Natural lifespan and whether a woman is designed to give birth

Advocates of alternative health attribute all sorts of fantastical properties to the human body. The body supposedly “knows” how to live a long healthy life; the body is supposedly “designed” to work perfectly. The tenets of natural childbirth philosophy also invoke these fantastical properties. The body “knows” how to give birth; a woman’s body is “designed” to give birth.

On their face these claims are obviously false. The body doesn’t “know” anything and the body is certainly not designed by anyone. It is the product of millions of years of evolution with the many trade offs that evolution requires. At a deeper level, claims about what the body “knows” or is “designed” to do reflect a fundamental misunderstanding of evolution. There is an unstated belief that the human body reflects precision craftsmanship, but evolution is not a precision craftsman. Indeed it has much more in common with a football coach than an individual who works according to a predetermined template.

I became a football fan when one of my sons played PeeWee Football. I hated the experience; I was always worried that my son would get hurt, but I learned the game and loved it. It took me a while to understand the different types of players and the different types of plays. But there was one thing I realized from the very beginning: every football play is designed so that if executed properly, it results in a touchdown.

So every play is literally designed to result in a touchdown but very few actually do. Why? One problem is execution. The quarterback fumbles the hand off to the receiver; the receiver slips while running toward the goal line; a lineman throws an illegal block and the play is called back. All of these represent mistakes. Someone fails to do what he is supposed to do and the play never develops as it was designed to do. It’s not surprising then that it doesn’t result in a touchdown.

Illness and accident are the medical equivalent of botched plays. The individual would have gone on to live a long and healthy life had he avoided the polio virus, had he not fallen and broken his leg, had he never started smoking. There was nothing intrinsically wrong with the body. The problem arose outside and then affected the body.

But most plays in a football game are properly executed and yet many don’t result in touchdowns, either. If every play is designed to end in a touchdown, why are touchdowns so rare? The hand off is made properly, the linemen throw their assigned blocks, the crease opens up, yet the receiver never gets to the end zone. What went wrong?

Usually what “goes wrong” is a big guy from the opposing team getting in the way and tackling the receiver far from the goal line. The play is “designed” to the extent that the team members know exactly what they should do, and indeed, if there was no opposing team on the field, every play would end in a touchdown. But there is an opposing team and the play can never account for what they will do.

Similarly evolution means that while every person is supposed to live out his natural lifespan (a touchdown), the environment can never be predicted in advance. The environment is the opposing team and, as in football, it can change at every play. What confers fitness in one environment, may be a fatal weakness in another.

In football, an individual team member can adjust his role in response to a particular player on the defense, while the rest of the play takes place as designed. That option is not possible in human evolution. The woman with the slightly narrower pelvis that conferred on her the speed to escape animal attackers cannot modify that pelvis at the time of birth. The narrow pelvic dimensions that allowed her to be fleet of foot and escape the tiger that killed her sister may condemn her to death during childbirth when the baby cannot fit through that pelvis.

If individuals did not have to contend with environmental factors they would live out their natural life spans, every women would give birth successfully. But that’s the equivalent of no opposing side on the field; it never happens. Therefore, the claim that people are “designed” to live until old age or that women are “designed” to give birth is about as meaningful as the fact that every football play is designed to end in touchdown. The design does not guarantee success.

In football, most plays fail when they come up against the reality of the opposing team. In evolution, many individuals fail (die) when they come up against the reality of the environment. In football, one side wins when it gets more points than the other side, which is doing its best to keep it from getting any points at all. In evolution, a species wins (survives) when enough of its members live to reproduce successfully despite the problems posed by the environment and the additional difficulties posed by the fact that what is adaptive in one environment can be maladaptive in another.

