Wednesday, July 27, 2011

Natural Childbirth: Under the Skeptical Movement's Radar?


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!)

"Women's bodies have near-perfect knowledge of childbirth; it's when their brains get involved that things can go wrong." -Peggy Vincent (Silly brains, always getting in the way.)
"I have personally come to believe that childbirth is a blessing to women sent straight from God. I mean, in its purest form, birth is the most fantastic orgasm married with a miracle! What more heavenly gift could there be?" -Laurie Annis Morgan (Yes, those pesky doctors are trying to take away the best orgasm of your life. And a miracle. Those bastards.)
But, hell, if pregnant women at low-risk for complications want to think of childbirth without painkillers as some kind of earth-shattering, mega-spiritual experience, let 'em. So long as the end result is a healthy mom and baby, it's all good. The problem arises when even women with greater risk factors and their midwives are so moved by the power and importance of having a natural childbirth experience that they don't take proper precautions and take necessary actions when complications ensue, putting both the woman and child in harm's way.
Let's get to the real meat of the debate. To put it most bluntly, will more babies die during homebirths than would have had they been delivered in hospitals? Many advocates of natural childbirth mention the United States's high c-section rate and connect it with the USA's realtively high infant mortality rate. Dr. Amy argues that infant mortality is the wrong statistic:

"It is a measure of pediatric care. That's because infant mortality is deaths from birth to one year of age. It includes accidents, sudden infant death syndrome, and childhood diseases.

The correct statistic for measuring obstetric care (according to the World Health Organization) is perinatal mortality. Perinatal mortality is death from 28 weeks of pregnancy to 28 days of life. Therefore it includes late stillbirths and deaths during labor.

The US has one of the lowest rates of perinatal mortality in the world."

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.



36 comments:

  1. It seems to me that having a certified nurse midwife and giving birth at a birth center combines the best of both sides of the birth experience. The midwife's entire raison d'etre is to help the mother and baby. The OB is trained to handle any medical problem. Bring the OB in when there is a problem, and make sure one is nearby. I used a birth center for both of my children. My first, Martha (the skeptic above), required the assistance of an OB and a last minute trip to the hospital for a spinal. My second, Geoff, barely made it to the birth center before he was on the scene. Both births were successful and served both parents' and babies' needs. I never felt out of the loop, as patients sometimes do with busy docs, but also felt entirely safe in the care of these dedicated professionals: midwives and doctors. For modern childbirth, this alliance does seem to be the most "natural."

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  2. Ah! Thank you so much for this. There is a small but growing group of skpetical women fighting this movement. Many of us can be found on Dr. Amy's site and many more on "Fed Up with Natural Childbirth" a group of parents and skeptics on Facebook. We welcome all level of crunchy or non crunchy parents (Not everything in the crunchy movement is woo, as many of us love cloth diapering, breastfeeding, baby wearing and non dangerous practices) come check us out and join the club!

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  3. Thanks for writing about this. As a skeptic, I have been disappointed by how infrequently this has been mentioned by well known skeptics. Harriet Hall has written about it on Science Based Medicine, but not toi often.

    I would add that it's the whole concept of "natural = best" aka the natural fallacy, that's the root of the problem. It starts with woo, and proceeds to full fledged scientific denial. The obsession with childbirth pain is important- there is nothing special about pain in childbirth, so why is even considered Ok to tell others to avoid painkillers? If you want to go unmedicated for whatever reason, that's fine. BUT, we still need to examine what makes women choose this pain (and tell others they should, too) when they would not choose other painful events without painkillers. It's disturbing.

    The fact is, this has been ignored because it's a womans issue. Most prominent skeptics and non theists are men, so is isn't on their radar. It needs to be.

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  4. Excellent post. I have shared this with everyone I know, very well said.

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  5. staceyjw,

    The reason I went for a natural childbirth without painkillers with my first pregnancy was actually unique. I have a pretty severe phobia of medical settings and needles. Basically my anxiety over needles and being in a hospital environment was greater than my fear of the pain of childbirth. I gotta say, while the pain of labor was rather extraordinary, it was pretty endurable - for the first 16 hours. Then it started to get a bit intolerable, and by the time I got the epidural (after 24 hours of labor) I was in so much pain I truly was almost crazy out of my mind. If I had had no complications and my pregnancy ended after less than 18 hours, painkillers really wouldn't have felt necessary. My plan this time around is to see how far along I am once I'm at the hospital, and if it seems things are progressing rather quickly, I may not get the epidural. I'd hate to get it and pop the kid out less than an hour later. But if it seems it'll be another long, drawn-out affair, I'm certainly going to get the epidural as soon as I can.

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  7. I agree completely with this, and Martha, I relate, because my reason for an unmedicated birth was strong anxiety (not quite a phobia, but enough to make me nauseous) about needles. Of course, I needed meds for group b strep, but that was more than enough for me!

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  8. This is an excellent post!! I am one of those moms in the Daily Beast article and active in the movement Jade mentioned. Too many babies are dying because of this movement and it's not acceptable. I can't believe I bought this crap!

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  9. Outstanding article, Martha. As a childbirth educator and doula, I get to hear all manner of opinions and beliefs on how to "do" childbirth and early parenting. While the voices on the extreme ends of the spectrum are loudest, it's your moderate voice that speak's to most women. Keep speaking. Keep writing. We need to hear your perspective and experiences.

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  10. I am a doula and an advocate of natural childbirth, in whatever setting is most comfortable and safe for the family in question. The problem with birth today is BALANCE. Not every woman needs to deliver in a hospital. Not every woman should be delivering out of a hospital. Why can we not respect the female body, trust that MOST women can deliver their babies safely without intervention and STILL gain the unmeasurable benefit of the medical advances that can routinely save lives? We should be able to do both, and instead the chasm between the two seems to be growing bigger.

