We are NOT using the evidence: it’s time to change

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I am posting this on #NHSChangeDay 2014.

I pledge to continue to make the case for change in maternity services, until ears listen.

Recently, my lovely Italian midwife friend who is a Doctoral student in England, told me of her confusion. ‘What I can’t understand’, she began ‘is why practice in maternity services in UK remains unchallenged when you have so many esteemed academics and the some of best research evidence in the world? She made me think.

Last week I was invited to present evidence related to continuity of care and choice in place of birth at one of the Personalised Maternity Care stakeholder events, in Leeds. The events are being held around the country, and are hosted by NHS Health Education England in response to a request from the Permanent Secretary for Health, Dr Dan Poulter. Dr Poulter wants to explore the ambitions for future Maternity Services and what such services might look like by 2022.

You can read info via the tweets here.

So on finding the evidence it became very apparent-we certainly aren’t using it.

Here are my slides.  I decided to share them widely to enable discussion and hopefully receive comments and ideas from readers to help inform the Minister.

Slide 1: There is an abundance of policy, guidance and results of surveys directing maternity services, which is largely being ignored. This is alarming, though not surprising. Yet let us consider: why was the Peel Report (Ministry of Health 1970) directing 100% hospital ‘deliveries’ given urgent attention, and fully implemented WITHOUT  evidence presented or women’s opinions to back it up?

 

Slide 2: We are not using latest research evidence, and according to the National Audit Office report (NAO) and the Public Accounts Committee report  (PAC) there is no measuring or reporting progress, no data, no assurance of value for money, and huge variations in cost, quality, safety and outcomes. In addition, women and families are reporting dissatisfaction with their care (Birthrights, CQC, Women’s Institute), few women are receiving continuity, and choice in pace of birth (NAO, BirthChoice UK). Furthermore, stillbirth rates in England are highest in UK, and litigation costs increasing.

Slide 3: Margaret Hodge MP spells it out for you to read. Maragert chairs the PAC, and her observations are, I believe, a true reflection of maternity services in England today.

Slide 4 and 5: Reality for midwives. Desperation which often leads to leaving the profession, and for those can’t leave, numbness which increases risk of substandard care. There is a link to another post on this blog, where many comments have been made.

Slide 6: The NHS Mandate gives some direction for the future. Named midwife. What does that mean? The NHS England definition is ‘a midwife who co-ordinates all the care and delivers some of the care’ .   Continuity of care is another misused phrase, but if continuity is good, surely there would be improved responses to ‘mental health concerns’.

Slide 7: Highlights the main references for the research evidence for continuity of care

Slide 8: Reveals some of what this evidence tells us. How can we not take notice?

Slide 9: Did you know that the National Service Framework for children, young people and maternity services was still the current directive for maternity services?  And it states that every woman should be able ‘to choose the most appropriate place and professional during childbirth’

Slide 10, 11 & 12 : The evidence for choice in place of birth has NEVER been so strong as it is now, for women with no or expected complications. These are the key findings of the Birthplace Study but in general it tells us:

Giving birth is generally very safe

-Midwifery units appear to be safe for the baby and offer benefits for the mother

-For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother

-For women having a first baby, a planned home birth increases the risk for the baby (this is very small- four more babies in every thousand births had a poor outcome as a result of a planned home birth in first pregnancies).

-Women planning to give birth in a midwifery unit experienced substantially less medical intervention than those in an obstetric unit.

For women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother

 For multiparous women, there were no significant differences in adverse perinatal outcomes

between planned home births or midwifery unit births and planned births in obstetric units.

 For multiparous women, birth in a non‐obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.

Important points I would like to make here, for those working closely with expectant parents:

Do you mention the above evidence when talking to women about their choices? I expect most will remember to mention the small risk for first time mothers wishing to birth at home. But do you advise women about the potential increased risk of unnecessary  medical intervention?