Claiming that people are “designed” to live out their natural lifespans or that women are “designed” to give birth and insisting that things go wrong rarely if ever is like claiming that every football play is designed to end in a touchdown and things rarely if ever go wrong on the field. The play may have been designed perfectly, but when the 350 pound lineman knocks the receiver to the ground, the design is meaningless. Similarly, a woman may be “designed” to give birth, but when the baby doesn’t fit, or her blood pressure rises dangerously, or the placenta does not provide adequate blood flow to the baby, the “design” is meaningless.

Amy Tuteur is an obstetrician-gynecologist who blogs at The Skeptical OB.

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  • skeptikus

    Amy, Yr anti-midwifery crusade has morphed into philosophy–with similar results. I don’t think advocates of natural childbirth think that nothing can go “wrong” in pregnancy and birth. It’s rather that there are reasons to many natural things that modern medicine fails to realize. (I.e., the value of breast feeding, which for generations modern medicine had dismissed).

    It’s not that the body “knows” the right answer; it’s that doctors “know” the right answer far less than they think. (Umm . . . of all the treatments you performed last week, how many were evidence based in a rigorous way). Therefore, a consumer is wise to choose approaches with minimal medical intervention.

  • Cody

    Great article, spot on. And, I LOVED the football analogy!!

  • Ellen

    Belief that all here on earth and in the universe, including the human body, is the result of random, chaotic and disordered coincidence requires a huge leap of blind faith. I’ll stick with the simpler faith – which does not defy rational logic, if one has an open mind – that there is a Creator, and He does indeed have the Master Plan. The alternative is to believe that humans are the most intelligent and powerful creatures in the universe … and that is simply absurd.

    Pride is a very dangerous thing.

  • Andrew

    “Blind faith”. If blind referred to lack of evidentiary support, what you call the simpler faith would instead be a blind faith. And since when does evolution have anything to do with pride. If I remember it correctly, it was established by studying birds and not humans.

    Is ignorance better than pride?

  • DrTan

    I’m a christian who shares ellens beliefs, but that is not the point of the article. It is about the reality that things DONT always go as planned,and that cries that doctors ‘play god’ by intervening in the ‘natural process’are completely unfounded. From this perspective,the author is spot on.

    • http://Www.twitter.com/alicearobertson Alice

      Can I ask then why there are so many unnecessary C sections? Is it to prevent a lawsuit at times? Is it because doctors know parents who do not get a perfect child often sue? And could that mindset make women desire a home birth? Isn’t that one of the gists of the Caesarean prevention movement? I went to a meeting once and a doctor there was encouraging use of one hospital because the nurses and midwives were known to take the time it takes to help you give birth naturally.

      Oh yes, they also did something else…they worked with your preprgrammed body that is fearfully and wonderfully designed to help a woman nurse…oops…are we preprogrammed to do such a thing? Um…evolution at work? Not! But, then again, lately I am thinking about vegolution because doctors here keep inferring I have a pea brain!:)

  • http://www.twitter.com/alicearobertson Alice

    On their face these claims are obviously false. The body doesn’t “know” anything and the body is certainly not designed by anyone. It is the product of millions of years of evolution with the many trade offs that evolution requires.[end quote]

    So we have no Divine Designer and the body doesn’t know anything……but it can evolve…..while knowing nothing? Now that takes real faith to believe in.
    .

    If you want to compare statistics of hospital and homebirths the football analogy is poor on that level. And, no, I was a bad candidate for a homebirth and knew it. After six children I can share the doctors often hindered the process because it seems medicine protects the doctor and their career first then the patient. It makes childbirth much harder on many women……but admittedly it will save lives.