    The biggest problem with your article though is this - healthy mom and healthy baby can not be the only consideration. It just plain can't. The experience of giving birth has long lasting and significant emotional effects on mothers, couples, and babies. Women need to feel cared for and respected during their births, and they need to feel in control of the decisions made during the process. It's IMPORTANT. If as a society we taught our women about their bodies, if girls learned about childbirth when they were young, if stories of birth were told of the empowering, miraculous experiences they should be and not the horrible, painful, scary experiences that they become - then we would be on our way to a better balance. Childbirth shouldn't be scary, ESPECIALLY today. It's easy, really. Low risk? Trust your body, educate yourself, don't be afraid of it. Have a medical condition that makes you higher risk? Manage it appropriately. See an OB, deliver in a hospital, make decisions that are right for your situation. Its really not that hard and shouldn't be a "war". Common sense will tell you that a surgeon is overqualified for a low-risk vaginal birth. Common sense will tell you that there are risk factors (conditions, history, distance from a good hospital) that make someone a poor candidate for a homebirth.

    Birth can't be fixed with one person, one mom and baby, one midwife or doula or OB. It's a cultural shift that has to happen, and a pretty big one. Childbirth via common sense and rational thinking - there's a concept.

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  11. I am a skeptic. But what I am skeptical about is the "Medical Model of Care for Childbirth"

    I am skeptical about the need for induction as a routine treatment. I am skeptical about the need to be in a medical setting to do what my body will do naturally.

    Dr Amy is a fanatic and actually a prevaricator, when it comes to natural childbirth. She hates it and fears it but she is not a practicing doctor, she is just a wildly frightened woman who seems intent on scaring people. Almost nothing that she says and most of the statistics she sites are wrong or slanted.

    Dr Grantly Dick-Read was a wonderful man who wrote a very important book on childbirth. He believed women could do it best when relaxed and basically left to their own devices while being supported by someone who trusts birth.But he did NOT invent natural childbirth. That made me laugh. Natural childbirth has been around as long as humans have.

    Skepticism is a good thing. But educate yourself first before deciding what you think. Watch some home birth videos before you criticize the women who advocate for them.

    A home birth is nothing like a hospital birth. They are NOT the same. The only comparison I can think off the top of my head is the difference between being artificially inseminated in a doctors office versus making love to your husband in the privacy of your own comfortable bed.Think about it. Why do you suppose women have begun to question hospital settings as the best place to give birth? Do you think that all of a sudden women have become more stupid? Or perhaps they have begun to take control of their own birthing....could that be it?

    Since Home birth increased 20% between the years of 2004 and 2008 I believe we have to take a look at why that is. Ricki Lake's movie The Business of Being Born did not come out until 2008 so she is not the reason for the 20% increase. She is just one more of the advocates for women who are saying "Wake Up" you can do this. I hope that the increase in home births doubles or more for those who see her movie. We don't have the latest statistics yet.And make no mistake. A home birth can be the most amazing, empowering, exhilarating and just simply wonderful experience a woman can have.

    Why were all my 16 grandchildren born vaginally? Their mothers all believed in birth, trusted their bodies and educated themselves about midwives before they gave birth. Several of them (5) had home births, some were birth center births and a couple were hospital births (with midwives). None of their babies spent time in the NICU. All of my daughters and daughters in law were happy with their births and none would ever say that natural birth is something to be skeptical about.

    It is the way birth should be. But sometimes interventions are necessary. And I thank God that we have the ability to save lives of women who cannot give birth naturally or vaginally even in a hospital. I welcome our advances in medicine for those cases. But they are under 10% of women.... And many of those are already risked out before they ever attempt to give birth. They know they are going to get the best MEDICAL care for their problem births.

    Women of low risk do not need medical ANYTHING.

    Dr Any Tutuer is known throughout the natural birthing community as probably the most outspokenly biased "authority" out there.
    Ina May Gaskin who though not a medically trained midwife in the modern sense is a highly educated woman when it comes to birth.

    I welcome this discussion, but wonder why people are so skeptical about birth. I guess we have been brainwashed for so long it is hard to undo it.

    That is the reason I started the websites www.childbirthsolutions.com back in 1999 to help women educate themselves about birth.

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  12. I agree with Rachel. I am a doula, childbirth educator, apprentice midwife and mother. This blog I am skeptical of ... where is your research? Any competent midwife can evaluate risk. It is not us against them. Effective collaboration between OBs and midwives is the key. States that license direct-entry midwives allow for this collaboration to happen. Furthermore, all midwives CNM, CPM, LDM ... deserve autonomy and the right to practice their profession. Let the parent choose! Let's support licensing of midwives and statistic collecting such as what MANA is doing. Let's get the real story out there and stop this campaign of fear. To the author of this article... did you ask why the birth center you went to does not support VBAC? Is it their malpractice insurance that dictates this? Is it the midwifery licensing committee in your State? I am sorry you are so afraid of birth.

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  13. I left out a word when trying to say that Dr Amy says things that are not true, just in case anyone missed it. She tries to slant things her way so much that she misses the mark.

    While Ina May Gaskin just tells it like it is. And here is something about her that will give evidence of her truth:

    "Ms. Gaskin’s center is noted for its low rates of intervention, morbidity and mortality despite the inclusion of many vaginally delivered breeches, twin and grand multiparas. Their statistics were published in “The Safety of Home Birth: The Farm Study,” authored by A. Mark Durand, American Journal of Public Health, March, 1992, Vol. 82, 450-452. She was featured in Salon magazine’s feature “Brilliant Careers” in the June 1, 1999 edition."

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  14. As a mom who's had two completely low risk and normal pregnancies that ended in safe, satisfying home births, I both agree and disagree with your article. I agree in that women, in general, need to be skeptical about the traditional view of the birth process and how birth is "conducted" in our culture. However, I disagree in that home births aren't safe. According to research...science....they are, and should be accepted and available options for women who choose them (for whatever reason). To each her own.

