Is vaccine refusal a function of privilege?

That’s the question that sociologist Jennifer Reich asks and answers in her provocative paper Neoliberal Mothering and Vaccine Refusal: Imagined Gated Communities and the Privilege of Choice published in the October 2014 issue of Gender & Society.

Reich starts by explaining that there are two group of children who are unvaccinated, the poor and the privileged:

On one side, there are undervaccinated children who lack consistent access to medical care. These children are more likely to be Black, live in a household with an income near the poverty line, and have a mother who is younger, unmarried, and does not have a college degree. Children who are unvaccinated because of parental choice, however, look significantly different. They are more likely to be white, have a married, college-educated mother, live in a household with an income over $75,000, and be geographically clustered. Although vaccine refusal is referenced in gender-neutral terms, it is in fact a gendered process in which women are responsible for navigating meanings of health, necessity, risk, and state intervention for their children.

Indeed, Reich notes:

In a striking illustration of this, the state of Colorado, which has among the most liberal legal frameworks for opting out of vaccines, nonetheless sanctions welfare recipients whose children are not fully vaccinated.

In other words, when unmarried women of color on public assistance refuse to vaccinate their children, they are punished, but when white, partnered, economically independent women refuse to vaccinate their children, they are accommodated because of their elite status.

Reich’s description of these privileged women is spot-on:

… Bobel found that the women she termed “natural mothers,” who reject mainstream parenting advice in favor of natural and instinctual mothering practices, believed they “wrested control of their personal lives away from institutions and experts and others who claim to ‘know best’ and returned it to the site of the individual family,” even as they relied on privilege to do so…

Vaccine refusal is the paradigmatic example of the way that privileged women leverage their privilege to protect their own children and ignore everyone else.

As privilege facilitates choice, it also potentially jeopardizes the health and well-being of other children who lack resources or whose families are more constrained in their options… [T]hese women’s “choices” about vaccines carry consequences for other women’s families as well. It is thus important to understand how and why vaccines, touted as one of the greatest accomplishments of medicine and the cornerstone of public health, have been rejected by women privileged enough to do so in the guise of good mothering.

What did Reich find?

First, I show how mothers, seeing themselves as experts on their children, weigh perceived risks of infection against those of vaccines and dismiss claims that vaccines are necessary. Second, I explicate how mothers see their own intensive mothering practices— particularly around feeding, nutrition, and natural living—as an alternate and superior means of supporting their children’s immunity. Third, I show how they attempt to control risk through management of social exposure, as they envision disease risk to lie in “foreign” bodies outside their networks, and, therefore, individually manageable…

In other words, privileged mothers believe that they know better because they are “experts” on their own children; they believe that intensive mothering practices “boost immunity” to disease; they believe that disease comes from the underprivileged, and that they can use their privilege to avoid those people.

As they place their children at the center of their neoliberal mothering practice, the potential consequences their choices carry for others remain invisible, even as they claim a gendered identity of themselves as good mothers and condemn others.

What about other, underprivileged children who are harmed by their choices? They don’t care.

Only a few describe themselves as activists for all children, in which they aim to persuade other parents to also reject vaccines. None mention, for example, issues of food insecurity, even as they tout the importance of organic foods in their homes, nor express concerns about toxic exposure in other children’s neighborhoods, even as they agonize about their own. These women identify problems with healthcare systems that limit physicians’ time with patients, lack of transparency in product labeling, or inadequate emphases on promoting good health and nutrition. Yet, few describe efforts to transform these issues for all children.

Mothers who refuse vaccines claim to be empowered by their decision:

Yet, they do so by claiming their power through dominant feminine tropes of maternal expertise over the family and by mobilizing their privilege in the symbolic gated communities in which they live and parent. They utilize resources that facilitate their choices as informed consumers without feeling compelled to support the health or decision making of other families with fewer resources. They also refuse to acknowledge the role their children play in protecting or undermining systems of public health that aim to stave off infections at a community level.

