In thinking Dr Alice Roberts is a bit thick?(73 Posts)
Big double page article by her in the Observer today complaining that mothers don't get unbiased information about birth choices. She talks primarily about the Place of Birth Study 2011 and the different ways its findings have been interpreted.
She says: 'Not surprisingly there were fewer interventions in the non-hospital settings. (this is something which is often put forward as a pro for homebirths, which I find odd, There are fewer forceps deliveries in home births because you can only do them in hospital. There are fewer - no - epidurals in home births, but that's to be expected, unless you happen to keep an anaesthetist in your cupboard for just such eventualities)'.
Now - surely, surely, she must have actually READ the study before writing a BIG article about it for a national newspaper?
But if she had read it she'd know that the intervention rates among the out of hospital mums in the study wasn't half that of similar mums giving birth in hospital because they can't do c-sections in birth centres or on the kitchen table at home. Surely she must know that women who opt for birth centres or homebirths whose labours become complicated GO TO HOSPITAL, and the interventions take place in these settings, but are included in the 'out of hospital' arm of the study?
I mean - that's a massive, fundamental misunderstanding to have made in the article isn't it? Why did nobody at the Observer spot it before it was printed?
It really worries me that so many people will take her opinion on this subject seriously because a) she's a doctor and b) she's being given a double page spread to talk about the issues in a national newspaper. And not realise how ill informed and biased she is.
Would add, she also has a little dig at the NCT here. She says that the way the NCT presents the birth place study 'prioritises the birth process over the risk to the baby'. An unfair accusation and an inaccurate one. The NCT clearly points out on its website that the Place of Birth study found that home birth is associated with an increase in the risk to the babies of first time mothers.
So in the process of complaining about mothers not having accurate information to make birth choices, Alice Roberts writes a poorly researched and inaccurate article, just to add to the confusion. It really is a shame.
She probably won't see your comments here.
Write to the paper.
Having not read the study either would the studies findings about interventions in home births not include births that started as home births and then transferred to hospital for required intervention?
Because otherwise the intervention rate would be zero as opposed to low?
Is this the female that is on Coast? She Professor of Public Engagement in Science - whatever that is!
Yes it is that "female" from Coast
I noticed a few glaring inaccuracies in her reporting too.
C&P your post to her Facebook/Twitter/website and see if you get a personal response from her.
Article here mobile version, sorry.
"Because otherwise the intervention rate would be zero as opposed to low?"
Really - it's such a poor article.
If you have a look on the NCT website and look at the page about the Place of Birth study the paragraph on homebirth says this:
"Women planning a home birth were more likely than women planning for
birth in other settings to have a normal birth: 88% of planned home births are
normal births compared to just under 60% of planned obstetric unit births.
For women having a second or subsequent baby, home births are safe for the
baby and offer benefits for the mother.
For women having a first baby, a planned home birth increases the risk for the
She has taken the fact that the NCT don't mention the higher rates of poorer outcomes for first time mums giving birth at home until the third sentence of this very short statement as evidence that they prioritise normality of birth over the safety of babies.
Apparently this makes the NCT's response to the Place of Birth Study 'spin'.
"No one should feel that having an epidural, a forceps delivery or a caesarean section is a failure"
Individual mothers shouldn't consider interventions a sign of personal failure, but if I was in charge of a labour ward, I'd be wondering why double the numbers of healthy mums giving birth under my supervision were needing them, in comparison to similar mothers giving birth in out of hospital settings. Particularly if the outcomes for the babies were no better.
Alice Roberts has also steadfastly ignored one of the most interesting findings of the POB studies which is that for ALL healthy mothers (including first time mums), giving birth in free standing birth centres where intervention requires transfer to hospital by ambulance, doesn't seem to make mothers any less likely to go home with a healthy baby.
The other factor that impacts the figures is that the planned home births will generally be v low risk. In a hospital setting it will include higher risk births and inductions which are more likely to require intervention than a low risk birth - or does the study exlcude these?
Out of interest do the studies identify the percentage of women who know in advance that they will have a complicated labour and therefore (presumably) chose a hospital setting? I am not sure of the exact examples that would lead to this decision but possibly the presentation of the baby (breach? transverse?), risk factors in the mum (high blood pressure or diabetes through-out the pregnancy?). Setting these women aside would make for a more fair comparison between hospital births and other setting births.
I've not read the study, but I would have thought you need to make a like-for-like comaprison.
