Why people believe wrong things, pt 1/?

In our continuing quest to understand why people believe wrong things (and how to be better judges of information ourselves,) let’s take a look at this article: ‘I brainwashed myself with the internet’: Nearly 45 weeks pregnant, she wanted a “freebirth” with no doctors. Online groups convinced her it would be OK.

Not exactly the catchiest title, but still worth a read.

Long story short, Judith, a first time mom-to-be, started listening to homebirth and “freebirth” podcasts on her way to work and decided that giving birth at home, with just her husband and maybe a couple of friends (but no doctors, midwives, or other trained medical personnel,) sounded like a good idea.

Unsurprisingly, there were complications and the baby was stillborn, a month late.

Birth is hard. Childbirth has historically been one of the major killers of women (and their infants). Modern medical care does not remove all of the risks of childbirth, but you are still significantly less likely to die giving birth in a hospital than alone in your bathroom.

I don’t want to spend this post criticizing Judith (there’s enough of that already out there.) I want to examine what could possibly possess a woman intelligent enough to have a job and drive a car to trust her life and her infant’s to… nothing at all? What made her think this was a good idea?

The article blames three things. First, Judith blames herself (naturally). Second, the author blames “algorithms,” the modern scare-word for “the internet is run on code.” And third, the “freebirth” and similar communities themselves fall under scrutiny.

I think one more person deserves blame: Judith’s husband, who supported his wife’s decision to forgo medical care during childbirth and didn’t intervene on behalf of his child.

1. Let’s start with the algorithms. We’ve seen a lot of scaremongering lately about “algorithms.” Supposedly the dark magic of the internet can lure unsuspecting, innocent people deeper and deeper into the depths of political conspiracies, creepy kids’ videos on YouTube, or straight up flat-Earthers:

With a little help from algorithms that nudged increasingly questionable information and sources her way, Judith had become a part of the internet’s most extreme pregnancy communities. …

Social media has come under fire in recent years for amplifying extreme views and employing algorithms that connect users to these potentially dangerous echo chambers. Although much of this criticism has focused on political extremism, experts and lawmakers have also pointed to extremism fueled by health misinformation as a threat to individuals and the public health at large.

“Things can get a little dicey,” said Kolina Koltai, a researcher at the University of Texas at Austin, who studies the social media behavior of alternative health communities. “Not to demonize all of the groups, but when women start diagnosing and crowdsourcing health-related issues, they can end up getting bad medical advice that can be pretty dangerous.

“We’re in this weird time, like a new digital Wild, Wild West,” Koltai said.

Wow, “algorithms” sound really bad–except that all these algorithms actually do is recommend things similar to things you already like. It’s the same thing that happens on Amazon. If you search for slime, Amazon will show you a bunch of other slime-related products bought by other people who searched for slime. If you listen to your favorite folk band on YouTube, the suggestions bar will be filled with more folk bands listened to by people who also listened to your favorite band. Judith searched for freebirth, so she got recommendations related to freebirth.

A well-functioning algorithm does nothing more than try to recommend more of what you’re already interested in. If it works, you find something you want, like a new song or the perfect slime. If it doesn’t, you’re frustrated. 

If you join a bunch of Facebook communities about “natural birth” and “free birth,” you’ll get recommendations for more of the same. But there is nothing that compels people to click on these links, join these communities, and uncritically believe everything they read in them, any more than people are forced to buy “related items” advertised on Amazon. (And, by the way, no one is forcing you to watch weird porn on YouTube. “The algorithm made me do it” is the most pathetic 14-year-old-who-just-got-caught-watching-porn excuse I have ever heard.)

Judith didn’t just click recommended links–she actively sought out communities that would support her decision to ignore her doctor and midwife:

Judith also checked in with a local midwifery collective but ignored the gentle, constant advice that she induce.

Judith found a second opinion on Facebook. …

Searching the hashtag ‪#‎43weekspregnant‬ led her to a Facebook group called “Ten Month Mamas,” made up of a few hundred women who knew what she was going through. Judith joined.

Maybe, without the algorithms, she wouldn’t have known that there was more out there or thought to search for #43weekspregnant, but since she had just seen her doctor and midwife, she could have just as easily searched for information from doctors or real medical papers on the risks of being 43 weeks pregnant. Sweden did a whole study on this, but canceled it when 6 babies died at 42 weeks, so that information is definitely out there. (Thanks, Swedish friend, for the information.)

