Beyond the Birth Wars

The Grieving Parents by Kathe Kollwitz

Since writing two essays which address the natural childbirth movement (first in 2011, then again last week) I feel a bit as if I've been sucked into the tunnel vision of the Birth Wars. 

Taking a step back, I see it all as a paltry debate among those of us who are lucky enough to have quality and choices when it comes to our health care.

Don't read me wrong; it's clear that there is a whole lot of natural childbirth woo out there that is distinctly anti-science, anti-medical establishment, and anti-feminist. It is clear that lay midwives attending high-risk births in homes instead of hospitals has resulted in the preventable deaths of babies and women. 

It's just that in reading about the broader picture of birth in both America and across the world, I see a much greater concentration of death and harm among the economically disadvantaged, and especially women of color. I feel compelled to check my priorities. It's not that every woman and baby doesn't matter. It's that every woman and baby does matter.    

The Widow II by Kathe Kollwitz

For many pregnant women and their newborn babies, the difference between rich and poor is the difference between life and death. For instance, according to Save the Children's State of the World's Mothers 2013, in Cambodia, babies born to the poorest 20% of parents have a 144% elevated risk of death compared to babies born to the richest 20%. More than a quarter million women die every year because of complications from childbirth.The dead babies (and consequentially the grieving mothers, many of whom must endure their grief without sufficient social or mental health support) number over a million every year. Without question, most of these deaths are preventable, connected to, and exacerbated by the conditions of poverty.   

America's GDP doesn't make Americans immune to the deadly disadvantages of poverty. In 2011 the World Health Organization reported that the USA had a higher newborn mortality rate than 40 other nations. And a 2010 publication by Amnesty International reported about the high rates of maternal deaths and complications associated with pregnancy and birth for American women. 

In addressing these issues, natural childbirth advocates cry out about overused medical interventions and unnecessary c-sections. But it seems apparent to me that the problems for women and babies at higher risk begin long before a woman becomes pregnant. Food insecurity, poor nutrition, unsafe and/or highly stressful living conditions, and inconsistent access to preventative health care set women up with issues such as high blood pressure, diabetes, and obesity, all of which can easily lead to complications in pregnancy, which then may very well require all those interventions and c-sections. 

Then there's the elephant in the room that nobody wants to talk about, and often if anyone does, they are shut down: racism. Race is the strongest predictor of outcomes for birth in America (with black women and babies suffering the worst outcomes), and yet when these huge disparities are reported and discussed, the focus tends to stick exclusively to economic disadvantages and ignore the *gasp* possibility that black women are treated differently by doctors, nurses, and other health care workers (not to mention employers, teachers, social workers, or anyone else they encounter and who might impact their lives.) But is it so hard to imagine that pervasive and damning stereotypes of pregnant black women, especially poor, young, pregnant black women, could have at least a subtle impact on the way they are handled and advised by medical professionals during prenatal care, birth, and postpardum care? 

Authors of the 2010 article Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach, outline a 12 point plan which includes suggestions which seem indirectly connected to pregnancy and birth, such as "Invest in community building and urban renewal", and "Reduce poverty among African American families." People who enjoy strong communities and financial security often take their huge benefits for granted and fail to see how they dramatically impact a person's overall health, behavior, and choices. 

Of course the broad suggestions in this 12 point plan need to be refined into specific programs, many uniquely tailored for particular communities, but the overall point is sound. 

The issues that result in dead or injured women and babies at birth can't be solved by either warm and fuzzy homebirth midwives or even a well-trained OB with a scalpel. The physical, emotional, and social needs of impoverished women not being met are far too great. 

On Some Liberals' Distrust of Doctors

Baby Gaga is in for a checkup.

I make no secret of the fact that I'd be thrilled if one of my kids grew up to be a medical doctor. Doctors have job security and respectable status in society, which would please any parent concerned about our kids' futures. But another part of the appeal to me is the ethics. A doctor's job is to use knowledge obtained through science to try to heal people. What could be a more noble profession from the secular humanist perspective? 

The medical field isn't for everyone. Not only does it require a strong ability to study difficult subjects such as organic chemistry. There is also the gross factor: blood, guts, tissues, fluids, horrible smells, and basically being able to look at human bodies just as a mechanic looks at a car. I couldn't even handle dissecting a frog in high school (I got light headed and ended up being excused to the library. Oddly enough, I'm okay cooking a chicken.) 

Monkeys need doctors too!

Given the rigorous training and noble objectives, it surprises me that not everyone shares my deep respect for the medical profession. 