    Personally, I think midwives are the best thing to happen to childbirth. They give you loads of time…..which is something many doctors won’t or can’t do. They give you patience, comfort and care………hmmm……..do ya’ think maybe women are preprogrammed to be nurturing? Seems I read a study that said in the ER women doctors have a slight advantage when it comes to outcomes. Wonder how that happened?:)

  • Maria

    Just have to comment, that while the author is correct about evolution (it is about survival of the species as a whole, not a particular individual), her child birth vs escaping predators example is absurd. For a trait to be passed-on to future generations, the carrier of that trait must be able to produce offspring that survive to sexual maturity and proceed to mate. Therefore, a trait that makes it impossible for offspring to survive (ie. cannot be born or mother/caretaker/breastfeeder for mammals, dies) cannot possibly be prevalent in ANY species. It is extremely unlikely that a human female (unless she has a rare mutation) will have a pelvis too small to give birth, because such a trait would be difficult to pass-on to future generations (only through male inheritance). Thus, as my wonderful female OBGYN explained to me when I was pregnant with my first: all human females have a large enough pelvis to give birth to a normal size child. The problems occur when modern human females overeat during pregnancy and end-up gaining way too much weight and have children who are abnormally large at birth (a human infant should not weight 10lbs.!!!). A normal size baby will fit through the pelvis which widens during birth. BTW, I had this conversation with my obgyn after my medical-school friend told me that there was no way that I (at 90 lbs. size < 0) could give birth without a c-section. She was wrong. I was 130 lbs. when I gave birth naturally, with no intervention, to my 7+ lb. boy in under 7 hours total :) While emergencies can occur during birth, they are much, much rarer than doctors make them out to be.

    • stitch

      Maria, when we do operative deliveries for infants that would otherwise not be able to be delivered because of cephalopelvic disproportion, shoulder dystocia, or whatever the case may be, chhildren are born who may, in fact, inherit a trait that would have not allowed them to be born if we just let nature take its course. We’ve been doing operative deliveries on a frequent basis for several generations now. So I’m afraid your argument goes out the window. But I am glad you had the experience you had. Being 90 lbs has nothing to do with whether or not your pelvis will allow you to have a vaginal deliver, btw.

      • http://Www.twitter.com/alicearobertson Alice

        Stitch…isn’t that a perk of modern medicine, ultrasounds, etc. Can’t high risk deliveries and babies usually be identified before birth. Isn’t it true the vast majority of births do not really need a doctor? Yes, long ago women died or bleed to death in childbirth, but we have hospitals, ambulances, prenatal testing. Education is the key, not condemnation.

        I think evolution is a ridiculous thought…a poor analogy….survival of the fittest can be taught through the animal kingdom amd even childbirth. I know My DNA isn’t an exact match for a monkey…just a little bit of chromosomal difference going on there….eugenics teaches us a bit about preprogramming and longevity…even if it is just 30% of a risk factor the preprogramming is still there….and I was not preprogrammed in any animal kingdom.

        The truth is childbirth practices have changed as midwives are more available…changed for the better. My oldest child is 33 years old and my youngest will be 14 years old this week. The changes are phenomenal. I will spare you the details of giving birth 30 years ago (I will share ultrasounds were not available, so a ruler was placed on your bum and you were xrayed, clamps used, the drugs were not good, you suffered miserably while on your back…the rest is not for an open forum).

        Stats show home birth with the right candidate is very safe.

      • Andrew

        A few generations of physicians affecting the birthing process (i.e. delivering babies that would not have survived previously) would not have any effect on the gene pool created by millions upon millions of years of evolution.

        So this does not really do anything to disprove the argument by Maria.

        • stitch

          To an extent I agree; however, the point is more that in this day and age, we deliver children through interventional means who would not have survived in an earlier time. Mothers and infants did die when the maternal pelvis could not accomodate that delivery, for whatever reason; see Dr. Tuteur’s post below.

        • http://Www.twitter.com/alicearobertson Alice

          Yes, and the ignorance of doctors about germs used to kill about half the babies, and I believe a quarter of the mothers. Doctors would do an autopsy and run up and do a delivery. The doctor who advocated hand washing realized midwives did not do autopsies, and more babies and mothers survived. Louis Pasteur fought the scoffers who defended their own ignorance and refused to wash their hands and caused sepsis that was lethal to the mothers who had just been handled by the germ ridden hands of a doctor.

