New website, Evidence Based Birth, suffers from a shocking lack of evidence.

There has always been something Orwellian about natural childbirth, from it inception in a monstrous racist lie (primitive women don’t have pain in childbirth) to its insistence on euphemism (rushes = contractions, vocalizing = screaming). Natural childbirth employs a form of “Newspeak,” author George Orwell’s term for language designed to prevent the thinking of prohibited thoughts. According to Wikipedia:

… Newspeak is closely based on English but has a greatly reduced and simplified vocabulary and grammar. The totalitarian aim of the Party is to prevent any alternative thinking — “thoughtcrime”, or “crimethink” in the newest edition of Newspeak – by destroying any vocabulary that expresses such concepts as freedom, free enquiry, individualism, resistance to the authority of the state and so on…

Moreover:

The aim of Newspeak is to remove all shades of meaning from language, leaving simple concepts (pleasure and pain, happiness and sadness, goodthink and crimethink) that reinforce the total dominance of the State. Newspeak root words serve as both nouns and verbs, further reducing the total number of words; for example, “think” is both noun and verb, so the word thought is not required and can be abolished…

Hence “gave birth” becomes “birthed.”

Natural childbirth advocates love mantras. They are a Newspeak way of claiming something without ever having to prove it. One of the most favored, and over used mantras is that obstetricians don’t practice evidence based medicine. Indeed, when natural childbirth advocates invoke the phrase “evidence based,” it is almost always a short hand way to criticize modern obstetrics. I was interested, therefore, to check out a new natural childbirth website called Evidence Based Birth. I wasn’t disappointed; it is profoundly Orwellian in many ways, particularly in its use of Newspeak and its shocking lack of scientific evidence.

I have already criticized the author, Rebecca Dekker, for her deliberately misleading guest post for Science and Sensibility in which she poses one question and deliberately and misleadingly answers another.

Now let’s look at the latest post on her own blog. Entitled Labor Day 2012: The State of Evidence-Based Maternity Care in the United States, it is remarkable for the fact that it doesn’t contain even a single piece of evidence, not one, to support its central claim that obstetrics in 2012 is not based on scientific evidence. Even Orwell would be impressed by that.

Who is the author of the website and what are her qualifications for writing about scientific evidence in modern obstetrics? Once again Orwell would be proud. Rebecca L. Dekker, PhD, RN, APRN, is an assistant professor of nursing at the University of Kentucky:

… holds a Master of Science in Nursing and Doctor of Philosophy in Nursing from the University of Kentucky. Her research focuses on improving the health outcomes of patients with heart failure who are experiencing symptoms of depression. She has served as the primary investigator on six studies examining the link between depression and heart failure outcomes. She recently completed a randomized, controlled study testing a brief cognitive therapy intervention for depressive symptoms in hospitalized patients with heart failure…

In other words, she has precisely zero training and experience in modern obstetrics, midwifery or even obstetric nursing. Like most self-proclaimed “birth professionals,” birth is her hobby. Perhaps that explains why she can’t find even a single piece of evidence to back her central claim.

As I have written in the past about the extraordinary claim that modern obstetrics is not based on scientific evidence:

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.

Extraordinary claims require extraordinary evidence. To my mind, that should include, at a minimum, 10 solid examples of current obstetric recommendations, central to the practice of obstetrics, that ignore current scientific evidence.

Let see what Dekker offers in her post.

1. A definition of evidence based medicine: so far so good.

2. Praise for the Cochrane Reviews: Dekker immediately goes right off the rails. She apparently doesn’t realize that the Cochrane Childbirth Reviews are riddled with statistical errors. She apparently doesn’t realize that the Cochrane reviews are all systematic reviews, a form of scientific evidence particularly subject to bias

  • There are numerous ways in which bias can be introduced in reviews and meta-analyses of controlled clinical trials.
  • If the methodological quality of trials is inadequate then the findings of reviews of this material may also be compromised.
  • Publication bias can distort findings because trials with statistically significant results are more likely to get published, and more likely to be published without delay, than trials without significant results…
  • Criteria for inclusion of studies into a review may be influenced by knowledge of the results of the set of potential studies…

These limitations can be summarized by the pithy phrase “garbage in, garbage out.” A meta-analysis or systematic review is only as good as the quality of the papers reviewed.

3. How does contemporary obstetric care compare to evidence based care? Answering that question would involve presenting the actual scientific evidence for various obstetric practices. Dekker doesn’t bother. Instead she provides a bunch of irrelevant crap and expects her gullible readers to be impressed.

