Apparently in the world of natural parenting, “mom-petition” is not enough. Sure you may have had the longest unmedicated labor, breastfed your child until high school, and risked his life by refusing vaccines, but how’s your sex life?

According to Rose Hollo, crunchy moms do it best! However, after reading her explanation of what makes crunchy sex better, I’m forced to conclude that if this is better sex, crunchy moms have terrible sex lives.

What makes crunchy sex better?

1. Co-Sleeping

Really? Having a toddler or preschooler in your bed makes sex better. On what planet would that be?

2. Breastfeeding

Breasts that used to belong to one’s mate suddenly belong to the baby. The thought of that particular body part being “shared” for different applications is just plain weird for some crunchy mamas. Of course, there’s the milk itself, which leaks and sprays in abundant blessings at the most inopportune times.

Who knew that milk in the eye was erotic?

3. Natural Family Planning:

Expanding on the notion of “inopportune:” Mamas who have recently given birth are believed to be extra-fertile, and are encouraged by doctors to take precautions. But instead of popping a hormone pill daily, many crunchy moms use the “natural family planning” method, or “NFP.” This means that before relations happen, mom must take her temperature, pee on a stick, and record various “signs” into a charting application that tracks her monthly cycle. For those avoiding pregnancy, this time-consuming process is worth it for health reasons. Unfortunately this method is not 100% effective at preventing pregnancy. Those who prefer the “natural” style like to avoid condoms or other devices, so only have relations when they are in the “safe zone” of their cycle. That’s not a great factor in spontaneity.

Well, if that isn’t an aphrodisiac, what is?

4. “Different Down There”

Rose acknowledges that many women are ashamed of their postpartum bodies and we all know how conducive shame is to sex. And let’s not forget vaginal dryness associated with breastfeeding.

*****

Evidently for crunchy mothers, sex is like childbirth and breastfeeding: the more difficult, painful and inconvenient it is, the better it is!

If that what makes sex better, it’s no wonder crunchy mothers are confused on the issue of birth orgasms. It sounds like they may never have had orgasms at all.

Allison Dixley, the self-proclaimed Alpha Parent, is the perfect foil. She’s my go-to source for sanctimony, viciousness, and misinformation on breastfeeding and formula feeding. Now I find out that she is also clueless.

Her most recent post, Embarrassing Tricks of the Mommy Wars, is a delicious illustration of her utter lack of insight. It’s supposed to be an analysis of the faulty logic that opponents use against her, but, instead, it is a shining example of her faulty logic.

Allison writes:

Let’s take a look at the 15 most common badly-thought-out tactics that mothers resort to in their fight for maternal supremacy.

Her cluelessness occurs on three levels. First, Allison fails to appreciate that she routinely uses many of the tactics she despises as illogical. Second, she clearly does not understand specific logical fallacies. Third, many of her examples are not illogical at all. She simply tars them as such in an effort to avoid answering them.

Here are the highlights of Allison’s list, with my comments:

1. The Ad Hominem:

Attacking the character of the person with whom you are arguing rather than finding fault with his or her argument is a technique of rhetoric. As a debating strategy it is an epic fail because discrediting the source of the argument usually leaves the argument itself intact.

That’s rich coming from the woman who routinely refers to formula feeders as selfish cheaters.

2. Anecdotes

The temptation to over-generalize on the basis of a potentially misleading particular experience seems to be irresistible in the Mommy Wars.

I laughed out loud at this one. Every week Allison features “Triumphant Tuesday,” the story of a woman who overcame a specific breastfeeding challenge, aka an anecdote.

3. The correlation =/= causation safety net

If all else fails, recite the mantra “correlation does not mean causation”.

Earth to Allison: Correlation does NOT equal causation. That’s not a logical fallacy; that’s fact.

5. It’s not child abuse

That’s not a logical fallacy; that’s yet another fact. Formula feeding is NOT child abuse.

7. and 8. are “missing the point” the point and irrelevance. Too bad the examples Allison offers fail to illustrate either missing the point or irrelevance.

10. The schoolyard comparison

The Schoolyard Comparison involves the rhetorical question: “In a class of 30 kids, can you tell who was formula fed and who was breast fed?” To which the answer is – of course you can’t bloody can’t. That’s what scientific studies are for.

No, that’s what scientific studies can do when the differences are tiny and not necessarily clinically relevant. It is perfectly reasonable to question the supposed superiority of breastfeeding by asking if it has any real world advantages. If there are no advantages, or the advantages are so trivial that you have to do a scientific study to establish them, you can’t really make the case that breastfeeding is superior.

12. Prove it

Prove it’, also known as ‘proof by ignorance’ or ‘OMG SAUCE’, is an informal fallacy in which lack of known evidence against a belief is taken as an indication that it is true.

Allison gets this precisely backwards. The argument from ignorance is NOT an absence of evidence. The argument from ignorance is the fallacy that demands proving the negative.

In order to make a claim, you MUST prove it. Otherwise it is nothing more than your opinion.