          Neither the problem, solution, or comparison is evolutionary as stated, it is evolution of thought via the reformation of science enlightening our minds to understand the human body in it’s magnificence.

  • http://www.skepticalob.com Amy Tuteur, MD

    ” It is extremely unlikely that a human female (unless she has a rare mutation) will have a pelvis too small to give birth, because such a trait would be difficult to pass-on to future generations”

    No, that’s false.

    The size of the maternal pelvis is only one factor in determining whether a baby will fit. Other factors, including the baby’s size and position are equally important. The the mother’s genes are not the only genes controlling the size of the baby and therefore, the size of the baby is completely independent of the size of the mother’s pelvis. It is not only possible, but all too common for a mother to gestate a baby too big to fit throug her pelvis.

  • http://www.johnson-family-chiropractic.com/ Peoria chiropractor

    It is self-evident that the body is capable of healing itself through a myriad of complex chemical interactions. The papercut I just got will heal all by itself: it needs no special intervention, no surgeries, no pharmacology. The body is capable of delivering the right kinds of cells at the right times to clot the bleed, form new skin, and rebuild blood vessels. That’s pretty amazing stuff, and it doesn’t really matter whether the body was created or it evolved: it can do it all by itself.

    More serious concerns like broken bones, heart failure, aneurysms, etc., need outside intervention. Of course they do. But the main principle behind alternative medicine is to be as conservative as possible. When able, we don’t want to give the body unnecessary side effects while it’s attempting to heal itself.

    We don’t fully understand the body’s mysterious healing capabilities, nor why studies say that prayer actually helps patients recover faster, nor why a patient recovers faster if a nurse touches her than if a nurse never contacts her at all, etc. We don’t know these things, and it’s okay.

    Medical doctors, chiropractors, therapists: we’re all working towards the same end. I prefer to work together, because the patient tends to recover faster and better, and that equals less cost to them.

    • MD in recovery

      @chiropractor…”studies say that prayer actually helps patients recover faster”

      Can you cite some studies that support this? I would be interested in reading them. Thank you.

      • http://nourishourselves.blogspot.com Marie
        • http://Www.twitter.com/alicearobertson Alice

          If you click on my name and go to my Twitter you will see a post from last October that links to a video of a much younger me sharing what I consider to be pretty amazing…that video is about our son’s documented inoperable brain tumor (a neurologist from Cleveland Clinic shows the before and after MRIs). It is a documented miracle as the direct result of prayer.

  • http://thedocsquawk.com thedocsquawk

    Saying the body should not be able to evolve while “knowing nothing” is ridiculous, and displays ignorance as to how evolution works. Evolution does not require knowledge on anybody’s part. This is unfortunate, as if it did, perhaps we’d have fewer backwards creationist wackos than we currently do.

  • Hexanchus

    Yes there are times when a C section is the best choice, but IMHO the rate in the US is excessive and out of control.

    According to the CDC’s recently released statistics for 2008, there were 2% fewer births than in the previous year. But about a third, or 32.3% of these newborns came into this world by way of cesarean sections – a 2% increase – which marks the twelfth consecutive year that the number of c-sections has gone up. At the same time, there has been no corresponding decrease in the perinatal mortality rate.. Twelve consecutive years of increase is not a statistical anomaly, it’s a trend – and IMHO, an alarming one..

    Recent studies reaffirm earlier World Health Organization recommendations about optimal cesarean section rates. The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006).

    • http://www.skepticalob.com Amy Tuteur, MD

      “Recent studies reaffirm earlier World Health Organization recommendations about optimal cesarean section rates. The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006).”

      The WHO has RESCINDED their “optimal” C-section rate after acknowledging that NO studies ever supported it. It was basically made up from wholecloth.

