Natural childbirth advocates employ birth affirmations as a form of magical thinking. They appear to believe that if they just wish hard enough, they can affect the likelihood of the unmedicated vaginal birth that they are supposed to want.

That’s nonsense, of course. But birth affirmations are also anti-feminist. They are anti-feminist because they assume that a woman’s virtue resides in her vagina, because they ignore women’s needs and desires, and because they arise from philosophies that seek to immure women back into the home.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]A woman’s virtue does not reside in her vagina.[/pullquote]

My feminist mothering affirmations rest on the opposite premises:

• A woman’s virtue resides in her mind, talents and character. Whether or not a baby transits her vagina is no more important than whether or not she wears glasses.
• Women’s needs — for pain relief in labor, for control of whether their breasts are used to feed their babies, for participation in the world beyond mothering — are more important than any purported benefits from natural childbirth, breastfeeding or attachment parenting. Whether or not a woman chooses to adhere to these philosophies is her decision, based on what she thinks is best for her children, not what other people, ignoring scientific evidence, think is best for her children.
• Women — and society — benefit when they are encouraged to use the full range of their talents in the wider world, and women — and society — are harmed when women are immured in the home, forced to restrict themselves to childcare.

Here are my top ten feminist mothering affirmations:

1. It makes no difference how my baby is born.

Over the course of your son or daughter’s childhood, you will have many occasions to ponder how your actions impact your child’s life and you will second guess yourself many times, wondering if you had handled a specific situation differently might your child have been happier or more successful. Whether your baby was born vaginally or by C-section should never be one of them. It will make absolutely, no difference to your child how he or she emerged from your womb (or, in the case of an adopted child, even if he or she emerged from your womb). There is no reason for you to worry or obsess about how your baby is born.

2. There is no reason for me to suffer.

Some lucky women have a manageable amount of pain in labor and don’t need any relief. Most, however, have an unmanageable amount of pain and desperately seek relief. There is NO REASON to forgo pain relief when you are in pain. It is not safer, healthier or better in any way for your baby or for you to withstand hours of excruciating pain.

3. I am not in competition with other women.

Admittedly this is hard to believe when your friends, acquaintances and casual strangers demand details of your birth so they can compare their “performance” to your “performance,” but it’s true. It’s nobody’s business how you choose to give birth to your child and they don’t deserve to comment upon or even to know those private details.

Childbirth is not a performance that ought to be rated or compared. Childbirth is a bodily function like vision. Sometimes it works well; sometimes it needs help. No one judges women who wear glasses or contacts for nearsightedness even though their eyes don’t work “as nature intended.” Nearsightedness just happens, is no one’s fault and implies nothing about the overall health or quality of a woman’s body. Similarly, childbirth complications just happen, are no one’s fault and imply nothing about the overall health or quality of a woman’s body.

4. I am not guaranteed a healthy baby, so I need to consult with the professionals who can help me ensure my baby’s health.

Human reproduction, like all reproduction, has a high degree of “wastage,” which is another way of saying that death is a common complication of pregnancy. For example, 1 in 5 established pregnancies will end in miscarriage. No amount of wishing and hoping will change that. Similarly, in nature, nearly 10% of pregnancies will end in the death of the baby, the mother or both. Fortunately, the interventions of modern obstetrics can prevent the vast majority of those deaths, but only if you avail yourself of those interventions and the expertise of the people trained to use them.

5. I will not trust birth, because birth is not trustworthy.

Trusting birth makes about as much sense as trusting vision. No amount of trusting will prevent nearsightedness, so refusing eye exams in favor of trusting vision is stupid in the extreme. That goes double for childbirth, which is far more deadly than nearsightedness.

6. I will carefully analyze the motives of those who declare that any particular way of giving birth is “better” than any other.

When you take the time to analyze the advice and recommendations of “birth workers” like midwives, doulas and childbirth educators, ask yourself if they profit when you follow their advice. That does not mean that their advice is necessarily wrong, but it can and too often does compromise their recommendations. Instead of recommending what is good for you and your baby, they may be recommending what is good for their wallet.

Similarly, you should analyze the advice and recommendations of friends and acquaintance looking at how they benefit if you do what they suggest. Are they anxious for you to validate their birth choices by making the same choices? If so, feel free to ignore them.

7. I will not take pregnancy advice or care from anyone who won’t take responsibility for that advice or care.

If a homebirth midwife doesn’t carry insurance, and makes you sign a document declaring that the responsibility for any and all outcomes in yours, she is signaling that even she doesn’t believe that she is educated enough or trained enough to take responsibility your baby’s life or for your life. Real professionals take legal and ethical responsibility for their work; amateurs and hobbyists never do.

8.My baby does not care whether he or she is breastfed or bottlefed.

It makes literally no difference to the baby how he or she gets fed, only that he or she gets fed. Yes, breastfeeding does have some advantages, but those advantages are small and in industrialized countries those benefits are trivial.

9. Both the baby’s needs and my needs matter when it comes to infant feeding.

Yes, breastfeeding can be difficult and stressful in the first few days and weeks, and it is great to persevere through those difficulties if breastfeeding is important to you. But the baby’s hunger and suffering count for a lot, and if you feel your baby is suffering from hunger, you should feel free to feed the baby formula. Your pain and suffering count, too. If your nipples are raw and bleeding, if you have horrible pain when nursing, if you start crying every time the baby cries with hunger, dreading nursing, it is perfectly healthy and acceptable to use formula instead, either for supplementing or exclusively.

