Monday, April 2, 2012

Retrospective versus Prospective: A Very Important Distinction

There's a cliche that hindsight is 20/20 and it would appear that when it comes to birth few are able to make the distinction between retrospective and prospective. This is where the term "unneccessarian" comes from. This is also where studies that proclaim Homebirth to be safer than hospital birth fail. Ditto for most studies that compare birth outcomes between vaginal births and Caesarian births.

Retrospectively (hindsight) the claims made might be true - but the difficulty is that decisions must be made prospectively (foresight) and there is no crystal ball that will tell you how everything will play out. The decision about where to birth is made before you actually give birth. Many planned home births (more than 10 percent) result in emergent/urgent transfer to a hospital. The decision about how to birth (planned caesarean versus planned vaginal) again is made before hand - however, it should be noted that many planned vaginal births result in emergent/urgent caesarean births.

So as a mother who is prospectively making plans, a woman must consider how her plan will mesh with the wide variety of potential outcomes.

Researchers also need to turn their minds to the issue of "prospective" versus "retrospective" so that they can provide better information to those who are trying to make prospective decisions, but are currently forced to base their decisions on "retrospective" studies.

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