It has long been known that C-sections are safer for babies than vaginal birth. Now a new study on maternal request C-sections shows that they may be safer for mothers.

As the Times of London explains, Cesarean section no riskier for mother or baby:

Women who plan to have a caesarean section are no more likely to suffer poor medical outcomes for mother and baby following birth than those who opt for a vaginal delivery, a study has found.

The Canadian research, which looked at more than 400,000 low-risk pregnancies, found hints that women popularly characterised as “too posh to push” might even be better off.

Why might that be? Because although a C-section is surgery, vaginal birth has many risks for mothers as well as for babies.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The right to choose a C-section should be respected not merely for ethical reasons, but because they are safer.[/perfectpullquote]

The paper is Birth outcomes following cesarean delivery on maternal request: a population-based cohort study just published in the Canadian Medical Association Journal.

Women may prefer CDMR [Cesarean Delivery on Maternal Request] for many reasons, including scheduling convenience, anxiety regarding labour pain, perceptions that the quality of obstetrical care is better for women who have cesarean deliveries, and concerns about possible urinary incontinence and sexual maternal care and obstetricianbased antenatal care.

It has been difficult to study outcomes of CMDR because they make up such a small proportion of births, for example less than 4% of C-sections in Ottawa. This study is especially compelling because it includes so many women.

A total of 422 210 pregnancies met our inclusion criteria, of which 1827 (0.4%) and 420 383 (99.6%) were categorized as planned CDMR and planned vaginal delivery (including unplanned cesarean deliveries), respectively.

Our cohort included 46 533 cesarean deliveries, of which 1827 (3.9%) were planned CDMR, and 44 706 (96.1%) were unplanned cesarean deliveries. The proportion of all deliveries that were planned CDMR was 0.5% in the first and last fiscal years of our study (2012/13 and 2017/18) and the proportion remained stable across all fiscal years.

Who chooses CMDR? Women who are in a higher risk category than average.

Planned CDMR was associated with late maternal age (≥ 35 yr), being White, living in a neighbourhood of a higher educational quintiles, gaining more than the recommended weight in pregnancy, nulliparity, conception by in vitro fertilization, anxiety, not attending prenatal classes, delivering at a hospital that provides maternal level IIc or III care and receiving antenatal care from obstetricians.

How did the authors evaluate outcomes?

The primary outcome was the Adverse Outcome Index (AOI), a composite of 10 adverse events related to labour and delivery. 33,34 The AOI is reported as the percentage of individual patients with at least 1 adverse event relative to the total number of deliveries. As the AOI may be influenced by dominant outcomes, it cannot be used as an exclusive measure of quality and safety. For this reason, we also measured the Weighted Adverse Outcomes Score (WAOS) and the Severity Index (SI). The WAOS reflects a combination of the frequency and severity of events, and the SI evaluates the severity of adverse events among the pregnancies with an adverse event.

What were the results?

Overall, the AOI was lower in women with planned CDMR (3.8%) than those with planned vaginal deliveries (8.3%) (Table 3). The frequencies of adverse maternal and neonatal outcomes were both lower for women with planned CDMR than those with planned vaginal deliveries. The most common maternal adverse outcomes were unanticipated operative procedures (1.2%, n = 21) for women who planned CDMR, and third-or fourth-degree perineal tear (3.3%, n = 13 686) for women who planned vaginal deliveries. Admission or transfer to the neonatal intensive care unit (NICU) was the most common neonatal outcome for both the planned CDMR and planned vaginal delivery groups…

The WAOS was lower in women with planned CDMR than in those with planned vaginal deliveries (mean difference [MD] −1.28, 95% CI −2.02 to −0.55) (Figure 2), largely because of a lower neonatal WAOS score (MD −1.35, 95% CI −2.00 to −0.69). There was no statistically significant difference in the overall severity of adverse outcomes as measured by the SI between women with planned CDMR and planned vaginal deliveries (MD 3.6, 95%CI −7.4 to 14.5). However, the severity of maternal outcomes was greater for planned CDMR than planned vaginal deliveries (MD 20.1, 95% CI 10.6 to 29.7).

These graphs illustrate the results:

The authors conclude:

…[W]e found that planned CDMR was accompanied by a decreased risk of adverse outcomes. The AOI and WAOS were lower for women with planned CDMR than women with planned vaginal deliveries, and the risk of adverse outcomes was lower after adjusting for confounding factors.