10. I will not judge my mothering by the performance of my body.

You mother with your entire body. Your arms hold and embrace your children. Your hands guide. Your lips kiss. Your brain plans and worries, and your metaphorical heart loves your child. Your uterus, vagina and breasts are trivial when compared to the other body parts, so it makes no sense to judge your mothering by whether you had a vaginal birth or breastfed your children.

Mothering is hard. I know; I have four children and I have spent countless hours caring and worrying, wishing I could carry their burdens, smooth their paths, and absorb their hurts. My children are adults now, and no doubt there are many things that they think I could have done better, but they never, ever give any thought to their route of delivery or to whether or for how long they are breastfed.

Don’t judge yourself on these issues, and don’t let anyone judge you. It isn’t simply doesn’t matter and it’s anti-feminist.

 

Adapted from a piece that first appeared in August 2014.

Imagine if I said the following:

The proportion of parents refusing vaccines has steadily increased over the past decades. Let’s stop debating whether refusing vaccines is safe and instead engage in examination of the factors that may make vaccine refusal safer.

I’d be roundly and appropriately condemned by pediatricians, immunologists and public health officials even though vaccine refusal has grown tremendously to affect as much as 20% of children.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There’s nothing subjective about the fact that homebirth with a CPM leads to preventable infant deaths. [/pullquote]

Why?

Because we understand that vaccine refusal stems from lack of knowledge about how vaccines work or the dangers of vaccine preventable illnesses, and a fraud committed by Dr. Andrew Wakefield falsely connecting vaccines to autism. It is the responsibility of medical professionals to meet this knowledge deficit with accurate information, correcting myths and misapprehensions with scientific data.

We are also coming to understand that vaccine refusal is closely tied with privilege, defiance and a faux sense of empowerment. Nothing screams privilege louder than ostentatiously refusing something that poor women around the world are desperate to have. Anti-vax parents glory in defying authority, imagining that it marks them as “educated.” Similarly vaccine refusal is viewed by anti-vax parents as an empowering form of rugged individualism, marking out their own superiority from those pathetic “sheeple” who accept medical authority because they haven’t done “their own research.”

So why are some obstetricians insisting that we need to examine the factors that may make homebirth safer when it has risen from a fringe of a fringe practice (0.87% of births) to a fringe practice (1.5% of births)? That’s the terrible mistake made by Ellen L. Tilden, PhD, CNM; Jonathan M Snowden, PhD; Aaron B Caughey, MD, PhD; Melissa J. Cheyney, PhD, CPM, LDM in their Medscape commentary Making Out-of-Hospital Birth Safer Requires Systems Change.

They write:

… [O]ut-of-hospital births have steadily increased over the past decade, up 72% from 0.87% of US births in 2004 to 1.5% in 2014. This trend shows no sign of reversing; disengaging with the debate over whether out-of-hospital birth is safe and instead engaging examination of the factors that may make out-of-hospital birth safer is of critical import. Formally including home and birth center care in US maternity care systems will improve outcomes for the growing numbers of women seeking care outside of the hospital. In parallel, increasing the availability of physiologic birth in-hospital may decrease the number of women choosing out-of-hospital birth as a means of avoiding unnecessary intervention, with the added benefit of reducing iatrogenic maternal morbidity for the predominance of low- to moderate-risk women who choose hospital birth.

Why should we take that approach to a dangerous fringe practice when we would appropriately condemn pediatricians like Dr. Bob Sears who take that approach to vaccine refusal, a dangerous practice that is widespread.

I have deep sympathy for Dr. Caughey and his obstetric colleagues who are daily forced to witness the tragic outcomes of homebirths attended by CPMs, counterfeit midwives who can’t be bothered to meet the international standards for midwifery practice. Obstetricians are desperate to save the lives of babies endangered by incompetent practitioners, and mothers who have been fed a steady diet of mistruths, half truths and outright lies by the homebirth industry.

But American homebirth is MORE dangerous than vaccine refusal; an approach that attempts to straddle the homebirth fence is unlikely to address the deadly risk it poses.

Why?

Because homebirth, just like vaccine refusal, is based on misinformation, privilege, defiance and a faux sense of empowerment. CPMs are just like vaccine charlatans, spreading lies about the inherent dangers of childbirth, and encouraging potential clients to imagine themselves as smarter than and superior to the sheeple who merely follow the medical advice of their obstetricians.

The authors write:

What one deems “safe” is inherently subjective, involving a series of judgments and a relative weighing of multiple (and sometimes conflicting) factors.

That is spectacularly wrong! There’s nothing subjective about the fact that vaccines don’t cause autism and there’s nothing subjective about the fact that homebirth with a CPM does lead to preventable neonatal deaths.

There’s no more reason to validate homebirth advocates’ fanciful view that childbirth is inherently safe than there is to validate anti-vax’ parents fanciful view that vaccines cause autism.

There’s every reason, in fact, to meet misinformation with accurate scientific evidence, and to make it clear to mothers contemplating homebirth that it poses a serious risk to their babies.

