Periodically a homebirth advocate will parachute in to the blog to school the rest of us on the appeal of homebirth. In the case of homebirth deaths and injuries, the claim is often made that the best way to avoid such tragedies would be to “increase trust in obstetricians.”

Rather ironic, don’t you think? That’s because the cornerstone of homebirth advocacy is the tireless effort to undermine trust in obstetricians. It is the centerpiece of homebirth (and natural childbirth) advocacy, and its most potent marketing tool.

Craig Thompson, professor of marketing at University of Wisconsin wrote about this tactic in Consumer Risk Perceptions in a Community of Reflexive Doubt in the September 2005 Journal of Consumer Research. Thompson marveled at the ability of homebirth advocates to market a “product” by directly defying common sense:

Advocates of natural childbirth seek to inculcate reflexive doubt by countering two commonsense objections to their unorthodox construction of risk: (1) medicalized births would have never gained a cultural foothold if they were so risk laden and (2) the medical profession would not support obstetric practices that place laboring women at risk.

In other words, it is absolutely critical to the natural childbirth project to convince women that doctors don’t know what they are doing, and willfully and cheerfully risk the lives of women and babies to promote a secret agenda.

I can’t think of a single prominent homebirth or natural childbirth advocate who does not work assiduously to undermine trust in obstetricians.

The approach may differ among individuals and organizations:

Ina May Gaskin resorts to new-agey nonsense, and animal birth, which she believes, in her absolute cluelessness, to be perfect. Whereas Henci Goer favors cherry picking data, selective interpretation of scientific papers and pandering to homebirth advocates’ desire to see themselves as “educated.”

Feminist anti-rationalists like Robbie Davis-Floyd deride rationality and insist that women have “other ways of knowing.”Clowns like Jennifer Margulis point to diseases they don’t understand and pretend they are caused by “technology.”

Every homebirth and NCB book, blog and website is predicated on the belief that obstetricians are “surgeons” “untrained in normal birth” who make millions performing unnecessary C-sections in the few moments they have each day between endless rounds of golf.

The tremendous successes of modern obstetrics and the fact that 99+% of women give birth in hospitals is dismissed as the result of an economic war perpetrated by obstetricians on midwives.

Childbirth lobbying organizations like the Childbirth Connection are front and center in the effort to destroy trust between women and obstetricians. How else to explain the endless iterations of the “Listening to Mothers Survey,” a giant push polling project that desperately seeks evidence that obstetricians are not “listening to mothers” and repeatedly finds that the vast majority of American mothers are very pleased with obstetric care?

Homebirth and natural childbirth advocates fiercely grab on to new methods for demonizing obstetric care, such as the unproven claims that modern obstetrics causes “traumatic birth,”  and the hope that C-section cause long term health problems which have heretofore escaped detection despite the fact that there are tens of millions of adults walking around who were born by C-section and appear no different than those born by vaginal delivery.

NCB and homebirth bloggers pile on with inane accusations like “every day 12 babies are given to the wrong mother.” That makes it sound like there’s an epidemic of women leaving the hospital with the wrong baby, when what it really means (if it is true at all), is that an attendant (and that includes midwives) may bring a baby into the room of the wrong mother and discover her mistake when she checks the ID tags on mother and baby.

What about the spectacular advances in modern obstetrics, dropping the neonatal mortality rate by 90% and the maternal mortality rate by 99% in just 100 years?

That is simply dismissed out of hand, with claims that hospitals actually kill babies, or at instigate the medical disasters from which obstetricians thereby appear to be “saving” babies.

Homebirth and natural childbirth advocates have an “answer” for just about every objection you can name to homebirth and those “answers” often involve misinformation, and always involve undermining women’s trust in obstetricians.

Of course, the irony of homebirth and natural childbirth advocates bewailing the very loss of truth between women and obstetricians that they themselves promoted is exceeded by another irony. That irony is the reflexive and unstated reliance of homebirth and natural childbirth advocates on obstetricians to save their lives when they’ve taken terrible chances and made hideous decisions.

The backup plan is always to head for the hospital with the expectation of immediate access to the care of …. you guessed it … obstetricians. Apparently those evil doctors, who can never be trusted, can always be trusted in an emergency.

