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Comment by reacharavindh | Hacker News Reader

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.

View on HN

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.

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.

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!

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...

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.

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).

> 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.

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.

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.

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.

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.

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.

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.

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.

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 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).

> 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!

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).

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.

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.

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 :-)

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

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

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.

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