Thursday, May 22, 2008

Homebirth in a post-fact society

Most homebirth advocates cannot independently evaluate the claims and scientific evidence used to promote homebirth because they lack basic knowledge about science, statistics and childbirth. Much of what they think they "know" isn't factually correct. You might expect, therefore, that if homebirth advocates learned more about those topics, particularly science and statistics, that they would stop making false claims. That wouldn't necessarily happen, because many of these people simply make up their own "facts" and feel justified in doing so. They are not alone. As Farhad Manjoo details in his new book, True Enough: Learning to Live in a Post-Fact Society we live in a society that not only promotes belief over fact, but justifies belief in utterly discredited claims by promoting belief AS fact.

Manjoo writes:
In the book, I spend much time on Leon Festinger's theory of "selective exposure" — the idea that in order to avoid cognitive dissonance, we all seek out information that jibes with our beliefs and avoid information that conflicts with them. While the theory is controversial, there's ample evidence that selective exposure plays a role in how people parse the news today. Survey data show that folks on the right and folks on the left now swim in very different news pools. Right-wing blogs link to righty sites, while left-wing blogs link to lefty sites.
This phenomenon is definitely at work in the world of homebirth advocacy. While it is not suprising that lay people will create websites filled with misinformation to promote a point of view, the web is currently filled with websites created by supposed experts, direct entry midwives, that are filled with fabricated claims that bear no relationship to reality. The midwives in question have absolutely no idea what the facts are, and they don't appear to care. If they believe it, they simply present it as a fact.

Websites such as Midwife: Sagefemme ..., Homebirth: A Midwife Mutiny, Woman to Woman Childbirth Education and many more operate as "post-fact" zones, where simply believing something makes it true. It appears that direct entry midwives write off the top of their heads, check nothing, and copy citations without ever actually reading them; then they link to each other as "proof" in one vast echo chamber of misinformation.

In a post-fact world, it does not matter if a claim is objectively demonstrated as untrue. The claimants just go on making the claim as if it were true. The "Swift Boat Veterans for Truth" (a truly Orwellian name) fabricated a story of John Kerrey's service in Vietnam that had absolutely no basis in reality. It was discredited thoroughly and repeatedly in the mainstream media, yet the "Swift Boat Veterans" continue to receive sympathetic treatment in the right wing media.

The world of vaccine rejectionism is also a post-fact world. Andrew Wakefield, the originator of the claim that the MMR vaccine "causes" autism, has ADMITTED that he faked the claim for financial gain. Vaccine rejectionists continue to cite his thoroughly discredited work as "proof" even after he admitted that he made it up.

Similarly, it appears not to matter how many times homebirth advocates are told that neonatal mortality is the wrong statistic to measure obstetric care; perinatal mortality is the correct statistic; and the US has one of the lowest perinatal mortality rates in the world. Virtually every homebirth advocacy website continues to repeat the claim because they "believe" that modern obstetrics is unsuccessful and they "believe" that the neonatal mortality rate is an indication of this "fact".

Anyone seeking objective information about homebirth would do well to keep this in mind. The chance of finding out the facts about homebirth on a homebirth advocacy website are the same as finding out the facts about Bush's incompetence on Fox News. Reading the homebirth literature and homebirth websites does not make a person "educated" about birth options. The only way to become educated on the topic is to read the scientific literature itself, and to read competing interpretations of that literature. In a "post-fact" world of homebirth advocacy, beliefs are presented as "facts"; people pick the "facts" that appeal to them; and advocates make sure that they never have to read or hear anything that has not been vetted in advance by people who share their beliefs.

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