They say that everything old is new again and that is certainly true in the world of “alternative” health. One of the axiomatic premises of contemporary “alternative” health puts its believers behind the times … by approximately 500 years.

A fundamental premise held by believers in “alternative” health is that we are swimming in a world of “toxins” and those “toxins” are causing disease. Like most premises in “alternative” health it has no basis in scientific fact; makes intuitive sense only if you are ignorant of medicine, science and statistics; and speaks to primitive fears and impulses.

The preoccupation with “toxins” is a direct lineal descendant of the obsession with evil humours and miasmas as causes of disease. It is hardly surprising that prior to the invention of the microscope the real causes of disease went undiscovered. The idea that disease is caused by tiny organisms that invade the body is not amenable to discovery in the absence of scientific instruments and scientific reasoning. And it goes without saying that the same people who were unaware that bacteria and viruses cause disease could not possibly imagine chromosomal defects, inborn errors of metabolism or genetic predispositions to disease.

Instead, people imagined that diseases were caused by excess evil humours, substances that were named, but never seen or identified in any way accessible to the senses. It was recognized that some diseases were contagious, and in that case, people invoked the idea of “miasmas” that somehow transmitted disease.

Even religion got into the act. Rather than attributing disease to evil humors of miasmas, religious authorities often claimed that disease was attributable to evil demons or to sin itself.

These theories shared several important features. The evil humours, miasmas, etc. were invisible, but all around us. They constantly threatened people, and those people had no way of fending off the threat. Indeed, they were often completely unaware of the threat that was actively harming them.

Evil humours, miasmas, demons, etc. were put to rest by the germ theory of disease. That was the first big breakthrough in our understanding that each disease was separate and has its own specific cause. The search for causes has taken us beyond bacteria and viruses, through errors of metabolism and chromosomal aberrations, right down to the level of the gene itself. We now understand that tiny defects in individual genes can cause disease or can increase the propensity to a specific disease.

But fear and superstition never die and the “alternative” health community has used that fear and superstition to resurrected primitive beliefs. It is axiomatic in the “alternative” health community that disease is caused by evil humours and miasmas. They just don’t call it that anymore; they call it “toxins.”

Toxins serve the same explanatory purpose as evil humours and miasmas. They are invisible, but all around us. They constantly threaten people, often people who unaware of their very existence. They are no longer viewed as evil in themselves, but it is axiomatic that they have be released into our environment by “evil” corporations.

There’s just one problem. “Toxins” are a figment of the imagination, in the exact same way that evil humours and miasmas were figments of the imagination.

Poisons exist, of course, but their existence is hardly a secret, and their actions are well known. Most poisons are naturally based, derived from plants or animals. Indeed, the chemicals responsible for more diseases than any others are nicotine (tobacco), alcohol (yeast) and opiates (poppies).

Nonetheless, “alternative” health advocates persist in subscribing to primitive theories of disease. For those who have limited understanding of science, primitive theories apparently make more sense.

Hence the obsession with “toxins” in foods, in vaccines, even “toxins” arising in the body itself. The height of idiocy is the belief in “detoxifying” diets and colon cleansing. The human body does not produce “toxins.” That’s just a superstition of the “alternative” health community. The waste products produced by the human body are easily metabolized by organs such as the liver, and excreted by organs particularly designed for that purpose such as the kidneys.

“Alternative” health practitioners are nothing more than quacks and charlatans and their “remedies” are nothing more than snake oil. The fact that anyone in this day and age still believes in such crackpot theories is a tribute to the power of ignorance and superstition.

Evil humours and miasmas have not died, they’ve been reincarnated as “toxins.”

We’ve all heard about bridezillas, the women who are so obsessed with having the perfect wedding that they become tyrants toward everyone else. There’s an argument to be made that many homebirth and “natural” childbirth advocates are “momzillas” who justify their hypersensitivity, obsessive need for control, and rudeness to everyone else with the all purpose excuse “It’s my special day.”

Consider:

Obsessive need for control – One of the hallmarks of the bridezillas is the obsessive need for control. No detail is too small for consideration, planning and decrees.

Momzillas? It’s difficult to imagine anything more obsessive than birth plans. Birthplans, in addition to being useless for their stated purpose of improving the birth, are attempts to plan the unplannable. You might as well have a “weather plan” for the day of birth for all the good it’s going to do you. Birthplans, like obsessive wedding plans, have the added drawback of irritating everyone around you. The need to ruminate on every aspect of the day, and share those ruminations with everyone else is boring at best and narcissistic at worst.

