It’s often an “aha” moment for women when they realize that birth is an industry.

I’m not talking about hospital birth. While that, too, is a money making proposition, no obstetrician is afraid of running out of patients. For better or worse, pregnant women need obstetricians, will always need obstetricians, and obstetricians have no need to convince women to give birth in hospitals since 99% already do so. Obstetricians are not afraid of losing business to “birth workers.”

Moreover, a substantial proportion of obstetricians are salaried or paid by insurance companies that offer no premium for extra services. There is no incentive to do any more than what he or she thinks is necessary to ensure a healthy baby to a healthy mother.

No, I’m talking about “Big Birth,” the industry of birth workers (doulas, childbirth educators, and midwives to some extent). They sell services, books, products and courses. No one actually needs any of those books and products; they are entirely discretionary. Therefore, the entire industry of Big Birth depends on convincing women that they need these books and services. Although many women don’t realize it, advocates of natural childbirth (and virtually all “birth workers” are advocates of natural childbirth) must be engaged in full time marketing in order to make a living.

That marketing involves two major prongs: convincing women they need what birth workers are selling, and warning women that obstetricians are not to be trusted.

What is Big Birth selling?

They are selling their personal view of the ideal birth.

It is important for women to understand that natural childbirth is one-size-fits-all approach. It doesn’t matter who you are, what your medical problems are, what your specific fears and concerns are, what you think is the ideal birth for you; all of that is irrelevant. Big Birth must convince you that unmedicated vaginal birth is what you really want and need.

There are important obstacles in the way. The first is pretty obvious: hours of agonizing labor pain. Ever since the discovery of chloroform for easing labor pain, women have avidly adopted analgesia in childbirth. Indeed, in the early years of the 20th Century, pain relief in labor was recognized by women’s groups in nearly all industrialized countries as a fundamental right. All women were seen as entitled to pain relief in labor regardless of their ability to pay for it, just like all women were entitled to anesthesia during surgery regardless of their ability to pay for that.

Because childbirth is inherently agonizing (it so impressed the writers of the Bible that the only way they could explain it was as a divine curse) and because human beings natural wish to avoid agonizing pain, it’s been an uphill battle for Big Birth, but they finally hit on a double barreled solution. The first part is to convince women that epidurals, the only truly effective method for abolishing the pain of childbirth, are dangerous for their babies; that’s nothing more than a lie, but as I explained yesterday, lying is central to natural childbirth advocacy. And although Big Birth does not lie outright about the maternal risks of epidurals, they grossly inflate the risks and minimize the benefits.

The second barrel is the imperative to convince women that the “ideal” birth as envisioned by birth workers (an unmedicated vaginal delivery) is somehow superior to other ways of giving birth and that women who “achieve” an unmedicated vaginal birth are somehow superior to women who don’t. Why would a woman buy any of the services and products sold by birth workers if they weren’t convinced that they needed them? Obviously they wouldn’t, so it is absolutely critical for Big Birth to convince women that there is a “best way” to give birth and they can help you achieve it.

The other important obstacle to Big Birth is that they don’t have the knowledge and skills to offer life saving services. The marketing solution to that is simple: just convince women that birth is so safe that almost no one ever needs those life saving services. It’s a lie, but, once again, a lie is no problem for the marketing gurus of Big Birth.

To summarize, the first part of the Big Birth marketing strategy is to convince women that unmedicated vaginal birth is “ideal,” that pain relief is dangerous, and that birth is so safe that almost no one needs the interventions recommended by obstetricians.

The second major prong in Big Birth’s marketing strategy is to create distrust of obstetricians. Women need obstetricians. They don’t need birth workers, so thy must be convinced that obstetricians are out to harm them and that only birth workers can prevent that harm. That, too, is a lie, but in Big Birth the ends (profit and autonomy for birth workers) always justifies the means. Most of the claims of Big Birth are ludicrous on their face and no one would believe them of other doctors, but it is a testament to the marketing genius of Big Birth that they have managed to convince a great number of women that the people who devote their lives to caring for pregnant women and their babies (obstetricians, obstetric anesthesiologists, perinatologists and neonatologists) actually want to harm women and babies. Or, equally ludicrous, the idea that obstetricians don’t follow scientific evidence while “birth workers” do. Obstetricians don’t merely follow scientific evidence, they are the ones who create it. Birth workers, on the other hands, follow their hearts and prejudices, with their own autonomy as their only fixed lodestar. They simply make stuff up and then pretend that it is true.

Case in point, Barbara Harper, the doyenne of American waterbirth, and basically a buffoon when it comes to neonatal physiology, is revered in the world of Big Birth as an “expert” on waterbirth. She just makes it up as she goes along and major childbirth organizations from Lamaze, to the American College of Nurse Midwives throw ethics and intelligence to the wind to back her.

Indeed waterbirth is an outstanding illustration of the marketing tactics of Big Birth.

Whatever you want to say about waterbirth, no one can deny it is unnatural since no primates, let alone human beings, give birth in water. But for Big Birth the truth is irrelevant and waterbirth is marketed as “natural” pain relief.

Waterbirth was never tested before birth workers implemented it as a “treatment.”

Point out to midwives and other birth workers that waterbirth has deadly iatrogenic complications ranging from drowning to tearing off the umbilical cord while lifting the baby out of the birth pool, and midwives and birth workers won’t even bother to investigate the reports before dismissing them out of hand.

As Dr. Clay Jones notes in today’s post on Science Based Medicine, An Update on Water Immersion During Labor and Delivery:

A fine example of complementary and alternative reality in regards to labor and delivery can be found at Waterbirth International, which is run by >Barbara Harper, a nurse who preaches the benefits of waterbirthing all over the world and who is a proud proponent of rebirthing-breathwork. Rebirthing-breathwork is the concept that suppressed negative emotions can be healed by reliving one’s birth…and breathing a lot. Also there is something in there about cells having feelings. Harper gets the last word in the NPR article:

“I think this is backlash from the gaining popularity of water birth,” says Barbara Harper, founder of Waterbirth International, an advocacy organization…One thing that happens in a water birth, you as the attending physician pretty much have to stand there with your hands in your pockets and let it happen without your participation. That is pretty scary to a physician-oriented institution.”

