Homebirth advocates take another page out of the tobacco playbook

In the late 1960’s, a tobacco company executive circulated a memo among his colleagues. He was attempting to counter the large and growing body of research that demonstrated that smoking caused lung cancer and other serious illnesses.

Doubt is our product since it is the best means of competing with the “body of fact” that exists in the mind of the general public. It is also the means of establishing a controversy. Within the business we recognize that a controversy exists. However, with the general public the consensus is that cigarettes are in some way harmful to the health. If we are successful in establishing a controversy at the public level, then there is an opportunity to put across the real facts about smoking and health. (my emphasis)

The memo is startling for its insight. Simply put, tobacco companies did not have to refute the scientific evidence about smoking and cancer; merely creating doubt in the mind of the American consumer was all that was necessary to maintain or increase demand for cigarettes.

Homebirth advocates have taken a page out of the tobacco playbook. They don’t have to refute the large and growing body of scientific evidence that homebirth increases the risk of perinatal death; merely creating doubt about the evidence, as well as doubt about motives of obstetricians and hospitals is all that is necessary to maintain or increase the demand for homebirth.

In reviewing the book Doubt is Their Product: How Industry’s Assault on Science Threatens Your Health, a journalist explains the process, now used by pseudoscience aficionados from creationists to climate denialists:

They can always get it published somewhere. And if they can’t, they can just start their own peer-reviewed journal, one likely to have an exceedingly low scientific impact but a potentially profound effect on the regulatory process.

All of science is subject to such exploitation because all of science is fundamentally characterized by uncertainty. No study is perfect; each one is subject to criticism both illegitimate and legitimate — and so if you wish, you can make any scientific stance, even the most strongly established, appear weak and dubious. All you have to do is selectively highlight uncertainty, selectively attack the existing studies one by one, and ignore the weight of the evidence…

How does it work in practice?

1. Never mention the large and growing number of studies that demonstrate that homebirth increases (often spectacularly) the risk of perinatal death.

2. Never mention state or national statistics that also show that homebirth increases the risk of perinatal death. If someone else mentions them, declare that it hasn’t been published in a peer review journal; don’t tell anyone that government collected statistics don’t have to be published in a peer review journal since they are raw data.

3. Criticize one or two bad studies and imply that they are representative of the entire scientific literature. The go to studies for homebirth advocates are Pang and Wax. Don’t mention that the rest of the scientific literature shows the same thing.

4. Start your own journal to publish the “studies” that reputable journals refuse to publish. It is a little known fact that Birth: Issues in Perinatal Care, is owned by Lamaze.

5. Hide internal data that shows that homebirth increases the risk of death. One day, an enterprising state attorney-general is going to subpoena the safety data on 24,000 homebirths gathered by the Midwives Alliance of North America (MANA). The we will have confirmation that MANA executives like Melissa Cheyney have known all along that homebirth increases the risk of neonatal death.

6. Point out that obstetricians have been wrong in the past, even though that has no bearing on whether they are wrong about this issue.

Tobacco executives wanted only to cast doubt on the link between smoking and lung cancer. Homebirth advocates, on the other hand, want to cast doubt on the entire field of obstetrics. Prof. of Marking Craig Thompson detailed their methods and goals back in 2005 in a paper about their primary tactic, inculcating reflexive doubt.

Thompson is talking about natural childbirth advocates, of which homebirth advocates are a subset:

… Advocates of natural childbirth seek to inculcate reflexive doubt by countering two commonsense objections to their unorthodox construction of risk: (1) medicalized births would have never gained a cultural foothold if they were so risk laden and (2) the medical profession would not support obstetric practices that place laboring women at risk.

… [T]he cultural dominance of medicalized childbirth is explained as the historical artifact of a fin de siecle struggle between midwives and physicians, where the latter group held a decided economic and sociocultural advantage… [and used it] to displace midwives (both socially and legally) as the authoritative source of childbirth knowledge…

… [M]any obstetric interventions that were once deemed to enhance the safety of birth or to improve postpartum outcomes, shaving of the women’s pubic region; … lithotomy position; enemas; … have all been discarded as ineffective, unnecessary, and in some cases, potentially harmful. The natural childbirth community invokes this historical legacy to argue that many contemporary obstetric interventions are likely to meet a similar fate

Homebirth advocates recognize that they don’t have to prove that homebirth is safe, and they couldn’t do that if they tried. All they have to do it sow doubt about the existing scientific evidence that homebirth increases the risk of perinatal death.

And why not? If it’s good enough for tobacco executives in promoting their product, it’s good enough for homebirth advocates in promoting theirs.

[edited to include the full title of the journal Birth: Issues in Perinatal Care. The Journal of Perinatal Education, a journal for childbirth educators, is also owned by Lamaze.]