      Marsden Wagner, a noted critic of contemporary obstetrics who was working for the WHO at the time, appears to be behind the recommendation and even he has been forced to acknowledge that there was never any data to support it. He is one of the authors of “Rates of caesarean section: analysis of global, regional and national estimates” (Paediatric and Perinatal Epidemiology, 2007; 21:98–113.):

      “Since publication of the WHO consensus statement in 1985, debate regarding desirable levels of CS has continued; nevertheless, this paper represents the first attempt to provide a global and regional comparative analysis of national rates of caesarean delivery and their ecological correlation with other indicators of reproductive health.”

      So what did Wagner et al. find when they actually looked?

      Although they insist that their study confirms the recommendation, that’s not what it shows at all. What the data actually shows is this: The only countries with low rates of maternal and neonatal mortality have HIGH C-section rates (except Croatia and Kuwait). The average C-section rate for countries with low maternal and neonatal mortality is 22%, although rates as high as 36% are consistent with low rates of maternal and neonatal mortality.

      Which is very similar to what the Althabe and Belizan paper also showed. The authors looked at 119 countries. Of those countries, only 30 countries had low levels of both neonatal and maternal mortality. Only 10 had C-section rates of 15%. In other words, of the 30 countries with low neonatal and maternal mortality, fully two thirds had C-sections above the WHO recommendation.

      The WHO rescinded their recommendation last year, acknowledging in In its handbook Monitoring Emergency Obstetric Care, that the figure was not based on solid evidence:

      “Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage . . . the optimum rate is unknown …”

      • Hexanchus

        The optimum rate may be unknown, but I submit that almost 33% is way too high. As I said, there are times when a C-section is necessary and prudent for medical reasons, but I don’t believe for a moment that it is almost 1/3 of births.

        Another factor that should be considered is the effect of c-sections on neonatal mortality (death within the first 28 days of life). In 2006 the CDC released the results of a study (MacDorman, et al.) that found babies born by cesarean section face a risk of death nearly three times that of vaginally born babies, regardless of risk factors. The purpose of the study was to examine the neonatal outcomes of primary cesarean delivery in women who had no other known complications or medical risk factors. The results show that cesarean delivery independently raises the risk of neonatal death by almost three-fold – .62 per 1000 deaths among vaginal births versus 1.77 per 1000 infant deaths among cesarean babies. Even when the researchers adjusted for sociodemographic, medical and congenital factors, and removed infants with APGARs under 4, the risk of death was only reduced “moderately”. A clear difference in the death rates between cesarean born infants and vaginally born infants remained even with no medical explanation.

        IMHO, the medical industry (and yes, that is what it has become) needs to take a hard look at why the cesarean rate has continued to climb. They need to do some serious root cause failure analysis to find the causes and address them.

        • http://www.skepticalob.com Amy Tuteur, MD

          “In 2006 the CDC released the results of a study (MacDorman, et al.) that found babies born by cesarean section face a risk of death nearly three times that of vaginally born babies, regardless of risk factors.”

          No, that’s not true either.

          The conclusion of the MacDorman 2006 study were not supported by the data, and the authors have already been forced to readjust their claims downward, although even the new claim is not supported by the data. Moreover, although MacDorman has prepared reports for the CDC, the 2006 study was not prepared for or supported by the CDC.

          What did MacDorman say she found and what did she actually find? MacDorman et al. compared outcomes of C-sections with “no indicated risk” (a blank space on the risk section of the birth certificate) with outcomes from vaginal deliveries with “no indicated risk” and believed that she had found that the neonatal death rate was higher in the C-section group.

          After extensive criticism of the methodology used in the 2006 paper MacDorman et al. published a new paper in 2008, and applied a corrected analysis, Neonatal Mortality for Primary Cesarean and Vaginal Births to Low-Risk Women: Application of an “Intention-to-Treat” Model. This time she found:

          “…In the most conservative model, the adjusted odds ratio for neonatal mortality was 1.6 (95% CI 1.35–2.11) for cesareans with no labor complications or procedures, compared with planned vaginal deliveries.”

