The internet is a tremendous source of health information. Unfortunately, it is also a tremendous source of misinformation. How can a lay person tell the difference?
I've designed the following scoring system to distinguish between factual information about childbirth, and the pseudoscience and made up mumbo-jumbo that passes for "knowledge" among natural childbirth and homebirth advocates.
If a website or publication does not get a grade of at least 50 points out of 100, you should ignore the site as worthless or worse, an active purveyor of falsehoods. The beauty of this system is that it is not restricted to websites. The same evaluation process can be used for books, pamphlets, editorials, etc.
Every site is given 100 points to start. Points are subtracted as follows; it is possible to end up with negative points.
1. Subtract 80 points if it is written by a lay person.
For the life of me, I cannot understand how anyone could be gullible enough to follow medical advice from a layperson.
2. Subtract 70 points if is written by a doula or childbirth educator. Subtract 50 points if it is written by a direct entry midwife.
Doulas and childbirth educators are paraprofessionals who lack direct experience with patient care. Looking to them for medical advice about childbirth is like asking a stewardess for advice about aerodynamics.
Direct entry midwives (like CPMs) are pseudo-professionals. They lack the minimal education and training required by midwives in every other first world country and are considered unqualified to practice in every other country in the industrialized world. They are birth "hobbyists" who like to attend births but couldn't be bothered to get a real degree in midwifery.
3. Subtract 40 points if it makes the claim that women were "designed" to give birth.
In the first place, no one is "designed." We are products of evolution and evolution favors survival of the fittest, NOT survival of the perfectly fit. In the second place, to the extent that you wish to use such language, every part of the body is "designed" for specific functions, but that doesn't mean they are always performed correctly. Eyes are "designed" to see, but that doesn't prevent a large proportion of the population from being nearsighted.
4. Subtract 40 points if it insists that sanitation is responsible for the massive drop in neonatal and maternal mortality.
The great developments in sanitation (and the drops in general mortality that followed) occurred in the late 1800's with the discovery of the germ theory, and the implementation of public health measures like clean water, sewers, etc. The precipitous drop in both perinatal and maternal mortality did not start until the late 1930's with the advent of antibiotics, blood banking and improved anesthesia.
5. Subtract 30 points if it makes the claim that "obstetricians" are surgeons.
Just because someone knows how to do surgery doesn't mean they will do it for every case they see. Ophthalmologists are surgeons, but they do surgery as a last resort. Dermatologists are surgeons, but you wouldn't hesitate to see one to check for precancerous lesions. Ear, nose and throat specialists are surgeons, but you wouldn't hesitate to see one for problems with your ears, nose or throat.
6. Subtract 100 point if it includes "birth affirmations."
Birth affirmations are an endorsement of magical thinking, the belief that our thoughts have the power to cause various events. Magical thinking has no place in science.
7. Subtract 80 points if it claims that childbirth outcomes are affected by "fear."
That is a racist, sexist claim made up by Grantly Dick-Read, the father of natural childbirth, to back up his lie that "primitive" (read black) women gave birth without pain.
8. Subtract 50 points if it mentions "pathologizing birth."
Childbirth is and has always been, in every time, place and culture, a leading cause of death of young women, and the leading cause of death in the entire 18 years of childbirth. The "natural" death rate in childbirth is about 1% for women and 7% for babies. Obstetrics is about preventing those "natural" deaths.
9. Subtract 20 points if it claims that the World Health Organization recommends a C-section rate between 10-15%.
The World Health Organization quietly withdrew that claim in 2009, acknowledging that there was NEVER any evidence to support it.
10. Subtract 40 points if it claims that the Netherlands has excellent mortality rates.
The Netherlands, the first world country with the highest rate of homebirth, as one of the worst perinatal mortality rates in Western Europe and poor maternal mortality rates.
11. Subtract 50 points for the claim that puerperal sepsis (childbed fever) would have been eradicated if only people hadn't ignored Semmelweis.
Semmelweis did not publish his findings for nearly 20 years, probably because he was battling serious mental illness. When he did publish, his writing was extremely difficult to understand and the key point was buried within reams of text.
12. Subtract 30 points if it includes the claim that "good nutrition" improves pregnancy outcomes in any place besides the developing world.
There is NO scientific evidence that nutrition plays any role in pregnancy outcomes in first world countries, with the exception that folate supplementation reduces the incidence of neural tube defects like spina bifida.
13. Subtract 50 points if it claims that "no study has ever proven hospital birth to be safe."
No study has ever proven in hospital surgery is safe than home surgery, but that doesn't mean that it isn't.
14. Subtract 40 points for the claim "babies die in hospital, too."
The issue is not whether babies die. As I've already pointed out, childbirth is inherently dangerous. The key point is that FEWER babies (proportionally) die in the hospital.
15. Subtract 30 points if it includes an anecdote about obstetric malpractice in a hospital. Subtract an additional 20 points if that episode of malpractice has been official punished.
Malpractice can occur any time human beings are involved. There is no evidence that there is more malpractice among obstetricians than among midwives. The difference is that hospitals and medical boards have systems of accountability. Homebirth midwifery does not hold midwives accountable for the tragedies that occur at their hands.
16. Subtract 20 points for mention of Dutch midwifery studies without also mentioning that Dutch midwives delivering low risk patients have higher mortality rates than Dutch obstetricians delivering high risk patients.
Moreover a recent study showed that Dutch midwives have a 30% higher mortality rate than Flemish midwives who work in hospitals just across the border.
This list is far from exhaustive; it merely hits the high points of the standard false or misleading claims of NCB and homebirth advocates.
To see how this rating system works, we can apply it to an opinion piece that appeared recently in The Sydney Morning Herald last week. It is written by celebrity Tara Moss (-80 points).
Here are the relevant quotes:
Childbirth is still seen by many as something best ''cured'' by a doctor in hospital. (-50 points)
... the largest study conducted into home births (examining 529,688 births and published in BJOG: An International Journal of Obstetrics and Gynaecology (-20 points)
Some of the most important medical advances in the past century have had to do with proper sanitation. (-40 points)
Puerperal fever, or ''childbed fever'', took the lives of large numbers of mothers and babies for two centuries because - wait for it - doctors did not believe in washing their hands between patients and many even performed autopsies and delivered children without disinfecting their hands between. (-50 points)
... we now have a far better understanding of prenatal nutrition needs (-30 points)
we may as well use the tragic case of Grace Wang, who had antiseptic injected into her spine instead of an epidural in a mix-up at a Sydney hospital last year. (-50 points)
In the Netherlands, about 30 per cent of women give birth at home, providing the ideal opportunity for a long overdue large-scale study into its safety. (-40 points)
The score for Ms. Moss' opinion piece? She started with 100 points, but when we subtract 360 points for false or misleading statements, the pieces ends up with -260 points. That's an F by any stretch of the imagination.
With this system it's easy to find out if a childbirth website or publication is providing accurate information or merely pseudoscientific mumbo-jumbo masquerading as "knowledge." Just apply the simple criteria above to determine if a childbirth website is worthwhile or worthless.
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