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.

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?

Unfair!

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.

aaargh!

"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.

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?'

here

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.