Alice Roberts' article today on evidence based childbirth (HB/MLU/hospital)

[VinegarDrinker]

Not sure if this has been discussed elsewhere?

m.guardian.co.uk/lifeandstyle/2013/mar/10/alice-roberts-on-science-childbirth-risks

Seems a fairly balanced article to me, but I am an evil patriarchal obstetrician.

[jchocchip]

Hang about I don't object to your ideas. Just the putting down of other people's.

[jchocchip]

Its what you said about posts of total fail that I thought was mean. I thought mumsnet was a supportive place where people encouraged each other. Not belittling what others have to say if their opinions are not exactly what you sanction.

[Shagmundfreud]

Chunderella - a woman at home will probably spend fewer hours labouring without a health professional present than the equivalent mother in hospital.

If DV is an issue to the point where the mother is not safe to labour in the presence of the partner then I'd say that birth setting is probably the least important issue.

[Shagmundfreud]

Chunderella doesn't bother me - she's on a hiding to make a massive beef out of fuck all.

Every proposed h/b for a low risk mum needs to be assessed in light of her specific circumstance, which will include whether she is subject to dV.

What more needs to be said?

[jchocchip]

Please can you stop being so mean Chunderella? Just because someone disagrees with you doesn't mean they are wrong.

[LaVolcan]

'In terms of the study' is a key phrase here. It doesn't mean it wasn't important in itself, just that they have to draw a line somewhere, otherwise they would still probably be collecting and analysing data now.

[Shagmundfreud]

MedicalEd - have you watched the film I linked Cardamom to?

[MedicalEd]

It's not only longer term problems for the mum that were not included but also the baby.
I asked the authors at the press conference presenting the findings about milder cases of cerebral palsy caused by birth trauma which quite feasibly might not be diagnosed until after six months of age. Was told those would be mild and so were dismissed as not mattering, in terms of the study.
There were also a collection of other infant morbidities which were not included in the aggregate infant outcome measure but I forget what those are now.

[LaVolcan]

Good questions cardamom.

If later outcomes could be related back to the birth, we might hear a bit less of this 'the only thing which matters is a healthy baby', (with its implication 'what are you making a fuss about?'), and have equal attention paid to the mother's health.

[cardamomginger]

Thanks shagmund.
I guess my point is a general point concerning outcomes, as well as a question about this particular bit of research. Will have a look at the link.

[Shagmundfreud]

Cardomomginger - details of what the study was looking at here:
You'll have to watch the whole film to understand it.

The study talked about in the OP only looked at these aspects of maternal morbidity: unplanned c/s, forceps, third degree tears, and admission to HDU.

"my birth which was a catastrophe for me, I assume, is categorised as having a pretty good outcome."

The study doesn't refer to 'good outcomes' in relation to maternal outcomes - only to rates of intervention.

[cardamomginger]

I've read some, but not all of this thread (dealing with an ill DD), so apologies if this has been mentioned elsewhere.

I'm interested to know which outcomes are measured in these type of studies and how they are measured. Clearly it's not just about mortality, it's also about morbidity. But what is measured, how is it measured, and when is it measured? A data collection point 1, 3, even 6 months after giving birth may not be long enough to capture the true picture of what is going on for that individual.

In my case (1st timer, MLU transferring to CLU, epidural, medium bleed, 2nd degree tear), the full extent of the damage (cystocele, rectocele, enterocele, uterine prolapse, displaced coccyx, severe trauma to pelvic bones, detached puborecalis) and the toll on my health (PTSD, double incontinence, pain, infection, mobility problems) has only become apparent as the months, and indeed years, have gone by. The labour unit where I gave birth is, as far as I can deduce, not aware of any of this, as nothing has yet to come to light when I was discharged from the CM service. None of this will show up in their data, internal audits, whatever, and my birth which was a catastrophe for me, I assume, is categorised as having a pretty good outcome.

I can't imagine that this just applies to me - birth injuries often take some time to reveal themselves.

