A Not-So-Subtle Shift in Wording
Medical News Today reported what seems to be good news for women who have fractured their pelvis and intend to have children and/or give birth vaginally.
In research led by a Saint Louis University surgeon, investigators found that women who give birth after suffering pelvic fractures receive C-sections at more than double normal rates despite the fact that vaginal delivery after such injuries is possible. [Emphasis mine]
The choice of words sets this article apart from so many others like it, in particular, articles about obese women being more likely to receive a cesarean section. Even if the party they are interviewing or the study on which they are reporting doesn’t intend to convey it, many journalists begin with the assumption that women with [insert condition or trait here] need more cesarean sections and [insert name of researcher or institution] is working to find out why such women require cesareans at a higher rate than women without that condition or trait.
Whether it’s given a tongue-in-cheek fallacy status or merely viewed as poor reporting, the cultural tendency to ignore the care provider’s and/or patient’s decision-making process that led to performing a cesarean implies causation where none might exist.
Amy Romano blogged at DrGreene.com that one of the strongest predictors of whether or not a woman will receive a cesarean is where she gives birth.
A large body of literature suggests that where a woman gives birth is one of the strongest - or even the strongest - predictors of whether she’ll have a cesarean. Yes, you read that right. The same woman could walk into two different hospitals and walk out having had either a vaginal birth or abdominal surgery. The same is true with care providers. Some have high cesarean rates and others have low cesarean rates, and most of that difference has little to do with how many women in their care actually need cesareans to give birth safely.
The choice of the words “receive C-sections” in the Medical News Today article acknowledges the care provider as an independent variable in analyzing cesarean rates retrospectively. When studies fail to control for this variable and instead rely on maternal characteristics to describe and compare risks, women are left with incomplete information with which to make informed choices, not to mention the misguided notion that their bodies are incapable of giving birth vaginally without great risk or difficulty.
The researcher interviewed in the Medical New Today article agrees that neither patients nor doctors can be dropped from the equation.
“The C-section rate is so high. It’s important to educate women and their obstetricians that it is possible to deliver vaginally after a pelvic fracture,” said Cannada, who is also a SLUCare orthopaedic surgeon.
“Frequently, these issues are not addressed when women are first treated for a fracture. In some cases, women are given inaccurate information, such as being told not to become pregnant after a pelvic fracture or that they must have a C-section. This is not the case.”