13. Shifting the goal posts and 14. Zigzagging

Once again, the examples that Allison cites, aren’t illustrative of either shifting the goal posts or zigzagging

At the end of the list, I was left with several impressions.

First, Allison doesn’t understand logic. She routinely labels valid arguments as fallacies, and misunderstands specific logical fallacies.

Second, Allison thinks that shouting “logical fallacy” relieves her of the twin responsibilities of proving her allegation that a claim is a logical fallacy, and of addressing facts that aren’t fallacies at all.

Allison’s ultimate problem is that she has no scientific evidence to support the grossly inflated benefits of breastfeeding and the grossly inflated risks of formula feeding that she espouses. Her list is one long excuse for why she believes she doesn’t need to present scientific evidence for her claims.

That’s her biggest mistake of all.

Lactivism has a problem. It privileges process over outcome.

It is no longer enough to raise a healthy, happy, well-adjusted child who becomes a healthy, happy, well-adjusted adult. How you raise that child, specifically how you feed that child, has assumed outsize importance.

Prior to lactivism, there was no right way or wrong way to feed an infant. Properly prepared infant formula was considered no better and no worse than breastfeeding. Since the advent of lactivism, there is only one right way to feed a baby, and it is women’s ability and willingness to emulate a fantasized version of paleo infant feeding that supposedly determines whether they will be good mothers, and whether their babies will bond to them and they to their babies.

Does that sound familiar? It should because it bears great similarity to natural childbirth and homebirth advocacy.

The point of childbirth is no longer seen as having a baby, but instead, the specific process by which you have a baby has developed outsized, and in my view thoroughly misplaced, importance. Birth has become a performance. Process is privileged over outcome.

Prior to Grantly Dick-Read, there was no right way and no wrong way to have a baby. Any birth in which both the mother and baby survived was a good birth. Dick-Read, and the string of old white men who followed him (Fernand Lamaze, William Bradley, Michel Odent, etc.) changed that. Now women are encouraged to judge themselves and other women by faithfulness to a carefully scripted performance of birth: no pain relief, no C-sections, no interventions of any kind. Women have been taught that it is their ability to emulate a fantasized version of paleo-childbirth that determines whether they will be good mothers, and whether their babies will bond to them and they to their babies.

I, on the other hand, am a momivist.

What’s a momivist?

A momivist privileges people over process. Specifically, a momivist privileges mothers and what works for them and their families than over any specific process for giving birth to and raising children.

When you think about it, it is difficult to understand why women have allowed others to evaluate and render moral judgments over whether the process they are using in giving birth and raising their children is optimal. But when you consider that there is an entire industry complete with products, courses and cadres of health paraprofessionals designed to support the “correct” way to give birth and to feed and nurture children, it isn’t so surprising after all.

That industry is only profitable to the extent that it convinces women that there is a right and a wrong way to give birth or feed a baby. In order to preserve and increase their profits, they engage in massive and well funded marketing campaigns to make women feel badly about doing anything any other way but their way. In contrast, there’s not a lot of money in putting mothers ahead of process. You can’t sell books, products and courses to people who think that they can raise perfectly happy and healthy children without the guidance of moral arbiters.

It’s just an extension of the marketing principles applied to other products. Want to sell mouthwash? Convince people that without using mouthwash, they will have bad breath, and be social failures with no chance of having sex with attractive people.

What to sell natural childbirth? Convince women that without natural childbirth, they will fail at their very first task of motherhood and be unable to bond with their own children.

Want to sell lactivism? Convince people that, contrary to the scientific evidence, breastfeeding supposedly has massive benefits and formula feeding supposedly has massive risks. Make it difficult for women to obtain formula in hospitals, and, above all, shame them with threats that their formula fed children will be sick, dumb, and socially maladjusted.

Natural childbirth, homebirth, lactivism and attachment parenting privilege processes because they make money from promoting those processes.

Momivism privileges mothers over process and there’s not a lot of money to be made in telling people they are doing fine and don’t need any special products, books or courses.

Momivism, by encouraging respect for individual mothers and the personal choices of others, does not allow one mother to feel superior to another mother for parenting the “right” way.

Momivism, by recognizing that there are many right ways to give birth and raise children, deprives some women of the opportunity to publicly shame other women for not mirroring their own choices back to them.

Momivism has a lot of downsides for the industries that promote feelings of inadequacy, shame and depression, but only upsides for mothers.

Imagine a world where mothers support each other instead of tearing each other down. Imagine a world where mothering choices are judged based on the actual effect on specific children, not grossly inflated theoretical risks and benefits. Imagine a world where mothers recognize each other as having different needs, aspirations and desires and respected those differences.

We could have that world if we were all momivists instead of advocates for a preferred method of parenting.

Let me give thanks where thanks is due: Thank you homebirth advocates; I can always rely on you to do my work for me, helpfully illustrating my central claims about homebirth advocacy.

