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Science denialism on the left and the right

Science

Recently, I was catching up on some podcasts and one that was particularly good was this recent Point of Inquiry with George Lakoff.  Even if you're familiar with Lakoff's theories, it's a good summary, and the host Chris Mooney conducts a good interview, as usual.  But I had one quarrel with it.  Mooney asks Lakoff about science denial---an even more relevant question in light of the fact that denying science has become mandatory for Republicans vying for national office---and Lakoff started off by saying that science denial is rooted in a conflict between scientific discoveries and the metaphorical framework that conservatives or liberals use to view the world.  Of course, the problem that this answer faces is that conservatives have made science denialism a huge part of their worldview and liberals have not.  Conservatives deny science facts when it comes to evolutionary theory, reproductive health, global warming, and pretty much anything that might challenge their ideology.  But science denialism just isn't as widespread with liberals.

Lakoff's take on this was a tad unsatisfactory for me.  His reason for the disparity struck me as sound enough, which is that avenues of scientific inquiry tend to be framed in terms of what is good for human beings, which fits into the liberal worldview.  (HIs theory is that liberalism is governed by a model of nurturance whereas conservatism by a model of hierarchy, two models he calls the Nurturing Parents vs. the Strict Father.)  On the other hand, conservatives have a Strict Father view, where truth is a matter of what the father figure dictates it to be, and everything---even scientific fact---must submit to the strict father's authority.  Liberals are more egalitarian, so knowledge tends to be ranked less by how it fits into a hierarchical model of authority and therefore needs to be taken on its own merits, i.e. how in a nurturing family every family member, including wives and children, is allowed to have their own worldview and father doesn't always know best.  So, just as a wife or a child who is armed with facts is allowed to argue with a father and win the argument if they're in the right, scientists are allowed to operate with more freedom in the liberal worldview.

Lakoff realized there were limits to this, and that there are definitely cases where science conflicts with liberal values and therefore runs a risk of being rejected by liberals.  But the only example he could think of was one where the science eventually fell apart, i.e. when liberals resisted scientific claims of IQ differences between the races.  He was right that liberals rejected these theories out of hand without the evidence to disprove them, but since liberal scientists like Stephen Gould eventually made a mockery of the poor evidence conservatives brought to bear for these theories, turning them into "theories", I kind of thought he was cheating a little.

A more troubling example is vaccination denialism, and the entire tent of liberals being quick to panic about "chemicals", even when the evidence that said chemicals are toxic just isn't there.  In my experience, vaccine denialism is rooted in a nurturing-mother worldview on steroids.  Many vaccination denialists tend to have a counter-theory where disease isn't prevented by medical interventions, but that all children need is a highly attentive mother who feeds them nothing but organic food and wheatgrass, and they won't need any silly vaccines.  Vaccines are demonized by equating them with the strict father worldview---doctors are cast as imperious patriarchs who force toxins on mothers and their children.  In a weird way, anti-vaxxers are the what conservatives imagine feminists to be, women who are bound and determined to replace the patriarchy with a matriarchy where things like "feminine intuition" replace reason and common sense.  Of course, real feminism has nothing to do with this, but I do think that there's a strain of matriarchal hooey that a percentage of liberals can drift towards.  Even feminists.

Ironically, however, I think it's feminism itself that works keep this kind of bullshit in check.  Feminism is rooted in an ideology of equality, and the rejection of stereotypes about feminine intuition.  In fact, most feminists I know see this kind of mother-knows-best hippie shit as just the same old gender stereotypes, repackaged as empowerment but actually putting women right back in the kitchen.  Having power over your child's diet and medical care shouldn't be confused with having real power in the world.  Kicking and screaming at a doctor's knowledge isn't the same thing as demanding that men stop hoarding scientific knowledge for themselves. 

So I think Lakoff had it right, but only half right.  I think that he's right that liberal's worldview of egalitarianism is one that automatically makes more room for facts, because people who abandon authority as the source of knowledge will be drawn to rationality and evidence.  But it's interesting to consider that the egalitarianism in the liberal worldview is in conflict with the nurturance, at least on a metaphorical level.  These internal conflicts aren't unique to liberals, of course.  Conservatives also have tension in their model, mostly between the idea that father knows best and the belief that discipline is geared towards bringing children up so they can be adults and take over the role of strict fathers.  You see this particular tension playing out between conservative populists and elites, with the former acting the part of the grown son who has reached the point where he's challenging his father over who's the man of the house.

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Posted by Amanda Marcotte on 06:05 PM • (155) Comments

Yeah - although I’d hesitate to make common sense a good, because I think often both left and right denialists claims - at least sometimes genuinely - that a scientific result is wrong because it conflicts with common sense.  From a conservative point of view, common sense is usually a cipher for tradition, and all it entails.  On the left, you get a slightly more democratic view that common sense is raw intuition, self-proving because your natural conclusions must be better than any objective science. 

Now, if you’re reasonably scientifically minded, you’ll find your intuitions and common sense opinions start to line up with the body of science you’re familiar with, so common sense isn’t an unmitigated good.  But it’s very important to keep the faith that the world will frequently conflict with our intuitions and common sense judgements, and to be ready to throw those overboard. Most abrasively, I think, is quantum mechanics in this regard.

Comment #1: Billingham  on  05/06  at  07:15 PM

Is the anti-vax movement really liberal?  I suspect that if is, it’s mainly because faith healing siphons off the conservatives.

Comment #2: jfpbookworm  on  05/06  at  07:31 PM

Vaccine denialism is a misfire on environmental concerns in general.  The yuppie American lifestyle is unsustainable, but people don’t want to admit that.  So real concerns with environmental toxins such as hormone-imitating compounds and stuff that affects sensitive kids but not most kids is combined with denial on how one’s lifestyle is contributing to that kind of pollution.

The result is the neo-hippie “live perfect and you won’t get sick” where only a person in a high socioeconomic class has the resources to live perfect.  Panic about class warfare (because you can always lose status) combined with genuine concern about the impossibility of mastering all the science behind why some pollution is acceptable and some is not.

Comment #3: Punditus Maximus  on  05/06  at  07:33 PM

There are right wing antivaxxers, who tend to find religious sources to oppose health care, and a fair string of Libertarian types who believe that vaccines, like everything else, are a conspiracy of the Trilateral Commission, the Bilderberg Group, and the Reverse Vampires. 

But aside from those units, most of the alt-Med community is affiliated with the political left.  They rant against Big Pharma, (which, needless to say, has its sins but is not poisioning children in the guise of preventing the mumps) frequently appropriate concepts from other cultures because they’re supposedly more pure, and otherwise act against the traditional power structures that the right endorses.  So they’re broadly on our side, which honestly makes them all the more intolerable.

Comment #4: Billingham  on  05/06  at  07:38 PM

What about the birth at home movement? I never know what to think about that one cause it seems to have a bit of a matriarchy thing to it, but then on the other hand there is the whole issue about the high number of cessarian deliveries and if the number is inflated cause people want to schedule child birth between 9 to 5.

Comment #5: Tersa  on  05/06  at  07:38 PM

I love me some science, but I also think it’s important that we don’t put faith in the veracity or wisdom of everything that has been scientifically “proven.” Studies, tests, experiments, etc. don’t happen in a vacuum. There are all kinds of biases, politics, financial incentives, and general goonery that surround work in every discipline. At the very least, it would be good to be open to evolving understanding that actually advances science as opposed to clinging to old understanding that limits progress. The strength of the peer review system is that some flaws in the understood science can be addressed, but the weakness is that it magnifies the amount of human nonsense that gets injected into science.

Comment #6: David B.  on  05/06  at  07:45 PM

BTW, my usage of the word “faith” was accidental there. I just meant get too invested in it.

Comment #7: David B.  on  05/06  at  07:47 PM

A liberal politician who expressed doubts about vaccination would get laughed out of the room by both ideologies. A conservative politician who expressed doubts about evolutionary theory is damn near every one of them.

Comment #8: Matt T.  on  05/06  at  07:47 PM

David B.,

Does anyone actually do that, though, put undue “faith” in everything sciences had “proved”? Most folks who put “faith” in what science can do have a fairly solid grasp on how science works and how we find things out, and therefor know that with every scientific discovery or theory comes the unspoken but definitely there caveat of “best we can tell with the tools we got, anyway”? Certainly, there is confusion sometimes with scientists stating with firm belief that, for example, the universe as we know it began 15-20 billion years ago with a “Big Bang” and smart asses will say “Well, how do they know, no one was there”. However, there isn’t enough hours in the day to preface every scientific statement with “Best we can tell” and smart asses are going to be smart asses.

Comment #9: Matt T.  on  05/06  at  07:53 PM

Regarding #8, I’d say the fact that there are virtually no nationally prominent liberal politicians, it’s almost a moot point.

This is one area, at least, where it’s a relief that our side isn’t controlled by its noncentrist members.  If only we could still get some left-wing voices into the conversation on virtually everything else.

Comment #10: Billingham  on  05/06  at  08:01 PM

Right-wingers often suggest that the most common type of left-wing science denialism can be seen in the feminist response to some evolutionary psychology and neuroscience that suggests an adaptive/biological difference between men and women (that somehow legitimizes inequality according to many people who make this criticism).

Like the race and IQ issue, you could easily argue that the science behind such things is/was poor anyway (“women like pink because of their prehistoric role gathering berries, even though pink was seen as a masculine colour until the 1920s, derp”). I just point this out because when (usually libertarian) folks criticize liberals for denying science it nearly always has to do with some perceived inability to accept The Scientific Fact That White Dudes are Number 1. They don’t really care about the more valid examples given in this post/thread of what might constitute real left-wing denialism, because they are not as easily used to try and score political points.

Comment #11: Treefinger  on  05/06  at  08:03 PM

Left-wing denialism is a hypertrophy of good things.  So the alternative medicine woo movement is a function of allopathic medicine’s insistence that it does not have blind spots.  Anti-vaccination is a function of concern regarding environmental degradation and the fact that the new vaccines don’t have as much good science behind them as the old ones.

It is, like left-wing corruption, a human failure to live up to the ideal.  That’s why it’s different from right-wing denialism.  Right-wing denialism, like right-wing corruption, is fully consistent with their ideals.

Comment #12: Punditus Maximus  on  05/06  at  08:19 PM

I’m actually willing to say that I would be EXTREMELY skeptical of any sort of scientific claim of race or gender differences no matter the evidence. Basically, I am so suspicious of racial and gender stereotyping, and science has such a bad track record in this area, that every time I hear about a study that is presented in the form of “girls are more likely than boys to X”, I react extremely skeptically.

But I have to say that even if someone could present evidence that would be sufficient to overcome my skepticism, I would still be VERY reticent to endorse this sort of conclusion. I think the political consequences of race and gender difference science are far reaching and scary. People always use it to try and oppress blacks and women and restore “the good old days”.

So maybe that makes me anti-science. It seems to me that I have a better, more articulate reason for it, however, as compared to conservatives’ “we don’t like anything that calls our religion into question or which might cost polluters money”.

Comment #13: Dilan Esper  on  05/06  at  08:42 PM

Comment #1: Billingham on 05/06 at 07:15 PM

From a conservative point of view, common sense is usually a cipher for tradition, and all it entails.

I’m gonna have to challenge that one.  The problem is that what the conservatives often call “tradition” is actually a fantasy of a “golden age” that never actually existed.  See, e.g., the conservatives’ version of the 50s—you know, the days when we had no teenage pregnancies and small government.

Comment #14: sacundim  on  05/06  at  09:01 PM

but I also think it’s important that we don’t put faith in the veracity or wisdom of everything that has been scientifically “proven.”

well, for starters, nothing in the universe can be or has been “scientifically proven”. science works with evidence, not proof. proof is for math. if you want to criticize something, please first understand how it works

A liberal politician who expressed doubts about vaccination would get laughed out of the room by both ideologies.

erm. you do know that, for example, Bernie Sanders, is pro so-called alternative medicine? And that Bill Maher is an anti-vaxxer?

Comment #15: jadehawk  on  05/06  at  09:14 PM

I thought the anti-vaxxer mentality was adopted by the conservatives when they started believing that the vaccines came from aborted fetuses.

Comment #16: Albert Cirrus  on  05/06  at  09:18 PM

I wouldn’t say that liberals rejected the idea of IQ differences between the races without evidence. Some scholars have told me that there were statistical points in the Bell Curve that liberals couldn’t immediately refute without further study, but that’s not the same thing.

Liberals already had a large, empirically well-supported body of evidence that made them aware of race/cultural biases on IQ tests as well as a large body of evidence showing how material deprivation (correlated with race in a racist society) could decrease IQ in non-genetic ways. James Flynn of the Flynn Effect has some amazing free iTunes lectures on the research behind the Bell Curve and Bell Curve Skepticism.

Liberals also knew that inter-generational deprivation due to chronic racism could show up as “heritable” in these kinds of analyses because of how the construct of heritability is defined. So, for a lot of liberals (and anyone else trained in then-state-of-the-art psychology and public policy) there were profound reasons to be skeptical, much like when that Lancet study purported to show a scientifically bizarre correlation between vaccination, autism, and GI disorders in children.

So, liberals (and other people who were interested in testing) were skeptical about the Bell Curve, and they kept pushing until they figured out to reconcile this apparent anomaly with their larger body of beliefs. This is an example of how science should work.

Comment #17: Lindsay Beyerstein  on  05/06  at  09:22 PM

Chris Mooney did a short roundup recently, on whether anti-vaccination beliefs are actually a mostly left-wing phenomenon (as tends to be the assumption).  He concluded that anti-vaxxers doesn’t seem to be especially tied to either the left or the right. 

There does not seem to be a terribly great amount of polling data on this, which is surprising since vaccine denialism is a somewhat mainstream thing these days.

Here is Mooney’s piece:
http://blogs.discovermagazine.com/intersection/2011/04/27/more-polling-data-on-the-politics-of-vaccine-resistance/

Comment #18: chaucerchu  on  05/06  at  10:02 PM

One example of liberal science denialism, and a troubling one at that is energy policy, particularly with regards to nuclear power which provides a pretty good alternative to fossil fuels when you consider the existing centralised infrastructure of energy distribution, the reliability of renewable sources and the extent to which they must be implemented to provide our existing energy demands, and the need to reduce contributions to global warming. The anti-nuclear movement does seem to be particularly strong amongst those of liberal persuasion, regardless of whether nuclear power can provide a reasonable alternative to fossil fuels.

