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I'm sorry for your friend, this is a terrible situation to be in. And it's exactly why many people think pregnancies and births are over medicalized, especiall

I'm sorry for your friend, this is a terrible situation to be in. And it's exactly why many people think pregnancies and births are over medicalized, especially in the US. Women have given birth for a long time without medical intervention, using competent mid-wives, and now were at a point where every pregnant woman wants an epidural, a scheduled C-section (!!), inducing labor via medicine, etc. It's pretty insane.. The movie "Business of being born" (http://www.imdb.com/title/tt0995061/ http://www.imdb.com/title/tt0995061/) goes into detail of how the mindset of handling pregnancies shifted over the last decade, and how pregnancies are almost a "disease" to be treated. Edit: Since I'm getting downvoted for this, I simply wanted to correlate that more interventions = more risk. No other intent, and definitely not trying to "victim blame" given I have no knowledge of the specific situation above.

rayiner 10y ago
> Women have given birth for a long time without medical intervention And they were dying in droves: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm (Figure 2); http://www.cdc.gov/mmwr/preview/mmwrhtml/00054602.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/00054602.htm (Figure 1). Maternal mortality decreased from 700-800 deaths per 100k live births at the turn of the century to less than 30 in 1967, and 5-10 by 1996. Hospitalized births is one of the, if not the most astonishing triumph of modern medicine. It's bigger than the advances in cancer treatment and HIV put together.
- Florin_Andrei 10y ago
  Plenty of medical care, and therefore quite a few medical errors: live until 85. No medical care, and therefore zero medical errors: live until 62, die of something trivial.
  - cloverich 10y ago
    A more correct interpretation would be "Much higher chance of dying of something trivial at any time before 85."
  - Scoundreller 10y ago
    Average US life expectancy: 79 Average Cuban life expectancy: 78 High priced and highly available medical care doesn't always buy the outcomes one would expect. Source: https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
    - eru 10y ago
      Do the Cubans have as much American food? (Otherwise, it might not be a fair comparison.)
    - Florin_Andrei 10y ago
      I was thinking more like 500 A.D. versus today.
    - mapt 10y ago
      You've picked a hell of a confounder there. Cuba's medical corps has been grown as if it were a civil defense project of a country on the brink. They have 2-3 times as many doctors as the rest of us per capita - but it's also a very poor country crippled by a lack of supplies and equipment, and doctors in Cuba often have second jobs where they get their actual income. http://www.slate.com/articles/news_and_politics/explainer/2007/02/whats_with_all_the_cuban_doctors.html http://www.slate.com/articles/news_and_politics/explainer/20...
  - firebones 10y ago
    Number of errors versus expected value of errors is important. So plenty of the right kind of medical care would be an important qualifier. Routine preventive medical care with no fee-for-service perversions creating incentives to over-treat, perhaps more errors, but each of lower consequence: live to 95.
  - bnolsen 10y ago
    Medical technology and available procedures have exploded in the last 50 years or more. i would like to see a survey of the actual number of invasive medical procedures done per capita today compared with say 1950 and 1900. That includes what are today routine things like being put under for wisdom teeth extraction, joint repair and replacement work, reconstructive surgeries, cosmetic surgeries, skin cancer removal, etc.
- NotHereNotThere 10y ago
  Giving epidurals and scheduling c-sections don't reduce mortality rates. I'm not saying that pregnancies shouldn't benefit from advancements in disease detection to prevent potentially fatal outcomes. It's not a black or white situation. Inducing labor to prevent a fatal outcome during birth and inducing labor because you want to be at a party/whatever the next week aren't the same.
  - rayiner 10y ago
    I'm talking about this part of your post: > Women have given birth for a long time without medical intervention, using competent mid-wives[.] My dad works in international development and has spent a better part of his career working on programs in Bangladesh to get people to use hospitals instead of mid-wives. Now rich people in the United States are using mid-wives instead of hospitals. It's pure insanity.
    - shimon 10y ago
      It's not really as parallel as you suggest, though it is ironic. Using a mid-wife in the US means starting out in a birth center with a nurse midwife, and finishing there assuming no dangerous complications. There is usually a quick route to a hospital if needed, and screening for risky situations well in advance of the delivery.
    - mentalpiracy 10y ago