          But the improper analysis wasn’t even the biggest flaw in the paper in the 2006 paper. MacDorman neglected to mention that it is well known that the risk section of the birth certificate is often left blank even when there are serious risk factors and complications. Indeed, in 50% or more of serious risk factors (heart disease, kidney disease, etc.) the space is left blank. So their assumption that “no indicated risk” means no risk is completely unjustified. The only way to determine whether the “no indicated risk” group was actually a “no risk” group would be to look at the hospital records, but MacDorman never bothered to do that.

          The MacDorman studies show nothing because they were done using a database known to be seriously flawed.

          • http://Www.twitter.com/alicearobertson Alice

            I spoke with a researcher who won a big award for the best research paper about my online travels. He felt that anyone can quote research and so much of it is bogus….basically, we are swimming through sewage.

            So let’s use common sense…it doesn’t take a PhD to know that a C section can save a life, but it has risks. It is a “Duh!” type of debate to even enter. And we know there are to many C sections and they are not all about saving a child’s life…sometimes it is the doctor’s time, or fear of a lawsuit. Many of these women banded together and changed medicine by demanding the chance to at least try to give birth naturally. Because doctors often worry about lawsuits they used to practice the, “Once a C section, always a C section”. Women did it themselves at home with overall fabulous results. Yes, some bad candidates delivered dead children (I know of two women personally, but hundreds of others that enjoyed the experience and delivered healthy babies).

            Modern medicine is wonderful…but moreso when doctors actually listen to their patients and make medical intervention a last resort…because we are designed to heal ourselves….but, occasionally, we do need the help of a doctor or technology. God gave me legs, but I still like to drive a car….so it is with the use of medicine…it is a nice advantage and perk…..it helps heal…and, sadly, sometimes creates problems because …..well.. …we have evolved onto narcissists! :)

  • Miss Stiff Pelvis 1990

    I have a milder case of Ankylosing spondylitis. My sacroiliac joints were not normal at the time I was nearing delivery of my first and only child.
    I was overdue, went in for induction – i was already in labor when I got there, but they added pitocin anyway.

    I’m grateful the doctor acted quickly on my own preference not to wait too long for c-section. Perhaps the choice was hasty, but there were decelerations, meconium when the amniotic sac was ruptured, and my cervix never got past 2cm after many hours of strong contractions.

    He posited it would be better to go ahead and do it now (the infamous 6pm c-section) than wait for the inevitable wee hours emergency that could occur.

    I quite agreed and in hindsight was glad I did – although the partners muttered to themselves as they began, that It would turn out to be a mere 7 pound baby, he was a large baby, nearly ten pounds. He also had extremely broad shoulders (and still does). I imagine he might have been hung up on them. – and might have had a broken or dislocated shoulder if lmy abor had been allowed to continue.

    I might add I might have ended up with a broken pelvis. Mine would not have the normal flexing ability of a woman without ankylosing spondylitis with fused SI joints.

    I didn’t have an “emergency” c-section, and it was a judgment call, and also arranged for some convenience to the physician.

    Every case is different, however, and I do not regret mine, and am actually glad I did not have some overly conservative physician demanding I keep at it for 20 hours.

  • http://nourishourselves.blogspot.com Marie

    After reading this essay several times, I am still not entirely sure what the point is. Is it to debunk alternative medicine? Are you saying there are no biological imperatives?

    The arguments for the body not being a perfect machine seem pointless. I don’t know anyone who maintains that it is. Who says the body knows how to live a long and healthy life? I have been a childbirth educator for over 20 years. I know of no ‘tenet’ that gives ‘fantastical’ properties to a woman’s body.

    I do know that alternative medicine and practices are generally more patient with natural processes than mainstream medicine. There is more of a watch and wait philosophy applied to childbirth in particular. Not because some mystical thing is about to occur (although one could argue birth is mystical), but because most of the time nature will take its course without any intervention. Some people might refer to this as a body “knowing” what to do, but that is semantics, just an expression. The body does what it does spontaneously in response to hormonal signals. Is this a way of “knowing”? I would argue it is, but again, that is just an expression.

