NHS Choices were clear that the risks being touted as horrendous and dangerous were substantially overblown and that these figures represent “a very small increase in blood clots”.
"Unfortunately, most of the UK media overhyped the potential risk in their reporting. The Mail’s panic-maximising implication that 1 million women could be at risk doesn’t reflect the reality that only around 12 women per 10,000 taking combined contraceptives are thought to be at risk of having a blood clot in any given year." They said.
So far so good. This was, of course in response to a Mail Online headline, in this case that
“A million women who take Britain’s most popular contraceptive pills are to be told they risk developing potentially fatal bloods clots”
Importantly, the review found that the benefits of any combined contraceptives far outweigh the risk of serious side effects, and that women who have been using them without any problems have no need to stop.
So that's a “small” increase in likelihood from 2 out of every 10000 women to from 5 to 12 out of every 10000 women depending on particular synthetic hormones in the pill.
”There is a 12.6 in 10,000 chance of neonatal death following a home birth compared to a 3.2 in 10,000 chance of death in hospital.”
On the blog of the Skeptical Ob, Aka Amy Tuteur, more info about the study emerged:
This led the Skeptical Ob to sum up the situation: “Once again, we find that the dramatic increased risk of death at US homebirth is a remarkably robust finding. No matter where you look, whether it’s at state data like that of Oregon (9X higher), CDC data or even MANA’s own database (5.5X higher), midwife attended homebirth has a risk of neonatal or perinatal death anywhere from 3-9X higher than hospital birth.”
Now it may be comparing apples and pears, but it strikes me that given the fact that the samples in these two situations were the same size, the differentials look pretty similar too. Yet one of the risks is referred to as “astronomical” and the other “small”.
Blood Clots don’t always cause death, so that’s one difference obviously, but they do in a fair number of cases, if they progress into the lung and cause pulmonary embolism. But blood clots do also have other well known and long lasting effects.
From the website of the Vascular Disease Foundation:
“DVT can cause leg swelling that is usually treated with 3-6 months of a blood thinner. A long-term side effect of DVT is the development of the post-thrombotic syndrome (PTS). About one-third of patients who experience a DVT (a higher percentage if the clot goes into the large veins in the pelvis or abdomen) can develop PTS even after treatment with blood thinners. This condition can show up months to years later as chronic pain, swelling and discoloration of the leg, as well as the development of open sores or ulcers, caused by damage that is done by the clot to valves in the veins. The effects of PTS can be long lasting and can lessen one’s quality of life.”
So, the level of risk taken may not be identical but the instance of the problem is very similar in both cases.
In the birth study the gross increase in the numbers for first time and/or geriatric mothers (what!? That's what they call us!), point to the existence of variables which significantly effect outcomes; this is acknowledged, but does not significantly effect the advice given.
This contrasts with the blood clot narrative which holds that attention to the variables is the key to reducing risk.
The medical information narrative only accepts further investigation of the variables in the context of the risk of blood clot and possible stroke or even death but not in home birth, even where it is acknowledged that the outcomes are significantly effected by the variables.
I rather hurriedly overlaid the statistics from the midwife study on the graph of the blood clot ones, and you can see how similar they are:
Nevertheless, the medical advice for these two risk factors is completely opposite.
Here’s the Skeptical Ob on US Homebirth risks:
"Given the study's findings, Amos Grunebaum, M.D. and Frank Chervenak, M.D., the main authors of the study, said that obstetric practitioners have an ethical obligation to disclose the increased absolute and relative risks associated with planned home birth to expectant parents who express an interest in this delivery setting, and to recommend strongly against it."
But here’s the advice on the risks for the combined pill:
As Dr Sarah Branch of the MHRA, said: “Women should continue to take their contraceptive pill. These are very safe, highly effective medicines for preventing unintended pregnancy and the benefits associated with their use far outweigh the risk of blood clots in veins or arteries.”
So what’s the harm in statistics? That obviously depends on your agenda, your bias, and, dare I say it, your beliefs.
NB
The authors of the homebirth study also said that hospitals should create a welcoming and comfortable birthing environment, as well as address unnecessary obstetric interventions, both of which are often a primary motivation for planned homebirth.
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