  • She is sure that there are too many C-sections but provides no evidence of an optimal number.
  • She is sure that there are not enough VBACs but references a government goal, not the scientific evidence.
  • She is sure that there are too many inductions, but she provides no evidence of an optimal number and throws in the irrelevant claim that Cytotec is being used off label.

Most of the remainder of her examples concern atmospherics that are the subject of hospital policy, not obstetric practice. Where is the discussion of the major issues of contemporary practice? Where is the discussion of preventing hypoxic ischemic encephalophathy? Missing. Where is the discussion of preventing preterm birth? Missing. Where is the discussion of management of postdates? Missing. Where is the discussion of treating obstetric complications like hemorrhage? Missing. Instead we have the substitution of NCB tropes like whether or not women should get out of bed during labor.

4. Having provided no evidence for any of her assertions, having ignored most of the major issues in contemporary obstetrics, and having proved nothing, Dekker concludes in a flourish of Newspeak:

… the vast majority of U.S. women are not receiving evidence-based care during childbirth.

We may not be able to draw a conclusion about modern obstetric practice from Dekker’s drivel, but we can draw a conclusion about her website. The website Evidence Based Birth, yet another natural childbirth website put together by a hobbyist with precisely zero experience in obstetrics or midwifery, is just a collection of typical NCB Newspeak. It has nothing to do with evidence, and everything to do with the classic aim of Newspeak: to enforce ideological conformity, the truth be damned.

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  • Katie

    All due respect, midwives are trained in that area among many other areas. Are you? If you aren’t I don’t understand why you would think the way you see something and the way a professional sees it are the same. A midwife would have a much educated outlook on what jaundice looks like vs the general public. Odds are the second nurse was simply agreeing with you to make you feel better.

    • theNormalDistribution

      What kind of midwives are you talking about?

  • Katie

    I failed to see any evidence in this post. I did see plenty of criticizing which would have been perfectly acceptable if you had given examples where the author of the website you are referring to was wrong AND what the correct information should have been, saying “she claims, but where is the evidence?” really gives nothing to your credibility. I enjoy reading critics reviews in order to know whether or not to put stock in a certain website or movie or book, etc … Yet this isn’t even a good critical review. It is basically stating that she is wrong without telling us why or what is right. I mean it actually made me agree with her more and you less. More flies with sugar.

    By the way, evidence based care is the platform for the schooling of top medical fields such as nursing. I would think you would know that. Also, ripping apart the language women prefer to use that steer more toward natural childbirth gives your article even less credibility. Why do you even care if it makes birthing easier for someone to say rushes rather than contractions. Why does that have to be wrong?

    Just from my personal experience, which is all I can give (and it is evidence enough for me): My first birth, I let the doc do her thing, I never argued I never questioned. Above all I TRUSTED her. Without all of the detail it resulted in pitocin before my body was ready and nearly ended in a n unnecessary cesarean. A friend of mine, under the care of the same OB, had two unnecessary cesareans. The first one simply because she was told “we need to do it now while I have time.” ….there was no emergency. My second however, I was allowed to wait out my pregnancy and baby came when he was ready, I was trusted instead, which was refreshing and ultimately what got me to respect and listen to my second provider.

    Also I am having a hard time understanding the attack of natural childbirth…. isn’t it optimal to listen to your body, birth how you feel you need to and bring a child into the world without drugs in their system? Or is it best to lie down, shut up and do as your told? The latter is news to me. By attacking normal childbirth you are giving your subject all the evidence in the world as to why we should be listening to her over you.

  • Snou

    I fail to detect a single bit of evidence within the content if this post. And I truly don’t appreciate the insulting tone and words. How is one supposed to develop any trust before such vicious ranting.

    • Amy Tuteur, MD

      And we should care what you think because … why? What are your qualifications anything related to obstetrics?

    • PJ

      Why do you need to develop trust before you consider the rationality of an argument? Analyse the science, not the tone. That’s what rational people do.

      • katie

        Mostly because if you don’t trust the source you are less likely to see it as rational. Being rational is more than just analyzing the science … of which there is NONE in this blog post.

    • Anj Fabian

      This is vicious? You have led a sheltered life.

      • Katie

        How does it make her sheltered to see the ripping apart of how someone chooses to birth and the language they use to do so as vicious? I consider the act of attacking NORMAL childbirth simply because someone may use a different word here and there than she is used to to be very vicious.

  • Rachel

    Whenever I read Dr Amy i’m reminded of the line from MacBeth- methinks the lady doth protest too much. All i see is the spittle, not intelligent arguments made by reason. (I’m not debating the content of the spittle, I love to read point/counterpoint, and I’m sure you have valid points). All i’m saying is that’s all I see. And I don’t like venom – it makes me question your motives. That’s all.