Stories like this also appeal to my inner technocrat, who thinks that we could be doing so much better if only we implemented a few Special Fixes.
Those stupid white trash peckerwoods [grumbled curses].
Honestly, the whole concept of how babies happen seems absurdly dangerous.
It seems like you'd just expect to die if you thought about it.
What made Alien so uniquely effective.
The difference is pretty trivial so far as egress is concerned.
The 'overmedicalized' arguments are often aesthetic. This article is a much more effective, and basic, argument, which is that in the United States medical institutions struggle with systemization. It's probably not a coincidence that, lacking a single payer system, they also lack the supervisory punch that goes along with that.
That or rising income inequality and grinding poverty.
There's an analogy here. Sigourney Weaver is evidence-based medicine. Paul Reiser is the Republican Congress. Bill Paxton is the Democrats.
I'm pretty anti-woo, so I don't think I'd sign onto maternity being overmedicalized as much as imperfectly medicalized, weirdly moralized (ask yourself -- why on earth should it be anyone's business how a baby exited a woman's body, let alone seen as an accomplishment to be bragged about on Facebook during the birth announcement?). and terribly unequal. Reducing maternal mortality will require more access to medical care, not less.
In any case, the last thing I want is some legislature deciding that we're spending too much on what is after all a wonderful blessed natural experience and/or God's punishment, so epidurals shouldn't be covered by insurance, or that the best way to reduce your risk of C-section is to have your first between 20-24, so we should nudge women to have kids earlier by restricting C-section access.
why on earth should it be anyone's business how a baby exited a woman's body, let alone seen as an accomplishment to be bragged about on Facebook during the birth announcement?
The ones with the gifs are the worst.
the last thing I want is some legislature deciding that we're spending too much on what is after all a wonderful blessed natural experience and/or God's punishment, so epidurals shouldn't be covered by insurance...
Which makes me very reluctant to pursue the over-medicalized critique, given today's climate of radical cutbacks and politicized resentment ('why should we have to pay for their health care?').
But isn't there some fairly convincing evidence that maternal outcomes are worse in the US even for those women who have good insurance and access to the best available American care? Worse than, e.g., outcomes in Canada, the UK, the Netherlands, etc? Is this about the level of medicalization (induction rates, C-section rates, and so on), or about the organization of systems of medical care?
In any case, I'm certainly not going to argue for less medical care, especially when too many women lack access to basic services.
While each of the circumstances was different, I certainly noticed a lack of systematicity in the births I was present for (all in different types of hospitals in different US regions). Even within individual l&d teams, there was often conflicting advice, and a fair amount if it seemed to contradict what I had read to be current best practices. I can only imagine how much more that would have stressed me out if I had been the one giving birth.
As for the linked article, I'm curious how well the featured narrative represents the dismal US maternal mortality rates.
One fairly formative memory was knowing a woman who died in childbirth when I was about 5. She was homeless and a former drug addict and had a damaged heart. The stress of pregnancy was too much, and both she and the baby died in labor. She was on bed rest in the hospital for several weeks before labor, but that wasn't enough. As a kid I assumed hospitals could fix anything, so it was a bit of a shock to me that they couldn't.
It's also sort of criminal how early we discharge women. In both Australia and China women spend about a week in the hospital after they've given birth, and my guess that is standard procedure elsewhere. In China, public heath nurses come a week after discharge to make sure the mother and baby are doing well, and postnatal care is free. Of course, this is a country working to aggressively lower maternal and infant mortality, not raise it (as we apparently are).