Over time, to my surprise, I’ve begun to feel sorry for many natural childbirth advocates.

Why?

Because they clearly suffer from a pathetic lack of self-esteem, so pathetic that they cling desperately to any opportunity to feel superior to other women, even if they had no control over the issue in question.

I would feel sorry for any woman who bragged that she was superior because her nose was larger than that of other women. I would feel sorry for any woman who set up a website boasting about the size of her feet. And I do feel sorry for women who feel that their greatest “achievement” is their large breasts.

Therefore, I feel very sorry indeed for the women of the Big Baby Project. Apparently they are so desperate for some sense of self worth that they have set up a website dedicated to their internal pelvic dimensions.

The purpose of the website, according to the woman who created it:

This is a collection of stories. The stories are about Mamas who vaginally birthed babies that some people may consider to be big. People need to hear and see these stories, I hope you share it far and wide, and participate if possible.

The real purpose of the website? To scavenge for praise for the “achievement” of having a pelvis large enough to accommodate an obese baby.

The technical term for a very large baby is macrosomia. Macrosomia is no more worthy of praise than a 45 pound 3 year old or a 10 year old who wears size 14 sneakers, but that doesn’t stop psychologically needy women from bragging about it.

Not all macrosomic babies are obese. Some families simply grow large babies and macrosomia is known to be more common among those of Hispanic descent. However, a substantial proportion of fetal macrosomia is due to untreated or poorly treated diabetes, excessive maternal weight gain, or maternal obesity, which can double or triple the risk of macrosomia. In other words, women have no control over the size of their babies beyond the ability to render them obese through poorly controlled diabetes of excessive maternal consumption.

You will notice that the website refuses to accept pictures of macrosomic babies who were born by C-section, only those born vaginally.

Why?

Because these pathetic women are anxious that you should admire them for their pelvic dimensions, yet another characteristic over which they have no control yet want to take credit.

Just like there is tremendous variation in maternal stature, there is tremendous variation in the dimensions of women’s pelves. As this illustration demonstrates, there are four main “shapes” of the female pelvis.

The most common female pelvic shape, and the one best suited to accommodate a baby, is the gynecoid pelvis. Size variations within a specific shape can make a significant difference in the size of the baby that can pass through.

So the women who post on the site are bragging about the size of their baby and the shape and size of their pelvis, as they have control over either one, and as if you should be impressed with either one. In that sense, it is no different than boasting that you have a bigger nose than other women, or bigger breasts. It is the same old tiresome effort of women to judge each other by physical characteristics, with one important exception.

Macrosomia is a risk factor for various childbirth complications, including neonatal injury, neonatal death and maternal injury. The most dreaded complication is shoulder dystocia. That’s what happens when the baby head fits through the pelvis, but the shoulder become stuck. This is a life threatening emergency because the umbilical cord is compressed by being trapped between the baby’s body and the walls of the pelvis, thereby cutting off oxygen to the baby. The baby will die if not delivered in a timely fashion. Death is the worst possible outcome, but babies who survive are also at risk for serious injury to the nerves of the arm, which can be stretched as they pass through the neck. If the nerves are injured during birth, the baby may suffer permanent paralysis of the arm.

This can cause lifelong difficulties for the child as illustrated in a charming series of books produced by the Erbs’s Palsy Group:

As far as I can determine, The Big Baby Project makes no mention of whether any of the featured babies suffers from Erb’s palsy or whether any of the mothers had long term problems (tears, incontinence) from delivering a big baby. And of course, there are no dead babies on the site, because, apparently, women aren’t entitled to “hear and see” those stories.

It’s really rather pitiful when you think about. A group of women is so desperate for attention and validation that they post to a website bragging about the size of their baby and the size of their pelvis, as if they had anything to do with either. You really have to be pathetically needy to boast about that.

There’s denial and then there is something so desperate, so illogical and so ridiculous that labeling it denial seems grossly inadequate.

The story is simple and straightforward. A pregnant woman was facing a C-section because all the obstetricians she consulted advised her that vaginal delivery might result in the death of one of her twins or herself. She decided to ignore their warning and gave birth at home unassisted. She died of a massive postpartum hemorrhage. Whose fault is that?

