Katerina Janouch: Natural Birth Quacktivist and Hooligan Supporter

Katerina Janouch is a journalist, sexologist and author. However, she is also a homebirth quacktivist. She fear mongers about hospitals and demonizes (elective) C-sections, believes that homebirth is just as safe or safer as hospital births, refuses to engaged with peer-reviewed scientific studies showing that homebirth has a 3x increase in neonatal mortality and other risks, thinks that providing false information and tricking women into homebirth is an act of feminism and that birth should be joyful. She has even cheered on when about a hundred masked hooligan supporters went around the Swedish capital and used violence against innocent onlookers before retreating by claiming that she tweeted in affect without knowing anything about it. This is a point-by-point refutation of all of her pseudoscientific claims and ends with touching on the partial lack of accountability of journalists.

Katerina Janouch on Opinion Live: fear-mongering about hospitals and C-sections

A recent episode of the Swedish televised debating show Opinion Live (31 March), a video blogger by the name of Vanja Wikström talked about how hard it was to get a planned C-section for her first birth and why this mattered to her. Wikström has a strong fear of the birth process, thinks the Swedish maternity care is underfunded and is concerned about the delivery complications that can arise from a vaginal birth. She talked to a midwife about her fears and the possibility of getting a planned C-section, but the midwife made her feel judged, shamed and guilted. Not only that, Wikström felt that the midwife started a “campaign of persuasion” and that the midwife “fought with tooth and claw” to get her to a vaginal delivery. She felt that the midwife did not even take her fears seriously and the encounter made her decide not to have a baby for several years. When she did got pregnant, she got another midwife who was much better, gave her the pros and cons of both vaginal delivery and C-section and let her chose for herself and she chose a planned C-section (but only got it at week 36).

The opposing party was Katerina Janouch, a mother of five (with two homebirths after three vaginal births at a hospital). She dismissed Wikström by suggesting that Wikström took an irrational decision out of fear and that therefore, women should not get a C-section if they want to. If Wikström had just met the people and midwives that support vaginal deliveries (and are supposedly against elective C-sections), she might have had come to a different conclusion. So right of the bat, Janouch dismisses and shames Wikström just like the previous midwife.

The homebirth quackery does not end there. Janouch goes on to claim that C-sections are a “luxury operation” and compares it with cosmetic surgery and even goes so far as to claim that most non-elective C-sections (“acute” and “catastrophic” C-sections, as she calls them) are caused by the hospital stress impacting the mother. She also continuously interrupt Wikström, hardly ever allowing her to talk. Later on, Janouch claims that the female body and the vagina specifically is “designed” to give birth, apparently being totally ignorant about the risk of maternal mortality in the past. Wikström retorts that she had to go through so-called aurora talks and meet with a specialist midwife and that she has done all of the things that Janouch thinks that she should have done instead of opting for an elective C-section. Janouch responds by fear mongering about C-sections, how it is not “natural”, how the child does not get gastrointestinal bacteria and so on. Wikström responds by pointing out the dangers of vaginal delivery and that half of all women get some injuries and about 7% of them get serious injuries (damage to the anal sphincter muscle).

After discussing costs, Janouch claims there is no excess mortality from homebirths, but later on we will see that this is not true.

Twitter exchange with Katerina Janouch

After her appearance at Opinion Live, I tweeted the following two scientific papers to her showing that homebirth triples neonatal deaths, has over a 10x the risk of a 5 minute apgar score of 0 and almost a 4x the risk of “neonatal seizures or serious neurologic dysfunction”.

Grünebaum, A., McCullough, L. B., Sapra, K. J., Brent, R. L., Levene, M. I., Arabin, B., & Chervenak, F. A. (2013). Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. American Journal of Obstetrics & Gynecology, 209(4), 323.e321-323.e326. doi:10.1016/j.ajog.2013.06.025

Wax, J. R., Lucas, F. L., Lamont, M., Pinette, M. G., Cartin, A., & Blackstone, J. (2010). Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. American Journal of Obstetrics & Gynecology, 203(3), 243.e241-243.e248. doi:10.1016/j.ajog.2010.05.028

I pointed out that an approximate 2 out of 3 babies that die during homebirth could have been saved at a hospital, and that promoting homebirth like she does means that she has blood on her hands.

