Monday
Apr042011
New Maternity Care Data Visualization from Childbirth Connection
Monday, April 4, 2011 at 6:03PM
By Jill Arnold
Childbirth Connection hosted a Health 2.0 Developer Challenge to visualize maternity care data, including outcomes, cost, procedure use and variation. Damien Leri and Ian Bennett, MD, PhD, from the University of Pennsylvania answered the call and their clean, consumer-friendly site won the challenge.
Damien Leri presenting Mapping Health at the Health 2.0 Spring Fling in San Diego, CA
Check out the interactive states map on Mapping Health.
Mapping Health is included as a resource in the Data Center (Resources > Data Center) on the Transforming Maternity Care site, which was just launched by Childbirth Connection.
Reader Comments (17)
Interesting tool. Really highlights the disparities in outcomes in the south.
Disappointed to see the 12 free standing birth centers in Washington State weren't included, presumably because none are accredited with the American Association of Birth Centers...though several are members.
Right off the bat I can see 4 very serious problems with the data.
1. It does not correct for either race (which is closely associated with risks level) or for risk level itself. In other words, it is based on the assumption that the racial composition and risk level of all populations is the same, whereas both have wide variations among populations.
2. It presents the rising cost of C-section without any comparison to the rising cost of other medical procedures and therefore encourages a false correlation between C-section cost and C-section rate.
3. Cost comparisons among various types of deliveries fail to take into account the fact that delivery types are not interchangeable and that mortality rates would be quite different if the C-section rate were lower.
4. It provides only an overview of perinatal mortality rates instead of an analysis that would allow us to compare C-section rates and mortality rates across states or countries. Infant mortality rates are not a substitute for perinatal mortality rates.
Those 4 very serious deficiencies make the results misleading and relatively useless. You cannot use the data to claim that the C-section rate is too high or that outcomes would be better if the C-section rate were lower. In fact, you can't claim much of anything based on this data.
It does show, however, that physician compensation has nothing to do with C-section rates.
The Childbirth Connection is a lobbying organization that exists to promote NCB. It's hardly surprising that they manipulate the data to get their preferred outcome. It is extremely unfortunately, though, that they put their own financial well being ahead of providing accurate information for women.
Amy,
You can always contact them to let them know what you would like to see added. This is a data visualization... a visual representation of data that's out there from neutral sources. If you think they need to contextualize the available data with an analysis or study, give'em a ring. Maybe you are just the person to do the research.
Liz, that sounds like something you could suggest that they add. From what I got from the presentation, they intend to build this out.
The state comparisons are really fascinating ... I could spend all day clicking around there!
"from neutral sources"
The sources of the data are neutral, but the choice of which data to include and which data to leave out is not neutral at all. I just want people to understand that the data is presented in a misleading way to support a pre-determined conclusion.
Technically, the people you should share your feedback with are the creators of the Mapping Health project. http://www.mappinghealth.com/about
Ian Bennett, MD, PhD.: http://www.publichealth.med.upenn.edu/IanMooreBennett.shtml
I'm sure he'd love to hear all about how he has no academic integrity and is a part of a big "NCB" conspiracy to defraud the public.
Johanna, I find the variation from state to state fascinating, too.
Thanks for the suggestion, Jill. I emailed Dr Bennett, with the revised total of 14 birth centers! So glad I live in Washington State.
Wow, I had no idea Pennsy was so good with the medicaid coverage.
Thanks for the overview Jill. I was really excited to see the visualizations and the new website.
I agree. Amy, please don't let us take up any more of your valuable time.
Thanks for the post, Jill, I was wondering what sort of visualizations would be created.
It's a nice looking site, but I wish it included more information. C-section rates and costs are not the only factors that matter when it comes to maternal health. Also, Childbirth Connection does look pretty biased to me.
One thing I found interesting was the rate of midwife-attended births. Since I became a very amateur "NCB-advocate," I've had 4 good friends give birth (after discussing the topic of NCB extensively). 3 ended in C/S for "FTP." The one which did not was in New Mexico (attended by a hospital MW), a state where 29% of births are attended by MWs-- which I would think is also an indicator of the overall atmosphere there around NCB. The one that most recently ended in a C/S after many pushed interventions was also attended by a hospital MW in a state where 8% of births are MW-attended.
It's correlation and not causation, of course, but I would think that births are less-interventive and have better outcomes OVERALL in states with higher %s of MW-attended births. And that if you are planning a MW-attended birth, it's best to do so in a state where such is common. I mean, duh. But just saying... Take the (theoretically) same sort of MW or MW practice and place it in a more NCB-friendly climate and I imagine you have less interventive experiences and lower C/S rates. Social support is very important. In a more NCB-friendly state, you're not the only one seeing a MW, or having a HB, which normalizes it immensely, and of course in a more MW-friendly overall atmosphere, the MWs themselves are likely more respected* and less likely to be constrained. I imagine they're also more likely to have a number of peers to consult with (rather than potentially being "alone in a sea of OBs" and influenced more by OB care).
