The truth about pregnancy
Reported January 16, 2009
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.