Hospital births- take out all the inductions and high-risk births (VBACs, obese women, diabetic women etc).
I had elective CSs, but I'm assuming you're only advised to go ahead with a homebirth/midwife unit if you're low risk?
I agree that we don't get unbiased info regarding birth choices. I, and many others, had a midwife who glossed over the complications of a VB.
Isn't her PhD archaeological?
YANBU to disagree with her but YBU to say she is "a bit thick".
shagmund - ""Women planning a home birth were more likely than women planning for
birth in other settings to have a normal birth: 88% of planned home births are
normal births compared to just under 60% of planned obstetric unit births."
No shit, sherlock.The "planned homebirth" cohort will always be lower risk by default, as higher risk women will already have been excluded from planning a homebirth. That's not surprising, and doesn't indicate that homebirth is safer, just that you were less at risk to begin with.
This might not fit with your worldview, but Dr Roberts pointing this out, doesn't make her "thick". I'd agree though, that the article is a bit weirdly phrased, wonder how much that is down to Dr Roberts and how much the journo/sub-editor is to blame.
pigrabbit, no, she is a medical doctor
oops, sorry piprabbit....<gets glasses>
with a PhD in paleopathology on top
So what do you call yourself if you're a medical doctor and also have a PhD?
I always thought her Dr status referred to her PhD.
"No shit, sherlock.The "planned homebirth" cohort will always be lower risk by default, as higher risk women will already have been excluded from planning a homebirth. That's not surprising, and doesn't indicate that homebirth is safer, just that you were less at risk to begin with."
No - the Place of Birth study from 2011 that AR discusses in the article (like all decent research into place of birth done in the past 20 years) used only healthy, low risk mums IN ALL ARMS OF THE TRIAL.
That means that it compared the outcomes for healthy, low risk mums giving birth at home with healthy, low risk mums giving birth in obstetric settings. It made sure the groups were matched for risk factors at the start of labour.
"but Dr Roberts pointing this out, doesn't make her "thick".
Actually she doesn't point this out. She just points out that the c-section and epidural rates for home birth are going to be lower than for hospital because, guess what? You can't do c-sections and epidurals at home! To which the response is no of course you bloody can't, which is why the c-section and epidural rates in the homebirth arm of the POB study aren't '0%', but are a reflection of the number of women who transfer in from out of hospital settings for interventions in CLU's, and that it's these figures that make up the intervention rates for this group. Something of course she'd have worked out if she'd a) read the study b) had read any other studies on the subject of birth settings c) spent 5 minutes thinking about it and maybe discussing it with someone who knew something about obstetrics and midwifery.
'A bit thick' is unpleasant.
It's a bloody difficult subject to tease the truth out of, as any fule kno.
I take your point that if it's not right then it shouldn't be in the article.
At the end of the article you get the point that all women should be able to access unbiased data, the better to make their choices and to be able to demand the service they (really) have a right to.
We all know that the reasons the data are obfuscated - totally deliberately by all involved, in my view - are because the commitment to providing a gold standard service would cost a fortune and nobody has the cash or the will to provide it. Same true in private sector.
The NCT is a law unto itself and at this point in history - despite its achievements in the past - is largely irrelevant to the vast majority of women. Highly relevant to a select few, though, before I get slated for that comment.
"We all know that the reasons the data are obfuscated"
Are you suggesting that there's a deliberate conspiracy to muddy the waters?
Who's involved in this conspiracy then? The NCT? The Royal College of Midwives? The Royal College of Gynaecologists?
"The NCT is a law unto itself and at this point in history - despite its achievements in the past - is largely irrelevant to the vast majority of women"
If the NCT is campaigning to improve standards of maternity care (it is), increase access to one to one midwifery care (it is), and to flag up concerns about the rising tide of interventions in birth (against a background of a stillbirth rate that hasn't fallen for 10 years) then I would say it's relevant to all women.
The home birth mothers are a self selecting group that actively don't want to have an epidural. If you are a mother who thinks that they might want one you're much more likely to choose to give birth within screaming distance of an anaesthetist.
I don't think there is a conspiracy (at least not one which involves all those bodies ) but I think there is a passive resistance to carrying out the research which needs to be done, in order to provide the best data. As many have pointed out on this thread and the other one, the data are being obfuscated, badly collected, badly expressed, and then badly interpreted in articles such as these.
