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July 23, 2009

God is my OB-GYN: Unassisted childbirth for Christ

Kathryn Joyce reports on one sad result of the ultra-pro-natalist Christian Quiverfull movement's love affair with unassisted childbirth: Carri Chmielewski, a mother of eight, has died ended up in intensive care from complications following an unassisted birth that also killed her baby.

The Quiverfulls are Protestants who refuse birth control because they think women should bear as many children as God sends them. They reject birth control because they object on principle to women making choices about their fertility.

As Kathryn explains in her excellent book, Quiverfull, the movement prizes large families as proof of wifely submission.

Resigning yourself to 12 or 13 children sounds pretty submissive, but every flock has its overachievers. Some Quiverfulls demonstrate that extra measure of self-abnegation by accepting as many life-threatening complications as God thinks they should have.

For these folks, trusting a healthcare provider shows a lack of resignation. They see it as a slap in the face to God.

I'm not making this up.  Joyce quotes from Carri's own blog: “God never meant for man (Pregnant Women) to surrender himself (herself) to the total control of man (dr./technology, etc.) God considers that idolatry. We are to surrender ourselves to GOD.”

In an unassisted home birth, the woman, her husband, and God are expected to deal with whatever complications arise. And if not, woops, God's will. It's not exactly a pro-life position, but Quiverfulls are refreshingly direct about their priorities. Fetuses are all well and good, but ultimately they're just props for women to play out their elaborate gestures of submission.

Carri's unassisted birth went tragically awry. Her death and that of her infant son might have been averted if she'd sought competent medical advice. Instead, when she was two weeks overdue and suffering from high blood pressure, she went to see a quack who told her that her abnormal pregnancy was A-OK. She went ahead with the unassisted birth on the basis of that terrible advice.

The party line in unassisted birth circles is that Carri's complication, an amniotic fluid embolism, could just as easily have killed her in the hospital. But as Dr. Amy Tuteur points out, Carri was two weeks overdue and much larger than she should have been--both risk factors for an AFE. A competent provider would have realized that the longer Carri was allowed to linger with an overdue baby and high blood pressure, the more likely something was to go wrong. We'll never know what Carri would have chosen if she'd had the benefit of the medical facts.

This being the USA, it wasn't long before someone suggested criminal prosecution as Carri clung to life in the ICU: "I'd be wondering why this type of willful neglect wasn't being prosecuted with the same fervor that a crackhead abusing and neglecting their children would warrant," one blogger wrote. It was a popular point of view. In fairness, there was almost as much enthusiasm for prosecuting her husband. How about a lawsuit against the quack instead?

Criminalizing stupid birthing decisions is doing the Quiverfulls' work for them. It's saying that women can't be trusted to make their own medical decisions. If you let people make their own decisions, a certain percentage of them will make spectacularly bad choices. Grown women have the right to refuse lifesaving treatment for stupid religious reasons, whether they are Jehovah's Witnesses foregoing blood transfusions, Christian scientists rejecting antibiotics, or Quiverfulls turning their backs on modern obstetrics. That's what it means to be an adult. Pregnant adults are still adults.

Besides which, trying to prosecute unassisted birthers will just feed the persecution complex that makes the Quiverfull lifestyle seem alluring to its adherents. Worst of all, if unassisted birth is a crime, laboring women in trouble might refuse to seek lifesaving help.

Correction: In an earlier version of this post I wrote, incorrectly, that Carri had died. At last report, she was fighting for survival in intensive care.

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Study shows 6 times as many JW women die in childbirth for their non blood stance over those who accept emergency transfusion treatment.
Get the facts about Jehovah's Witnesses deadly blood transfusion ban:

"Official Web Site of Jehovah's Witnesses for Reform on Blood"
http://www.ajwrb.org/

Did Carri actually die? The links above (including Katheryn Joyce's article) say the baby died, but I haven't found any that said that Carri died also (though they do report that she was in the ICU in critical condition).

To a certain extent, I agree with you that respecting people's choices involves letting them make really bad choices. The exception to that is when other people's lives are involved. For example it is a spectacularly bad choice to drive a car when you have a high blood alcohol level. That bad choice is subject to criminal sanction because it threatens the lives of other motorists and pedestrians.

We had a case in Minnesota recently of a family who refused chemotherapy for their 13-year old son on religious grounds. The diagnosis was non-Hodgkins lymphoma which is very treatable with chemo. Child Protective Services got involved, and the parents were ordered to have the child undergo the treatment. After some drama, they eventually complied.

This fact situation really bumps up against the line between reproductive autonomy and criminally reckless behavior (reckless in that it risks the life of an innocent third party). The only line separating this situation and a decision to terminate a third trimester pregnancy is that no one here was making a constitutionally protected decision about terminating a pregnancy. They wanted the child to be born healthy, they just went about it in a horribly reckless fashion.

A woman's right to control her body should not be conflated with a person's right to refuse live-saving medical treatment -- that's a rhetorical frame that puts a woman's right to choose in a bad light.

Focusing the debate on these extreme cases is also a bad rhetorical frame.

I agree with the above comment. As a perinatal nurse specialist I have seen plenty of poor decisions made by physicians that have resulted in poor outcomes. To what grand Committee are you, as a patient, going to surrender your decision-making? If you were a woman living in a country in which homebirth was an accepted norm and their "Committee" agreed that you were a perfect homebirth candidate and that you HAD to have one, how would you feel about that?

