This won’t work. It won’t work. The correlation between adverse outdcomes and inexperience is, frankly, expected. It is the reason that in my trade — medicine — we have long periods of supervised practice: in NZ you are provisionally registered (an Intern) for at least two years, and then specialty training takes a further five.
This is professional bullying. One hopes that the Health and Disability Commission (which all malpractice complaints must go through) will not refer it to the medical council.
The College of Midwifes has laid a complaint to the Medical Council against Dr Beverley Lawton’s research, which found babies were more likely to die at birth – or soon after – if the midwife was in her first year on the job.
Dr Lawton, who was the lead author of the study, said researchers from the Women’s Health Research Centre and Illinois University had matched the level of experience of New Zealand midwives to data on baby mortality in New Zealand between 2005 and 2009.
They found a higher likelihood of a baby dying at or near birth if the midwife – with midwifery-only training – was in the first year out of midwifery-only training, compared to midwives with between five and nine years’ training, she said.
The findings were published in the International Journal of Gynaecology and Obstetrics a few weeks ago.
But, since then, Dr Lawton said she had come under fire for the research from various midwifery groups.
“We’ve had letters attacking myself or the group, things like trying to block some of the research, the important research about severe morbidity, trying to get membership on the same maternal monitoring committee and lastly but not least they’ve made a complaint to the Medical Council.
“It must be the first time anybody’s made a complaint about public health research to the council.”
The College of Midwives said it could not comment on the complaint as it had yet to be heard by the Medical Council, which has also declined to comment.
Ele Ludemann notes the following in her blog:
The College and other midwifery groups should be concerned about the findings of this report but if they take issue with its contents they should respond with professional and academic rebuttal of the message not personal abuse of the messenger.
Instead they appear to be more defensive of their members than advocates for high professional standards.
Well I’ve looked at the paper. It is a fairly standard bit of retrospective epidemiology. The authors conclusion is reasonable: I have extracted and edited relevant paragraphs, as the paper is behind a paywall: the link is to the abstract.
The finding of increased adverse events in pregnancies cared for by early-career midwife-only LMCs is consistent with previous studies that found an increased risk of in-hospital patient mortality with care by newly qualified doctors. Recent evidence using US nationwide inpatient data suggests that the junior doctor effect on mortality could be related to case mix, with the more serious and acutely ill patients more likely to be at risk of death.
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There are some limitations to the present study. Although the results suggest an increase in perinatal mortality rates for pregnancies cared for by early-career, midwife-only LMCs, this does not equate to causality. Unknown bias or a possible Type 1 error due to multiple testing cannot be ruled out; confidence intervals around the rate ratio estimates were also wide, which is in large part a result of the small absolute number of events (deaths) that can be observed in NZ (bearing in mind that the current study examined 5 years of pregnancies and their outcomes). The MOHIG master midwife list was supplied by the Midwifery Council and was matched to named data in the current study based by correct name only. Further, it was not possible to assess the presence of comorbidities, previous cesarean delivery, obesity, or smoking at booking, all of which could bias results. If these risk factors for perinatal mortality are differentially associated with access to midwives with more or less experience, there could be residual confounding of the reported associations. Despite these reservations, there appears to be a convergence of evidence to support the increased perinatal mortality associated with early-career, midwife-only LMCs, including the significant trend found in the present study of decreased mortality with increased years of midwifery experience.
The complaint by the Midwifery council is bullying. It has a chilling effect on any person who does research into the behaviour of health workers. Because this paper identified an issue: an issue known in other areas. One should not censor such messengers.
