Henci Goer has staked her career on a simple premise: scientific evidence supports natural childbirth.
In her book, The Thinking Woman’s Guide to Childbirth, Goer, declares:
“Obstetric practice does not reflect the research evidence because obstetricians actually base their practices on a set of predetermined beliefs. If you start from this premise, everything about obstetrics, including the inconsistencies between research and practice, makes sense…
There’s just one teensy, weensy problem. Actually, it’s a big problem. Obstetric practice IS based on scientific evidence. Moreover, a large and growing body of research has failed to support the central claims of natural childbirth advocacy.
What to do? I posed that question back in December 2009.
… [Midwives] could address this problem in several ways. Midwives could modify their specific ideological beliefs on the basis of scientific evidence. Childbirth educators could question whether ideology has had an inappropriate impact on the promulgation and validation of their recommendations. Both those approaches would involve a threat to cherished beliefs. They, therefore, have taken a different approach. They’ve tried to justify ignoring scientific evidence.
That’s precisely what Henci Goer has tried to do in her new book, Optimal Care in Childbirth, written with Amy Romano, CNM, another professional natural childbirth advocate.
Chapter 2 is entitled Why This Book? The Failure of Obstetric Research. What is the failure? Scientific research has “failed” to support Henci Goer’s beliefs. She could, of course, modify those beliefs to reflect the actual scientific evidence. Instead, she attacks the very idea of scientific evidence.
After years of relentlessly insisting that anyone who has a professional or personal interest in childbirth must follow the scientific evidence, Goer does an about face, insisting that the scientific evidence can be ignored because it suffers from problems.
Problem #1: The highest quality scientific studies do not support NCB tenets.
Scientific studies have a hierarchy of reliability. The highest quality studies are randomized controlled trials (if they can be done ethically), followed by other types of experimental studies, population based studies, an observational studies. At the bottom of the hierarchy are case reports, which are simple observations.
“Solution”: Insist that the hierarchy is arbitrary, and that the weakest type of studies should be considered the strongest:
Nowadays, experts reject this hierarchy. Jadad and Enkin (2007) write, “We believe that the … tendency to place RCTs at the top of the evidence hierarchy is fundamentally wrong. Indeed, we consider the very concept of a hierarchy of evidence to be misguided and superficial. There is no ‘best evidence: except in reference to particular types of problem, in particular contexts”. Case reports, for example, can serve as a warning of serious problems too rare to be detected by RCTs, and observational studies are often the only way to gather information on long-term outcomes. In addition, grading the validity of the evidence according to this hierarchy can be misleading. The conclusion of a systematic review of several small, poor-quality RCTs will outrank the results of a single, large, high-quality RCT, and valuable data from well-conducted observational studies are often excluded altogether.
Experts rejected this hierarchy? Anybody besides noted natural childbirth advocate Murray Entkin and his colleague? Nobody else that I (or Henci Goer) could find.
Problem #2: Studies that look at large groups do not support NCB dogma.
… [Scientific studies] aggregate populations and include and exclude participants based on predetermined criteria. This means that, however valid the results may be for the study population, they cannot be generalized with certainty to populations with different characteristics under different circumstances, or even to individuals within the study population.
Duh! That’s the definition of a scientific study. It uses specific criteria. That’s why the results are valuable.
“Solution”: insist that each person is radically unique.
This is a classic technique in quackery. As Boudry and Braekman explain in Immunizing Strategies and Epistemic Defense Mechanisms:
… [I]n discussions about alternative medicine one often hears the claim that each person or patient is “radically unique”, thus frustrating any form of systematic knowledge about diseases and treatments. Of course, advocates of unproven medical treatments use this argument as a way to deflect the demand for randomized and double-blind trials to substantiate their therapeutic claims. If each patient is radically unique, there is no point in lumping patients together in one treatment group and statistically comparing them with a control group… The argument is so convenient that it has been borrowed as an immunizing strategy by countless alternative therapists …
Problem #3: Studies done by actual scientific researchers fail to support the precepts of NCB.
“Solution”: Declare, without any evidence, that scientific researchers are biased.
That medical-model management and its precepts form the backdrop of every study has consequences for the obstetric research … First and foremost, this renders the effects of the medical management model invisible in the same way that fish do not notice the water in which they swim. Under this model, what procedures, drugs. tests, and restrictions the woman undergoes depend little on her condition and almost entirely on her care provider’s philosophy and practices…
Really? Fish don’t notice the water in which they swim? And what has that got to do with anything? If bias affects the results of scientific studies then Goer should be able to show that bias affects the outcome of scientific studies. Simply declaring it is not enough.
Problem #4: Studies that look at bad outcomes don’t support NCB beliefs.
“Solution”: Insist that everything, even bad outcomes, is just a variation of normal.
… [A]lthough all biological processes have wide normal ranges, the medical management model has imposed ever narrower definitions of normal on the physiology of pregnancy and labor without regard for whether certain deviations from the norm represent real problems. Studies then hold women and babies to these restricted parameters, classifying deviation as abnormal…
I could go on and on, but I think you get the idea. The real “problem” is that obstetrics is evidenced based and the philosophy of natural childbirth is not. The “solution” is simply to ignore the scientific evidence.
This is old news in the world of quackery. As Professor Rory Coker explains in Distinguishing Science and Pseudoscience:
Pseudoscience appeals to the truth-criteria of scientific methodology while simultaneously denying their validity. Thus, a procedurally invalid experiment which seems to show that astrology works is advanced as “proof” that astrology is correct, while thousands of procedurally sound experiments that show it does not work are ignored…
Just replace astrology with “natural childbirth” to replicate Goer’s claims. Indeed, every one of Goer’s “solutions” is also invoked by creationists, climate denialists, AIDS denialists and other quacks.
Natural childbirth advocacy is quackery. That’s why Henci Goer is reduced to parroting the classic claims of quacks to defend it.