How’s that for a straw man? Medical experts are apparently only skeptical of waterbirth because we don’t get to participate, which I have little doubt is code for “we don’t like it cause we don’t get paid.” I wonder if she works for free.

I believe that most rational people, even those with no medical experience, intuitively understand that delivering a baby into a body of water, even a sterile one, would be inherently risky. Human newborns, as with all other primates (take that Discovery Institute) breathe almost immediately upon arrival into this world. This helps to initiate a chain of events that assists the neonate in transitioning from fetal to adult circulatory patterns, and there are millions of years of evolutionary momentum behind this process. But besides being a completely unnatural act, something that usually sends proponents of pseudoscience running, there are numerous potential risks involved with giving birth underwater.

In other words lying (about the risks), denying (the complications), decrying (obstetricians) and defying (science).

Birth Big is a business. They are selling a product (unmedicated vaginal birth) that has no real benefits so they’ve had to make up the benefits. Many birth workers have no real skills, and even the best educated lack the lifesaving skills of obstetricians, so they’ve had to deny the need for such skills (Trust birth!), and demonize both the skills and the obstetricians who wield them.

There is an old Latin aphorism that comes to mind in this situation: Caveat emptor! Let the buyer beware!

That’s good advice when it comes to Big Birth. Pregnant women should be savvy consumers and understand that Big Birth is trying to sell them products and services that they don’t really need. If women want to buy them, it’s up to them, but they ought to recognize that Big Birth markets its products the exact same way that Big Business markets theirs: convincing you that you need the product, that buying the product will indicate that you are a superior person, that the competition is not to be trusted, … and that the safety standards of the competition aren’t really necessary at all and just add to the price of the product.

Would you buy a car from a manufacturer who claimed that buying their car indicates that you are a superior person, that other car manufacturers are ignorant fiends who want to hurt you, and that airbags are unnecessary because most people never crash? Probably not.

Then why would you buy a birth from a provider who claims that there is an “ideal” way to give birth, that if you do it their way you are a superior person, that the people who are experts in every kind of birth (obstetricians) are ignorant fiends who want to hurt you, and that safety features (interventions) are unnecessary because most women won’t have life threatening emergencies?

Rory Coker, professor of physics and University of Texas Austin, has written a very informative article for the website Quackwatch. The article, Distinguishing Science from Pseudoscience, was not written with the philosophy of natural childbirth in mind, but the criteria he describes make it quite clear that natural childbirth in general and homebirth midwifery in particular are nothing more than quackery.

Consider Prof. Coker’s principles in light of the recent efforts by natural childbirth and homebirth advocates to suppress the dangers of waterbirth and homebirth.

Pseudoscience displays an indifference to facts.

Waterbirth is unnatural. No primates give birth in water and everything we know about neonatal physiology tells us that babies are “designed” to be born into air. No matter. Waterbirth is touted as soothing, comforting and above all “natural.”

Pseudoscience “research” is invariably sloppy.

Of course, that’s when there is any research at all. The tenets of natural childbirth in general, and waterbirth in particular, were instituted without any efforts made to empirically validate theirs claims. The fear-tension-pain cycle? It was made up by Grantly Dick-Read and is still promoted by natural childbirth organizations in the absence of any evidence to support it. Barbara Harper has never done any research to validate her nonsensical claims about waterbirth. She probably wouldn’t know how to conduct research even if she wanted to do so

Pseudoscience begins with a hypothesis—usually one which is appealing emotionally, and spectacularly implausible—and then looks only for items which appear to support it.

That pretty much describes the entire natural childbirth literature; it is one giant festival of cherry picking, highlighting papers that appear to support it and ignoring the vast body of medical literature that does not.

Pseudoscience is indifferent to criteria of valid evidence.

At this point, natural childbirth and much of contemporary midwifery theory isn’t merely indifferent to the criteria of valid evidence, they are actively hostile to it, offering claims as disparate as randomized controlled trials are “tyrannical“; case studies of deadly waterbirth outcomes are meaningless; the series of bald-faced lies about birth certificates put forth by Melissa Cheyney, CPM and Wendy Gordon, CPM to justify their refusal to compare MANA’s homebirth death rates with US perinatal death rates; and my all time favorite: Including the Non-Rational is Sensible Midwifery.

Pseudoscience relies heavily on subjective validation.

Waterbirth advocates like The Feminist Breeder have twisted themselves into knots over this. On the one hand, case studies demonstrating catastrophic outcomes at waterbirth are derided as useless and large scale studies that show that waterbirth is poor at relieving labor pain are dismissed out of hand, while at the exact same time (without any consciousness of irony), waterbirth advocates claim that they “know” that waterbirth provides excellent pain relief because some women claim it does, and we should avoid telling women about the dangers of waterbirth until we have large scale studies of those outcomes.

TFB’s piece is downright buffoonish, implying as it does that because she can’t see bacteria in waterbirth pools, there is no bacteria.

Pseudoscience always avoids putting its claims to a meaningful test. I would add to that the fact that natural childbirth and homebirth advocacy, like all pseudoscience, strenuously avoids debating real scientists.

Natural childbirth and midwifery theorists rarely carry out quantitative research to validate their claims, and often cheerfully ignore the results of those carried about by medical researchers. They never follow up and they never acknowledge, let alone learn from, mistakes. Midwives implemented waterbirth without ever investigating whether it is safe, are desperately trying to ignore the research from neonatologists and perinatologists that shows that waterbirth has deadly dangers, and, most revealing, have absolutely no plans to investigate the deadly dangers. Waiting for a large scale midwifery study to evaluate the risk of hyponatremia, drowning or umbilical cord avulsion during waterbirth? Don’t hold your breath.

