August 19th, 2010
I’ve held off commenting on the now notorious, and as of yet unpublished, Wax homebirth meta-analysis and the ensuing hullabaloo because I had wanted to keep negative birth politics to a minimum here on my blog. Then, the viscerally disturbing Lancet editorial came out a few weeks ago and WHOA. We’re starting to see some of the anti-homebirth roots coming to the surface. It’s time for each and every inspired individual to speak up.
A number of smart science minds have already broken down the methodological flaws of the Wax meta-analysis into comprehensible nuts and bolts so I won’t expound upon its junk science here, suffice it to say the authors’ conclusion of a tripled increase in neonatal mortality in homebirth is a gross misrepresentation of the actual data. Based on the ongoing anti-homebirth and anti-midwife smear campaign, one might reasonably surmise the misleading conclusion was crafted to incite more anti-homebirth rhetoric among the medical community.
Next up, the highly regarded and independent Lancet medical journal published an editorial “Home Birth – Proceed With Caution” in response the pre-release of the Wax paper. The overall tone of the editorial is dry and straightforward in its homebirth politics. There was some acknowledgment of the methodological flaws present in much of the “evidence” used to question the safety of midwife-attended homebirth:
“These data come from small observational studies that are subject to confounding. Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location……”
Yet credit is still given to the Wax paper as “the strongest evidence so far that home birth can, after all, be harmful to newborn babies.“ The editorial concludes with a deeply inflammatory, disturbing attack on childbearing women, offering us a glimpse into the depths of the anti-homebirth sentiment:
“Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk….”
I will enumerate the ways in which I find the statement revolting. It encompasses: 1) validation of poorly conducted research and data analysis, aka junk science 2) the belief that childbearing women are not capable of critical thinking 3) mother-blaming 4) the dead-baby card and 5) moral condemnation of mothers — “bad” mothers who make the well-informed, responsible decision to birth at home precisely because they believe it is the safest place for themselves and their babies and 6) the political semantics of babies at “risk.”
Should women be legally required to take folic acid supplements because failure to meet the daily requirement increase babies risk of spinal bifida? Should women be legally required to breastfeed their infants since failure to do so can leave newborns vulnerable to infections that breast milk can provide immunity against?
What the above statement says to me is: women don’t have “the right” to put their babies at risk — but physicians do. They have the right to subject babies to unnecessary and harmful policies, procedures, and cesareans that frequently put babies at risk. And women birthing in the hospital have the right to choose interventions that put the baby at risk, but women choosing to birth outside the medical conglomerate (for whom it cannot control and profit from) do not have the right to put their babies at risk. Now we’re getting somewhere. So the politically charged controversy over the safety of homebirth boils down to a set of ethics that applies only to women birthing outside the medical monopoly of maternity care? Should the assault on what women have the “right” to do with their bodies in labor come as a surprise? When in human history have there not been aggressive attempts to control women’s bodies?
I will talk about the role of “evidence” in convincing the maternity care conglomerate to support homebirth and out-of-hospital midwifery care in my next post.