Talk:Childbirth
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Due to the relatively-large size of the human skull and the shape of the human pelvis forced by the erect posture, human childbirth is more difficult and painful for the mother than that of other mammals. A variety of anaesthetics have come into use to alleviate labour pains.
No mention of Lamaze? This is quite subtly POV. --Calieber 13:18, Nov 6, 2003 (UTC)
Added Lamaze Ich 23:02, May 2, 2004 (UTC)
Under the "Legal Apsects" section it states... "In many legal systems, the place of childbirth decides nationality of a child". I'm not an expert, but I don't think this is very common. The U.S. is the one notable exception.
- Yes, but please await responses here, rather than deleting text from an article. I've reverted it. Could you provide some sources to inform this discussion? JFW | T@lk 21:38, 29 Jul 2004 (UTC)
- Why not link to more wikipedia articles... Jus soli
- Notice the paragraph starting with "However, increasingly countries are restricting lex soli by requiring that at least one of the child's parents be a national" Jus sanguinis
- Gotta, love this choice quote from the "Legal Aspects" section...
- "The birth certificate is the basic document that proves that the individual is a human being."
- I guess the billions of people out there without an official certificate aren't actually human. If they're not human, what are they? If I forge a birth certificate for my cat, are people going to start thinking its human? I wonder if it works the same way for squirrels. If the squirrel has a birth certificate, it becomes a member of "Sciurus griseus". Without one, it quietly vanishes into the void.
- You're correct, that was complete nonsense. I'm glad you've changed some things. Linking to Jus d'orange as well :-) JFW | T@lk 23:00, 3 Aug 2004 (UTC)
One of the headings uses the spelling "Labor." However, internal mentions of the word are spelled "labour." Can we come to a consensus about which one to go with, for the sake of consistency within the article? Joyous 16:52, Aug 21, 2004 (UTC)
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Circumcision: Fathers in the delivery room
Is there some source to verify that circumcision rates went down as a direct result of increased fatherly presence in the delivery room? Joyous 23:15, Sep 13, 2004 (UTC)
Sorry, I may have overstated. I was referring to the overall empowerment of parents in the whole childbirth process, as opposed to the pure medicalization of childbirth. I have adjusted my wording to reflect historical changes, including some links to articles regarding parental choice in the hospital-context changing over time. DanP 00:10, 14 Sep 2004 (UTC)
Eating the placenta
"any parents like to see and touch this mysterious organ. In some cultures, there is a custom to dig a hole and plant a tree along with the placenta on the child's first birthday -- in some populations, it is ceremonially eaten by the newborn's family."
Does somebody have a source to the fact that some cultures eat the placenta after birth? I find just the image of sitting around the dinner table eating a placenta, really kinda strange... It seems a bit unhygenic too, Anybody have any more info on this or if it's true?
- Unhygienic? Not if it's thoroughly cooked! Perhaps the WikiCookbook should include some placenta recipes. You're right, it sounds like an urban legend. JFW | T@lk 19:18, 20 Oct 2004 (UTC)
- Well, I'm trying to come up with a suitable recipe. I have a couple weeks maybe before I'll need it, and of course I'll put it in the wikibooks cookbook. I've already tried stir-fry; it came out kind of like tough foam rubber. (maybe overcooked) Baking did the same, but I think I really overcooked it. Note that I don't care for onions, garlic, and peppers. (I tend to use rosemary, ginger, sage, thyme, basil, oregano, cumin...) Usually I'm a pretty good cook, but it's hard to tell what to do when cooking something I rarely get a chance to cook. Maybe I should mix the placenta into some scrambled eggs. I'd probably make tacos if I had a grinder, but I'm out of luck for that. Ideas? AlbertCahalan 15:46, 12 May 2005 (UTC)
- OK, we have a Spicy Australian Placenta recipe now. AlbertCahalan 19:58, 23 May 2005 (UTC)
It certainly isn't unhygienic! I'm appalled at the suggestion. Have you ever been to an abattoir - now that is unhygienic. I have known friends to eat their placenta - onions and garlic make it particularly tasty. Tastes a little like liver I am told. Some people believe it stops post partum haemorrage. It is reasonably common within the home birth movement in Australia. --Maustrauser 10:47, 12 May 2005 (UTC)
- Please ask them for recipes. I need one, fast. Let me know if I can just copy it into the Wikibooks cookbook, and if I should give credit to someone. AlbertCahalan 15:46, 12 May 2005 (UTC)
"the opposite of death"?
