Re: A snack for the laborers

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And it's handled so irrationally! With Sally, I was planning on a midwife-assisted natural childbirth, and they didn't have any restrictions on what you could eat -- I had a sandwich before leaving for the hospital at five. Things got weird -- Sally had turned breech in early labor -- so I ended up laboring in an operating room in case they needed to do an emergency C-section (as it turned out, no. I had the natural childbirth, just with every single trainee OB in Manhattan staring at my crotch because they'd never seen a breech delivery before, and weren't likely to see another. The room was packed. It was ridiculous.)

But despite the fact that I had a full stomach anyway, because I'd eaten only a couple of hours ago, they wouldn't even let me drink water, and let me tell you your mouth gets fucking dry when you're in labor. They gave Buck a wet washcloth and told him to let me suck on it a little, but not too much. This is not a good thing to do to a marriage, telling a man to restrict his wife's access to fluid when she's dying of thirst -- I was snarling and snapping at the washcloth like a big dog.

In short -- labor? Not a dignified process. And they were totally stupid not to let me drink water.


Posted by: LizardBreath | Link to this comment | 08-11-10 11:49 AM
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I'm still pissed about that bit. Very fond of the OB/scary Czech-midwife duo who let me avoid the c-section, but pissed about the water.


Posted by: LizardBreath | Link to this comment | 08-11-10 11:50 AM
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I forgot about being extremely thirsty. I think at one point I just went into the bathroom and drank from the faucet because I was so frustrated with how they were only providing me with dixie cups of water spaced appropriately far apart.


Posted by: heebie-geebie | Link to this comment | 08-11-10 11:52 AM
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1: Was Buck filming with his other hand? Is there video?


Posted by: peep | Link to this comment | 08-11-10 11:52 AM
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No video that I know of, no.


Posted by: LizardBreath | Link to this comment | 08-11-10 11:53 AM
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Ooh, I have judgmental opinions about labor and delivery interventions too! I wonder how much they overlap with yours.

Happily, our hospital is fine with moms eating up until the epidural (if any) goes in, after which clear liquids are still allowed. After emphasizing that they're hands-off about that sort of thing, our OB did say that if you're hungry, you're pobably not really in active labor, though.


Posted by: Osgood Yousbad | Link to this comment | 08-11-10 11:54 AM
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+r


Posted by: Osgood Yousbad | Link to this comment | 08-11-10 11:55 AM
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(Admittedly, my issue is a little different. I was at identified high-risk, once the breech thing happened, of having a highspeed c-section which would have been under general anesthesia, so there was a real point in wanting my stomach to be empty. What made it stupid is that I'd eaten recently enough that my stomach wasn't going to be empty whether or not I drank all the water I wanted to.)


Posted by: LizardBreath | Link to this comment | 08-11-10 11:56 AM
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4: Dude?


Posted by: Moby Hick | Link to this comment | 08-11-10 11:57 AM
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9: ?


Posted by: peep | Link to this comment | 08-11-10 11:59 AM
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Teh creepy.


Posted by: Moby Hick | Link to this comment | 08-11-10 12:01 PM
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Aside from the nudity issue, I'm sure video would be hysterical. Buck still cracks up at the memory.


Posted by: LizardBreath | Link to this comment | 08-11-10 12:02 PM
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Nah.


Posted by: nosflow | Link to this comment | 08-11-10 12:03 PM
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It's curious. I kind of think it's creepy too, but lots of people do seem to film their deliveries. I have a hard time believing that any of the people directly involved (mom, dad, kid) would ever want to watch such a thing, and surely it's nobody else's business...

Per LB on preview, maybe I'm wrong and it could be a lifelong source of entertainment...


Posted by: Osgood Yousbad | Link to this comment | 08-11-10 12:04 PM
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Sometimes babies die during delivery, sometimes the mom, sometimes both. Still happens, despite all we can do. The problem is that when there is such a tragic result, it has to be somebody's fault .

Faced with getting sued for a delivery gone wrong how surprising is it that the medico's want to control everything possible.

Don't forget obstetrician comes from the Latin for "stand around watching"


Posted by: Tasseled Loafered Leech | Link to this comment | 08-11-10 12:06 PM
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11, 12: It was a joke! And LB described herself in such an amusing manner!


Posted by: peep | Link to this comment | 08-11-10 12:06 PM
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My mom says she learned her lesson with my older brother's 20+ hours of labor. When labor started with me, she calmly asked my dad to drive her to White Castle and then the hospital. True story.


