Wednesday, May 24, 2006

From Sailorman: What would it take?

Sailorman asks the following question:

WHAT WOULD IT TAKE?

We have identified two studies which have been a matter of much debatebetween those claiming that home birth death rates are higher thanthose in the hospital, and their opponents. Those studies are the Johnson and Daviss study, and the Farm study.

Dr. Amy's and my argument essentially boils down to this: "the data were faulty. If they did proper study analysis, their answer would have been different".

Their opponents argue, in essence: "there is nothing wrong with the data. The analyses were properly done, and the printed conclusions are reliable".

If you're a supporter of these studies, WHICH OF THESE OPTIONS is most correct?

A: I would change my mind about the results of the studies if a well known home birth advocate did so publicly.

B: I would change my mind about the studies only if the authors retracted the study.

C: I would change my mind about the studies only if an epidemiologist told me the authors interpreted the study incorrectly.

D: I would change my mind about the studies only if a statistician (not an epidemiologist) explained that the authors interpreted the study incorrectly.

E: None of the above options would cause me to change my mind about the studies.

10 Old Comments:

This comment has been removed by a blog administrator.

By Blogger Mama Liberty, at 5:33 PM  

Mama, they're in the archives. However, can you delete YOUR post? I would love to keep this thread on track.

A note to posters:

Yes, of course I know there are other options not listed there. But can you please, please, answer the question as it is written? If you're not happy with anything I suggested, there's always choice E.

By Blogger sailorman, at 5:43 PM  

This comment has been removed by a blog administrator.

By Blogger Mama Liberty, at 6:25 PM  

What do you mean by "supporter of these studies"? That one believes the conclusions are gospel truth or that one believes that the studies lend support to the idea that homebirth is safe? Or none of the above?

As it is written, I would say my answer is E.

By Blogger Mama Liberty, at 6:39 PM  

"supporter of these studies"

=

"Someone who supports the conclusions and/or methods of these studies".

As far as I can tell, it's almost everyone here. Or not. We'll see.

By Blogger sailorman, at 6:53 PM  

E would be my answer by default-- not an ideal answer- would have preffered different wording
more studies please with more detailed information
I don't believe that the Farm study truly represents low risk births- how many sets of twins and breeches? also the time span issue compare the collective rate over that time period--not just todays rates
as far as discrepancy- i would have to talk to Ina May- I could think of several plausible reasons - maybe the commune records included everyone's birth and death records even for members who had intentional hospital births from the outset- perhaps some of the deaths were infant mortality instead of neonatal ....
I also want to ask why when a client switches from medical care that they are not carried as a "medical " client in stats?
there is a basic assumption that is prejudicial

as for statistics I am no longer interested in neonatal mortality alone I want the death rate from the post natal period to be included because the area of increase in infant mortality has to do with perinatal conditions that survive beyond the neonatal period-- so if it is an infant mortality that has to do with perinatal conditions I want them included in the stats-- in other words a bigger review of the data not just from home but also from hospital births.

By Anonymous Anonymous, at 7:21 PM  

I have to choose E also, due to wording. C and D are influential with me... but I would not take the word of a single person. It would have to be a collective voice to sway my opinion.

By Anonymous Anonymous, at 7:36 PM  

C would carry a lot of weight with me. More about this down below, in this post's comments.

By Blogger Jamie, at 11:28 PM  

My answer to your survey question would be "B: I would change my mind
about the studies only if the authors retracted the study." And perhaps
the term should not be retract but perhaps clarified. If sailorman and
Dr. Amy feel the Johnson and Daviss study has serious flaws then why
don't you write a quality editorial and send it in to the BMJ. The
authors would then have an opportunity to address your concerns in a
reply in the BMJ if your editorial was published. You have raised
questions here that would be most appropriately answered by the authors
within the context of the BMJ editorial system. This would make both
your concerns and their replies "public" and quotable. I'm new to this
blog (and I don't want to alter the thread of this discussion) but has
anyone been discussing the study done by Peter Schlenzka at Stanford
entitled "Safety of Alternative Approaches to Childbirth." Its available
through a link on www.cfmidwifery.org/resources/ It addresses some of
the concerns sailorman brought up about matched populations in the BMJ
article. This study carefully matched all appropriate data to examine
perinatal outcomes of nearly 816,000 births, comparing low risk births
outside and inside the hospital in California using the state's matched
data sets of birth and death certificates, hospital discharge data and
other data sources. I mention this study since it adds to the discourse
on specific issues of matched populations related to the presented BMJ
critique. It also seems appropriate to be talking about a wider body of
evidence regarding out-of-hospital birth since the BMJ article was one
of many articles that have looked at out-of-hospital birth. Thanks.

By Anonymous Anonymous, at 1:08 PM  

"has anyone been discussing the study done by Peter Schlenzka at Stanford entitled "Safety of Alternative Approaches to Childbirth."

It is an unpublished dissertation, not a research paper. Why weren't the findings published?

By Blogger Amy Tuteur, MD, at 9:46 PM