Hyersensitivity – Bridezillas spend a lot of time being angry. Things aren’t going according to plan. People are not taking their desires as seriously as they take them. People don’t behave as instructed. Everything is perceived as a slight. Flowers the wrong color? Have a fit. Napkins not folded just so? Accuse the caterer of incompetence. Groom expresses a different preference that has not been preapproved? Who does he think he is? After all, it’s not about him. It’s all about, exclusively concerned with, revolving only around Bridezilla.

Homebirth and “natural” childbirth advocates spend a lot of time being angry. The birth is not going according to plan. The hospital staff are not taking their desires as seriously as they take them. The hosptial staff is not behaving as instructed. Everything is a slight. Offered an epidural? Have a fit. Labor support not exactly as desired? Accuse the nurses of evil intentions. Baby needs something different than the preapproved birth plan? Who does that baby think he is? After all, birth is not about the baby. It’s all about, exclusively concerned with, revolving only around Momzilla.

Outsize feelings of disappointment – Bridezillas are psychologically very fragile, and make no apologies for their fragility. Cake filling the wrong flavor? The wedding is ruined.

Momzillas are psychologically very fragile and make no apologies for their fragility. Baby need resuscitation before being placed skin to skin with Momzilla? The birth is ruined. C-section needed to deliver a healthy baby? That no longer qualifies as a birth at all!

Using others as characters in performance art – This is perhaps the worst of the many unattractive traits of Bridezilla. Everyone, from the guests, to the bridesmaids, to the groom himself, are nothing more than bit players in Bridezilla’s ultimate piece of performance art, her wedding. Bridezilla feels free to dictate what the guests should wear, how much the bridesmaids should weigh, and every possible details of the groom’s existence. What if those people feel badly about the way they’re treated? Bridezilla doesn’t care. It’s her day and that means she’s entitled to use people any way she wants.

Momzilla is the same. Everyone, medical personnel, her partner, even the baby are nothing more than bit players in Momzilla’s ultimate piece of performance art, “her” birth. Momzilla feels free to dictate what everyone involve is allowed to do or say. What if her requests compromise the obligation of medical personnel to provide safe care? Momzilla doesn’t care. It’s her day and that means she’s entitled to use people any way she wants.

Bridezillas are narcissists. They have an outsize view of their own importance, a hypersensitivity to slights, a feeling a being persecuted when things don’t go their own way, and an insensitivity to others who work with or for them. Homebirth and “natural” childbirth advocates often behave like narcissists, too. They have an outsize view of their own importance, a hypersensitivity to slights, a feeling of being persecuted when the birth does not go as planned, and an imperiousness and insensitivity to others who work with or for them.

Ultimately, both bridezillas and momzillas are psychologically fragile. Instead of integrating the inevitable disappointments associated with a wedding or birth, they get psychologically “stuck.” They experience their disappointments as narcissistic injuries and respond with rage and accusations of persecution. They have no time for and no interest in the feelings of others, and feel entitled to use other people for their own ends.

Ironically, the behavior of momzillas often fails to produce the perfect birth, just as the behavior of bridezillas cannot produce the perfect wedding. Because of their psychological neediness and fragility, they are unable to appreciate that every change in plan is not the “fault” of someone, unable to accept that unwillingness of providers to follow commands is not a sign of persecution and, worst of all, unable to enjoy what they have.

There’s a new mother on the block and she’s cheerfully terrorizing everyone else. The sanctimommy is here!

The sanctimommy knows how you should raise your children. Specifically, she knows what foods they should eat, what toys they should be allowed to play with; heck, sanctimommy even knows how you should have given birth.

The best part about sanctimommy is that she is always ready to share her wisdom with the rest of us. She doesn’t hesitate to point out the deficiencies of your parenting practices (in other words, how your parenting choices differ from hers). She doesn’t hesitate to make dire predictions about what the future holds for your children (“You give him a pacifier? You know he’s never going to be able to …”). She never hesitates to bemoan your lack of understanding of the key issues of childrearing, letting you know that you are not as “educated” as she is.