For example:

1. The narcissism of homebirth advocates

Rixa Freeze attempts to enumerates many of my claims:

Along with accusations of being selfish, narcissistic, irresponsible, horribly misinformed, or tragically brainwashed, home birthers also are accused of wanting to control their birth.

Now read the whole post (it’s very short). Does it strike you that anything is missing?

That’s right. There’s no mention of the baby! You remember the baby, the entire point of the birth for the rest of us, not a prop unworthy of mention.

But apparently not for Rixa. In a post of only 302 words, Rixa uses the words “I,” “my,” and “me” 20 times. She mentions the baby 0 times.

Just in case you had any doubts that homebirth was about anything but the mother, Rixa confirms the narcissism of homebirth.

2. Earlier this week I wrote about homebirth and defining deviancy down. Simply put, homebirth has so many bad outcomes that  advocates have been forced to redefine bad outcomes as “good.”

Case in point: in the post Grounded Midwives, Chris Brecheen raved about the homebirth midwives who attended the female partner in his polyamorous relationship.

What wonderful things did they do?

Then they started talking about the placenta.

Not if, mind you, but what should be done with the placenta. I sat there trying desperately not to bust out into a few choice lines of Tim Minchin’s Storm while they were calmly discussing encapsulation vs. placenta stew with the apprentice midwife. It was just too much.

“So, is there any science behind this placenta stuff?” I asked, knowing full well there wasn’t …

“Not even a little bit,” the midwife said in a relieved voice.

Wait, what? Was she . . . maybe . . . as uncomfortable as I was?

I watched the midwife’s eyes flick over to the apprentice—the one who was offering to do the encapsulation. The midwife bit the corner of her bottom lip a little, and then launched into a discussion about how a placebo you believe in has real power even if it is the placebo effect. “If it works, it works—even if everyone knows it’s a placebo.” …

Suddenly, I had an ally—a midwife ally who knew this placenta crap was something people believed in, took seriously, would probably get offended about, but had absolutely no science backing it.

And that’s when I realized Renee was going to be in good hands …

Wait, what? The midwife condones her assistant making money from a procedure she knows to be pseudoscience and Chris is impressed because she acknowledged that it has no benefit?

This guy has very low standards.

And that turned out to be a good thing, because his partner ended up with a C-section after 80 (count ’em, 80!) hours of labor. What did the midwives do that was so impressive?

Renee needed a midwife who could in one moment stand defiantly between her and our utterly obnoxious doctor and say, “Her hips are perfectly wide enough.” But she also needed a midwife who could, an hour later, be gracious enough to defer to modern medicine when it was time to admit that progress had stopped and exhaustion was kicking in.

Wait, what? Chris thinks it was a good thing that the midwife delayed a necessary C-section by an hour because she had absolutely no idea what was necessary or not?

The midwife and Chris’ family behaved like toddlers: “How do you know!” “You can’t make me.” And, like toddlers, they ended being wrong and having to do it anyway.

This is supposed to be impressive?

3. I’ve often written that homebirth advocates have absolutely no concept of risk. They dramatically exaggerate the risk of rare complications, and grossly minimize the dangers of homebirth. Once again, my friends at MANA (the Midwives Alliance of North America) come through for me and illustrate my point.

In a post entitled HUMANizing Birth (get it “human”), MANA gives pride of place to a startlingly stupid analogy promulgated by midwife Saraswathi Vedam. You may remember Vedam. She’s responsible for the grossly irresponsible Homebirth: An Annotated Guide to the Literature ©, which includes 66 separate citations that purport to show the safety of homebirth. But if you read each and every citation, as I did, you will find that only 3 of the 66 “citations” support the claim that homebirth is as safe as hospital birth.

Of the 66 citations:

Fully 25, more than 1/3, are not scientific studies at all
1 was never published
1 was published in a non-peer reviewed publication
1 was publicly retracted
17 do not even address the issue of homebirth safety
2 are underpowered
4 compared homebirth to a hospital group containing high risk women
12 showed that homebirth had an INCREASED risk of perinatal or neonatal death

What does Vedam have for us now?

Tell a man that he could possibly have a heart attack when making love. Then tell him that it would be safer for him to come to the hospital and make love while being monitored by a physician. Do you think a doctor coming in to take his blood pressure and monitor his heart every 10 minutes would affect his performance?

Ha, ha, ha; hospital birth is stupid. It’s no different from insisting that men have sex only in hospital. Ha, ha, ha. There’s just one teensy, weensy problem with this analogy. It is grossly misleading. The risk of a heart attack during sex is approximately 2-3/1,000,000 episodes and the natural risk of maternal death from childbirth is 10,000/1,000,000 births and the risk of neonatal death is 70,000/1,000,000. In other words, the risk of DEATH in childbirth is almost 50,000 times greater than the risk of having a heart attack during sex, and almost certainly more than a 100,000* times greater than the risk of dying of a heart attack during sex.

Apparently the point is supposed to be that if we don’t hospitalize men during sex, we shouldn’t hospitalize women during childbirth because the risk of death is only ONE HUNDRED THOUSAND TIMES HIGHER . Well, that sure convinced me (NOT)!

