People in the skeptic movement are well acquainted with a great deal of common quackery due to articles in publications such as Skeptic Magazine, Skeptical Inquirer, bloggers such as Harriet Hall, the SkepDoc, and speakers at conferences like James Randi's Amazing Meeting. On topics of how irrational, anti-science thought impacts health, these skeptics-at-large regularly touch on homeopathy, anti-vaccine activists, chiropractic nonsense, acupuncture, detoxing, and even repressed memory.
But one rapidly growing and potentially dangerous trend in alternative medicine has largely been ignored by big name advocates of skepticism and skeptic organizations. In general, it is the natural childbirth movement, and specifically, the increasing popularity of homebirths.
Googling "natural childbirth skepticism" produces some revealing results. At the top is an article which is in fact skeptical of natural childbirth, although not published by any organization focused on the promotion of science and skeptical inquiry. It is Skepticism of the Natural Woman by Amanda Marcotte, published last year in Slate, and is a sassy, feminist counter to the idea that natural childbirth is better for women. The next two links are to articles posted in a blog called The Healthy Skeptic, which is in fact run by an acupuncturist who promotes a good deal of woo.
A search of Skeptic Magazine's archives for "natural childbirth" produced no relevant articles.
A search on skepdic.com of "natural childbirth" produced no entries on the practice and a search of "homebirth" produced only one story about a "homeopathic homebirth" buried under a number of examples of harm done by "occult, paranormal, pseudoscientific, and supernatural beliefs."
Nothing about Natural Childbirth made its way into Dr. Harriet Hall "the SkepDoc"'s 2009 article Top Ten Things You Should Know About Alternative Medicine and a search for "natural childbirth" and "homebirth" produces no entries on her blog.
In eight seasons of Bullshit!, Penn and Teller find room for whole episodes on lawns and cheerleaders, but the closest they ever got to criticizing natural childbirth was when they reached for the low-hanging fruit of dolphin-assisted birth.
I must give credit to Skeptical Inquirer. Searching their archives online, I was able to find one article on this subject: 'Natural' Childbirth by Ben Radford, published in the March/April 2006 issue.
The absence of much attention on the natural childbirth movement and increased advocacy and demand for homebirths in skeptic circles begs the question: is this actually something to be concerned about, or does natural childbirth have a sound basis in science and are homebirths just as safe as hospital births? After all, even the Wikipedia entry on natural childbirth makes no mention of any criticisms. So is there really a problem?
I would answer, skeptics should be concerned.
In 2009 I got pregnant and had a baby. What became an epic journey began at a prestigious but humongous hospital, moved to a small birth center, and ended up back at a large hospital. At the start I had lots of fear and few opinions or knowledge of pregnancy and birth, then decided to attempt a totally natural childbirth (efforts which included 24 hours of active labor with no pain killers), then had an epidural, a pitocin drip, and finally an emergency c-section. Involved were several obstetricians and other doctors, many certified nurse midwives, a couple of doulas, a psychologist, and an army of nurses. The long version of the story isn't necessary. Sufficed to say that I experienced almost every typical aspect of childbirth in America today.
Now I'm pregnant again, and the options are more complicated since I had a previous c-section. This and all that happened in 2009 has motivated me to learn as much as I can about childbirth, and it is during these inquiries that I have become fully aware of what has been dubbed by the media as the birth wars.
The birth wars have often been simplified as doctors verses midwives. In this simplification, obstetricians are painted as scientifically brilliant and competent, but also cold, selfish, and arrogant, and midwives are viewed as experts in transforming one of the most horrible experiences for pregnant women into one of the most wonderful, but also hit-and-miss as far as medical competency goes. Of course the truth is far more complex.
First, many of the criticisms of obstetricians coming from the "other side" of the birth wars are unfounded and incredibly insulting. The contentions include that obstetricians use pitocin to induce labor for the sake of their own convenience, that they discourage or refuse to offer VBAC (vaginal birth after c-section) out of personal fears of being sued and total disregard for what is best for the patient, and generally push for unnecessary c-sections because they like doing surgery and make more money that way. These accusations and more are frequently and casually expressed by advocates on the side of natural childbirth. They were expressed in Ricki Lake's film The Business of Being Born, and they come up over and over again in literature and websites advocating natural childbirth.