According to a fellow homebirth advocate who was her friend, it’s the fault of obstetricians. Let me say that again to make it clear: She was warned she might die if she attempted a vaginal birth. She attempted a vaginal birth and died. But supposedly she bears no responsibility for the choice that killed her.

The story of this preventable maternal death, My Friend Died: A Story of How the War Over Women’s Bodies Continues to Kill, can be found in the appropriate named journal Squat. Everything in the journal isn’t worth squat. It was written by Nekole Shapiro who “focuses on oxytocin-infused states, birthing parts and healing birth trauma.”

Our friend died last year.

She was pregnant with twin girls that would be daughters number 3 and 4… When she was 36wks pregnant, I received a text message that the family had exhausted their search for a provider who would support her to birth her twins vaginally… [T]he couple had decided to do it on their own.

This did not sit well with me. This was not a family who said, We would like an unassisted vaginal home birth of twins. This was a family who felt they were left with no better option since no one would support them in what they saw as the best and safest option: a spontaneous vaginal delivery…

What happened?

Next thing I knew, I got a text that she had birthed her twins: spontaneous labor at 38 weeks. I was elated and couldn’t wait to hear more. But then the second text came: she had lost quite a bit of blood and was in a coma…

Initially, the mother’s prognosis was unclear. Unfortunately:

Then they reported that there was only brain stem activity…

The next update I got was via this Facebook post, “[My wife] has not, and will not, wake up again. She has been moved to a room where she will be kept comfortable until the end.” Some days later she passed away.

Nekole grappled with tremendous cognitive dissonance:

At first, I was quite shaken by these events and I knew others would be as well. I knew people would quickly say, “See, you can’t trust birth. Birth IS inherently dangerous. How dare you be one of those people who support anyone thinking otherwise! See what can happen?” But, I also knew that this is one story of many and I did not want my raw emotional state to start dictating my view of the world. I reminded myself that many people die in car accidents, but we have not outlawed cars.

We don’t go around pretending that driving cars is “as safe as life gets,” either.

But cognitive dissonance is hard. Denial is easy:

Ultimately, this story is a horrific reminder of our broken system. If we walk out of a birth with this type of unfathomable outcome when in fact all the support needed was present, that is one thing. But, to have this outcome with a complete lack of support, that is simply unacceptable. Our system should be designed and focused on supporting mothers to birth the way they feel is best for them!…

No, no, no. This is not a horrific reminder of a broken “system.” It is a horrific reminder of a broken philosophy, the philosophy of natural childbirth.

Natural childbirth advocates encourage women to value process over outcome. They encourage women to seek an idealized “birth experience.” They encourage women to reject medical advice in favor of “intuition.” They encourage women to risk the deaths of themselves and their babies and as a result, women and babies die preventable deaths.

Obstetricians do not exist to provide support. They exist to provide safety. Women ignore them at their own peril. They have every right to do so, but let’s at least be intellectually honest enough to acknowledge what actually happened. A woman ignored the lifesaving advice of obstetricians and died as a result.

The people who bear responsibility for the outcome are not the people who warned her; the people who bear responsibility for yet another preventable death are the mother who made the choice, and the natural childbirth community who encouraged her to pretend that women are “perfectly designed” for childbirth, that obstetricians should not be trusted, and that women should make complex medical decisions by relying on intuition instead of education and training.

A philosophy that encourages women to value process over outcome is a philosophy that inevitably kills women and babies. Unfortunately, Nekole’s friend died as a result of that philosophy and left 4 motherless daughters as the true victims. Too bad Nekole and the editors of Squat didn’t learn anything as a result.

Remember Tracey Cassels, another sactimommy suffering from sadness?

Apparently she’s suffering from self-doubt. Why else would she (and her followers) fear what I write unless they:

• knows it’s true?
• can’t offer any substantive criticism?
• feel their desperate desire to imagine themselves as superior to other mothers is threatened?

