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Home birth vs. hospital: Strong WSJ evaluation of new UK guidelines

Rating

4 Star

Tags

New Support for Home Births U.K. board NICE, in a surprise, rules having a baby at home is safer than a hospital in some low-risk pregnancies

Our Review Summary

iStock_000046032846_SmallThe story looks at guidance from the UK’s National Institute for Health and Care Excellence (NICE) — and related research — to pregnant women. Specifically, the guidance says home births pose fewer risks than hospital births for woman with low-risk pregnancies who are not having their first child. The story features plenty of expert views on both sides of this issue and is well-reported overall. However, it does little to explain the difference in risk between home and hospital births to readers — and it never defines what constitutes a “low-risk” pregnancy in this context.

 

Why This Matters

Giving birth is an intensely personal experience, and therefore the decision about where to give birth is an extremely personal decision. It’s also a decision that can affect the health and well-being of both mother and child. More than 3.9 million children were born in the U.S. in 2013, so this is clearly a subject that affects a great many people, and the range of factors that come into play when making that decision is significant. A story that specifically highlights a reported reduction in risk for at least some home births should be sure to clearly articulate that difference in risk, and to explain precisely how those risks change for both mother and child.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not address cost at all. The story is focused primarily on childbirth practices in the U.K., which has a significantly different healthcare system from that in the U.S. However, the story does discuss childbirth practices in the U.S., and speaks to U.S. experts on the subject. Home births are often significantly less expensive than hospital or birth center deliveries, but there are still costs involved. The story would have been stronger if it had addressed this, even in broad terms.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story addresses benefits in only general terms. For example, when summarizing the NICE guidance, the story states “home births are safer than hospital births for women who are having their second or later child with a low-risk pregnancy.” And when describing the findings of the U.K. study that was the basis for the guidance, the story notes that “among low-risk women who chose to have a second or later child at home, there were fewer interventions and complications, such as cesarean sections, forceps delivery, infections and hemorrhage compared with hospital births, while the health of babies didn’t differ.” How much safer are home births under the relevant circumstances? How much lower was the risk of complications? It would be helpful to have at minimum an estimate of a summary figure, such as the frequency of complications and interventions overall for home and/or hospital births. In addition, while the story makes clear that the reduced risk is only for women with low-risk pregnancies — it doesn’t tell readers what that means. Does having had a previous C-section rule out a low-risk pregnancy? Which chronic medical conditions might rule a low-risk pregnancy out? It’s not clear.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

Potential harms are mentioned at different points in the report: maternal deaths; interventions and complications, such as cesarean sections, forceps delivery, infections and hemorrhage compared with hospital births; “complications” for the babies. But the story does not really explore the difference (if any) between risks that would be of potentially greater concern during home birth versus hospital birth — or vice versa. The story does note that the U.K. study behind the guidance found that there was a slightly increased risk of complications for babies born at home if it was the mother’s first birth. We’ll rule this Satisfactory with suggestions noted for next time.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story reports on an expert guideline published last spring that draws on a high-quality UK cohort study (Birthplace) and a Canadian case-control study.The story offers a broad overview of the cohort study that served as the basis for the NICE guidance. The overview would have been stronger if it had offered some additional details, such as information on the likelihood of complications for mothers and infants in both home and hospital settings. However, the story did include a link directly to the relevant research, which is always laudable. The story also offers limited details about the Canadian case-control study — but again the story linked directly to the study. One thing that’s missing from the discussion is any explanation of the hierarchy of evidence — how these two studies differ from one another and how the evidence they provide might compare to, say, a randomized trial.

Does the story commit disease-mongering?

Satisfactory

No disease mongering here. The story was very careful not to over-hype risks associated with giving birth, whether at home or in the hospital.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

This was a strong point for the story. The story cites multiple sources on both sides of the issue, and clearly notes when a given source has written about the issue and what that source’s position was.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story is, by its nature, about comparing alternatives. The story looks explicitly at home births compared to births in medical centers; and, among medical centers, the story explains the difference between hospitals and birth centers.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

This is another close one. The story does explain the difference between hospitals and birth centers, but doesn’t let readers know how common birth centers are in the U.S. Nor does it mention the availability of midwife services for home births, which can vary by state. However, the story does cite one U.S.obstetrics expert as saying that more birth centers could be established. Because the story addressed the issue, at least tangentially, we’ll give it the benefit of the doubt.

Does the story establish the true novelty of the approach?

Satisfactory

The novelty here, which the story emphasizes, is the evidence-based statement from an expert medical group that hospital births may be riskier than home births for uncomplicated second or later pregnancies.  It is unusual to see a medical group recommending against a higher level of medical intervention.

With that being said, there is a fairly broad body of work on risks associated with childbirth, and home birth in particular, but the story only mentions the U.K. and Canada studies we noted above. While other research findings may not offer as convenient a comparison to the study used to inform the NICE guidance, they could help readers understand the levels of absolute risk facing mothers and infants at home, in hospitals, or at birth centers. And if the U.K. and Canada studies offer insights that were simply not to be found in other work, that would have been worth mentioning too.

But the story earned a Satisfactory here.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not seem to be tied a news release, and clearly draws from interviews with multiple sources.

Total Score: 8 of 10 Satisfactory

Comments (1)

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Lee J. Siegel

October 5, 2015 at 11:43 am

Reminds me of a friend, a neonatal ICU nurse, who used to have a bumper sticker on her car reading: “Home deliveries are for pizzas”

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