Monday, December 17, 2007

The dead baby card

Jill at Keyboard Revolutionary finds it "amusing and frustrating" when people "pull out the dead baby card."

I don't find it amusing; I find that it is generally worth taking notice. What exactly is "the dead baby card, anyway?" Jill seems to think that it is telling women that their baby is at increased risk of death even though that is not the case. What Jill and most homebirth advocates don't seem to realize is that they literally have no idea about the existence or the magnitude of the increased risk of perinatal death. Not only do they not know about the increased risk; they actually parade their ignorance while congratulating themselves on being "educated".

Take Jill's comments for example:
"You're not going to do the glucose test? Your baby will die!"

Gestational diabetes DOES increase the risk of perinatal death. Untreated gestational diabetes increases the risk of perinatal death even further.

"You're not going to be induced if you go past 40 weeks? Your baby will die!"

The perinatal death rate DOES increase every day beyond 40 weeks. We have set an abitrary cut off at 42 weeks when the death rate has essentially doubled, but it has been rising steadily every day of the previous 2 weeks and continues rising every day thereafter.

"You're having a homebirth? Your baby will die!"...

Homebirth DOES increase the risk of preventable neonatal death. All the scientific evidence to date shows that it increases the risk of preventable neonatal death approximately 1-2/1000 ABOVE the hospital neonatal death rate.

"You're not getting him his vaxes? Your baby will die!"

Rejecting vaccination DOES increase the risk of death from vaccine preventable illnesses.
Of course Jill, like most homebirth advocates who lack an understanding of even basic statistics, makes the typical homebirth advocacy mistake. She assumes that when doctors inform people that something increases the risk of death, that means the risk of death is 100%; and if the risk of death is 100% and the baby doesn't die, then the doctor was wrong. However, increasing the risk of death means just that: it is increased over what it was before. It might be double, triple or 10 times higher. It does not mean that the risk is 100% or even 10%. When the risk is increased, that does NOT mean that a baby is guaranteed to die. That does NOT mean that if the baby doesn't die the doctor was wrong. It simply means that if you group together all the people in the higher risk group, their babies have an increased risk of dying compared those in the low risk group.

It's like carseats. If you drive to the store and don't put your baby in a car seat, it does not mean that your baby will die. And if you baby doesn't die on the way to the store, that does NOT mean that the benefits of carseats have been exaggerated. The mortality rate of a baby not strapped into a carseat is not 100%; it is simply higher than the mortality rate of a baby who is strapped into a carseat.

Jill goes on to illustrate an irony of homebirth advocacy.
Really, now, what mother in her right mind WANTS her baby to die? Look at all the fun stuff we have to abstain from just to ensure that we cook a healthy baby!

We can't smoke, drink, or take drugs. We can't eat undercooked meat, certain kinds of fish, or soft cheeses. We can't dye our hair. We can't ride rollercoasters or mechanical bulls. We can't take a dip in a hot tub. We can't drink coffee or soda. We can't put artificial sweeteners in our tea. We can't take ibuprofen, or any legitimate pain reliever for that matter, since Tylenol is the only option, and Tylenol really sucks. We can't take most cold medicines if we get stuffy. In a nutshell, we can't do a whole lot of stuff that we'd normally enjoy, all for the sake of our unborn baby.
Those risks are actually LESS than the risks that homebirth advocates dismiss as playing the "dead" baby card.

What's the neonatal mortality rate of hair dying? It's zero. How about riding roller coasters, drinking coffee or drinking soda? Zero. What about artificial sweetners? Zero again.

Personally, I find it "amusing and frustrating" that women who obsess about theoretical risks of drinking coffee and soda during pregnancy casually dismiss REAL risks of increased rates of perinatal death as playing the "dead baby card."

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