Immediate skin-to-skin contact with unstable newborns improves survival chances | Hacker News Reader

Immediate skin-to-skin contact with unstable newborns improves survival chances

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376 pointsbillyharris228 comments

Interesting to read this here. When my son was born (naturally, normal weight, fully healthy, and around expected due date), the midwife in Denmark had educated us about the Danish way of handling the birth - as soon as the baby comes out, they literally put the baby on mom’s chest, and leave us(parents, and baby) alone in the room for about an hour. Nothing needs to be done other than the baby being in care of it’s parents! They believed it helps the baby form a natural bond, but also acclimate to the outside world better than being whisked away and cleaned.

It was such a lovely experience. One of the many things I am thankful to Denmark for.

Several things that I was surprised to learn while going through this in DK.

1. Childbirth is handled by midwives (Jordemothers) instead of doctors. Doctors are brought only when medication or any treatment is necessary.

2. Child birth is considered a natural process and never treated/thought of as a sickness or medical condition. This is reflected in the whole process.

3. The social healthcare system works great. It changed my perspective even more. Not having to think about hospital bills or insurance leaves us parents to enjoy the arrival of our little one.

4. If everyone in the country, regardless of their current financial condition gets such an experience for their childbirth, I will gladly pay my taxes, and never complain. Healthcare should not be a business imho.

using midwives is quite common in most European countries. in some countries people usually bear there children at home instead of in the hospital as well.

Yes, this way of care was new to me as I have only lived in India and the USA prior to moving to Denmark. It simply makes sense to have midwives be the specialized practitioners for this normal natural human care.

My son would probably be dead if we didn't give birth in a hospital. The cord was wrapped around his neck three times and he wasn't breathing when he came out. A small team of doctors (angels) came in and saved his life. An hour or so later, they had to do it again.

It was a short part of their work day, but made all the difference for us.

Don’t know your specific circumstances and it sounds like it was kinda a rough birth so sorry. I will say that the cord wrapped around the neck is super common and something midwives deal with all the time.

I’m in the US and most hospital does the same now. They call it the golden hour where it’s just an hour of skin to skin just like you mentioned with no baby health routine until after such.

...and despite it being essentially a time period where the hospital leaves you alone, you still get billed for it.

Well, the bed and room itself is a limited resource of the hospital and it's one of their expenses.

Of course ... but it's incredibly sad to read how it is even a part of the thought process of childbirth in some countries.

> ... the thought process of capitalism in some countries.

FTFY.

Providing poor service and still making money isn't capitalism. That's a lack of competition. Plenty of countries have poor government run services and there's no alternative. Same deal - no competition.

Charging for things just because you can is a capitalist mindset, however.

Besides, hospitals will never be more competitive than an oligopoly in most cases, simply because only so many are built in any given geographic area, and most people can only travel so far for medical care. There are some services the “free market” simply can’t deliver efficiently.

The reason why "only so many are built in any given geographic area" is because we aren't being very capitalist or free market. One must obtain a "certificate of need" before opening a new facility, and that will be opposed in court by all possible competitors.

We could give capitalism and free market a try.

Why do people always want to fix problems arising from capitalism by doing more capitalism?

The error here: it's not problems arising from capitalism

You complained that "only so many are built in any given geographic area", and I pointed out that this is for a very non-capitalist reason. Regulation prohibits opening new hospitals.

https://en.wikipedia.org/wiki/Certificate_of_need

It's not just your time in the bed/room, there's often a line item on your bill for skin-time. On top of that, you pay for your time in the room.

Have you heard about hotels? They bill me for a full day, and barely even communicate with me all night long?

When you stay at a hotel do you receive a specific line-item in your bill for being time spent lying in bed with your partner?

I'm pretty sure there are places in rural Nevada that work exactly like that.

Why is this getting downvoted? They bill for this specifically. This isn't the same thing as a damn hotel.. this site, I swear..

Kaiser in California is all about midwives and skin on skin contact with delayed umbilical cutting. For my daughter's birth, though, they decided it was prudent to take her to the side right away to flog her upside down with a rubber mallet!

Had a baby 3 weeks ago in the UK, it was the same. Baby was immediately on mum's chest.

It goes like this in the Netherlands as well. Typically with only a midwife, and a nurse if you want pain reduction medication because the midwife is not allowed to handle that. The exception is if there are medical indications like an early birth (I think before week 36), then a doctor would be present from the start.

Home births are a choice and a lot of people make that choice because it is a less stressful environment. We were told that the Netherlands has an above average amount of home births compared to the rest of Europe.

However for my daughter we were offered an even nicer option: There are special "non medical delivery" rooms in the hospitals around here. It looks and feels much more homely than a hospital room, has some normal chairs in it, the walls aren't white, it has a nice bathroom. You go there with your midwife that you already know from all the checkups. The process is like you describe it in Denmark, they indeed give you a lot of time to relax before and after.

But there is one thing different from home birth: It is right across the hallway from the medical delivery rooms, with full baby-ICU capabilities less than 10 seconds away and a red alarm button to press when you need medical help immediately. That was for us a comfortable feeling, because if things don't go right the natural way, you really don't want to be 15 minutes away from the hospital by ambulance.

Luckily we didn't need any of it, but the fact that it's there when needed feels safe.

It is reassuring to hear that Netherlands works more or less the same. Today is my first day in the Netherlands(moved here from DK) :-)

Just to add, we also had the exact situation as you described. An annex physically close but separated from the hospital. The child birth rooms are similar to normal room with a "help please" button. I'd also take this close proximity to the hospital over home births. Just in case something unexpected occurs and medical help is needed.

> 1. Childbirth is handled by midwives (Jordemothers) instead of doctors. Doctors are brought only when medication or any treatment is necessary.

This is perfectly rational in the context of publicly-funded healthcare; for many mothers (younger and in optimal health) pregnancy has little complications. On the other hand, we really benefited from high-intensity pre-natal care with frequent ultrasounds, as we were able to increase our kid's chances of survival with lung development-accelerating steroids.

What I mean is that it's a wonderful cost-saving tactic which doesn't imply better care. In Brazil we have MDs handling sore throats in overloaded ERs, and it might be more cost-effective to have teams of RNs in a more distributed proactive fashion. I still can't think of a case where, individually, I would prefer a RN rather than a MD handling my sore throat. Billionaires might even have MDs clipping their toenails to care for fungi.

Surely frequent contact with a lower-cost specialist who is trained to monitor for situations requiring escalation very much implies better care?

Maybe I'm misreading your tone, but it sounds like you're dismissing midwifery as being only about cost savings. I don't think that's true at all (parent of three; we did a midwife for the younger two), but even if that was a major motivation, it's like saying SpaceX is only about cost savings. The cost savings are a game changer in terms of access/frequency/etc.

I'm not sure why you're talking as if these are mutually exclusive?

I'm in Canada, where midwives are publicly funded, but still not that common (there's a waitlist and not everyone gets in). The midwives have hospital privileges, and are basically the "primary care provider" (instead of an obstetrician or family doctor). They still do ultrasounds, and if there was a concern, they can turn over care to a MD.

We actually did the birth in the hospital, and were just alone in the room with 2 midwives the entire time (no nurses / doctors involved). Our midwife did warn us that if a complication became up - especially at the end - that the room could get very busy very fast if they had to call in people, but thankfully that didn't happen.

We have a friend that had their kids at home. The midwives notify the hospital and ambulance service this is happening. They actually had to go to the hospital for one kid who had a complication, and my understanding is the ambulance was there very quickly and things were turned over to the medical team for birth, then after everything was ok, care turned back to he midwife a few hours later.

> What I mean is that it's a wonderful cost-saving tactic which doesn't imply better care.

I don't agree.

It is not mutually exclusive to have a midwives dealing with childbirths and Doctors providing excellent care when needed. The midwives perform the scheduled ultrasound and if there was any inkling of complication, they would have immediately involved a Doctor into the process(I was told so, but my son didn't need any). This way the Doctors are engaged only when necessary thereby increasing chances of better care and not wasting their time handling sore throats or clipping rich people's toe nails.

I had a similar experience in the US with a large private healthcare provider at a large regional hospital. They did some quick health checks but then quickly left the baby with my wife and I for skin-to-skin time. This was planned ahead of time and encouraged by the nurses and doctors.

I’m not sure if it’s become commonplace across the country but our care was impeccable and the nurses and doctors were happy to recommend and support as natural a birth as possible.

I've heard / overheard from multiple women from multiple states that birthing has changed and the baby is put on mom as immediately as possible, to the point it seemed odd from my experience 20 years ago. Doctors in the states have read all this too and things have changed.

We had both our kids at a birth center in the US (actually both born in the same room three years apart) and it was a great experience. There are certainly cases where you can’t but I really liked not being in an overly medical setting. Also (as a new exhausted Dad) taking that first nap in the same bed your baby was just born in and your wife is beside you wide awake… magic. Then about 6-8 hours later we are back home for when my wife was ready to crash as the hormones wear off.

