I am writing to comment on the following article, published in The
Independent, 26 August 1999:
Give Me Hospital Birth Any Day, By Yasmin Alibhai-Brown
I understand that it is probably too late to send a letter for publication, but wanted instead to give you some feedback. The article in question did not meet the standards that I normally expect from the Independent - it was not clearly thought out, nor was it well researched. It was, however, negative in tone, and insulting to many women.
I would be grateful if you could pass the following comments to the author of the article.
Ms Alibhai-Brown starts by noting that 1,600 women die in pregnancy and childbirth daily worldwide (WHO stats), whereas in the UK the childbirth-related maternal death rate is 1 in 5,300. These figures do not actually allow us to compare maternal mortality in the UK with that worldwide - for that, we would have needed the maternity-related death rate worldwide, as a proportion of women giving birth. However, most readers will nonetheless be aware that the death rate for mothers here is mercifully low.
Few people would disagree with the author's assertion that one reason for such a low maternal death rate in the UK is medical intervention in childbirth, but the article implies that this is the only reason for such a disparity in death rates, and that, more ominously, medical intervention in childbirth is therefore always a good thing.
Ms Alibhai-Brown accuses the National Childbirth Trust (NCT) of 'wittering' about natural childbirth - apparently 'wittering' is another term for expressing a concern that the author deems irrelevant. This charitable organisation aims to support new parents, and what many parents want is informed choice in childbirth. I wish them the greatest success in their 'wittering'.
'Without doctors, surgeons and nurses to provide essential care when crises arise - ..what we call natural childbirth would be unsustainable.'
Few individuals or organisations would dispute the value of medical intervention in emergencies, yet the fact that intervention can sometimes be life-saving does not logically imply that all intervention is life-saving, or that all births need intervention to avoid deaths. Yes, emergency care is sometimes needed; does that render natural childbirth, or the desire for it, somehow pointless? Worthless? Unfortunately the author does not elaborate, so we cannot tell quite where this argument was leading.
Apparently natural childbirth is something that only white, middle-class women value:
'Third World people like me, remain enormously grateful to the British medical professionals for the way they have succeeded in making childbirth almost a risk-free activity. I have had two children... Both were complicated deliveries and in both cases I chose - like many other black and Asian women - so suffer as little pain and complication as possible. Perhaps this is why NCT remains white and middle class... for many of us, childbirth is a difficult and dangerous process and we need all the help we can get.'
I wonder how many black and Asian women would be happy with the idea that, by virtue of their cultural heritage, they 'need all the help (they) can get'? Or that they, apparently, are not interested in finding out what their bodies can achieve unaided; they are instead simply grateful that doctors can make these decisions for them. The notion of childbirth as a highly individual experience, where a woman tries to do what is right for her baby and her body, seems not to have occurred to the author. Who needs to treat people as individuals when you can just lump them together by race?
An NCT spokesman told Ms Alibhai-Brown that, for normal deliveries, home births can be safer than hospital births.
'Well, what is normal? And who does not know a story where a normal pregnancy turned very rapidly and frighteningly to abnormal?'
A little more background research would have helped your author find out what is meant by 'normal' childbirth. 'Normal' means healthy women with no complications in their pregnancies. From the article I wonder if she was thinking of the defninition of a 'normal' labour, which is given only when labour is finished. When healthy women with normal pregnancies planning a home birth are compared to those planning a hospital birth, the outcomes consistently show that home birth is just as safe as hospital birth, and sometimes safer. The home birth figures in the studies worthy of attention include women who transferred to hospital from home because of unforseen complications in labour, so it is not the case that the hospital groups include the higher-risk women who wanted to give birth at home, but did not manage it. For more information, look at the summaries of research on home birth on my website at http://www.horns.freeserve.co.uk/homebirth.htm . Is it fair - or even good journalism - to dismiss the NCT comments without even considering the research which supports them?
It is true that some low-risk women end up having difficult and dangrous labours, but this does not change the empirically proven fact that home birth is statistically a safe option for low-risk women. Nor does it change the fact that planning a home birth is one of the best ways to give your baby a healthy start in life. The National Birthday Trust 1994 report on home births was one of the most comprehensive studies in this country, and its results echoed those of many others. Comparing low-risk women planning home births with low-risk women planning hospital births, the home birth group had half as many caesareans and forceps or ventouse deliveries (and this includes those transferred to hospital because of complications). Babies planned for home birth were less likely to be in poor condition at birth (5.2% APGAR score below 7, compared to 9.3% in the matched hospital group). Compared to babies whose births were planned in hospital, planned home birth babies were approximately half as likely to have resuscitation at birth, and less than half as likely to suffer from bruising during the birth. The mothers of the extra 4.1% of hospital babies who needed resuscitation probably wish the NCT had 'wittered' louder.
The fact is that, when a woman chooses to give birth at home, her labour is likely to proceed more smoothly and efficiently than it would in hospital. She is less likely to need intervention, and is minimising the chances of complications occurring. This makes birth safer for the baby, and for the mother. If complications do occur, despite her best efforts, she can always transfer to hospital. The British Medical Journal has stated in its editorial (26 November 1996) that home birth is 'safe for normal, low-risk women, with adequate infrastructure and support' ; Ms Alibhai-Brown might find it helpful to read some of the literature concerning evidence-based practise in childbirth, before commenting on it again.
Concluding her article, Ms Alibhai-Brown accuses the NCT and the natural childbirth movement of making thousands of women feel like 'failures' and 'imperfect mothers' because they had intervention in childbirth. Her contention appears to be that natural childbirth is not something worth aiming for, and that all medical intervention should be gratefully accepted without question.
I would imagine that nearly every 'natural childbirth activist' is indeed truly grateful for medical intervention in cases where the intervention is genuinely needed, and where it works. However, Ms Alibhai-Brown does not offer any evidence that all, or even most, intervention in childbirth in the UK is necessary, or is even beneficial to mother or baby.
Medical intervention in childbirth comes at a price. An increase in the risk of fetal distress, and pain or injury to the mother, may be the price of a quicker labour. Further risks are tendered in exchange for pain relief drugs. The benefits for each mother and baby need to be weighed against those risks. When interventions are applied without genuine need, women and babies pay the price, in pain, in fear, in bruises, cuts, infections, psychological and physical trauma.
(1) National Birthday Trust - Report of the Confidential Enquiry into Home Births
Chamberlain, G, Wraight, A & Crowley, P (eds).
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