I bet we'd reduce the need for extreme intervention like this if we'd encourage women to deliver in more traditional positions. Prone and sedated is just about the worst possible way to have a kid.
[edit] Part of it is that the patriarchal doctor wants to be "in charge" of the situation and treat childbirth like some kind of medical operation.
(This is not to say that modern medicine saves many children's and mother's lives. A modern, optimal, approach is to have a traditional birth with ready access to a hospital for a c-section, etc if necessary.)
It's the same reason you don't conduct Phase I clinical trials of new chemotherapeutic agents with people who don't already have cancer.
Birth is already risky enough. "Let's science that, to see which has the best outcome," while a completely rational approach not only to decreasing harm, but also to increasing health, just isn't going to fly.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/
"The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician."
No offense, but the data says you're wrong.
You can't compare those numbers, they aren't the same populations of pregnant women.
A comprehensive study in Oregon found death rates 6-8x higher in home births than hospital births: https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeM....
See also this meta-survey of the literature: http://www.ajog.org/article/S0002-9378(10)00671-X/abstract ("Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.").
However, the increased death rate in the Oregon study is
a) localized to that state, and b) attributed to an overabundance of uncertified midwives:
> But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.
In other words, there are a lot of "birth attendants" practicing midwifery in Oregon who aren't necessarily CNMs (certified nurse-midwives) or CMs (certified midwives) -- which is perhaps closer to the barber acting as surgeon analogy.
EDIT: Here's a rebuttal to the Wax study: http://www.midwiferytoday.com/articles/ajog_response.asp
"Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians."
and
"We included all planned home births ... and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives ... We also included a matched [my emphasis] sample of physician-attended planned hospital births (n = 5331)."
Up until I think 10 or so years ago we had one of Europe's best delivery success rates with that.
After that it seems that hospital deliveries became a safer choice and we've had relatively bad percentages since then because we culturally still value home births highly.
There is a line or argument that intervention is a self-reinforcing cycle, in that the initial intervention raises stress levels in the mother, which promotes a fight-or-flight response, which causes the birth process to regress, which increases the likelihood of more intervention, and so on. This isn't to say intervention should be avoided, but only do it if it is necessary, since it does have consequences.
Midwives are not part of the field of obstetrics, any more than sanitation workers are part of the field of engineering.
[1] http://www.baylor.edu/nursing/nursing_grad/index.php?id=5668...
My wife's cousin is going through the program right now and will graduate with the equivalent of an MD. She's doing residency at a large hospital in Seattle and did clinical at another in Boise. When she graduates she'll be working adjunct at either another hospital up here, or through Stanford. I'm no medical expert, but I trust her experience and expertise. I'm not sure where you're information is coming from, but I think you may be misinformed.
I think you're thinking of midwives from a few hundred (or more) years ago, before the fields of medicine and nursing existed as they do today.
Every scientific advancement must be preceded by a time when that advancement was not known or known but not used, no matter the age of the field.
Yes. Perhaps not all medical people personally, but as an institution, the medical field totally did.
[1]http://www.amazon.com/Expecting-Better-Conventional-Pregnanc...
Source: Doulas, certification info at: http://www.icea.org/content/doula-certification
I guarantee you a huge percentage of the women who die every year giving birth are not 'prone and sedated'. They are (if they're lucky) in a rural clinic, with a midwife who may or may not be terribly skilled. If she _is_ skilled, it's because she has decades of experience watching mothers and babies die, and has learned many lessons in very painful ways.
This device seems to provide a means for those midwives to assist in cases where labor simply isn't progressing (and believe it or not, that still happens, despite all the 'traditional positions' in the world).
http://www.midwiferytoday.com/articles/globalissues.asp
"Outcomes in these maternity centers were so good that Dr. Araujo began to study what the traditional midwives did, and ended up incorporating hammocks, more patience, and upright positions for birth into the hospital"
i.e. The traditional methods are occasionally acknowledged but rarely adopted.
This is what happens when over-educated people take first-world problems to the extreme and turn them into third-world problems. Like a highly-educated acquaintance of my brother's who married a sherpa and is now upset that he won't accept her working outside the home.
> The time I've spent in developing countries, it's just anecdotal to me that a midwife is the first call for a pregnant woman rather than an obstetrician.
My father (who works in international development and has long specialized in maternal health) has spent much of his life trying to disabuse women in developing countries (like his native Bangladesh) of this habit.
That's a little bit like the crazy parents who won't vaccinate their kids. We've done such a good job with immunization that they've never seen the consequences of ignoring it, so they pick up woo-woo theories about autism and ignore all medical science.
http://sfari.org/news-and-opinion/news/2013/large-study-link...
http://www.ncbi.nlm.nih.gov/pubmed/15546805 --- abstract -- Autism spectrum disorder (ASD) is a spectrum of behavioral anomalies characterized by impaired social interaction and communication, often accompanied by repetitive and stereotyped behavior. The condition manifests within the first 3 years of life and persists into adulthood. There are numerous hypotheses regarding the etiology and pathology of ASD, including a suggested role for immune dysfunction. However, to date, the evidence for involvement of the immune system in autism has been inconclusive. While immune system abnormalities have been reported in children with autistic disorder, there is little consensus regarding the nature of these differences which include both enhanced autoimmunity and reduced immune function. In this review, we discuss current findings with respect to immune function and the spectrum of autoimmune phenomena described in children with ASD. -- end quote ---
The immune system in new-born babies and young children is immature and under-developed.
There are a lot of people responding to you repeating the claim that we encourage women to deliver prone, and one who says they normally do it lying on their backs. Personally, culture has given me a strong impression that supine is normal and prone would be bizarre. Where's this "prone" idea coming from?