I just watched the Frontline episode on the Healthcare Divide where US safety-net hospitals (accept anyone hospitals of last resort) have been closing or being sold to vulture investors who buy, trim costs, and sell them at the cost of reduced care.

For-profit healthcare should be like for-profit prisons: illegal.

I'm not sure about that, I live in the UK with public healthcare and optional private for-profit; I think that's fine.

Non-profit replacing the public is an interesting idea though, I've never heard that suggested before, people usually just argue about public being available or not. (And invariably quite pointlessly since neither side will budge!)

Most Americans don't know this, but in the US, most people have healthcare insurance through a non-profit such as BCBS or Kaiser or Wellmark. Additionally, 2/3 of the hospitals themselves are non-profit.

The non-profit model is more prominent than the for profit model in the direct care area of healthcare.

This sounds exactly like the process my wife and I are going through in the US right now.

I’ve never heard of pregnancy being treated like an “illness” (??).

Midwives are also extremely common here.

Granted I live in Arizona, and I know much of HN lives in SF. So maybe this is unique to Arizona in some way?

Except for the bills part

My first kid in 2008 in Chicago wasn't like this, my second in 2012 in Portland was. I'd say America is adopting the approach; maybe it fully has by now.

Not unique to Arizona. It's rather common throughout the country now.

The country’s c-section rate is somewhere near 33% when most estimates say it should be around 15%. That’s a pretty good indicator of systematic over-medicalization.

Lots of women I know elect to have C-sections.

I would not call it a "good amount" but I know women who elected for C-sections because they attribute too much value and significance to the date of birth.

My understanding is that that is often because doctors fail to educate them sufficiently on the cons. The recovery from a C-section is worse, the outcomes are worse for both mother and child, future children are likely to be more difficult. There's not much reason to recommend an elect C-section in most cases (certainly not 33% of cases) except that the doctors get to bill for it.

The case linked below started off with an attempt at a normal vaginal delivery. Based on your comment, you might think it admirable that the doctors didn't consider doing a c-section and continued to try vaginal deliver for around 60 hours - but then had to do a c-section and the baby had severe brain injury.

"Specifically, the family alleged the hospital did not properly estimate the weight of the fetus, even though the ultrasound estimate was more than the average weight. The family also asserted that the hospital failed in assessing the safety of vaginal delivery, which constituted malpractice. Finally, the family claimed the hospital did not recognize the deteriorating fetal heart rate pattern, which showed decelerations and a rising baseline. The family stated that if the hospital and its staff adhered to the appropriate standard of care, the infant’s injuries could have been prevented.

Through careful monitoring, the physicians would have noted that delivery via cesarean section was viable — and, in fact, the most appropriate option. This is reinforced because despite the administration of labor-inducing drugs, delivery had not occurred after 60 hours. This timing should have concerned the physicians and care providers, and they should have re-evaluated their initial course of treatment. Absent any evidence indicating otherwise, the abnormal 60-hour labor period could easily have injured the fetus. Whether the physicians acted negligently while monitoring the fetus’ heart rate would likely have been a significant material issue in this case. However, the family presented strong evidence that the care providers were negligent based on the totality of the circumstances and obvious disregard of cause for concern."

It's easy to have opinions when you don't have responsibility for people's lives.

https://www.reliasmedia.com/articles/145690-birth-injury-lit...

Uh, nope, that's exactly a situation where a C section is warranted. That's not what I was referring to by an "elect" C section.

The WHO has long emphasized that the expected rate of necessary C sections is 10-15%. The US is sitting at around 30%, 2-3x the desirable rate. Some of that is doctors trying to avoid malpractice suits (it's harder to get sued for doing too much), but some of that is convenience for doctors or moms.[0] Those are the cases I'm concerned about.

[0] https://www.usnews.com/news/healthiest-communities/articles/...

Thats fair, I didn’t pick up on your use of the word “elective”. But vaginal births have twice the incidence of urinary stress incontinence, overactive bladder and pelvic organ prolapse. There is also a risk of tearing of the vagina, and even tears that extend into the anus [2]. If I could choose a surgery that would prevent tearing of my genitalia, at the cost of money pain and possibly other complications somewhere away from my genitalia, I might well choose that - one might even say that a woman should have the right to choose.

It seems weird that we think that the WHO, an organization run mostly by men [3] would somehow know the “correct” rate at which women should risk urinary incontinence and genital injuries - why wouldn’t we let the patients decide with the assistance of their doctors?

[1] https://jamanetwork.com/journals/jama/fullarticle/2718794 [2] https://www.mayoclinic.org/healthy-lifestyle/labor-and-deliv... [3] https://apps.who.int/gb/gov/en/composition-of-the-board_en.h...

This is true. My aunt chose to have all of her children by C-section, and this was over 30 years ago.

> I know much of HN lives in SF

SF has more options for different types of prenatal/delivery medical experiences than most regions of the US, and has been ahead of the trend for years. My 2 kids were delivered by midwives in a hospital focused on respecting parents’ choices to the extent possible.

I know that in Russian culture, pregnancy is often treated somewhat like an illness. Not in the sense that it's bad, but it's commonly believed the pregnant woman needs a lot of bed rest, should avoid any physical activity more strenuous than walking, etc. In the last trimester, the woman is treated similarly to someone recovering from a major surgery. Medical supervision is handled by a doctor throughout the pregnancy.

This is in complete contrast to the thread starter's Danish approach, or the approach where I am in Sweden. Women are encouraged to remain physically active, to only abstain from very major activities (think skydiving or marathon running), and to generally keep doing things as long as they're physically comfortable. Midwives handle everything from the first checkup until labor, a doctor only gets involved if there's something that requires a doctor's skills in particular.

This is the experience we had 8 and 10 years ago, and I live in the US. I'm sure some people have had bad experiences, but there are exceptions to every rule.

My wife had a couple of complicating factors, so we had doctors involved from the get-go. Fun fact for the unaware: if you're predisposed for diabetes or just unlucky, you get gestational diabetes because pregnancy does WILD things to hormones.

But we've had instant skin to skin (after a quite o2 check, but within minutes) for both pregnancies, even the "urgent" c-section (not quite "emergency", but better safe than sorry, story for another time).

This sounds very similar to our experience in the public hospital system in Australia.

With both our sons the process was mostly handled by midwives including a lot of the pre and post natal checkups. The births were done naturally and immediately afterwards mum was given the baby to skin cuddle. They didn’t wash the baby and we were advised not to bath the baby for the first few days even.

Mum was also given the option of how long she wanted to stay in hospital (anything from 6 hours to 4 days if I recall).

The U.S. experience used to be this way, but about 100 years ago the medical industry realized they could make a lot of money off of child birth (our last bill was $40k).

The hospitals released advertisements scaring women from voodoo (read: black) women/midwives helping with birth so that doctors and surgeons could take over, it worked fantastically. The doctors eventually chained women to beds and tested various chemicals to ‘cure’ their pain that resulted in profound unintended consequences.

This history is still with us, and creates a lot of uncanny valley experiences. I.e. treating pregnancy like a disease.

When we gave birth during covid, I had to use an elevator to get to my wife. When the elevator door opened, a group in hazmat exited with a patient clearly dying of covid.

I was like: “are you fucking kidding me, this is still where we give birth in this country…”

We did it in the hospital too but there's nothing stopping you from using a midwife at home right?

Another thing that seems to be pushed a lot is epidurals. They expect everyone to get one and are very surprised when someone does not want it.

Then you have to deal with the circumcision sales pitch.

We never heard even the slightest hint of a sales pitch for circumcision. A single question of whether we were planning to do it or not was all.

In fact, we had an anti-circumcision pitch. They showed a video of the process. It was horrible and makes me queasy just remembering it.

If they were trying to convince you against it, I'm guessing they weren't giving you a video of the average procedure. Kind of like how peta videos aren't exactly representative of how most of the farming industry operates.

I watched the one on my son, and while it wasn't nothing, it was a tiny amount of skin and it was healed up very nicely before even his umbilical cord had fully dried and fell off.

I should have been more clear in my comment. I don't think they were trying to convince people against it, just that it had that effect on me personally.

The epidural costs $6000. A 10 minute procedure.

I saw my wife before and after an Epidural so I could not dispute it's effectiveness.

But I generally can't see a reason why we need to spend 12 years in school to learn how various needles and rules of thumbs work.

Only the US has such an education burden, and only does the US have such a strong physician cartel to mandate it..

Edit, and even with midwives you will be hitting max out of pocket with 1 night stay.

The training length for physicians is pretty much the same in all countries. In the US to become an anesthesiologist: 4 years undergrad, 4 years medical school, 4 years residency. Total: 12 years. In the UK to become an anesthesiologist: 6 years medical school, 2-3 years of general postgraduate training, 5 years specialty training. Total 13-14 years. Why did you not look this simple fact up before saying it authoritatively on here?