None of these people involved are particularly thick. There has to be a lack of will - political, personal, whatever - which prevents good data from being collected and well analysed, and then believed. Look what happened to Marjorie Tew. She barely rates discussion, it seems, despite having had a bloody good go at it.
I think the NCT has a major, major problem with its image, which renders it easy to discount. It does not present an honest appraisal of birth, feeding, home birth, post-natal period, birth education, hospital vs home birth: it is highly partisan and exceedingly FORCEFUL in a way that simply puts backs up. Good luck to them increasing their share of the say in the way things are run, with the current attitude the organisation displays.
Just to clarify, it would be fantastic if the NCT could be FORCEFUL and RIGHT but it often isn't, and therein lies the problem.
I agree with what was said upthread.
You absolutely need to take out all women with conditions that would stop a home birth being recommended and so birthed at hospital, high blood pressure, low placenta, being induced ect, and only look at those who would have been a good home birth prospect.
Then a proper comparison can be made.
"but I think there is a passive resistance to carrying out the research which needs to be done, in order to provide the best data. As many have pointed out on this thread and the other one, the data are being obfuscated, badly collected, badly expressed"
Actually I think the Place of Birth study is a pretty decent attempt to get to the bottom of what's going on.
The problem is that impact of place birth is a difficult subject to research because of the impossibility of doing RCT's, and because of huge cross-overs between the different arms of the trials.
"I think the NCT has a major, major problem with its image,"
Yes - partly because its views and attitudes are reported in such a biased and distorted way by the likes of Alice Roberts (whose comment in the article in question is unfair and not based on the evidence presented on the NCT website) and also on high profile whingers like Kirsty Allsop who has never attended an NCT course and who never refers to any of the actual information published by the organisation, only to her own interpretation (as a mother who's had 2 c-sections and who's never attended an NCT course or, clearly, read any published NCT information on c-section) of their stance.
" It does not present an honest appraisal of birth, feeding, home birth, post-natal period, birth education, hospital vs home birth"
I challenge you to find ANYTHING on the NCT website which backs up your view that the NCT is giving non-evidenced based information about pregnancy and birth.
"exceedingly FORCEFUL in a way that simply puts backs up"
Oh bollocks. It's a charity. It delivers antenatal education to a tiny minority of women, the vast majority of who are happy with their classes. It also campaigns for more midwives and higher quality maternity care. What's not to like? For goodness sake, from your description you'd think the organisation was out there chaining placentas to the railings of number 10 downing street. There may be a few nutty teachers, but the organisation as a whole is not saying anything that's not also being said by the Royal College of Midwives.
They perhaps would have been better getting an obstetric dr who understood it all a bit better to write the article.
"You absolutely need to take out all women with conditions that would stop a home birth being recommended and so birthed at hospital, high blood pressure, low placenta, being induced ect, and only look at those who would have been a good home birth prospect.
Then a proper comparison can be made"
This is EXACTLY what the Place of Birth Study 2011 does.
As actually did the National Birthday Trust study from 1994.
I doubt woman with her qualifications could be classed as 'thick'.
She maybe has an opinion that is contrary to your own.
With this topic EVERYONE has a bias one way or the other.
She points the finger at the RCOG as well for 'spinning' it in their favour.
She is also trying to condense the complex findings of a very large study into a small newspaper article.
Highlights some interesting point, give her a break!
They'd have been better getting someone who has the broadest possible perspective and experience of birth to write the article.
Which would have meant getting a midwife.
There aren't many obstetricians who've had a lot of involvement in normal birth in the UK, let alone out of hospital birth.
But they want a CELEB. A pregnant one. And this one is a scientist don'tcha know? Even if she's not read or understood the studies she's writing about.
Also agree NCT has an image problem.
I am a supporter in the main and believe they do good work BUT they do not present a full picture with regards to birth and feeding especially.
They definitely have their own agenda.
"I doubt woman with her qualifications could be classed as 'thick'.
She maybe has an opinion that is contrary to your own."
So why the astonishingly simple minded misunderstanding about how the figures on intervention in the Place of Birth study were arrived at?
A first year midwifery student would get marked down if she made this mistake in an academic essay.
"BUT they do not present a full picture with regards to birth and feeding especially."
Would you like to give some evidence from their website that they misrepresent birth and breastfeeding?
They produce a MASS of published information. It's all online.
