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Do you think it likely that an entire field that evolved over a period of thousands of years, has thousands of people doing the job all over the world daily, an

Do you think it likely that an entire field that evolved over a period of thousands of years, has thousands of people doing the job all over the world daily, and is so common and important that there is scientific research performed on it pretty much not-stop, just missed this idea?

anigbrowl 13y ago
If only. I strongly recommend this documentary: http://www.thebusinessofbeingborn.com/ http://www.thebusinessofbeingborn.com/
jonah 13y ago
Yes. [edit] Part of it is that the patriarchal doctor wants to be "in charge" of the situation and treat childbirth like some kind of medical operation. (This is not to say that modern medicine saves many children's and mother's lives. A modern, optimal, approach is to have a traditional birth with ready access to a hospital for a c-section, etc if necessary.)
- mikeash 13y ago
  Why haven't any researchers run a trial to compare the two and revolutionized this area of medicine after pronouncing dramatically better results for the traditional way?
  - rosser 13y ago
    Because the ethics committee is never going to sign off on an experiment that has even a hint of risk to mother or child who aren't already at greater risk from a lack of intervention. It's the same reason you don't conduct Phase I clinical trials of new chemotherapeutic agents with people who don't already have cancer. Birth is already risky enough. "Let's science that, to see which has the best outcome," while a completely rational approach not only to decreasing harm, but also to increasing health, just isn't going to fly.
  - willyt 13y ago
    They have, in the UK when you have your first appointment with the midwife they encourage you to consider it as an option. If you decide to do this you will then be assigned an experienced midwife who will attend the birth at your house, will monitor the situation for complications and will have an ambulance on standby at the first hint that things are not progressing normally. Also, if there is any hint of complications at all during the pregnancy you will be strongly recommended to have a birth in the hospital.
- rayiner 13y ago
  No, the modern optimal approach is to have a birth in a giant hospital so 1) you don't risk leaving the medical decision of whether intervention is necessary to someone without medical training; and 2) you don't risk the time lag of transferring to a hospital when a distressed baby is getting more brain damage from a lack of oxygen with every second that goes by.
  - ceejayoz 13y ago
    It's possible to give birth in a giant hospital with medical professionals present without being prone and sedated, though.
    - deleted 13y ago
      [deleted]
    - rayiner 13y ago
      You're not sedated during birth. An epidural is localized anesthesia.
      - donaldc 13y ago
        You seem to be avoiding addressing the "prone" part of the equation.
rosser 13y ago
Western medicine treats pregnancy and childbirth like a disease. So, yes; I do think they probably get delivery wrong.
- daughart 13y ago
  In what way?
- rayiner 13y ago
  Western medicine treats pregnancy and child birth like a high-risk situation, which it is. It's the same principle behind having doctors standing by at a boxing match, except the natural rate of maternal mortality in child birth is far higher than the mortality rate of even the dirtiest fight scenes.
  - toomuchtodo 13y ago
    Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/ "The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician." No offense, but the data says you're wrong.
    - smokey_the_bear 13y ago
      The average woman who plans to have a homebirth is having a complication free pregnancy, and anecodotally, everyone I know who has had one it has been for their 3rd or higher birth after complication free deliveries in hospitals. You can't compare those numbers, they aren't the same populations of pregnant women.
    - rayiner 13y ago
      The problem with such comparisons is that high-risk pregnancies won't be planned for home birth to begin with. Also, in a hospital, a physician will be called in at the first sight of any complication, so midwives won't be attending births that go wrong. A comprehensive study in Oregon found death rates 6-8x higher in home births than hospital births: https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585 https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeM.... See also this meta-survey of the literature: http://www.ajog.org/article/S0002-9378(10)00671-X/abstract http://www.ajog.org/article/S0002-9378(10)00671-X/abstract ("Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.").
femto 13y ago
The field itself is fractured. Many midwives make the point that a complication free birth is not a medical event, and the majority of births are complication free. Have the medical intervention nearby for an emergency, but don't make it the default. There is a line or argument that intervention is a self-reinforcing cycle, in that the initial intervention raises stress levels in the mother, which promotes a fight-or-flight response, which causes the birth process to regress, which increases the likelihood of more intervention, and so on. This isn't to say intervention should be avoided, but only do it if it is necessary, since it does have consequences.
- rayiner 13y ago
  > The field itself is fractured. Many midwives make the point that a complication free birth is not a medical event, and the majority of births are complication free. Midwives are not part of the field of obstetrics, any more than sanitation workers are part of the field of engineering.
  - pradocchia 13y ago
    Don't be absurd. Midwives are practitioners in the field of child birth. Some will have acquired a highly developed sense of what works and what doesn't. It is foolish to ignore their experience.
    - rayiner 13y ago
      Midwives are practitioners in the field of child birth in the same way barbers used to be practitioners in the field of surgery. Yes, they engage in the practice and for a long time they were the only game in town. But it's not a systematic discipline and therefore experience isn't cumulative.
      - joshdulac 13y ago
        This isn't true. Midwifery is a serious discipline and you must be licensed in the US. Also, they even have Doctors of Nurse Practice (DNP) of Midwifery at the respected Baylor [1] and other schools. I would recommend watching "The Business of Being Born" (it is on Netflix) - it is very enlightening about the safety and discipline of midwifery, and why hospital births are unnatural and in some ways incredibly unsafe. [1] http://www.baylor.edu/nursing/nursing_grad/index.php?id=56683 http://www.baylor.edu/nursing/nursing_grad/index.php?id=5668...
amalag 13y ago
As with politics, follow the money.
- yetanotherphd 13y ago
  That leads to another useful heuristic: since the people currently practicing in a field are making money, the current practices and norms in any field are always wrong.
michaeldhopkins 13y ago
As you know, any field is constantly advancing and sometimes it returns to an older idea and uses it in a new way. This is happening in obstetrics right now. It isn't that the downsides of sedated, prone births were "missed" so much as that they were part of the best birth technology of the time and innovation and changes in viewing that technology do not happen quickly. That model is now being replaced by births that combine medical advances with the mother's natural abilities more effectively. Every scientific advancement must be preceded by a time when that advancement was not known or known but not used, no matter the age of the field.
donaldc 13y ago
Do you think it likely that an entire field that evolved over a period of thousands of years, has thousands of people doing the job all over the world daily, and is so common and important that there is scientific research performed on it pretty much not-stop, just missed this idea? Yes. Perhaps not all medical people personally, but as an institution, the medical field totally did.
pacaro 13y ago
The research is often there, but not read or understood by the practicing doctors. I found the book “Expecting Better”[1] to have a great analytical approach to the existing research. [1]http://www.amazon.com/Expecting-Better-Conventional-Pregnancy-Wrong/dp/1594204756 http://www.amazon.com/Expecting-Better-Conventional-Pregnanc...
616c 13y ago
You would be surprised. The cultural norm (not scientific, mind you) to have women give birth on their backs in reclining position was French royalty and aristocracy, according to our birthing coach. Why that continued into modern medical practice is unclear, and many women are in so much pain, they do not question. Doulas, or birth coaches, try to tell you early to force yourself to stand or hold yourself on arms and knees on the bed, if possible. Source: Doulas, certification info at: http://www.icea.org/content/doula-certification http://www.icea.org/content/doula-certification