Inevitably:

As in other mothering projects, women who are able to negotiate with providers, complete paperwork, and move through social worlds without fear of state surveillance are best able to exercise choice. As women aspire to be good mothers, key to their gender identity, and remain disproportionately responsible for defining these family projects, they claim and reify their privilege.

When you’re pregnant, you’re expecting a baby. It’s easy to forget that you will end up with a child … a child who will eventually ask probing questions.

So, homebirth mothers, how you are going to explain the fact that you put your birth experience ahead of your baby’s health, brain function and even life?

How are you going to explain that first week of baby pictures with your son intubated, sedated, with tubes in every orifice and monitors all around?

How are you going to explain that because you wanted to be “comfortable” in your own home, your let your baby girl be uncomfortable during labor, struggling for oxygen, marinating in meconium, putting her future cognitive abilities at risk?

How are you going to explain that because you wanted to avoid an IV, you refused to give birth in a hospital, and your baby ended up with multiple IV’s, including the one they stuck in his scalp after they ran out of other veins?

It’s hard for me to imagine the pain and the guilt of explaining that because you had your heart set on a vaginal birth, your son can’t play catch with the other kids due to the limited function of his right arm as a result of the shoulder dystocia.

And the discussion with your daughter is likely to be agonizing when you acknowledge that her cerebral palsy will never improve, and she will never walk, let alone run, because you listened to your internet friends who encouraged you to have a VBAC at home, instead of your obstetrician who warned you that if your uterus ruptured at home, it was unlikely that your baby would survive unscathed.

You may be boasting now about how you “rocked” your homebirth, but will you still be proud when you see the pain that you have caused your child? Or will you ignore that, too, like you ignored his safety?

How are you going to explain to your son that his identical twin didn’t survive the homebirth because the second baby’s placenta detached right after the first baby was born?

What are you going to tell your daughter when the other kids in her class make fun of her because of her cognitive disability that almost certainly resulted from the fact that she was born blue and pulseless at home, and your homebirth “midwife” had never performed a resuscitation, had left her oxygen in the car, and was trying to perform CPR on a bed instead of a hard surface?

What are you going to tell your older children when the new baby they were eagerly anticipating dies in front of their eyes because you wanted them to be with you at the moment you triumphantly pushed a baby out of your vagina? Will you tell them some babies just die, or will you tell them the truth, that it was your desire to avoid the hospital that led to the baby’s death? You might be able to get the “some babies just die” story by them when they are small. What will you say when they are adults and they ask you again why they lost a sibling.

What will you tell the baby’s father if the baby dies at the homebirth he didn’t want you to have? Will you apologize to him for the loss of his child? Will you beg forgiveness for suffering he now has to endure?

How will you justify your choice when you see the devastation you have caused?

Or will you spend the rest of your life wondering if the pain, suffering, and even death could have been avoided if you’d put your baby’s health ahead of your own bragging rights?

I don’t get it.

I am a mother of four grown children. Their health and safety is so precious to me that I am still kicking myself about the time that I leaned into the backseat to place one of my sons in his carseat and bumped him against the door, cutting him next to his eye. He recovered in moments; I haven’t forgotten in 25 years.

Therefore, I am aghast at the revolting narcissism that leads a mother to proclaim that she “rocked” a birth that nearly killed her baby.

…I totally rocked by HBAC with my cesarean baby by my side and then about an hour later, my new love began having breathing issues. He has meconium aspiration syndrome and we have been admitted to the nicu. We are likely to be here for a week or more so he can fully recover…

I will share the birth story once we’re home again. It was so amazing and empowering!

Really? REALLY??!! Ashley dares to boast that the birth was empowering when it left her baby like this:

What’s next, Ashley? You “rocked” your drive to the store even though you accidentally backed over your baby?

Unfortunately, Ashley is not alone in her nauseating selfishness and self-absorption.