Pseudoscience often contradicts itself, even in its own terms.

See above: we don’t have to pay attention to case studies of death at waterbirth, but we “know” that waterbirth provides excellent pain relief because women (case studies) tell us so.

Pseudoscience appeals to false authority.

A high-school dropout is accepted as an expert on “normal birth” and is awarded a fake midwifery credential (CPM). Barbara Harper, an RN thoroughly ignorant of neonatal physiology and even basic chemistry, is considered an “expert” on waterbirth even though though she has never studied it in any remotely scientific way. Henci Goer, who is not an obsterician, midwife or scientist is regarded as an “expert” on the obstetric literature.

Celebrity endorsements are integral. Ricki Lake swears that homebirth is safe, so it must be. Emotional appeals are common. (“Trust birth!” “Trust your mama intuition!”) Natural childbirth/homebirth advocates are fond of conspiracies. (“Doctors just want to ruin your birth experience!” “Obstetricians recommend interventions because they make money from them!”) When confronted by inconvenient facts, they simply reply, “Doctors don’t know everything!”

Pseudoscience relies heavily on anachronistic thinking.

It’s the wisdom of our ancient foremothers! That goes twice for ideas that are obviously wrong and have been debunked by science, while pretty much sums up natural childbirth and contemporary midwifery theory.

To paraphrase Coker’s conclusion:

Characteristics of Pseudoscience

The natural childbirth/homebirth literature is aimed at the general public. There is no review, no standards, no pre-publication verification, no demand for accuracy and precision.

No physical phenomena or processes are ever found or studied. No progress is made; nothing concrete is learned.

Natural childbirth/homebirth appeals to faith and belief. It has a strong cult-like element: it tries to convert, not to convince. You are to believe in spite of the facts, not because of them. The original idea is never abandoned, whatever the evidence.

Natural childbirth/homebirth advocates often earn some or all of their living by selling products (such as doula services, books, courses, and supplements) and/or pseudoscientific services (such hypobirthing, natural childbirth courses, etc.)

Most damning of all, infant deaths (and maternal deaths) are ignored, excused, hidden, lied about, discounted, explained away, rationalized, forgotten, avoided at all costs.

It happens with waterbirth, it happens with homebirth, and it happens with deaths at the hands of contemporary midwifery theorists. Lie, deny, decry, defy. Those are the hallmarks of quackery and those are the hallmarks of natural childbirth and homebirth.

I have a riddle for you.

What would I get if I added the following?

Nuance + Compassion + Dr. Amy =

Give up?

I would get IGNORED.

That’s the real answer to the riddle posed by Kristin of Birthing Beautiful Ideas. Kristen ponders:

That’s right. Sometimes, I agree with Dr. Amy.

But I rarely agree with her delivery. Sometimes it’s rife with logical fallacies*: straw man arguments, appeals to pity, appeals to authority, ad hominem attacks. It’s often mean-spirited and shrill and condescending…

And so after I read the piece from Feminist Midwife, I wondered: what might Dr. Amy’s blog posts look like if she injected nuance, compassion, a less dogmatic form of critical thinking, and some simmering-down-now (with a teensy bit of snark, just to let off some of her steam)?

At the end of her piece, Kristen highlights a previous encounter:

You’ve been here before, and you called me a “gullible, woefully undereducated women who’s likely never read a scientific study in its entirety.” It was fun(ny). In any case, I have read plenty of scientific studies in their entirety, though surely not as many as you have. Likewise, you may have read a bit of philosophy, but likely not as much as I have. Your training gives you the upper hand when it comes to expertise in practicing medicine. Mine gives me the upper hand when it comes to expertise in all things philosophical. These different trainings and types of expertise give us somewhat different approaches when it comes to reading said scientific studies: you will arrive from a clinical background based both on your medical education and your practice of medicine, and I will arrive from a philosophical background based on an in-depth examination of the philosophy of science and on a specialization in theories of autonomy…

Kristen is referring to this post, Newsflash: you did risk your baby’s life for your own experience. Not surprisingly, I stand by everything I wrote. I will add, though, that I have more training in philosophy than Kristen might imagine. I nearly completed a master’s degree in biomedical ethics with Dan Brock when he was still at Brown (everything but the thesis). Kristen would probably be surprised to know that my interest is also in theories of autonomy, especially as they relate to reproductive decisions. That’s why I disagree so vehemently with anyone who claims that homebirth ought to be made illegal; doing so is a violation of a mother’s right to medical autonomy.

Be that as it may, I believe that Kristen’s post deserves a reply.

In a way, Kristen, you have already answered your own question. You imagined what my blog might be like if I wrote in the same style as a midwife whom you admire. You didn’t ask what my blog might be like if I wrote in the style of Dani Repp at What Ifs and Fears are Welcome or Lisa Murakami of Married to Medicine or the many bloggers like them. Both Dani and Lisa are much nicer than me! They write about the same topic as I do with more nuance and more compassion, yet you didn’t mention them. Why? Either you’ve never heard of them or they made so little impression that you forgot them.

For better or for worse, nuance and compassion don’t attract readers. Years ago I briefly tried it and it nearly killed the blog. When I started the predecessor of this blog in 2006, I got about 550 visits a day, 500 of which I bought through Google Ad Words. I haven’t paid for advertising in years. Today this blog averages 6000 visits a day on weekdays, and often thousands more. For my most popular posts I’ve gotten 5,000 visits an hour. I’m sure that you’ve already guessed that the posts with the most traffic tend to be the snarkiest.

