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Archive for April, 2008

Home birth Safety - some clarification

Monday, April 7th, 2008

I have just had correspondance with Dr Phil Steers, Editor-in-Chief of the British Journal of Obstetrics and Gynecology, who was interviewed last week in response to the new publication on home birth. He kindly responded to several queries I had regarding the study, and so much of what he said was so useful in light of the current debate that I think it is important to pass on some of his wisdom. Firstly ,the statistics for the Netherlands, which I referred to in my last blog and which are still so often bandied about, are actually hopelessly out of date. In fact, it was some twenty years ago that the Netherlands had some of the best outcomes in the Western world. Now, as their home birth safety rates have not fallen in line with hospital rates, they now lie near the bottom of the league table, at 24 out of 25. Many a book and website needs updating it seems!!

Having said that, we should still not be so alarmed as to dismiss the idea of home birth altogether. Whilst on average one in four first time mothers need to be transferred during their labour, that does not mean that one in four come up against serious problems. Often the transfer is precautionary- because there are signs of foetal distress or labour might be stalling- and yet these are rectified with little or no intervention. Similarly, women who decide thay would like an epidural are included in these statistics. Whilst those in the transfer group face considerably more chance of things going wrong, Dr Steers emphasised that it is important to look at these bare-faced statistics in a much wider context. To question the safety and danger of home birth vs hospital births as absolutes is a futile exercise and misses several points. The first is that in either setting the risks of problems is low compared to several generations ago and the developing world. Secondly, risk is everywhere. We take a risk every time we walk out the door. When making dcisions about where it is best to birth, risks need to be weighed up against the benefits, and women- in conjunction - with their carers can then decide what is best for them. As Dr Steers said, ‘When you go for a home birth you might get the best, or the worst. The problem is, we are not good at predicting which’. No birth setting is perfect, and the right place for one woman will not necessarily be so for another. As the overall risks for women and babies are now very low, a woman’s personal sensibilities and her emotional preferences need to also be taken into account, especially when they are based on a good understanding of both the science and the physiological needs of a woman in labour. Whether it is the mother’s first or second birth should also be considered significant- for second time mothers who have had a previously successful spontaneous birth, the likelihood of transfer from a home birth is only 5%. As with many things, the choice as to where to give birth is a balancing act, but one that should be taken from a position of maximum knowledge. I reiterate it is always important to delve beneath the headlines, whoever might be writing them. Balance doesn’t often make for very good stories……..

The Safety of Home Births

Monday, April 7th, 2008

In the most recent issue of the British Journal of Obstetrics and Gynaecology, an article was published suggesting that home births that encountered problems were less safe than hospital births. This was reported in recent articles in both The Telegraph and The Guardian. This is an important finding, not least because it refutes the previous research that concluded that planned home births were at least as safe as hospital births for low-risk pregnancies. It is essential hat we take heed of research such as this, and do not simply refute it because it is not smething hat we want to hear. We also need to be careful not to be reactionary and end up throwing the baby out with the bath water.  Studies like these do, and should prompt healthy debate and further research. And it is essential that we dig beneath the headlines ( note how different they were depending on the newspaper) and work out what the possible reasons for such findings might be. If the conclusion of the research was that home births by their very nature were inherently more risky, then how do we account for the birth outcome statistics in Holland- which are some of the best in the Western world- and thier unusually high home birth rate at around 30%. Equally how does Ina May Gaskin, famed for her birth practice on The Farm in Tennessee manages to have a c-section rate of only 1.4% and a transfer rate of only 13% inlcuding postpartem transfer, when her births are always at home or at her home-from-home centre. ( There is an interesting article on home birth safety on their website)

Instead of simply labelling home birth as dangerous, it is essential that we establish why, if the data is correct, it might be dangerous in some situations and not in others. And based on this, we need to make provisions for the minority who might still choose to birth at home, to ensure that being at home is made as safe as it can be. In scenarios such as these, scare-mogering headlines are not at all useful. What we need is to establish what the science is really telling us, and act accordingly.

Go gently

Monday, April 7th, 2008

A recent review of our dvd on amazon advised women to go to a class before doing yoga by dvd at home. Although she enjoyed the dvd and gave it a good review, she found that her pelvis had begun to hurt a little after the practice. I can not emphasise enough how important it is to be easy on yourself with yoga for pregnancy. During pregnancy a hormone called relaxin is produced by the body that works to soften the ligaments in preparation for birth. Whilst this is ultimately beneficial, as it helps the pelvis to open for birth, it also means that you need to exercise caution when doing any exercise as the potential for over-stretching is there. I always say in my classes, and on the inside of my yoga dvd, it is essential that you work gently and well within your comfort zone. Before starting yoga practice, with a teacher or at home, seek advice from your midwife. For the vast majority of poeple, gentle yoga will be a help not a hinderence during pregnancy, but only so long as you are not already suffering from sdp or dsp, and that you do not get over-excited by your potential newfound flexibility and push yourself accordingly.

The beauty of yoga is that it does not require you to push yourself hard or to be in outlandish positions to be effective. You can do moderated or simplified versions of each pose - with your legs together and knees bent etc- and still the physical benefits of improved posture, circulation, a stronger more aligned pelvis and spine and better breathing. Additionally, the benefits of yoga are not simply physical but also mental. The time to focus on your breath, your baby and yourself is essential- and in our fast paced world somewhat rare. It is also necessary during birth to allow the back part of your mind, that primal instinctive brain that tends to take a back-seat in day to day living, to come to the fore and play its essential role during birth- and the best way to aid that process is with gentle yoga practice before the birth.

So in all ways during pregnancy, be gentle on yourself and allow both your body and your mind to release and relax slowly and with ease. And if you find that even gentle practice causes you any pain at all, then please discontinue doing yoga and speak to your midwife.