There are so many homebirth deaths occurring that I am having a hard time keeping up. I originally planned to blog today about the recent homebirth death in New Jersey attended by a CPM who had already had her license revoked. I’ll need to save that one for another day.

I came across the story of this homebirth death because of a post entitled, The MOTHER of all posts: IT’S NOT OUR FAULT.

Her heart rate was monitored closely with consistent reassuring heart tones the entire time. At the point when she was crowning … we were still getting a steady, consistent heartbeat. I pushed for a reasonably short amount of time and delivered her without the need of an episiotomy … and I only tore minimally not requiring stitches. She was born and had already passed, the cause of which we can only conclude was having suffered a cord accident in the last moments of birth. She received immediate emergency care but was unable to be revived.

The stories are sickeningly familiar. The blog detailing the mother’s commitment to unmedicated childbirth as “healthier”; the death that supposedly took place in the moments before birth; the clueless midwives who had no idea that the baby was dead; and the link to site where donations can be made to cover the cost of the funeral.

The mother is livid that someone chose to mention that it was her decision to have a homebirth that led to her daughter’s preventable death.

I received a comment on my blog yesterday. Completely, off the topic of the post it was attached to. Unrelated. Here is what it said:

Knowing that this was a “home birth” and that you have NOT once mentioned home birth in all the blog entries that you have written…I would like to just say one thing, that “women who give birth at home trade the “birth experience” for “safety”. There are “risks” with both home birth and hospital birth, but I can’t understand why anyone would want to sacrifice safety for experience…just saying!

… We are devastated by the tragic loss of our baby girl and this judgmental, hateful “anonymous” has the audacity to tell us it’s our fault…

If this person believes we are responsible that’s one thing, but to point their finger at grieving parents in the midst of our immeasurable pain, something this individual could NEVER understand, and try to shame us and blame us by telling us our child’s death is our own fault is disgusting. What type of human being could sink so low? How revolting can someone really be?

What type of human being? The type that cares that babies are dying unnecessarily.

One of the delicious little lies of the homebirth movement is that women who choose homebirth take responsibility for the outcome. The hell they do.

They blather on about being “educated,” about doing their “research,” about ignoring the advice of obstetricians, family members and friends. They insist they understand the risk that the baby might die … right up until the moment the baby dies.

Then they blame God, the universe, fate, anything else but themselves, the people actually responsible for making the choices that led directly to the death of their babies.

Hey life, universe, god or whomever it concerns,

I’ve got some questions for you.

I’m suppose to be celebrating the birth of my baby girl right now. Snuggling her, holding her and kissing her. Why am I planning a funeral?

She was healthy, strong and perfect, why couldn’t she survive the last moments of childbirth?? Why wasn’t my body perfect for her exit? I TRUSTED it. I trusted you.

No, you didn’t trust life, the universe or god. You trusted YOURSELF to know better than medical experts.

Who made the choice to deliver at home, far from emergency equipment and personnel? The homebirth mother. Who made the choice to hire a substandard practitioner? The homebirth mother. Who chose to ignore the medical advice of obstetricians? The homebirth mother. Therefore, who is responsible for the death of a baby that could have been prevented by obstetrical interventions provided by legitimate obstetrical providers in a hospital? Who else but the homebirth mother?

Saying that the homebirth mother bears responsibility for the death of her baby at homebirth is not incompatible with feeling sorry for her loss. It’s no different than grieving for a child who went through the windshield and died because her mother didn’t buckle her into a carseat. That mother is no doubt devastated, and no feeling person can failed to be moved by that devastation, but that doesn’t change the fact that the mother, through her action or inaction, is ultimately responsible for the death.

It is all so damned repetitive:

• The claim of being “educated”:

We researched for months, we read all the information we could find, we learned from every source out there. Our midwives educated us but never pressured us or even encouraged us to give birth at home.

• The claim that the midwives were not at fault.

Our midwives closely monitored the entire pregnancy… The attention, genuine concern and high quality care we received from these three amazing women (and EVERYONE who worked at the midwifery practice) was incredible…

Incredible? That’s not how I would characterize midwives who didn’t know that the baby was in distress until it dropped into their hands already dead.

• The pathetic assertion that the baby received the same resuscitative measures that would have been available in the hospital.

Could she have been revived if she were in a hospital? The same procedure that would have been made to attempt to resuscitate her in a hospital WAS MADE for Aisley.

No, the same resuscitative measures were not used. There was no expert resuscitation with intubation.

• The insistence that it is no one’s fault.

It was an accident that she died. Accidents occur in hospitals as well. The risk of infant death in a home birth is less than 1%. It was an unforeseeable tragic event. Would anyone blame a mother in a hospital for being responsible for her baby’s death? How dare anyone blame us!