Comment #19: ayjay  on  05/06  at  10:05 PM

I’m willing to support nuclear power from a left wing perspective if the reactors are state owned and operated. I’m a big believer in philosopher/economist Amartya Sen’s observation that there has never been a famine in a democracy in modern times. Democratic governments are so attuned to the needs of people they just don’t let large fractions of the electorate die of starvation, no matter how incompetent they are. I suspect the same would hold true if the public, rather than the market, were fully in control of the nuclear industry. Meltdowns would never be allowed to happen because shot-term profits would never, or hardly ever, eclipse large-scale public safety.

The immediate possible downside of nuclear power is so large, relative to a respectable future upside (minus massive public subsidies), that citizens should have voting power over nuclear reactors. It’s them and their children and grandchildren who will have to suffer if anything goes wrong.

Comment #20: Lindsay Beyerstein  on  05/06  at  10:23 PM

I’m a little indifferent on the issue of state ownership vs. regulation when it comes to nuclear plants. However, I’m very, very pro-nuclear in general, with the proviso that we make serious efforts to work on disposal and reprocessing matters, as well as work on reactor safety.

Comment #21: BrianX  on  05/06  at  10:28 PM

What about the birth at home movement? I never know what to think about that one cause it seems to have a bit of a matriarchy thing to it, but then on the other hand there is the whole issue about the high number of cessarian deliveries and if the number is inflated cause people want to schedule child birth between 9 to 5.

You’re playing into the “natural” childbirth talking points.  The idea of selfish women and/or doctors who prioritize convenience over the life of a baby is largely a strawman.  There may be a very few bad doctors out there who induce labor and perform c-sections because they need to get the golf course by tee time, but it’s certainly not the standard procedure.

I also hate hate hate the trivializing of pain.  Women’s pain is either seen as unimportant or somehow magically empowering.  Is there any other case where someone experiences that much pain and people try to pretend that it’s somehow good for them to not get pain relief?  The only case I can think of is withholding certain painkillers from terminally ill patients out of a ridiculous fear of addiction.  But when women want pain relief during labor, they will get criticized for it even though there’s no actual benefit to feeling the pain.

Comment #22: bananacat  on  05/06  at  10:32 PM

erm. you do know that, for example, Bernie Sanders, is pro so-called alternative medicine? And that Bill Maher is an anti-vaxxer?

Bernie Sanders the socialist? Seen a lot on the Sunday morning talk shows, is he. And doesn’t Maher self-identify as a libertarian? Regardless, the point stands. Anti-vaxxers and alternative medicine fans aren’t considered “mainstream”, while global climate change “skeptics” and evolution deniers have been in the White House.

Comment #23: Matt T.  on  05/06  at  10:36 PM

This isn’t really about science, but an example of how the same shit can be dressed up in a different package.  A while ago I saw a necklace on Regretsy as a gift for a girl’s first period.  It used the term womyn, which is allegedly feminist but not a type that I’ve ever been involved with.  And the description basically said the girl is now able to get pregnant so she has to be careful about who she “shares her body with”.  Same old slut-shaming wrapped up in matriarchal garbage.  I guess being coerced into not having sex is ok if liberals tell you not to do it.  I guess a woman making the choice to have sex is still scary.

Comment #24: bananacat  on  05/06  at  10:37 PM

Amanda, part of being a scientist is understanding that a lack of proof of hazard doesn’t mean a lack of hazard.  I deal with air toxics research on a regular basis, and the EPA people I deal with frequently admit that there are a hell of a lot of chemicals out there for which there is little evidence of harm ... and little evidence of safety, either.

Absence of evidence is NOT evidence of absence.  That goes for many things in life, but it is painfully and exquisitely true when it comes to toxicity of chemicals.

Comment #25: Ms Kate  on  05/06  at  10:42 PM

bananacat, Tenya is in no way playing into “talking points”. The US has a whopping high C-section rate, higher than a lot of other developed countries IIRC, and a maternal mortality rate we should be deeply ashamed of. Birth at home is as safe for mothers and slightly safer for babies, in most pregnancies, than hospital birth. And we know that interventions in birth lead to more interventions, increasing the risk of iatrogenic complications.

It’s not about pain medication as much as it is about the culture around hospital birth that still doesn’t, on the whole, accept perfectly well substantiated practices like moving around during labor, as much privacy as possible for the laboring woman, use of water for pain relief, and sufficient food during labor to fuel the intense work the body is doing. It’s also about the insurance companies, who are making obscene amounts of money insuring OBs and imposing one-size-fits-all cookie cutter rules for how a birth should proceed.

Also, you will have a point about women being guilted into homebirth when there are tons of OBs and insurance companies pressuring women OUT of hospital births, states make the practice of attending hospital births illegal, and the most frequent comment you hear about a woman planning a hospital birth is “how could she do that, does she want her baby to die”.

Comment #26: kristin  on  05/06  at  10:42 PM

Bananacat, please explain why countries where birth at home is supported have considerably lower rates of bad outcomes for mothers and children? 

Most US homebirths are attended by certified midwives.  You probably didn’t know that.  Scientifically, health systems in Europe have far better statistical outcomes - scientifically measured and standardized.  These same systems have large numbers of home births and births in low tech settings.  Explain.

Comment #27: Ms Kate  on  05/06  at  10:47 PM

bananacat:

I’m not too sure what to say—that’s certainly good advice even to someone who is in fact a slut. But it does definitely have shame overtones, doesn’t it?

Comment #28: BrianX  on  05/06  at  10:48 PM

kristin, give me a break.  Pregnant women face all kinds of guilt from every side, and you know it.  Of course they’ll be criticized for having an epidural, just as they’ll be criticized for not having one.  The claims that some alleged liberals make that pain relief is unnatural or selfish or bad doesn’t help anyone.  It’s bad when it comes from either side, and I’m not gonna give liberals a free judgment pass just because the other side is also bad.  I don’t know if you’ve ever had kids or known any women who have kids, but consider yourself extremely privileged if you haven’t faced shaming for choosing a hospital birth.

Comment #29: bananacat  on  05/06  at  10:50 PM

Tracing scientific opposition to theories of racially inherited intelligence to Gould is very ahistorical; the opposition starts way back.  The earliest significant opponent I can name is Franz Boas, and I’m by no means a historian of science.

The more fundamental problem with all the “scientific” theories of intelligence, IMHO, is that it’s just a blatant instance of the naturalistic fallacy.  “Mary is intelligent” is fundamentally a value judgement: it says that Mary has some unspecified set of qualities that the speaker presupposes we ought to value.  It doesn’t articulate what those qualities are, and sweeps under the rug the whole question of whether we really ought to value all of those qualities.

But of course, if you dig under the surface a lot of the qualities end up being bullshit, like whether the people you’re judging speak the standard dialect or not (to the detriment of minority groups who speak nonstandard dialects; e.g., African-Americans), or whether they value sitting down and earnestly doing pointless busywork to “prove” their intelligence to a scientist.

Comment #30: sacundim  on  05/06  at  10:58 PM

Bananacat, as you don’t plan children, you probably don’t know that the real issue with any and all obstetric care in the US is that care does not proceed from scientific findings and best practice statistics for various issues, and that women are given little if any choices in participating in that care.  As an epidemiologist who gave birth to a breech baby without a totally unnecessary c-section, you can trust me on this: a lot of birth care has more to do with tradition than with data and science and measured outcomes for given interventions.

Comment #31: Ms Kate  on  05/06  at  11:00 PM

Bananacat, please explain why countries where birth at home is supported have considerably lower rates of bad outcomes for mothers and children?

I’d really like to see some evidence for this.  Does this only apply to developed countries?  If you’re only looking at relatively rich countries, then I would say that both homebirths and good outcomes are the results of the same cause(s), and that one doesn’t directly cause the other.  European countries generally have better health care coverage than we do in the United States.  They also tend to have fewer unplanned pregnancies in general.  They tend to just be more supportive of pregnant women and new mothers in general.  The tend to take better care of their poor people in general.  All of these things are great, and make both home birth and hospital birth safer.

You probably didn’t know that.

Actually I did know that.

Maybe what you don’t know is that I’m not anti-home birth.  I’m also not anti-hospital birth.  What really bothers me is when people feel like pregnant women have to justify their decisions for their birth.  I don’t like the implicit assumption that c-sections are done selfishly for convenience.  I don’t like the implicit assumption that women who want epidurals are somehow bad mothers or doing it wrong.  Pain relief should be enough of a justification, or liberals could just mind their own business.  It’s also bad when conservatives do the same thing (and they tend to do it even worse), but that’s not what this thread is about, and it also doesn’t justify liberals doing the same thing just because it’s to a lesser extent.  I could go on for pages about how the other side is even worse, but that’s a different topic and one that I think we can agree on.  My point is that pressuring women into one choice so that they can have a way out of a different choice doesn’t seem like much progress to me.

Comment #32: bananacat  on  05/06  at  11:00 PM

the real issue with any and all obstetric care in the US is that care does not proceed from scientific findings and best practice statistics for various issues

But making women feel guilty for pain relief or having a c-section or an induction isn’t the solution!  What we need is more science, not some naturalistic fallacy.  I’m glad your breech baby turned out ok, but do you have any evidence that breech babies turn out better without c-sections?  You just admitted that evidence is lacking.  So rather than assume c-sections are unnecessary for most women with breech babies, maybe that’s something we should actually, you know, study, and stop telling women they were wrong either way until we actually find out.

Comment #33: bananacat  on  05/06  at  11:04 PM

The optimal c-section rate, in terms of absolute mortality (mother and infant) is always going to be slightly higher than what, in retrospect, appears to have been absolutely necessary. That’s because there are babies and moms who showed signs of genuine distress, the signs strongly correlated with serious injury or death for the baby and/or the mother, who nevertheless turned out okay without a c-section.

That’s how medicine works. That’s how medicine should work: Erring on the side of caution. That’s presumably what most mothers want for their babies, in the abstract. OBs don’t just do c-sections for shits and giggles. They err on the side of cutting the mother open because, if anything goes wrong with a questionable vaginal birth, the baby can sustain permanent brain damage in minutes. I’m not even getting into what often happens to a mother in terms of tears due to cephalopelvic disproportion, blind luck, etc.

Comment #34: Lindsay Beyerstein  on  05/06  at  11:05 PM

I’m not too sure what to say—that’s certainly good advice even to someone who is in fact a slut. But it does definitely have shame overtones, doesn’t it?

I was just sort of ranting so I didn’t really explain how slut-shamey it was.  Luckily, through the power of Google search and insomnia, I have found said post and link to it for you convenience:

http://www.regretsy.com/2011/03/25/red-tent-event/

Here are some choice gems.  (BTW, Womyn is supposed to be capitalized, apparently)

I sought a balance between pure, uncorrupted innocence, represented by the white, and the awakening of the blood mysteries

Words like pure and innocence generally raise red flags for slut-shaming.

This is one of the most important moments in her life, as she is now capable of bringing forth children, so she must take care about who she chooses to share her body with.  A young womyn’s body and virginity should be held in high regard

Yeah, it doesn’t get any more slut-shamey than that.  Basically virginity and female bodies are finite commodities that get used up.  Condoms aren’t enough to stop the womyn from being corrupted and made impure, even though they’re pretty good at preventing “bringing forth children”.

 

Comment #35: bananacat  on  05/06  at  11:22 PM

I support the right of women to give birth wherever they want, under whatever conditions they choose, acccompanied by whichever attendants they want—from unassisted birth at home to a full obstetrical and neonatological team in the hospital, or anything in between. That’s every woman’s choice. No matter what she chooses—from lowest-tech to highest-tech—some people will invariably accuse her of putting her own safety above that of her infant, or vice versa. Because women’s bodies are never truly their own. Because women’s choices are never truly final. It’s all bullshit.

The reason this is under continual dispute is not because the science is unclear (we know the odds for mother and infant in a wide range of scenarios) but rather because women’s autonomy is always in question. It’s still not unequivocally socially acceptable for a laboring woman to say, “Save me, sacrifice my baby.” Which is what I’d say if it came right down to it.

Our society just doesn’t love women enough to make that the default thing for a woman to say on her own behalf. Even though it’s what the medical establishment does by default for her in those situations. Sometimes, I think obstetrical science did better for women in an underhanded way than culture would have allowed otherwise.

Comment #36: Lindsay Beyerstein  on  05/06  at  11:27 PM

Anti-vaccination woo is one of those weird things where the right and left loop around and meet so you get proponents from both sides.

And the description basically said the girl is now able to get pregnant so she has to be careful about who she “shares her body with”.  Same old slut-shaming wrapped up in matriarchal garbage.
“Be careful who you have sex with” just sounds like common sense to me, how is that “shaming” in any way?

Comment #37: Devonian  on  05/06  at  11:59 PM

Devonian:

You know what else you get when right and left loop around and meet in the back?

Lyndon Larouche.

Comment #38: BrianX  on  05/07  at  12:43 AM

Sounds uncomfortable.

Comment #39: Punditus Maximus  on  05/07  at  12:51 AM

Maybe I’ve swallowed too much kool-aid but I’m going to balk just as hard at “nurturing mother” as “strict father.”  The nurturing and strict parts are fine, stapling gender onto them kind of sucks.

And not just because in my household I tend to be the nurturing one while my partner’s strict.  Or maybe sort of: when you’re in it, with the company of other parenting couples, you start to notice that “strict” and “nurturing” are a) kind of socially contructed but also b) actually pretty evenly distributed between mothers and fathers.

But what I really wanted to bring up is that some of the nurturing/strict liberal/conservative confusion arises because we’re talking about two dimensions, not a single spectrum.

For instance a lot of resistance to science on the left isn’t so much affinity towards motherly nurturing as it is being anti fatherly strictness.  (See civil libertarians or anti-war activists.)  Similarly, by trying to understand contemporary conservatism entirely in terms of strict father worship you’re going to miss a lot of people who aren’t really very strict-father fetishists at all but are very anti nurturing mother.  (See capital-L Libertarians, and a lot of “right to carry” gun types.)

If you don’t get that nurture and strictness can be mixed and matched with their opposites I don’t think you’ll ever get a handle on nominally “liberal” issues like home childbirth, vaccination, breast feeding, and circumcision issues, the organic vs. affordable food debate, nuclear vs. carbon energy.  On the right, opposition to universal healthcare is all about resistance to strict-father/nurturing-mother hegemony. 

Most “NiceGuy(tm)” guys are at least ambivalent towards strict fathers and maybe a little too over-invested in the idea of nurturing mothers.