On Mother’s Day, from Baby Center:

My husbands cousin passed away today while giving birth. She was 24, beautiful, had just graduated with her masters in engineering, and was getting married. She was due may 15th. She went into labor today. She had a home birth and midwife. She bled to death on the way to the hospital that was 8 minutes away. Her daughter is alive…

This young woman did not have to die, leaving her infant daughter motherless. She died because she chose homebirth, because hemorrhage is and has always been one of the leading causes of maternal mortality, and because a hospital only “8 minutes away” isn’t close enough.

But almost certainly contributing to her death is the fact that homebirth midwives know virtually nothing about postpartum hemorrhage.

Actually, it’s worse than that. Homebirth midwives believe that they can control hemorrhage by doing what they know how to do best: nothing.

In the world of homebirth midwifery clowns, few are as inane as Jan Tritten, the editor of Midwifery Today. Consider her recent editorial on postpartum hemorrhage.

Tritten is appallingly ignorant about the causes of postpartum hemorrhage. She actually appears to believe that postpartum hemorrhage occurs when mother and midwife don’t have the proper thoughts.

The most important thing I can say about hemorrhage is, “Don’t cause one.” If the body is well fed and mom is low on stress and feels loved, motherbaby and their process of labor and birth work well. Our first and most important job is to facilitate what is already a beautiful process. God designed this process to work, but birth workers can come along and do interventions that may cause hemorrhage…

The real causes of postpartum hemorrhage include uterine atony (failure of the uterus to contract after birth), retained placenta (failure of the placenta to completely detach after birth) and injuries to the uterus itself (such as tears of the cervix, which can happen if a woman tries to push the baby through before the cervix is completely dilated). Obviously, none of these has anything to do with what the mother or the midwife “thinks.”

Where did Tritten get such an appallingly stupid idea about what causes postpartum hemorrhage?

Perhaps she got it from these midwifery clowns, Jenny A. Parratt, and Kathleen M. Fahy, the authors of Including the nonrational is sensible midwifery:

For example, when a woman and midwife have agreed to use expectant management of third stage, but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking. Depending upon all the particularities of the situation the midwife may focus on supporting love between the woman and her baby; she may call the woman back to her body; and/or she may change to active management of third stage…

So not only do we have the editor of Midwifery Today indulging in massive stupidity, there are actually midwifery professors and journalists who encourage this idiocy.

And they’re not the only ones. According to Tritten:

I asked a question about hemorrhage and Margie Dacko had the most interesting response:

“I never used Pitocin in over 2400 homebirths. My hands are my favorite and best tool to stop bleeding (or getting placentas out). BTW, I don’t use eating placenta, herbs or homeopathic bleeding remedies either. They are unnecessary. The uterus wants to stop bleeding, just needs a “helping hand” on occasion…”

The uterus wants to stop bleeding??!!

And just how does a uterus with a tear in the cervix stop itself from bleeding? It can’t.

There is an old saying that to a hammer, everything looks like a nail. To a homebirth midwife, who knows nothing and can do nothing, everything looks like it needs no treatment.

For a homebirth midwife to acknowledge that childbirth, just like pregnancy, just like any natural process, is not perfectly designed, is to acknowledge her own worthlessness. It gives new meaning to the bizarre claim that homebirth midwives are “experts in normal birth.” They’re experts in doing nothing and pretending that nothing is what needs to be done.

God help you if you or your baby needs emergency treatment. These clowns certainly won’t.

One of the most depressing aspects of our depressingly dysfunctional political landscape is the corruption of journalism.

According to the Society of Professional Journalists, journalism is supposed to encompass:

Test[ing] the accuracy of information from all sources and exercis[ing] care to avoid inadvertent error.

Today it means: staking out an ideological position and ignoring anything that controverts it.

Hence self-proclaimed “journalists” of the anti-science Left like anti-vaccionationist Jennifer Margulis and self-proclaimed “journalists” on the Right like those at Fox News have a lot more in common than either would be pleased to acknowledge.

• Both start with the ideologically preferred conclusion and work backward.
• Both make no attempt to avoid journalistic bias.
• Both rely heavily on the claims of “experts” vetted for ideological purity.
• Both refuse to mention, let alone address, inconvenient facts that undermine preferred conclusions.

Surprisingly, both rely on similar claims.