Posted by: Stanley | Link to this comment | 08-11-10 12:07 PM
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7th grade health classes at my junior high all watched a film of some Swedish woman giving birth. It was much looked forward to -- because the teachers would always run the film backwards at the end and we got to see the baby pop back in.


Posted by: oudemia | Link to this comment | 08-11-10 12:07 PM
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we got to see the baby pop back in.

SADISTIC FUCKS!


Posted by: heebie-geebie | Link to this comment | 08-11-10 12:09 PM
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It's easy to see that no such video can exist; if it did, then apo would have somehow magically shown up with a link to it.


Posted by: essear | Link to this comment | 08-11-10 12:09 PM
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20 to 4 et seq, though 18 may indicate a flaw in my proof unless apo rescues me.


Posted by: essear | Link to this comment | 08-11-10 12:10 PM
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17: Do you have a greater love for grilled onions than your sibling?


Posted by: Moby Hick | Link to this comment | 08-11-10 12:10 PM
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Home birth seems like mostly a big plus for the Dad. I would really have rather slept in my own bed than on a cot at Cedars for four days.

I'm fine with midwifes/non-intervention. I draw the line at doulas doing body-art on pregnant bellys and water-births.


Posted by: Robert Halford | Link to this comment | 08-11-10 12:11 PM
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+s


Posted by: Moby Hick | Link to this comment | 08-11-10 12:11 PM
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15: Certainly--I've heard an OB friend express frustration with 9-page single-spaced birth plans detailing exactly how things are going to go, and having to explain that she's going to deviate from the plan *so that your baby will live*. ("look, lady, you dropped a cord and if kid's not out in 8 minutes, it's over. We're not waiting for your attending to drive to the hospital because your Birth Plan says you won't be treated by an intern.")

At the same time, in many/most cases watchful attention is enough to stay out of a crisis, instead of preemptive everything.


Posted by: Osgood Yousbad | Link to this comment | 08-11-10 12:14 PM
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I draw the line at ... water-births.

Why?

Based on what I learned watching The Business Of Being Born, water birth looked like it could make a lot of sense.


Posted by: NickS | Link to this comment | 08-11-10 12:15 PM
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Home birth seems like mostly a big plus for the Dad. I would really have rather slept in my own bed than on a cot at Cedars for four days.

Jammies is emphatically pro-hospital because of the gigantic fucking mess.

Also, you're anti-water births? You know it helps hugely with pain management?


Posted by: heebie-geebie | Link to this comment | 08-11-10 12:15 PM
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I haven't really researched this extensively, I just associate water births with the doulas/painted belly crowd.


Posted by: Robert Halford | Link to this comment | 08-11-10 12:16 PM
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My line is drawn at home births. For me, the balance of risk/reward doesn't justify deliberately putting yourself far from medical help in a situation that could become an emergency at a moment's notice. Go as natural and hippy-dippy as you want (I might make fun of you, but as long as it's the woman's informed choice I won't disapprove), just have doctors nearby if you need them.


Posted by: Osgood Yousbad | Link to this comment | 08-11-10 12:22 PM
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We did a home birth for our second. Rented a big hot-tub. Wife swears up and down that it was the best thing in the world.


Posted by: A Guest | Link to this comment | 08-11-10 12:23 PM
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There's laboring in water, which was very helpful, thank you very much, and delivering under water, which is a little out there by my standards, but no one's making you do it if you don't want to. Two fairly different things.

And I've heard doulas are very helpful, although I don't know firsthand.


Posted by: LizardBreath | Link to this comment | 08-11-10 12:23 PM
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29: While there's nothing wrong with balancing risk and reward, my recollection of the research is that for a non-high-risk pregnancy, a home birth really isn't any more dangerous than being in the hospital -- there's no additional risk to balance out.


Posted by: LizardBreath | Link to this comment | 08-11-10 12:24 PM
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Wasn't a doula something from the Dune sequels?


Posted by: Moby Hick | Link to this comment | 08-11-10 12:24 PM
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34

unless apo rescues me


Posted by: apostropher | Link to this comment | 08-11-10 12:25 PM
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We had a doula, mostly due to social pressure. She was very sweet, but other than taking some nice pictures with a good camera, it was kind of like "what are you doing here?"


Posted by: Robert Halford | Link to this comment | 08-11-10 12:25 PM
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Also, there is no way that I'm clicking on any link Apo posts in this thread.