There's more to it than you think, and it's easy to think that it's a simple procedure whenever you don't know what can go wrong, why things can go wrong, and how to fix things if it does go wrong.

Also, the doctor isn't why it's expensive. Doctors don't set the prices, hospitals and health insurance companies do.

Midwives are the way. My first child's prenatal and birth was < $5k, born at home.

Amazing. In the Netherlands it is free. You get a midwife, hospital and medical staff when required. You get a box of goods for the first days of baby care. We get 4-6 weeks paid leave as a father and 16 as a mother. There is help in the house for about a week to take care of baby and mother and do checkups.

The only thing you pay a symbolic amount of money for is some to borrow tools like bath chairs.

Probably some pain meds require a contribution but you never pay the whole thing.

Children up until 18 are insured on your own insurance policy without additional fees.

It must be hell to live in a cold place as the US where everything costs tons of money out of pocket.

Parental leave in the Netherlands, both for women and man, is the lowest in the EU. By a wide margin. So, while we get some things right, leave and the conseqences that implies for the carreer of the mother is not something we can boast about.

In 2018 we were indeed among the lowest but not the lowest: https://www.capital-ges.com/wp-content/uploads/2019/01/1.png from https://www.capital-ges.com/maternity-paternity-and-parental...

I am not sure the career consequences are better elsewhere. What makes you say that pregnancy/motherhood has less effect on careers in different countries?

That graph does not represent the actual situation, it might include just full-paid leave. In countries like Germany, France and in Scandinavia, you get a shared budget: e.g. in Germany as a couple you get 14 months of which one parent can take 12months max, at ~65% pay. That's a whole different ballgame than the Dutch 5 weeks, even if fully paid.

I lost access, but I seem to recall this [1] article covers it quite thoroughly: low paternal leave is a likely explanation for the low (again, lowest in the EU) number of woman working fulltime. Then there's [2] and [3].

It seems obvious that once you enable the partner to take care, you enable the couple to make their own choices, whatever they may be.

[1] https://www.ftm.nl/artikelen/kasboekje-vrouwen-financien [2] https://decorrespondent.nl/8071/vind-jij-ambitieuze-vrouwen-... [3] https://decorrespondent.nl/8071/vind-jij-ambitieuze-vrouwen-...

Lowest in the EU? The father has 1 week off in Italy, and this has been increased from 3 days in the last 2 years. Mother has up to 2 months I believe (I'm a father and was shocked by this. If you had a kid, you'll laugh at anyone presuming 1 week is enough)

I really don't get that sentiment though, as a German citizen for example health care insurance is mandatory as in you pay a certain percentage of your salary each month towards health care insurance. So by any means it isn't the land of free healthcare some people made it to be. Also in the US there is the Charity Care Policy that applies when you make under a certain yearly salary.

In essence if everyone pays it through their income it is free as it will effect the buying power of everyone. Also because everyone chips in the individual contribution is lower.

Most people have good health care plans through their employer that pays for most of this stuff. I paid a few hundred dollars to the hospital when my child was born and we were there for several days. There are just a lot of people who for one reason or another do not have those benefits. It’s a very multimodal experience here unfortunately.

But if your employer is holding your insurance they can do all kinds of things. You are afraid to quit because you will lose insurance.

I have also read here on HN someone from SF paying a $4000 fee per month and still having to pay for a large part of hospitalisation. So it appears to be not so rosy even for the well off.

Given my experience with both the US and Swedish healthcare systems, I'm not sure I would rate even the absolute best healthcare plans as good. Growing up, my healthcare plan was about the best possible (both parents were doctors in the same hospital so we got a sort of deluxe super plan better than even the regular doctor families got with only one doctor parent), but I would still say it was about as good as Sweden's setup.

I don't mean this as an attack on you, but I think Americans overestimate the quality of their healthcare. The US system really is pretty bad from top to bottom. There are of course people who have it _worse_ (e.g. those not insured at all), but I don't find any aspect of the system particularly impressive. And considering the fact that it's by far the most expensive per capita of any healthcare in the world, it really becomes totally inexcusable. American healthcare is a national disgrace.

> We get 4-6 weeks paid leave as a father

this is technically true, but for context: it started in 2021. Before it was 2 paid days and 3 unpaid days _in total_.

Also the last 5 weeks are 70% paid (at least for me)

That was about the total for each of our hospital births.

Medical experiences and costs in the US really are crazy variable.

There is no "U.S. experience" because of the absolute mess of our healthcare system. There are birthing centers that work very much like the process described above.

Indeed - I have to give a plug for UPMC Harrisburg in Pennsylvania.

My wife gave birth to all three of our kids there, and while it was more institutional than what's described above, they were big on skin-to-skin contact and leaving it to the parents to parent while the nurses and docs took care of medical needs. Staff was uniformly great throughout all of our births.

how much did it cost if you dont mind me asking?

Of course no country of the size of the US has a single experience of anything. But in this case, it's about as close as it can be: 98.4% of births are in hospitals, with 0.52% in birthing centres [1].

[1] https://www.ncbi.nlm.nih.gov/books/NBK555484/

>but about 100 years ago

It wasn't really an issue for the most part until laws were changed in the early 70s - by Nixon.

That was when for profit health care took over here.

Person not alive in the 70s here (and not researched it), but curious why our heath care system is so bad. Could you elaborate on your point / give some sources? It seems interesting to me.

Immediate skin-to-skin contact has reemerged based on data in the United States. Some hospitals made the switch years ago. Immediate skin-to-skin contact and the newborn, unless there is a medical reason to do otherwise, is never removed from the presence of the birth mother.

In some cases this requires re-tooling and renovating the birthing wing of hospitals as they were previously optimized for immediate incubation by default. It takes time and money.

It's exactly the same in Canada. It was a great experience and we were so happy that we could be with our baby 100% of the time.

It's pretty common in the US as well although not the norm. I think it's kinda dumb to be honest. Just get an epidural. My wife was induced twice due to risk factors and got two epidurals. We still got to cuddle them new born. We also had to bottle feed the first week pretty heavily to stave off jaundice although they were mostly breast fed afterwards.

No, don't get an epidural. Pain has a purpose. It guides you to minimize injury. Be thankful you can feel pain.

There are people with genetic defects that prevent feeling pain. These people constantly injure themselves.

They are constantly giving birth? That seems like a much more relevant medical condition. (But yes, I get your point -- it's just that it's not relevant when you're conflating burning a finger with giving birth.)

Pain definitely does have a purpose. It alerts you to things you may need to know about. Once you're alerted, its purpose is mostly lost. And many, many people living with chronic pain can tell you that sometimes the message is worse than the cause. The fact that complete absence of pain is a problem in no way supports your imperative to not get an epidural during childbirth.

I agree that getting an epidural before handling sharp objects is unwise.

Lol, you know epidurals only last as long as they're administered right? As soon as the baby and placenta are out, they stop the flow and feeling starts coming back pretty quickly. The doc can also adjust the level of meds on the fly to allow enough sensation to facilitate pushing. And mom just stays in a hospital bed until it's safe anyway.

It's not just about injury after the birth. It's about injury during the birth.

As soon as the baby and placenta are out, it's too late to avoid injury during childbirth. It is no longer possible to let pain be guidance for minimization of injury. The chance was missed.

"Epidural analgesia had no impact on the risk of caesarean section or long-term backache, and did not appear to have an immediate effect on neonatal status as determined by Apgar scores or in admissions to neonatal intensive care." - Cochrane meta analysis: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD....

Have you seen a childbirth, and one without an epidural? There's so much pain that it's not going to be guiding anything. Physicians monitor the status of the infant via fetal heart rate monitoring and monitor the progression of the delivery.

Your study does not address all types of injury.

I have seen more than a childbirth. I have 12 kids.

The most miserable and painful birth was in a hospital. That birth featured pain medication, fetal heart rate monitoring, beeping machines, and a prison-like situation with doors that locked us in. My wife was in pain for months afterward. We learned our lesson and didn't do another hospital birth.

The other 11 births were definitely not "so much pain", but pain did guide my wife to be careful. She was always up and about right afterward, without pain. One time she walked around town doing errands the next day.

I resonate with #4. I'm in US, so healthcare is tied to employer. My first job ever paid 12/hr and I did not have health care and it was a part time job, so I'm glad I could rely on my mother's health insurance until age 26 (thanks Obama).

I got my first "real" job after spending a year trying to find a full time job after graduating college, during which I was working that 12/hr job. Even at the new job which paid 80k a year, I had to pay $30/paycheck ($60/mo) towards healthcare. Thankfully never had to use that insurance while I worked there.

