In july, we reported on the Guardian’s very ridiculous coverage of a very ridiculous meta-analysis of international data on homebirths that purported to show that homebirths are safer for the labouring woman, but more dangerous for baby.
Reader Wahine has just sent us links to a Lancet editorial about the findings, and its attendant angry letters. The editorial states that
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home.
The author goes on to claim that this is due to methodological problems, and continues,
Professional organisations, perhaps unsurprisingly, have issued contradictory policy statements regarding home deliveries.
This is followed by a list of various countries and their various contradictory policy statements. The author then goes on to cite the meta-analysis mentioned above, and conclude that, well, now we know it’s really unsafe for babies, everyone ought to fall in line and recommend hospital birth.
So… lots of different countries have lots of different healthcare systems, with lots of different approaches to midwifery, homebirth, and indeed birth more generally…and the evidence across all (or many) of these systems is (big surprise) conflicting (as it would be, given we’re not comparing like for like). And the fact that this ‘conflict’ is reflected in ‘conflicting’ international guidelines is…further evidence of confusion? What? Circumstances differ cross-nationally; so evidence differs cross-nationally; so advice differs cross-nationally. That’s a sign that the advice is good: that it reflects the applicable evidence.
So, alright, I’ve ranted about this already. Let me start a new rant. The author of the editorial concludes, no big surprise, that
Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk. There are competing interests that need to be weighed carefully.
And in letters there’s huge anger over this.
Reducing rights to mere interests that can be weighed changes the mother from the owner of to a mere factor in the perinatal decision process. This is directly deleterious to her right to self-determination. The weighing of interests, risks, and outcomes is part of a capable exercise of human autonomy, not the other way around.
Quite right. But here’s my further worry: the meta-analysis purports to show that standard practice (hospital birth) is less safe for the patient (the pregnant woman) than a viable alternative (home birth). This shows a problem with existing medical practice. And yet, seemingly across the board, the discussion has been (only) about whether and which way the patient herself might be at fault; what the patient ought to do; what rights the patient ought to have (NB. the rights discussion never seems to stray into the question of what the woman’s rights are wrt decent medical care; we only ever discuss her rights wrt maiming babies).
I don’t get it. Why aren’t we talking about what’s wrong with obstetrics? What the hell is going on here?
In related news, a midwife in Hungary has been arrested for assisting in home births. Read more here.