There’s been a push recently to blame “algorithms” for all of the bad stuff on the internet, whether it makes sense or not, as part of a wider push to make certain kinds of information more difficult to find. But the problem here is not the algorithms. (I, too, have been pregnant, and I have researched my options and even encountered freebirth advocates, but I didn’t try to give birth unassisted in a yurt because the idea never appealed to me.) The problem was the things Judith wanted.

You can’t change the overall algorithm to stop people like Judith from finding the information they want without breaking the algorithms for everyone. You might be able to build an algorithm that automatically detects certain types of behavior, like trolling or pornography, but “bad advice” is much harder to recognize (otherwise we wouldn’t be having this conversation). Communities like Judith’s would basically have to be shadowbanned or deleted on a case-by-case basis, which is both a lot of work for Facebook and an intrusive level of censorship. Yes, freebirth communities are clearly advocating something dangerous, but what about communities devoted to homebirth? Midwives? People who just really hate c-sections? Drawing a line between what is and isn’t “clearly dangerous” isn’t easy.

Finally, I would just like to note, in response to Mrs. Koltai’s comment, that millions of women (and men) have gotten excellent, life-saving medical advice online, much of it from non-professionals.

2. More credible blame lies, of course, with Judith and her husband. Judith chose her podcasts and sought out communities of like-minded people for support. She admits that she effectively “brainwashed” herself.

Why were these more appealing to Judith than regular medical advice?

Remember the old X-Files tagline: I want to believe?

Judith wanted a healthy pregnancy, uncomplicated labor, and a healthy baby–like almost all pregnant women–and if she’d had that, her freebirth would have gone off without a hitch. (Unfortunately, even the best of pregnancies can go wrong, rapidly and unexpectedly, once labor begins.) I think Judith wanted a healthy baby and uncomplicated labor so strongly that she refused to take seriously any information to the contrary. 

“43+1 today, politely declining hospital induction. … I really feel like this baby wants a home birth too but we are definitely being tested. What would you mamas do?”

This is a big red flag. Obviously fetuses cannot “want” anything. They are fetuses. Even babies do not “want” anything beyond the basics of infant care, like feeding, sleeping, and not being hot or cold. Do breech babies “want” to be born via c-section? Do ectopic pregnancies “want” to be implanted outside the uterus? No. This is magical thinking. You’re deluding yourself into thinking that “the baby wants” what you actually want, when it shouldn’t be about what anyone wants. It should be about what’s healthy.

When we want something to be true so much that we are willing to ignore evidence to the contrary, we experience cognitive dissonance. And we all do it. We all have things that we want to be true. Could our favorite politician really be a scumbag? Could our most cherished political solutions actually make things worse? Could our spouse cheat on us? Could we be not as smart as we think we are?

Sometimes I can feel cognitive dissonance–it’s this uncomfortable sensation in my head when trying to think about specific topics, like “presidents” and “people who are prettier than me.”

One sign that you are lying to yourself is that you have to hide what you are doing or thinking from the people who love you. Judith knew her relatives, aside from her husband, wouldn’t approve. She knew they would be afraid for her health or her baby’s health, but instead of listening, she hid what she was doing.

Unfortunately, merely wanting something to be true doesn’t make it true, in politics or real life, but these birth communities Judith had joined focused on the kind of magical thinking that leads people to believe that they can influence reality just by wishing hard enough:

“Birth is not a medical event but a spontaneous function of biology,” Free Birth Society instructor Yolande Norris-Clark says in the welcome video. It isn’t luck, Norris-Clark, an artist and mother of eight in the Canadian province of New Brunswick, breathily offers, but education, mindset and love of your baby, that hold the keys to successful freebirthing.

Education, love, and mindset have nothing to do with it. There are completely uneducated sharks mindlessly having bunches of healthy babies they’ll never love or care for out in the ocean and deeply loving, educated women with degrees in obstetrics and midwifery who need emergency c-sections due to ruptured uteruses.

Young people, especially, are used to having a fair amount of control over their lives, especially their bodies. They aren’t old enough yet to have been betrayed by hips, backs, or failing memories. They know that if they exercise they can lose weight or gain muscle. If they drink coffee they can stay up all night. They are used to thinking that with enough willpower, they can make their bodies do whatever they want.

Then comes labor. Labor is out of your control. You can no more “willpower” your way out of a bad labor than out of a failing kidney, and anyone who tells you that you can is lying. It can be deeply shocking.

3. The freebirth podcasts sold Judith a story–literally. She paid $300 for the freebirth society’s guide to how to have a baby at home, even though the process is literally “Wait until you go into labor. Try to find a comfortable position. Keep doing this until the baby comes out.” It’s a beautiful story, full of candles and yurts and beautiful thoughts and soaring spirits, but it’s still just an extremely expensive story.

