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3 Comments

  1. 1

    Ruth Armstrong

    It is important to note that the study under discussion only reports associations.
    Although the authors have presented plausible mechanisms, there is no evidence from the study that birth interventions have caused any of the outcomes mentioned here. It may be that the conditions leading to birth interventions also led to some of these outcomes.
    We are not told about the indications for the birth interventions, and the lack of a control group (understandably not available in this study) means we don’t know what the outcomes would’ve been without intervention.
    Also, the study does not report outcomes for high risk pregnancies.
    A post from the same authors (about the same study) in the Conversation, garnered some important observations in the comments section about potential biases in the study.
    https://theconversation.com/how-birth-interventions-affect-babies-health-in-the-short-and-long-term-93426
    Re the headline: Really?
    Can we compare an altered microbiome with the possible damage for a baby who has become hypoxic due to prolonged or obstructed labour? What is the acceptable number of interventions to prevent one catastrophic outcome?
    There are undoubtedly unnecessary birth interventions in Australian hospitals because the risks are hard to pick and the stakes are high. Continuity of care from an experienced, competent midwife is a great place to start, but while we’re in the mood to stop blaming people, let’s not get too carried away about vested interests either. In the end, I think doctors, midwives and parents all want the same thing.

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  2. 2

    Hannah Dahlen

    Thanks for your comments Ruth and I agree with many of them. This study does indeed show association and not causation. Intervention when undertaken appropriately and with the informed consent of the woman can and does save lives. Having said that a recent systematic review published in PLOS Medicine (link above) of 79 large studies including thousands of women and children show something is going on. What the mechanism is is less clear and we have proposed two possible explanations where the evidence is mounting (epigenetics and microbiome). What we also know is certain models of care (continuity of midwifery care) lead to better outcomes for women and babies by reducing intervention and improving the health and wellbeing of mothers and babies. This is level one scientific evidence and yet we continue to choose to ignore it. Why? We also know there are countries beyond our shores that have half our intervention and equally good or better maternal and perinatal outcomes. We all need to work together to make sure women in the 21st century get both safe and satisfying care.

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  3. 3

    Andrew Watkins

    Can we compare an altered microbiome with the possible damage for a baby who has become hypoxic due to prolonged or obstructed labour? What is the acceptable number of interventions to prevent one catastrophic outcome?

    It is not a straight 1:1 comparison – altered microbiome v. catastrophic injury

    What we are comparing is an altered microbiome etc for 30-60% of babies, depending upon which hospital they are born in, with the incidence of catastrophic brain injury due to perinatal asphyxia ( rough incidence of severe encephalopathy 10/1000LB, or 1% , an overestimate for good centres in Australia)

    When one then factors in the relative paucity of evidence that urgent caesarian section and other interventions make an appreciable difference to this rate on a population basis, the Dahlen argument has some force.

    It is also worth noting that the private hospitals with CS rates of 40-60% care for the lowest risk women in the community – they dump most high risk women to the public sector, which is appropriate, given their abilities, but it further underscores the question about whether there may be other cultural factors and conflicts of interest driving the intervention rate.

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