Now at my current place I get HDHP (high deductible health plan) and when I messed up my leg the hospital I went to didn't even have crutches in their inventory.. got wheeled out to my car and I had to drive to a pharmacy to purchase crutches.. it was horrible, and I couldn't imagine what this situation must be like for someone without insurance.

Anyway the worst part is that I still ended up paying about $1500 out of pocket, because the 1st X-Ray was covered, but the next two were $600 each....... $40 crutches ..............

> I could rely on my mother's health insurance until age 26 (thanks Obama)

I don't know the particulars of what law enabled this, but I used my dad's health insurance until I was 26 as well, before Obama's first term.

Are you from Massachusetts? In that case it was Mitt Romney's healthcare reform.

Could have been the loophole for college students, too: I know back in the 90's, you could stay on your parents insurance until 24 or 25 if you were in college. If not, you were dropped at 19.

I am very sorry for what you went through.

I lived in the US for 6 years, and worked at above average tech company and had excellent healthcare benefits through employer. I must admit it blinds people to say "country's messed up healthcare system is not my problem" because my employer took care of it :-(

Before my move to Europe, I risked living in the US for a month without health Insurance, and I was very anxious about it. I can't imagine what most Americans who don't have that luxury of employer benefits feel daily.

It's silly to think that the richest country on earth by far does not have a decent healthcare system that covers all of its citizens.

>it blinds people to say "country's messed up healthcare system is not my problem" because my employer took care of it :-(

This is something I never understood. If your employer is in power of your health insurance, how free are you?

I'm not saying it's a good system, but I'm not following your logic here. If the government is in power of your health insurance, how free are you? I can change my employer a lot easier than I can change my government.

But when you change employers you risk losing access to your healthcare. Whereas if government pays for the health system you can maintain continuity of care, which can be essential to treat various psychiatric and medical conditions. Imagine if, because you got a new job, your lease on an apartment were canceled and you had to go find a new place to live? That's what our healthcare system is like and it's maddening.

I'm not defending the system, I was trying to point out the absurdity of the parent's statement.

To your point, the affordable health care act addressed the issue with not being able to get insurance due to preexisting conditions. In the US you're required to have healthcare insurance. You can buy it yourself, get it through your employer, or, assuming you qualify, get it from the government.

The point I'm making isn't that you can't get insurance, it's that the insurance you have changes every time you change jobs. At one employer you might be on an HMO plan like Kaiser Permanente and be limited to their providers. But then your next employer uses Blue Cross / Blue Shield or United Healthcare and you can no longer use your Kaiser Permanente doctors. So you're not guaranteed continuity of care, and you might lose coverage for certain optional things if you change jobs. And your costs, which are nebulous to begin with, might change substantially depending on who your employer is. It's a crap shoot.

Also you're not required to have insurance. The individual mandate was repealed a couple of years ago.

You can generally keep paying for the same health insurance for to 18 or 36 months after leaving a job via COBRA except in cases of gross misconduct. It can be shockingly expensive though.

https://www.dol.gov/sites/dolgov/files/legacy-files/ebsa/abo...

> Childbirth is handled by midwives (Jordemothers) instead of doctors.

Is midwife a female-only profession or are there male midwives too?

Are you objecting to 'mother' in the Dutch as if 'wife' in the English doesn't imply the same?

I didn't read that as objecting to anything, it looks like an honest question...

Fair enough. The quote made it seem like 'That's so non-PC why do you call it that' to me, so I was just pointing out it's not any different in English, quoting the Dutch is redundant!

Do they assist in cutting the umbilical cord and delivering the placenta before leaving the parents and baby alone?

Yes, I think the midwife gave me (father) a choice to cut the umbilical cord. I didn't want to, so she did it, and also removed the placenta, and sutured the mother(while the baby was in mom's chest). Once the suture was complete, the midwife and the helper nurse went out of the room and said they are available immediately if we needed them. That hour went like a minute :-)

Same in the UK. Literally immediately as the kid came out he was on my wife's chest... umbilical still connected and everything.

They banged on and on about the importance of "skin on skin" in all the ante-natal stuff. Even for the father they say skin on skin is beneficial. Apparently it promotes oxytocin for both parties.

We had 2 children within the last 5 years, both born at Stanford, Palo Alto, and both were immediately put skin to skin after birth, so I don't think it's unique to Denmark.

Palo alto is not typical of America. Its one of the richest places in the country for one along with having a high percentage of liberal/educated people.

IN America you have to be upper middle class at minimum to have the same standard of living as the bottom tier in Scandinavian countries.

Doubtless, you're leaving soon then...

I've been a digital nomad for about 4 years. got stuck back stateside for a few months due to the pandemic but I can't wait to leave again.

I always assumed poor people had midwifes

Source: born in a house not a hospital like my whole family

I live in the Midwest. Skin-to-skin is the standard of care. It is not just the coasts that do these things.

Thanks for educating me about Scandinavia, I only lived in Sweden for 30 years :) With regards to standard of living, I disagree that you have to be upper class to maintain a typical Swedish standard of living. If you derive "upper class" from the national median salary then yes, but that would put a lot of the California working class in the "upper class" bound as well.

2.8 million people die during childbirth every year. It's absolutely a medical condition. And you should absolutely have a doctor there.

Thanks for saying this, most do it in the hospital because if something goes wrong we want to have the best chance of saving mom and child.

It's wild that on a site that educated people use that you're seeing people advocate for homebirths. I'm guessing that next to nobody on hacker news have seen a delivery go south and need an emergency C-section. If you're at home, the ambulance is going to be way too late to prevent serious harm to the baby (hypoxic brain injury) or the mom (hemorrhage, hypotensive shock). There's a reason why OB/Gyns don't have their babies at home - it's because they have seen it go wrong.

Where did you get the 2.8 million figure? Wikipedia says "an estimated 303,000 women killed each year in childbirth and pregnancy worldwide", which isn't the same.

https://en.wikipedia.org/wiki/Maternal_death

I'd guess the stats favour non-hospital births because they are only done when deemed safe beforehand. No midwife will let you do it outside hospital if they spotted anything wrong.

Our midwife literally threw the doctor out of the room: "Everything is ok. You go now!" The doctors know that the midwife is in charge and respect this.

how do you manage getting around the hospital system? seems overwhelming with having a different language, and it isn't as simple as going to the ER I assume

According to a recent study reported by Reuters, child birth in a hospital setting is far safer: https://www.reuters.com/article/us-health-homebirths-newborn...

Skin-to-skin contact immediately after birth is pretty common in hospital settings now.

You shouldn't care about it all being a "lovely" or "natural" experience. You should care that everyone gets out safely. Birth can be a brutal and deadly affair.

What's wrong with it being a lovely experience?

Couldn't we assume that OP's hierarchy includes the "everyone gets out safely" box having been ticked?

This is like saying cars should not be enjoyable because they exist purely to move us around.

> What's wrong with it being a lovely experience?

It shouldn't be a priority. At all. If it happens to also be a lovely experience, that's of course fine. But it's not something to plan around when it significantly reduces the chance of everyone being safe.

> Couldn't we assume that OP's hierarchy includes the "everyone gets out safely" box having been ticked?

They didn't have a hospital birth, so no. It's not a box that was sufficiently ticked.

> This is like saying cars should not be enjoyable because they exist purely to move us around.

This is like buying a two seater sports car and putting your child's car seat up front. It might be more enjoyable for you, and it'll probably be fine most of the time, but it's significantly more dangerous for your child.

My post might sound harsh, but continuing to spout the "benefits" of a home birth is just plain dangerous when the facts don't support safety. I feel the harshness is appropriate.

Country A infant mortality rate in 2021: 2.86 deaths per 1000 births.

Country B infant mortality rate in 2019: 5.75 deaths per 1000 births.

Guess which country is which.

Intra country results can be challenging as who chooses a home birth & who goes to the hospital is already a likely biased population. Maybe the pregnancy is already known to be an at-risk factor, thus biasing things. Or choosing one vs the other may be a confounding socioeconomic factor.

If it's this hard for intra country comparisons, why would one expect inter country comparisons, where one country has socialized medicine & the other doesn't, to meaningfully reflect the specific policies around child birth vs the larger differences between societies?

I don't know the answer, but I don't think simply comparing mortality rates can be used to conclude "natural home birth is safer".

This is almost exactly reflective of our experience here in Australia, too.

The midwifery service was genuinely amazing and our midwife also positioned childbirth as a natural thing, not a "medical event" (by default anyway).

We got to do this, in the United States, when each of our kids were born, living in a village in desert Southwest.

We were very fortunate.

And as the area had been designated as economically distressed, there were other support policies in place, not optional, and covered by either private insurance (via my employer), or public grants (from state or federal government programs) -- 48 hours stay in hospital, a quiet, private room. It was a slow day for the hospital. And a social worker would come visit our house a few times, a few weeks later.

