Beware Big Birth!


It’s often an “aha” moment for women when they realize that birth is an industry.

I’m not talking about hospital birth. While that, too, is a money making proposition, no obstetrician is afraid of running out of patients. For better or worse, pregnant women need obstetricians, will always need obstetricians, and obstetricians have no need to convince women to give birth in hospitals since 99% already do so. Obstetricians are not afraid of losing business to “birth workers.”

Moreover, a substantial proportion of obstetricians are salaried or paid by insurance companies that offer no premium for extra services. There is no incentive to do any more than what he or she thinks is necessary to ensure a healthy baby to a healthy mother.

No, I’m talking about “Big Birth,” the industry of birth workers (doulas, childbirth educators, and midwives to some extent). They sell services, books, products and courses. No one actually needs any of those books and products; they are entirely discretionary. Therefore, the entire industry of Big Birth depends on convincing women that they need these books and services. Although many women don’t realize it, advocates of natural childbirth (and virtually all “birth workers” are advocates of natural childbirth) must be engaged in full time marketing in order to make a living.

That marketing involves two major prongs: convincing women they need what birth workers are selling, and warning women that obstetricians are not to be trusted.

What is Big Birth selling?

They are selling their personal view of the ideal birth.

It is important for women to understand that natural childbirth is one-size-fits-all approach. It doesn’t matter who you are, what your medical problems are, what your specific fears and concerns are, what you think is the ideal birth for you; all of that is irrelevant. Big Birth must convince you that unmedicated vaginal birth is what you really want and need.

There are important obstacles in the way. The first is pretty obvious: hours of agonizing labor pain. Ever since the discovery of chloroform for easing labor pain, women have avidly adopted analgesia in childbirth. Indeed, in the early years of the 20th Century, pain relief in labor was recognized by women’s groups in nearly all industrialized countries as a fundamental right. All women were seen as entitled to pain relief in labor regardless of their ability to pay for it, just like all women were entitled to anesthesia during surgery regardless of their ability to pay for that.

Because childbirth is inherently agonizing (it so impressed the writers of the Bible that the only way they could explain it was as a divine curse) and because human beings natural wish to avoid agonizing pain, it’s been an uphill battle for Big Birth, but they finally hit on a double barreled solution. The first part is to convince women that epidurals, the only truly effective method for abolishing the pain of childbirth, are dangerous for their babies; that’s nothing more than a lie, but as I explained yesterday, lying is central to natural childbirth advocacy. And although Big Birth does not lie outright about the maternal risks of epidurals, they grossly inflate the risks and minimize the benefits.

The second barrel is the imperative to convince women that the “ideal” birth as envisioned by birth workers (an unmedicated vaginal delivery) is somehow superior to other ways of giving birth and that women who “achieve” an unmedicated vaginal birth are somehow superior to women who don’t. Why would a woman buy any of the services and products sold by birth workers if they weren’t convinced that they needed them? Obviously they wouldn’t, so it is absolutely critical for Big Birth to convince women that there is a “best way” to give birth and they can help you achieve it.

The other important obstacle to Big Birth is that they don’t have the knowledge and skills to offer life saving services. The marketing solution to that is simple: just convince women that birth is so safe that almost no one ever needs those life saving services. It’s a lie, but, once again, a lie is no problem for the marketing gurus of Big Birth.

To summarize, the first part of the Big Birth marketing strategy is to convince women that unmedicated vaginal birth is “ideal,” that pain relief is dangerous, and that birth is so safe that almost no one needs the interventions recommended by obstetricians.

The second major prong in Big Birth’s marketing strategy is to create distrust of obstetricians. Women need obstetricians. They don’t need birth workers, so thy must be convinced that obstetricians are out to harm them and that only birth workers can prevent that harm. That, too, is a lie, but in Big Birth the ends (profit and autonomy for birth workers) always justifies the means. Most of the claims of Big Birth are ludicrous on their face and no one would believe them of other doctors, but it is a testament to the marketing genius of Big Birth that they have managed to convince a great number of women that the people who devote their lives to caring for pregnant women and their babies (obstetricians, obstetric anesthesiologists, perinatologists and neonatologists) actually want to harm women and babies. Or, equally ludicrous, the idea that obstetricians don’t follow scientific evidence while “birth workers” do. Obstetricians don’t merely follow scientific evidence, they are the ones who create it. Birth workers, on the other hands, follow their hearts and prejudices, with their own autonomy as their only fixed lodestar. They simply make stuff up and then pretend that it is true.

