Myth Buster: Do Headlines Lie?
There’s nothing that can make a birth junkie’s blood boil faster than reading stories about childbirth in the popular press
(except perhaps watching A Baby Story or Maternity Ward on TV). Its not that we don’t want to believe that epidurals don’t
impact the length or outcome of labor or that inducing every birth will cut the c-section rate in half – there are times when we
truly wish that the next scientific advance or new technique really would help keep moms and babies safer and more well. It is
just that when we read these headlines we can hear them echoing again and again in our future conversations – in our
childbirth classes when moms are challenged by the idea that low-intervention birth is safe, in our prenatal visits when parents
are afraid of taking a low-tech approach or trusting their bodies when everyone else in the prenatal yoga class with them has
already had their c-sections scheduled or is going in for ultrasounds to see if the baby is too big to birth, and in the heat of the
moment when our doula clients are being told by their obstetricians that there are no negative side effects to the drugs they are
about to accept for their pain.
There wouldn’t be a problem if they were actually true. But the truth is that for the moment, the things that have been true
about birth for the past millennia are still true – that birth goes best more of the time when it is unhindered and unforced, that
interventions can be life-saving but are often over-used, and that drug-based pain relief can offer a lot in the way of comfort to
a mom but sometimes will impede a labor.
The headline often conforms instead to what mainstream society wishes were true – that pain-relieving drugs really wouldn’t
have negative impacts, that controlling the labor process makes it safer, and that there is a way to save every baby and mom
from a bad outcome. But when we look deeper into these stories and take a critical glance at the scientific studies that
preceded them, we often find that there is some disconnect between what the study found and what the news story reported.
Also, sometimes when we look even deeper, we find disturbing conflicts of interest or manipulation of results.
One common problem that occurs in these studies is comparing apples to oranges. Two very well-known studies in the
relatively recent past came up with results that have helped set very influential policies in the medical childbirth world – the
Pang homebirth study in Washington State and the Hannah Term Breech Trial.
The Pang study found that the death rate for homebirth babies in Washington was much higher than the death rate for low-risk
babies in a hospital setting. However, that study simply looked at the result from birth certificates and recorded the place of
birth – the homebirth group included planned homebirths but also babies who had born unassisted, even babies born to moms
who had no prenatal care. How could the risk of those births be determined to match the hospital group?
In the Hannah study, it seemed that c-section was a safer delivery method than vaginal birth for breech babies. The results held
up for several years and contributed to the virtual vanishing of vaginal birth options for moms carrying breech babies,
especially in the hospital setting. A closer look revealed, though, that more babies with birth defects were included in the
vaginal group than in the c-section group and that when those babies were removed from the analysis, the results were very
different.
This Mythbusters column was inspired by a much more recent headline – “A New Way to Reduce C-Section Risk.” You can
read the whole story by following a link on the Birthproject blog at thebirthproject.blogspot.com. The article makes it seem
like if all women were induced at the point where their labors were determined to be most successful (a point most likely
determined by frequent ultrasounds, other technological monitoring, and vaginal exams) then the c-section rate could be
reduced to a low rate of just over 5%. If this were true it would be completely fantastic, given that the 2006 c-section rate
was over 31% nationally.
The first clue that the study might be a little bit fishy is the fact that it was sponsored by a pharmaceutical company that makes
prostaglandins – the substances used in medical labor inductions. Another clue is the low c-section rate of the control group –
11.8 percent. How could the conclusions of this study be applied to the birthing population as a whole if the control group is so
different from the general population today?
Looking at the abstract of the study provides some clues – the study took the experiences of a very rural population, collected
the information after the fact, and had data in it that is now as much as 15 years old. So much has changed in technological
childbirth in the past 15 years – the ballooning c-section rate, for example, it is hard to draw conclusions about what kind of
birth a mom in rural Pennsylvania circa 1993 would have today.
You would also expect that a study that showed the benefit of inductions and deduced that making an induction plan for all
women was highly beneficial would have a lot of inductions, right? The story about this study makes it seem like that was true
as well, but when you look at the study itself, the control group was induced 20.4% of the time and the group with the lower c-
section rate was induced 31.4% of the time. If you compare that to our modern induction rates, which approach 50% of all
births, it really changes the interpretation. The difference between the control group and the treatment group is also not all that
large.
The moral of the story is, if something challenges the things you know to be true about birth, dig deeper. You don’t know
what you might uncover.