What about previous studies that claimed to show that C-sections are riskier for mothers? Most did NOT look at C-sections on maternal request but on C-sections for which the authors could not find a medical indication on the birth certificate. But it is only by checking the medical record that they could know whether there was a medical indication or not.

The results confirm what we’ve always known: childbirth is inherently dangerous. It has a natural neonatal mortality rate of approximately 7% and a natural maternal mortality rate of approximately 1%. Although modern obstetrics mitigates the risk, vaginal birth is still dangerous. For example, in this study:

– 14 women in the vaginal delivery group died compared to zero in the CMDR group.
– 100 women in the vaginal delivery group sustained a uterine rupture, but none in the CMDR group.
– And 13,686 women in the vaginal delivery group suffered a 3rd or 4th degree tear compared to zero in the CMDR group.

Does this mean that C-sections are always safer than vaginal birth? No, because this study looked only at non-emergency C-sections that were chosen in advance. C-sections done for medical indications are more dangerous than those done electively and the comparison with vaginal birth might yield different results.

But the study DOES mean that women who choose CMDR are making a request that isn’t merely consistent with their right to bodily autonomy but is certainly safer for their babies and also safer for themselves. The right to choose a C-section should be respected not merely for ethical reasons, but — as this paper demonstrates — for medical reasons as well.

Medical patients are uniquely vulnerable.

Ill, in pain and immersed in a system where the professionals seem to speak a foreign language, hospitalized individuals require special ethical and legal protections to make sure healthcare providers do not take advantage of them.

That’s especially true for unconscious individuals who are incapable of speaking for themselves. There is a specific ethical and legal standard used for making healthcare decisions about unconscious individuals, the substituted judgment standard. It requires that healthcare professionals choose NOT what the providers believe to be in the best interest of the patient but — as far as can be known — what the patient would choose for herself.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]An infant’s benefit should NEVER be the determining standard for the mother’s medical care.[/perfectpullquote]

Therefore, it is appalling that a group of lactation professionals had the temerity to violate those ethical and legal principles to force an unconscious woman to breastfeed. Those professionals are so woefully ignorant about their ethical and legal violations that — amazingly — they published a paper to report them.

The paper is Who Makes the Choice: Ethical Considerations Regarding Instituting Breastfeeding in a Mother Who Has Compromised Mental Capacity. The answer is both simple and obvious to anyone with a basic understanding of medical ethics: the providers are REQUIRED to choose what the patient would have chosen for herself. But that’s not what the lactation professionals decided; they decided to FORCE the patient to breastfeed.

According to the authors:

A 25-year-old G4P3003 pregnant female was brought to the emergency department after being struck by a motor vehicle as a pedestrian. There was minimal past medical history available and no record of prenatal care in the electronic medical record, except report of her being ‘‘6 months’’ pregnant.

The mother had sustained a head injury, a fractured leg and there was evidence that the fetus was compromised by an abruption of the placenta.

On ultrasound, fetal biometry con- firmed an approximate 35 weeks of gestation with a weight of ~2,500 g, and a hematoma in the amniotic fluid with a thickened placenta consistent with abruption. The fetal heart rate was 75 beats per minute with minimal variability, and no fetal movement was seen on ultrasound. The patient was taken for an emergency cesarean delivery and exploratory laparotomy. A viable male infant was delivered with APGARS of 2 & 2 was brought to the neonatal intensive care unit (NICU) for care.

The decision to treat the abruption with surgical delivery of the baby (as well as the other treatment decisions) are entirely consistent with what any patient herself would choose since the abruption puts the mother’s life in danger.

In contrast, the authors have absolutely no reason to believe that this woman would have breastfed. No matter. They simply decided they could force her to do so.

The Lactation Medicine physician reviewed maternal medications, noted her history of illicit substance use, lack of prenatal care, homelessness, and placement of two prior children in foster care through Child Protective Services. Through network record sharing with other hospitals, the provider noted that the mother had provided breast milk to a prior child.

“Providing breastmilk” is not the same as breastfeeding; it sounds like something she was pressured to do during a previous maternity hospitalization. There is precisely zero evidence that this poor, homeless, substance abusing woman struggling desperately to survive would have chose to breastfeed this baby. But the well-educated, well-off lactation professionals thought they knew better.

How SHOULD the providers have determined what to do in this situation?

According to Substituted decision making and the dispositional choice account published in the Journal of Medical Ethics.