Posted by: Robert Halford | Link to this comment | 08-11-10 12:26 PM
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We hired a doula and we're using her again. We were able to find someone who we got along with really well, and so the whole thing was hugely beneficial. I wouldn't recommend hiring someone that you didn't click with.


Posted by: heebie-geebie | Link to this comment | 08-11-10 12:26 PM
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Believe it or not, my first wife and I planned on a water birth at the birthing center. Then she developed toxemia and all bets were off.

I have told this story before, but one of the interesting exercises at the birthing center classes was the line of pain. We were supposed to line up across the room to show our level of commitment to no pain medication, one wall being full epidural and the other no meds at all, come what may. After dutifully lining up, the instructor chided any partner not right next to the expectant mom.


Posted by: Tasseled Loafered Leech | Link to this comment | 08-11-10 12:27 PM
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35: You might have been successfully filling her role, of providing emotional support/tending to minor physical needs for your wife (or, rather, her role would have been to step up if you weren't). I can't think of what a doula would have done for me that Buck didn't, but if he hadn't been there I would have wanted a non-medical-professional there for handholding and similar.


Posted by: LizardBreath | Link to this comment | 08-11-10 12:28 PM
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There's laboring in water, which was very helpful, thank you very much, and delivering under water, which is a little out there by my standards,

I'm not sure I see why you're drawing the line there. You're still experiencing contractions the whole time. Also, the water must help support the weight of the baby, and it's not like it harms them to be immersed.


Posted by: heebie-geebie | Link to this comment | 08-11-10 12:28 PM
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After dutifully lining up, the instructor chided any partner not right next to the expectant mom.

They won't give the partner any pain medication, no matter what the birth plan says.


Posted by: Moby Hick | Link to this comment | 08-11-10 12:29 PM
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They won't give the partner any pain medication, no matter what the birth plan says.

Dude. Does that seem fair ?


Posted by: Tasseled Loafered Leech | Link to this comment | 08-11-10 12:31 PM
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40: I'm not committed to there being a rational distinction -- I'm sort of stuck on problems like "How does the midwife/OB see what's going on? What if someone slips and drowns the baby?" Probably not real problems in practice, it just seems more complicated than necessary.


Posted by: LizardBreath | Link to this comment | 08-11-10 12:31 PM
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You might have been successfully filling her role, of providing emotional support/tending to minor physical needs for your wife

Not likely!


Posted by: Robert Halford | Link to this comment | 08-11-10 12:31 PM
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The two best things our doula did:
1. Kept us home for eight hours past when I would have headed to the hospital.

2. We could count on her to intercept and navigate any intervention that might have been tried without our knowledge. Given how insanely interventionist my ex-OB and that hospital are, this counted for a lot in peace-of-mind.


Posted by: heebie-geebie | Link to this comment | 08-11-10 12:32 PM
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"Doula" is really a terrible name. "Slave woman" -- let's all hire one!


Posted by: oudemia | Link to this comment | 08-11-10 12:33 PM
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I don't have numbers in front of me or anything, but my impression is that 32 overstates the case somewhat. Certainly, non-high-risk means it's very likely that things would go the way they're supposed to, but sometimes the kid will just twist around and get the cord around his neck, or wedge his shoulder into the birth canal and get really stuck--not often, but sometimes--such that you really need help. I know I'm probably talking about less than 1 in 100, but how high does that number have to be before it's worth staying home?

At any rate, "no additional risk" is surely not right.


Posted by: Osgood Yousbad | Link to this comment | 08-11-10 12:33 PM
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I was down for whatever either of the wives wanted, and certainly have no strong feelings about the choices of anybody I didn't impregnate myself. However, if it was *my* delivery, there's no way I'd want anything other than a hospital room and as much analgesia as they were willing to pump into me.


Posted by: apostropher | Link to this comment | 08-11-10 12:34 PM
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I'm sort of stuck on problems like "How does the midwife/OB see what's going on? What if someone slips and drowns the baby?" Probably not real problems in practice, it just seems more complicated than necessary.

Our doula ran our birth class, and showed a zillion videos of water-births. It just doesn't seem to be a problem. Most women were on all fours, or supine, but not precariously standing up. The tubs were clear and easy to see what was going on.


Posted by: heebie-geebie | Link to this comment | 08-11-10 12:34 PM
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48: That's pretty much my thought also.