It can be considered the opposite of death, as it is the beginning of a person's life.
There are just too many things wrong with that sentence. First of all it would deeply offend those who believe that "life begins at conception, man" and second of all, how is it relevant? It's a badly phrased semi-philosophical statement thrown in the middle of a technical article on a biological process. LeoDV
Birth defects
Is there any connection between neo-natal alloimmune thrombocytopenia and Rh disease? My initial thought was that it sound like the same disease. Then on a second read on the article, i realised she have never had a life child before. That doesn't say much since an aborted child earlier in her life could also trigger Antibodies in her body. Anyway, a medical trained wikipedian would be more helpful since i am not even sure what i am even saying. [1] (http://news.bbc.co.uk/2/hi/uk_news/wales/4246385.stm) gathima 14:48, 8 Feb 2005 (UTC)
Photo
Is anyone wedded to the photo? I think it is awful. It makes childbirth look high tch, impersonal and medical. I'll look for something better. It would be nice to have a photo of the Mum! --Maustrauser 13:02, 24 May 2005 (UTC)
- I noticed too. That photo brings back horrid memories from before I learned about homebirth. There definitely needs to be a more reasonable photo, perhaps of a homebirth baby getting a chance to nurse before the cord is cut or the placenta is out. Keeping that awful hospital photo might be OK though, making for a rather dramatic comparison. Note that the placenta photo is similar, showing somebody with their sleeves tucked under latex gloves. You'd think the thing had Ebola! AlbertCahalan 14:53, 24 May 2005 (UTC)
"Childbirth" not "Homebirth Advocacy"
I'm concerned that the very appropriate and reasonable mentions of midwives and homebirth as an alternative to hospital and doctor-assisted delivery are beginning to metastasize into inappropriate advocacy of midwifery and home birth over mainstream medical care. Wikipedia is not, and should not be, an advocacy resource. How can we clean up the article to stop the spread of this while it's still salvagable?
- I see it the other way. You only see inappropriate advocacy because of your own position on the matter. It's the same as in politics, where a politician is simultaneously viewed as a conservative by the librals and as a libral by the conservatives. The way I see it, this article is dripping with implicit advocacy of hospital births. Just look at the cold and frightening pictures. The section on complications is without any mention of probablility; one might assume that complications are perfectly normal. The section on pain control is out of whack too; for example the word "try" implys that non-drug methods don't really work. It's also implicit that pain is bad (it is not; it is a message you should heed) and that women are not tough enough to handle this. AlbertCahalan 04:10, 26 May 2005 (UTC)
One suggestion I have is that the petty bickering where we're adding "midwife or" before every instance of "obstetrician" (or vice-versa) has got to stop. In addition to being annoying, it makes the article read like garbage. As a compromise, I'll propose that we find a term such as "person assisting the delivery" or somesuch. At the first time we use that, we mention that that can be an OB or a midwife, and then use the term for the rest of the article.
My other suggestion is that everyone please, please, please PLEASE monitor their edits for NPOV. If your edit implies that doctors hate mothers and want to multilate them, or that midwives are witches who want to gift your baby to the Devil, take a few extra minutes and re-edit it to be more neutral, OK? Nandesuka 12:48, 25 May 2005 (UTC)
- As the one 'guilty' of adding midwife in front of obstetrician I shall defend it. The medicalisation of birth is reality and part of that has been the view that obstetricians are the providers of expert care and midwives are subservient to them. In these articles on childbirth / homebirth etc, the word obstetrician appears first everytime, even when the activity being described is in most cases undertaken by the midwife. This is not NPOV and simply suggest a medical heirarchy. Obsetricians are experts in pathological conditions. Midwives are experts in normal birth. They work together as a team, and yet most of these articles suggest a heirarchy of skill. This is incorrect. I was simply evening things up with my edits. I do NOT intend to call obstetricians 'butchers' or midwives 'saints'. I simply want a more accurate portrayal of their relative skills and abilities, and rest assured I'm not going to go around sticking midwife first in every sentence!