Midwives come in a several stripes, and can hardly be aligned as a whole group to one side in the birth wars. Many fall somewhere in the middle of a spectrum between the two sides. There are two basic types of midwife in America. Certified Nurse Midwives (CNMs) are trained and certified as both nurses and midwives. They most typically work in hospitals. They are part of and have a good reputation within the medical establishment. The other type is direct-entry midwives, who gain their experience through self study, apprenticeships, or midwifery programs. They most frequently work in homebirth settings. Some direct-entry are Certified Professional Midwives (CPMs), certified by the North American Registry of Midwives. Others are merely licensed in a particular state, and still others are lay midwives. As one can imagine, direct-entry midwives level of training, experience, and competency can vary widely. Whenever horror stories of homebirths gone wrong appear in the news, the midwife involved is a Direct-entry midwife.
While most midwives tend to advocate natural childbirth to some degree, CNMs tend to be more knowledgeable and concerned with risk factors that might disqualify a woman from attempting totally natural childbirth.
For example, the Birth Center I went through will not accept clients who are VBAC, over a certain age or weight, pregnant with multiples, and many other risk factors. Women in labor had transfer to the hospital across the street if any complications ensued. Roughly 20% of the Birth Center's clients end up giving birth at the hospital, and 10% end up having a c-section. I was in that 10%.
I never had any doubts about the care I received at the Birth Center. All the midwives were experienced CNMs. I was required to have blood tests for various risks such as parvovirus B19. 24 hours after my water broke we promptly packed up and went to the hospital. After many hours of excruciatingly painful contractions, a midwife was the one to strongly recommend an epidural so that I could relax, rest, and have enough strength to push. And when it finally became apparent that a c-section was necessary, a midwife stood side by side with the doctor, explaining the process and paperwork I was required to sign. Clearly this was a competent operation where the health of mother and child are paramount. Right?
In the case of my first pregnancy, yes, the Birth Center's approach was competent, totally appropriate, and ultimately successful. Any pregnancy that ends with a healthy baby and mother is a success. So here's the problem. This time around I'm no longer a totally low-risk candidate. When I found out I was pregnant again, I immediately called the Birth Center. I found out I couldn't have my second baby there, so I asked for recommended options. I was given a short list of CNMs who work at or with hospitals, which was great.
But then the person on the phone said, "I can also give you the names of midwives who do homebirths." What!? If it isn't considered safe enough for me to attempt VBAC at a top notch Birth Center across the street from a hospital, why the hell would it be safe for me to try it in my home that is a 20 minute car ride (not accounting for traffic) from the nearest hospital? If the Birth Center is responsible enough to not take on clients with higher risks, why would they be so irresponsible as to recommend alternatives which are even less safe? This is the influence of natural childbirth, a movement that is more motivated by crackpot theories and warm-and-fuzzy feelings than science and evidence.
Dr. Amy, the Skeptical OB, is a one-woman army at war with natural childbirth pseudoscience. In her article Is Natural Childbirth a Form of Quakery? she explains one characteristic of natural childbirth that might partially explain why it has managed to fly under the larger skeptical movement's radar:
"Unlike traditional pseudosciences (homeopathy, creationism) which have always denigrated scientific research, in the last decade, natural childbirth advocates have based the validity of their philosophy on the claim that it is supported by science while modern obstetrics is not."
Dr. Amy points out that the founder of natural childbirth, Grantly Dick-Read, was a white man whose ideas about childbirth are not rooted in any science, and whose writings and work were motivated by his concern that upper class white women were not having enough children to keep up with poor, black women.
Dr. Amy also writes frequently (and harshly) about "the mother of authentic midwifery", Ina May Gaskin. An article in Salon about Gaskin mentions her total lack of formal medical training, and more startling, the story of how one of her own children died during a natural childbirth that could have been prevented had it happened in a traditional medical setting.
Quotes from both Dick-Read and Gaskin, as well as quotes from other major proponents of natural childbirth are frought with bullshit, identifiable as such to any seasoned skeptic. Consider these:
"It is important to keep in mind that our bodies must work pretty well, or their wouldn't be so many humans on the planet." - Ina May Gaskin (Yeah, let's just ignore the fact that childbirth has always been a leading cause of death for women and babies. There's billions of people on earth, therefore childbirth must be inherently safe!)
She further points out that the Netherlands, which has the highest percentage of homebirths in the world, also has a higher perinatal morality rate than any other European country.
If she's correct, then the rising rate of homebirths in the United States should be as alarming as the anti-vaccine crowd. After all, both put the most vulnerable in our population at risk.
Why is this not an issue regularly raised by skeptics-at-large? Could this be the result of what PZ Myers calls The Woman Problem? Or is it that the natural childbirth movement has managed to convincingly appear "evidence-based"? Whatever the reason, it seems clear to this skeptic that there needs to be more skeptical critics of the pseudoscientific and dangerous aspects of natural childbirth.