andrewducker (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
andrewducker) wrote2011-11-25 11:00 am
andrewducker) wrote2011-11-25 11:00 am
Entry tags:
- adsl,
- android,
- apple,
- art,
- asia,
- autumn,
- badoo,
- bank,
- birth,
- brain,
- broadband,
- business,
- children,
- cinema,
- copyright,
- culture,
- design,
- dogs,
- edinburgh,
- education,
- epicwin,
- ethics,
- genetics,
- glucose,
- google,
- healthcare,
- internet,
- ipv6,
- isp,
- jkrowling,
- journalism,
- law,
- links,
- media,
- movies,
- nhs,
- nudity,
- poster,
- posters,
- privacy,
- psychology,
- samsung,
- scotland,
- self-control,
- sex,
- sexuality,
- shopping,
- socialnetworking,
- society,
- sugar,
- tax,
- uk,
- vaccine,
- weather,
- willpower,
- women
Interesting Links for 25-11-2011
- IPv6 for consumers on DSL at last
- Apple is the UK's second most popular shopping site (after Amazon)
- Google and Samsung confirm Galaxy Nexus volume bugs - glad I'm not upgrading until January!
- Badoo - the billion pound social network you've never heard of (massive in Brazil, Spain, France...)
- Genetic Study Confirms: First Dogs Came from East Asia
- Britain has had a record-breaking freakishly warm autumn
- Courts cannot force ISPs into broad filtering and monitoring for copyright-infringing traffic, ECJ rules
- Offshore unit launched to tackle international tax avoidance
- UK switching cervical cancer vaccine to one which also protects against genital warts
- Seeing nude people tunes up the brain
- Some very interesting stats on home births, midwives, etc.
- Ethical bank Triodos opens its first UK branch (in Edinburgh)
- Organising movie posters by different tropes they use. Strangely hypnotic.
- It's nice to know that there's at least one class out there getting decent sex education
- Willpower Is more than a metaphor: Self-control relies on glucose as a limited energy source.
- Journalists tried to reach JK Rowling through her five-year-old daughter. Can we shoot them now?
- 50p tax rate not actually causing a massive problem.
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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.
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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
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There were complications when dalglia was born. Suddenly. He could have died or been permanently mentally disabled. Fortunately, we were already in the NRIE and within seconds a medical team was in the room. They acted like poetry in motion, like they were telepathically linked. Stuff happened. And dalglia was delivered safely.
Would I want to have waited for an ambulance? No. dalglia could have died. Would I want to have waited for the ambulance to reach the NRIE from the wrong side of the city? No. dalglia could have died.
I realise this experience may skew my opinion but: fuck that study.
Forget the statistics for a moment: can adding 30 minutes of delay to treatment of an ongoing life threatening situation increase the risk of death? Let's say... ::shakes magic 8-ball of deadly childbirth complications::...massive bleed out from mother after birth due to tearing.
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Then they saved him, then he had an 8 minute seizure. He's only marginally impaired.
I was very tempted to have my second baby at home, but lived more than an hour from hospital so decided it wasn't prudent. He was born with no doctor in the room because I had him so fast they didn't have time to get there from down the hall.
In light of my experience, I absolutely believe that, in the case of a healthy woman who has been screened for complications and attended by a midwife, home within reasonable range of a hospital is just as safe as hospital.
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I strongly suspect that the reason second-child home-births have the same complication rate as hospital births is that those who were most prone to complications (as demonstrated the first time) went to the hospital. This skews the result heavily... indeed, I'm surprised that home-birth for second children doesn't show a greater safety rate because of that bias.
Of course I haven't seen the study design or how they controlled for this so perhaps I'm being unfair.
-- Steve's not a stats genius in any case.
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Which means that the sensible thing to do is to have your first child in a hospital, and then make a decision about the second child based on the results of that experiment.
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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?
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Dalglivk did an obs and gynae attachment at St Johns and saw the fallout of enough outcomes, that would have been statistically insignificant for this study, to convince her that hospital was best for her births.
I'm with danieldwilliam: I'd want to be where all the surgeons hang out.
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This is why anecdotes make for awful recommendations, and the people who are mostly exposed to the things that go wrong have a more negative view on things.
(See, also, doctors who deal with people who have massive alcoholism problems, and thus want to ban everyone from drinking. If you only get involved once people have problems, of course that makes a bigger effect on you.)
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I'm not convinced that a majority of people are like that. Certainly there's a loud cohort who make people's lives a misery on a Saturday night, but I don't think that's that many people out of the whole population.
The GMC aren't bad - but you end up with some doctors advocating tougher and tougher measures on alcohol pricing, because of the alcoholics they see, without seeming to realise that this is have a large affect on ordinary people, without making much of a difference to the actual alcoholics.
(Don't get me started on the "You shouldn't be allowed to smoke in your car..." stuff that came out a couple of weeks ago.)
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And agreed re GMC. The problem here is that some members have a political and ambition agenda that they can only further by spouting heavy handed garbage.
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And I think that _sometimes_ they have a point, but I'd rather that most people got to make their choices than we restrict everyone because of a few people.
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In that scenario, where would you rather your wife and child be?
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In that scenario, would you go outside?
(Less flippantly, Julie gets to make the call, and I'm sure she'll do oodles of research before deciding anything. First child will almost certainly be born in a hospital, and choices about further ones will depend on what happens then...)
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Now: if i lived in a 200 window building and I knew that a rogue police marksman was aiming at a random window and was going to shoot whoever opened it, would I open my window? Probably not. I'd find a less risky way of getting fresh air.
.
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In which case, what _are_ the odds of a situation occurring which gives different outcomes depending on whether you're at home or in the hospital?
Because I read a study earlier today that said the differences were statistically insignificant (for second child and onwards).
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Let's say risk of 'complication' from rogue police sniper is 1% in an apartment block 45 minutes from the hospital and a hospital block being terrorised by another rogue police sniper.
What the statistics of the study say is that, for people who have already been shot by a rogue police sniper once before ~45% of the unlucky 1% who get shot back at the apartment block end up have to go to hospital anyway (albeit mostly for flesh wounds). Critically, the statistics say that the risk of dying from being shot by a rogue police sniper the second time around is the same whether your at the apartment block (a 45 minute ambulance journey from the hospital) or at the hospital block (where all the surgeons are).
You know what? I'd still rather be shot by a rogue police sniper at the hospital block.
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This is why anecdotes make for awful recommendations
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