How do you make evidence accessible for parents? How do you deliver the evidence, do you know what it says? This is a brilliant article on how to share evidence based information. It’s a must read.

Slide 13: Is self-explanatory. Note the decrease in obstetric units (OU) and increase in alongside midwifery led units (MLU). This coincides with the number of amalgamated Trusts, and the aforesaid NSF. There is only a slight increase in the number of freestanding midwifery units (FMU), probably due to closures corresponding with others opening.  The slide informs us that very few women have the full choice guarantee as proposed in the NSF in 2004.

Slide 14: Because of the above, the slide shows that most women (87%) give birth in an OU.

Slide 15: Two recent media articles demonstrating ongoing constraints of providing home birth and birth centre births, yet the evidence is clear that women choosing to birth in these venues are there less to endure unnecessary interventions, and the service is more cost effective.  Does that make sense?

Slide 16: The best estimate of women eligible to have their baby in a non OU setting (low risk) is 50%, although WHO estimate this should be between 70-80%.   Taking 50% of 2012 birth rate (700,000) = 350,000  and deducting 89,000 women who actually had midwife led births in non OU setting, leaves us with the shocking figure of 261,000 women and babies who, according to Birthplace Study, are potentially exposed to unnecessary medical intervention.

This is unacceptable. Yet it remains silent, unspoken, when the small risk of home birth is magnified out of proportion. In addition to the human cost in terms of morbidity, there are financial implications, and pressures on the workforce. So now we have the evidence, and things MUST to change.

Slide 17: Some of the effects of the previous slide, in terms of mode of birth, and maternal feelings. Diagrams taken from the Dignity Survey 2013.

Slide 18: The potential consequences of current maternity service provision.

Slide 19: What Personalised Maternity Care should look like, including flexible use of clinical guidelines, to support women’s choices.

Slide 20: Relevant and important recommendations from the Public Accounts Committee.

The following slides give and example of maternity services in East Lancashire, where I worked for 35 years. I have highlighted these award-winning services to demonstrate how choice and continuity can be achieved. The service is situated in one of the most socially deprived Local Authorities in England, and has undergone a significant reconfiguration in 2013. With 30% of 6,700 births per year in the three birth centres (2 FMUs and 1 AMU), they are maximizing opportunity for women and staff, with excellent results.  The slides demonstrate financial gain from the model of care, and how mothers, midwives and managers feel about the service.  The key factors of success for the model in East Lancashire are:

-Model of care: midwives work in the community AND the birth centre, providing continuity and accurate and positive information sharing about place of birth

-Collaboration: obstetricians, midwives, neonatoligists, service uses, auxiliary staff support each other, and work together to ensure the woman and her family are supported.

-Leadership: the service has strong midwifery leadership at all levels.

The last slide is of my newest granddaughter, Myla. When Myla is of age to have children of her own, I want her to know that the evidence we now have was used well, to give her the best chance ever to have a positive experience and healthy baby.

Please leave your comments. We musn’t give up.

Screen Shot 2014-03-06 at 18.46.46

Table: Dodwell and Newburn (2010) 

Reference:

Ministry of Health (1970) Domiciliary Midwifery and Maternity Bed Needs: the Report of the Standing Maternity and Midwifery Advisory Committee (Sub-committee Chairman J. Peel), HMSO, London

Photographs used in slides are owned by Sheena Byrom and East Lancashire Hospitals Trust

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By sheenabyrom

33 comments on “We are NOT using the evidence: it’s time to change

  1. Totally inspiring and great resources thank you.

    I tell all my women ALL of the evidence, we chat at length about it if that’s what they wish!!

    Sadly in our area all birth centres have closed and MLU’s are attached to OUs which are inaccessible to the local population.

    With the only choice for our women being home or hospital- I feel strongly that caseholding would improve satisfaction for both women and midwives.