    It is not for us to judge another's desires and motives when it comes to birth. If a woman has done her duty in learning about her body and birth, then her birth choices are valid. If not, then she is running a huge risk.

    I say, know thyself. Know your limits, your personal beliefs, health history, and so forth. No two women are alike, but hey, that's the way it should be. So--natural childbirth movement or not--we should be supporting each other as mothers and doing our best to educate rather than divide.

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  15. Rachel,

    Birth does not need to be "fixed".

    Sorry, but healthy mom and baby are the only significant concern. You seem to be implying that conventional hospital births are inherently emotionally destructive.

    My birth experience was pretty traumatic compared to most. It involved sleep deprivation, dropping blood sugar levels, excrusiating pain that lasted for hours and hours, injections, IVs, surgery, and then recovery from surgery. But who cares since I got a healthy baby at the end and totally healed up in a few weeks.

    What are these lasting emotional effects you speak of? Are you suggesting that women are not resilient enough to deal with a crappy day or two in a hospital? What is your evidence for this (presumably detrimental) long-lasting effect on mothers and babies?

    Are you accusing OBs of not treating women with respect? Are you accusing OBs of not expressing genuine care and concern for their patients? You mentioned surgeons. You mean OBs? OBs are not overqualified to deal with a normal, healthy, birth. They are trained to deal with all kinds of birth scenarios, including ones that turn out just fine with no special intervention. Do you realize how insulting your comments are to OBs?

    I learned perfectly well in school how my body works. Birth isn't empowering or miraculous. That is ridiculous. Why would you feel empowered by something out of your control? See, that's the sort of crap that makes women who get c-sections feel like failures. It is about luck, not power. Do you feel empowered if you happen to have 20/20 vision?

    Birth isn't miraculous. Unless you change the definition of the word "miracle" to mean what you want it to mean.

    My birth was horrible, VERY painful (until I got the epidural), scary, and I totally dread the next one. But as I tell my girlfriends who've never had kids, "Eh, I can deal with anything for a day or two." You can try to pretty it up as much as you like, but anything that involves hours of excruciating pain and a 20% chance of complications even for totally healthy candidates sucks. Fortunately, our babies are well worth it.

    On the side of hospitals, birthing is not getting worse. Hospitals and OBs have become more and more sensitive to women's emotional needs and desires over the past 40 years. CNMs presence in hospitals is growing, as are birth centers located within hospitals. In other words, conventional medicine is moving to make birth a little less crappy while keeping it just as safe. It's the fringe of the natural childbirth movement that is moving in the other direction, in many cases promoting homebirths even when they are clearly inappropriate.

    I have a hard time taking anyone seriously who says crap like, "Trust your body." 20% of the Birth Center patients who are low risk end up at the hospital. Bodies are flawed.

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  17. Jennifer,

    "However, I disagree in that home births aren't safe. According to research...science....they are, and should be accepted and available options for women who choose them (for whatever reason). To each her own."

    What research? In my article, I cite evidence that perinatal deaths are higher in the country with the most homebirths, and that the perinatal deaths in the United States are low. And what of the research showing that homebirths significantly increase the risks for newborns that has motivated the AMA to oppose homebirths? How much more dangerous does homebirth have to be for you to back down on your "to each her own" attitude? In a civilized society we aren't allowed to just do whatever we want when it risks the lives of others. Health care workers have many restrictions on what they can and cannot do for good reason.

    I have a question for you, how high would th

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  18. Although I generally disagree with your assessment of natural childbirth, as a skeptic I have to say that I'm more disappointed with this article's use of skepticism. To an outside reader interested in learning about the pros and cons, there is more than one logical fallacy and little evidence presented here.

    * Failure to cite sources: Is childbirth a leading cause of death for women and babies? Under what conditions? Why should we believe your word on it?

    * Appeal to authority: Your only scientific source in this article is Dr. Amy (the WHO quotes are from her site too where they were also uncited).

    * Use of anecdote instead of/without scientific evidence.

    * I agree with staceyjw on the naturalistic fallacy being used by the natural birth crowd but that doesn't mean they're automatically wrong on specific issues.

    As a response to your anecdote, what you were criticising the birthing center for is offering you informed choice. The VBAC-at-home midwives offered to you likely would have been able to explain the potential risks to you and your baby (including the likely timetable of complications). The choice would then have been yours. Again, you don't offer us the actual evidence.

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  19. The AMA usues a study that includes births at home that happened unplanned and unattended by professional midwives to try to persuade people that planned homebirth with a qualified attendant is not safe. Their attempt at pulling the wool over our eyes in not safe ... why trust them? Planned homebirth with a qualified attendant is as safe, if not safer than a planned low-risk hospital birth. American women deserve the respect to research this topic on their own, come up with the conclusion that fits their needs and have access to a care provider of thier choice!
    1. Conclusions of BJM research.... Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. site: http://www.bmj.com/content/330/7505/1416.full?ehom%EF%BB%BF
    2. Maternal Mortality in the United States: A Human Rights Failure according to The Association of Reproductive Health Professionals site: http://www.arhp.org/publications-and-resources/contraception-journal/march-2011
    3. When Research is Flawed:
    The Safety of Home Birth http://www.lamaze.org/Research/WhenResearchisFlawed/Homebirth/tabid/172/Default.aspx
    4. Amnesty Internation states there is a human rights crisis in the USA concerning childbirth http://www.amnestyusa.org/pdf/DeadlyDeliveryOneYear.pdf
    5. A research blog the author of this one needs to read http://www.scienceandsensibility.org/?p=2762

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  20. Dear Martha Knox,

    I am so sorry your birth experience was traumatic. Often women who have traumatic births begin to educate themselves and learn to trust their bodies and then become huge advocates for birth outside the hospital norm. (That is what happened to me)

    It is sad that you may have done much research and still be so afraid of birth, dreading your next one. I am so sorry for your fear and trepidation.