- Having said that, we both probably need to be careful from a cultural perspective. I am aware that in the US, midwives are generally subservient to obstetricians and are more accurately called 'obstetric nurses' in most cases. Only a few practice true midwifery, and yet are called midwives. --Maustrauser 13:09, 25 May 2005 (UTC)
- From a practical perspective, then, are you OK with picking a neutral word to cover both doctors and midwives, defining it early, and using it consistently throughout the article, then? In doing that, we get to avoid the entire issue. Nandesuka 14:23, 25 May 2005 (UTC)
- I think "someone" will do. Remember, it might be neither. For my last son, it was just family. Even in a hospital, the placenta might be sent to be examined by a lab technician, or a nurse could take care of the matter. AlbertCahalan 04:10, 26 May 2005 (UTC)
- Yes indeed. I think this is a good suggestion. --Maustrauser 07:44, 26 May 2005 (UTC)
- Uh, yes. Hospitals have recently started to claim that you can have the comfort of a midwife-attended birth and the safety (ugh) of a hospital. Of course, packing up and traveling to an unfamiliar place is not quite the same. When you arrive, they may decide to direct you to the regular birth area anyway. (there, you may see women laboring in the halls because the rooms are too crowded) Hospitals are trying to compete, mostly with each other, but also with true midwives. Hospitals have discovered, to their horror, that people are using the new services in sufficient numbers to negatively affect hospital finances. Meanwhile, true midwifery is once again legal in 37 states and the number keeps growing. AlbertCahalan 04:21, 26 May 2005 (UTC)
- Show me the medical/biology courses the midwife has taken, and his/her grades in each course, or alternatively, their degrees, and maybe I'll consider them as having some sort of skill. Until then, my trust is staying with the hospital, since there is actually accountability. I don't see those medical pictures as "cold" (sounds awfully POV), rather that they are taking the proper steps to ensure the health and wellbeing of the mother and child. Look at the figures for life-expectancy and number of deaths in birth (either of the mother or child) in the past and now, and try telling me with a straight face that midwifery is the way to go. --brian0918™ 16:36, 26 May 2005 (UTC)
- No problem, OB. :-) To start, there are many types of midwife (http://www.mana.org/definitions.html). One can be a Certified Midwife (CM), Certified Nurse-Midwife (CNM), Certified Professional Midwife (CPM), Direct-Entry Midwife (DEM), Lay Midwife, Licensed Midwife (LM), and so on. As for accoutability... many hospitals now insist that you sign something that states your acceptance that the doctors are contractors, not employees of the hospital. Many doctors now refuse to pay malpractice insurance, preferring to place assets into places that are protected from bankruptcy proceedings. So, your plans for a lawsuit over an imperfect baby might not work out as well as you were hoping. Ensuring the health and wellbeing of the mother would require that the baby nurse ASAP, but this is not done. Ensuring the health and wellbeing of both mother and baby would require that narcotic drugs not be given to the mother. Looking at life-expectancy in the past is silly: poor nutrition, little winter heat, poor handling of sewage, and even poor sanitation in hospitals. Actually, the death rate for births increased when mothers started birthing in hospitals. Puerperal fever or "childbed fever" was a common cause of death for hospital births; today it goes by the term "hospital acquired infection". Today you stand a 5% to 10% chance of picking up an infection from a hospital stay in the USA. But anyway, have a look at the stats you were hoping I wouldn't find (http://www.texasmidwives.com/Safety_stats.htm). Yow! Your chance of dying is 3x greater at the hospital! (1983-1989, Texas Department of Health statistics) Take a look at this evidence (http://www.texasmidwives.com/Home_Safe.htm) too. AlbertCahalan 18:08, 26 May 2005 (UTC)
- Since when does "evidence" on a site called texasmidwives.com count? That would be like saying "the time cube is real, see here (http://www.timecube.com/)." Show me peer-reviewed medical journal articles, please. (You can start with PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi)) --brian0918™ 20:52, 26 May 2005 (UTC)
- Excuse me, you think the Texas Department of Health is biased or clueless??? Perhaps you suspect that the texasmidwives.com site has falsified this? (an outrageous charge, so you must prove it) I'm not about to purchase journals for you. If you choose not to believe the state of Texas, how about the WHO? (that's the World Heatlh Organization, a part of the United Nations) The WHO has repeatedly suggested that the USA move more towards a midwife-based system of childbirth support. WHO statistics show clearly that the European countries with the highest rates of midwife usage have the lowest rates of serious problems. Every country in Europe that beats the USA has midwife usage of at least 70%. Anyway, if you will believe neither the Texas Department of Health nor the World Health Organization, then I can not help you. AlbertCahalan 22:48, 26 May 2005 (UTC)