If it's the truth that they are promoting an unrealistic and distorted view of birth and breastfeeding this would be reflected in their published information surely?
So - where is it?
Does anyone know what the different arms of the trials might be and how they deal with cross-over?
Purely speculating here but based on logic I can see the following alternatives:
For women who chose a home birth it's easier you presumably have three arms:
1 women who plan and go onto have an unassisted birth at home
2 women who plan an unassisted birth at home but require intervention of the type only available in hospital (the majority of which presumably get transferred to hospital but there is a possibility that for some reason some are not transferred and have a negative outcome because of this)
3 women who change their minds about home birth during labour and request transfer (a small number I assume but still worth differentiating)
4. women who have been warned they will require intervention but refuse to attend hospital and go on to have an unassisted birth
5. women who have been warned they will require intervention but refuse to attend hospital and go on to require intervention or have a negative outcome due to refusal of intervention
Presumably one wants to exclude no 3 and no 5 options and then compare the rates of (1 and 4) to 2 with:
Women who give birth to a hospital (now the possibilities are more complex):
1. women who plan and go on to have an unassisted birth in hospital
2. women who know in advance that they will require intervention and this turns out to be true
3. women who know in advance that they will require intervention but this turns out to be false and they have an unassisted birth
4. women who plan an unassisted birth but go on to require intervention
Presumably here one wants to exclude no 2 option and then compare the rates of (1 and 3) to 4.
...which should give you an indication on whether the setting affects intervention rates (still doesn't tell you much about birth outcomes which would presumably also interest people!).
Shagmund, when I say forceful, I do not mean just the handful of nutso teachers.
I've met the high-ups, they were terrifying
I've read books
I've been to talks
I've even read threads on here
Nothing I have read, seen or heard suggests a group of reasonable people who are taking clear evidence and presenting it clearly. The spin is incredible - and I say this as one who WANTS to believe it and has had two great births which would conform to their best case scenario.
The spin on the 'other side' is shitty as well. And shameful, sometimes.
I don't think the NCT as it presents itself right now is doing the job it could be doing.
However, we all know that any good findings will tell us that we need many more, far better facilities with many more, highly-trained well-paid motivated midwife staff - that's just not politically possible.
Actually I think the absolute, most telling thing about the NCT is how it deals with criticism. I have never, for example, once seen a representative of the NCT say 'I think we could do some things better' or 'we got that wrong.'
I have always seen a fevered, slightly sarcastic (sometimes) response, and that says a lot about the organisation as a whole, because it's not one person: it's endemic. You're either with us or against us. Any time an article like this comes up: which is actually saying 'Women deserve to be fully and well informed!'
The NCT website gives nothing but evidence based, balanced information.
I didn't attend NCT classes, but I'm heavily involved as a volunteer. I speak as someone who had a high risk pregnancy and who never had a completely normal birth - but I don't see what you see in the organisation.
The NCT is doing exactly what it should be doing: campaigning for one to one midwifery care, improvements in postnatal care, and a widening of choice for parents.
The current system is not financially sustainable either - babies and mothers are being damaged by the lack of simple, not very expensive midwifery care, and the NHS are making bigger and bigger pay outs to children who've had their lives ruined by injuries in childbirth caused by substandard care.
Midwifery care is CHEAP compared to having to provide more and more obstetric input for women whose labours are going shit-shaped from a lack of one to one care in labour.
Nothing is cheap when there's no money, that's the long and the short of it.
Agree with others re NCT,they definitely have an agenda and sorry describing Alice Roberts as thick is laughable.
Oh wow, I'm glad I haven't read this. One of the greatest strengths of the Birthplace study is that it compares like for like (low risk) and bases outcomes on PLANNED place of birth, not actual place of birth!
Someone should write to the Editor.
I logged into Mumsnet to discuss this article myself and was somewhat startled by ShagmundFreud's post. She asks if Alice Roberts is a bit thick, because "surely, surely, she must have actually READ the study before writing a BIG article about it for a national newspaper?"
Shagmund continues: "But if she had read it she'd know that the intervention rates among the out of hospital mums in the study wasn't half that of similar mums giving birth in hospital because they can't do c-sections in birth centres or on the kitchen table at home. Surely she must know that women who opt for birth centres or homebirths whose labours become complicated GO TO HOSPITAL, and the interventions take place in these settings, but are included in the 'out of hospital' arm of the study?"