Shannon:

Meconium has always been a hobby of mine to research, given my son’s birth … My son’s speech issues, muscle tone have always made me wonder which came first, chicken or egg … I was shocked at how many kids with sensory issues had problems with nursing or early speech but had meconium issues in common.

Melissa:

With my vbac last July my little guy also had meconium aspiration syndrom. He spent the first 8 days of his life in the nicu as well… He also had shoulder dystocia and he required full resuscitation.

Selena:

This is what happened to me in Jan. My hbac went perfect, but little man had breathing issue because of meconium, so to the NICU we went for 5 days…

Amanda:

I had my second HBA2C in birth pool on March 24. He aspirated fluid when he was born and we spent his first 4 weeks in the NICU…

And let’s not forget the midwife boasting about how she handled the birth:

A hypoxic event in utero, Charlie Rae? Ya think? How is it that you had no idea of the hypoxic event until after he was born? It was your responsibility to prevent it.

What is wrong with these women? Who thinks that a baby so sick that he needs to spend days or weeks in the NICU is a reasonable price to pay for a vaginal birth? Only a selfish, self-absorbed narcissist who looks at the world through her vagina, that’s who.

We’ve long known that vision is more than the light that hits the retina at the back of the eye. The nerve signals generated by the light get transmitted to the visual cortex, located in the occipital lobe of the brain. It is there that the information is processed to create what we see.

Scientists have recently discovered a fundamental biologic defect that goes a long way to explaining otherwise irrational phenomena like anti-vaccine advocacy. Vaccines have been one the greatest public health advances of all time, yet some people don’t see it that way and now we know why.

According to lead investigator Professor Cy N. Tist, anti-vax advocates suffer a specific, previously unrecognized visual processing error. Tist and colleagues have named the distortion conspira-scopic vision.

Prof. Tist explains:

As far as we can determine, conspira-scopic vision results from a processing error that rotates visual signals 45 degrees, leading inevitably to a slippery slope. Whereas the average person sees a preventive health measure, those suffering from conspira-scopic vision mistakenly see an assault.

Look at the following historical image:

Most of us see happy children proudly showing off the fact that they have been vaccinated.

Unfortunately, those with conspira-scopic vision, like “holistic” psychiatrist Kelly Brogan, as well as the folks at StopTheCrime.net who created the image, see the following profoundly distorted image:

Hard to believe that we are looking at the same picture, but we are.

Here’s another example:

Most of us see a woman happily receiving a vaccination.

The folks at the Australian Vaccination Network, all of whom suffer from conspira-scopic vision, see a rape:

Is it any wonder then that anti-vaccine activists have an irrational fear of vaccines that is resistant to any and all scientific evidence?

According to Prof. Tist, anti-vaccine advocates are not the only people who suffer from conspira-scopic vision. He believes that food activists like Vani Hari (The Food Babe), anti-GMO activists, and even homebirth advocates suffer from conspira-scopic vision. Their vision is mistakenly skewed, causing them to see conspiracies everywhere.

There’s only one known cure for conspira-scopic vision, and that is a thorough education in science and statistics. Unfortunately, conspira-scopic vision has recently been developing resistance to both facts and education, which dramatically complicates efforts to treat it.

What you see depends on how you process visual information. Those who have processing defects like conspira-scopic vision deserve our sympathy and support. Obviously we cannot agree with them since they have no idea what they are talking about, but we can acknowledge that it is a processing error that leads to their ignorant and outrageous conclusions, not mere stupidity.

This piece is satire.

There are so many women routinely dangling their babies over the abyss of homebirth death that I could create my own blog based reality show called Homebirth Death Watch. Consider the excitement: unedited, outcome unknown, innocent babies exposed to hideous deaths … by their own mothers.

Perhaps I will.

In our first episode Ariel risked the life of her son Gambit (I’m not kidding about the name!) by insisting on attempting a HBA4C, a homebirth after four Cesareans. She never got anywhere near delivering vaginally and waited until her son was nearly dead (heart rate in the 50’s) before agreeing to a C-section, which had to be done under general anesthesia. But at least he’s alive.

