Sunday, October 14, 2007

Whatever the scientific evidence shows, do the opposite.

One of the hallmarks of homebirth advocacy is defiance. The classic homebirth prescription is to review the evidence, then ignore it and advocate the opposite. All the while, homebirth advocates congratulate themselves for solving complex medical problems WITHOUT DOING ANY RESEARCH. Homebirth advocates consider themselves so smart that they don't need to do any research; they can just learn about the current recommendations and do the opposite.

Take the issue of diet in pregnancy. There are some pregnancy complications that can be modified by diet and there are other pregnancy complications that cannot be modified by diet. Gestational diabetes, a form of insulin resistance, leads to a variety of pregnancy complications including stillbirth. Diet and exercise are extremely effective in reducing blood sugar, and in reducing the need for more aggressive treatment like insulin injections. So what do homebirth advocates have to say on the subject? Henci Goer claims that the standard management of gestational diabetes is useless.

On the other hand, a great deal of research has been done on the role of diet in pre-eclampsia, and there is no evidence that pre-eclampsia can be averted or modified by diet. So what do homebirth advocates have to say on the subject? You guessed it. They recommend diet (specifically the Brewer diet) to prevent or limit the severity of pre-eclampsia.

It would be amusing if it were not so serious. So much of homebirth advocacy is simple defiance. If obstetricians or scientists show that something works, insist that it doesn't. If they show that something doesn't work, insist that it does. Don't worry about not having any evidence, and don't worry about issuing harmful recommendations that may hurt babies and mothers. Evidently, those issues pale in comparison to the righteousness and self satisfaction that come from defying authority.


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