tag:blogger.com,1999:blog-6193043695356712843.post1973436225786939598..comments2023-09-02T23:55:45.583+10:00Comments on Doctor Skeptic: Keeping childbirth normalDr Skeptichttp://www.blogger.com/profile/09376469049519802493noreply@blogger.comBlogger15125tag:blogger.com,1999:blog-6193043695356712843.post-8030197768663366842013-09-18T16:35:24.354+10:002013-09-18T16:35:24.354+10:00Advertising-only comments are removed.Advertising-only comments are removed.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-89585091384823667012013-09-18T15:48:14.819+10:002013-09-18T15:48:14.819+10:00This comment has been removed by a blog administrator.Philippine Prudentialhttp://lifestyle.inquirer.net/123355/supporting-your-health-as-you-agenoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-15217206957155558252013-04-09T13:59:23.351+10:002013-04-09T13:59:23.351+10:00Thanks Eugene, a very good question. Allow me to g...Thanks Eugene, a very good question. Allow me to generalise, because I am asked that question (the gist of it, anyway) a lot, whether it be about arthroscopies, fracture fixation, spine fusion etc. The gist of it is: if it works, why do less? Without having a long discussion about what we mean by "works", I guess it comes down the the core of my message, that benefits are overestimated and harms are underestimated. If x% of C-sections are necessary and (x+y)% are being done, then y% are being done unnecessarily, costing money and exposing people to risk.<br /><br />It also comes down to practice variation. If the rate is 10% in one country and 50% in another then, barring any unusual differences in the population, someone is wrong (10% is too low or 50% is too high). The only other alternative is that they are both wrong.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-10333656549050416652013-04-01T16:35:20.631+11:002013-04-01T16:35:20.631+11:00Thanks Carolyn,
I agree with your opinion on wome...Thanks Carolyn,<br /><br />I agree with your opinion on women 'choosing' surgical birth. It is similar to other surgical procedures and medical interventions: patients may be free to choose, but their choice is heavily influenced by what they are told by their doctor and the current opinion in society. These are often biased towards the intervention because, as usual, the benefits are overstated and the harms understated.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-10798791794893954962013-04-01T12:21:24.232+11:002013-04-01T12:21:24.232+11:00Thanks for your post on this important topic. I wo...Thanks for your post on this important topic. I would like to challenge the assertion that older women are 'choosing' surgical birth. I suggest it is more appropriate to say that older woman have been socialised and programmed to think that surgical birth is safer. Younger women are also having their views on birth constructed negatively with predicable results. As to breastfeeding issues, it is very true that breastfeeding is affected by multiple variables, but you only have to work as a midwife in a postnatal ward to see the immense difficulties that women struggle with post caesarean in that crucial first few hours after birth to understand the trajectory of diminishing breastfeeding rates. Thinkbirthhttps://www.blogger.com/profile/09813359204378047414noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-15867265547433153262013-03-06T11:00:15.030+11:002013-03-06T11:00:15.030+11:00My remark came out too harsh I think, I apologize ...My remark came out too harsh I think, I apologize for that. As far as Brazilian CS rate goes, if it works well in that place, why would you want to reduce the caesarean rate? Eugenehttp://www.allaboutepidural.comnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-13127016269124858112013-03-02T14:36:35.889+11:002013-03-02T14:36:35.889+11:00Thanks Eugene,
I think all your points are good, ...Thanks Eugene,<br /><br />I think all your points are good, but I have two comments. I don't have an 'ideal' cesarean rate, but in answer to your question, no, I can't be certain, but I am pretty certain that the cesarean rate in Brazil could be lowered without causing much harm, and probably reducing some harms.<br /><br />Regarding the epidural case I mentioned, you are right. I didn't check the facts because I was working there at time, but because it was the anaesthetic staff talking about it, and because I work in theatres, I always assumed it was in theatres. I have removed it from the post. Thanks for picking that up.