In today’s episode, Ingrid is risking the life of her PREMATURE baby; her membranes have been ruptured for more than 72 hours and she does not know if she’s colonized with group B strep (a known killer of newborns to which premature babies are especially vulnerable) since she refused to be tested.

Ok ladies I need some prayers and support/encouragement.

Currently she’s being encouraged in this idiocy by a Greek chorus of buffoons (“get a pedicure!”)  in the Home Birth Support Network.

No, Ingrid, you don’t need support or encouragement (or a pedicure). You need a reality check. Go to the hospital because your baby’s life is in danger!

Once membranes rupture the risk of infection starts to rise and rises precipitously after 24 hours. Premature babies like yours are particularly vulnerable to infection. Your baby could die without you ever feeling a thing.

Refusing group B strep testing was idiotic. Group B strep is the biggest threat to your baby, and, of course, premature babies are especially vulnerable. Why are you douching with Hibiclens; it can’t be because it is natural, right? Your midwife recommended it NOT because it works better than antibiotics but because she can’t keep control of you as a patient if you go to the hospital for antibiotics. Do you really want to let your baby die to improve your midwife’s finances?

No, you CAN’T treat GBS with vitamins, probiotics, echinacea or garlic. Are you really so gullible and desperate to have a homebirth that you will fall for the claim that antibiotics can be replaced with stuff you can buy at the grocery store? Are you willing to risk your baby’s life on that nonsense?

What might be happening to your baby right now?

Here’s what a commentor who is a pathologist wrote in regard to the baby who died after his mother stayed home with ruptured membranes for 5 days:

When I do an autopsy on a stillbirth I always take a section of stomach to look at microscopically. I can physically see the pus in the stomach, clusters of neutrophils, white blood cells that have collected in the fluid and that the baby has subsequently swallowed. I can physically see the pus in the lungs where the baby has aspirated pus cells, because babies practice breathing in utero , and so suck all this pus into their lungs. And you know what? The pus is mixed with squames, skin cells that the baby has shed, and in its last desperate frantic panic it starts to gasp and draws these deep into its lungs.

These babies are literally swimming in a bag full of pus, in a giant bacterial laden boil. They are swimming in it, swallowing it, breathing it, and I see the end result. And you know what else? It makes me despair that there are midwives out there who write this off as normal. Membranes ruptured for 5 days? Not a problem….

And when the baby is born dead, not sleeping, and covered in meconium, and he stinks of bacterial poisons, and I see the pus, I want whoever delivered that baby in front of me, so that they can see this is not a game. This is not a game of ‘ooh, doctors are horrible, they just want to cut you, so let’s pretend there’s nothing wrong’.

Your baby is at even greater risk than a term baby.

Is that what you want? Is a homebirth so important to you that you would let your baby marinate in pus for days?

Sure your baby could still be born fine and not succumb to infection, just like your baby could survive if you drove drunk with him in the backseat, but is it worth the risk?

You’re in the spotlight now, Ingrid. Think carefully about what you are willing to risk. We’re watching and hoping you make the right decision and head to the hospital NOW!

You cannot make this stuff up!

Yesterday I promised that I would update you on the mother who was attempting an HBA4C (homebirth after 4 previous C-sections) and had been laboring for the previous 36 hours. She had ruptured membranes and noticed meconium. She went to the hospital, but left when they advised her to have a C-section.

This is what happened:

…I did not get my vba4c. I’m OK with it though because the reason for the CS was an actual emergency. I had gone in [again] because my contractions were about 3 minutes apart. Plus the meconium was really thick and dark now. Only made it to 2.5, 90%, -1. He had begun having a lot of decels that were taking 4-5 minutes to recover from. At one point they lost his heart beat and when they found it, it didn’t get above 57. So I was rushed to the OR and put to sleep for an emergency CS… [B]oth baby and I are doing great…. We named him Gambit …

What does the word “gambit” mean?

