Supplemental material for a risk communication workshop emphasizing principles of biostatistics and shared decision-making

1. Risk Communication Workshop
Tufts University
September 2014

2. TEDx Talk: Own your body's data
(Talithia Williams)
• http://youtu.be/_GMVTJ9ZKVc
• Talithia effortlessly shares a memorable personal example
of Risk Communication (from a patient/statistician's
perspective) on Risk of post-dates miscarriage.
• The rest of her TEDx talk is engaging & funny, check it out!

3. True or False:
“Your chances of having a
miscarriage double when you go
past your due date.”
Show me the DATA!

4. • Perinatal death was reported in 0.3/1000 births in the Induction of Labor
(IOL) group and 2.6/1000 births in the Expectant Management (EM) group
(95% CI: 0.10-1.09, P=0.07)
• Meconium aspiration was reported in 12.6/1000 births in the IOL group
and 29.8/1000 births in the EM group (95%CI: 0.23-0.79, P=0.007)
• C-section was reported in 198.3/1000 births in the IOL group and
227.3/1000 births in the EM group (95%CI: 0.8-0.96, P=0.004)

5. “Your chances of having a miscarriage
double when you go past your due date.”
False.
In summary, the majority of women have normal deliveries without
complications if they decide to wait.
The risk of miscarriage does not change if you wait and "opt-out" of an
induction, although this might change with future studies.
However, chances of your baby having a labor complication called "mec"
double if you decide to wait and go into labor naturally. There are a lot of
other labor complications, but none of those studied showed any
difference for mothers who decide to wait.
Opting-in for an induction of labor is a mother's choice and those who do
opt for it, have lower rates of "mec" and c-section and around 17 out of
1000 infants and 30 out of a 1000 women benefit from induction.
Knowing this, what would you like to do?

7. (Accessory slides for Tutor review)
• (Full script in the notes page as well)
• Tutor notes: What a great question.
• I looked at a meta-analysis, which is a study of more than a dozen smaller studies that summarizes all of the medical literature up until 2009. Would you be interested if I shared some of
the numbers with you?
• The medical literature shows that women who were post dates (>41 weeks) did NOT have a higher risk of miscarriage if they decided to wait rather than be induced, although larger
studies could change our view of this in the future. In an auditorium of 1000 pregnant women past 41 weeks, around 800 had a natural delivery without a c-section and 998 did not have
a miscarriage.
• However, these studies did show two differences.
• The first is an infant complication and the second is the rate of c-section. Would you like to learn more about these numbers?
• Infants needed to be hospitalized for a labor complication for 30 out of 1000 infants instead of 13 out of a 1000 women who opted to wait instead of being induced. In other words, your
risk for this complication called “mec” doubles, or 17 out of 1000 infants could have had the complication prevented by induction.
• You were worried about the risk of c-section with induction. You do not need to worry about this causing a problem. The risk of a c-section was about 200 out of a 1000 women had an
induction versus 230 out of a 1000 women who decided to wait. That means that 30 women out of 1000 benefited from having an induction.
• Do you have any questions?
• In summary, the majority of women have normal deliveries without complications if they decide to wait.
• The risk of miscarriage does not change if you wait and "opt-out" of an induction, although this might change with future studies.
• However, chances of your baby having a labor complication called "mec" double if you decide to wait and go into labor naturally, from 13 to 30 out of 1000 infants hospitalized for this.
There are a lot of other labor complications, but none of those studied showed any difference for mothers who decide to wait.
• Opting-in for an induction of labor is a mother's choice and those who do opt for it, have a slightly lower rate of c-section and a lower rate of "mec."
• Knowing this, what would you like to do?

8. Perinatal death

9. Meconium aspiration

10. Caesarean section