How dare they blame you?

YOU are the one who chose to give birth far from emergency equipment and personnel. YOU are the one who insisted that you were “educated” about the risks of homebirth. YOU are the one who chose midwives who were so clueless that they didn’t even know that the baby died during your labor.

When a baby dies at homebirth, those who warned you are entitled to say “I told you so.” What happened to your daughter is precisely what those who warned you were afraid of. They did tell you so; you chose to ignore them. YOU were the one who made the decisions and therefore, YOU are the one who is responsible.

Homebirth advocacy websites are classic “rumor communities.”

What is a rumor community?

… Community members limit the scope of conflict by asserting authority to speak publicly and rejecting contributors with countering opinions as irrelevant. They sustain their threatened community by denying scientific evidence and demanding unattainable levels of scientific proof, and they socialize conflict by recruiting bystanders to enter the fray using appeals to wider social values.

That description applies to every homebirth website I’ve ever seen from Mothering.com to Lamaze’s Science and Sensibility to the personal websites of homebirth midwives and homebirth advocates:

Asserting authority to speak publicly ✓
Deleting other opinions as irrelevant unsupportive ✓
Denying scientific evidence ✓
Recruiting bystanders to the fray with talk of feminism and rights ✓

The quote above comes from a new paper, The Persistence of Rumor Communities: Public Resistance to Official Debunking in the Internet Age, recently presented to the American Political Science Association Annual Meeting by Jill A. Edy and Erin E. Baird of the University of Oklahoma. Edy and Baird discussed the anti-vax community, but their findings apply to the homebirth community as well.

Rumor communities use two distinct strategies to promote their views, one strategy for insiders and another for “bystanders.”

The insider strategy is obvious and the banning of outsiders is critical to that strategy. A rumor community is designed as an echo chamber where only approved views can be shared. Anyone who disagrees must be banned so that accurate scientific information will be suppressed. Of course homebirth advocates don’t acknowledge that the widespread banning occurs in an effort to suppress accurate information. Instead they claim that the rumor community is designed for “support” and that alternative viewpoints (or even additional information) is unsupportive.

The bystander strategy is more subtle. Edy and Baird believe that we need to change the way we view the propagation of conspiracy theories and rumors, both political and scientific to encompass these bystander stategy:

Current research on rumors, conspiracy theories, and other forms of political misperceptions favors a modernist perspective and a psychological research paradigm. The scholarship emphasizes the factual inaccuracies of individual beliefs and theorizes about how individuals came to hold or spread those beliefs, what sorts of messages might dispel them, and the impacts of inaccurate beliefs on political opinions. Communication is conceptualized as a means of transmitting inaccurate or accurate information, and public opinion is conceptualized as the aggregation of individual opinions.

This conception is inadequate because it ignores the social dimension:

… Generated and sustained by interest groups, political rumors, conspiracies, and misperceptions speak to fundamental elements of political culture. They survive because they are persuasive, not because they are true in any kind of modernist sense. These characteristics of rumors, conspiracy theories, and misperceptions are better understood with a cultural approach to communication and an understanding of public opinion grounded in group conflict.

The new paradigm they propose has its origin in political science:

E. E. Schattschneider offered a theoretical model for understanding political conflict that involves group conflict, describing a process of “socialization of conflict.” He observed that a party on the losing side of a political argument seeks to broaden the scope of conflict by recruiting allies who may come in on the losing side and turn the tide in their favor … Thus, we might expect that ardent believers in a debunked rumor might both resist changing their beliefs and seek to recruit additional supporters from amongst those Schattschneider referred to as “bystanders.” … Rumors may survive and thrive not because debunking messages fail but because rumor communities appeal to wider social values and broader audiences in order to sustain the political conflict they are losing.

The social value invoked by rumor communities is typically personal liberty:

… Many members of the anti-vaccine movement describe themselves as engaged in political action, resisting government and public health authorities. The rumor they believe has been debunked by scientific and public health experts, yet they continue to agitate against childhood vaccination. Political conflict over the rumor is both visible and archived in Internet coverage of the debunking and public responses to it. In responding directly to online news coverage and blog posts, the rumor community engages in public discussion that includes both believers and nonbelievers before an audience of interested citizens whose opinion may be affected by what it sees. According to Schattschneider’s model, the rumor community’s public discussion socializes conflict to the extent that it appeals to bystanders to enter the conflict on the side of the antivaccine advocates.

Sound familiar? It should because homebirth advocates make the same claims in an effort to engage bystanders.