A gambit is a chess move where the player sacrifices a relatively unimportant piece in order to win.

Fitting, no? Perhaps she decided “Afterthought” was too long for a name.

What did this mother accomplish by risking her baby’s life attempting a homebirth after 4 C-sections? As far as I can tell, her only “accomplishment” was waiting until her baby was almost dead in order to convince herself that the C-section was necessary. She put her son through hours of pointless labor that never made any progress, allowed him to become so oxygen deprived that he expelled copious meconium and his heart rate dropped deeply, repeatedly and finally entered a death spiral.

Instead of having a C-section under regional anesthesia (much safer for her), she had one under general. Instead of being awake for her baby’s birth, she missed it. Instead of protecting her baby’s brain function, she risked it.

The comments on her post were inane as would be expected for a group that encourages women to risk their babies’ lives:

You made great decisions during your birth! Sorry it wasn’t as planned, love his name!
Like · 2 · More · 16 minutes ago

He is adorable! Congratulations!!! Good job listening to your body & baby, mama!
Like · 2 · More · 16 minutes ago

Sorry you didn’t get your dream birth but congratulations! Love his name!
Like · 1 · More · 15 minutes ago

Congrats on your baby! Sorry to hear it didn’t go as planned

Actually, she made hideously bad decisions. She did not listen to her body; had she listened she would have had an elective repeat C-section as her body and the baby’s body tried to tell her for hours upon hours. Instead, she came pretty close to killing her baby.

Way to go, Mama!

Gambit indeed.

You really have to feel sorry for the women who run Facebook groups that support homebirth and other risky birth choices.

They face a terrible dilemma. If the group is private, it can’t proselytize to others that homebirth is wonderful and that they are warrior mamas. On the other hand, if the group is public, then everyone will see the endless stream of homebirth deaths and that won’t be good publicity.

Meg Heket and co-administrators face that problem with their private Facebook group. These women are well aware that homebirth kills babies who didn’t have to die. Heket herself lost a baby at homebirth, and Heket’s sister Janet “dead baby not as traumatic as birth rape” Fraser was personally excoriated by the coroner for her role in her baby’s death.

Supposedly, groups like Heket’s are private so that only words of support will be heard. But the urge to preen and proselytize is so strong that administrators find it hard to resist allowing in new recruits. After all, it’s very hard to make new converts when you only preach to the choir.

Of course if you let in new recruits who aren’t already committed to the group’s ideology that dead babies are just collateral damage, there will be some who will share the group’s private posts.

Ostensibly that shouldn’t be a problem. If homebirth and home VBAC and unassisted birth are truly safe, the group should be a endless stream of happy outcomes, with women defying their doctors and boasting about their births. But apparently it is a problem since whenever an outsider is discovered, the group institutes mass bans and tries to preserve privacy by becoming more exclusive.

The fact that administrators wrestle with dilemmas like these demonstrates that even true believers know that their choices kill their babies and may very well kill other women’s babies in the future.

The fact that they feel the deaths are something that must be hidden is consciousness of guilt. If they truly believed that these deaths “would have happened anyway,” there would be no reason to hide them.

Which raises the question: if these women know that homebirth kills babies, are they morally culpable when they encourage another mother to risk her baby’s life on the altar of vaginal birth?

Another month, another sad round up of homebirth deaths.

It’s only the 23rd of the month, but I’ve already been informed of 2 separate homebirth deaths.

One took place in Michigan. It was the “standard” homebirth death: 42 weeks gestation, careless monitoring, followed by inability to locate the fetal heart rate, followed by the frantic trip to the hospital, followed by ultrasound confirmation of the death of the baby. The mother gave birth shortly thereafter, but the baby was already dead.

Almost certainly this baby would be alive today if the mother had chosen hospital birth instead of a homebirth midwife.

The second death took place after a labor followed avidly in the a HBAC support administered by Meg Heket who runs the website Whole Woman, among others.

