An aquaintance of mine is currently preggers. The baby is due in just a few weeks and appears to be adamant in his insistence that he be born ass-first, so like any good soon-to-be mother, my friend has explored the options available to her. The only trouble is that there don’t appear to be many options out there.
The most common result in a situation such as this is a caesarean section, which is the way my friend will probably go. It’s a choice that might seem obvious and everyday but in its own small way is really quite admirable and highlights the sweet lack of selfishness that defines parenthood: pursuing the option that presents the most protection for the baby, despite the slightly increased risk to the mother’s health. One recent study suggests that 27 of 1,000 women will face “severe morbidity” undergoing c-sections, compared to 9 out of 1,000 for vaginal delivery. (“Severe morbidity” refers not just to immediate death but also to the development of potentially life-threatening organ dysfunction, like severe hypotension and pulmonary oedema. For the generally accepted definition of “severe acute maternal morbidity,” about one in five such cases will die.)
On top of all that, of course, there is still some risk to the baby born via c-section. Basically, if you happened to be a remarkably intelligent and well-spoken fully-developed fetus with access to all the latest research and statistics, you would most likely choose to be born vaginally, head-first. (Unless in addition to your remarkable intelligence you are also blessed with a correspondingly large neuroses, at which point you may opt for the c-section for fear that the memory of passing through your mother’s vagina might leave you emotionally scarred and unable to establish meaningful relationships as an adult, but that’s another matter.)
With that in mind, it’s only natural that a caring mother would try her best to ensure a natural birth, by spinning her baby around to emerge head-first. There is a way to do this — it’s called external cephalic version, which is a fancy way to say “pushing the baby into place.” (While researching this procedure, I found this delightful quote from American Academy of Family Physicians: “Physicians can begin with the classic forward roll or the ‘back flip.’ ” Wheee!)
It works like this: the mother lays down and gets gelled up with ultrasound goo. Then, the biggest, strongest doctor in the office/hospital pushes hard on the mother’s abdomen, coaxing the baby into place. It works 40% – 80% of the time (depending on physician and gestation time), and from what I hear, it hurts like hell. I mean, just think about it for a second. Ouch.
When you consider that the only option is a painful procedure that might not work, who can blame a mother for going to the dark side? I speak, of course, about “alternative” medicine. Alt med isn’t always about ingesting herbal cure-alls — there are plenty of homeopathic and naturopathic substances marketed toward pregnant women, which can be very dangerous considering that such things aren’t well-regulated. In this case, though, the alternative to the scientifically proven method consists of reiki and “postural management.”
Reiki is a pretty word to describe waving your hands around like the Karate Kid, hoping that some magical combination of movements will result in a miraculous healing of the problem. No scientific study has ever shown that reiki cures anything that can’t also be cured by a good nap.
Postural management involves maintaining certain positions to increase the likelihood that the baby will turn on his own. An exhaustive study in 2000 concluded that there is, “not enough evidence on encouraging the mother to adopt different postures during pregnancy to change a breech baby’s position in the womb.”
Of course we know that all the carefully controlled studies in the world can hardly compete with power of superstition ingrained in communities, so people continue to try these methods. Most of you would, too, if you were just a bit less skeptical. Think of the benefits these methods have over external cephalic version:
- Painless
- Harmless to the mother and child
- Performed outside the cold and sterile hospital environment
- Relaxing
- Easy to do by yourself (positioning)
- All the benefits of a massage (reiki, often)
With all that going for it, one can hardly even notice the drawbacks:
- Added expense
- Completely ineffective for reducing breech birth
My friend’s doctor encouraged her to do version, repeatedly saying that she could try alternative treatments if she wanted, but, “I’m a scientist, and science says version is the thing that works.” The science talk did nothing at all to reassure my friend, who was facing a painful procedure. She decided to do reiki and positioning anyway, saying, “I know it probably won’t work, but if there’s a chance, why not try it? And I get a massage out of the deal.”
