Sadly, we live in a world where people feel free to ignore scientific fact when it conflicts with their philosophy. There are large numbers of people who feel free to ignore the scientific fact of evolution because it conflicts with their philosophy that the Bible is literally true; there are large numbers of people who feel free to ignore the scientific fact of climate change because it conflicts with their economic philosophy of zero legislation to protect the environment; and there are large numbers of people who feel free to ignore the scientific fact that childbirth is inherently dangerous. We call those risk deniers “natural childbirth advocates.”
Comedian John Oliver parodied the mainstream media’s efforts to portray the denial of scientific fact as a “debate” with one commentor on the side of science and the other on the side of denial. Below, you can watch the full hilarious clip of what a real debate on scientific fact should look like:
Let’s examine some of Oliver’s points, points he made about climate denialists, but which, in my judgment apply equally to natural childbirth and midwifery denialists of childbirth risks.
1. In regard to those who deny scientific fact:
Who gives a shit? You don’t need people’s opinion on a fact. You might as well have a poll asking: ‘Which number is bigger, 15 or 5?’ or ‘Do owls exist?’ or ‘Are there hats?
Similarly, when natural childbirth and midwifery advocates like Milli Hill insist that childbirth is not inherently dangerous, our response ought to be”
“Who gives a shit what Milli Hill thinks? You don’t need midwives’ or their advocates’ opinion on a fact.”
2. On scientific consensus:
As the Guardian explained,
The body of scientific evidence supports human-caused global warming: 97% of peer-reviewed scientific papers taking a position on the subject over the past 20 years are in agreement about this.
Similarly, a large body of scientific and historical evidence supports the inherent dangerousness of childbirth. Childbirth is and has always been, in every time, place, and culture (including our own) a leading cause of death of young women. Moreover, according to recent paper in the British Journal of Obstetrics and Gynecology, The dangers of the day of birth:
Even with modern obstetric practice the risk of a baby dying on the day of its birth in the UK is greater than the average daily risk of death until the 92nd year of life. We have shown that this risk is comparable with many other high-risk activities, and results in many life years lost.(my emphasis)
The scientific consensus among obstetricians, the people who are experts in all form of childbirth, not just “normal” birth, is overwhelming.
3. False journalistic balance:
The media nevertheless continues to treat the subject as a ‘debate’, often with 1 person representing the 97% consensus and 1 person representing the less than 3% fringe minority.
Similarly, the mainstream media treats midwifery and natural childbirth claims about the risks of childbirth as a debate with 1 person (an obstetrician) representing the overwhelming scientific consensus on childbirth risk and 1 (a midwife or lay natural childbirth advocate like Hill) representing the fringe denialists.
4. The real debate should be how we respond to scientific fact.
The ‘debate’ should center on what to do about climate change; it’s not about the science.
There is no “debate” on the fact that childbirth is and has always been a leading killer of women and THE leading killer of children. The debate should center on how we manage the very real risks.
I wrote last week about the way in which natural childbirth advocate Milli Hill and Royal College of Midwives Head Cathy Warwick are actively misrepresenting the risks of childbirth.
Hill subsequently acknowledged on Twitter that childbirth might be more dangerous than she claimed, but then asserted:
I don’t say birth is not risky. Life is risky. Picking your nose is risky. But birth risks are overemphasised to women’s detriment.
Hill’s casual dismissal of the risk of death (and permanent injury) in childbirth is just another example of natural childbirth denialism.
As astrophysicist Neil de Grasse Tyson has said in regard to climate change denialists:
The good thing about science is that it’s true whether or not you believe in it.
I will say the same to Hill and other natural childbirth advocates.
Childbirth is inherently dangerous whether you believe it or not. There is no debate about it. The only thing up for debate is how best to handle the deadly risks of birth.
