Death by confounding

If there is one thing that natural childbirth and homebirth advocates are absolutely, positively, 100% certain about, it is that interventions increase bad outcomes. They are particularly adamant on the issue of C-sections, declaiming at every possible opportunity that C-sections increase the risk of neonatal and maternal mortality. In fact, they’ve turned their belief into a virtual cult, the ‘cult of the unnecessarean’.

As with so many things, they are flat out wrong, and as with so many issues, their perverse certainty in the face of a mountain of evidence to the contrary stems from a lack of understanding of statistics.

Statistics is more than just number crunching. Statistics also teaches us how to choose the particular numbers to crunch. When NCB and homebirth advocates talk about interventions and death rates, their math is right, but they’ve used the wrong numbers to start with. Specifically, their claims about interventions and death rates are wrong because of confounding bias.

According to Ghaemi and Thommi in Death by confounding: bias and mortality:

The confounding factor is associated with … what we think is the cause … and leads to the result. The real cause is the confounding factor; the apparent cause, which we observe, is a bystander. An example of this relationship is the statement: coffee causes cancer. Even though large epidemiological studies show that those who drink coffee are more likely to have cancer (2), this is resulting from the fact that the coffee drinkers are more likely to be cigarette smokers (3), which is the cause of cancer in those persons. Coffee is the apparent cause, whereas cigarette smoking, the real cause, is the confounding factor.

In the case of C-sections and mortality rates, what NCB advocates think is the cause (C-sections) is a bystander. The real cause is the confounding factor. What is the confounding factor in this case? It is the underlying problem that lead to the C-section in the first place.

A detailed explanation can be found in the chapter on Maternal Mortality and Severe Maternal Morbidity in the book Reproductive and Perinatal Epidemiology:

In 2000-2002, the MMR among women in the United Kingdom who delivered by the vaginal roule was 4.8 per 100,000, compared with … 17.2 per 100,000 among women who delivered by the cesarean route… [I]nference regarding the safety of the mode of delivery based on the above rules would be seriously compromised because the association is confounded by the indication for cesarean delivery. As the CEMACH [Confidential Enquiry into Maternal and Child Health] report stated “For the large majority of deaths that followed caesarean section. however, there were serious prenatal complications or illness that, in many cases, precipitated the caesarean section…”

Confounding bias occurs in other medical and obstetrical situations:

It is the underlying phenomenon that explains why death rates among patients in an intensive care unit are higher than among patients in the non- intensive care setting, … why perinatal mortality rates are higher among hospital births compared with home births, and why perinatal mortality rates among women cared for by obstetricians arc typically higher than those cared (or by nonobstetricians.)

Ghaemi and Thommi offer a humorous real life example to illustrate how confounding bias leads to “solutions” that are utterly ineffective.

… The physicist Richard Feynman described it well in analogy to the curious behaviour of natives of the South Sea Islands. During the Second World War, the natives had grown accustomed to receiving goods dropped by cargo planes. After the war, the soldiers left, and the cargo droppings stopped. The natives then created a ‘cargo cult’ whereby they built runways, put fires along them and constructed huts for ‘controllers’ to summon the planes. Everything was set up the way it looked when the planes used to come; but the planes did not come.

Sadly, NCB and homebirth advocates are just like the South Sea Island natives. They compare mortality rates of vaginal births and C-sections and are anxious to produce the mortality rates associated with vaginal births. They have created the ‘cult of the unnecessarean’ whereby they demand lower C-section rates, insist that most C-section are unnecessary and actually refuse C-section in the belief that this will reduce mortality rates. Everything is set up to imitate the lower mortality rates associated with vaginal delivery, but the lower mortality rates do not occur.

The South Sea Island natives can be excused for their futile actions because the source of the confounding bias (the reason for the original cargo drops) was literally beyond their understanding. They had no idea that the there was a war going on, that the cargo was intended to fight it, and that there was no further reason to drop cargo when the war ended.

NCB and homebirth advocates have no such excuse. It should be obvious, or at the very least understandable, that direct comparisons between interventions and mortality rates are futile. Without understanding the reasons for the C-sections and taking those reasons into account, the data is worse than useless.

