Birthplace in England: A Tale of Medical Reporting

A large prospective study comparing planned place of birth (home, hospital, freestanding midwife units, and in-hospital midwife units) for low-risk mothers in England, the BirthPlace study, was just published in the British Medical Journal. What has followed is a barrage of news headlines about the study--with drastically different conclusions.

If you click on the Daily Mail report, you'll be warned that "First-time mothers who opt for home birth face triple the risk of death or brain damage in child." TopNews Arab Emirates reports that "Motherhood is bliss but a minute mistake in planning the birth may lead to severe complications," while its US affiliate asserts that "According to a recent study, first time mothers should always opt for hospital birth." Even more dramatic is NewTonight's comment that home birth is "an extremely dangerous practice." (Definitely some one-upmanship going on here!)

If you're thinking that home birth is akin to traipsing over a minefield, you only have to turn to another set of news headlines that herald the opposite conclusion. "Study finds home birth is safe" proclaims the Peterborough Herald. "Women who have low-risk pregnancies should be able to choose where they give birth -- hospital, home or midwifery units -- researchers in Britain say," according to UPI. The Huffington Post declares that "over half of all pregnant women could give birth at home."

I've seen one report claiming that Professor Peter Brocklehurst, one of the study's authors, has "expressed disappointment that there is a significant increase in the number of first -time mothers who are planning to deliver their baby at home." (Granted, this was not a very reputable-looking site.) In contrast, the Huffington Post quoted Brocklehurst thus: "Birth isn't an abnormal process, it's a physiological process. And if your pregnancy and labor is not complicated, then you don't need a high level of specific expertise."

If news reports are this conflicting, imagine what's going on in the blogosphere. "SEE I TOLD YOU HOME BIRTH KILLS BABIES!" is coming from one corner of the net, while "SEE I TOLD YOU HOME BIRTH IS SAFE!" is coming from another. This controversy will keep certain bloggers entertained for months.

At this point, a reasonable response would be "what the $#@! is going on? Can't anyone agree on anything?"

Another reasonable response would be "So what about midwifery units? All the hullabaloo has focused on home and hospital birth and left out the other two studied locations!" 

This is how I'm feeling right about now:

I'm not going to tell you what to think. But here's where I'd suggest starting:

1. Read the original study.
2. Read the official National Health Service discussion of the study's significance and ramifications.
3. If your statistical skills are a bit rusty, you can polish them up over at Science and Sensibility's statistical discussion of the study.
4. Another statistical examination of the study: Are homebirths really risky? at Statistical Epidemiology

Original Study
Birthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400

Project details, including qualitative case studies and economic analysis
http://www.sdo.nihr.ac.uk/projdetails.php?ref=08-1604-140

News reports emphasizing risk

• Home birth 'carries higher risk' for first-time mothers BBC News
• First-time mothers warned over home birth risks The Daily Telegraph, November 25 2011
• Home births three times more risky than hospital, says study Metro, November 25 2011
• Women with low-risk pregnancies 'should have birth choices' The Guardian, November 25 2011
• First-time mothers who opt for home birth face triple the risk of death or brain damage in child Daily Mail, November 25 2011
• Home as safe as hospital for second births The Independent, November 25 2011
• Home birth risks up for new mums The Sun, November 25 2011
• Home Birth Imposes Higher Risks for First-Time Mothers MD news press release
• Home birth riskier for first time moms Press TV
• Home Birth Can Be Dangerous for a Baby TopNews Arab Emirates
• Hospital Birth Safer As Compared To Home birth TopNews United States
• Home birth 'carries higher risk' for first-time mothers International News Network
• Home births riskier for first-time moms: Study IBNLive

News reports emphasizing safety

• Study finds home birth is safe Peterborough Today (UK)
• British researchers OK birthing options UPI.com
• Home Birth a Good Option for Second-Time Moms Associated Content
• British Study: Half Of All Pregnant Women Could Give Birth At Home Huffington Post
• England study: Low-risk births don't need hospital Aurora Sentinel