In June 2011, Heket described herself thus:

I am an Australian woman who had an hba2c and a stillbirth, 10 months ago. I read a lot about what’s happening in the US and think it’s important for women and midwives there to realise that THIS IS A WORLD WIDE ISSUE. It’s not just women and midwives in the US that are being hounded.

At present my own private midwife is being investigated on the most absurd of charges. I won’t detail them here due to privacy issues, but believe me when I say they’re completely inane. From what I gather, many of the complaints against midwives stem from transferring to a hospital. This upsets me a great deal because what I see is that when a woman and her midwife decide that it is appropriate to use medical technology, and transfer in a timely fashion, the midwife is reported FOR DOING HER JOB WELL.

We must stand together, around the world, to bring about real and lasting change. Change that benefits, women, babies, midwives, and society as a whole. Heal birth, heal the earth.

Apparently having let her own baby die at homebirth, she wants to encourage other women to do create their own tragedies.

The mother in question was attempting a UBA3C (unassisted homebirth after 3 C-sections).

It’s not as though she didn’t understand that babies can die. She had already lost 1 infant to SIDS and had multiple miscarriages. Several years ago she posted this video on YouTube to raise awareness of infant and pregnancy loss.

What happened?

Birth Story of Garlen **Trigger warning: Loss, trauma**

I went into labor late Wednesday (4/1/15) night… Thursday my water broke, and I had a small leak, not the huge gush. I stayed hydrated to help replenish fluids. Contractions continued, and we monitored movement and when baby wasn’t moving much, we’d use the doppler to find baby’s heartbeat.

She labored on and off with rupture membranes for FIVE DAYS!

Around 5 am on Tuesday, I had been in and out of sleep from hard contractions, and I realized I hadn’t felt the baby move for a few hours. I got the doppler…and we couldn’t find their heartbeat. We came into the hospital. They confirmed with an ultrasound baby had passed… The attending said he would let me attempt a vaginal birth…

…They called another ultrasound, and found he was breech and the new attending doctor was not comfortable with me continuing …

They couldn’t give me any pain relief, so they started prepping me for a c-section under general. While the doctor was out, she came up with an idea of attempting vaginal delivery under the general and if it didn’t work, then they would go ahead with the c-section. Before the gases knocked me out, they were still trying to have me push in the OR.

She had labored on and off with ruptured membranes and a breech baby for FIVE DAYS!

I was in recovery when I woke up and they told me I had avoided the c-section. I had mostly superficial tearing. Nothing seemed terribly amiss until I got back to my room. They noticed a lot more blood than they expected. They started looking for bleeding tears, but none seemed to be enough to cause such significant bleeding. They soon realized it was coming from my uterus. Although my placenta had detached and they’d done a curettage after he was born, I had four small pieces of retained placenta. They had to perform another curettage without my having pain meds, otherwise they were going to have to perform a hysterectomy. Luckily they got the retained placental pieces out, and the bleeding resolved.

After they monitored me a little longer, I got to meet my son. (We hadn’t done any ultrasounds, so we were team green.) Garlen … was born sleeping at 3:43 pm on April 7, 2015. He was 9 lbs 3 oz and 21 inches long. He has a full head of black hair and daddy’s olive complexion.

Initially the mother insisted that the homebirth had nothing to do with the baby’s death; she believed that it was related to a blood clotting issue that she learned about at the hospital. However, the pathology report showed the baby had died of infection, not surprising considering that she had ruptured membranes for 5 days.

Almost certainly this baby would be alive today if the mother had chosen hospital birth. Instead she was so desperate to have a baby transit her vagina that she put his life on the line and lost it.

That’s two entirely preventable homebirth deaths this month SO FAR.

There is another potential tragedy unfolding in the HBAC support group. A woman attempting an HBA4C (yet, 4 previous C-sections!) has been laboring for the past 36 hours. She has ruptured membranes and noticed meconium. She went to the hospital, but left when they advised her to have a C-section.

