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This hypno-birthing quackery shows profit has no place in healthcare This hypno-birthing quackery shows profit has no place in healthcare
(6 months later)
'What's the problem?", the NHS reformers always ask, cod innocence and superciliousness mingled in their faces. "Healthcare will still be free at the point of need."'What's the problem?", the NHS reformers always ask, cod innocence and superciliousness mingled in their faces. "Healthcare will still be free at the point of need."
"Well," we counter, "these reforms mostly amount to a process of privatisation. Often, the private sector is not the bargain it's cracked up to be. Often its savings just come from cutting wages. Often the private company is only cheaper until it's the only provider – then it is suddenly radically more expensive, but there's nothing you can do about it. Often it fails to build up and reward pro-social behaviour (a psych word for "kindness") in its staff, because paying them so little exhibits so little kindness towards them. Often, often, often … but no, we can't prove it. We can't prove you'll ruin it until you've ruined it.""Well," we counter, "these reforms mostly amount to a process of privatisation. Often, the private sector is not the bargain it's cracked up to be. Often its savings just come from cutting wages. Often the private company is only cheaper until it's the only provider – then it is suddenly radically more expensive, but there's nothing you can do about it. Often it fails to build up and reward pro-social behaviour (a psych word for "kindness") in its staff, because paying them so little exhibits so little kindness towards them. Often, often, often … but no, we can't prove it. We can't prove you'll ruin it until you've ruined it."
And then something comes along to remind us that there is a principle behind all this, one that doesn't require the accumulation of depressing evidence; one that leaves its own sour taste.And then something comes along to remind us that there is a principle behind all this, one that doesn't require the accumulation of depressing evidence; one that leaves its own sour taste.
On the 15th of March – a Saturday, incidentally, a weird time to send out a press release, almost as if they'd prefer nobody to notice – two hospitals announced "a new model of antenatal care". Chelsea and Westminster, along with Queen's hospital in Romford, are offering parents "pioneering antenatal education about natural birth preparation techniques, including hypnotherapy, as an addition to its maternity and antenatal services".On the 15th of March – a Saturday, incidentally, a weird time to send out a press release, almost as if they'd prefer nobody to notice – two hospitals announced "a new model of antenatal care". Chelsea and Westminster, along with Queen's hospital in Romford, are offering parents "pioneering antenatal education about natural birth preparation techniques, including hypnotherapy, as an addition to its maternity and antenatal services".
The crucial point about this "enhanced service", apart from there being no evidence for its clinical usefulness, is that parents have to pay for it. It's £190 per couple, which is coincidentally the same amount pregnant women have had taken away from them with the removal of the health in pregnancy grant. There was a time, in other words, when women who couldn't afford the A+ pregnancy package, the gold-plated parturition experience could have used their grant for it; but those days are long gone.The crucial point about this "enhanced service", apart from there being no evidence for its clinical usefulness, is that parents have to pay for it. It's £190 per couple, which is coincidentally the same amount pregnant women have had taken away from them with the removal of the health in pregnancy grant. There was a time, in other words, when women who couldn't afford the A+ pregnancy package, the gold-plated parturition experience could have used their grant for it; but those days are long gone.
"What?", say their communications departments. "You have to pay for the National Childbirth Trust. This is no different." Yet it is different, and the differences are significant. First, I remember the way midwives refer to the NCT. They say "you can go to the hospital antenatal classes or you can go to this one you have to pay for". The message was you'd get everything you needed from the free version, but if you were the kind of person who liked to pay for things, that option was also available. I certainly didn't leave with the idea that the paid-for class was designed for me to ascend to some special level of pain management so I'd ultimately "treasure my experience of childbirth". Second, the hospital was never making a profit from referring people to the NCT. Third, while many assertions from a NCT class dance at the very edge of medical demonstrability, when the hospital isn't making any money out of it, it doesn't seem to matter."What?", say their communications departments. "You have to pay for the National Childbirth Trust. This is no different." Yet it is different, and the differences are significant. First, I remember the way midwives refer to the NCT. They say "you can go to the hospital antenatal classes or you can go to this one you have to pay for". The message was you'd get everything you needed from the free version, but if you were the kind of person who liked to pay for things, that option was also available. I certainly didn't leave with the idea that the paid-for class was designed for me to ascend to some special level of pain management so I'd ultimately "treasure my experience of childbirth". Second, the hospital was never making a profit from referring people to the NCT. Third, while many assertions from a NCT class dance at the very edge of medical demonstrability, when the hospital isn't making any money out of it, it doesn't seem to matter.