I found Vedam’s analogy instructive in yet another way. She, like most homebirth advocates, seems to think that childbirth is a “performance” and that any performance is necessarily ruined by scrutiny. In the first place, childbirth is not a performance and it is deeply misogynistic to suggest that it is. In the second place, most performers (actors, musicians, athletes) have no trouble performing at the highest levels when under scrutiny.

So it’s an awesome analogy except for the fact that birth is a 100,000 more likely to result in death than sex, childbirth is not a performance, and there is no evidence that scrutiny ruins performances.

4. Here’s a bit of this week’s lactivist idiocy for your entertainment pleasure. It comes from (who else?) Allison Dixley, the self-proclaimed Alpha Parent:

Question sent to me today:

“I feel awkward around formula feeders. I don’t know where to look. Is it okay to look at their baby? Is it okay to ask them why they don’t breastfeed, or when they stopped? What’s the etiquette? Any chance you could help with these questions? I’m not being weird, I’m genuinely curious.”

I’ll leave you to analyze this gem for yourselves.

 

*Edited to correct a math error.

Midwifery has a serious problem. A lot of its central claims simply aren’t supported by science.

There are two ways that midwifery theorists could address this problem. They could modify the central claims of midwifery theory (unmedicated vaginal childbirth is best, midwives provides evidence based care, obstetricians ignore scientific evidence) or they could dismiss science. They have taken the second approach with truly laughably results. Their pathetic attempts at dismissing scientific evidence extend from improperly invoking scientific theories of quantum mechanics and chaos theory, which they clearly don’t understand and which have zero applicability to midwifery, to attacks on the notion of randomized controlled trials, to rejecting rationality altogether and insisting that Including the Non-Rational Is Sensible Midwifery.

Simply put, while scientific research seeks to learn, specifically to learn how the human body works and how to maximize healthy outcomes, midwifery research seeks to justify, specifically to justify a primary role for midwives in the delivery of obstetric care and to justify the use of methods and claims not supported by scientific evidence.

Now comes the latest bit of midwifery buffoonery produced by Denis Walsh. You may remember Walsh, a professor of midwifery, as yet another in a line of old white men mansplaining the “benefits” of labor pain to women. Walsh has mangled yet another mainstream theory in a desperate effort to justify ignoring scientific evidence. His new paper, Critical realism: An important theoretical perspective for midwifery research, published in this month’s issue of the journal Midwifery, will no doubt impress other midwives (such big, fancy words!), but real scientists and philosophers would just howl.

According to Walsh:

Midwifery research has grown exponentially over the past 20 years and has been widely disseminated in a range of midwifery and obstetric journals. Research methods that are utilised are increasingly eclectic and reflect the variety of research questions addressing different aspects of childbirth. However conspicuously absent in midwifery journals has been in-depth discussion and debate about the philosophical underpinning of different research methods, though these have taken place in midwifery research texts and other health professions’ journals. The debate asks important questions about the nature of reality (ontology) and how we gain knowledge of it (epistemology). Such a focus is fundamental to research endeavour because unless the right questions are asked about the reality we are attempting to describe, explore or explain, then our knowledge of that reality will remain superficial and impoverished and is less likely to make a difference to childbirth practices and women’s experience. In addition, it can result in research that is inadequately justified, lacks internal coherence and therefore lacks wider credibility.

English translation: Midwifery research is, in large part, nothing more than crap and therefore no one takes us seriously. But even though our research looks crappy, it’s only because no one has explored the deeper philosophical underpinnings.

That’s where critical realism comes in.

What is critical realism?

Critical realism is a philosophy of the SOCIAL SCIENCES (not the natural sciences) combines a general philosophy of science (transcendental realism) with a philosophy of social science (critical naturalism) to describe an interface between the natural and social worlds.
It was promulgated by philosopher Roy Bhaskar:

… [W]hen we study the human world we are studying something fundamentally different from the physical world and must therefore adapt our strategy to studying it. Critical naturalism therefore prescribes social scientific method which seeks to identify the mechanisms producing social events, but with a recognition that these are in a much greater state of flux than those of the physical world (as human structures change much more readily than those of, say, a leaf). In particular, we must understand that human agency is made possible by social structures that themselves require the reproduction of certain actions/pre-conditions. Further, the individuals that inhabit these social structures are capable of consciously reflecting upon, and changing, the actions that produce them—a practice that is in part facilitated by social scientific research.

This may make sense in the world of social science research (although there are many other philosophers who would disagree), but midwifery claims are generally natural science claims, so critical realism doesn’t apply.

Walsh doesn’t really care about the validity of invoking critical realism in assessing the validity of midwifery research, he merely intends to use it as an excuse to ignore scientific evidence in favor of midwifery beliefs and intuitions.