Simply put, snark is my schtick. Don’t get me wrong: my anger over the preventable deaths of babies and the misinformation spread by natural childbirth and homebirth advocates is real. I’m no different than the pediatricians who despair over the deaths of babies as a result of the anti-vax nonsense. But I’ve chosen to take a different approach. Recently a study was published that showed efforts to educate anti-vaccine parents about the benefits of vaccination have backfired. When public health officials have tried a respectful presentation of facts to educate parents about the benefits of vaccination, those same parents ignored the facts and figured that the public health officials had something to hide. In the best case scenario, they simply ignored the public health messages.

I take a very different approach because I attribute a very different cause to both anti-vax nonsense and natural childbirth/ homebirth. Both have nothing to do with medical facts and everything to do with the tendency of contemporary parents to judge themselves and others by their willingness to defy authority. Defiance and denial are at the heart of both movements: defiance of medical “authority” and denial that bad things can really happen to them and their children that no amount of good food or breastfeeding is going to prevent.

My approach can be summed up very simply. My snarky posts about parenting decisions tend to make the exact same statement:

You think that having an unmedicated birth, refusing interventions, giving birth at home, refusing vitamin K for your newborn, etc. etc. etc marks you out as an “educated” person and a superior parent. I’m here to tell you that it marks you as an uneducated, gullible fool.

Harsh, I know, but very effective at getting attention and causing people to question what they’ve been told.

And when I write about the luminaries of the natural childbirth/ homebirth world, I deliberate tweak the love of conspiracy theories that seem so prominent among advocates:

You think that Melissa Cheyney, Lisa Barrett, Lamaze International, the Childbirth Connection, etc. etc. etc. care more about whether your child lives or dies than her obstetrician or pediatrician? Haven’t you noticed that they have a greater financial interest in conning you to buy their services, books and products than either an obstetrician or pediatrician ever could?

Most natural childbirth/homebirth advocates lack the basic knowledge to understand a nuanced argument about childbirth, but no one lacks the basic knowledge to understand the desire to profit by convincing someone to buy what you are selling.

I have a goal that I am always working toward and that is the prevention of infant and maternal deaths. Although there are a few nitwits out there who like to put my title in quotes, I find that being retired offers a great advantage in gaining trust. Everyone knows, whether they agree with me or not, that I have no skin in the game. It makes no difference to my well being or the well being of my own children whether you listen to me or not. I write for YOUR children because I care about what happens to them.

If that isn’t nuanced and compassionate, I don’t know what is.

There is a chilling story on the front page of The New York Times this morning, General Motors Misled Grieving Famiies on the Lethal Flaw:

It was nearly five years ago that any doubts were laid to rest among engineers at General Motors about a dangerous and faulty ignition switch. At a meeting on May 15, 2009, they learned that data in the black boxes of Chevrolet Cobalts confirmed a potentially fatal defect existed in hundreds of thousands of cars.

But in the months and years that followed, as a trove of internal documents and studies mounted, G.M. told the families of accident victims and other customers that it did not have enough evidence of any defect in their cars, interviews, letters and legal documents show. Last month, G.M. recalled 1.6 million Cobalts and other small cars, saying that if the switch was bumped or weighed down it could shut off the engine’s power and disable air bags.

In other words, GM absolved themselves of all responsibility for the deaths that occurred as a result of their mistake, even though they knew all along that people were dying as a direct result of the flaw.

The exact same thing is happening in the world of homebirth. Melissa Cheyney and co-authors have a commentary in this month’s issue of Birth: Issues in Perinatal Care, the “journal” published by Lamaze International. I use the term journal in quotes because a real medical journal publishes everything on a topic. Birth is nothing more than an industry mouthpiece; editors have acknowledged that they will not publish papers and reviews that don’t comport with their philosophy.

Cheyney’s piece, A Crusade Against Home Birth, is delightfully and deliberately misleading. Or it would be delightful if babies weren’t dying as a result.

The executives as GM could take lessons in obfuscation, misdirection, and outright lying from Cheyney and her fellow executives at the Midwives Alliance of North America (MANA) the trade and lobbying organization that represents non-nurse midwives (CPMs, LMs, and DEMs, laypeople who awarded themselves the designation “midwife” despite being unqualified to work as a midwife in any other industrialized country).

Cheyney and the folks at MANA are worried. Their little empire (and source of 100% of their income) is threatened by a large and growing body of evidence that homebirth at the hands of a non-nurse midwife has a hideous perinatal death rate. Indeed, their own statistics showed that homebirth with a CPM has a mortality rate 450% higher than comparable risk hospital birth, a fact that they unsuccessfully tried to lie about in another paper that Cheyney wrote.

Cheyney’s commentary is ostensibly about the Grunebaum paper that showed that homebirth increases the risk of a 5 minute Apgar score of 0 by nearly 1000%. The obfuscation starts with Cheyney’s title, A Crusade Against Home Birth. I have to give her credit for encapsulating in a so words the self-pity, conspiracy theories and mendacity that are at the heart of homebirth midwifery.

Instead of responding to a scientific article with a scientific analysis, Cheyney signals from the get-go that she will be using a tactic perfected by the tobacco industry. SourceWatch describes the tobacco industry’s attempt to reframe the debate:

The “reframe the debate” strategy consists of moving the topic of a contentious dispute onto a wholly different topic. This involves making dire predictions of a more extreme outcome, portraying the original action as dangerous, tying activists to the dangerous outcome, linking the originally-proposed action to a fear-inducing outcome …

As the Tobacco Institute explained to its members:

Our judgement, confirmed by research, was that the battle could not be waged successfully over the health issue. It was imperative, in our judgement, to shift the battleground from health to a field more distant and less volatile …

Grunebaum wrote an excellent paper demonstrating that homebirth dramatically increases the risk of a baby being born without any sign of life, and Cheyney almost certainly knows that the paper is true. Therefore, she has reframed the debate to switch attention from the scientific evidence (where Cheyney has less than nothing to stand on) to the dire prediction of an extreme outcome, portraying the paper as part of a conspiracy to deprive women of autonomy. The title is the equivalent of: “Don’t look at the growing numbers of dead infants; look over there where evil men are trying to take away your freedom.”