    It does not have to be that way. Birth can indeed be empowering and positively magnificent. Do you really believe that all these women who say so are lying? I know the pain of a frightening childbirth.....I remember screaming and screaming with my first birth. But luckily after that I began to understand that the hospital believed just as you say you do that a woman can deal with "anything" for a day or two. Bull!!!! That is NOT what childbirth should be.

    MY last birth (my 5th baby) was so painless that my doctor brought in an anesthesiologist just to "look at me" because I was so calm. I was reading a book much of the time and my blood pressure and pulse were normal. I was not in any really difficult pain and at all and during contractions I was completely calm and comfortable.....The whole labor and birth was only about 4 hours or so....including checking into the hospital. It was 1974 and because of a shortage of gasoline and energy in general they had extended day light savings time....we lived an hour away from the hospital....and I knew I was about to be in labor but really got there before much cramping had even begun. It was 9 days past my due date and I was sincerely hoping to have that baby THAT DAY. We left our house about 8am and drove in to the hospital and I had the baby at 2:30 pm that afternoon. It was so much fun! And I was so good at it by then....I was not scared at all....and looked forward to labor and birth. And it was so easy. I was mad at myself for not just staying home.

    In fact I still regret not having that baby at home. But in those days there was no Internet. I had no idea that I could have even found a midwife....I was the only one I knew who really wanted to have a baby at home and I was a bit afraid of seeming "Crazy".

    Now that I am older I know how important it is to listen to that little voice in my head that tells me when to be true to myself. I WISH I had been mature enough and confident enough in my OWN judgement to stay home and have that baby. Oh well....

    Later on I got to "catch " my own grandchild when one of my daughters came home to our house to have her baby. She had a WONDERFUL home birth....and I was thrilled to have witnessed it. (It was my first view of a home birth) And it changed my ideas completely.

    Before seeing that birth I thought of home birth as something I would have liked to do but not a normal thing to do. After seeing what it was like....the comfort, the bonding, the love between my daughter and her young husband....the ease with which she had the baby squatting on a birthing stool...The immediate placing of the baby on her breast, no separation of mother and baby, and later that evening a wonderful chicken dinner which was cooking in the oven while the baby was being born....

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  21. to continue to Martha Knox:


    Oh i wish I could convey to you the difference. The difference in care of a midwife (who actually leaned against a wall of the room and took photos while I caught the baby) But she also was there WITH my daughter in spirit and payed attention to her....gave her confidence and approval and suggested wonderful things like hot compresses on her perineum to ease discomfort. My daughter and I were both surprised at this and asked how come they don't do that for mothers in the hospital....

    "No time for such individual attention" said the midwife. She was a direct entry midwife, not a CNM....but she had a gift for knowing a woman's body. Childbirth is NOT a science and birthing a baby is NOT scientific it is an art. An ART that is sadly hard to find in a hospital where they do not believe in it as such. Hospitals are full of fear and precautions and that carries over to the mother changing her mood and helping to make her less sure of herself and her body.

    When I hear someone say that the only important thing is to get a healthy baby and for the mother to survive, it literally hurts me to hear it.

    Because I know that anyone who says that is missing something so special, so spectacular, so moving, so empowering that there is absolutely nothing to compare it to. I wish you the same. I hope you will set aside your anger and guilt about the birth you had and realize the YOU are in control of your body. It is not a "accident" waiting to happen. Birth is largely in the control of the mother. Her attitude and beliefs will shape how the experience plays out.

    Be sure, no matter WHAT you think, now that you work on your attitude to erase fear and dread. Because if you don't you will have another unpleasant birth. However, if you can get some coaching, perhaps some hypnobirthing sessions, and read everything you can get your hands on about trusting birth and your body. I hope one day to hear that you, too had a fantastic birth....(and I promise not to say I told you so)

    Good luck to you! Now go watch some home birth videos on Youtube or go to my Facebook page for Childbirth Solutions

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  22. You treat natural birth as if it were the establishment and is never questioned. Quite the opposite - natural birth advocates are the skeptics - hospital/medical birth is the establishment which is rarely questioned. Not only that, but natural birth is, unfortunately, often discounted and criticized by the establishment. 90% of women give birth with doctors, 10% with midwives, and less than 1% have homebirths. I would also point out that there are many obstetricians who are skeptics of the medical model. (see The Unnecessarean).

    I and many natural birth advocates like myself are most concerned with women making informed choices. Many women do not inform themselves at all, and many doctors have no interest in helping them inform themselves. I agree that skepticism is necessary but that it should be directed at all models of care. It should be accepted that there are good and bad providers of both medical and midwifery care and that no assumptions should be made about quality of care based on title. I do, however, agree with a previous commentator. The numbers of birth centers and homebirth midwives (and OBs) will speak for themselves. How is is that childbirth is universally risky when a birth center in my area (similar to birth centers across the country) have a 2% c-section rate, 10% hospital transfer rate, and no emergency transfers. That is not pseudo-science or quackery - it is an group whose very existence is skeptical of the assumption that ALL birth is ALWAYS risky or that risk cannot be anticipated.

    While you should make the best and most informed choice for you, please don't allow your (one) experience to color all natural birth. In the same vein, do not allow one or some poor care providers to color the natural birth movement. There are many credible organizations who promote skepticism of American birth. And if you do not "believe" in evidence-base care and its support of natural birth, you have lost the ability to be skeptical of American birth and fallen under the spell of Dr. Amy and the likes. You're too smart for that.