…[T]he surrogates should attempt to reconstruct the decisions the patient herself would have made, if she were capable, in the circumstances at hand… This standard is commonly justified by the principle of respect for autonomy. It has been suggested that when the patients are incapable of making the relevant decisions, their autonomy can still be indirectly respected by reconstruction, to the greatest possible extent, of the autonomous decisions they would have made if they had been able to make decisions.

The lactation professionals — in contrast — used a wholly inappropriate standard: the best interest of the baby.

The first question is if breastfeeding is the best option for the baby.

You don’t have to have a degree in medical ethics to know that not only is that not the first question; it isn’t an appropriate question at all. We don’t make medical decisions for one patient by what is best for ANOTHER patient.

As breastfeeding is the physiological norm and prevents infant morbidity and mortality one could argue that infants have an ethical right to human milk.

Even if the physiological claims were true — and there’s no evidence that they are true for 35 weekers — the authors are on extremely dangerous philosophical grounds when they imply that the baby’s interests are more important than the mother’s interests. The infant’s benefit should NEVER be the determining standard for the mother’s medical care; that would be both unethical and illegal.

An infant has no “ethical rights” vis a vis the mother’s body. If they did, mothers could be forced to give up kidneys or other organs to their offspring and their behavior could be regulated on an ongoing basis by society if it determines that certain behaviors are in the best interest of their children.

It’s difficult to imagine that the authors don’t know this. Had the mother told them she didn’t want to breastfeed, they would be REQUIRED to respect her wishes regardless of what they deemed in the best interest of the baby. Had the baby’s father or grandmother told them that the mother didn’t want to breastfeed they also would have been REQUIRED to respect the mother’s wishes.

This woman wasn’t merely unconscious, she was a member of a vulnerable economic class and was rendered even more vulnerable by having no family members to speak for her. And because of her profound vulnerability the authors had no compunction in ignoring what she might want.

And she made it clear what she wanted when she regained consciousness:

The mother in our case made the decision to stop breastfeeding due to nipple pain and engorged breasts… The mother then became engorged when she declined pumping due to nipple pain. She required multiple interventions to prevent mastitis…

Even now the authors – engaged in massive self-deception — fail to understand that their behavior was profoundly unethical.

Our case discusses the decision to initiate pumping for a comatose mother using biomedical ethical principles: (1) beneficence (breastfeeding is likely be good for the infant and mother); (2) nonmaleficence (breastfeeding might cause undue stress for a critically ill mother: there are risks of complications); (3) patient autonomy (preserving the choice to lactate preserved the mother’s ability to self-determination and avoidance of provider assumptions and bias); and (4) justice (attending to biopsychosocial features of the care, including potential biases, to promote a fair decision-making process). We believe beneficence, nonmaleficence, and justice may be met while preserving patient autonomy best by initiating pumping for comatose mothers.

But forcing a woman to breastfeed does NOT respect patient autonomy. Moreover, justice requires treating this poor homeless woman exactly the way they would have treated a well-educated, well-off woman who had a supportive family. I doubt they would have dared to substitute their judgment for hers had they thought she had the ability to hold them to account for what they did — using the fact that she was unconscious to force her to breastfeed.

Patching up False Dichotomies in the Birth Subculture by anthropologist Jessie K. Tougas should be required reading for all midwifery students.

Some birth scholars (Melissa Cheyney, Robbie Davis-Floyd, and Elizabeth Davis) have argued that there are two models of birth that value different kinds of knowledge. They assert that the “technocratic” model has been adopted by “mainstream” culture, which values reason and scientific knowledge. Meanwhile, the “countercultural” birth subculture, which has adopted a “holistic” model, values intuition and “body knowledge” instead…

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Beware anyone who promotes intuition over empirical facts — in politics or in midwifery.[/perfectpullquote]

But it’s a false dichotomy:

…[T]he dichotomy between reason and scientific knowledge on the one hand, and intuition and “body knowledge” on the other, is also inaccurate. Feminist epistemology also warns that this dichotomization undercuts a diversity of thinking styles by limiting them to just two.

Moreover radical midwifery theorists do not behave like they value women’s intuition over their own education and training which they presume to be empirical knowledge.

