby units (SCBUs) for birth in water,4,14,15 caution is advised because of small numbers, possible under-reporting of SCBU admission and exclusion of women who were in labour in water but gave birth conventionally after complications.
One review identified 16 articles reporting a total of 63 neonatal complications attributable to water birth, including drowning, respiratory problems, cord avulsion and waterborne infections.16 One can argue that this anecdotal evidence is reassuring, given the thousands of women who have given birth under water in the last few decades. However, we still do not know how the low perinatal mortality and morbidity rates compare with those babies born in air.
The respect for maternal autonomy and choice is important; however, it is important that any possible concerns for fetal and neonatal safety are made clear. Women who make an informed choice to give birth in water should be given every opportunity and assistance to do so by attendants who have appropriate experience. More research is needed on third-stage management in the pool, as there is currently no reliable evidence that can be used to inform women regarding the benefits and risks of experiencing the third stage of labour under water.”
You really are quite stuck on yourself, aren’t you?
“I know you spent all those dreary years and thousands of dollars educating yourself but really, you need to listen to me. I’ve HAD babies before. More than one! Shocking! You’ll learn from me.”
Ha!
You’re funny.
That’s what I always used to tell the pilots on my holiday flights – until they banned me from the cockpit. Clearly they care more about their so-called ‘training’ than about listening to good, common sense advice from laypeople. Their loss, right?!