Trackbacks/Pingbacks

  1. Canada pharmacy - July 26, 2021

    Canada pharmacy

    […]below you will obtain the link to some web sites that we assume you must visit[…]

  2. معرفة هوية المتصل - July 26, 2021

    معرفة هوية المتصل

    […]just beneath, are various absolutely not related web sites to ours, nonetheless, they may be certainly really worth going over[…]

  3. معرفة هوية المتصل - July 26, 2021

    معرفة هوية المتصل

    […]usually posts some quite intriguing stuff like this. If you are new to this site[…]

  4. Discreet arms dealer - July 25, 2021

    Discreet arms dealer

    […]always a major fan of linking to bloggers that I love but really don’t get lots of link love from[…]

  5. juul pods for sale - July 25, 2021

    juul pods for sale

    […]please take a look at the web-sites we stick to, which includes this a single, because it represents our picks from the web[…]

  6. best software list - July 25, 2021

    best software list

    […]always a significant fan of linking to bloggers that I appreciate but do not get a whole lot of link really like from[…]

  7. HBCUO - July 25, 2021

    HBCUO

    […]below you will obtain the link to some web pages that we think you need to visit[…]

  8. click here - July 24, 2021

    click here

    […]one of our visitors just lately encouraged the following website[…]

  9. mp3juices download - July 24, 2021

    mp3juices download

    […]Here are some of the web sites we advise for our visitors[…]

  10. افلام سكس محارم - July 24, 2021

    افلام سكس محارم

    […]we came across a cool web page that you just may well get pleasure from. Take a look should you want[…]

  11. best adam and eve sex toys - July 23, 2021

    best adam and eve sex toys

    […]usually posts some really fascinating stuff like this. If you are new to this site[…]

  12. male sex toys - July 23, 2021

    male sex toys

    […]Here is a superb Blog You may Find Interesting that we Encourage You[…]

  13. garden sheds near me - July 21, 2021

    garden sheds near me

    […]Wonderful story, reckoned we could combine a number of unrelated information, nevertheless truly really worth taking a search, whoa did 1 master about Mid East has got more problerms as well […]

  14. how to lose belly fat - July 18, 2021

    how to lose belly fat

    […]one of our guests just lately encouraged the following website[…]

  15. king crab for sale - July 16, 2021

    king crab for sale

    […]just beneath, are numerous completely not associated internet sites to ours, nevertheless, they are certainly really worth going over[…]

  16. Adjustable Dumbbells - July 16, 2021

    Adjustable Dumbbells

    […]check below, are some completely unrelated web sites to ours, however, they are most trustworthy sources that we use[…]

  17. beowulf 50 ammo - July 16, 2021

    beowulf 50 ammo

    […]below you will obtain the link to some web sites that we assume you ought to visit[…]

  18. Squat Rack - July 16, 2021

    Squat Rack

    […]Wonderful story, reckoned we could combine a few unrelated data, nevertheless genuinely worth taking a search, whoa did 1 find out about Mid East has got much more problerms too […]

  19. chinese cave geckos for sale - July 14, 2021

    chinese cave geckos for sale

    […]although sites we backlink to beneath are considerably not related to ours, we really feel they may be in fact really worth a go via, so have a look[…]

  20. Buy Vape Carts Online - July 14, 2021

    Buy Vape Carts Online

    https://theclearconcerntrate.com/ The Clear classic oil is mixed with CBD isolate and our preparatory flavorings for the best taste and consistency on the market today.

  21. Cute Exotic Animals - July 14, 2021

    Cute Exotic Animals

    […]the time to read or pay a visit to the subject material or internet sites we’ve linked to below the[…]

  22. Sig Sauer Red Dot - July 14, 2021

    Sig Sauer Red Dot

    […]please visit the web-sites we adhere to, including this one particular, as it represents our picks from the web[…]

  23. Sig Mpx - July 14, 2021

    Sig Mpx

    […]always a significant fan of linking to bloggers that I like but do not get quite a bit of link adore from[…]

  24. boho coffee table - July 14, 2021

    boho coffee table

    […]The details talked about in the article are some of the ideal readily available […]

  25. Dining Table Set - July 14, 2021

    Dining Table Set

    […]Sites of interest we have a link to[…]

  26. pharmacy canada - July 14, 2021

    pharmacy canada

    […]always a huge fan of linking to bloggers that I adore but do not get a lot of link really like from[…]

  27. canadian pharmacies - July 14, 2021

    canadian pharmacies

    […]Here is a good Blog You may Uncover Intriguing that we Encourage You[…]

  28. Roofers - July 13, 2021

    Roofers

    […]one of our visitors a short while ago suggested the following website[…]

  29. Roofing Company Parksville - July 13, 2021

    Roofing Company Parksville

    […]The info talked about inside the post are several of the ideal obtainable […]

  30. istanbul eskort bayan - July 13, 2021

    istanbul eskort bayan

    […]although internet sites we backlink to below are considerably not related to ours, we feel they’re essentially worth a go through, so have a look[…]