Does that make sense? The rich get richer, basically. I'd imagine a woman choosing to birth with a CNM in a state with 5% MW-attended births would be exponentially less-likely to receive evidence-based care and to achieve the most favorable possible outcome in her case. Not that it wouldn't still be a step up, most likely, but this reminds me of the post (was it here? or referred to here?) about societies breastfeeding, not individuals. In a MW/NCB/HB-friendly "society," it's much easier have a minimally-interventive birth.
It just strikes me because my friend who ended up with C/S after many interventions by her hospital MW... She's BFing beautifully after barely having cracked a book on it or anything (even in a place where BF isn't super-supported, even after the hospital forcefed some formula). Her mom had C/S and also BFed for quite a while, which makes me think SOME of it is psycho-social. Although my friend really did not want a C/S, her mom had two, and both C/S and "trusting your care provider" were normalized for her. She chose the only CNM practice around and kind of "went with the flow" because it was not in her nature to do the kind of insane research I do, and because she isn't as confrontational and comfortable bucking authority as I am. She wanted evidence-based care, but she didn't want to have to FIGHT, so she went with what probably was her best option (if she didn't want to travel farther). Had she had a more textbook labor, I think she would have had a MUCH better chance at a natural, low-intervention birth with the CNM practice she went with than had she gone to a local OB. Unfortunately, she had a couple of very minor "strikes" (PROM, etc.) so it was not going to happen-- even though it likely could have in a HB setting, or (and this is the important part) in, say, New Mexico.
But OTOH, like I said-- she is BFing beautifully "from instinct"-- even with interference-- in large part because THAT was also normalized for her. It just never occurred to her that she couldn't, her mom was 100% encouraging, etc.
Just very striking to me, the importance of psycho-social support.
*She moved back here from Miami, where she spent the first ~20 weeks of PG. She just saw the most convenient OB because she knew she wasn't going to stay there. When he asked about who she was going to see after she moved, she mentioned the CNM practice and the guy practically recoiled in disgust! I mean, she wasn't even talking about a HB or anything-- just a hospital-based CNM practice that works with OBs, out of a state-of-the-art hospital in a wealthy area. But he essentially said, "fine, if you want squat in a ditch and kill your baby." (Insert my ironic laugh, as the CNMs were very interventive IMO.)
My point? That the local culture makes a big difference in outcomes. I'm sure MWs and NCB-seeking women in Miami have an even more uphill battle.
Amy- you keep saying this, yet this statement is simply not backed by research.
"3. Cost comparisons among various types of deliveries fail to take into account the fact that delivery types are not interchangeable and that mortality rates would be quite different if the C-section rate were lower."
Mortality rates have not decreased dramatically in the last 20 years, which they should have if you are right and c-sections are mostly always necessary for a healthy baby. Crazy increase in c-sections has not equated with a reduction in infant mortality that is anywhere close to that rate. We all know that the US has a relatively high infant mortality for our income level/technology level, despite (because of!?) our high c-section rate.
At the birth I recently attended there was really no medical indication for a c-section. Just a lot of bored nurses, a tired, drugged-up mother, and peer pressure. I wonder what her charts will say was the reason for the surgery. "maternal request"? Probably.
This is the second post where Amy Tuter has accused a natural childbirth advocate (this one here and one on babble, i believe, with Ina May Gaskin) of presenting false data to further promote NCB. I find this interesting why would somebody, as a NCB advocate, want to intentionally present woman with biased untrue facts about giving birth to their babies. Im sorry but that does not at all sound right nor will I believe it. Its biased to go into any natural childbirth blog or study or what ever looking for things to find wrong with it, looking to make the point that Obstetrics is the right way and the only way for all woman. By the way if the c section rate in this coutry isnt to blame for the rising maternal death rate (lets say interventions too) then what is? Please some one enlighten me because if Im not mistaken when our countrys average c section rate was lower so wasnt maternal death. I want a real explanation too not oh rise in maternal age and multiple pregnancies.
I happen to find the data on the map great and disappointed to see my state (Mass) c section rate is the same as the countrys 34% its apalling
My local hospitals is 40% with a target of 15%
Amy, why didn't you submit your own visualization tool? If you read the description for the contest, you can see that it was on the onus of the developers to select the specific data to visualize. And yes, while of course it would always be nice to include more more and more data, you have to draw the line somewhere. I'd imagine at some point people want to spend times with their families.