So, I looked at figures, and it appears China's maternal mortality rate is now lower than ours. Theirs seems to be 19.9/100,000 live births in 2017 to our 26.4.
http://usa.chinadaily.com.cn/epaper/2017-01/23/content_28035692.htm
It's normally within 36 hours in the UK, and often the same day. It's a week in Japan, but that's mainly because most maternity hospitals are private clinics that profit from keeping people in as long as possible. I pleaded for an early discharge after Tatsu was born because the clinic was so very medicalized and commercialized. There was a formula advertisement on every cot, and a rep from the formula company came in every few days to give a "seminar" to new mothers on how to use their products. They did let me have the baby in my room, but only because I fought like hell - all the others were kept in a nursery and mothers were only allowed to see them at scheduled feeding times.
that's mainly because most maternity hospitals are private clinics that profit from keeping people in as long as possible
Actually that's unfair - in Japan new mothers used to be expected to rest completely for the first month postpartum (traditionally they returned to their family home before the birth so their own mothers could look after them), and the long hospital stay is related to that as well.
17: Where did you get that figure for the US? According to the WHO, the US rate has risen from 10 to 12 deaths per 100,000 live births between 1990 and 2015, and China's has dropped from 97 to 27. (The UK is almost static at 10 -> 9, Japan has gone from 14 -> 5).
Pete Townsend paying attention to kids again?
The linked article didn't seem to me to have much to do with the over or under-medicalization of childbirth -- in the central incident, the woman who died was in a hospital, getting lab tests, being seen by doctors and nurses. Her birth was as medicalized as they get, no one was avoiding medical intervention for principled reasons. She wasn't getting too little modern medical care exactly, she was getting incompetent medical care. So I can't do much with that other than say that either it's the kind of fluke that happens sometimes in any system, or it's an indictment of how bad American hospitals are generally.
I would believe (again separate from that central incident) that American practices do much too little monitoring of maternal health after a birth, but that's again pretty distinct from the medicalization of birth generally.
17: Tim's sister in law in Canada used a midwife and her discharge was fast, but the midwife visited her at home. The second kid was born at home, because he came so fast (and they lived 10 min from the hospital!). The paramedics took her to the hospital at about 2 in the morning, and they had discharged her by 6 am.
One reason they want healthy women out of the hospital is the cost of keeping them there, but they also worry about infections.
According to the WHO, the US rate has risen from 10 to 12 deaths per 100,000 live births between 1990 and 2015, and China's has dropped from 97 to 27. (The UK is almost static at 10 -> 9, Japan has gone from 14 -> 5).
Texas has stayed over 30 since 2011:
The rate of maternal mortality in Texas spiked from 18.6 deaths per 100,000 live births in 2010 to more than 30 per 100,000 in 2011 and remained over 30 per 100,000 through 2014, according to a recent study in the medical journal Obstetrics and Gynecology. That's significantly higher than Italy (2.1 deaths per 100,000 live births), Japan (3.3) and France (5.5), and more in line with Mexico (38.9) or Turkey and Chile (15.2), according to World Health Organization statistics.
Also from that link:
Across the USA, the rate of maternal deaths also jumped from 18.8 per 100,000 live births in 2000 to 23.8 in 2014 - a 27% jump, the study showed.
Anyway, it sounds like in the US, red states probably exceed China and blue states probably are safer than China.
25: WTF!? Incoherent rage over here. This is fucking disgusting and awful and somebody needs to have their head on a pike over this.
Did you see the link at the tail end of the OP? Republican pro-life extremists this week killed the two bills that had broad bipartisan support to start addressing the problem.
The main recommendation in the linked article, as I understood it, was indeed standardization of practices.
As someone expecting baby #2 in a few months, this was rather unsettling to read. I trust my doctor but...it's still scary to think about.
On the other hand, the I read (i don't remember if it was in that article or in something i googled afterwards) that in many countries we've so effectively lowered maternal mortality that women's partners were more likely to die during her pregnancy than she was.
From the same link:
Part of the problem is that pregnancy health care traditionally focused on the health and survival of the baby and not the long-term health of the mother, said Elliott Main, medical director of the California Maternal Quality Care Collaborative and professor at Stanford University School of Medicine.