    I am always puzzled by extreme antipathy on any side of a philosophical difference of opinion. Healthcare cannot be all or nothing, all intervention and no alternative practices, or the other way around. There is a place for both approaches and they can complement each other. If we learn as much as we can about what everyone brings to the table then we will have more tools and options to offer our patients.

    To continue to battle, when it is documented that both sides have validity, does everyone a disservice. And makes the combatants appear petty and unreasonable.

  • http://Www.twitter.com/alicearobertson Alice

    I have the same situation with a small pelvis….placenta previa, all sorts of problems that were not ideal (and mythical evolutuion didn’t take care of :) )…etc. And I am grateful to have avoided a C section. It is a last resort, although some moms claim they actually scheduled it in. Go figure!

    So how does genomic sequence fit in the conversation?

  • skeptikus

    Amy, As an epidemiologist, I take exception to your characterization of MacDorman’s work. Yes, there was disagreement on the coding of complication. Correct, she did a more conservative approach in her second paper. BUT, SHE STILL FOUND HIGHLY significant results. Remember, both papers were accepted by reputable peer reviewed journals. This suggests she’s on to something.

    You have this absurd way of dismissing empirical claims because they fail to be perfect lab experiments. I.e., your complaints about the underlying MacDorman data. But, we can’t ethically randomize treatment in this country.

    Further, you can’t beat something with nothing. Sure, MacDorman’s not perfect–but I’d take an imperfect empirical study to guide my treatment over a doctor’s “professional advice,” which is nothing but a grab bag of interest and experience cognitibe biases.

  • http://www.skepticalob.com Amy Tuteur, MD

    “both papers were accepted by reputable peer reviewed journals”

    Both papers were accepted by the journal Birth, which is basically a journal of the natural childbirth movement, and of which MacDorman is an editor. Moreover, being accepted by any peer review journal does not mean that your paper was judged to be the correct interpretation of the subject, merely that the paper is worthy of being included in the scientific conversation.

    But you failed to address the central point: birth certificates are known to be inaccurate in regard to risks. If the risk section is empty, it does NOT mean that the patient had no risk factors. The entire paper rests on the premise that “no indicated risk” means “no risk” and it does not.

  • skeptikus

    Amy, The data is what the data is. When you’re writing about midwifery, you often credit studies based on flawed data bases. (Wanna talk about that recent ACOG metastudy???) ALL data is flawed to a degree.

    The question is do C-sections raise certain risks. You say no . . . based on what? Your “experience”? Puhleez.

    MacDormann finds a link between c-sections and higher mortality. Shouldn’t this be a factor when making the decision to have a a c-section? If your answer is no, Amy, then you must show that all the treatments YOU use have a firm empirical basis than MacDormann’s. I don’t think you can do that.

    Doctors aren’t trained in empirical methodologies–and it often shows . . . .

  • http://www.lovelessdo.com Brian Loveless, DO

    Amy, the analogy you supplied actually makes the point you were trying to refute. In a football game, the offensive team isn’t a simple robot running a play as it is drawn up, the players are thinking human beings who are able to adapt quickly as the play develops. Quarterbacks respond to the presenting defense by calling audibles, changing the play at the line of scrimmage, linesmen change their blocks based on blitzes, running backs and receivers create plays in the open field. All of these things happen, on every play, in real time in response to the “attack” coming at them. In turn, the defense makes its own adjustments. Maybe if you had watched more than Pop Warner football you would have a more complete understanding.

    This is much more analogous to the human body. It has not only a conscious brain which can adapt, there are a multitude of unconscious, reflex responses which are built into the system. The musculoskeletal system is intricately linked with the neuro-endocrine system via the extracellular matrix, down to the level of the DNA. This system of interactions is able to respond, sometimes almost instantaneously, to perturbations in the body. During a process such as labor and delivery, the body is able to respond actively to changes that occur, and it “knows” what to do based on the pre-programmed pathways that are present.

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