1. It’s a conspiracy!

The folks at Fox News are always sure that there is some conspiracy behind most everything they report. It’s a conspiracy to take away our rights! It’s a conspiracy to encourage socialism! It’s a conspiracy to institute One World Government!

Margulis and her buddies on the anti-science Left are equally convinced of conspiracies. It’s conspiracy on the part of drug companies! It’s a conspiracy on the part of infant formula manufacturers! It’s a conspiracy in which government is concluding with Big Medicine!

2. It’s the government!

According to the Right, the government is trying to deprive people of their weapons in preparation for a total takeover. The government is trying to promote “secular humanism.” Heck, the government is engaged in a war on Christmas.

According to the Left, the government is trying to dupe people into buying, eating and injecting themselves with “chemicals” because they are in cahoots with industry.

3. Don’t criticize my God!

The God of the Right is the god of traditional religion. Anything that does not comport with the perfection, wisdom and infallibility of that god must be denied.

The God of the Left is Nature. Not nature as it really exists, but a gentle, benevolent and perfect “Nature” as imagined by those fail to recognize the incongruity of extolling “Nature” while simultaneously living in huge homes with central heating and airconditioning, Wi-Fi, and professional grade espresso makers, communicating their “message” using the Internet, video, photography and smart phones.

4. I’m being persecuted!

The Right is sure that they are being persecuted. Even when government was in the control of a Republican President, Republican Congress, and conservative Supreme Court, the Right was still bleating about persecution.

The anti-science Left is also constantly claiming persecution, but that is often in an attempt to inflate their own importance. No one is persecuting homebirth advocates, AIDS denialists and vaccine rejectionists. Most people don’t even know they exist.

The end result of this “journalism” is a country where the majority of people don’t believe in evolution, the Congress legislates against reproductive rights, and vaccine preventable diseases are once again claiming the lives of the youngest and most vulnerable among us.

If that’s not depressing, I don’t know what is.

Poor homebirth advocates!

It’s getting harder and harder to fill their narcissistic need for attention by having a homebirth. Merely boasting to friends and family is certainly not enough.

Live blogging and live tweeting the birth? Ho hum, it’s been done.

Live video transmission? Yawn.

No medical attendants? That’s so 2012!

In order to get attention and stand out from the rest of the narcissitic crazies, you have to be far more creative than ever before.

At a minimum, you have to give birth outside,surrounded by nature, like this.

First you assemble your midwife, doula, and birth photographer (most vital member of the team). Then you quickly run outside to the pool when you are fully dilated and pushing. Finally, you are in the inflatable kiddie pool just like the one used by a prehistoric foremothers. That should make them sit up and take notice.

But let’s face it, outside homebirth has been done a million times.

If you really want attention, you need to change the venue. Any narcissist can give birth in her own backyard. It takes a special narcissist to give birth in the rainforest, like this:

Simone gave birth on a yoga mat with a video camera focused on her vagina, just like thousands of generations before her.

Of course, anyone can give birth in a rain forest. To truly experience birth as Mother Nature intended, you have to give birth along side exotic animals, like these clowns are planning.

Last month, Adam Barringer, 29, and his pregnant wife Heather, 27, boarded a plane for Hawaii. The couple traveled over 4,500 miles in the hopes of welcoming baby Bodhi into the world during a dolphin-assisted birth in Pohoa, Hawaii.

Why?

Traveling and living in harmony with the earth is a way of life for this couple.

It’s hard to imagine how you are living “in harmony with the earth” if your massive carbon footprint includes an 11 hour plane flight to Hawaii. Oops, bet they didn’t think about the fact that living in harmony with the earth would involve staying home.

But consider the benefits:

At the institute, the couple will spend time in the water, forming a connection with a dolphin pod they hope will bond with them and ultimately their newborn.

“It is about reconnecting as humans with the dolphins so we can coexist in this world together and learn from one another,” says Heather.

The couple hopes to find this connection during prenatal and postnatal swims with the dolphins.

Because women from Siberia to Nigeria and everywhere in between have bonded with dolphins as preparation for birth, right?

Frankly, I’m unimpressed. These people are wimps.

Anyone can give birth in their backyard on a sunny day or a clear evening. How about giving birth in your backyard during a tornado? I’d watch that.