It is repeated within the text of Cheyney’s piece:

This article was not published in isolation, but is part of a larger effort by senior author Dr. Frank Chevernak from Cornell University, who has published at least six other articles critical of home birth in the past 2 years in major obstetrics, pediatrics, and ethics journals (19– 24). A recent article published in Pediatrics is typical of Dr. Chevernak’s work. In it, he claims to discuss the ethics of home birth, but his discussion runs counter to contemporary democratic principles of free choice and autonomy for the expectant mother, and to women’s control over their own bodies…

It’s a conspiracy to deprive women of their freedom!

That’s the exact strategy from the tobacco playbook, and every bit as unethical.

But even Cheyney knows that she has to address the actual scientific paper, so she copies the same strategy that appears to have guided GM: lie, deny, cover up.

Here’s what GM did:

… [B]y the time Benjamin Hair, 20, crashed into a tree in Charlottesville, Va., on Dec. 13, 2009, while driving a Pontiac G5 home, G.M. had conducted five internal studies about the ignition problem, its records indicate. Though Mr. Hair used his seatbelt, he died after the car’s air bags failed to deploy. His parents were baffled. “The police couldn’t tell us what caused the accident,” said Brenda Hair, his mother. The Hairs contacted G.M., providing accident reports but no vehicle data, because the car’s black box had been destroyed. “They came back and said they’d presented it to their board of engineers, and they couldn’t say it was related” to a defect, Ms. Hair said.

It is difficult to comprehend that anguish of losing a child in an accident. How much greater will that anguish be now that Hair’s parents have learned that GM knew all along that their cars had a fatal defect, hid that defect from consumers, failed to repair the defect, and then lied about it when presented with evidence?

Here’s what Cheyney and MANA have done:

1. First, they hid the death rate of homebirth for 5 years.

2. Then when they finally published the death rate, they refused to compare it to the appropriate comparison group (low risk women who gave birth in the hospital in the same years), and instead compared their data to studies from other countries.

3. Although Cheyney and MANA have known all along that their death rates are hideous (hence the decision to hide them for 5 years), they simply lied in their own paper to claim that their data showed homebirth to be safe when their own data shows homebirth to be dangerous.

In other words:

GM hid the existence of the faulty ignition for 5 years
and
MANA hid the existence of dramatically higher perinatal death rate at homebirth for 5 years.

In the wake of accidents involving the faulty ignition, GM claimed to grieving families that there was no safety problem
and
in the wake of homebirth deaths, Cheyney and MANA have claimed to grieving parents that there is no safety problem with homebirth.

While GM’s own data showed that the ignitions were fatally flawed, they went forth and lied about the issue
and
when MANA’s own data showed that homebirth with a non-nurse midwife is fatally flawed, they went forth and lied about it.

In GM’s defense, they did not go as far as Cheyney and MANA. GM could have said that the claims about the faulty ignition were the work of a conspiracy on the part of Ford who only wants to take away the right to drive GM cars or maybe even ALL cars.

Cheyney and MANA appear to have no problem saying that claims of (and scientific papers about) deaths of babies at the hands of homebirth midwives is a conspiracy on the part of obstetricians to take away the right to have a homebirth, or maybe even ALL of women’s rights.

You know that Melissa Cheyney and MANA have gone to a bad place when a major corporation that allegedly hid a preventable cause of death from the public, looks better than professional homebirth advocates.

The analogy is inescapable:

Cheyney and MANA are no different from any organization that tries to hide safety defects from the American public for no better reason than to preserve market share.

You wouldn’t let your baby play in the toilet; why give birth to him there?

Apparently waterbirth proponents can’t figure out how to deal with my “negativity” about waterbirth in the wake of the cautions issued by the American Academy of Pediatrics and the American College of Obstetrician Gynecologists.

It’s not as though any of them could mount a rebuttal to the paper. They haven’t read the literature, wouldn’t know how to understand it if they read it, and couldn’t care less what is says in any case.

So what if babies are injured and die unnecessarily at waterbirth from infections as a result of inhaling fecally contaminated water; umbilical cord avulsion and umbilical cord rupture leading to hemorrhage and shock; drowning or near drowning; and seizures and perinatal asphyxia?

Is that any reason to be so negative?

Ananda Lowe doesn’t thinks so. She is the co-author with Rachel Zimmerman of The Doula Guide to Birth; Secrets Every Pregnant Woman Should Know. Hmmm. Rachel Zimmerman; that name sounds familiar. Oh, I remember why; she’s the doula who authored the piece on waterbirth on WBUR, the Boston affiliate of NPR. Zimmerman revealed her bias by “balancing” the scientific evidence from the AAP and ACOG with the blithering of Barbara Harper, as if a nurse who just makes stuff up provides balance.

Lowe doesn’t like the comments I left on the piece. She wrote an email to her doula list about it and the email was posted on Facebook.

Hi all,

Thank you to those who responded to my previous email asking for your comments on the water birth article that my colleague wrote for the NPR Web site. You truly made a constructive contribution to the conversation.

If you looked at the article, you probably noticed the “flame wars” started in the comments section by Dr. Amy…

… Dr. Amy instigated perhaps the worst comment war I have ever seen her create. There were over 600 comments in just 2 days, many of which are posted by a small handful of people (Dr. Amy’s followers) repeating themselves many times and with extreme hostility. Dr. Amy had posted the very first comment to the article: “Would you completely immerse your head (eyes open, of course) in the fecally contaminated bloody water of a birth pool in the aftermath of a birth?” and the flame war took off from there.