Homebirth advocates routinely describe themselves as engaged in political action, resisting “Big” government, “Big” Pharma and “Big” Medicine. In this way they elide the fact that most of their claims are nonsensical (“homebirth is as safe as hospital birth”; “obstetricians don’t follow the scientific evidence”; “childbirth is only painful because women have been socialized to think it is painful”) and attempt to engage bystanders by appeals to freedom and rights. They solicit support from outsiders who reject the nonsensical claims by invoking claims of political liberty. The Human Rights in Childbirth Conference and the new movie Freedom for Birth are merely the latest and most explicit efforts along these lines.

Homebirth advocates love to claim that they have “educated” themselves by reading and participating in homebirth websites. It should be obvious, however, that you cannot educate yourself by participating in a rumor community. So how can the average person decide what it is a rumor community and what is a legitimate source of accurate information? That’s relatively easy. Any community that resorts to frequent banning of commentors with different opinions is a rumor community and, therefore, thoroughly unreliable.

In other words, virtually every homebirth and natural childbirth website is a rumor community and not a source of accurate information. It doesn’t matter whether the community is sponsored by Lamaze, by Mothering Magazine, by Ricki Lake, by The Feminist Breeder or any other of the myriad homebirth and natural childbirth bloggers. It’s a very simple rule of thumb:

If they ban dissenters, they are rumor communities. Websites that offer accurate scientific information don’t need to ban people who disagree.

Breech babies make up only 3-4% of all births, yet they represent a disproportionate share of homebirth deaths. Why? Because breech birth is dangerous.

I’ve written before that, contrary to the prattling of homebirth advocates, breech is not a variation of normal. I have also pointed out that homebirth advocates indicate their awareness of this when they brag about breech homebirths in which the baby did not die.

Homebirth advocates are fond of quoting the PREMODA study to support the decision for breech birth at home, conveniently ignoring the fact that the PREMODA study found that breech birth could be relatively safe in high resource settings, using extremely strict exclusion criteria, and attended by a very experienced obstetrician (though even then not as safe as C-section). Obviously, none of that applies at homebirth.

So what is the real risk of breech homebirth? I just came across a study about breech birth in low resource settings that put the risk of breech birth in perspective and the risk is huge.

As the name of the study, Neonatal Outcome of Term Breech Births: A 15-Year Review at the Yaoundé General Hospital, Cameroon, indicates, it looked at breech birth in a low resource setting, a hospital in the developing world. Like the PREMODA study the breech births took place in a hospital with access to emergency C-section, involved some exclusion criteria and were attended by obstetricians and midwives. Unlike the PREMODA study, however, the exclusion criteria were not extremely strict and births were attended by obstetricians and midwives, not necessarily those who had the most experience in breech birth.

What did the authors look at?

We conducted a cross-sectional analysis of data collected from March 1992 to March 2007 at the Yaoundé General Hospital, Cameroon…

From the birth registers and the neonatal discharge summaries we identified respectively all term singleton breech deliveries and all term breech delivered infants transferred to the neonatal unit. The mode of delivery, cesarean or vaginal was also noted. The exclusion criteria were multiple pregnancies, antenatal fetal death, and major fetal congenital malformation such as anencephaly and hydrocephaly… The sample size calculated using the incidence of breech delivery of 3% was 45 with a confidence interval of 95%.

Even in this low resource setting, elective C-section was performed nearly 30% of the time because breech vaginal birth was felt to be too dangerous.

… Of 249 term singleton infants in breech presentation, 73 (29.31%) were born by elective cesarean section and 176 (70.67%) were allowed for trial of vaginal delivery with 136 (54.61%) delivered vaginally and 40 (16.06%) delivered by intra-labor cesarean section.

What did the authors find?

… Compared to infants born by elective cesarean section, those delivered vaginally or by intra-labor cesarean section were more likely to have low 5-minute Apgar scores (4.1% vs. 17.77%; P <.001), require admission to neonatal unit (08.21.% vs. 13.63%;P <.001), and have an increased risk for perinatal mortality (0% vs. 05.68%; P < .001). Trial of vaginal delivery of term infants in breech presentation was associated with significantly increased risk of perinatal death and neonatal morbidity.

In other words, more than 1 of every 20 term breech babies died despite the fact that the delivery took place in a hospital with access to emergency C-section and despite the fact that more than 1 in 5 were ultimately born by C-section anyway. To put that into perspective, the Hannah trial, the study that found that breech vaginal birth increased the risk of perinatal death, found only a 1.3% rate of perinatal death at breech vaginal birth.