Some of my friends are dismayed that I would encourage my kids to be doctors. It's sort of the bizarro version of adults who discourage kids from taking an interest in the arts for fear they'll grow up to be impoverished, drug-addled bohemians. In this case, the fear is that as doctors the kids will grow up to be arrogant automatons, brainwashed by scientism and serving the corporate greed which supposedly drives the medical establishment. 

These are the sort of liberals - mostly highly educated, middle class, and white - who drive today's Anti-Vaccination, Natural Childbirth, and other Alternative Medicine movements. 

I was reminded of this sort of contempt toward doctors while reading/viewing New Mom's Uncensored Photos Reveal the Beautiful, Messy Reality of Homebirth. It includes an interview with writer Ruth Fowler followed by the live documentation she and her photographer husband did of her son's birth on Twitter and facebook. 

Right off in the video, the interviewer refers to the "intrusive" nature of modern "technology", and it is clear that this story is framed as a human interest story about the beauty of a natural childbirth in contrast to the sterility of a conventional hospital birth. 

Ruth Fowler describes herself as not the extreme. She says to the interviewer, 

I'm not the kind of crunchy, granola mama who's like "Women who go to hospitals are bad mothers" I'm somewhere in the middle. My birth experience kind of reflects that. I'm somebody who had a natural, un-medicated home birth, but then I had to go to the hospital afterwards to get treatment that probably saved my life. And so I'm not an anti-hospital person. I just wanted to birth at home with my husband, with the people I care about, in the environment I care about. 

Doctor Lysi and Nurse Bebe get to work.

I found this statement puzzling. First of all, her birth experience doesn't reflect a moderate position. She had to be transferred to the hospital because she had a postpartum hemorrhage and would have certainly died otherwise. So according to Fowler, she isn't extreme because her distaste for the medical setting isn't so severe that she's willing to die to avoid it. That's a pretty low bar for extremism. 

She makes a point of saying she chose an "un-medicated" birth, but then used a whisky sour to help ease the pain. So in her view drugs designed to ease the pain of contractions and dispensed by medical professionals are undesirable, but hard liquor is just great? I'm not faulting her for the whisky sour (I've been in labor without pain meds for 24 hours, I know what that feels like), only the hypocrisy. 

Even though the headline of the Huffington Post article includes the word "messy", nothing messy is actually shown. The series of photographs show a beautiful, pregnant woman enduring great pain with dignity and ending up in a naked embrace with her newborn son. Then, suddenly, there is a jump to a couple of photos of mom and baby (hauntingly gorgeous) in the hospital, and the statement: 

… Nye was occidental [sic] posterior. He flipped to come out but shoulder dystocia ripped me apart. Then the placenta wouldn’t come out – some medical termI don’t know – which basically mean, it tried to detach and ripped more of me out! So I lost over half my blood and got transferred by great emt’s [sic] after the birth.

Felt awful but now recovering in UCLA Santa Monica on a TON of fentany1 (it kicks ass!) and blood transfusions and will be back home with Jared and Nye Soledad Iorio tomorrow. This mad experience Just reiterated how goddamn crazy birth is…

I don’t want to be an ass but this experience has taught me birth is beautiful and primal and mysterious and painful as ****. Thanks to my amazing midwife Racha Tahani Lawler for getting me through that, and her assistant Tanya and my brilliant doula Allegra Hill.

At this point my mind is screaming, what the fuck!? Does Huffington Post not realize that the messiest (and also terrifying) part of this birth experience has gone completely undocumented and downplayed? On her blog The Skeptical OB, Amy Tuteur lists crucial elements of this experience that have been omitted from any photographic or written documentation, including: 

Where is the photo of the postpartum hemorrhage with the blood pouring from between your legs?

Where is the photo of your husband’s face, horrified and frightened, as it dawns on him that you may bleed to death and leave him as a widower with a new baby?

Where is the photo of the EMTs hustling you out the door, racing against time to save your life?

What I find also concerning (and is noted, too, by Amy Tuteur) is how Fowler makes a point of thanking all the people who made her feel warm and fuzzy, but then neglects to thank the doctor/s and other medical staff who literally saved her life. Just as she wanted to give birth at home because that environment was one she "cared about", the midwife, her assistant, and doula are people she cares about, and the medical staff are to be treated as cogs in a machine. 

Little sis tries on big sis's lab coat.

A lot of people complain about the poor bedside manners of doctors as if the rift of contempt and distrust that often exists between doctors and patients were all the fault of one side. And as if things like a jolly bedside manner are worth a damn when one is lying on a table bleeding to death. 

