Independent Midwives UK (IM UK formally IMA) welcomes the findings of
the study that show the normal birth rate and established breast feeding
at six weeks for both high and low risk women cared for by independent
midwives is dramatically higher than a cohort of women cared for by the
NHS in Scotland. Low risk women are no more likely to experience a
stillbirth or a neonatal death if they are cared for by an independent
midwife. The apparent increased perinatal mortality rate for babies of
high risk mothers needs further investigation and IM UK welcomes the case
review study currently in progress to explore the possible reasons.
IM UK does however have major concerns about aspects the study.
Primarily there is no report of the full study to refer for details
necessary to effectively critique this article. The lack of a detailed
report would also make the study impossible to reproduce.
The size of the study severely limits its value when looking at
mortality rates. IM UK concerns are reflected in a recently published
article highlighting the risks of drawing conclusions from studies that
are weak in their design and methodology. (Estimating intrapartum-related
perinatal mortality rates for booked home births: when the ‘best’
available data are not good enough. G Gyte, et al BJOG Vol116, Issue 7, p
933-942 May 2009)
Issues such as whether the NHS cases were selected by computer or
manually to match the IMA cohort cannot be clarified and therefore bias
cannot be excluded.
Poor data collection in the NHS also makes a comparative study almost
impossible. For example home births were not recorded in the Scottish data
unless the woman was transferred to hospital following the birth. www.isdscotland.org/ Data about the use of different methods of
pharmacological analgesia (Entonox, opiates, epidural) is not available
for the NHS cohort, making only a generalised comparison possible and even
then, this relied on an incomplete data set. Breast feeding rates were
only recorded at the time of discharge from hospital in the NHS and this
was also incomplete but the figures are compared with the IMA cohort at
six weeks.
In the interest of safety and choice, IM UK urges the government to
ensure that independent midwives have access into NHS hospitals to care
for women the NHS will not support to give birth normally. Women with high
risk pregnancies such as breech and twins are increasingly told that a
vaginal birth is not an option within the NHS. Hiring an independent
midwife, who is skilled in these births, is often the only option.
However, most NHS organisations will not allow independent midwives to
deliver babies in their hospitals, forcing women to choose between a
caesarean in hospital or a high risk birth at home.
Independent Midwives UK
Competing interests:
Independent Midwives UK (formally IMA)
Rapid Response:
Independent Midwives UK Response
Independent Midwives UK (IM UK formally IMA) welcomes the findings of
the study that show the normal birth rate and established breast feeding
at six weeks for both high and low risk women cared for by independent
midwives is dramatically higher than a cohort of women cared for by the
NHS in Scotland. Low risk women are no more likely to experience a
stillbirth or a neonatal death if they are cared for by an independent
midwife. The apparent increased perinatal mortality rate for babies of
high risk mothers needs further investigation and IM UK welcomes the case
review study currently in progress to explore the possible reasons.
IM UK does however have major concerns about aspects the study.
Primarily there is no report of the full study to refer for details
necessary to effectively critique this article. The lack of a detailed
report would also make the study impossible to reproduce.
The size of the study severely limits its value when looking at
mortality rates. IM UK concerns are reflected in a recently published
article highlighting the risks of drawing conclusions from studies that
are weak in their design and methodology. (Estimating intrapartum-related
perinatal mortality rates for booked home births: when the ‘best’
available data are not good enough. G Gyte, et al BJOG Vol116, Issue 7, p
933-942 May 2009)
Issues such as whether the NHS cases were selected by computer or
manually to match the IMA cohort cannot be clarified and therefore bias
cannot be excluded.
Poor data collection in the NHS also makes a comparative study almost
impossible. For example home births were not recorded in the Scottish data
unless the woman was transferred to hospital following the birth.
www.isdscotland.org/ Data about the use of different methods of
pharmacological analgesia (Entonox, opiates, epidural) is not available
for the NHS cohort, making only a generalised comparison possible and even
then, this relied on an incomplete data set. Breast feeding rates were
only recorded at the time of discharge from hospital in the NHS and this
was also incomplete but the figures are compared with the IMA cohort at
six weeks.
In the interest of safety and choice, IM UK urges the government to
ensure that independent midwives have access into NHS hospitals to care
for women the NHS will not support to give birth normally. Women with high
risk pregnancies such as breech and twins are increasingly told that a
vaginal birth is not an option within the NHS. Hiring an independent
midwife, who is skilled in these births, is often the only option.
However, most NHS organisations will not allow independent midwives to
deliver babies in their hospitals, forcing women to choose between a
caesarean in hospital or a high risk birth at home.
Independent Midwives UK
Competing interests:
Independent Midwives UK (formally IMA)
Competing interests: No competing interests