    Kindest regards

    • Hi Sally,
      Thanks for your comment-it’s a pity the birth centres have closed. What I haven’t mentioned on my post is that the staffing model at East Lancs is such that the midwives who do first booking session with women are the ones who work in the birth centre. It is therefore accessible to all women who fit the criteria. This is a crucial part. There is continuity of care too.

      My aim is to encourage and support using the evidence that we now have, by developing or reviving birth centres, and to promote continuity of care schemes.
      Sheena 🙂

      • I thought that was the case at East Lancashire I’ve been looking at casehold models etc.

        I wish you every success with your aim, I’m sure I speak for hundreds of midwives and women. I’ll keep chipping away in my own small way and hope one day I’ll be in a stronger position where my voice and women’s voices will be heard 😀👍

  2. You raise some very interesting points here, and I absolutely agree that continuity of care should be more widely available and that we should be using evidence to determine policy.

    But, I think we always need to be conscious of how our own opinions can alter the interpretation of evidence. You interpret the 4/1000 risk for first births at home as “very small” and therefore worth taking for the benefit of decreasing the risk of unnecessary interventions. I consider avoiding the small risk of very serious outcomes for my baby to be more important than avoiding the greater risk of less serious outcomes to me – interventions, which, although very unpleasant, rarely result in death or lifelong disability. Both of our interpretations are taken from the evidence, but both are skewed by our own personal beliefs, experiences and the value we place on the avoidance of the different risks.

    I am also very wary of setting any kind of target on where women should give birth. You calculate that: “261,000 women and babies … are potentially exposed to unnecessary medical intervention”. But many of those women, given the opportunity to asses the risks for themselves, would still choose to give birth in hospital, because they feel safer and more confident knowing that medical care is right there, just in case, or because they want the option of an epidural. This is an equally rational and valid choice to home birth and should be equally championed. Once we start putting in quotas we are actually reducing women’s autonomy.

    Finally, rather than just saying women should avoid hospital to decrease the chance of interventions, we should also be asking WHY there are more interventions in hospitals. Of course, to some extent there will always be more because almost all high risk cases where interventions are genuinely needed will either start out, or transfer to, an obstetric unit. But assuming that this has been controlled for, and that there really are a large number of unnecessary interventions going on in hospitals, then work should be done to find out why and how this can be stopped.

    For the record, I was lucky enough to have the choice of home, hospital or along-side midwife unit for my first baby. I planned a natural birth and chose the midwife unit, with the intention of considering homebirth for subsequent children if all went well. Unfortunately, despite having everything going for me there were major problems and I ended up with an emergency C/S, without which my baby and most likely I, would have died. I chose a planned C/S for my second child, as it was marginally safer and gave me the control I lacked first time.

    My experience has no doubt coloured my interpretation of the evidence. In the moments where I thought my first baby had died I would have endured every intervention all over again, a hundred times, just to hear her cry. Thankfully we were all fine in the end.

    • Thank you so much for responding to my post, I really appreciate it.

      I have to agree, our own experiences can cloud our interpretation of evidence, and we should acknowledge that it does. For me, more 35 years of working as a midwife, and seeing the unbelievable rise in medical intervention and the impact of that, influences my perspective, and my actions. This is mainly because with this increase, there are unfortunately no advantages for mother and baby.
      Personally, my experience is like yours, I am thankful for medical assistance. My two daughters needed life saving interventions for both their pregnancies and births. The interventions were necessary, and that’s where the difference lies.
      My purpose in highlighting the statistics is that we now have very clear evidence which we hasn’t been available before. It’s worrying that women are making the choice (if they have one) of hospital birth because they feel safer, as they may be unaware of the facts. I quite agree that women SHOULD have a choice of place of birth, but they should always have the information on which to make that choice. WHICH? consumer group have merged with BirthchoiceUK to develop an excellent interactive web based tool to help women make the choice that is right for them. http://www.which.co.uk/birth-choice
      Unfortunately, and one of the reasons why I wrote the post, many women don’t have access to out of hospital birth even if they wanted it.
      I highlighted the ‘small’ risk of perinatal morbidity because the ‘actual risk’ (4/1000) is often not known, and is articulated only as ‘increased’ risk which is unhelpful and alarming. I intended to demonstrate the bias in reporting risk (from my perspective too).

