Pregnancy, Birth and Beyond

http://www.pregnancy.com.au/midwifery/midwifery-resources/midwifery-articles/the-politicisation-of-science-a-critique-of-the-so.shtml

The politicisation of science: A critique of the South Australian Homebirth Paper and its portrayal in the media

Homebirth continues to incite powerful responses and passionate debate. In January 2010 the Medical Journal of Australia released a study about planned home and hospital births in South Australia occurring from 1991 to 2006. This article explores the resulting media frenzy and the true findings of the study, 

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A-critique-of-the-South-Australian-Homebirth-Paper-and-its-portrayal-in-the-media-2

‘Imagine a woman being forced to birth at home when what she craves and needs is the support of a hospital. Imagine a woman being forced to birth in hospital when what she craves and needs is the support of her familiar home environment. The miracle of producing new life, and bringing that life into the world should never be overshadowed by a lack of birth options - certainly not in today’s society’

These words come from one of the more than 900 submissions received by the Commonwealth during the recent Review of Maternity Services1,2. Over half were from consumers and nearly 60% asked for greater support for, and access to, homebirth. The government choose to ignore homebirth in its raft of impressive reforms to maternity services, following intense lobbying by the medical profession. In the Report of the Maternity Services Review 2 they stated their reason for this was that “incorporating home birthing risks polarising the professions.” Ironically, the decision was made in the interests of the professions and not women.
 
Homebirth continues to incite powerful responses and passionate debate. On Saturday 16th January 2010 the Medical Journal of Australia released a study about planned home and hospital births in South Australia that occurred between 1991-20063. A carefully crafted press release was released and the President of the Australian Medical Association (Dr Pesce), a long time opponent of homebirth, wrote the accompanying Editorial. Dr Pesce had been telling the media about the paper since September, which in the academic world is a big ‘no no’ as there is no opportunity to comment or critique it, but it is also a ploy to put blood in the water and whip the media into frenzy when the article comes to light. It was successful from that point of view. 
 
The most horrifying aspect of the new study “proving” the dangers of homebirth is the way it’s been reported by the media and promoted by sections of the medical profession. Melissa Sweet wrote about this in an article for Crikey on January 20th 2010 4.
 
Associate Professor Hannah Dahlen, Vice President of the Australian College of Midwives, and academic at the University of Western Sydney, and Professor Caroline Homer of the University of Technology Sydney also had a critical look at the study and the way its findings are being portrayed. This critique was published on Croakey on the 20th January 2010 5.

Critique

What was missed?

The conclusion of the paper is very sensible recommending risk assessment, transfer and fetal monitoring. So then why did the data get so grossly misinterpreted in the media? 
This is a classic example of science being usurped by politics. It is dangerous, misleading and sadly the media seem to prefer sensation to reality. The politicisation of this study has been unfortunate as important and useful lessons were lost in what followed.
 
At the end of the day homebirth will not go away. It has, does and will exist in every country on earth. So we have two options – burry our heads in the sand and hope it goes away (it won’t) or put in place responsive, evidence based systems of care (we haven’t). When the dominant politics is determined for homebirth to be eradicated there is little chance for science to project an informed and balanced voice into the debate.  
 
Note: you can see Dr Pesce’s right of reply 6 and the MJA editors response 7 to Melissa Sweets inquiries over the paper.

References

Commonwealth of Australia. (2008). Improving Maternity Services in Australia: A Discussion Paper from the Australian Government. Australian Government Department of Health and Ageing Online ISBN: 1-74186-694-4
Commonwealth of Australia. (2009a). Improving maternity services in Australia, The Report of the Maternity services review, 2009. Canberra: Commonwealth of Australia.
Kennare RM, Keirse MJNC, Tucker GR, Chan AC. Planned home and hospital births in South Australia, 1991–2006: differences in outcomes. Med J Aust 2010; 192: 76-80.
 
4 http://blogs.crikey.com.au/croakey/2010/01/20/more-critique-of-the-homebirth
-study-and-its-reporting-by-the-media/
 
5 http://www.crikey.com.au/2010/01/20/don%E2%80%99t-believe-the-home-birth-horror-headlines/
 
6 http://blogs.crikey.com.au/croakey/2010/01/21/the-ama-says-we-are-shooting-the-messenger-re-homebirth-critique/
 
7 http://blogs.crikey.com.au/croakey/2010/01/21/medical-journal-of-australia-editor-responds-to-homebirth-study-concerns/