The professional homebirth advocate’s most important tool

What’s the most important tool of any professional homebirth advocate? It’s the delete button, of course!

At every level of homebirth advocacy, from clowns like The Feminist Breeder, through organizations like Lamaze; from self-proclaimed “experts” in obstetrical research like Henci Goer to people with academic credentials like Darcia Narvaez, PhD, the delete button is integral to maintaining Orwellian control over what people read and think.

I would have thought someone like Darcia Narvaez had at least a smidgen of academic integrity, but I was disappointed. I left a comment in response to her inane post on Psychology Today entitled Jesus Had a Home Birth.

No, not the obvious comment:

“So did Hitler? What’s your point?”

This comment:

This piece is filled with so many half truths, mistruths and lies that no single comment can address them all. Let’s hit the high points:

“In the USA, home birth used to be the way babies came into the world until the 20th century when increasingly hospital births became the norm.”

True, but since the introduction of hospital birth in the US, the neonatal mortality rate has fallen 90% and the maternal mortality rate has fallen 99%! It has fallen so far, so fast, that people who know nothing about obstetrics mistakenly think that childbirth is inherently safe.

“At the same time unfortunately, the USA has the highest infant and maternal mortality rate in the developed world for the perinatal period.”

A lie, based on a misrepresentation of the data. Infant mortality and perinatal mortality are two different things, as Narvaez ought to know. Infant mortality is a measure of pediatric care (deaths from birth to 1 year). According to the WHO, the best measure of obstetric care is perinatal mortality (stillbirths plus deaths to 28 days of life). According to the WHO, the US has one of the LOWEST rates of perinatal mortality in the world.

Morever, as is widely recognized scientists and physicians, direct international comparisons of mortality rates are INVALID because many countries cheat in calculating both infant and neonatal deaths. They cheat by deliberately excluding very premature babies. In other words, they classify the babies who are most likely to die as stillborn (and therefore not included) even when they are born alive. That’s why the WHO insists on looking at perinatal mortality because it makes it impossible to hide infant deaths by pretending they are stillbirths.

“Despite concern over the safety of home births in the USA, several studies reveal that when planned and appropriately overseen, home birth stands on its own merit as a safe and suitable option.”

A lie. There is not a single study of homebirth in the US that shows it to be safe. Not even one. And the largest study that claims to show that homebirth is safe, the Johnson and Davis BMJ 2005 study actually shows that homebirth has a mortality rate triple that of comparable risk hospital birth. The only way that J&D could make homebirth look safe was to compare it to a bunch of out of date papers extending back to 1969.

Even the papers that Narvaez cites from other countries don’t show what she says they show. She appears to be unaware that Patricia Janssen was forced to publicly retract the claims made in her 2002 paper after acknowledging that the death rate in the homebirth group was HIGHER than than in the hospital group.

So in the first three claims of this post, 1 is a misrepresentation and the other 2 are flatly untrue.

Unfortunately, Narvaez appears to be recycling the mistruths and lies that characterize American homebirth advocacy.

Just how dangerous is homebirth in the US?

According to the latest CDC data, PLANNED homebirth with a non-nurse midwife has a neonatal death rate more than 600% HIGHER than comparable risk hospital birth.

In fact, homebirth is so dangerous that the Midwives Alliance of North America (MANA), the group that represents homebirth midwives, is HIDING their own death rates. They have assembled a database of 27,000 homebirths and have publicly bragged about the C-section rates, the intervention rates and the transfer rates, but they absolutely refuse to disclose how many of those 27,000 babies died.

Even MANA knows that homebirth has an appalling death rate; they just don’t want you to find out.

It was posted, deleted, returned and ultimately permanently deleted nearly 12 hours after it was first received.

Why do professional homebirth advocates reflexively reach for the delete button, and, if available, the ban button, when confronted with dissent? I suspect there are three reasons:

1. It is vital for their advocacy (and I suspect for their fragile self-esteem) to create a space that doesn’t simply reinforce their beliefs, but makes it look like no one believes anything else. Dissent simply cannot be tolerated.

2. They are incapable of addressing the criticism.

Most professional homebirth advocates are aware at a certain level that they don’t have science on their side. They readily vomit up bibliography salad, but they don’t analyze (or, in many cases even read) the citations they offer. For example, Darcia Narvaez, who presumably should know enough to check, was completely unaware that the conclusion of one of her citations was publicly retracted by its lead author who acknowledged that her claim about the safety of homebirth was untenable because the data in the paper itself showed deaths in the homebirth group, and none in the hospital group.

Narvaez could have acknowledged her mistake and corrected it, but that would have required two things she apparently cannot tolerate: actual research into the topic she’s babbling about and intellectual honesty.

3. They are afraid of letting their readers think for themselves.

If they had even a fraction of confidence in their own claims and/or a modicum of respect for the fact that their readers are intellectually capable of drawing their own conclusions, they wouldn’t merely let dissent stand, they would welcome it. By defending their claims against those launched by critics, they could strengthen their case that homebirth is safe. But they are exquisitely aware that they lack the knowledge base and the intellectual ability to defend the safety of homebirth. Most importantly, they are well aware that the dissenters are often right and they are wrong.

What should women conclude from the fact that professional homebirth advocates have a totalitarian approach to dissent?

They should understand that, as in the case of totalitarian governments, efforts to remove dissent and create the image that dissent never existed are tools to force or trick people into beliefs that could never be defended in an intellectually honest way. Deleting and banning reflect the desperation felt by those trying to hold onto power that was gained by lying to people in the first place. Most importantly, women (and men) should understand that professional homebirth advocates are terrified of letting people think for themselves. Who knows what might happen if they treated women like intellectually capable human beings instead of like sheep?