- Brian the debate is not, nor should it be obstetricians versus midwives. Both are essential. There is significant and growing evidence showing that for healthy women, midwifery care is best and for women with complications obstetric care is best. It is 'horses for courses'. I assume that you know that aphorism. Can I suggest that you look at "Pursinging the Birth Machine - The Search for Appropriate Birth Technology", by Marsden Wagner (UCLA trained paediatrician and neonatologist). This book provides much of the statistical and research evidence that you seek, including the WHO statistics. Your local library will have it.--Maustrauser 01:30, 27 May 2005 (UTC)
- Firstly, midwives are trained professionals. In Australia it is a 3 year University Course followed by 12 internship. So women meeting with midwives are meeting wtih trained medical professionals. Secondly, you miss the philosophical distinction between hospitals and birth centres (or home birth). Hospitals for every other human condition is for sick people. Birth is not an illness. It is a normal part of life. Attending a hospital or an obstetrician indicates immediately that "something can go wrong." Birth, is a very 'cerebral activity' for women and women need to feel safe. Being told that something may go wrong at any moment requiring major abdominal surgery fails to keep adrenaline at bay. For more information on the interplay of hormones involved in birth and the affect of hospitals on women, I suggest you follow up some of the work undertaken by the French Obstetrician Michel Odent. A search on Google will find many references to his research.--Maustrauser 01:30, 27 May 2005 (UTC)
- If something goes wrong, it's better to be in a hospital than to realize when it's too late that you're going to have to call an ambulance and lose precious time. To claim that women have adverse reactions to hospitals because you claim they see hospitals as places to treat the sick is ridiculous. I can just as easily say that people see hospitals as sanitary places run by professionals trained for such situations, with the proper equipment to handle such situations as well as any complications that may arise, and whether or not it is true that people believe this, it remains true that hospitals staff such professionals and have such equipment. --brian0918™ 01:54, 27 May 2005 (UTC)
- Sure, if something goes wrong, it is better to be in a hospital. That's a big "if" though, and hospital interventions bring problems of their own. Hospitals are indeed places to treat the sick. In the USA, the CDC estimates that you stand a 5% to 10% chance of getting a new infection just by being a hospital patient. The risk varies from 2% to 29% at hospitals in the British Isles, averaging 9%. That's a risk that you shouldn't take lightly, considering that you can get some pretty exotic germs in the hospital. (the home may have more germs, but your body is well-prepared for them) Study after study has shown that doctors often don't wash their hands, even when they know they are being watched. I just saw a recent study showing that airborne germs are very easily carried from room to room on clothing, being caught and rereleased as the cloth moves. AlbertCahalan 02:50, 27 May 2005 (UTC)
- A mother with your worries would indeed have difficulty delivering at home. A decent midwife will help to correct this, knowing to give up if the fear is hopelessly ingrained. A fearful mother will hold back, sometimes to the point of preventing delivery. A mentally prepared and healthy mother is very unlikely to have any trouble at home. Getting the right mental attitude is virtually impossible in a hospital. The mother is almost certain to end up on drugs of some sort, with an IV, and generally "out of it" while being poked and prodded. Complications are to be expected in such a case. AlbertCahalan 02:50, 27 May 2005 (UTC)
- I dearly hope that someday you will experience a gentle and happy childbirth, planned or not. Hopefully you won't call 911 to ruin it, or make some dangerous attempt to prevent the birth. AlbertCahalan 02:50, 27 May 2005 (UTC)
- Brian, DON'T PANIC! Childbirth isn't as difficult and as dangerous as you appear to fear. All 'emergencies' in Childbirth (even the worst - Uterine Rupture) can be handled by midwives until they get the woman to hospital. Are you aware how long it takes an operating theatre to be prepared for an emergency caesarean (which in 90% are not true emergencies - in the sense of life and death)? A minimum of 30 minutes, assuming staff and obstetrician are immediately available. This is plenty of time for most women to be transferred to hospital (at least in Australia - I can't speak for the US). So kick back, relax and have a good red wine. --Maustrauser 06:56, 27 May 2005 (UTC)
OK, let's look at what the Texas Department of Health actually has to say (http://www.tdh.state.tx.us/bvs/stats98/ANNR_HTM/98t28.HTM). Basically, I no longer believe any of AlbertCalahan's numbers, because they appear to have no connection with reality. He cites a neonatal death rate of 0.1%. This is so far removed from reality that it beggars description. Here are some actual statistics from Texas. I apologize for the formatting:
YEAR OF BIRTH #BIRTHS PNTAL DTH NNTAL DTH FETAL DTH 1989 312,279 3,708 11.8 1,598 5.1 2,110 6.7 1990 321,041 3,554 11.0 1,467 4.6 2,087 6.5 1991 322,065 3,375 10.4 1,350 4.2 2,025 6.2 1992 325,104 3,432 10.5 1,455 4.5 1,977 6.0 1993 326,267 3,302 10.1 1,403 4.3 1,899 5.8 1994 325,521 3,191 9.7 1,272 3.9 1,919 5.9
(Source: Perinatal Mortality in Texas, 1998-1994 (http://www.tdh.state.tx.us/bvs/reports/perinatl.pdf)).