Anyone can give birth in mild climate like a rainforest. How about giving birth on the summit of Mount Everest? I’d watch that.

Anyone can give birth with measly dolphins, but what about the king of beasts? How about giving birth in a lion’s den? I wouldn’t watch that, but only because the baby or the mother or both would end up as cat food.

Extreme homebirth poses a real problem for me, though. It means that it is getting increasingly difficult for me to parody homebirth advocates because they are so busy parodying themselves.

There is nothing so ludicrous that homebirth advocates can’t dress up as “natural” in effort to fill their desperate need for attention.

I can’t decide.

Does Ina May Gaskin really believe the crap that she spews?

Or does she simply have contempt for the intelligence of her followers?

Consider one of the the quotes for which she is best known:

Remember this, for it is as true and true gets: Your body is not a lemon. You are not a machine. The Creator is not a careless mechanic. Human female bodies have the same potential to give birth well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo. Even if it has not been your habit throughout your life so far, I recommend that you learn to think positively about your body.

What’s the purpose of this quote? Its purpose is to convince women to pay uneducated, untrained birth junkies (lay midwives, DEMs, CPMs) to attend them at birth on the theory that nothing is going to go wrong.

Does Ina May actually believe that nothing is going to go wrong? Or is she simply trying to dupe potential customers into believing it?

Let’s parse the quote:

1. Your body is not a lemon?

Ever notice that it is only natural childbirth advocates who insist that anything less than an idealized birth is a sign that a woman is defective?

I’ve read a great deal of the obstetric literature and I haven’t come across any obstetricians who even tangentially imply that a variation from ideal is a sign of a defect in the individual women. Obstetricians don’t tell women who have miscarriages that they are “lemons.” Indeed, they reassure women that miscarriages are a normal part of human reproduction and they should never blame themselves for miscarriages. They would no more think of a woman who needed a C-section as “broken” than they would think of a woman who needed an appendectomy as broken. It is only NCB advocates who try to convince women that they should be ashamed of complications and avoid that shame by pretending those complications don’t exist.

2. You are not a machine?

In find this particularly ironic since Gaskin’s implication that everyone can have an unmedicated vaginal delivery without complications suggests that she thinks that woman ARE machines that can faithfully churn out perfect children in an endless stream of perfect births. It is she who can’t acknowledge that many variations of pregnancy experiences, complications and outcomes, not medical professionals.

3. The Creator is not a careless mechanic?

So that would explain why no one ever has a miscarriage; there are no birth defects and there is no disease, right? Oops, that can’t be it.

Or maybe it is simple blasphemy, implying as it does that pregnancy complications are something that “the Creator” never intended but was too sloppy to prevent.

Or maybe it simply means that Ina May is a creationist.

4. Human female bodies have the same potential to give birth well as aardvarks, lions, rhinoceri, elephants, moose, and water buffalo?

That’s funny. Why didn’t Ina May invoke animals with which we are familiar like cows, horses, sheep, dogs and cats?

Perhaps it is because she knows that anyone with experience caring for farm animals and domestic pets knows that birth complications, dead offspring and dead mothers are quite common (horse intrapartum mortality is 13.7%; lamb neonatal mortality is 14.3%; among dogs 24.6% of litters experience at least one death), revealing her claim of perfect birth in the animal kingdom to be the lie that it is. How much better to invoke animals that are exotic so that Ina May can pretend that their births are perfect.

So what’s the perinatal mortality rate for aardvarks, Ina May? What is the complication rate for rhinocerous birth? Let me guess: you have absolutely no idea; you just figured that no one else would know, either, so they wouldn’t be able to recognize your claim for the lie that it is.

5. I recommend that you learn to think positively about your body?

Not exactly. Ina May actually recommends that you think unrealistically about your body and then pretend that the diagnosis of pregnancy complications reflects an obstetrician’s desire to insult you.

Now that we’ve parsed the quote, I have to ask:

Who believes this crap? And why?

Inquiring minds want to know.

What’s the difference between a journalist and a hack?

A journalist tries to address substantive criticism of her claims. A hack tries to silence her critics.

