Feminism & Psychology study of UK birthing classes draws ire, winds up retracted

The debate — in entrenched medical circles, anyway — over whether it’s safe to give birth at home can be fierce. Just last month, for example, Nature reported that a review of the subject in the American Journal of Obstetrics & Gynecology that found home births more dangerous than those in the hospital generated so much controversy that it forced an investigation. Outside reviewers found problems, but the journal didn’t think they rose to the level of a retraction. Critics disagreed.

The same fraught subject came up in a paper published in Feminism & Psychology last year by Mary Horton-Salway and Abigail Locke. The original paper had concluded:

Our analysis suggests that the normativity of medical interventions in labour and childbirth is discursively reproduced in ante-natal classes whilst parental choice is limited by a powerful ‘rhetoric of risk’.

In other words, NCT classes were scaring women into choosing hospital births. But it turns out that conclusion wasn’t actually supported by the findings, which were based on a review of National Childbirth Trust’s classes. That led to a retraction:

We, the authors, wish to retract the article on the basis of two errors. The first error is a transcription error, which occurs on extract 6 (page 445) of the article where the final sentence (line 5) has been ascribed incorrectly to the class leader. It is now apparent that this line was uttered by another female participant, one of the pregnant women attending the course, not the class leader. The second error was the use of the plural ‘course leaders’. The four courses observed were taught by one course leader so the plural ‘course leaders’ should not have been used. The authors feel that due to these errors, the claims made in this article concerning choice and ‘cautionary tales’ can only be based on one extract and one course leader. For these reasons, we have requested a full retraction of the article. We apologise for these errors. We do not wish to downplay the support the NCT gives to new parents in their transitions.

So, to sum up: We generalized the behavior of hundreds of childbirth course leaders all over the UK from a single course leader, making our results, um, difficult to interpret. And sorry, but that exchange from which we took the provocative title of our paper actually had a pretty serious error in it.

Here’s that exchange:

Extract 6 – ‘but you might be damaging your baby’ (NCT 4: 3 March 2006)

Rita: So that’s why I’m quite keen to avoid induction if I can it depends on how much they let you go doesn’t it because sometimes you don’t feel in control. Do you know what I mean, when people are suggesting things to you, and if they’re saying to you ‘oh but you might be damaging your baby’ then you almost you don’t know whether they’re saying that’s reality or whether they’re just trying to force you into

Bob: Surely you’re eventually going to go into labour aren’t you, or not?

CL: I would think so

((pause))

CL: I know somebody whose baby died because she didn’t get induced and the placenta gave out.

The last line, as the retraction notice points out, was actually from a participant, not the course leader.

The retraction also included, unusually, a note from the complainant:

Note from the NCT: These errors were identified following a complaint to the journal by the NCT. Mary Newburn, Head of Research and Information, wrote objecting to ‘an unrepresentative description of our antenatal classes, unjustified criticism, and potentially serious damage to our reputation’. NCT, who were not given sight of, or invited to comment on the analysis prior to publication, said ‘We simply do not recognise [the authors’] claim’. NCT feels that the prominent use of the charity’s name throughout the article was inappropriate particularly in light of the sample size of class leaders being one. NCT have asked that this is put in context, stating that in addition to courses taught for the NHS and children’s centres for which NCT does not hold comprehensive attendance records, 512 NCT teachers taught one or more NCT antenatal courses in the UK ending during the period 1 October – 31 December 2010, and these were attended by over 20,000 parents.

What left us a bit befuddled is that Newburn and the NCT seem quite welcoming of home births. Here’s an excerpt of a piece Newburn wrote for The Guardian last year in response to their coverage of that troubled AJOG study, titled “Home birth should be considered a safe option for pregnant women”:

For a healthy woman with a straightforward, low-risk pregnancy, home birth is a safe option. The NCT’s own detailed review of home birth concludes that there is no evidence that, for women with a low risk of complications, the likelihood of a baby dying during or shortly after labour is any higher if they plan for a home birth than if they plan for a hospital birth.

Newburn told Retraction Watch that she was “partially” satisfied with the outcome of the Feminism & Psychology retraction:

I feel journals should give their peer reviewers methodological and ethical guidance (lots of professional and research organizations produce guidance) and make this guidance explicit and transparent. I have not be advised about which university ethics committee approved the study, nor shown the proposal. I ought to ask for that once again (with names removed, to protect anonymity of the NCT branch / NCT course leader who cooperated with the researcher. It has been withheld from me on the basis that it would breach confidentiality.

I feel there is greater awareness among those directly involved about the risk of unreasonable damage to an organisation’s reputation on the basis of  using a real name when this is not necessary and using an n=1 sample (within our organization, on the journal and at two universities). However, I do not feel confident that wider systems have been changed as a result of my complaint and the  matters arising from it.

Update, 2:30 p.m. Eastern, 4/30/11: Virginia Braun and Nicola Gavey, editors of Feminism & Psychology, have responded to our request for comment on a) whether they had any reason to think “course leaders” in the text was incorrect when the paper was submitted; b) whether it was typical for the journal to include a comment from the complainant; and c) whether they were satisfied with the outcome:

The article in question was peer-reviewed by three reviewers, as part of our double-blind review process, the revised version was re—peer-reviewed, and the article was read thoroughly three times by the editor. At no stage did we have any reason to suspect that “course leaders” in the text was incorrect.

As this is the only case of a retraction that we have had to deal with since we have been editing the journal, we don’t have a typical way of handling a situation like this. Publishing the complainant’s comment seemed to us and our publisher (SAGE) like the right thing to do in this case, given the particular circumstances. Having to issue a retraction is a regrettable situation, but in the circumstances we are satisfied with the outcome.

Hat tip: Martin Gardiner