APPLES TO APPLES

I know…there are “lies, damned lies, and statistics” (according to Mark Twain) and I have previously written a blog post about what is considered “low risk” vs “high risk” and statistics related to that..
But this blog post I want to get people thinking about what they read in a different and more critical way.

“Compare apples to apples…not apples to oranges.”

Sometimes I think people THINK they are looking at apples, when they aren’t.  We need a critical eye (and mind) whenever someone starts talking statistics.

Recently I have seen touted in headlines over and over again: Homebirth rates have increased 20% in the last 4 years! WOW! That’s amazing! Until you look closer at the numbers and while 20% sounds like a lot, and some headlines even read “Dramatic 20% increase”…

0.67%

That’s what the most current homebirth rate is. 0.67%. Nationally, the homebirth rate rose from 1 in 179 in 2004 to 1 in 143 in 2008. That is 0.56% – 0.67%. Not quite as “dramatic” when you look at it that way.

But that’s what people do – they look at things and think, “how can I make this sound the way I want it to without being dishonest”.

I want to know the truth, not your version of it, not your interpretation of it, not your swing on it.

We run into the same problem when trying to compare hospital births to homebirth. Hospital supporters cry out, “It’s not a fair comparison! We are dealing with pre-existing high risk pregnancies and births! You can’t weed out the high risk mothers, send them to us, and include them to prove homebirth is safer!” They are absolutely right, that doesn’t tell you anything! Are you trying to prove that homebirth is safe? Or are you actually interested in the TRUTH – looking at our outcomes, seeing what they are, how they compare, and how we can improve…?

Homebirth supporters are equally indignant and exclaim, “You are including unattended accidental homebirths and known demises and that’s not a fair comparison!” They, too, are absolutely right. Those aren’t homebirths – they are hospital births that didn’t make it. Or someone without any prenatal care.

There are times when I wish I had the education, money, and ability to run a study, crunch numbers, and come up with an unbiased true valid comparison. Here is what I want to do…
* Hospital births attended by either CNM or OB that were low-risk at the onset of labor.

~ COMPARED TO ~

* Homebirths attended by a CPM, CNM, or LM (or equivalent) who were low-risk at the onset of labor and are in a state in which the midwife is well integrated into the medical system. She is practicing legally and able to provide full prenatal care (including screening tests, labs, ultrasound, etc) as well as transfer freely to the hospital without fear of retribution.

I think that is what is needed in order to see how the LOCATION (and care provider) affects the outcome. It’s unfair to include high risk mothers in the hospital statistics, and it’s also unfair to tie a homebirth midwife’s hands so that she can’t make it as safe as possible and claim that she is making it unsafe.

How can you look at homebirths without full prenatal care and think that’s a fair comparison? How can you include someone who calls themselves a “midwife” without knowing what she MEANS by calling herself that? I knew a mother once who chose an unassisted homebirth – she had no professional prenatal care and no professional present at her birth.  She told me, “My husband was my midwife.” I have to disagree – your husband was your husband, he just took care of you the best he could with his limited knowledge and experience.  He was not a midwife.  Being the most knowledgeable person in the room doesn’t make you a midwife anymore than it makes you an OB.

A midwife should have training and experience.  She should also be able to carry the tools that she knows how to use and that allows her to actually do her job effectively! How can you tell a midwife that she can’t carry oxygen, can’t carry a Doppler, can’t carry emergency equipment, can’t order labs, can’t order an ultrasound…and then compare her outcomes she is able to achieve with her hands tied that much to hospital births?  That’s like me telling a man he must build me a home but he can’t use blueprints or a hammer or screwdriver.  Am I trying to see his skills as a builder or am I trying to prove that he’s incompetent?

I just had to transfer a client 4 days ago to the hospital – and as I called my CNM friends on their cell phones and gave report and arranged for medical care to be waiting for them at the hospital and sent them off to the hospital knowing they would be well taken care of, being told by my CNM friends, “Good job!” – never having to think for one minute whether there would be legal retribution for me having done my job…I realized how lucky MY CLIENTS are that we live in the state that we do. That I am ALLOWED (by virtue of being a licensed midwife) to be the best midwife I can be, as non-interventive and as supportive as possible but also to be able to provide medical responses if they need them, to have tools to be able to identify problems earlier (labs) and treat them sooner (O2, Pitocin, etc) – that is not for me, that is for the client. That makes things safer for the client.

So why can we not compare THOSE numbers? Look at what homebirths CAN be compared to what hospital births CAN be! (and I would include those who transfer to the hospital in labor or postpartum into the HOMEBIRTH stats! After all, that is MY client and the fact that she turned high risk is still on me…and my responses are on me…)

All the numbers tossed from person to person, juggled then handed off like a hot potato – do you want to prove a point or do you want to learn? I want to learn, and I am not so proud and arrogant as to think that don’t have room for improvement! I do keep track of my statistics, the raw statistics, and think we need to get away from “us vs. them” and get into “birthing families” and so they can make informed decisions with real information.

What do you think?

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