And anyway, people get surgeries all the time, how is this any different?
A Caesarean is often performed even when it is not medically necessary. Hence "why are so many babies born around 8:00 AM"? Additionally, above a certain rate in industrialized countries, they are not even associated with better birth outcomes.
> And anyway, people get surgeries all the time, how is this any different?
Because childbirth is not an injury or deformity that requires fixing (or any intervention) in the large majority of cases. Surgery should be done when medically necessary. A Caesarean has many potential side effects for the mother and the infant, and doing it just to hurry things up is (IMO) unethical.
Why is this unethical?
In such a highly emotional situation, many mothers will feel pressured to do what their medical provider recommends. So, yes, it's technically true that it's the mother's decision, but many mothers don't realize they have the right to refuse these interventions, or are too scared to advocate for themselves in these situations, or are not fully aware of the risks -- both to the mother and the baby. In that sense, the decision is largely made by the medical provider, and this decision is often made because of an unnecessary urgency to get the birth done (or other reasons, such as a lack of experience with vaginal births or a fear of being sued, but in any case these reasons are not primarily the mother's). That is the part I was referring to as unethical.
To be clear, if it is medically necessary, a Caesarean should absolutely be done.
Also a personal experience of a nurse yelling at the mother to stop pushing when the baby is already partially out because the doctor is not there yet. Some babies just don't care to wait for the doctor if he is late.
Unfortunately, in my personal experience, the mothers desires are not generally held in high regard inside of a hospital.
The decision is left up to the mother, sort of. Inside the hospital is an environment that the doctors are very familiar and the mother, not. It is very interested in following procedure, within which the doctors orders are held in high regard and the woman's desires not so much.
If you try to buck the desires of the hospital+doctor you had better have a will of steel and a willingness to walk out. Ornery nurses and doctors can make your stay an absolute hell.
And poking the "birth options bear" is not something you want to do unless you're really in for a fight. There are strong opinions available.
I was literally 3 days ago. And "butcher shop" is nowhere close to how I describe it.
I also know some who stopped using epidurals, but fewer and most of them simply had become interested in more natural births between children.
The comment makes even less sense if they're talking about labor and delivery generally, which maybe they are. Maybe hospitals are a little too clinical for some, but that doesn't make them a butcher shop, and that's why you can bring your own doula. And maybe the clinicalness is part of the reason hospital births are far safer than home births.
Of course this doesn't mean you're wrong—it means you need to present your view thoughtfully and in a way that appeals to curiosity. That's especially important if your view happens to be right, so it's in your interest. (I'm adding this because the field around childbirth is intense and there are such strong feelings about it—justifiably.)
We detached this subthread from https://news.ycombinator.com/item?id=33437247.
Scheduled c-sections outperform emergency c-sections in every metric tracked. Scheduled c-sections are no worse for the baby than natural delivery, and if you take into account recovery time from surgery, no worse for the mother.
You can have an opinion on whatever you like, but to be blunt, if it's as stupid as this one you should get called out for it.
Of course, the process of going through labor pains for many hours might make things even between the two...
It's not. Labor pain is more time limited and the mother is kind of "out of it", and doesn't usually remember it clearly - plus there's a prize at the end :)
C-section pain is worse, and it lasts several weeks exactly at a time when the mother needs to do stuff. It's worse in every way.
My wife remembers every instant of all of her births.
If you are scheduling a c-section it means you are not trying for a natural birth and that means your outcome for the mother is strictly worse.
There is no good reason to have a medical doctor attend every birth. Of course in a country with a 30% c-section rate, there is much more for doctors to do. I don't think that any credible source will defend 30% as an optimal rate of surgical intervention in birth, but feel free to rebut me.
C-sections are only "no worse" for the mother and baby if you only consider mortality. Let's also consider:
1) Mother-child bonding time in the first two hours after birth.
2) Inoculation of the baby to mother's flora in the birth canal.
3) Mother's ability to care for the baby while recovering from surgery.
4) Postpartum mental health of mother who has been denied natural birth.
I said wait until medical intervention becomes necessary, not force active labor on everyone. As others have pointed out, we can detect the need for medical intervention at an early stage sometimes. That's great, people should have the medical care they need. They should not have surgery forced on them.