Kind of off topic but since we are making analogies of types of people…Is a CPM to a CNM what a “biologic” or “holistic” dentist is to a regular dentist? I am wondering because my child has a dentist need and I looked up local dentists and both types came up together as equals. Should I be be concerned? My kid who brushes daily has a primary tooth rotting away and I want to pick the right kind. So are these all legit dentists or what? I am starting to wonder if there are quacks everywhere now. Trying not to get overly paranoid. And they are all covered by insurance. I
Dr. Amy- love the hard hitting approach against pseudo science/woo, but not a fan of the oft condescending tone towards people of faith/religious persuasion. Many (myself included) reconcile faith and science.
What are you talking about? Some people DO refuse to accept evolution as fact, doesn’t mean everyone who has a faith does.
Just a theme sometimes running through the Dr. Amy’s posts at times. Sometimes a bit ostracizing, which is a bummer because I feel that very fundamental women are often swept up in the home birth woo.
So why not debate how to address the dangerous risk of birth? You have the data, you know the truth. When will action be taken to end the oppression and exploitation? End the kyiarchy for everyone’s sake.
That John Oliver Youtube on false balance in scientific debate is just BEAUTIFUL!
There’s also one on Dr Oz – worth watching
OT , but Bill Nye seriously needs to bring more buddies along to these debates, I think unfortunately he’s enabling a lot of debates based on false balance.
I watched him debate Ken Ham and he was not compelling. He gets muddled in the details of evidence rather than explaining where the scientific evidence comes from and why we should trust science as a system.
It’s the same pattern with the anti-vax crowd-denial of facts and scientific consensus, false balance, and preferring their opinions over actual facts. And they get mighty offended when this is pointed out, since many of them would identify as green as can be.
And just to be super confusing, that group are often the ones putting their children through horrible things-bleach enemas and chelation come to mind-to ‘cure’ them, all at great expense, while they say ‘big pharma’ are out to rip us all off.
She compared the risks of childbirth to the risks of picking your nose. What an absolute moron. I wouldn’t listen to her advice on what restaurant to get lunch, much less trust her with the life of my child.
I will bring up again my favorite comparison: drunk driving.
I am trying to understand, by the “everything has risk” model, how do you argue against drunk driving? The absolute risk of drunk driving is somewhere between picking your nose and childbirth. But, for some reason, no one thinks the risks of drunk driving are overemphasized.
(actually, they absolutely are, deliberately so, of course; for example, see the campaign of “drive drunk and you will get caught” that goes on; how likely are you to get caught if you drive drunk? By the DOT’s own estimates, there is one DUI for every 27000 miles driven drunk. If you drive 5 miles drunk, that would put your chance of getting a DUI at about 1 in 5000. No, you won’t get caught. In fact, your chance of getting caught is about the same as your baby dying in a low-risk hospital birth)
How do the odds of killing someone else while driving drunk compare to the odds of killing a baby by having a home birth?
Way, way lower, I would think, on a per-incident basis.
Assuming that the risk of a baby dying in homebirth is 3 times higher than in a hospital, and the low-risk death rate in a hospital is .2/thousand, that means that HB needless kills 4/10000 babies.
The chance of having an accident that results in ANY death is 2 per million drives. Even assuming that all of these are deaths of someone other than the driver (which isn’t true, since the vast majority of those who die are the drivers themselves), that means a drunk driver is 200 times less likely to kill someone else in a single drive than a homebirther is to kill their baby.
The chance of a drunk driver even having an accident is only half of the chance of getting a DUI, so about 1/10 000, so 6 times less likely than a low-risk homebirth. And most drunk driving accidents don’t result in death.
I’ve pointed it out before, the biggest problem with drunk driving is not the absolute risk, but that it’s so common. The problem with drunk driving is that the average american driver drives drunk on average once a week. Considering that most people don’t actually drive drunk, that means that the people who are drunk driving are doing a lot!
You’re so mathy.
Anecdotally, in my local news, the drunk drivers who cause serious accidents and fatalities often have multiple prior DUI offenses.
So we can actually say that home birth is more dangerous than drunk driving?
For sure.
However, to be fair, hospital birth is also more dangerous than drunk driving. Birth itself is relatively very dangerous.