My personal observation on the behavior of sanctimommies in their natural habitat is that they tend to suffer from overwhelmingly from ostentatious “sadness”. They are so “sad” for you that you don’t do everything their way. They are so “sad” for your children that you are not parenting the way they prescribe. They are just so “sad” that everyone in the world does not recognize their incredible superiority and their expert status on every aspect of parenting at every age.

Sanctimommy has lots of all purpose rules for parenting. No need to tailor your parenting choices to the personality and needs of the individual child. All childbirth should be unmedicated; all children should be breastfed for the prescribed amount of time, all children should be carried, every child should sleep in the family bed. There’s a rule for every behavior and every situation.

Despite her apparent self assurance, sanctimommy needs constant validation and she intends to get it from you. Your parenting choices serve as the perfect foil for sanctimommy since she can criticize them and you.

Sanctimommy is quick to take offense. In fact she is always sure that she is being “disrespected” by those who don’t make the same choices.

Sanctimommy is sure that she is being persecuted. Mothers who don’t agree with her are accused of interfering with her choices even if you have no interest in her choices at all.

Fundamentally, Sanctimommy cannot abide uncertainty, and if there ever was it job fraught with uncertainty it is motherhood. It is difficult to get feedback on job performance from children. Children live in the moment, are overwhelmed with their own needs, and don’t take the long view.

Children don’t tell you whether being allowed in the parental bed promotes security or inability to manage separation. They don’t tell you whether limiting television is crucial to wellbeing or merely an affectation that has no impact on them. They don’t thank you for discipline and they don’t applaud your performance. In fact, it often turns out that your best moments as a mother were the ones that they appeared, at the time, to hate the most.

All mothers must cope with this uncertainty, but some are more challenged than others. Sanctimommies deal with uncertainty by pretending that it doesn’t exist. They adopt all purpose rules for parenting and insist that following them demonstrates unequivocally that they are doing the right thing (and, inevitably, if you don’t agree, you are wrong).

And because they are so insecure, they cannot resist interrogating other mothers and demeaning their choices. Had an epidural? Too bad you gave in to the pain. Stopped breastfeeding before age 2 (or 3 or 4)? How sad that you didn’t try hard enough. Your children’s food is not 100% organic? How unfortunate that you don’t care enough about your children to serve the very best.

Ironically, Santimommy’s choices don’t necessarily reflect what is best for her children. They don’t reflect the fact that children are individual human beings with individual needs and desires. There is no one-size-fits-all parenting formula and pretending that there is ignores the specific needs of a specific child. Sancitmommy’s choices are all about her, her need for reassurance and her inability to tolerate uncertainty.

There once was a time when all food was organic and no pesticides were used. Health problems were treated with folk wisdom and natural remedies. There was no obesity, and people got lots of exercise. And in that time gone by, the average lifespan was … 35!

That’s right. For most of human existence, according to fossil and anthropological data, the average human lifespan was 35 years. As recently as 1900, American average lifespan was only 48. Today, advocates of alternative health bemoan the current state of American health, the increasing numbers of obese people, the lack of exercise, the use of medications, the medicalization of childbirth. Yet lifespan has never been longer, currently 77.7 in the US.

Advocates of alternative health have a romanticized and completely unrealistic notion of purported benefits of a “natural” lifestyle. Far from being a paradise, it was hell. The difference between an average lifespan of 48 and one of 77.7 can be accounted for by modern medicine and increased agricultural production brought about by industrial farming methods (including pesticides). Nothing fundamental has changed about human beings. They are still prey to the same illnesses and accidents, but now they can be effectively treated. Indeed, some diseases can be completely prevented by vaccination.

So why are advocates of alternative health complaining? They are complaining because they long for an imagined past that literally never existed. In that sense, alternative health represents a form of fundamentalism. Obviously, fundamentalism is about religion and the analogy can only go so far, but there are several important characteristics of religious fundamentalism that are shared by alternative health advocacy. These include:

The desire to return to a “better” lifestyle of the past.
The longing for a mythical past that never actual existed.
An opposition to modernism (in daily life and in medicine).
And the belief that anything produced by evolution (or God, if you prefer) is surely going to be good.

Advocates of alternative health bemoan the incidence of diseases like cancer and heart disease without considering that they are primarily diseases of old age. That both cancer and heart disease are among the primary causes of death today represents a victory, not a defeat. Diseases of old age can become primary causes of death only when diseases of infancy and childhood are vanquished, and that is precisely what has happened.

