And don't be put off sections by this research

[bellissima]

Interesting article in the Independent today showing how researchers managed to transform a 60% lower risk of the mother dying when having an elective into a 2.7 times higher risk - purely by statistical manipulation. No one - yes that's right - no one - actually died following a section.

www.independent.co.uk/life-style/health-and-families/health-news/nigel-hawkes-a-b ad-case-of-bias-against-caesareans-1883667.html

I suppose it just shows the dangers - whether talking about home births or sections, of relying on one bad (or good) story.

That's a really interesting (and quite shocking) link, thank you for posting.

As a first time mother-to-be,I have to say, I have been very, very surprised at the sheer lack of impartial, reliable basic info about all birth methods. (I wanted to use the word 'options' there, but of course not everyone gets to choose the course or outcome of their labour).

This is a conversation I've had with my partner and another friend who is expecting her first. It seems like everyone has a strong agenda in one direction or another, and just trying to get basic facts is very hard. I posted here a little while ago because my mate suddenly became pro-homebirth because she'd read, on one pro-homebirth website, that a QUARTER of women who give birth in hospital got a post partum infection, and was very scared as a result.

I guess an important lesson there is 'don't believe everything you read on the internet', and fair enough. But reading an article exposing misleading weaknesses in a report in the LANCET is much more disturbing, and has made me feel quite angry (with the Lancet).

Basic up-to-date info about what proportion of 1st time births involve the mother tearing - what is the average length of labour for a first time mother - what proportion of VBs involve instrumental intervention - what is the average length of stay in hospital following a caesarian, and what percentage of babies are injured during c-section delivery, and what is the maternal morbidity rate....these are all questions that have come up for us recently, and what we really wanted was some accurate, impartial info. It's virtually impossible to find. What we saw instead was a wealth of anecdotal material and a LOT of arguments on blogs and forums - many of them v hostile and emotionally coercive.

I understand that there are methodological challenges for any piece of research (how do you define categories, what gets left out/included etc). And I understand that there are many competing views on the subject of birth. All that said, I'm finding the lack of impartial info and the 'battlefield' nature of the subject very depressing and alienating.

That's turned into a moan, I'm sorry - I did come on just to say ta to OP for posting the link! Could I please also say, I don't intend any offence to mumsnettters with what I've said above, and I really hope I haven't offended anyone here. My gripe is with the lack of sound impartial info available - I am very aware that a lot of women come here to help.

Have you seen these?

NICE

Or looked on the RCOG site? Some very useful stuff there.

Would also recommend the MIDIRS Informed Choice series of leaflets, which you can order from here:

here

Re: tearing at vaginal births, my understanding is that rates across the board for first time mums are over 70%. Worth remembering though that perineal tissue is very forgiving, and most women experience uncomplicated healing after a vaginal birth. Would also want to add that for a low risk mum avoiding an epidural and avoiding giving birth in a consultant led unit considerably reduces your risks of damage associated with intrumental birth.

If you are considering an elective section I do think it's also important to factor in the possible impact on subsequent pregnancies and labours, should you be planning more children.

"a QUARTER of women who give birth in hospital got a post partum infection"

Infections following hospital births are very common after both vaginal and operative births, which is why (I think) all women are given prophylactic antibiotics after a c-section.

Would want to add though - we're not talking about serious, life-threatening infections in the vast majority of cases. Most clear up quickly with a dose of antibiotics.

Home birth advocates are very vocal. But the evidence does seem to support the view that rates of complications are significantly lower for women birthing out of hospital. And most women who have a home birth have also had a hospital birth, and VASTLY prefer giving birth at home. Doesn't mean it's right for everyone though, and ultimately you have to go where you feel safest.

Thanks standandeliver - NICE I found a little while back, and yes, the info is useful although it takes a bit of rooting around IME to find specific stuff -

Both the NICE doc and the MIDIRS info are aimed primiarily at healthcare professionals, though, aren't they? Unless I'm reading that wrongly.

That's not a criticism of the info, exactly -it's just consistent with what I've found, that clear info, in terms of facts'n'figures, aimed directly at the punter/patient/non healthcare professional is thin on the ground.

I'm fine with the approach and language of the NICE doc, for example - but not everyone would be.