Hopefully, she will ultimately go back to the hospital and everything will be fine.

I’ll keep you posted.

Every few months we read a terrible story about a child or adult mauled by a wild animal that someone thought to keep as a pet. The owners never intended for anyone to get hurt. They simply thought that with enough love and nurturing, they could tame the animal. Indeed, right up until the moment of the mauling, many thought they had tamed a wild animal.

Unfortunately, the owners failed to respect the essence of the animal; wild animals cannot be domesticated and it is foolish and dangerous to pretend otherwise.

Midwives and natural childbirth advocates often approach birth in the same way. Birth is a lioness, but if you read the nonsense that many midwives and natural childbirth advocates write about it, you’d come away with the impression that its a fluffy kitten. And if you reached your hand out to pet it, that hand might get bitten off.

UK midwives and natural childbirth advocates in particular have a tendency to blither nonsense illustrated with hearts and flowers (although they are hardly alone). Consider The Positive Birth Movement. It’s hard to imagine anything more inane and nonsensical:

We are a grass roots movement, spreading positivity about childbirth via a global network of free Positive Birth groups, linked up by social media.

We aim to challenge the current epidemic of negativity around childbirth by bringing women together …

Wait! It gets worse:

Get Positive: One Day Workshops from the Positive Birth Movement!

…This is a completely new kind of birth preparation – not a plastic pelvis in sight. At the PBM we think that your body already knows how to give birth but your mind needs a little attention. We want to help you take everything you thought you knew about birth and replace it with some really gorgeous stuff that will make your eyes sparkle with anticipation.

These one day workshops are run by our experienced PBM Facilitators, and are designed specifically to help pregnant women:

Challenge any existing negative expectations of birth
Fill up with excitement and positivity about the big day
Build a toolkit to maximise chances of the best birth possible
Leave feeling strong, confident, and inspired.

The website is filled with “positive” birth stories, but:

Many people believe that the Positive Birth Movement is all about sharing good birth stories, and that those who have had ‘less than positive’ experiences are not a part of what we do.

This is not the case.

We exist because, at a global level, many women are not currently having a positive birth.

Often these women feel without a voice. They want to speak up, but are told consistently: “all that matters is a healthy baby”

In other words, lets all get together and pretend that there’s no need to be afraid of birth because its a fluffy kitty. Don’t listen to anyone who tries to warn you that in reality, birth is a lioness and wouldn’t hesitate to kill you by sinking its teeth in your neck.

The organizers are so privileged that they actually imagine that a less than positive birth means that someone’s feelings were hurt; it never crosses their mind that a negative birth experience can mean a dead baby or a dead mother or both.

It amazes me how the organizers disrespect both women’s intelligence and birth.

Pregnant women are not empty headed ninnies who need to be protected from the reality of birth. They are not little girls and they should not be offered fairy tales with “happily ever after” endings in place of science.

Fear and negativity don’t harm women in labor. Fear and negativity harm natural childbirth advocates’ fantasies and midwives’ employment prospects, but that has no impact on most women.

Positivity harms women by setting unrealistic expectations around labor and birth, leading to disappointment, feelings of failure, and self loathing for not being “positive” enough.

The Positive Birth Movement unwittingly highlights the central difference between many midwives and obstetricians. Midwives pretend that birth is tame, while obstetricians know that it is dangerous.

Midwives and natural childbirth advocates figuratively reach out with “positivity” to pet birth … and babies and mothers die as a result.

Obstetricians respect birth for what it is, wild, dangerous and untameable … and that’s how they save lives.

Dr. Oz, the cardio-thoracic surgeon who has trademarked his moniker “America’s Doctor” is under fire for promoting quackery.

According to the NY Times:

The celebrity talk show host Dr. Mehmet Oz plans to respond aggressively on Thursday to doctors who have criticized his medical advice and questioned his faculty position at Columbia University, a spokesman for the show said on Monday.