I am curious what our community feels is the best way to handle her and others like her. She has an orchestrated way of disrupting the comments section of articles on a frequent basis. I wonder, should there be an orchestrated response to her, or should some other approach be taken? …

My feeling, and I have heard others speculate, is that she and her followers are acting out their pain over their own difficult births or difficult breastfeeding experiences and lack of support for mothers in our society, or other difficult experiences in their lives that somehow come out in their anger toward the natural childbirth community…

I myself do not have a lot of time to devote to a campaign to dealing with Dr. Amy. But she seems to be getting more and more wild, if that is possible, and I would be interested in hearing your ideas about relating to bullies in general, as well as those who inflame the childbirth wars and mommy wars in particular.

Ananda Lowe

How sad. I’m harshing the mellow of doulas and natural childbirth advocates everywhere and for the absolutely trivial reason that babies are being harmed by being delivered into the equivalent of toilet water.

Here’s a thought, Ananda:

Instead of reflexively opposing anything that calls your birth “knowledge” into question, maybe you ought to consider that the American Academy of Pediatrics Committee on the Fetus and Newborn knows much more about neonatal physiology than all the doulas in the country put together. They have no reason to claim that waterbirth injures and results in preventable deaths of babies unless it does. Y0u are wrong and babies are suffering because of your lack of knowledge, and the willingless of natural childbirth advocates to privilege process ove3r outcome.

We have a saying in medicine that doulas might want to take to heart: Primum non nocere. First, do no harm.

Waterbirth can and does harm some babies. That’s not negativity. That’s the truth.

Deal with it!

I’ve been wondering about the professional ethics of the American College of Nurse Midwives for years. Although they are well aware that American homebirth midwives, CPMs, LMs and DEMs are substandard practitioners, (even acknowledging it within their own publications), they have repeatedly allied with them. I’m not sure why they don’t see that it is harming their own reputation, but apparently they operate by the theory that “the enemy of my enemy is my friend.”

So their professional ethics have been suspect from the get go, appearing as it does that the ACNM values professional autonomy over the lives of babies and mothers. That impression of professionally unethical behavior was strengthened when the ACNM came out with a bald faced lie about the reliability of birth certificate data to support MANA in claiming that homebirth is safe when MANA showed quite clearly that it is not.

Now comes word that the ACNM is preparing to go even farther in unethical behavior. A new memo alerts CNMs that their organization “disagrees” with the American Academy of Pediatrics Committee of the Fetus and Newborn and the American College of Obstetricians and Gynecologists that waterbirth poses deadly risks to babies.

Are we really supposed to believe that a bunch of certified nurse midwives knows more about neonatal physiology than a group of neonatologists and perinatologists? Maybe ACNM believes it, but no one else will. Are we really supposed to believe that CNMs care more about whether babies live or die than the people who actually care for and save the lives of those babies? I doubt even the ACNM believes that. But what they apparently do believe is that waterbirth is their “turf” and just because a bunch of babies died from inhaling birth pool water contaminated with feces, or died of hemorrhage because their umbilical cords were torn off as they were lifted from the pool, is not reason enough for them to tell the truth about waterbirth.

The ACNM set out a memo to its members this morning:

ACNM believes this document does not accurately reflect the large and growing body of research that supports water birth as a reasonable choice for healthy women experiencing normal labor as well as birth.

What large and growing body of research? The ACNM doesn’t say.

Most water births occur under the care of a midwife and it has been a safe option for decades that provides comfort with good outcomes for the mom and her baby.

No one said otherwise. Most of the time giving birth in water, despite being non-physiologic and despite being dangerous, will end fine. But, of course, most of the time not buckling your infant into a car seat will end fine, too, yet we don’t say to mothers that if not buckling their infants into car seats improves the mother’s experience, she doesn’t need to use a car seat. Our babies are precious to us, and we want to mitigate risks of death, even when those risks are small.

However, this new ACOG/AAP opinion statement cautions about immersion in water during the second stage of labor. These cautions are similar to those in their prior publications, including warnings about a lack of data on the safety and benefits of water birth. The organizations refer to case studies of adverse outcomes, but case studies are not a reliable form of research, and should not be the foundation for their conclusion—that water births should only be considered as part of “experimental” clinical trials.

Case studies are generally the first warning sign that a medication or procedure is dangerous. For example, the companies that made a certain type of artificial hip presented a number of studies demonstrating the benefits of their new hip. The device was introduced into clinical practice based on those studies. It wasn’t until doctors began reporting unusually early failures of the device that both patients and physicians were alerted to the high failure rate of these devices.

The ACNM is either disingenuous or uneducated about the value of case studies in exposing unusual risks that occur unexpectedly when new medications, devices or practices are introduced.

Despite limitations, the best available research indicates that water birth is associated with perinatal outcomes similar to those expected in a low-risk population. In other words, healthy women and their babies generally stay healthy during and after normal labor and water birth. Therefore, water birth is a reasonable choice for healthy women to make in collaboration with their care provider, given the state of the science.

All you have to do is ignore the dead babies and you can keep recommending waterbirth!

The ACNM should be ashamed of themselves. They are placing their turf battles above the lives of babies who didn’t have to die. They are no different from Big Pharma who, when faced with case reports that a blockbuster drug has unexpectedly killed people it was supposed to benefit, insists that “their” safety data shows that the drug is safe and tthat no one needs to be warned about any risks.

Maybe things have changed since I practiced for years with dozens of CNMs. Those women cared just as much about babies as I did. They were highly educated, highly trained, and scientifically rigorous. Maybe I am naive, but I can’t imagine a single one caring more about her turf than about providing accurate information to mothers so they could make the choices that were right for them and their babies, not the choices that were advantageous for midwives.

