In the last two weeks there has been much panic among mothers planning home births, plenty of heated debate on mumsnet and other online chat rooms as everyone asks is home birth really safe? This comes after The British Medical Journal’s publication of the UK’s biggest ever study of the safety of different maternity settings.
In response to some requests I have now read the study, the media reports, the comments and here is my interpretation and summary for you.
The study of almost 65,000 births across England’s health care trusts, led by professor Peter Brocklehurst, examined the risk of rare but serious adverse outcomes for babies born with no known complications in different maternity settings comparing home, freestanding midwife-led units, midwife-led units attached to obstetric wards and obstetric led units.
The findings were these:
1. Birth was safe wherever it happened with the chance of harm befalling your baby less than 1% in any birth setting.
2. The care in a Midwife-led unit was much more likely to lead to a normal birth than obstetric care.
3. For a first birth the risk to a baby born at home was slightly higher than a baby born in hospital. 5 out of 1000 babies having serious complications for the baby in hospital, and 9 out of 1000 at home.
4. For a second and subsequent birth there was no difference in the risk to babies whether born in an obstetric unit, a midwife-led unit or at home.
All the above is good news. It means we finally know that homebirth is nearly as safe as hospital for first time mothers and as safe as hospital for mothers birthing for a second or further time. We also know that midwife led care is superior and better for mother and baby with no known complications than obstetric care.
However the British Newspapers felt that highlighting the dangers of home birthing was a much more readable story:
The BBC Website headline read : Home Birth Carries Higher Risk for First Time Mothers
This was moderate compared to the dreadful health reporting of The Daily Mail which said:
First Time Mothers who opt for Home Birth face Triple the Risk of Death or Brain Damage to their Child
Unacceptable misrepresentation and sensationalism
This is plainly untrue as the risk of serious adverse outcome (not death) is not three times as they quote, and not quite even double, but 5 out of 1000 as opposed to 9 out of 1000. That is less than 1%.
The Mail went on to say erroneously that almost half of all women who home birthed transferred in because of complications going on to infer that those complications led to emergency situations.
This is what the study actually said:
About 45% of women planning to have their first baby at home were transferred during labour, although this was mainly because of delays in giving birth and the need for an epidural pain-relief injection, rather than because the baby was in distress.
Instead The Mail’s readership will misleadingly assume that birth is inherently complicated and home birth dangerous.
The Daily Telegraph took a similarly negative position with:
First Time Mothers Warned Over Home Birth Risks
What people should be asking is why was there an increase in home births incidents which is not unexplained by the survey.
The Guardian who headlined with a much more sensible headline:
Women with Low-Risk Pregnancies should have Birth Choices
asked study-leader Professor Brocklehurst to explain the slight increase:
“I don’t know why. We don’t know which aspects of the care or the site contributed to this,” said Brocklehurst. “It could be to do with the sort of women who chose home birth, who tended to be white, slightly older, better educated and live in more affluent areas, the midwife’s experience, problems in transferring to hospital in an emergency or something else entirely. More work would be needed to establish what was happening.”
Certainly giving birth for first time mothers is longer, and therefore more challenging and more prone to complications than birth for multiparous women which explains the high transfer rate.
Perhaps even more worrying are some of the responses from obstetric professionals on The BMJ website including one obstetrician who writes: Public funding of home births should be stopped.” He goes on to say that money could be diverted to more forceps and caesarean deliveries.
Just what a new mother facing birth wants to hear.
What should have been the headlining story emerging from this study is that there were more adverse outcomes in hospitals than midwife-led centers – 5.3 per 1000 in hospital compared to 4.5 in birth centers.
This means labour wards pose a greater risk to our babies than mid-wife led units. In the case of birthing doctor does not know best.
For mothers the hospital experience comes with much greater intervention:
Healthy, low-risk women will have over 40% chance of an intervention like a caesarean or assisted delivery in an obstetric unit. In a midwife-led unit in a hospital there’s a 24% chance which decreases to 17% in free-standing midwife-led care and right down to 10% for home birthers.
Of course no-one is going to go around saying, ooh, you don’t want to have your baby in hospital, it’s terribly dangerous you know…
Currently 90% of women favour a hospital birth.
But as any mother who has birthed can tell you, safety is not everything – especially when it undermines the birth itself. As one mother told me:
I found it hard to read this report as everyone I know who’s had a home birth has had a great experience whilst so many of my friends have had a terrible hospital one.
It is no good strapping a mother to a bed with a constant monitor, tubes in her veins, artificial stimulants in her veins and forceps in her vagina, undermining her innate birth rhythms and traumatising her otherwise healthy baby just to make certain the baby is safe and out on time. Which seems, so often, to be the case these days with four women in ten ending up with either a cesarean or instrumental delivery.
So instead of running in a moral panic back to the clinical safety of the hospital lets use the information contained in this study as a basis for an informed conversation about birthing venues. Lets explore more the rise in home birth risk and look at ways to make this optimum way of birthing even safer for first time mothers. Home birth has the lowest costs for the nHS and the best rates of ‘normal’ birth. This study has really demonstrated what a safe and excellent birth model it is.
Other ways forward for the maternity services based on the findings of the study might include:
1. More midwife led units and more mothers going through them. They are so often empty while the labour wards are full.
2. Let’s keep the obstetricians for the genuine labour emergencies and return normal birthing to its rightful guardians – the midwifes.
3. Look at expanding the midwife role so that she can cope with minor emergencies.
4. Actively encourage more home births especially for multiparous women.
5. Initiate an inquiry into the challenges facing midwifes and first-time mothers home-birthing and see how this birth option can be made as safe as the hospital.
If all these measures were successfully initiated, the statistics for birth experience, maternal wellbeing, successful breastfeeding and normal birthing would almost certainly improve – alongside safety.
Finally, a word on the study’s conclusions which was this:
Our results support a policy of offering healthy nulliparous and multiparous women with low risk pregnancies a choice of birth settings… Adverse perinatal outcomes are uncommon in ALL settings while interventions during labour and birth are much less common for births planned in non-obstetric unit settings.
That is the bottom line, giving birth is safer than it has ever been – not 100% guaranteed – it can never be but safer than its ever been – especially if you’ve done it before.
Why didn’t the English headlines say that?