Believing what you are
told.
Foreword
My name is Debby Miller. I am a
thirty something mother of two boys. One born by caesarean
and the other a VBAC.
I work full time as a financial
adviser in a Government Department and am currently studying
two degrees Accounting and Human Resource Development.
From my work and study I have developed a good ability to
research things. A skill that was particularly helpful to
me when I was researching for my VBAC birth.
I have a great interest in birth
issues, particularly related to being an informed patient
because of my first bad birth experience and my subsequent
good one.
I have offered to write a series of
articles about a variety of subjects for Birthrites in the
hope that my experiences and investigative abilities can
help other mothers and mothers to be to make informed
decisions about their birth choices. The topics I intend to
write about are shown in the Discussion Topics Index. I
will not be writing them in any specific order or to any
specific time frame.
I would advise all readers to read
the first article Believing What You Are Told as this
provides the basis for you to understand how assessments are
made, both by myself and in the references I use, on the
remainder of the topics discussed.
I will try to keep the articles
simple and will provide examples where possible. If medical
terms are used I will add them to the Glossary so you can
see what they mean.
I would ask that readers note that
I will try to keep the research factual and not input my own
personal bias, however whilst I am aware of my own
prejudices, I will probably lean towards documentation that
supports my view.
Secondly I am not a medical
practitioner, nor do I have any medical training. The
information I present will be based on research, journal
articles and texts, and my interpretation of those. I will
quote all references. Women wishing to use the information
I provide are recommended to read the references for
themselves and should discuss any issues pertaining to their
own medical management with a qualified medical practitioner
or midwife.
Topic 1: Believing What You Are
Told
Introduction.
When making a decision based on information received from
external sources whether that is advice from your doctor or
midwife, something you have read in a book or journal, or
even just a friends opinion on something, you need to have
an understanding of how that information was
gained.
The importance of this
understanding is it enables you to identify what kind of
weight or importance you want to give the information
supplied. This will help you to make an INFORMED decision
rather than one based on fear or some-one's
prejudices.
Information Sources. Information
can be gained from a number of sources these
include:
a. A Personal Opinion -
this is a statement made by a person, that they believe to
be true, which may or may not be based on fact or
experience.
b. A Personal Experience -
this is where a person relates an example or examples to you
in which they have personally been involved.
c. Secondary Data
Information - this is where a person relays information
to you based on their interpretation of studies and articles
they have read, and they might also have had some personal
experience in the situation.
d. Research - there are
three types of research approaches.
- Surveys: where information is
gathered by questionnaire. The information asked for may
be a persons opinion on something or facts related to
their experience of something. Interviewing people is
also a means of conducting a survey.
- Experiments are where the
researcher is trying to establish a cause and effect
relationship. The most reliable experiments are where
the researcher has control over everything that may
affect the outcome, such as experiments that occur in a
laboratory.
Field experiments can also occur where the researcher has
less control over the environment, eg. they are conducted
in a hospital ward or home, but can usually still see if
there is a cause and effect relationship.
- Observations: this is a record
of observations. This method is non reactive meaning
there is no interference into the situation being
observed. (1)
Examples of Information Sources.
Here are some examples of things you may read or hear on
birthing issues. (*Note they are all fictional):
a. A Personal Opinion
"Mrs Mummy I think you will have to
have a caesarean because all women with red hair and brown
eyes have a small pelvis".
- "Your caesarean scar will
definitely rupture because they always do in people who like
to wear purple hats"
b. A Personal Experience
"The last three VBAC attempts I had
by women whose husbands names are Fred, had to have a
caesarean".