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  23. Dear Martha:
    I am sorry you had a difficult experience and am hoping you find a way to heal. It would be helpful if you could see your bias and work with it. am surprised that you do not seem to recognize that an anecdote such as your experience is just that.
    you call yourself a skeptic yet you do not question everything. Where is your questioning of the AMA, Dr Tauteur, and studies that you cite? do you have any idea how political and non scientific some of the AMA and ACOG;s stands/policies are? I am a maternity nurse, have worked at many hospitals and an out of hospital birth center and have educated myself a lot. So, I am asking you to truly educate yourself.
    This is not black and white, not OB vs midwives since there are great humanistic OB;s and midwives that do not trust birth and women and are not supportive of their families in labor.
    I am surprised to hear you talk about how untrue it is that doctors are not supportive of VBAC's. where do you get this information? in many states, there many counties in which women would not find a hospital that would allow a VBAC. We have women that travel far becasue our little hospital does offer it. you are appalled that a you could not VBAC at a birth center but home birth midwifes might take your case. Birth centers work under certain constraints and sveral yrs ago, their policies changed to no longer allow VBAC's at their facilities. the evidence has not changed but the politics have.
    I am so sad when I hear you say that in the end, all that matters is a healthy baby and mom. you believe that as a skeptic? there is so much research out there that talks about how women remember their births even 30 or 40 yrs later. It does not matter if a woman has a difficult labor, a C/S or what, but how she is treated-with caring, love and respect-all those things so often missing in busy hospitals. do you have any idea how different prenatal care is between an OB, CNM and home birth midwife? look at animal births and the environment they seek-we are mammals and need safety, warmth, darkness. I am at times surprised that babies get born at all in hospitals when you look at all families go through, surrounded by strangers, bright lights, people staring at your perineum when you are pushing, etc.
    births have become so medicalized and we ignore at our peril what the physiological birth process entails, the dance of hormones between mom and baby.
    how do you think the human race made it this
    far? I am sad when in our hubris, we think we can improve upon nature. I could go on and on, dear Martha but time is short. I wish you a great birth and much learning in your life. Please travel to the Farm and interview Ina May Gaskin or hear her speak at a conference. you would be so impressed if are able to have an open mind and be aware of your bias.

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  24. In response to Anon:

    It surprises me that I am being criticized for not citing sources to prove that childbirth has been a leading cause of death for both women and babies in places and times without or before modern medical technology. But okay: WHO stats on maternal deaths clearly indicates a much higher rate in developed nations: http://www.who.int/making_pregnancy_safer/topics/maternal_mortality/en/ Infant mortality is also much higher in developed nations: http://upload.wikimedia.org/wikipedia/commons/6/65/Mort.svgRegarding the past: Maternal mortality rates in the United States in the 1600’s was about 1 in 100, and thus would have been among the worst 5 nations by today’s standards. http://www.digitalhistory.uh.edu/historyonline/childbirth.cfm Infant death rates have dropped in the USA over the past 90 years: http://www.laalmanac.com/vitals/vi07a.htm There are, of course, tons of stats out there showing that childbirth in the past and in less developed nations is much more risky for mothers and infants, and they are easy for any educated person to look up. Are you questioning that assertion? Do you have evidence to the contrary?

    Regarding Appeal to authority as a logical fallacy, how does my citing Dr. Amy’s articles commit that fallacy? Dr. Amy is an authority in the field I wrote about. (Appeal to authority is a logical fallacy when an authority cited is NOT an expert in the subject.) So the only way left for it to be a logical fallacy would be if the information which I quoted from Dr. Amy is shown to be false. Are you asserting that the information cited by Dr. Amy is false? You say she didn’t cite her sources, but she did, she quoted the WHO. I would assume that there is no link because she was not citing a source which is available online. But there is nothing stopping you or anyone else from checking her sources.

    You claim that I used an anecdote instead of/without scientific evidence. My personal birth story was integrated within larger commentary about various aspects of the national childbirth movement. I cited a great deal of evidence that had nothing to do with my personal story. If my personal story was removed from the article, the essential message and arguments would still stand.

    I never claimed that because the natural birth crowd uses the naturalistic fallacy that there are automatically wrong on unrelated issues.

    I criticized the birthing center for referring higher-risk women to homebirth midwives where they would give birth under circumstances deemed unnecessarily risky by their own operating standards. It was a hypocritical act on their part. You can disagree with my criticism, but I am in no way being illogical in making it.

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  25. In response to Carmen:

    You claim that the AMA uses a study in a disingenuous way to persuade people against homebirth. In the United States, many homebirths are attended by midwives who are not certified professional midwives (In fact I linked to a story about some), and that is a concern. The expectation that every single pregnant mother will have the education and wherewithal to do extensive research of their options is ridiculous – this is a modern, industrialized nation, what are standards and regulations for? People have come to reasonably trust that any significantly unsafe options are not legal. Unfortunately, in many states, it is perfectly legal for unqualified midwives to attend homebirths, so why fault the AMA for including them in its arguments against homebirth?

    The BJM research showed less medical intervention with homebirths, and no difference in infant or mother death. And your point is…? Are you arguing that interventions which include pain relief or inducing labor are inherently damaging? If so, you’ll need to provide some evidence that that is the case. Otherwise, all that study shows is that women who decide to have a birth in a hospital are more likely to opt for epidurals and other interventions. Sure, they might be influenced by the suggestions of doctors, but if homebirth wasn’t an option for the women who would otherwise choose homebirth, what stops those women from choosing to give birth in a birth center with a midwife, and thus be just as unlikely to have any medical interventions? Here’s a study from Australia that found evidence for homebirths being more dangerous in much more concrete terms: http://ama.com.au/node/5275 From the article: “Prof Keirse said that while the data showed that planned home births had a perinatal mortality rate similar to that of planned hospital births, they had a sevenfold higher risk of intrapartum death and a 27-fold higher risk of death due to intrapartum asphyxia (lack of oxygen during childbirth). This was despite the finding that women with recognised risk factors, such as nulliparity, Indigenous status, lower occupational status, and residence outside metropolitan areas, were less likely to plan a home birth.”

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  26. Also in response to Carmen:

    On maternal mortality in the United States – please re-read the articles YOU linked to. The first reads:

    “The comparatively high rates of maternal deaths in the United States is an indicator of the failure to ensure that women have guaranteed lifelong access to equitable, quality health care, including reproductive health services. Indeed, in countries such as Canada and the United Kingdom where maternal deaths are reviewed and universal access to health care is guaranteed, fewer women die of preventable causes during childbirth than in the United States.”