Alternative health as a form of fundamentalism also makes sense in that it has an almost religious fervor. It is not about scientific evidence. Indeed, it usually ignores scientific evidence entirely. All the existing scientific evidence shows that all of the myriad claims of alternative health are flat out false. None of it works, absolutely none of it. That’s not surprising when you consider that it never worked in times past; advocates of alternative health merely pretend that it did, without any regard for historical reality.

Alternative health is a belief system, a form of fundamentalism, and like most fundamentalisms, it longs for a past never existed. It is not science; it has nothing to do with science; and it merely reflects wishful thinking about the past while ignoring reality.

This post originally appeared in September 2008.

Critics the current C-section rate often quote the World Health Organization recommendation of an ideal C-section rate of 10-15%. Unfortunately, the WHO appears to have pulled those numbers out of thin air. Its own data shows that a 15% C-section rate does not result in the lowest possible levels of either neonatal mortality or maternal mortality. Indeed, Dr. Marsden Wagner, who has probably done more than anyone to promote the notion of a 15% C-section rate as ideal, is a co-author of a study that actually demonstrates the opposite.

The paper is Rates of caesarean section: analysis of global, regional and national estimates (Paediatric and Perinatal Epidemiology, 2007; 21:98–113.) The article explicitly acknowledges that the 15% C-section rate recommendation was made without any data to support it. This paper is actually the first paper that attempts to compare international C-section rates with maternal and neonatal mortality.

Since publication of the WHO consensus statement in 1985, debate regarding desirable levels of CS has continued; nevertheless, this paper represents the first attempt to provide a global and regional comparative analysis of national rates of caesarean delivery and their ecological correlation with other indicators of reproductive health.

The data regarding C-section rates below 10% is stark:

…[T]he majority of countries with high mortality rates have CS rates well below the recommended range of 10–15%, and in these countries there appears to be a strong ecological association between increasing CS rates and decreasing mortality.

How about the data on C-section rates above 15%? The authors claim:

Interpretation of the relationship between CS rates and mortality in countries with low mortality rates is more ambiguous; nevertheless, the sum total of the evidence presented here supports the hypothesis that, as has been argued previously, when CS rates rise substantially above 15%, risks to reproductive health outcomes may begin to outweigh benefits.

Not exactly. Indeed, not even close. The data show that low maternal mortality and low neonatal mortality are associated almost exclusively with high and very high C-section rates.

The article contains a variety of charts that make this clear. Of note, the charts are of an unusual kind. Rather than graphing C-section rates against mortality rates, the authors chose to graph the log (logarithm) of C-section rates against the log of mortality rates. A log-log graph has the advantage of exposing tiny differences when all the values are bunched close together, but all the values are not bunched together in this situation. C-section rates occur along a broad range, and mortality rates occur along a broad range. As a consequence, the log-log graph magnifies the effect of tiny differences and minimizes the effect of large differences. Therefore, you need to be very careful in interpreting the graphs.

addendum: This is an adaptation of the chart that appears in the paper. The area representing a C-section rate of 10-15% has been highlighted in yellow. The vertical blue line represents a mortality rate of 15%. Lower mortality rates are left of the blue line and higher mortality rates are right of the blue line.

The data themselves are quite clear. There are only 2 countries in the world that have C-section rates of less than 15% AND low rates of maternal and neonatal mortality. Those countries are Croatia (14%) and Kuwait (12%). Neither country is noted for the accuracy of its health statistics. In contrast, EVERY other country in the world with a C-section rate of less than 15% has higher than acceptable levels of maternal and neonatal mortality. There nothing ambiguous about that.

The authors claim:

Although below 15% higher CS rates are unambiguously
correlated with lower maternal mortality; above this range, higher CS rates are predominantly correlated with higher maternal mortality.

No, that’s not what it shows at all. It shows that all countries with high C-section rates have low levels of maternal and neonatal mortality EXCEPT Latin American countries (represented on the chart by open diamonds) with high C-section rates. The only conclusion that you can draw is that high C-section rates for medical indications are associated with low rates of maternal and neonatal mortality, and high C-section rates for social reasons (as in Latin America) do not lead to low rates of maternal and neonatal mortality.