And meanwhile the fairly radical activists who publish or subscribe to Mothering Magazine are actually pretty strict “fathers” about whether a 4th-degree tear is better for you than a namby-pamby there-there-dear episiotomy and whether 48 hours of up-hill-both-ways labor is superior to copping out with an epidural or, worse, a c-section.  (Those of us at the intersection of the two characteristics think very highly of the entirely situational midwife Penny Simkin, who sensibly points out that it’s ok to change your mind either for more intervention or less once you’re actually in labor.)

Summary, anyway: two dimensions, not a single spectrum.  Stapling conventional genders to strictness and nurturing is still just totally wallowing in gender stereotyping.

figleaf

Comment #40: figleaf  on  05/07  at  12:54 AM

I think the largest problem is that while science is sound; doctors and researchers are human. And humans are habitual, they tend to stay set in their ways, they don’t (and can’t) know everything, and when they make mistakes they can make huge fucking mistakes.

On the birth tack, I’ll bring up episiotomies as that’s generally not something that people “choose.”

Episiotomies used to be typical care, but evidence is piling up that they are generally not useful and in fact can actually add to the problems they are trying to prevent (tearing, pelvic floor dysfunction, etc.) ACOG, is a little uneasy on what to tell their members to do, but they state that there is no shown benefit in normal labour and that, in fact, it can cause more damage. They even warn about procedure becoming “routine” when they are not actually needed.

http://www.acog.org/from_home/publications/press_releases/nr03-31-06-2.cfm

However it has become routine, “obstetricians performed episiotomy in 54% of their low-risk patients,” the exact type of behaviour that ACOG is warning about.

http://www.jabfm.org/cgi/content/full/18/1/8
(Interestingly that family doctors come out as less likely to use interventions on a Family Medicine publication.)

Then you have things like Vioxx… yeah.

I really do think part of the problem is that doctors are put on pedestals. When you set someone up as a paragon of truth, and then they’re wrong; it’s almost like a question of faith. Incidents like these can really shake the trust that people have in these institutions. Everyone at some point or another is going to run into a doctor, or a medical professional who makes the wrong diagnosis or even seriously screws up. My father-in-law had cancer, but his actual cause of death was a botched centesis to draw fluid from his abdominal wall. It punctured his stomach lining and leached it’s contents into his body, and then nobody noticed it had happened.

It’s not just that doctor making a mistake, it becomes a systematic problem and all doctors are ‘in on it.’ “It” happening to be whatever the fervor is that day but generally some of kind of money or power motive.

It actually kind of reminds me of the “money-grubbing lawyer” stereotype. People see a lawsuit in the news that they think is superfluous and it’s all the lawyer’s fault; they believe the lawsuit has no benefit and just wouldn’t happen if the lawyers weren’t out looking for a paycheque. That horrible allergic reaction, to that one vaccine, that one child had, just wouldn’t happen if doctors weren’t trying to make money off of vaccinations. And you know, it’s not like anyone dies from these diseases, so vaccines don’t have any benefit either.*

*Which is total snark of course, but so many anti-vaxxers claim that it’s “different” in North America. Or that the health risks associated with measles are acceptable. Or my favourite, that polio would never spread in America due to advanced sanitation. Oy.

Comment #41: hypatia  on  05/07  at  01:25 AM

When we’re talking “optimal c-section rate for mother and baby”, it’s well below the 30% which is standard in the US.  And having major abdominal surgery is neither painless or free of complications.  I had my second baby in a university-hospital alternative birthing center which had a csection rate of 5%, despite serving some high-risk populations, and they were doing research on what led to the best outcomes.  Then I moved to another city, with my research papers under my arm, and my new doctor refused even to look at them.  He talked to me like a dumb little girl who didn’t understand what was best for me, and insisted that I would need interventions like an iv, and continuous monitoring, because that’s what’s “safest for the baby” as if I needed prodding to care about that.  The average csection rate in the new city was then 20%  (it’s now much higher), so I quadrupled my chances of major abdominal surgery just by moving.  I spent most of the labor arguing with the nurses to be allowed to move around, or have a sip of water on a hot August day (they’d let me suck on a wash-rag - ugh!), which was not a help to my comfort.  People need epidurals when they’re strapped down with monitors and iv’s, kept from moving, induced and pitocined to speed things up.  It’s much less necessary when the mother’s comfort, rather than the insurance company’s dictates, come first.  I’ve done it both ways, the high-tech epidural hospital birth, and the natural supported birth (in a hospital), and believe me, the second is way more comfortable. I can see the temptation of a home birth to get away from fighting off interventions during the stress of labor.

Comment #42: gretchen  on  05/07  at  01:42 AM

Sacundim, as someone who does cognitive testing in the course of my work, believe me, most of us are quite aware that intelligence is only a construct. It is really very hard to come into contact with any psychological material related in any way to that construct - assessment tools, research papers - without being made very aware of how relative and imprecise a term that is.

Just because it is an imperfect model that has, for the most part, been discredited and replaced by more sophisticated ways of describing the way people think and interact cognitively with their environments does not mean that the research surrounding it is entirely without merit. Nor is that research without merit just because some social scientists used it in developing a theory that has been discredited by subsequent research, unless you want to disown the science that was used to discredit it.

Since this thread is about anti-science attitudes, I thought I should point that out.

Comment #43: Dymphna  on  05/07  at  01:48 AM

In other words, just because something is wrong or inaccurate, it does not follow that it is therefore not science. Science works by being progressively less wrong and progressively more accurate.

Comment #44: Dymphna  on  05/07  at  01:59 AM

I’m rather amused that I was defended from spouting the home birth talking points when not actually around. But yeah, actually, this coming from my health care background labors that are progressing just fine, but slowly, suddenly become failures to progress and require a section at 4pm on Friday is not a myth, nor done solely at the discretion of the to-be mother has decided she has had enough of this laboring shit.

But while I’d say there is most definitely a pronounced matriarchy tone to the whole thing (“this is superior womanly intuition guiding this decision rather than stoopid old men’s icky science”) C-sections and other trappings of hospital births like internal monitoring and IV access and nothing by mouth (nice that we’ve mostly done away with the enemas) and induction tends to cause more problems than solve. Internal monitoring means you cannot walk around, when walking is one of the best interventions to keep a labor progressing, you’re more likely to die with a c-section, etc. But these have clear, clean steps and processes - unlike natural birth. This is convenience and, to an extent, defensive medicine, rather than best as chosen by the patient.

Comment #45: Tenya  on  05/07  at  08:38 AM

figleaf, you’re mistaking my descriptive language for prescriptive language.  So yes, don’t balk.  Whether you like it or not, people’s metaphors are gendered.  Wishing doesn’t make it not so.  Feminism, and fighting, and a looooooong process we’ve only just begun will make it so.

Comment #46: Amanda Marcotte  on  05/07  at  08:51 AM

I just can’t not comment on this.  I am extremely pro-scientific method and I do believe that scientific knowledge is, by far, the most “accurate” form of knowledge out there.

That said, science can be flat wrong which is why we also can and should always question the biases and motives behind the scientists conducting experiments.  We should also always evaluate studies with a critical eye looking at methodologies and making sure that the conclusions are reasonably drawn from the data.  That kind of critical information can help us evaluate how accurate studies and assertions based on scientific data really are. 

So, scientific claims about global warming are incredibly widely accepted, I see no real agenda on the part of the scientists producing the data, and I see a lot of genuine reflection and speculation by the scientists themselves.  Thus, I give this data and the arguments about global warming credit.

On the other hand, evolutionary psychology produces numerous studies on gender difference.  This data is usually methodologically flawed, there is a LOT of disagreement about what the data means, and the people producing these kinds of studies are often promoting their own specific position.  Thus, I’m a lot less willing the blindly accept this scientific data as accurate. 

The shifting attitudes around BPA in plastic is the kind of thing that makes me wary of trusting corporations and government entities to tell me what is genuinely safe.  I think there are clear profit motives at play here (I am a liberal after all) and, after working as a lobbyist in Washington, I have seen how profit plays out in terms of regulation of things like chemicals.  It ain’t pretty and I’m not willing to accept the lack of data about things like PDBEs, phthalates, pesticides, PFAs, PCBs, dioxins, bisphenols, and even some heavy metals including a total lack of information about the ways in which these things interact with each other.  Are you suggesting we are silly to question the use of these chemicals in just about every mass-produced consumer product we buy?

This all leads me to your really offensive stance on anti-vaxers.  Yes there are Jenny McCarthy crazies out there, but many of us who question the vaccination schedule currently promoted are much less extreme.  I don’t think vaccinations cause autism, I don’t even think they are inherently toxic on any level.  My son is fully vaccinated.  That doesn’t mean I’m not worried about my inability to access accurate information about the trials conducted on these things that I am injecting into my child. 

This is tied to a much larger issue I have with modern medicine.  Even doctors are increasingly looking at the ways in which medical decisions are made and questioning their lack of evidence based approach.  There is a huge movement in the medical community to promote less reliance on “standard operating procedure” and more emphasis on evidence of outcomes.  This alone should encourage us to all be aware of the ways in which medical choices are usually made.

I have lived in numerous third world countries and have seen the very real, very positive impact vaccinations have on public health.  However, I think we need waaaay more transparency in issues relating to things such as vaccinations. 

Comment #47: fizgigs  on  05/07  at  08:56 AM

In particular, the science on the older vaccinations is WAY better than the science on the new stuff, and there is almost no science on how densely ordered the vaccinations need to be.

Comment #48: Punditus Maximus  on  05/07  at  09:58 AM

Re. homebirth and pain medication, there’s no good reason that a woman giving birth at home can’t have some form of pain relief. An epidural, of course, is not possible. Gas-and-air (aka Entonox, aka nitrous oxide), however, which is used by just about every woman giving birth in the UK, can be used in the home. Likewise pethidine injections, waterbirth, and TENS are all options at home. That women in labour don’t have access to gas-and-air in US hospitals is a disgrace*, but I doubt very much it is the fault of the homebirth movement.

* I believe a single-digit number of hospitals offer it. It is in every single ambulance here - cheap, effective, safe, and - crucially - self-administered by the patient who remains in control.

Comment #49: Nineveh  on  05/07  at  10:29 AM

@Amanda: “you’re mistaking my descriptive language for prescriptive language.”

Point taken.  (Ow!)

fl

Comment #50: figleaf  on  05/07  at  10:36 AM

Just for the record, I’d note that the “strict father vs nurturing mother” model isn’t a product of the American left/right dichotomy per se, but an historically recurring phenomenon. For example, in the “far-left” Soviet Union, Darwinian evolution was rejected in favour of a bizarre neo-Lamarckism, on the grounds that Darwinism was “fascist”. (And all this despite the fact that Karl Marx himself had been enthusiastically Darwinist!) The “strict father” model, and so ideological denialism, tends to come with the accumulation of power in a certain limited part of society, whether it be the American business class or the Soviet bureaucracy.

Comment #51: Finnegan  on  05/07  at  10:55 AM

http://balkin.blogspot.com/2011/05/david-brooks-gets-nostalgic-for-18th.html
Liberals and arguments from authority:

“As Gordon Wood points out in his magisterial Oxford history of the United States between 1789-1815, the Federalists (like, for that matter, most of those who framed the Constitution) decidedly mistrusted the masses and wished for leadership by elites who could be counted on to identify and then to act on “the public interest” instead of crasser interests (such as the preferences of their unenlightened constituents, who were expected to defer to their betters rather than prefer officeholders who took constituents’ views all that seriously).

For better or worse, this vision of American politics, which among other things is based on the premise that there will be no “factious” political parties, was, as some say about decisions like Plessy, “wrong the day it was decided,” and that was made clear for all to see no later than 1800. But the call for a return to a “republican” political order is a constant of American politics. <u>It is the heart of the Progressive vision of high technocracy</u> (and non-partisan elections) and of Michael Sandel’s emphasis on the politics of the “public good” instead of a necessarily selfish “liberalism.” One could also see such elements in the revival of “civic republicanism” that was an important part of the legal academy in the ‘80’s (led by, among others, Cass Sunstein, who is now a leading member of the Obama Administration). Though Brooks is a Republican, Democrats, like Sunstein and Obama, are certainly attracted to it. (Perhaps this helps to explain why the “community organizer President” basically suspended any community organizing, which is too “democratic.” Brooks very much likes that Obama.)”

Comment #52: seth edenbaum  on  05/07  at  11:08 AM

fizgigs, I am going to assume that your concerns are in good faith, but the truth is that it looks like the “vaccine spacing” thing is much like Obama’s birth certificate or the idea that Kerry shot himself in Vietnam—ie, that it’s a controversy that’s “out there” and so scientists “need” to address this, and the complainants’ concerns are valid because they’re only raising an issue of concern that’s been “out there.”

Comment #53: Tyro  on  05/07  at  11:11 AM

What I’m about to say is a bit tangential to the anti-science point, but I think it’s related and also ties into the birth sub-thread. There’s a tendency that’s particularly strong in American culture to look for individual solutions to communal problems. That’s why we have “bootstraps” narratives instead of an adequate social safety net and investment in health and education. I see the anti-vax movement in that context. I see the pink-ribbon bonanza around breast cancer in that context as well. There ARE a lot of chemicals in our environment that weren’t there 200 years ago, and it’s hard not to believe there is some relationship between that and cancer rates and autism and all manner of things. But instead of organizing to demand more and better research and regulation, we leave it up to individuals to attempt to opt out. I think it gives people a way of feeling in control. And it gives other people (people who run institutions) a way to avoid making larger changes.

Circling back to birthing/mothering choices, I - and most women I know concerned about our obstetric climate - don’t blame individual “selfish” women for our c-section rate. I blame an obstetric culture that privileges physician discretion over patient autonomy, that privileges institutional convenience over patient welfare, that treats a woman like a baby container, not a human being, that discourages patients from being informed. A LOT of things that doctors do to laboring women in hospital are NOT scientifically based. They are based on culture and convenience. Things could be very different than they are today. But it’s structural! It’s not about individual women making “good” or “bad” choices.

Comment #54: chingona  on  05/07  at  11:37 AM

Ok, the anti-spacing thing is silly.  The purpose of a vaccine is to excite an immune response, and there has been very little good research on how many immune responses we want to excite in a given period of time.  We are finite organisms with finite capacities for stress.