Anyway, I really don't think the issue with the majority of scheduled c-sections is surgery being forced on patients. It's patients and their doctors discussing the risks of an attempted natural birth vs a scheduled c-section and opting for a scheduled c-section. In some many cases the patients involved have no increased risk for a natural birth but may still opt for a c-section. And yes, on the flip side, no one should be forced into an attempted natural birth.
The comparison is natural birth to c-sections. Comparing scheduled c-sections to emergency c-sections is a ridiculous thing to track, go compare GP visits vs admission to emergency while you're at it.
1. Unassisted (with and without medication)
2. Assisted (vacuums, etc.)
3. Scheduled c-section
4. Emergency c-section
The problem with #4 is that it often happens after attempting 1 and/or 2 unsuccessfully. The baby is in a much worse position, sometimes medically and often physically within the mother's body. You can't compare 1 and 4 without also comparing 1 and 3, 3 and 4, etc. Everything is interrelated.
Comparing outcomes of natural births as a whole vs scheduled c-sections is far more useful comparison.
* Not the person you replied to, just my two cents.
reasonable people can understand
— law - medicine - accounting - investing
if we leave all judgment to experts we won’t be able to do anything or even judge experts
always remember the doctor who barely graduated is still called a doctor…
After all, in my country we have a doctor telling people that their illnesses were caused by demon sperm and being on record saying that medical treatments come from alien DNA yet they're still allowed to keep their medical license and practice thanks to the Texas Medical Board.
It's possible that our public_defender is entirely wrong, but isn't better to attack the false claim than to attack a person or dismiss their opinions on the basis of their job title? Don't you suspect that you yourself have some useful information on things outside of your job description?
As a legacy of upright locomotion balanced with large cranium size and infant helplessness, humans have ended up with an objectively poor design for giving birth to offspring. Death during that process is “natural”.
C-sections are scheduled in advance (sometimes over a month in advance) because the American medical system has optimized for cost reduction (which includes extreme risk aversion) rather than patient outcomes.
Additionally, there are many factors that can be used to determine the risk of natural birth.
However, there was a significant difference in the reasons things went wrong. Because in a hospital you're more likely to receive unnecessary treatment due to the "cascade of intervention"; and interventions such as C-sections have inherent risk. While at home, you're more likely to have an actual emergency.
Mostly the advice we got was, if you have a medical condition that increases risk, then go to a hospital or a birthing centre. But if not, and you live reasonably close to a hospital, home birth is quite safe.
I am speaking from personal experience with births in one of the biggest US cities in the last five years. Anecdotally, I think that some less-dense areas have better CNMW practices and more access to midwives due to traditionally less access to hospitals, but it seems very variable.
Not everyone giving birth is a fit 25 year old with absolutely no other health issues and a desire to have several more kids.
Tsk tsk all you like about women “waiting too long” - the majority of first-time mothers over 40 have c-sections. Would my child and I have survived a natural birth? Most likely. Would I definitely not have further damaged my diaphragm, debilitating me far more than the planned c-section did (hardly at all) at a point when we could least tolerate it? My gyno, my gastroenterologist, and I decided the c-section was a much better bet for both me and my child.
The example that sticks in my mind is from one of the Ina May Gaskin books where the doctor tells a woman that she has a "big baby, but only an adequate pelvis." I can't imagine the amount of damage this kind of doctoring is still doing to people, but it's surely significant.
In retrospect, this guy is practically the prototype of villain in healthcare. He's Eric Lander levels of villainy.
He shouldn't be considered a credible voice just out of corruption. There are many doctors who can write.
Consider his role at Partners (now "Mass General Brigham"): overseeing the growth of a notoriously money grubbing institution, run anticompetitively, despite the excellence of its providers. He has parlayed... saucy New Yorker writing into becoming the very hospital administrator who is responsible for all the fuckups he shits on.
Trust me, if he has something to say about, I don't know, fucking childbirth, it has been known to everyone for years. The difference is his presence in The Magazine New Yorkers Care About lets him omit anything shitty to say about himself and his Partners.
With all due respect your post sounds a little like a conspiracy theory without a set of good sources. Is condemning someone for being evil even an intellectual position that invalidates a technical statement they're making?
what has he done that’s bad?
After watching The Business of Being Born, Gawande's article was really helpful in understanding why things are done the way they are.