Sunday, July 4, 2010

Shame on you, Auntie

On Stateline last week, there was a snippet about calls to change laws over stillbirth investigations (link is to video with sound). In a shocking example of "jouranlism", the story went from a woman who wanted her interuterine fetal death at 28 weeks (I'm guessing there - she said "7 months") investigated for some kind of explaination, to a beat up about homebirth. The woman's horrible experience had NOTHING to do with homebirth - she was under the care of a hospital and birthed there.

The tenuous bow that seems to have been drawn between these two stories was that one woman had her baby die in her pregnancy, and another had her baby die during birth, and that latter woman was birthing at home. The case of the latter woman has now rocked the entire concept of "life" because the assistant coroner seems to have an axe to grind about homebirth.

The findings of the case make for interesting reading (go on, read it - it's only 14 neatly formatted and well spaced pages). The assistant coroner seems to have ignored eminent experts in the area of cardio-thoracic medicine and has decided that something akin to the heat left in a boiled kettle, now constitutes life. Instead of leaving the Spencer-Kock family to grieve and live their lives, the decision has been made that their baby was in fact alive at some point and therefore is a "person" under the law and so the coroner has jurisdiction to investigate the death and make recommendations under other laws, like criminal law, against people involved.

This is a scary, scary path to go down. Life has to begin somewhere, just as it has to end somewhere. Funnily enough, the definition of life and the definition of death aren't the same thing - one can be dead but a teeny bit alive as is the case of organ donors. But the line in the sand has always been that "signs of life" be seen in a baby - heartbeat, breath, movement, crying, reaction to stimulus. If these are absent, and the baby is stillborn (oh how my heart aches to write that), then no investigation can be held, no charges laid, no blame attributed. This is a two-edged sword, no doubt - but it also means that until that baby is apart from its mother and is alive, it is not a person. Augh it's confusing and I'm sure someone has been offended by the way I've put it.

Anyway Lavender, as the president of the AMA in SA, then claimed in the Stateline article (yes I was getting back to my point) that homebirth is 7 times more likely to result in a baby's death, which is (a) not true, (b) not supported by any research the whole freaking world over, and (c) not what the recent Flinders University research said. The "data point" that Lavender is referring to ERRONOUSLY is the one I've previously blogged about and kind of indicates that not only is he an idiot, but he also didn't bother reading the study and only read the press release.

Add to that recent beat ups about homebirth being more dangerous with triple the neonatal (first month - hardly a lot to do with homebirth) death rate, which is hard to comment on as the actual study doesn't come out until September, and there is a lot of attack on the process from many sides. Add to that changes here in Australia to registration and insurance for midwives and you have a very muddy water from which to sup. I'm sure there's a line there about babies and bathwater but meh, I can't be bothered.

What I can be bothered with though is to say to the ABC - shame on you for such appalling and upsetting and shallow "journalism". You didn't check the facts, you didn't bother getting any other side of the story, you didn't stop to question what agendas might be being wheeled through your "story" and you certainly didn't bother to notice that a story about stillbirth suddenly turned into a witchhunt for homebirth.

And you didn't stop to think about what this means. Let's say that all stillbirths from 28 weeks onwards get investigated. That is a lot of deaths, firstly, because not all pregnancies end in a live baby. So the coroner is now overwhelmed with them. And what if the parents do not want an investigation? What if the answer is that someone is to blame, that something could have been done, that something could have changed the course of events? How would that help the family? Instead of supporting them, financially and socially, they'll be dragged through the courts. The coroner could then autopsy babies, which means that parts of their bodies can be kept for analysis.

And the funny thing is that hospitals, where 98% of births occur, will suddenly have to be party to many more inquests. And for what?

From Medscape Medical News

Less Medical Intervention for Home Birth Linked to Increased Neonatal Mortality Rate

Laurie Barclay, MD

July 2, 2010 — Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate vs planned hospital birth, according to the results of a systematic review and meta-analysis reported online first July 1 and will appear in the September 10 print issue of the American Journal of Obstetrics & Gynecology.

"The American College of Obstetricians and Gynecologists does not support home birth, citing safety concerns and lack of rigorous scientific study," write Joseph R. Wax, MD, from Maine Medical Center in Portland, and colleagues. "We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth."

Selection criteria for the meta-analysis were English-language peer-reviewed publications from developed Western nations, in which maternal and newborn outcomes were reported by planned delivery location. The investigators calculated summary odds ratios with 95% confidence intervals for these outcomes.

Compared with planned hospital births, fewer maternal interventions were associated with planned home births, including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. Women who delivered at home had lower rates of lacerations, hemorrhage, and infections, and their offspring had lower rates of prematurity, low birth weight, and assisted newborn ventilation.

Perinatal mortality rates were similar for planned home and hospital births, but neonatal mortality rates were significantly higher with planned home births.

"Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate," the study authors write.

Limitations of this study include those inherent in the included studies, self-selection of women for home birth, and insufficient data for some outcomes.

"Future research needs to be directed at identifying contributors to and reducing the apparently excessive neonatal mortality among planned home births," the study authors conclude. "Data regarding maternal mortality, maternal and newborn readmission rates and indications, and newborn neurologic injury are insufficient for evaluation and comparison.... Ideally, the results of such work will contribute to an obstetric and newborn best practices model benefiting women and children regardless of chosen birth location."

The study authors have disclosed no relevant financial relationships.

Am J Obstet Gynecol. Published online July 1, 2010.

1 comment:

Not Jenny said...

Thank you for sharing that article. I hate how the media twists things up so much. And really, those families don't need "experts" making them feel worse, they need space to grieve.

I know from experience that plenty of babies die in the hospital and no one can do anything about it. I was on the obs ward one night when a woman was delivering her 39 week baby who had died. She had the best OB in the city with her. I heard the doc say later at the desk that she had no idea what went wrong. What would be the point of pushing that further???
(I know I sound really cold there, but how can you soften typed words?)

I good friend of mine is considering home birth for her third baby. Her friends are trying to change her mind based on crap like this that they hear.

It makes me so angry and sad. I am trying very hard to be supportive of her, and considering the midwife who is assigned to her delivered two of my three, I really want her to have the same incredible opportunity I had, free of drama and angst.