Posting these personal anecdotes because it might be of interest to know how different things can be, out in remote locations of the US, different cultures and history.

Interesting.

Our baby arrived 10 weeks premature and although it wasn't immediately after birth (as I'll explain why below), the hospital strongly encouraged the kangaroo care as mentioned in the article, which mom did daily until we could take our baby home.

In a week it will be a full year since birth and the baby is in no way behind developmentally compared to other 10 month olds (when adjusting age due to prematurity). So although anecdotal, I can believe this can be a very helpful practice.

Due to arriving mid-pandemic and because neither of us had COVID tests prior to the unexpectedly premature birth, we weren't allowed to visit the baby in the NICU until our tests came back negative, which was about 30 hours later. I wasn't even allowed to be with mom during delivery, but the doctor did allow me to see the baby for a couple of minutes from a distance and under the proviso that I touched nothing in the NICU (including things like walls, windows, doors, handles, etc).

Anyway, somewhat superfluous information at the end there, but it was quite an experience and I'm just happy everything turned out fine.

I’m so glad to hear your 10 month old has been making out well.

My wife and I are weeks away from our first.

While very lucky—our close friends and family have not had serious encounters with covid, We’ve been most affected by regulations that have interrupted what would have been normal parts of a couple’s first pregnancy.

I’m sorry to hear you were not allowed to be with the mom during delivery. And that you were delayed in visiting the nicu by those tests.

That must have been very difficult.

I remember being told I wouldn’t be able to be there with my wife for the first ultrasound. I attended via FaceTime.

I was a little more accepting of the circumstances at the 28 week, but still not happy about it.

One of the bigger bummers has been having no I’m person social interaction with other new parents approaching the same life stage. It’s just not the same over zoom and it feels like a pretty big miss.

Always trying to keep these things in perspective. As of now I’ll be there for the birth, and really just want a good outcome after all.

Congratulations and I'm glad to hear that things seem to be good as could be hoped for considering the pandemic.

With everything else that happened I kind of forgot about not being allowed to join for check ups and ultrasounds, it definitely sucked.

Fortunately they made an exception on the day of the birth (where we made an appointment only because my wife was feeling uncomfortable), otherwise I probably wouldn't have been with my wife at all before she was rushed off to theatre.

Good luck and enjoy.

Congratulations!

My kid was also a preemie and got kangaroo care alternating with being wrapped in a UV-emitting blanket. Now he is 8 and still blows me away every day with his kindness, smarts, skills and ... uh ... argumentation. :)

The benefits of kangaroo care are worth studying, but the results of the study are about as unexpected as the 'your cats love you back' study.

> the 'your cats love you back' study

Hold on, your cats love you back?

I don't remember which study it was, but a quick search will find quite a few, e.g. https://www.inverse.com/science/how-do-i-know-if-my-cat-love...

We had a 35-week baby stay a couple of weeks in the NICU too. Our maternity ward was far less paranoid over COVID, and we got to hold the baby during the C-section and for a while afterwards. Baby is just two months (unadjusted) and it's already annoying to always be explaining adjusted age and where people should be counting from for developmental placemarks.

I find as a father that sometimes the only way I can soothe the baby (mom breastfeeds and has to sleep during the daytime) is to take my shirt off and place him on my chest. I can almost code one-handed this way. I think babies somehow imprint to your smell or taste.

Totally hear you but the bright side is that they catch up extremely quickly. My kid “caught up to average” within around nine months or so.

Yes! I just read this to my wife and we had to laugh a little as the adjusted age thing has definitely been a bug bear at times.

At this point when people ask our child’s age, we almost always just say the adjusted age as it’s easier, especially with my wife’s gran who doesn’t speak English as her first language and then is worried about her being behind developmentally.

In regards to the bonding, for me it’s a feeling like no other to have your baby see you and mom as the greatest two people in the whole world.

I received the opposite care. Was delivered by C-section, no contact with anyone while in incubation for several weeks. My mother would often tell the story of how she was unable to touch me for weeks after my birth.

45 years on and I haven’t a single bond, not with family, not with friends, not even with animals. Like a ghost floating through the world with no attachments and seemingly no compelling interest in them. Active avoidance is on point. But don't be sad for me. It's just the way I developed. And the lack of bonding, skin-to-skin contact with my mother is one possible reason.

They’ve tried to make a number of diagnoses fit, from autism to Schizoid Personality Disorder, Bipolar to Asperger's. Nothing. Nothing fits. There's nothing wrong with me except that I don't bond, at all.

One of the more disturbing experiences was watching what happened to chimpanzees when their mothers were taken away from them after birth (or were denied bonding entirely). They rock back and forth with anxiety; they grapple for the nearest comfy thing; more rocking. It was like watching myself. I'm typing this 45 years later holding a pillow for comfort. You'll rarely see me seated without one. I rock all the time. The pillow, the rocking. They fill a hole. It's protective somehow. I'm sure a shrink would say it reminds me of the womb that was stolen from me.

And I know I'll live the rest of my life like this, without bond, alone, and not really sad because of it, just totally missing what compels others towards their own kind, to bond.

So, yeah, more skin-to-skin sooner. No more lost people like me. Again: not sad about it, but life without others (and very much not wanting them) can be a severe challenge. You have only yourself.

Sounds like emotional avoidance; check out DBT, it is an effective treatment and might improve your suffering even if it doesn’t “fix” it. God Bless, friend.

I will say this is something we've known for a while: https://pubmed.ncbi.nlm.nih.gov/27885658/

Yes, and it’s standard practice in hospitals.

Additionally, our doctor prescribed a certain quota of skin-to-skin contact daily for the first several weeks after birth.

Skin-to-skin is standard. Skin-to-skin for unstable neonates is not, which is the debate in the medical field and the question that the study sought to answer.

This is not what the study addressed - the study is about contact with premature babies which is typically withheld until they are stable. The outcomes are better if the skin-to-skin contact is initiated before they are stable.

Lots to be learned about the microbiome, and how vaginal birth, breastfeeding and skin contact feeds that. The trend towards caesarian births and formula feeding countervenes this trend in health research.

Everything about birth is incredible. For example it’s extremely common to defecate while giving birth. Oh no lots of germs and bad for baby right? Actually the exposure helps jumpstart the infants gut biome.

And in the 1930s they were trying to figure out why there’s a type of sugar in breast milk which the infant can’t digest. Why the weird evolutionary waste? It turns out these oligosaccharides are there to feed not the baby but the good bacteria in the gut. The incredible and amazing mother anatomy. Amazing in so many levels.

https://www.nature.com/articles/d42473-018-00007-1

It’s not unsurprising reading about western doctor’s historical skepticism of this practice.

Reading about the history of child birth in the U.S. over the last century is messed up. No wonder we have such high mortality rates still.

I remember having to change hospitals in Boston because they were proud of the fact that 50% of the births were c-sections…

Home birth, natural, c-sect, whatever works for you to have a happy healthy baby.

We had c-sect under GA, as my wife was scared of birth and c-sect, so we opted for GA. So there wasn’t even an option for skin to skin, or me to even be in the room during the procedure.

But our daughter came out happy and healthy. Wouldn’t change a thing.

Not getting skin-to-skin contact with our daughter (and only child we will have) for several days because of very minor complications is something we really resent.

We had a preemie baby at 26 weeks in December and feel fortunate our hospital (UCSF) practiced this recommendation. I was surprised they could do kangaroo care that fast (was a few hours after birth), but we did it then and everyday our daughter was in the ICN for 4 months. I'm convinced it made a difference and am sad when I hear about parents who can't do this.

I hope this research helps this become more standard practice.

I'm sceptical of single study medical research and especially that which involves the crazily political world of birth. It might be better to wait until the Cochrane collaboration does a meta analysis on multiple studies before anyone changes what they are currently doing.

Skin-to-skin for children has been studied for a few decades, and the consensus is strongly in its favor, after a pile of studies have all pointed in the same direction.

This study isn't "skin to skin care is good." This study was aimed to answer the question, as contextualized, "We have established that skin-to-skin care for healthy children is good (pile of studies); for unhealthy children that have been stabilized is good (pile of studies), but is it good for kids that are still unstable? (controversy)"

"I'm skeptical of a single study" is only a valid criticism if you're familiar with the body of scientific literature. Otherwise, what you're actually saying is, "I'm skeptical of results that pop magazines and press releases have only surfaced to my attention once" - which is a shoddy mechanism for curating your knowledge.

Your response is great. Thanks for sharing information about the literature and way more context.

> Otherwise, what you're actually saying is, "I'm skeptical of results that pop magazines and press releases have only surfaced to my attention once" - which is a shoddy mechanism for curating your knowledge.

At the risk of nitpicking, this seems like a good principle to follow? Like, assuming skeptical means "I won't instantly buy into this being as great as the pop magazine claims" rather than "I will strongly presuppose that this is untrue because it was in a pop magazine".

