The Astonishing Quackery of the Natural Birth Movement
There are few large areas in modern life that has not been infested by pseudoscience and quackery. From quantum woo and fake bleach ‘treatments’ for autism to genocide denial and conspiracy theories about mass shootings, it seems to be all around us.
One of the greatest achievements of modern medicine is reducing maternal mortality during childbirth. This has, to a large degree, been due to increased understanding about pathogens and how they are spread as well as how to handle incidents during childbirth with medical competence. Yet birth has not escaped the long reach of pseudoscientific nonsense.
Homebirth
Some people who reject the modern world that science has built and prefer to have a planned homebirth. Compared with hospital births of the same risk, planned homebirth triples neonatal mortality rates and 10x increased the risk of a 5 minute Apgar score of 0.
In particular, homebirth quacks often use certified professional midwives (CPMs) rather than certified nurse midwives (CNMs). This might seem like a trivial difference, but CNMs are nurses with a master’s degree in midwifery whereas CPMs only require a high school diploma and some correspondence courses.
Birth in the wilderness
As if homebirth with an underqualified midwife was not unreasonable enough, some have even decided to give birth in the middle of wilderness, far from human settlement and medical help should something go very bad. In fact, the American cable/satellite TV channel Lifetime created a television series called Born in the Wild, where they covered six families and their wilderness birth in a bizarre maelstrom of narcissism, medical danger and pseudoscientific quackery. In some cases, the nearest medical help was 30 minutes by helicopter. If something were to go wrong, the mothers and their babies might very well end up seriously harmed or dead. Not to mention the fact that a stream in some random forest is probably not an ideal location as far as cleanliness is concerned.
Lotus birth
Lotus birth involves letting the umbilical cord stay attached to the child for an extended period of time after birth. This is done because of questionable beliefs about health. In reality, leaving the umbilical cord opens up for pathogens from the rotting placenta to invade the newborns body and risks harmful infections. This is of such a concern that Royal College of Obstetricians and Gynaecologists issues a statement warning for these dangers:
[…]
“If left for a period of time after the birth, there is a risk of infection in the placenta which can consequently spread to the baby. The placenta is particularly prone to infection as it contains blood. Within a short time after birth, once the umbilical cord has stopped pulsating, the placenta has no circulation and is essentially dead tissue.”
Orgasmic birth
Some natural birth quacks believe that a birth is not perfect unless the mother gets an orgasm during birth. It denies the facts about physiology in childbirth and shames mothers who do not attain this experience. If that was not enough reasons to call orgasmic birth a bizarre delusion, some doulas even attempt to masturbate the mother during the birth process by touching the clitoris. This can qualify as sexual abuse or assault in some countries and regions.
Water birth
While giving birth outside hospitals or medical centers, some mothers want to give birth in a pool or a bathtub.
Like lotus birth, expert groups such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have released a statement highlighting the dangers of this practice:
The complications discussed by these experts in the paper in question are maternal or neonatal infections, problems with neonatal regulation of heat, umbilical cord rupture leading to hemorrhage and shock in the newborn, respiratory distress and electrolyte imbalance, drowning, seizures and suffocation.
Dolphin midwives
Some homebirth quacks do not only advocate water births, but water births assisted by dolphin midwives. Yes, you read that correct: assisted by dolphin midwives. Why? Presumably it is because they have been convinced by Disney movies and zoos that dolphins are friendly creatures that would do no harm, but in reality, dolphins are predators and can harm mothers and newborn and there is also the same risks as water births without dolphins
Eating placenta
Many non-human mammals eat the placenta after birth. This is largely due to the mother gaining nutrition, but placentophagy is extremely rare to non-existent in humans, both historically and today. This might be explained by the fact that the placenta can easily get infested with pathogens that are harmful to humans.
Conclusion
Reading about natural birth quackery and its very real risks and consequences is a weird experience. Just when you think you have come across the most ridiculous nonsense you have ever heard about when it comes to quack birth, the next thing shocks you even more.
What I’ve never understood is why there isn’t simply an attempt to make the hospital birth experience more palatable. The data obviously show it’s safer, yet there’s clearly some dissatisfaction about the experience. I’ve always thought that rather than abandoning hospitals altogether, all of this time and energy trying to forge new “alternative birthing” movements should be spent trying to improve what hospitals do.
One simple thing would to simply let women deliver standing up. Laying on your back is a horrible position for giving birth, but there’s no reason why hospital policies couldn’t change to allow other birthing positions.
If water births are what women want, why not simply open a few tubs in a hospital or some other outpatient medical setting?
I guess ultimately I just see why the people in this argument are so black and white about the issue. They go from 0 to 60 in less than a second.
Probably due to costs and the disconnect between doctors and natural birth activists. Likely ties into the perceptions of doctors being super-stressed and only having a few minutes with each patient.
That would be very productive, but a lot of natural birth activists are anti-medicine on a larger scale and the contempt for hospital birth is just one way this manifests.
I think the classic delivery position is done because 1) it is easier for the health care professionals, 2) reduces risk of secondary tears and 3) decreases risk of > 500 ml blood loss (reference). But my general feeling is that there isn’t a whole lot of solid research on this, some low quality research, possibility of publication bias and there were several suggested benefits with alternative birthing positions as well.
I do not know enough about how many hospitals allow alternative birthing positions, but it seems like something that could be useful to explore in more detail. The emphasis on choice was also found in the Cochrane review.
I suspect that such a scenario might mitigate some of the risk, but suspect that e. g. the infection risk cannot quite be compensated by maternal comfort in this case.
I think it is hard for people to get an intuitive and correct feeling for risk assessment. Natural birth activists often reply to the fact that homebirth in the U. S. triples neonatal mortality rates by saying that the absolute risk increase is low. While this is true, these same individuals would often happily put the baby on the back for sleeping or do other modifications in their daily life that have similar absolute risk reductions, or react to extremely low risk or even imaginary risks by eliminating GMOs, refusing vaccines etc. This makes the discussion of risk largely unproductive and inconsistent.
I think that natural birth activism also ties into larger issues such as medicine, science, libertarianism, feminism, healthcare politics and many other issues (both for those supporting or opposing quackery), so it is in some sense understandable that there is a tendency for black-and-white thinking. I have no easy answers for how to mitigate this.
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