Stacia Proefrock
From Winter 2008 Issue V
There’s nothing that can make a birth junkie’s blood boil faster than reading stories about childbirth in the popular press
(except perhaps watching A Baby Story or Maternity Ward on TV). Its not that we don’t want to believe that epidurals don’t
impact the length or outcome of labor or that inducing every birth will cut the c-section rate in half – there are times when we
truly wish that the next scientific advance or new technique really would help keep moms and babies safer and more well. It is
just that when we read these headlines we can hear them echoing again and again in our future conversations – in our
childbirth classes when moms are challenged by the idea that low-intervention birth is safe, in our prenatal visits when parents
are afraid of taking a low-tech approach or trusting their bodies when everyone else in the prenatal yoga class with them has
already had their c-sections scheduled or is going in for ultrasounds to see if the baby is too big to birth, and in the heat of the
moment when our doula clients are being told by their obstetricians that there are no negative side effects to the drugs they are
about to accept for their pain.
There wouldn’t be a problem if they were actually true. But the truth is that for the moment, the things that have been true
about birth for the past millennia are still true – that birth goes best more of the time when it is unhindered and unforced, that
interventions can be life-saving but are often over-used, and that drug-based pain relief can offer a lot in the way of comfort to
a mom but sometimes will impede a labor.
The headline often conforms instead to what mainstream society wishes were true – that pain-relieving drugs really wouldn’t
have negative impacts, that controlling the labor process makes it safer, and that there is a way to save every baby and mom
from a bad outcome. But when we look deeper into these stories and take a critical glance at the scientific studies that
preceded them, we often find that there is some disconnect between what the study found and what the news story reported.
Also, sometimes when we look even deeper, we find disturbing conflicts of interest or manipulation of results.
One common problem that occurs in these studies is comparing apples to oranges. Two very well-known studies in the
relatively recent past came up with results that have helped set very influential policies in the medical childbirth world – the
Pang homebirth study in Washington State and the Hannah Term Breech Trial.
The Pang study found that the death rate for homebirth babies in Washington was much higher than the death rate for low-risk
babies in a hospital setting. However, that study simply looked at the result from birth certificates and recorded the place of
birth – the homebirth group included planned homebirths but also babies who had born unassisted, even babies born to moms
who had no prenatal care. How could the risk of those births be determined to match the hospital group?
In the Hannah study, it seemed that c-section was a safer delivery method than vaginal birth for breech babies. The results held
up for several years and contributed to the virtual vanishing of vaginal birth options for moms carrying breech babies,
especially in the hospital setting. A closer look revealed, though, that more babies with birth defects were included in the
vaginal group than in the c-section group and that when those babies were removed from the analysis, the results were very
different.
This Mythbusters column was inspired by a much more recent headline – “A New Way to Reduce C-Section Risk.” You can
read the whole story by following a link on the Birthproject blog at thebirthproject.blogspot.com. The article makes it seem
like if all women were induced at the point where their labors were determined to be most successful (a point most likely
determined by frequent ultrasounds, other technological monitoring, and vaginal exams) then the c-section rate could be
reduced to a low rate of just over 5%. If this were true it would be completely fantastic, given that the 2006 c-section rate
was over 31% nationally.
The first clue that the study might be a little bit fishy is the fact that it was sponsored by a pharmaceutical company that makes
prostaglandins – the substances used in medical labor inductions. Another clue is the low c-section rate of the control group –
11.8 percent. How could the conclusions of this study be applied to the birthing population as a whole if the control group is so
different from the general population today?
Looking at the abstract of the study provides some clues – the study took the experiences of a very rural population, collected
the information after the fact, and had data in it that is now as much as 15 years old. So much has changed in technological
childbirth in the past 15 years – the ballooning c-section rate, for example, it is hard to draw conclusions about what kind of
birth a mom in rural Pennsylvania circa 1993 would have today.
You would also expect that a study that showed the benefit of inductions and deduced that making an induction plan for all
women was highly beneficial would have a lot of inductions, right? The story about this study makes it seem like that was true
as well, but when you look at the study itself, the control group was induced 20.4% of the time and the group with the lower c-
section rate was induced 31.4% of the time. If you compare that to our modern induction rates, which approach 50% of all
births, it really changes the interpretation. The difference between the control group and the treatment group is also not all that
large.
The moral of the story is, if something challenges the things you know to be true about birth, dig deeper. You don’t know
what you might uncover.
Stacia Proefrock
From Winter 2008 Issue V
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