Medicaid, for example, kicks in automatically for pregnant women in most states, but runs out six weeks after they give birth, leaving low-income women at risk from lingering ailments, he said. The Texas task force report found that most of the state's maternal deaths occurred after 42 days from birth.
That last sentence is crazy. It sounds like it's not preeclampsia, then? What happens a month after delivery?
21
The 26.4 number is from the NPR article:
http://www.npr.org/2017/05/12/527806002/focus-on-infants-during-childbirth-leaves-u-s-moms-in-danger
Their chart shows it continued upwards since 2015. China's has also been rapidly falling, so even 2015 statistics are somewhat out of date.
27
In China too though, deaths are not equally distributed, with Western and rural China having much higher numbers than Eastern and urban China. I wouldn't be surprised if the numbers for educated urbanites are similar to those in developed countries (I'm trying to find recent data, so far the WHO gives 2010 figures of: 45/100,000 in Western China, 29 in Central China, and 18 in Eastern China.) Women of China Federation (the official women's organization of the CCP) gives a figure of 7.9 for Beijing urban residents in 2007, and "three to five times higher" for rural migrants in Beijing (who at that point wouldn't have had any legitimate access to health resources).
Sources are:
http://www.womenofchina.cn/womenofchina/html1/survey/7/7840-1.htm
http://www.wpro.who.int/china/mediacentre/factsheets/mch/en/
In hindsight, 27 is pretty hilariously US-centric. The United States has shades of gray, compared to the perfectly uniform China!
33: Hard to say, but that timeline would make sense for infection (especially something like MRSA). Here's the CDC list of maternal mortality. I think the message is that even after birth, a woman's body is still pretty vulnerable. I'm a bit surprised how many deaths were cardiovascular. Maybe some women who are on bed rest before should be on bed rest after giving birth.
This is pretty shameful, from the link in 37:
2011-2013 figures:
12.1 deaths per 100,000 live births for white women.
40.4 deaths per 100,000 live births for black women.
16.4 deaths per 100,000 live births for women of other races.
These figures are also lower than present numbers. I wonder if it's a roughly even rise or (my guess) deaths for nonwhite women have risen disproportionately. Also, IIRC Asian women have the lowest maternal mortality rate in the US, so it seems like they should disaggregate "other races."
I had a friend who had a baby in China. She went to some special private hospital though.
39
Did she say what the experience was like? Was she in Beijing?
What happens a month after delivery?
I don't remember. Too much not sleeping.
While the cause of Texas' spike in maternal mortality rates is unclear, what is beyond dispute is that one community is disproportionately affected.
The task force report found that Black women "bear the greatest risk for maternal death." During the two-year period examined by the task force, 11.4 percent of births in Texas were by Black women, while Black women accounted for 28.8 percent of maternal deaths.
Everyone cites this same fact, forcing me to do MATH if I want to convert it to n/100,000. I am coming up with n=75, which is INSANE but also possibly an arithmetic error.
She was in Beijing, and she said it was like a Western hospital. I can find out more, if you thinking of doing it.
37: MRSA makes sense. I wonder if there's been a spike in general post-operative deaths over the last five years. Also Texas has really huge problems with the poverty-obesity-hypertension situation.
Six weeks after is when they let you have sex again- come on, guys, take it easy.
44
Yeah, it seems like maternal mortality is a symptom of our generally shitty and dysfunctional healthcare, and won't be solved until we tackle health more generally. America has a high MMR because maybe in part because births aren't always well managed, but also probably mostly because we have a less healthy population in general.
46: But this death didn't seem to be a problem of shitty health. More like the issues that Atul Gawande addresses in the CHecklist Manifesto. There was poor communication (nobody communicated her out-of-control vital signs), and the nurses weren't empowered to act when the ob/gyn didn't think it was important.
And there was no good way for the husband to bring in other people/ get a 2nd opinion quickly once his wife's diagnosis was pretty clear.