You see this over and over again in the world of natural childbirth advocacy. Virtually every natural childbirth website deletes posts that question the received wisdom and bans people who dare to offer scientific evidence that contradicts NCB claims. Partly it is because NCB advocates have an insatiable need for validation of both their personal choices and their preferred view of themselves as incisive thinkers who can’t be fooled by corporate conspiracies. Partly because they recognize that they aren’t equipped to address criticism; they have absolutely no idea of what the scientific evidence shows since they never read it.

Jennifer Margulis wrote an astoundingly crappy and irresponsible book, and she’s being called on it.

As Annie Murphy Paul wrote in the NYTimes:

Inaccurate or inflammatory statements are repeatedly reproduced without adequate substantiation or comment from the other side… Margulis’s treatment of scientific evidence is similarly unbalanced… [U]ltrasound exams of pregnant women may be responsible for rising rates of autism among their children, according to “a commentator in an online article.” This anonymous individual has “used ultrasonic cleaners to clean surgical instruments (and jewelry),” which apparently qualifies him or her to offer an opinion on how the vibration of ultrasound waves may be causing the developmental disorder: “Perhaps this vibration could knock little weak spots in myelin sheeting of nerves or such, I don’t know.”

Amy Wong of the Oregonian offered an equally cutting review:

…Margulis builds her argument mostly on individual parents’ anecdotes, without providing context for whether they represent common experiences. Many of the anecdotes seem to have been selected purely for their shock value. And she frequently describes in detail how mothers suffered at the hands of doctors or nurses apparently without having sought out the doctors or nurses for verification, comment or context. This is not journalism.

I wouldn’t be surprised if Margulis were stung by these reviews, but the appropriate response is to provide the scientific evidence to support her claims, something which she has not done (and possibly believes that she cannot do).

Margulis responds on her Facebook page with this bit of self-serving drivel:

Comparing her book to Rachel Carson’s classic Silent Spring? Now that’s funny!

But Margulis has gone further, advising her supporters to manipulate Amazon reviews of her book as demonstrated by the Facebook post at the top of this piece. Margulis is asking her supporters to bury unfavorable reviews so that people browsing Amazon will not be able to find them. I can’t imagine that Amazon would be happy with this attempt at manipulation. Morever, I suspect that the folks at Brandeis’ Shuster Center for Investigative Journalism would take a dim view anyone on its staff responding to substantive criticism in this way.

I’m surprised. Anyone who writes a book as misleading and irresponsible as Margulis’ book isn’t likely to be able to defend her claims against those who present actual scientific evidence, but this response puts her journalistic integrity into question. I would have thought she knew better.

One of the best ways to determine if a profession follows scientific evidence is to determine how it reacts to evidence that contradicts established practice.

Obstetricians were convinced that episiotomies prevented more serious tears, but when high quality evidence showed that to be wrong, the rate of episiotomy plummeted. Pediatricians routinely recommended placing infants to sleep on their stomach to reduce the risk of aspiration, but when high quality data showed that the prone position increased the risk of Sudden Infant Death Syndrome (SIDS), they changed their recommendations to placing infants on their backs and the SIDS rate dropped precipitously.

New, high quality evidence now shows that co-sleeping dramatically increases the risk of SIDS among breastfed infants under 3-4 months of age (Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies), and the La Leche League is in denial. They base their denial on a “white paper” that insists that the new evidence should be ignored.

The lactivists who wrote this white paper are supremely unqualified to pass judgement on scientific research: 2 are lay people who run parenting blogs, 1 is a nurse, and 2, including Darcia Narvaez, PhD, are an minor faculty in psychology departments. Not surprisingly, they have produced a piece of junk, but to understand why it is so disingenuous, we need to review the study it purports to critique.

The study in question, Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies, is remarkably rigorous. The authors set out to answer a very specific question: what is the risk of co-sleeping in breastfed babies whose parents do not smoke or drink?

They found:

…[T]he combined data have enabled the demonstration of increased relative risk associated with bed sharing when the baby is breastfed and neither parent smokes and no other risk factors are present (see figure 2 and table 2). The average risk is in the first 3 months and is 5.1 (2.3 to 11.4) times greater than if the baby is put to sleep supine on a cot in the parents’ room (table 3). This increased risk is unlikely to be due to chance (p=0.000059).

