Science, politics and headlines

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Australian journalist Melissa Sweet writes in the BMJ this week (subscription req’d for full access) about “Science, politics, and headlines in the home birth war,” regarding a recent study published in the Medical Journal of Australia

She raises questions about journal editorial practices, journal news release practices, and news coverage that relies on those news releases. (Disclosure: she interviewed me for the BMJ article.) Excerpt:

“Last month the Medical Journal of Australia published a study on outcomes of home birth that generated many media stories sounding the alarm about the safety of such births.

Many stories focused on the study’s findings that babies were seven times more likely to die during labour in a planned home birth and in particular were 27 times more likely to die from asphyxiation.”

Some also did mention the finding that there was no significant difference in the overall perinatal mortality rate between planned home births and those planned for hospital delivery.

These were also all findings highlighted in the media release accompanying the journal, which made no mention of uncertainty surrounding the relative risk estimates. The confidence interval for both was wide: 1.53 to 35.87 for intrapartum deaths and 8.02 to 88.83 for deaths from intrapartum asphyxia.

Other questions she raises:

• the journal news release didn’t mention the numbers of deaths involved or the absolute risks.

• “Nor did it mention the authors’ caveats that ‘small numbers with large confidence intervals limit interpretation of these data” and that ‘in the 16 year study period there were only three perinatal deaths for which one can reasonably assume that a different choice of care provider, location of birth, or timing of transfer to hospital might have made a difference to the outcome.’ “

• the news release quotes an obstetrician who is president of the Australian Medical Association and who wrote the accompanying editorial. The association, Sweet reminds readers, “which owns the Medical Journal of Australia, opposes home births and has been at loggerheads with nurisng and midwifery organizations over propoed reforms of maternity services in Australia.”

• One homebirth advocate said that most of the journalists who interviewed her “said they had not read or even sourced the study.”

Sweet has also written about this in more detail on the Croakey health blog.

If you’re interested, here are links to related materials:

• The study on homebirth outcomes.

• The journal news release.

• Other posts on the Croakey blog about this issue.

Why is this worth the attention? Because it’s a case where research – and how it’s published and intepreted – could affect public health policy. It happens all the time. We just don’t often see it broken down as well as Sweet did in this case.

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Lori P.

February 25, 2010 at 12:01 pm

One quibble: although the confidence intervals may indeed be wide, they do not include zero. Therefore, we can conclude that there is a significant increase in the risk of death; we just don’t know how big that risk is. A CI of 1.53 to 35 means the increase in relative risk could be as low as 53% to as high as a 35-fold increase.