She failed to respond to this scientific evidence. When I asked her if she did not want to comment the scientific evidence I presented about the dangers of homebirth, she replied that she could not be bothered with it. I rhetorically asked if I should interpret her answer as her intentional advocacy of dangerous and unscientific methods and asked if she had no shame. I also highlighted a perceived lack of accountability when journalists like her spew nonsense. The interaction turned even more unproductive when she, instead of making arguments defending her position, told me to leave her alone, that she stood firm in her belief and that I should study homebirth in other countries. I rhetorically replied with “you mean countries like the Netherlands?” and linked a paper showing homebirth is more dangerous even in the Netherlands. I followed up by emphasizing that it is sad that she completely failed to engage in a reasonable discussion about the evidence against her position and instead chose to play the martyr card. After that, I just blocked her. Some time later, she also blocked me. Cached versions of our twitter exchange can be found here and here.

Katerina Janouch has advocated homebirth in newspaper opinion piece

In 2002, Janouch wrote an opinion piece together with Cina Madison and a few other supporters of home birth. Madison was the former director of the Swedish organization Give Birth at Home (“Föda Hemma”), a now defunct non-profit group promoting home birth that never had a turnover over 1000 SKR (~123 USD).

In the opinion piece, Janouch and others claim that home birth is just as safe as hospital births, both for the mother and the child by referencing a meta-analysis by Olsen et al. (1997):

Perinatal mortality was not significantly different in the two groups (OR = 0.87, 95% CI 0.54-1.41)

However, what Janouch and her collaborators did not say what that the error bars were very large: the 95% confidence interval (CI) ranges from an odds ratio of 0.54 (homebirth has a considerably lower perinatal mortality than hospital births) to an odds ratio of 1.41 (homebirth had a considerably higher perinatal mortality than hospital births). So what Janouch is claiming is that there is no difference between the two groups in terms of perinatal mortality simply because the difference was not statistically significant. This, however, is not true. Statistical non-significance does not imply equivalence. This is because statistical non-significance can depend on many other factors, in this case the overall rarity of perinatal mortality (but see paper about neonatal mortality above) and the large uncertainty in the dataset used.

Janouch and co-authors also fetishize ‎natural birth by claiming that natural birth is safe (my translation):

In reality, giving birth is an eminently natural process, that in the vast majority of women happens all on its own without any responses or intervention whatsoever.

Perhaps they have never heard about maternal mortality. According to the WHO, 830 women die per day due to pregnancy or giving birth and most of them are in developing nations. In the past, maternal mortality was much, much higher. So yes, being pregnant and giving birth are processes that is associated with considerable danger for humans in the natural state.

They finish off by offering their own personal anecdotes (my translation):

Those of us who have given birth at home can also testify that it is something completely fantastic. For those of us that can compare giving birth at a hospital with giving birth at home, the difference is enormous.

The reality, of course, is that this is anecdotal evidence and completely useless in a scientific discussion. That is because we can just as easily present cases were homebirth has gone horribly wrong with mothers and babies either dying or getting permanent serious damage. But those who have experiences those kinds of homebirths are either not here or not interested in signing onto the opinion piece by Janouch and friends.

To put it more bluntly, it appears as if homebirth quacktivists are more interesting in their own privileged relaxation than in the health of babies and mothers. A horribly erroneous prioritization.

Katerina Janouch has co-authored a quack homebirth book

As if all of this was not enough, Janouch and another journalist homebirther by the name of Anna Toss wrote an online book about homebirth called Giving Birth at Home (“Föda Hemma”) in 2005.

The book starts by describing a homebirth scenario were the midwife does not do anything, the mother takes a bath and gives birth on her own in the bed while primal screaming. Yet it is not at all clear that this is the way a typical birth works. For the average first-time mother, Mayo Clinic states that it is somewhere between 6 to 12 hours. At no point during this first chapter are alternative experiences presented, including mothers and babies that have died or suffered moderate to severe injuries as a result of homebirth. At this point, it is clear that this online book is filled to the brim with bias.