The doctor will get sued if you die in his care, so the doctor has some incentive not to let you die. The random lady on the internet who sold you a $300 video about using your dog as a midwife will not, because who the hell trusts a dog to be their midwife?

Beware of people selling you a beautiful story who will not be impacted if you are the one who dies. They have no skin in this game.

These people sold Judith the idea that the magic of wishful thinking would get her a healthy baby and uncomplicated labor, and Judith wanted that healthy baby so much that she bought into it.

The actual claims of the “freebirth” and “home birth” communities bear investigating.

The course paints expectant mothers as warriors — and experts, doctors and midwives as the enemy.

In the video, Norris-Clark warns against induction, calling any procedure to bring on labor an “eviction from the womb.” …

Judith said the podcasts fanned her unease with doctors and medicine into a hot distrust, a common refrain in the freebirth community, in which hospital births are largely spoken about as traumatic experiences — harried medical teams rushing, poking, strapping women down to beds and pumping them full of drugs that confuse the mind, strangle the hormones responsible for love and push them into procedures that they didn’t feel they needed. Terms like “industrial obstetric tyranny” and “rape culture” are often used.

In general, you shouldn’t trust anyone who uses the phrase “rape culture” for anything that doesn’t involve actual rape. Prisons? Rape culture. Epidurals? Not rape culture.

Many people talk about women having “more control” at home than at the hospital. This is true, in a sense: you certainly won’t get an epidural if you don’t want one. It is untrue, though, in an emergency: you have far fewer options at home. If you need a c-section, well, you’re out of luck.

Doctors are not always right. Doctors are human; they make mistakes. Certainly people need places to talk about medical issues, get second opinions, and discuss what they should do if they disagree with their doctors’ opinions. But this kind of emotional language (“enemies”) is ridiculous and should be a big tip-off if you encounter it.

4. Let’s talk about these communities themselves. Obviously some of the people running them are absolute scum, making money off of other women’s suffering and their dead babies, but most of the people in them are good-hearted and well-intentioned. They are people like Judith herself, who really do want healthy babies.

The problem with these communities–and as a mom, I have been in many parenting-related communities and seen these problems first hand–is that they are always structured as “A supportive community for [activity X]” rather than “A supportive community for moms.” Activity X–whether it’s freebirth, breastfeeding, cloth diapering, etc–becomes the the focus, not the actual humans involved in them, and saying anything negative about the activity is forbidden.

So if you’re in a breastfeeding support group, you can’t give anti-breastfeeding advice like “Hey, sounds like this is really not working for you, maybe your baby would be better off on formula,” even if that is actually what someone needs to hear.

“43+1 today, politely declining hospital induction. They think I’m crazy,” Judith posted in Ten Month Mamas in January 2019, along with a list of the midwives’ concerns, including the baby’s larger size, her decreasing amniotic fluid and the integrity of her placenta, the organ that carries oxygen and nutrients from mother to baby. “… What would you mamas do?”

The comments rolled in, more than 50 per post.

“Trust your body.”

“Your baby isn’t ready to come out!”

“I would do exactly what you’re doing!”

“Keep going mumma, listen to your baby and your instincts — you got this.”

You only get positive comments on these sorts of posts because any negative comments get deleted and negative commentators get kicked out. Any time you are not getting at least some negative feedback, you have to ask why.

Yes, there is the argument (presented by one of the moderators) that these communities exist to allow discussion of a certain topic and if you want to discuss things that are not this topic, you can go literally anywhere else. The problem is that this is not how people actually operate. While you don’t want your group or message board to turn into 100% “Why this topic is wrong” posts, any discussion of a topic that doesn’t involve both sides is incomplete. Normal messageboards (take writers’ forums) have dedicated spaces for off-topic conversations, complaining, rants, and debates. Scientists and doctors welcome (at least in abstract) people who come up with new ways to test, falsify, and disprove theories, because this is how science and medicine advance.

If your advice is within the bounds of REALITY then you do not need to fear reality coming in and saying, “Hey, this is not for everyone. Some people need to do something different.”

If you can’t tell a woman in your community that maybe at 43 weeks she needs to get her ass to the doctor right away before her baby dies, then you have a PROBLEM.

I am not sure if this problem is specific to female-run communities, because I haven’t been in that many all-male ones, but I think it is. I think it is kind of a failure mode of how women prefer to interact, by removing points of view they don’t like from the conversation so they won’t have to interact with them rather than engaging directly.