- "I have never attended a
successful VBAC and therefore I dont believe they can
possibly happen".
c. Secondary Data
Information
- "Drs Wergle and Snergal indicate
in their study on birth, that any woman with a poodle for a
pet will have a successful VBAC but those with cocker
spaniels will have caesareans
- "Mrs Mummy, in the book The
Birthing Woman by Drs Gurgle, Mergle and Dergle, several
studies are quoted all of which indicate that standing on
one foot and singing the national anthem will make labour
progress twice as quickly compared to those that
dont"
d. Research - there are
three types of research approaches:
- Surveys: A survey of
doctors at the New Mummys Hospital indicated that doctors
with red hair and green eyes had a higher caesarean rate
than those with brown hair and blue eyes. It also
indicated that doctors with the first names Dot and Don
induced patients more often but had did less forceps
deliveries than doctors named Jan, Jill and John.
- Experiments:
- 1) Laboratory
Experiment: An experiment was conducted to see if a
greater rate of fertilisation of eggs occurred in
solution A or solution B. An equal number of eggs, of
the same age, from the same woman were placed in the two
dishes with an equal proportion of sperm of the same age,
from the same man. The eggs were viewed at 1 hourly
intervals. The results showed that the sperm had greater
mobility in solution A and 60% of the eggs were
fertilised within 24 hours. In solution B only 20% were
fertilised within the 24 hours.
- 2)Field Experiment: It
was proposed that the having intercourse at certain times
of a womans cycle increased the possibility of conceiving
either a male or female child. Women were advised to
monitor and record their cycles to identify when they
were likely to ovulate. If they wanted a female child
they were to have sex once four and three days before
ovulation and then not again until well after ovulation.
If they wanted a male they were advised to have lots of
sex on the day before, the day of, and the day after
ovulation. Reports indicated that the chance of
conceiving a child of a selected gender was slightly
increased by following these (and other) directions.
(This is based on the theory by Dr Shettles if any of you
want to try it there is a book available).
- Observations: An
observer was situated in the delivery room of a major
hospital. During their observation they were to note all
actions that occurred by the patient, their support
persons and the medical attendants. They were not to
talk to the patient or other persons in the room or
assist in any manner. Observations indicated that the
caesarean rate was lower amongst women who had good
support from partners and others. Birthing tended to be
quicker in women who moved around rather than being
confined to bed. More women had pain relief after
oxytocin induction compared to prostaglandin induction
and natural commencement.
Advantages and Disadvantages of
Information Sources. Information sources have varying
degrees of value and accuracy:
a. A Personal Opinion - a
person may make a statement to try to bring you to their way
of thinking. It may be based on fact or it may be a pure
fabrication. When a doctor or midwife make a statement to
you it is particularly important to find out the facts
behind that statement. I would be extremely suspicious of
someone who was reluctant or unable to provide me with the
documentation or references that could support their
opinion, as this would indicate to me that their statement
is based on caution, fear, stubbornness or laziness as
opposed to fact. One doctor I am aware of seems to prefer
caesareans and told a friend of mine that it was safer for
her to have another caesar than a VBAC, I have not seen any
documentation that supports this statement (except in a few
very special situation none of which she
fitted.).
b. A Personal Experience -
personal experiences can be of great value, I would be much
happier to be delivered of a breech baby by a doctor who had
done a number of them than by someone who knew the theory.
However take care that the personal experiences relayed to
you may only relate to one or two cases. For scientific
studies to be of value the number of cases studies to reach
a conclusion has to be significant in most fields of study
100 is considered the minimum. Therefore the doctors one or
two cases may not give you the true statistics..
c. Secondary Data
Information - Interpretation is the key word here. We
all like to read what we want to hear. If your doctor or
midwife is quoting studies ask them if they have read
studies with a contrary view to the one they are telling
you. If they have ask them why they disregarded these
studies.
d. Research - there are
three types of research approaches.
- Surveys: Surveys can be
skewed by the way the questions are asked. We have all
done the CLEO questionaries you have to chose an answer
from four options and none of them is quite right. The
more opportunity there is to make comment in a survey the
more likely it is to provide accurate information. They
can be a valuable source of gaining large amounts of
information relatively quickly in a relatively
inexpensive manner.
- Experiments:
Laboratory experiments tend to be very reliable. Most
study results from experiments will be subject to peer
review eg. other doctors will comment on the study, and
retesting by other teams. Consequently bad studies that
are poorly conducted or in which the results cannot be
duplicated tend not to be widely published.