Homebirth is not a low resource setting; it is a no resource setting. There is no ability to perform an emergency C-section and most homebirth midwives have no exclusion criteria for breech homebirth. The perinatal death rate for breech homebirth is almost certainly much higher than 5.68%.

Why do so many breech babies die at homebirth? Because breech vaginal delivery is extremely dangerous.

Rather than boasting about breech homebirth, homebirth advocates should be ashamed of taking such a hideous risk with the lives of their breech babies.

My doctor says my blood pressure is high at 160/100 and wants to start me on  blood pressure medication.

I was shocked because I do everything right. I eat lots of kale, exercise everyday, and have a normal BMI. How could I have high blood pressure? My doctor explained that as people get older, their blood vessels stiffen and blood pressure rises in response… and she expects me to believe that something that happens in the normal course of aging is pathological.

I bet she was surprised that I didn’t respond like all the other sheeple and accept her explanation and take the prescription for medication. I, unlike those fools who simply follow their doctors’ advice, refused. I have done my research and I know that the doctor is simply fear mongering.

I can’t really blame her. She’s been socialized by a medical system that insists on viewing the normal changes of aging as pathological. She probably thinks she has my best interests at heart when she warns me that high blood pressure increases the risk of heart attacks and strokes, but have educated myself about blood pressure and I can’t be fooled. I, like many of my friends on the Home Blood Pressure and Unassisted Blood Pressure forums on Narcissism.com, are no longer going to respond with fear when a doctor plays the “dead-person” card.

From my extensive research on Google and at various blood pressure blogs, I’ve learned 10 reasons to reject blood pressure medication:

1. My body is not broken. Even my doctor acknowledged that increased blood pressure is often part of normal aging and I am sick and tired of doctors pathologizing aging bodies.

2. The human race has survived tens of thousands of years without blood pressure medication. If high blood pressure were really as dangerous as my doctor claims, we wouldn’t be here now.

3. I know plenty of people who never treated their high blood pressure and lived to old age. My own grandmother refused to take the blood pressure medication prescribed by her doctor and she died at age 85.

4. Treating high blood pressure is big business for drug companies and doctors. Did you know that 3 of the top 10 most prescribed drugs in the US are high blood pressure medications? If that doesn’t indicate a conspiracy between Big Pharma and doctors, I don’t know what does.

5. Have you ever read the package inserts for high blood pressure medications? Look at all the possible side effects. Why would I want to risk that?

6. My doctor insists that high blood pressure leads to heart attacks and strokes, just because it is far more likely to have a heart attack or stroke if you have high blood pressure. But the fact is that most people with high blood pressure don’t have a heart attack or stroke. Many of them die of cancer, or diabetes or Alzheimer’s so it is wrong for doctors to play the “dead person” card to every person who has high blood pressure.

7. The US spends a massive amount of money on high blood pressure medication, but all older Americans eventually die anyway showing that treating high blood pressure is ineffective.

8. Heart attacks and strokes don’t necessarily lead to death or even to permanent damage. I know plenty of people who have had heart attacks and didn’t die. I know plenty of people who had strokes and didn’t die either. Yes, some of them have partial paralysis and others can’t speak, but some people are just meant to be paralyzed and aphasic and it would have happened whether they followed their doctors’ advice or not.

9. Since most people with high blood pressure don’t have heart attacks or strokes, there is no reason to over treat everyone who has high blood pressure. We should wait to treat only the people who do have heart attacks or strokes. We can do angioplasties, bypass surgeries or give clot busting drugs once we know exactly who has had a heart attack or stroke.

10. Everyone knows that the first hour after heart attack or stroke is a “golden” hour. Heart attack and stroke victims are much more likely to survive if they get treatment in the first hour. Since I live only 10 minutes from the hospital there is really no reason for me to treat my high blood pressure. If I have a heart attack or stroke I have plenty of time to get to the hospital before that hour is over.

So that’s why I am not going to respond to the “dead person” card, contribute to the profits of Big Pharma and follow all the other sheeple who take high blood pressure medication for no better reason than that they have high blood pressure. I may be old, but my body is not “broken” and if I am one of those unfortunate few who does have a heart attack or stroke I can transfer quickly to the hospital since I only live 10 minutes away.

There is way too much fear surrounding blood pressure these days. It hasn’t always been this way. For countless generations we have survived without blood pressure medication and I intend to die live the way nature intended. I personally feel empowered by rejecting blood pressure medication; I feel empowered by ignoring my doctor; I especially feel empowered by boasting to my friends on Narcissism.com that we are the truly educated and that everyone else is an idiot.

