One of the things I absolutely adore about homebirth advocates is that no sooner do I write a blistering take-down of their behavior than I turn around and find yet another spectacular example of said behavior.

On Friday, I wrote about the evil at the heart of homebirth advocacy. Homebirth advocates promote pure, unadulterated evil by aiding, abetting, and praising killer practitioners. Apparently homebirth advocates have never met an incident of babyslaughter that they can’t justify (to themselves).

Now Jennifer Margulis goes a step further. She lauds a doctor criminally convicted of sexually exploiting a patient.

Because home birth is gentler than hospital birth. Just ask this M.D. who used to fight with his colleagues to allow women to have VBACs and vaginal breech births in the hospital but now attends home births in southern California, including twins and breech babies.

Apparently his conviction for sexual exploitation perfectly okay as long as he supports homebirth.

Margulis’ piece is Why Doctors, Nurses, and Other Medical Professionals Are Choosing to Birth at Home. It is a classic example of the ignorant leading the gullible. Margulis’ found two (just count ’em, 1, 2) physicians who support homebirth. And that is supposed to prove what, precisely? That some doctors are venal enough to promote a deadly practice in an effort to make money through books, workshops and attracting new patients?

There are nearly 900,000 active physicians in the US and Margulis found 2. That means that 0.00022% of physicians support homebirth. The climate deniers are supported by a higher proportion of climate scientists, and the creationists are supported by a higher proportion of biologists. What a resounding endorsement … NOT!

So the post is pretty stupid on its face and would only convince those profoundly challenged by basic arithmetic and that isn’t even the biggest problem. The biggest problem is that Jennifer Margulis features a doctor convicted of sexually exploiting a patient, Dr. Stuart Fischbein. I first wrote about Fischbein in 2009 (Can you still be “Dr. Wonderful” after conviction for sexual exploitation of a patient?). What did he do?

According to the Ventura County Star:

His patient, identified in Medical Board records as S.K., was 14 years younger than he and earning her doctorate degree in psychology. She came to Fischbein’s office in Century City with her fiancee. They wanted to have a baby.

… He performed surgery … to remove a mass in her uterus and called her “sweet pea” in the recovery room. He sat at her bedside for long intimate talks, testifying in a hearing he viewed her as not just a patient, but as a woman…

S.K. said Fischbein told her he would be a better father than her fiancee. He persuaded her to leave him.

They talked about the ethics of doctor-patient relationships. She said he told her he dated “bushels” of patients. Fischbein denied the comment or any other relationship with a patient.

She said he advised her not to have sex for four to six weeks after surgery. Fischbein said in court he didn’t remember the discussion.

Five days after she was released from the hospital and eight days after surgery, he called and asked to visit her at her home in Los Angeles. They had sex then and again two days later at Fischbein’s home.

Fischbein was convicted of sexual exploitation in LA County Superior Court. The Medical Board of California placed him on probation for 7 years. The sordid story doesn’t end there.

In 2011, Fischbein petitioned the Board for early termination of his probation.

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The board was unimpressed with Fischbein’s request for a variety of reasons. However, most compelling to them was the fact that Dr. Fischbein has attempted to make a movie promoting “his side” of events, and portraying himself as a victim.

12. In the Fall of 2007, after Petitioner was placed on probation by the Board, he began working with a screenwriter friend on a … a script entitled “Bedside Man.” By this time. Petitioner had already completed the PACE Professional Boundaries program. The cover of the script states it is “based on a true story,” and credits “Story by Stuart Fischbein.” A promotional trailer was later made, in which Petitioner was also involved and credited… Although fictional names are used in the story, the script and trailer are obviously based on Petitioner’s version of events. [They] tend to minimize Petitioner’s culpability, make him look more like a victim and his victim less of one, and depict Petitioner as being persecuted for his views on some aspects of medicine.

13. In an effort to promote “Bedside Man” for financial investment to make a full length movie, the trailer was made accessible over the internet. One hospital where Petitioner was affiliated found out about it and contacted Petitioner’s psychotherapist… From her letter detailing the events, it appears that [she] was readily able to see the impropriety of the project while Petitioner had not. She told him that the project “did not represent him as a man who had made a terrible error in judgment.” [The psychotherapist] persuaded Petitioner that the project was an error and for the trailer to be removed from the internet. Petitioner has done so.