…[A]lthough birth activists use their connection to the “alternative health arena … to position themselves as avant-garde, counter-cultural and discriminated against,” they nonetheless “make appeals to science in order to stress the benefits of their preferred practices” and their ideas have become hegemonic since the introduction of “normal birth” campaigns in the U.K. and North America …

That’s especially true when it comes to making money:

While birth activists perceive “women requesting birth interventions as being conditioned by consumerist values,” they themselves profit from … “natural birth” product placement and … commercial support services…[B]y presenting a certain kind of birth as radically different from the mainstream kind of birth, the “natural birth” industry can profit from various products and services that are deemed necessary to “achieve” the counter-cultural birth, since it cannot be easily learned through free mainstream sources. This in turn may also explain why the birth subculture is largely composed of white, middle-class women who can afford these products and services.

Midwifery hypocrisy is a real issue. In my view, however, there’s an even deeper problem with privileging intuition, a problem best illustrated by contemporary radical conservatism.

Radical conservatism also privileges intuition over facts. Although racism is still endemic in the US, conservative white people “feel” that people of color get better treatment than they do. Although Black people are under-represented in the professions, on corporate boards and among tenured faculty, many white conservatives “feel” it is white people who face discrimination. Although Black men are literally being shot to death in the streets and are merely trying to survive, it is white conservative men who “feel” that people of color are trying to replace them.

Contemporary radical conservatism has hit upon a incredibly powerful way to privilege intuition over facts. They label facts as “fake news.” Simply put, if something doesn’t “feel” to them to be true, it simply can’t be true. Intuition reigns supreme.

They’re not the only ones.

Anti-vaxxers trust their “intuition” that vaccines are dangerous and treat vaccine science as fake news bought and paid for by Big Pharma.

Wellness charlatans trust their “intuition” that disease can be cured by eating right and buying supplements and that contemporary medicine is fake news bought and paid for by the medical industry.

And midwives trust their “intuition” that childbirth is inherently safe, their “intuition” that pain relief is harmful and their “intuition” that unmedicated vaginal birth is best.

But as even a cursory investigation of contemporary radical conservatism shows, “intuition” is just another name for prejudice — often ugly and almost always unjustified.

We should be very wary of anyone who promotes intuition over empirical facts. That’s just as true for midwifery as it is for politics.

Hi, there, it’s Ima Frawde, Tooth-wife and I’m here to educate you about Spiritual Tooth-wifery.

I trained as a dental hygienist but that doesn’t sound particularly impressive — especially when compared to dentists who have initials like DMD and DDS after their names — so my friends and I created our own credential, the RTW (registered tooth-wife). The RTW signifies that we are experts in normal teeth. It’s an awesome credential because you don’t need any education or training, just the desire to hoodwink unsuspecting clients and the $450 fee.

But I digress.

Tooth-wives are sick and tired of dentists infringing on our turf by medicalizing teeth. Teeth are perfectly designed by nature, but you’d never know that if you fall for the dentocratic model of tooth care promoted by dentists. Between filling cavities, extracting teeth and drilling root canals dentists have encouraged people to fear the state of their teeth.

In contrast, tooth-wives promote the holistic tooth-wifery model of care. We trust teeth! That’s why tooth-wives should serve as gatekeepers to dental care. You’re only allowed to see a dentist if we approve … and we rarely approve.

Dentists criticize tooth-wives for demonizing interventions, but that’s simply untrue. We vigorously promote home tooth-brushing, home flossing and we recommend and provide professional tooth cleaning every 6 months. These are spiritual practices that empower individuals to take control of their own tooth care.

We do reject dentocratic practices like X-rays; we trust intuition instead. Dental X-rays could be wrong whereas intuition about the state of your teeth is always right. If you don’t feel like you have a cavity then there’s no need to check.

And if your intuition tells you that you need an intervention like a root canal, we can transfer your care to a dentist, but ONLY if we agree that you need one. After all, we are experts in normal teeth and we know that many sources of mouth pain — even excruciating mouth pain — are simply variations of normal.

We are also available to accompany you to the dentist’s office (for a fee) where we encourage you to reject recommended treatments if at all possible. However, if you do opt to undergo dentocratic interventions we will stay with you, hold your hand and prevent you from getting Novocaine. Tooth pain is natural and abolishing it with chemicals numbs you to the spiritual power of taking responsibility for your own pain. Our motto: “no tooth pain, no joy!”

Don’t think you can stand the pain of a root canal without anesthesia? Try hypno-toothing! For the low, low price of $800 we offer courses of multiple sessions to teach you to hypnotize yourself into ignoring the pain. But before you do anything else, you must purchase your own copy of Spiritual Tooth-wifery. It’s filled with stories of women who were empowered by employing tooth-wives and taking control of their own tooth care.