Posted by: Moby Hick | Link to this comment | 08-11-10 12:35 PM
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We hired a doula for the birth of our first (and only) and she was invaluable in getting us through the process. It was an almost entirely unmedicated childbirth after four days of labor (we resorted to Pitocin at the very end for fear of exhaustion). No doubt I would have done more if the doula wasn't there, but I don't think I would have been able to do as much, or as well, as she did.


Posted by: widget | Link to this comment | 08-11-10 12:35 PM
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45.1 - This is a big benefit. A good friend of ours just had a kid and she was dilated to 7cm before she went to the hospital. I don't know that we'll get that far, but in general this seems like something worth aspiring to. (she also wound up needing a section [which she hadn't wanted but agreed was necessary in the end] when the kid got stuck at an angle and wouldn't budge after 3 hours of pushing!)


Posted by: Osgood Yousbad | Link to this comment | 08-11-10 12:37 PM
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sometimes the kid will just twist around and get the cord around his neck,

From what I understand, this is an exaggerated risk. The kid isn't breathing yet. The cord is still working just fine to deliver oxygen. It's a narrow spot in the body, and hence a very natural spot for the cord to rest when everything is shoved through the canal.

It just seems scary because for the rest of your life, that would cut off your breathing.


Posted by: heebie-geebie | Link to this comment | 08-11-10 12:39 PM
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53: Right--the problem isn't that the neck is constricted; it's that the cord can get constricted when you get to the narrow parts of the exit. When the cord is pinched, the kid suffocates.


Posted by: Osgood Yousbad | Link to this comment | 08-11-10 12:40 PM
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Also, anecdatum: if we had tried to deliver at home with Noah (emergency C-section), he almost certainly would not have survived the delivery. So yeah, a 1% chance doesn't seem like much until you consider that nearly half a million babies are born (or not) every day.


Posted by: apostropher | Link to this comment | 08-11-10 12:42 PM
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47: Close to 1 in 100 would be a huge difference. Here's a link to which mostly seems to show literally no increased risk. I think most things that can go wrong in childbirth, you do have enough time to get an ambulance without anyone dying.

Although come to think I do remember seeing something really recent showing an increased risk from home birth, although it was weird -- IIRC it wasn't about babies dying during delivery, but about some increase in the risk of death in the first week or two. But I didn't see it pop up on a quick google.


Posted by: LizardBreath | Link to this comment | 08-11-10 12:42 PM
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Also, anecdatum: if we had tried to deliver at home with Noah (emergency C-section), he almost certainly would not have survived the delivery.

Almost certainly wouldn't have survived the delivery, or almost certainly would have died before an ambulance could have gotten your wife to the hospital? It's a big difference, riskwise, if you see what I mean.


Posted by: LizardBreath | Link to this comment | 08-11-10 12:45 PM
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When the cord is pinched, the kid suffocates.

But a pinched cord doesn't really have anything to do with the kid's neck. And yet you always hear "The cord was wrapped around his NECK! We got so lucky!"


Posted by: heebie-geebie | Link to this comment | 08-11-10 12:47 PM
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Didn't I just read that there was a higher mortality rate with home births? Aha -- a "controversial" study showing a tripling of newborn mortality.


Posted by: oudemia | Link to this comment | 08-11-10 12:47 PM
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In 16th-18th century Europe, childbirth was fatal for the mother in about 5% of births. I've heard that having the mother lie on her back does not help, since the mortality rate in Asia and Africa without medical intervention was and is apparently lower.

When my son was born, 41 weeks of term, labor was induced as the OB had noticed at a checkup that the placenta was decaying rapidly. Easy for me to say, I know, since I'm male, but both personally and statistically, giving birth seems pretty risky, both equipment and medical expertise seem useful to have at hand. Obviously, I agree that liability-avoidance motivated OB practices are unfortunate.


Posted by: lw | Link to this comment | 08-11-10 12:49 PM
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57:

And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation -- two factors associated with poor midwife training and a lack of access to hospital equipment. In the USA, for example, only a third of home births are accompanied by a certified midwife.


Posted by: oudemia | Link to this comment | 08-11-10 12:50 PM
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Friends of ours planned to have their kid at home, unsupervised, just the two of them. That strikes me as completely insane.

It turns out there were all sorts of complications, and so the plan was abandoned, and this was all five years before I ever met them. But still! We'll just hang out at home by ourselves, and eventually we'll have a baby! Woo!


