If homebirth is safe, why do pediatricians oppose it?

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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?

  • GoodDaySunshine

    I’m sure there are plenty of pediatricians out there who abhor the idea of homebirth, I know my old one did. She was not supportive of anything not main stream. She would get excited if I told her that my son had had some formula because he drank what I had pumped, then she would always look so let down when I told her it was one 4oz bottle and just on that one day. She always made me feel like I was going to have to circumcise my son because he was not fully retractable at birth. Then when I stated I was having a homebirth with my second, she berated me for 5 minutes on the phone before I could politely end the conversation. Needless to say, I found a new one who is much more knowledgeable about caring for un-circed boys and who follows the WHO growth chart which is more breastfeeding friendly. They did not like that I was having a homebirth but they were very respectful about it, which was really all I was asking for. It is not in their field to take care of a pregnant mother and help her birth, they are in the business of taking care of the babies afterwards. I’m sure it is heartbreaking to have a new patient who is damaged or didn’t make it. But, they also have a battle of their own in wrestling the monster called SIDS.

    • Box of Salt

      Good Day Sunshine ” But, they also have a battle of their own in wrestling the monster called SIDS.”

      Have your heard the phrase “Back to Sleep”? We’ve been wrestling that monster for over a decade now.

      • GoodDaySunshine

        I know the phrase, but even that isn’t bullet proof. I’ve seen the hundred dollar systems that companies make to help feed the fear in parents.
        I was just stating that each line of practice has it’s own Goliath to tackle.

  • amyrobin

    I’ve always found the claim that OBs are only against homebirth for the money, ridiculous since, like you said, there is a shortage of OBs and they certainly are not hurting for work, even if it were just high risk patients! Also no ones seems to look at the obvious other question within that accusation…If OBs are against homebirth (supposedly) for their own vested interest, what about homebirth midwives? Talk about a vested interest to make you believe that natural drug free homebirth is better and safer!