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Giving epidurals and scheduling c-sections don't reduce mortality rates. I'm not saying that pregnancies shouldn't benefit from advancements in disease detecti

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
    A large component of this is also emergency services; if a midwife delivery has complications, an ambulance is only a quick call away. Also, 1st world homes are significantly sanitized when compared to other homes.
    - dminor 10y ago
      A college friend of mine wrote a blog post on how this logic is (sometimes tragically) flawed: https://www.dreamhost.com/blog/2011/03/09/wren-jones/ https://www.dreamhost.com/blog/2011/03/09/wren-jones/
  - rayiner 10y ago
    A recent study in Oregon found that the risk of maternal death for planned out-of hospital births was more than double that of planned in-hospital births when adjusted for various factors: http://www.ohsu.edu/news/media/images/NEJM-article-Snowden.pdf http://www.ohsu.edu/news/media/images/NEJM-article-Snowden.p....
    - mentalpiracy 10y ago
      > risk of maternal death for planned out-of hospital births more than double While your assertion is technically correct, this singular take is a misleading characterization of the source you linked. Per your source: > Perinatal mortality was higher with planned out-of-hospital birth than with planned in-hospital birth, but the absolute risk of death was low in both settings. More specifically > adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54 I'm not sure this necessarily follows your original description of "pure insanity."
      - rayiner 10y ago
        More than a doubling of maternal death risk isn't pure insanity to you? It wipes out 20-30 years of progress on that statistic. It's also not that low in absolute terms. With 4 million births per year, an increased death rate of 1.52 deaths per 1000 births is an additional 6,000 deaths per year, under pretty much the most tragic circumstances imaginable. And that's with the status quo of only the healthiest pregnancies being candidates for home birth. It'll only go downhill as it becomes more prevalent.
- theli0nheart 10y ago
  > 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. Can you explain what part in particular about this is insane? My wife is 9 months pregnant and our hospital has midwives on staff. Having a midwife doesn't preclude going to a hospital.
deleted 10y ago
[deleted]
BinaryIdiot 10y ago
> Giving epidurals No but it increases a patient's comfort. I'm going to assume you've never given birth because it's exceptionally painful and can last over 30 hours (especially if it's the first baby). Pain management is huge in medicine and many people are willing to take risks. FYI being able to properly manage the pain actually can save lives though those statistics are far harder to get. For instance extreme pain during child birth causes some mothers to pass out which, if the baby is in the birth canal, can be incredibly dangerous. I've seen this. It's very scary. > scheduling c-sections don't reduce mortality rates. Absolutely false. The vast, vast majority of the time you're scheduling a c-section because the mother has a complication that could put her or her baby at risk for a normal birth (previous c-sections for instance; extremely dangerous to try a v-back for many women). Maybe there are some doctors who schedule it just because but that's an exceptional case, statistically.
- exhilaration 10y ago
  I don't know dude, where I lived (New Jersey), some of the hospitals have insanely high c-section rates - much, much higher than could be justified by mothers having complications. Here's 2015: Hospital Name City State Rate ----------------------------------------------------------- Hackensack Medical Center Hackensack NJ 41.8% HackensackUMC Mountainside Montclair NJ 29.8% Holy Name Medical Center Teaneck NJ 16.1% Morristown Medical Center Morristown NJ 30.1% Source: http://www.njspotlight.com/stories/15/10/07/effort-to-reduce-nj-s-high-c-section-rate-could-be-aided-by-new-report/ http://www.njspotlight.com/stories/15/10/07/effort-to-reduce...
  - riffraff 10y ago
    I think a slightly higher propensity to give c-sections leads to much higher total numbers because if you get one for birth X you are generally going to get another for birth X+1.
  - ptaipale 10y ago
    Did this statistic control for how people select certain hospitals (where applicable)? Obviously, if a hospital is specializing in C-sections, it will handle cases where the likelihood of having a sectino is much higher. (Similarly, hospitals are very dangerous places if you compare the death rate in a hospital to the death rate at any other place where people stay. Of course it's mostly not because hospitals kill people, it's mostly because people go to hospital when they are sick.)
dragonwriter 10y ago
> Giving epidurals and scheduling c-sections don't reduce mortality rates. Giving epidurals is pain management, and managing pain helps the mother do what she is being coached to do (and manages adverse stress reactions that the body has as a result of pain), so I'd be surprised if it didn't reduce mortality, though the effect is probably small. Scheduled C-sections are often because of early-identified risk factors of vaginal delivery; they certainly do reduce mortality rates.