How do we go about stamping out superstitious, ineffective treatments when they present such a tempting alternative to the cold pain of science? Listening to my friend discuss her treatment with others, the word “science” came out like a slur. I’m reminded of the Gingritch-era Republicans’ savvy attempt to give an unfavorable connotation to words like “liberal,” public relations tactics that continue today. I can’t help but wonder if the alt med crowd has accomplished the same spin job on “science.” “Skeptic” is often misunderstood as “cynic,” something we critical thinkers fight every day. I know some people have considered abandoning the term “skeptic” altogether because it is so often used in a negative context. I’m not quite ready to give it up yet, but can understand the sentiment.
The word “science,” though, is not going away and we need to be protective of it now. Think about that the next time you’re discussing alternative treatments — or any pseudoscience — with someone who may believe in them. How do you use the words “science,” “skeptic,” “rationality,” “reason,” and “logic?”
It can be difficult to be aware of how you come across 100% of the time, and that’s something I’m always trying to work on, too. I admit that in the case of my pregnant aquaintance, I was unable to find an appropriate response that wouldn’t alienate her. So, I’ll throw it to you readers: what would you do if you were involved in a conversation like the one above, and how would your approach change depending upon if the pregnant woman is your best friend, your sister, your coworker, your boss, or a stranger at a party?
Yeah, science gets a really bad rap, especially for a system that's basically about asking, "Really? Why? How can we verify that?" It seems especially cold in situations like this, when the process is blamed for the realities it exposes. Her baby has a problem, and all the solutions that we know can work are risky and painful. I can hardly blame her for taking a chance on something unproven but easy. I doubt I would ever criticize her for it, whatever our relationship. It's probably significant that these techniques are things that /she/ can do, and not things that are done to her. I imagine it helps her a lot to be able to do something about it, even if she knows it won't work.
I may not criticize her, but I think I would defend science itself, in as gentle a manner as I could manage. The key fact to point out is what I already mentioned: it's just a process; a rigorous extension of common sense. It's not to blame for her baby's circumstances, and shouldn't be maligned for revealing when assertions aren't true. It's natural to want something to blame, but it just isn't fair to do so. Some things you just have to accept, and weather as best you can. Even if that involves the biggest and strongest doctor around doing terrible things to your insides *wince*
Two of my best friends went through this with their daughter. That the latter was positioned for hiney-first delivery was discovered late in the pregnancy.
They opted for cephalic version first. From I was told, it was pretty much like Rebecca described: painful and time-consuming. And to top it all off, while my friend was resting after the doctor had successfully turned the baby around… the stubborn little creature reversed herself AGAIN.
So they went with the C-section, which came off just fine for all involved. As far as I know, they never considered any "alternative" methods.
When it comes to defending science (Gad! That we have to makes me a bit ill!), with friends I'm usually more direct than I am with acquaintances or strangers. I appeal to their intelligence and education (most of my friends are better educated than I am).
With those I have less or no personal connections to, I try to politely correct their reasoning. I can't recall any immediate successes, however.
On top of all that, of course, there is still some risk to the baby born via c-section. Basically, if you happened to be a remarkably intelligent and well-spoken fully-developed fetus with access to all the latest research and statistics, you would most likely choose to be born vaginally, head-first. (Unless in addition to your remarkable intelligence you are also blessed with a correspondingly large neuroses, at which point you may opt for the c-section for fear that the memory of passing through your mother’s vagina might leave you emotionally scarred and unable to establish meaningful relationships as an adult, but that’s another matter.)
There's actually limited evidence that a c-section might provide one particular benefit to the baby – increased intelligence. The hypothesis is that during vaginal delivery, the baby's loose skull gets pressed down on the brain, somewhat limiting its development. On the other hand, if delivered through a c-section, this doesn't happen.
Of course, you can see how it would be hard to test a hypothesis like this. Basically, the only way it can be done is with identical twins where one is delivered vaginally and the other through a c-section. It's rare, but it happens, and of these cases it's not uncommon for the c-section baby to be significantly more intelligent.
