Donald Trump has erased large swathes of data from government websites and replaced it with ideology for the worst of reasons; he seeks to reward the industries that give large amounts of money to Republican candidates.
In issuing new recommendations, Intrapartum care for a positive childbirth experience, the World Health Organization replaces science with ideology for the best of reasons, white hat bias.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Why is the WHO concerned only with the experience of pregnant women, ignoring the experience of every other patient?[/pullquote]
What is white hat bias?
‘White hat bias’ (WHB) [is] bias leading to distortion of information in the service of what may be perceived to be righteous ends… WHB bias may be conjectured to be fuelled by feelings of righteous zeal, indignation toward certain aspects of industry, or other factors…
The new WHO recommendations on intrapartum care reflect righteous zeal instead of scientific evidence.
The title is the give away. There are 7 billion people whose health is under the purview of the WHO. As far as I can determine from searching their websites, in their entire 70 year history they have never demonstrated concern for the experience — positive or otherwise — of anyone receiving healthcare except women during childbirth.
Is the experience of the terminally ill irrelevant? Is the experience of pediatric patients of no concern? How about the experience of victims of natural disasters or refugees from wars? The WHO supervises care of all these group yet only demonstrates concern for the positive experience of a small subset, those eligible for midwifery care. That’s not a coincidence.
While the WHO has done exemplary work in the area of vaccines and other public health issues, it has unfortunately become a primary entity fanning the flames of moral panic around C-sections and breastfeeding.
A moral panic is a widespread fear, most often an irrational one, that someone or something is a threat to the values, safety, and interests of a community or society at large …
Listening to the WHO you might think that a high C-section rate and low breastfeeding rate threaten the health of world populations. You would be wrong. While low C-section rates have been shown repeatedly to lead to neonatal and maternal deaths, high C-section rates have no correlation with outcomes. For example, American avatars of C-section panic bewail our 32% C-section rate, but ignore the fact that Italy has a 42% C-section rate and lower rates of neonatal and maternal mortality.
Breastfeeding rates have absolutely no correlation with outcomes at all. The countries with the highest infant mortality rates have the highest breastfeeding rates and the countries with the lowest infant mortality rates have the lowest breastfeeding rates.
The ugly effort to generate moral panic around C-section rates seems to have originated with Dr. Marsden Wagner and has been fanned ever since by midwives in industrialized countries. It is the lie that will not die — his claim that the optimal C-section rate is between 5-15%.
Wagner, a pediatrician who served as the European Head of Maternal and Child Health for the WHO, without any evidence of any kind, declared the optimal rate by fiat in 1985. In 2009, the World Health Organization surreptitiously withdrew the target rate. Buried deep in its handbook Monitoring Emergency Obstetric Care, you can find this:
Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage … the optimum rate is unknown …
So the WHO has a long history of promoting ideology as science. The WHO press release, Individualized, supportive care key to positive childbirth experience, says WHO, continues the tradition. It is a paean to the failed midwifery ideology of promoting normal birth.
Childbirth is a normal physiological process that can be accomplished without complications for the majority of women and babies. However, studies show a substantial proportion of healthy pregnant women undergo at least one clinical intervention during labour and birth. They are also often subjected to needless and potentially harmful routine interventions.
Actually the key to a positive childbirth experience is a healthy baby and a healthy mother, neither of which is guaranteed.
The truth is that childbirth is a normal physiological process that naturally has an appalling rate of injury and death. In every time, place and culture it is a leading cause of death of young women and THE leading cause of death in the entire 18 years of childhood. Even today over 800 women and 14,000 babies (half stillborn) die EVERY DAY.
Many women want a natural birth and prefer to rely on their bodies to give birth to their baby without the aid of medical intervention,” says Ian Askew, WHO Director, Department of Reproductive Health and Research.
And many women, perhaps the majority of women, prefer to have pain relief, inductions, C-sections and all possible safety interventions.
In a future post I will address the specific recommendations, but for now I want to leave you with these questions:
Why is the WHO so concerned with patient experience in a world where so many mothers and babies die in childbirth each day?
Why is the WHO concerned only with the experience of pregnant women and ignores the experience of the largest consumers of healthcare, children and the elderly?
Why is the WHO generating moral panic about C-sections and interventions when there is no evidence that either is particularly harmful to patients?
Why do the WHO’s concerns map almost exactly to the concerns of midwives in industrialized countries?