      This may be a first-world bias here, but would it be reasonable to expect that US midwives are generally better trained than their Bangladeshi peers, given the US's expanded access to educational resources and licensing oversight? Again I recognize a first-world bias here, but my reactionary rationalization process to justify this phenomenon is that in the US you have much easier access to a midwife of at least moderate training/expertise, whereas Bangladeshi midwives may have much wilder variations in level of expertise. Would your dad be able to share his thoughts on this?
      - smileysteve 10y ago
- strictnein 10y ago
  Yeah, my wife would have died the from birth of our first child at the turn of the 20th century, as would my first child. She's short (5' 1.5") and the kid was too big (9lb 11oz). He simply would not have made it out.
  - deleted 10y ago
    [deleted]
- jvvw 10y ago
  There's no doubt that C-sections etc. have saved huge numbers of lives. On the other hand, the US actually doesn't have great maternal mortality rates for childbirth for a developed country: http://www.theguardian.com/news/datablog/2010/apr/12/maternal-mortality-rates-millennium-development-goals http://www.theguardian.com/news/datablog/2010/apr/12/materna... (slightly out of date but not ridiculously). It also has a high C-section rate for a developed country. Not necessarily causal, but once you've covered the clear emergencies, it's often not clear when to intervene and when not to (and I say this as somebody who was very glad that there there were obstetricians down the corridor even though both my births were natural!) and there are measures that matter beyond maternal and baby mortality.
snowwrestler 10y ago
This is all correct, but might be rude in context. You have no idea if the epidural in the story above was medically necessary (many are), so replying with a post about voluntary procedures could be interpetted as subtle victim blaming. My wife and I could not have done more to avoid medical interventions during the birth of our child, but the baby was facing the wrong way and an epidural was necessary to allow the midwife an opportunity to turn it. Thankfully the epidural was done properly.
pmarreck 10y ago
As usual, science and data should come to the rescue here, with the optimization goal of "mother and child both survive and are healthy post-birth" Given that criteria, the current medical system seems to be doing OK, as others have stated. If (for example) midwifing was superior, then the data would show that, period.
ksenzee 10y ago
Personally I'd as soon have a root canal without anesthesia as give birth without an epidural. Modern medicine is a net good.
- NotHereNotThere 10y ago
  That's fine and definitely up to you to decide. Although I don't really agree with your example, as your body manages the pain in biologically different ways when giving birth. As an anecdote, my wife gave birth 3 times, never in a hospital or anesthesia. She doesn't remember the pain.
  - ksenzee 10y ago
    I've given birth twice, and I can tell you that my body manages the pain in ways that do not feel the slightest bit different. Your wife is very lucky.
  - ams6110 10y ago
    People don't remember pain after it's over. Well they do, but not the literal sensations. They do certainly experience it in the moment though.
nommm-nommm 10y ago
>now were at a point where every pregnant woman wants an epidural, a scheduled C-section (!!), inducing labor via medicine. This is so blatantly factually incorrect that it actually makes me sick to read. >I simply wanted to correlate that more interventions = more risk. This is not always true and the maternal death rate shows that. I'll give you an example - I have a friend who had a scheduled C-section recently. She had a medical condition that made giving birth vaginally very risky from a health perspective. She could have been fine but there was a very large chance childbirth also could have triggered disability or death. She had a whole team of doctors coordinate with each other to choose the least risky option and they agreed that a scheduled C-section was best option for both maternal and fetal health. More intervention = much less risk in this case.
- theli0nheart 10y ago
  >> now were at a point where every pregnant woman wants an epidural, a scheduled C-section (!!), inducing labor via medicine. > This is so blatantly factually incorrect that it actually makes me sick to read. Many of our friends are pregnant or have just had kids, and my wife is 9 months pregnant. We've had a lot of talk about this with them. I wouldn't by any means say that scheduling a C-section is something everyone does, but it's incredibly common. I know of two pregnant women in our peer group that already have a date on the calendar.
  - nommm-nommm 10y ago
    There is not very many obgyns you can convince to do that.
    - theli0nheart 10y ago
      That's good to hear. There's no way our OB would do it either, but I suppose if you're the sort of person who wants one, you keep asking until you get it.