Sorry, folks, women have the right to choose something you disagree with.

Dave W., thanks for checking. I misread. At last report, Carri was still in intensive care after the amniotic fluid embolism. Her son died. It's hard to be sure how she's doing because her friends on the unassisted birth boards have clammed up.

If you were a woman living in a country in which homebirth was an accepted norm and their "Committee" agreed that you were a perfect homebirth candidate and that you HAD to have one, how would you feel about that?

I realize you're trying to construct a "converse" situation, but the analogy doesn't fit well. I know people who have opted for home birth, with a midwife, but then gone straight to the hospital once complications arose. And then gone back to home birth for subsequent children.

I actually do know a pastor who's rather old, and one of the subjects he discusses with his parishioners is how helpful modern medicine is, because he actually remembers when people suddenly died due to undetected cancers or when people were pretty much non-functional because there was no access to anti-depressants or when childbirth was much more life-threatening than it is now.

This sort of thing reminds me of anti-vaccination believers: it's a belief borne of a life lived in an era where the medical problems of the past are so remote that people no longer understand why modern medical solutions are necessary.

I wouldn't be so quick to dismiss anti-vaccination believers if I were you Tyce. While I sure wouldn't have wanted my son to catch polio or TB, there are a number of diseases on the current vaccination regime which are only very rarely serious in young children, and which usually require a facilitating issue like poor nutrition (i.e. Chickenpox). You have to balance this against the current desire to expose babies as young as six months old, often to 6 or more vaccine strains at once (because the insurance prefers to pay to deliver them once per month instead of split over two weeks). At six months, the immune system is still developing and subjecting it to that many significant "infections" in such a tight timeframe could conceivably have long term repercussions. All the much touted past studies usually don't track complications past a 1 month time frame.

Now I had CFS for a few years (now mostly in remission). A major part of CFS is an unbalanced immune system, but that wasn't well known when I first had it. So I did what had done the previous few years, I got a flu shot during my first year of CFS. Mysteriously enough, my condition which had been improving got worse again more than a month after my flu shot. The start of my CFS occurred a couple of months after the previous year's flu shot. Another data point is that my immune response to all flus and colds for the 5-6 years that I had a flu shot was markedly different than the period prior or since. I don't believe that the flu shots were the sole cause of my CFS (an undiagnosed lactose intolerance triggered by a virus was another big factor) but I do believe it was a contributing factor.

I think you have to carefully weigh the benefits against the drawbacks when it comes to vaccination. A lot of pro-vaccination doctors bang the herd-immunity drum while dismissing the effects on susceptible individuals. My anecdotal experience is that individual immune responses vary and that, for some individuals, vaccinations need to be used a lot more judiciously than what is recommended for the general population. You should be careful in the 6 mo. to 2 year-old range or if someone has a history of immune issues in the family, just the same as you would with a family history of circulatory problems.

Certainly, there's some anti-vaccination extremists that are for the equivalent of the JW proscription against blood transfusion. But if you had caught AIDS or Hep C in the 70s and 80s from a blood transfusion before tests and controls were widely available, you might also have some appreciation for the people who wanted to push for techniques (like banking your own blood) to decrease the necessity for blood transfusions. However blood donations aren't as big a profit centre as vaccinations are for pharmaceutical companies, so it's going to take longer for an equivalent attitudinal change.

and which usually require a facilitating issue like poor nutrition (i.e. Chickenpox).

Huh? Do you have any idea what you're talking about?

Huh? Do you have any idea what you're talking about?

Mostly, but it was late when I posted that and I confused a couple of things.

"Nutrition and smoke are major risk factors for pneumonia. Poor nutrition underlies many pneumonia deaths."
http://linkinghub.elsevier.com/retrieve/pii/S0264410X06009984
These risk factors are much less prevalent in western industrialized nations and should be considered in a decision to immunize against pneumococcal conjugate.

The problem with chickenpox is that serious complications are more common among adults. However it now appears that the immunity conferred by the vaccine is more likely to expire in adults than the natural immunity conferred by the disease. So you're probably better off catching it as a child.

As a former Quiverfull woman, I understand all too well the connection between QF and unassisted childbirth ~ for those women who plan to have as many babies and the Lord chooses to bless them with, there is a strong motivation to find the least invasive, least expensive, most comfortable birthing options. Unfortunately, being patriarch wives means that these women are conditioned to let others (men) make the decisions ~ and so they are denied an important safety net ~ that of woman's intuition or mother's instinct.

As a former Quiverfull woman, I understand all too well the connection between QF and unassisted childbirth ~ for those women who plan to have as many babies and the Lord chooses to bless them with, there is a strong motivation to find the least invasive, least expensive, most comfortable birthing options. Unfortunately, being patriarch wives means that these women are conditioned to let others (men) make the decisions ~ and so they are denied an important safety net ~ that of woman's intuition or mother's instinct.

Why do we continue to let religious murderers get away with these crimes against women?

However it now appears that the immunity conferred by the vaccine is more likely to expire in adults than the natural immunity conferred by the disease.

References, please. It's certainly plausible that immunity could decline (just like tetanus) but it's also plausible that we could get booster shots if it were a big issue (just like tetanus). Shingles hurts like heck, and even if a booster shot is needed to prevent it, that could well be cost-effective when compared to the costs and side-effects we endure to avoid pain in general. And, plain and simple, caring for a kid with chickenpox has costs; the vaccine is probably cheaper.

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