Natural mothering and the irreducible conflict between scientific evidence and radical individuality

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Natural mothering advocates have a serious philosophical problem and infants and children have become the collateral damage.

On one hand natural mothering ideologues are wedded to one size fits all precepts as the foundational “evidence based” recommendations around childbirth, infancy and childhood:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The victims of the conflict are our babies and children.[/pullquote]

  • Unmedicated vaginal birth is “best” for all mothers and all babies
  • Breastfeeding is “best” for all mothers and all babies
  • Natural immunity is “best” for all children and all diseases

But that inevitably leads to problems when the scientific evidence shows something quite different:

  • A minimal C-section rate of 19% is needed to achieve low perinatal and maternal mortality
  • Insufficient breastmilk affects up to 15% of first time mothers in the days after birth
  • Natural immunity can only be achieved with astronomical child mortality rates

That means that relentlessly promoting unmedicated vaginal birth puts newborns at risk of brain injuries and deaths. Aggressive promotion of breastfeeding is leading to the iatrogenic hospitalization of tens of thousands of newborns each year. And anti-vaccination ideology has led to the resurgence of deadly diseases that threaten the most vulnerable among us: infants, immunocompromised and elderly.

That’s when natural mothering advocates fall back on the claim of “radical individuality” to justify ignoring mainstream medical recommendations.

  • Studies that show homebirth to have a higher death rate than hospital birth can’t be applied to individuals
  • Studies that show that insufficient breastmilk has an incidence of 15% can’t be applied to individuals
  • Studies that lead to an optimal vaccination can’t tell us the vaccination schedule that an individual child might need

Why not?

As natural childbirth advocates Henci Goer and Amy Romano wrote in their book Optimal Care in Childbirth:

… [Scientific studies] aggregate populations and include and exclude participants based on predetermined criteria. This means that, however valid the results may be for the study population, they cannot be generalized with certainty to populations with different characteristics under different circumstances, or even to individuals within the study population.

Or as Romano wrote on the Lamaze International blog Science and Sensibility:

…[T]here is no such thing as a good or bad healthcare decision. There’s only such a thing as a good or bad healthcare decision for a certain person. Evidence cannot guide practice without the other piece of the equation – the person to which the evidence is to be applied.

So how do natural mothering advocates justify one size fits all recommendations purportedly based on scientific evidence while simultaneously insisting that no scientific study can yield recommendations for individuals? The simultaneous use of incompatible strategies falls squarely into the category of “motivated reasoning.”

As Wikipedia explains:

When people form and cling to false beliefs despite overwhelming evidence, the phenomenon is labeled “motivated reasoning”. In other words, “rather than search rationally for information that either confirms or disconfirms a particular belief, people actually seek out information that confirms what they already believe”. This is “a form of implicit emotion regulation in which the brain converges on judgments that minimize negative and maximize positive affect states associated with threat to or attainment of motives”.

But there’s more here than an evidence double standard. Natural mothering advocates square the circle with a specific kind of motivated reasoning: the conspiracy theory.

When you stop and think about it, it is clear that the philosophy of natural mothering is based on conspiracy theories:

  • Natural childbirth ideology routinely invokes an economic conspiracy among obstetricians who have marginalized midwives in an effort to increase market share.
  • Lactivism routinely invokes an economic conspiracy among formula companies to profit by increasing market share
  • Anti-vax ideology routinely invokes a massive world-wide conspiracy that seeks to increase Big Pharma profits by mandating vaccines and indemnifying manufacturers

The paper Conspiracy Endorsement as Motivated Reasoning: The Moderating Roles of Political Knowledge and Trust investigates political conspiracies, but it has a lot to tell us about medical/mothering conspiracies.

The authors start by defining conspiracy theories:

[C]onspiracies compose the belief that actors, usually more powerful than the average citizen, are engaging in wide-ranging, “black-boxed” activities to which individuals can attribute an insidious explanation to a confusing event.

The economic conspiracies at the heart of natural mothering ideology firmly fit within this definition. The confusing event is that the scientific evidence does NOT support the claims of ideologues.

How can that be? According to the ideologues, this is the result of deliberate actions on the part of the conspirators.

[E]ndorsing [conspiracy theories] that attribute nefarious intent to political opponents can serve an ideological worldview-confirming function by reinforcing one’s political views through impugning opposing viewpoints…

It may look like the scientific evidence supports a high C-section rate but the doctors who produce the scientific evidence have a financial conflict of interest that leads them to promote the use of technology in birth.