      Your point is very valid-you have explained that you would rather risk potential unnecessary intervention than the smaller risk of harm to your baby. I fully appreciate that; most women feel the same. ‘Risk’ is fluid and individual, and each one of us will feel differently about each scenario presented to us. Unfortunately, the interventions that are often thought to be helpful, may be the cause of harm (iatrogenic). We cannot assume that medical intervention doesn’t have the potential to result in lifelong disability or death, indeed we know it can and does. The disability can be physical or psychological, or both. In addition, we are becoming increasingly aware of the emerging evidence of long term side effects of some of the interventions used during childbirth http://www.youtube.com/watch?v=e2kLpHo3__0

      I fully agree with your comment about asking why there are more interventions in hospital, and I you may want to read my post http://sheenabyrom.com/2014/01/14/its-2014-time-to-listen-and-hear-what-midwives-say/ which includes some of the potential reasons. Fear is probably the greatest factor.
      I am certainly not advocating that we place a target on where women give birth. But given we have clear and valid evidence about safety of place of birth, we need to ensure women aren’t deluded in believing hospital birth is safer, and that they have the information to make the decision for themselves. But that information needs to include the evidence on increased risk of intervention with hospital birth, which is rarely articulated. And of course, women need enough midwives, out of hospital facilities, and appropriate models of care to maximize potential for a safe and positive experience. Thanks again, Sheena ☺

      • Hi sheena,

        Thanks for posting and replying to my comments.

        I have a few more questions!

        Do you have a figure for the increased probability of interventions in hospital? You don’t give an actual number which makes it hard to compare it with the 4/1000 figure.

        Also, has a survey ever been done to determine how many women would choose home birth/ birth centres if they were presented with convincing evidence that it was as safe or safer than hospital? The numbers choosing these options nationaly are pretty low, but is that entirely due to lack of availability?

        I ask because I often feel that the only people and organisations representing women and advocating better maternity care, are those who are very pro-natural/home/normal birth. I wonder if this is truely representative of the majority of women? I know plenty of people who have done a lot of research and made, what I think, are perfectly rational decisions, to have a hospital birth, an epidural, or a c-section. Yet those who advocate choice rarely seem to mention these choices.

        In the area where I now live there is far better access to home birth than in much of the country. The home birth rate is well above the national average, although it is almost exclusively the older, white, middle class Mums using these services (it is a very diverse area). If anything, mums here are more likely to get a message that over emphasises the safety of home birth and the risk of hospital, rather than the other way around.

        This has all had a number of consequences. Within that socio economic group many women feel guilt or trauma if their birth isn’t “normal”, at the very least there is a tendancy to apologise or make excuses for why they HAD to eg have an epidural (just saying they wanted the pain to go away is not ok , but why shouldn’t it be?) .

        More worryingly though, there is a kind of two tier care system. Those willing and able to have a home birth will have a named, caseload midwife who will be with her throughout pregnancy, birth and for up to a month afterwards. Eveyone else gets whoever happens to be on shift. The hospital is extremely busy and postnatal care is generaly poor and chaotic. As a result, the choice over place of birth often comes down to a choice not over place but over model of care.

        So my fear is, that most advocacy will focus on improving access to out of hospital birth. But, if this isn’t what the majority of women actualy want or can have, we risk creating an NHS premium service for a priveledged, vocal, minority, while services for the rest stagnate or deteriorate.

      • Hi, the figure for potential increased risk of intervention is actually on my post. It is 261,000 of 700,000 and is derived from the Birthplace Study, and BirthChoiceUK. The references are on my blog.

