Sunday, November 04, 2007

Magical thinking in childbirth

As I wrote in a previous post, magical thinking among homebirth advocates is a coping strategy for managing the uncertainty and fear associated with childbirth. Magical thinking does not mean believing in magic; it means believing that thoughts and actions have the power to affect unconnected events.

Let's look at some real world examples of magical thinking in homebirth advocacy.

Rixa, from the True Face of Birth, believes that affirming (aka pretending) is needed to ensure a vaginal delivery. The entire concept of "birth affirmations" is magical thinking in its purest form. It is involves a startlingly childish belief that wishing will make it so, and a rejection of the objective reality of chance, probability and randomness in favor of mysterious "forces" like trust.

Here are some of her "birth affirmations":
- My body will go into labor when the baby is ready.
- The baby will get into the perfect position for birth: head down, chin tucked into her chest, her back facing my stomach, and the umbilical cord tucked safely out of the way.
- My cervix will thin and open at just the right pace.
- My uterus will clamp down quickly and firmly after the birth.
- My placenta will release cleanly and all in one piece. After the placenta is out, my uterus will continue to clamp down.
Look at all the different medical conditions that can be prevented or managed by simply affirming: premature labor, postmature labor, malposition, asynclitism, cord prolapse, dystocia, uterine atony, hemorrhage, retained placenta, the list is practically endless!

Obviously, premature labor, postmature labor, malposition, asynclitism, cord prolapse, dystocia, uterine atony, hemorrhage and retained placenta are the result of complex mechanical and biochemical causes. They can NEVER be prevented, managed or treated by subjective beliefs and desires. Yet here is a grown women, boasting to other grown women, that she planned to wish her way out of these possible complications, and that they should, too.

Magical thinking involves special magical thinking ceremonies, such as the Blessing Way Ceremony. According to Birth Works:
The Blessing Way Ceremony is a special gathering to honor a woman close to her time of birth... They include rituals such as massaging the honoree's feet with cornmeal, a Native American custom symbolizing the nourishment given by the earth. Sometime there is a sharing of beautiful yarn or string that is wrapped around each attendees wrist while they share their personal wishes for the mother's upcoming birth. The bracelets are worn until after the birth to symbolize unity and continued goodwill. Or, is a special presentation of hand made gifts. Words of strength and courage are shared to fortify the woman's spirit for birth. For some women the blessing way is a time of great healing, where they can experience feeling truly honored and strengthened by the love and support of other women who believe in them, believe in birth, and trust that the ancient wisdom that has grown their baby, will soon birth their baby as well.
Such a ceremony is recommended as having the ability to change the objective outcome of a particular labor or birth, when in reality, it has the ability to do precisely nothing. A blessing way ceremony is a very primitive appeal to magical forces, created by primitive people, invoking protection for a pregnant women. Why was such protection implored? Not because primitive people "trusted" birth, but precisely because they did not trust birth. They understood, in a way that contemporary homebirth advocates do not, that appalling rates of neonatal and maternal mortality are inherent to childbirth in nature.

Magical thinking rejects objective decisionmaking, because it rejects statistical analysis (chance and probability). Instead, it substitutes faith and luck. Consider this approach to fetal malpositioning advocated by Empowered Childbirth:
What is the one thing that separates the women who birth "malpositioned" babies in empowering ways (can you imagine the kind of awe you must feel when you realize you delivered an 11 pound breech baby? :) from the women whose children are "rescued" from her womb by a surgeon? OK, there are two things... 1) She trusts in birth and 2) She accepts the fact that her baby might die.

If you can't do both of these things completely, you will need to become clear on just what conditions you require in order to feel safe.

Birth is normal, until it is interFEARed with. Normal means babies sometimes die, mamas have been known to die, it's normal.

Hospitals do not guarantee your baby will live. They will interFEAR with your birth in hopes of increasing your child's chance of surviving birth but their track record (at least in the USA) is deplorable. Study after study shows that homebirth with a midwife is safer than hospital birth but many midwives won't handle breech births either. Why? Because they can't accept condition #2 above. Too risky.
What are the chances that a breech baby might die during vaginal delivery. Proponents of magical thinking don't know, and don't care, because proponents of magical thinking insist that it doesn't matter! If your baby dies, it dies; stuff happens and that's not important. What IS important is pretending that you can have a vaginal delivery.

A hallmark of homebirth advocacy is a lack of basic understanding about childbirth. Most of what homebirth advocates think they "know" is factually false. This knowledge gap is filled with magical thinking: invoking mysterious forces such as "trust" and "intuition", creating magical thinking ceremonies, and adopting a fatalistic attitude that childbirth outcomes are the result of luck and cannot be modified by science.


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