The Board did not terminate the probation, writing:

[He] views probation as punishment and an inconvenience… Although he no doubt has encountered difficulties practicing while on probation, he still tends to overstate those difficulties. He has openly chaffed at the requirement that he have a third party chaperone during interactions with female patients. It is clear that once off probation, the chaperone requirement would quickly disappear from his practice as the lessons learned from these events fade and the inconvenience grows…

The report concludes:

More alarming was Petitioner’s participation in the movie script and trailer. This activity shows that Petitioner still harbors bad feelings about what happened to him, suggesting that he does not fully believe he engaged in misconduct… Such a state of mind does not bode well for the proposition of removing Petitioner completely from the Board’s probationary oversight. In all, these events demonstrate sufficient concern over the course of Petitioner’s rehabilitation as to indicate that continuing probation with all terms should continue in order to protect the public…

Yes, it is alarming and disturbing that Fischbein does not understand the seriousness of the crime. It is equally disturbing that Margulis and other homebirth advocates do not understand the seriousness of the crime and are prepared to overlook it. Sexual assault and sexual exploitation are very serious problems in this country. It is appalling that Margulis would dismiss such egregious behavior in her desperation to find someone, anyone, to support homebirth.

I hope that she will remove any reference to Fischbein in her post and stop lauding a doctor convicted of sexually exploiting a patient. To portray such a doctor favorably, and to fail to warn other women of his conviction, is, in my view, nothing short of evil.

Homebirth kills babies who didn’t have to die … and that’s not the worst thing about it.

The worst thing about homebirth is the way that it countenances and promotes evil.

Homebirth advocates promote evil by deliberately lying about the dangers of homebirth.

They promote evil by opposing any efforts at regulation.

They promote evil by burying dead homebirth babies twice, first in a tiny coffin in the ground, and then by erasing their existence from homebirth websites, blogs and message boards.

They promote evil by deleting and banning those who disagree with them.

But worst of all, in my view, homebirth advocates promote pure, unadulterated evil by aiding, abetting, and praising killer practitioners. Apparently homebirth advocates have never met an incident of babyslaughter that they can’t justify (to themselves). What is babyslaughter? My view is that a newborn death resulting from taking of an unreasonable and high degree of risk should be considered criminally negligent babyslaughter.

Think about it. Has there been even a single episode babyslaughterer that has been held to account by homebirth advocates? If there has been, I haven’t heard.

Quite the opposite, in fact, as babyslaughters from Lisa Barrett to Rowan Bailey are never even questioned by the homebirth community and instead showered with support and money. Apparently homebirth means never having to say your sorry for your role in a baby’s death.

The latest example is Dr. Robert Biter. I’ve been writing about Dr. Biter since his hospital privileges were suspended in 2010.

In the intervening years, Dr. Biter has been the subject of disciplinary hearings that revealed the details of multiple instances of medical malpractice and gross negligence (reports available at the Medical Board of California website). Still his supporters clung on and women continued to hire him to deliver their babies. Then in July of 2012, having already put his signature to a legal document requiring him to have another physician supervise him, he attended a homebirth by himself. The baby died and, as in the previous cases, the findings of the inquiry included malpractice and gross negligence. At that point Biter was stripped of his license.

According the Medical Board’s order, Biter has now agreed that if he ever asks the Medical Board or any other health care licensing agency to reinstate his license or grant him a new license, “all of the charges and allegations” in that accusation will be considered true and correct and could be used against him in the application process.

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Dr. Biter has no license, no malpractice insurance, has filed for bankruptcy to prevent those he injured from collecting legal judgments against him. Now he’s opening a birth center!

Biter declined to answer a series of questions from NBC 7 Investigates. However, he did send a statement, expressing deep concern for the Lukacses.

“The loss of [their] baby was a horrible tragedy and was devastating to all involved,” Biter wrote. “It is absolutely heartbreaking, and despite their animosity towards me, I extend my deepest sympathies to the Lukacses…”

Biter also said he is “committed to ensuring no other family is faced with a similar tragedy.” He also confirmed that, “I am no longer practicing medicine in California…”

Biter is still receiving support from homebirth advocates:

UTC resident Kelli Auld said Biter delivered her daughter, who is now 2. Auld has known the doctor for six years and considered him “a member of our family.”

“To me, it’s a travesty he can’t practice there. I know he’s going to find all the people who are trained and have the expertise to run an amazing birth center,” Auld told NBC 7. “There’s no one I would trust most with my body, my baby, with future babies.”

“There’s nobody like Dr. Biter. We feel at a loss that we can’t have him as our doctor anymore,” Auld said.

Biter denies that he will attend patients at the Center:

Biter told NBC 7 Investigates that he will not “be providing clinical services at Babies By the Sea Birthing Center, where my role will be purely administrative.”

But Amber and Michael Lukacs insist that Biter’s presence at this center is a danger.