Educate yourself! Trust teeth! If you do you’ll never again fall for the dentocratic model of care and you’ll demand holistic tooth-wifery care for all the years until your teeth naturally fall out.

Three words provoke horror in natural childbirth advocates: maternal request Cesarean!

How dare women choose to bypass the excruciating pain and terror of hours of labor and vaginal birth?

How dare women do everything possible to protect the health and brain function of their children?

How dare women take control of their own bodies to protect against future incontinence?

These prospects appall most midwives and natural childbirth advocates, hence the outsize attention paid to maternal request C-sections despite the fact that they represent less than 1% of births.

But a new study shows — yet again — that C-sections are safer for babies.

Determinants and outcomes of cesarean delivery on maternal request (CDMR): A population-based study in Ontario, Canada was published in May 2020.

Of 668,468 women, 0.7% (4,821) planned CDMR and 85.6% (569,212) planned vaginal deliveries… Older age, higher education, IVF, anxiety, nulliparity, Caucasian race and maternal level IIc hospital deliveries were associated with CDMR.

What did they find?

Women who planned CDMR had fewer adverse outcomes than women who planned vaginal deliveries (aRR:0.59 [95% CI 0.52–0.67]). The WAOS [Weighted Adverse Outcome Score] was lower for planned CDMR than planned vaginal delivery (2.6 v 3.6)…

Conclusions
CDMR rates have not increased in Ontario over the last 5 years. Planned CDMR is associated with decreased risk of short-term adverse outcomes, compared to planned vaginal delivery…

Why would C-sections be safer for babies? Because birth (vaginal birth in particular) puts them at risk for all sorts of injuries.

The paper Neonatal Morbidity and Mortality After Elective Cesarean Delivery by Signore and Klebanoff appeared in the June 2006 special issue of Clinics in Perinatology focussing on the epidemiology and neonatal effects of C-section.

The authors conducted a decision analysis:

…modeling the probability of perinatal death among a hypothetical cohort of 2,000,000 women who had uncomplicated pregnancies at 39 weeks, half of whom underwent ECD and half managed expectantly. After taking multiple chance probabilities into account, the model estimated that although neonatal deaths were increased among women delivered by elective cesarean, overall perinatal mortality was increased among women managed expectantly, because of the ongoing risk for fetal death in pregnancies that continue beyond 39 weeks.

They found that C-sections were dramatically safer for babies:

In other words, if 1 million women underwent C-section at 39 weeks instead of waiting for onset of labor and attempting vaginal delivery, 692 more babies would be saved, 517 cases of intracranial hemorrhage and 377 brachial plexus injuries would be prevented. In exchange, there would be 8476 additional cases of short term respiratory problems and 5536 neonatal lacerations.

But wait! Midwives and natural childbirth advocates insist that C-sections increase the risk of maternal death. To support that claim they present papers that show that maternal death rates for C-sections are higher than for vaginal birth. Sure, just like people who spend time in ICUs have higher death rates than those who do not. The individuals in the former group are sicker than those in the later group. They don’t die because of the C-sections; they die in spite of them for the same reasons that they had the C-section in the first place: pre-existing medical conditions and severe complications of pregnancy.

That doesn’t mean that C-section is a trivial procedure. It is major surgery with all the risks that major surgery poses to anyone. Though the Ontario paper does not show it, vaginal birth is probably safer for mothers in the short term, though it does dramatically increase the risk of future pelvic organ prolapse and urinary incontinence in the long term.

The balancing of risk to the baby and risk to the mother is best done by the mother herself. If a woman can elect to have a homebirth, then surely she has a moral right to elect to bypass labor and have a C-section. C-sections are undoubtedly safer for babies and offer mothers both short and long term advantages. Mothers — not midwives or natural childbirth advocates — are best equipped to weight the risks and benefits for themselves.

Here’s a recent comment from The Skeptical OB Facebook page:

I love how this page tries so desperately to falsely reassure obese people that it’s ok to be obese and there will be no long term complications to your health. It’s mental snake oil and people are eating this page up.

It’s similar to many comments over the last few day. The morally conceited apparently can’t tell the difference between health and moralizing about health.

The comments were precipitated by a series of posts and memes that called attention to the harms of health moralism.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Their devotion to the “health” of others allows the morally conceited to feel morally superior.[/perfectpullquote]

I noted that thin people feel superior to those who are overweight; that appeals to health involve moral assumptions, as well as power and privilege; and that we are hypocrites: demeaning those who risk their health by being overweight while venerating those who risk their health (and brain function) by playing pro football.