Comment #55: Punditus Maximus  on  05/07  at  12:02 PM

@55 chinonga:  This!  I’m deeply troubled by them number of autistic kids just among people I know, while this was vanishingly rare 50 years ago.  Like you, I feel there are things in the environment that are causing this, but what?  And chemical companies and polluters and such just say you haven’t proven that what we’re doing is unsafe, so we’ll keep doing it.  In Europe, they have the opposite metric, prove that it’s safe or you can’t do it.  How do you cope with this to protect the people who can’t opt out and go live in a cabin in the woods?

Comment #56: gretchen  on  05/07  at  12:33 PM

Hospitals are dirty, dirty places.  Choosing to leave your home to go to a hospital to give birth is like choosing to leave home in order to eat lunch in a privy.

Comment #57: Dr. Psycho  on  05/07  at  12:46 PM

This!  I’m deeply troubled by them number of autistic kids just among people I know, while this was vanishingly rare 50 years ago.

I think it’s more an artifact of under diagnosis of autism years ago, rather than an increase in incidence per se.

About 50 years ago, my brother was diagnosed with childhood-onset schizophrenia, and it was blamed on ‘poor mothering’ because of the prevalent theories of the time, and Mother Avenger cried because she was basically being blamed for his disease.

Today, he’d be diagnosed as autistic, and MA wouldn’t be blamed for his condition.

My youngest brother, born in 1963, fit a lot of the criterion for Aspergers’ syndrome, but, he too was diagnosed as a case of childhood-onset schizophrenia as well.  He had perfect pitch, a startling memory for sports statistics, and could tell you what day of the week any date in the Gregorian calendar he was given fell on, which apparently he learned to do after being taught how to calculate a day of the week in his head going back 2 or 3 weeks from the present date.

This is from the Wiki:

The most recent estimate states that “up to 1 out of every 110 children born today has some form of ASD.” [34] The number of diagnosed cases of autism grew dramatically in the U.S. in the 1990s and early 2000s. For the 2006 surveillance year, identified ASD cases were an estimated 9.0 per 1000 children aged 8 years (95% confidence interval [CI] = 8.6–9.3).[17] These numbers measure what is sometimes called “administrative prevalence”, that is, the number of known cases per unit of population, as opposed to the true number of cases.[24] This prevalence estimate rose 57% (95% CI 27%–95%) from 2002 to 2006.[17] A further study in 2006 concluded that the apparent rise in administrative prevalence was the result of diagnostic substitution, mostly for findings of mental retardation and learning disabilities.[24] “Many of the children now being counted in the autism category would probably have been counted in the mental retardation or learning disabilities categories if they were being labelled 10 years ago instead of today,” said researcher Paul Shattuck of the Waisman Center at the University of Wisconsin at Madison, in a statement.[35]

http://en.wikipedia.org/wiki/Epidemiology_of_autism

 

Comment #58: Dark Avenger Guardian Chow Mein  on  05/07  at  01:05 PM

This all leads me to your really offensive stance on anti-vaxers.  Yes there are Jenny McCarthy crazies out there, but many of us who question the vaccination schedule currently promoted are much less extreme.  I don’t think vaccinations cause autism, I don’t even think they are inherently toxic on any level.  My son is fully vaccinated. 
Comment #48: fizgigs on 05/07 at 08:56 AM

Then you’re not an anti-vaxxer.

In particular, the science on the older vaccinations is WAY better than the science on the new stuff, and there is almost no science on how densely ordered the vaccinations need to be.
Comment #49: Punditus Maximus on 05/07 at 09:58 AM

The science on the new stuff must by definition be scarcer than the science on the old stuff, because there’s been less time to study it.

Should there be research on alternative vaccine schedules?  Yes.  People are using these schedules now so it would be silly not to follow these people versus those who use the recommended schedule, and see if there’s a difference in outcome.

Comment #59: oldfeminist  on  05/07  at  01:46 PM

About 50 years ago, my brother was diagnosed with childhood-onset schizophrenia, and it was blamed on ‘poor mothering’ because of the prevalent theories of the time, and Mother Avenger cried because she was basically being blamed for his disease.

Today, he’d be diagnosed as autistic, and MA wouldn’t be blamed for his condition.
Comment #59: Dark Avenger Guardian Chow Mein on 05/07 at 01:05 PM

Slight correction—since women can never win, MA would probably be blamed today for allowing him to get vaccinated, assuming she did.  And then blamed for not handling his autism correctly, regardless of how she did it.

Happy Mother’s Day everyone.

Comment #60: oldfeminist  on  05/07  at  02:02 PM

Bananacat:  You are right that women will be jumped on regardless of what birth she ends up having.  We live in a misogynist culture. And certainly individual promoters of natural birth have elevated it to a form of woo, but no less than the “don’t question the doctor” proponents.

But we can’t really begin to discuss epidural vs. unmedicated birthing when so many women do not even know it is possible to give birth without pain relief, when our whole medical apparatus for birth is structurally aligned against natural birth.  When major metro areas have no Lamaze or Bradley birth classes, when OBs do not help their patients understand how the body naturally copes with pain during labor and what the woman can do to make the pain work for her rather than against her, when many OBs will not work with a labor doula, when hospital policies ensure labor will be MORE painful, when women are told endlessly that the pain is simply too great and they should just go for the epidural rather than try to be a hero (there are no medals, after all), these all mean that it is not simply a matter of personal preference.  Most women are not being offered a real choice.

The science is there, if you want to find it (I don’t have time to use my Google-fu for links).  Frankly, you have a much rosier view of OBs than I do, knowing my own experiences and that of my sisters and friends.  Best medical practices are often antithetical to good business in the current health system.

Comment #61: history_mom  on  05/07  at  03:22 PM

I’m deeply troubled by them number of autistic kids just among people I know, while this was vanishingly rare 50 years ago.
I think nobody was diagnosing it properly, is all.

I would be extremely surprised if my late aunt hadn’t had some form of autism, for example.

Comment #62: Devonian  on  05/07  at  03:50 PM

I think the egalitarian nature of the left also plays into the anti-vaxers, “I know as much as any scientist! “

Comment #63: Woodrowfan  on  05/07  at  04:35 PM

so many women do not even know it is possible to give birth without pain relief,

What sort of a rock do you have to be living under to think this?  Isn’t assuming ignorance rather than choice a little misogynistic?  Or at least it puts real women’s choices below some ideal of what they should choose, under a natural childbirth ideology.

Women giving birth choose epidurals (and other pain relief) because, like other human beings, they don’t like pain.  Like other human beings (hell, like all creatures with developed nervous systems) they deserve medical care that looks to their subjective comfort.  We can get pain relief for dental work without anyone batting an eyelid - is it a breach of our right to choose that you can’t go to courses to hypnotise yourself into sitting through a root canal?

Pain relief in childbirth was something that women once demanded, and got against the express resistance of the church, members of whom thought that pain in childbirth was God’s punishment for Eve’s sin.  As late as the 1940s, people like Grantly Dick-Read argued that pain in childbirth was all in the minds of overcivilised women, who needed to be convinced back into their natural roles, like “primitive” women.  I don’t quite understand how a movement with those origins found traction amongst feminists, but the impersonal labour and delivery practices of the past (or present) don’t justify throwing the baby out with the bathwater.

Comment #64: Trouble  on  05/07  at  04:41 PM

Hospitals are dirty, dirty places.  Choosing to leave your home to go to a hospital to give birth is like choosing to leave home in order to eat lunch in a privy.

Thank goodness we decided to eat our lunch in a privy 20 years ago, or my second son, Jamie, would have died within hours of his birth.

Comment #65: Michael Bérubé  on  05/07  at  04:58 PM

Absence of evidence is NOT evidence of absence.

I’ve always hated that saying.  Absence of evidence certainly is evidence of absence, in those cases where you would expect evidence.  It’s just not conclusive evidence.  What is true is that “absence of proof is not proof of absence”.

With many chemicals we haven’t looked for evidence of toxicity, so lack of such evidence is extremely weak reason to consider it safe.  The quote’s conclusion is essentially true, but that’s not the case in general.

 

Comment #66: wnoise  on  05/07  at  05:24 PM

I’m deeply troubled by them number of autistic kids just among people I know, while this was vanishingly rare 50 years ago.
I think nobody was diagnosing it properly, is all.

Bingo.  We’re also diagnosing milder forms than even 10 or 20 years ago, so there are a lot of people who have managed to ‘pass’, though still having to deal with the issues of being autistic, who haven’t been diagnosed until later in life, if at all.

Comment #67: Jayn Newell  on  05/07  at  05:43 PM

And then blamed for not handling his autism correctly, regardless of how she did it.

When we took in a cousin of mine from PA’s side of the family, my aunt threatened to come and shoot PA, so we took refuge at a friends’ house for a while(I didn’t learn about the former until a few years after the fact).

My cousin recently told me that the word around town was that MA would do plays at the local community theater because she had ‘a built-in baby-sitter’ which of course was grossly unfair.

MA had me ‘hold book’ for her plays instead of my cousin because she was in middle school/high school and holding book wasn’t my cousin’s bag.

So, you’re right oldfeminist, in the mid/late 60s’ women could never win.

As MA used to say, “Dumb shits!”

Comment #68: Dark Avenger Guardian Chow Mein  on  05/07  at  05:45 PM

Hospitals are dirty, dirty places.  Choosing to leave your home to go to a hospital to give birth is like choosing to leave home in order to eat lunch in a privy.

Oo, yucky, yes, we wouldn’t want anyone sick going to one of those dirty, dirty, places, let alone someone about to squeeze a 3 kilo baby who can’t breathe yet out of a narrow aperture over the course of 8 or so hours.  Maybe if they did something to make up for it like offering, I dunno, lifesaving care to the 1 or 2 in every hundred women and lots more babies who wouldn’t make it without it.

Comment #69: Trouble  on  05/07  at  06:08 PM

The birth discussion has gone a bit pear-shaped.

A. Properly speaking, “natural” birth is not what most birth-rights activists are aiming for, mostly because “natural” is a meaningless term. “Respectful” and “evidence-based practices” are the goals, here.

B. The dicey-to-abusive treatment of women in medical culture is well-documented; the problems that women who do birth-rights activism fight are based around issues of lack of consent (as in the woman in Florida who was c/sectioned against her will by judicial order), issues of bad practice (see: episiotomies, which were used until very recently despite a complete lack of evidence of their efficacy, and the permanent damage they caused) and issues of plain old abuse (tying women down; shackling them during labor; threatening them with CPS taking away their children; denying them food, water, and the ability to move during labor).

C. From my perspective and that of the women I work with, woo is the enemy. We do not believe medicine is bad; we do not believe pain is good; we do not believe every woman is capable of vaginal birth and therefore culpable if she cannot have one. We also believe that since consent is paramount, shaming a woman for her medical decisions is not ok.

D. There are those out there who hold those views, often for religious reasons, but more sadly, sometimes because they have been traumatized by an abusive medical experience.

E. Homebirth, water birth, use of midwives, whether to use pain relief and what kinds, are not and should not be “doctrine” for any woman, but instead based on what works best for her. The objections to epidurals is not that they block pain but that they immobilize women on their backs, forcing them to labor in the worse possible position, and making it harder for them to know when to push. This can result in more risks due to increased c/sections/tearing or other complications.  In addition, many woman find that being tethered to an IV and monitors cords keeps them from moving and dealing with their pain, and that this in turn increases their pain.  We do not yet have magical drugs that work for all women in allowing both movement and pain relief while still preserving enough sensation to let women know when to push. I for one would be thrilled if we did. In the meantime, things like waterbirth do show lots of promise for pain relief for at least some women.

/end clarification

Comment #70: emjaybee  on  05/07  at  06:40 PM

Also, there are structural factors that make doctors more likely to diagnose kids with autism when they present with a bunch of complicated developmental an behavioral problems. The structural incentives used to go the other way. In decades past, there were services for children identified as having cognitive disabilities but few to none for children diagnosed with autism. So, if a kid had both (and obviously not all kids with autism do), it would be to everyone’s advantage to label them as “mentally handicapped” as opposed to “autistic.”

Now, thanks to decades of parent activism and increased awareness, specific services are opening up for children diagnosed with autism and special services for kids with developmental delays are getting squeezed. So, doctors have a structural incentive to label kids as autistic for the same symptoms that might have gotten them labelled as cognitively disabled a generation ago. This results in an apparent increase in the autism rate with no change in the underlying disorder.

Comment #71: Lindsay Beyerstein  on  05/07  at  06:46 PM

Maybe if they did something to make up for it like offering, I dunno, lifesaving care to the 1 or 2 in every hundred women and lots more babies who wouldn’t make it without it.

Call me a hopeless idealist, but I think they could still fulfill this mission without treating too many women like unthinking, unfeeling baby containers.

And everything emjaybee said.

This is very much a feminist issue. Just like advocating for access to abortion does not mean that any particular woman should or should not have an abortion, advocating for more patient choice and autonomy in birth does not mean that any particular woman should or should not have an epidural/a c-section/a home birth. See how easy that is?

Comment #72: chingona  on  05/07  at  09:35 PM

bananacat, all the science in the world won’t help against entrenched traditions and medical staff
I had a long post written, but look at this. 

Here: http://www.wbez.org/story/regulators-let-breast-milk-compete-formula-hospitals-86129

Comment #73: phylosopher  on  05/07  at  09:44 PM

Also want to note that we are at a tipping point where our c-section rate and complications related to c-sections are now driving an increase in the maternal mortality rate in this country. Lindsay is right that the c-section rate will always be higher than optimal because of imperfect information, but we are way out of balance right now and it’s killing women.

Comment #74: chingona  on  05/07  at  09:50 PM

But TYro, you can’t deny that for some vaccines, either the info isn’t there, or the Medical types don’t /won’t take the time to disseminate.  Eg. Varicella.  In my experience, chicken pox had been a nice two week vacation from school, with a very slight if any fever, and one minor pox scar on my hand, long since faded. The same for most of my European descent cohorts.  I know that isn’t the case for everyone, particularly Asian/Pacific Islander immigrants and their descendents. 

So, I asked what the benefits were of this vaccine, especially if it would increase/decrease chances and severity of shingles, as I had just watched a relative suffer with this. Not only would could no one give me an answer, but the condescension encountered on my even asking - such as when I requested a contact number to the manufacturer to find out for myself, was enough to turn me into an anti-vaxxer out of shear cussedness when someone tells me I should just shut up and let the expert who obviously knows so much better, blah, blah ,blah.  This was a fricking nurse, not a research scientist.