"I mean - that's a massive, fundamental misunderstanding to have made in the article isn't it? Why did nobody at the Observer spot it before it was printed?"
I was so surprised by this that I carefully re-read the piece. No nice way of putting it, Shagmund. You've misread the article. The people at the Observer didn't spot it because there is no fundamental misunderstanding. And none of the subsequent posters appear to have gone back and double-checked. What Dr Roberts' article says is:
Not at all surprisingly, there were fewer interventions (like forceps deliveries and caesarean sections) in the non-hospital settings. (This is something which is often put forward as a pro for home births, which I find odd. There are fewer forceps deliveries in home births because you can only do them in hospital. There are fewer no epidurals in home births, but that's to be expected, unless you happen to keep an anaesthetist in a cupboard at home for just such eventualities.) The study found that about four in 10 first-time mums who planned a home birth or birth in a midwife-led unit had to be transferred to hospital during labour, whereas about one in 10 women having second or subsequent births were transferred.
The author is saying (though, I agree, not very clearly) that although these births started or were planned to take place at home or in a birth centre but they ended up in hospital because intervention was needed. They are counted statistically as home births to compare them with births which take place in hospital where there was never an intention of home delivery. If they didn't classify them like that you'd end up with totally pointless statistics. You could claim that home births never need C-sections because if one is needed then, by definition, it's not a home birth.
I think the OP may have been confused by Dr Roberts misguidedly trying to be amusing with her reference to anaesthetists in cupboards. But Dr Roberts hasn't made a mistake, and I suggest that anyone who thinks she has do as I did, and re-read the article. Carefully.
I also think the difference in risk between 1st time and other mums having home births is pretty significant. Personally, I would consider a chance of 2 in 5 of ending up having to be whipped into hospital in the midst of labour as significantly worse odds than 1 in 10. And I also agree with Dr Roberts that the NCT's site plays this down big time.
For anyone interested in the original report, the "home" of the Birthplace study is at https://www.npeu.ox.ac.uk/birthplace/results. The round-up of the report's main findings includes the following:
For women having a first baby, a planned home birth increases the risk for the baby
For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth
Compare this to the section reporting Birthplace's findings on home births and first babies on Home Birth the NCT's site. In my view it misrepresents the findings to the extent that I would consider improper, if not unethical. I'd go along with Dr Roberts' comment that the NCT's spin "prioritises the birth process over the risk to the baby." I'm not a fan of the NCT, and this is one of the reasons.
Instead of tearing at each others throats on this time and again, why isn't the following question being asked: what can we do to provide the postives of a home birth in a hopsital setting where medical intervention is immediately available when needed?
For what its worth I think there are a lot of myths peddled about home birth vs hospital. I was even told by a midwife that if I went to hospital then, because I was low risk I would 'just be ignored". Far from it in reality, I was wonderfully well supported to labour actively by lovely midwives and my memories are all positve.
My friend on the other hand was so persuaded by the myth that homebirth is the holy grail that she fought against obsetricians advice and things went horribly horribly wrong
I would just like to see a sensible, constructive debate which finds ways to bring the benefits of homebirth into the hospital and finds ways to improve what happens if things start going wrong at home. That would be far more helpful to women than all this partisan hysteria
Just to clarify, I am upset with the 'myth' about homebirth being pushed so strongly by some quarters, not with my lovely friend who only wanted to do the right thing but was forcefully persuaded by certain groups and individuals to ignore the obstetrician
I'm not tearing at anyone's throat over home births, StillStuck. I'm just annoyed that the OP started a thread inaccurately criticising Dr Alice Roberts for a non-existent mistake in her Observer article, and that none of the other posters seem to have bothered to read the original article to check whether the criticism was justified. She didn't make a mistake. It was quite a good article, too, and it addresses in part those issues you raise.
The NCT's summary of the Birthplaces research as it relates to first time mothers is not an accurate or realistic portrayal of the research findings. It's skewed.
This is something I know about, having produced summaries of medical research findings for various different reader groups over many years. But I think anyone who compares the paper's own summary (link) to the NCT's version will see the blatant bias.
Sorry, should have read "The NCT's summary of the Birthplaces research as it relates to home births for first time mothers is not an accurate or realistic portrayal of the research findings. It's skewed.
Er, Alice Roberts, the author of the article.
For 24 years I've been living next door to Alice. Alice, who the fuck is Alice? .
Writehand, I wasn't meaning your post.