I didn’t think the argument was particularly sophisticated but clearly I was wrong. Many people confused my opposition to health moralism with opposition to health. Nothing could be further from the truth.

What’s the difference between health and health moralism? Health is a state of being; health moralism is a method of controlling others. I’m entirely in favor of people being healthy but I strongly oppose efforts to control personal behavior under the guise of promoting health.

Why? Because health moralism is astoundingly arrogant and often harmful TO health.

Consider this excoriation of preventive care by David Sackett, MD a pioneer of evidence based medicine. It’s really an excoriation of health moralism.

First, it is aggressively assertive, pursuing symptomless individuals and telling them what they must do to remain healthy. Occasionally invoking the force of law …, it prescribes and proscribes for both individual patients and the general citizenry of every age and stage.

Second, preventive medicine is presumptuous, confident that the interventions it espouses will, on average, do more good than harm to those who accept and adhere to them.

Finally, preventive medicine is overbearing, attacking those who question the value of its recommendations.

The moral panic over the “obesity epidemic” is a classic example.

Of course morbid obesity is a serious health problem with potentially deadly consequences. However, simply being overweight is not only safe, but actually appears to be protective compared to “ideal” weight. That’s what the scientific evidence shows.

Despite that:

– Health moralism pursues healthy individuals and tells them they are ill or will soon be ill.

But the truth is that you can be overweight and healthy.

You’d never know that from the disgust toward the overweight.

– Health moralism assumes that any problem experienced by an overweight person is due to weight.

But you can be overweight and ill and your illness is not caused or even affected by overweight.

You’d never know that from the harms that overweight people experience when trying to get care for health problems. They are often told that their problems are due to weight when they are completely unrelated.

– And, as the comments on my Facebook page demonstrate, health moralism is incredibly defensive, attacking anyone who questions their effort to judge and control the behavior of others.

You can recognize that overweight is a risk factor for — NOT an inevitable prelude to — illness without condemning those who are overweight.

But you’d never know that from morally conceited fatphobes who feel entitled to rage against any effort to treat overweight people honestly and with respect.

Do you tell yourself you and your friends are the only ones who see the lies?

Do you mock those who believe in expertise or follow the mainstream media?

Do you deride as “sheeple” those who respect authority?

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]Have you failed to notice you are being led over a cliff?[/perfectpullquote]

The joke’s on you!

You are a denialemming … so busy reassuring yourself of your insight and independence that you have utterly failed to notice you are docilely being led over a cliff.

If it weren’t so tragic it would be hilarious! You have become everything you claim to despise: gullible, biddable, tractable. Why? Because you have failed to see the big picture.

The big picture is not, as you have been told, that educated elites are misleading you. The big picture — which you could see if only you had a modicum of intelligence and awareness — is that no one attempts to subvert trust in authority figures unless planning to supplant it with their own authority for their OWN benefit, NOT your benefit.

But what about the conspiracies, the elite efforts to fool you about vaccines, climate change, COVID and the presidential election? Those are figments of your imagination. There IS a conspiracy, though, but it’s a conspiracy to manipulate denialemmings like YOU. You haven’t protected yourself from THAT conspiracy; you haven’t even merely fallen for it; you have happily jumped over the cliff to your own destruction.

COVID is the paradigmatic example.

COVID has always been deadly, easily transmissible but impeded by simple public health measures like masks. Yet Trump lied about it and you — gullible fool that you are — believed him. You took power away from doctors and scientists and handed it to Republican politicians.

The result? Millions were sickened and hundreds of thousands died while denialemmings pretended otherwise. Refusing a mask didn’t mark you as “free”; it branded you as easily manipulated and mind bogglingly stupid.

Climate change is similar. The planet is warming rapidly due to human beings and the deleterious results are already being felt. Yet Big Business and the politicians in their pay lie about it and you — gullible fool that you are — believe them. You take power over your life and health away from scientists who care about you and give it to business and politicians who care only about themselves. Denying climate change doesn’t mark you as clever; it brands you as easily manipulated and pathetically naive.

Make no mistake: COVID denial, climate denial and election denial ARE conspiracies about power and money. But they’re not about the power and money of experts but rather the power and money of politicians, quacks and charlatans.

Sadly, denialemmings like you haven’t got a clue. You are so busy laughing at the “sheeple” that you have failed to notice that you are being manipulated right over a cliff.

