Re: [ozmidwifery] me too - my letter to Miranda

[Susan Cudlipp]

Well said indeed!   Sue "The only thing necessary for the triumph of evil is for good men to do nothing" Edmund Burke ----- Original Message ----- From: Janet Fraser To: ozmidwifery@acegraphics.com.au Sent: Thursday, September 29, 2005 1:22 PM Subject: [ozmidwifery] me too - my letter to Miranda I gave in. I couldn't bear it any longer. J <- apparently proud to hang out with the zealots....       Ms Devine, I am at a loss to understand why you are promoting such appalling medical misinformation. You have provided no evidence and obviously misunderstand the importance of normal physiological birth to healthy babies, and the physically healthy and emotionally intact mothers who must care for them. Your childish depiction of those of us who oppose the poorly evidenced medical model of birth in favour of the internationally recognised standard, is inaccurate in the extreme. I am a consumer who researches and makes choices on the available worldwide evidence, and despite scaremongering by obstetricians, and illinformed persons like yourself,  the evidence remains the same. Routine obstetric care leads to high rates of unnecessary and dangerous interventions and concomitantly poor outcomes for mothers and babies. Let me give you some actual evidence because you have none. Citing a number of undeniably tragic case studies, given by a leading opponent of evidence based care, namely Pieter Mourik, and presenting it without references does not a case make.   The World Health Organisation states clearly in it’s 1996 publication “Care in Normal Birth: a practical guide” ( http://www.who.int/reproductive-health/publications/MSM_96_24/care_in_normal_birth_practical_guide.pdf)   that routine obstetric care is potentially dangerous and just plain inappropriate for most women. “Women and their babies can be harmed by unnecessary practices. Staff in referral facilities can become dysfunctional if their capacity to care for very sick women who need all their attention and expertise is swamped by the sheer number of normal births which present themselves. In their turn, such normal births are frequently managed with "standardised protocols" which only find their justification in the care of women with childbirth complications”. A study of 1765 women published in the British Medical Journal in 1996 concluded that “Routine specialist visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit.”(http://bmj.bmjjournals.com/cgi/content/abstract/312/7030/554 ) We  know from Australian studies that the outcomes of our private hospitals and private obstetricians are very poor even when compared with our deeply flawed public system. “ medically 'low risk' multiparous women who gave birth in a private hospital with a private obstetrician were less likely to have spontaneous onset of labour, more likely to have induction and/or augmentation, less likely to have a vaginal birth and significantly more likely to have obstetric interventions at birth. They were also more likely to have an elective or an emergency caesarean section. These women were twice as likely to have an episiotomy for a vaginal birth 19.2% v 7.0% and three times more likely to have an epidural 31.3% v 9.2%.” (Rates for obstetric intervention among private and public patients in Australia: a population based descriptive study. BMJ 2000; 321: 137-141) In Ireland, the MDU found that maternal deaths accounted for 8% of all maternal negligence claims taken against obstetrician/gynaecologists from 1978-1998 (The MDU, Ireland, 1998) – a clearly appalling death rate. WHO drew attention to the overprevalence of caesarean back in 1985 and yet our rates are inexorably rising as we continue to employ surgeons as primary carers. What effect does this have? To quote Marie O’Connor, “National surveys on maternal deaths in the United Kingdom (Hall and Bewley, 1999) show that while the mortality rate for all caesareans is six times that of vaginal birth, the fatality rate in elective caesareans is three times that of spontaneous or unassisted birth. The principal risks posed by caesarean delivery to the baby are iatrogenic prematurity and respiratory distress syndrome.” As Peter S. Bernstein has noted  “Unfortunately, much of the change in practice related to caesarean delivery has not been supported by evidence-based medicine; nor has there been a demonstrated improvement in neonatal outcomes with increasing rates of caesarean delivery.” (COMPLICATIONS OF CAESARIAN DELIVERIES (MEDSCAPE) Author: Peter S. Bernstein, MD, MPH)     The reality is that a safe birthing environment is one in which evidence based practice occurs, and this is obviously not with obstetricians, who are surgeons, and not experts in normal physiological birth. How do we know this to be fact? Because the best, safest outcomes occur worldwide in planned home births with a midwife in attendance and obstetric care available only if required. Again, the evidence is clearly in favour of obstetrician-free space. Any number of studies show over and over ad nauseam that hospitals are not safe places for birth.  A 1996 study concluded that “perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables.” ( BMJ 1996;313:1309-1313 (23 November) http://bmj.bmjjournals.com/cgi/content/full/313/7068/1309) and a 2000 study showed that “There is no evidence that hospital is the safest place to give birth.” (BMJ. 2000 Mar 18;320(7237):798.)   The most recently published BMJ study of home birth covered a population of 5418 women in North America and Canada who were attended by midwives - somewhat larger than your 12 alleged cases. It showed a caesarean rate of 3.7% in all women which is immeasurably superior to any in Australian hospitals. (http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom)  Caesareans are not routine procedures but life threatening surgery which should only be attempted if the risk of death from it is less than the risk of pursuing a vaginal birth in the circumstances. If we look to the BMJ again, we learn that "Caesarean sections are not without complications and consequences. Maternal risks in the short term include haemorrhage, infection, ileus, pulmonary embolism, and Mendelson's syndrome. The prevalence of hysterectomy due to haemorrhage after caesarean section is 10 times that after vaginal delivery, and the risk of maternal death is increased up to 16-fold. (BMJ 1998;317:462-465 ( 15 August ) http://www.bmj.com/cgi/content/full/317/7156/462) In case you’re missing the point here, employing an obstetrician as your primary carer leads to higher rates of unnecessary intervention and surgery which has life threatening risks for mothers and babies. So unless you have access to more studies than the World Health Organisation, the Cochrane Review and PubMed, or more insight than the authors of countless published studies on large populations, I suggest you take some time to have a rethink about your prejudices which clearly have no foundation in truth. Many people are sucked in by misinformation but in the public position you hold in a major daily newspaper, it ill becomes you to peddle myths and superstitions. Allowing Pieter Mourik to use you as a mouthpiece for his untrue, hysterical and indefensible assertions is pretty poor form. Why don’t you do some research for yourself and find out what the rest of the world knows? You will be less likely to fall prey if you have some hard facts in front of you. Take a look at the Netherlands and New Zealand, both countries where midwifery is the norm, and see how much better the outcomes are for mothers and babies. Obstetricians, like smoking and other suboptimal practices, should come with a health warning. And if Pieter Mourik has actual clinical evidence, he should quote it, and not rely on selfserving rubbish and innuendo. Disgusting. Janet Fraser No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.344 / Virus Database: 267.11.8/114 - Release Date: 28/09/2005