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Posts Tagged ‘Stillbirth’

Two days ago I received a Google alert regarding Independent Midwives, the link provided was to the Nursing Times, and the precis supplied indicated that a recent study had found that there were increased risks of stillbirth or neonatal death in pregnancies and births booked with Independent Midwives. I started reading the article ‘ Stillbirth more likely with independent midwives, says study’ and immediately realised that either the study was intrinsically flawed, or that the author of the NT article, Clare Lomas, had not interpreted the study correctly.  I was certain that IM would have something to say about the study so I made them my next click. As I started reading their response to the study I began to suspect that the sensationalist headline in the Nursing Times had been just that, and that the detail of the study was revealing more than the increased stillbirth rate being associated solely with the care provided by IM’s.

My next click was to the study in the BMJ, “Outcomes for births booked under an Independent midwife and births in NHS maternity units: matched comparison study”. When I read the title I began to argue, how on earth could you do a ‘matched comparison’ and why not compare like with like, NHS homebirths and IM homebirths? As I pondered this I realised that the reason it was NHS hospital was because NHS homebirths are generally low-risk, whereas IMs have a high proportion of women who have been refused homebirth by the NHS due to being considered high risk. An editorial, also in BMJ, points out the shortfalls in the research study eloquently without detracting from the positive aspects.

So, what were the outcomes? If a woman employs an IM for her low-risk pregnancy and birth is she placing her unborn baby at higher risk of mortality? No, there is not a significant difference in perinatal mortality. However, if the pregnancy is a twin or breech birth then there is a higher perinatal mortality rate. There are other factors which were discovered in the study; “Women attended by an independent midwife were more likely to go into labour spontaneously, less likely to require pharmacological analgesia, more likely to achieve unassisted vaginal birth, less likely to give birth prematurely, and more likely to breast feed”.

Sounds pretty positive to me, if you are low-risk, but if you read the title of  The Times report of the study findings “Risk of stillbirth ‘tripled for women who have their babies at home'” you wouldn’t think that, and then just see how the article starts – ‘Women who give birth at home with an independent midwife are nearly three times more likely to have a stillbirth than those who give birth in hospital, a study has found’. The reporting does become slightly more balanced after that but the sound bite has happened and what some will inevitably take from this is that 1) Homebirth is dangerous 2) Independent midwives are especially dangerous. Is this biased or just sensationalist headlining as it’s certainly not balanced or accurate?

Yes, I’m annoyed by Nursing Times and their cheap swipe at IM’s, and I’m saddened that The Times should resort to cherry-picking findings to lure readers. What these publications should have done was to disseminate the findings and realise that accuracy would advise a title like Nursing in Practice’s ‘Study calls for urgent review of  NHS and independent birth care’  or the  BBC’s ‘Urgent’ birth care review needed’. They are honest titles which both report the conclusion the study leads the reader to arrive at.

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Work is manic at the moment. One of our team is off sick with………..chicken pox and another 2 are on annual leave. I have been finishing over an hour late everyday, getting home and then spending another hour making phonecalls and doing all my paperwork.

The couple whose little girl was stillborn were having an especially sad day today as it was today that their baby was ‘due’. The results of the postmortem are expected on Monday, I’m visiting them on Sunday but then I’m off until Friday so I’ve given them my mobile number, just in case they need a chat when they have received the results, if there are any. I know that sounds strange but that’s how it is sometimes, there is no reason found as to why baby did. I suppose that there are different ways to look at a ‘non’ result like that. It could. perhaps should be seen as positive as there was no abnormality found with the placenta or any problem with baby so it would not indicate any reason as to why the next pregnancy should not result in positive outcome. However, a different perspective from the parents point of view may be that it happened for no apparent reason before, why not in subsequent pregnancies? I do know though that, if they go on to have another baby, they will be hugely anxious as they approach and enter the weeks when their first baby stopped moving in the womb.

Last weekend Nanny and Grandad had Jack, Amy and Izzy to stay. I was anticipating bedlam, instead I had a wonderful cuddly time with 3 really angelic (most of the time) grandchildren. On Thursday I took the twins, Jamie and Louis, to a local open farm, it was a messy, glorious affair! I’ve invested in a set of twin reins, they go around my waist and then the boys are attached to me, rather like 2 huskies pulling a sledge, I think we provided an interesting side-show for the other farm visitors.

Jack has, finally, developed chicken-pox. He has taken so long about it that we thought that he may have immunity, we were wrong. His Mummy reported that he had said he was really tired this evening, and then when he had his bath 10 spots were spotted :). When they told him he had the pox he slowly took himself upstairs, got into his bed and announced that he was ‘very poorly’. What a man.

twinrein_011

Not me, or ‘the boys’.

We had all, including son, though that his ulcerative colitis was a thing of the past following his total colectomy and ileostomy, this isn’t the case though. What none of us had appreciated was that a short length of bowel is left behind and, obviously now we know, that is still affected by UC. Son doesn’t go into great detail but from the comments he has made it was starting to cause him discomfort, so he is back on medication. Nasty, nasty disease.

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