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Saturday
Feb272010

The Science of Woo

Woo used to mean to try and get someone to love you, to write them love notes or send them flowers. 

Today, however, “woo” is a derogatory term that many of us know as Complementary and Alternative Medicine (CAM) – homeopathy, acupuncture, herbology, chiropractic, aromatherapy, massage therapy and, in some circles, midwifery care – are all included in CAM. Woo… as in “woo woo,” all spiritual-like, not completely understandable how it works and doesn’t work for everyone or, what it really means – fake. 

Remember how we just discussed women and how if they knew enough, they would surely choose natural birth, that there really is so much evidence that if they took half a second to look at it, they could never subject their child to an epidural, remaining in bed in labor or, what many women get, a hospital birth at all. There is another side we don’t often think of; the scientific side. There are whole groups of women who look at birth scientifically and decide woo is nuts and they are going to utilize any and all technology to ensure the safety of their child, no matter its inconvenience physically or emotionally. This is the side that looks at us and says, “If you surely knew the information, you could never endanger your child by having a homebirth.” This side’s thinking, however we might want to dispute it emotionally, has a valid point and we do need to look at it if we are to truly be fair and truly be as informed as we say we are.

I’m a half-woo practitioner. Of course, being a homebirth midwife, believing in chiropractic, acupuncture, massage therapy –for those that believe in them. I don’t think any of the CAMs work for everyone; I think that’s pretty much an understanding we woo’s all share. I have a very hard time with homeopathy, Tibetan bowls, therapies that diagnose through muscle testing or therapies that hook you up to machines and tell you how to relieve your headaches with five more sessions and two referrals. I know, I know… if I just took the time to learn about them, I would believe they worked, too. If I just knew more, I would surely change my mind. I know a LOT about CAMs; I used to own an holistic healthcare center where CAMs came and went, each new therapy sure to cure everything from a broken marriage to cancer. I watched desperate people turning to CAM when traditional medicine didn’t work. I was saddened by how many got sicker and went back to allopathy to try it once again.

Through the years, I’ve recommended acupuncture for inducing labor “naturally.” I’ve sat with women as they’ve had tiny needles flicked into their skin, zaps of heat or deeper twists “opening chi” to allow the hormones of labor to begin. I have never seen it work. Ever. (I will surely be told either I was the detriment that kept it from working properly or that it works every single time with their clients. I don’t believe either of those statements.)

That said, I am not a scientist. Not even close. Science confounds me as much as some CAMs do, but, even though they use big words I have to look up, I’ve been directed to Science-Based Medicine a number of times. These doctors pick apart CAMs (which they call “sCAMs”) with the studies we tend to discount or dismiss. They hold in their hands proof that what many of us hold as fact is, in reality, wishful thinking.

I’d not read SBM before, but then that Dr. A joined up and I had to see what the heck she was going to say to a bunch of scientists, her spouting of statistics, her smashing the research we’ve used for years and her obnoxious attitude – how would she fit in?

She didn’t. And after three months, she left. “Dr. Amy Tuteur has decided to leave Science-Based Medicine” is a decent enough article, but reading the comments (and there are plenty of them!) tells the real story of Dr. A’s three months of trying to convince, connive, manipulate and outright lie about midwifery, NBAs, homebirth stats and even her own agenda. I learned more about that Internet bully from her stint on SBM than I could have reading her (and I didn’t) for a year. I know I promised never to bring her up again, but it was too delicious to show that even Dr. A, the poster child for hating CPMs, homebirth and NBAs, even she is butts up against these scientists.

I do acknowledge that SBM are not the Gods of All That Is True In the World, but their beliefs, their knowledge-base and their proof is what many, if not most, hospital birthing women know as true. When we say, “If they only knew the truth,” – to them, they do. To them, we are the nutcases who endanger the lives of our babies –because, the Truth really is, if the shit hits the fan, the safest place for a mother and baby is in the hospital. Hospitals do have more resources, more medications and more knowledge than can be had in a homebirth setting. However, we NBAs weigh that information/risk with the reality of if-we-limit-too-much-technology,-there-will-be-fewer-episodes-of-shit-hitting-any-fan. But, many, many women don’t see it like that at all. They just see the potential catastrophe and bypass all the concern about technology/interventions and want to be where, if things do become life-threatening, they are already where it is safest to be. That is, most certainly, what doctors (and loads of nurses) see and believe as well.

I was going to end this here, but a situation was brought up to me this morning. Apparently, Mothering.com has hired, as a fundraiser, an “Intuitive” to, for pay, “help provide insightful information to interested MDC members.” Ask-an-Intuitive has been very busy, answering such questions as, “I am trying to conceive and am debating surgery on my uterus to resect a septum. Dr is making no strong recommendation either way. Any senses/feelings on this?” and “I'm 32 weeks pregnant... what do you see for me with the delivery of my second child? (I ask because my first delivery had a LOT of drama with pre-e, HELLP, and bleeding.” She’s also being asked a bunch of questions about relationships, life paths or basic life conundrums, but aren’t some of these questions practicing medicine/midwifery without a license? Is this really who NBAs have become? That we will go by what a total stranger “feels” instead of concrete knowledge about our own bodies and cases?