It may look like the scientific evidence support the principle that Fed not Breast is best, but the research is secretly funded by formula companies to promote the use of formula.

It may look like the scientific evidence shows beyond any reasonable doubt that vaccines are safe, effective and do NOT cause autism, but the researchers are secretly in the employ of Big Pharma; they are paid to produce these results.

Theories of radical individuality in this view are not merely self-dealing on the part of ideologues —midwives, doulas, lactation consultants and anti-vax advocates. They are the only way open to those brave enough to confront the conspirators.

There’s one serious problem with this view, however. There’s no empirical evidence to support it.

There is simply no empirical evidence that scientists and physicians are engaged in any effort to promote the economic fortunes of obstetricians. Conflict of interest disclosure mean that breastfeeding researchers who receive formula industry funding must disclose it and most researchers on the risks and complications of breastfeeding have no such relationships. And while there is all too much evidence of Big Pharma take immoral and sometimes illegal steps to produce research that bolsters particular products (for example, Merck and Vioxx), there is no empirical evidence that Big Pharma had any need to pay anyone to prove that vaccines are safe and effective because they are safe and effective.

The bottom line is that there is an irreducible conflict between the scientific evidence about childbirth, breastfeeding and vaccines and the claim that the evidence can’t be applied because of radical individuality. Natural mothering ideologues are fighting a losing battle, invoking fantastical conspiracy theories as a form of motivated reasoning. In the meantime, the collateral damage to infants and children has been enormous.

  • fiftyfifty1

    Radical individuality. You know who provides that sort of obstetric care? OBs do. Emergent CS for the woman who comes in the ER bleeding from an abruption, epidural aided NSVD for the 14 year old nullip, tricky mid forceps rotations for each of the 6 (and counting) births of the grand multip with the wonky pelvis, unmedicated NSVD for the woman who wants a “natural birth”, planned preterm CS for the mono-di twins with TTTS, NSVD for the vertex-vertex twins, maternal request CS.

  • mabelcruet

    “There is simply no empirical evidence that scientists and physicians are engaged in any effort to promote the economic fortunes of obstetricians”

    It’s astounding how fervently some of the natural birth advocates believe that a clinician would decide how best to treat a particular patient based on how much money he can get out of them. In the NHS, there is a consultant salary scale. All of us get the same basic rate across the board, regardless of speciality. There are pay increments based on how long you’ve been doing the job, but obstetricians get paid the same whether they do 100 sections a week or none. It’s the same with midwives-NHS midwives get paid the same whether they deliver the baby or whether the care is taken over by an obstetrician. The financial cost of the procedure doesn’t come into the question of whether it should be done or not, so if an obstetrician suggests a section, its not because he needs the money.

    If you look at the NHS litigation figures (NHS Resolution), the highest amounts paid out are for obstetric care. Litigation arising from surgical or medical care are higher in number overall, but obstetric care claims absolutely dwarf those pay outs. When you look at the obstetric claims, most arise because a section wasn’t done quickly enough to prevent brain damage, rather than a section was done and wasn’t actually needed (which is in itself a retrospective diagnosis). If all obstetricians cared about was money, they’d be insisting everyone got a section at 37 weeks-that’s about the only way we’ll get perinatal mortality down to near-zero.

    • Daleth

      These days in the US, most OB’s work for hospitals or large physician groups affiliated with hospitals, and they work for a salary. It makes zero difference to them how you give birth; their money doesn’t depend on that. Neither does their time: when their shift ends they leave, and another OB takes over. (Unless the shift ends in mid-emergency, of course, in which case they’ll stay until the emergency is resolved.)

      All the NCB myths come from the 1970s and 1980s, when medicine was practiced very differently in the US. The world has evolved, but NCB activists haven’t noticed (or are they refusing to notice?).

      • MaineJen

        LOL! True story. My first birth took me through a shift change on a Saturday night; I started the day with a CNM and one pair of nurses, ended the day with an OB and a completely different pair of nurses. Fine with me! Everyone was rested and alert, and all were content for the process to take as long as it took.

  • fiftyfifty1

    But we’re special. And wise. And persecuted!

    • rational thinker

      yup snowflake syndrome.