    From the Amnesty International link you gave:

    “Women living in low-income areas across the US were twice as likely to
    suffer a maternal death as women in high income areas.”

    From the Science and Sensibility link you gave: “2x: Women living in low-income areas across the US were 2 times as likely to suffer a maternal death as women in high income areas.”

    That last link also speaks of women who die or almost die in complications in childbirth – you do realize that these are not women who were low-risk, perfectly healthy, who suddenly died from complications from c-sections and other interventions, right? They died because of complications of pregnancy that weren’t adequately attended to through hospital care. These are not people who would even be likely candidates for a low-risk homebirth in the first place!

    Women who opt for homebirths in the United States tend to be white, older, more educated, and married (http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_11.PDF) – exactly the sort of people who tend to have access to better health care in general, so had they instead chosen a hospital birth, they likely would have received on-average better care than lower-income counterparts.

    Also, despite rising, the rate is relatively very low compared to underdeveloped nations that have poor access to medical care – see the link I provided above from the WHO, and that’s nothing to sneeze at. Also, in addition to economic disparity and the wide range of health care access in the USA as a major contributor to poor maternal and infant health, the rising rates of maternal mortality have also been tied to rapidly growing obesity rates and the fact that women are choosing to have children at older and older ages. The WHO recommendation for c-sections being 5-15% was brought up by your links, but that recommendation is no longer being made by the WHO, and all the developed nations with very low maternal and infant mortality rates have higher than 15% c-section rates. Consider that Italy has the lowest rate of maternal death, and also have a relatively high c-section rate. So is it clear that unnecessary c-sections are a major culprit in America’s rising death rates? No, the evidence does not point to that at all.

    On the safety of homebirths, the link to the article in Lamaze International did not provide any evidence of the safety of homebirths. It only criticized a single study that supposedly showed homebirths to be less safe.


    Why have you wasted my time with so many links to irrelevant articles that do not contradict what I wrote in my blog post?

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  27. In response to Bonnie,

    I wrote weekly opinion columns for a large university newspaper for 3 years, and your comments are by far the most condescending drivel I’ve ever received in response to something I wrote. You do not know me personally, and yet you have made many false assumptions about my feelings, desires, and character.

    You have very selective reading habits. You noticed when I wrote in a comment that my birth experience was more “traumatic” than most, but apparently you missed where I wrote right (in the same paragraph) that I tell my girlfriends you can deal with anything for a day or two, or rather, you seem to have missed the implications of that statement with regards to my overall feelings about my birth experience. Let me spell it out for you: it was a really shitty couple of days, but I got over it pretty quick since everything was cool in the end. You also seemed to miss when I commented about the resilience of women. You seem to view childbirth being painful and uncomfortable (crappy) as some great injustice. Give me a break. Injustice is my poor, intercity students having their teeth rot out of their mouths because they don’t have regular, proper access to health care. Get some perspective.

    You seem to be of the conclusion that my birth experience would have been all nice and wonderful had I only “trusted my body” enough. What sort of magical bullshit thinking is that? I ended up in a hospital because my kid’s cord was in the way, so every time her head tried to push through the birth canal, she experience fetal distress (in other words, her heart rate got sketchy and her life began to be threatened.) Nothing in my power could change that. It is bullshit like what you are saying that makes women who attempt natural childbirth but then have c-sections or other medical interventions feel like failures. Bodies are flawed. That’s why people have glasses and hearing aids and pace-makers, etc.

    Also, the aspects of my birth that sucked the most happened BEFORE I got to the hospital (specifically the pain, how long it was going on, and concerns about what would happen if complications ensued, which they did. From that point on, the concern was that my baby and I would be okay. Had complications not ensued, and I was able to give birth at the birth center, that would have been all fine and dandy, too, but it wouldn’t have been “magnificent” or “empowering”. Good lord – I went with the birth center to make something crappy less crappy, not to orchestrate some sort of miraculous experience. That you think such a thing is even possible for a person of my temperament and worldview just shows that you have no idea who I am and are only interested in inappropriately projecting our own ideas and feelings onto other people.

    I am not “so afraid of birth”. I do not have “anger” or “guilt” – that is more of you projecting your own feelings and opinions onto me and taking things I wrote out of context. Who would I be angry at? Who did I express anger toward? Nobody. You seem to have imagined that. And guilt? Guilt for what? When did I express guilt? Again, you seem to be imagining things.

    I dread birth in the same way that I dreaded getting my wisdom teeth out (it fucking hurts and the recovery is a bitch.) Although mainly any fear I have is about the safety of my child. If I’m fine and the little guy comes out as healthy as the last one, whatever else happens won’t matter, just like it didn’t matter last time. I find this fetishizing of the birth experience quite creepy.

    Regarding your personal experiences, what is your point? I’m sure Ina May was listening to the little voice in her head and trusting her own judgment when she tried to give birth on a bus and her infant died because of it. We all have little voices in our heads. Sometimes they are wise. Sometimes they are foolish.

    To be continued...

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  28. Continued to Bonnie:


    You seem to assert that hospital and birth center births are deficient in allowing the parents to bond properly with child and that they do not inspire confidence in parents. Do you have anything to back that up other than your own subjective feelings? I felt extremely grateful to all the health care practitioners I encountered in my experience, including the OB and other hospital staff. They all worked together to make me feel that my baby and I were in good hands, and indeed we were, and it all culminated in an incredible feeling of joy when I heard my daughter’s first cries. They put my baby in my arms as soon as they cleaned her off and cut the cord. A midwife helped me nurse her as soon as we were out of surgery and other nurses and lactation specialists helped me more with it during my 3 days of recovery in the hospital. I kept my daughter in my room, and we bonded plenty. Of course I have excellent health insurance and access to some of the best medical care in the United States, not something that many Americans have. But most important to the issue at hand, when deciding on public policies, laws, regulations, people should look to facts and measurable outcomes, not personal anecdotes. So in that regard, both your subjective experience and mine are irrelevant.

