Individuals don’t behave according to statistical means…

“Many individuals do not behave according to statistical means, and population models will fit them poorly.”

– J Christopher Glantz

 

This quote is taken from a paper that I chose as my ‘study of the month’ in the February edition of my Birth Information Update.

Published in Birth: Issues in Perinatal Care, this article was written in response to the author’s astonishment at a debate which took place at the 2016 American College of Obstetricians and Gynecologists (ACOG) annual meeting. The debate was entitled, “If No Elective Inductions Before 39 Weeks, Why Not Induce Everyone at 39 Weeks.” The author of the current article, J Christopher Glantz, is a Professor of Obstetrics and Gynecology who has previously spoken out about the illogical nature of the technocratic approach to routine induction of labour and he describes his astonishment thus:

“With labor already induced in 23% of all United States pregnancies as of 2014, it may astonish some that this provocatively titled concept is being put forth, but perhaps even more astonishing is that both “debaters,” Drs. Charles Lockwood and Errol Norwitz, apparently were in agreement with delivering every still-pregnant woman at 39 weeks; neither took the opposing side.” (Glantz 2017).

So the article in Birth is an eloquent and excellent rebuttal of the argument for early routine induction, and I would hereby like to buy him a drink to say thank you for writing it. The crux of his argument is this, and I have added bold for emphasis of what I see as the key points which anyone interested in this area may like to have ready for use in discussions on this topic:

“Some epidemiologic studies and meta-analyses report reductions in some morbidities, but the actual degree of risk reduction in low-risk populations is very small and the number of 39-week inductions required to prevent one complication is very large. No data exist as to whether there are any differences in long-term morbidity.” (Glantz 2017).

Professor Glantz goes on to cover more of the myriad reasons why such a policy is inappropriate.

“Counseling all pregnant women that the safest choice for their baby is to be delivered at 39 weeks does not account for women’s preferences, inappropriately extends conclusions that are tentative at best to many women, and may “guilt” large numbers of susceptible women into agreeing to have unnecessary interventions and procedures. Who wants to takes risks with one’s baby, even when the actual risks are very small or based on convoluted mathematical models? An individual woman is not a statistical mean, and women should not be coerced into interventions by directive use of modeled statistics.”

This article contains some discussion of mathematical notions that might be a stretch to those who don’t feel comfortable with numbers (though if you want to better understand the stats or the evidence, maybe I can help), but it’s well-written and the arguments are very woman-centred so I think this paper is well worth adding to the files of anyone who talks to pregnant women about such issues.

 

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Glantz JC (2017). Why not induce everyone at 39 weeks? Birth: Issues in Perinatal Care. DOI: 10.1111/birt.12275
Photo credit: henriquefelix

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