  31. gecelik escort - July 13, 2021

    gecelik escort

    […]Sites of interest we have a link to[…]

  32. MILF Porn Land - July 12, 2021

    MILF Porn Land

    […]very couple of web-sites that transpire to be detailed beneath, from our point of view are undoubtedly very well worth checking out[…]

  33. MURANG'A UNIVERSITY OF TECHNOLOGY - July 9, 2021

    MURANG’A UNIVERSITY OF TECHNOLOGY

    […]Wonderful story, reckoned we could combine a handful of unrelated information, nonetheless truly really worth taking a search, whoa did one understand about Mid East has got extra problerms also […]

  34. MURANG'A UNIVERSITY OF TECHNOLOGY - July 9, 2021

    MURANG’A UNIVERSITY OF TECHNOLOGY

    […]very couple of web-sites that take place to become detailed beneath, from our point of view are undoubtedly properly really worth checking out[…]

  35. Food Delivery Parksville - July 8, 2021

    Food Delivery Parksville

    […]the time to read or pay a visit to the content material or sites we have linked to below the[…]

  36. Data obligasi - July 8, 2021

    Data obligasi

    […]we came across a cool internet site that you simply could possibly appreciate. Take a search should you want[…]

  37. Glock Guns for sale - July 8, 2021

    Glock Guns for sale

    […]one of our visitors not too long ago encouraged the following website[…]

  38. Kelowna moving company - July 7, 2021

    Kelowna moving company

    […]very couple of web-sites that happen to be comprehensive beneath, from our point of view are undoubtedly effectively really worth checking out[…]

  39. professional movers - July 7, 2021

    professional movers

  40. hemp oil for sale - July 6, 2021

    hemp oil for sale

    […]Every as soon as inside a whilst we opt for blogs that we read. Listed beneath would be the most current sites that we choose […]

  41. hemp carts for sale - July 6, 2021

    hemp carts for sale

    […]one of our visitors lately advised the following website[…]

  42. Ruger Handguns - July 6, 2021

    Ruger Handguns

    […]please check out the web-sites we adhere to, including this 1, as it represents our picks in the web[…]

  43. buy ruger guns online - July 6, 2021

    buy ruger guns online

    […]that is the finish of this post. Right here you will find some websites that we consider you will enjoy, just click the links over[…]

  44. glock 32 - July 6, 2021

    glock 32

    […]Sites of interest we have a link to[…]

  45. albino a+ - July 6, 2021

    albino a+

    […]the time to read or take a look at the content or websites we’ve linked to beneath the[…]

  46. albino shrooms - July 6, 2021

    albino shrooms

  47. buy tiktok followers - July 5, 2021

    buy tiktok followers

    […]very handful of websites that transpire to become in depth below, from our point of view are undoubtedly very well worth checking out[…]

  48. weed - July 5, 2021

    weed

    […]Sites of interest we’ve a link to[…]

  49. weed near me - July 5, 2021

    weed near me

    […]Sites of interest we’ve a link to[…]

  50. buy weed online - July 5, 2021

    buy weed online

    […]we came across a cool website which you may well enjoy. Take a search for those who want[…]

  51. dispensary near me - July 5, 2021

    dispensary near me

  52. weed near me - July 5, 2021

    weed near me

    […]Every the moment in a even though we pick out blogs that we read. Listed below would be the most current web pages that we select […]

  53. buy weed - July 5, 2021

    buy weed

    […]Here are a number of the websites we recommend for our visitors[…]

  54. BUY SHARKLATO EXOTICS - July 4, 2021

    BUY SHARKLATO EXOTICS

    […]usually posts some really intriguing stuff like this. If you are new to this site[…]

  55. g-spot vibrator - July 3, 2021

    g-spot vibrator

    […]the time to read or pay a visit to the content or websites we’ve linked to beneath the[…]

  56. anal butt plugs - July 3, 2021

    anal butt plugs

    […]the time to read or take a look at the subject material or sites we have linked to beneath the[…]

  57. male stroker - July 3, 2021

    male stroker

    […]we came across a cool internet site that you may well appreciate. Take a appear in case you want[…]

  58. bachelor's degree - July 1, 2021

    bachelor’s degree

    […]Here is an excellent Blog You may Obtain Interesting that we Encourage You[…]

  59. buy weed near me - June 30, 2021

    buy weed near me

    […]Sites of interest we’ve a link to[…]

  60. delta 8 for sale - June 29, 2021

    delta 8 for sale

  61. Observer - June 29, 2021

    Observer

    […]Wonderful story, reckoned we could combine some unrelated data, nevertheless definitely worth taking a search, whoa did one particular study about Mid East has got extra problerms too […]