I watch this sort of spectacle, roll my eyes and know, as sure as I’m sitting here, why people think we are not only full of woo, but also quite a bit crazy. Where, where do we go from here?

Reader Comments (10)

A very good follower for your last post, as this really seems to come down to some of the same questions: what kind of person are you? Where does your "acceptable risk" line lie? Some people I think also need the "guilt-free" aspect of the hospital, and I can respect that. For all that I know goes on during a "normal" birth there, for me it would never feel that way. So that part of the equation was taken out, because I know that honestly no matter what and no matter where I'm probably always going to ask "why?" and "what could I have done?" should something unthinkable occur. What can I say, I was raised christian/jewish, we're good at self-flagellating. ;)

And I'll add another *headdesk* to yours about the "Ask an Intuitive". I guess you could call me a believer, my best friend is "sensitive" but we both know at the end of the day signals can get crossed, personal hopes/ideas can get in the way of a "read", and yeah, it's really not going to raise the bar on how the outside views that particular NBA community. Unfortunate that it reflects on us all! (Interesting also to see some women getting snotty after hearing her tell them what they don't want to hear. She's not a "psychic" people, she's not here to play to your desires to keep you coming back for more!)

February 27, 2010 | Unregistered CommenterStassja

The "woo" part is asserting that if you have only good thoughts, that only good things will happen. That good thoughts will prevent, for instance, placenta previa.

Other forms of magical thinking like acupuncture and homeopathy are also woo. Believing that they are effective when they have been studied and shown not to be effective is just as counterproductive as believing in any other intervention that has been studied and shown not to be effective.

Looking at the world, absorbing what we know about it and about ourselves, and making a decision we can live with is not woo, even if the decision is that we have faced down Dr A and could live with (for instance) the small possibility of placenta previa and a dead baby in a home birth.

Standing up for ourselves and speaking up when we feel humiliated and objectified is not woo either. If that's how we feel, then that's how we feel.

As oil prices rise and we fight wars to secure our access to fuel, stuff in general is going to become much more expensive and there are going to be many more people who won't be able to afford 'stuff.' Figuring out how to apply the knowledge we have so that as many people as possible will be able to have good and safe births when resources and technological interventions are scarce is not woo. Choosing to be part of that experiment when you have options is an ideological, not magical choice, and it's a choice that can be made by someone fully aware of the risks (and benefits).

Dr A. may have her problems, and it's possible that there are reasons she can't cope with real-life practice (I'm not the only person to wonder about Asperger syndrome) but she isn't always wrong. Her signature is to always bring the topic back to dead babies: how do we deal with them, what price are we willing to pay to prevent babies dying. (To her credit, she often poses that question without claiming to have a good answer herself.) This is a quantifiable outcome that both obstetricians and mothers committed to home birth need to be able to treat realistically. There are different ways of addressing this possible outcome realistically; claiming faith in magic is not one of them.

February 27, 2010 | Unregistered CommenterAlison Cummins

I chose/choose hospital birth. I am 100% supportive of other women choosing homebirth, I have read statistics, I know it is plenty safe, and have even suggested to a close friend, who has an intense anxiety with hospitals and doctors of any kind, that she have a homebirth.

But I am more comfortable in a hospital, *I* feel more in control in the hospital. That's just me. I know what works for me. My daughter was born in a hospital based birthing center with a bare minimum of interventions,including no IV and intermittent monitoring.

When I hear the "if she only knew", my ears turn off, not necessarily because choosing to birth in a hospital is *my* truth, but because I already know the person saying this to me isn't actually interested in what my truth is, she/he is interested in pushing their truth onto me. I couldn't bring myself to engage in one of your conversations on facebook, because I was seeing women saying that children are inherently damaged by hospital birth. Why would I EVER want to engage in a conversation with someone who believes that anything other than homebirth is damaging? Where is the RESPECT for other woman's choices? Why don't people understand that we can all read/study the same information and come to conclusions?

Anyway, for what it's worth, I support traditinal western medicine and alternative/eastern medicine. Yes, I give a lot more support to western medicine, but I think many kinds of alternative medicines/treatments can be very positive and complimentary. It doesn't have to be either/or.

February 27, 2010 | Unregistered CommenterJen

I just wanted to quickly chime in to tell you that acupuncture got my labor going two years ago, and also worked for my friend this past Tuesday. I'd choose it over any other type of induction again.

February 27, 2010 | Unregistered CommenterNicole

I don't think that just because you had a homebirth (as I have) means that you believe in other CAM modalities such as an "Intuitive." I personally would never ask some random person who labels themselves as an "Intuitive" any kind of question and expect a meaningful response, especially a medical question.