The current leadership of the ACNM is apparently different:

Additional information will be forthcoming to members in the coming weeks to further support our collective efforts to maintain women’s access to water birth under appropriate conditions. These include:
• An official ACNM position statement on Hydrotherapy During Labor and Birth
• Articles to be published in an upcoming issue of JMWH
• ACNM’s official response to the ACOG/AAP committee

I can’t speak for others, but for me whatever the ACNM has to say is going to be ethically suspect. I don’t believe that they have even a tiny fraction of knowledge of neonatal physiology as neonatologists and perinatologists so their opinion is pretty worthless. And unlike neonatologists and perinatatologists who have no plausible reason to inflate the dangers of waterbirth, CNMs have an utterly self-serving reason to dismiss those risks; their desire to hold on to “turf.”

The ACNM commitment to “normal birth” and their cavalier willingness to dismiss babies who die at waterbirth reflects their preoccupation with processes that they can control and their demonizations of skills and procedures that are beyond their their education and training. But caring for women in childbirth is not supposed to be about process; it’s supposed to be about outcome, a healthy baby for a healthy mother.

The truth about waterbirth threatens CNMs. They’d rather suppress that truth and threaten babies lives.

The practice of waterbirth, widely beloved of natural childbirth and homebirth advocates, is nothing more than giving birth in a gigantic fecally contaminated toilet.

There is no difference at all.

Wait! Scratch that; there is one difference. Toilet bowl water is room temperature, leading to slower growth of microorganisms. Birth pools are heated to body temperature, the favorite temperature of harmful bacteria and the one that allows the bacteria to multiply to pathogenic levels.

The American Academy of Pediatrics’ Committee on Fetus and Newborn in conjunction with the American College of Obstetricians and Gynecologists has just updated its position on waterbirth. Nothing has changed since the previous edition published in 2005, except in the intervening years, more cases of perinatal death and injury have been reported.

The scientific evidence for giving birth in water has failed to demonstrate any benefit, but case reports have demonstrated a wide variety of risks:

Some of the reported concerns include higher risk of maternal and neonatal infections, particularly with ruptured membranes; difficulties in neonatal thermoregulation; umbilical cord avulsion and umbilical cord rupture while the newborn infant is lifted or maneuvered through and from the underwater pool at delivery, which leads to serious hemorrhage and shock; respiratory distress and hyponatremia that results from tub-water aspiration (drowning or near drowning); and seizures and perinatal asphyxia. (my emphasis)

But wait! Barbara Harper, the nurse who is the doyenne of American waterbirth claims that infants can’t breathe in the contaminated bathwater because the “diving reflex” prevents them from gasping.

Not so, according to the AAP and ACOG:

Although it has been claimed that neonates delivered into the water do not breathe, gasp, or swallow water because of the protective “diving reflex,” studies in experimental animals and a vast body of literature from meconium aspiration syndrome demonstrate that, in compromised fetuses and neonates, the diving reflex is overridden, whichleads potentially to gasping and aspiration of the surrounding fluid.

We know that fetal breathing movements (aspirating amniotic fluid into the lungs and out again) is a part of normal lung development. If there is not enough amniotic fluid, the baby’s lungs will be fatally underdeveloped (Potter’s Syndrome). And the presence of fetal breathing movements in utero is a sign of fetal well being when seen on ultrasound. So we know that babies breathe in and out in the uterus, even when they are well oxygenated, and we know that babies who are oxygen deprived breathe meconium into their lungs. It is the height of foolishness to claim that they won’t breathe fecally contaminated birth pool water into their lungs as well.

Most mainstream media outlets have covered this story by providing the facts. Unfortunately, the health column for WBUR, the Boston affiliate of NPR, is written by a doula, Rachel Zimmerman, among others. Zimmerman revealed her bias by “balancing” the scientific evidence from the AAP and ACOG with the blithering of Barbara Harper, as if a layperson who just makes stuff up is the equivalent of balance.

There’s currently a vigorous debate going on in the comments section, and I predict it is only a matter of time before Zimmerman starts deleting comments.

The bottom line is that waterbirth is no different from delivering in a giant toilet warmed to the preferred temperature of fecal bacteria. It is unnatural (no primates give birth in water); it is dangerous; and it is ludicrous to claim otherwise.

I have a simple question for waterbirth advocates:

Would you completely immerse your head (eyes open, of course) in the fecally contaminated bloody water of a birth pool in the aftermath of a birth?

I have a second question:

If you wouldn’t for a moment contemplate immersing your head in a pool of water with feces floating in it, why do you think it is a good idea to force your baby to do so?

American homebirth midwives, like all quacks, are incredibly paternalistic.

That’s because when a homebirth midwife admonishes a client to “trust birth,” what she is really means is “trust me.”

She’s decided to gamble with your baby’s life … literally. She bets that the odds of everything working out fine are high enough that she can put your baby’s life down as her marker and you will walk away with a live baby. She doesn’t plan to do a single thing to improve the odds, since she doesn’t know how to do anything to improve the odds, besides dial 911 and get real medical professionals involved.

She is no different from an gambler who asks to borrow $5000 to invest in a deal that “can’t go wrong.” You’re a fool if you hand over the money and you’re a fool if you hire a homebirth midwife.

I wrote earlier this week that homebirth midwives have a one size fits all approach to pregnancy and birth. That’s because they “know” that everything is going to work out fine. Obstetricians, on the other hand, despite their tremendous reserve of obstetric knowledge and experience, freely admit that they don’t know how your pregnancy and birth is going to turn out. And because they don’t know for sure that everything is going to be fine, they recommend everything that can raise the odds that your baby will be fine. That includes prenatal testing, ultrasounds, prophylactic treatments, fetal heart rate monitoring, and giving birth in a place that has the emergency equipment and personnel to handle just about any disaster, whether it was predicted in advance or not.