Walsh does not like the scientific evidence about dystocia (stalled labor):

An example of this is the current research into dystocia, a complication of labour that is the principal contributor to caesarean section in nulliparous women. Most of the research has explored interventions to speed up labour … The methods utilised in these studies have been randomised controlled trials … [which] promises certainty in addressing the condition, based as they are on a positivist epistemology (knowledge that is always true and generalisable) … However, the incidence of dystocia and its negative consequences for women continues to rise. If researchers had grasped the limitations of their research methods by critiquing their ontological and epistemological underpinning, they might have asked different questions about the aetiology of dystocia, researched different interventions to manage it and ultimately had a greater impact on women’s outcomes and experience.

English to English translations: The large body of scientific literature on dystocia does not support midwives’ intuitions and claims about dystocia.

Never fear! Critical realism supposedly comes to the rescue:

Nine years ago, Anderson  began asking different questions about the aetiology of dystocia, suggesting some new categories – organisational dystocia (lack of continuity of care on labour wards), environmental dystocia (clinical, non-homely décor) and interpersonal dystocia (disagreements between labour ward midwives and obstetricians). Of course what she was hinting at were environmental, social and psychological effects that could impinge upon a woman’s ability to labour normally. Later, Downe and McCourt articulated the limitations of studying labour predominantly by using randomised controlled trials (RCT’s) because the theoretical foundations of trials reside in a positivist epistemology based on simplicity, linearity and certainty. However, labour does not unfold with a singular cause and effect physiology (oxytocin secretion therefore cervical dilatation) which then proceeds with regularity (cervix dilates in a constant trajectory) to end with birth at a relatively predictable point (average of 10 hours). It is a much more complex phenomenon which might more accurately be referred to as ‘orderly chaos’. Clearly, experiences like labour are impacted on by multiple factors in the physiological, psychological and social domains. Simply applying quantitative research methods suited to the controlled confines of a laboratory are not going to capture the intricacies of the uncontrolled milieu of a labour ward.

In other words, midwives don’t like what the scientific evidence shows so it’s okay if we ignore it.

Let’s leave aside for the moment that critical realism has been dismissed on its own terms by philosophers and let’s focus on the relevant facts:

1. The central claims of midwifery theory are not supported by scientific evidence.
2. Midwives have no intention of modifying cherished beliefs just because science shows they are false.
3. There is a desperate, ongoing search among midwifery theorist to justify ignoring scientific evidence.
4. A variety of theories from other disciplines, poorly understood or misunderstood by midwives, are invoke by midwifery theorists to baffle their followers with bullshit.

What should the average pregnant women take away from these bizarre, goofy theoretical justifications? It’s startlingly simple:

If you want science based care in childbirth, stick with obstetricians.

If there’s anything I’ve learned in more than 25 years of parenting, it’s that different children, even from the same family, need different things. And if there’s anything I learned from practicing medicine, it’s that there are many different ways (cultural traditions, religious traditions, family traditions) to raise children successfully.

But not for attachment parents, for whom there is only one way, their way.

I’m reminded of the famous quote from Henry Ford, describing the sale of the Model T:

Any customer can have a car painted any color that he wants so long as it is black.

In the world of attachment parenting, any mother can have any birth she wants, so long as it is vaginal, unmedicated, and “unhindered.”

Any mother can feed any baby what ever way she prefers, so long as it is breastfeeding.

Any mother can carry her child anyway she wants, so long as it is strapped to her body, not in a stroller or, heaven forfend, not carried, but placed in a playpen.

In other words, in attachment parenting, there are 50 shades, but all of them are either black of white, bad or good. Attachment parents don’t do nuance.

Hospital birth bad.

Homebirth good.

Never mind that homebirth dramatically increases the risk of perinatal death.

Cesarean bad.

Vaginal birth good.

Never mind that there are countless situations in which a C-section is the better, safer mode of birth for both baby and mother.

Bottle feeding bad.

Breastfeeding good.

Never mind that there are women who can’t make enough milk, find breastfeeding too painful, or simply prefer bottle feeding.

Epidurals bad.

Cranio-sacral therapy good.

Cribs bad.

Family bed good.

Vaccines bad.

Ground up herbs with unknown quantities of active ingredients good.

All parenting choices can be characterized as bad or good, nothing in between. There is absolutely no appreciation for the concept that what is good for one mother-child pair may need to be modified slightly or dramatically in order to be best for another mother-child pair. There is absolutely no appreciation that when it comes to parenting, there are infinite shades of all colors because there are infinite combinations of mother and child.

Why are parenting choices black or white in the world of attachment parenting? Because attachment parenting has nothing to do with parenting and nothing to do with children. It’s all about women and how they view themselves in relation to other women. There’s only black (not a good mother like me) and white (mirroring my own choices back to me).

But real parenting is about trying to meet the varied needs of many family members, within varied cultural and religious traditions, not to mention a multitude of family traditions. In the real world, there is no magic recipe for raising healthy, happy children.

In other words, in the real world, there are infinite shades of every color, not simply black and white.

In the winter of 1993, Senator Daniel Patrick Moynihan published a deeply influential scholarly paper entitled Defining Deviancy Down.