Basically, you are cherry picking sources that, as near as I can tell, are just making things up. I will not allow such garbage to stay in this article.
Nandesuka 15:48, 27 May 2005 (UTC)
- First of all, it is not "so far removed from reality that it beggars description". Note that your numbers are NOT percentages. You need to move the decimal point. Second of all, I only used Texas as an example. The 0.1% was an international number, taken from about the midpoint of the highly-developed countries on the WHO list. The USA is at the bottom of that part of the list, and of course Texas is in the USA. Plus I gave 1983-1989 numbers, while you chose mostly different years and didn't separate out the different types of birth provider. Let's take the reasonable assumption that most births are in the hospital, so using my 0.57% rate. Now let's take the 1989 neonatal death rate from your chart, which is 0.51%. (not 5.1%) Hey, that's a better number than mine! Don't be so damn quick to revert next time. Generally I've been grabbing the first numbers I come across, not the nicest ones I could find. (Iceland would be the nicest - they didn't have any deaths) I did do some hunting specifically for the WHO numbers, because the WHO is kind of the standard for worldwide health statistics. BTW, note that even your 1994 number (0.39%) is over twice as bad as my 1983-1989 midwife number (0.19%), which in turn is twice as bad as the better European countries. (making your number 4x as bad) AlbertCahalan 02:00, 28 May 2005 (UTC)
- Nandesuka, what you have done (NPOV marking) is not right. Since you appear to be new here, I'll try my best to be really nice about explaining this. Try to forgive me if I fail. We all make mistakes sometimes. I certainly do. Yesterday you messed up your statistics horribly, being off by a decimal point and confusing the neonatal death rate with the perinatal death rate. It happens. You then accuse me of cherrypicking statistics at best and even suggest that the statistics are fabricated, which was not the calmest thing to do. I guess you were suspicious from the start too, with my statistics conflicting with what you thought to be obvious and common sense. I hope I was reasonably polite in pointing out the errors you had made. The proper response would be to accept that you had made an error and apologize for reverting. I, and many others, have a lot of respect for someone brave enough to admit their own error. I know it isn't easy, especially when you are trying to "win". (just get it over with; it even makes you feel better)
- See NPOV Flag section below. AlbertCahalan 14:08, 28 May 2005 (UTC)
- So now I see that you have marked the article as having a NPOV dispute. Huh? There was a factual dispute, which is something different, but I hope you can admit that your report definitely uses per-1000 numbers instead of percent. (mine did too, until I converted it in expectation of such confusion — perhaps the per-million numbers should be converted too) While I think I would be justified in removing that tag based on the fact that you have only an extinct factual dispute on the talk page, I think I'd rather not make anybody suspicous just now. (Can anybody point me to the point of view that is in dispute?) I hope you will remove that soon. Else, I guess I will have to file a complaint of some sort or hold a vote. Alternately, I could provide the POV dispute. I think I see one now, in a part of the article which I have not yet edited. AlbertCahalan 12:47, 28 May 2005 (UTC)
- See NPOV Flag section below. AlbertCahalan 14:08, 28 May 2005 (UTC)
Lewis Mehl source
Well, brian0918 demanded (via revert, which is not nice) to see a reference for Lewis Mehl. Fortunately brian0918 had earlier been kind enough to provide a link to PubMed. Searching on "mehl l" finds the study and a followup. The author has published a number of other interesting articles as well; the Tasered mother one is kind of famous I think.