I just find it depressing how much time and energy people devote to sticking up for one 'side' or the other rather than trying learn lessons to improve both options. And the myths and propaganda that various groups (and people trying to justify decisions they made and risks they took) spew out really doesn't help.
When the NCT stops selling homeopathy I will take seriously their commitment to evidence-based information.
When the NCT stops selling homeopathy I will take seriously their commitment to evidence-based information.
Splutter. Coffee down front. They don't, do they?
No, I'm not Alice Roberts. I'm another medical writer. There are several dozen of us now.
writehand, I read this thread earlier, but didn't have time to respond. Agree with you entirely.
"When the NCT stops selling homeopathy I will take seriously their commitment to evidence-based information."
They hire TENS machines out, despite the lack of good quality evidence that they are effective.
I think you'll also find that a good number of midwives use and recommend homeopathy for labour, despite being aware of the lack of any evidence that it works. The NCT website notes that there is no evidence that homeopathy is effective for inducing labour.
"I'm just annoyed that the OP started a thread inaccurately criticising Dr Alice Roberts for a non-existent mistake in her Observer article"
So it wasn't a mistake to say that the figures showing low rate of interventions in home births in the POB study is a reflection of the fact that most interventions (like forceps births ) can't be done at home? Thereby ridiculing and diminishing the strongest argument for the provision of a home birth service for low risk women, which is that these women have very high rates of normal birth compared to similar women who book hospital births, even when we take into account those women who transfer from home to hospital during or after labour?
"Not at all surprisingly, there were fewer interventions (like forceps deliveries and caesarean sections) in the non-hospital settings. (This is something which is often put forward as a pro for home births, which I find odd. There are fewer forceps deliveries in home births because you can only do them in hospital."
It is a foolish mistake. An embarrassing one.
And I'd also add - the NCT website information on Place of Birth clearly, repeatedly acknowledges that there are a range of opinions about the safety of home birth.
It provides links within the body of the summary of the Place of Birth study to the published study in the BMJ, links to a summary of the study produced by the BirthPlace in England research programme, and to a presentation by a doctor on perinatal outcomes for babies born to mothers who've transferred in labour. All of this in the first paragraph of the NCT summary of the Place of Birth study.
And yet you're still accusing the NCT of distorting and withholding information?
And those of you who still want to bash the NCT's 'spin' on this - please have a look at the actual webpage first. here
Here is the NCT response to the question: "Are there risks associated with home birth compared with planning for a hospital birth?"
^Risks for these low risk women were low in all settings, with over
990 babies in every 1000 born healthy and well. For low risk women
who have previously had a baby, there was no difference in the risk of
an adverse outcome for the baby (a serious or potentially serious
complication, including a small number of deaths), between those
planning to have their baby in a hospital obstetric unit and those
planning a home birth.
For low-risk first-time mothers there was a difference for those
planning to have their baby in hospital and those planning a home
birth. In round numbers, the risk of an adverse outcome for the
baby was greater for those planning a home birth:
1 in 190 - for women planning to have their baby in hospital
1 in 110 - for women planning a home birth.
So, while overall, the chance of an adverse outcome was small
in these low risk mothers wherever the birth was planned.
However, the chance of an adverse outcome was about 1.75
times greater for first-time mothers who were planning for a
home birth at the start of their care in labour. (Actual numbers
(to nearest whole number): planned OU births 1 in 189 vs. planned
home births 1 in 108.) This can also be expressed another way.^
In what way is this 'spin' or 'distortion'?
The point about selling homoeopathy is a brilliant one, and actually cuts through any other debate by establishing an inherent lack of credibility.
Of course they will not pay the slightest bit of attention to feedback on their image so our words fall on deaf ears.
Anyway this isn't about the NCT really (sorry for going on, I just find their propaganda loathsome, and I am on their side, or should be) so thank goodness for WriteHand's post.
Selective quoting, Shagmund. That's cheating!
You pasted this quote: "Not at all surprisingly, there were fewer interventions (like forceps deliveries and caesarean sections) in the non-hospital settings. (This is something which is often put forward as a pro for home births, which I find odd. There are fewer forceps deliveries in home births because you can only do them in hospital."
But you left off the final sentence of that paragraph:
"The study found that about four in 10 first-time mums who planned a home birth or birth in a midwife-led unit had to be transferred to hospital during labour, whereas about one in 10 women having second or subsequent births were transferred."
