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The Information Fallacy...

Shae's blog post about the birth debate got me thinking...

When I was doing my communications degree in the early 90s, we were told, not infrequently, that we were living in the Information Age. Thanks to the emergence of the internet, information was becoming global and people would have the information of the worlds libraries at their very fingers, in their homes, via their personal computers. What a wonderous world we lived in!

That was 17 years ago, and 17 years on, all the wonders we heard about have come to fruition. In under a minute I can google and find out all about almost anything that takes my fancy, and in fact, I've spent many entertaining hours doing just that!

Thanks to the internet, I found out about attachment parenting, extended breastfeeding, homeschooling, co-sleeping, babywearing, and the vaccination debate. I also found out about homebirthing and freebirthing. I found out that many of the "facts" given to me by hospital staff when I was having my first son, had another side to them, could be question, were taken out of context or played up to make it easier for the staff to get on with their job, to save time and effort, to ensure I wouldn't turn around and sue them down the track, etc...

On the other hand, I've seen some information passed off as "fact" by people who want to encourage women to homebirth or freebirth, even if their might be questions over the safety of these options for the woman in question. I recently saw a member of one forum, tell another member that a blood pressure of 190/120 was "just at the high end of normal" and so the caesarian section the second woman had was an unnecessary intervention.

Information...

There is a lot of arguing done that women need to inform themselves about birth - I support that idea, I believe that information can be empowering.

What I wonder about though, is whether it is really possible to "have all the information", or even to trust all the sources of information. When people are running agendas, they tend to decontextualise information, because they are biased in one direction or another and they need the information to support their bias...

For example, The Herald Sun ran a story last weekend about four deaths in homebirths. Four sounds like a lot when you think of four lives lost. It doesn't sound like a lot when you think of how many babies are born each year. It does sound like a lot when you think of how many homebirths there are each year, but then again it doesn't sound like a lot when you think of how many babies die in hospital each year (if you can get that figure out of anyone, but I am certain it's more than four)... But what percentage of homebirths is four deaths? How does that compare to the percentage of deaths in hospitals? Can the two be compared if homebirths are all supposed to be low risk births and many hospital births are deemed high risk? But then again, how many of these deaths were as a result of freebirth with no professional in attendance rather than homebirth with a midwife in attendance? You might as how that even matters, but of course it does because it's the midwife who assesses whether or not a pregnancy is likely to be low risk or not, and midwives routinely refuse pregnancies deemed to be high risk.

So, how was "four deaths in homebirths" satisfactory information? Well, it probably wasn't, but it is still considered information, even if taken out of context and biased to suit a particular agenda.

So, can free birthing women be "better informed"? Does it depend on where they source their information? Are forums filled with lay people who have read journal articles and studies a good source of reliable information? If some of those "information disseminators" on the forums midwives, does that make the information more reliable. Is it only reliable if it comes from an OB. Can the information from a study of 2000 women be reliable? Can a study done 20 years ago be reliable? Is one done 2 years ago MORE reliable? Do people research who funds the research and what the funding organisation's bias is. Is a bias toward natural birth more reliable than a bias towards supporting the medical model?

I'm not arguing one way or the other here. I'm just saying, I believe there is a fallacy about having all the information and particularly about free birthing women being "better or more informed" than other birthing women, and therefore not needing a midwife, because they essentially become their own midwife (well, except for the fact that most of them have not attended nearly as many births as a qualified midwife, most - I'd say - would have only attended their own previous births, or maybe that of one or two friends)...

And in all the information about natural birth, is there information about modern life and it's affect on the body. I recently read that being obese has NO AFFECT on a woman's ability to give birth because "you don't get fat on the inside"... That was passed of as a statement of fact on a forum... Only thing is, many other sources of information argue that fat is deposited around all the internal organs, as well as inside those organs, restricting the efficency of the organs... How that doesn't affects a woman's ability to labour confounds me...

And hey, in anticipation of much carry on about how I am doing homebirthing and other options no favours with this blog, I just want to say, I'm all for homebirthing, I'm all for being informed and informing yourself, I'm all for women doing all they can to birth naturally. I just think we can do better than simply denying that obstacles may exist.

Not all information is going to tell you what you WANT to hear, but even seemingly negative information can be a boon. It can be the catalyst for change that leads to EXACTLY the outcome you desire. Instead of denying that obese women can have challenges in pregnancy and labour, or that 190/120bp is high, we can use that information to make changes that can positively impact pregnancy and labour for women facing these challenges, so babies CAN be born with the least possible intervention and the highest possible safety...

Hmmm, I rambled a bit with this one - it's a big a topic, so many interesting facets - but basically... Not all information is equal, and not all the information CAN be had - particularly BEFORE the event of birth. Beware the fallacies...

