{"id":2032,"date":"2011-01-27T09:00:04","date_gmt":"2011-01-27T14:00:04","guid":{"rendered":"http:\/\/girlwpen.com\/?p=2032"},"modified":"2011-01-27T09:00:04","modified_gmt":"2011-01-27T14:00:04","slug":"bedside-manners-peeing-when-you-laugh-is-not-funny-neither-is-misrepresenting-research","status":"publish","type":"post","link":"https:\/\/thesocietypages.org\/girlwpen\/2011\/01\/27\/bedside-manners-peeing-when-you-laugh-is-not-funny-neither-is-misrepresenting-research\/","title":{"rendered":"BEDSIDE MANNERS: Peeing When You Laugh is Not Funny, Neither is Misrepresenting Research"},"content":{"rendered":"

I\u2019m collaborating on a study of traumatic childbearing experiences, so I\u2019ve been thinking a lot about the types of injuries that can occur as a result of pregnancies, labors, and different types of deliveries.\u00a0 My research partner forwarded me a recent blog post on a board-certified urogynecologist\u2019s website titled \u201cCesarean on Demand Does Not Eliminate Risk of Prolapse<\/a>.\u201d \u00a0This post highlights the findings of a 2009 research article<\/a> published in the International Urogynecology Journal<\/em>. In this research, three groups of women were studied: \u201cvaginal delivery with sphincter tear (n<\/em>\u2009=\u2009106), vaginal delivery without sphincter tear (n<\/em>\u2009=\u2009108), and cesarean without labor (n<\/em>\u2009=\u200939).\u201d [The numbers reflect how many\u00a0women were\u00a0in each of the three groups.]<\/p>\n

Now, I\u2019m no urogynecologist, but I found it hard to believe that c-sections \u201con demand\u201d (a.k.a. without labor) would not at least reduce the risk of pelvic floor damage, including pelvic organ prolapse<\/a> (pelvic organs \u201cslipping out of place\u201d when the supportive muscles and ligaments are weakened or torn).\u00a0 Prolapse can greatly impact the health and quality of life: for example, women with prolapse may suffer one or both types of incontinence and\/or painful sexual intercourse.\"File:Pelvic<\/a><\/p>\n

I recognize that many medical practitioners, authors and laypeople have come to believe we have too high a rate of c-sections here in the U.S.\u00a0 Research studies, such as the one celebrated in the recent blog post, call into question whether there are any health benefits of c-sections without labor.\u00a0 As a medical sociologist who teaches research methods, I consider it to be of utmost importance to discuss research findings with the highest degree of accuracy.\u00a0 No study is perfect: no study is without bias and no study is without limitations.\u00a0 So, I read the complete\u00a0research article to find out if it\u00a0truly supported the blog author\u2019s contention that these researchers \u201cfound NO DIFFERENCE in moderate prolapse between the three groups.\u201d\u00a0<\/p>\n

I was struck by\u00a0significant methodological flaws and limitations which, while acknowledged by the authors of the original article, were glossed over or flat out ignored by the author of the blog post.\u00a0 I found myself asking several questions:<\/p>\n

Question #1: how healthy were the women before this childbearing experience?\u00a0\u00a0<\/strong>No one knows: the researchers admit, “our findings cannot be attributed with certainty to delivery method, since some women may have developed prolapse before delivery or pregnancy and prolapse was not assessed prior to delivery in this population.”\u00a0<\/p>\n

Question #2: who were the women who participated in this study?<\/strong> \u00a0The women for this study were recruited from prior studies performed through the Pelvic Floor Disorders Network<\/a>, specifically from the follow-up study to their CAPS Study<\/a> (which focused on \u201cfecal and urinary incontinence after childbirth\u201d).\u00a0 How can we rule out a self-selection bias of those women who said “yes” when they were recruited to this initial study?\u00a0 Could it be certain women who had\u00a0C-sections, perhaps\u00a0those\u00a0feeling some pelvic\/vaginal discomfort immediately following delivery were more likely to say “yes” because they saw value in being interviewed about incontinence?<\/p>\n

Question #3: did the researchers recruit enough women for each of the three groups to be able to\u00a0answer their main question?<\/strong>\u00a0 No.\u00a0 The authors wrap up their article by\u00a0noting that “further research would be required to determine whether cesarean delivery before labor reduces the incidence of pelvic organ prolapse.”\u00a0 So, this research doesn’t actually determine anything about what they claim as their primary research question.\u00a0 Why not? \u00a0The short answer is that they never got enough women to participate.\u00a0 The authors claim that they would have needed 132 women per group in order to test the statistical significance<\/a> of the difference in rates of\u00a0stage II prolapse<\/a> between those women who had C-sections without labor and those women who had vaginal deliveries.\u00a0 While they got reasonably close to their\u00a0sample size goal of 132 for the two vaginal delivery groups (106 and 108), they only got 39 women to participate in the C-section group.\u00a0 Is this\u00a0acceptable? \u00a0Statistical significance is key to evaluating any study because it means that the results are \u201cprobably true (not due to chance)<\/a>.\u201d\u00a0 The researchers finally own up to the likely irrelevance of their study towards the end of the published journal article: “Furthermore, our sample size was not sufficiently large to exclude a significant difference between groups.”\u00a0 In plain language: they didn\u2019t study enough women to know whether or not\u00a0there are not real differences between the health outcomes for women who have c-sections without labor and those experience other types of labor and delivery.<\/p>\n

Question #4: can the researchers say anything definitive that might help improve women\u2019s health?<\/strong>\u00a0 Hmmm.\u00a0 The only factor they definitively connect with less pelvic floor damage is lower birth weight: I\u2019m betting that it won\u2019t surprise many to find out that smaller babies causes less damage.\u00a0 But, what are we supposed to do with this finding?\u00a0<\/p>\n

The\u00a0author of that recent blog post dares to call it a “beautifully executed study,\u201d and that\u2019s why I had to wrote this post: to help those of us who are not medical researchers better understand what we should value and what we should question when it comes to research studies that can impact women’s health.<\/p>\n","protected":false},"excerpt":{"rendered":"

I\u2019m collaborating on a study of traumatic childbearing experiences, so I\u2019ve been thinking a lot about the types of injuries that can occur as a result of pregnancies, labors, and different types of deliveries.\u00a0 My research partner forwarded me a recent blog post on a board-certified urogynecologist\u2019s website titled \u201cCesarean on Demand Does Not Eliminate […]<\/p>\n","protected":false},"author":1918,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21094],"tags":[33,3109,3290,665],"class_list":["post-2032","post","type-post","status-publish","format-standard","hentry","category-bedside-manners","tag-health","tag-motherhood","tag-pregnancy","tag-science"],"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts\/2032","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/users\/1918"}],"replies":[{"embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/comments?post=2032"}],"version-history":[{"count":0,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/posts\/2032\/revisions"}],"wp:attachment":[{"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/media?parent=2032"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/categories?post=2032"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thesocietypages.org\/girlwpen\/wp-json\/wp\/v2\/tags?post=2032"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}