Wax study might be onto something

Ugh, I can't help myself. Despite the heap of schoolwork before me - grown even larger by four days of conference attendance - I can't help but keep dwelling on some of what I heard over the weekend. What really rocked the boat for me and was outside of what I would have expected to hear at a midwifery conference (I mean - Huge maternal and infant mortality: big, bad problem, Midwifery model of care: good, appropriate solution - that's pretty predictable and formulaic, right?) was what Michel Odent said about the recent research about neonatal mortality and other indicators of birth outcomes that has made home and hospital vaginal birth appear more dangerous for mothers and babies. It wasn't "Those studies are shoddy." It was, "They're right, I would have expected as much, and here's how we're doing harm even in home births."

Since Science & Sensibility posted about the Wax study again yesterday, I had to comment:

I got to hear Michel Odent speaking about this study last week and was really fascinated to hear his take. Rather than criticizing the study methodology, he said that its results as well as a couple of others of the last 6 months (Netherlands and China) indicate that birth is becoming more difficult in all settings. He suggests that we have a gross misunderstanding of the needs of a laboring woman across the board, even in natural childbirth circles. I’ll be writing more about this in the coming weeks because it is possible that we are largely turning a blind eye to a lot of widely accepted and in fact celebrated and endorsed practices even in the most natural and low-intervention approaches that may not actually be physiologically sound.

That being said, I’d be delighted to see this study retracted or taken down as inflammatory or unsound – but if there IS a kernel of truth in it, I think we’re wise to look directly and honestly at the implications.

I made a few corrections over the actual comment I left where I made a bunch of mistakes - my fingers are thundering through this today so I can get to "real" work. If you see any typos or mistakes, please give me a heads up.

I had no idea, until this weekend, that midwives are widely ignoring a number of the less convenient and conventional (midwifery-wise) criticisms Odent makes about very common and very accepted interventions (or as we like to think of them, practices.) That dude is way more fringe than most midwives, makes some very specific and potentially revolutionary observations, and we're not listening.

To give you a teaser... Is it possible, despite all our advocacy for allowing women to have food and water freely in hospitals, that they don't actually need food and water in labor, and that we are actually making their labors more difficult, prolonged, and unnatural by insisting that they do? 

More to come, more to come.

Temptation

Posted by Tatiana

I'm in earshot of the siren call of the temptresses of number-bending.  Oh, the lure, the lure!  Not number bending, exactly, but we'll call it selective emphasis. I did a research project this fall about the experience of babies in labor and birth and it involved an online survey. I ended up with over 500 responses from all sorts of birth settings (I didn't only post it in natural birth cyber land, you know!) so I have this amazing spreadsheet of quantified experience. It makes me drool just thinking about it.

I can think of dozens of fascinating comparisons to make, and it's been a pleasure to get my hands dirty with collating data. I fully expected that all of that would the fruit of this experience, but I didn't anticipate that it would acquaint me with the temptation that I can now imagine faces many "real" researchers.  Sitting before a mound of numbers and running various comparisons, it is very easy to say "Hmm, that set of numbers doesn't make much of an impact, don't bother listing it." or "Gee, those numbers make a statement but if I alter the definition of such and such to include this and that it might show it even more strongly, let's see.."

It's very much my style to go about these things backwards (trying my hand at research without really knowing my nose from my elbow with it, and then embarking on getting the academic foundation for how it "should" be done.) I can't help it, I learn well this way.  And I totally disclosed that it was an informal survey, so don't yell at me! I know I'm not a real researcher. Just one little organism pushing my own boundaries and investigating curiosities with the tools on hand.

Midwifery education survey

Posted by Tatiana

Daphne Singingtree is conducting some research about the experience of student midwives and precepting midwives. Take a little time to take the appropriate survey.

2010 Clinical Education Survey - Students

2010 Clinical Education Survey - Midwives

Cheers!

Unnatural Causes - More about race and birth outcomes

Posted by Tatiana

Here are a couple of clips from the documentary series Unnatural Causes. Each is valuable in its own right and I can't decide which makes a more effective statement. With just a little bit of overlap they tell the story differently and use different sets of data. So here they both are.

I'm posting them because now and again when these conversations about race happen, someone actually is taken aback by information they didn't have before and reconsiders their preconceptions on this subject. And the more that happens, the better our chance at progress.

So let's keep shaking up our perceptions. Oh yeah, and pass it on.

How Racism Impacts Pregnancy Outcomes

UCLA obstetrician and gynecologist Dr. Michael Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions that impact women's health not just when they become pregnant but from childhood, adolescence and into adulthood.

Kim Anderson's Story

When Atlanta lawyer Kim Anderson was pregnant with her first child, she did everything right: she ate a healthy diet, exercised, and got the best prenatal care. But her baby was born almost three months premature. This excerpt from When the Bough Breaksexplores racism's impact on pregnancy outcomes.