It's not clear how representative it is of the problem as a whole, but it definitely seems like a big part of the featured case was the amount of deference doctors get.
The more holistically tricky thing, besides the well known phenomenon of how assholish doctors, Republicans, and various medical industry profiteers can be, is that even without malice involved, every new system failing discovered, like say pre-eclampsia, tends these days to necessitate system redesigns, additions to checklists, yet another thing to key through on EHR, maybe a new procedure to emplace - it really loads down front line workers, and can spur revolt if not very well socialized and implemented, with solicitude toward staff time. I think we all realize single payer is a critical tool to make this work easier - part of why the better outcomes in other developed countries - but I suspect strong health worker unions are also an undercited need.
but it definitely seems like a big part of the featured case was the amount of deference doctors get.
At my university there is a big push for interprofessional education, where the medicine, nursing, pharmacy, and social work students work on joint projects throughout the curriculum. Implementation is still underway and very spotty, but I wonder if this sort of approach* will cut down on excessive deference to doctors years down the road.
*I've heard that other universities are doing it too, or at least getting interested in the idea.
Apparently Fusion did a documentary on this earlier this year, Death by Delivery:
In New York City, African American women are more likely to die from a complication during pregnancy or birth than the U.S. national average. Between 2006 to 2010, they were 12 times more likely than white women to die.
"We have a very segregated city, and that didn't happen overnight. That's the result of years and years of policies to exclude and oppress women of color in general," Kaplan told Univision Noticias.
"We have to take into account the issues that most affect them: the homes, the food, the security of their streets, the violence they are exposed to and that can impact their health and increase the probability of chronic diseases and stress, which keep them from having a healthy pregnancy," she added.
A study by the New York City Health Department found that even black women with higher levels of education, such as university studies, showed a worse health picture than white women who had not graduated from high school.
(Also, unrelated, but: Thanks for your comments in the S-town thread, Buttercup. I never got back to it but appreciated your insight.)
Also, interesting (grim) data from the CDC:
The higher pregnancy-related mortality ratios during 2009-2011 are due to an increase in infection and sepsis deaths. Many of these deaths occurred during the 2009-2010 influenza A (H1N1)pdm09 pandemic which occurred in the United States between April 2009 and June 2010. Influenza deaths accounted for 12 percent of all pregnancy-related deaths during that 15-month period.4
I definitely would not have predicted that. I thought flu was really only an issue for elderly people or those with really compromised immune systems.
You get stronger strains of most diseases if you pick them up in the hospital. That's why you really should give birth in a pool surrounded by dolphins.
Just make sure they use clean water and get the dolphins straight from the autoclave.
53: Pregnant women are considered to have compromised immune systems. Hence the food restrictions to avoid food-borne disease.
I thought they were supposed to avoid raw fish to keep the dolphins from getting jealous.
Also, Happy Mother's Day where applicable.
Anyway, cards and flowers are much easier than reforming the healthcare system or reducing extremes of economic inequality. Even cards that play music.
52
(Aw thanks! I'm glad they were useful. If you ever do decide to listen to S-town I'd be interested to hear what you think.)
56: Oh, interesting. I guess I was thinking of people with MS, HIV, organ transplant recipients, and that kind of thing -- people whose immune systems are being actively suppressed by their disease and/or medications.
Celibacy/lesbianism/buttsec/human extinction or a small increase in the marginal tax rate at the higher brackets?
I have to say my own experience on medicaid was that it was definitely better than nothing, but there was a distinct disparity in treatment when I went to my medicaid doctor vs. the university health clinic. I felt less listened to, less trusted, and like the focus was on solving any immediate symptom as quickly as possible with little interest in solving the underlying issue, and I am a highly educated white woman who is comfortable advocating for myself with authority figures.* I can see how, with something a complex and possibly dangerous as birth, if the providers are hurried and overworked and interested mainly in making the symptoms go away and who do not trust the patient that the outcome could be very bad. Something like this happened to the woman in the article, who was herself a medical professional with a doctor husband and presumably good insurance. This woman seems very unlucky and like she had a pretty crappy doctor, but my guess is, say, a poor black woman with a history of substance abuse claiming to be in severe pain is far more likely to be ignored than a middle class white woman.
