The XX Factor

Midwifery Good, Zealotry Not So Much

American culture has produced many great things, from jazz to air sex competitions . But one thing I must criticize is that we have a strain of extremism in our culture that leads to widespread crankery.  Our cranks have gotten attention lately because of national kerfuffles over birth certificates and terrorism-related conspiracy theories, and now we have an even sadder example of what happens when people take their pet causes a step too far. Karen Carr of Baltimore has pleaded guilty to child endangerment and unlicensed medicine for performing a high-risk birth at home that led to the death of the baby.  Despite the ugliness of this situation, the diehards in the midwifery-uber-alles community won’t back down .

Don’t get me wrong; I’m all for midwifery and home births as an option.  Midwife proponents make a good case for low-risk births being performed with minimal interventions in environments that feel more like home than a medical setting.  Midwifery costs less than using a doctor, and cost-effectiveness isn’t something we should turn our nose up at in these times of rising health care costs.

But in some corners of the home birth movement, a zealotry has set in.  Doctors have become demonized and the belief that women’s bodies were “designed” for childbirth drifts into believing that because childbirth is “natural,” it’s not dangerous.  The ugly truth of the matter is that while childbirth is safe for many or even most, it’s still very dangerous by most reasonable measures.  Extremists in the home birth movement remind me of anti-vaccination zealots; they paint a picture of “natural” medicine being superior to medical science without acknowledging the sky-high maternal and infant mortality rates of the era before medical science.  The result is what happened in Carr’s situation, where a breech birth led to an infant stuck in the birth canal for 20 minutes, leading to the baby’s death.

To be clear, the vast majority of midwives are moderates in this debate.  The woman who hired Carr only did so after other providers refused to do a home delivery of a high-risk pregnancy.  Again, I have no problem with most midwives or with trying to reduce medical interventions on low-risk births.  But as with the people who drift from being organic-food enthusiasts to anti-vaccination zealots, there is a danger of extremism eclipsing common sense.  And unfortunately in these cases, children are the ones who pay the price.