The subjective issue is NOT whether homebirth with a CPM is safe; it isn’t. The subjective issue is how an individual balances the various risks and benefits to make her own choice. Some women may find any increased risk to the baby anathema, whereas some will find the increased hospital risk of C-section deeply problematic. It is the right and prerogative of women to make their own informed medical decisions. But accurate scientific data is required for informed decision making and it’s the ethical obligation of obstetricians to provide it.

Tilden et al. start their piece with a quote:

Birth is as safe as life gets. – Harriette Hartigan, direct-entry midwife

That is abject nonsense from a charlatan, no different from Andrew Wakefield’s contention that vaccines cause autism.

Health care providers MUST respect patient choice, but we MUST NOT pander to charlatans and their acolytes by validating lies. If we do, we won’t stop preventable deaths at homebirth; we’ll encourage them.

You can’t make this stuff up.

I woke up this morning to find that Gaye Demanuele, the midwife who watched Caroline Lovell bleed to death at her homebirth, extolling a piece by Henci Goer’s “rebuttal” of my Washington Post piece How the natural birth industry sets mothers up for guilt and shame.

I wrote:

…[T]he crunchy natural-birth subculture has slowly morphed into an industry, mainly catering to the most privileged women in society. Second, a cabal of natural-birth activists — online, on the air and even inside hospitals.

Goer, a stalwart of the natural childbirth industry, who makes her money selling books about natural childbirth, takes to her new website, selling her natural childbirth videos ($5 per video, $25 for a yearly subscription), to disagree.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]C’mon Henci, you may think your followers are gullible and stupid, but no one is that stupid![/pullquote]

As with most things that come from the industry, it’s an exercise in mendacity.

Goer starts with a dig:

Amy Tuteur has managed to score a commentary in the Washington Post … You would think that the inflammatory rhetoric would have given the Post’s editors a clue that they should get their fact checkers on the case. If they had, they would have realized that the piece cherry picks bits out of context, distorts and sensationalizes the data, and just plain makes statements that are factually incorrect, but perhaps the “Dr.” in front of her name gave her an automatic pass…

Goer appears to be oblivious to the fact the piece is adapted from my new book PUSH BACK: Guilt in the Age of Natural Parenting. I’ve done quite a few print pieces and radio interviews to promote the book. The Washington Post CHOSE to post an excerpt from the book and THEY chose this excerpt.

Poor Henci. She whines that the “Dr.” In front of my name gives me an automatic pass. She’s apparently disgusted that someone would take the word of a Harvard educated, Harvard trained obstetrician gynecologist who’s written for The New York Times, TIME.com, The London Times and a variety of other publications instead of Goer, who has NO formal training in midwifery, medicine or anything else. Goer is a legend in her own mind, a self-appointed “expert” in the obstetrical literature. Who else considers her an expert? No one.

I’ve written about Goer and her mendacity for years and first challenged her to a debate in 2008.

Her lies back then were legion:

“…The blanket accusation that U.S. direct-entry midwives have less training than other midwives in industrialized countries requires no denial because it is fatuous.”

“… If Amy Tuteur is saying that our perinatal mortality rate is low, that is just not true.”

And my personal favorite:

“I don’t know if you ran across that thread while surfing this Forum, but some of us–including me–theorize that “Dr. Amy” is a disinformation strategy of the American College of Ob/Gyns. We can’t prove it, of course.”

So much for Goer’s vaunted “research” skills.

Goer ended up banning me from her message board; it was far easier than acknowledging that I was telling the truth and she was trying to deceive women.

Goer tries the same disinformation tactics in her “rebuttal.”

I wrote in WaPo:

A study in Oregon found that the death rate for babies delivered in planned home births with midwives in 2012 was roughly seven times that of hospital-born babies.

And Goer inexplicably replies:

Tuteur appears to be referring to Snowden (2015). After adjustment for maternal characteristics and medical conditions, the odds ratio for perinatal death in planned out-of-hospital birth was 2.4 times that of planned hospital birth, amounting to an absolute difference of 1.5 more deaths per 1000. Nowhere is there a mention of a 7-fold greater mortality rate.

No, I’m referring to the Rooks 2012 dataset from Oregon and I’d be willing to bet serious money that Goer knows exactly what I’m talking about.

She knows as well as I do that the Rooks data shows that planned homebirth with a licensed homebirth midwife had a death rate 800% higher than comparable risk hospital birth and there’s no way she can rebut that data. Instead she choose to substitute a study on a different group (including birth centers) done 3 years later which reached NO conclusion about homebirth itself.

I guess she figures her readers are so gullible that they won’t notice.

I wrote:

The Midwives Alliance of North America . . . is a major professional organization for American midwives but requires no educational credentials of its roughly 450 members beyond a high school diploma.

And Goer nonsensically replies with:

MANA has nothing to do with the training or credentialing of direct-entry midwives …

I didn’t say it did. I said it requires no educational credentials beyond a high school diploma and it doesn’t.

I guess Goer figures natural childbirth advocates are stupid as well as gullible.

I wrote:

Lamaze’s website states, adding with a note of pity that an epidural still might be needed if a mother ‘can’t move beyond [her] fear of labor pain.’ Rather than teaching strictly the facts about childbirth, Lamaze promotes one particular vision of labor as normal and therefore good.

