Monday, April 02, 2007

Is homebirth advocacy akin to a religious belief system?

I have repeatedly argued that homebirth advocacy is a belief system, and therefore, is relatively impervious to facts about the nature and safety of childbirth. In the following legal article, a homebirth advocate argues for the same understanding.

In a densely argued article in the Indiana Law Review in 2005, The Midwifery Stalemate and Childbirth Choice: Recognizing Mothers-to-Be as the Best Late Pregnancy Decisionmakers, Amy Cohen advances her theory on the legal right of women to choose homebirth. She herself has had 3 homebirths, and is anxious to ground the right to homebirth in established legal theory.

First, Cohen rejects the classic explanation why direct entry midwives have had very little political success:
One standard explanation for the stalemate on midwifery reform is that the powerful medical lobby seeks to preserve its economic share of the birthing business by preventing midwifery regulation and utilizing its traditional influence over courts. While this has been convincingly argued, there are other, more complex issues that underscore the midwifery debate and have consistently undermined efforts to achieve greater childbirth freedom.
... midwifery advocates must effectively confront two misconceptions regarding their own attitudes toward birth. If personal preferences and safety concerns were the extent of the justification for home birth, there would not be a privacy right at stake, and rational basis review would likely come out in favor of the state. Rather, at the heart of the right to privacy are acts and choices that define the self. Therefore, advocates must communicate to courts the deeply held feminist, political, religious, and philosophical beliefs that support their alternative understandings of birth...
Cohen wants to ground a "right" to choose homebirth, not as simply a privacy right, since that would not be effective, but rather as a quasi-religious right, as a choice that defines the self.

To that end, she claims:
Home-birth mothers believe that the choice about where and how to give birth is not a trivial decision that merely reflects personal, aesthetic preferences ... [V]iews about birth may express deeply held beliefs about nature and religion, and are often the product of parental, political, religious, and feminist choices...

In fact, a good analogy for the relation between the medical and alternative theories of birth would be the contrasting evolutionary and creationist views of the Earth’s history. There is such a deep division between the medical and natural models of birth that neither can “convince” the other. The two models operate on different assumptions, and adherents to both the scientific and religious views define themselves according to those assumptions. Just as the state may not impose religious viewpoints on citizens, the law should recognize multiple viewpoints in the birth context ...
This seems to me to be a very apt, accurate, and unfortunate (for midwifery) description of homebirth advocacy. Why is it unfortunate?

Creationism is a fairy tale. It does not respect scientific evidence and it is impervious to facts. It is a belief system, not science.

The analogy to creationism establishes that homebirth is not about safety and better medical care, but about deeply held personal beliefs and freedom of personal expression.

It confirms that homebirth advocates are not more "educated" about birth; they are simply socialized to a different construct of birth.

It explains the desire to denigrate women who make different choices. They are not just making different choices, the are rejecting the one right way.

Although Ms. Cohen is passionately committed to finding a legal justification for homebirth midwifery, I suspect that she is not going to find it through this type of reasoning. Moreover, comparing homebirth advocacy to an anti-intellectual, close minded, unscientific philosophy like creationism makes it even more difficult to take the claims of homebirth advocacy seriously.


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