*E.g. I had persistent abdominal pain, and was prescribed prescription strength naproxen without an exam. I pressed for a physical exam and was told it wasn't necessary. I chipped a tooth, and the tooth was repaired without any x-rays.When I went to a private dentist 6 months later because the repair had fallen out twice, they refused to repair it without doing a workup, and discovered the tooth had died and I had an infected abscess. It sort of horrifies me to think had the repair stuck, I might not have known about the infection for at least another 6 months-year.
One reason they want healthy women out of the hospital is the cost of keeping them there, but they also worry about infections.
The risk of infection is real. When my son, at 8 months old, had surgery to correct a double ureter, the surgery (which was all state-of-the-art and laparoscopic) went off without a hitch, and we had him home within 2 or 3 days of the operation. And then, within hours of his homecoming, he got very, very sick (I mean, scary-sick, and he might have died), and ended up back in hospital in an isolation unit for another two weeks. Turns out he had picked up a nasty infection while in hospital for surgery.
Barring complications from childbirth, most new mothers and new infants don't need longer hospital stays (because, really, hospitals are germ factories, and some of those infections are quite scary), but they do need a strong support system. In-home visits by registered nurses, for example, to check in, and to check up on things, and to make sure there aren't any medical issues that need to be addressed. This is one area where, I suspect, the American system tends to break down into a catch-as-catch-can lack of a health care system.
61: Yeah, I didn't realize until I worked in a lab with infectious diseases and had a pregnant coworker. I just figured restrictions around food were to minimize risk, not because pregnant women actually had immune systems that work differently. (Disclaimer: immune response varies by stage of pregnancy and mictoorganism/pathogen, so outcomes vary wildly, but in general, you could think of risk of infection and the response to infection being different.)
63: Buttercup, I think that this varies by location. In MA, and at the hospital where I work, I don't see this. If anything, Medicaid is sometimes better, e.g. It covers things for special needs kids.
It's true that a lot of private practice doctors don't take Medicaid, but where I am, there are vanishingly few private practice doctors. They are mostly concierge, I. You pay between 5 and 15k a year for 24-hour access and the cell phone number of your doctor. Middle class and even upper middle class people can't afford that.
At my hospital, the Medicaid patients are seen disproportionately at our health centers, but, honestly, there is better social work support at the health centers. I have definitely seen crummy health centers though. My expensive hospital system only takes exchange plans from one insurer that we own, but we definitely take straight Medicaid.
Now, I think the experience of care for non-rich people has gone down -at least in primary care. Shortened appointments and long wait times for new patients. But that's not Medicaid. That's poorer reimbursement for primary care and a shortage of primary care docs.
63: Buttercup, I think that this varies by location. In MA, and at the hospital where I work, I don't see this. If anything, Medicaid is sometimes better, e.g. It covers things for special needs kids.
It's true that a lot of private practice doctors don't take Medicaid, but where I am, there are vanishingly few private practice doctors. They are mostly concierge, I. You pay between 5 and 15k a year for 24-hour access and the cell phone number of your doctor. Middle class and even upper middle class people can't afford that.
At my hospital, the Medicaid patients are seen disproportionately at our health centers, but, honestly, there is better social work support at the health centers. I have definitely seen crummy health centers though. My expensive hospital system only takes exchange plans from one insurer that we own, but we definitely take straight Medicaid.
Now, I think the experience of care for non-rich people has gone down -at least in primary care. Shortened appointments and long wait times for new patients. But that's not Medicaid. That's poorer reimbursement for primary care and a shortage of primary care docs.