Thank you.

I think it's a poor mechanism because "appeared once in a pop magazine" isn't a good signal for knowledge curation regardless of whether you assign it a positive or negative weight; especially when the original comment implied (to my reading) "the topic has only surfaced once, therefore the existing knowledgebase is only one study."

The existence of a single study in pop literature is a very poor predictor of whether the study was accurate or not, and a very poor predictor of whether there are other studies on the topic. So I think it a mistake to substitute "it has come to my attention once" for "it has only been studied once."

It is however a very good indicator that the pop portrayal is inaccurate though!

At least this is 'med life style news', arguably not really 'pop', by the time this hits, I don't know, 'ifl science' or whatever, Techcrunch for general science/medicine, I wouldn't count on 'with unstable' in the headline, or perhaps even the body.

The conclusion may be 'keeping baby warm' increases the survival rate. I agree with you, these researches are too vague, there are so many parameters, correlation maybe.

They sniff like little piggys on the breast and suck it. It must be traumatic coming out of womb and very comforting when getting the breast.

I wish we could have experienced this. Our OBGYN didn't catch (after we insisted) that the baby was breach. After 2 hours of labor we were rushed to an emergency c-section.

I'm thankful that my wife did get a little skin-to-skin but it was not immediate and it was for maybe 5 minutes before they were seperated. I think we got to see our baby about an hour later.

The whole experience during and after was horrible but I'm not sure if we or the hospital could have handled it better other than if we had insisted more strongly that the position felt wrong weeks before delivery.

imho: correction of the side effects of "evidence-based medicine"

related-satire:

"Satirical paper puts evidence-based medicine in the spotlight"

"A spoof paper about mothers kissing their children’s ‘boo-boos’ draws attention on social media."

https://www.nature.com/news/satirical-paper-puts-evidence-ba...

"The paper’s underlying message is in line with the journal’s philosophy, says Miles, who is also senior vice-president of the European Society for Person Centered Healthcare in London and Madrid. In medicine, he notes, scientific research is only one type of knowledge, which must sit alongside other forms, such as professional medical experience, and not above them. “Over-reliance on science is a very dangerous thing,” Miles says. Next month, the journal will publish another article unpacking the lessons contained in the satirical paper, he adds."

Is this news? This was the crunchy stuff we did when my son was born ~13 years ago. It seemed like crunchy 101 then, shrug.

Was your son born 'unstable'?

There is a lot of “woo woo” crap in the child birth industry. All the way from hardcore “all natural” proponents to traditional “hospital birth no matter what” people. Unfortunately this causes a lot of anxiety and second guessing on the part of new parents. I really didn’t appreciate the quasi-relgious or cult-like guidance we received on breast feeding our son, only to have him lose 15% of his body weight and not gain it back until we supplemented with formula.

Sounds like poor pediatric oversight FWIW.

Reminded me of the Behavioral Despair experiment on the psychology of hope

https://en.m.wikipedia.org/wiki/Behavioural_despair_test

Newborns can die from lack of food, water or touch.

Huh, you should never give a newborn water…

You’re not supposed to give water to a newborn. Maternal milk has plenty of it already.

Based on this, expect US hospital prices for that service to go up.

It should not be charged at all IMHO. And it should be a right of the parents to hold their newborn in the moment they enter this world.

OP was being sarcastic. “Skin-to-skin” contact with mum is the very first thing they do after child birth, and continue recommending for the entire stay.

there's a lot of stories / examples about this an item in the hospital bills .

You might be thinking of one story that went viral a few years ago, and was amplified by the media. It was successful at generating outrage and so became popular, but it was not correct.

It would only be one of many ridiculous charges in the US medical system. I personally think it's pretty outrageous that one has to pay for medical care while giving birth at all.

So the doctors and nurses involved should just deliver babies for free? Does the free care apply only to standard births, and then they get paid if there are complications? Or is anything involving the delivery plus anything arising from it provided for free?

The central bank prints money (partially offset by tax). Some of that money could go to basic medical care like this, as it does in most other countries.

We're currently seeing exactly what happens when the central bank money printer goes into overdrive, which is rising inflation. Maybe we shouldn't be encouraging that.

Taxation funded healthcare seems to work pretty well. It allows you to avoid the situation where individuals pay significantly more due to bad luck with their health. Plus you get to cut out the insurance companies' cut completely.

Some of the countries that implement universal healthcare could actually use some increased inflation. So it doesn't seem like a real concern in practice.

They do actually charge for supervised skin-to-skin contact after a C-section [1].

1. https://www.cbsnews.com/news/doula-explains-why-hospital-cha...

IYHO?! It's patently absurd to expect anything less

Edit: I'm agreeing with you but it seems absurd that it should have to be opinion!

Do you have to pay to hold your newborn in the US? Land of the free indeed

Medical is probably the single most regulated industry in the US. The US landed at the worst possible system where the government mostly only pays for medical for old people (where the returns on expenditures are very low), but simultaneously interferes a lot with hospitals and insurance in ways that make the process very punishing for everyone.

You can get much better service for way less money if you avoid the red tape and do a home birth.

We’ve had 2 home births now. And the 1st birth was nearly a homebirth too.

They’ve all gone well for us, so I recommend them from that point of view, but on the other hand, I don’t recommend them because I’d hate to have any hand in a situation that went wrong for someone else.

Our last we actually delivered on our own because the midwifes didn’t get to us in time.

While home birth is certainly possible and apparently can be a very nice experience, I strongly suggest going into a hospital for birth (you should be able to choose a hospital of your liking after talking to the nurses/doctors/midwifes working there). Birth is safe in most cases, but complications do happen. While the probability is low, the possible damage is extreme. Please consider the availability of experienced medical professionals as a safety net for mother and child! I witnessed an "emergency" C-section after 18hours of labor without any prior indications and was extremely happy that professionals were literally in the next room when this became necessary.

As a counterpoint, home births are in general very safe if recommended prerequisites have been met. Typically: 1) low-risk pregnancy 2) within X minutes of suitable hospital 3) higher level of monitoring in late pregnancy and perhaps two midwives at birth

Birth - a natural process - has been commercially medicalised, especially in Brasil (C-section rate >60%) and the US (>30%). If giving birth at home was normalised, we'd see a huge growth in natural birth and an increased availability for medical staff to support in emergencies if required. But the rates of emergencies would actually decline too.

Point 1 is a big point. Lots of things make a birth not “low risk.”

Otherwise I think it’s an awesome idea and encourage people to consider it.

Birthing centers are also a great alternative. I do not especially like the idea of hospitals as default places of birth, but acknowledge the potential value when needed.

I probably wouldn't have most of my family if I'd gone to a hospital. My twins would have been a C-section, and then the scar would have led to another C-section and to troubles with the placenta invading the scar. Before long the uterus just plain wouldn't work OK, and would endanger the lives of future babies. Avoiding a C-section is really important for having a large family. My 13th is due in 6 weeks.

Congrats on your family!!

Very interesting. A coworker hired a professional doula and their home birth went well. I'm not sure yet what we would do.

> You can get much better service for way less money if you avoid the red tape and do a home birth.

My wife had unexpected complications that would have been disastrous, possibly fatal if we had been at home rather than a hospital for delivery. I can’t imagine trying to rush her from home to the hospital mid-delivery.

I’m forever grateful for the medical care we received at the hospital during delivery. It’s simply not possible to deliver the same care at home.

Yes. For caesarean they do. https://www.cbsnews.com/news/doula-explains-why-hospital-cha...

    “During a caesarean, many people become shaky, nauseous, uncomfortable, even faint,” Grant explained. “These are normal physiological reactions. In order to facilitate skin to skin in the OR, an extra nurse needs to be available to assist.”

I don’t understand how that is a “mic drop” as they put it in the article. If these are normal physiological reactions, why would you charge extra for it? It must be the request to hold your newborn child that they consider not to be normal, then?

Normally the baby is whisked quickly out of the OR to a place that's not a tightly controlled clean environment, where skin to skin contact is facilitated without charge (to the father/non-birthing-close-relative, obviously, since mother is still in recovery). Source: two sons born this way in the US.

Sure

https://www.vox.com/2016/10/4/13160624/medical-bills-birth-d...

"Skin to Skin after C-Sec" $39.95

[C-Sec here means Caesarean section, a relatively safe surgical procedure to delivery a baby via an incision in the mother's abdomen. Although mostly safe, and certainly preferable to situations where vaginal delivery would incur an undue risk to mother or baby, C-Section is undesirable because it increases the rate of complications both that time, and in any subsequent pregnancy. But it's very common in the US, for a variety of reasons.]

facepalm

how long until they try to give everyone the best service according to their budget. one arm holding 30$, two arms 40$, full cuddle 70$

I think the whole rhetoric about C-sections needs to be adjusted for a time where many older women are having babies. There's a kind of narrative about optimal pregnancy/childbirth/early care that seems to make sense for 27-year-olds who will sneeze and squeeze out their baby and shoot milk at the thought of their baby. But that's increasingly not the norm.