In a strongly worded email sent last week to the university, 10 physicians wrote that Dr. Oz, the vice chairman of Columbia’s surgery department, had shown “an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.” In particular, the doctors attacked Dr. Oz’s “baseless and relentless opposition to the genetic engineering of food crops.”

Apparently Oz plans to attack the credibility of his critics:

Dr. Oz will question the credibility of the letter’s authors, several of whom have ties to the American Council on Science and Health, a pro-industry advocacy group that has supported genetically modified foods, the spokesman said.

Oz may have a point. Some of the letter’s authors may have their own conflicts of interest. However, when you have to devote a segment of your nationally syndicated TV show to declare, “I am not a charlatan!” you may win the battle, but you are perilously close to losing the war.

The letter’s authors intended to use the national media to highlight Dr. Oz’s ethically dubious practice of promoting products that he knows (or ought to know) are quackery. They have been spectacularly successful in achieving that goal.

No, Dr. Oz is not going to lose his faculty appointment at Columbia, but that was never really in the cards. Academic freedom, the right of educators to hold and transmit controversial views, is precious. I don’t agree with much of what Dr. Oz has to say, but I defend his right to say it.

Nonetheless Dr. Oz is a medical doctor and doctors have ethical obligations. In my judgment, the most pressing question about Dr. Oz is whether he has violated those obligations.

Dr. Oz isn’t a charlatan; he just plays one on TV.

Hippocrates never worried about this kind of ethics problem. He conceived of the doctor-patient relationship as one on one, and wrote his Hippocratic Oath under the assumption that a physician has specific ethical obligations governing the medical advice he offers to his own patients. He never considered whether physicians have ethical obligations to the public at large.

By all accounts, Dr. Oz is an outstanding clinician. Moreover, no one has ever accused him of offering his own patients “quack treatments and cures in the interest of personal financial gain.” That would be a clear violation of his ethical obligations. But he has incontrovertibly offered quack treatments on his TV show, almost certainly in the interest of personal gain.

His influence is so pervasive that the British Medical Journal published a paper on the unreliability of his TV recommendations and those of a competing television show. Their conclusion:

Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows.

I suspect that this did not come as a shock to Dr. Oz.

But Oz’s show is not a private medical consultation; it is med-utainment, a television show that incorporates the many disciplines of medical science (or pseudoscience) to provide entertainment to viewers.

Yet even as an entertainer, Dr. Oz is still bound by medical ethics. Academic freedom gives him the right to promote medical treatments that he knows don’t work. That doesn’t change the fact that it is a violation of medical ethics to do so.

Although Dr. Oz is not engaged in a traditional doctor-patient relationship with the members of his audience, he is speaking from a position of medical authority (including touting his faculty appointment at Columbia) and he is still offering medical advice to others. He is trading on his medical credentials and therefore his actions are bound by the same ethical constraints.

He has a tremendous conflict of interest and he ought to explicitly inform his viewers of that fact. His medical “advice” is determined by considerations other than what is supported by scientific evidence. These considerations include ratings, and advertising revenue. Higher ratings = more advertising revenue = more money for Dr. Oz. He’s like any doctor who prescribes a medication or treatment based on how it profits him, not on what is best for the patient. We recognize that it is unethical for doctors to take kickbacks from pharmaceutical companies for prescribing their medications. It is equally unethical for Dr. Oz to profit from promoting quackery. If he’s not offering the same medical advice to his patients as he’s offering to his TV audience, he’s violating the primary tenets of medical ethics: beneficence (benefiting the patient) and non-maleficence (not harming the patient).

There are doctors out there who offer quack treatments because they believe that they work. Their recommendations are wrong, but they’re not unethical. Dr. Oz almost certainly knows better, which means that his efforts and renumeration as a med-utainer conflict with the obligations of medical ethics.

Dr. Oz is not a charlatan; he just plays one on TV.

And that’s unethical.