He started from the premise of sociologist Emil Durkheim that there is a maximum amount of deviance that a society can recognize before that society begins to fall apart. In order to preserve society  if deviancy rises above that level, standards will change so that behavior previously recognized as deviant is no longer considered deviant. In other words, if society is not careful about enforcing standards, standards will constantly be lowered.

Moynihan wrote about crime in New York City, but the analysis has been extended to many disparate areas, and I’d like to extend it further … to homebirth.

Homebirth as a philosophical movement is only legitimate as long as its central premise is legitimate. The central premise is that homebirth is as safer or safer than hospital birth. But as homebirth has risen in popularity, it has become glaringly apparent that homebirth isn’t safe at all. There are far too many deviations from safety, including deaths, brain damage, and other permanent injury, for anyone to rationally conclude that homebirth is safe. Therefore, homebirth advocates have been defining deviancy down, by insisting that what is dangerous is actually safe, that what is a disastrous outcome could not have been avoided, and that there is more to safety than whether the baby or mother lives ordies.

Consider:

1. The magic umbilical cord

It is common knowledge that any baby born blue, struggling to breath or not breathing at all, is a baby who has been compromised and perhaps seriously injured by oxygen deprivation. But in the world of homebirth, an appalling number of babies are born blue and struggling to breath or not breathing at all. How do homebirth advocates reconcile the purported “safety” of homebirth with the many babies born obviously suffering the effects of oxygen deprivation? Simple, they’ve redefined what it means for a baby to be born blue, struggling to breath or not breathing at all.

Instead of acknowledging that these babies are oxygen deprived, homebirth advocates have redefined blue babies to be “normal” and invoked the magical umbilical cord, which purportedly supplies copious amounts of oxygen after birth even though it wasn’t supplying enough oxygen before birth.

Voila! A blue baby is now “normal.”

2. Rejection of risk factors

Homebirth advocates often claim that homebirth is for low risk women, yet encourage high risk women (breech, twins, VBAC) to give birth at home. How does that make sense? It does if you define deviancy down an insist that what were previously considered deviations FROM normal are now merely variations OF normal. Presto-chango! Anyone can give birth at home because everyone is “low risk.”

3. The rejection of risk, aka “the dead baby card”

Homebirth advocates haven’t merely re-defined risk factors, they’ve redefined risk. Previously, when an obstetrician told a woman that she was at risk for a serious complication, she took that advice into consideration. Homebirth advocates have deliberately defined risk down, such that any risk that isn’t 100% isn’t a risk at all, just the obstetrician trying to scare the mother.

4. Any birth that doesn’t result in death is safe

We’ve recently seen this attempt to define safety down in the antics of Ruth and Jared Iorio desperately trying to pretend that Ruth’s birth involving a near death experience from postpartum hemorrhage, transfusions and a 2 day hospitalization is an example of the safety of homebirth. Ruth didn’t die, so homebirth is safe.

5. Dead babies are unavoidable

If you were naive you might think that a dead baby (or mother) was the ultimate example of a homebirth gone wrong. But now homebirth advocates have defined dead babies down, too. Whereas dead babies were previously recognized as homebirth disasters, they are now treated as inevitable deaths so that homebirth can be justified since the baby was going to die anyway.

Contemporary homebirth advocacy is a paradigmatic example of defining deviancy down.

Blue babies are now getting “enough” oxygen.
Risk factors are all variations of normal.
There is no such thing as risk.
If no one died it was a safe homebirth.
And even if the baby or mother died, it was inevitable.

The philosophy of homebirth is legitimate only so long as its central premise, that homebirth is as safe as hospital birth, is true. It can’t survive as a social movement otherwise. Since homebirth is obviously not safe, with mortality rates approaching 1000% higher than hospital birth and brain injury rates exceeding 1800% of hospital birth, homebirth advocates have been forced to define deviations from safety down, proving Durkheim correct. If we are not careful about enforcing standards for safe birth, those standards will be constantly lowered until they are meaningless, as they already are in the world of homebirth.

I’m often accused of being a homebirth hater, as if that means that what I write about homebirth should be discounted. Apparently homebirth advocates believe only those who love it should be allowed to write about it.

The truth is, though, that I don’t hate homebirth. Homebirth is a choice that every women is entitled to make and I would never ban the choice even if I could.

I don’t hate homebirth, but here’s what I do hate:

1. I hate preventable deaths of babies.

I freely admit that I have a soft spot for babies and I absolutely abhor the idea that some babies are dying because their mothers have been convinced that homebirth is safe when it is not.

How many babies are dying?

If you look at the data from Oregon on planned homebirth with licensed midwives (the most comprehensive data ever collected on American homebirth), we find that the death rate at homebirth is 800% high than comparable risk hospital birth. While 0.6 babies/1000 die at hospital birth, fully 5.6/1000 die at homebirth. That means for every 1000 babies whose mothers choose homebirth, 5 will die preventable deaths. Even though homebirth is a fringe practice, that means that more than 100 babies die each year simply because their mothers chose to deliver them far from the expert personnel and emergency services that would have saved their lives. I hate that.

