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A Game of Telephone and Misinterpreting Information

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Regular contributor Deena Blumenfeld shares her recent experience with a “research” article that washed over social media outlets and was shared and discussed by many birth professionals.  Deena explains how she fell in step with others and ended up being lead down the wrong path.  Have you every made this mistake too?  Please share your thoughts in our comment section.- Sharon Muza, Science & Sensibility Community Manager.

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Gathering information from social media can be like playing a giant game of “telephone” with a million of your closest friends.

This is often how it goes:

  • Someone reads an article. They post to Facebook (or other venue) a link and a comment.
  • We read this person’s comment and add our own comment.
  • Then we go back and skim the article, and comment again.
  • Next we post a link to the article, with our own comments and opinions regarding the article.
  • The next reader takes our opinion as gospel, only reads the headline of the article and then shares our opinion on their page, neglecting to link the article with their comment.
  • So now we have a rumor about an opinion and after 345 more postings, no one knows where the original source was of what anyone is talking about anymore.  But, whatever it is, it sounds AWFUL and we are indignant about it.

Does this sound familiar to you? Have you ever taken a rumor, opinion or comment about an article or study to be gospel truth, without fully reading and researching the information on your own… and then go on to repeat that rumor or opinion? 

I’ll sheepishly raise my hand here…

Not too long ago, there was an article on medpagetoday.com entitled New Form of Misoprostol Speeds Up Labor.” Now, without reading the article, doesn’t it seem that we now have a form of misoprostol being used for augmentation? 

This is the misinterpretation that was flying around Facebook, Twitter and other social media sites for days after the article was published on February 18, 2013. The outrage, fear and condemnation of anyone who thought it might possibly be a good idea to use misoprostol for augmentation was overwhelming. I read, and participated in, many discussions regarding the dangers of this drug; uterine rupture, mothers who have died, babies who have died, the Safe Motherhood Quilt Project, and so on. 

But yet we all missed it, me included.  That misleading headline leads us to believe that this was misoprostol for augmentation of labor; when in reality, it is an article about a new form of misoprostol, designed in the appropriate dosage, to induce labor.  This ‘little oops’ caused a big stir for not much. 

So, let’s look at what the article really talks about and what we should know.

  • This is an article about an abstract which was presented at a conference. It is not a peer-reviewed, published study.
  • We do not have access to the full study, since it isn’t published. So, we cannot evaluate it effectively.
  • The study compared the efficacy of this new form of misoprostol suppository to the existing dinoprostone (cervadil) suppository for induction of labor.
  • This study of 1,358 women found that the misoprostol suppository worked more quickly than the dinoprostone to get women to active labor as well as to birth.

“Along with the primary efficacy benefit of shorter time to vaginal delivery, the novel agent was also associated with faster delivery of any type, vaginal or cesarean (median 18.3 hours versus 27.3 hours with dinoprostone, P<0.001).”

“Other secondary outcome benefits were shorter time to active labor at 12.1 hours versus 18.6 hours, respectively (P<0.001), with substantially fewer women needing oxytocin prior to delivery (48% versus 74%, P<0.001).” 

Hang on a minute: “faster delivery of any type, vaginal or cesarean.” If the results of the induction end up as a cesarean, can we call it a successful induction? I’m not sure we can. I think this is a failed induction. Sure the medication worked to get labor started, but for whatever reason she ended up with a cesarean section. Faster to a cesarean section – wouldn’t it have been even faster to just schedule the cesarean section? 

“T’he primary safety outcome of cesarean delivery came out similar between groups at 26% with misoprostol and 27% with dinoprostone (P=0.65). Nor was there a difference in indication for cesarean section.”

When asked at the session why a faster vaginal delivery didn’t translate into fewer cesarean deliveries, Wing pointed to the myriad other factors that play into delivery mode. “We can flip the switch on but that doesn’t always get us the desired result,” she told the audience.” 

The article is leaning towards “faster is better” in terms of labor. We are left with more questions than answers. The answers may be found within the study itself, however, we don’t have access to the study. My questions:

But why? Why is a faster induction (or faster labor) better than a slower one?

Aren’t faster labors more painful? Aren’t contractions more challenging to cope with when they are more intense?

Do we have high rates of fetal distress with a faster labor vs. a slower one?

Who benefits from a faster birth?

The articles states that fewer women needed to be augmented with pitocin with a misoprostol induction vs. a dinoprostone induction. Is that a good thing? Bad? Neutral?