Birth survey

Posted by Tatiana

I'm conducting a survey for some research I'm doing about a baby's physiological and psychological experience of childbirth.  If you've vaginally birthed a full term baby, please take a few moments to take the survey. And even more importantly, whether you've birthed a babe or not, please pass this along where mamas might see it and participate.

I'm interested in as diverse a response as is possible (on the internet.)

Cheers!

Your Baby's Birth - A Short Survey

Free learning resource on PPD

posted by Tatiana
 
Just added to the Free Resources for Midwifery Study post:

Postpartum Depression Learning Modules from MedEdPPD.  You can pick and choose whichever modules interest you, or do them all and become eligible to be listed in the provider network.

One could clobber together an excellent education with all the free resources out there, plus the stack of books recommended by NARM, plus a study group and a high quality local apprenticeship.  There are definite advantages to a formal program that I don't want to minimize, but clearly formal education is still inaccessible to many.  With internet access becoming possible and sometimes common even in remote and impoverished corners of the earth, that accessibility issue is changing.  You could give yourself a great education, but you still have to come up with the bucks if you want an education that the wider public will regard as legitimate.

Purely anecdotally, there doesn't always seem to be a direct relationship between the depth of knowledge and understanding that a midwife had and how she (or he, I suppose) obtained her (or his) education.  I've heard tell of very scary midwives that excelled in formal programs and went on to practice recklessly, and also know a number of midwives who have taken on the responsibility of educating themselves completely and have earned the esteem of local hospitals with the quality of their knowledge and practice.

Anyway, I'm excited to have found another up-to date and research based set of educational modules available to anyone with web access and time.

That pesky meta-analysis

Posted by Tatiana

I don't know about you, but that meta-analysis that has been all over the news has made me uneasy.  I hear the criticisms of it, but it still makes me uneasy.  If it is true that there is this large increase of neonatal mortality in home birth, would I really want to be a home birth midwife?  I kinda don't think so.  I want to think the study is just wrong, but it doesn't satisfy to say, "Oh well, people I respect have dismissed the study, so... that should be cool."  I want to be a bit more clear than that.  If a client or, say, a policy maker happens to ask me "What about that study published in 2010 about the threefold increased risk to babies in home birth?" I'd like to answer coherently, and in a way that's grounded in real science.  Not convenience science.

I've alluded before that I really want a stronger understanding of how studies are conducted so that I can be a better judge of their quality, and I'm not there yet.  (Pan camera across floor riddled with toys and clothes to baby cheerfully pinching my arm and erupting with a river of spit-up.)  In time.  In the meanwhile, I've read a bunch of articles about this study over the last few weeks, and I came accross this reponse today which does well with specifics and left me curious to see what better studies in the future would show:

Planned home birth and neonatal death: Who do we believe? - posted by Amy Romano of Science and Sensiblity

I look forward to the results of the de Jonge and Buitendijk analysis she mentions.

Dorky new additions to the free resource list

Posted by Tatiana

I've added the following free learning opportunities to the Free Resources for Midwifery Study post:

Pelvic Floor Muscle Trauma from Medscape.  You need to join the site (free) to access this one, and there's a free CEU for completing it.

Examination of the Newborn from the University of Oslo in Norway.

The Little Handbook of Statistical Practice from Gerard E. Dallal of Tufts University in Boston.  It is my opinion that with the amount of "studies show..." spouting that midwives do, we better well be equipped to coherently interpret studies.

The first two were posted to discussion groups by other folks, the last one I unearthed myself because I kept bumping up against "I really don't know enough about statistics to interpret studies."  I wish I didn't need to be reading for the doula training I'm doing next week so I could just read through that statistics handbook.  It's absolutely delicious because it answers so many questions I've had about statistics, plus it's math and that's just a good time on a Friday night as far as I'm concerned.  I really think that I need the ability to critically analyze research as a midwife, and doing that when I'm not even sure what p= actually means is problematic. 

Free Resources for Midwifery Study

Posted by Tatiana

I started a blog about becoming a midwife a while back, but it fizzled because it lacked the collaborative awesomeness of this one. So I put it to bed, but I wanted to repost this collection of resources I've found to be instrumental, particularly in self-study mode. I update whenever I find something new, so please feel free to point me to anything you think should be on the list. Enjoy!

I've found a number of pieces to fit into the matrix of my studies that have made it easier to feel like I have access to quality information and that I'm a part of a larger community as I huddle with my books at home. I'd like to share!

Local Midwifery Organization:
I'll leave it to you to find your own local organization, for me it is the Oregon Midwifery Council. I joined the council on a suggestion of a midwife in my town. I go to the quarterly meetings, am a voting member, follow the happenings and lend my support in whatever small ways I can. This does a few things for me: It connects me to the midwifery community in my own area, it educates me about the political and legal issues in midwifery and also makes me a familiar face to midwives with whom I hope to have future alliances, apprenticeships, and friendships. One of the most valuable pieces of advice I've received!