Time Out for Good News

by Melissa Garvey, ACNM Writer and Editor

It’s a busy week at ACNM. We’re getting ready to open registration for our Annual Meeting and staying on top of a flurry of midwifery advocacy. In the midst of the activity, it’s been especially gratifying to see a hefty amount of positive press about midwives pop up in my inbox each morning. It feels great to have a chance to pause and revel in interviews well done, stories well told, and an inspiring midwifery mission making a difference in Haiti.

• Judith Rooks, CNM, MPH, FACNM, former president of ACNM, speaks up in the Portland Tribune about rising cesarean birth rates. It’s a balanced article that includes solid statistics and the midwifery perspective.
  
  
• Debbie Boucher, CNM, of Illinois is interviewed in an excellent Fit Pregnancy article titled “Home, Sweet Home.” Kudos to Fit Pregnancy for balanced coverage of home birth.
  
  
• ACNM Senior Practice Advisor, Eileen Ehudin Beard, CNM, FNP, helps women prepare for conception with straight-forward advice in the Vellejo Times-Herald, “Ready, Set Conception: 9 Steps to Prepare Your Body for Baby.”
  
  
• Nadene Brunk, CNM, explains the background and mission of Midwives for Haiti, an organization making a difference in Haiti before, during, and after the earthquake.
  

What Do U Think of Text4Baby?

by Melissa Garvey, ACNM Writer and Editor

ACNM has just signed on as an outreach partner of Text4Baby, a new service that sends free text messages (available in Spanish and English) to new and expectant moms. Launched by a DC-based mobile technology firm in cooperation with the National Healthy Mothers, Healthy Babies Coalition (HMHB), Text4Baby aims to encourage healthy habits and birth outcomes by delivering free texts on topics such as nutrition, flu prevention, substance abuse, and mental health. It also connects women with relevant support services.

Within the first 24 hours of going live, 6500 people had subscribed to the service, and at a sign up rate of as many as 250 per hour, total subscription numbers continue to climb. From the beginning, ACNM staff members were impressed with the concept and execution of Text4Baby. With an estimated 90% of US adults carrying cell phones, this project has the potential to reach millions of women with positive messages. We’re especially pleased that HMHB staffers sought out midwifery input before going live.

Thanks to feedback from ACNM staff midwives, many of the texts contain provider-neutral, midwifery-inclusive language. One of the first texts subscribers receive is “You can choose who you see for pregnancy care. Midwives, family docs, OBs & nurse practitioners can all provide care. Call 800-311-2229 for free/low-cost care & to find a provider who's right for you.”

What do you think? Do you expect Text4Baby to make a meaningful difference in the lives of women and their babies?

Becoming a Critical Reader: Bias, Bias Everywhere!

by Andrea Lythgoe, LCCE (Originally published on Science and Sensibility for Lamaze International)

Pretty much everyone would agree that there is bias in research. Most people would say that bias is inherently bad. While it absolutely can be a bad thing, it can’t be completely eliminated. So what can be done about bias in research?

There are many kinds of bias:

• Researcher bias: researcher sets out wanting to the study to prove something, and intentionally or unintentionally manipulates the study to make sure that happens
• Sponsor bias: The organization that sponsors the study either encourages researcher bias or manipulates the publication of the data. Some studies might be completely suppressed, some might have overly inflated press releases touting minimal results.
• Publication bias: Journals must be selective in what they publish due to space limitations, but I think it is fair to say that some journals may choose not to publish a study that might anger its audience.

But today I want to focus on READER bias:

Your first job in the critical reading of an article is to check your bias. We are all human, and so we all have bias. Sometimes it is hard to see your own biases. Take a look at the pictures below. In the first picture, we can tell that there is something there, but it is difficult to see. In this case, the letters are lined up with our angle of vision.

In this second picture, the letters are running the opposite way as our line of vision, and as you can see, suddenly that bias is crystal clear!

The same is true with our reading of the research. The biases that we have act as a filter that alters our reactions to the research. If we already have our minds made up that induction of labor = bad, then any research on labor induction is going to be seen through that filter. Any research that seems to place induction in a favorable light will be seen has highly suspicious. Any minor flaws will be exaggerated. Any research showing bad outcomes from inductions will likely get a “free pass” and flaws may be overlooked.

Murray Enkin, author of “A Guide to Effective Care in Pregnancy and Childbirth”, said this:

Perhaps the most important bias of all resides in the (potential) reader, who determines how (or if) the results will be read and interpreted.

I would agree with him. I have, over the years, seen the best and worst of research used to back up various points, ignoring the quality (of lack of it!) as long as it agrees with them. This is a normal human tendency, and one that is at the heart of many discussions about the available research.

But the good news is that reader bias isn’t impossible to overcome.

The solutions? Awareness of bias and a change of perspective! As you read, consider how this research might be read and understood by someone with a completely different perspective. When you read a study that really resonates as a great study with you, play “devil’s advocate” and pick it apart. Be merciless in looking for flaws, weaknesses and the other types of bias listed above. The same is true of seeing an article you disagree with. Look for strengths and solid evidence. Have an open mind to other possibilities. Sometimes when doing this, you’ll be able to see some aspects you would never have noticed otherwise.

So, here’s an exercise for you. Take a few minutes, and write down what your biases are when it comes to research. Which kinds of research, which methods, which topics do you particularly feel drawn to? Which ones seem silly or useless? For inspiration, you may want to read a personal commentary article written by Murray Enkin (2008) where he goes through his own personal biases. The things he feels a bias for or against may not be the same for you. I know I have a disagreement with one of his stated preferences. But taking the time to carefully think through your own personal biases, to clearly acknowledge the filters through which you view the research, can only help you as you try to step back and make a critical analysis of the research.

