I recently satirized one of the inane papers published by Dr. Michael Klein. Klein has heavily publicized his papers in the mainstream press and on natural childbirth blogs like Lamaze’s Science and Sensibility. The conclusion that drew the most press attention was Klein’s claim that women who seek care from obstetricians are undereducated about childbirth decisions.
The study was ludicrous on its face because it never actually assessed women’s knowledge of the risks and benefits of various childbirth interventions. It only assessed women’s self-perceptions of their level of education. In other words, Dr. Klein never showed that women who seek the care of midwives know more about childbirth interventions, only that women who seek the care of midwives THINK they know more about childbirth interventions.
The study is sloppy and lazy; sloppy because it did not control for when in pregnancy the self-assessments were made. It assume that women who felt that they didn’t know much about childbirth interventions during the first trimester would feel the same way in the third trimester. It is lazy because Klein didn’t bother to do the difficult work involved in assessing what each woman knew; he took the lazy way out and relied on each woman’s personal assessment of her knowledge.
Klein, a family practice physician, has in the past worked in conjunction with the Society of Obstetricians and Gynecologists of Canada (SOGC) in efforts to lower the C-section rate and increase the rate of breech deliveries in Canada. Yet in a nearly unprecedented move, the SOGC has issued a position paper condemning Klein personally for his shoddy and irresponsible conclusions.
The Society of Obstetricians and Gynecologists of Canada is concerned that the conclusions highlighted in the UBC media release issued on 13 June 2011, regarding a trio of studies, has oversimplified the issues related to the use of technology in childbirth. While the SOGC has be a strong proponent for normal childbirth and the reduction of C-sections rates in the country, the issues related to decision-making in obstetrics is far more complex than the conclusions drawn by Dr. Michael Klein.
As Dr. Ahmed Essat, president of the SOGC points out:
It is inappropriate to draw conclusions based on attitude alone. The decision making process during labor and delivery is far more complex than that.
The SOGC objects to Klein’s underlying assumption that technology is bad, pointing out that:
Society, including the new generation of health-care professionals (not only obstetrician-gynecologists), favor the use of technology.
Dr. Andre Lalonde, executive vice president of the SOGC, rejects Klein’s studies and his claims about what they show:
The SOGC feels that comments and conclusions expressed by Dr. Michael Klein are too simplistic and do not take into account a large number of factors that affect the care of pregnant women …
I couldn’t have said it better myself.
If you go to the CDC WONDER database, and limit cause of death to the O and P causes (stuff that happens around pregnancy) the death rate is lowest at 39 weeks. They show 38 as being better than 42, and those 38 weekers likely include more people with complications causing the early inductions.