        The WI and NCT conducted a survey published last year asking the question about choice in place of birth:
        ‘Almost half of women surveyed wanted to give birth in an AMU – a midwife-led unit inside a hospital (see Figure 2). Only 25% wanted to give birth in an obstetric unit, in stark contrast to the number of women who end up there’.
        http://www.nct.org.uk/sites/default/files/related_documents/Support%20Overdue%20FINAL%2015%20May%202013.pdf
        I expect most of these women wouldn’t have either the evidence or the facilities to make a choice, which makes this result even more disappointing.

        I can understand your view about better maternity care campaigners and organisations seeming to be from a ‘normal birth/home birth’ camp, and that may because there has been (and still is to some degree) active resistance to out of hospital birth from various powers, with no evidence to back that up. As I said in my post, the shift from home birth to hospital in the 1970s took place without evidence or opinion of mothers. We now have a situation where women are increasingly fearful of childbirth, even hospital birth, and yet believe hospital to be safer. I have witnessed this first hand throughout my career.

        Your latter points are very important, and what we have to aim for is improved and positive childbirth for all. If you look at my slides I give an example of East Lancashire maternity service, which has some of the most social and economically deprived wards in the country. Yet 30% of women are experiencing out of hospital birth, and the numbers are increasing. The medical teams can focus on those women that really need it, and unnecessary (and potentially harmful) intervention is minimised.

        My aim is to highlight the evidence that is underused, and to share positive practice so that all women have access to the most appropriate care for her, even if she chooses something else.

        Hope this helps…thanks for your comments…it adds to the debate! Sheena 🙂

  3. Hi Sheena, just wondering if you got the comment I left a few days ago as it doesn’t seem to be here? Also worried that you may have decided not to post it because of what I said? It certainly wasn’t intended as an attack on you or your work. I thought that, as you said you wanted debate and comments, you would be interested in alternative opinions, and I was very much hoping to hear your responses to mine.

    • Oh certainly not! It took me a little longer to write my reply…you should see it now. I really appreciate your comments (sorry don’t have your name), and would like to stay in touch. Its so useful to have your perspective, which I completely respect and understand. Thank you 🙂

      • sorry I appear to be the queen of long comments today! I avoid using my real name as my kids are quite small still so I try to give them a degree of privacy despite blogging about them, but the name I’ve given here should be clickable to take you to my blog which has a contacts page.

  4. Pingback: Why Do Bad Maternity Systems happen to Good People? | dralisonbarrett

  5. Absolutely agree with you Sheena, we need to make sure we are all listening to the evidence and using it to make change.
    Tracey x

  6. I share your frustration with current maternity care Sheena, as I am sure many midwives and women do too. It always seems as though people are quick to identify ‘risks’ to normal birth practices before they are willing to address the many complex issues and complications that a medical approach can have on birth when not necessary for the mother or baby. Excellent article which challenges our practice and allows us to keep pushing forward. Eventually we will be heard.

  7. I share your frustration with current maternity care Sheena, as I am sure many women and midwives alike do too. You summarize beautifully in these slides and discussion the changes needed to move forward and offer more appropriate choices to women at a time where choice seems to be consistently removed.

    Risk is indeed fluid and interpreted differently by each individual. This however serves to further argue the point that ALL options including home, hospital and midwifery led units should be viable options for women and not based on a game of maternity postcode lottery. Southwarkbelle raises a valid point that some women do feel more comfortable in the presence of close medical supplies and their needs should be respected as much as any other. If women would feel more relaxed at home however their needs should also be respected and supported and adequate provision made for their care. All too often we see that home birth services are restricted or postponed at busy periods and are inevitable the first part of care to be compromised. We also observe many of our midwifery led units shutting as they are not deemed cost effective. Not only have reports found home birth and birth centers to be cheaper overall I do wonder whether we are putting enough of an emphasis on the importance of a woman’s transition to motherhood. Until as a culture we acknowledge the significance of birth, I fear that these changes will not be made that hold the wishes of the woman at their heart.