- where: Women Health. 1980 Summer;5(2):17-29
- title: Evaluation of outcomes of non-nurse midwives: matched comparisons with physicians.
- authors: Mehl LE, Ramiel JR, Leininger B, Hoff B, Kronenthal K, Peterson GH
- PMID: 7210691 [PubMed - indexed for MEDLINE]
Hopefully this link to the abstract (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7210691&query_hl=8) isn't going to expire. Notice that the midwives came out slightly ahead even after the worst 50% of the doctors were eliminated from the comparison. (more fetal distress and placental problems with the doctors)
That's pretty damning I think.
AlbertCahalan 03:11, 27 May 2005 (UTC)
It's not damning at all. It's consistent with the idea that a professional, licensed midwife understands his limits, and transfers patients with risk factors or complications to the care of doctors when appropriate. Basically, according to your logic, nurses at elementary schools are more competent than hospitals, since zero percent of the 8 million children(*) who received first aid from school nurses died, while 10%(*) of the 894,444(*) children who were hit by trucks at school and then transferred to a hospital died.
(*) number completely made up for illustration.
In other words, it's called risk because there's a higher chance that something may go wrong. It is not surprising to anyone with a brain that doctors see higher negative outcomes if they are seeing the mothers with a higher risk. Your weird implications that birth is a beautiful thing where nothing can possibly ever go wrong if we just let nature take its course aside.
Nandesuka 16:02, 27 May 2005 (UTC)
- Where did you ever get the idea that I suggested "nothing can possibly ever go wrong"? Also, you misunderstand the study. Patients were matched up according to risk factors in advance. Attempted midwife births that ended up in the hospital were counted toward the midwives, so the doctors weren't getting any extra disasters counted against them. This is 100% justified; a qualified midwive knows when to call it quits and seek a caesarian section. The point is to measure outcomes for starting conditions that are identical except for the choice of place to start the birth. AlbertCahalan 02:09, 28 May 2005 (UTC)
Third stage - placenta
Nandesuka, I don't intend to get into a revert war over the placenta inspection description. But I must say I am surprised by your claim that it is the obstetrician who delivers the placenta. I was under the impression that it was the woman!
Are you Australian? It is my experience in Australia that it is the midwife's job to inspect the placenta to ensure that it is intact. Next to no obstetricians do this task. How shall we manage these cultural differences? --Maustrauser 13:19, 25 May 2005 (UTC)
NPOV Flag
Nadesuka, you have decided to put up the NPOV flag. Would be kind enough to put in concise point form your concerns, rather than simply raising the flag. Do you not like Albert's statistics? He seems to have explained them clearly. --Maustrauser 12:41, 28 May 2005 (UTC)
- I think Albert has been perfectly open and straightforward that his objective is to advocate midwifery, that he thinks hospitals cause infection and death, and that if a woman has complications in childbirth, it's probably her own fault for not having the right attitude. I think regardless of the statistics (and here I'll acknowledge I was wrong in reading the percentages – although I find it funny that Albert doesn't like the more recent numbers from Texas showing that hospital births overall are slightly safer than homebirths) the bias in his position comes through loud and clear, in every single sentence he has added to the article. Every single one. --Nandesuka 19:36, 28 May 2005
- Credit me for resisting the urge to directly point out that, in study after study, the doctors come out 2x to 3x worse. I simply gave the raw objective facts; the reader may draw their own conclusion. Completely eliminating these facts from the article would be hiding something. Why should we hide the truth? AlbertCahalan 01:58, 29 May 2005 (UTC)
- Factually, hospitals both cause and cure infection. (makes perfect sense: hospitals are full of sick people) Do you dispute this? I've seen numbers from the CDC in the USA (5% to 10% of hospital patients get new infections), from the UK and Ireland (2% to 29% depending on hospital, averaging 9%), and from similar studies in other countries. (there are lots of these studies; it's been a hot topic) Of course you must go to the hospital if your condition is serious enough to merit taking the risk of additional infection. If you have a a foot-first baby or the placenta over the cervix, you probably should get a caesarean section. AlbertCahalan 01:58, 29 May 2005 (UTC)
- I certainly don't believe that "if a woman has complications in childbirth, it's probably her own fault for not having the right attitude". This could be a cause, if she tenses up and resists the birth. More likely she is very unlucky, in bad health to begin with, or being attended to by someone who can't resist the urge to intervene. AlbertCahalan 01:58, 29 May 2005 (UTC)