Dr Cooper is trying to be amusing in her pretend surprise that people don't keep anaesthetists in the cupboard, and she's getting in a side swipe against those who promote home births with claims that women delivering at home don't have c-sections (!), but I find it difficult to understand why you can't see that (though she expresses it badly) she is saying that to understand the statistics you have to realise that if major intervention is needed during a planned home birth then you're likely to have whatever it is done after you've been transferred to hospital. Which is what the report said.
Writehand - yes, but both you AND she are deliberately avoiding acknowledging that the over all normal birth rate is still massively higher for women who opt for a home birth EVEN WHEN YOU INCLUDE ALL THOSE WOMEN WHO TRANSFER IN LABOUR!
"she's getting in a side swipe against those who promote home births with claims that women delivering at home don't have c-sections"
Oh that's utter twaddle, as NOBODY who promotes home birth has ever said that you won't/can't have a c-section if you opt for one. All advocates of home birth argue is that opting to have your baby at home is associated with a significantly lower rate of intervention (including c-section) in birth. And it is!
"she is saying that to understand the statistics you have to realise that if major intervention is needed during a planned home birth then you're likely to have whatever it is done after you've been transferred to hospital. Which is what the report said."
Oh for goodness sake - do you think people who would go to the trouble of searching out and reading the statistics from the Place of Birth study are too stupid to realise that women who opt for a home birth who need medical input don't go to hospital for it? I mean - really, this is the most blindingly stupid comment.
"the Place of Birth study are too stupid to realise that women who opt for a home birth who need medical input have to go to hospital for it? I mean - really, this is the most blindingly stupid comment.
I don't honestly think she knows what she's saying in that article. I think she wrote it when she was half asleep. It's bollocks.
Shag as ever you are correct in what you have said and the so called medical writers on this thread are showing exactly why there is no point having science reporting in newspapers.
<holds head and weeps>
Shagmund, if you'll permit me an observation, your aggression is rather unsettling and contributes nothing to your argument.
"yes, but both you AND she are deliberately avoiding acknowledging that the over all normal birth rate is still massively higher for women who opt for a home birth EVEN WHEN YOU INCLUDE ALL THOSE WOMEN WHO TRANSFER IN LABOUR!"
This seems a starling claim. Can you link to the data indicating a "massively higher" normal birth rate for home births, compared to low-risk hospital deliveries?
Shagmund, you ask In what way is this 'spin' or 'distortion'?
I'll try to answer this. This is the NCT's commentary on the report's findings on home births for first time mothers:
For women having a first baby, a planned home birth increases the risk for the baby somewhat. In all groups of women there were at least 990/1000 births without adverse outcomes. There were 9.3 adverse outcomes for babies per 1000 planned home births compared with 5.3 per 1000 for births planned in obstetric units, and this finding was statistically significant. So there may be around 4 extra adverse outcomes in every 1000 planned home births compared with births planned in obstetric units.
Increased the risk "somewhat", eh? That's a very scientific term. But 9.3 is getting on for twice 5.3. It is, as the NCT admits, statistically significant. The risk of serious damage or death to the baby due to home births of first time mums is nearly double the risk of having the baby in an obstetric unit.
I am interested in their use of language. They use the term "adverse outcomes" and I wonder what the average reader understands by the phrase. An adverse outcome doesn't sound very worrying. But it is. Here's the definition from the research:
Adverse perinatal outcome: a composite of perinatal mortality and specified neonatal morbidities: stillbirth after the start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle.
To be fair, the NCT site has a section defining adverse outcomes -- if you look for it -- but, as a writer, I'd say they're glossing over that adverse outcome is medic speak for a dead or badly damaged baby and that your risk of that is nearly doubled if you insist on a home birth with your first baby. The NCT commentary doesn't make this clear at all. It minimises the risk.
On transfers to hospital from planned home births and midwifery units the NCT site says that they "are relatively frequent, particularly among first-time mothers. Transfers are one of the reasons why planned home and midwifery unit births are as safe as they are, enabling additional care to be provided when it is needed.
Compare this to what the research paper itself says:
For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth. For nulliparous women, the peri-partum transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births.
Relatively frequent? How about nearly half of them? 45% is a lot. Again, the NCT site is minimising to suit its passionate home birth agenda.