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
  A large component of this is also emergency services; if a midwife delivery has complications, an ambulance is only a quick call away. Also, 1st world homes are significantly sanitized when compared to other homes.
  - dminor 10y ago
    A college friend of mine wrote a blog post on how this logic is (sometimes tragically) flawed: https://www.dreamhost.com/blog/2011/03/09/wren-jones/ https://www.dreamhost.com/blog/2011/03/09/wren-jones/
- rayiner 10y ago
  A recent study in Oregon found that the risk of maternal death for planned out-of hospital births was more than double that of planned in-hospital births when adjusted for various factors: http://www.ohsu.edu/news/media/images/NEJM-article-Snowden.pdf http://www.ohsu.edu/news/media/images/NEJM-article-Snowden.p....
  - mentalpiracy 10y ago
    > risk of maternal death for planned out-of hospital births more than double While your assertion is technically correct, this singular take is a misleading characterization of the source you linked. Per your source: > Perinatal mortality was higher with planned out-of-hospital birth than with planned in-hospital birth, but the absolute risk of death was low in both settings. More specifically > adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54 I'm not sure this necessarily follows your original description of "pure insanity."
    - rayiner 10y ago
      More than a doubling of maternal death risk isn't pure insanity to you? It wipes out 20-30 years of progress on that statistic. It's also not that low in absolute terms. With 4 million births per year, an increased death rate of 1.52 deaths per 1000 births is an additional 6,000 deaths per year, under pretty much the most tragic circumstances imaginable. And that's with the status quo of only the healthiest pregnancies being candidates for home birth. It'll only go downhill as it becomes more prevalent.
theli0nheart 10y ago
> 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. Can you explain what part in particular about this is insane? My wife is 9 months pregnant and our hospital has midwives on staff. Having a midwife doesn't preclude going to a hospital.

deleted 10y ago

[deleted]

BinaryIdiot 10y ago

> Giving epidurals No but it increases a patient's comfort. I'm going to assume you've never given birth because it's exceptionally painful and can last over 30 hours (especially if it's the first baby). Pain management is huge in medicine and many people are willing to take risks. FYI being able to properly manage the pain actually can save lives though those statistics are far harder to get. For instance extreme pain during child birth causes some mothers to pass out which, if the baby is in the birth canal, can be incredibly dangerous. I've seen this. It's very scary. > scheduling c-sections don't reduce mortality rates. Absolutely false. The vast, vast majority of the time you're scheduling a c-section because the mother has a complication that could put her or her baby at risk for a normal birth (previous c-sections for instance; extremely dangerous to try a v-back for many women). Maybe there are some doctors who schedule it just because but that's an exceptional case, statistically.

exhilaration 10y ago
I don't know dude, where I lived (New Jersey), some of the hospitals have insanely high c-section rates - much, much higher than could be justified by mothers having complications. Here's 2015: Hospital Name City State Rate ----------------------------------------------------------- Hackensack Medical Center Hackensack NJ 41.8% HackensackUMC Mountainside Montclair NJ 29.8% Holy Name Medical Center Teaneck NJ 16.1% Morristown Medical Center Morristown NJ 30.1% Source: http://www.njspotlight.com/stories/15/10/07/effort-to-reduce-nj-s-high-c-section-rate-could-be-aided-by-new-report/ http://www.njspotlight.com/stories/15/10/07/effort-to-reduce...
- riffraff 10y ago
  I think a slightly higher propensity to give c-sections leads to much higher total numbers because if you get one for birth X you are generally going to get another for birth X+1.
- ptaipale 10y ago
  Did this statistic control for how people select certain hospitals (where applicable)? Obviously, if a hospital is specializing in C-sections, it will handle cases where the likelihood of having a sectino is much higher. (Similarly, hospitals are very dangerous places if you compare the death rate in a hospital to the death rate at any other place where people stay. Of course it's mostly not because hospitals kill people, it's mostly because people go to hospital when they are sick.)

dragonwriter 10y ago

> Giving epidurals and scheduling c-sections don't reduce mortality rates. Giving epidurals is pain management, and managing pain helps the mother do what she is being coached to do (and manages adverse stress reactions that the body has as a result of pain), so I'd be surprised if it didn't reduce mortality, though the effect is probably small. Scheduled C-sections are often because of early-identified risk factors of vaginal delivery; they certainly do reduce mortality rates.