You know the dilemma. There’s this small scab, you know you shouldn’t pick it but you just can’t resist it. Once you think about it you can’t stop the compulsion, and next thing you know you’ve given in and you’re picking at it. Immediately you regret it, but it’s too late, and you can’t turn back the clock. Well, Homebirth Debate is my scab. I know that reading it can make my blood boil but I still find myself just taking a little peek, and then spluttering my disagreement at the screen.
The problem is that it isn’t always Dr Amy who riles me, in fact sometimes I even find myself agreeing with her because one of her commentators, generally a UC*, has come out with some statement/assertion so frightening that I want to shake her. Back to Dr Amy Tuteur and her latest offering ‘Primum non nocere’. I found it so paternalistic that I just had to comment and then read every other comment. Someone, who obviously has a similar outlook to Dr Amy wrote ‘but external monitoring is simply the standard of care’ Is that true? Well, it isn’t according to NICE, in fact that august body states ‘This reduction has not been demonstrated in the systematic reviews of randomised controlled trials (RCTs) T. Furthermore, However an increase in maternal intervention rates has been shown.’ and then ‘Current evidence does not support the use of the admission cardiotocography (CTG) in low-risk pregnancy and it is therefore not recommended.‘ You see, I started off being annoyed by the authors interpretation of beneficence and quickly moved on to having issues with one of her commentators.
Dr Amy maintains that she doesn’t believe that every woman should have a caesarian section, however she certainly appears to support their unrestricted use and definitely holds them in higher esteem than homebirth. When reading some comments from UC’s I can appreciate why Dr Tuteur is so persistent in her support of medically controlled childbirth, but I still end up with the feeling that Dr Tuteur chooses to ignore facts about CS which really should be taken into account when reviewing their long term effects. It was in 2005 that the results of research demonstrated a relationship between lower fertility, whether through choice or chance, and a previous caesarian. One of the known causes for this is the scarring of the uterus which can reduce the places for the fertilised egg to implant successfully. If the embryo does implant there is a higher incidence of placenta praevia , uterine rupture and placental abruption, all of which can cause stillbirth and maternal mortality. At the time of a caesarian section, disregarding the risks associated with any major surgery, there is a greater risk of an haemorrhage, which could lead to the necessity for a hysterectomy, than there is with a vaginal birth. I really believe that these are all incredibly important facts. I do appreciate that Dr Amy is concerned about the present pregnancy and birth, but I really would like her to acknowledge the potential impact of a caesarian section on the woman’s future fertility with the same enthusiasm as she points out the potential risks associated with a professionally, attended homebirth.
* UC – Unassisted childbirth (Freebirthing)