“It’s Robert Biter’s birth center, so he’s inherently involved in everything,” Amber said. “I don’t believe he’s going to sit in the back office and push paper.”

I suspect that his supporters don’t believe that he’s going to sit back and just push paper, either, and that is evil.

Of course homebirth advocates, particularly professional homebirth advocates, can easily prove me wrong. I’d like to see Ina May Gaskin, Henci Goer, Melissa Cheyney and other professional homebirth advocates publicly call for Biter’s dismissal from the Birth Center. If they truly care about homebirth safety, they would be shouting from the rooftops that unsafe practitioners should be banned and punished.

Any homebirth advocate who doesn’t protest against Dr. Biter’s involvement in this Birth Center is part of the pervasive evil in the homebirth movement, allowing a babyslaughterer to continue in their midst as if the lives of the people he hurt and the lives of the baby who died are utterly irrelevant.

It’s like shooting fish in a barrel.

I’m referring, of course, to my ongoing effort to reveal American homebirth midwives (CPMs, LMs, lay midwives) for the pathetic, incompetent, ignorant fools that they are. In that endeavor I have no greater ally than homebirth midwives themselves.

Case in point: this website and e-book entitled Birth – What’s in it for me?

I couldn’t have come up with a better satire of the narcissism of homebirth no matter how hard I tried. The problem? It’s not a satire. It’s the product of Deb Puterbaugh CPM.

Who is Deb? According to the website of one of her many projects:

Deb Puterbaugh is an interior designer, retired midwife, social activist, mother and grandmother who brings years of experience in both birth and design to your project.

With her dedication to human evolution, women’s empowerment, and cultural change, Deb practiced midwifery from 1977 to 1995 in both Alaska and Santa Cruz, California. After retirement in 1995 she earned a degree in interior design and for the last 15 years her company, B. Design Inc., has created nurturing environments for both commercial and residential clients…

Actually, Deb is yet another avatar of the silliness, stupidity and narcissism that characterizes homebirth midwifery. Let’s take a look at the introduction to her site, shall we?

Let’s Begin With a Definition of Reality

To have a scientific and intellectually significant conversation about birth procedures and customs in the world we are living in (the first world industrialized corporate world) it is necessary to understand the significates of culture on the social morays (sic) and reality of the birth women who are living in these cultures…

O tempora! O mores!

The first world industrialized corporate world? The world where Deb Puterbaugh is an interior designed of birth centers? Apparently. That same world where Puterbaugh is also a feminist anti-rationalist.

Deb’s website is a veritable cornucopia of nonsensical claims meant to sound deeply philosophical:

You are literally creating the future of humanity … ONE BABY AT A TIME!

Which means what, precisely?

I suggest that most of the pathology we are seeing surrounding fertility and childbirth is culturally created.

All those mothers and babies who died in childbirth since the beginning of time were duped. They weren’t really dead, they only thought they were dead due to the pernicious influence of culture.

And, my personal favorite:

I ask you to ask yourself this question; BIRTH, what is in it for me?

Ummm, Deb. Come closer and let me whisper in your ear:

What’s in it for you? THE BABY, YOU FOOL!!

In your entire 764 word definition of reality in the context of childbirth you don’t mention the word baby even once! Are you truly so narcissistic and desperate for self-affirmation that you think that birth is about you and what’s “in it” for you, and not about the baby?

I guess you do, and I am truly grateful for this demonstration of the “thinking” of homebirth advocates. I can only tell people that homebirth midwives are silly, self-important, narcissistic fools, but you can prove it.

Sometimes I almost feel sorry for natural childbirth advocates. Just about everything they think they know is factually false.

Elective induction is a case in point.

Judith Lothian explained in Saying “No” to Induction:

Saying “no” to induction and to other interventions that are becoming routine takes courage and confidence, as well as the knowledge that women have the right to informed refusal. What women learn from you about nature’s plan for labor and birth, including the beauty of waiting for labor to start on its own and the risks of interfering without clear medical indication, will insure that the women you teach will have the information they need to confidently say “no” to routine induction.

Except that study after study shows that saying “YES” to elective inductions IMPROVES both maternal and neonatal outcomes. A new study, Maternal and neonatal outcomes in electively induced low-risk term pregnancies, comprising 131,243 low-risk births is merely the latest example. As the authors explain:

Several studies have presented information refuting the association of induction with increased cesarean delivery. Two large prospective multicenter studies of late term (41 weeks’ gestational age) pregnancies found no difference or a decreased rate of cesarean delivery in elective inductions vs expectant management. A metaanalysis reported an absolute risk reduction in cesarean delivery rate with elective induction of 1.9% (95% confidence interval [CI], 0.2-3.7%) for late term and post term pregnancies. Similar findings have been reported across different obstetric cohorts, including those with hypertensive disease, fetal growth restriction, and diabetes.

