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

[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]

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.

[laplor.livejournal.com]

If we're going anecdotal, my son nearly died due to complications caused and worsened by hospital procedures and conditions. For one thing, the hospital had no air conditioning or hot water - I'm not kidding! I had both at home.

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.

[anton-p-nym.livejournal.com]

Apparently there's a saying going around Microsoft now; bowdlerized, it's, "the average person has one breast and one testicle." It's a caution against relying on statistical models without examining the context.

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.

[andrewducker]

Yup, that's what I'd expect.

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.

[del-c.livejournal.com]

Because complications are rare, pulling complications out of the home birth pool is like pulling tokens out of a bag with a lot of tokens. So removing the mothers who had complications the first time shouldn't affect the home birth statistics positively enough to detect. Which is just what we observe: home births rise to the safety level of hospital births on and after second birth, but do not exceed it, despite the theoretical skew from first-birth complications electing hospital the second time around.

[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?

[andrewducker]

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

[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.)

[dalglir.livejournal.com]

Actually, I thought the GMC had given guidance that everyone can drink as long as they do it in moderation. Sadly, the general drinking populace are generally incapable of understanding 'in moderation' and come up with things like 'alcopops don't count' etc. So it's easier for government to say 'don't drink at all'. Of course, government also has an agenda to reduce NHS costs which are hammered by heavy drinking related illness and injury every Friday and Saturday night...

[andrewducker]

Sadly, the general drinking populace are generally incapable of understanding 'in moderation' and come up with things like 'alcopops don't count'

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.)

[dalglir.livejournal.com]

I correct 'general drinking populace' to 'loud cohort who make people's lives a misery on a Saturday night'.

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.

[andrewducker]

This is true. I do think that doctors get a negative view of people, because they only see the ones that have fucked up in some way (or are unlucky). I know a few GPs who have ended up thinking largely of the general population as incompetent idiots who can't be trusted to look after themselves.

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.

[dalglir.livejournal.com]

The anecdote is to illustrate that even with statistics on your side, shit still happens.

In that scenario, where would you rather your wife and child be?

[andrewducker]

If you step outside of your door you could be instantly shot and killed by a rogue police marksman.

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...)

[dalglir.livejournal.com]

I not sure that question is a fair comparison. They do not carry like for like possibilities of 'complications'.

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.

.

[andrewducker]

Aaah, so it comes down to probabilities.

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).

[dalglir.livejournal.com]

Let's see how far we can take this analogy :)

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.

[andrewducker]

And I am absolutely fine with you making decisions that aren't backed up by data. Tis your right!

[dalglir.livejournal.com]

Reading more on this. It's quite fascinating seeing the different studies from different groups with different agendas.

[kerrypolka.livejournal.com]

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

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[andrewducker]

Thank you