Interesting Links for 25-11-2011

[andrewducker]

• IPv6 for consumers on DSL at last
  (tags: ipv6 adsl isp uk internet broadband )
• Apple is the UK's second most popular shopping site (after Amazon)
  (tags: apple shopping uk )
• Google and Samsung confirm Galaxy Nexus volume bugs - glad I'm not upgrading until January!
  (tags: google samsung android )
• Badoo - the billion pound social network you've never heard of (massive in Brazil, Spain, France...)
  (tags: business socialnetworking sex culture badoo )
• Genetic Study Confirms: First Dogs Came from East Asia
  (tags: dogs asia genetics )
• Britain has had a record-breaking freakishly warm autumn
  (tags: autumn weather uk )
• Courts cannot force ISPs into broad filtering and monitoring for copyright-infringing traffic, ECJ rules
  (tags: law privacy internet copyright EpicWin )
• Offshore unit launched to tackle international tax avoidance
  (tags: tax uk )
• UK switching cervical cancer vaccine to one which also protects against genital warts
  (tags: uk nhs vaccine women )
• Seeing nude people tunes up the brain
  (tags: nudity brain psychology )
• Some very interesting stats on home births, midwives, etc.
  (tags: birth children healthcare )
• Ethical bank Triodos opens its first UK branch (in Edinburgh)
  (tags: uk scotland edinburgh bank ethics )
• Organising movie posters by different tropes they use. Strangely hypnotic.
  (tags: posters design cinema movies art poster )
• It's nice to know that there's at least one class out there getting decent sex education
  (tags: sex education sexuality society )
• Willpower Is more than a metaphor: Self-control relies on glucose as a limited energy source.
  (tags: glucose sugar willpower self-control )
• Journalists tried to reach JK Rowling through her five-year-old daughter. Can we shoot them now?
  (tags: journalism uk media jkrowling )
• 50p tax rate not actually causing a massive problem.
  (tags: tax uk )

Comments

[thejeopardymaze]

Home birth 'carries higher risk' for first-time mothers

I always thought it was elementary or high school biology that the human female body put up with more potential dangers during pregnancy and childbirth than most mammals, but apparently the message is being lost due to romanticism about nature these days. I won't deny there are a lot of assholes and clueless doctors out there, indeed I think it's harmful to the cause of the anti-quackery crusade, but medical advances and technology for pregnant women aren't an evil conspiracy against women, its saved so many mothers and babies.

The headline was honest

[thejeopardymaze]

The rest of the article, too much pro-homebirth propaganda, just because there are lower rates of cesareans doesn't mean it's a better outcome for the woman and child. The Skeptical OB makes a pretty good analysis of... nearly anything really-

http://skepticalob.blogspot.com/2011/11/its-official-homebirth-increases-risk.html

[thejeopardymaze]

The emergency Caesarean rate for the low-risk women...

Low risk can become high risk very quickly, they're estimations, not psychic inquiry in to the future.

[dalglir.livejournal.com]

The BBC article on increased risks in home births is news?

Anyone who, through a process of informed choice, chooses to put themselves far away from hospital is electing (but not guaranteeing) themselves and their unborn child for a Darwin Award.

Anyone who has convinced themselves that birth is some kind of magical, low risk activity because it is 'natural' is deluded. It is painful, frightening, bloody and fraught with risk. Afterwards, it is magical. 

No amount of home comfort will make up for a child, carried for nine months, that dies through any number of sudden complications that might otherwise have been saved if the appropriate teams and equipment had been on hand.

Of course, a hospital birth is by no means a guarantee. But I would say that it's the equivalent of adding an extra couple of D20's to a Saving Throw and I, for one, would rather have those the increased odds of survivability.

[andrewducker]

This is true for a first child (doubling of risk from 0.45% to 0.93%, but not even slightly true for further children, where the article states "For a second birth there was no difference in the risk to babies between home, a midwife-led unit or a doctor-led hospital unit."

[dalglir.livejournal.com]

According to this single study.

From a personal point of view, I would ask myself: does waiting for an ambulance to arrive and then get to hospital increase risk to mother or child when a sudden complication arises? Bearing in mind that if the midwife could cope with the complication, the ambulance would probably not have been called.

I would choose to already be in the place where the specialist teams and equipment are.

[andrewducker]

This single study being the largest one carried out in the UK, covering tens of thousands of births. If you want to dispute its findings then feel free to point to opposing data.

Looking at the data for second children:
For multiparous women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units.

For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.

So your outcomes are as good at home, and the odds of you not being sliced open are better.

https://www.npeu.ox.ac.uk/birthplace/results

[dalglir.livejournal.com]

Edit: the study is talking about comparable risk of complications occuring between different birth settings for the second birth but doesn't cover what happened when there were complications.

So, the risk of complication is roughly equal between birth settings for the second birth, but: where there were complications, was there an increased risk to the health/well being of mother and child being away from hospital?

[danieldwilliam.livejournal.com]

I broadly agree with your sentiment.

I remember discussing this forcefully with My Lovely Wife in advance of the birth of our first son. I also remember my mum (a doctor) threatening to bully MLW into going to the hospital. After a 36 labour resulted in an unplanned C-section all of us were glad we’d been in hospital. Saying that being able to nip off to my own spare bed for a kip would have helped me function a lot better.

However, doesn’t the research indicate that home births are just as safe as hospital births for second births with parent-child combinations that are low risk?

