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Are you measuring a concept?

Chances are you know what a concept is…something that represents something that isn’t physical.  Like “democracy” or “faith.” And chances are you could list a few concepts that relate to childbirth.  In case you are feeling lazy, I can list a few:

  • natural childbirth
  • continuous support
  • elective induction
  • woman-centered care

I’m sure you get the idea.

So, why is this important? Because when you read research about concepts, you need to be very careful about how those concepts are defined.  For example, is an induction for post-dates at 41 weeks an elective induction?  Is scheduling one-to-one nursing care the same as continuous support? Is it a natural childbirth if the woman chooses to use oxytocin, or if she has a vacuum assisted birth?

For researchers, the decisions about what “counts” and what “doesn’t count” when measuring these things matters because if your definition isn’t correct you could be measuring the wrong thing.  There is also potential for misunderstanding on the part of the reader, especially if the reader does not have access to the full article and can only see the abstract. If the authors make a statement such as “our results show home birth is safe” (or “not safe”), you need to be able to look at the inclusion and exclusion criteria to see how they defined a home birth.  Was it any birth that didn’t happen in the hospital? Was it only planned home births? Did it include women with risk factors that would ordinarily prevent them from choosing home birth? If you just assumed the researcher thought about home birth the same way you did, you could be making assumptions the actual research doesn’t support.

Some of the concepts in the birth world are big and hard to measure. Think for example of mobility in labor.  Do you count it as mobility if the woman has the freedom to move, but chooses to stay in bed? What if the only walking she does is to the bathroom? How much walking would a woman need to do for you to count her as “mobile” during labor? Or would she not have to walk at all, but simply change her position as much or as little as she wanted?  See, these are not always easy things to measure. In reality, you might want to measure different aspects of the same concept.  How much women do walk when a policy promoting mobility is put in place is a great question.  How does labor change when women spend at least 10 minutes of every hour walking is another great question.

So the next time you read a research paper or the abstract, ask yourself if what they are measuring is a concept. Then try to figure out how close you think they came to actually capturing the effect it has on labor, and what other ways the concept could be measured.

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas, childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student learning to become a producer of knowledge.

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