Lie, deny, decry, defy: the indisputable signs that natural childbirth is quackery

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Rory Coker, professor of physics and University of Texas Austin, has written a very informative article for the website Quackwatch. The article, Distinguishing Science from Pseudoscience, was not written with the philosophy of natural childbirth in mind, but the criteria he describes make it quite clear that natural childbirth in general and homebirth midwifery in particular are nothing more than quackery.

Consider Prof. Coker’s principles in light of the recent efforts by natural childbirth and homebirth advocates to suppress the dangers of waterbirth and homebirth.

Pseudoscience displays an indifference to facts.

Waterbirth is unnatural. No primates give birth in water and everything we know about neonatal physiology tells us that babies are “designed” to be born into air. No matter. Waterbirth is touted as soothing, comforting and above all “natural.”

Pseudoscience “research” is invariably sloppy.

Of course, that’s when there is any research at all. The tenets of natural childbirth in general, and waterbirth in particular, were instituted without any efforts made to empirically validate theirs claims. The fear-tension-pain cycle? It was made up by Grantly Dick-Read and is still promoted by natural childbirth organizations in the absence of any evidence to support it. Barbara Harper has never done any research to validate her nonsensical claims about waterbirth. She probably wouldn’t know how to conduct research even if she wanted to do so

Pseudoscience begins with a hypothesis—usually one which is appealing emotionally, and spectacularly implausible—and then looks only for items which appear to support it.

That pretty much describes the entire natural childbirth literature; it is one giant festival of cherry picking, highlighting papers that appear to support it and ignoring the vast body of medical literature that does not.

Pseudoscience is indifferent to criteria of valid evidence.

At this point, natural childbirth and much of contemporary midwifery theory isn’t merely indifferent to the criteria of valid evidence, they are actively hostile to it, offering claims as disparate as randomized controlled trials are “tyrannical“; case studies of deadly waterbirth outcomes are meaningless; the series of bald-faced lies about birth certificates put forth by Melissa Cheyney, CPM and Wendy Gordon, CPM to justify their refusal to compare MANA’s homebirth death rates with US perinatal death rates; and my all time favorite: Including the Non-Rational is Sensible Midwifery.

Pseudoscience relies heavily on subjective validation.

Waterbirth advocates like The Feminist Breeder have twisted themselves into knots over this. On the one hand, case studies demonstrating catastrophic outcomes at waterbirth are derided as useless and large scale studies that show that waterbirth is poor at relieving labor pain are dismissed out of hand, while at the exact same time (without any consciousness of irony), waterbirth advocates claim that they “know” that waterbirth provides excellent pain relief because some women claim it does, and we should avoid telling women about the dangers of waterbirth until we have large scale studies of those outcomes.

TFB’s piece is downright buffoonish, implying as it does that because she can’t see bacteria in waterbirth pools, there is no bacteria.

Pseudoscience always avoids putting its claims to a meaningful test. I would add to that the fact that natural childbirth and homebirth advocacy, like all pseudoscience, strenuously avoids debating real scientists.

Natural childbirth and midwifery theorists rarely carry out quantitative research to validate their claims, and often cheerfully ignore the results of those carried about by medical researchers. They never follow up and they never acknowledge, let alone learn from, mistakes. Midwives implemented waterbirth without ever investigating whether it is safe, are desperately trying to ignore the research from neonatologists and perinatologists that shows that waterbirth has deadly dangers, and, most revealing, have absolutely no plans to investigate the deadly dangers. Waiting for a large scale midwifery study to evaluate the risk of hyponatremia, drowning or umbilical cord avulsion during waterbirth? Don’t hold your breath.

Pseudoscience often contradicts itself, even in its own terms.

See above: we don’t have to pay attention to case studies of death at waterbirth, but we “know” that waterbirth provides excellent pain relief because women (case studies) tell us so.

Pseudoscience appeals to false authority.

A high-school dropout is accepted as an expert on “normal birth” and is awarded a fake midwifery credential (CPM). Barbara Harper, an RN thoroughly ignorant of neonatal physiology and even basic chemistry, is considered an “expert” on waterbirth even though though she has never studied it in any remotely scientific way. Henci Goer, who is not an obsterician, midwife or scientist is regarded as an “expert” on the obstetric literature.

Celebrity endorsements are integral. Ricki Lake swears that homebirth is safe, so it must be. Emotional appeals are common. (“Trust birth!” “Trust your mama intuition!”) Natural childbirth/homebirth advocates are fond of conspiracies. (“Doctors just want to ruin your birth experience!” “Obstetricians recommend interventions because they make money from them!”) When confronted by inconvenient facts, they simply reply, “Doctors don’t know everything!”

Pseudoscience relies heavily on anachronistic thinking.

It’s the wisdom of our ancient foremothers! That goes twice for ideas that are obviously wrong and have been debunked by science, while pretty much sums up natural childbirth and contemporary midwifery theory.

To paraphrase Coker’s conclusion:

Characteristics of Pseudoscience

The natural childbirth/homebirth literature is aimed at the general public. There is no review, no standards, no pre-publication verification, no demand for accuracy and precision.

No physical phenomena or processes are ever found or studied. No progress is made; nothing concrete is learned.

Natural childbirth/homebirth appeals to faith and belief. It has a strong cult-like element: it tries to convert, not to convince. You are to believe in spite of the facts, not because of them. The original idea is never abandoned, whatever the evidence.

Natural childbirth/homebirth advocates often earn some or all of their living by selling products (such as doula services, books, courses, and supplements) and/or pseudoscientific services (such hypobirthing, natural childbirth courses, etc.)

Most damning of all, infant deaths (and maternal deaths) are ignored, excused, hidden, lied about, discounted, explained away, rationalized, forgotten, avoided at all costs.

It happens with waterbirth, it happens with homebirth, and it happens with deaths at the hands of contemporary midwifery theorists. Lie, deny, decry, defy. Those are the hallmarks of quackery and those are the hallmarks of natural childbirth and homebirth.