Three recent retrospective analyses found no increase in operative delivery with induction of labor and a decrease in the cesarean delivery rate among nulliparous women delivering at 39-42 weeks’ gestational age and all women delivering in the term period (37-40 weeks). Cheng et al also reported improvement in other associated neonatal morbidities including meconium aspiration, 5-minute Apgar <7, infection, ventilator use, composite morbidity, and neonatal intensive care unit (ICU) admission with induction at 39 weeks’ gestation. Using discharge and birth certificate data, Darney et al also recently found a reduction in cesarean deliveries with induction of labor compared to expectant management at 37, 38, 39, and 40 weeks of gestation. Importantly, Darney et al also reported no increase in neonatal ICU admission or respiratory distress with elective induction of labor, including those performed at 37 and 38 weeks of pregnancy.

The new study confirms these previous studies:

Of 131,243 low-risk deliveries, 13,242 (10.1%) were electively induced. The risk of cesarean delivery was lower at each week of gestation with elective induction vs expectant management regardless of parity and modified Bishop score (for unfavorable nulliparous patients at: 37 weeks = 18.6% vs 34.2%, adjusted odds ratio, 0.40; [95% confidence interval, 0.18-0.88]; 38 weeks = 28.4% vs 35.4%, 0.65 [0.49-0.85]; 39 weeks = 23.6% vs 38.5%, 0.47 [0.38-0.57]; 40 weeks = 32.3% vs 42.3%, 0.70 [0.59-0.81]). Maternal infections were significantly lower with elective inductions. Major, minor, and respiratory neonatal morbidity composites were lower with elective inductions at ≥38 weeks (for nulliparous patients at: 38 weeks = adjusted odds ratio, 0.43; [95% confidence interval, 0.26-0.72]; 39 weeks = 0.75 [0.61-0.92]; 40 weeks = 0.65 [0.54-0.80]).

The authors note:

Using a cohort of low-risk pregnancies within the Consortium on Safe Labor database, we examined maternal and neonatal outcomes for women who were electively induced compared to those expectantly managed at each week of term gestation. For our primary outcome of mode of delivery, we observed a reduction in cesarean section with elective induction, regardless of week of gestation, parity, or cervical examination. For secondary outcomes including maternal and neonatal morbidity, no outcome was shown to be worse with elective induction. Conversely, several maternal outcomes including infectious morbidity, obstetrical lacerations, and shoulder dystocia were reduced with induction of labor. For those electively induced, we observed a reduction in composite neonatal morbidities with induction of labor at 38, 39, and 40 weeks’ gestation. (my emphasis)

How did natural childbirth advocates get it so wrong? They relied on studies that compared induced labor at specific gestational ages with spontaneous labor at the same gestational ages. The correct comparison is induced labor at specific gestational ages vs. waiting (expectant management).

The authors include an important caveat:

…These data do not attempt to define what the best gestational age is for delivery at term. Rather, we submit that our results demonstrate that when maternal and newborn outcomes are analyzed through the prism of the true clinical alternatives of induction or waiting, the findings may be drastically different than what has been reported previously. Clearly, these data suggest that outcomes for mom and baby are complex with competing interests. Evaluations that only consider differences in observed neonatal morbidities by week of delivery paint an incomplete picture as they do not account for the risks of waiting… (emphasis in original)

Poor natural childbirth advocates. Yet again nature does not know best. Mothers who choose inductions for “convenience,” far from increasing their risk of C-section, maternal complications or neonatal complications, may actually be making the safer decision.

Any major field of pseudoscience worth its salt creates an alternative world of internal legitimacy. It doesn’t matter whether it is deadly antivaxx activism, naturopathy, or natural childbirth. They all do it to hide the fact that mainstream science and medicine look upon them as ignorant fools.

What’s an alternate world of internal legitimacy?

[They]have built an alternative world of internal legitimacy that mimics all the features of the mainstream research world — the journals, the conferences, the publications, the letters after the names — and some leaders have gained access to policy-making positions. Mixing an environmentally inflected critique of [obstetrics] and Big Pharma with a libertarian individualist account of health has been a resonant formulation for some years now, with support flowing in from both the Left and the Right.

This is a description of vaccine rejectionists, paraphrased from the paper The Legitimacy of Vaccine Critics: What Is Left after the Autism Hypothesis? by Anna Kirkland, published in Journal of Health Politics, Policy and Law in October 2011. It applies equally well to natural childbirth and homebirth advocates.