    Fantastic post Sheena and eventually we will be heard, if we continue to shout loudly enough.

    http://midwifebecomesmum.wordpress.com/

  8. I’m responding to the point made above about the debate of home vs hospital birth and that the main argument is in relation to interventions.

    I gave birth in a unique place in Paris (Groupe Naissance) where the midwives were more like midwife/doulas, there was continuous care during pregnancy, the same midwife for the birth (and s/he behaves as a doula, although she’s a midwife) and to check up on you afterwards. The doctors are anti-intervention and they practise what they preach. There are also two clinical psychologists to work with both women and the fathers.

    My experience was phenomenal and their model is just fantastic. What they offer is, in intervention terms, a home birth in a midwife-led centre/hospital. If hospitals could offer a service more like this, then the hospital/home birth debate would change drastically.

    It perhaps also signals that the hospital/home birth debate is a red herring. What should be being discussed is intervention and intervention alone. Why do doctors feel the need to do it so frequently? Are they working from a place of fear? If so, what is that and why is that? Are they working from the position of “If something goes wrong, I’ll be judged by my peers and superiors (and the hospital legal team) on what I didn’t do, not on what I did do.”? If so, how can that be changed. As long as we focus on the physical location of the birth, I’m really not sure that the situation can change.

    • Hi Anna,

      Congratulations on the birth of your baby! The care you received sounds just wonderful, I would love to hear more.
      I agree that the issue of unnecessary intervention is the main concern here, and that we should focus on reducing it. Doctors and midwives are fearful as you suggest, and I have written about it here http://sheenabyrom.com/2013/06/17/midwifery-in-the-nhs-my-opinion/

      But the hospital/home debate isn’t a red herring, it’s a fundamental part of the conversation, as women are becoming more and more doubtful of their ability to give birth without medical assistance, and midwives and doctors too. The evidence is clear, location and environment matter. But that doesn’t mean we can’t try to reduce fear and to improve the experience and outcomes for hospital birth. Both are important.
      Thanks so much Anna for adding your thoughts, they are so important. Sheena 🙂

  9. Pingback: We are NOT using the evidence: it’s time to change By Sheena Byrom - Birth Balance

  10. Hi Sheena, this is a great resource, thank you.
    I am really interested in your reference to this topic: ‘The changes made to a pathway tariff for maternity have made the model more sustainable as perverse incentives linked to birth complexity have been removed.’
    Are you able to explain more about this, or point me to somewhere where this practice (of incentives that encourage interventions and enthusiastic classification of high risk) is explained please?
    Many thanks!

  11. Thanks Sheena!
    I’m just trying to work out the ‘incentive’ part. How does a trust make money out of this? Is it as though the trust is able to pocket a margin on each bit of money they receive for each birth? (So a low cost birth would net a lesser ‘profit’ for the trust than a high risk/ intervention birth?)
    Thanks so much, Elizabeth

    • I can’t comment on this at all, it would be better to speak to a commissioner or a trust manager? I’m not working in the NHS now, and I believe each Trust will do things a little differently. Sheena 🙂

  12. Sorry Sheena – me again!

    Thanks again for replying. I’ll have a look at the NCT study, I’d personally like to see a lot more in hospital midwife units as that seems to be a great compromise for those like me who wanted a natural birth but felt reassured to know full hospital care was on hand just in case. In my case it also meant that when I needed that hospital my transfer was just down the corridor!

    The stats you give for the increased risk of intervention isn’t quite what I was looking for though. We know from the birth place study that 4 in 1000 planned first baby home births resulted in a negative outcome which would not have happened had the birth been planned for hospital.

    So what I want to know is how many hospital births resulted in an intervention or other negative outcome which would not have happened had the birth been planned for home/birthing centre?

    The 261,000/700,000 figure that you calculated is (if I understand you correctly) the number of women having hospital births who could have had out of hospital births. Surely not ALL of those actually suffered complications?