This really gets me on a personal level since I am someone who attempted a totally natural childbirth with my first kid and vaginal birth with a CNM. (Neither were homebirths. I view homebirth as a reckless choice.) With both labors I experienced complications which ended with necessary surgeries. In the case of my second child I had a uterine rupture that threatened the lives of myself and my child. 

And I'll tell you what, while I appreciate the care I received from the very professional CNMs who did my prenatal care and were there with emotional support while I was in labor, I damn well feel immense gratitude toward the skilled obstetricians - both stern, serious-looking women - who opened me up and got my babies out safe! 

Sure, Fowler's not saying other people should do things the way she has chosen to do them. But she is romanticizing her experiences and then allowing that prettied-up narrative to be presented as reality. For a writer using documentation supposedly to better understand her own experiences, she seems utterly oblivious to the irrational prejudice she has against the medical establishment. 

My daughters may grow up to enter any number of careers. Right now my four-year-old wants to be a ballet dancer and painter, either of which would be amazing paths to follow. I certainly don't discourage those interests. But if either of them happen to grow up to be a stern, serious-looking obstetrician who saves the lives of women and babies, I'd be as proud as if they were Martha Graham or Louise Bourgeois. 

Kris Kringle, Kids, and Kandy

Miracle on 34th Street is the most anti-secular-humanist holiday film ever made.

Just stick with me on this for a bit.

The skepticism of Doris Walker, a bright, capable, divorced mother, should be viewed as a strength. Instead, it becomes apparent that this trait, along with her drive to instill a skeptical outlook in her daughter, comes from a place of personal pain and fear. The message is clear; skeptics, especially women skeptics, are callous people with trust issues, and in need of saving.

Fred Gailey, a handsome attorney, comes to Doris's and her daughter Susan's rescue. He's concerned about mom's refusal to teach Susan fairy tales. Fred wins Doris over with an incredible display of faith and friendship; he takes in Kris Kringle, the Macy's Santa who Doris has hired, and who claims to be the real Santa Claus. When Kris is threatened with being locked up in a mental institution, Fred successfully defends him in court, arguing that Kris is indeed the one and only Santa Claus.

Lip service is paid to deeper values, mostly by Fred (he is an attorney, after all):

It's not just Kris that's on trial, it's everything he stands for. It's kindness and joy and love and all the other intangibles.

But if you really listen to what Fred says, it's vague enough to be open to interpretation. Worse yet is the implication that belief in supernatural forces is required to experience awe, joy, or love.

Look Doris, someday you're going to find that your way of facing this realistic world just doesn't work. And when you do, don't overlook those lovely intangibles. You'll discover those are the only things that are worthwhile.

A holiday story with Santa that I like much better: Tim Burton's "The Nightmare Before Christmas."

The fuzzy meaning of all Fred's flowery talk is, in the end, overshadowed by another message, one of self-absorbed materialism. Even after Doris is converted to a happier woman and in love with good ol' Fred, and Kris Kringle wins his freedom, Susan remains doubtful and depressed all the way up until when Kris Kringle gives her a house. (Technically Doris and Fred have to buy it. But Kris magically made Susan's dream house appear for sale at just the right time and place.) Not only is faith necessary to experience love, but to keep children happy, we must buy the stuff on their wish lists.

If all that wasn't enough, the film even justifies violence. Kris Kringle is on trial because he believes he's Santa Claus, right? Well, that and the fact that he thumped a psychologist, Granville Sawyer, on the head with his cane. Thumped him so hard that Sawyer is left with a goose egg so large he can't wear his hat. What did Sawyer do to deserve it? Kick a puppy? Smack a baby? No. He mis-diagnosed and mis-advised another character who had come to him for help. Apparently if you're righteous enough, you can skip diplomacy and appeals to proper authorities, and go right to smacking naughty people around.

Miracle on 34th Street is a product of a culture that champions faith, and regards doubt with contempt. A world where discreet forces of good and evil exist, and where virtue will be cosmically rewarded, while sin is punished. It achieves this by pulling on our heartstrings, and getting us to turn our brains off. The good guys Fred and Kris are respectively handsome and adorable, and both tremendously charming. The villain Mr. Sawyer is weaselly and ugly.

Santa Claus is one of modern, American society's sacred cows. To be more specific, convincing children that Santa Claus is real is thought to be virtuous. Just as Fred expresses dismay toward Doris for denying Susan fairy tales, real people express dismay when other adults refuse to play along with the Santa myth. As a school teacher, I knew to keep my mouth shut around the kids, and say, "Ask your parents."

Some people in my life have expressed concern that being denied Santa realness, my kids are missing out on an important part of their development. I'd love to know what we're preparing kids for when we knowingly blur the lines between reality and fantasy. To pray, instead of going out and doing something? To be complacent in the face of injustice in hopes of pie in the sky when we die?

