Monday, July 09, 2007

Caution or prejudice?

I am pregnant. The baby is due on Christmas Day. Because of this, I have been looking into the choices available for childbirth. My local maternity unit has a birthing pool, so I've been looking into water birth as a possibility.

This study, published in 2000, disturbed me a little. The results section of the abstract, which was all I had access to, seemed to suggest a whole host of benefits from labouring and/or giving birth in water: less injury to the mother, less pain relief needed, happier mothers, healthier babies… and yet the conclusion is a very underwhelming 'Waterbirths … do not demonstrate higher birth risks for the mother or the child than bedbirths'.

Why the vote of unconfidence? I started looking for more recent articles, and for articles which described drawbacks to water birth. I found that many of the latter appeared to be published in a single journal, Pediatrics. One article in particular, a description of four case reports of water births with complications, had a comment appended by the editor of the journal. 'Editor’s Note: I’ve always considered underwater birth a bad joke, useless, and a fad, which was so idiotic it would go away. It hasn’t! It should!' Speak your mind, why don't you, don't be shy!

Further searching in this journal revealed a more recent article, from 2004, whose main thesis appeared to be that water births shouldn't be used because they had not been subject to randomised controlled trials. Yet a Cochrane review from 2002, two years earlier, found eight such trials, and confirmed that water immersion did reduce the pain levels and the need for pain relief.

So, when such information is so easily available, why should an article that denied it be published? Could it be that the editor's opinions lead him to selectively publish articles that reflect his own viewpoint, rather than making up his mind on the available evidence? The latter is surely the point of evidence-based medicine, and the gold standard of randomised controlled trials.