And Goer tries this whopper:

Tuteur’s quote is taken out of context.

Says the person who wrote The Thinking Women’s Guide to a Better Birth. It’s an implicit insult to women who don’t follow her precepts but no doubt Goer would claim that the title is taken out of context.

In what context is it appropriate to claim that epidurals are for a women who ‘can’t move beyond [her] fear of labor pain?

In what context is it appropriate to promote “normal” birth as better than any other form of birth?

C’mon Henci, you may think your followers are gullible and stupid, but no one is that stupid!

Goer is a paper tiger. She fancies herself an “expert” in obstetric research yet she won’t appear in any forum where the people who do most of the obstetric research (obstetricians) could question her on her claims. She deletes and bans people from her websites when she can’t address their substantive claims. She has point blank refused to publicly debate me because she knows her arguments would be eviscerated in short order.

She’s exactly what I rail about when I criticize the natural childbirth industry, an industry that puts personal beliefs ahead of scientific facts, and uses shame and guilt in order to profit.

Yesterday I wrote about the ways in which the Baby Friendly Hospital Initiative (BFHI) is hurting babies (Help me stop the Baby Friendly Hospital Initiative before more mothers and babies are harmed). It appears that the incidence of severe dehydration, sometimes accompanied by permanent brain damage, is rising as well as the incidence of skull fractures of babies who fall from their mothers’ hospital beds, and infants being accidentally smothered by their mothers who fall asleep while feeding or cuddling them.

I advocated for ending the BFHI on the twin grounds that it is not friendly to babies and it doesn’t work to promote breastfeeding. The BFHI is going to be around for the near future, though. How can mothers protect their babies and themselves from the misguided totalitarian rules of the BFHI that muzzle nurses preventing them from telling you about the options for feeding your baby?

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Women who have easy access to formula supplementation in the first few days are MORE likely to breastfeed successfully.[/perfectpullquote]

If you want to be successful at breastfeeding, I recommend bringing formula to the hospital.

I recommend it for both practical reasons and philosophical reasons.

The practical reasons include:

• We KNOW that many women won’t have their milk come in for more than two days after birth, but babies may get hungry before then.
• We KNOW that 5-15% don’t make enough breastmilk to fully nourish and infant.
• We KNOW, as even Dr. Alison Stuebe of the Academy of Breastfeeding Medicine acknowledges, that as many as 44% of babies will need formula supplementation in the early days.
• We KNOW that judicious formula supplmentation INCREASES rates of successful breastfeeding.

In other words, women who have easy access to formula supplementation in the first few days are MORE likely to breastfeed successfully, not less. The BFHI explicitly ignores this.

Why?

In my view it’s because the BFHI is designed to be both humiliating and punitive.

• The BFHI mandates refusing to offer supplementation to hungry babies.
• It forces mothers to beg for formula and subject themselves to lectures on the benefits of breastfeeding (as if they are idiots and aren’t already aware).
• It muzzles postpartum nurses from appropriately counseling women about the risks of dehydration and the benefits of supplementation.
• It prohibits soothing hungry infants with pacifiers even though there is no evidence that pacifiers interfere with breastfeeding and a growing body of evidence that they reduce the risks of SIDS (sudden infant death syndrome).

Why is it designed to be humiliating and punitive?

Because the proponents of the BFHI cling to the beloved fiction that women don’t breastfeed or stop breastfeeding because they are too stupid and gullible to resists the marketing of formula manufacturers when the truth is quite different. The truth is that women don’t breastfeed because initiating breastfeeding can be frustrating for both mother and babies, and painful. They stop breastfeeding because continuing may be frustrating, painful,  inconvenient and may fail to provide the baby with enough nutrition.

The BHFI folks fear that if mothers see how easy, convenient and satisfying formula is, women will be seduced into using it instead of breastfeeding. So they prattle on about how easy and convenient breastfeeding is when it’s neither. They babble that breastmilk is the perfect food when it isn’t perfect if there is not enough of it. And, of course, they grossly exaggerate the benefits of breastfeeding when the truth is that in countries with clean water the benefits are limited to a few less ear infections and episodes of diarrheal illness across the entire population of babies in the first year.

Women are not selfish fools who must be forced into breastfeeding. Most women want to breastfeed and will make strenuous efforts to do so.

If you are one of those women I recommend that you take both formula and pacifiers to the hospital. Your baby will probably never need the formula, but knowing you have it will be reassuring. If your baby screams incessantly from hunger, you can offer a little formula to settle her and allow her (and you) to get some sleep. Pacifiers can also help in bridging the gap between your baby feeling distressed and your milk coming in.

The practical reason for bringing formula and pacifiers is that they can promote successful breastfeeding, but there’s a philosophical reason, too:

Having easy access to formula and pacifiers puts mothers, not lactation professionals, in charge of both babies and their own bodies. It eliminates the ability of hospital personnel to pressure and humiliate women into fulfilling the hospital agenda and leaves personal decisions to the person actually affected by them, the mother.

Lactation professionals and all healthcare providers should never forget:

HER baby, HER body, HER breasts, HER choice!