The latest addition to the alternate world of natural childbirth advocacy is the film Microbirth, conceived, produced, and funded by natural childbirth advocates desperate to demonize C-sections. Its thesis?

…We believe “seeding of the baby’s microbiome” should be on every birth plan – for even if vaginal birth isn’t possible, immediate skin-to-skin contact and breastfeeding can still help to provide bacteria crucial to the development of the baby’s immune system. In the scientists’ view, if we can get the seeding of the baby’s microbiome right at birth, this could make a massive difference to the baby’s health for the rest of its life. Consequently, we believe that “Microbirth” is of extreme importance for global health and potentially, for the future of mankind!

Let’s leave aside the breathless hyperbole for the moment and ask some simple questions. Who do is the “we” when the producers of Microbirth announce “we believe”? It’s not microbiologists since there is NO scientific consensus on the composition of the neonatal microbiome, let alone what it ought to be. Microbiologists do not yet understand how much of the tremendous variation from individual to individual reflects anything other than the fact that individuals differ in a myriad number of ways. Microbiologists do not yet understand the short term impact of the neonatal microbiome, let alone the long term impact. Microbiologists do not yet understand how the micro-virome (the viruses that normally live inside human beings) impacts the microbiome.

It’s not neonatalogists and pediatricians since they aren’t going to “believe” anything about the microbiome that isn’t established by microbiologists. That goes for obstetricians, too. So the ONLY people who “believe” that the neonatal microbiome is crucial to the development of the health and future wellbeing of infants … the only people who believe that vaginal birth is necessary to create the proper neonatal microbiome … the only people who “believe” that C-section deprives babies of the necessary microbiome are ideologues committed to unmedicated vaginal birth and strongly opposed to C-sections.

The movie Microbirth, therefore, is yet another attempt to bolster the alternative world of internal legitimacy that characterizes NCB advocacy. It was produced by, about, and for natural childbirth advocates, and is designed to convince the gullible who are ignorant of basic microbiology and desperate to demonize C-sections.

My questions for the midwives, doulas and natural childbirth advocates waxing rhapsodic about Microbirth are these:

1. How can you be so oblivious as to fail to notice that the only people promoting Microbirth are people with no expertise in microbiology?

2. Are you so ignorant and naive that you would actually believe a movie about microbiology made by people who have no expert knowledge of microbiology?

3. Why are you foolish enough to imagine that natural childbirth advocates either know or care more about the wellbeing of infants than neonatologists and pediatricians?

4. Can’t you see that you are being manipulated?

5. Or are you just so desperate to believe that you simply don’t care?

Inquiring minds want to know.

Another day, another example of the homebirth trifecta.

The homebirth trifecta is the ugly combination of ignorance, narcissism and contempt for the wellbeing of babies that characterizes many homebirth advocates.

This one is a classic of the genre: The Complicated Home Birth (HBAC) of Harlow Taylor…and Why I’m Glad I Wasn’t At A Hospital.

Harlow’s birth was wonderful (albeit very painful) and therapeutic and redemptive. It was everything I hoped it would be.

Was it therapeutic and redemptive for Harlow? Not so much.

Once Harlow’s head was born and her shoulders didn’t come with the next contraction, my midwife became very firm and serious with me. She instructed me to PUSH AS HARD AS YOU CAN AND GET THIS BABY OUT. She immediately had me turn over on all fours. I’d like for you to imagine trying to go from laying on your back to turning over on your hands and knees with a babies head hanging out of your body. It was interesting to say the least, but adrenaline kicked in and as my doula recounted to me, “You turned over like a cat! I’d never seen a pregnant woman turn over so fast!” Once I was on all fours I continued to push with all of my might, but Harlow still was not coming out. She then told me to turn back over, and once I did she was able to manipulate her just enough where she came down and out.

The result?

Thankfully, and by the sheer grace of God, Harlow was born healthy, albeit with some bruising and a small clavicle fracture. Also, I had no tearing whatsoever.

It is staggering to contemplate the immaturity, self-absorption and narcissism required to formulate a sentence like that, let alone publish it to the whole world.

But wait! Let’s not overlook the napalm grade stupidity required by this claim:

Now, some of you may be thinking to yourselves, “You should have been in a hospital.” or, “This could have been avoided had you been with a doctor.” To that I say, absolutely NOT. Heres why:

Because I was under the care of a midwife, I was under the care of someone who handles birth like the natural life process that it truly is instead of like something to be treated for. Because of this, she knows how to also handle all manner of complications during delivery as they may arise, and sometimes do…

[She] sprung into action with me when the need presented itself because THIS HAPPENS SOMETIMES. I’m so thankful that I was under the care of a skilled midwife who knew how to handle it in the least invasive way that was possible for my birth. At the end of the day, everyone was safe, healthy, and alive, and I didn’t have to add an additional 2 weeks recovery time. That I’m thankful for!

