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!
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.
"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.
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.
"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.
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