Tuesday, January 23, 2007


We have looked at the philosophical underpinnings of the homebirth movement including the rigid dualisms of nature/technology, female/male and home/greater world; the veneration of pain; and the implicit or explicit moralism. We have looked at the rhetorical tactics of the public efforts of the movement, including the invocation of tradition, the (often erroneous) claims of safety, the appeal of "choice" and the accusation of turf battles.

I have noticed another characteristic which seems fundamental to the homebirth movement, and the attempts to advance it. It is striking to me because it nullifies the claimed professionalism and scientific basis of the homebirth movement. I am referring to the pervasive use of ridicule as a form of argument and a defense against difficult questions. This extensive deployment of ridicule as a rhetorical device and as the first and frequently sole defense against challenging questions is in stark contrast to the formalism, the marshalling of evidence, and the statistical analysis that is the hallmark of true scientific inquiry.

At first, I thought ridicule was restricted to homebirth advocates who like to post on blogs, since ridicule is a staple of many debate blogs. After examining a large number of homebirth websites and publications, interacting with a few homebirth professionals, and reading the professional literature of homebirth, I have become convinced that ridicule is a cornerstone of homebirth advocacy.

Let's look at some examples:

Marsden Wagner, in Choosing Cesarean Section,, in the journal The Lancet, cannot resist. Starting with a quote from the Girlfriend's Guide to Pregnancy about the benefits of schedule C-section, he continues:
This statement from a popular US paperback illustrates the degree to which society appears to condone women choosing caesarean section and doctors committing insurance fraud..."

"Elective CS is convenient; it allows the doctor to get closer to “daylight obstetrics”."

"Having a highly trained obstetrician surgeon attend a normal birth is analogous to having a paediatric surgeon babysit a healthy 2-year-old."
Ridiculing both doctors and patients in a scientific journal? This is what passes for "discussion" in the professional homebirth movement.

Look at articles in other professional journals:
Why do women go along with this stuff? Kitzinger, et al. Birth 2006 Jun;33(2):154-8.

A Butcher's Dozen, Wainer, Midwifery Today 57, Spring 2001.

The Assault on Normal Birth: The OB Disinformation Campaign, Goer. Midwifery Today 63, Autumn 2002.

Fish Can't See Water, Wagner, Int J Gyn and Ob, 75, supplement s25-37, 2001
Look at Henci Goer's recent comments to me when asked specific questions about homebirth research:
"All I can say is you seem to be suffering from a case of "my mind is made up; don't confuse me with the facts."

" ... you will allow me and other normal birth advocates to gain insight into how adversaries of normal birth like you think while providing me an unparalleled opportunity to expose and dismantle their fallacies, illogic, and the extent to which they are willing to misrepresent the evidence. I couldn’t ask for a better teaching tool, so, please, fire away...

...I’m happy to spend the time. Lamaze International pays me by the hour."

"you want a fair, fact-based debate on birth issues about as much as Bill O'Reilly wants one on political issues."
The pervasive use of ridicule, primarily of obstetricians, but of patients as well, highlights the fact that homebirth advocacy is a belief system, not a scientific endeavor, and throws into sharp relief the inability of professional homebirth advocates, like Henci Goer and Marsden Wagner, to address scientific issues in a serious, respectful, statistically sound, and, above all, scientific manner.


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