Alex Martin

What are the real risks associated with vaginal births and planned CS? Maternity services once again demonstrate themselves to be incapable of interpreting scientific evidence and communicating it to patients. I'm guessing the paragraph photographed here is based on this study which reviews almost entirely observational literature looking at outcomes from cs and vaginal births: journals.plos.org/plosmedici… 💥First rule of statistics: Correlation is not causation 😤Yet here we have the nhs informing women that a cs will increase the risk of their child becoming obese and developing asthma. WRONG! 👉Cs are not given randomly. Women are only offered CS if there is a particular risk associated with them delivering vaginally so things like higher rates of obesity in babies born by cs are neither surprising nor attributable to cs. ❓But if you did want to answer that you'd need randomised trials of women and babies randomised to different planned modes of delivery: cs vs vaginal birth. 🙌Lucky for us, there are a good number of these trials and some researchers reviewed 15 of them: sciencedirect.com/science/ar… Guess what they found: 😱Planned vaginal birth leads to (not just associated with but LEADS to) -higher rates of low umbilical artery PH (an indication of oxygen deprivation) -higher rates of birth trauma -higher risk of needing tube feeding -higher risk of hypotonia (poor muscle tone) -higher risk of chorioamniomitis (infection) -higher risk of incontinence at 3 months and at 1-2 years -higher risk of painful perineum at 2 years -higher risk of perinatal death 🤓CS delivery leads to -higher risk of needing a general anaesthetic -higher risk of wound infection 🙄Talk to me about cs rates being too high again! It's not enough to just listen to women, maternity services must implement evidence based practice. Unfortunately that means a lot of what is currently there will need to go where it belongs 🚮🗑️ Frankly the standard of information @AdaJusic received amounts to deception and undue influence to vaginal delivery. #BirthTraumaInquiry

Am I alone in skepticism and a general sense of frustration at the #BirthTraumaInquiry? A very long 🧵 I get where @Theodoraclarke is coming from. She, like so many others, have had terrible experiences in maternity care including experiences of life threatening medical complications, medical negligence, cruelty from staff. Who doesn’t want to do better than this? Who doesn’t want to ensure that babies enter the world safely, causing the least possible injury to their mothers on the way out as possible? While a survey of women’s experiences inviting women who identify as having had a traumatic birth can tell us important information about current bad experiences of maternity care, it cannot be used to conclude that bad care is the norm rather than the exception as this survey will not include women who don’t consider their experiences of maternity care to be poor. It also doesn’t tell us why maternity care is so poor or why there are so many preventable deaths and a slew of bereaved families every year who will live with the consequences of medical negligence for the rest of their lives. WHAT is responsible (not just WHO) for the cruelty with which women are treated and the casual disregard of women who ask for, and sometimes end up pleading for, medical care and to be taken seriously. This inquiry hasn't come close to examining what is happening to begin to answer these questions much less work out how to turn things around. And yet.. once again, we see the usual faces, the NCT CEO seizing the opportunity for a photo op and everyone jumping on with their pet recommendation that they are sure, so sure, will make big difference to mums. (And yes, I hate it when they call us mums too) -an extra appointment for mums as well as babies at the 6 week cheek -birth reflections services -a new maternity minister -more antenatal education But here’s the rub. We have one way to facilitate safe medical care and it has a wonderful tendency to substantially reduce life threatening complications and deaths in maternity care. And that is, quite simply, the implementation of science based medicine. Do we have evidence as to what the specific purpose of an additional 6 week check would be and that it would improve outcomes for women? Can grown women not decide for themselves if and when they need a GP appointment or are we going to fill GP’s surgeries with healthy women who do not need additional medical care over and above what is currently offered? Or do we risk women taking additional time, transport costs and effort to make 2 trips to a GP surgery instead of one? Do we have evidence that birth reflections service produce favourable outcomes? Or do we risk potentially doing more harm than good with non mental health professionals attempting to provide an ill-defined and not evidenced psychological intervention without any comprehensive mental health assessment? Do we give services the opportunity to divert women away from a formal complaints process if they are unhappy with the care they have received? What would a maternity minister actually do? Politics in health care does not always lead to sound healthcare policy or practice. Will we get what pleases the current zeitgeist of the electorate, something inevitably created and informed by the many businesses (including charities, because charities are also businesses) vying for influence and market share. Informed by scientific evidence about what would actually make maternity care safer and more effective… I very much doubt it. And antenatal education’s dark history of seeing to de-medicalise birth, promote “normality” and eschew pain relief leaves my blood running cold at the suggestion of more of it. Why do women need anyone other than the qualified health care professionals who are responsible for their care to influence their medical care?