Oh, dear. Homebirth and midwifery advocates appeared to be having great success with their campaign to discredit obstetrics as “not based on scientific evidence.” But then it turned out that obstetrics IS evidence based.
Time for a change in tactics: Obstetrics shouldn’t be based on something as cold and impersonal as … scientific evidence!
I’ve written many times about popular smear strategy of accusing modern obstetrics of ignoring scientific evidence. The celebrity natural childbirth advocate Henci Goer has stake her entire professional life on the smear. As recently as this week, a major homebirth organization distributed a (hypocritical and mendacious) press release accusing obstetricians of having evidence that was less than perfect to support some of their recommendations (no other kind being available currently).
That’s why I laughed out loud when I read the latest opinion piece by Dr. Mark Keirse in the journal Birth, The Freezing Aftermath of a Hot Randomized Controlled Trial.
Dr. Kierse is publicly known for his relentless support of breech vaginal delivery. Now he dolefully acknowledges that the existing scientific evidence, of the highest quality, shows that C-sections are safer. And Dr. Kierse makes it clear that breech homebirth is NOT a safe alternative:
Home birth is a well-established recipe for disaster for a baby in breech presentation and contrary to any sensible guidelines that have ever been developed. (my emphasis)
Given that the scientific evidence supports C-section for breech, patients face two choices, C-section or unsafe homebirth. Dr. Kierse is eager to place “blame” for this outcome.
Clearly, the blame must rest fairly and squarely with what was heralded as a new paradigm, “evidence based medicine” … [which] means a new scientific order in which there is no place anymore for the concepts of old. In the new evidence-based paradigm anything randomized became the gospel and anything else became either low evidence or lack of evidence. (my emphasis)
In fact:
Obstetrics, perhaps even more than any other discipline, fell victim to this new paradigm determined as it was to get rid of the slur that had hounded the specialty before.
And just who was responsible for the slur? Why none other than midwifery and homebirth advocates. Oh, the irony!
Dr. Kierse acknowledges that the recommendation of C-section for breech is based on rigorously, obtained high quality scientific evidence.
A fundamental issue is that probably no study with selection and management criteria such as those applied in the term breech trial would have seen the light of day in a prestigious journal if it had not been randomized.
Kierse then peevishly dismisses the value of rigorously obtained, high quality scientific evidence:
Of course, nothing is wrong with advocating or promoting randomized trials. There is a great deal wrong, though, with the perception that evidence, to be evidence, needs to be randomized evidence. There is also a great deal wrong with the belief that only evidence is an e-word that deserves to be written with a capital “E,” whereas other e-words, such as education, experience, expertise, and even excellence, are merely ignominious. (my emphasis)
So after years of insisting that the recommendation for breech delivery by C-section was not based on scientific evidence, Kierse now claims that, oops, scientific evidence isn’t really that important anyway.
Just in case you didn’t pick up on the claim that scientific evidence isn’t really that important after all, Dr. Kierse hammers it home with his clunky title. Those mean, heartless obstetricians are making recommendations based on cold scientific evidence and thereby “freezing” out warm, loving recommendations for a vaginal birth that could kill your baby.
Time to edit the midwifery and homebirth battle cry:
Don’t listen to obstetricians, because their recommendations aren’t are based on ^cold, impersonal scientific evidence!