    Frankly I’m sick of hippie, feel-good types who place more importance on subjective bullshit. It is annoying that you have decided to focus so intensely on my birth experience, which was only one small part of my post, and not necessary to the point of my article.

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  29. In response to Meg:

    I do not treat natural birth as if it were the establishment. One of the main points of my article is that this particular issue has been largely ignored by the skeptic community, and the entire introduction of the article was devoted to backing that up. I think I made it clear that the “skeptic community” I’m referring to is the organized movement represented by organizations such as the Skeptic Society, the James Randi Educational Foundation, and the Center for Inquiry. I am largely addressing a movement and community that I, as a secular humanist volunteer, leader, and paid administrator, have played a significant role in for over a decade. I made no statements what-so-ever regarding how the natural childbirth movement is viewed or questioned by the mainstream. And I did mention the medical establishment’s opposition to various aspects of the natural childbirth movement, so I did in fact explicit talk about how it is questioned, and made it clear that natural childbirth is NOT establishment. Rather, I painted it as a varied movement that is small but on the rise, and which has both healthy/sensible and dangerous/extreme/irrational aspects to it.

    The fact that many women do not inform themselves is partially why laws and regulations for medical practice are necessary. For instance, my husband works in medical research, and regularly talks about how strict the rules for human experimentation are. The reason the rules today are so strict is because of incredible abuses that have occurred in the past, particularly against the poor, least educated, and disenfranchised minorities in the population. The real problems with childbirth in America today clearly have much more to do with unequal access to health care and the need for tort reform than they have to do with women “trusting their bodies” and OBs not treating women with appropriate care and concern.

    You ask how is it that the birth center in your area and others across the country have extremely low c-section rates and 10% hospital transfer rates. There is an obvious answer: they ONLY take on clients who are low risk (under a certain age, under a certain weight, not VBAC, no multiples, and a handful of other requirements.) Add in that women who choose birth centers tend to be middle class women who have had better-than-average health care and health habits their whole lives and tend to be women who genuinely prefer to experience natural childbirth (opposed to low-risk women who genuinely want and request epidurals or to be induced if they pass their due date) and there you have your answer. If ALL women started out in birth centers, regardless of risk factors, the stats would not be so nice.

    You refer to the “spell” of Dr. Amy and call natural childbirth “evidence-based care”. Are you going to actually provide any evidence that Dr. Amy’s claims which I cited are false? Do you have any citations which counter the evidence I presented in my article? Your comment implies that I used my personal experience to make my argument, but what I really did was make my argument based on facts and evidence and then threw my personal story in to illustrate a point and explain some of my interest in the topic.

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  30. In response to Judith:

    Good god, you are about as bad as Bonnie with the assumptions about my feelings and character. Find a way to heal? Lady, I healed physically from my birth experience within weeks, and I healed emotionally from it the moment I heard my beautiful daughter cry for the first time (a moment where I was probably still being sewn up after the c-section.)

    And again with the claim that I used my birth experience as my entire argument. Read my blog post over again ignoring my personal story. You will find that the arguments stand.

    What do you say is my bias and how would you say this supposed bias is influencing my opinions and arguments in a bad way?

    I do question Dr. Tauteur. I have yet to find any flaws with the logic and studies she cites in her articles on the natural childbirth movement. Just because I agree with her on that subject hardly means I don’t question her. Same thing with the AMA’s stance on homebirth. Doesn’t mean I agree with everything the AMA does or says. Hell, I don’t know everything the AMA does or says. My concern in this blog post in about this particular issue, so bringing up other stances the AMA and ACOG has is a moot point.

    You say “truly educate yourself.” Okay, tell me what I wrote that was wrong and why it was wrong. Tell me where you disagree with what I’ve said and why, and I’ll give it fair consideration.

    I know it isn’t black and white. That’s why I didn’t paint a black and white picture. That’s why I talked about the good and the bad within the natural childbirth movement. That’s why I said in my blog post that it is not OBs vs midwives really. Did you read my blog post or just skim it?

    You ask where I got my info on doctors who support VBAC. What I wrote was: “The contentions include that obstetricians… 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” As you can see, I didn’t deny that doctors discourage or refuse to offer VBAC. I denied that the reasons for this are so shitty. Dr. Amy talks a bit about the real reasons why many doctors discourage or refuse to do VBAC here: http://skepticalob.blogspot.com/2009/08/doctors-used-to-encourage-vbac-what.html

    In your comment you suggest that OBs and hospitals do not treat women with care and respect. But any such problems when they do occur are more associated with health care access than anything else. Yes, there are differences between prenatal appointments at a cozy birth center or private office and a large hospital. I’m a big fan of the more cozy birth centers and minimal medical intervention. But I have a friend who feels much more comfortable with an OB in a more medical setting and lots of ultrasounds and such. But we both live in a big, metropolitan area and have good health insurance, so we are lucky enough to have the option to shop around. Not everyone is so lucky because of financial or geographic restrictions. But what does any of that have to do with the things I addressed in my article?

    You can talk all you want about how uncomfortable the bright lights and being surrounded by strangers can be for some women, but those same things make other women feel more safe and secure. There you are talking about personal preference not what is best for the health of women and children.

    The bottom line is that births being so “medicalized” is why maternal and infant mortality rates in developed countries are so much better than rates in developing nations, and rates today are so much better than they were just 100 years ago. The human race made it this far because enough women and children survived childbirth to quickly propagate the species. Even if one in ten women died in childbirth, the species could flourish, so that is hardly an argument.