Conversely, the natal hypnotherapy wheeze is designed to spin profit for the hospital – Chelsea and Westminster "hope to make £8,000-£10,000 annually. This will be reinvested into maternity services at the trust, such as training for staff and volunteers and equipment for the wards."Conversely, the natal hypnotherapy wheeze is designed to spin profit for the hospital – Chelsea and Westminster "hope to make £8,000-£10,000 annually. This will be reinvested into maternity services at the trust, such as training for staff and volunteers and equipment for the wards."
When did training staff and buying equipment become a bolt-on that you fundraised for with a hocus-pocus service for couples with more money than sense? Does it look to you as if they're downplaying the figure, given they deliver about 1,200 babies a year in a very affluent area? If half the parents signed up for the "treasure" experience, that would be more than £100,000.When did training staff and buying equipment become a bolt-on that you fundraised for with a hocus-pocus service for couples with more money than sense? Does it look to you as if they're downplaying the figure, given they deliver about 1,200 babies a year in a very affluent area? If half the parents signed up for the "treasure" experience, that would be more than £100,000.
Queen's, meanwhile, is less precise, suggesting merely that "any surplus goes to training other midwives to support parents in this technique". Here it all goes a bit Escher – you charge some parents to be tutored in a technique of unproven efficacy, and any money you make goes into training more midwives in a still unproven technique for yet more parents to pay for? "We're just giving mothers the choice," said the spokesperson for Queen's, making the mistake so otiose that it must be deliberate, of portraying a choice for people who can afford it as a meaningful choice.Queen's, meanwhile, is less precise, suggesting merely that "any surplus goes to training other midwives to support parents in this technique". Here it all goes a bit Escher – you charge some parents to be tutored in a technique of unproven efficacy, and any money you make goes into training more midwives in a still unproven technique for yet more parents to pay for? "We're just giving mothers the choice," said the spokesperson for Queen's, making the mistake so otiose that it must be deliberate, of portraying a choice for people who can afford it as a meaningful choice.
The last thing I want to pour scorn on is hypnotherapy itself, which I've heard anecdotally works for childbirth. I've been hypnotised seven times, I've done it by Skype, I've done it in a hypno-pod; when I say "no thank you, I don't smoke," it is in my first hypnotist's light Australian accent.The last thing I want to pour scorn on is hypnotherapy itself, which I've heard anecdotally works for childbirth. I've been hypnotised seven times, I've done it by Skype, I've done it in a hypno-pod; when I say "no thank you, I don't smoke," it is in my first hypnotist's light Australian accent.
But I can also read, so I know that – contrary to the implied assertions of the weirdly worded press release – the evidence simply isn't there to support the claim that hypnosis results in "reduced need for drugs and intervention". The largest and most recent study found no difference in the need for epidurals between the hypno-birthed mother and the regular mother. The consensus on PubMed, the US database of clinical effectiveness reviews, is a stern "more evidence required".But I can also read, so I know that – contrary to the implied assertions of the weirdly worded press release – the evidence simply isn't there to support the claim that hypnosis results in "reduced need for drugs and intervention". The largest and most recent study found no difference in the need for epidurals between the hypno-birthed mother and the regular mother. The consensus on PubMed, the US database of clinical effectiveness reviews, is a stern "more evidence required".
In a way, that's a good thing – if hypno-birthing had a proven clinical benefit, I would be much more distressed to see it offered to some mothers and not others. And yet it's simultaneously more depressing to see a noble institution brought so low by selling what may be no more than snake oil.In a way, that's a good thing – if hypno-birthing had a proven clinical benefit, I would be much more distressed to see it offered to some mothers and not others. And yet it's simultaneously more depressing to see a noble institution brought so low by selling what may be no more than snake oil.
This picture, parents being told by midwives, by obstetricians – by people whom they have to be able to trust – that if they spend money that they probably can't afford, on a service that probably doesn't work, they'll be doing the best for themselves and their babies – this is why profit has no place in healthcare.This picture, parents being told by midwives, by obstetricians – by people whom they have to be able to trust – that if they spend money that they probably can't afford, on a service that probably doesn't work, they'll be doing the best for themselves and their babies – this is why profit has no place in healthcare.
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