I will conclude with a shout out to to natural childbirth and homebirth advocates who, through their rejection of modern obstetrics, have convinced us to reject modern cardiology and neurology as well. It’s time we take back blood pressure from doctors in the exact same way that they have taken back birth. I’m sure we’ll be every bit as successful at preventing death and serious injury as homebirth advocates are, since our logic is just as impeccable. And if we’re not, we’ll take yet another page from their playbook and simply hide our death rates!

This piece is satire. The inane “reasoning” of homebirth advocates, however, not satire.

Having an unassisted homebirth after five c-sections was an awesome experience. It was my easiest labour and birth. I could do whatever felt comfortable with and be in any position.

There was just one teensy, weensy problem: the baby died.

We had many discussions about how and where we should have this baby. Having had five c-section and two natural births we knew any doctor/ob would push for another c-section. We did a lot of praying but didn’t get many answers! We felt a peace about a natural birth, labouring at home and going to hospital if time allowed.

There was time, but they didn’t go to the hospital.

 By around 6am I got the feeling that this was going to be it! Mike got up and started slowly packing up the bus. He did a lot of praying about whether to go to the hospital or stay put. At 7.30am my waters broke! They were clear which was good. Contractions picked up a bit but were still not unbearable. I coped by supporting my weight on the hand rails of the bus! (Glad we hadn’t removed them!)  I started to feel a bit pushy around 8.30am so we made the decision to stay put. At 9am our 9lb 9oz daughter slid silently into the world into the waiting arms of her daddy. The cord was (loosely) round her neck but Mike could easily slip it off. We noticed too that the cord was already white and not pulsing.  We immediately realised that something was wrong – she was purple, limp and not breathing!

Paramedics ultimately resuscitated the baby, but she had suffered massive brain damage. The parents made the decision to remove life support and the baby died.

What we believe happened the cord prolapsed when my waters broke trapping it between Serenity’s head and the cervix. So she was about 1 – 1 1/2 hours without oxygen before she was born.

Was this a good home birth?

The outcome was a dead baby, but we all know that the process is much more important than the baby, and when it comes to the process of this baby’s birth, the mother had an “awesome” experience. In the world of homebirth narcissism and self absorption, what could be more important than that?

I’ve noted in the past that homebirth and natural childbirth advocates love mantras and memes. They represent simple ways to communicate complex ideas, make wonderful sound bites, and for advocates, whether or not they are true is irrelevant.

I’ve written about the “obstetricians ignore the scientific evidence” mantra, which doesn’t make sense if you think about it for any length of time.

We are supposed to believe that obstetricians (with 8 years of higher education, extensive study of science and statistics, and four additional years of hands on experience caring for pregnant women), the people who actually DO the research that represents the corpus of scientific evidence, are ignoring their own findings while NCB advocates (generally high school graduates with no background in college science or statistics, let alone advanced study of these subjects, and limited experience of caring for pregnant women), the people who NEVER do scientific research, are assiduously scouring the scientific literature, reading the main obstetric journals each month, and changing their practice based on the latest scientific evidence.

I’ve also written about the meme that the media is to blame for the pain of childbirth.

… Childbirth is not inherently painful; its depictions in popular media like TV shows and movies tricks women into believing that childbirth is painful. Hence the otherwise inexplicable preoccupation on NCB blogs with how childbirth is portrayed in specific TV shows and movies.

That one isn’t getting much traction since it is obvious that it isn’t true. The people who wrote the Bible thousands of years ago were so impressed by the pain of childbirth that they explained it as God’s punishment, and they weren’t exposed to many TV shows or movies.

The latest meme in homebirth and natural childbirth circles is “human rights in childbirth.”

That’s the name of a conference organized by, for and restricted to homebirth advocates. And it figures prominently in a new film make the rounds in homebirth and natural childbirth circles, Freedom for Birth.

Freedom for Birth is a new 60 minute campaigning film that re-frames Human Rights as the most pressing issue in childbirth today.

In many countries around the world, women are being denied the most basic human right of autonomy over their own bodies. They cannot choose how and where to give birth. Those that persist in their desire to have a normal, physiological birth are sometimes forced by judges to surrender to surgery or threatened with having their babies taken away by child welfare services.

In other words, the meme of human rights in childbirth refer to the rights of the mother.

Let’s leave aside for the moment the fact that there is no legal or ethical right to have a homebirth; the right of autonomy allows for the refusal of hospital care (or any medical care), but it does not mandate an obligation on the part of others to provide a specific form of care.

Let’s ask an obvious question: does the baby have any human rights in childbirth?

The baby? You remember the baby, the other individual whose life is at stake during the process of birth? What about the baby?