The data is quite robust as demonstrated by the following graph:

The graph shows Adjusted ORs (AORs; log scale) for Sudden Infant Death Syndrome by age for bed sharing breast-fed infants, when neither parent smokes and both smoke versus comparable infants sleeping supine in the parents’ room. AORs are also adjusted for feeding, sleeping position when last left, where last slept, sex, race, and birth weight, mother’s age, parity, marital status, alcohol and drug use.

What is most remarkable is linear nature of the increased risk of SIDS with co-sleeping compared to the risk of SIDS if the baby is sleeping in the parents room, at every gestational age, and regardless of whether or not the parents smoke. Up until the age of 14-15 weeks, co-sleeping always increases the risk of SIDS death.

The authors go so far as to apply Hill’s criteria to their findings:

• Assessment of bed sharing, in the absence of parental smoking alcohol and maternal drug use, as a causal risk for SIDS by Bradford Hill’s criteria31
• Strength of association: Adjusted Odds Ratio (AOR) for bed sharing=2.7 (95% CI 1.4 to 5.3), p=0.0027, for breastfed infants with no other risk factors. AOR for the first 3 months of life=5.1 (2.3 to 11.4), p=0.00006. These AORs are moderately strong.
• Consistent: Of more than 12 published studies, all but two small ones show, after multivariate adjustment, increased risk of SIDS associated with bed sharing, some combined with sofa sharing…
• Temporally correct: Bed sharing always precedes SIDS.
• Dose response: New Zealand study showed risk increased with duration of bed sharing. Not otherwise investigated.
• Biologically plausible: Bed sharing risk is greatest to youngest infants who are most vulnerable.
• Coherence: The proposition that bed sharing is causally related to SIDS is coherent with theories that respiratory obstruction, re-breathing expired gases, and thermal stress (or overheating), which may also give rise to the release of lethal toxins, are all mechanisms leading to SIDS, in the absence of smoking, alcohol or drugs. Infants placed prone are exposed to similar hazards.

The authors conclude:

… Our findings suggest that professionals and the literature should take a more definite stand against bed sharing, especially for babies under 3 months. If parents were made aware of the risks of sleeping with their baby, and room sharing were promoted, as ‘Back to Sleep’ was promoted 20 years ago, a substantial further reduction in SIDS rates could be achieved.

The white paper touted by the La Leche League condemns the findings of this study and attempts to mislead readers about what the study actually shows.

The authors share two graphs that show how various risk factors (such as infant position, parental smoking and bottle feeding) increase the risk of SIDS. That’s nice, but that’s not what the study is about. The study is specifically about the increased risk of co-sleeping in babies without any risk factors who are breastfed.

The authors insist:

Without consideration of [bedding and temperature], it is not possible to determine that one variable, such as bedsharing itself, is inherently responsible for risk remaining in this study

Really? Is there any reason to believe that the temperature of the bedroom and the blankets on the bed differ between women who breastfeed and those who don’t? Of course not.

The authors continue:

Instead of looking at how each of the variables in the dataset can contribute to risk of infants’ breathing or compromise arousal — the authors focus on whether the act of breastfeeding protects against all risk of SIDS.

Did these women even read the paper? It does not focus on whether breastfeeding prevents all cases of SIDS; it focuses SPECIFICALLY on whether co-sleeping increases the risk of SIDS in babies who are breastfed and finds that it increases the risk by a factor of 5.

The second issue pertains to the risk factors included and not included in the analysis…

Missing from the analysis are other known risk factors: specifically … environmental context (bedding) or infant vulnerability (prematurity)…

But is there any reason to believe that breastfeeding women are more likely to have inappropriate bedding? Is there any reason to believe that breastfeeding women are more likely to have babies who are premature? Of course not.

The lactivists end with this rousing call:

So, let’s stop going around in circles talking about secondary issues and focus on discussion on primary issue: decreasing the risk of SIDS events. If we want to decrease risk of SIDS events, then we must assure infants’ are in the best possible situation to support breathing and arousability.

Apparently they haven’t noticed but that’s EXACTLY what the authors of the original paper are doing. They are looking at an issue that has the potential to dramatically decrease SIDS among breastfed infants.