Responses to 'Home births or hospital? It's baby who knows best' by Karen Robinson, Sunday Times, 29 August 1999.
'Many doctors oppose home births. They have good reason.' says Karen Robinson. Apparently women who choose home births are selfish and irresponsible, and are risking baby's life for their own benefit, because of course hospital birth is the 'safest and best' option.
Baby does indeed know best in the debate over home versus hospital birth - and she does not share Karen Robinson's assumption that hospital birth is necessarily the 'best and safest option'(Home birth or hospital? Sunday Times, 29 August 1999).
Where a healthy mother has a normal pregnancy, the benefits of home birth for infant health have been shown empirically. Mortality rates for planned home birth in low-risk cases have been shown many times to be the same as, or better than, those for hospital birth. However, the condition of the baby at birth is also important. 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 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' - or does Karen Robinson know something that the BMJ doesn't?
The 'cold steel of medical science' shows that home birth has many benefits for both baby and mother. Your writer bludgeons us instead with the tepid blancmange of ill-informed prejudice.
(1) National Birthday Trust - Report of the Confidential Enquiry into Home Births
Chamberlain, G, Wraight, A & Crowley, P (eds).
Dear Ms Robinson,
I am writing in response to your article Home birth or hospital? Sunday Times, 29 August 1999.
Home birth is clearly something which you feel strongly about, and I understand that you argue for what you believe to be the best interests of babies. However, I have two general issues with your article.
It seems that you have assumed that hospital birth is the safest option for all babies, but you do not give any evidence to support this assumption. In fact, there is considerable peer-reviewed medical research showing that home birth is just as safe as hospital birth for low-risk mothers, and sometimes safer. These statistics are not 'loaded'; any study worth looking at on this subject compares women of the same risk levels, differentiated as far as we can tell only by whether they plan home or hospital births. I have summarised a number of such studies, with links to the original medical journals, on my website at http://www.horns.freeserve.co.uk/homebirth.htm . I would urge you to have a look; if you are worried that my summaries are biased, you have only to follow links to the British Medical Journal and others, to read the authors' abstracts.
My second concern is that the article was highly insulting to the 2% or so of UK mothers who choose home births. You imply that we are selfish, irresponsible, and worse. Like most mothers who plan home births, rather than being selfish and irresponsible, I wanted what was best for my baby, and for our new family. I put my PhD on hold to fully explore my childbirth options. I spent many hours in my pregnancy, reading through medical journals, finding out as much as I could about how to keep my baby safe and healthy, and what I could do to increase the chances of a good and safe birth. There are many variables in the home-hospital equation. Some emergency situations are best dealt with in hospital, but many of those situations do not occur in home births; fewer interventions are necessary, so the risk to the baby is reduced. Life-threatening infections are little risk to mothers and babies born at home, whereas I have among my friends two children who picked up near-fatal infections after hospital births. Incidentally, far from being selfish, many home-birthing mothers miss out on the ultimate pain relief - epidurals, which are not available at home - because they believe that home birth will be best for their baby.
I do not insult mothers who choose hospital births, nor do I seek to persuade all women to have home births. What I do hope for is that women are supported in making informed choices, and that GPs and other medical staff practise evidence-based medicine, and give advice which is based on evidence rather than assumption. I also hope that medical staff will stick to the spirit of the 'Changing childbirth' report, in making sure that women are aware of their options.
A copy of my letter to the Editor of the Sunday Times is enclosed. I hope you will forgive the choice of words and comments about the author's arguments, but reflect on how hurtful the words in your own article are, before you take offence.
"Home births or hospital? It's baby who knows best by Karen Robinson" made me wonder what the writer was trying to achieve? Did she wish to sow seeds of doubt in the minds of mothers considering homebirth? Or, maybe to belittle a section of your readership who have opted for and had successful homebirths?
Freedom to make decisions relating to personal circumstances is a fundamental human right, and to take away that right runs the risk of leading our society into a 'Big Brother' State mentality.
Instead, energies should be channelled into providing parents with enough balanced, researched and unbiased information, support and guidance to ensure the best outcome for mother and baby in all situations.
Mrs Shirley Parsley
Beverley Lawrence Beech is Hon. Chair of AIMS - the Association for Improvements in the Maternity Services. This letter is reprinted here with her permission.
Dear Ms Robinson
I read your article "Home births or hospital? It's baby who knows best" and I have the following comments:
You state that "home-birth champions, blazing with earth-mother bravado and an almost insulting dismissive attitude to the medical profession, seized the hour" and suggested that Sheila Kitzinger failed to point out that the comparison between home and hospital birth is loaded, given that women with a low risk of problems make up the vast majority of home birthers. I am sorry that you have such an ignorance of statistics or the evidence. Low risk women also make up the majority of women who birth in hospital. That, however, is beside the point the statistical analysis has shown, time and again, that home birth is a safe option for the majority of women. The British Medical Journal, last year, publised a series of five articles demonstrating the safety of home birth.