I don't have any responses to Rebecca's question that don't involved rolled-up newspaper and physical violence, so I'll just quietly sit in the corner in that regard. However, I have to point out that the graphic representing external cephalic version is, in fact, hilarious.
(Unless in addition to your remarkable intelligence you are also blessed with a correspondingly large neuroses, at which point you may opt for the c-section for fear that the memory of passing through your mother’s vagina might leave you emotionally scarred and unable to establish meaningful relationships as an adult, but that’s another matter.)
Another reason to go for c-section from the fetuses' point of view could be in case you one day find yourself needed to kill someone who, it has been prophesied, cannot be killed by any person born of woman. If you just like being prepared.
Meri wins the thread with her fantastic reference to 'The Scottish Play'*
"Lay on, Macduff;
And damned be him that first cries, 'Hold, enough!'""
Hmm. Probably shouldn't have assumed Meri's gender. Whoops, my apologies if I guessed incorrectly :-X
The problem with science is that it gets blamed as the messenger when it delivers bad news, ironically news (i.e. knowledge) which only science itself has made possible in the first place, and blamed again when it is honest enough to admit there is no perfect answer. Unfortunately, people prefer certainty, or at least the appearance of a solution, over the position that there is no perfect solution. Both alternative medicine and religion invariably offers this certainty and get away with it only because people refuse to hold either to the same standard they demand of science.
That's the problem with science – it doesn't tell you want you want to hear, and it doesn't hold your hand. It's just the facts, extrapolated out to the point that they can predict future trends. Not that "wiggle room" that makes the religious feel so warm and fuzzy.
I can never understand why people get so upset that science doesn't have all the answers. Science doesn't claim to have all the answers! Science presents honestly the best knowledge available. I find that reassuring (but I am in the minority on a lot of my views I guess!) What people don't seem to believe is that noone has all the answers even though some pretend to.
In terms of advice I would be more forceful with those I knew better but it would depend who it was. I have a couple of friends where past arguments have led to an agree to disagree attitude on alternative medicine. Of course they would know better than telling me they were going to a reiki practitioner! At work I tend to just not comment because it the woo-woo attitude is so all pervasive and it is important to get along with these people for my job.
Hmm. Probably shouldn’t have assumed Meri’s gender. Whoops, my apologies if I guessed incorrectly :-X
Nope, you guessed right (It's short for Meredith, because I'm too lazy to type my full name on the Internet). I'd also like to point out that I've never liked Macbeth, but I can resist the chance to make nerdy references.
Should be can't resist. I'm also too lazy to proofread.
"I can never understand why people get so upset that science doesn’t have all the answers."
Generally, I don't think they do.
People mainly get upset when it disagrees with them, and trot out 'Science can't give *all* the answers!" when they really mean "…so it's not perfect, so maybe it's wrong where it doesn't support *me*".
Even the most ardent citizens of the wooniverse are likely to agree with science where it agrees with them.
You could be right PH – it annoys me so much when people say "Science doesn't have all the answers" that maybe I am missing the point of why they are saying it. Not that they think it should or that they are upset it doesn't but that they are trying to prove it is fallible. Which, of course, it is. Which, of course, does nothing to support their particular bit of woo.
Oh and "Wooniverse" is fantastic – I will be stealing that term!!
The risks notwithstanding, some women do elect for C-section, and given that neither one of the two ultimate outcomes (regular birth or C-section) are hugely and systematically feared over the other, even though either might be preferred, the case in question is maybe a rather special case when it comes to alternative medicine.
It's not really in the same ballpark as alternative medicine diverting someone from a potential cure for a serious disease or chronic condition, and/or preying on the desperate.
In much of medicine, where there's a range of possible outcomes, it's often pretty obvious which is to be preferred, and anything which diverted someone from methods that had a chance of giving a desired outcome might be looked on with particular disfavour.