The most common mistakes of science denialists are mistakes of logic. They assume that what “makes sense” to them is automatically true. Thomas Kida, a professor at the UMass Isenberg School of Management, explains why this assumption is unjustified in his book Don’t Believe Everything You Think: The 6 Basic Mistakes We Make in Thinking.

The 6 mistakes are:

Mistake #1: We prefer stories to statistics. Stories are easy to understand; statistics are hard. The problem is that particular stories which may not be representative while statistics, which are merely the aggregation of thousands or millions of stories, offer a realistic assessment of what typically happens. Antivaxxers’ striking reliance on anecdotes shows how alternative health advocates embrace this mistake.

Mistake #2: We seek to confirm our opinions, not challenge them. Homebirth advocacy is a perfect example of this mistake. To my knowledge, there is not a single homebirth advocacy website or publication that contains accurate information about homebirth. Nonetheless, homebirth advocates actually think that they have done “research” simply because they read the opinions of others who agree with them. In contrast, they generally make no effort to read websites and publications by those who offer information that does not support predetermined conclusions.

Mistake #3: Lay people often do not understand chance and coincidence. Most people have no idea of incidence of various risks. They grossly overestimate the chances of rare events and grossly underestimate the chances of common events. Antivaxxers vastly overestimate the chances of injury from a vaccine, while simultaneously dramatically underestimating the chance of death from from the disease it is designed to prevent (a risk often more than a thousand times higher).

Mistake #4: Our personal perceptions about what is happening are often wrong. Unfortunately, the level of confidence in our perceptions is often entirely unjustified.

Mistake #5: We tend to oversimplify our thinking. Oversimplification is easy; reality is hard. While some simplification is necessary, particularly for lay people when first learning about complicated concepts, we must always keep in mind that simplification introduces distortions. Simplification is the merely the first step in thinking about complicated issues. It does not lead us to correct conclusions.

Mistake #6: Our memories are often inaccurate. This has actually been studied quite extensively. People tend to alter their memories to create a “narrative” that makes sense to them. Reality is not a narrative, however.

These mistakes are a vestige of the thinking processes that served us well in the hundreds of thousands of years of evolution in the wild. Statistics did not exist, so stories were the best way that we had to understand the world around us. Our perceptions were all we had available to us, and oversimplification is almost always the first step to understanding. In other words, there was a time when reasoning from what “makes sense” was the only thing that we had. Now those methods have been superceded by other, more accurate methods, but some people are still stuck in the past.

The typical science denialist does not know about or does not understand the new, more accurate methods for evaluating the world around us. Denialists believe what they think because they literally do not know better.

My email and Facebook messages are filled with the same question over and over again:

Are the new COVID vaccines safe for use in pregnancy?

I don’t know … and the truth is that no one knows.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]The truth is that no one knows.[/perfectpullquote]

Yet the American College of Obstetrician Gynecologists (ACOG) is recommending the vaccine for pregnant persons.

They have issued the following guidance:

ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups.

My personal view is that ACOG has been too quick in issuing recommendations. They risk their credibility — and in a climate of active vaccine skepticism in the US — the credibility of all vaccine recommendations by getting out ahead of the data.

I’m not sure why they felt the need to make any recommendation at this time. The latest information in their own journal suggests a more cautious approach.

According to Coronavirus Disease 2019 (COVID-19) Vaccines and Pregnancy; What Obstetricians Need to Know:

Because pregnant persons were excluded from the initial phase 3 clinical trials of COVID-19 vaccines, limited data are available on their efficacy and safety during pregnancy. After developmental and reproductive toxicology studies are completed, some companies are expected to conduct clinical trials in pregnant persons. Until then, pregnant persons and their obstetricians will need to use available data to weigh the benefits and risks of COVID-19 vaccines.

There are a myriad of factors to be considered:

• Data from animal studies (once developmental and reproductive toxicology studies become available)
• Lack of data on pregnancies during vaccine clinical trials
• Risks of vaccine reactogenicity, including fever; treatment with antipyretic medications (eg, acetaminophen) might reduce this risk
• Timing of planned vaccination during pregnancy
• Extensive evidence for safety of other vaccines during pregnancy
• Risk of COVID-19 complications due to pregnancy (increased risk to pregnant person of severe disease and death)
• Risk of COVID-19 complications due to underlying conditions (eg, diabetes, obesity, heart disease)
• Risk of COVID-19 to fetus or newborn (intrauterine transmission is rare, but preterm birth appears to be increased)
• Risk of exposure to SARS-CoV-2 and potential for mitigation with working from home, wearing masks, and physical distance

This is a uniquely difficult situation for three reasons: we don’t fully understand the disease in non-pregnant people; we don’t know whether the disease impacts the embryo or fetus; we have no experience at all with this new type of mRNA vaccine since there has never been another one like it.