Comment #75: phylosopher  on  05/07  at  10:04 PM

Because, Trouble, c-sections often have much worse outcomes and certainly much longer recovery times.  Epidurals can have pretty severe problems too - ever hear of an epidural headache? Spouse and I went through this after a homebirth labor and eventual C-section.  Back to the hospital as mom couldn’t lift her head off the pillow without screaming in pain.  Hospital absolutely sucked, as they then wouldn’t allow the baby back in to stay with mom, not even in a private room - while they THEN went to wait and see mode if it would close naturally, without ever mentioning the option of an epidural repair - Oh yeah, it was a holiday weekend….hmmmm.

Comment #76: phylosopher  on  05/07  at  10:14 PM

What sort of a rock do you have to be living under to think this?  Isn’t assuming ignorance rather than choice a little misogynistic?

When nobody you know has had an unmedicated birth, and indeed other women seem to delight in telling pregnant women their birthing horror stories and how horrendous the pain was, every birth class assumes you will have an epidural and therefore does not teach you how to cope with the pain, your doctor assumes you will have an epidural like you have no other choice, and natural birthers are demonized, yeah a lot of women are not aware that there is a lot you can do to manage labor pain without an epidural.  And people underestimate how much fear of the unknown contributes to the experience of pain; when you teach women the stages of labor and how the body handles it you empower them to make the best decisions for themselves.

I don’t consider it ignorance when information is more often deliberately witheld. I spent four years working for a non-profit for mothers and pregnant women often do not know what information to trust, where to look for accurate information, or are constantly undermined if they even dare think they can birth without an epidural.  Often, doctors won’t even tell their patients that there are side effects to an epidural or that it increases their odds of a c-section.  Yes, pregnant women have a responsibility to inform themselves but when the system is the problem, I prefer to think about how to make the system better than to blame individual women.

But hey, if you want to believe that the practice of obstetrics in this country is hunky dory and that this all comes down to personal preference, you go right ahead. Don’t let evidence stand in your way.

Comment #77: history_mom  on  05/07  at  11:22 PM

And I should add, I have never, will never, and don’t support forcing women to do without epidurals if that is what they want.  I support informed consent. I chose a natural birth because it was best for me (a previous abdominal surgery convinced me I never wanted a c-section if I could possibly avoid it); not all women can or should labor without pain medication and the only person equipped to make that decision is the individual woman.  It is hardly a misogynist position or one requiring adherence to some self-sacrificing ideal of womanhood.

Comment #78: history_mom  on  05/07  at  11:28 PM

Bingo.  We’re also diagnosing milder forms than even 10 or 20 years ago, so there are a lot of people who have managed to ‘pass’, though still having to deal with the issues of being autistic, who haven’t been diagnosed until later in life, if at all.

I use a popular cultural reference that I think supports this. Consider some examples of characters who have been on TV over the last few years: Brennan and Zach on Bones and Reid on Criminal Minds. Word of God from the producers is that Zach has high-functioning Aspberger’s, Matthew Gray Gubler says he plays Reid that way, and Brennan is wildly assumed by fans to also have the condition. So three mainstream characters on the autistic spectrum disorder.

But if you ignore that and look at how the characters are portrayed, all three easily fit the “socially awkward, bit odd genius” that’s been part of fiction, and cliché, for a lot longer than people have really understood and looked for autism. There’s constant speculation about which fictional characters, ranging from Reed Richards to Sherlock Holmes, would be diagnosed with some form of autism today.

So what we today recognize as behaviour that falls on the autistic spectrum has been with us, and relatively common, forever.

 

Comment #79: KeithM  on  05/07  at  11:33 PM

I didn’t suggest the practice of obstetrics in your country is hunky dory, history_mom, and you shouldn’t assume it’s the same country as mine.  I’m very grateful I don’t have to choose between full obstetric care and the too-loosely regulated midwifery system in the US, and if I did choose private care in my country, I’m profoundly grateful the full service would cost maybe $3000 US, without insurance.  I don’t think the problem is women’s knowledge about pain relief, unless what you mean by knowledge is believing that really complicated and ineffective pain relief techniques are better than effective but not zero-risk techniques.

I have had childbirth education, in a hospital, and we looked at a selection of types of pain relief, and talked about the benefits and risks of all of them.  I know friends who’ve had unmedicated births, gas only, epidurals, c-sections, footling breeches, epis that only worked on half the body and all sorts.  The toughest woman I know, an endurance racer, tried it without pain relief and changed her mind halfway through.  I didn’t have to go out of my way to gather these experiences, they just happened around me.  And I’m not special, I think every woman who’s contemplating having a baby gathers those stories around her.

Comment #80: Trouble  on  05/07  at  11:43 PM

But TYro, you can’t deny that for some vaccines, either the info isn’t there, or the Medical types don’t /won’t take the time to disseminate.  Eg. Varicella.  In my experience, chicken pox had been a nice two week vacation from school, with a very slight if any fever, and one minor pox scar on my hand, long since faded. The same for most of my European descent cohorts.  I know that isn’t the case for everyone, particularly Asian/Pacific Islander immigrants and their descendents. 

Lots of things we are vaccinated for now were simply non-fatal diseases we just endured—at least, most of us did. A few suffered very badly.

So far, we’ve had the chicken pox vaccine for quite a while, and it’s working out pretty well.

But hey, concerns about the chicken pox vaccine and concerns about the vaccine spacing schedule are “out there” and “some people say” it isn’t safe, so, I guess it might be dangerous because “people are saying that.”

Comment #81: Tyro  on  05/08  at  12:04 AM

Trouble, it helps to know that you’re not in the US when you say you think you’d have to live under a rock to not know it’s possible to give birth without pain relief.  Here, it is possible.  All the interventions that cause increased pain, like pitocin, immobility, continuous monitoring, and withholding food and water, are standard, and when all these increase pain, it’s “see, it’s too hard without an epidural”.  And if you want to do without some of this, it’s suggested that you don’t care about your baby’s safety. 
As I said above, I’ve done it both ways, the full-bore hospital epidural delivery, and the all-natural, no medication, supportive, comfort-based, woman-respecting way, and the second was way better.  I’m not saying that everyone should do it the same way, but I’m saying there should be real alternatives, and in the US at this time, there definitely aren’t.

Comment #82: gretchen  on  05/08  at  12:09 AM

And if we’re doing more than gathering anecdotes from the people around us, and care about evidence-based medicine, a Cochrane review of the use of epidurals showed that “epidurals relieve pain better than other types of pain medication, but they can lead to more use of instruments to assist with the birth. There was no difference in caesarean delivery rates, long-term backache, or effects on the baby soon after birth. However, women who used epidurals were more likely to have a longer second stage of labour, need their labour contractions stimulated, experience very low blood pressure, be unable to move for a period of time after the birth, have problems passing urine, and suffer fever. “

That’s consistent both with my own experience and the information I was given prior to my daughter’s birth.

Comment #83: Trouble  on  05/08  at  12:12 AM

Gretchen, I don’t quite follow.  My understanding is that interventions like pit, immobility, monitoring and withholding food (but not water in my experience; besides, you don’t get so thirsty when you’re on iv fluids), happen more often after the epi’s in.  They don’t cause people to choose the epi.

I felt that state of the art medical care was both supportive, comfort based and sufficiently respectful, in a professional sort of way.  That’s pitocin, trainee midwive internal exams, instrument assisted delivery by a twentysomething registrar who didn’t introduce herself and all.  It’s not a holiday spa.  There is, to bring things back to the topic of the post, an Issue with the concept of expert authority here.  When we engage any expert, in medicine or law or electrical work or whatever, we’re hiring their judgement; they owe us their best judgement and experience, not just telling us what we want to hear and doing what we want them to do.  Feminism understands that authority has and still is misused, but it’s throwing the baby out with the bathwater to insist that expert authority is in itself suspect.  That’s the essence of the egalitarian, liberal, lefty problem with science.

Comment #84: Trouble  on  05/08  at  12:30 AM

On a somewhat related note about fucking up science, Vox Day has apparently equated “new atheism” with autism.

http://voxday.blogspot.com/2011/05/it-seems-new-atheism-is-not-on-rise.html

What a dumbass.

Comment #85: Albert Cirrus  on  05/08  at  12:37 AM

Perhaps you didn’t hear me, Tyro.  I asked for more information, not because I am anti-vaxx, but because from my experience, it was like “why bother?”  I obtained the dangerous to those not of your ancestry on my own.  I still haven’t heard a definitive on the “prevents shingles.”  So do I have a reason TO vax for varicella yet - no.  If I were of different ancestry I would consider it. 

In the meanwhile, I have heard another theory that says shingles is on the rise because as adults, we haven’t been exposed to milder from from chicken pox kids. Sort of a natural immune booster.  Now, does that make sense?  well, I know that lots of allergies and asthma are on the rise and that has been in part because of our extreme germophobia and kids not being exposed to enough germs/allergens.  (Interesting study the other day on Israeli kids and peanut allergies).  So, a priori, yes it makes sense - and since I’m a bit lazy and it really isn’t important to my family to definitively find out - meh. BTW, it was the f’ing health department that couldn’t wouldn’t give me any answers when they had me right there, ready to varicella vax. 

So, until I can obtain the answers, one kid has the vax, one doesn’t. 

No to mention the “religious exemption” thing pisses me the fuck off.

Comment #86: phylosopher  on  05/08  at  12:43 AM

Nice that you conveniently edited the part about more research needed on long term outcomes.  ANd I’m betting there are quite a few - based on my family experience and and others, and that review, it would be quite likely that epidural drawbacks in outcome short term would result in a cascade of other bad outcomes - breastfeeding problems, bonding problems when mother and infant are separated, etc.

Comment #87: phylosopher  on  05/08  at  12:50 AM

Vaccination works by exposing our immune system to safe versions of pathogens/germs - things that look like the germs but aren’t infectious.  I’ve heard it described as like getting the navy to come out by running up a skull and crossbones flag, rather than sending in a full pirate ship.  It’s keeping your immune system in shape.  People concerned about the spacing of vaccines worry that two or three or five different pathogen-shaped things overwhelm an immune system, but we’re exposed to far more naturally.

And IIRC, after you’ve had real chickenpox the varicellla goes dormant in your body and can later become shingles when you’re older.  You need to have had chickenpox first.

Comment #88: Trouble  on  05/08  at  12:51 AM

@ Trouble ... Pit, immobility and continuous monitoring are SOP in most U.S. hospitals before the epidural. Gas isn’t an option in the U.S.

 

Comment #89: chingona  on  05/08  at  12:54 AM

Jeezuz, Trouble, there are a shit load of things that are done with the idea that a c-section will be needed. Like insertion of a catheter that later can’t be removed - put in improperly, it will necessitate a c-section because the bladder will rupture otherwise, even if the cervix ends up dilating sufficiently for vaginal delivery.

If food and sufficient water aren’t given and walking isn’t allowed because of a monitor, the labor is likely to be prolonged which increases the overall pain quotient to over thresh-hold.   

You hire a medical expert not because they are necessities at birth, but because they are a back up if/when things don’t go as planned. Therefore, it’s different than an appendectomy - no one does those on their own - ya know? Therefore, by definition it will be a medical intervention.  Women have been birthing children without medical intervention for millenia.  It should be a cafeteria of choices, not chef’s dictum blue plate special - OK?

Comment #90: phylosopher  on  05/08  at  12:59 AM

I’m betting there are quite a few

Ok, well, when you have some evidence for that position, then we can have that conversation.

Comment #91: Trouble  on  05/08  at  01:01 AM

Duh, your own study said further study would be a good idea - so we’re back to, the study that should be done, hasn’t been done, and we get to rely on our experiences and common sense to fill in the blanks. 

Did you look at that NPR link I posted earlier - it seems to me simple common sense, that if you’ve got a busy nurse and an epiduraled mom who hasn’t regained a lot of mobility - or a c-sectioned one, then they are more likely to shove a bottle at the kid than take the time to work with a semi-mobile patient and latch on. 

Go back and read that transcript, or listen to the tape if you can.  With no support, especially for low-income and young mothers,  it’s so friggin easy to assume it’s just there choice (fits that lazy, irresponsible, bad mom stereotype, doesn’t t?)  But how much of a choice is it when you’re not given the tools to succeed?

Comment #92: phylosopher  on  05/08  at  01:09 AM

Women still birth children without medical intervention in many parts of the world, and in countries where that’s more common, maternal morbidity and mortality are a lot higher, not to mention the babies.  The idea of a trained assistant is that they should spot problems before the woman who’s actually in labour - you might not know what to ask for, or worse, you might think you know but have it wrong.

To take the chef’s analogy a bit further - do we agree that there’s a certain standard of service a chef/ cafeteria should provide?  If I ordered a rare chicken steak, a responsible waiter should say “we don’t serve that, ma’am, it’s not safe to eat”?

Comment #93: Trouble  on  05/08  at  01:27 AM

Ok Trouble, Here’s the wiki on varicella vaccines- and it’s footnoted and cited and I’m not at the office so I can’t confirm all those citations, but go for it if you feel so moved:
http://en.wikipedia.org/wiki/Varicella_vaccine

HOpe the link I find pertinent _ International Journal of Toxicology - will do for you?
http://www.herpesdoctor.com/chickenpox-vaccine-linked-shingles-epidemic

Seems there’s tons of evidence that what we’ve done is traded @ 100 deaths per year for a heck of a lot of pain and suffering among the elderly, and a 4-7% fatality rates among them.  .  And the way to prevent it - another vaccine, post 60, which my now anti-Medicare country won’t be paying for. 

So, let me get this right, (and no, I’m not an anti-vaxxer per se.  There is no way I would not vaccinate a kid against polio or whooping cough, diptheria, or tetanus)  But it seems as if we’ve taken a minor problem with little expense and turned it into a two vaccines required major expense and not necessarily eliminated fatalities or decreased total suffering - but we didn’t get the information as a society to make the informed choice, did we?  And the only pure “winner” as in profiteer in all this?  Big Pharma.  So excuuuuuuuuuuse me, for being a bit suspicious.

Comment #94: phylosopher  on  05/08  at  01:31 AM

No, I didn’t follow the link, but I have been a semi-mobile mother tucked into bed with a new baby, half asleep, and breastfeeding as far as the baby was concerned went fine - she snacked away half the night.  I was very grateful for the catheter, which meant I didn’t have to get up and pee, and the nurse came and helped us get rearranged when I needed it.  The last thing they would have done, even three nights later when the milk still hadn’t come in and we were both desperate, was give us formula - you had to explicitly ask and pretty much explain yourself if that’s what you wanted to do.