rayiner 10y ago

> Women have given birth for a long time without medical intervention And they were dying in droves: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm (Figure 2); http://www.cdc.gov/mmwr/preview/mmwrhtml/00054602.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/00054602.htm (Figure 1). Maternal mortality decreased from 700-800 deaths per 100k live births at the turn of the century to less than 30 in 1967, and 5-10 by 1996. Hospitalized births is one of the, if not the most astonishing triumph of modern medicine. It's bigger than the advances in cancer treatment and HIV put together.

Florin_Andrei 10y ago
Plenty of medical care, and therefore quite a few medical errors: live until 85. No medical care, and therefore zero medical errors: live until 62, die of something trivial.
- cloverich 10y ago
  A more correct interpretation would be "Much higher chance of dying of something trivial at any time before 85."
- Scoundreller 10y ago
  Average US life expectancy: 79 Average Cuban life expectancy: 78 High priced and highly available medical care doesn't always buy the outcomes one would expect. Source: https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
  - eru 10y ago
    Do the Cubans have as much American food? (Otherwise, it might not be a fair comparison.)
  - Florin_Andrei 10y ago
    I was thinking more like 500 A.D. versus today.
  - mapt 10y ago
    You've picked a hell of a confounder there. Cuba's medical corps has been grown as if it were a civil defense project of a country on the brink. They have 2-3 times as many doctors as the rest of us per capita - but it's also a very poor country crippled by a lack of supplies and equipment, and doctors in Cuba often have second jobs where they get their actual income. http://www.slate.com/articles/news_and_politics/explainer/2007/02/whats_with_all_the_cuban_doctors.html http://www.slate.com/articles/news_and_politics/explainer/20...
- firebones 10y ago
  Number of errors versus expected value of errors is important. So plenty of the right kind of medical care would be an important qualifier. Routine preventive medical care with no fee-for-service perversions creating incentives to over-treat, perhaps more errors, but each of lower consequence: live to 95.
- bnolsen 10y ago
  Medical technology and available procedures have exploded in the last 50 years or more. i would like to see a survey of the actual number of invasive medical procedures done per capita today compared with say 1950 and 1900. That includes what are today routine things like being put under for wisdom teeth extraction, joint repair and replacement work, reconstructive surgeries, cosmetic surgeries, skin cancer removal, etc.
NotHereNotThere 10y ago
Giving epidurals and scheduling c-sections don't reduce mortality rates. I'm not saying that pregnancies shouldn't benefit from advancements in disease detection to prevent potentially fatal outcomes. It's not a black or white situation. Inducing labor to prevent a fatal outcome during birth and inducing labor because you want to be at a party/whatever the next week aren't the same.
- rayiner 10y ago
  I'm talking about this part of your post: > Women have given birth for a long time without medical intervention, using competent mid-wives[.] My dad works in international development and has spent a better part of his career working on programs in Bangladesh to get people to use hospitals instead of mid-wives. Now rich people in the United States are using mid-wives instead of hospitals. It's pure insanity.
  - shimon 10y ago
    It's not really as parallel as you suggest, though it is ironic. Using a mid-wife in the US means starting out in a birth center with a nurse midwife, and finishing there assuming no dangerous complications. There is usually a quick route to a hospital if needed, and screening for risky situations well in advance of the delivery.
  - mentalpiracy 10y ago
    This may be a first-world bias here, but would it be reasonable to expect that US midwives are generally better trained than their Bangladeshi peers, given the US's expanded access to educational resources and licensing oversight? Again I recognize a first-world bias here, but my reactionary rationalization process to justify this phenomenon is that in the US you have much easier access to a midwife of at least moderate training/expertise, whereas Bangladeshi midwives may have much wilder variations in level of expertise. Would your dad be able to share his thoughts on this?
    - smileysteve 10y ago
strictnein 10y ago
Yeah, my wife would have died the from birth of our first child at the turn of the 20th century, as would my first child. She's short (5' 1.5") and the kid was too big (9lb 11oz). He simply would not have made it out.
- deleted 10y ago
  [deleted]
jvvw 10y ago
There's no doubt that C-sections etc. have saved huge numbers of lives. On the other hand, the US actually doesn't have great maternal mortality rates for childbirth for a developed country: http://www.theguardian.com/news/datablog/2010/apr/12/maternal-mortality-rates-millennium-development-goals http://www.theguardian.com/news/datablog/2010/apr/12/materna... (slightly out of date but not ridiculously). It also has a high C-section rate for a developed country. Not necessarily causal, but once you've covered the clear emergencies, it's often not clear when to intervene and when not to (and I say this as somebody who was very glad that there there were obstetricians down the corridor even though both my births were natural!) and there are measures that matter beyond maternal and baby mortality.