anigbrowl 13y ago

If only. I strongly recommend this documentary: http://www.thebusinessofbeingborn.com/ http://www.thebusinessofbeingborn.com/

jonah 13y ago

Yes. [edit] Part of it is that the patriarchal doctor wants to be "in charge" of the situation and treat childbirth like some kind of medical operation. (This is not to say that modern medicine saves many children's and mother's lives. A modern, optimal, approach is to have a traditional birth with ready access to a hospital for a c-section, etc if necessary.)

mikeash 13y ago
Why haven't any researchers run a trial to compare the two and revolutionized this area of medicine after pronouncing dramatically better results for the traditional way?
- rosser 13y ago
  Because the ethics committee is never going to sign off on an experiment that has even a hint of risk to mother or child who aren't already at greater risk from a lack of intervention. It's the same reason you don't conduct Phase I clinical trials of new chemotherapeutic agents with people who don't already have cancer. Birth is already risky enough. "Let's science that, to see which has the best outcome," while a completely rational approach not only to decreasing harm, but also to increasing health, just isn't going to fly.
- willyt 13y ago
  They have, in the UK when you have your first appointment with the midwife they encourage you to consider it as an option. If you decide to do this you will then be assigned an experienced midwife who will attend the birth at your house, will monitor the situation for complications and will have an ambulance on standby at the first hint that things are not progressing normally. Also, if there is any hint of complications at all during the pregnancy you will be strongly recommended to have a birth in the hospital.
rayiner 13y ago
No, the modern optimal approach is to have a birth in a giant hospital so 1) you don't risk leaving the medical decision of whether intervention is necessary to someone without medical training; and 2) you don't risk the time lag of transferring to a hospital when a distressed baby is getting more brain damage from a lack of oxygen with every second that goes by.
- ceejayoz 13y ago
  It's possible to give birth in a giant hospital with medical professionals present without being prone and sedated, though.
  - deleted 13y ago
    [deleted]
  - rayiner 13y ago
    You're not sedated during birth. An epidural is localized anesthesia.
    - donaldc 13y ago
      You seem to be avoiding addressing the "prone" part of the equation.