Make no mistake: at the moment there is no evidence that the new vaccines are harmful to pregnant persons or their unborn babies.

The odds are high that the vaccine is safe and offers real, important protections during pregnancy. But good odds are no substitute for scientific data, and in my judgment, professional organizations should not make recommendations in the absence of data.

What does that mean for you if you are offered one of the new COVID vaccines during pregnancy?

It means — in my view — that the decision to accept or forgo the vaccine should be based on your specific circumstances, not based on a blanket recommendation.

Keep in mind that this is both a rare and a temporary situation. It’s a rare situation because the disease is relatively new, the vaccine was developed very quickly and we don’t have much data on the short and long term risks of either.

It’s temporary because going forward we will be gathering massive amounts of data on the disease, the vaccine and the impacts of both on pregnancy.

A year from now we will have a much better idea of whether pregnant people should take the vaccine. Until then, I believe we should honestly tell the public that we don’t know.

Over the past four years it has become increasingly clear that many Americans are suffering from the sickness of science denial. It’s a dangerous infection that profoundly weakens the body politic, is transmitted through the air(waves), and mutates easily, making it difficult to control.

As with any illness it helps to recognize the symptoms so you protect yourself.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]When someone displays see one or more of these symptoms, run in the opposite direction.[/perfectpullquote]

There are six cardinal symptoms of science denialism:

1. The secret knowledge symptom: When someone implies they are sharing secret science knowledge with you, ignore them. There is no such thing as secret science knowledge. In an age where there are literally thousands of competing scientific journals, tremendous pressure on researchers to publish papers, and instantaneous dissemination of results on the Internet, nothing about science could possibly be secret.

2. The giant conspiracy symptom: In the entire history of modern science, there has NEVER been a conspiracy to hide lifesaving information among professionals. Sure, an individual company may hide information in order to get a jump on competitors, or to deny harmful effects of their products, but there can never be a large conspiracy because every aspect of science is filled with competitors. Vast conspiracies, encompassing doctors, scientists and public health officials exist only in the minds of denialists.

3. The flattery symptom: Purveyors of science denialism invariably try to flatter those they seek to infect by implying that the potential victims are uncommonly smart, insightful and wary. They portray non-believers as “sheeple” who are content to accept authority figures rather than think for themselves. But a real scientists does not need to flatter you and would not waste the time to do so. He or she knows what is true and what isn’t and shares that information whether it makes you happy or is the last thing you want to hear.

4. The toxin symptom: I’ve written before that toxins are the new evil humors. Toxins serve the same explanatory purpose as evil humours did in the Middle Ages. They are invisible, but all around us. They constantly threaten people, often people who unaware of their very existence. They are no longer viewed as evil in themselves, but it is axiomatic that they are released into our environment by “evil” corporations. There’s just one problem. “Toxins” are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.

5. The “brilliant heretic” symptom: The typical science denialist often has no training in the relevant branch of science. No problem. A pervasive theme in science denialism is the notion of the brilliant heretic. Believers argue that science is transformed by brilliant heretics whose fabulous theories are initially rejected, but ultimately accepted as the new orthodoxy.

The conceit rests on the notion that revolutionary scientific ideas are dreamed up by mavericks, but nothing could be further from the truth. Revolutionary scientific ideas are not dreamed up; they are the inevitable result of massive data collection. Galileo did not dream up the idea of a sun-centered solar system. He collected data with his new telescope, data never before available, and the sun-centered solar system was the only theory consistent with the data he had collected.

6. The “quantum” symptom: Science denialists love to baffle followers with bullshit, hence the invocation of esoteric scientific theories that they don’t understand. Quantum mechanics and chaos theory are two incredibly abstruse scientific disciplines, heavy on advanced math. If you don’t have a degree in either one, you aren’t qualified to pontificate on them.

There is a saying in science that “extraordinary claims require extraordinary evidence.” Denialists’ claims are typically extraordinary, but denialists don’t offer evidence. Instead they display some or all of the six symptoms in an attempt to trick you into buying what they are selling, and they are invariably selling something. When someone displays one or more of these symptoms, you can be virtually certain that you are in the presence of full blown science denial. To avoid being infected don’t walk — run — in the opposite direction.