Case in point, Barbara Harper, the doyenne of American waterbirth, and basically a buffoon when it comes to neonatal physiology, is revered in the world of Big Birth as an “expert” on waterbirth. She just makes it up as she goes along and major childbirth organizations from Lamaze, to the American College of Nurse Midwives throw ethics and intelligence to the wind to back her.

Indeed waterbirth is an outstanding illustration of the marketing tactics of Big Birth.

Whatever you want to say about waterbirth, no one can deny it is unnatural since no primates, let alone human beings, give birth in water. But for Big Birth the truth is irrelevant and waterbirth is marketed as “natural” pain relief.

Waterbirth was never tested before birth workers implemented it as a “treatment.”

Point out to midwives and other birth workers that waterbirth has deadly iatrogenic complications ranging from drowning to tearing off the umbilical cord while lifting the baby out of the birth pool, and midwives and birth workers won’t even bother to investigate the reports before dismissing them out of hand.

As Dr. Clay Jones notes in today’s post on Science Based Medicine, An Update on Water Immersion During Labor and Delivery:

A fine example of complementary and alternative reality in regards to labor and delivery can be found at Waterbirth International, which is run by >Barbara Harper, a nurse who preaches the benefits of waterbirthing all over the world and who is a proud proponent of rebirthing-breathwork. Rebirthing-breathwork is the concept that suppressed negative emotions can be healed by reliving one’s birth…and breathing a lot. Also there is something in there about cells having feelings. Harper gets the last word in the NPR article:

“I think this is backlash from the gaining popularity of water birth,” says Barbara Harper, founder of Waterbirth International, an advocacy organization…One thing that happens in a water birth, you as the attending physician pretty much have to stand there with your hands in your pockets and let it happen without your participation. That is pretty scary to a physician-oriented institution.”

How’s that for a straw man? Medical experts are apparently only skeptical of waterbirth because we don’t get to participate, which I have little doubt is code for “we don’t like it cause we don’t get paid.” I wonder if she works for free.

I believe that most rational people, even those with no medical experience, intuitively understand that delivering a baby into a body of water, even a sterile one, would be inherently risky. Human newborns, as with all other primates (take that Discovery Institute) breathe almost immediately upon arrival into this world. This helps to initiate a chain of events that assists the neonate in transitioning from fetal to adult circulatory patterns, and there are millions of years of evolutionary momentum behind this process. But besides being a completely unnatural act, something that usually sends proponents of pseudoscience running, there are numerous potential risks involved with giving birth underwater.

In other words lying (about the risks), denying (the complications), decrying (obstetricians) and defying (science).

Birth Big is a business. They are selling a product (unmedicated vaginal birth) that has no real benefits so they’ve had to make up the benefits. Many birth workers have no real skills, and even the best educated lack the lifesaving skills of obstetricians, so they’ve had to deny the need for such skills (Trust birth!), and demonize both the skills and the obstetricians who wield them.

There is an old Latin aphorism that comes to mind in this situation: Caveat emptor! Let the buyer beware!

That’s good advice when it comes to Big Birth. Pregnant women should be savvy consumers and understand that Big Birth is trying to sell them products and services that they don’t really need. If women want to buy them, it’s up to them, but they ought to recognize that Big Birth markets its products the exact same way that Big Business markets theirs: convincing you that you need the product, that buying the product will indicate that you are a superior person, that the competition is not to be trusted, … and that the safety standards of the competition aren’t really necessary at all and just add to the price of the product.

Would you buy a car from a manufacturer who claimed that buying their car indicates that you are a superior person, that other car manufacturers are ignorant fiends who want to hurt you, and that airbags are unnecessary because most people never crash? Probably not.

Then why would you buy a birth from a provider who claims that there is an “ideal” way to give birth, that if you do it their way you are a superior person, that the people who are experts in every kind of birth (obstetricians) are ignorant fiends who want to hurt you, and that safety features (interventions) are unnecessary because most women won’t have life threatening emergencies?