I’m not talking about legal rights. Children have virtually no legal rights before birth. I’m talking about moral rights. When a mother makes the decision to take a pregnancy to term, does the baby have a moral right to receive appropriate and life-saving medical care?

Let me be very clear: I’m not talking about the rare situation in which the mother’s life is pitted against the life of the baby. The mother has the unfettered right to determine treatment in that setting. But homebirth and natural childbirth advocates are not talking about that situation, either. As the movie details make clear, homebirth and natural childbirth advocates are talking about the “desire to have a normal, physiological birth.”

So in a very real sense, the question is: Does a baby have a moral right to receive life-saving medical care when the mother is refusing it for no better reason that to have a specific birth “experience”?

Philososphy Professor Julian Savulescu and obstetrician Lach De Crespigny of the Oxford University Centre for Practical Ethics believe that a baby does have that moral right.  They make their case in an article entitled The Continuing Tragedies of Home Birth and the Rights of the Future Child.

The authors acknowledge:

… [T]he fetus has few ethical or legal rights; maternal autonomy includes the right to risk perinatal death as well as her own death. Ultimately women have autonomy regarding whether to take such risks. Professionals and pregnant women have an ethical obligation to minimise risk of long term harm to the future child; harm to people who will exist is a clear and uncontroversial morally relevant harm. Consistent with this, antenatal care focuses on minimizing the risk of harm to the future child, whether by advocating for alcohol abstinence in pregnancy, folic acid supplementation to reduce the chance of neural tube defect, or minimizing teratogenic risks of medications in pregnancy.

But:

Maternal and perinatal mortality are truly tragic outcomes. Professionals must encourage women to deliver in a safe environment and also practice safe and competent obstetrics. The professional bodies and the law must do all they can to ensure this happens.

… [T]he silent tragedies are not the deaths, but the long term disability that results from homebirth. And it is this risk that weighs most heavily against homebirth.

What disability? When a baby is obstructed in labour at home, or born with hypoxic brain injury, the delay in transferring to a tertiary hospital may result in permanent severe disability that will persist for the rest of that person’s life. In some cases, that disability was avoidable if the delivery had occurred in hospital. To take an extreme example, a person might be avoidably quadriplegic.

Now what risk could should a parent take to have “a really lovely spontaneous birth at home” that justifies quadriplegia? One in 1000? One in 1000 000? Anything?

We contend that the choice to have “a really lovely spontaneous birth at home” is only justified if exposes the future child to zero risk of avoidable disability. And this is just never the case. (my emphasis)

I would agree. Simply put, an unborn term baby has a moral right to receive potentially life-saving medical care, and that moral right is not trumped by something as trivial as the mother’s desire for a specific birth “experience.” This is analogous to a right of a child already born to receive life-saving medical care. That is a legal as well as a moral right. The parents’ desire to avoid medical care, to substitute prayer, or to simply ignore the child’s distress pales into insignificance next to the child’s legal right to life-saving care.

And as Savulescu and De Crespigny note, there is more at stake than simply the child’s right to live. The child also has a moral right to be born with the full complement of brain cells and potential that it possesses at the start of labor. The child has a moral right to receive care that minimizes the risk of brain injury and that mother’s desire for a specific birth “experience” pales into insignificance next to that moral right.

So the next time a homebirth or natural childbirth advocate insists that childbirth is a human rights issue don’t hesitate to ask the obvious question: what human rights in childbirth does the baby have?

Is jumping out of plane without a parachute dangerous?

Suppose that the folks at the Cochrane Review searched the scientific literature for randomized controlled trials that compared jumping out of plane with and without a parachute. Not surprisingly, there aren’t many studies like that.

Suppose that they discovered one study that looked at 11 people who jumped out of planes with and without parachutes. Any study that looks at only 11 people isn’t large enough to draw any conclusions. Would it therefore be acceptable for them to write the following?

There is no strong evidence from randomized trials to favor jumping either with or without a parachute.

Would it be acceptable for them to send out the following press release?

A new Cochrane Review concludes that all countries should consider allowing people to jump out of planes without parachutes.

That would be idiotic, right? The best thing we could say about such a study is that it is shockingly irresponsible. When randomized trials cannot be performed because letting people jump out of planes without parachutes would be unethical, we are not entitled to conclude that there is no evidence to favor jumping with or without parachutes. We are not entitled to conclude anything at all. So any study that drew that conclusion would be a piece of garbage.

That’s why the folks at the Cochrane Review owe the scientific community an abject apology for publishing a “study” on homebirth that amounts to a piece of garbage.

Homebirth advocates including the Midwives Alliance of North America are declaring that the Cochrane Review on homebirth shows that “planned home birth…as safe as planned hospital birth…w/ less intervention & fewer complications.”

