The 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
The story does not seem to be tied a news release, and clearly draws from interviews with multiple sources.
Systematic, Criteria-Driven
We’ve written about the hype of liquid biopsies for years (see link in comment below). And now this…. https://www.statnews.com/2022/01/12/medicare-shouldnt-cover-liquid-biopsies-early-cancer-detection/
Case counts still matter. “(There) are stories that may not be told adequately if only hospitalizations and deaths are emphasized.” @garyschwitzer interviewed by @dbauder of @AP. https://apnews.com/article/omicron-changing-news-outlets-covid-data-da9272f7c4c8a109c3bfb56bed9e9c76
My friend Gary @garyschwitzer wrote to his city council representative in a Minnesota town about a Viva Las Vegas event scheduled for January.
The response he got seems to perfectly capture where we are now.
https://www.healthnewsreview.org/2021/12/2021-ends-with-covid-craziness-in-sports-and-politics/
Comments (1)
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Lee J. Siegel
October 5, 2015 at 11:43 amReminds me of a friend, a neonatal ICU nurse, who used to have a bumper sticker on her car reading: “Home deliveries are for pizzas”
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like