What the data actually shows is this: The only countries with low rates of maternal and neonatal mortality have HIGH C-section rates (except Croatia and Kuwait). The average C-section rate for countries with low maternal and neonatal mortality is 22%, although rates as high as 36% are consistent with low rates of maternal and neonatal mortality.

The authors claims are not supported by their own data. There is simply no support for a C-section rate of 15%, since virtually none of the countries with low rates of maternal and neonatal mortality have a C-section rate of 15% or below, and most have rates that are far higher. There is also no support for the claim that “the sum total of the evidence presented here supports the hypothesis that … when CS rates rise substantially above 15%, risks to reproductive health outcomes may begin to outweigh benefits”. When C-sections are performed for medical indications, there is no evidence that rising C-section rates lead to rising rates of maternal or neonatal mortality.

The authors own data indicate that a C-section rate of 15% is unacceptably low, and that the average should be at least 22%, with rates as high as 36% yielding low levels of maternal and neonatal mortality.

I’ll be traveling intermittently for another week, and will occasionally repeat an old column. This article originally appeared on my Open Salon blog in August 2008.

Who said: “the mother is the factory, and by education and care she can be made more efficient in the art of motherhood”?

That was written in 1942 by Grantly Dick-Read, widely considered to be the father of modern natural childbirth. Most people don’t realize that natural childbirth was invented by a man to convince middle and upper class women that childbirth pain is in their minds, thereby encouraging them to have more children. Read’s central claim was that “primitive” women do not have pain in childbirth. In contrast, women of the upper classes were “overcivilized” and had been socialized to believe that childbirth is painful.

Grantly Dick-Read’s theory of natural childbirth grew out of his belief in eugenics. He was concerned that “inferior” people were having more children than their “betters” portending “race suicide” of the white middle and upper classes. Read believed that women’s emancipation led them away from the natural profession of motherhood toward totally unsuitable activities. Since their fear of pain in childbirth might also be discouraging them, so they must be taught that the pain was due to their false cultural beliefs. In this way, women could be educated to have more children.

According to Read: “Woman fails when she ceases to desire the children for which she was primarily made. Her true emancipation lies in freedom to fulfil her biological purposes”..

The comparisons between “overcivilized” white women and “primitive” women who gave birth easily was not merely the product of racism, but reflected the anxiety that men felt about women’s emancipation. This anxiety was expressed in medicine generally, and in obstetrics and gynecology particularly, by the fabrication of claims about the “disease” of hysteria and the degeneration of women’s natural capabilities in fertility and childbirth compared to her “savage” peers. Simply put, the result of women insisting on increased education, enlarged roles outside the home and greater political participation was that their ovaries shriveled, they suddenly began to experience painful childbirth and they developed the brand new disease of “hysteria”, located in the uterus itself.

Pain in childbirth served a very important function in this racist and sexist discourse: it was the punishment that befell women who became too educated, too independent and left the home. The idea that “primitive” women had painless childbirth was fabricated to contrast with the painful childbirth of “overcivilized” women.

Grantly Dick-Read was issuing a warning to women of a certain social class: if you step beyond the roles prescribed for women, you will be punished with painful labor. And if you have had painful labor, you should understand it as a punishment for ignoring your “natural” duty to stay home and procreate.

In light of this, the contemporary popularity of natural childbirth is more than a bit ironic. The central claims of natural childbirth, that childbirth is not inherently painful, and that if you “prepare” properly, your birth will be painless, too, were utter fabrications. Read would be delighted that these fabrications have been embraced by many women and that his philosophy has been propagated so successfully that most women don’t even realize that the central tenets of natural childbirth are racist and sexist lies.

Dooce has discovered stuntbirth, also known among aficianados as freebirth or unassisted childbirth (UC).

…I accidentally stumbled upon a show about a new fad in childbirth called Freebirthing where women have their babies at home without the aid of a nurse or midwife or any trained professional. And at one point there was this three-year-old kid going WHY IS MOMMY SCREAMING LIKE THAT?! And the woman is clawing at this head coming out from between her legs, and she’s all GET IT OUT! GET IT OUT! Except, there is no one there who knows how to get it out, and her husband is just standing there shrugging like DUDE, THIS WAS YOUR IDEA!