There are no lies on the NCT site, but they are definitely biased. Compare their commentary to the blunt speaking of the research itself (I've now read quite a lot of the paper ) and it's obvious that they're playing down the risks. I'd call that "spin".
writehand all very interesting I'm sure. However your original contention was that the Alice Roberts of the thread title had not made a mistake by making reference to the idea that home births have lower intervention rates was unsurprising because no-one can have a C-section or epidural at home.
This is clearly a stupid thing to either say or defend as the study included numerous such interventions for 'home- births'.
Feel free to admit this any time you like......then maybe we can dissect the NCT's handling of the issue which, while it may be a little biased certainly isn't as blatantly bullshit as the aforementioned Alice Roberts comments.
Lets right the bigger wrongs first eh?
"Can you link to the data indicating a "massively higher" normal birth rate for home births, compared to low-risk hospital deliveries?"
From the Place of Birth study: For first time, low risk, healthy mums giving birth at home the rate of normal birth was 69.3%. For similar women giving birth in an obstetric led unit the rate was 46.4%. For first time mums giving birth at home the neonatal outcomes were worse. However, for first time mums giving birth in free standing midwife led units - where any medical input will require transfer by ambulance to a hospital, the neonatal outcomes were not worse, and the normal birth rate was even higher at 71%. To me this suggests that it's not opting for an out of hospital birth setting that it responsible for poor outcomes, it's something to do with the training and practices of midwives working at home with first time mums.
Writehand - the NCT give the figures. They give them in the first paragraph. They provide a link to the BMJ and all the responses there. What do you want them to do? Say categorically that 'Birth at home is unsafe for first time mothers and their babies'? I think you will carry on with your accusations of spin and distortion unless they do say this, but they're not going to, because like the authors of the study itself, they acknowledge that poor outcomes are still very rare and that it's reasonable on the basis of this to say that homebirth for first time mums is a safe and reasonable option. Obviously you and anyone else are entitled to disagree with that opinion - but they're not hiding the figures or the research from anyone.
"The NCT commentary doesn't make this clear at all. It minimises the risk"
I just don't agree. They can't be minimising the risk if they are a) giving the figures and b) provide the opportunity for people to know in detail what 'adverse outcomes' means.
"adverse outcome is medic speak for a dead or badly damaged baby"
Which is explained clearly in the page 'What is meant by an adverse outcome?'
Would point out - it doesn't actually mean that all the babies who had an 'adverse outcome' were 'dead or badly damaged'. You have clearly not read the definition. 13% of the 'adverse outcomes' were deaths, neonatal encephalopathy for 46%, meconium aspiration syndrome 30%, 12% brachial plexus or fractured collar bone/arm. The study doesn't give information on the severity of the injuries, but given what I know about the incidence of these things in the population, some of these babies with birth injuries would be expected to make a full recovery.
Luckily, for those who are interested in knowing more, this information is all accessible on the NCT website. But you do have to read it you know!
ICBOMEG, I don't think there's any point in me going over what Dr Cooper wrote, pasting quotes, etc. I've done all that. My reading of it, which I've already explained in detail, is that she didn't make a mistake. However she did try to make a joke and have a dig in that key paragraph, and this seems to have confused many readers.
She's made the mistake many academics do of assuming that her readers all share her level of familiarity with the research and it seems from this thread that she didn't communicate as clearly as one might hope. The meat of that paragraph is in the last sentence. The rest of it is misguided humour.
"transfers are relatively frequent, particularly among first-time mothers"
How is this minimising the likelihood of transfer?
It says they are relatively frequent. Which they are!
OK - I get it, you want the NCT to flag up the risks of home birth.
You want them to do the 'glass half empty' rather than the 'glass half full'.
You want them to not just give the figures and the facts (which they do), you want them to emphasise the drawbacks of home birth.
Wow reading isn't your strong point is it?
"There are fewer forceps deliveries in home births because you can only do them in hospital."
This is factual incorrect from the point of view of the study she is referring to in the article. Many of the planned home births in the study ended in forceps deliveries.
It IS surprising that even when you include all those transferred to hospital the rate of interventions is still lower for home births. It is important.
"My reading of it, which I've already explained in detail, is that she didn't make a mistake"
There's none so blind as them that will not see.
She did make a mistake.
It's there for everyone to see.
As for the author having a clever little 'dig' - there are NO advocates of homebirth who have made a case that one of the benefits of it is that you can't have a c-section at home. No one has said or implied this. EVER. It's a stupid comment.
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