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.

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.

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.