Comment #95: Trouble  on  05/08  at  01:34 AM

Continuing that analogy then, - if I didn’t know about that, I might indeed say why thank you.  But if the waiter or chef then said, oh, and with that we insist that you have green beans, and use this hand sanitizer before you eat, we insist, and really, you shouldn’t have a sharp knife you might cut yourself, we’ll cut it up for you in the kitchen.  And what coffee? Oh no, no, no we don’t allow any hot drinks here, you might spill and burn yourself….

Comment #96: phylosopher  on  05/08  at  01:37 AM

The way I read the chickenpox links is that people who haven’t had the vaccine might become more susceptible to shingles because the people who have had the vaccine aren’t spreading it around.  So the risk, if there is one, is to people who haven’t had the vaccine rather than the people who have. 

It’s not on the schedule in my country.  You can have it if you pay about $60 I think, I’m not yet sure about the cost-benefit on that.

Comment #97: Trouble  on  05/08  at  01:43 AM

Trouble:  you admit that “in your experience” occurred outside the US.  Let me assure you that in the US, I experienced withholding food, and, yes, water, immobilitiy, and continuous monitoring with no pain medication.  It was SOP, for the supposed “safety of the baby”, as if it was a wild chance-taking to allow labor to proceed without these preparations for a possible csection.  And these interventions created a much more uncomfortable labor, with no more benefit to the baby, than the watchful monitoring of my second labor created.  The difference was, the medical team for the third labor had their SOP that they were determined to follow, and were convinced that it was the only possible way to proceed and were very disrespectful to any of my requests for variation.  This was in sharp contrast to my second labor, at a university medical center, conducting research on best practices.  I’m glad you were satisfied with your experience.  I also believe in deferring to the knowledge and experience of professionals, when they are open to the most current information on the subject.  When they insist on adhering to hidebound, outdated information, or take their cues from what their insurance company’s lawyers require (something I’m sure you don’t have to deal with outside the US), I don’t see any benefit to thoughtlessly going along with whatever is asked of me.  Including not taking a drink on a hot August morning, since my thirst wasn’t slaked by the unnecessary IV they insisted upon, “just in case surgery is required”.  And surgery would have been required, if anybody had bothered to call anaesthesiology in.  But since nobody did, I had a delivery worthy of a 14th century midwife.  Despite all the minor precautions, when real problems occurred, they were unprepared for major complications.  Thankfully, the baby was ok, despite, not because of, their preparations for a surgery they were unable to perform.

Comment #98: gretchen  on  05/08  at  01:46 AM

The nicest restaurant I ever went to thoughtfully brought little extras between the courses - a shot glass of soup, or a little chocolate thing in bowl of dried ice.  Sure, I could have sent it back saying I didn’t order it, but I would have been cheating myself out of a good time.  And it would have been rude in the extreme to complain about being pressured into things I didn’t want.  Admittedly an internal exam is no shot glass of delicious soup, but the analogy holds up to a point.  I could have walked out, gone somewhere else, or left it on my plate, but I probably couldn’t have told the waiter to bring me a cheese sandwich, or serve me on a different sort of plate or whatever. 

Comment #99: Trouble  on  05/08  at  01:49 AM

One more thing, Trouble.  Nobody is saying it’s a choice between the perfect, caring, all-knowing physician, and dropping the baby alone in your dirty cabin.  The present state of affairs is that if you go to a hospital, you get every possible intervention whether it’s needed or not, and if you object, it’s because you’re a selfish bitch who doesn’t care about the safety of your baby, and it’s a good thing the professionals can overrule you and do what needs to be done to your body without question because it’s the only possible and best, rightest way.

Comment #100: gretchen  on  05/08  at  01:51 AM

Also want to note that we are at a tipping point where our c-section rate and complications related to c-sections are now driving an increase in the maternal mortality rate in this country. Lindsay is right that the c-section rate will always be higher than optimal because of imperfect information, but we are way out of balance right now and it’s killing women.
Comment #75: chingona on 05/07 at 09:50 PM

Health care in the US is increasingly different for the haves and the have-nots.  I don’t doubt that iatrogenic effects contribute to poor outcomes for many births, but being underserved by the medical establishment is probably just as bad.

http://www.scienceandsensibility.org/?tag=maternal-mortality-2 says:

African-American women are 3 to 4 times as likely to die from pregnancy-related causes as white women.

Women living in low-income areas across the US were 2 times as likely to suffer a maternal death as women in high income areas.

Comment #101: oldfeminist  on  05/08  at  02:05 AM

@ Trouble ... the situation in the U.S. is not really comparable to the U.K. Amnesty International did a report on our maternity care system, it’s that bad.

There was a study recently out of California - big state, lot of hospitals, lot of births - that found that for-profit hospitals had significantly higher c-section rates than non-profit hospitals serving the same population. How can a woman look at that and not suspect that something fishy is going on?

We also have much higher rates of non-medically-indicated induction, which IS shown to increase c-section rates, particularly for primips.

It’s been practically impossible to get a VBAC in large swaths of the country for about a decade now, which is the main thing driving the huge increase in our c-section rate. Vaginal breech is practically non-existent, as well.

A lot of OBs claim worries about getting sued drive their decision-making. The actual impact of that fear is much debated, but it’s one more factor that you all don’t have.

I agree that when you hire someone, you are hiring their judgment. To me, that means that if my midwife or doctor recommends an intervention, I expect them to explain what they’re concerned about, how the intervention will address that concern and what the risks are. And then it’s up to me.

(And as an aside, your story @ 96 really shows the differences. If a nurse here catches you sleeping with your baby in a U.S. hospital, you’re treated like you’re trying to kill your baby. My SIL works in a hospital that still gives sugar water to babies in the nursery.)

Comment #102: chingona  on  05/08  at  02:07 AM

@ oldfeminist ... Good thing I’m not arguing for underserving poor women and women of color! And adequately serving marginalized populations does not automatically mean providing them more surgical births! If you look at the causes of maternal mortality in this country, it’s not that women are being denied c-sections because they are poor. However, some studies have found poor follow-up care after c-sections to be a big contributor to morbidity and mortality, and I’m quite sure that’s worse for poor women. The woman I know personally who came closest to dying in birth had an absolutely, 100 percent, no questions about it, necessary c-section, but what happened afterward was a downright criminal level of malpractice.

Comment #103: chingona  on  05/08  at  02:17 AM

Please go back and read, or better yet listen to the WBEZlink I posted, oldfeminist.  I think you;ll find it interesting.  I particularly love the rising defensive paranoia in the one hospital officials voice as she INSISTS it’s the woman’s choice not to breastfeed, when the hospital is doing everything it possibly can to undermine breastfeeding, including refusing volunteers..

Comment #104: phylosopher  on  05/08  at  03:04 AM

INteresting you mention that that the international community is now looking at the U.S. as what NOT to do.  Again, that WBEZ transcript shows another hospital using a UN grant to implement best practices for breastfeeding.

Comment #105: phylosopher  on  05/08  at  03:08 AM

@100, Trouble if you can’t understand the difference between being offered something and having it forced on you, then there’s really no discussion. 

@ 98, You’ve read it wrong.  It’s because earlier, there was a natural booster effect.  That’s gone.  The subtstitute for that natural low cost method of delivery is now an expensive shot, to a population that is hard to illicit vaccination from - adults.  We are seriously (Ryan) considering yanking healthcare coverage from seniors - so that’s really going to improve the situation - and low income seniors will get the brunt of it, as usual. Grayson had it right - Die quickly.

Comment #106: phylosopher  on  05/08  at  03:15 AM

I can understand the difference between having something forced upon you, and it being offered.  But I was under the impression that American women had the right to refuse medical treatment, the same as in my country.  Perhaps I’m wrong.  I’ve read of a few instances of women in the US co-erced into unwanted interventions, or had inappropriate child protection intervention after refusing treatment - I thought that was actually against the law but happened because of some management fubar.

There is the grey area that history_mom picked up - the being offered something in a very persuasive way that in her view, prevents women from exercising truly free choice.  I don’t have a problem with persuasion, so long as it’s evidence-based.  Breastfeeding is encouraged that way where I’m from - you can’t advertise or free gift formula; hospitals don’t offer formula unless asked, and lactation consultants prowl the hallways offering advice and encouragement.

Comment #107: Trouble  on  05/08  at  03:39 AM

I’m still trying to figure out what the cheese sandwich is supposed to represent.

Comment #108: chingona  on  05/08  at  03:39 AM

Cheese sandwich?  Who knows.  Typing while hungry.

Comment #109: Trouble  on  05/08  at  03:43 AM

Call it a stand-in for a nice-to-have that’s not on the menu because it’s not best practice.  Perhaps a Coronary Burger would have been better.

Comment #110: Trouble  on  05/08  at  03:52 AM

In theory, we’re supposed to have the right to refuse medical treatment, but it is violated routinely in obstetrics with the justification that the fetus is a separate patient and the doctor has the right to act in the best interests of the fetus over the objections of the mother. It’s not so much management fubar and our entire view of women is fubar. Women have been court-ordered to have c-sections or go on bedrest. In one of the cases in which a woman was court ordered to have a c-section, the reason was that the baby was believed to be large. That was it. Suspected large baby. The woman had previously birthed an 11-pound baby without complications. In that case, the woman actually left the hospital before the court order was obtained. Police went to her home, but she wasn’t there. She had gone to have the baby at a different hospital, where she had birthed vaginally without complications.

The other issue is that doctors who violate hospital policy risk losing their hospital privileges, so if a hospital has a VBAC ban, it doesn’t matter what the doctor thinks or wants. There have been cases where women with previous c-sections have shown up crowning, and doctors have pushed the babies back up so they can do a c-section. (And yes, that increases the risk of injury to the baby.)

Comment #111: chingona  on  05/08  at  04:01 AM

I still haven’t heard a definitive on the “prevents shingles.”

Well, having the chicken pox virus causes you to develop shingles later in life—it’s an outbreak of the chicken pox virus that you’re carrying.

Comment #112: Tyro  on  05/08  at  10:22 AM

And some of those hospital policies are dictated, not by evidenced-based studies of best practices, but by the insurance company lawyers.  Therefore, even if you can cite studies showing that continuous fetal monitoring is not safer for the baby than periodic monitoring by a nurse with a stethoscope, or that a young, healthy, low-risk woman is not served by being tied to an iv, the hospital will insist on it anyway.  Not suggest, but insist.  Not because it’s best for you or the baby, but because the lawyers call the shots.

Comment #113: gretchen  on  05/08  at  10:28 AM

Brian @ #29:  since I don’t see anybody else addressing this, I need to.  What does it mean to say it’s “good advice to somebody who is in fact a slut”?  A “slut” is a woman (or maybe, if you’re progressive enough, could be a man) who is having more sex than you/the Etsy poster/the media/etc. think she (or he) should.  Nothing objective or factual about it, and the term “slut” is a shaming term.  Period.

(In case it needs to be said:  I, personally, would agree there’s a point at which having sex with “too many” people; I would define “too many” as meaning more than the person is comfortable with, i.e. because she feels pressured to do so or if she’s feeling objectified, or if she’s endangering herself in some other way.  And none of those cases would make it OK to call her a slut; it would mean that there was reason for concern.)

Comment #114: ookpik  on  05/08  at  11:24 AM

Please go back and read, or better yet listen to the WBEZlink I posted, oldfeminist.  I think you;ll find it interesting.  I particularly love the rising defensive paranoia in the one hospital officials voice as she INSISTS it’s the woman’s choice not to breastfeed, when the hospital is doing everything it possibly can to undermine breastfeeding, including refusing volunteers..
Comment #105: phylosopher on 05/08 at 03:04 AM

I wasn’t saying there was nothing wrong with the system. 

I was saying that the increase in maternal death is going to be not only overserving but underserving women.  Amnesty International’s report discusses disparity in health care delivery and the huge disparity in maternal mortality that results.  Women who don’t have any health care at all don’t get prenatal care, don’t get contraception or abortion services, don’t get followup after they give birth, have language barriers to getting help when they need it, have to negotiate bureaucracies that insured people don’t (yes, it’s even worse on Medicaid), go to crappier hospitals with crappier staff, and so on.

Low-income women are like a separate country when it comes to health care—if you separate out African-American women from the population, for example, you have the same maternal death rate as other developed countries.  That’s why a lot of people don’t “get” that part of the crisis—it’s not right up in their faces if they’re White and not poor.  They don’t see the bad outcomes.

People with health insurance are subjected to the health care industry leaching more and more money from them for unnecessary care, and this overdelivery causes problems you wouldn’t see otherwise. 

I’m not saying this is not a problem, but it’s a different problem.  It hits people in middle and upper class families most because those are the ones who have health insurance coverage.  And because they have the coverage, they’re put in danger and then saved from it routinely when in the past they weren’t put in that danger at all.

The Amnesty International report covers all these issues.
http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.pdf

Both/and blog, you know.

Comment #115: oldfeminist  on  05/08  at  11:56 AM

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4823a3.htm

MMR for White women in the US is 5.3 per 100,000 live-born infants.  Black women?  19.6.

That’s the difference between first and second world countries.  Switzerland is about 5; Netherlands is about 7.  South Korea is about 20.

THIS DOES NOT MEAN UNNECESSARY C SECTIONS AND STUPID HEALTH CARE ARE NOT A PROBLEM.  It means that you’re getting less of any health care if you’re Black, and any stupid health care you get isn’t as quickly or often remedied by more health care or the support to deny stupid health care if you’re poor and Black as it is when you’re insured and White.

Comment #116: oldfeminist  on  05/08  at  12:07 PM

Trouble:  You admit that your experience is not within this system. You’ve heard from several of us who have direct experience with this system and your response continues to be “Nuh uh. la la la I can’t hear you”. 

Persuasion is not what we are talking about. More often it is coercion.

When a laboring mother is told that hospital policy insists on IV, CFM, hourly cervical checks (which increase the risk of infection), only ice chips, when they won’t abide by a birth plan unless signed by your OB (and thus, doctor’s orders), ask you to sign pre-consent forms for epidurals and c-sections (“just in case”, y’know), I think it is unreasonable to lay the onus on the laboring women to stand up to that.  Especially when nurses and doctors are not above using emotional manipulation (famous “dead baby” stories) to obtain compliance.