Although most of us find comfort in certainty, by the time we’ve become adults, we recognize that there is very little certainty in life. We buckle our seatbelts in the car, not because we think we are going to be in an accident; we don’t. We buckle them because we want to be prepared for the rare but life threatening possibility that we will be in a car accident. We try to eat healthy and exercise, not because we believe that we will definitely get ill otherwise, but because we want to decrease the odds of getting ill to as low as we possibly can. We seek shelter during a lightning storm, not because we are sure that we will be struck by lightning if we stand in the open, but because we want to minimize the chances that disaster will happen.

Homebirth midwives are masters at emotional manipulation and they recognized long ago that there was not going to be much profit in telling women “Trust me to be sure that everything is going to work out fine even though I am just a layperson with no idea how to prevent or treat disaster.” So instead they hit on the idea of telling women “trust birth.”

It sounds so much more transgressive and romantic, to trust birth than to trust obstetricians. The irony is that obstetricians aren’t asking you to trust them. They are admitting up front that they can’t guarantee your baby’s health (or your health), but they can do a wide variety of things (tests, treatments, etc.) to dramatically raise the odds that your baby will be fine. They have the track record to prove it. Over the past century, modern obstetrics (and pediatrics and anesthesiology) have dropped the neonatal mortality rate by 90%. And it didn’t drop because they trusted birth.

There’s also a quasi-religious element to trusting birth, as if Birth were a goddess that requires your praise and your sacrifice. The implication is that if you trust “her,” Birth won’t ever send complications your way. Homebirth midwives, in this scenario, are like those who practice religious snake handling:

… the religious ritual based on a Bible passage: People hold deadly snakes, believing that a poisonous snakebite won’t hurt anyone “anointed by God’s power.”

Similarly, homebirth midwives, the high priestesses of Birth, hold babies’ lives in their hands, believing that Birth won’t hurt anyone anointed by her power.

Inevitably, many of these snake handlers die, even the one who had his own reality TV show:

Tragedy struck [Pastor] Coots this past weekend when he died of a rattlesnake bite during a church service — following his wishes, his family reportedly refused medical help …

Inevitably, tragedy will strike homebirth advocates, too. Their babies will die at even higher rates than those who didn’t trust birth. The critical difference, though is that Pastor Coots chose to gamble with his own life. Homebirth midwives and advocates choose to gamble with a baby’s life, a baby who had no say in the matter, but surely wanted to live.

Homebirth midwives are gamblers and they their gambling has quasi-religious overtones. Just cede all control to them; your baby’s survival is a sure thing, so long as you trust them birth.

Make no mistake. Homebirth midwives, like all fundamentalists, are deeply paternalistic. They “know” what you should do. They “know” that everything will turn out fine. They “know” that if your baby dies it isn’t their fault; it’s your fault for not believing enough in birth.

Homebirth midwives are con artists whose only redeeming feature is that they actually believe their own con. But that’s not particularly surprising since they are too uneducated and untrained to believe otherwise.

So women who are contemplating homebirth need to ask themselves:

Do I want to bet my baby’s life that a layperson can predict the future?

Do I want to bet my baby’s life that Birth will protect my child if I just believe fervently enough?

Or am I mature enough to recognize that the world is full of uncertainty, no one knows what the future holds, and those who take precautions are more likely to survive than those who don’t?

The con artist knows that the con is always more comforting than reality. The real question for mothers contemplating homebirth is whether they prefer the paternalism of the con over the uncertainty of reality … and are they willing to risk their babies lives in exchange for the comfort of trusting birth?

Homebirth midwives don’t have a motto, but if they did, I propose the following:

Nobody ever went broke underestimating the intelligence of the homebirth advocate.

If you think that’s not snappy enough, they could just shorten their motto to this:

There’s a sucker born every minute.

Don’t believe me?

Consider today’s post from Gloria Lemay, the Canadian version of Australian killer midwife Lisa Barrett:

I discourage routine ultrasound and recommend that dopplers and imaging devices be kept well away from the developing fetus.

But women still want to see how the baby is doing inside the uterus, so she offers them a nonultrasound solution. (The picture is NSFW, but only because it will make you laugh out loud, so be prepared before you click on it).

This is part of the growing amount of cargo cult science in homebirth midwifery.

What is cargo cult science?

Physicist Richard Feynman coined the expression in his 1974 commencement address at CalTech.

…In the South Seas there is a cargo cult of people. During the war they saw airplanes land with lots of good materials, and they want the same thing to happen now. So they’ve arranged to imitate things like runways, to put fires along the sides of the runways, to make a wooden hut for a man to sit in, with two wooden pieces on his head like headphones and bars of bamboo sticking out like antennas –he’s the controller– and they wait for the airplanes to land… So I call these things cargo cult science, because they follow all the apparent precepts and forms of scientific investigation, but they’re missing something essential, because the planes don’t land.

More familiar examples of cargo cult science include the TV shows Gilligan’s Island and The Flintstones. The Professor on Gilligan’s Island used coconut shells to mimic all sorts of technology, like telephones, and, because it looked like the item of technology, it worked like the item of technology. Similarly, when Wilma Flintstone vacuumed her living room floor with a baby mammoth on wheels, we were to assume that because it looked like a vacuum cleaner, it functioned like a vacuum cleaner.

Melissa Cheyney and Oregon homebirth midwives were the first to employ cargo cult science in homebirth midwifery by creating Auscultated Acceleration Testing, the cargo cult version of the non-stress test (NST).

Now Gloria Lemay has gone them one better with the cargo cult version of ultrasound. Just like real ultrasound it creates an anatomically detailed image of the developing fetus. You can send pictures of it to your relatives and friends and post it on Facebook just like other women post their ultrasound picture.

Here’s what I’m puzzling over: Does Gloria Lemay think that homebirth advocates are morons and will find the image useful? Or does she think they are such simpletons that they will actually believe that there are benefits to the image? Or is it supposed to be a statement? Other women may expose their babies to ultrasound, but I can find out everything I need to know with a drawing.

In any case, she is certainly operating by the motto that there’s a homebirth sucker born every minute.