She says, “…you’ve got to have a special combination of bravery and stupidity going on to attempt such a thing.” I agree with the stupidity part, but I suspect that bravery has nothing to do with it. It’s all about competitive mothering. Hence the progression of ever more bizarre claims and practices in an attempt to claim superiority for one’s self. A says, “I had my baby in a birth center” and B says, “Oh, yeah, well I had my baby at HOME” and C says, “Well, ladies, I can top that. I had my baby at home BY MYSELF!”

Stuntbirthers like to pretend to themselves and others that this is how birth happens in nature (no, across all times, places and culture, birth is assisted), that birth is so deeply personal and “sexual” that a couple must experience it alone (really, then why are you posting a video of it on YouTube for all the world to see?) and that it is safe. The entire practice would be nothing more than a punch line were it not for the fact that it kills babies, in fact a startlingly high proportion of the babies whose mothers were ignorant enough to embrace this stunt.

On one of the leading UC support boards, there was recent crowing and self congratulation among the members that their neonatal death rate is 8/1000. They seemed to have no idea that this is 20 times higher than the neonatal death rate for uncomplicated, low risk hospital birth. Unassisted childbirth is nothing more than medical neglect, and babies are dying or rendered permanently disabled because of that neglect.

Perhaps more compelling than the statistics is the fact that both the leading American and Australian advocates of UC have ended up with dead babies as a result. Laura Shanley, the American, likes to boast that she had 4 wonderful unassisted births, but she has actually had 5. She deliberately and knowingly gave birth to a premature baby alone at home and, over the next several hours, watched him die without ever summoning help.

In April of this year, Janet Fraser, Australia’s leading advocate of UC, experienced the death of her baby during labor. Fraser had proudly boasted to an Australian paper that she had no prenatal care of any kind, and planned to have no medical assistance at the birth. Her baby paid the ultimate price for her idiocy.

Tragically, unassisted childbirth has no benefit for the baby and poses very serious risks. It is a form of medical neglect based on appalling ignorance and extraordinary selfishness and self-absorption. In short, it is nothing more than a dangerous stunt.

Pondering strange practices associated with childbirth, many people imagine that they are the product of third world cultures. While it is true that third world cultures have unusual and superstitious childbirth practices, the most bizarre and the most disgusting almost always come from first world countries. No one in the third world devised the spectacular lie that childbirth is “orgasmic;” and women in the third world did not make up the practice of waterbirth and pretend that delivering a baby into fecally contaminated water provides a good start in life. For the winner of wackiest (and most disgusting) childbirth practice ever, though, I’d nominate another stunt made up by first world women: lotus birth.

Louts birth is the decision to leave the placenta attached to the baby for several days until it rots off. It is a bizarre practice with no medical benefit and considerable risk, particularly the risk of massive infection. I’m not making this up. According to Lotus Fertility.com (“Serving your Inner Midwife”):

The baby is born and remains attached to its cord while the placenta is birthed. The baby’s placenta-cord is kept in-situ with the baby, gently wrapped in cloth or kept in an uncovered bowl near the mother, and the cord is sometimes wrapped in silk ribbon up to the baby’s belly. The cord quickly dries and shrinks in diameter, similar to sinew, and detaches often by the 3rd Postpartum day (but up to a week in certain humid indoor air conditions) leaving a perfect navel.

How is this accomplished?

…[T]he placenta is placed in a special bowl or wrapped in a ceremonial cloth (it is helpful to rinse it first, and remove clots)… Sea salt is also applied generously on both sides to aid drying and minimize scent. This small pillow and its cord are easily kept with the baby, and some women even use the Lotus pillow as an elbow prop during nursing…

In other words, in order to minimize the smell of rotting, the placenta is salted like a piece of dried meat. And as a bonus, you can use the rotting placenta as an elbow prop!

Why would anyone engage in such a bizarre and potential dangerous practice? Here’s the ostensible reason:

The practice … [is] called “Lotus Birth”, connecting the esteem held in the east for the Lotus to the esteem held for the intact baby as a holy child … Ahimsa, (non-violence in action and thought within one’s self and towards others) … is from the writings and leadership by Gandhi … and Martin Luther King, Jr.’s civil rights inspired marches followed soon after. Approaching birth options with Ahimsa in mind is something that can create a tremendous liberation of creative energies, freeing the potential of birth & early parenting to be a peaceful experience for the human family at large…

What’s the real reason behind lotus birth? Homebirth and other fringe birth advocates are engaged in a battle of oneupsmanship, and the woman with the most bizarre (and often the most dangerous) birth practices wins.

