Friday, 15 July 2011

Disproving your own argument

From The Evening Standard:

Mothers, stay at home for a safer, cheaper birth

There's a secret ritual a couple of weeks after having a baby: you sit down with your NCT group and compare notes on the birth.

My session last year was in a Crouch End coffee shop where six shell-shocked new mothers relived various birthing battles. Most of the salient details were hair-raisingly similar: chaotic, rude midwifery, lots of drugs and medical intervention, shoddy aftercare. Three of us ended up having emergency C-sections.

But one tale stood out - the home birth. Sure there were hairy [sic] moments, but these were comedic rather than life-threatening... Other friends who delivered their offspring at home have similar tales: very few stitches, barely any drugs and midwives treating them with respect.


Unless all those emergency Caesarians were entirely unnecessary, I'd say hats off to the NHS for identifying the potentially riskier births, wouldn't you? If those three mothers who ended up having a Caesarian had insisted on a home-birth, heck knows what would have happened.

22 comments:

Blue Eyes said...

Indeed. The reason that rich-world mothers tend to prefer hospital births is that if things go wrong they are already in the right place. This is why our child mortality rates are so much lower than places without decent healthcare.

Derek said...

My wife has been a midwife and a mother over the years. She argues that the NHS could save a ton of money and improve the experience for the great majority of women by using home births BUT at the cost of losing a few babies/mothers.

As she says, everything is great with home births until you actually need all the specialist hospital equipment. At which point things can go bad far too quickly to do anything about it. And a midwife just has to lose one home birth to become a big fan of hospital deliveries.

The major problem with hospital births tends to be that the hospital has a schedule and if mothers don't meet it then the staff have a tendency to "move things along" by administering oxytocin or whatever. Also it seems to me that there is little doubt that epidurals, while effective at their main job of pain relief, often have the unintended side-effect of interfering with "pushing" and thus leading to these dreadful 24hr-plus sessions which some poor women have to suffer.

If only it were possible to combine the beneficial aspects of both. Doesn't sound as if it should be too difficult.

Mark Wadsworth said...

BE, correct. You pays your money etc.

D, that's a fair if brutal summary.

"If only it were possible to combine the beneficial aspects of both. Doesn't sound as if it should be too difficult."

Easy. Buy a house right next door to a maternity unit and go for a home birth. If it starts to look a bit dicey, you just go next door.

Derek said...

That would work! Or even better: just rent!

My wife's own decision was to go into hospital for her last two births, stay on her feet as long as possible, and to refuse everything but NOx (laughing gas) for pain relief and come home with the baby immediately afterwards. Seemed to work fairly well. Particularly when compared with her first birth where she let the hospital staff do it their way, (epidurals, etc.) and suffered a very long and unpleasant labour.

Mark Wadsworth said...

D, "just rent" is even better, then when you've finished with babies you can move out and some other prospective mother can move in.

I didn't know that epidurals prolongued labour (making it a self-defeating exercise), that certainly accords with my (wife's) experience.

As a beneficiary of an emergency Caeasarian, I wouldn't knock them one bit. It's better than being dead.

Derek said...

Abs-so-lutely.

James Higham said...

Homebirthing - homeschooling.

A K Haart said...

Are home births a comparable risk to smoking during pregnancy?

Mark Wadsworth said...

JH, homeschooling and homebirthing are for nutters, if you don't mind me saying.

AKH, funny you should ask that. Going by this lady's experience, if all six mums to be had insisted on home births, then there would have been one or two deaths or serious problems. Multiply that up by 750,000 babies born each year and you get "a large number".

Conversely, going by the statistics promulgated by the BBC, there are well over 100,000 births to mothers who smoke during pregnancy, as a result of which there may be about 100 babies born with birth defects, many of them operable, such as hare lips.

Ross said...

The dangers of homebirthing are downplayed because of a misconceived nature worship.

It's almost impossible for independent midwives to get insurance for home births for the simple fact that the dangers are huge.

Anonymous said...

James Higham is a nutter. Although I think everyone should homeschool for a few years. The progressives will argue that only the rich can afford it though.

James Higham said...

James Higham is a nutter.

Care to itemize why, Anonymous or are you going to hide behind your moniker?

Anonymous said...

@MW "homeschooling and homebirthing are for nutters, if you don't mind me saying"

I do.

Our first child was born in hospital. That same hospital recommended home birth for the subsequent kids (unless there were medical reasons not to).

So, home birth for no. 2. A great experience for all concerned. As was no. 3 (attended by an audience of trainee midwives).

I delivered no. 4 at home - the baby came quickly, the midwife didn't. (She arrived 10 minutes after the birth.)

We are not 'nutters', we investigated the peer reviewed studies then available (1970s and 80s), these showed that home birthing was safer. We had antenatal care, and had any potential complications been identified, we would have had a hospital birth.

