If homebirth is safe, why do pediatricians oppose it?


I’d like to come at the homebirth issue from a different angle. That’s because homebirth advocates have created an alternate reality of internal legitimacy complete with immunizing strategies to defend against logical arguments.

This alternate reality is based firmly on the notion that obstetricians cannot be replied upon for accurate information because they fear competition from homebirth midwives. The argument is ludicrous on its face, since there is a shortage of obstetricians and homebirth is a fringe of a fringe movement that threatens no one except babies.

But lets bypass the alternate world of internal legitimacy entirely and ask the obvious questions:

If natural childbirth is better for babies, why don’t pediatricians think so?

If waterbirth is safe, why do neonataologists believe strongly that it is dangerous for babies and leads to drowning?

If homebirth is as safe or safer than hospitals, why aren’t pediatricians and neonatologists endorsing it?

The concept of an alternative world of internal legitimacy was introduced in the paper The Legitimacy of Vaccine Critics: What Is Left after the Autism Hypothesis? by Anna Kirkland, published in Journal of Health Politics, Policy and Law in October 2011. It describes vaccine rejectionists, but applies equally well to natural childbirth and homebirth advocates.

[They]have built an alternative world of internal legitimacy that mimics all the features of the mainstream research world — the journals, the conferences, the publications, the letters after the names — and some leaders have gained access to policy-making positions. Mixing an environmentally inflected critique of [obstetrics] and Big Pharma with a libertarian individualist account of health has been a resonant formulation for some years now, with support flowing in from both the Left and the Right.

NCB and homebirth advocates need to ask themselves:

If midwifery and natural childbirth journals are legitimate, why aren’t pediatricans and neonatologists citing their papers?

If NCB is better for babies, why aren’t prominent NCB advocates invited to lecture at pediatric and neonatology conferences?

The answer is obvious. Pediatricians and neonatologists recognize that the empirical claims of NCB and homebirth advocates are flat out false.

Professional NCB and homebirth advocates have long recognized that their claims have no legitimacy outside of their alternate world and have created “immunizing strategies” to deal with the scientific evidence provided by obstetricians. Therefore, they take the precaution of deploying immunizing strategies such as those described by Boudry and Braekman in their paper Immunizing Strategies and Epistemic Defense Mechanisms.

What are immunizing strategies? They are used to “immunize” true believers against the data and arguments of those who disagree. By introducing small bits of those data and arguments, professional homebirth advocates seek to train followers to ignore and discount the valid data and arguments to which they will be exposed.

As Boudry and Braekman explain:

… [A]dvocates of a theory may resort to certain generic strategies for protecting a cherished theory from mounting adverse evidence: cherry-picking the data, shooting the messenger, distorting findings, special pleading, discrediting the methods employed in research with unwelcome results, accusing the new ‘orthodoxy’ of a hidden agenda etc.

In the case of NCB and homebirth advocacy, these include the claim that obstetricians claim that homebirth is unsafe for no other reason than to reduce economic competition.

However, NCB and homebirth advocates have never taken into account the views of pediatricians and neonatologists. Precisely because there is no economic argument to make to vilify those who care for children, they’ve tried to ignore them completely. So let’s not ignore them.

If anyone knows what is safe for babies it is pediatricians and neonatologists who devote their entire professional lives to caring for babies and have no economic incentive to oppose either natural childbirth or homebirth.

Yet pediatricians and neonatologists do not endorse NCB or homebirth and categorically reject most of empirical claims about the purported benefits of NCB and the purported safety of homebirth.

Every NCB and homebirth advocate needs to ask herself the obvious:

If pediatricians and neonatologists can find no benefit of NCB for babies, why should I believe that there is any benefits?

If pediatricians and neonatologists strongly believe that homebirth increases the risk of perinatal death, why should I believe it is safe?