snowwrestler 10y ago

This is all correct, but might be rude in context. You have no idea if the epidural in the story above was medically necessary (many are), so replying with a post about voluntary procedures could be interpetted as subtle victim blaming. My wife and I could not have done more to avoid medical interventions during the birth of our child, but the baby was facing the wrong way and an epidural was necessary to allow the midwife an opportunity to turn it. Thankfully the epidural was done properly.

pmarreck 10y ago

As usual, science and data should come to the rescue here, with the optimization goal of "mother and child both survive and are healthy post-birth" Given that criteria, the current medical system seems to be doing OK, as others have stated. If (for example) midwifing was superior, then the data would show that, period.

ksenzee 10y ago

Personally I'd as soon have a root canal without anesthesia as give birth without an epidural. Modern medicine is a net good.

NotHereNotThere 10y ago
That's fine and definitely up to you to decide. Although I don't really agree with your example, as your body manages the pain in biologically different ways when giving birth. As an anecdote, my wife gave birth 3 times, never in a hospital or anesthesia. She doesn't remember the pain.
- ksenzee 10y ago
  I've given birth twice, and I can tell you that my body manages the pain in ways that do not feel the slightest bit different. Your wife is very lucky.
- ams6110 10y ago
  People don't remember pain after it's over. Well they do, but not the literal sensations. They do certainly experience it in the moment though.

nommm-nommm 10y ago

>now were at a point where every pregnant woman wants an epidural, a scheduled C-section (!!), inducing labor via medicine. This is so blatantly factually incorrect that it actually makes me sick to read. >I simply wanted to correlate that more interventions = more risk. This is not always true and the maternal death rate shows that. I'll give you an example - I have a friend who had a scheduled C-section recently. She had a medical condition that made giving birth vaginally very risky from a health perspective. She could have been fine but there was a very large chance childbirth also could have triggered disability or death. She had a whole team of doctors coordinate with each other to choose the least risky option and they agreed that a scheduled C-section was best option for both maternal and fetal health. More intervention = much less risk in this case.

theli0nheart 10y ago
>> now were at a point where every pregnant woman wants an epidural, a scheduled C-section (!!), inducing labor via medicine. > This is so blatantly factually incorrect that it actually makes me sick to read. Many of our friends are pregnant or have just had kids, and my wife is 9 months pregnant. We've had a lot of talk about this with them. I wouldn't by any means say that scheduling a C-section is something everyone does, but it's incredibly common. I know of two pregnant women in our peer group that already have a date on the calendar.
- nommm-nommm 10y ago
  There is not very many obgyns you can convince to do that.
  - theli0nheart 10y ago
    That's good to hear. There's no way our OB would do it either, but I suppose if you're the sort of person who wants one, you keep asking until you get it.