(BTW: We also successfully home schooled all 4 to GCSE standard. 'A' levels and degrees obtained through more conventional channels.)

James Higham said...

Just because something is mentioned, does not mean one advocates it. I've a series up right now where I disagree with much he says but it's on my site anyway because one of the authors at my site wanted it up.

I mentioned homebirthing-homeschooling to gauge reaction and that reaction is savage in this thread, aside from ict558 and some neutrals. It's not a topic I've been much into but in a post I did on it some time back, this was mentioned:

http://www.oxfordhomeschooling.co.uk/GeneralInformation/HomeSchoolingAndTheLaw.htm

http://www.ahomeeducation.co.uk/what-subjects-does-home-schooler-have-teach.html

Alara Kennett wrote that it was good. Calum Carr wrote that it was not:

James, I agree with Alara but we home-educated one child for a period but this was not a success. Home education isn’t for all parents and it isn’t for all children: the trick is realising when it is NOT working!

I have issues with the parent knowing when it was working or not. AS someone who was in the education field, there are obviously certain things which one would like to see covered and England does not seem to demand these, in law.

The advocates look at the dire state of the unstated education going on in schools today - the sex, drugs, PCism, the leftist political ideology the teachers just can't keep away from.

Seems to me that if a person homeschools, it would still be necessary to bring in specialist teachers to do the teaching.

Homebirthing - don't know enough about that one.

Mark Wadsworth said...

@ ict558, OK let me rephrase that, it is only a very tiny minority of parents who have the skills needed to be able to educate their children at home, without their children being seen as the village weirdos.

And yes, 95% of births would go absolutely fine if they happened at home, but you never know, do you? What if you are one the one in twenty? Is it worth the risk?

JH, if people refuse to send their children to school, then there's not much we can do about it. But when I'm in charge and replace it all with education vouchers, I'm not minded to hand them out for home schoolers.

Anonymous said...

@MW: "very tiny minority of parents who have the skills needed to be able to educate their children at home".
@JH: "it would still be necessary to bring in specialist teachers to do the teaching."

Me: 5 'O' Levels, MBCS.
Missus: City & Guilds Catering.

@MW: "But when I'm in charge and replace it all with education vouchers, I'm not minded to hand them out for home schoolers."

If we don't use schools, why would we want education vouchers?

The only involvement of the state in out childrens' primary and secondary education was to provide the school in which the GCSE exams were taken.

Mark Wadsworth said...

ICT, if you were lucky with home births and your kids ended up doing well at school, then great, I'm glad it all turned out OK. Doesn't bother me or prove anything one way or another.

"If we don't use schools, why would we want education vouchers?" Because they are worth money (i.e. a cash payment to the school or your choice). The battle will then rage over where the dividing line between "school" and "home school" is, of course...

Anonymous said...

@MW: "95% of births would go absolutely fine if they happened at home, but you never know, do you?"

Apparently 99.8%: BBC News - Home birth risks under scrutiny.

No, you never know. However, When deaths occured among the home birth group, they were overwhelmingly attributed to respiratory problems during birth and failed attempts at rescusitation. UK Midwives are skilled and experienced at home births and resuscitating newborns.

"Is it worth the risk?" The Missus says "Yes".

Anonymous said...

@MW:

Not trying to prove anything, just irritated by the blanket derision of "nutters".

Mark Wadsworth said...

ICT, 95% was my wild guess. Maybe 99.8% of births take place in hospital but need nothing more than a midwife, who could have done it at home. Of course it's usually nicer having a "natural birth" at home than in a hospital.

But it's a numbers game - how accurately can doctors and midwives identify the 0.2% which are going to go wrong? What's an acceptable level of deaths? is it worth employing four times as many midwives to be on 24-hour standby for home births, or better to employ a quarter as many on rotas in a hospital?

As Ross points out above: "It's almost impossible for independent midwives to get insurance for home births for the simple fact that the dangers are huge."

Mark Wadsworth said...

ICT, OK, I was extrapolating from the very few people I've known who home schooled. All complete and utter nutters (and I hope none of them is reading this).

Anonymous said...

@Ross: "The dangers of homebirthing are downplayed because of a misconceived nature worship."
Really? And yet the facts are so readily available nowadays, or don't nature worshippers use the net?

"It's almost impossible for independent midwives to get insurance for home births for the simple fact that the dangers are huge."
It is impossible for independent midwives to obtain Personal Indemnity Insurance because they are personally liable for any negligence claims, which could be as much as £6m. That's negligence claims not the 'huge dangers' of a home birth.

The increasing number of negligence claims against the NHS, and the size of the settlements, led to a concomitant rise in the premiums paid by independent midwives. Fewer and fewer independent midwives could afford to practise, eventually leading to the exit of insurers from an insignificant market.