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Dr. Amy and Conspiracy Theories

tinfoil hatA friend pointed out this 2012 article by Amy Tuteur about skepticism versus denialism. It’s a worthy topic, and I’m right with her (or perhaps more accurately with her cited material from Andrew Dart) regarding vaccine and evolution “skepticism.” But I take issue with her broad brush getting paint on me when she states, “Though it isn’t as obvious, natural childbirth and homebirth advocates are denialists, too.”

I’m a natural childbirth and homebirth advocate in part because I’m a skeptic! (The other major impetus for me is gender equality and bodily autonomy.) Look, I realize there are loonies in the natural/home birth camps. There are people so out there that Koi-Assisted Birth was greeted not simply with “Great satire!” but with many readers taking it as real. But there are plenty of advocates interested in evidence-based medicine and freedom of choice. Take someone who questions the benefit of routine continuous electronic fetal monitoring. That’s a reasonable question to ask when the intervention was introduced on the guess that it would be helpful, then later research showed it may result in worse outcomes. When you equate a skeptic about that issue with a crank who believes against all evidence that the earth is 6,000 years old, you’re being both inaccurate and insulting.

Here’s a rundown of the most glaring logical problems in Dr. Tuteur’s article.

Universal statements – Note the lack of “some” or “many,” or “the most extreme,” preceding the terms natural childbirth advocate and homebirth advocate. The existence of a single skeptical, reasonable advocate of natural childbirth upsets her argument.

False Dilemma – she gives the impression that a person either supports typical hospital birth, or is a loony conspiracy theorist who ignores all evidence that homebirth is imperfect. There’s no intimation that some people might occupy a middle ground.

Equivocation - Tuteur quotes Dart’s discussion of conspiracy theories, then uses an unexplained, idiosyncratic definition of “conspiracy theory” to assert that natural childbirth advocates are conspiracy theorists. Under her implicit redefinition of “conspiracy theory,” anyone who acknowledges unconscious bias (such as the possibility that a doctor might intervene quicker if he wants to get to a golf game) is evoking a conspiracy theory.  She also redefines conspiracy theory to include the realization that medical schools often teach by tradition, rather than strictly keeping to the latest evidence-based practice. The normal definition of “conspiracy theory” hinges on deliberate plotting. Dr. Amy’s special definition includes totally unconscious, unplanned behavior. I guess if she used the real definition, she couldn’t include natural childbirth advocates under Dart’s definition of denialists.

Guilt by association: “And natural childbirth and homebirth advocates share key attitudes with vaccine rejectionists, creationists and other denialists.” First she lumps natural childbirth and homebirth advocates together, then further assumes that homebirth advocates universally support poorly trained CPMs, and don’t care about any evidence that they might be less safe. Through this chain of association, suddenly a mother who gave birth in a freestanding birth center because she was worried about unnecessary interventions is equated with believers in a global conspiracy to give kids autism with vaccines.

Personally I get the impression that “The Skeptical O.B.” is herself a bit of a denialist, that she believes typical hospital birth with lots of interventions is the best, safest practice, and that no evidence will ever be good enough to dissuade her. So rather than searching out the best evidence about these practices and questioning her own biases, she targets people who do question, and paints us all as crazed fringe ideologues who don’t care about dead babies.

I admit I am biased toward natural childbirth and questioning medical interventions. But, I at least try to remember that I have that bias and attempt to embrace the foundation of skepticism – watching out for my own perceptual foibles. If there is solid, evidence-based consensus that the benefits outweigh the risks for routine continuous electronic fetal monitoring, routine episiotomy, or nil by mouth during labor, I would be interested in seeing it, and if it’s convincing I would change my mind about the desirability of these procedures. Being willing to change your mind is what skepticism is all about, while protecting your current beliefs at all costs is denialism – even if your beliefs are culturally mainstream.

(For the record, I’m a natural childbirth advocate and homebirth advocate in that I believe in making these options available to women, I am skeptical of some of the typical hospital practices, and I was personally more comfortable birthing outside a hospital, where I felt my providers’ approach to birth dovetailed with mine. I’m 100% in favor of making CNM-attended homebirth a common option. I am not personally as comfortable with CPMs, and unattended childbirth scares the hell out of me. But I still think women have the right to do either, though they should have access to the risks and benefits information as best we have right now.)

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