2. I hate preventable brain injuries.

While death is, of course, the worst thing that can happen to babies whose mothers choose homebirth, it’s not the only disaster to befall them. A poster to be presented at next month’s meeting of the Society of Maternal-Fetal Medicine demonstrates that the risk of brain damage due to lack of oxygen is 18 times higher at homebirth than in the hospital.

Yes, babies born in the hospital do suffer brain damage, too. But for every 100 babies who suffer brain damage in the hospital, 1800 suffer brain damage at home. I hate that!

3. I hate that the Midwives Alliance of North America (MANA), the organization that represents homebirth midwives, has been hiding their own death rates for the past 5 years.

(MANA) has assembled a database of over 27,000 homebirths attended by their members. They publicly boasted about a low C-section rate, low intervention rate and a low prematurity rate. How many babies have died to achieve that low C-section rate? For the past 5 years, MANA has REFUSED to release the death rate. You don’t have to be a rocket scientist to suspect that those death rates are hideous.

Even MANA knows that homebirth kills. They just don’t want American women to find out.

I hate that.

4. I hate that homebirth midwives (CPMs, LMs) aren’t real midwives, just lay people who couldn’t be bothered getting a real midwifery education.

The CPM and LM designations were made up by laypeople and awarded to themselves, despite the fact that they lack the education and training of all other midwives in the industrialized world. In the UK, the Netherlands, Canada, Australia, etc., you need a university level degree to practice midwifery. In the US, you need a master’s degree in midwifery. In contrast, the requirements of the CPM were “strengthened” in September 2012 to require a high school diploma.

Most women have no idea of the vast difference between real midwives (certified nurse midwives) and self-proclaimed “midwives.” I hate that.

5. I hate the fact homebirth advocates lie about the safety of homebirth in other countries.

Homebirth advocates are forever proclaiming that homebirth and midwifery in other countries leads to lower mortality rates. They point to the Netherlands, but the Netherlands has one of the highest mortality rates in Western Europe, and the perinatal mortality rate for Dutch midwives attending low risk births (home or hospital) is HIGHER than the mortality rate for Dutch obstetricians caring for high risk women.

They point to the UK where the system is led by midwives, but that system is experiencing a terrible crisis. A recent government report was scathing in its assessment that UK midwives put the lives of mothers and babies at risk.

They point to Australia where midwives published a study claiming to show that homebirth is safe even though their study found that homebirth had a death rate 5X HIGHER than comparable risk hospital birth.

I hate those lies.

I could go on and on, but I suspect that I have made my point.

I don’t hate homebirth, but I do hate that babies die preventable death and sustain preventable brain damage all because their mothers were fed lies about the safety of American homebirth, the safety of international homebirth, and the vast differences between American homebirth midwives and midwives everywhere else in the first world.

The only thing that surprises me is that homebirth advocates don’t hate those things, too.

Ruth Fowler Iorio is shocked, shocked that anyone could question the safety of her near-death homebirth experience. All she did was nearly exsanguinate. What’s the big deal?

Ruth is like the drunk driver who claims that drunk driving is perfectly safe because she survived her own spectacular crash with just a few blood transfusions and a 2 day hospital stay. She exhibits approximately the same level of insight of that drunk driver.

Ruth parachuted into an awesome homebirth discussion (hosted by Iola Kostrezewski) to offer typical homebirth nonsense and flounced off before she could be question on it. It instructive to look at what she wrote and address the myriad mistruths, half truths and lies she invoked.

Here’s what Ruth had to say:

Myth #1 Midwives in other countries have fantastic outcomes.

…There’s no studies on the safety of home birth in the US, nor can we compare the system here with Europe, disrupted by the medical industry and disabled by legislation and quackery which limits midwives from performing necessary procedures to the best of their ability.

Ruth is apparently unaware that the midwives in other parts of the world have nothing to brag about. Dutch midwives caring for low risk women (home or hospital) have a HIGHER rate of perinatal death than Dutch obstetricians caring for HIGH risk women.

UK midwives were recently chastised for putting the lives of babies and mothers at risk, and then attempting to cover up the resulting deaths.

Myth #2 Obstetricians are motivated by money but homebirth midwives work for free.

The system here is punitive and money based, and midwives are demonized by the medical industry because they do not earn money for insurance companies or hospitals, and they do not rush women into hospital for c sections in order to increase their profits. Women are profit here. Birth is profit. Not all obgyns work on this basis, but their training is geared towards limiting liability and earning money.

There is copious evidence that salaried obstetricians have intervention and C-section rates no different than those who are compensated on the basis of procedures. Moreover, homebirth represents a potential loss of obstetric income for obstetricians of 1/2% (and, of course, no threat to GYN income). On the other hand it represents 100% of the income homebirth midwives, who charge thousands of dollars to attend a birth. You tell me who has a greater financial motivation to lie about the death rates at homebirth.