If you want to control your own body AND ensure a successful breastfeeding relationship, take formula to the hospital. You probably won’t need it, but if you do, you’ll be very glad you brought it.

Dear Neonatologists, Pediatricians, Neonatal Nurses, and the organizations that represent them:

Please help me help babies and mothers. The Baby Friendly Hospital Initiative is killing babies and you’ve got to stop it.

Nearly every day I get another email or Facebook message about a baby who has been injured seriously or even fatally by the Baby Friendly Hospital Initiative (BFHI). And it’s not just mothers who are writing to me. It is postpartum nurses, neonatologists, pediatricians and other physicians who can’t believe what they are witnessing and seek my assistance in publicizing it and putting an end to these preventable tragedies.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Babies are being harmed and even die, yet the physicians and nurses who care for them feel powerless to help them in the face of the BFHI.[/pullquote]

In the last few months I’ve heard about multiple infants sustaining skull fractures by falling from their mothers’ hospital beds, multiple infants who have suffered brain damage from dehydration and greater numbers of hospital re-admissions to treat dehydration before it leads to permanent injury, and countless cases of poor weight gain and failure to thrive.

Babies are being harmed and even die, yet the physicians and nurses who care for them feel powerless to help them in the face of lactation professionals who have seduced hospital officials with the promise of saving money by implementing the BFHI.

What is the Baby Friendly Hospital Initiative and how is it hurting babies?

The BFHI is a hospital credential that is given to institutions that can demonstrate that they follow the ten steps of the initiative (and have given a big slug of money to BFHI to pay for it). It’s meant to encourage breastfeeding though there is evidence that it doesn’t even work.

You can find the Ten Steps here. The most dangerous steps are these:

• Give infants no food or drink other than breast-milk, unless medically indicated.
• Practice rooming in – allow mothers and infants to remain together 24 hours a day.
• Give no pacifiers or artificial nipples to breastfeeding infants.

This despite the fact that:

We KNOW that 5-15% of mothers will not produce enough breastmilk to fully nourish an infant.
We KNOW that judicious formula supplementation in the days after birth INCREASES breastfeeding rates.
We KNOW that there is no evidence that rooming in has ANY impact on breastfeeding rates.
We KNOW that there is NO EVIDENCE that pacifiers or artificial nipples reduce breastfeeding rates.

And most importantly:

We KNOW that the benefits of breastfeeding term infants in industrialized countries are SMALL.

No one can point to even a single term infant whose life was saved by breastfeeding whereas we can now point to many infants lives that have been destroyed or ended by letting a special interest group control infant care. And that doesn’t even take into account the suffering of mothers forced to endure their babies’ screams of hunger and are deprived of desperately needed sleep by the closing of well baby nurseries and enforced 24 hour rooming in.

Lactation professionals and the breastfeeding industry mean well. They honestly believe, in the face of copious evidence to the contrary, that breastfeeding has nearly magical health benefits, and that virtually any risk is worth taking to enforce breastfeeding among new mothers. But they aren’t medical professionals.

Neonatologists, pediatricians and postpartum nurses are medical professionals, and as such, are charged above all with ensuring infant well being. Outcome (a healthy baby) is far more important to medical professionals than any specific process like breastfeeding.

Neonatologists, pediatricians and postpartum nurses should immediately institute three specific measures:

1. Easy access to infant formula and a low threshold for supplementation in the first few days.
2. Routine access to pacifiers to soothe babies who are comforted by them.
3. Mandatory access to well baby nurseries where every mother can send her baby for large blocks of time so she can sleep.

I don’t doubt for a moment that the breastfeeding industry is sincere in its beliefs, but babies are being harmed by those beliefs. We are experiencing an upsurge in serious adverse outcomes like infant skull fractures, severe neonatal dehydration, and even smothering deaths of infants left to sleep in their mothers’ beds because of forced rooming in. We should be tracking those adverse outcomes and doing everything in our power to prevent them.

I know that it is difficult to buck the hospital administration when it finds intellectual cover for financial decisions like closing well baby nurseries by insisting that it will boost breastfeeding rates. But babies have no one to defend them besides neonatologists, pediatricians and postpartum nurses.

Please, please stand up for them.

It’s been nearly two weeks since my Op-Ed, Why is American Home Birth So Dangerous?, was published in The New York Times in which I explained that American homebirth has higher death rates because of substandard self-proclaimed midwives known as CPMs (certified professional midwives). It seems to me that if anyone were going to rebut my claims, they would have done so by now. Yet no one in the homebirth industry has addressed them; that tells you something very important:

The American homebirth industry has no data to show it safe and even they can’t think of a reason why CPMs should fail to meet international midwifery standards.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why no rebuttal from Ricki Lake? Gene DeClercq? Lamaze International? The Childbirth Connection? Because American homebirth IS dangerous.[/pullquote]

Where are its public champions?

Where is Ricki Lake, who has made a career of promoting homebirth?

Where is Melissa Cheyney? She didn’t even bother to defend her 2014 paper that purported to show that homebirth is safe but actually showed it has a mortality rate 450% higher than comparable risk hospital birth.

Where is Marian MacDorman, who in her role as a CDC statistician has published several papers extolling the rise of homebirth while never mentioning the death rate?

