“Rituals could feed conflict by turning opinions into ‘sacred values’.”– Scott Atran, director of anthropological research at Centre National de la Recherche Scientifique
“Definition of myth: a usually traditional story of ostensibly historical events that serves to unfold part of the world view of a people or explain a practice, belief, or natural phenomenon.”– Merriam-Webster Dictionary
Once Upon A Time…
“Do you know what women were dreaming of when they were giving birth in a cabin with the wolverines prowling around? A hospital! This sterile environment where their baby would be safe!!!”
I was listening to one of my favorite podcasts and had encountered a moment in an otherwise great podcast that irked me. Two men- only one of whom had even witnessed a birth in a hospital- expounding on the history of childbirth. ( I love how anyone, man or woman, who may not have ever even seen a birth but believes hospital birth to be 100% safe is suddenly more of an expert on childbirth than any midwife, doula or mother.)
It’s completely understandable that they would think that hospital birth reduced neonatal and maternal mortality. Most people think that’s how the story goes.
But it’s not.
The Actual Data Behind Hospital Birth
Hospitals and even doctor care were actually much higher risk for most births in the 19th and early 20th centuries. For example in her book Inside The Victorian Home, Judith Flanders describes how women who had midwife care had lower rates of death than women who delivered with doctors because doctors spread infections from vaginal dilation checks. Ignaz Semmelweis formed his ideas of the transmission of puerperal fever after noticing that women who gave the birth in the street had lower rates of death than women who gave birth in the obstetrical clinic with doctors in attendance. (These clinics catered to low-income women who wanted the doctor care after their baby was born, but were terrified of the 10% mortality rate of the clinic. These women frequently chose to give birth on their own claiming precipitous labor rather than risk delivery in the clinic.)
Even into the 20th century women who delivered with midwives had a better chance of surviving delivery. Records from England and Wales in the 1930’s showed that the wives of manual laborers who had midwife care had better survival rates than higher income women who had doctor care for pregnancy and birth. And infant mortality? Many hospitals in the early 20th century had higher rates of infant mortality because of the increased use of forceps and other equipment. The White House Conference on Child Health and Protection of 1933 found that during the period between 1915 and 1929 there was a sharp increase in the number of hospital births, along with a 40-50% increase in infant mortality due to birth injury.
Long story short, if you believe that women with uncomplicated pregnancies can deliver safely outside a hospital, you are right. It is a myth that hospitals and doctors lowered the rates of maternal and neonatal mortality. Birth moved into the hospital because scopolamine was touted as a way to spare women the pain of childbirth. But if you really believe that tying a laboring woman to a hospital bed and giving her a hallucinogenic drug that leaves her paranoid is an improvement over a natural birth, I think you need to reevaluate your morals.
Legends And Tall Tales From Public Health
Let’s take on another popular myth: Jonas Salk single handedly saved the world from polio out of sheer altruism. It makes a great epic, something like Beowulf or King Arthur, but there is no data to back that story. The 1955 Vital Statistics report states that the Salk polio vaccine could not be completely responsible for the decline in polio because polio declined for all age groups, though the vaccine was given only to children. The Salk and Sabin (sugar cubes) vaccines were both widely used so the Salk vaccine can not be credited with ending polio.
Salk and his work also had their own sets of flaws. He tested flu vaccines on mental patients who were unable to consent and unable to adequately describe symptoms for research purposes. And a mysterious batch of the Salk vaccine from Cutter Laboratories also caused the death 10 and paralysis of more than 200 children. Salk’s remark that he could no more patent the sun than his vaccine was more a reflection on how he could not patent his vaccine because of prior art. (Others had done similar vaccine research and trials.) In fact, Salk and the National Infantile Paralysis Foundation had looked into patenting Salk’s IPV. Getting personal about Salk, a book that came out a little while ago about him and Sabin portrays Salk as an ambitious scientist who could be difficult to work with. And for that matter, statistics show that before either Salk or Sabin vaccines were released polio rates were in an overall downward trend.
Louis Pasteur a genius? He stole ruthlessly from others and misrepresented his work. (It’s no wonder he didn’t want his notebooks released to the public.) Edward Jenner was known to be very proud of his son Edward Jr. and loved him dearly. However, he also Used his son as a test subject over and over again, repeatedly inoculating him and then exposing him to diseases. Sometimes Edward Jr. recovered and other times he became seriously ill. (Some have speculated that Edward Jenner Jr.’s mental and physical impairments may have been caused by the repeated cycle of illness or contaminated inoculation materials, though it’s hard to say one way or the other.)
Even breastfeeding comes with its own set of myths from both sides- either that it makes your baby smarter or that it really doesn’t have any substantial health benefits. Both are untrue, but different sides of the breastfeeding debate cling to these myths. Ultimately, those myths end up hurting mothers and babies because they alienate women who encounter difficulties and create a “us” vs. “them” dynamic. That’s why I designed my curriculum to be as “myth free” as possible. I want any woman who is interested in breastfeeding to feel welcome to learn more.
The More Things Change, The More They Stay The Same
In so many ways, we are no different than our ancestors. We tell stories about heroes, monsters, rituals and weapons to try to understand our world. And we live in a world that is still full of fear and uncertainty despite our technology and efforts. 99% of births in the US take place in hospitals, 30% of which are c-sections- and the US still has the highest rate of maternal and first day infant mortality of any developed nation. People don’t worry about polio any more, but acute flaccid paralysis is on the rise and emerging diseases like the nonpolio enterovirus EV-D68 are causing more cases of serious disease. We still have little control over our world.
What If We Approached New Health Data Like A Black Hole?
In my opinion, we in the health field need to take some lessons from the astrophysics folk. They are always finding out new information about our universe that makes them re-think current models. When that happens, they say, “COOL! This helps us better understand the universe we live in!” I think it’s hard for public health and medical professionals to take that attitude because everything feels so high stakes. After all, discovering a super massive black hole from the early days after the Big Bang doesn’t impact anyone’s health or life.
Kevlar Vest Or Security Blanket?
The problem with myths is that they are security blankets: they feel comforting but don’t provide any actual protection. Myths becomes an even bigger problem when people start thinking their security blanket is actually a Kevlar vest. This is what happened with puerperal fever. Though Dr. Semmelweis had shown strong evidence that doctors’ lack of hygiene was spreading the disease, the widely accepted myth that puerperal fever spread through the air and was exacerbated by womens’ emotional nature prevented the acceptance of handwashing for almost a century, costing the lives of millions of mothers.
Just because “everyone” says things are a certain way doesn’t mean it’s true. If you find something doesn’t match up, it’s OK to ask questions and look for data to find out if you are dealing with a sound hypothesis or a myth.