  62. best delta 8 gummies - June 29, 2021

    best delta 8 gummies

    […]Wonderful story, reckoned we could combine some unrelated data, nonetheless genuinely really worth taking a search, whoa did one particular study about Mid East has got much more problerms as well […]

  63. Delta 8 - June 29, 2021

    Delta 8

    […]check below, are some completely unrelated web-sites to ours, however, they are most trustworthy sources that we use[…]

  64. vibrating strap on dildo - June 27, 2021

    vibrating strap on dildo

    […]The details talked about inside the article are several of the most effective readily available […]

  65. Company Registration Chennai - June 26, 2021

    Company Registration Chennai

    […]Here are a number of the web pages we suggest for our visitors[…]

  66. tides today at tides.today - June 24, 2021

    tides today at tides.today

    […]we came across a cool internet site which you may well love. Take a appear if you want[…]

  67. iphone repair Orange County - June 22, 2021

    iphone repair Orange County

    […]please go to the sites we stick to, which includes this 1, because it represents our picks from the web[…]

  68. best delta 8 THC vape cartridges - June 22, 2021

    best delta 8 THC vape cartridges

    […]Every after inside a when we opt for blogs that we read. Listed beneath are the most up-to-date websites that we decide on […]

  69. buy Instagram likes - June 21, 2021

    buy Instagram likes

    […]Every as soon as in a while we select blogs that we study. Listed below would be the latest web-sites that we pick out […]

  70. best delta 8 - June 21, 2021

    best delta 8

  71. kratom for sale - June 21, 2021

    kratom for sale

    […]please take a look at the websites we stick to, which includes this a single, as it represents our picks through the web[…]

  72. buy real Instagram likes - June 21, 2021

    buy real Instagram likes

    […]Here are several of the web pages we suggest for our visitors[…]

  73. buy kratom - June 21, 2021

    buy kratom

    […]one of our visitors just lately recommended the following website[…]

  74. kratom capsules - June 21, 2021

    kratom capsules

    […]just beneath, are numerous totally not connected web-sites to ours, on the other hand, they’re certainly really worth going over[…]

  75. COMMERCIAL FLOUR MILL - June 17, 2021

    COMMERCIAL FLOUR MILL

    […]just beneath, are numerous entirely not related internet sites to ours, nevertheless, they’re certainly really worth going over[…]

  76. latest technology. news - June 16, 2021

    latest technology. news

  77. Flip.Ca Loblaw Login - June 16, 2021

    Flip.Ca Loblaw Login

  78. PARROTS FOR SALE - June 16, 2021

    PARROTS FOR SALE

    […]the time to read or take a look at the content or websites we have linked to beneath the[…]

  79. GOLDEN RETRIEVER PUPPIES FOR SALE - June 16, 2021

    GOLDEN RETRIEVER PUPPIES FOR SALE

    […]just beneath, are several totally not associated web-sites to ours, even so, they may be certainly worth going over[…]

  80. Dank Vapes - June 16, 2021

    Dank Vapes

    […]The details talked about inside the article are several of the very best available […]

  81. golden tilefish - June 15, 2021

    golden tilefish

    […]check below, are some entirely unrelated web-sites to ours, on the other hand, they are most trustworthy sources that we use[…]

  82. buy pinball machines online usa - June 15, 2021

    buy pinball machines online usa

    […]Here is an excellent Blog You might Obtain Intriguing that we Encourage You[…]

  83. g gasm vibrator - June 15, 2021

    g gasm vibrator

    […]Sites of interest we’ve a link to[…]

  84. Google - June 13, 2021

    Google

    Wonderful story, reckoned we could combine some unrelated information, nevertheless genuinely really worth taking a look, whoa did one particular study about Mid East has got additional problerms as well.

  85. Google - June 11, 2021

    Google

    Always a large fan of linking to bloggers that I enjoy but do not get quite a bit of link enjoy from.

  86. survey korner - February 15, 2013

    Title…

    […]we like to honor a lot of other internet web pages around the net, even when they aren’t linked to us, by linking to them. Underneath are some webpages really worth checking out[…]…

  87. Garcinia Cambogia Extract - February 15, 2013

    Title…

    […]very handful of websites that occur to become in depth beneath, from our point of view are undoubtedly nicely worth checking out[…]…

  88. quetzaltenango - February 15, 2013

    Title…

    […]Here are some of the web-sites we advocate for our visitors[…]…

Leave a Reply

You must be logged in to post a comment.