Reference: Enkin, M. W. (2008) Biases in evaluating research: Are they all bad? Birth: Issues in Perinatal Care. 35(1). 31-32.

While We Were Out

by Melissa Garvey, ACNM Writer and Editor

ACNM staff have been out of the office due to two major snowstorms that hit the DC area last week. Now that power is restored and major roadways are cleared, it’s time to catch up on all the midwifery news I missed.

• ACNM volunteers and telecommuting staff put the finishing touches on our newest Position Statement: Nitrous Oxide for Labor Analgesia. Stay tuned for more information on why this is so exciting and important.
  
  
• A new service named Text4Baby is now available for expectant moms. The free service delivers messages about physical and emotional health to women who may not have Internet access. ACNM’s staff midwives had a chance to review the messages in advance and pushed for more provider neutral language. Amie Newman has posted her take on the service at RH Reality Check.
  
  
• Last Friday, midwife supporters rallied to demand that midwifery services return to St. John’s Pleasant Valley Hospital in Camarillo, CA. Watch the Birth Action Coalition for continuing developments.
  
  
• A new certified midwife (CM) program has been announced at the University of Philadelphia. They are now accepting applications for fall 2010. For Midwife Connection newcomers, the certified midwife credential is a direct-entry route to midwifery designed for applicants with bachelor’s degrees in disciplines other than nursing. CMs are educated to meet the same high standards that every state in the US has recognized as the legal basis for nurse-midwifery practice. Learn more in this QuickInfo document.
  
  
• The California Dental (CDA) Foundation published Oral Health During Pregnancy and Early Childhood: Evidence-Based Guidelines for Health Professionals. (Did you know February is National Children’s Dental Health Month?)
  
  
• Science and Sensibility had its fourth healthy birth blog carnival. This round addresses how to avoid interventions that are not medically necessary.
  

What else did I miss?

Midwives Don’t Deliver? What's the Catch?

by Melissa Garvey, ACNM Writer and Editor

In preparation to launch the A.C.N.M. Foundation’s online quiz at www.DeliverMyBaby.org, one of the biggest hurdles was choosing a name. Our review panel consisted of midwives around the country of varying ages and practice settings, A.C.N.M. Foundation Board members, and the ACNM communications team. DeliverMyBaby had that snappy ring we were looking for, but there was that word…“deliver.”

Our review team members had opinions both for and against “deliver.” Most midwives prefer saying “I will attend a woman’s birth” or “I will be there to catch a woman’s baby”—not deliver a woman’s baby. It’s a noteworthy distinction, which acknowledges that the woman does the work of birthing the baby.

Midwives have a distinct style of care, and it shows up even in their word choices. Many midwives say they have clients—not patients. Some clients end up needing a cesarean birth—not a cesarean section.

But, of course, there is a flip side when it comes to naming an online quiz. The quiz was made for expectant parents who may have never considered using a midwife as their care provider. What are they most likely to click on: attend, catch, or deliver my baby?

This reasoning is causing some traditional midwifery word preferences, such as "client" and "catch," to take a back seat to more mainstream, commonplace terms of today’s health care scene. As an ACNM communications team member, I prefer the traditional, unique words used by midwives whenever possible and appropriate. I do, however, think there is a time and a place for both “deliver” and “catch.”

What do you prefer? And what do you think about the evolution of how midwives are using these words?

Can We Reduce Premature Birth with Better Communication?

by Eileen Ehudin Beard, CNM, FNP, ACNM Senior Practice Advisor

We are so time conscious in our society. Life in the fast lane frequently requires scheduling out major events. Childbirth is one of the important life events that cannot and should not be scheduled. I wonder if midwives and other health care providers are taking the time to explain why. More specifically, how many women understand how the estimated due date (EDD) is calculated and what constitutes a full-term pregnancy?

Last month, we looked at a study in Obstetrics and Gynecology that analyzed women’s perceptions of full-term birth. And in December, we made note of the rising incidence of premature birth in the United States. I’d like to expand on one aspect of the study authors’ conclusion:

“…with the trend of an increased patient role in medical decision-making, ensuring that women understand the implications of the timing of delivery may be an important component of interventions to reduce the number of elective or semi-elective late preterm and early term deliveries.”

Do women and their families really understand the possible consequences of a preterm delivery? Perhaps we need to spend more time explaining how the EDD is calculated and why it is important to avoid delivery before 39 weeks.

Midwives need to take time to explain that the 40 weeks used to calculate EDD is 9 months because there are 4½ weeks in most months. We need to explain that for the EDD to be most accurate, a woman must be certain of her last normal menstrual period and have a regular 28-day cycle. Even then, EDD is an estimate. Women are not machines and don’t always have the same cycle. The EDD can often be unreliable, which may unwittingly lead to early induction of what looks like a full-term pregnancy on paper—more reason to avoid unnecessary induction.

Since many women and obstetricians are “scheduling delivery’” before 40 weeks, the picture can get pretty fuzzy for women. Early delivery may appear safe since it happens so often. There are many important issues to discuss on the initial prenatal visit, but I wonder if we breeze over the issue of what constitutes preterm delivery and how the EDD is calculated. We need to give this topic the careful explanation that it deserves. It could turn out to be a key intervention that helps decrease the incidence of late preterm and early term delivery.