Archive for August 4th, 2008

Otherwise engaged

August 4, 2008

Dr Aust has not been blogging much lately.

Well, actually Dr Aust never blogs all that much, being much better at ranting off-the-cuff in the comments threads of other peoples’ blogs (thanks again, Holfordwatch, Orac, Dr Crippen at NHS Blog Doctor, Ben Goldacre and David Colquhoun) than at penning considered well-researched essays (too much like work). Another problem is that, like many ageing academics, Dr Aust likes to take his time writing things. And to make sure that what is in them is (mostly) accurate. Sadly, this takes time, which is rather at loggerheads with topicality. Blogosphere stories go round the world like waves, and are often seven day wonders. So by the time Dr Aust has got round to laboriously concocting a comment, the Bad Science Blogoverse has usually moved on. And typically several other people have already covered whatever-it-was far better than I would have done.

As a result, quite a few Dr Aust posts that are lengthily gestated never actually reach the point of delivery.

Which brings me, in a desperately tortured link, to the more specific reason why I haven’t finished anything for the blog recently.

It’s a boy

Yes, Dr Aust and Mrs Dr Aust have recently taken delivery of our second child, henceforth “Baby Aust”. Baby Aust (who is a he) arrived just over a week ago, after a rather short time in hospital (just under two hours “door to floor”), but following the usual nine months, plus a few days past due, of angst-y anticipation – and also following about eighteen hours of uterine contractions, though according to Mrs Dr Aust it was only the last four or five hours that really hurt.

The contractions started, as they frequently do, at around 2 am, though Mrs Dr Aust – who is a stoic sort – soldiered on through most of the next day pretty much as normal. We made it to hospital in the early evening, having cooked an early dinner and then deposited a mildly protesting Junior Aust with relatives. Mrs Dr Aust was finding it rather difficult to eat between the by-then distinctly painful spasms, but after last time we know the food at the local hospital only too well, so we figured it was eat now or not at all.

Dr Aust’s main (only?) contribution was to drive to the hospital without crashing the car, while Mrs Dr A sat in the passenger seat making strange noises and sinking her nails into the dashboard trim. Thankfully the Aust-mobile is over ten years old, and was a cheap-as-you-can-get box on wheels to start with (who says scientists don’t make the big money?) so the damage will not have decreased its current market value of zero pounds.

Hard labour

The birth itself was a contrast to our previous time a few years back. Junior Aust’s arrival was very high-tech, a past due induction of labour, with painful labour for nearly a dozen hours, epidural anaesthesia, full-bore Syntocinon (synthetic oxytocin) drip, and continuous electronic monitoring of uterine contractions and foetal heart rate.

This time was quite different, as we were shown into the “active birthing suite” – a bit like a hotel room, complete with sofa, en-suite kitchenette, CD player and whale music CD, large padded floor mat and a kind of giant inflatable exercise ball. Although we passed on the whale music, all went smoothly, and something less than 90 minutes later, there was Baby Aust, looking somewhat jaundiced (literally and figuratively), but otherwise fine and with all his bits in the right places.

Birth – all very political

Now, apart from ending up with a caesarian section, or an instrumental delivery (which we probably avoided first time around by about twenty minutes), one could not really have had a more “medicalised” techno-birth than our first time. And apart from a water birth in a darkened room, or a home birth, one could not have had a much more “minimal intervention” delivery than our second one.

I have to say, though, that I honestly couldn’t tell you which one was “better”. Well, of course, I’m only a bloke, so what would I know.

So – I asked Mrs Dr Aust which one was better. And she, too, says she has no opinion one way or the other. All she said was “Well, I was pleased it was quicker this time”.

Thinking about it, we are of the joint opinion that the only thing we cared about was having a healthy baby – which we have, thankfully. All the other stuff that is nowadays ringed around the experience of childbirth just seems like… baggage. So to us, the two very different experiences were equal in terms of THE THING THAT ACTUALLY MATTERS.

Which makes me wonder why modern childbirth is an issue that provokes such tremendously heated arguments. Examples are home birth versus birth in hospital, pain relief or not or what, midwives versus doctors (for the record, we had both Junior Aust and Baby Aust in a midwife-led delivery unit with one-to-one midwife care and on-site consultant-level medical cover, though we never saw a doctor during either delivery) and even independent midwives versus NHS ones.

The things that seem to prod people away from hospital births (a line that some advocates pursue with missionary zeal), are bad experiences of hospital care, fear of “medicalised” birth, and sometimes an ideological drive to “de-doctor” the process.

Now it is hardly news that NHS maternity care is not 100% marvellous in every respect. While our experience of the local delivery suite and its staff has been brilliant, I have to say that the pre-natal and post-natal wards left something to be desired. The food is bad. The wards are inevitably noisy and make sleep difficult to impossible. You have to wait ages for things to get done. But… how big a problem is being stuck hanging around for a few hours waiting for the paediatrician to show and do the routine next-day check on the baby?

Irritating, certainly. Stressful, perhaps.

Life or death – hardly.

In the end, the only thing we cared about both times was ending up with a healthy baby. And the most logical place to choose for that seemed to be a hospital delivery suite, with access to the full panoply of medical back-up just in case the sh*t were to hit the fan.

Of course, I know people who have taken other views, including among the neighbours in our nice middle-class enclave, and among friends of friends. I have known a couple of people who fought to get homebirths when the doctors and midwives advised against it. These pregnancies ended happily, with healthy babies and happy parents.

But does that prove that home birth is as safe as the advocates tell you?

I have also known people who had complex pregnancies and births, up to and including serious trouble that was life-threatening to mother and baby. If some of these folk had not made it promptly to well-equipped hospitals with specialist maternity care, Special Care Baby Units and Adult Intensive Care, the outcome would likely have been dire. And I used the word “dire” there euphemistically – you can say “dead” if you prefer.

So does that show that you would be mad to give birth at home?

It’s the statistics… again

As so often in modern healthcare, the devil is in the detail. The medics will tell you that homebirth statistics loudly quoted by homebirth advocates to show that homebirth is safe are misleading, because the people having homebirths are mostly a carefully-selected population of low-risk mothers; youngish, in excellent health, and often having second or third children after having had a normal delivery with a first baby. (The point, of course, being that this is predictive of a low likelihood of complications). In addition, pregnancies slated for homebirth, but where indications of “non-uncomplicated-ness” appear at any point, will often be “re-routed” to be hospital births for safety’s sake. The result, say the doctors, is that the “birth at home is safe” statistics you get quoted are not representative of a general population of the women giving birth in the UK. The homebirth advocates, unsurprisingly, dispute this analysis.

One interesting (though anecdotal) thing – Mrs Dr Aust and I know an awful lot of female doctors with children, and we only know one who opted for a home birth. Are all the others brainwashed? Or just careful?

So you could say that, at bottom, it is a matter of statistics. And, once you have the statistics, of your personal beliefs about, and attitude to, risk. And, critically, your view of the relative importance of the things you are risking, or weighing up.

Unless, of course, you pick the ideological view first – perhaps, the kind of “birth experience” you want -and then select the statistics that match the ideology. In which case, you are not REALLY making your decision looking primarily at the risk at all.

Now, I would say I am relatively ideology-deaf, but I am pretty risk-averse. And Mrs Dr Aust, being a doctor, is extra super-duper risk-averse. When it came right down to it, “Why take the chance?” is very much the way we looked at it. So hospital birth for us, thank you very much. And we are very happy with how it turned out, both times.

Because, when all is said and done, it is ending up with a healthy kid that matters. Not whether there was a CD player and candles.