Many women I know are not, in fact, aware that they can refuse medical treatment but have heard stories about what happens to women when they do refuse to comply with hospital policy. At the hospital I gave birth at a mother recently had a nurse call CPS on her for continuing to breastfeed her jaundiced baby (which you are supposed to do) and leaving the hospital.  The three day old child was taken from its parents for 24 hours because this nurse decided to put a mother in her place.  It makes no difference that the nurse was reprimanded because now every mother in a metro area knows this could happen to them.  The scales are massively tipped in the favor of hospitals and medical personnel.

I have to say, having hands shoved up my vagina every hour to check my progress is not even close to being offered extra food at a restaurant.  That you would make this comparison makes me think you are simply trolling.

Comment #117: history_mom  on  05/08  at  02:52 PM

“He was right that liberals rejected these theories out of hand without the evidence to disprove them, but since liberal scientists like Stephen Gould eventually made a mockery of the poor evidence conservatives brought to bear for these theories, turning them into “theories”, I kind of thought he was cheating a little.”

Wrong. Silly dichotomy at work here.  Many rejected scientific racism from the beginning because of the faulty methodology at work, among other reasons.  “Liberals” did not reject IQ-race nonsense without evidence—many rejected it because these “theories” provided proof of nothing. 

Many “liberals” did not reject the research purporting to find IQ differences between the races.  Also, Stephen Jay Gould was no liberal.

Last of all, the anti-vaccination people are mainly libertarians, not liberals per se.

Stick to the run-of-the-mill political stuff.

Comment #118: whatever100  on  05/08  at  03:12 PM

Perhaps I need to be briefer.  I don’t disagree that there are problems with how the US system is run.  I explicitly said an internal exam is no amuse-bouche.  Pressure is not the same as coercion, but it can be close.  The answer to these problems is better run, more woman and baby-friendly hospital systems, not more natural childbirth, home birth, breathing classes, birthing pools and a move to reject evidence when it conflicts with people’s preferences for the above.

Comment #119: Trouble  on  05/08  at  03:39 PM

Trouble, what is your objection to natural childbirth, breathing classes, and birthing pools in a hospital setting?  There is plenty of evidence that these are as safe as or safer than epidural/cfm/iv births.

Comment #120: gretchen  on  05/08  at  05:40 PM

Well, there’s a potential confound in that the U.S. health care system only grudgingly supports anyone without money. Irrespective of midwifery, or home birth rates, U.S. stats would look worse than most European countries on the basis of access alone. Lack of prenatal care contributes to poor outcomes. So, it’s a little misleading to compare a country with universal healthcare to a country without one.

Of course, certified midwives are cost-effective providers of quality prenatal and maternity care. If the U.S. invested in midwives as primary care providers, we could get a lot of value for our healthcare buck and improve outcomes in the process.

Comment #121: Lindsay Beyerstein  on  05/08  at  07:13 PM

No, Trouble, perhaps you need to spend more time LISTENING to those of us with actual experience and who have studied the issue.  If you were a man you would already have been accused of mansplaining at this point. 

I noted your qualification about internal exams, but the overall comment was dismissive and belittling.  For some women, vaginal checks are more than mere inconvenience; they are an unnecessary bodily violation.  Having someone’s hands in your vagina every hour does not improve childbirth outcomes and in fact substantially increases the risk of introducing bacteria.  I wonder how many sudden mid-labor fevers that necessitate c-sections could be reduced if nurses and doctors weren’t constantly sticking stuff in women’s vaginas?

Comment #122: history_mom  on  05/08  at  07:39 PM

If these periodic checks are risky, and invasive for patients, why do health care providers insist on doing them?

Comment #123: Lindsay Beyerstein  on  05/08  at  09:00 PM

Um, I do have actual experience, just not of the US system, and I’ve done a lot of reading on the issue, the material of which is mostly US-based.  I consented to a bunch of unneccesary internals so a trainee midwife got some practice, and learned a bit about what they were checking for in the process (dilation, baby position).  My point was to illustrate that state of the art medical care can be both science-based and not treat patients like battery chickens.  I support people’s efforts to change that (and I appreciate emjaybee’s distinction between birth rights activists and natural birth activists), but not attempts to invent alternative ideologies that don’t meet safety and efficacy criteria, that are based in unsubstantiated woo, or attempts to explain the ongoing popularity of interventions like epidurals as a kind of false consciousness.

I’d be happy to reconsider my view on the safety of homebirth and waterbirth (as opposed to labouring in the water and getting out for the birth) if someone could point me to the appropriate study.  I owe a good friend’s life to the proximity of a hospital following a homebirth and postpartum haemorrhage.  If having someone’s hand up you increases the risk of introducing bacteria, then so does swimming a newborn through a pool of meconium and everything else that emerges with the baby.  I’ve read several case reports of problems with babies aspirating the birthing pool water.

Comment #124: Trouble  on  05/08  at  10:17 PM

Trouble, you didn’t answer the question about your objection to natural birth and breathing classes, except that you regard them as “unsubstantiated woo”.  Natural birth has met every imaginable safety and efficacy criteria.  If you didn’t want to do it, good for you.  But you can’t extrapolate that “my doctor said this was best for me”  to “all doctors say this is best for all women.”

Comment #125: gretchen  on  05/08  at  10:36 PM

I have no problem with natural birth, if by that you mean birth without pain meds.  If people want to do that, then go for it.  What I do object to is the suggestion that the vast majority of women who choose some sort of artificial pain relief are doing it because they’re ignorant, rather than responding rationally to unpleasant stimuli.  I object to claims made by the natural childbirth movement that pain is somehow necessary to the mother-child bond, or that it’s all in our heads, or that pain relief is bad for babies.  That we’re somehow made more worthy by suffering.  That to me is fundamentally unfeminist - putting women and women only at the mercy of nature for the sake of some greater good.

Comment #126: Trouble  on  05/08  at  11:33 PM

Ok, the anti-spacing thing is silly.  The purpose of a vaccine is to excite an immune response, and there has been very little good research on how many immune responses we want to excite in a given period of time.  We are finite organisms with finite capacities for stress.

You are the one who is being silly.  We’re exposed to immune stress constantly.  3 or 5 or a dozen more things won’t be the tipping point.  The problem with spacing is that it leaves babies vulnerable to disease for a longer period of time, without actually providing benefits whatsoever.  Maybe if you have such a misunderstanding of how the immune system works, you shouldn’t think that your arguments are as valid as everyone else’s.  Learn first, then argue.

Comment #127: bananacat  on  05/08  at  11:34 PM

I object to claims made by the natural childbirth movement that pain is somehow necessary to the mother-child bond, or that it’s all in our heads, or that pain relief is bad for babies.

That’s such a straw-natural childbirth movement thing to say.  I have quite a few friends who campaign for natural childbirth (for the record, I had my baby in hospital, via c-section, in case that increases my expertise in your eyes), and not a single one of them woud suggest that pain is necessary and pain relief is, in all instances, bad.  In heated moments of frustration, they have railed against medical intervention (quite often from personal experience), but moments such as that are not the basis for the movement, at all. 

I imagine the “pain-relief is bad for babies” thing you appear to believe comes from a certain amount of opposition to pethidine perhaps.  I think it’s fair to say that that can be bad for babies, since as an opiate, it has a number of physiological effects that may be negative (such as making the baby drowsy).  Thats why quite a few sources recommend use of Meptid instead of pethidine, since it doesnt pass to the baby the same way.  Also, it’s 3-4 times as expensive as pethidine, but you will be given it on the NHS if you ask for it. 

But again, not a single person I know who advocates for natural childbirth would suggest that pain relief is bad, or that women are weak for choosing it.  Most of their work is advocating alternative pain relief, not the absence of it.  If they were against relieving the pain of childbirth, why would they be talking about stats on massage as pain relief, or water pools as pain relief, or birthing positions to reduce stress and pain - it’s ALL about pain relief, just appropriate pain relief, and pain relief that won’t unnecessarily knock women out, or make them immobile for no good reason.

It does seem pretty clear that you are talking from a UK pespective.  I’m glad you had a good experience.  Many of my friends did too, including, for example, a friend who evangelises for the cause of the mobile epidural she was given that was, for her, absolutely brilliant.  We have midwife-led care, midwife run birth centres with water pools, the right to have community midwives attend a home birth, and all sorts of lovely things like that.  We get to move around, and eat, and bring in music if we want, and this whole “rooming in” thing isn’t even an issue, because that’s entirely standard practice everywhere.

But I also had a friend who was subjected to an entirely unnecessary c-section due to “failure to progress” that, once it was looked at afterwards, was no such thing. The medical staff - the consultant, specifically - didn’t want to wait for her to progress in her own time and lied to her - she had a deely unhappy birth experience as a result.  I had my daughter by caesarian section because she was breech - but again, not because it was, strictly speaking necessary, but because the hospital consultant admitted that they had lost the skills to deliver a breech baby vaginally and I would be effectively an experiment for them.

And now listen to the US experience, which these people are trying to describe to you.  They don’t even get gas and air for goodness sake!  It’s opiates or nothing!  The standard practice is the most full-on medical intervention that we can imagine here in the UK!  That’s simply not okay.  For all of the problems we have in the UK, and I would say we have quite a few - our c-section rates are far higher than they need to be, for example, and whilst you may have had a blast with your c-section and catheter, I had a godawful time, and my experience is just as valid as yours - it pales in comparison to the US. Surely you can see that?

Comment #128: Katherine  on  05/09  at  05:19 AM

Katherine, I’m not talking about you or people you know who advocate for natural childbirth.  I’m talking about published influential natural childbirth “experts” like Michel Odent, who claims that caesarians and pain relief interfere with bonding and that support from your partner in the birthing room causes divorce.  And I’m from New Zealand, not the UK; I had a ventouse-assisted birth, not a c-section. 

I read up on all the natural stuff, Kitzinger, Wolf, just about every book in the library I could find before I had my baby.  I was supportive in principle, but of all things, I found them alarmist and pushy - “say no thanks to continuous fetal monitoring”, um, how about I decide that one?  I found, in a UK book, chapters on homeopathy as a safe alternative pain relief that gave me no credit as someone deserving of quality medically-sound advice.  I read in another, plenty of patronising foof about releasing your inner goddess along with a suggestion to bring some rescue remedy with you in your hospital bag.  That is just as disrespectful of me as a rational adult, as a pushy doctor who doesn’t stop to explain things properly before they charge ahead.

Maybe I should say it again - there is obviously a lot that needs to be fixed about the US obstetric model.  Prenatal care for low income women is a standout.  Inappropriate use of legal sanctions against women who aren’t doing things the Right Way is another.  Goodness knows what the objection to entonox over there is.  But.  The natural childbirth movement, with its associated woo on board, doesn’t provide answers to these problems.  It’s too easy to dismiss by the establishment, because of its woo, and the woo stuff works at a placebo level at best.  Neither do direct entry midwives or unattended childbirth advocates - they’re a symptom of the problem rather than a cure.

Comment #129: Trouble  on  05/09  at  06:36 AM

What’s wrong with DEMs?  You don’t go to the hospital everytime you have the sniffles—most of the time, things can be dealt with outside of the hospital setting.  Why not the same with childbirth?  If you have someone who is trained to deal with most of the normal possibilities of birth, I don’t see the problem with staying out of the hospital, especially if you’re near to one should an emergency arise.

To go back to the restaurant analogy, you don’t go to a four-star restaurant if all you want is a sandwich.  That doesn’t mean there’s something wrong with four-star dining, just that it’s not always the appropriate choice.  Most of what I’ve seen from the homebirth movement falls into this line of thinking—they don’t paint midwives as better, or OBs as worse, or vice versa.  They just say that they’re different, and a woman should be able to choose which she thinks suits her needs better.

Comment #130: Jayn Newell  on  05/09  at  08:58 AM

The idea that the chickenpox vaccine is unnecessary because chickenpox is just “a two week school vacation” is criminally stupid. That so-called vacation is also two weeks of wasted paid time off for Mommy (assuming she even has two weeks - it’s a fat financial hit if she doesn’t). Not only does Mommy get to burn all her personal sick and vacation time, it’s all completely wasted since coddling a sick brat gets old really fucking fast.

Comment #131: Yawgmoth  on  05/09  at  09:54 AM

To echo #132: a “two week school vacation” for the infected kid is also a *much* more serious deal for a non-immune pregnant woman with whom that child has contact.

Which would be the whole point of vaccination: it’s not just about you, it’s about the people around you who are protected by you not getting ill.

phylosopher, again, @ 91:

Women have been birthing children without medical intervention for millenia.

With a much, *much* higher rate of maternal and infant mortality, yes, yes they have.

Comment #132: Nic_C  on  05/09  at  11:09 AM

I know I’m late, but did anyone link to Amanda’s piece on Slate about a midwifery tragedy? It’s really interesting, especially if you live in the DC area and have been following this case. Hopefully, there will be a separate post about that since clearly this topic (and science in general) has gotten people talking.

Comment #133: serious bette  on  05/09  at  01:03 PM

I think there have been a lot of good comments on the safety and efficacy of home birth and less-interventive practices, so I won’t reiterate those here but merely add my support.

I think Trouble has a good point (perhaps not articulated as well as it could be) that home birth, while supported by evidence, is often explained and justified in terms of essentialist ideas about women: that we are more “natural,” that we instinctively know how to give birth, that we will sacrifice our own comfort for our children, etc. Here is a good article on “feminism and politics of childbirth in the US” that discusses some of these issues: http://fty.sagepub.com/content/6/3/251.abstract  .

Likewise, ideas about men’s role in birth tends to be rooted in gender ideologies, such as that men should protect and provide for their partners.

I wrote my master’s thesis in cultural anthropology on home birth in the US and found that explanations for choosing home birth tend to revolve around (a) the evidence that hospital birth is unnecessarily interventive to the detriment of good care, (b) the evidence of home birth’s safety, (c) beliefs about gender, and (d) economic ideologies.

This last has to do with the fact that the US has ideologies about individualism and the free market: we can get good care by individually being savvy consumers of health care. This feels empowering, at least to those with the resources to be influential consumers, but ignores the structural problems that make our maternity care system so lousy.