Where is Gene DeClercq? He has argued repeatedly, and in a variety of forums, that American homebirth is safe, but apparently he couldn’t step forward to provide any proof.

Where is Henci Goer?

Where is Lamaze International?

Where is the Childbirth Connection?

Not a single one could present even a single bit of data to rebut my claims.

How about my assertion that CPMs are essentially lay people who want to attend births but fail to meet international midwifery standards?

No one denied it.

What about my claim that American homebirth is more dangerous than homebirth elsewhere because of a woeful lack of regulation?

No one offered anything to rebut that either.

Which suggests:

Professional American homebirth advocates and organizations know that American homebirth has a high rate of preventable deaths, deaths that do not occur in homebirth in the Netherlands, the UK, Canada or Australia. They known and they haven’t done anything about it.

Why not?

The American homebirth industry thinks it’s more important to protect itself than to protect babies and mothers.

It’s just that simple.

When confronted with the evidence that American homebirth is dangerous, professional homebirth advocates and organizations couldn’t deny it.

They didn’t even bother.

For years many US and world health organizations have behaved likely wholly owned subsidiaries of the breastfeeding industry. La Leche League has been an advisor to such organizations for decades and had engineered near complete replacement of scientific evidence with the goals and personal beliefs of lactivists.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Whether or not a woman breastfeeds is no more your business than whether or not a woman is gay.[/pullquote]

The United States Preventive Services Task Force (USPSTF) has begun to push back ever so gently and the Academy of Breastfeeding Medicine is not happy, not happy at all.

The latest piece on their blog is dripping with their hallmark contempt for women who can’t or don’t want to breastfeed.

Dr. Joan Meek lays out the problem as the ABM sees it:

Recently, the USPSTF proposed a new recommendation: “The USPSTF recommends providing interventions during pregnancy and after birth to support breastfeeding.” Note that this statement does not state “promote and support,” but just “support.” … In explanations about this change, a member of the Task Force, Dr. Alex Kemper, as quoted in MedPage Today, stated that “the reason the Task Force made this slight word change is to recognize the importance of a mother doing what she feels is best for her and her baby and not wanting to, for example, make mothers feel guilty or bad if they decide not to breastfeed,” he said. “It’s really a personal choice that needs to be made based on her own personal situation.”

In other words, the USPSTF has decided to support ALL new mothers in choosing the feeding method that is right for them and their babies, not only the mothers who breastfeed.

According to the USPSTF:

“We systematically reviewed the literature for a variety of potential adverse events associated with breastfeeding interventions, including mothers reporting feeling criticized by the interventionist, guilt related to not breastfeeding, increased anxiety about breastfeeding, and increased postpartum depression. Only two of our included studies reported adverse events that mothers experienced related to the intervention and included reports of increased anxiety, feelings of inadequacy, and concerns regarding their family’s confidentiality. Although the goals of these interventions focused on initiating and continuing breastfeeding and empowering women to do so, it is important that interventionists respect family’s individual decisions.”

Meek responds with a statement of doublespeak that would make George Orwell proud:

If breastfeeding is truly a public health issue with benefits that have been widely documented for both women and children, then health care providers should be promoting breastfeeding to empower women to make an informed decision about their infant feeding choice.

Pro tip: You aren’t empowering women when your goal is to convince them to do it YOUR way.

Why isn’t supporting breastfeeding enough for the ABM? Because they like shaming and humiliating women who don’t knuckle under to their efforts to intimidate them into breastfeeding.

We don’t seem to worry so much about guilt when counseling patients about smoking cessation, weight reduction, or need to increase exercise.

Actually, physicians DO worry about inducing guilt and have long recognized that it is not effective in motivating people to undertake healthy behaviors. Moreover, last I heard smoking cessation, weight reduction and increasing exercise can and do save thousands of lives while promoting breastfeeding doesn’t save the life of ANY term infant.

Dr. Meek’s protestations remind me of our long national debate about homosexuality. In just a few generations we have gone from viewing it as a form of deviancy to legalizing gay marriage and there are large groups of people (particularly religious fundamentalists) who are still upset about it. They spend their time devising ways to promote heterosexuality such as privileging “traditional marriage” and promulgating laws to allow discrimination against the LGBT community. They insists that heterosexuality is normal because “that’s what nature intended.”

Dr. Meek, what’s the difference between insisting that we promote breastfeeding because “our bodies are designed for it” and religious fundamentalists insisting that we promote heterosexuality because “our bodies are designed for it”?

I don’t see much difference at all. In both cases those who demand that we promote the preferred choice instead of merely supporting it WANT to shame those who don’t make their preferred choice. It’s ugly when fundamentalists do it, and it’s ugly when breastfeeding advocates do it.

Whether or not a woman breastfeeds is no more your business than whether or not a woman is gay. There is no more need to promote breastfeeding than there is to promote heterosexuality. Promoting either does not empower women, it humiliates and shames … just as it is designed to do.

Last week I wrote about the theology of quackery.