Gah, I should stay out of this (especially since I have 2 deadlines before 3 pm today), but: "overmedicalized" may have become a fraught term (indicating the moral judginess and performative parenting Cala complains about in 13), but it's nonetheless true that midwives have better medical outcomes than hospitals, and that applies to women of all backgrounds and income levels. IOW, birth centers are the only places in American where poor black women get the same outcomes as wealthy white women. There's some self-selection going on, of course, but reread that last sentence and think about how few places in American life can make claims remotely like that.
Yeah. I may be kidding myself, but I think of my concerns about unnecessary caesarean sections as being concern for the concrete medical well-being of the women involved -- abdominal surgery is a big dangerous deal that should, all things being equal, be avoided where possible. And comparative statistics suggest that there are a lot of avoidable caesareans being done in the US.
Medical statistics aside, I can see the desirability of being drugged into oblivion during the whole process.
If you were John hurt, would you have wanted to wake up?
68 The birth center my daughter was using ended up sending her to the hospital, in decidedly non-emergent circumstances, which ended up doing a C section about 16 hours later.
The data may have some inherent selection biases, is all I'm saying.
When I've seen comparative stats for birthing centers, they've compared people who began labor at a birthing center to ones who didn't, rather than comparing on the place of delivery. Because you're right, that'd make the comparison meaningless.
I think you'd need to do an "intent to birth" analysis, because otherwise you'd exclude from the birthing center cohort all women who had some kind of medical emergency prior to showing up at the center.
You'd still have a huge amount of self-selection bias regardless. To really do it right, you've have to randomly assign plus blind the women and the birthing center/hospital staff.
Yeah, maybe people who got prenatal care through a birthing center-affiliated practitioner and planned to deliver there? That may be what what I've seen -- I'm sure it's not 'place of actual delivery', but I don't know what it is.
Nosy question -- is there a story about the non-emergent transfer? That is, did the midwife think it was an emergency and then it turned out not to be, or what?
Mr. Hick, have you ever considered a career in exobiology?
blind the women and the birthing center/hospital staff.
I'm not sure your IRB would approve that.
To avoid the whole Paul Rieser-evil thing, what you'd probably need to do (and what somebody may have already done) is take a group of women, screen them for willingness/eligibility to use a birthing center and then randomly assign them to either birthing center or a hospital.
Assuming we're still trying to avoid evil.
On reflection, you may not have what we're looking for in candidates right now.
Anyway, I though that the accepted way to prevent Paul Rieser from being evil was to marry him off the Helen Hunt.
86: I thought the secret was correcting the spelling of his name.
'i' before 'e', except after 'c'.
It's an iron-clad rule to me.
91 would have been funnier if it had been by Opinionated Helen Hunt.
Thanks for the advice, guys. It's bringing back such beautiful memories of my time working on a sitcom.
68: It is very hard to figure out what causes the good outcomes. If the birth center is run well, they're risking out anyone who who doesn't meet a strict set of criteria, and transferring on a strict protocol, too, which of course means they have better outcomes -- they're selecting for most likely-to-be uncomplicated births. And the hospital then correspondingly gets the harder cases.
Almost like some other parts of the US healthcare system.
I'm so sad you and Dennis Quaid couldn't make it work.
5 Which is what should be happening. The problem with overmedicalizing isn't that we have medical options,* it's that they shouldn't be used when they aren't needed.
* Pace fans of woo.
94. Writing with a long-standing appreciation of your work: is there any chance that you would be free for a drink?
95: Again, while Moby's right that you can't do a properly double-blind study, the better medical outcome statistics I've seen are matched for objective criteria. Women with criteria that keep them out of birthing centers are dropped from the comparison, so the better outcomes are as among only women who would objectively qualify as low risk.
As Charley said, the presence of hospitals is good and necessary for people who need them (high risk pregnancies, emergencies that take place during births, and so on). But if you are one of the people lucky enough to not actually need them, you're probably slightly better off staying out of them.
