After watching The Business of Being Born, Gawande's article was really helpful in understanding why things are done the way they are.
* Not the person you replied to, just my two cents.
reasonable people can understand
— law - medicine - accounting - investing
if we leave all judgment to experts we won’t be able to do anything or even judge experts
always remember the doctor who barely graduated is still called a doctor…
After all, in my country we have a doctor telling people that their illnesses were caused by demon sperm and being on record saying that medical treatments come from alien DNA yet they're still allowed to keep their medical license and practice thanks to the Texas Medical Board.
It's possible that our public_defender is entirely wrong, but isn't better to attack the false claim than to attack a person or dismiss their opinions on the basis of their job title? Don't you suspect that you yourself have some useful information on things outside of your job description?
Scheduled c-sections outperform emergency c-sections in every metric tracked. Scheduled c-sections are no worse for the baby than natural delivery, and if you take into account recovery time from surgery, no worse for the mother.
You can have an opinion on whatever you like, but to be blunt, if it's as stupid as this one you should get called out for it.
Of course, the process of going through labor pains for many hours might make things even between the two...
It's not. Labor pain is more time limited and the mother is kind of "out of it", and doesn't usually remember it clearly - plus there's a prize at the end :)
C-section pain is worse, and it lasts several weeks exactly at a time when the mother needs to do stuff. It's worse in every way.
My wife remembers every instant of all of her births.
If you are scheduling a c-section it means you are not trying for a natural birth and that means your outcome for the mother is strictly worse.
There is no good reason to have a medical doctor attend every birth. Of course in a country with a 30% c-section rate, there is much more for doctors to do. I don't think that any credible source will defend 30% as an optimal rate of surgical intervention in birth, but feel free to rebut me.
C-sections are only "no worse" for the mother and baby if you only consider mortality. Let's also consider:
1) Mother-child bonding time in the first two hours after birth.
2) Inoculation of the baby to mother's flora in the birth canal.
3) Mother's ability to care for the baby while recovering from surgery.
4) Postpartum mental health of mother who has been denied natural birth.
I said wait until medical intervention becomes necessary, not force active labor on everyone. As others have pointed out, we can detect the need for medical intervention at an early stage sometimes. That's great, people should have the medical care they need. They should not have surgery forced on them.
Anyway, I really don't think the issue with the majority of scheduled c-sections is surgery being forced on patients. It's patients and their doctors discussing the risks of an attempted natural birth vs a scheduled c-section and opting for a scheduled c-section. In some many cases the patients involved have no increased risk for a natural birth but may still opt for a c-section. And yes, on the flip side, no one should be forced into an attempted natural birth.
The comparison is natural birth to c-sections. Comparing scheduled c-sections to emergency c-sections is a ridiculous thing to track, go compare GP visits vs admission to emergency while you're at it.
1. Unassisted (with and without medication)
2. Assisted (vacuums, etc.)
3. Scheduled c-section
4. Emergency c-section
The problem with #4 is that it often happens after attempting 1 and/or 2 unsuccessfully. The baby is in a much worse position, sometimes medically and often physically within the mother's body. You can't compare 1 and 4 without also comparing 1 and 3, 3 and 4, etc. Everything is interrelated.
Comparing outcomes of natural births as a whole vs scheduled c-sections is far more useful comparison.
As a legacy of upright locomotion balanced with large cranium size and infant helplessness, humans have ended up with an objectively poor design for giving birth to offspring. Death during that process is “natural”.
C-sections are scheduled in advance (sometimes over a month in advance) because the American medical system has optimized for cost reduction (which includes extreme risk aversion) rather than patient outcomes.
Additionally, there are many factors that can be used to determine the risk of natural birth.
However, there was a significant difference in the reasons things went wrong. Because in a hospital you're more likely to receive unnecessary treatment due to the "cascade of intervention"; and interventions such as C-sections have inherent risk. While at home, you're more likely to have an actual emergency.
Mostly the advice we got was, if you have a medical condition that increases risk, then go to a hospital or a birthing centre. But if not, and you live reasonably close to a hospital, home birth is quite safe.
I am speaking from personal experience with births in one of the biggest US cities in the last five years. Anecdotally, I think that some less-dense areas have better CNMW practices and more access to midwives due to traditionally less access to hospitals, but it seems very variable.
Not everyone giving birth is a fit 25 year old with absolutely no other health issues and a desire to have several more kids.
Tsk tsk all you like about women “waiting too long” - the majority of first-time mothers over 40 have c-sections. Would my child and I have survived a natural birth? Most likely. Would I definitely not have further damaged my diaphragm, debilitating me far more than the planned c-section did (hardly at all) at a point when we could least tolerate it? My gyno, my gastroenterologist, and I decided the c-section was a much better bet for both me and my child.
The example that sticks in my mind is from one of the Ina May Gaskin books where the doctor tells a woman that she has a "big baby, but only an adequate pelvis." I can't imagine the amount of damage this kind of doctoring is still doing to people, but it's surely significant.
In retrospect, this guy is practically the prototype of villain in healthcare. He's Eric Lander levels of villainy.
He shouldn't be considered a credible voice just out of corruption. There are many doctors who can write.
Consider his role at Partners (now "Mass General Brigham"): overseeing the growth of a notoriously money grubbing institution, run anticompetitively, despite the excellence of its providers. He has parlayed... saucy New Yorker writing into becoming the very hospital administrator who is responsible for all the fuckups he shits on.
Trust me, if he has something to say about, I don't know, fucking childbirth, it has been known to everyone for years. The difference is his presence in The Magazine New Yorkers Care About lets him omit anything shitty to say about himself and his Partners.
With all due respect your post sounds a little like a conspiracy theory without a set of good sources.
Is the claim that someone is evil even an intellectual position (versus, a religious one)? And finally but not facetiously, does being evil invalidates a technical statement they're making -- sounds like an ad hom?
what has he done that’s bad?