I don't think the population who frequents the MDC represents homebirthers as a whole. While I have no idea what percentage of homebirthing women would seek the opinion of an "Intuitive," I suspect it would be low as there is a large percentage of the homebirth community that is devoted to an organized religion who would find the powers of such a person originating from "evil."

I would be fascinated to see a demographic report of homebirthers just to see if what people think matches reality. (It's funny how some people believe that homebirthers are all uber-liberals or all radical conservatives.) I suspect that many would be surprised with the findings as many who have met me in person are surprised that I had a homebirth as I don't "look like" someone who would "do that." I think the decision to homebirth really cuts across so many socio-demographic categories except income. As you have previously stated, homebirth really is a luxury afforded to those who have sufficient financial resources.

February 27, 2010 | Unregistered CommenterJen @ VBACFACTS.com

I don't think it has really been proven beyond a doubt that homebirth is just as safe as hospital birth. First of all, the outcomes *might* be even, but there are completely different sets of risks. What might end in a fetal death at home may have ended in a live baby in a hospital and vice versa. Personally though, I don't feel this issues should be informed by the scientific data. The data is not yet conclusive in my mind (though I think the risks are fairly even, I'm not sure we can prove that beyond a doubt at this point), but even if we found out that homebirth was not as safe as hospital birth, I would still believe that women have a right to make the decision where to give birth. What if we found out that hospital birth was not as safe as homebirth, would we then try to make laws restricting women from birthing in a hospital? I feel that NBA's take the bait when asked, "ah, but is homebirth *safe*? It is ridiculous to try to tease apart studies, and discount this one, and accept that one, and argue and debate this issue. Because ultimately it doesn't matter! Homebirth should be a woman's legal right regardless, just like refusing treatments in a hospital should be her legal right - even if those treatments would benefit the fetus. A fetus is not a legal person and as long as it is in the woman's body it is subject to the choices she makes for her own body. I do feel that women themselves should have access to the scientific data so that they can make informed choices for their own bodies.

As for CAM, I think it really complicates the issue of trying to inform women about the option of out of hospital birth. When you tell a scientific minded person the risks and benefits of homebirth, they may accept that and opt for it. But when their midwife then starts pulling out the homeopathy and acupuncture and the self published anti-vax books (I know that's a controversial topic, but in scientific circles vaccines have been proven safe beyond a doubt, so this is where they are coming from), they are going to raise a few eyebrows and even loose a few prospective clients. When dealing with scientific minded people, they are going to want peer reviewed studies, published within the last 10 years - but more recent if possible, and they will want many proving the point, not just one or two, and not studies that have controversy surrounding them or many other studies countering them. This is how the scientific mind works.

Personally, the way I feel about CAM is that if it doesn't hurt, then might as well give it a try. If it works and it's just the placebo effect, that is fine with me as long as it works. If it doesn't work, then I don't do it. If I find several peer reviewed studies debunking it, and none proving it works, then I tend to feel it is just woo and there is no benefit to it at all. When a profession such as midwifery routinely recommends "woo", it will give their profession a bad name. It's unfortunate that they align themselves with CAM in my opinion, it's not going to win anyone over.

February 28, 2010 | Unregistered CommenterJennifer Z.

I think there is a big difference between making different judgment calls based on the evidence and blowing off the notion of evidence altogether. I think Dr. Fogelson at Academic OB-GYN does a good job of explaining how midwives and OBs can practice differently based on the same body of accepted evidence: http://academicobgyn.com/2009/12/28/a-bit-about-receiver-operator-curves/. However, if one believes that evidence is beside the point, well, then we're beyond rational discussion and have entered the realm of faith.
As a nursing student and woman TTC, I find it really frustrating that it is hard to find much of a homebirthing and midwife community that isn't entangled with discredited CAM practices.

March 1, 2010 | Unregistered CommenterChristie

*laughing*

Apparently, I'm your gal, Christie! And while I wish I could say I'm not the only one out there, sometimes I feel like I am. Fitting in just doesn't seem like something that's going to happen anymore. *shrug*

I'm glad my type of midwifery is there for the women that choose me. I am flat out clear about it, right?

March 2, 2010 | Registered CommenterNavelgazing Midwife

Just wanted to chime in briefly: I'm totally a evidence-based person, I'll take the statistics, research, and science over emotions, feelings, or personal stories each and every time, regardless of what I'm dealing with. (pretty much everyone who knows me says I'm overly logical) And this evidence-based medicine person chose homebirth as the safest, most logical choice for a low risk pregnancy. So its not always the 'woo' group who chooses homebirth/midwife and its not always the 'science' group who chooses hospital care. :)

March 6, 2010 | Unregistered CommenterJespren

Yes, yes, yes!! Incredibly well said. You and I have a very similar viewpoint on these matters. Interesting info on Dr A, also.

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