Earth to Lauren! Earthy to Lauren! Everyone was not safe and healthy. Since when is a fractured clavicle, with the attendant severe pain and possible associated nerve damage healthy? It isn’t, but who really cares since it is only the baby who has to suffer? Evidently Harlow’s agonizing pain is a small price to pay in exchange for Lauren’s pristine vagina.

Earth to Lauren! Your midwife did NOT handle the situation well. The baby is injured, and possibly permanently impaired, because she did not handle it well enough to keep the baby’s bones intact. The fractured clavicle might have been unavoidable but it might not. With an episiotomy, a competent provider and an assistant to apply supra-public pressure, Harlow might have been delivered without breaking any of her bones. After all, at 7 lb 9oz, she was hardly a large baby.

Of course the dangerous situation could have been avoided entirely by an elective repeat C-section, but that wouldn’t have involved Lauren’s redemption and what could possibly be more important than that?

Thanks, Lauren, for illustrating so clearly the self absorption and narcissism that leads awoman to value a pristine vagina above a baby’s pain and potential disability. Thanks for illustrating the stunning ignorance and massive denial that leads you to imagine that a fractured clavicle is a good outcome and to pretend that others with more skill wouldn’t have gotten a better result.

In other words, thanks for demonstrating the homebirth trifecta that leads so many homebirth advocates to feel proud of themselves for putting their dreams ahead of their babies’ health and wellbeing.

The midwifery and natural childbirth communities are abuzz with news of the premiere of Microbirth, a movie based on purported new medical discoveries about childbirth and the microbiome, the bacteria that normally live within the human intestines.

Microbirth supposedly presents:

…brand new science investigating crucial microscopic events that occur during and immediately after birth.

And, more importantly, what happens when the natural processes of childbirth are interfered with or bypassed completely …

[I]ncreased medicalization of childbirth may be having severe consequences on the life-long health of our children.

What’s more, it could be having a devastating effect on the future of our entire species.

Specifically:

The purpose of the documentary is to raise public awareness of the importance of “seeding the baby’s microbiome” at birth with the mother’s own bacteria – this bacteria helps train the immune system to recognise what is “friend” and what is “foe”. We believe “seeding of the baby’s microbiome” should be on every birth plan – for even if vaginal birth isn’t possible, immediate skin-to-skin contact and breastfeeding can still help to provide bacteria crucial to the development of the baby’s immune system. In the scientists’ view, if we can get the seeding of the baby’s microbiome right at birth, this could make a massive difference to the baby’s health for the rest of its life. Consequently, we believe that “Microbirth” is of extreme importance for global health and potentially, for the future of mankind!

We can predict with near certainty that the movie is going to be a bunch of crap. How do we know? Real medical discoveries aren’t introduced in movies for laypeople.

Imagine if the tobacco industry created a movie for laypeople to present the scientific evidence about the “risks” of quitting smoking. How about if the coal industry produced a movie for laypeople on the “dangers” of solar power? What would you think of the chemical manufacturers banding together to produce a movie about the “benefits” of dumping industrial waste into lakes and streams?

Most of us would recognize these as deeply cynical efforts on the part of industries to bypass real scientists, who would laugh at and eviscerate their specious, self-serving claims, in favor of presenting marketing propaganda directly to laypeople incapable of telling the difference between the two. Microbirth is a similar cynical attempt by the natural childbirth industry (“Big Birth”) to bypass real scientists, who would laugh at and eviscerate their specious, self-serving claims in favor of presenting marketing propaganda directly to laypeople.

Big Birth has a big problem. The scientific evidence does not support their claims. Natural childbirth isn’t safer and hombirth isn’t safe at all. You might think that would cause Big Birth to re-evaluate its core beliefs, but you’d be wrong. Natural childbirth and homebirth are cults, and their core beliefs are non-falsifiable. Therefore, they must abandon their original claims that natural childbirth and homebirth are visibly safer. No problem! Natural childbirth and homebirth are safer on the microscopic scale!

The truth is that the microbiome is extremely complex and interacts with the body and with both helpful and pathogenic bacteria in ways that we do not yet comprehend. That’s why any contemporary claims about the microbiome, including claims about possible differences in the microbiome of babies born by C-section vs. babies born by vaginal delivery are just wishful thinking on the part of Big Birth. We are dealing with something powerful, but we don’t know enough about it yet to make ANY recommendations since we have no idea of what the optimal microbiome looks like, how the virome (viruses that live inside humans) and the microbiome interact, how the body uses the virome to manage the microbiome, whether individual differencess in the microbiome are clinically meaningful, and the long term effects of attempting to manipulate the microbiome.