Homebirth advocacy meets many of the same criteria. It imagines a Paleolithic Garden of Eden where every woman gave birth in a state of grace, easily and safely. It ascribes The Fall to the advent of modern obstetrics that “pathologized” birth. It believes in predestination; the elect can be recognized by their unmedicated vaginal births; and it has a religious hierarchy of midwives, doulas and childbirth educators who are needed to reach spiritual fulfillment.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Awe is reserved for women who insist on homebirth with twins, a breech baby or a previous C-section. The bigger the sacrifice, the greater the risk, the higher the praise.[/pullquote]

It also has stories of human sacrifice akin to the biblical story of Isaac.

You may remember that to test his faith, God commands Abraham to sacrifice his only son. God wants to find out if Abraham would be willing to kill the person most precious to him simply because He commanded it. Would Abraham being willing to make the supreme sacrifice to demonstrate his devotion to God?

If you know the story, you know that at the last minute, when Isaac is already bound on the altar and about to be killed, God sends an angel to stay Abraham’s hand. Evidently God never meant that Abraham should actually sacrifice Isaac. God does not want or need human sacrifice.

The sacrifice of Isaac is meant to demonstrate that the God of monotheism, of Judaism, Christianity and Islam, abhors human sacrifice. Unfortunately, it appears that Birth, the goddess in which homebirth advocates place such trust, has no such qualms.

“Birth,” like any goddess demands worship. Her power must be acknowledged and her essential goodness must be constantly praised through birth “affirmations.” “Birth” also demands constant evidence of belief. What could possibly be more demonstrative of true faith than the willingness to sacrifice your newborn child?

Unlike the God of the Old Testament, though, “Birth” does not send an angel to stay your hand. Quite the opposite, “Birth” sends tests; hence the praise for women who take the greatest risks at homebirth.

You can demonstrate your trust in “Birth” by having a homebirth in a low risk situation, where an unpredictable emergency can kill or maim you child. But women who really trust “Birth” are those who choose homebirth when they are at high risk of killing their babies. That’s why the greatest praise and awe is reserved for women who insist on homebirth with twins, a breech baby or a previous C-section. The bigger the sacrifice, the greater the faith, the higher the praise.

Unlike the God of the Old Testament, “Birth” apparently does want and need human sacrifice.

Babies die all the time at homebirth, and the biggest risk factors lead to the greatest number of deaths. As with any religion, believers must then deny that the deity had anything to do with it. Yes, they trusted “Birth” and the baby died, but that was just an incredible coincidence. They vehemently insist that the baby would have died in the hospital anyway, and they might have ended up with a C-section scar, too. A C-section scar is a horror because it is a permanent brand, marking its wearer as one who lost faith in “Birth.”

It’s easiest to figure out who are the truest believers. They are women who lost babies at homebirth but still trust “Birth.” To demonstrate their continued faith, they immediately being planning for the next “healing” homebirth.

Sacrificing your baby on the altar of “Birth” isn’t the highest form of devotion. That honor is reserved for deliberately placing your next child on the same altar and trusting that the goddess who killed your last baby won’t kill this one, too.

 

Adapted from a piece that appeared in September 2011.

Natural childbirth advocates are distressed that in the space of one week The New York Times published my piece on the dangers of homebirth and The Washington Post published my piece on the role of shame and guilt in promoting the natural childbirth industry.

What seems to make them most upset is that I point out that childbirth is inherently dangerous. It is a reflection of their profound ignorance of the medical and historical reality of childbirth that they are unaware of this basic fact. Sure, childbirth seems safe to them, but they are clueless that it only looks safe because of the liberal use of the routine interventions of modern obstetrics.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The risk of a baby dying on the day of its birth is greater than the average daily risk of death until the 92nd year of life.[/pullquote]

Perhaps they’ve never considered how the many tiny graves in old cemeteries got there or why family genealogies tend to be full of forefathers who survived to old age having buried two or three young wives along the way.

In that respect, the natural childbirth industry has a lot in common with the anti-vaccine industry. Both looks at the US as it is, with low rates of death from vaccine preventable diseases and low rates of death from childbirth, and imagine in their naïveté that this is how it has always been. It’s the intellectual equivalent of pretending that we know no longer need to use car seats for babies because the motor vehicle fatality rate for infants is so low. Both modern obstetrics and vaccines are the equivalent of car seats. Take them away and the appalling death rates will return.

But you don’t have to take my word for it.

The dangers of the day of birth was published in the British Journal of Obstetrics and Gynecology in Februrary 2014. One of the authors wrote about it on his personal blog.

The authors recognize that most people in industrialized countries think that childbirth is safe:

… these risks are generally perceived to be low, and as a result many parents resent the intrusiveness of hospital birth, fetal monitoring, and other recommendations…

Much of the risk of childbirth remains concentrated in a relatively short period: the day of labour and delivery. In addition, when death occurs so early in life it results in more life years lost on average than when death occurs at an older age.

We speculated that expressed on a daily risk scale, instead of as per thousand births, childbirth risks would appear very different. We aimed to calculate the risk of dying on each day of your life, and compare these risks with other activities or events that an individual may encounter. This information would then be used to calculate the loss of life expectancy sustained with death occurring on the day of birth.

What did they find?

Even with modern obstetric practice the risk of a baby dying on the day of its birth in the UK is greater than the average daily risk of death until the 92nd year of life. We have shown that this risk is comparable with many other high-risk activities, and results in many life years lost.