But it doesn’t show anything of the kind. In fact, it doesn’t show anything at all.

Here’s a typical media report on the study:

A new Cochrane Review concludes that all countries should consider establishing proper home birth services. They should also provide low-risk pregnant women with information enabling them to make an informed choice. The review has been prepared by senior researcher, statistician Ole Olsen, the Research Unit for General Practice, University of Copenhagen, and midwifery lecturer PhD Jette Aaroe Clausen…

The updated Cochrane Review concludes that there is no strong evidence from experimental studies (randomised trials) to favour either planned hospital birth or planned home birth for low-risk pregnant women. At least not as long as the planned home birth is assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary.

There’s no strong evidence because there is no evidence at all.

Here’s what the Review actually showed:

Main results

Two trials met the inclusion criteria but only one trial involving 11 women provided some outcome data and was included. The evidence from this trial was of moderate quality and too small to allow conclusions to be drawn. (my emphasis)

Authors’ conclusions

There is no strong evidence from randomised trials to favour either planned hospital birth or planned home birth for low-risk pregnant women.

No, there is no evidence PERIOD. Therefore no conclusion can be drawn PERIOD.

Well, actually there is one conclusion that can be drawn:

The Cochrane Review wants to promote homebirth. Therefore, they published a “study” written by homebirth advocates that included no data, but nevertheless concluded that homebirth is safe.

It’s been established that Cochrane Childbirth Reviews are riddled with statistical errors. But the Reviews have sunk to a new low with the publication of this homebirth “study” that is nothing more than the personal opinions of the partisan authors. The folks at the Cochrane Review should be ashamed of themselves.

So, homebirth and natural childbirth advocates, let me see if I get this straight:

You trust obstetricians to save your baby’s life, regardless of the nature of the emergency, regardless of the complexity of the medical problem, regardless of how much time you have wasted because you had no idea your baby’s life was in danger, but you don’t trust them to prevent the very emergency that threatens your baby’s life?

Does that make any sense?

And how about this?

You trust homebirth midwives and childbirth educators who have absolutely no idea how to save your baby’s life, who have never seen many types of emergencies, who have no idea your baby’s life is in danger in the first place, to tell you an emergency is about to occur far enough in advance that you can actually do something like that?

Sounds incredibly foolish when you put it like that, doesn’t it?

Every bit as foolish as this:

You believe that the very people who know how to save your baby’s life have nothing better to do with their time than pretend that your baby’s life is at risk? And that the very people who don’t know how to save your baby’s life are honest with you about the real risks your baby faces?

I’m curious:

Do you think that oncologists are playing the “dead person card” when they tell people that smoking causes lung cancer?

Do you think architects are playing the “damaged building card” when they tell people the building with no structural beams will fall down?

Do you think lawyers are playing the “incarceration card” when they tell certain clients that if they take the stand they will hurt their own case?

So why on earth do you fall for the obviously self-serving cant of homebirth midwives and childbirth educators that obstetricians are “playing the dead baby card” when they warn you that your baby is at risk for postdates stillbirth, or shoulder dystocia, or breech with a trapped head?

As far as I can tell, the only reason is because you are incredibly gullible and know very little about childbirth, but feel free to offer valid a reason that doesn’t make you look so easily manipulated.

Chalk up another perinatal death to inane affirmation that a woman’s body is perfectly designed to give birth.

After professing her belief in her body’s ability “to birth this baby naturally,” and “every confidence” in allowing the baby to choose her own birthday, the mother refused a postdates induction. She did not want to put at risk her desire for a VBAC after 2 C-sections.

She finally went into labor at 42 weeks and 3 days. But her baby didn’t “choose” that date because her baby was already dead and had been for nearly 48 hours.

In light of this senseless death, it is worth reviewing why a woman’s body is NOT perfectly designed to give birth. None of us are perfectly designed for anything, because the human body is was not “designed.”

As anthropologist and evolutionary medicine pioneer Peter Ellison has pointed out:

We’re trying to … educate physicians who will have a broader perspective and not think of the human body as a perfectly designed machine… Our biology is the result of many evolutionary trade-offs, and understanding these histories and conflicts can really help the physician understand why we get sick and what we might do to stay healthy.

What does Ellison mean by evolutionary trade offs?