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  31. I think you're my hero. *Loved* this. Thanks Martha! -Meredith in Utah

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  32. This was a well written, funny, and thoughtful post on a very contentious issue (your comments may have been even better than your original post). I love the ideas of breastfeeding, low intervention birth, baby wearing, and organic food very much, but it has always troubled me the amount of really crazy ideas I would run into when discussing issues of child rearing and child bearing with otherwise like minded, largely non-religious, well educated people. The amount of woo that's present, and pursued with a religious fervor in natural child birth, and likewise with its travel companion, attachment parenting, flew under my own radar because I agreed in principle with so many of the tenants of both. Also, the reason for poor skeptical coverage may be that unlike something like homeopathy, sound reason and utter bullshit mingle together in much of NCB, and it's only at the extreme edges that it really starts to stink.

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  33. I think it's good to be skeptical of both the natural birth community AND the skeptics of natural birth. I find that both, when too extreme in their beliefs, tend to cling to any statistic or fact that confirms their own beliefs and disregard anything that might be used as evidence in favor of the other side.
    I'm not really interested in the birth wars. I'm interested in the science, and the truth is, the science comes down somewhere in the middle--and our scientific understanding of birth is constantly changing. A healthy mother and a healthy baby with a totally normal labor and birth process are probably best off with as little intervention as possible. By intervening unnecessarily, you expose mother and baby to the risks of those interventions without the benefits. But in situations where intervention is called for, where mother and baby are already at risk, it's important to figure out how to balance the risks and benefits of each intervention and figure out which will provide the most benefit, while exposing mother and baby to the least amount of risk. This is where doctors' and CNMs' knowledge of AMA and ACOG standards, their hospital's standards, and current medical research, are so critical.
    I don't want to shut down a conversation about natural birth just because there are definite benefits sometimes to using pitocin or epidurals or c-sections. I also don't want to shut down a conversation about the benefits and right moments to use these interventions (and others) just because "natural is better." I think we should make the best decisions we can based on the full body of current medical research and recommendations from groups like ACOG, and continue studying and improving medication and technology that can help us better understand when and why certain interventions are useful and to make those interventions more beneficial and less risky to mothers and babies.
    On a final note, I understand your skepticism toward Ricki Lake and Ina May Gaskin. I just wish you had the same amount of skepticism for Dr. Amy, who is not a licensed medical practitioner and has not been for over a decade. She often says things that are inaccurate or completely false. Her arguments about the Netherlands' supposedly high perinatal mortality rate are utterly baffling. While the US does have a low perinatal mortality rate, it is only a single point lower than the Netherlands' perinatal mortality rate. The Netherlands’ perinatal mortality rate is identical to that of Denmark, Portugal, and the UK. (The UK has a home birth rate of 2%.) Its rate is actually lower than that of Ireland. (http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf) Based on how Dr. Amy discusses the Netherlands' perinatal mortality rate and home birth, though, one would assume it was markedly higher than our own or than other developed countries with low home birth rates, but it isn't. It's virtually the same, or within a point or two, which means home birth, attended by educated, licensed, and experienced medical professionals, in the right conditions, with low risk pregnancies, might not be that dangerous after all. I am not arguing that the Netherlands' low perinatal mortality rate with home births attended by doctors and midwives, in any way makes a good case for unsanctioned home births with direct entry midwives. Rather, my point is that "Dr." Amy's claims are not credible or backed up by the very statistics she claims support them.
    Part of being a skeptic--and more importantly, of being interested in science and evidence-based medicine--is doing your homework. Merely parroting crusaders, regardless of what they crusade for, you're not being very skeptical.

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  34. Also, on Ina May Gaskin: her baby that died was 2 months premature in 1970. In 1970, the survival rate for all preemies was only 18%. For babies 2 months premature, it would have been much lower. NICUs were a fairly new concept at the time and the technologies to save babies' lives still very much in development and experimental. For a baby born at ~32 weeks gestation, likely the only difference between a baby born in a bus and one born in a hospital is that at least on the bus, the baby died in its mothers arms instead of in a cot surrounded by medical practitioners.

    I'm not saying you have to like her or agree with her, but demonizing her based on specious claims that she allowed her baby to die in a botched home birth and refused life-saving medical care, which did not even exist at that time, due to her beliefs about natural birth, is pretty much as far from evidence-based skepticism as you can get.

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  35. Katie, I'm not parroting Dr. Amy. I'm agreeing with her. There's a difference. I'm not going to debate you on all the fine points because I don't have the time. I will say this: I wrote this article before giving birth to my second child. Remember that point where I mentioned that the Birth Center (licensed and employing CNMs) offered me a list of midwives who would do a homebirth, even though I was VBAC? As it turned out, I had a uterine rupture. In other words, if I had taken their list and gone ahead and had a home birth, my daughter Eulabee would be dead. I might be dead, too. That same Birth Center is no longer in partnership with the hospital across the street where I gave birth to my first child because a baby died because of their negligence in having sufficient safety protocols followed for transferring a birthing mother in distress to that hospital. (They forgot to have someone unlock the front door, and the paramedics couldn't get to the woman in time.) Again, that's a licensed birth center with CNMs - which is NOT something I'm arguing we should be skeptical of in this post. In this post I'm arguing that we need to be concerned about professional midwives who are not part of the medical establishment Hardly an extreme stance.

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  36. Katie, actually, it seems I do have a little time to debate some of the fine points you mentioned. I don't know what Dr. Tuteur being no longer a licensed practitioner has to do with anything. She stopped working as an OB to raise her kids and then decided to devote her time to her writing and speaking out. When people retire from a profession, all their knowledge, education, and experience doesn't just fall out of their brains. Finally, I referred to an article by Tuteur where she stated that the death of Gaskin's baby "could" have been prevented by medical intervention, not "would" have been prevented. Even if the chances of survival were low, they were certainly higher than on a bus where, according to Tuteur, the baby was alive although struggling to breath for 12 hours after birth and was not taken to a hospital. 1970 was a long time ago, but it wasn't 1870.

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