[dalglir.livejournal.com]

As above: risk of complication was found to be equal between birth settings for second child by the study does not appear to cover the risk of how complications are dealt with in those birth settings, if they occur.

I would still choose to be already in the place where the specialist teams and equipment are, rather than be hanging about for an ambulance with wife in agony/baby dying.

[danieldwilliam.livejournal.com]

Ah - I see.

I guess you pays your money and you takes your choice on whether the additional risk of the ambulance ride and consequently anxiety if thing go wrong are worth being at home at all that loveliness are worth it to you.

Personally, I'm with you on. Take me to the place where the surgeons hang out.

Next time tho' I'm taking my own blow up bed and blanket.

[naath.livejournal.com]

There's a strong chance you would have to hang about by a hospital bed with wife in agony/baby dying - waiting for the right doctor to be found, the OR to be prepared, the team to scrub up, etc etc. There is a usually a delay between requesting even the most emergency of emergency procedures (especially ones involving complicated kit/specific people; which is what we are talking about because midwives have the easy kit with them and lots of training) and actually receiving the procedure.

How that delay compares to the time spent waiting for / in an ambulance depends of course on where exactly you live.

[feorag.livejournal.com]

The safest option is, of course, to either not get pregnant in the first place, or to have the thing aborted as soon as you notice. This is infinitely safer than carrying a foetus through to term. The difference in risk between a home birth and a hospital one is minuscule in comparison.

Any woman who, through a process of informed choice, chooses to become pregnant and continue with that pregnancy, usw...

[dalglir.livejournal.com]

Well, quite. :)

And then squirrels would rule the earth as humanity died out !

[channelpenguin.livejournal.com]

:-) now that has been MY choice. I have no desire for children, and never have - BUT I think that even *if* I did, the risks of death, injury and long standing and profoundly unpleasant health problems for myself (diabetes, lost teeth, single or double incontinence, fistula(e), prolapse...etc. etc..) would STILL probably convince me otherwise.

[alitheapipkin.livejournal.com]

My choice too. Despite my Home Ec teacher at high school who once thought it was appropriate to tell me I was silly for not wanting children and that getting pregnant was the only way I was ever going to have decent sized breasts...

[naath.livejournal.com]

Ah, but you forget the other side of the coin - for a birth that has no complications and proceeds in the normal and expected manner to produce a healthy child and healthy mother a hospital setting carries additional risks (generally speaking simply being in a hospital carries risks such as increased exposure to MRSA; specifically speaking many women experience hospital births as involving more stress, and more unnecessary/unwanted medical intervention during their birth).

There are many women and babies whose health post partum are vastly improved by not being in a hospital setting, and simplifying that to "home comfort" is unfair; it is desperately unpleasant to think about but, yes, I would venture to suggest that for most people there is a number of people in perfect rather than slightly-dodgy health that "makes up for" a single death collaterally caused. What you feel that number is, and how it fits into the evidence presented here, are things that I obviously do not know.

The risk equation also requires further information which is non-obvious (although presumably covered in this report) - exactly what procedures are there which you are very likely to be able to access in hospital but not at home? Home births supervised by NHS midwives are not the same thing as a birth free of medical intervention or assistance; not all hospitals are able to guarantee to offer all types of intervention that are theoretically available (that is, that exist, are approved etc); what is the likelihood of experiencing unexpected complications? Further - how far is your home from the hospital, how long will it take you to get there in an emergency situation, which you should compare with how long you would have to wait in the hospital for the appropriate teams and equipment to be available to you when you are considering what risk you are actually running by having a home birth.

So; yes. It's news. Just because the answer turns out to agree with your gut-feeling about the risks doesn't mean that you were correct to trust your gut-feeling rather than go out (well, send someone out) and collect evidence about the question.

[alitheapipkin.livejournal.com]

Yes this. By their nature these things miss out the personal experience bit. I know two women who opted to give birth at home for their first child. Neither of them are stupid, they both did their research and decided the added comfort and reduced medicalisation outweighed the extra risk. They were both lucky enough to have no complications and found birth a more positive experience than several other women I know, who had a horrible time in hospital. Including one who still had to wait for an ambulance and be transferred because the hospital she was in couldn't perform the necessary intervention.

By which I mean that if we rely on people's gut feelings and personal experience, we get a story based entirely on who is in our sample.

[dalglir.livejournal.com]

It turns out that I am an opinionated old fart, lucky enough to have friends like Andy who are patient enough to keep arguing their corner. The result was that I went away, read some more around the topic and am now more sympathetic to other point of view.

Hurray!

[danieldwilliam.livejournal.com]

I'm not advocating shooting journalists or bankers but I am surprised that neither group has seen members become the victims of vigilanties or terrorists.

[momentsmusicaux.livejournal.com]

Could you put a note in the link title when it's a PDF?
(Or recommend a Firefox plugin that can open them rather than download :)

[andrewducker]

I didn't realise Adobe Reader didn't work on a Mac!

Try this? http://www.schubert-it.com/pluginpdf/

[feorag.livejournal.com]

Eh?

[erratio.livejournal.com]

If you're interested in reading more about the glucose/motivation stuff, Roy Baumeister keeps a lovely page where you can get pdfs of his papers emailed to you. He's also looked at sex drive.

[skreidle.livejournal.com]

Gardasil has been in use here for a few years, though it's only been approved for use in women up to age 26, if I recall correctly. Sucks to be older than that -- you can't get it on request, It Hasn't Been Approved.