Myth #3 High infant mortality is an indictment of obstetric practice.

Remove the profit motive from medicine and put midwifery care back into birthing, offering the same kind of care as Europe, and the US will see a marked improvement in its frankly shocking infant and maternal mortality rates, and the ridiculous rates of unnecessary medical interventions.

Typical of most homebirth advocates, Ruth is clueless that infant mortality (death from birth to one YEAR of age) is a measure of pediatric care, not obstetric care. The correct measure of obstetric care is perinatal mortality (late stillbirths + deaths to age one month). According to the World Health Organization, the US has one of the lowest perinatal mortality rates in the world.

Ruth also appears to be clueless about what happened to her.

And no, I didn’t nearly die. Placenta accreta is not detectable before birth and it’s a simple malfunctioning of ones body.

Sigh; so much misinformation, so few words! Ruth, you didn’t have a placenta accreta. You had a retained placenta. There’s a world of difference.

A retained placenta is just a placenta that doesn’t come away from the wall of the uterus. It often leads to postpartum hemorrhage because postpartum bleeding stops when uterine contractions close down the blood vessels, not by clotting. If the uterus can’t contract because the placenta is in the way, the bleeding can approach the flow of a faucet, resulting in the death of the mother. In 3rd world countries, this is a major cause of death.

The placenta is not a part of the mother’s body and has nothing to do with the mother’s body “malfunctioning.”

Placenta accreta, in contrast, is an obstetric disaster of the first order. Placenta accreta occurs when the placenta grows INTO the uterine lining, instead of remaining separate from the mother’s body. Placenta accreta CAN be detected before birth by ultrasound, although that does not always occur. Placenta accreta often results in an immediate C-section because that is the only way to stop the bleeding. Most accreta patients wind up in the ICU, and a few blood transfusions is the least of the interventions they experience. Women with placenta accreta can and do die.

But blood transfusions are nothing to scoff at, Ruth. They don’t give blood out to anyone who walks in the door, ONLY to people in danger of dying without it.

Ruth does nail the flounce, however.

Now i am off to bed. Amy, retrain. Your knowledge is from 1985 and you sound like Nestle sponsor you. Even my dad as a GP is more up to date with OBGYN practices and current medical studies than you.

If Ruth wants to advertise naked pictures across the internet to promote herself and her homebirth, that’s her business. But when she starts spreading misinformation about the safety of homebirth in general, and the “safety” of her own near-death experience in particular that’s my business.

Ruth nearly killed herself; those who try to copy her risk not only their own lives, but the lives of their babies, too. They DESERVE to know the truth, not the made up rationalizations of a narcissist desperate for social media celebrity.

Ruth Fowler Iorio‘s 15 minutes of fame are winding down in classic homebirth narcissist fashion, with Ruth wailing about those mean people at Facebook who won’t host her exhibitionism:

But before she’s replaced by a new homebirth narcissist, I have some questions for her:

Ruth, why did you sanitize the photos are that are supposed to show the “messy reality” of homebirth?

Specifically:

Where is the photo of the postpartum hemorrhage with the blood pouring from between your legs?

Where is the photo of you deathly pale and slipping in and out of consciousness as you head toward hemorrhagic shock?

Where is the photo of your husband’s face, horrified and frightened, as it dawns on him that you may bleed to death and leave him as a widower with a new baby?

Where is the photo of the EMTs hustling you out the door, racing against time to save your life?

Where is the photo of you in the emergency room, with doctors and nurses struggling to start large bore IVs before you bleed to death?

Where is the photo of the obstetrician with his gloved arm in your vagina up to his elbow peeling off the remains of the placenta from your uterine wall, averting your certain death?

Where is the photo of you, not bonding with your newborn, but totally out of it from large doses of fentanyl?

I could go on and on, but I think you get the idea: where are the photos of the REALITY of homebirth?

Did you refuse to include them because they didn’t tell the story as you wanted it told, allowing you to make it seem like your near death was just a minor moment in your piece of birth performance art?

Did you refuse to include them as part of the never ending effort of homebirth advocates to hide the dangers of homebirth?

Or did you fail to include them because they didn’t exist, because near death has a way of clarifying things for all participants, so that they finally drop the cameras? Even narcissists and the friends and family of narcissists tend to put the camera down when they are sliding on your blood pouring out on the floor.

It doesn’t really matter why you failed to include the pictures that tell the REAL story of your homebirth and near death experience, but it is critically important for everyone to understand that those pictures, the most important pictures, are missing.

The REAL story of homebirth is that childbirth is inherently dangerous, that death is always only moments away, that giving birth at home is taking a terrible risk, and homebirth can never be safe.

Enjoy your 15 minutes of fame while it lasts, but I wonder:

What does it say about you, homebirth and narcissism that you are spending the first weeks of your newborn’s life, not nurturing him, but giving interviews, accepting accolades and tweeting endlessly … in other words, nurturing your own self image?

How about thinking about him as a newborn for a moment, not merely as a prop in your endless efforts to publicize yourself?