Do obstetric intranatal interventions make birth safer?

British Journal Obstet Gynaecol 1986 Jul;93(7):659-74 

By Marjorie Tew

 

Marjorie Tew argues that statistical analysis shows that the shift to
hospital birth, and increased obstetric intervention, has not made birth
safer, but more dangerous. She suggests that improvements in perinatal
mortality are due to healthier mothers, rather than improved maternity care.

 

Abstract in full:

 

Impartial analyses of the evidence from official statistics, national
surveys and specific studies consistently find that perinatal mortality is
much higher when obstetric intranatal interventions are used, as in
consultant hospitals, than when they are little used, as in unattached
general practitioner maternity units and at home. The conclusion holds even
after allowance has been made for the higher pre-delivery risk status of
hospital births as a result of the booking and transfer policies. It holds
even more strongly for births at high than at low predicted risk. It follows
that the increased use of interventions, implied by increased
hospitalization, could not have been the cause of the decline in the
national perinatal mortality rate over the last 50 years and analysis of
results by different methods confirms that the latter would have declined
more in the absence of the former. Data are presented which point to the
deleterious effect of interventions on the incidence of low birthweight and
short gestation and their associated mortality. Also presented are data
supporting the alternative explanation of the decline in perinatal
mortality, namely the improvement in the health status of mothers built up
over several generations. The organization of the maternity service stands
indicted by the evidence. Despite the beliefs of those responsible, it has
not promoted, and cannot promote, the objective of reducing perinatal
mortality. 

http://www.homebirth.org.uk/homebirth6.htm


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