[RedToothBrush]

LaVolcan, I've had very bad treatment by a GP before. I don't/didn't accept it.

I appreciate questions being raised; but my experience was far from that.

Discussion of certain things, has to come from the patient, on their own terms and in their own time. A doctor can mention it, but can not push it beyond a certain point.

It might not be what the doctor wants, nor may it even be in the patients 'best interests' at times - but having a good relationship between the patient and doctor trumps that - doors need to be always left open rather than slammed shut by the doctors actions.

It comes down to free consent rather than coercion and bullying ultimately. I don't think all medics know where the boundary lies.

Beyond that I don't think I can really comment as I don't feel my personal experience in this really helps this debate much beyond that.

[LeBFG]

RedTooth: there are fears and phobias - these are two very different things. I have very much talked about fears surrounding cb rather than tokophobia for example. I think the fears come from a cultural idea of cb - one that involves pain relief and hospitals. It's so prevalent that the majority of UK births follow this model.

As in any righting of a societal norm, the side proprosing change may go too far in their evanglising, or perhaps be seen to be undermining the other side. Following the bf analogy: I live in France where ff is the norm. I've never seen promotion of bf like in the UK - my MW said this was so ff mothers wouldn't feel guilty. Whether true or not, the point is, it's very hard to promote physiological births without immediately feeling like we're aleinating others who can't/don't want these sorts of births. Should this ultimately stop the debate? I think that would be unfair.

[Shagmundfreud]

"HB advocacy that doesn't consider the safety of the home= bad because it ignores women whose homes are unsafe"

And hospital birth doesn't consider the issue of safety in relation to infection issues, something no particular study has looked at, and something which is absolutely endemic in UK hospitals.

Really - this is a slightly pointless discussion, and I think I'm going to check out of it.

[LaVolcan]

RedToothBrush - yes to all those, but to take it a step further back do accept that this is just the way health professionals are? Or do you say, no I am not prepared to accept being talked to like that? (It's hard to do, I know: right now my DH is avoiding the Dr because he expects to be nagged about his blood pressure).

IMO there is usually scope for questioning. We could question things like: are these interventions happening,(or in some cases necessary interventions not happening) because our staffing levels are inadequate? Why does your protocol dictate that I 'must' be induced at 40+ 10/12/14 - how does it apply to my circumstances? What are the alternatives?

Personally, I am very glad that there are people prepared to question and not to 'just accept'.

[Shagmundfreud]

"I don't have a problem with Alice Roberts not mentioning DV in her article. I have a problem with people who were talking about HB as a safer option ON MUMSNET not giving it even a sentence."

Sorry - people who discuss hb on mumsnet are generally very clear that it's not suitable for EVERYONE.

Is that not good enough for you?

There is no 'category' of women who are excluded from having a homebirth in the uk. Some disabled women will have their babies at home, and some women who have experienced dv. It goes without saying that individual circumstances -whatever they are, are always taken into account when assessing the suitability of home birth.

[RedToothBrush]

LaVolcan, I think its pretty clear that being insensitive in your approach to dealing with obesity adds to the problem. Language is as important here as in child birth. If its aggressive or confrontational, it just alienates and hurts and is counter productive to the very thing you are trying to achieve.

Some obese people avoid going to the doctors, generally, because they fear they will be nagged or bullied about their weight in the process. Why do you think that certain groups are low-users of ante-natal clinics? I suspect I can think of a few answers...

[LaVolcan]

It is normal in this day and age to have an assisted birth. Yes, its is. Accept it.

Why? 50 years ago shaving and enemas were considered an essential part of childbirth. Women didn't accept this, and they no longer are. Surprise, surprise it hasn't made birth any less safe.

Let's take modern examples:

Obesity causes more problems. Do we just say, accept it, it's one of those things? Or do we say, what can we do to tackle obesity?

Certain groups are low users of ante-natal clinics. Do we just say, accept it and deal with the problems when they arise. Or do we say, what can we do to go out and meet these women, to prevent as many problems as we can arising?