What if, instead of blinding everybody, we just dressed the dolphins in scrubs?
Or stood the doctors in a tank of sea water.
The average U.S. doctor has a single hull and displaces .085 tons.
The average dolphin has completed zero years of medical education and been the subject of the sexual fantasies of at least two Californians.
||
So my daughter has to write a school report, and she wants to write it about George Washington. You can guess which song I want her to use as her primary reference.
|>
106: I grew to hate "Hamilton" songs. Then I learned to regret that because of "Moana" songs.
I like both Hamilton and Moana songs. Objectively I am the alpha parent, sent to judge all other parents as unworthy.
But if you are one of the people lucky enough to not actually need them, you're probably slightly better off staying out of them.
I was lucky enough to give birth at a birthing center that was attached to a hospital (St. Vincent's in Manhattan, which sadly closed for good in 2010). For me, this really was the best of both worlds: I wanted a minimal- to no-intervention birth (I refuse to say a "natural birth," I find that phrase a bit icky and obnoxious) unless medically necessary, but I also wanted the reassurance that medical interventions were readily available if needed.
And it's true, as Cala argues in 95, that the birthing center screened out problems and complications, and transferred patients to hospital care well before labour and delivery. While the philosophy of the center was fairly woo, its protocols were actually quite strict, and I was subject to a lot of testing and screening throughout pregnancy (which, again, gave me a sense of reassurance).
But what about transnational studies and comparisons? It's been years since I looked into any of this, but I have a notion (perhaps wrong or misguided) that those countries with the best maternal outcomes really do have lower rates of "medicalized" interventions (lower C-section rates, lower rates of induced labour, and so on). But also that those countries tend to have more generous and comprehensive systems of care (not only medical care) in general.
But again, given the American context of insufficient care (and not only medical care) for large numbers of men, women, and children, I'm not willing to argue for fewer hospitals, or for reduced access to medical care.
I've a friend on the faculty of a prestigious mother-infant teaching hospital, her specialty relates to post-partum maternal health. She is constantly up against indifference-to-hostility in trying to secure resources.
107 is horrifying, but appears in fairness to be blinding incompetence rather than treason.
Right. He's incompetent. The party that put/keeps him there is treasonous.
The FBI paid Robert Hanssen tens of thousands a year to spill secrets to the Russians. Trump got the taxpayers a better deal.
Does this mean we don't need a treason thread, at least until morning? I'm in bed already when it occurred to me to post one. Discuss here! Until morning.
heebie's maternal concern for the blog is touching. Hopefully it won't kill her.
Discussing treason in a maternal mortality thread is a new form of steganography.
No OT comments until you eat your greens!
As if there's any contradiction.
"Yes, I'm planning to travel to at least one non-extradition country. What of it?"
If the Cheeto Benito hadn't opened his stupid mouth the big story of the day would be that the has US lost control of a cyber weapon which is now being deployed against our allies. It's a clusterfuck of epic proportions that needs to end careers, but instead we're distracted by straight-up treason. He's really the gift that keeps on giving.
Sort of on-topic because the NHS is being hit.
Birth center outcomes from births that get transferred to hospitals are superior to outcomes of women who are in hospital care for 9 months.
That is, when things go sideways and the birth center requires medical intervention, that slice of population has better outcomes than the average of all women who use hospitals, including the fully healthy ones who reject "woo".
I heard of breech birth, but I had no idea things could go sideways.
That's because they self-select and only send over the emergency patients who they think will produce great statistics.
...that slice of population has better outcomes than the average of all women who use hospitals, including the fully healthy ones who reject "woo".
I'm pretty sure birth centers are just fine, but including all populations in the group over which you average isn't the same thing as making an apples to apples comparison.
Until birthing centers have well-designed research plans, we'll never know if they do better than hospitals because of more attentiveness to women or because of the lack of iatrogenic infections or because of vaginal steaming.