Comments

katef said…
Hmmm the information thing is such a tough one... what I call informed someone else calls 'brain washed'....

Is either of us right or wrong?
Does it matter?

If I seek the information I need to feel good about my decision making process... does it matter if it is not 100% unbiased and true?

If later that information comes back to bite me on the bum then I will have to do something about it... to either modify my next decision or process the past events....

I guess if you take responsibility for your decisions you have to take responsibility for the information you base those on... to some extent anyway.

Or maybe not? man... such a huge and confusing topic but I have to say I am so enjoying the discussion!
Sif said…
LOL, I like the way you think! It's a huge topic! Inornation is not cut and dried though, is it? It's not finite or infallible or precise. It's neither right nor wrong. It seems to be quite intangible and malleable...

So, I guees information, no matter the source, can't be wholly reliable. It requires interpretation and judgement, and those things aren't fool proof either...

So, can we really say that being informed is some sort of safety net that protects us from harm or poor judgement or poor circumstance - is being informed any kind of guarantee at all?
katef said…
On a personal level I think getting information (biased or unbiased one-sided or not) can help you own your decisions.... I wonder if that 'owning of decisions' is what we are striving for?

I guess that is what I want... especially in regards to birth.

That is why I'll listen to loads of information and try to take it in, understand it and then make my own choices about what I believe is right or wrong for me... because I want to own my decision.

It's not going to protect me from crappy things happening.. some crappy things are beyond my control... some crappy things are within my control but I don't always choose the right way to avoid them.... but I guess I feel it gives me a better shot at a less crappy outcome and a better chance at dealing with crap if it arrives?

um... not sure if I am just going round in circles now LOL
shae said…
Sif you make an excellent point!
It really is a huge issue with many, many sides.
*sigh*
Stitch Sista said…
OMG I think I'm agreeing with you! LOL.

What bothers me is the amount of anecdotal evidence or 'information' going around. Like surveys asking people 'is homebirth safe?' and myriad people writing with their own experience to try to prove that it is or it isn't. Without stepping back and looking at the bigger picture - that is all the births, deaths, complications, birthing environments, lunar charts (kidding) etc etc one person's experience really adds little value in answering the question. I can say that in my case, yes, it was safe. I did everything I considered I needed to to have a 'safe' birth at home - and lo and behold I did. But that in itself offers no guarantees to Jane Doe down the road if she chooses a homebirth based on my experience...

Geez so much to say on this issue - I can feel myself jumping on the bandwagon soon!
Sif said…
Rach, can I take that one step further... My home birth of Ari was safe, it was straightforward, it was unintervened. I *could*, quite easily, have free birthed him. The same goes for Luey's birth (though that was initiated by my waters being artificially broken). I could have laboured on my own, birth, and caught my own baby and been a great example of how safe free birth (and home birth is)...

Not only would that not help women who have lost their babies, or women who haven't tried yet and so don't know what their labour will bring, but it also tells me NOTHING about how my NEXT birth might pan out...

Recently, one woman who had had a very straight forward home birth with her previous baby, had a very scary "near miss" home birth experience with her most recent birth. There were no warning signs (that anyone was aware of), and this woman had considered possibly free birthing but changed her mind. Her baby is doing well now, but it was a very close call.

To some extent each and every birth stands alone. Having information is good, but even out own anecdotal information from previous births can't give us all the information for subsequent births (and thankfully that goes the other way, too, a previous difficult birth doesn't mean subsequent birth will definitely be difficult)...

Again, only one person's story, so can only show one part of a wide spectrum of outcomes...
Stitch Sista said…
Absolutely - of course each birth stands alone.

We can only mitigate risk to a certain incalculable limit. After that it's in the hands of the universe I suppose...

Such a ridiculous argument "My baby and I were fine so obviously home/free/hospital birth is safe/best/the only way"

That said there needs to be an objective (if possible) look at introduced risks to what is a natural process- as I don't think the general population quite have a handle on that. Anyway don't want to go off on another tangent...
Joy Johnston said…
Sif I have enjoyed reading through the blogging and comments on these complex matters.
The information age seems to have brought with it a generation of thinkers who actually believe they can be experts in any subject they choose, without systematic study of the subject. I see this particularly in that unique field of maternity, which interfaces between the 'natural' and 'expert managed' (whether the expert is a doctor or a midwife). For some, the pendulum has swung from the extreme patriachy of 'doctor/midwife knows best' to 'I know best'.

In my mind neither 'I' nor the 'expert' can possibly know. The process of decision making is an active and live process, and decisions can only be made on the current situtation, or what can be predicted as likely.

That's where the partnership between a woman and a known midwife is effective.

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