- Your more-recent Texas numbers do not show that hospital births overall are slightly safer than homebirths. Remember, my number for midwives was 0.19%. (you had 0.39% as your best number, which includes both birth settings) If we make the big assumption that the midwife numbers did not change over the years, the doctors improved from being 3x worse to being only 2x worse. Lovely. I like using the older numbers for everything, so that we don't make the mistake of crediting the hospital with improvement that came from better nutrition. Perhaps people change their eating habits in response to fad diets, unemployment, etc. Who can tell? So we must compare similar years; your 1989 number is the only one that overlaps with my 1983-1989 range. AlbertCahalan 01:58, 29 May 2005 (UTC)
- Don't forget Dr. Lewis Mehl's study. That multi-author peer-reviewed study showed a 3% rate of "birth injuries" in the hospital. This would be stuff like cracked skulls, pinched nerves, forceps scars, etc. AlbertCahalan 01:58, 29 May 2005 (UTC)
- Wait a second... you think I added the stats to the "Complications of birth" section just for the purpose of advocating midwifery? (That would explain your "Conversely..." text.) No, I added the numbers because we needed some numbers. Back when you had the decimal point wrong, you didn't think "What the heck???", did you? That's the problem. Complications are rare, but people think they are pretty much normal. So my primary reason for adding the numbers was to express how likely it is that problems will occur. One should be aware of the potential problems, but one should also keep things in perspective. I suspect that people believe complications are common because that's what sells ratings on TV births. When neighbors chat, they tend to discuss disasters. You don't walk over to your neighbor and tell him about how you had an absolutely normal day the week before last August. So the stats need to be there for that purpose. While I'm at it, I may as well compare countries or birth environment. It would also be reasonable to briefly list the major risk factors: smoker, very young, very old, obese, malnourished, alcoholic, diabetic, and so on. Anything else that would help give people a dose of reality? You might die, and the baby might die, but the chances are very low. AlbertCahalan 02:32, 29 May 2005 (UTC)
- Do you think for a New York minute that if I, for example, added a link and a paragraph about the Western Australia study that shows statistically significant poorer outcomes in midwifed homebirths vs. hospital births, he'd let that stand? Don't make me laugh. --Nandesuka 19:36, 28 May 2005
- Given your own edit history, I would be suspicious. Given the degree to which I've been asked to justify things, I'd have to return the favor. The only study I've ever heard of that put hospitals ahead was one that counted unplanned unassisted births with the midwives. These would be the women who try to push the baby back in while screaming for emergency help, the ones too drugged up to realize they are giving birth, etc. AlbertCahalan 01:58, 29 May 2005 (UTC)
- I have already proposed a methodology for cleaning up the article that I think was reasonable (and I think you thought that too, Maus): mention midwives vs. OBs as an option early in the article, and then spend the rest of the article discussing aspects common to both. Throwing in cherry-picked stats and hysterical language ("disfiguring and disabling" in respect to episiotomies, which might be done because of an incompetant doctor or midwife, or might, y'know, be done to save the life of an infant) adds absolutely nothing useful to this article. If we're going to leave hysterics and the cherry-picked statistics in the article, then I think it's super-important for readers to realize that they're getting a political pamphlet rather than impartial information. Thus, the NPOV flag. --Nandesuka 19:36, 28 May 2005
- Your proposal covered the annoyance of repetitive "midwife or obstetrician" text. It did not cover the problem of the case when the description of something is different for midwife and obstetrician. AlbertCahalan 01:58, 29 May 2005 (UTC)
- "disfiguring and disabling" is not just in respect to episiotomies. It covers both mother and baby. It counts cases like my mom's own birth; she can not raise one of her arms above horizontal because a motor nerve was crushed by forceps. AlbertCahalan 01:58, 29 May 2005 (UTC)
- Specifically regarding the issue of episiotomies, one must realize that they are routine for many doctors. If they were saving infants, then we'd expect to see that reflected in the death statistics. Instead we see the opposite. There is lots and lots of research showing that the vast majority of episiotomies are unneeded. The wound takes about 2 months to heal, while a normal birth takes a week or two. The long-term damage can cause anal incontinence, loss of sensation, future tearing, and so on. As for the baby, did you know that the intact vaginal opening serves a purpose? It effectively performs a Heimlich maneuver on the infant. AlbertCahalan 01:58, 29 May 2005 (UTC)