Tuesday, November 12, 2013

Bad Evidence Drives Bad Decisions

Before I ever was a mom (and even now), I spent a lot of time with health statistics. Health statistics are experiences that have been reduced to numbers - they represent what happens to real people and describe how often specific things happen. Statistical analysis is a tool that is used to help figure out why those things happen - but it is far from perfect and far too often correlation is confused for causation. Equally problematic - the things that are not measured, often go unaddressed. When health statistics are done well - they shine a light on a problem and motivate positive change. When health statistics are done poorly - they keep real problems in the dark and hinder progress. Often, ideology colours the research that is undertaken and the result is a body of evidence that is at best poorly understood, and at worst used to make policy that does far more harm to those who it was meant to benefit.

I have come to the terrible and tragic realization that health statistics done poorly and obscured by ideology are endemic when it comes to pregnancy and childbirth.

It is the only way I can possibly understand the widespread propaganda that is largely focussed on promoting a specific kind of birth (normal birth) and a specific kind of infant feeding (breastfeeding) - even at the cost of the physical and emotional health and well-being of mothers and their children.

It is the only way I can explain Ottawa's and Toronto's public health stance on breastfeeding.

It is the only way I can explain the BC Minister of Health encouraging homebirth last year.

It is the only way I can explain all the "failure" felt by women who do not manage to have a normal birth or to breastfeed - all the while ignoring whether or not it really matters in the first place.

It is the only way I can explain why cesareans and VBACs are used as system measures, but rates of psychological trauma are not - it is also the only way I can explain why the costs associated with birth seem to end 6 weeks post-partum.

If health statistics and research in this area were being done well - the things that really mattered would be measured and better understood. If that was the case, maybe I wouldn't get the feeling that we are being penny wise and pound foolish, and short-changing the health and well-being of women and their children in the process.


  1. I am suprised to see you use the term "normal birth". I might be remembering incorrectly, but I thought that was a term that offended you.

  2. Vaginal delivery is the better descriptor, but "normal birth" seems to be what is in widespread use. I dislike it because it makes anything else "abnormal", and as a result there's a lot of connotations about what is good or bad with deliveries that are not vaginal deliveries.

  3. Birth is so connected to culture. There is a huge "pro-nature" "pro-natural" "pro-caveperson diet, lifestyle, exercise and birth" culture in Canada - it is "in" right now.

    Like all other fads, it will get old. Then the statistics will show something else that seems to correlate well with whatever is "in" at that time.

  4. Anonymous - regardless of what the "culture" is, those who do not ascribe to it, should not be forced to conform. I find it really reprehensive that there is a willingness to cross a line - the line that says "this is this woman's body, and as such she gets to make the decisions with respect to it." Those decisions might conform with the culture, or they might not, and if they do not - that needs to be her right and it needs to be respected. Otherwise, women are not persons - and that is an idea that should be universally offensive.

  5. I am agreeing with you.

    "I have come to the terrible and tragic realization that health statistics done poorly and obscured by ideology are endemic when it comes to pregnancy and childbirth."

    Culture is ideology. I believe statistics will always be obscured by ideology. Always. So either we continue doing what we are doing (and ignore this), or we recognize that there is more to "best care" than just statistics. I am not subject 1234, I am a unique person. I should have the option of personalized healthcare - because no one can truly say with 100% certainty that having a vaginal birth is safer for ME and MY baby (two individuals).