In a short section about “if the baby dies”, they write that “it happens” and that the responsibility, guilt, sadness and pain feels the same if the child dies during a homebirth or at the hospital. This shows that they must realize that there is a problem with children dying during or after a homebirth. It is also clear that they do not even care about this issue. Of course the responsibility, guilt, sadness and pain feels worse if the child dies directly or indirectly due to a homebirth than a hospital birth. After all, 2 out of 3 children that dies during a homebirth could have been saved during a hospital birth. The feeling that many mothers who had a botched homebirth get against themselves and against the person that conned them into having a homebirth with faulty claims and lies is probably substantially worse in a lot of cases. After all, it is doubtful that a child that dies during a hospital birth (despite having access to the world’s best health care) would have been saved by a medically unqualified people attending a homebirth.

Yet another section about reliving pain during childbirth is decisively anti-medical and recommends acupuncture needles over the pubic bone, hip or back, as well as in the forehead, because it allegedly “helps the mother to relax between contractions”. In reality, acupuncture is probably clinically irrelevant placebo.

In perhaps the most absurd part of the book, they list ten alleged benefits of homebirth: (1) no need to move, (2) we decide, (3) we know the midwife, (4) we can be and do whatever we want (5) calmer start for parents and children, (6) benefits for the family, (7) choice, (8) hospitals have flaws, (9) a feminist perspective and (10) giving birth should be joyful.

However, this is not really a list of ten items. Instead, several of them are really just duplicates of each other. Alleged benefit 1, 2, 3, 4, 5, 6, 7 all have to do with perceived autonomy and are not qualitatively different things. Basically, the authors claim that it is a hassle to move, that the father could walk around in the house and eat whatever he wants (which of course is possible during hospital births as well because the guy could stay at home if we values eating stuff in his home so much), familiarity and emotional safety with the midwife etc. are all subjective beliefs that not all women share.

The link to the post about how hospitals have supposed flaws is a broken link that leads nowhere. No post on that blog with that name or content exists. Somehow, they must have deleted it. Wonder why? Was it because they realized it was pseudoscientific nonsense?

The second to last alleged “benefit” claim that homebirth is somehow a feminist struggle, but promoting homebirth with scientific errors, emotional manipulation and fear mongering about hospitals and painkillers denies the informed consent of the pregnant woman. This is deeply anti-feminist and severely threatens the autonomy of the woman in question. The fact that these homebirth quacktivists would go so far as to abuse feminism in order to promote their nonsense is despicable.

The final alleged “benefit” is perhaps the most bizarre one: giving birth should be joyful? Although not going so far as you suggest that births should give the mother an orgasm, they do quote Sheila Kitzinger, author of “Birth at Home”:

A process that continued trough the labor were the woman is free to find her own rhythm, to express her femininity and her sexuality and be herself, without inhibitions and shyness and where even the man is free to express his own feelings and become a father instead of being an onlooker.

Why does a woman need to “express her sexuality” during a birth? Clearly, all of these are subjective “benefits” that a lot of people can experience during a hospital birth as well. There does not seem to be anything intrinsic in the things in the above quote that is reserved for homebirths.

Katerina Janouch “accidentally” supported an angry and violent mob

In January of 2016, an angry mob of about 100 right-wing extremists went around in central Stockholm and attacked bystanders. Some of them were masked and they were allegedly organized against young homeless people from northern Africa.

On twitter, Janouch wrote and asked if “is there a civil war against the Moroccan street riffraff?” and “For the first time in my life, I am team ‘Hooligan'”. She later stated that she did not know what it was about and that she regretted the phrasing used, that she used wrong facts and tweeted in affect. Sources are available here, here, here and here.

With this low capacity for elementary fact-checking and inability for emotional regulation, it is not strange that she supports the pseudoscience of homebirth. It is also problematic that there seems to be a partial lack of accountability for journalists who spew nonsense and then refuse to engage with counterarguments and evidence.