So let’s try to summarize what went wrong:

  1. Algorithms: not that big a deal
  2. Wishful thinking: huge deal. We all do it, at least sometimes. Watch out for it.
  3. Sociopaths selling a beautiful dream: they want your money.
  4. Emotional language: interferes with logical thinking; big tip-off.
  5. Getting your information from communities that don’t allow for dissent or won’t tell you when you’re doing something dangerous.

12 thoughts on “Why people believe wrong things, pt 1/?

  1. I was surprised by this post. First, of all it comes across sniffy and dismissive not just of the free-birthers, but of home-birthers in general. Perhaps you didn’t mean it that way, but that’s how it reads. Surely, given the themes of this blog, you are not unaware of the bureaucratization of birth or of the way that hospitals routinely ignore evidence in favour of over-medicalization, or of the simple psychological fact that people get stressed out and miserable in hospitals. Women absolutely should have a trained midwife on hand and be in short driving distance of a hospital when they give birth, but, excepting those with a specific risk factor, home is absolutely a better place for the overwhelming majority of women to give birth. You’re saving the country a ton of money too.

    Secondly, you criticize the husband for not stopping his wife, but western men have absolutely zero tools at their hands to deal with irrational women unless they happen to be expert rhetoricians. If he put his foot down then she could have just divorce raped him, or worse.

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    • I had a home birth. It was the worst experience of my entire life and the only time I have seriously thought about putting a bullet in my brain.

      Everyone has tools for dealing with the other people in their lives.

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      • 1) So you’re biased. My wife hated her hospital birth and loved her home birth, but that’s not relevant either. What’s relevant is the evidence which shows that complications are less likely to occur during home births, but more likely to be fatal if they do, which is really just common sense. Increasing the proportion of home births in mothers without risk factors is probably the single best healthcare reform on the table.

        2) Not even remotely true. Short of a A Handmaid’s Tale, a wife always has at least one means of persuading her husband to stop acting like such a nut, but what exactly is an ordinary husband in 2020 supposed to do if his wife is a cra-cra? Really? Maybe you’re biased on this one too. (Really, both parts of your comment are the most irrational things I’ve ever seen you write, by a large margin)

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      • The data on home vs hospital births is crud at best because we don’t have any large, randomized trials of women assigned to home or hospital birth procedures. We only have self-selection, which of course already means that the people who are more likely to have medical complications will tend to opt for hospital births and the people without will be more likely to opt for home births. See, eg https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Planned-Home-Birth

        “In the United States, approximately 35,000 births (0.9%) per year occur in the home (1). Approximately one fourth of these births are unplanned or unattended (2). Among women who originally intend to give birth in a hospital or those who make no provisions for professional care during childbirth, home births are associated with high rates of perinatal and neonatal mortality (3). The relative risk versus benefit of a planned home birth, however, remains the subject of debate.

        High-quality evidence that can inform this debate is limited. To date, there have been no adequate randomized clinical trials of planned home birth (4). In developed countries where home birth is more common than in the United States, attempts to conduct such studies have been unsuccessful, largely because pregnant women have been reluctant to participate in clinical trials that involve randomization to home or hospital birth (5, 6). Consequently, most information on planned home births comes from observational studies. Observational studies of planned home birth often are limited by methodological problems, including small sample sizes (7–10); lack of an appropriate control group (11–15); reliance on birth certificate data with inherent ascertainment problems (2, 16–18); reliance on voluntary submission of data or self-reporting (7, 12, 14, 15, 19); limited ability to distinguish accurately between planned and unplanned home births (16, 20); variation in the skill, training, and certification of the birth attendant (14–16, 21); and an inability to account for and accurately attribute adverse outcomes associated with antepartum or intrapartum transfers (8, 16, 22). Some recent observational studies overcome many of these limitations, describing planned home births within tightly regulated and integrated health care systems, attended by highly trained licensed midwives with ready access to consultation and safe, timely transport to nearby hospitals (7, 8, 10, 11, 16, 19, 23–28). However, these data may not be generalizable to many birth settings in the United States where such integrated services are lacking. For the same reasons, clinical guidelines for the intrapartum care of women in the United States that are based on these results and are supportive of planned home birth for low-risk term pregnancies also may not currently be generalizable (29). Furthermore, no studies are of sufficient size to compare maternal mortality between planned home and hospital birth and few, when considered alone, are large enough to compare perinatal and neonatal mortality rates. Despite these limitations, when viewed collectively, recent reports clarify a number of important issues regarding the maternal and newborn outcomes of planned home birth when compared with planned hospital births.”

