text4baby Evalulation Info!

I'm excited to share some new information about evaluation of text4baby. A small (n=160) survey-based study was done in San Diego with some pretty neat results. There's a great pdf showing it all but it was emailed to me in the text4baby newsletter, instead of posted online, so I can't link to it, boo.

I think my favorite stat is that "63.1% reported that text4baby helped them remember an appointment of immunization that they or their child needed." Missed appointments are a big deal, and this is a pretty direct text->action connection.

I also liked "38.5% ... of participants reported that they called a service or phone number that they received from a  text4baby message. These messages range from perinatal and infant care services such as breastfeeding and post-partum support lines, teratogen information, low-cost health services to product safety, poison control, and infant immunization information lines." This kind of integration is a strength of mHealth. You're looking at a phone number on your phone so you just go ahead and dial. Also neat is that this percentage jumped to 58.3% for those participants without health insurance.

The study also looked at cultural and linguistic appropriateness for the Spanish version of text4baby. Oddly, a third of recipients reported incorrect Spanish in the messages. Were they not checked by native speakers? Fortunately, a large majority said that the messages were understandable anyway.

More general information in a whitehouse.gov post here, and if you're interested in reading details about other upcoming larger scale evaluations, let me know and I can forward the email! (Some of it is available at the links here.)

Guest Post at Unnecesarean on Hospital Variation in Induction and Cesarean Rates

The lovely Jill asked me if I could write up a guest post for The Unnecesarean - a review of this article on the effect of hospital type (community or university) on labor induction and cesarean rates.

I'm planning to work on a similar topic - the association between different hospital characteristics and their cesarean rates - for a lit review in my Perinatal Epidemiology class. I'm delighted to see articles that look at birth outcomes with exposures other than maternal factors. It'd be easier if every cesarean section were an obvious outcome of a medical or personal factor that made it necessary, but the data just doesn't bear this out. This kind of research is a great step toward figuring out what's going on with the rising c-section rates and I am particularly excited about this lit review because I don't think - fingers crossed, or I don't have a topic - it's been done before, and I love the idea that my classwork could actually mean something to someone.

(Also, my inner feminist is itching to shout 'stop blaming women!' from the rooftops. Guess what? Maybe the 33% cesarean rate isn't because we're fat, or old, or unhealthy.)

Quick Hit on Midwifery Care and Disparities

Prepare yourself for the longest sentence ever:

• In a system where truly collaborative OB-midwifery care is a relative rarity and transfers/transports from home births or birth centers can result in terrible antagonism and poor treatment,

• and therefore many women are summarily (and possibly wisely, in this context) risked out of midwifery care in these settings,

• then to the extent to which midwifery care is associated with better outcomes,

• out-of-hospital midwifery care becomes a means by which the bad and worsening sociological disparities in perinatal health (by race especially, but also by insurance status and income, geography etc.) for both mother and child are exacerbated,

• because exactly those populations who could most benefit from midwifery care are systematically excluded from accessing it,

• due to the bigger problem of the fragmented system of maternity care.

Please, your thoughts?

Navelgazing

Lots of navelgazing lately about what I'm about regarding childbirth.

I would say right now I am mostly trying to hash out a spot somewhere between three angles on the topic:

One. The fact that many or even most aspects of modern American birth are not optimal for healthy mothers and babies, aka the public health angle.

Two. The severe lack of information, choice, and agency most women face in their childbirth experiences, aka the feminist angle.

Three. The devious little inner know-it-all birth nerd that thinks everyone should have a non-interventive birth and breastfeed as long as possible, aka the asshole angle.

Woops! I let that one come out of my virtual mouth. You know, I'm working on this, and I'll be frank and say that I haven't whooped it yet. I can talk big about how both One and Two are problems on a population/society level, not an individual level, but talk to me about a pregnant woman and the asshole wheels start spinning, true story.

In my head, this is wrapped up with a few other issues, which I hope to write about in the short term future:

A. The question of what actions my convictions about these issues compel me to.

B. Issues I seem to have with advocacy. And you know it's true because I once had to get told by a certain BU professor interested in childbirth that "Advocacy is real, you know." Doy!

In Which My Law Professor Sets a Question To Rest

Since I've had one session of my Public Health Law class, I now know everything about the law. In particular, the professor (unwittingly - this was not his particular topic) set up some tenets that relate to the periodic internetz question of the supposed 'alegal' status of midwives in states without laws about midwives, as follows:

1. In the United States, everything is legal unless it's illegal.

2. "Can [someone] be sued for [something]?" is never a meaningful question, because the answer is always yes, yes s/he can. (You can try it: Can I be sued for picking my nose? Yes I can.)

Rather, the meaningful question is "Can [someone] be successfully sued for [something]?" (Can I be successfully sued for picking my nose? No, probably not.)

3. QED, dudettes.

PS. I am being sassy. But I am also rather sure - 92%, say - that my conclusions here are correct. Please tell me I'm wrong if you know better.

Short labor, long labor

I have been thinking about the use of length of labor as an outcome of interest in scholarly papers about birth. If you search length of labor on Google Scholar, all 8 relevant hits on the first page assume that shorter is better.*

(Molly wrote a post about this from a birth story or personal perspective - that some women may find fast labors more frightening, and that her very long labor was wonderful for her.)

I'm not sure length of labor makes any more sense as a study outcome in populations, either. Is this really the ideal curve?

sciencey drawing

In a medical birth setting, providers are invested in speeding labor up; many common interventions serve this purpose. Since all of these interventions will not have been withheld in studies, the data is going to be a little warpy (technical term). This is like the data conundrum in looking at average length of gestation. Many women gestate their babies for much shorter than the norm, but few will remain pregnant way longer than the norm because they'll be induced to prevent it. Similarly, many labors will be much shorter than the norm, and few will be much longer than normal. (We can separate out labors/pregnancies that are shorter than normal because of medical interventions, needed or not, and those that are shorter than normal just because that's what that woman's body is doing, pathological or not.)

Why the professional bias toward shorter labors? My guess is because of the relationship between length of labor, failure to progress, and eventual cesarean section. It sounds dumb to say it, but short labors never fail to progress. Long labors do often result in c-sections, but as ever, it's important to think of cesarean as a medical decision, rather than a medical outcome. In some long labors, a c-section is really called for. In other cases, it's not - more time is what's needed.

Using 'length of labor' as a measurable outcome in published studies fails to distinguish these cases (and ignores overly short/precipitous labors) by looking at average length of labor and assuming that shorter means better. Women's experiences contradict this blanket statement; it seems like common sense does too.

Does anyone know of other writing or thinking on this topic?

PS. If you enjoy reading about babies and epidemiology and curves and stuff, try this out. It will either blow your mind or put you to sleep.

*(It took me like 30 seconds to realize that "Optimal length of labor contracts" was not a relevant hit. I'm thinking I've never heard the use of 'labor contracts' to refer to contractions ... then realize it's from an economics journal. Oh.)