Sunday, April 08, 2007

"Kindly confine yourself, Ms. Hewitt"

I have written before about NICE's intrapartum guidelines that indicate that homebirth has an excess risk of preventable neonatal death in the range of 1-2/1000. I also wrote about the government's efforts to suppress the NICE findings. A draft of a revised NICE report (revised because NICE's original claims of the dangers of homebirth were greeted with criticism by homebirth advocates like the Royal College of Midwives) still maintains that homebirth has an increased risk of preventable neonatal death. The final report will be released in September. Carol Sarler, writing in today's Guardian UK, suggests that the NHS announced its plans to increase homebirths now, before the final NICE report that establishes the dangers of homebirth.

Sarler writes in Kindly confine yourself, Ms. Hewitt:
Patient choice, perhaps the craftiest currency in the political purse, was jingle-jangling for most of last week as Patricia Hewitt announced that, by 2009, all pregnant women would be able to choose a home birth. 'Clearly,' she said, as she always does say, 'far more women out there would like to have home births.' Equally clearly, if you listened to her language, she would like far more women to have them, too.

There was lots of 'more' and 'increase' and 'priority' and 'guarantee' and 'gold standards' ... Among the words wholly absent from the rhetoric, however, were 'risk' and 'danger'. Which, under the circumstances, is puzzling...

... She was happy to promote home births with passion - albeit, according to reports yesterday, without provision for the extra numbers of midwives that would be needed. At no point, however, did she acknowledge that the relative safety of babies born at home, against those born in hospital, is under new scrutiny.

In June last year, the National Institute for Health and Clinical Excellence (Nice) consulted for a guideline on care during labour. On only one matter has it been forced back to the drawing board: on that of places where women give birth. While Nice accepts that women should be able to choose between home, midwife-run birthing centres or hospital wards run by consultant doctors, it expects them to do so following discussion with their doctor or midwife. Crucially, however, Nice has 'identified a significant gap in the available evidence on place of birth' and says: 'More research and monitoring at a national level is needed to inform healthcare professionals' understanding of the risks and benefits of different settings...'

... And so the questions niggle: why didn't she mention it? Why didn't she wait until September, when she might have been able to append Nice's recommendations? Did she pre-empt them for fear that they might not, after all, suit her purposes?
Sarler's doubts seem entirely justified by the fact that the government has no intention of providing either the funding or personnel to safely implement the plan. Yesterday's Guardian UK contained this article, Figures show Hewitt's birth care promise is unattainable:
Six out of nine English regions have too few midwives to achieve even the basic level of care for families before, during and after the birth of a child, figures obtained by the Guardian reveal.

The chronic shortage of midwives means that the government's promise this week to offer all women a choice of a home, hospital, or midwife-led birth by 2009 cannot be met...

The health secretary, Patricia Hewitt, confirmed this week that the £1.7bn annual budget for maternity services would not be supplemented to see the plans through.
The NHS decision to promote homebirth is cynical in the extreme. Homebirth is not as safe as hospital birth, even under ideal conditions, and the government has no intention of providing the personnel required for conditions to be ideal. Homebirth is being promoted because it is a substandard form of care that requires fewer NHS resources. "Choice" is pasted on the plan to make a virtue out of an unsafe effort to save money.


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