Thursday, March 15, 2012

The first step in fixing a problem, is recognizing that there's a problem to be fixed

And the first step in recognizing that there's a problem to be fixed, is measuring it effectively.

I would love to blog about how exceedingly rare it is for women to have traumatic birth experiences in British Columbia in recent years. I would love to have the ability to proudly proclaim that my case was some sort of bizarre and rare exception, and that there is no evidence of a current and continuing problem in the care received by women who are giving birth in British Columbia.

I would also love to blog about where in British Columbia women are least likely to have bad experiences or about which providers and hospitals are rated the most highly as providing quality care. I would love to be able to blog about the kind of objective statistics that would truly help women avoid having a birth experience that is traumatic to them.

I can blog about some statistical sources of information on birth in BC, but for the most part what is available says little about the things that really matter. There is the "What Mothers Say: The Canadian Maternity Experiences Survey" (the most recent of which is 2005/06), which indicates that about 12 percent of women in British Columbia had a somewhat or very negative experience of labour and birth, and a further 12-13 percent had a neither negative or positive experience of labour and birth. However, there is no sub-provincial break down of data, nor is there a provincial breakdown for satisfaction by type of care provider, nor for specific aspects of interaction with health care providers during entire pregnancy, labour and birth, and immediate postpartum period. The maternal experiences survey also has some interesting information on the use of pain management techniques and their effectiveness - in it, it is reported that about 36 percent of women in BC who have a vaginal birth or attempt a vaginal birth have an epidural. This compares to a Canadian average that is nearly 60 percent. However, there is no sub-provincial break down of the use of epidurals, nor is there any information on the availability of different pain management techniques. Further sources of statistical information on birth in British Columbia, include the BC Vital Statistics Agency annual report and the Perinatal Services of BC website and the Canadian Institute for Health Information. Again there are some serious gaps in the kinds of questions that can be answered by these data sources.

So for the most part, I am left blogging about anecdotes - my own personal story about what happend to me when I gave birth in 2010, about the birth stories that result in legal action or media reports and my own personal opinions. While anecdotes are meaningful and poingnant, rarely are they a measure of the size or extent of a problem. All an anecdote is, is evidence that something happend once to somebody - and a sample size of 1 is simply inadequate to draw broad conclusions from. Further, a personal opinion, is just that, one person's thoughts on an issue which must be put into the context of who that person is and their own knowledge and experiences.

I'd love to be blogging about the issues and problems and successes of maternity care in BC from a position of adequate data on the subject. But as of 2012, adequate data on the subject doesn't exist. There's evidence of problems, but just what kind of problems and where and to what degree, is surprisingly scant. Unfortunately, I don't think that the problems that exist will be fixed until they are identified and adequately measured and identification and adequate measurement seem like rather distant goals.

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