In fact, there are pretty much no other things that we actually do regularly or routinely that is as dangerous as childbirth, and most of it is nowhere near. For example, skydiving is a relatively dangerous activity. In fact, life insurance won’t cover you if you die from skydiving. Yet, it is only about as dangerous as drunk driving (2 per million die).
As has been mentioned somewhere recently, the chance of dying on the day you are born is higher than that for any other day until you are like 92 years old. You are more likely to die on the day you are born than to die in a car accident anywhere in the next 16 years (basically, until you start driving yourself). Driving a NASCAR race is about the same risk as low-risk childbirth. Climbing Mount Everest is is about 100 times more dangerous than low-risk childbirth (and, considering that it is an activity restricted to a highly fit population, that’s pretty risky). You are about 100 times more likely to die from a heart attack than as a baby in childbirth (compared all births, not just low risk (since heart attack is not restricted to the healthy population).
The lesson out of all this is not that drunk driving is safe, but compared to our everyday activities (picking your nose, crossing the street, all the things folks like Hill try to compare it too), childbirth is really risky. So you don’t want to mess around and get careless.
The risk of homebirth gets dismissed as being low in an absolute sense. But as we see, if childbirth is low risk, you have to go to pretty far extremes to find something that isn’t.
There is NOTHING that people commonly do that is as dangerous as being born. That’s why folks like Milli Hill are so completely wrong.
I demonstrated awhile ago that giving birth at home is approximately as dangerous as driving your child around in a car with no carseats, airbags or modern safety features from birth until he’s old enough to get his own license.
Spot on.
Just saw this article:
”
Women who receive an epidural
during childbirth significantly lower their risk of postpartum
depression, according to new research.
Study participants whose pain was
managed during labor had a 14 percent rate of depression six weeks
after delivery, compared to a nearly 35 percent rate of depression for
those who did not have the pain relief. The study also found that women
who attended childbirth classes during pregnancy and those who breastfed
after labor also lowered their risk of postpartum depression.
Breastfeeding was more common in the group that had an epidural for pain
(70 percent) compared to those who did not (50 percent).”
https://www.yahoo.com/health/epidural-during-childbirth-can-cut-postpartum-92645729712.html
I’m trying to think of a mechanism that would lead to a significant correlation between not having an epidural and not breastfeeding.
1) Socioeconomic confounders having to do with access to epidural.
2) The mechanism the article is trying to imply, which is that pain control in childbirth leaves a mother better equipped to immediately care for her child. I’d need more evidence to fully accept that theory, however.
3) Other odd reasons, like birth order?
They switch to talking about postpartum pain in the article without giving a lot of details. Breastfeeding can be quite painful, a few weeks of breast pain and afterpains might change someone’s mind, and of course the lactivists are ready to make sure you feel guilty about it.
I would really like more information, the write up is just not enough.
The article seems to imply that women who had epidurals and/or pain management (post Csection) are more rested and comfortable and willing to deal with trying to breastfeed, as opposed to a woman whose pain was/is poorly managed.
Off Topic: Wanted to say that we welcomed our little girl, Olivia Jane, last Thursday morning! She weighed 10lbs 3oz – less than I’d guessed, but as it turns out, I had over 6 liters of amnio fluid and my placenta weighed 4 pounds! One of the nurses in the OR said I must have lost 25-30 lbs right there in the operating room! She wasn’t exaggerating: I’m 30 lbs down!
The scheduled c-section was a breeze and the recovery would’ve been even easier had I not developed a spinal headache due to a dural puncture (I think that’s what it’s called? I don’t know the proper terminology.) They did a blood patch the next day, which worked like magic – except the headache returned after I’d gone home. Luckily, it only hung on for two more days and seems to have subsided. So, if you take away that, I can’t believe how much easier the planned CS was over the mid-labor.
She is doing great, had to spend part of the day in the “progressive” nursery – not as serious as the NICU, I guess but she still had her own nurse – for respiration concerns, but she was back with us that evening. Gave me and my husband time to rest and gain some energy before diving in.
Anyhow, I just wanted to update everyone here! Now that I don’t have the headache, I feel like I can function in the real world a bit more. Ha!
1) Congratulations
2) You are definitely NOT my wife. I think that is clearly established now.