Posted by: heebie-geebie | Link to this comment | 08-11-10 12:51 PM
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Duh, wikipedia has the recent study showing an increased risk from home births:

A 2010 metastudy of studies which specifically compared only planned home births with planned hospital births among healthy, low-risk mothers in industrialized countries found no difference in the home and hospital rates of perinatal death, but also found that planned home birth holds more than twice the risk for death from the ages of 1 week to 1 month (commonly called the neonatal period).

That's unsettling, but not the sort of crash emergency people are thinking of, and difficult enough to explain mechanism-wise that I have a hard time believing it's real rather than some kind of statistical fluke. But I'm pretty sure there's no research showing any increased risk of perinatal (that is, literally at the time of birth) injury or death from planned homebirths.


Posted by: LizardBreath | Link to this comment | 08-11-10 12:52 PM
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63 pwned by 59.


Posted by: LizardBreath | Link to this comment | 08-11-10 12:52 PM
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I was starving. I would have eaten anything. The baby's dad and my birth coach (two separate people) had to keep sneaking out of the room to eat. But my water broke on a Wednesday and the kid didn't decide to emerge until Sunday morning, so it was a long tedious slog and it was only the last twenty hours or so that they wouldn't let me eat. Still, that's a long time to go without food.


Posted by: Sydnew | Link to this comment | 08-11-10 12:52 PM
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Didn't The Verdict revolve around aspiration under anesthesia? But I forget whether it was during a delivery. (And not that the plot of movie is relevant to anything.)


Posted by: JP Stormcrow | Link to this comment | 08-11-10 12:53 PM
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63: I can't square your
"I'm pretty sure there's no research showing any increased risk of perinatal (that is, literally at the time of birth) injury or death from planned homebirths"
with
"The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation -- two factors associated with poor midwife training and a lack of access to hospital equipment."


Posted by: oudemia | Link to this comment | 08-11-10 12:56 PM
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66: Yes! It's what I always think of. They would have given her different anesthesia if they'd known she'd eaten.


Posted by: oudemia | Link to this comment | 08-11-10 12:56 PM
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58: That's true. I picked the wrong scary example. What I was talking about is a prolapse, where a loop of cord gets ahead of the head in the vagina, so that the head pinches it shut as it tries to go by. Not as knee-jerk scary sounding as "around the neck," but from what I understand it's a bad emergency.

56: Hmm. I'd want to see more about the samples than I got from my quick skim of that page before I accept that it "shows no difference." It may be true, and if the data are out there they're hard to argue with, but as a matter of logic it seems that if there exist situations where prompt medical attention is necessary*, you can avoid some risk by putting yourself in a position to get prompt medical attention. Even if the ambulance is there in 5 minutes and you're at the hospital in 10, wouldn't you rather have been in the OR in 45 seconds?

*You seem to be contesting this point, which I find puzzling. "Emergency c-section" is a common enough phrase that I thought they were acknowledged to be part of the deal. That same OB friend told me that when baby's oxygen is cut off, you've got about 8 minutes before there's serious damage or risk of death. An ambulance ride, even in the city, seems non-trivial in that setting.

None of which is to say that there are no benefits to being at home--just that your "no additional risk" statement still seems incredible, although if there's no research supporting additional risk, well, maybe I need to open my mind.


Posted by: Osgood Yousbad | Link to this comment | 08-11-10 12:58 PM
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What I was talking about is a prolapse, where a loop of cord gets ahead of the head in the vagina, so that the head pinches it shut as it tries to go by.

Comity!


Posted by: heebie-geebie | Link to this comment | 08-11-10 1:04 PM
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69: just that your "no additional risk" statement still seems incredible

See the discussion above of the 2010 meta-analysis which seems to show some additional risk, but in a weird way. So maybe I'm wrong. But even taking the new study at face value, it's still a pretty tiny increase (that is, tripling a tiny risk remains tiny).

67: This is one of those things where I'd need to read the underlying studies -- I'm relying on wikipedia for 'no increase in perinatal deaths'. The language you quote is a little indefinite: saying that the causes of death were things that are generally associated with poor training and lack of access to hospital equipment doesn't quite say that the data show that poor training and a lack of access to hospital equipment were a factor in any of the cases of death. But the perinatal/neonatal distinction does make it weird: people spend so little time in the hospital these days that I don't quite understand how, e.g., the midwife's training versus a the hospital staff's would matter once the mother's gone home.


Posted by: LizardBreath | Link to this comment | 08-11-10 1:06 PM
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One point that is often made in favor of the home birth is that labor and delivery is not an illness to be cured. Overwhelmingly, things will probably progress naturally and healthfully.

