It’s time to give mums-to-be a break from pregnancy scare stories — having
babies is actually getting safer
In a week of gloom there was one cheerier piece of news: the risk of
epidurals, anaesthetic injections into the area around the spine, is lower
than that previously stated. In fact, according to research from Bath's
Royal United Hospital, it is ten times less.
Epidurals are used in surgical procedures but also to kill pain in mothers
giving birth, when the risk of permanent harm is less than 1 in 80,000. In
the past many mothers may have been put off having this effective form of
pain relief because risks have been overstated.
These headlines were particularly welcome because there is practically no
other area of health where risk of any sort assumes such significance.
Pregnant women are risk magnets, attracting every sort of scare about
potential damage to their babies at a time of their lives when they are most
fearful, for themselves and for the new life they carry. Not only are food
scares (too much liver, too much fish, etc) aimed squarely at mums-to-be,
but there are also horror stories about the maternity services. The irony is
that the perception of risks may be more harmful than the actual risks.
For example, home birth has regularly been claimed to be too risky, and
women who have wanted home births have been generally obstructed, demeaned
and made to feel irresponsible by doctors in particular. In reality, for
normal pregnancy, home birth appears to be safe, as Charlotte Church
demonstrated conclusively this week as she had her second baby at home. And
a home environment may even offer a small reduction in risk as far as
infection is concerned.
You would think from the headlines that Britain wasn't a very safe place to
have a baby. In the past couple of months we have seen stories about
negligence payments for maternity claims topping £1 billion and about the
chronic shortage of midwives. This in addition to the endless succession of
stories on bad births that we are all exposed to - just a couple of weeks
ago, for instance, a woman in Edinburgh gave birth in a bathroom by herself.
But the headlines do not reflect reality. Negligence claims, for example,
relate to events that occurred a decade ago and involve the few, not the
many. Evidence from the confidential inquiry into maternal deaths (and
Britain keeps scrupulous records in comparison with some other European
countries) make it clear that Britain is one of the safest places to have a
baby, with a perinatal mortality rate standing at 7 per 100,000 and falling.
Compare that with the US, where the comparable rate is 15 to 20 per 100,000.
My first job, 25 years ago, was working for the Royal College of
Obstetricians and Gynaecologists. I remember quoting the perinatal mortality
rate in the UK at the time. It was 18 per 100,000. The extraordinary
progress that has been made since is not simply a reflection of better
overall maternal health but of improvements in maternity services, which are
in the process of being made even safer.
Yes, there is a shortage of midwives, but there has been a government
commitment to increase their number and of obstetricians in line with the
rising birth rate and to make maternity care available as early in pregnancy
as possible. This last point is important because “bad” maternity units,
often quoted as if they were the norm, are usually those with high
proportions of immigrants, who may appear for care only when they are
already in labour.
And as for the bad-birth stories, let's be honest, the good ones aren't that
interesting, are they? The Commission for Healthcare Audit report on
maternity services in 2007 recorded that nine out of ten women rated their
care in labour and childbirth as good or better. It would be a tragedy if
headlines persuaded women otherwise.
