Tuesday, 28 January 2014

Is Home Birth As Dangerous As Not Letting Your Child Wear A Seat Belt?

Choosing a home birth is dangerous, unethical and akin to driving your child around without a seat belt on according to recent stories in The Independent and Mail Online. The articles are based on a review published in the BMJ . So should we be enforcing tougher rules to prevent reckless women endangering their babies or should we first be looking at why some women choose home over hospital?

First of all, the headline is a little alarmist. The review isn't talking about razzing around country lanes with your kid hanging out the back window like an excited spaniel. The author suggested that the risk of home birth was equivalent to not strapping your child in for a single journey. The chances of them sustaining a major injury on that one particular trip are very low. But that risk does exist so it is foolish/unethical not to strap the child in every time.

So just how dangerous is giving birth at home? It is very difficult to get good data on this. For one thing only a small percentage of UK babies are born at home (about 2%) and they tend to be born to low risk mothers, who are often from a very educated and affluent demographic. So it is difficult to compare outcomes to those in hospitals which deal with a broader range of women and far more complicated cases.  Also, a large number of women who planned to have a home birth, end up transferring to hospital.  Many studies then count them and any negative outcomes they have, in the hospital group. Basically, it's hard for studies to ensure they are comparing like with like. One thing we do know (and can be very grateful for) is that the risk of anyone dying during birth, in any setting, is very low in the UK. 

Some of the best recent data comes from the 2011 Birthplace study. This looked at almost 65,000 UK births and concluded that, for low risk mothers having a second or subsequent child, home birth was as safe as hospital birth.  However for first time mums, home birth was riskier and not recommended.  So the second time, low risk mums are perhaps in the clear here, but what about the first timers? Or those who aren't considered low risk because, for example, they had a previous child by caesarean? There is certainly a case for arguing that these women are choosing their own comfort over their child's safety. That in their desire for the perfect, natural, "empowering birth experience", fully set-dressed with candles and essential oils, they have forgotten that the most important thing is getting the baby out safely. 

Now, I spend way too much time on the internet and I've come across a fair few individuals for whom I actually do think that is true. But I also read many more complicated stories of women who firmly believe that home birth is in fact safer than going to hospital or who are afraid of what hospital birth may entail.

Have a little dig around websites that advocate home birth and it won't take long to find someone claiming that it is actually safer than being in hospital. This sounds counter-intuitive but there is something to it. Women who have home births are less likely to have interventions such as instrumental deliveries. These interventions can be pretty unpleasant (I can testify to that personally) and carry risks of their own. The chances of having an instrumental birth in hospital are far greater than of having a baby die during a home birth. So if you consider any deviation from a straight forward natural birth to be a dangerous outcome then yes, home birth is safer. But this means putting an unplanned epidural in the same bracket as a life threatening haemorrhage.

These websites are often carefully worded to make interventions in hospital sound terrifying and almost inevitable, while at the same time portraying the risks of home birth as so vanishingly small that they aren't worth worrying about.  They are very persuasive and they can easily be the dominant voice of advice for pregnant women. NHS antenatal classes vary a great deal in quality and availability. Many of the wealthier, well educated mums who are more likely to choose home birth, may not be happy to wait for a half day class late in pregnancy with thirty others*. Instead they turn to books, websites and private antenatal groups. Often these will claim to be fair, unbiased and evidence based. Sometimes they are. But they are entirely unchecked and unregulated**. With all that in mind it's quite possible that some mothers criticised for choosing home birth, genuinely believe they are doing the best thing for their baby.

Hospital births can be great, but they can be pretty very not great too. There are the midwife shortages and over crowded noisy postnatal wards etc. etc. etc. Where a woman's care has been lacking or complications have occurred during a birth, it can leave her with serious and lasting trauma. Imagine days of agony, humiliation, exhaustion and fear, then imagine knowing you may have to do it all again. Some such women choose to have a home birth. If they have had a complicated previous birth then they will not be considered low risk and will probably be advised against it by their doctor. But many will believe that it was the doctors who let them down last time. That trust is gone.

In many areas you even get a kind of NHS premium service if you select a home birth. When I had my first child I saw whichever midwife was at my GP surgery for my antenatal appointments, shared the midwives and doctors from several shift changes during the birth, endured some frankly cruel night staff on the post natal ward and then, at home, got whoever turned up (if they turned up) for care and advice in those first, difficult weeks. It was impersonal and often chaotic and confusing. Had I opted for a home birth I would have had many of my antenatal appointments in my own home with a named midwife or one of her small team. She would have been there for the birth and to settle me into my own bed afterwards and she would have visited me for weeks afterwards. Consistent care and advice from someone who knew me well. 