Comment #134: Nimue  on  05/09  at  01:51 PM

Hospitals are dirty, dirty places

Bacteriologically speaking, you are correct:

In August, 2000, Dr. Roger Wetherbee, an infectious-disease expert at New York University’s Tisch Hospital, received a disturbing call from the hospital’s microbiology laboratory. At the time, Wetherbee was in charge of handling outbreaks of dangerous microbes in the hospital, and the laboratory had isolated a bacterium called Klebsiella pneumoniae from a patient in an intensive-care unit. “It was literally resistant to every meaningful antibiotic that we had,” Wetherbee recalled recently. The microbe was sensitive only to a drug called colistin, which had been developed decades earlier and largely abandoned as a systemic treatment, because it can severely damage the kidneys. “So we had this report, and I looked at it and said to myself, ‘My God, this is an organism that basically we can’t treat.’ ”

http://www.newyorker.com/reporting/2008/08/11/080811fa_fact_groopman#ixzz1Lt1JPjqJ

You’re probably more likely to die of a terrorist attack at home than to pick up a superbug from a home area that has been reasonably sanitized for staging a home birth.

 

Comment #135: Dark Avenger Guardian Chow Mein  on  05/09  at  03:53 PM

What’s wrong with DEMs?  You don’t go to the hospital everytime you have the sniffles—most of the time, things can be dealt with outside of the hospital setting.

Sorry, I should have said midwives without formal professional qualifications.  Direct entry midwife just means someone who wasn’t a nurse first.  In NZ and other Western countries, midwifery is a four year university-level qualification with strict regulation and professional membership.  In the US, well, one explains it herself very well here.

You don’t go to hospital when you have the sniffles, but you might if you’re not sure if it’s the flu or meningitis.  You can’t tell in advance whether you’re going to have a complicated birth or not.  You want someone who you’re sure knows the early signs of something going wrong so it can be fixed in time.  It’s not good enough to have to check references - it can be life and death.  Regulation (which is what happens in the international jurisdictions the woman I linked to cites) is much better than word of mouth.

With that, I’m off to see my midwife.

Comment #136: Trouble  on  05/09  at  09:46 PM

Sorry Tyro, but from what I remember (from reputable sites, and even some pro-vaccines, the varicella vaccine can cause shingles episodes.  And the immunization effect in years varies widely.

Comment #137: phylosopher  on  05/09  at  11:29 PM

  Not because it’s best for you or the baby, but because the lawyers call the shots.
Comment #114: gretchen on 05/08 at 10:28 AM

Lawyers - heck even the fricking janitor has more say than the CNM and the patient.  At hospital where child was delivered, the use of the birthing suites whirlpool tub was verboten because the janitor was afraid it couldn’t be sterilized.

Comment #138: phylosopher  on  05/09  at  11:32 PM

Easy, oldfeminist - we’re on the same side here.  In the US, it certainly can mean over-healthcare- if there’s a profit to be had in it.  Just like that 1970’s NEstle in Africa scandal.  You have to wonder what kind of wining and dining that interviewee had from Nestle distributors that caused her to not seek or allow VOLUNTEER peer counselors. Rather hard for a mom to go back to breastfeeding, right? It doesn’t matter to the formula company who is paying - WIC or the individual - neither shows up on their bottom line.

Comment #139: phylosopher  on  05/09  at  11:38 PM

Exactly, history mom.  ANd really talk about a situation that creates an imbalance of power - woman in the midst of labor is likely to leave hospital and chance birthing in the car, on her way to another hospital where her carefully chosen doc may not have privileges, which would mean leaving behind doula, CNM and birth plan, and then if insured there’s the in/out of network, etc. 

I believe one term is “they have you over a barrel” and other more vulgar ones.  But either way, it’s not as if one is in a situation where principled choices can be easily made. And once the birth has happened…one doesn’t get a do-over.

Comment #140: phylosopher  on  05/09  at  11:43 PM

Trouble,
1) the certification of nurse midwives is much more complex than you make it out to be - it isn’t nurses/non-nurses - there are a range of certificate midwives in between, and it varies by state.

As far as homebirths go, in most city and suburban settings, a woman is likely minutes away form an emergency room.  And yes, a good midwife/doc and appropriate pre-natal care can predict within reason likely complications.  And most midwives attending home births won’t take on those cases - most won’t even VBAC at home.

Comment #141: phylosopher  on  05/09  at  11:53 PM

One very important point you seem to be missing, Trouble, all those books you read?  all the midwife/homebirth advocates out there?  they aren’t in positions of power, dictating what women do at the time of delivery.  They are ideas to be perused at leisure, in a non-stressful setting.  The medical interventions are all “on their turf” where the woman is without alternative. 

Sort of like the idea of sex being consensual between Thomas Jefferson and Sally Hemmings (master and slave if you aren’t familiar with the names, as a NZ’er)

Comment #142: phylosopher  on  05/10  at  12:06 AM

Lindsay: Since nobody else has answered…

Cervical checks help to determine dilation and to determine the position of the baby.  Used properly, they are a useful diagnostic tool, but that is not how they are used in hospitals.  Checking every hour is a way of measuring progress against a 24-hour time clock. Once admitted, a woman must deliver her baby within 24 hours.  If she is not dilating approximately 1cm per hour, she will be told she needs pitocin to speed her labor.  This means, in most cases, also getting an epidural, which is known to slow dilation. If pitocin doesn’t help, she’ll be told she needs a c-section. 

Almost every intervention has a beneficial purpose—fetal monitoring, cervical checks, rupturing the placenta, narcotic and epidural pain relief, IVs—but our system treats childbirth like a pathology that must be managed with constant intervention.  The result is more adverse outcomes that nevertheless fall below the threshold of malpractice.

Comment #143: history_mom  on  05/10  at  12:14 AM

Fair call, phylosopher.  But if you change the rules about authority, by, say, allowing independent midwives to do most of the supervision of hospital births and make it their call when to consult with the OB, anaesthetist etc, and their decision when to bring them in, does that change things?  Or does that simply replace the doctor with the midwife as the Big Bad Authority who must be defied?  Any labouring woman is vulnerable, whether she’s at home, in the delivery suite or in the hospital carpark.

I realise the certification is complicated, and that was kind of my point, although I didn’t have time to spell it out as well as the midwife I linked to.  It’s hard for a layperson to work out which out of multiple qualifications is high end and which is from the back of a cereal packet.

The problem, history_mom, sounds more like the 24 hour clock than the interventions.  But do you know what the reason for the clock is?  I hope your answer doesn’t include the golf course cliche: this article seems to offer some answers.

Comment #144: Trouble  on  05/10  at  12:49 AM

You really don’t know how American hospitals or homebirths work, do you?

The homebirth midwife is working with one woman at a time.  PERIOD. As a rule, the woman has had the same midwife for prenatal care.  There is a relationship built.  Her entire job is to be there for the woman from start to finish.  Not so the doc who is often in and out of the hospital and is not there for the birth, rather delivery nurses, working in shifts. Often orders are given over the phone.  The excuses given to a woman who wants to “discuss” are ridiculous - s/he is at office hours, another hospital, not in yet, etc.  Whether legit excuses or not, one is reduced to a child begging for attention, not a partnership working on a common project. 

And yes, it does make a HUGE difference between at home and in the hospital.  The home is the woman’s (and her partner’s) she can legally order anyone out.  There’s a balance of power there.

At a hospital, it is the women who is the customer, the interloper, the guest, if you prefer.  So indeed, that “guest” mentality can kick in - being on one’s best behavior, not wanting to offend.  It takes a really strong person to overcome that ingrained training of “being the good guest”, the polite customer. 


Comment #145: phylosopher  on  05/10  at  10:30 AM

Trouble,

Midwives can be authoritative and bullying, doctors can be open and communicative. But generally speaking, midwives have a different approach. There’s a big difference between my midwife saying (as mine did in my second labor) that the labor pattern is really irregular and slow (I had noticed this too) and that breaking my water might help get things going. That the main risk is cord prolapse, but that was unlikely in my case because the baby’s head was already really engaged. That if there was meconium in the fluid, we would have to go to the hospital. And then she said “What do you want to do?” (I said to go ahead and break my water. It really helped.) Versus an OB who automatically breaks the water of every woman when she shows up in the hospital, regardless of how things are going and where she is in labor. The OB who does that is setting some women up for life-threatening complications that they would not otherwise have experienced and many more for major surgery that might have otherwise been avoided.

There are two things at work here. One is simply limiting the use of interventions to when they are actually indicated, thus minimizing the iatrogenic effects. The other is that women have ultimate authority in their care, they don’t feel afterward like they were treated like a piece of meat. I think that has value for its own sake, regardless of outcome. A woman who is given every chance to allow her body to work and ends up with a c-section might still be disappointed, but she’ll probably have an easier time processing it than someone who was undermined and abused at every turn.

And yeah, there’s not no reason at all to be concerned about a long labor, but I prefer a provider who monitors and observes the patient, not one who imposes arbitrary rules. Let’s take induction. There’s some reason to be concerned about going late. At a certain point, stillbirth rates do go up. In the UK, 42 weeks is considered postdates. Used to be that way here. It’s rolled back over time to 41 weeks, which has contributed to a lot more inductions in primps, which has pushed up the c-section rate. (A primip with an unfavorable cervix has a 50 percent chance of ending up with a c-section if she’s induced.) The nurse-midwives I used for both my births still use 42 weeks, but start doing more monitoring of the babies around 41 weeks. With my first, there were a number of indications he wasn’t doing so well on the inside, and I was induced. With my second, she was fine, and I waited it out. I think being induced the first time was the right thing to do, but I was really glad to not do it again. One, it’s harder and more painful, but two, pitocin carries its own risks to the fetus.

In my second labor, I progressed really slowly and had an irregular labor pattern. The midwife was concerned about this and had a number of recommendations to get things going. In most hospitals, with most doctors, I would have had pitocin. Again, pitocin has a place, but it does stress the uterus and the fetus more than natural contractions. If things had truly stalled, we would have used pitocin. But the midwife waited and observed, and I was able to have her without it.

I think it is downright bizarre that my experiences are crazy exceptions, not standard care. Basic respect for the patient. Judicious and evidence-based use of interventions. Is that really too much to ask? Is that really woo?

Comment #146: chingona  on  05/10  at  10:35 AM

ANd Trouble - the fetal monitoring can as well be done intermittently.  BUt hey, since you seem fond of Citation Site Poker,

I’ll see your article, and raise you one ACOG and a couple of Preventive Health Task Forces. 

http://erinmidwife.com/2011/03/05/you-can-say-no-to-the-fetal-monitor-but-youll-need-to-bring-your-own-doppler-and-nurse/

Oh, and that “clock?” absolutely silly as an absolute on primaparas .

Comment #147: phylosopher  on  05/10  at  10:40 AM

The other reason not to do too many cervical checks is that every one increases the risk of infection, many women find them extremely uncomfortable (I’m fine with my annual exam, but find cervical checks in labor pretty painful), and for some women, they can make it harder to progress. There is a psychological aspect to labor that some women are more sensitive to than others. (Consider a bowel movement. Consider trying to have a bowel movement with 12 people watching you and someone periodically sticking their fingers in your rectum. There are some people who would not effected. There are some times when it would come whether you wanted it to or not. And there are times where that turtle is going to stick its head back in the shell and not come out for any amount of coaxing.)

Comment #148: chingona  on  05/10  at  10:47 AM

But to answer “why” do they do so many checks? In obstetrics, they seem to think that more information is always better. The more they can chart and document the labor, the better. As with any kind of medicine, there are the questions of at what cost that information is obtained (not so much financial, but risks, complications, etc.) and what you do with it once you have it. Continuous monitoring and hourly cervical checks might be compared to routine annual mammograms for women in their 20s. If you did a mammogram on every woman in her 20s, you’d catch a few cases of cancer that would otherwise be missed, but you’d subject a lot more women to invasive biopsies that carry their own risks and some smaller number to unnecessary treatment and some even smaller number would actually get cancer because of the increased exposure to radiation. As with other kinds of medicine, there are social factors as well. When they tried to roll back routine mammograms for women in their 40s, there was a backlash. The driving social factors in obstetrics are the idea that if you document everything, you won’t be sued and that the fetus matters more than the mother. But in general, there seems to be more awareness that there is a cost-benefit analysis in other branches of medicine, while in modern obstetrics, they act as if there were no draw-backs to interventions.

Comment #149: chingona  on  05/10  at  11:07 AM

You really don’t know how American hospitals or homebirths work, do you?

No, I don’t, which is why I’m not arguing about the American hospital process and whether it conforms to best practice.  You guys can do that as long as you like - you don’t need me to treat as a representative of a system I’ve never been a part of and don’t believe in.  I’ve tried to describe the hospital process in my own country as an example of science-based medical care that also has room for personal, respectful service led by highly-qualified midwives who work well with specialists when its necessary - I get jumped on because it’s not like that in America.  Whatever.

Comment #150: Trouble  on  05/10  at  10:21 PM

You got jumped on because you tried to deny others’ experiences and you also made blanket statements about midwifery.

Comment #151: phylosopher  on  05/10  at  10:43 PM

Devonian, 38:

And the description basically said the girl is now able to get pregnant so she has to be careful about who she “shares her body with”.  Same old slut-shaming wrapped up in matriarchal garbage.
“Be careful who you have sex with” just sounds like common sense to me, how is that “shaming” in any way?

“Be careful whom you have sex with because there are some wacky-ass motherfuckers out there” is common-sense (except when it’s victim-blaming). “Be careful whom you have sex with because you have to protect your purity” is ... something else.

And “Momma always told me, ‘be careful what you do, don’t go around breaking young girls’ hearts’” is the song that’s stuck in my head now.

Trouble, 151:

you don’t need me to treat as a representative of a system I’ve never been a part of and don’t believe in.

I don’t just believe in it, I’ve seen it done.

I don’t think anyone’s jumping on you for not being in love with the U.S. healthcare system—you’d be in a miniscule minority here if you were. The problem is that you seem to be saying U.S. practice isn’t important or relevant, and you’re saying that to a room full of Americans.

Comment #152: Hershele Ostropoler  on  05/10  at  10:59 PM

OK, so talking about my own experiences is denying others’, and talking about another country’s experiences is saying that American experiences aren’t relevant.  And the internet is a room full of Americans.

Also, citation please on the blanket statements about midwifery.

Comment #153: Trouble  on  05/11  at  12:11 AM

Also, since it’s obviously not clear, “I don’t believe in” means “I don’t support”, not “I don’t believe exists”.

Comment #154: Trouble  on  05/11  at  12:12 AM

You didn’t post to the Internet. You posted to Pandagon, where I think Americans are a plurality.

Since it’s obviously not clear.

Comment #155: Hershele Ostropoler  on  05/11  at  09:37 AM
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