On this day eight years ago I was 42 weeks pregnant, and finally resigned to the fact that I was about to undergo my second caesarian delivery.
A beautiful – and enormous! phew, dodged a bullet there – baby girl arrived at 5pm.
I recall many conversations my husband and I had with our obstetrician, a gentle and very experienced man aged about 60 years old. He knew I was a scientist, and so gave me plenty of good, factual information throughout the pregnancy. It was clinical care with data, if you will.
As we passed week 41 (most pregnancies are of about 40 weeks duration), we were still waiting for a natural labour to kick off but starting to feel a little stressed about the numbers. The graph showing fetal death rates plotted against weeks of gestation does a little jump up around 42 weeks. Eventually this, combined with the fact that I wanted to reacquaint myself with my toenails, lead us to surgery the following week and a fantastic outcome.
We were lucky to be able to weigh up risks and make an informed decision about when to have our baby. Natural delivery was the planned outcome; the plan was changed; healthy baby delivered.
But what if the numbers aren’t played to you straight?
A recent Guardian newspaper article by science engagement expert Alice Roberts shows how data about childbirth can be juggled according to political agendas. Referring to a Birthplace in England research project involving 65,000 women with births planned to take place at home, in midwife-led units and in hospital, Alice discussed the basic data, and then showed how different groups had presented the numbers.
- For first-time mums, the risk of a poor birth outcome was higher in home births compared with hospitals (death or injury of the child occurred in about 9 per 1,000 births at home compared with about 5 per 1,000 births in hospital);
- For women having 2nd or subsequent babies, there was no difference in risk of a poor birth outcome in home births compared to hospital births.
- For first-time mums, about four in 10 who had planned a home birth or birth in a midwife-led unit had to be transferred to hospital during labour;
- For women having 2nd or subsequent babies, about one in 10 who had planned a home birth or birth in a midwife-led unit were transferred to hospital during labour.
Same data, presented by The Royal College of Obstetricians and Gynaecologists, in this order:
- There is a relatively higher risk of poor outcomes for the baby in first-time mums giving birth at home;
- There is a 45% transfer rate to hospital for home-birthing first-time mums and 12% transfer rate for subsequent pregnancies;
- There is a lower intervention rates in home births.
Same data, presented by the National Childbirth Trust website, in this order:
- Women having a home birth are more likely to have a “normal birth” without intervention;
- Home births are safe for women having a second or subsequent baby;
- Home birth increases the risk to the baby for first-time mums.
The obstetricians highlight the risk of home birth. The home birth supporters highlight the normal and safe aspects of home birth.
So what is the average pregnant woman to do? Who can she trust to tell her the right thing? I don’t know the answer to that. But I think a comment by Alice’s towards the end of her article is worth highlighting:
” We should be celebrating the success of our multidisciplinary teams – including midwives, obstetricians and neonatologists – which means this (safe delivery) is the outcome for the vast majority of mums and babies.”
Using the multidisciplinary approach to combine expertise and introduce flexibility in birth options is surely what we’re after.
[image thanks to lrargerich on flickr]