Field experiments are generally reviewed in the same
manner as laboratory experiments and results are
therefore pretty reliable.
The main thing to be aware of in studies is the
manipulation of statistics from the studies lies, damn
lies and statistics. To say that a VBAC mother who is
induced increases her risk of scar rupture by 70% sounds
terrible, but the original risk rate was 0.05% so to
increase this by 70% means the risk is now 0.085% that is
an increase from 5 in 10 000 to 8.5 in 10 000, doesnt
sound nearly as bad does it?
- Observations: An
observation can provide a factual account of what
happened however the experience of the observer will
cause them to place different interpretations of what
happened. To compare observations the observers need to
have a clear guideline of what they are trying to see and
what is pertinent to ensure all relevant facts are
recorded in order to make an accurate assessment.
Assessing Risk
A risk is the chance that something
might happen. We all take risks every day, some of them
potentially life threatening like driving a car. When
someone presents a situation to you that either you or they
perceive as risky you need to ask yourself the following
questions
- what is the basis of their
assessment of this risk, is it fear or fact?
- can they provide studies and
articles that support this risk assessment?
- have any statistics been
manipulated to make something sound better or
worse?
- if I take this risk what are the
possible outcomes and how likely is each of these to occur?
Eg. Scar rupture
- no rupture / VBAC delivery /
baby and mother fine
- small window / VBAC delivery / no
repair / baby fine
- small window / caesarean
delivery / no repair / baby fine
- significant tear / caesarean
delivery / repair required / longer hosp stay / baby
fine
- significant tear / caesarean
delivery / blood loss / hysterectomy required
- significant tear / caesarean
delivery / baby partially extrudes from uterus but
survives
and so the list can go on with
endless possibilities of what might happen. Worst case is
the mother and baby die but how likely is this?
- what can this risk be compared to
that I do in everyday life? eg. What is the risk of being
severely injured or dying in a car crash and how do these
statistics compare to what you are looking at?
- what other factors can I
incorporate into my regime that might reduce this risk? Eg
having the baby in hospital, monitoring etc. (Do I want
these things?)
- what are the alternatives to
this? eg. VBAC or caesarean and what are the risks involved
with the alternative?
- am I willing to accept this risk
as is or in a modified format?
If you approach your assessment of
risk in a logical way you will be more satisfied and
informed in your decisions. When others try to convince you
to go an alternative view, you will be able to state with
reason why you wish to pursue the path you have chosen using
a logical process as opposed to emotional or gut
reactions.
Conclusion
Be acutely aware of what you are
being told. Ask what is the source of this information and
how reliable is it. Being informed is not only about being
told things it is about asking the right questions and doing
the right research. If you are not sure of the accuracy of
information discuss it with other people, get a second,
third or fourth opinion, and READ, READ, READ!!
It is only with knowledge that you
will be confident in your decisions and will be able to
relay your confidence to others.
Reference
(1) Business Research Methods by
W.Zikmund. Published by The Dryden Press 2000.
©.
Further articles to be
submitted by Debbie:
- Why Induction is
Used
- Methods of Natural
Induction
- Methods of Artificial
Induction
- Outcomes for Induced
Babies
- Methods of Birthing and
Birthing Alternatives
- The 'Natural'
delivery
- The Mechanism of Birthing
First Stage
- The Mechanism of Birthing
Second Stage
- Birthing Positions First
Stage
- Birthing Positions Second
Stage
- Water-births
- Support People
- Non Interventionist Pain
Relief
- Interventionist Pain
Relief
- Effects of Pain Relief on the
Baby
- What is Rupture of the
Uterus
- Risks of Rupture of the
Uterus
- Outcomes of Rupture of the
Uterus
- Types of Twin
Pregnancies
- Natural Delivery of the Twin
Pregnancy
- Caesarean delivery of the Twin
Pregnancy
- Risks of VBAC
- Methods of Managing
VBAC
- When to Go to Hospital
- Glossary
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