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-29981709498274005632013-03-02T10:27:36.991+11:002013-03-02T10:27:36.991+11:00Ah, caesareans. The comparison between countries i...Ah, caesareans. The comparison between countries in terms of caesarean rate and related mortality is pretty useless, as it assumes that except for the caesarean rate all other factors between countries were similar. Can you say with certainty that if you reduce the rate of caesars in Brasil from the current 50% to your "ideal" 10% related mortality will not increase? <br /><br />There are couple reviews showing that the morbidity related to elective caesarean is pretty much similar to that of vaginal birth. It is the emergency ones that are real evil, and they should be avoided. Ironically, one way to do it is to increase the number of elective caesareans. <br /><br />Another fallacy is to assume that a vaginal birth is always better than surgery. I covered one example of this in my article on my site. It is about the trial of forceps before caesarean: even though forceps inflict way more damage than a caesarean every midwife seem to be very happy that the baby came out "naturally". <br /><br />Longer term complication profile of an elective caesarean is pretty good. The risk of abnormal placentation increases with every consecutive pregnancy/caesarean. However, as most women these days have no more than two to three children, the rate is pretty manageable. The connection between caesarean and breastfeeding is observed in the emergency caesarean setting, but it is probably a secondary variable, as breastfeeding if affected by myriads of factors. As far as chronic pain is concerned, one study has demonstrated similar rates between vaginal and surgical birth (reference in the article on my site).<br /><br />Lastly, check your facts before making statements. The epidural accident you mentioned occurred in labour ward, and the woman was given the block for delivery, not caesarean. It was the substitution error, and this topic is covered in another article on my site. Even the figures of caesarean mortality cannot be taken at face value: was the caesarean the direct cause of death or was it associated with it? For example, if a woman starts bleeding and then has the caesarean, can you blame the surgery for the outcome?Eugenehttp://www.allaboutepidural.comnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-24276749715704933872013-03-02T09:28:37.228+11:002013-03-02T09:28:37.228+11:00Right, thanks! Looks like I need to add that to my...Right, thanks! Looks like I need to add that to my long list of papers to readAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-16773995875742655042013-03-01T22:39:58.696+11:002013-03-01T22:39:58.696+11:00Thanks,
Yes, according to the Cochrane review, mon...Thanks,<br />Yes, according to the Cochrane review, monitoring halved the seizure rate, but I am not sure of the significance of that. It can't be a surrogate for brain injury because the cerebral palsy rate was higher in the monitored group: RR 1.74, 95% CI 0.97 to 3.11, n = 13,252.<br /><br />Mainly, it led to more instrumented births and C-sections. Intervention begets intervention.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-57187168087707180362013-03-01T22:25:05.001+11:002013-03-01T22:25:05.001+11:00I understood (2nd hand only, I'm sorry) that c...I understood (2nd hand only, I'm sorry) that continuous fetal monitoring led to a decreased rate of neonatal seizures and ??something else that also was probably a surrogate marker for better neurological outcomesAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-34567248790116533942013-02-28T11:06:13.819+11:002013-02-28T11:06:13.819+11:00Thanks! And I"m so happy to have discovered y...Thanks! And I"m so happy to have discovered your blog.Alice Dregerhttp://alicedreger.comnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-28773842811406655012013-02-28T08:35:39.185+11:002013-02-28T08:35:39.185+11:00wow... great take down. Well done!wow... great take down. Well done!Anonymoushttps://www.blogger.com/profile/12264629041548251195noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-33092212326296759102013-02-28T06:58:37.158+11:002013-02-28T06:58:37.158+11:00Thanks Alice,
Your article is excellent. I had re...Thanks Alice,<br /><br />Your article is excellent. I had read it, but I have now added it to the blog post under "Further reading". You cover many aspects of technological interference, not just C-section, and explore the important issue of insurance company and society attitudes. I highly recommend it to my readers.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-1824042965941766202013-02-28T01:14:12.990+11:002013-02-28T01:14:12.990+11:00Great overview - thank you for doing this! I wrote...Great overview - thank you for doing this! I wrote about the difference between scientific and technological birth (including from a first person point of view) here: http://www.theatlantic.com/health/archive/2012/03/the-most-scientific-birth-is-often-the-least-technological-birth/254420/Alice Dregerhttp://www.theatlantic.com/health/archive/2012/03/the-most-scientific-birth-is-often-the-least-technological-birth/254420/noreply@blogger.com