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Home births: midwives versus doctors?

6 September, 2010

Home births: midwives versus doctors?

‘Home birth is being unfairly pilloried’ is the stance taken by RCM general secretary Cathy Warwick. Journalist Julie Griffiths finds out why. Midwives magazine: September 2010

‘Home birth is being unfairly pilloried’ is the stance taken by RCM general secretary Cathy Warwick. Journalist Julie Griffiths finds out why.

The debate about home birth has raged for some time now after being re-ignited by RCM general secretary Cathy Warwick’s comments in The Guardian recently. 

There are, says Cathy, some doctors who are guilty of ‘sweeping and misogynistic’ hype of the dangers associated with having a baby at home. 
 
Her outrage had been sparked by an editorial in The Lancet (2010) citing US research, which linked home birth and high perinatal mortality rates. Wax and colleagues (2010) concluded that neonatal death risk among babies with no congenital anomalies is three times greater when birthed at home.

Cathy says the research has ‘flaws’ and the publication of such evidence is being used ‘to deter women from choosing midwifery-led options, and to pathologise and demonise normal childbirth’.

So how had she come to such conclusions? And is she right?

Undoubtedly, says the National Childbirth Trust (NCT) (2010), at least when it comes to the flawed evidence. Its critique of Wax’s meta-analysis finds ‘serious methodological limitations’. These include a number of the non-randomised studies not being matched for confounding risk factors, and a lack of clarity about whether stillbirth data were included. 

RCM practice and standards development advisor Mervi Jokinen says that the validity of any meta-analysis is dependent upon the careful selection of studies that are capable of answering the research question. Wax et al includes data in the analysis that was collected as far back as 1976 even though home and hospital birth has significantly changed over the last 35 years. 

‘Midwives and service providers cannot ignore the fact that the authors selected to include data that was over three decades old as part of their argument that home birth is unsafe,’ says Mervi.

The authors also omitted studies, such as Johnson and Daviss (2009), that found that planned home birth was as safe for low-risk women as hospital birth when women were cared for by a registered midwife, she says.

The NCT concludes that, based on the quality of the data, the authors should not have reached the conclusion that planned home birth is associated with a tripling of the neonatal mortality rate. 

It is not hard to see why Cathy has concluded that some doctors have an ulterior motive.

Mervi says it is important to remember that other factors are at play here. ‘In the US, obstetricians deliver babies so there’s a rivalry in who’s getting the money.  It’s business,’ she says.

In the UK, NHS care is free, so there is more emphasis on women’s choice. But doctors may feel uncomfortable about home births, prompting them to influence this choice by misrepresenting risk.

‘Obstetricians don’t do home births so it’s unknown to them,’ she says.

There is a need for informed debate. Recently, the Mail Online ran a poll next to an article Planning a home birth? Sorry, but you’re just selfish and reckless (Fraser, 2010). The poll asked readers if home births were safe. The results were split with 54% saying ‘no’ and 46% ‘yes’.

Mervi says healthy debate is crucial. ‘But when it’s all negative, then it unduly worries women and maybe also midwives.’ 


References


Editorial. (2010) Home birth – proceed with caution. The Lancet 376(9738): 303.

Fraser L. (2010) Planning a home birth? Sorry, but you’re just selfish and reckless. Mail Online See: http://tinyurl.com/3a8lnod (accessed 20 August 2010).

Johnson KC, Daviss BA. (2009) Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 338: b2060.

NCT. (2010) Choice of place of birth. See: www.nctpregnancyandbabycare.com/about-us/what-we-do/policy/choiceofplaceofbirth (accessed 20 August 2010).

Wax JR, et al. (2010) Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis. AJOG See: www.ajog.org/article/S0002-9378%2810%2900671-X/abstract (accessed 20 August 2010).

 
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