When you don’t understand an obstetric recommendation …

Here’s a little unsolicited advice for natural childbirth and homebirth advocates who are constantly complaining about obstetric recommendations that they don’t understand.

If you don’t understand an obstetric recommendation:

1. Don’t conclude that your midwife, your doula, Henci Goer, or you have a better grasp on the scientific evidence than obstetricians do.

In the first place, neither your midwife, your doula nor you have read the obstetric scientific literature, so you literally have no idea what it says. And Henci Goer has read the literature, but she quotes it extremely selectively and in ways that are deliberately misleading. That’s how she makes her money: flattering women who are clueless into believing they are “educated.”

Any truly educated person knows this already. Educated people tend to have great respect for the education of other people. You won’t find too many doctors giving legal advice, or architects giving advice on dentistry. The classic sign of an uneducated person is their dismissal of others who have more education.

If you don’t understand an obstetric recommendation:

2. Don’t conclude that your obstetrician made it up in order to get to his golf game.

Newsflash, this is the 2010’s,not the 1950’s. The majority of obstetricians are women and most of them don’t play golf. Moreover, in case you haven’t noticed, a major proportion of obstetricians are on salary and work fixed hours. They aren’t going to play golf or do anything else while they are on call; they will be in the hospital anyway.

I’m not aware of a single study that demonstrates or even suggests that obstetric recommendations have their genesis in the desire to get to the golf course or anywhere else.

If you don’t understand an obstetric recommendation:

3. Don’t conclude that anyone is making money from that recommendation.

As mentioned above, a major proportion of obstetricians are on salary. Their compensation is not affected by whether you have a C-section, an induction, or any interventions. Entire countries have put doctors on salary (e.g. England) and their C-section rates have skyrocketed, too.

If you don’t understand an obstetric recommendation:

4. Don’t assume it is “defensive medicine.”

This is apparently going to come as a real shock to some NCB and homebirth advocates, but doctors (and nurses) are legally and ethically required to follow professional practice standards. It’s not discretionary. They must make recommendations in keeping with the latest scientific evidence, not the latest NCB fads.

What is “defensive medicine” anyway? It’s the attempt to prevent you or your baby from dying or being seriously injured. It is as “defensive” as seatbelts or flossing your teeth. It doesn’t guarantee good outcomes, but it makes them more likely. The fact that a recommendation turns out to have been unnecessary is no different than when it turns out that your car wasn’t involved in a crash today. It wasn’t “unnecessary” to wear your seatbelt.

If you don’t understand an obstetric recommendation:

5. Don’t assume that the midwife, doula, neighbor or a stranger on an internet message board who is advising you to ignore that recommendation has your best interests at heart. More often than not, they have THEIR best interests at heart. Midwives and doulas want more than anything else to get paid. It does not take a rocket scientist to figure out that midwives and doulas will tell you to ignore recommendations that they cannot get paid for (since they don’t know how to implement those recommendations). Even worse, they may lose you as a client (and your fee) if you decide to follow your obstetrician’s recommendation.

Your neighbor and the stranger on an internet message board may not have your interests at heart, but for an entirely different reason. They need to have their own choices mirrored back to them in order to boost their self esteem. They are invested in having you copy whatever they did.

There are a lot of things wrong with both natural childbirth and homebirth advocacy. Of course the principle fault is that most of it is not supported by the scientific evidence, but possibly the second largest fault is that its purveyors make money by creating mistrust and suspicion of professionals who have far more education, training and experience than they do. It’s obvious why they do it; they want you to discount the obvious benefit of having a highly educated, well trained and experienced provider in an effort to get you to choose an poorly educated, minimal trained, inexperienced (“experts” in normal and therefore incapable of preventing, diagnosing and managing complications) lay person like themselves.

Obstetricians are not saints and there is plenty wrong with the current organization of medicine, but don’t be fooled. Homebirth midwives, doulas, childbirth educators and purveyors of NCB and homebirth books and websites aren’t interested in you and don’t even care whether your baby lives or dies (since “babies die in the hospital, too”). There is NO ONE more committed to making sure that you and your baby are healthy than your obstetrician.

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