Sorry, just to go back a step (cross posted) -

The NICE doc says clearly, on page 71: "Women having a CS should be offered prophylactic antibiotics, such as a single dose of first generation cephalosporin or ampicillin, to reduce the risk of postoperative infections (such as endometritis, urinary tract and wound infection), which occurs in
about 8% of women who have had a CS."

I don't know if 8 percent counts as 'very common' or not (I guess I'd have to have some idea of what the infection rates for other major ops were?).

But I do feel that 8 percent is a long way off 25 percent.

I say this only because it comes back to the heart of what I posted about - clear reliable facts and stats are hard to come by.

Want to add a quick PS - standandeliver, I'm grateful for your response and help, my last post sounds a bit brisk.

Can I also just add, I would like every women to be able to get clear reliable info about every birth route. This isn't a pro/anti CS/homebirth/hospital birth arena for me in this respect -

If there's one thing I've learnt from the research I've done so far, it's that all women deserve respect, support and understanding, whatever their circumstances. My choices and situation are not a judgement of anyone else's.

Thanks for posting the link Bellissima. v. interesting. Statistics can be played with to get the outcome you want. There is so much junk science around, but surprising that it was in the Lancet.

"the MIDIRS info are aimed primiarily at healthcare professionals, though, aren't they?"

The MIDIRS leaflets are produced in two formats: one for women and one for health professionals. Each title covers the same ground but the ones for health professionals are more detailed and, more importantly, are referenced.

Re: infection risk, I was thinking about infections following vaginal birth as well.

Personally I'm fairly suprised that it's only one in 12 c/s that result in postoperative infections. I've been told by an experienced midwife who had a c/s herself, that it was more common that this. (she got a post-operative infection - her consultant told her this occurred in 1 in 4 c/s deliveries).

Re: all women having the chance to discuss the issues you raise at length with health professionals - you'd have to double the number of midwives! There simply isn't time for women to talk things through in depth at their antenatal appointments.

Re: the Independent article - I'm not sure this is as straightforward as it seems.

You really need to know more about the type of care that the two groups (the elective section group and the vaginal birth arm of the study) received - whether it was comparable.

I would also be interested to know if increased risk for pregnancies and c/s following c/s were factored in when it came to assessing the results (I suspect not, given China's one child policy)

I would also very much like to see the response to this article from those who produced the research. Either they're complete idiots (maybe, but I'd be surprised), or there is more to this than the journalist is revealing.

The Independent also has a pretty interesting track record of printing articles which are cynical about the push to increase rates of normal birth - some of them very partial indeed.

The way I read this article, standandeliver, it wasn't about caesarians being safer than vaginal births: more about how you can get totally unreasonable results by using skewed statistical methods, and how there is a tendency not to look too closely into statistics that agree with what we're thinking anyway.

for the anecdotal, I got an infection from my vaginal birth- but tbh it wasn't the end of the world; know several women who had infected vaginal stitches, noone who got infection after caesarian- assumed it was partly because it's easier to keep a caesarian scar clean

The main thing that was wrong with the original piece of research was that they lumped death and injury together as it was all equally serious- as if infected stitches which can be cleared up with antiobiotics are somehow on the same level of seriousness as a dead mother or baby. So you got the impression that there was a considerable risk of dying from a caesarian when, in fact, nobody in the sample had died. If they'd kept them in separate columns they might have made more sense.

cory, yes, that was what I understood from the article too.

Standandeliver - thanks for clearing up about MIDIRS leaflets - having 2 for different target audiences makes sense.

Re: infection rates. This kind of illustrates my point! Please don't feel I'm having a go at you, or anyone here -

• but we find an official accountable source (NICE) which offers a fact - 8 percent of CS's involve a post-op infection.

Now, that, along with every other piece of research done by anyone, is open to question and scrutiny. Fair enough. I understand what NICE are, what their role is, and that they have come up with this figure based on data gathered from UK PCTs (and which might well be available to a FOI request).

With all due respect, I am more inclined to 'go' with that info in terms of accuracy rather than something that your MW told you that your consultant said. I understand you might well feel the opposite, and make your decisions accordingly.

That sounds harsh, as I type it. I don't mean to be. I just mean, there is sooo much anecdotal evidence from all and sundry wherever you look - and that's the problem. It gets confusing at best. At worst, it's misleading and coercive (I'm not in any way suggesting you are, standandeliver.) My point is, we (my mate and me, not the Royal We) have had so much anecdotal input, our most asked question has become 'is that true?'

