August 24, 2011
Riddle me this.
For background, Isis the Scientist started some shit by posting
which sounds totally noncontroversial right from the start. But since it reviewed some data on home birth suggesting up to 37% of planned home births result in emergency hospital visits and noting as much as a 0.3% uptick in the neonatal death rate, well, the home birth fans went shitnutz.
One can only hope that this homebirth person who had one kid die, one need resuscitation and still can’t understand why anyone would think she’s high risk is rare. Very rare.
Kate Clancy, for whom I have a great deal of respect on most issues, has a somewhat reasonable post up on the motivations for home birther fanaticism.
And these motivations are key, I agree. Because these motivations are driving otherwise reasonable people into a frenzy of woo based illogic that is really something to see.
There is one particular bit of thinking that I cannot for the life of me grasp. I’m going to pick on this post from homebirthercurious Dr.B
Hospitals are clearly equipped for dealing with the worst case scenarios. But it also seems that they are big fans of unnecessary interventions.
but really it pops up everywhere. Such as on the Twitts:
Given that it’s kinda a one way trip, how does one determine this? RT @DrSnit: @drisis I don’t see your blog about unnecessary c-sections
absent evidence of convenience scheduling, you simply have no idea what the “unnecessary” rate actually IS. No way to tell. @DrSnit
In birthing, the only way to know if a procedure was “unnecessary” or “necessary” is to either do it or not do it and figure out if the bad consequence is prevented, ameliorated or unaffected. And unfortunately you only get one try for each case study. Which means that you cannot actually know for sure for any particular case whether the procedures were in fact “necessary”.
Please explain to me, homebirther fans who wield the “unnecessary intervention” cudgel, exactly how you can determine which procedures were and were not necessary in advance. Because I am missing your logic here.
Look, science-based and/or evidence-based medicine recognizes that in the cases that are interesting*, there is rarely such a thing as a clear cut 100% accurate prediction of the future. What there is are probability distributions. If the kid’s heart rate slows down by such and such, the damn cord is wrapped around it’s neck X% of the time. Or, when the kid is in breech, Y% of the time the delivery ain’t going well.
Which always leaves some percentage of the time that everything is going to be fine and dandy.
Between fine-and-dandy land and 100% of births, however, you are playing with the health, well-being and even viability of a new human being. And this, mind you, is just for the stuff we can actually detect with high confidence is an adverse effect on the child. Dying is a pretty good one there, also hypoxia induced brain damage.
We do not know, however, if there are more subtle effects. Maybe you knock 5 pts off the kid’s IQ because you insist on laboring too long for “the experience”. Maybe you bathe that little wackaloon in hormonal responses that produce a raft of a subtle effects on development? Or maybe the child’s innate stress responses set a different stage. Who knows? Me, I’m betting on the side of smooth deliveries. Relatively rapid appearance of the kid once the laboring commences is my preference.
This last part is MY version of birth woo. I’d rather not take chances.