Consider sickle cell anemia. Sickle cell anemia is caused by a genetic mutation that leads to “sickling” of the red blood cells. The abormally shaped blood cells clog the small vessels producing the characteristic painful symptoms. Evolutionary biology provides us with a reason why sickle cell anemia is so prevalent. Individuals who carry sickle cell trait (the unexpressed mutation of sickle cell anemia) are more likely to survive malaria and therefore, the trait is actually protective against a disease that is endemic in many parts of the world. When two individuals with sickle cell trait mate with each other and produce children, one quarter of the children will get a “double dose” of the trait and, therefore, suffer from sickle cell anemia. The overall benefit of sickle cell trait outweighs the cases of sickle cell anemia. Hence the trait (and the disease) have persisted.

Experts in evolutionary medicine believe that they may have found an important clue to the origin of auto-immune diseases:

Humans evolved alongside beneficial bacteria and parasitic worms, and so our ancestors built up immunity to such bugs. But nowadays with increased hygiene, we’ve eliminated the bacteria and worms. The result: Since our immune systems aren’t used to these good bugs, our bodies fight them as foreigners. That can result in allergies, asthma and autoimmune diseases …

And evolutionary medicine explains why childbirth is so dangerous for both babies and mothers. One reason is because evolution favors reproduction over health. In other words, the most successful of the species are those who produce more offspring, not perfect offspring. From an evolutionary perspective, it is better to have 10 children and have 5 die, than to have 2 perfect children.

Moreover, childbirth itself represents a compromise between competing evolutionary pressures. On the one hand, a more neurologically mature newborn is more likely to survive, so there is an advantage for a baby to be born more with a bigger head and therefore neurologically more mature. On the other hand, there is a limit to the size of the woman’s pelvis. That’s because a larger pelvis renders walking more difficult and if the pelvis is large enough, walking upright is impossible. There is tremendous evolutionary pressure to increase the size of the neonatal head and equally large evolutionary pressure to limit the size of the maternal pelvis.

As a result, there is naturally and inevitably a significant amount of incompatibility between the size of the baby’s head and the size of the mother’s pelvis. This is built into the system. In other words, a significant amount of maternal and fetal death is built into the system and is unavoidable. Understanding this leads to different conclusions than the erroneous assumption that women are “designed” to give birth.

The same principle applies to pregnancy length. The earlier a baby is born, the easier it is for the baby to fit through the maternal pelvis. The later a baby is born, the more neurologically mature it is, giving the baby a survival advantage. The variability in the length of pregnancy represents the competing evolutionary pressures on the timing of birth. The length of pregnancy is NOT a sign that the baby is “ready” to be born. We understand that premature babies are not born prematurely because they are ready to survive outside the uterus; often they aren’t. Similarly, postdates babies are not staying inside the uterus because they aren’t ready to survive; they are definitely ready to survive outside the uterus and staying inside longer can lead to avoidable stillbirth.

Human beings are not machines, and we are not “designed.” We have evolved a wide range of strategies to cope with hazards in our environment and these strategies usually represent compromised between competing imperatives. And in each individual, the compromises may be different, leading to dramatically different outcomes depending on the environment. Moreover, our personal goals are very different than the goals of evolution. Evolution favors successful reproduction; it does not favor perfect reproduction and it does not favor health. It is nothing more than wishful thinking to imagine otherwise.

Therefore, while it might be correct to state that women’s bodies have evolved to produce enough surviving offspring to perpetuate the species, it flat out false to claim that any individual woman’s body is perfectly designed (or evolved) to give birth.

Adapted from a piece that first appeared in January 2010.

With apologies to Laura Joffe Numeroff.

If you give a homebirth advocate a baby
She’s going to ask if it was born vaginally.

When you tell her the baby was born by C-section
She’ll ask you why.

When you explain that the baby didn’t fit
She’ll blame the pitocin.

Then she’ll insist that the only reason she got an epidural is because the pitocin made the contractions painful.

When you point out that the pitocin was necessary because she was stuck at 7 cm for 4 hours
She’ll declare that would never have happened if she hadn’t been induced.

When you remind her that she was 43 weeks pregnant
She’ll say that babies aren’t library books due on a certain date.

When you clarify that she also had a non-reactive NST and a bad biophysical profile with no amniotic fluid
She’ll insist she was dehydrated.

When you mention that can’t be true because she had lots of IV fluid in an attempt to improve the tracing
She’ll claim that the IV “immobilized” her and that’s why her labor stalled.

Then she’ll declare that you just wanted to ruin her birth experience so you could get to your golf game, even though you don’t golf.

When you point out that the baby was in danger as evidenced by the Apgars of 3 and 7 and the two week NICU stay for meconium aspiration
She’ll declare that the fact that the baby needed a little “jump start” doesn’t prove anything.

When you explain that the most important thing is a healthy baby
She’ll express her disgust at your flawed priorities.

And chances are …
She’s going to want another baby so she can have a healing homebirth!