rosser 13y ago

Western medicine treats pregnancy and childbirth like a disease. So, yes; I do think they probably get delivery wrong.

daughart 13y ago
In what way?
rayiner 13y ago
Western medicine treats pregnancy and child birth like a high-risk situation, which it is. It's the same principle behind having doctors standing by at a boxing match, except the natural rate of maternal mortality in child birth is far higher than the mortality rate of even the dirtiest fight scenes.
- toomuchtodo 13y ago
  Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/ "The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician." No offense, but the data says you're wrong.
  - smokey_the_bear 13y ago
    The average woman who plans to have a homebirth is having a complication free pregnancy, and anecodotally, everyone I know who has had one it has been for their 3rd or higher birth after complication free deliveries in hospitals. You can't compare those numbers, they aren't the same populations of pregnant women.
  - rayiner 13y ago
    The problem with such comparisons is that high-risk pregnancies won't be planned for home birth to begin with. Also, in a hospital, a physician will be called in at the first sight of any complication, so midwives won't be attending births that go wrong. A comprehensive study in Oregon found death rates 6-8x higher in home births than hospital births: https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585 https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeM.... See also this meta-survey of the literature: http://www.ajog.org/article/S0002-9378(10)00671-X/abstract http://www.ajog.org/article/S0002-9378(10)00671-X/abstract ("Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.").

femto 13y ago

The field itself is fractured. Many midwives make the point that a complication free birth is not a medical event, and the majority of births are complication free. Have the medical intervention nearby for an emergency, but don't make it the default. There is a line or argument that intervention is a self-reinforcing cycle, in that the initial intervention raises stress levels in the mother, which promotes a fight-or-flight response, which causes the birth process to regress, which increases the likelihood of more intervention, and so on. This isn't to say intervention should be avoided, but only do it if it is necessary, since it does have consequences.

rayiner 13y ago
> The field itself is fractured. Many midwives make the point that a complication free birth is not a medical event, and the majority of births are complication free. Midwives are not part of the field of obstetrics, any more than sanitation workers are part of the field of engineering.
- pradocchia 13y ago
  Don't be absurd. Midwives are practitioners in the field of child birth. Some will have acquired a highly developed sense of what works and what doesn't. It is foolish to ignore their experience.
  - rayiner 13y ago
    Midwives are practitioners in the field of child birth in the same way barbers used to be practitioners in the field of surgery. Yes, they engage in the practice and for a long time they were the only game in town. But it's not a systematic discipline and therefore experience isn't cumulative.
    - joshdulac 13y ago
      This isn't true. Midwifery is a serious discipline and you must be licensed in the US. Also, they even have Doctors of Nurse Practice (DNP) of Midwifery at the respected Baylor [1] and other schools. I would recommend watching "The Business of Being Born" (it is on Netflix) - it is very enlightening about the safety and discipline of midwifery, and why hospital births are unnatural and in some ways incredibly unsafe. [1] http://www.baylor.edu/nursing/nursing_grad/index.php?id=56683 http://www.baylor.edu/nursing/nursing_grad/index.php?id=5668...

amalag 13y ago

As with politics, follow the money.

yetanotherphd 13y ago
That leads to another useful heuristic: since the people currently practicing in a field are making money, the current practices and norms in any field are always wrong.

michaeldhopkins 13y ago

As you know, any field is constantly advancing and sometimes it returns to an older idea and uses it in a new way. This is happening in obstetrics right now. It isn't that the downsides of sedated, prone births were "missed" so much as that they were part of the best birth technology of the time and innovation and changes in viewing that technology do not happen quickly. That model is now being replaced by births that combine medical advances with the mother's natural abilities more effectively. Every scientific advancement must be preceded by a time when that advancement was not known or known but not used, no matter the age of the field.

donaldc 13y ago

pacaro 13y ago

The research is often there, but not read or understood by the practicing doctors. I found the book “Expecting Better”[1] to have a great analytical approach to the existing research. [1]http://www.amazon.com/Expecting-Better-Conventional-Pregnancy-Wrong/dp/1594204756 http://www.amazon.com/Expecting-Better-Conventional-Pregnanc...

616c 13y ago

You would be surprised. The cultural norm (not scientific, mind you) to have women give birth on their backs in reclining position was French royalty and aristocracy, according to our birthing coach. Why that continued into modern medical practice is unclear, and many women are in so much pain, they do not question. Doulas, or birth coaches, try to tell you early to force yourself to stand or hold yourself on arms and knees on the bed, if possible. Source: Doulas, certification info at: http://www.icea.org/content/doula-certification http://www.icea.org/content/doula-certification