Saturday, August 13, 2011

totally flawed research

Listed as a top article in today's Age, readers are confronted with the question: 'Caesarean births a better option for mothers? ' The article tells us that "Dr Stephen Robson, an associate professor of obstetrics at Australian National University, is recruiting 1000 pregnant women to test the long-held view that vaginal deliveries are better than caesareans for healthy women with uncomplicated pregnancies."

This 'study' requires well women who are expecting their first child, of whom 500 choose a caesarean (for no medical reason) and 500 plan a vaginal birth, and will look at "psychological and physical outcomes for the women and their babies, including depression and breastfeeding rates."

"Good luck!" I say. Good luck to the mothers and babies - they will need it.

This research is not good science - whatever results are achieved will not come anywhere near testing the safety of vaginal vs surgical births for healthy women with uncomplicated pregnancies.

What sort of ethics committee would give approval to this research? Anyone who has studied basic health science will know that the numbers in this study are so small that confounding variables will make the data useless.

Of the 500 women planning vaginal birth, assuming that they are standard pregnant women who receive standard maternity care, at least 30%, and possibly up to 50% will experience a Caesarean birth. That leaves the vaginal birth cohort of 250-350. Many of these women will receive powerful narcotic drugs either by injection or epidural; drugs that are kept locked up in the 'dangerous drugs' cupboard. A considerable number of the 'vaginal birth' cohort will have their labours stimulated artificially with synthetic prostaglandins and oxytocin; and many will be 'assisted' to give birth by obstetricians wielding forceps or ventouse caps. All of these interventions carry potentials for harm to the mothers and babies, with a potential to influence depression and breastfeeding rates.

Of the 500 women planning elective pre-labour Caesarean, there will be other variables. A few may even labour spontaneously and quickly, and give birth vaginally! A considerable number of the surgically delivered babies will experience difficulties with breathing, and require special care for the first day or so. A few of these babies may be very ill.

A few mothers in the elective Caesarean cohort will develop wound infection, and many will develop internal adhesions that may complicate future births. A few may experience serious iatrogenic complications of the surgery, including accidental surgical damage to uterus, bladder, ureters, or bowel; drug administration errors; harm resulting from spinal anaesthesia; and haemorrhage. Subesquent pregnancies for these women also bring the potential for abnormal placenta formation, with placenta accreta and percreta placing a woman at great risk of serious haemorrhage requiring urgent hysterectomy as a life-saving measure.

In 1996, World Health Organisation made the profound statement that "In normal birth there should be a valid reason to interfere with the natural process." (in Care in Normal Birth: a practical guide, p4)  It's a no-brainer.

Today, Australian women are being enlisted into research that pretends to address the question of which is better, vaginal birth or abdominal surgery. It's a stupid question. If the safety of vaginal birth for the primigravid well woman is considered anywhere near the risk of a Caesarean, it's an indigtment on what happens to women planning vaginal birth.   The researchers need to find ways to protect and promote the natural processes in birth, while reserving surgical intervention for those who have a 'valid reason'.

I hope there are midwives and doctors whose critical thinking alarm bells start sounding when they are asked to enlist women in this study, and I hope the women who are approached tell the researchers what they can do with their trial.

This is a personal opinion, and is not a policy statement for Australian Private Midwives Association.

Your comments are welcome.


Ben said...

I must agree that this study doesn't sound all that well thought out. Though I'm not an academic on the topic, unlike Dr Robson, nor a midwife, like my wife is. I can see that trying to obtain the data from such a small and poorly controllable sample isn't going to show real world results. If finding out which birth method is better for a healthy expecting mother to choose to obtain a healthy life post birth for mother & child. Then wouldn't it be better to recruit mothers into the study over a length of time after then birth, when the biggest variable's relating to the birth itself are known, & and a more consistent sample is achieved. Knowing the perimeters of the birth after the fact will show the immediate data of the birth itself without being tainted with the unexpected variables you've already mentioned to throw the numbers out. this then helps with the data correlation once the mothers go home, if you know that all participating mothers had uncomplicated pregnancies, & all women using each birth type were to be considered "normal" births, then the sample women can be sub categorized based off the family support unit and the results of depression & milk production can be better correlated into useable information for decision making.

4daughters said...

totally agree! thank you Joy for your blog, getting to the point of even talking about this is astounding! Red flag all over...