Lamaze: garbage in, garbage out

Amy Romano got tired of me making her look like a fool. No, she didn’t stop writing foolish things; she just deleted my latest comment that exposed her writing as foolish, and untrue to boot. Evidently I spoke too soon when I wrote last week:

Henci Goer has banned me: too hard to address my points. The Unnecessarean has banned me: too hard to address my points. Jennifer Block doesn’t let anyone comment on what she writes: good idea since she can’t address anyone’s points. Only the folks at “Science” and Sensibility haven’t banned me. I don’t know why since I have torn apart multiple posts that they have written. I guess that while they may not know much about science, they appear to understand integrity.

They apparently agree that I have torn apart what they have written and they don’t want to let me do it again. Fortunately, I have my own blog on which I can reply.

Amy Romano has discovered that:

I was wrong. Evidence doesn’t hold all of the answers.

In other words, she has caught up to the midwifery theorists who have already found out that the scientific evidence does not support their claims. I wrote about this problem almost a year ago in Midwives have a problem with scientific evidence:

… [M]idwives and childbirth educators like Lamaze have a problem. The scientific evidence often conflicts with their ideology… [Therefore] they’ve tried to justify ignoring scientific evidence.

As midwives Jane Munro and Helen Spilby have documented in The Nature and Use of Evidence in Midwifery, midwives were initially enthusiastic about basing clinical practice on scientific evidence. That’s because they had long told each other that midwifery was “science based” while obstetrics was not…

But (surprise!) it turned out that obstetrics had been based on scientific evidence all along and it was midwifery that ignored the scientific evidence in favor of ideology…

… As Munro and Spilby explain:

‘… [S]ome midwives have not been so enthusiastic [about evidence based practice], viewing the drive to create and implement evidence as a threat to their clinical freedom.’

In other words, cherished ideological beliefs conflict with scientific evidence. Thus began the attack on scientific evidence.

Romano is following that tactic. She writes:

There are many reasons I have come to believe [that scientific evidence doesn’t hold all the answers], but there are two I want to write about today. The first is that the way research is currently funded, conducted, and disseminated, it simply doesn’t address many outcomes that women care about.

Those evil doctors and scientists are concerned with what is safe and what is dangerous, but midwives don’t care about THAT.

The second is that we all arrive at the point of healthcare decision making with a different constellation of factors that affect our choices. We may have different financial resources, health situations, hopes and plans for the future, tolerance to pain, tolerance to risk, prior experiences, and so on.

In other words, with the exception of practices that cause harm with no counterbalancing benefit at all or benefit with no risk of harm at all, there is no such thing as a good or bad healthcare decision. There’s only such a thing as a good or bad healthcare decision for a certain person. Evidence cannot guide practice without the other piece of the equation – the person to which the evidence is to be applied.

So clinical practice SHOULDN’T be guided by scientific evidence, because scientific evidence does not support the central claims of natural childbirth. Better to pretend that scientific evidence cannot tell us about individuals and only they can figure out what is “safe” for them.

In support of this nonsense, Romano offers the typical NCB lie:

In May 2009, Science & Sensibility contributor, Henci Goer, presented the findings of her review of the literature on cesarean surgery and a little-known complication: new onset endometriosis. She wrote:

‘So why is this reasonably common serious adverse effect of cesarean surgery something you have never heard of?…Cesarean wound endometriosis would never turn up in a randomized controlled trial (RCT). Even if the problem made it onto the researchers’ radar, the trial would have to be extremely large and follow-up impractically long to detect it. Where RCTs are considered the only evidence worth having, outcomes that cannot be picked up on by RCTs functionally don’t exist.’

Endometriosis is not a “little-known” complication of C-section. Just a brief search of the internet brought up a paper from 1965 and it had been well described long before then. That same brief search revealed literally hundreds of papers on the topic (I stopped counting at 400). Oh, and those papers were not RCT’s because, contrary to Goer’s assertions, RCT’s are not required in order to recognize a phenomenon.

How can supposedly “educated” women fail to be aware that there are hundreds of papers on the topic extending back many decades? They lack basic knowledge of science, statistics and obstetrics. They actually think that because THEY didn’t know something, it must be unknown.

At least Romano has inadvertently acknowledged what I have been writing all along: scientific evidence does not support the central claims of natural childbirth advocacy. In the world of Lamaze, if the evidence doesn’t support the claim, you have to throw out the evidence, … and then you have to delete it if anyone dares to post it on your blog.