Not to jump threads, but that 2+ days of spinal headache was probably worse than my few hours of labor. The risk I take is ending up under general anesthesia if it all hits the fan in a handbasket. Worth it to me.
Except, not. They usually do a spinal for emergency c/s. It’s actually safer than general.
What’s the fastest one can be done?
Very quick in experienced hands (a few minutes).
What she said.
Ha! Yes, quite. 🙂 She would have some ‘splainin’ to do!
Mistress? Surrogate? Girlfriend? Secretary? Bit of stuff on the side? The possibilities are endless…
Hey, congratulations! Glad your big little baby is doing well!
Congratulations! Enjoy your big bundle of joy… and rest on the sofa, now that we know it isn’t Bofa’s.
Congratulations!
Congratulations!!!!
Man, I had a dural headache too!! Awful! Worst headache ever! Sorry the blood patch didn’t work the first time 🙁 mine did, luckily. Congrats on the baby!
It’s intense, right? The patch worked liked magic, it just appears that the headache outlasted the temporary nature of the patch. Fascinating process, but not so much when it’s happening in real time. 🙂
Congratulations!!so pleased you are both well!!
Congratulations to your whole family and welcome to Olivia!
Oooh yay! Congratulations on Olivia’s arrival. Glad you’re both home safely despite the few hiccups. Also, yay for a breezy caesarean. So glad you had one, she’s a giant baby!
Welcome to little Olivia Jane! Congrats!
And so for mothers-to-be who happened upon this blogsite our take-away message should be
1. The fetal-heart monitor is an important tool in the fight against infant -birthday death.
2. Precautionary IV placement can save precious time if your labor takes an abrupt turn for the worse
3. You can give birth in a nice safe clean professional staffed hospital and increase your chance and your infant’s chance of survival
Yes! Although medical staff need to be better about explaining the why. I had both for my VBAC, but had been told by some woo-infected friends that neither were necessary. The decision to follow my doc wasn’t hard because I wanted a safe and healthy baby, but it would have been easier if my doc had simply taken the time to explain why IVs trump heplocks and why continuous fetal monitoring is so important. I’ve learned on this blog what I should have learned from my OB and what women should learn from their OBs, too.
In my experience, a little explanation usually gains acceptance of the dreaded “unneccessary interventions”.
And saves a ton of speculation later. A neglected area for too many patients, probably deserves some looking into. A debriefing/explanation/question session fights woo with facts.
That’s exactly what the fight is against. Especially when books like Guide to Childbirth and Natural Hospital Birth exist. In both cases, ideology trumps evidence and provides a false sense of “knowledge” and “being educated.” An explanation about why procedures and routines were important would help assure “educated” moms that procedures are in place for the safety and well-being of mom and baby and not simply in existence becaus of Big Pharma, insurance companies, or tradition and routine. I had an OB and CNM with my first who took the time to explain. The OBs I had with my 2nd didn’t do that. It made it hard not to be a little skeptical because the decision-making and rationale wasn’t transparent to me.
It’s my opinion that owls don’t exist. There may be some large birds that fly around at night and hoot, but I’m sure that’s just a variation of normal for crows or something.
A few weeks ago, my friend’s young son told me that “bears don’t exist.”
Well, he’s working on the difference between fantasy and reality, I suppose.
http://www.blogcdn.com/nintendo.joystiq.com/media/2008/09/colbert_on_bears_lg2.jpg
Little kids are funny when they are sorting through the difference between reality and fantasy. Both my kids have gone through a phase where they seemed to earnestly believe that saying something made it true. If I said that there are no Popsicles, they would insist that we do have Popsicles. As if their insistence could make the Popsicles be there.
Most people grow out of that, though apparently not everyone. Repeating “birth is safe” doesn’t do a damn thing to change the reality of a baby suffocating.
“Both my kids have gone through a phase where they seemed to earnestly believe that saying something made it true.”
I have a number of undergraduates who still believe this.
“I’ve never seen one so it must not exist.” We’ve seen that line of reasoning before amongst NCB types, too.