We also don’t know the researcher’s intentions. Without being able to read the study, we can only make assumptions. Do we assume the intention is a faster labor? Do we assume the intention is to make misoprostol safer for induction? Something else? Or maybe, just maybe, we don’t assume anything at all. Assumptions can be very dangerous and in most cases, they are wrong. 

How to avoid misinterpreting the data and spreading rumors:

  • Always go to the study! An article about the study is someone else’s opinion. The abstract is the Cliff’s Notes version of the study.
  • Admit when you don’t understand something and talk to someone who does.
  • Look to the citations and in the study to check for further information.
  • Use the Cochrane Library and other sources for more information.
  • Don’t make assumptions based on other people’s opinions.
  • If you don’t know for sure, don’t spread the information!
  • If you made a mistake and misinterpreted a study or article, say so. It’s better to admit you are wrong than to continue to spread inaccurate information.

My Take Away

The take away from all of this is that an article about an abstract presented at a conference leaves us with more questions than answers. We cannot accurately evaluate that which we cannot read in its entirety. Social media is a good tool, but we should be cautious about that which sounds too good (or bad!) to be true. We should take others opinions as just that – opinions, until we’ve done our own solid research. We should also be cautious about the ‘click and share’ phenomenon. Double check, do your homework and make sure the information we share is accurate. I’ll do better next time too.

For more on misoprostol for labor induction please read:

  1. Science & Sensibility: Update on Spin Doctoring Misoprostol (Cytotec): Unsafe at Any Dose
  2. Science & Sensibility: ACOG’s 2009 Induction Guidelines: Spin Doctoring Misoprostol (Cytotec)
  3. Journal of Perinatal Education: The Freedom to Birth—The Use of Cytotec to Induce Labor: A Non-Evidence-Based Intervention by Madeline Oden
  4. WHO: Misoprostol for cervical ripening and induction of labour
  5. WHO: WHO Recommendations for Induction of Labor, 2011
  6. Induced and Seduced: The Dangers of Cytotec by Ina May Gaskin
  7. Adverse Events Following Misoprostol Induction of Labor by Marsden Wagner, MD, MS

 

 

Cesarean Birth, Childbirth Education, Evidence Based Medicine, Guest Posts, Maternity Care, Medical Interventions, New Research, Research, Uncategorized , , , , , , , , ,

  1. March 19th, 2013 at 06:20 | #1

    Hi Deena – I agree with you! It’s also happens with books, People are pro & con the new Lean In book and no one has read it! I’m torn as I don’t want to buy it, but I cant have an opinion unless I buy it and read it! ty, Kathy

  2. March 19th, 2013 at 06:24 | #2

    Great piece, Deena…thank you.

  3. March 19th, 2013 at 16:49 | #3

    Thornton & Lilford had this to say on the subject of whether faster is better: “An accelerated labor is as safe as a streamlined parachute.” The authors were writing about augmentation, but it applies equally well to induction. Rapid induction to delivery intervals are associated with increased instance of hyperstimulation syndrome (uterine hyperstimulation + nonreassuring fetal heart rate) without decreasing cesarean rate.

    Alfirevic, Z., & Weeks, A. (2006). Oral misoprostol for induction of labour. Cochrane Database Syst Rev(2), CD001338. doi: 10.1002/14651858.CD001338.pub2

    Crane, J. M. G., & Young, D. C. (1998). Meta-analysis of low-dose versus high-dose oxytocin for labour induction. J Soc Obstet Gynaecol Can, 20(13), 1215-1223.

    Thornton, J. G., & Lilford, R. J. (1994). Active management of labour: current knowledge and research issues. BMJ, 309(6951), 366-369.

  4. March 19th, 2013 at 18:28 | #4

    I am a much older doula whose post high school education began with a degree in Biology with a Chemistry minor. A very smart professor taught us in my first college Biology course to read research papers VERY carefully. Just because something is in print does not mean it is worth the ink consumed in that printing process.

    I have seen misoprostol used for induction but not the new form. It sometimes did not start contractions at all but sometimes caused hideous huge and painful contractions even at fingertip dilation. But this is not research. This is my anecdotal experience.

  5. March 21st, 2013 at 10:25 | #5

    Thank you! Thank you! Thank you for posting this! Always read the article before discussing or posting a link to it – A) how valid are the findings? B) how accurate is the headline? Grrr…I spend so much time trying to entice people to read the research or essay itself!

  6. avatar
    gabby
    September 30th, 2013 at 18:10 | #6

    Hello this was great thanks it really did answer my question. Thank you so much Deena

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