The movie Microbirth involves a microscopic amount of actual scientific evidence and a massive amount of propaganda. You’d be a fool to believe any claims it makes in the same way you’d be a fool to believe any scientific claim made directly to laypeople by any industry with a major financial stake in the claim.

But, of course a lot of natural childbirth advocates and a fair amount of midwives are fools. The rush to embrace Microbirth merely proves it.

Yesterday I asked whether promoting unmedicated vaginal birth is unethical. Today I’d like to ask a corollary: do midwives put their own needs ahead of the needs of their patients. I’m not the first to wonder whether this has compromised the care that midwives provide to women.

Canadian midwife Mary Sharpe and colleagues have written about the situation in Ontario in Essentialism as a Contributing Factor in Ideological Resonance and Dissonance Between Women and Their Midwives in Ontario, Canada. Sharpe starts with a definition of essentialism:

Essentialism is understood as the tendency to view entities according to a set of distinct and limiting characteristics, or essences. Furthermore, an essentialist approach regards these characteristics or essences as inherently true or correct…

Sharpe details how essentialism is expressed in the foundational documents of Ontario midwives:

While the values embedded within the document, when viewed pragmatically, simply set ideals for practice, they also tend to support the culture of essentialism within the midwifery community by making certain assumptions about the meaning of midwifery care, the women who seek midwifery care and the nature of the woman-midwife relationship…

But those beliefs and assumptions are not shared by a large proportion of women. Instead of acknowledging that essentialist beliefs are not held by all women, the Ontario midwives react with disdain and an unwillingess to care for women who have different beliefs.

While some midwives interviewed stated that they were delighted to be able to provide care for the more diverse group of women seeking midwifery care … they nevertheless noted that they remained wary of those who do not overtly behave in ways that correspond to Ontario midwifery’s stated values and philosophies… Some Ontario midwives indicated that they felt there are “ideal” or “peak” midwifery clients and that certain women are therefore particularly “deserving” of midwifery…

As midwife Vicki Van Wagner explains:

There is a real tension in the midwifery community between narrow essentialist views of women, midwives and birth, connected with the lure of the “natural” and other concepts such as choice and diversity… In a countercultural movement such as midwifery, the need for strength to combat outer forces can create narrow views, dogmatism and a fear of diversity…

Sociologist Helen Lenskyj notes:

It does not serve women’s interests well for midwifery supporters to essentialize women as either mothers or midwives… Where does this leave the non-conforming mother who does not view the midwife as her best friend … One [also] needs to consider the messages that [such] rhetoric convey[s] to a woman who has no … regrets about her conventional medicalized birth experience. Is she less female/ feminine/ feminist because she does not … reflect on [her] birth experiences with feelings of anger, regret, mourning and loss?

Ultimately:

Ontario’s model of midwifery care reflects the essentialist tendencies of the feminist movements of the 1970s and 1980s that led to the legislation of midwifery in Ontario… The essentialist tendencies revealed by midwives and women in Sharpe’s study tend to pose dilemmas for midwives in the manner in which care is provided, the manner in which women are selected for care and the ways in which the philosophy of midwifery care is upheld.

Helen Lenskyj offers midwives advice that they should take to heart:

It is not productive for midwifery’s advocates to cling to exclusory or essentialist notions of woman and midwife. Rather, it is important to respect the feminist principle of choice … and to allow for diversity and difference among women, both midwives and clients.

What I find most intriguing about the views expressed in this paper is that they highlight the fact that midwifery has become obsessed with the feelings of midwives to the detriment of patients. It suits certain midwives and virtually all midwifery theorists to claim that “the natural” represents the pure essence of what women should want and how women should behave.

The profession of midwifery has been led astray from the values that have preserved midwifery across time, place and cultures. Those values were to minimize the risk of death to baby and mother by observing the ways that treatments and preventive measures could improve outcome. In contrast, contemporary midwifery often seems devoted to a stylized piece of performance art where the process is viewed as more important than the outcome. It is ironic that a profession that proposed in the mid-twentieth century to offer women more choices has devolved into a profession that insists that only one choice is acceptable.

A version of this piece first appeared in December 2010.

Years ago when I first read the phrase “promoting normal birth” I was confused. Why would a healthcare professional be promoting any set of procedures or any particular approach to a health issue? I thought it was the job of health professionals to promote safety.