It's all very well telling women they can make their own decisions - but we have to know we are basing our decisions on sound evidence and fact, not rumour.

And the problem is where to go to get simple info that isn't being offered by someone with a very dominant agenda.

Anyway, I'm repeating myself now, sorry.

(the only other thought I had since posting earlier is that IF the 25 percent postpartum infection rate is true, and I haven't seen any evidence it is yet, AND the 8 percent post CS post-op infection rate is true... then logically, VBs in hospital must have a post op infection rate of way over 25 percent to get the combined rate to that level. Maybe NICE also offers research stats which show the rate of post-partum infection for VBs as well as CS's?)

Yes, very interesting article and even more interesting comments on this thread. I don't have anything to add but I just WISH we could drop the phrase "too posh to push" once and for all. It is so insulting and makes me wince every time I see it. It also devalues the article in which it is written imo.

Franke, me too. I feel like in addition to a lack of clear, impartial, transparent factual info about birth, there's also this horrible layer of judgemental language in the more anecdotal stuff to deal with too. TPTP is the most obvious, but then 'homebirth' often seems to invite the word 'hippy', so there's a whole load of dismissive assumption going on there too.

I'm going to stop moaning now, I'm boring myself. Still grumpy with the Lancet though.

For the record, I admit that I read this article with interest given that I had two elective sections. (Yep two, and absolutely no problems getting pregnant/having second child even though I was then over 40). And I bf both, found bfing a bit difficult with both, but found it a lot easier the second time around - which is exactly the same experience as friends who had VBs - it seems that your body is just better at doing things it has already done.

I should also add that I have three friends who have had home births (once twice). None of them was hacked to bits in the way that the latest horrendous story relates. All of them had 'good' births.

And yes, these are just a few personal 'anecdotal' experiences. But then, given the manipulation that can happen with 'respectable' research then maybe personal histories are valid and we should not seek to impose our own beliefs on others.

PS I also agree that some research on post-partum levels of infection for hospital births (both VB and CS) are utterly ludicrous and, if carried to their logical conclusion, suggest Jane Seymour-like puerperal fever in every fourth maternity ward bed. A random poll of MNers and their friends suggests that this is not only utter baloney but also that MNers and their friends would be better and more reliable recipients of the research grants given for studies in this area.

Heh -

I think my point about anecdotal stuff is not that it's 'invalid' (I'm not sure how we can say that about any personal stories) -

Just that that is exactly what they are - personal stories. This applies pretty much to every area, not just childbirth, but without overall objective, independent research to contextualise them, it's hard to understand how typical they are.

For example, 'I had a CS and it was awful!' means just that. It doesn't mean 'all CS's are awful.' Same for all kinds of birth.

My intial gripe was that while these days, what with the internet and all, it is easier than ever to access a wealth of anecdotal evidence about all kinds of stuff. And that's fine - but when I read someone's story about 'I had a CS and then had bad uterine scarring', what I want to know is 'so how common is that? how many women get bad uterine scarring after CS's?

And then you're straight into agenda territory, when what I desperately want are reliable facts.

That post-op infection of 25 percent rate is a good example. It was the MAIN issue that persuaded my friend that hospital births were a very bad idea, and that she wanted a HB. (she's since revised her opinion btw, after she got over that initial panic and did some more research/talked to MWs etc).

The only place that figure exists is on a pro-homebirth website, which quotes it as being in a report from 1996, called I think 'Birthdays'. It links to a summary of that report - which nowhere mentions anything about this 25 percent infection rate.

But there was my mate panicked, and me too, I admit - and I'm angry about that now. 2 first time mums being influenced by dud info. How is that empowering or even sensible?

(as an aside, standanddeliver mentions her MW being told by her consultant that there was a '1 in 4' rate of post-op CS infection. Now, if she'd been armed with the NICE info that the overall rate of infection was much lower, at 1 in 12, then she would have been able to ask him why HIS infection rates were so much darn higher. That's when having some general info would have been extremely helpful.)

So it's that 'next step' after anecdotal info that's the problem. I don't mean to discount the value of personal experience in any way - just that an accurate bigger picture needs to go alongside it all. After all, I didn't base my decision to give up smoking on 10 people's individual health experiences of being a smoker - I followed NHS info and advice.

And that's why this analysis of the Lancet report is so interesting and frustrating. And thank you for posting!