More generally: declining birth rates are one of our top-ten societal problems if we think 50-100 years ahead; part of addressing it is changing the conversation around pregnancy in one's late 30s and even early 40s. From watching TV shows it would seem by age 35 your shot is shot.

You pay for a nurse or aide to be ready to intervene if there’s an issue in a post-caesarean situation.

In our case, the hospital my wife delivered in pushed skin to skin heavily, but after a minute or two, I ended up holding our son, skin to skin for the next 10-15 minutes becuase their policy didn’t allow mom to hold the baby while they sutured and did their thing. Once they were done in the OR, back to mom.

Usually this sort of absurdity on the billing front is based on ways to increase Medicaid reimbursements. Since Medicaid patients are usually less likely to have good primary and pre-natal care, they have a high complication rate and typically are a money loser for the hospital. In an extreme case, an opioid addicted baby costs >$1M to deliver and discharge, a tragic story all around.

> You pay for a nurse or aide to be ready to intervene if there’s an issue in a post-caesarean situation.

We had a pediatrician in the room (which is also a perfectly opportunistic for the ob/gyn to score a referral). OR theater was main OB/GYN (which we chose), his assistant (also ob/gyn, younger and oddly published), anesthesiologist, instruments clerk and pediatrician. I don't think we had a nurse at all.

What country were you in? In the US, a nurse is highly standard.

If you're not getting a c-section, the usual array is: OB/GYN, plus or minus a resident or assistant, doing the delivery and doing any post-delivery laceration repairs; and a nurse who brought in instruments and is on hand to assist with repositioning the mother, getting more equipment, etc. In most places it's 1-2 nurses. If everything is expected to be, and remains, stable a pediatrician will swing by at some point to check in. This isn't generally a major source of referrals for the pediatrician - (a) many people have already established a relationship with a pediatrician in anticipation of the birth, and (b) in many reasonably sized hospitals the guy who drops by is either a hospitalist or a neonatologist, and they don't have an outpatient practice. Anesthesiologist may drop by to start an epidural, but otherwise isn't present on a continued basis.

If in the OR for a c-section, you'll have the OB and a resident or an assist; one nurse just looking after scrub and tools; a second nurse on hand for additional assistance and to receive the kid for the initial clean-up; an anesthesiologist handling your anesthesia; plus/minus a med student or two either holding instruments for the OB or speaking with the anesthesiologist. If everything is and remains stable, peds will swing by. If the kid is unstable or things go sideways, peds +/- their resident will be on hand for the delivery - a neonatologist if the hospital has one.

I've seen some variation in different places of course, but that's pretty much par for the course.

(When I was in the latter part of med school I had a brief fling thinking I'd do OB/GYN, so I did sub-I's in a few different hospitals around the country. Thank god that idea passed.)

> Thank god that idea passed

Why's that? Just curious, I always find it fascinating how physicians pick a speciality!

OB is ridiculously stressful, in an antagonistic kind of way.

1. A good subset of patients have wildly unrealistic ideas about pregnancy and delivery, and when their ideas meet reality it's not always reality that wins.

1.B. You will be the target of their ire whenever their desires are not fulfilled, because patients seem to think docs are actually in charge of something at the hospital. We usually are not.

2. It's wildly litigious. Their child was perfect (in their imagination) before being born; then you got involved, and now their child is not perfect. You must have fucked something up in the delivery and ruined the perfection of their child.

3. Way too much family involvement. When you're doing surgery, you're usually dealing with a patient's attempts to understand what's going on. When you're doing OB, you're dealing with the patient, the husband, the mother, mother-in-law, etc. Each person will come up with their own distorted vision of how things should be, and when it doesn't align with reality, the doctor is an idiot who doesn't know what they're doing. (Doctors are not perfect - just people - but it seems like every single person without medical training seems better equipped to identify the proper medical course of action than a physician is.)

4. Lots and lots of on-call time. Lots of unexpected interruptions and lots of drop-everything-and-drive-to-the-hospital.

5. There used to be good money in it. There isn't now, which makes all of the above grate on one's nerves.

The results of the above really add up to demolishing the spirit of OB/GYNs. Points 1-3 really make you feel like you're persistently at war with patients, which is the worst feeling ever. I've never been on anyone's side but the patient's, and having them treat me like an enemy ruins my job, and ruins my ability to do my job.

I ultimately chose to pursue a niche thing that shares a name with an existing medical specialty, but is a distinct niche. I can't really identify it without doxing myself, so forgive me for not.

>We had a pediatrician in the room (which is also a perfectly opportunistic for the ob/gyn to score a referral)

Can you clarify what you are implying here? Kickbacks or other financial incentives are generally pretty illegal.

Sure, but recommendation based on friendship is not, nor does it need to be unethical if you're convinced of your friend's high level of skill.

Got it, thanks for explaining. The phrase “score a referral” made it sound like there was some untoward relationship there.

Wait, you have to pay to have a baby in the US?

The wealthiest country in the world cannot even pay for the birth of its own citizens?

I can understand arguments for private healthcare etc....but making people pay to give birth is insane.

Tell me where it is completely free. And I don't mean paid for via taxes.

No offense, but that's such a weird way of looking at it. Even in the US every reasonable adult would say that driving on public roads is free, right? But roads are maintained from taxes so how dare you call them free!!! It's the same thing here - other countries just pay for their citizens giving birth from taxes. The cost to you as a citizen is zero. No it's not free, someone pays for it. But I never used the word free anywhere, so I feel like you want to have an argument for the argument sake.

> every reasonable adult would say that driving on public roads is free, right?

No? I certainly don't. I'm constantly aware of how much we don't spend on roads.

Any conversation trashing the US for not having healthcare that is free-at-point-of-sale is meaningless without discussing the larger system.

What can I say, I get tired of Europeans trashing the US using singular metrics as if they're a meaningful reflection of policy.

You want to get into a more interesting conversation, let's talk about how the US citizenry is essentially subsidizing the universal healthcare that many other countries enjoy. That's not some political talking point, either, it's legitimate.

>>No? I certainly don't. I'm constantly aware of how much we don't spend on roads.

Let me ask this then - is there anything in the world you would call free, or do you avoid the word out of principle?

>>Any conversation trashing the US for not having healthcare that is free-at-point-of-sale is meaningless without discussing the larger system.

I think you are purposefully trying to drag me into a discussion about a point I didn't make, I merely expressed surprise at the fact that United States of America, the wealthiest nation in the world, cannot even pay for the births of its own citizens. No statement anywhere about healthcare as such. If you want to read into it in my comment, then that's on you.

>>You want to get into a more interesting conversation, let's talk about how the US citizenry is essentially subsidizing the universal healthcare that many other countries enjoy.

Let's have that discussion then, please, I'm curious to hear your thoughts.

The US spends all of it's money that should be going to infrastructure and services on killing people overseas. We use migrant labor to produce crops below minimum wage, so large corporations can send Europe cheap produce.

Why should I pay for other people's kids if I'm never going to have kids? The only people that should have to pay for those services are the people who actually use those services. For things that are unplanned like injuries (or even unplanned pregnancies), payment can be deferred if necessary and wages deducted straight from the paycheck to pay back for those services.

Ideally, roads are that way too. People licensed should be charged a tax for road maintenance based on their odometer readings, or something to that effect. Or just use a Fastrak-type system where it automatically scans a device in your car when you get onto certain roads and charges you for that usage -- but do it in more places.

Everyone else can get a very minimal tax for the upkeep of the administration in case few very people use these services.

> Why should I pay for other people's kids if I'm never going to have kids?

Medical Debt Up => Poverty Up => Crime Up => Incarceration Up => Paying for their imprisonment instead.

You're protected by prisons, so you are a user of the service provided by them and must therefore pay under your model.

> Ideally, roads are that way too.

How would this work for e.g. Montana with seemingly-endless lengths of highway and a very low population density?

…

Let's take things a little further. Do you believe only private schools should exist?

>How would this work for e.g. Montana with seemingly-endless lengths of highway and a very low population density?

Why would they need nice roads then? Seems like a waste of money to build a bunch of expensive roads for the 5,000 people who use them. They can manage with cheap roads and dirt roads that don't need much maintenance. The Chinese rural areas manage just fine with dirt roads, and those areas have way higher population densities.

>You're protected by prisons, so you are a user of the service provided by them and must therefore pay under your model.

Why should I pay for someone's crimes? It's such a stupid system. If they are murderers they should just receive the capital punishment. And if the crime is not murder, they can be put into factories where they are able produce something of value -- farming or whatever. If their business is not profitable it should at least reduce the taxpayer burden. I know this is dreamland ideal world logic, but working closer to this certainly doesn't hurt, with the alternative being they don't do anything at all and are pure leeches. Yes, I know they make license plates but surely they can do a little more than that with such a huge prison population. This also incentivizes training them and providing them skills when they leave prison -- if training them with skills will help the prison make money, why not? The inmate also leaves the prison with job prospects with many years of experience in a trade.