It appears that like Isabel Ryan you too have assumed, despite the evidence to the contrary, that a woman booking into a hospital for birth is "minimising the risk". She will only minimise her risk if she is a high-risk woman for whom a hospital birth is appropriate. If she is a low-risk woman she will increase the risks to her baby and herself.
A study by Mehl compared a group of 1046 women giving birth at home with 1046 women having hospital births and found:
As the levels of intervention are far higher now than when Mehl undertook his study it is safe to assume that the risks are even greater.
There are other studies highlighting the risks of hospital birth. Not least the well researched papers by Jacobsen and Nyberg which revealed that the use of barbiturates and narcotics in labour results in a 4.7 times increased risk of subsequent teenage drug addiction in the babies. Women birthing at home rarely need pharmacological pain relief.
The fact that a midwife took a woman to hospital because she had meconium stained liquor is no reason to suggest that it was inappropriate for the woman to book a home birth. The midwife found an unexpected complication (and I won't go into the issues surrounding over-reaction to meconium stained liquor) and appropriately moved the woman to hospital.
Many GPs constantly refer to emergencies and describe situations which result in "blood all over the place". Few GPs have any experience of home births and the emergencies they have seen often follow medical intervention in hospital, and a failure to recognise the signs of potential problems. A recent case reported to us involved a woman whose labour had been accelerated with a drip the warning signs of impending problems were ignored and a blood all over the place scenario occurred.
AIMS files bulge with reports from women of near disasters which occurred in hospital, to such an extent that we wrote last year to the Confidential Enquiries into Maternal Death suggesting that they introduce a system of "near miss" reporting.
GPs do not "bludgeon poor, vulnerable, pregnant women with the cold steel of medical science" what they do is bludgeon them with their hysteria, lies, ignorance or misinformation. I have yet to hear of a GP who is opposed to home birth giving women a rational, evidence based, argument for recommending birth in hospital for a low-risk woman. GPs do not keep up with their obstetrics, or the research evidence, and few have ever seen a normal birth.
Few midwives requiring obstetric assistance during a home birth would contact a GP because what they need is a well-qualified obstetrician and they would, therefore, take the woman to hospital. Those GPs who do support home birth have an understanding of the normality of childbirth, have read and understood the research, and recognise the skills of the midwives. Unfortunately, they are too few and far between.
You finish the article by stating that "when birth goes wrong it is more often the baby, not the mother, who dies". What you failed to mention is that the latest Confidential Enquiry into Stillbirths and Deaths in Infancy found that, of the preventable deaths, 47% had sub-optimal care from obstetricians 30% hospital midwives 6% community midwives and 5% GPs.Furthermore, the most recent falls in infant mortality rates have occurred because those babies with abnormalities were aborted, so they appear in the abortion statistics and not in the infant mortality statistics. This gives the impression that there has been an improvement.
There is no evidence that hospitalisation for birth for all women has improved outcomes or brought about the falls in infant mortality, one could just as easily argue that the improvements have a direct correlation with the spread of colour television sets!
Analysis of infant death statistics by Marjorie Tew revealed that had the hospitalisation of all women for childbirth not taken place our infant mortality rates would be four points lower than it is. That, if you care to work is out, suggests that 3,000 babies die every year as a direct result of their mothers giving birth in hospital. I suggest that you read Safer Childbirth - A Critical History of Maternity Care, published by Faber.
Research and our case files show that there is a pandemic of damage to both women and babies throughout the developed world as a direct result of bringing women into hospital for birth. I am dismayed that, as a journalist, your level of ignorance on this subject is so low, you could have done no research at all into the subject. I suggest you start informing yourself by reading Marsden Wagner's book Pursuing the Birth Machine, ACE Graphics. When you have done that, you might then be in a position to write an article about childbirth that has some accuracy to it.
Beverley A Lawrence Beech
Mehl L. Scientific research on childbirth alternatives: What it tells us about hospital practice, in Stewart and Stewart. Twenty first Century Obstetrics now, NAPSAC International, 1978, Vol 1, pp171-208.
Jacobson B et al. Opiate addiction in adult offspring through possible imprinting after obstetric treatment. British Medical Journal, (1990), Vol 301, p1067-1070.
Jacobson B, Nyberg K, Eklund G, Bygdeman M and Rydberg U. Obstetric pain medication and eventual adult amphetamine addiction in offspring. Acta Obstet Gynaecol. Scand. (1988), 67: p677-682.
Jacobson B et al. Perinatal origin of adult self-destructive behavior, Acta psychiatr. scand. 1987: 76, pp364-371
Nyberg K et al. Obstetric medication versus residential area as perinatal risk factors for subsequent adult drug addiction in offspring. Paediatric and Perinatal Epidemiology, (1993), 7, p23-32.
Nyberg K et al. Socio-economic versus obstetric risk factors for drug addiction in offspring. British Journal of Addiction, (1992), 87, p1669-1676.
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