So childbirth isn’t safe for babies. It is quite dangerous, comparable to the risk of death for the average 92 year old adult and comparable to the risk of death for those facing major surgery. The graphic representation is impressive:

The risk in the US is even higher as a result of a higher rate of risk factors and a lower rate of health care access than in the UK.

And that’s the risk when the baby has access to immediate life saving care. The risk at homebirth is higher still.

When natural childbirth or homebirth advocates tell you that childbirth is safe, show them the graph, and see what they have to say then.

If they still tell you to trust birth, you have learned why you should never trust them.

 

Adapted from a piece that first appeared in April 2014.

I find pseudoscience anathema, but that does not mean that I am apologist for contemporary medicine.

I am quite critical of some aspect of medical practice. The subject of medical errors has particular personal resonance for me as my father died at age 60 in the wake of a major medical error that occurred at the hospital where I was on staff and which my professional colleagues tried (stupidly and unsuccessfully) to hide from me.

So when I read papers like the recent BMJ piece Medical error—the third leading cause of death in the US, it makes me angry and frustrated in equal measure that the problem has not gotten any better in the nearly 30 years since my father died.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The relentless emphasis on performance metrics forces doctors and nurses to care for ever more, ever sicker patients in ever less time.[/pullquote]

But I’m also concerned that we are missing something important. When we talk about medical errors we fail to talk about the role of the relentless emphasis on performance metrics that force providers to care for ever more, ever sicker patients in ever less time.

In the last few decades we’re witnessed an extraordinary change in the delivery of medical care. Medicine, typically viewed as a profession guided by elaborate professional ethics, became a business. We let it become a business, indeed we encouraged the change, because we thought it would save money. It’s not clear that much money has been saved, but it’s very clear that the nature of medical care has changed dramatically.

Forty years ago, most people had family doctors that they knew and who knew them and worked directly for them. They were admitted to the hospital early in the course of an illness and stayed until they were nearly fully recovered. Many diseases now successfully treated with elaborate high tech methods couldn’t be treated at all.

Now, in contrast, patients are forced to change physicians frequently as they change jobs or insurance. Doctors work for large corporations who make demands on them that aren’t always in the best interests of patients. There is tremendous emphasis on keeping patients out of hospitals, and when admitted sending them home quicker and sicker. Doctors have no control over the number of patients they are required to care for and may receive bonuses for moving ever more patients through the system ever faster. They waste tremendous amounts of time justifying their medical decisions to functionaries whose only goal is to avoid paying for expensive care.

Nurses are under similar pressure to be more “efficient.” Patient loads have been increased so that a nurse who might have been responsible for 5 patients in various stages of recovery on each shift are now responsible for 6 or more very sick patients, all in need of elaborate monitoring and complicated medical care.

Both doctors and nurses are constantly prodded to care for more patients, and sicker patients, in less time than ever before.

The error that preceded my father’s death was an administrative error. No one told him that a routine pre-op chest X-ray done before minor surgery showed a cancer in his chest since everyone thought someone else had already told him. But there are a limitless array of medical errors, including medication errors, surgical errors, iatrogenic complications and more.

How deadly are they? According to authors Makary and Daniel:

… We calculated a mean rate of death from medical error of 251 454 a year using the studies reported since the 1999 IOM report and extrapolating to the total number of US hospital admissions in 2013. We believe this understates the true incidence of death due to medical error because the studies cited rely on errors extractable in documented health records and include only inpatient deaths. Although the assumptions made in extrapolating study data to the broader US population may limit the accuracy of our figure, the absence of national data highlights the need for systematic measurement of the problem. Comparing our estimate to CDC rankings suggests that medical error is the third most common cause of death in the US. (my emphasis)

This is just an estimate since there is no standard for keeping track of medical errors. Lest you think this is a US problem, the authors point out that both Canada and the UK have a similar problem.

Makary and Daniel offers suggestions for dealing with deadly errors, summarized in the graphic below:

These suggestions include making errors more visible so we can understand the dimensions of the problem, making remedies available and creating a culture of safety by engineering more fail safe measures into the delivery of medical care. We might start by acknowledging that the provision of safe medical care requires TIME.

We have elaborate rules for airline pilots that involve strict limitations on how long they are allowed to work and what they are required to do during that period. What would happen if we insisted that pilots, instead of flying one plane at a time, should be responsible for flying multiple planes at a time AND supervising dozens of others who are also flying planes at the same time? Would we be surprised to find pilots making deadly errors in those condititions?

Yet we have no problem forcing nurses to care for ever greater numbers of ever more seriously ill patients at one time. Should we be surprised that they make errors?

We have no problem increasing “patient panels,” the number of patients a doctor is require to take on, by 10, 20 or 50%, expecting them to be able to provide the same level of care to each patient in a much shorter period of time. Should we be surprised that they make errors?

We have no problem forcing doctors to spend endless hours on phone calls and paper work attempting to get reimbursed for work they have already done, or attempting to get permission for care that they want to deliver. Should we be surprised that they make errors during ever shorter patient appointments?

In forcing doctors and nurses to be more “efficient,” have we made them more prone to errors?

I don’t know the answer to that question; I don’t think anyone knows. It seems to me, though, that if we want to take steps to reduce deadly medical errors, answering that question would be a good place to start.