Perhaps those things don't seem enough to justify risking a home birth, and yes there will be those who are so caught up in creating their own amazing performance-art birth that they won't think clearly about the risks. There will be others who will make a careful and balanced judgement that for their particular circumstances those risks are small and worth it. But again, search the Internet, every woman is different and for many fear, misinformation or the promise of better care, are more than enough. We do those women a great injustice by condemning them as unethical. Instead we need to ask why they have made that decision. We need to ensure that all women have access to simply presented high quality information and we need to call bullshit when we see data being misrepresented. We need to do more for postnatal women, to recognise and treat those who have suffered trauma so that they feel able to make use of hospitals and doctors in the future, if they so wish and we need to provide better continuity of care for all. Not just those willing and fortunate enough to be able to choose home birth.  In a struggling NHS that is probably a big ask, but if we can't do that, we can't condemn those that we have let down.


*At my first ever antenatal appointment, at a GP surgery in a very deprived part on London, the midwife took one look at me and my husband in his suit and told us to go to the NCT for childbirth classes "to meet people like us"

**My NCT teacher had a pretty strong pro-natural and home birth agenda. This isn't true of every teacher in the organisation, but, from talking to friends in other parts of the country, she doesn't seem to have been unique!

Friday, 17 January 2014

Name Me - I Need Your Help!

Time for a change
I've been thinking about making some changes to this blog for a while now. I've loved sharing my pregnancies and my little adventures with my girls, but E is now at school and will no doubt have her own online life soon. So I feel that it's time to hand that over to her and stop featuring her so much on the blog. M of course is younger but the time will come for her too.

I've also become increasingly interested in my sciency rants. There is a vast amount of ludicrous, patronising and occasionally downright dangerous "information" handed out to pregnant women and parents. It infuriates me that it's ok for alarmist advice to be given or products to be sold off the back of dubious "scientific evidence". Or for pregnant women to be treated as little more than reckless foetus carrying devices, who can't be trusted to make adult decisions. It's not an area often covered by UK "mummy blogs" but as I have a background in science I hope I can use this to help a few people better understand the issues. Or at least provide a bit of entertainment while venting my fury!

So, spurred on by a post today on the Tots100 site, it's time for a re-brand.

This is where I need your help. I need a new name for the blog that better conveys it's purpose, but I am really struggling to come up with anything. So I'm hoping someone out there can do better. The name needs to be easy to remember and somehow related to science and mum/parent. It also can't be an existing brand name or blog, (but I can check this out for any I like).

So please, save me from my total lack of ideas - post suggestions in the comments below or on facebook if you prefer. Then bear with me - the new look blog will be coming soon!


Tuesday, 7 January 2014

2013 A Year In Pictures

I did this for 2012 and it turned out to be a post that I came back to many times to remember what was, for us, a very special year. 2013 had a LOT to live up to after the birth of baby M and of course the Olympics in our very own home city. But while there may not have been so many big stand out moments in 2013 it was on the whole a pretty good year.

In January, with baby M out of those first few chaotic weeks, we set off to enjoy living in London:

Exploring the South Bank
The stunningly restored Cutty Sark
Not that M was all that impressed

February - we celebrated Valentines day as only the parents of small children can; wine, roses, chocolates, candlelight and two baby monitors

In March we were back out exploring,

Maritime museum, Greenwich

And E found the note from the painter, just a bit too late (picture taken after emergency bath)

In April we headed off for what is now becoming an annual trip to the wonderful Coombe Mill

Bunnies - always a winner

Our attempts at going for a nice walk were too much for E, who proved that it is actually possible to fall asleep while standing on a moving buggy board

Not to be left out - M slept right through her first trip to the beach

May - and lots of new treats for M

Solid Food!
Surprisingly good with a beaker

First go on a swing
and E proves she can beat daddy at bowling on her first attempt!

June. Summer at last and thanks to a last minute cancellation Carter's Steam Fair came to our local park

In July we had a rare opportunity, F had a long summer holiday off work and I was still on maternity leave. So we started six whole weeks of family time (minus the daily phone calls from F's IT manager) revisiting one of our favourite places from before we had kids - Andalucia.

Introducing E to hiking

Sharing a previously romantic spot with come unimpressed kids

E's diet in Spain was mostly cherries (picked from the tree) and Gazpacho

In August we carried on our adventures with our first ever family festival - Beautiful Days in Devon and E's 4th birthday.

Ready to rock!

Trying out my cake decorating skills again (I know there are no Orca's in the Owl and the Pussy Cat but we'd seen some in Spain)

September, and having turned four in August it was time for E to start school:

The obligatory starting school front door picture

Our pear tree produced record amounts of fruit this year - E helped Granny collect some of it

October, Time to get out the wellies and woolies once again

M's first Halloween

November, amazingly a whole year has gone by and our little baby M is one

This would be a lovely picture if it weren't for what E is doing in the background

Which just leaves December, and the Christmas preparations

Happy new year everyone. Thank you for reading and I hope 2014 will be kind to you