So, for example:

A says, “I had natural childbirth”
and B says, “Oh, yeah, well I had PAINLESS childbirth”
and C says, “Well, ladies, I can top that. I had an ORGASM during childbirth!”

and:

A says, “I had my baby in a birth center”
and B says, “Oh, yeah, well I had my baby at HOME”
and C says, “Well, ladies, I can top that. I had my baby at home BY MYSELF!”

now:

A says, “My partner cut the cord”
and B says, “Oh, yeah, well we waited until the cord stopped pulsating and then cut the cord”
and C says, “Well, ladies, I can top that. We didn’t cut the cord AT ALL and just waited for it to rot off!”

On this point I agree with homebirth and other fringe birth advocates. If the goal is to claim the wackiest childbirth practice, lotus birth wins: treat your baby like a “flower” and let the dead parts rot off.

Waterbirth has been touted as an alternative form of pain relief in childbirth. Indeed, it is often recommended as the method of choice for pain relief  in “natural” childbirth. It’s hardly natural, though. In fact, it is completely unnatural. No primates give birth in water, because primates initiate breathing almost immediately after birth and the entire notion of waterbirth made up only 200 years ago. Not suprisingly, waterbirth appears to increase the risk of neonatal death.

Perinatal mortality and morbidity among babies delivered in water: surveillance study and postal survey was published in the BMJ in 1999. Out of 4,030 deliveries in water, 35 babies suffered serious problems and 3 subsequently died. It is unclear if any of the deaths can be attributed to delivery in water. However, of the 32 survivors who were admitted to the NICU, 13 had significant respiratory problems including pneumonia, meconium aspiration, water aspiration, and drowning. Other complications attributable to water birth include 5 babies who had significant hemorrhage due to snapped umbilical cord. In all, 18 babies had serious complications directly attributable to waterbirth. The risk of serious complications necessitating prolonged NICU admissions was 4.5/1000.

Hospitals in Ireland recently suspended the practice of waterbirth after a baby died from freshwater drowning after delivery in a waterbirth pool.

The most nonsensical aspect of waterbirth is that it puts the baby at risk for freshwater drowning. The second nonsensical aspect is that the baby is born into what is essentially toilet water, because the water in the pool is fecally contaminated. In Water birth and the risk of infection; Experience after 1500 water births, Thoeni et al. analyzed the water found in waterbirth pools both before and after birth. The water in a birth pool, conveniently heated to body temperature, the optimum temperature for bacterial growth, is a microbial paradise.

The authors were aware that the water system itself can harbor bacteria, given the report of at least two neonatal deaths from Legionella pneumonia, one that occurred in the hospital, and one that occurred at home. Therefore, they tested the water before anyone entered the pool. To their surprise and dismay, analysis of the water itself revealed that 12% of samples contained Legionella pneumophila, 11% Pseudomonas aeruginosa, 19% Enterococcus, 21% coliforms, and 10% Escherichia coli. Most of these organisms can and do cause infections in neonates. After installing a special water filter, and instituting more stringent pool cleaning procedures, contamination of the water by these bacteria was reduced, but not eliminated.

The analysis of the water after birth was shocking. Almost all 200 water samples were heavily (as opposed to slightly) contaminated with various infectious bacteria.

In the samples taken after the birth there was a high rate of contamination with coliforms (82%) and Escherichia coli (64%) with concentrations of up to 105cfu/100 ml; Pseudomonas aeruginosa, Staphylocooccus aureus, and yeasts were found less frequently.

The authors claim that the fecally contaminated water did not affect the rate of infection. First of all, the study is underpowered to reliably detect the impact of the contaminated water on the rate of infection. Second, the authors express their claim in a curious way:

Only 1.34% of children (10 of 741) born in water showed infectious signs such as tachypnea and suspect skin color compared with 3.40% (15 of 440) in the [control] group.

The relevant finding is not which babies displayed signs of infection. The relevant finding is which babies actually had infections. The authors neglect to share that information, suggesting that there was a significant difference.

Waterbirth is praised for its ability to ease pain in some women, but is that really worth the risk of delivering a baby into toilet water teeming with harmful bacteria? What’s “natural” about that?