Can you say “conflict of interest”?
That’s the heart of the latest public relations effort by The Childbirth Connection, the leading lobbying organization of the natural childbirth industry.
The New York Times’ Motherlode blog notes, New Report Urges Less Intervention in Births.
But getting your information on birth from The Childbirth Connection is like getting your information on solar power from Big Oil.
Just like Big Oil has a financial interest in whether or not you choose solar power, the constituency of The Childbirth Connection (midwives, doulas and childbirth educators, aka “birth workers”) have a financial interest in whether or not you choose obstetric interventions.
The Childbirth Connection is well known for ignoring data, even its own data, in favor of promoting full employment for birth workers. The Childbirth Connection has published three “Listening to Mothers” surveys on the state of childbirth in the US, and each time they refuse to listen to what mothers tell them: approximately 90% of women in the US are happy with maternity care; the majority of women who use epidurals are extremely pleased with them; the majority of women who use alternative methods of pain relief find them to be ineffective, etc.
Despite what women have told them, despite the spectacular success of modern obstetrics, despite that fact that the only places in the world with low perinatal and maternal mortality are places with easy access to and liberal use of childbirth interventions, The Childbirth Connection insists there is a crisis.
“If overtreatment is defined as instances in which an individual may have fared as well or better with less or perhaps no intervention,” the report states in its forward, “then modern obstetric care has landed in a deep quagmire. Navigating out of that territory will be challenging.”
Dr. Sarah Buckley, who collected and interpreted the research and wrote the report, suggests within it a number of ways of escaping that quagmire, all based on the premise that the hormonal physiology of childbirth nearly always works best when it is left to work at its own speed. The benefits of the natural process, her synthesis of the research suggests, go far beyond what we had previously understood; preparing mother and baby for birth through hormonal changes up to and during the labor and birth process.
Dr. Buckley takes a page out of the playbook for challenging modern medicine. Paul Wolpe explains the steps in The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession.
1. Alternative health advocates must:
must portray the discourse as in crisis, must provide an alternative ideology to rescue the discourse, must legitimize their ideology through appeal to a reframed historical myth, and must portray the orthodoxy as a betrayer of the discourse.
Hence Buckley’s claim that modern obstetric care has landed in a deep quagmire. Really? In the past 100 years modern obstetrics has dropped the neonatal mortality rate by 90% and the maternal mortality rate by 99%! That doesn’t sound like a quagmire to me. The real quagmire is where “birth workers,” midwives, doulas and childbirth educators find themselves. They feel marginalized by lifesaving technology, so they demonize it.
2. Then offer the new philosophy, positioning it as the replacement for the old:
[The critic] draws from the marginalized or folk knowledge of the tradition and elevates the constructs found there to primary importance…
… [G]reat pains are usually taken … to show that the alien ideas are not in fact alien at all, but have existed in the discourse in a different form. [Critics] often import foreign, folk, and traditional forms of healing into their practices, [carefully describing] them as wholly compatible with Western medicine, scientifically valid, or historically present in other forms.
Hence, Buckley’s claim that “the hormonal physiology of childbirth nearly always works best when it is left to work at its own speed. The benefits of the natural process … go far beyond what we had previously understood.”
3. Blur the distinction between health and disease:
The goal of holistic health is more than the absence of disease; it is a state of optimal functioning, often referred to as ‘wellness’… [which] greatly expands the role of the [alternative provider] in medical intervention …
Hence the goal of The Childbirth Connection is more than healthy babies and healthy mothers, it is “normal birth,” a recapitulation of birth as practiced with the ancient wisdom of our foremothers.
4. Portray yourself as the savior:
The [critic] is the true keeper of the flame, the savior of the discourse, and should ascend to the position of power in place of the orthodoxy.
Hence Carol Sakala’s (director of Childbirth Connection Programs at the National Partnership for Women & Families) claim, “Our current high rates of intervention are not serving women well… But the community is really moving in the right direction. Professional societies are … talking publicly about the overuse of cesarean sections, the need to avoid constant fetal monitoring, and not permitting elective inductions or cesareans. “We are hopeful that the timing of this report will support that change.”
In the minds of natural childbirth advocates, demonizing modern obstetrics is the solution to the employment issues of birth workers.
Why? As anthropologists Caroline Bledsoe and Rachel Scherrer explain in The Dialectics of Disruption: Paradoxes of Nature and Professionalism in Contemporary American Childbearing:
If nature is defined as whatever obstetricians do not do, then the degree to which a birth can be called natural is inversely proportional to the degree to which an obstetrician appears to play a role. The answer to why obstetricians are described with such antipathy thus lies not in the substance of what obstetricians do … Obstetricians are … perceived as the chief source of disruption in the birth event …
And, not coincidentally, they represent the chief economic competition to midwives, doulas and childbirth educators.
For birth workers, fewer interventions = more employment opportunities.
To a hammer, everything looks like a nail. To a birth worker, every women looks like she needs a birth without interventions.
That doesn’t make it so.