        The little data we do have, with that big caveat, shows that, yes, home births have fewer interventions (how could they not? What’s there to intervene with at home, salad tongs?) but more dead babies.

        “Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although planned home birth is associated with fewer maternal interventions than planned hospital birth, it also is associated with a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000).”

        If you want to decrease unnecessary interventions, the place to start is in the hospitals, Put the midwives in the hospitals and enforce better practices about when to intervene (and when not).

        2. Yes, people can interact with each other and convince each other not to do dumb stuff. We do it all the time.

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      • The little data we do have, with that big caveat, shows that, yes, home births have fewer interventions (how could they not? What’s there to intervene with at home, salad tongs?)

        You are just being silly. A licensed home-midwife has a a number of interventions she can perform onsite and she also a has a car in which she can take the mother to hospital. In Israel, homebirths are only permitted within a 30 minute radius of a hospital, which is a good example of a sensible regulation.

        Everyone already knows that hospitals are not the best place to give birth, which is why an increasing number of hospitals have birthing centers and the like. They don’t have enough because they are phenomenally expensive, unlike a homebirth which costs around half of an ordinary hospital birth.

        In general, there is an excessive focus on immediate death-rates in this debate vs. likelihood of post-natal depression and other long term factors that affect the mother and the baby. By way of analogy, most western countries still strongly discourage or outright forbid cosleeping, which is what everyone used to do and still do in most of the world. Once you take out mothers who do drugs or drink, it turns out mortality rates are almost identical to cot-sleepers, but, even if they weren’t, these statistics completely ignore things like how many parents get divorced after two years of chronic sleep deprivation, how many crash their cars, how many commit suicide etc. I had kids before most of my friends and one thing that came up frequently in conversation was how I ‘coped’ with being woken up five times every night for weeks on end. I had to tell them that I never had to cope with this and, if I had, I wouldn’t have been able to. There are all sorts of reasons why western fertility rates are low, but an important factor is that parenting has become a miserable, exhausting experience as a result of excessive focus on preventing even the smallest chance of infant mortality (something that we lived with for entire history and, indeed, evolutionary pre-history). Unsurprisingly, ]there’s a pretty solid body of data showing that parents are, albeit temporarily, unhappier and less healthy than childless couples. Once people have had one or two they just can’t face having any more.

        Yes, people can interact with each other and convince each other not to do dumb stuff. We do it all the time.

        What species are you part of? Dealing with crazy, irrational people is one of the hardest things there is, full stop. Often the only solution is just to cut them out of your life completely, but, in the case of a husband, he doesn’t even have this option because she can just take all his stuff and turn him into an incel alimony slave if he does.

        ‘Nature has given women so much power that the law has very wisely given them little.’ Samuel Johnson.

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  2. I couldn’t agree more with this . being a person of six decades I have seen much self delusion. it reminds me of the “get ready for your first child class” that my wife and I went to before our daughter was born . It was the light eighties , so it went through the importance of breast feeding , La maz classes to prepare for the the labor , and of course anesthesia options. they ran the gamut from “tu won’t remember much” too oral or IV pain meds. with epidural the preferred compromise. one o the “earthy ” expectant mothers asked the senior nurse giving the class ” They won’t make me take pain meds if I don’t want the ill they? I mena unless I specifically ask for them ” . With a wry smile the nurse said ” I have been doing labor and delivery for 24 years and never once had a patient not ask for pain medication” . My daughter was a ” Stargazer” . the cord got pinched . the alarms all went off. the doctor ordered me and a large anesthesiologist to hold my wide . She then used forceps to pull the baby out with her feet on the bed pulling with all her might. my wife was not fully dilatated. without the hospital and the quick thinking of the OB gyn , I would have lost my daughter , and maybe my wife too. big fan of modern medicine here.
    BTW , If my wife had suggested at home birth I would have absolutely vetoed it.

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  3. Q: Why do people believe wrong things?

    A: Because, among other things, they base their convictions on MSM propaganda (bit of a tautology there..).

    Case in point: the NBC article – an obvious hit piece – being used here ;)

    But well-intentioned joking aside, there’s a serious issue left unmentioned that “visit your hospital, or else..” piece of journalism, especially where infant mortality is concerned. Why is it so high in the US? That disturbing figure may warrant a follow up article in the wrong beliefs-series (hint: perinatal vaccination schedule in the US compared to other affluent nations).

    Kind regs from Amsterdam,
    Richard

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    • I think the high infant mortality rates in the US are due to poor/black people having bad access to medical care and being more likely to be using drugs.

      This woman isn’t in one of those groups, so their data isn’t relevant to her case.

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