    If I get chance I’ll re-read the study myself but I was wondering if you happened to know as people can only really make a fair evaluation of the evidence when they have the comparable information for each option.

    • Hi again,

      Yes alongside birth centres are great for women who want a safety net close by…I think services should have both alongside and freestanding for the reasons in my blog post.

      I understand your request, but I am not aware of a study that investigated the exact number of confirmed unnecessary interventions. The estimated number I gave based on best available data was 261,000 and I quoted- ‘POTENTIALLY exposed to unnecessary intervention’. My point is that information is NEVER alluded to; only the risk associated with home birth. I realise that this isn’t ‘like for like’, but it is a fact even so.

      So how can women make a fair evaluation of the evidence, when it’s rarely articulated?
      Thanks for the questions-it’s great that you are interested….Sheena 🙂

      • Hello again Sheena,

        I’ve managed to find some more useful data on intervention rates.

        The BMJ paper from the Birth Place Study does give the intervention rates for each birth place but only for all women. However, the Which? Birth choice website (who presumably had access to the primary data) gives the intervention rates for the low risk first time mums group.

        This of course can’t tell us how many of the interventions were unnecessary, but then we also can’t tell how many of the “primary outcomes” were completely unavoidable so I think it makes a good basis for comparison.

        To avoid totally taking over your comments section, and because I can’t find anywhere else which has done so, I have put all this data together, as clearly as I can, in a post on my own blog. I’d be interested to hear your comments.

        http://southwarkbelle.blogspot.co.uk/2014/04/birth-choice-evidence-and-squishy.html

      • Thanks SB (we share same initials!) for interesting interpretation of the evidence. It’s great that we can have this debate. I really just want to clarify something to start with-I completely agree with you that choice is choice, and if women are requesting C-secition, epidural and hospital birth then their preferences are as important. The whole point of my post was to highlight the fact that we (HCPs ) haven’t been in a position until BP study was published, to give women as much information around the potential implications of their choice. We how have data to inform, but we don’t use it. For example, a woman choosing home birth has a risk assessment, but we never do that for women who decide to have their baby in hospital. The increased risk of unnecessary intervention isn’t usually articulated, and that’s we need to change.

        So my conclusion is that you and I are saying the same thing. It could be suggested that your view is clouded by your own experience-and that’s perfectly understandable. My view is too; I have witnessed over four decades the rise in intervention rates, no corresponding improvement in health outcomes for mother or baby, and increasing fear amongst pregnant women, midwives and obstetricians.

        As you say, we must try to make hospital birth better. Until then-we need to provide the facts around place of birth in a more balanced way. Best wishes, Sheena 🙂

  13. Hi Sheena, thanks for taking the time to read my post and respond to it.

    I very much hope that we are on the same side, and I actually agree with you on many things. Now that we have the data it should absolutely be used it to inform women. That’s why I think it is vital to make the data for intervention rates available too, which at the moment it doesn’t seem to be. I don’t really understand why that is.

    Out of interest – do you have a reference for the health outcomes for mother and baby v intervention rate? The only data I’ve found shows improving outcomes with time but I suspect very little (possibly none) of this is due to increased interventions as there have been so many improvements in other areas over that time.

    My views are of course influenced by my own experiences, as I noted in a previous comment on your blog. Personally I have heard far more about the risks of hospital and the benefits of “normal”/natural/home birth than vice-versa. This may well not be representative of all women, but I am certainly not alone. However, I have tried in the post to at least give the figures in as unbiased a manner as I can. I hope that will be helpful to some people.

    Thanks again for your comments.
    SB
    (Don’t tell anyone but I’m afraid those aren’t my real initials…)

  14. After I originally commented I appear to have
    clicked the -Notify me when new comments
    are added- checkbox and from now on each time a comment is added I receive four emails with the same
    comment. There has to be an easy method you are
    able to remove me from that service? Thanks a lot!

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