It is unethical for a medical professional to promotes one procedure over another when both are equally effective in dealing with the issue at hand. An ethical medical professional recommends whatever is safest for the patient, not whatever is most pleasing to or most lucrative for him or herself. There are no real medical publications claiming to promote one form of treatment or even one philosophy over another. Real medical publications promote health and promote safety, not the opportunity to confirm one’s prejudices or line one’s pockets.

In contrast, many midwives unabashedly promote one form of birth over another, ineffective pain relief measures over effective pain relief, and rejecting technology in favor of “unhindered” birth. Indeed, the entire midwifery corp of the UK is strictly committed to unmedicated vaginal birth, going to far as developing and maintaining the Royal College of Midwives “Campaign for Normal Birth.”

So I have a question for natural childbirth advocates, midwives and other birth workers: isn’t that unethical? Or more to the point: how can it possibly be ethical to promote one way of giving birth over any other?

Furthermore, aren’t attempts to promote unmedicated vaginal birth an abuse of midwives’ power over patients? Shouldn’t they be providing accurate, value-free medical information to patients and then honoring whatever decisions patients make? How can they justify promoting their own beliefs about birth over their patients desires?

I ask these questions because I’m anxious to see whether any natural childbirth advocates are willing to grapple with the ethical implications of their efforts to promote unhindered, unmedicated vaginal birth. I suspect that no one will.

Allison Dixley, self proclaimed “Alpha Parent,” is in a snit. Several women have dared to write books about new motherhood that attempt to soothe the hysteria over breastfeeding. Apparently these writers point out that in first world countries the benefits of breastfeeding are small, many women find breastfeeding painful and difficult, and not all babies can get enough nutrition from exclusive breastfeeding. Dixley is incensed and attempts to rip them to shreds. In doing so, she exposes the principal difference between herself and me: no, not the fact that I have years of scientific and medical education, and Allison has none, although that is indeed a major difference. The principal difference is that Dixley’s self-image rests largely on whether or not she is right about the value of breastfeeding; mine does not.

I’m not emotionally invested in determining the magnitude of the benefits and hardships of breastfeeding because I’ve already done it quite successfully. I breastfed 4 children, despite working ridiculous hours, until each weaned him or herself. I had very few difficulties, a booming milk supply, and babies who fed easily and avidly, although I did have several serious bouts of mastitis (temp of 104, shaking chills, etc). In Allison Dixley’s world I’m a goddess! My breastfeeding “accomplishments” far exceeding hers and most the women she profiles. However, I understood even then that it was largely a matter of good luck on my part, in addition to my commitment. My children are grown now and it is easy to see that breastfeeding didn’t have any impact on how they turned out. My self esteem never rested on breastfeeding success, even though I achieved breastfeeding success.

Dixley would have you believe that she is a better parent than women who couldn’t breastfeed, had insurmountable difficulties breastfeeding, or simply didn’t want to breastfeed. And since her self esteem appears to be directly proportional to the benefits she attributes to breastfeeding, she is deeply emotionally (not to mention professionally) invested in shaming women who don’t copy her. I, on the other hand, devote tremendous effort battling the shame, blame and soul-sucking criticism that Dixley and her lactivist sisters heap on women who don’t mirror their own choices back to them.

Simply put, Allison Dixley NEEDS breastfeeding to be critical to child wellbeing because if it isn’t, she’s just another mother, no better than the rest of us. She cannot look objectively at the scientific evidence about breastfeeding since if it isn’t as important as she maintains it is, she loses her self-awarded designation of “alpha parent.” In contrast, it makes no difference to me. I did it. I have everything to gain and nothing to lose by beating women over the head with my “achievement,” but I don’t do it because I know the scientific evidence simply doesn’t support such preening.

Unfortunately, new mothers are exquisitely vulnerable to the efforts of Dixley and her lactivist sisters to boost their own self-esteem by battering the self-esteem of others. Dixley is thoroughly untrustworthy on the subject of breastfeeding because her critical thinking skills are immobilized by her emotionally neediness. In contrast, there is no downside for me in telling the truth that the scientific evidence shows that while breastfeeding has real benefits in first world countries, those benefits are trivial; therefore, breastfeeding is not the holy grail of new motherhood, merely one of two ways to completely and successfully nourish a baby.

Who is more likely to provide you with accurate information about breastfeeding? Allison Dixley who can only be an alpha parent if breastfeeding is absolutely critical to infant wellbeing? Or me, medically trained, fully apprised of the scientific literature and able to understand it, as well as a woman who successfully breastfed 4 children and doesn’t think it makes me a better mother than anyone else? It’s up to you to decide.