So far this year women have learned that we can't have it all: We can't breast-feed past infancy without some idiot calling it pedophilia; we can't work a top political job in D.C. and raise a well-adjusted teenager in New Jersey. And we can't have a candle-lit home birth that isn't also dangerous, according to Michelle Goldberg at the Daily Beast.
For a long time home birth was too fringe to get caught in this parenting no-fly zone, but lately it’s been fitting quite nicely into the mommy war media narrative: There are the stories about women giving birth at home because it's fashionable, the idea that women are happy sacrificing their newborns for some “hedonistic” spa-like experience, or that moms-to-be (and their partners) are just dumb and gullible when it comes to risk management, making a decision that is “akin to not putting your child in a car seat because some layperson told you that car seats were unnecessary,” as blogger Amy Tuteur, M.D., put it.
I bring up Tuteur here because she is heavily quoted in Goldberg's piece, and. in fact, her point of view frames Goldberg's story, the gist of which is pretty well-summarized in its headline: "Home Birth: Increasingly Popular, but Dangerous."
For many parents, home birth is a transcendent experience. ... Yet as the number of such births grows, so does the number of tragedies—and those stories tend to be left out of soft-focus lifestyle features. Now a small but growing number of people whose home deliveries have gone horribly awry have started speaking out, some of them on a blog, Hurt by Homebirth, set up by former Harvard Medical School instructor Amy Tuteur. “These people are beating themselves up over this,” says Tuteur, perhaps the country’s fiercest critic of the home-birth subculture. “They did it because they thought it was safe, and it wasn’t safe.”
Goldberg's reliance on Tuteur is an interesting choice. Also known as “Dr. Amy,” Tuteur let her medical license lapse in 2003 and created the blog Home Birth Debate in 2006, which she used to advocate for her position, which is basically: Home birth kills babies. “Even the studies that claim to show that home birth is as safe as hospital birth actually show the opposite,” she'd frequently post in response to a challenge, smearing the researchers of those studies in dedicated blog posts and igniting flame wars in the comments section. On other sites, including Nature and RH Reality Check, her comments have been flagged and removed for being defamatory or basically spam.
In 2009 Tuteur moved over to her new blog, The Skeptical OB, the name of which is, on the one hand, misleading because she hasn't been in practice for more than a decade, but is ultimately more appropriate because her old site was never really about debate. She wrote briefly for Open Salon, where she took issue with Amnesty International's research on maternal mortality, and had a mutual parting with the blog Science Based Medicine (“mutual efforts between the editors and Dr. Tuteur to resolve our differences came to an impasse,” managing editor David Gorski wrote in the announcement). Her prose tends to be inflammatory. “It's hard to beat homebirth midwives when it comes to stupidity,” she recently blogged on her own site.
In January 2011, Tuteur added a new domain to her brand, Hurt by Home birth, in which she invites guest posts—“and please include pictures if you can”—from tragedy-stricken mothers.
Of course, there is nothing wrong with a site for parents who have lost their babies or had traumatic homebirth experiences. And there is nothing wrong with a one-sided advocacy blog. The problem is when a dogged journalist like Goldberg elevates Tuteur to expert. Tuteur is not a researcher, she's not currently affiliated with any medical institution, and more importantly, she's never published any of her kitchen-table calculations on the risks of home birth in any peer-reviewed journal. Yet she presents herself with the authority of a CDC epidemiologist when she writes, “Homebirth increases the risk of neonatal death. All the existing scientific evidence says so.”
Goldberg makes it clear in her piece that the research comparing home birth to hospital birth is difficult for nonscientists to parse. “One could spend days sorting through the claims and counterclaims,” Goldberg writes about the only recent study of American home births, which Tuteur has been beating up on for years and to which the authors, for better or worse, have been responding. Goldberg gives Tuteur a platform for her unpublished claims and number-crunching: “They sliced and diced the data to fool people who are not sophisticated,” Tuteur tells Goldberg, before going on to interpret Colorado state data as well.
“Ultimately, for those without medical expertise or statistical training, deciding whom to trust is as much a question of philosophy as of data, because the debate isn’t just about numbers,” Goldberg writes. “It’s also a metaphysical argument about the nature of childbirth.” Perhaps that's true for couples who are deciding what's best for them. But for a reporter trying to inform those decisions, it doesn’t seem very useful to throw up one's hands and say, hey, this is a metaphysical debate! What about the data? Why not call a scientist?