Kneejerk reaction to birth study to be avoided

Amajor study has shown babies born under the care of midwives face greater health risks than those born under the supervision of doctors. These findings are serious and research is urgently needed to uncover the reasons. Nobody, however, should leap to simple-minded conclusions about their comparative merits.

The University of Otago study found babies under the care of doctors had a 55 per cent lower risk of oxygen deprivation during delivery and a 39 per cent lower chance of neonatal encephalopathy, which can lead to brain damage. There was a 48 per cent lower risk of having a low Apgar score, a measure of the baby’s health immediately after delivery.

Lead researcher Ellie Wernham, a midwife training to be a doctor, points out that these are important findings based on a huge amount of data. The study looked at more than 240,000 births in New Zealand from 2008 to 2012.

College of Midwives chief executive Karen Guilliland said the babies of women cared for by midwives were at higher risk because the women were more likely to be younger, sicker, obese, or Maori or Pasifika – well-known risk factors for health problems among the newborn.

But a co-author of the study, Professor Diana Sarfati, says these factors ‘‘didn’t even come close’’ to explaining the difference in health outcomes.

It’s important not to overstate the study results. It found no statistical difference in the death rates among mothers and babies under the two forms of care. And the overall rates of adverse outcomes in New Zealand were low and compared well with other advanced Western countries like as Australia and Britain.

The tension between midwifeand doctor-led maternity care is old and leaves some bitter memories, though the reform of the system in 1990 decisively tilted in favour of the midwives. Now they account for most of the care of mothers and babies, and doctors, especially GPs, have largely withdrawn from the field.

The present issue should not be muddied with ancient sexual politics from the days when doctors were assumed to be nearly all men and midwives nearly all women. That time has passed, thankfully.

The question is why there appears to be a health problem with midwife-led births and what can be done about it. Wernham supports the present system and points to advantages of the midwife-led system. She wants improvement to the present model, not a wholesale return to the doctor-dominated one.

That is sensible, but nobody is quite sure of the source of the problem. Is it a question of different levels of training? Does something in the system disadvantage one side?

Serious questions, affecting the health of the most vulnerable in our society, the newborn. We need answers as quickly as possible.