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.

[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.

[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."

[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 :)

[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?

[andrewducker]

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

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

[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

[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]

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?

[feorag.livejournal.com]

Eh?

[andrewducker]

I was confused to. There are numerous mentions of Adobe Reader not working as a plugin for Firefox Mac, but some of the pages seem to be out of date. I'm confused, frankly.

[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.

[andrewducker]

As the quote I left just above makes clear, there were no significant different in outcomes.

[feorag.livejournal.com]

Not too sure myself. I have Adobe Reader installed, because it came with my Adobe CS4 Design package thingy, but I don't actually use it. PDF support is built-in to the OS, and you have to actively tell Safari (not my main browser) to save a PDF rather than just open it. In Firefox, I just set it to automatically open them in Preview.

[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.

[dalglir.livejournal.com]

We're still talking about general odds here. None of which are satisfactorily granular for me.

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.

[dalglir.livejournal.com]

I'm with you there. No beds for spouses in our local hospital. blanket is a good idea :)

[dalglir.livejournal.com]

Well, quite. :)

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

[danieldwilliam.livejournal.com]

Also chocolate. I never under estimate the moral boosting power of chocolate.

Frustratingly I noticed the "guest bedrooms" near the wards in our maternity hospital on the way out with my four day old son.

I definately felt that having a few hours sleep was really beneficial during the birth process. MLW was very tired, (close to exhausted) and full of a cocktail of several pain killers and other chemicals and my ability to translate what the doctor was saying in English into stoned, tired, anxious, pained MLW-ees was useful. I think had I had four hours proper sleep lying down with a blanket I'd have been able to do a better job.

[dalglir.livejournal.com]

At the risk of sounding flippant: a statistically insignificant outcome can feel pretty damn scary and significant when your result is one of the outlying exceptions to the rule.

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.

[andrewducker]

Of course a statistically insignificant outcome feels more important when you're in the middle of it.

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.)