>Do you believe only private schools should exist?

Private schools have higher success rate for their graduates. There are other factors that play into this, obviously. Let me ask you this first - do you think public schools are doing poor kids any good? Especially in the inner cities where many poor black families live? I think any alternative is worth looking into to bring them out of poverty. Or you can just leave them to their devices.

>>Why should I pay for someone's crimes? It's such a stupid system. If they are murderers they should just receive the capital punishment. And if the crime is not murder, they can be put into factories where they are able produce something of value -- farming or whatever. If their business is not profitable it should at least reduce the taxpayer burden.

God, I would hate to live in the system you're describing.

And again, it's all me me me. Society wants to punish people with prison, so society should pay for it. Whether you personally want to is fortunately irrelevant.

As for forcing people to work so they are not a burden on society - that's just slavery with extra steps. But oh wait, I forgot that US still does that. Nevermind then.

>>if training them with skills will help the prison make money, why not?

Because prisons should never ever ever be money making institutions in a functional society. I can't believe I actually have to say this.

>>Let me ask you this first - do you think public schools are doing poor kids any good? Especially in the inner cities where many poor black families live?

Of course they do, what are you on about.

People like this always imagine that they'll be on the "good" side of such a system—

That the private prisons wouldn't lobby to make all speeding illegal in order to increase the labor pool for profit.

That they'll hear about the law change in time.

That they'll never have to drive 5mph above the speed limit because they're running late.

That they'll never be one of the slaves in the cyberpunk dystopia they're longing for.

What's your suggestion for changes to our god awful prison system then? Or might you even be okay with it?

I am in favor of the way the prison system is run in Sweden; more broadly, the so-called "Nordic Model".

>As for forcing people to work so they are not a burden on society - that's just slavery with extra steps. But oh wait, I forgot that US still does that. Nevermind then.

This is just a difference in our morality I guess. I don't think prison should be a great place to live. They should be incentivized to leave prison. And they aren't treated as slaves, they are learning a trade and applying those skills. They should be paid a lower wage, have the option to send money to their families, and fund the prisons themselves to some degree. We already this to a lesser degree. Prisons just aren't doing this enough.

>Because prisons should never ever ever be money making institutions in a functional society. I can't believe I actually have to say this.

I don't understand why prisons should not make money. Why does there be distinctions for things that should or shouldn't make money? For things to function well, they need to be decently funded. Whether that's from you and me or them funding themselves.

>Of course they do, what are you on about.

Okay, then I guess we live in different realities if you think black kids are doing well in inner city public schools.

>>This is just a difference in our morality I guess. I don't think prison should be a great place to live. They should be incentivized to leave prison

No one said prisons should be nice. Just that we have empirical data which prison systems support rehabilitation and reintegration into society and which ones don't. American prisons aren't on the first list. They are disproportionately about revenge and retribution, which leads to low rehabilitation rates.

>>They should be incentivized to leave prison

Let me get this straight - you think current prison system doesn't incentivize leaving prison enough?

>>I don't understand why prisons should not make money. Why does there be distinctions for things that should or shouldn't make money?

Because it creates a whole lot of perverse incentives that simply shouldn't exist around the prison system. Incentives to both keep people longer than necessary in prisons as well as put them in prisons in the first place if they are places to make money. And it's not just a made up fear - there have been judges in the US found to be doing exactly this, taking cash bribes to send people to for-profit prisons. That profit making incentives shouldn't exist. Just like schools shouldn't be making profit, just like hospitals shouldn't be making profits - they are utilities for the society, not profit centres. Or at least in a well adjusted society they shouldn't be. As soon as you introduce profit the incentives shift where they shouldn't.

>>Okay, then I guess we live in different realities if you think black kids are doing well in inner city public schools.

That wasn't your question though. You asked if public schools are doing black kids in inner cities any good. To which my answer is still the same - of course they do. If you'd like to ask your question again I'll answer it again.

>Let me get this straight - you think current prison system doesn't incentivize leaving prison enough?

Yes, it doesn't. Many have nothing to look forward to outside of prison. I hate to use a movie as an example, but take a look at Shawshank Redemption. They should leave having gained something, maybe prisons can help inmates find employment for the skills they gained as they reach the end of their sentence.

>Because it creates a whole lot of perverse incentives that simply shouldn't exist around the prison system.

I view nothing as immune to corruption. It's just a matter of better alternatives. Ideally inmates are allocated more to prisons with high rates of success after serving their sentence, which gives prisons an incentive to get their inmates out and with marketable skills.

>taking cash bribes to send people to for-profit prisons

This is not exclusive to for-profit prisons. Prisons that have higher number of inmates can make an argument for a higher allocation of tax dollars.

>Just like schools shouldn't be making profit, just like hospitals shouldn't be making profits - they are utilities for the society, not profit centres

You've said this more than once, but I still don't see why they shouldn't be. All I hear is "they just shouldn't make money". Why? They're just going to play games to get more tax dollars if they're forced not to make any money themselves. Bad schools are allocated more funds, take the LA Unified School District for example -- some of the worse performing schools in the nation, yet some of the best funded public schools! If I'm pessimistic enough, I would even imagine the teachers and administration are not doing their job on purpose.

>>Why should I pay for other people's kids if I'm never going to have kids?

Hmmmm. I think the issue here is that you're looking at it from an individualism perspective. Why should I be paying for something that I'm not using. You're obviously completely entitled to such an opinion, and I'm not going to change it with one HN comment, but imho that's the wrong way to build a society. Society should be paying to support new births, because those people will eventually grow up to be the workforce of your country, they will be paying taxes, and supporting you in retirement. The individualist approach that I see so often in Americans just seems so short sighted to me - why should I pay for any of this. I don't care about any of those things, if people want workforce/taxes/retirement they should just work for it goddamit!

Like, ok. I just want to point out that societies, including American one, pay for things just because they want to have them, regardless of whether it benefits every individual or not. You pay for roads just so they are there and so that every American can use them, regardless of whether you personally are going to drive every mile of every road ever built. Most Americans want to pay for agencies that make sure you have clean water or air, even though personally you probably aren't going to live in Flint or next to a coal power station. And obviously all Americans pay for the biggest military in the world just to keep a certain level of control and place in the world, even though many people could say well, how does paying for the 20th aircraft carrier benefit ME?

Paying for people to give birth so that they don't end up in medical debt straight away when starting a family has benefits to the society. But you will never see it if you just try to see what's in it for you personally.

You're right that this is a matter of personal philosophy.

I view it as an optimization problem. Given a set number of tax dollars collected, everyone wants a piece of it. I don't trust people to allocate these correctly. The alternative is to give less of these dollars so less corruption and mistakes can occur, which is what I view is better.

As for using the next generation to support the older generation through taxation, this does not seem to work very well in practice. As societies reach higher quality of life, like in the US, Japan, some Euro countries, there tends to be a drop in birth rates. There are other factors in play (career opportunities, culture), as in some of these countries giving birth is highly encouraged (e.g. Japan pays families to give birth). I just view it as risky to expect there to be enough children to support all the old folks. They might even vote those benefits out and you'll be left hanging.

For example, if we're going to mandate something, rather than Social Security a mandatory 401k-style plan seems better. That account is yours, it's your own money, and the government just asks you to deposit 5-10% of every paycheck into that account and you can withdraw a fraction of that account with some interval once you're 50. Maybe it can used to pay for health care before 50.

I can only guess you are against universal healthcare also? In countries that have universal healthcare, that care is substantially cheaper; so you pay much less overall.

I live in the UK, which has quite a generous benefits system. Although such a system is open to abuse, it's much cheaper than imprisoning people that have resorted to crime to get by (they they do in the US).

This narrative is overblown and parroted by the uninformed. We do have Medicaid for low income families, and Medicare for seniors.

The problem is you have to apply for it. Maybe people should be automatically enrolled.

The government doesn't send you a bill if you elect to have a baby at home.

Most US citizens have babies in hospitals.

Many either don't know that alternative options exist or think of them as dangerous / an unnecessary risk.

Could we put aside the politics? Jeez.

Who charges? We just had our second and they didn't charge at all. Gave the nurses/midwives a chance to make more ready.....

And this was at Major CT Hospital.

The hospital may charge for this due to someone needing to stay and monitor you and the baby while you hold them. Ridiculous charge, certainly very rare, but that is typically the justification given

You're joking, but my wife gave birth to our first-born in the US, and she had to wait several hours until she could hold her baby because... the transportation team (whose job was to roll her bed to the elevator) was unavailable due to a change-of-shift.

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