Gene Declercq bemoans the lack of debate on homebirth. I’m ready, Dr. Declercq; bring it on.

In the latest issue of Birth: Issues in Perinatal Care (the journal that purports to be objective, but is actually sponsored by Lamaze International), Gene Declercq writes about The Politics of Home Birth in the United States.

According to Declercq:

… [T]he debates over home birth have increasingly begun to parallel current partisan battles in their emotion and intensity with the related gridlock and reluctance to consider compromises that are often necessary to achieve policy goals. This essay calls for a greater willingness for all sides to approach home birth less as an ideological mission and more as a health policy challenge to support consumers interested in an integrated system of care.

Who is Dr. Declercq and why he is involved with this issue?

Gene Declercq combines formal training in political science with almost twenty years of experience as a certified childbirth educator to examine policy and practice related to childbirth in the US and abroad…

He is a Professor of Community Health Science and Boston University School of Health and his work involves

social and behavioral sciences that focuses on identifying and analyzing the social determinants and behavioral risk factors that are associated with public health problems, and using this knowledge to understand and promote healthy behavior within communities.

Contemporary public health issues addressed by the social and behavioral sciences include the prevention and treatment of alcohol and drug abuse, tobacco control, injury control, mental health, domestic violence, prevention of sexually transmitted diseases and HIV, adolescent health, communications, and grassroots political and community organizing.

He served as an advisor to Ricki Lake’s The Business of Being Born and is a partisan of certified professional midwives and the Midwives Alliance of North America.

He is not a scientist, and has no training in medicine, midwifery or basic science.

Dr. Declercq is surprisingly candid about the reality of homebirth advocacy in the US.

The ideological fight over home birth is not between political liberals and conservatives, but rather, over differing perspectives on birth. The gulf between opposing sides in the home birth debate is every bit as wide as the political divide between Tea Party members and, and this division has regrettably led to adoption of some of the tactics used in those political disputes. Contemporary public debate is characterized by neither side feeling that they can be candid about any weaknesses in their position. The focus is essentially on “spin,” with each side coloring their opponent’s positions (or the opponents themselves in more vitriolic conflicts) as devoid of any merit and emphasizing only the most positive aspects of their own position. Calling such confrontations a “debate” is a misnomer, because the two sides invariably do not engage in the exchange of ideas. Rather, the disputants will talk past each other, focusing on either rallying their own core supporters or sending targeted messages to selected subgroups in the larger public. In the larger political context, such views get reinforced with the growth of increasingly narrow media and Internet sources allowing one to avoid contact with any views that conflict with their own…

Unfortunately, Dr. Declercq seems to think that obstetricians behave like homebirth advocates and they do not.

First of all, since homebirth is a fringe issue, most obstetricians don’t care about it, most journals rarely report on it, and there is virtually no one within the obstetrics community who will participate in it.

Second, obstetricians debate with each other all the time, both at conferences and in the pages of obstetric journals. They would be happy to debate professional homebirth advocates, but homebirth advocates won’t debate.

Declercq’s position is reminiscent of anti-vaccine advocates who also complain that scientists won’t “debate” them and that scientists collude to support pre-approved positions.

How often do medical and obstetric society members actually engage with the home birth or the larger birth advocacy communities? Likewise, how often are home birth advocates invited to speak to a medical society, serve on a study group, or participate in the writing of a position statement? This insularity on each side fosters stereotyping of opponents, for example, the repeated referral by home birth opponents to certified professional midwives as “lay midwives.”

To understand the problem with these claims, substitute homebirth advocates anti-vax advocates.

How often do medical and immunology society members actually engage with the anti-vax communities? Likewise, how often are anti-vax advocates invited to speak to a medical society, serve on a study group, or participate in the writing of a position statement? This insularity on each side fosters stereotyping of opponents, for example, the repeated referral by anti-vax opponents to anti-vax alternative practitioners as “quacks.”

Dr. Declercq views might also be more persuasive if he were intellectually honest.

  • Dr. Declercq knows as well as I do that the Midwives Alliance of North America is hiding their own death rates because they are hideous.
  • Dr. Declercq knows as well as I do that state homebirth statistics show astoundingly high death rates.
  • Dr. Declercq flogs the same tired homebirth tropes as other homebirth advocates do. This very paper mentions the Wax study but none of the many studies that demonstrate the increased death rate of homebirth.
  • Dr. Declercq provides intellectual cover for irresponsible homebirth advocates like Ricki Lake and Ina May Gaskin.

Be that as it may, I’m not afraid to debate Dr. Declercq on this issue (or Henci Goer, or Ina May Gaskin, or Jennifer Block, or Ricki Lake or any other celebrity homebirth advocate). We could have a written debate or a live debate in just about any setting he is willing to propose.

The problem with homebirth is not the politics, it is the fact that it leads to preventable perinatal death. Let’s debate the mortality statistics of American homebirth, the woefully inadequate training of certified professional midwives, and the fact that the homebirth movement is led by people with no training in midwifery, obstetrics, science or statistics.

How about it Dr. Declercq?