It doesn’t matter how hideous, it doesn’t matter how preventable, and it doesn’t matter whether the midwife broke the law. In the wake of every homebirth death, homebirth advocates console themselves with a variety of illogical claims. The recent arrest of self-proclaimed “midwife” Rowan Bailey in connection with a homebirth death is a case in point. Homebirth advocates are twisting themselves into pretzels to justify their support of yet another “midwife” who has presided over yet another death.
Let’s look at the various types of illogical argument constructed to justify homebirth deaths. They are all efforts to forestall the conclusion that homebirth increases the risk of perinatal death. To make this exercise easier to understand, lets substitute a claim of the same form that is obviously true, so we will not get sidestepped by issues of truth or falsity and can focus only on whether an argument is logical or illogical. This is important because illogical arguments are automatically invalid arguments. We’ll use the claim “there are more black cars in the US than lime green cars.”
I say: There are more black cars in the US than lime green cars. (The death rate at homebirth is higher than the death rate for comparable risk women in the hospital.)
Don’t say:
I saw a lime green car. (“Babies die in the hospital, too.”) – Can you understand how the fact that you personally saw a lime green car tells us nothing about the relative number of black cars and lime green cars in the US? That you saw a lime green car is perfectly consistent with black cars outstripping lime green cars 100 to 1, or even 1,00,000 to 1? Similarly, the fact that babies die in the hospital tells us nothing about whether the death rate is greater at homebirth.
I know ten people and not one of them has a black car. (I had two fabulous homebirths and my babies didn’t die.) – This is an illogical claim based on an unstated assumption. The assumption is that the small slice you observe accurately represents the whole. However, tiny samples are often unrepresentative. Knowing 10 people who own black cars is perfectly consistent with the number of black cars exceeding lime green cars, BUT it is also perfectly consistent with lime green cars exceeding black cars, so it can’t be used to support a specific claim. Similarly, the fact that you know ten women who had homebirths and not a single baby died tells us nothing about whether the homebirth neonatal death rate exceeds the low risk hospital death rate.
Lime green cars are prettier than black cars. (Homebirth is empowering.) – I hope it is obvious why value judgments about lime green cars tell us nothing about whether there are more or less black cars than lime green cars. Therefore, it should be obvious that claiming that women are more satisfied with homebirth tell us nothing about homebirth death rates.
You say that because you sell black cars. (You say that because you are a doctor.) – Whether or not I sell black cars is immaterial; it has absolutely no effect on the number of black cars or lime green cars. This is essentially an accusation that I am lying and offering as “proof” the fact that I have a reason to lie, but a reason to lie is not proof of lying. So don’t tell me that the fact that I am an obstetrician means that I am lying about neonatal death rates.
The people who make black cars have oppressed the people who make lime green cars. (Doctors have always oppressed midwives.) – Maybe yes, maybe no, but in either case, it does not affect how many black and lime green cars are on the road. Similarly, whether doctors have oppressed midwives has no bearing on whether the neonatal death rate at midwife attended homebirths is higher than hospital births.
There is a conspiracy against lime green cars. (Doctors are afraid of losing business to homebirth midwives.) – We are supposed to believe that the number of lime green cars would equal black cars except for a public relations campaign designed to make lime green cars less desirable. It is theoretically possible that there is a conspiracy against lime green cars, but it is far more likely that other factors account for the difference in numbers. And in any case, it doesn’t tell us anything about the relative numbers of black and lime green cars. So when confronted with the fact that homebirth death rates exceed hospital rates, it is illogical to counter with a claim that a conspiracy against homebirth exists.
There would be more lime green cars if the makers of black cars helped out. (There wouldn’t be so many deaths at homebirth if doctors backed up homebirth midwives.) – That might be true, or it might not. In either case, it tells us nothing about the truth of the claim that black cars exceed lime green cars. And while it might be true that the death rate from midwife attended homebirth would be lower if doctors were more supportive of midwives, it doesn’t change the reality of the current situation.
The Association of Lime Green Car Makers say that there are more green cars than black cars. (The Midwives Alliance of North America says that homebirth is safe.) – Cherry picking certain claims and ignoring all others is likely to lead people to the wrong conclusion. A lobbying group that disagrees with almost everyone else is not a reliable source of information. Similarly, professional NCB advocates and organizations are not reliable sources of information when they disagree with the bulk of the scientific evidence and the existing statistics.
The color of cars is influenced by culture. (Our culture promotes a technocratic model of birth.) – That is a non sequitur. It does not oppose the claim; it simply attempts to pin responsibility somewhere else and it is irrelevant. That’s why the claim that hospital birth is culturally favored is irrelevant to any argument about homebirth death rates.
There are more important things about cars than the color. (There’s more to birth than whether the baby lives or dies.) – That is what is known as “reframing the debate“. It is a tacit acknowledgment that there are more black cars than lime green cars and a barely concealed effort to divert everyone’s attention. That’s why when someone announces that there are more important things than whether babies live or die, I know they have accepted the fact that homebirth has an increased risk of perinatal death, and are trying to get everyone else to accept it, too.
Adapted from a post that appeared in February 2011.
