I think most people probably know that newspapers are not always the most reliable sources when it comes to conveying factual information. Certain papers tend to sensationalise things and some even tell outright lies to their readers in order to sell more papers. Because the real news is often nowhere near as interesting as the made-up stuff.
What kinds of headlines sell newspapers? Babies dying, sadly, is a big seller and it’s one we’ve seen in the wake of the release of the long-awaited Birthplace Report, which was published yesterday. The Daily Fail notoriously misreported the study’s findings, with a lead headline of
First-time mothers who opt for home birth face triple the risk of death or brain damage in child
- Half of women who chose home births had to be transferred to hospitals due to complications
Both of these statements are complete lies. Not just minor misrepresentations or misinterpretations of the facts, but actual lies, told to scare the public and stir up an emotive debate.
You may be able to tell that I have absolutely no respect for this publication, or others like it.
So, what is the truth behind this sensational headline?
The Birthplace report really did find an increased risk of death (stillbirth and neonatal mortality), brain damage (infant encephalopathy), meconium aspiration syndrome and bone fractures in the arm and collar bone in babies of first time mothers who plan home births, deaths did NOT make up the majority of these outcomes. HOWEVER, it was less than twice the risk of babies born in other settings, not three times the risk. Also, the actual risk is still less than 1% and the results are looking at the short term only, it is entirely likely that most of these babies are perfectly well after treatment.
Mothers who have children already face absolutely no increased risk to their babies by birthing at home.
There were so few infant mortalities in the study that the researchers decided to compound the results of a range of adverse outcomes in order to produce a study with statistically significant results. I have mixed views on this. On the one hand, it muddies the waters by mixing up the worst case scenario for the baby with a host of lesser problems. On the other, it does demonstrate very clearly just how safe birth is in the UK today (with a less than 1% risk of anything significantly bad happening to a baby, regardless of where it is born or how many babies the mother has had before).
As for the “Fail”‘s other assertion, well actually, it was less than half of mums, about 40%, who transferred and most of them were not for “complications” but for the infamous “failure to progress” and epidural pain relief.
A more accurate, and just as attention-grabbing headline might have read
Low risk mothers who plan hospital births are three times more likely to have an unplanned caesarean section than in any other birth setting
The study found that women planning births at home and in birth centres (both freestanding and attached to an obstetric unit) were overwhelmingly better off than those planning to birth in obstetric units. Women in hospital had a mere 58% chance of having a normal birth, whereas those planning to remain at home had an 88% chance. This study didn’t even touch on long-term results, such as breastfeeding duration or mental health.
These are all low risk women. And their health matters. Yes, we all care very much about babies and no one loves a mother’s baby or wants the best for it as much as she does… but mothers matter too. A healthy baby might not stay that way with a damaged mother and a damaged mother may remain damaged for the rest of her life as a result of her birth experience.
The elephant in the room with these results is… why do women do worse in hospital than in any other setting? The study can’t tell us that, but there are a number of theories. The most compelling to me personally, is that obstetricians view birth as a problem that needs fixing and that they have a tendency to step in and interfere where no interference is actually necessary. In an obstetric-led unit, even though all low risk women will be cared for primarily by midwives, there are always obstetricians waiting in the wings for something to do. At the study launch event at the Royal Society of Medicine yesterday, Dr David Richmond, Vice President of the Royal College of Obstetricians & Gynaecologists (RCOG) implied as much in his talk when he showed a slide of Mount Everest and quoted Sir Edmund Hillary, who famously replied to the question of why he climbed Everest with “Because it’s there”.
Those of us who have taken an interest in normal birth and taken the time to investigate how birth works, are aware that birth goes the smoothest away from time limits, bright lights, loud noises, routine interventions and alien environments, i.e. at home. So the results of this study are no surprise. Women do best at home.
I think it’s very important for women to have access to the right information, presented in the right way, to enable them to make choices for their births, so let’s just compare the statistics for a moment.
- A first time mum has roughly 0.5% chance of anything bad happening to her baby in hospital or in a midwife led unit. She has a less than 1% chance of anything bad happening to her baby at home. At home her baby is nearly two times more likely to have an adverse outcome.
- The same mum has a roughly 15% chance of an instrumental delivery (ventouse or forceps) in hospital and 4% chance at home. In hospital it is over three times more likely.
- She has a 10% chance of a c-section in hospital, less than 3% chance at home. In hospital it is over three times more likely.
- There is a 23.5% chance of having her labour augmented in hospital (with all of the associated risks to both her and the baby that come with that) and just 5.4% chance at home. In hospital it is over four times more likely.
I’ll leave it up to each reader to digest those figures and decide for themselves where their preference for birth place lies, but do remember that these are all like-for-like mums, they are all low risk, so what these numbers suggest is that it IS the place of birth that influences the numbers. The mere fact of being in hospital makes these interventions more likely, and avoidable by staying at home or birthing in a birth centre (which tend to come out roughly the same as home or somewhere in between the two). It’s not that more women in hospital need these interventions because they are high risk.
Next time you read a sensational headline in the press, take a moment to think about what they aren’t telling you or the fact that they could actually be telling a barefaced lie.