It's offensive to accuse adults of lying to children about Santa. But what else do you call it when one person tells another person something they know to be false? A common defense is to insist that Santa is something figurative (read Yes, Virginia, there is a Santa Claus), and then ignore that the kids are taking us literally.

And kids are taking us literally. Five year olds aren't musing over the warm, fuzzy feelings they associate with the jolly fiction of Santa Claus. They imagine a chuckling fat man in a factory full of elves.

Another argument is that it's not lying because young kids don't distinguish between fantasy and reality. Based on current understanding of children's cognitive development, that's wrong. Developmental psychologist Alison Gopnik said in an interview for Seed magazine:

Both Piaget and Freud thought that the reason children produced so much fantastic, unreal play was that they couldn't tell the difference between imagination and reality. But a lot of the more recent work in children’s theory of mind has shown quite the contrary. Children have a very good idea of how to distinguish between fantasies and realities. It’s just they are equally interested in exploring both.

Oh no, it's a monster!

In episode 188: Kid Logic of This American Life,  Gopnik mentions a specific experiment done by colleague Paul Harris. Harris had children imagine either puppies or monsters inside a box, and then observed the children's reactions to the box when left alone. Even though the children all agreed the box was really empty, up until the age of 6 or 7, the children who imagined a puppy tended to peek inside the box, while the ones who imagined a monster tended to move away from it. In his article Monsters, ghosts and witches: Testing the limits of the fantasy/reality distinction in young children, Harris concluded that,

Although young children are able to distinguish fantasy from reality, they do not necessarily understand that a fantastic entity cannot transform into a real one.

I suspect Spencer (my older child) sometimes wonders if Santa is real. They're still the age where, according to Harris's experiment, they doesn't understand that the fantastic cannot become real. When we talk about Santa, I don't lie. I tell our kids he's a lovable character like Dora.

Kids make their own magic. They don't need our help indulging in fantasy. They do need to know that they can trust us.

Santa is a regular character on one of Spencer's favorite shows, "Pucca". Here he is performing the dreidel song for an audition. 

Anyway, why this need to believe fictional characters are real to be enthralled and in awe by them? My kids enjoy Santa in the same way they enjoy Elmo. Spencer knows Elmo is a puppet.  In an interview with Rove McManus, Kevin Clash (the puppeteer of Elmo) said that children who come on the Sesame Street set,

...normally don't look at me. They just look at me like someone whose carrying around their favorite friend. Especially with kids, they keep their imaginations.

The magic isn't that the kids believe the puppets are alive. They know it's a show, but it's such a high caliber performance that suspension of disbelief is easy and natural.

We don't need to have faith to experience love and awe. We simply need to be human.

In the final scene of Miracle on 34th Street, we see that Fred and Doris didn't have faith in Kris after all. Upon seeing Kris's cane in the corner of the house, Fred and Doris fall silent, their expressions deadly serious. In a sober tone of voice, Fred remarks (referring to his victory at trial), "Maybe I didn't do such a great thing after all." The implication is that Kris never needed saving because he truly is a supernatural being.

"Lovely intangibles" aside, in the end, what is most titillating about the film is the idea that Kris Kringle, a living, breathing, flesh-and-blood person, might be the real Santa Claus, imbued with real magical powers. Fred's virtue by itself isn't enough. Virtue is instead a means of getting mystical forces on our side so they'll step in and help us. To put it another way, be good and you'll get to heaven (or at least fall in love and get a pretty, little house in the burbs.) Ah, yes, viewers' escape from reality is complete.

CAUTION: Trivial entertainment, like candy, should be consumed in moderation and not confused with stuff that's actually good for us.

My dirty little secret is that I love the film Miracle On 34th Street. I get a jolt of satisfaction when Kris Kringle thumps that weasel Sawyer. I'm swept away by Fred's good looks and charm, impressed by Doris's poise, and amused by Susan's deadpan delivery set against Kris Kringle's boyish charm. I feel a little thrill every time those giant sacks of letters to Santa from the USPS are poured over the cranky judge's bench. As I write this, exhausted after a long day of work and watching after the kids, all I want to do is put on a Snuggie and curl up on the couch with a cup of hot cocoa and watch this film. Cinematic candy, yum!

But hey, at least I don't fool myself into thinking the message of Miracle on 34th Street is anything other than feel-good bullshit.

And I don't tell my kids that Santa is real.

(If you'd like to read even more of my rantings about Santa Claus, last year I wrote, Dumping the Santa Myth.)

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.