In thinking Dr Alice Roberts is a bit thick?

[Shagmundfreud]

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.

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)

1. women who have been warned they will require intervention but refuse to attend hospital and go on to have an unassisted birth
2. 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!'

What books?

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.

Writehand

Are you Alice?

No. Who the fuck is Alice?

Er, Alice Roberts, the author of the article.