Speaking of the 1 in 100 figure, as I recall that was the rough rate of maternal deaths per live births around 1900. Sure, we might have become overly cautious and doubtless a major part of that number was whittled down by preventive care. But doing childbirth at the hospital is because childbirth routinely killed lots of people in recent history, and still does in poor countries.


Posted by: gswift | Link to this comment | 08-11-10 1:06 PM
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30: Same here. We had Tiny Jacobian #1 in the hospital and Tiny Jacobian #2 at home, both delivered by midwives. The big ol' labor tub we had for #2 was the best thing ever.

62: That also strikes me as completely insane. Not least because, um, "Hey, honey, would you mind going ahead and stitching up my perineum? Thaaaaanks."


Posted by: Bonsaisue | Link to this comment | 08-11-10 1:08 PM
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But doing childbirth at the hospital is because childbirth routinely killed lots of people in recent history, and still does in poor countries.

Sure. There's a reason people get identified as high-risk, and c-sections save lives where they're necessary. But one of the great things about modern medical science is that they've gotten good at identifying people who are probably going to be just fine without medical assistance.


Posted by: LizardBreath | Link to this comment | 08-11-10 1:08 PM
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I never realized that Bonsaisue and Turgid Jacobian knew each other!


Posted by: heebie-geebie | Link to this comment | 08-11-10 1:10 PM
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75: Biblically, even.


Posted by: Stanley | Link to this comment | 08-11-10 1:11 PM
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Biblically, even!


Posted by: Bonsaisue | Link to this comment | 08-11-10 1:11 PM
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78: Biblically, even?


Posted by: Cryptic Ned | Link to this comment | 08-11-10 1:11 PM
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Damn. Jinx?


Posted by: Bonsaisue | Link to this comment | 08-11-10 1:12 PM
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76-78 are now true for the authors of 76-78, as well.


Posted by: Sifu Tweety | Link to this comment | 08-11-10 1:12 PM
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57: Well, unless we had a fetal heart rate monitor at home (which maybe is standard?), we'd have never known anything was amiss. He turned out to have had a leak in the umbilical cord and hadn't been getting much in the way of nutrition for some undetermined amount of time, and so was weak and emaciated-looking and took his own sweet time to start breathing or responding once they got him out the side exit. His heart rate had been crashing during contractions and then started crashing randomly, which is when the OB hit the panic button.


Posted by: apostropher | Link to this comment | 08-11-10 1:13 PM
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how, e.g., the midwife's training versus a the hospital staff's would matter once the mother's gone home.

More accurate identification of slow-leak type problems and things that indicate extra testing?


Posted by: E. Messily | Link to this comment | 08-11-10 1:16 PM
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74:

Yeah, I don't even think I'm seeing much of anything I disagree with in this thread. But it seems like a sizeable number of people in this country have lost their damn minds and "let's just do this birthing thing home by ourselves" is right up there with the no vaccination movement. I'm reflexively throwing stuff out there against an argument that's not really being made.


Posted by: | Link to this comment | 08-11-10 1:17 PM
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gah, 83 was me


Posted by: gswift | Link to this comment | 08-11-10 1:17 PM
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Further to 71: Here's a blogpost from an OB on the study who finds it worrisome, but seems to confirm that the excess deaths aren't at the time of birth:

Unfortunately, the study has some serious flaws. First, it includes some data collected more than two decades ago. Second, it includes some papers that looked at very small numbers of births. Third, while it found a dramatically increased risk of neonatal mortality, it found no difference in perinatal mortality. This is not what we would expect if the excess deaths were due to intrapartum stillbirths or failed resuscitations.

Posted by: LizardBreath | Link to this comment | 08-11-10 1:23 PM
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I spent a lot of my pregnant months reading A Guide to Effective Care in Pregnancy and Childbirth and was very happy with my hands-off hospital birth with Kid A, very happy with my homebirths for Kids B and C, and over the fucking moon with my unattended birth for Kid D.


Posted by: asilon | Link to this comment | 08-11-10 1:25 PM
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Any dsquared fans fascinated by this topic should RTFA.


Posted by: LizardBreath | Link to this comment | 08-11-10 1:27 PM
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85: The same blog takes a much starker tone in the post Home Birth Kills Babies. That one links to the mid-2000s data, but is unrelated to the recent article.


Posted by: oudemia | Link to this comment | 08-11-10 1:29 PM
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gotten good at identifying people who are probably going to be just fine

I don't think that this is true. Doctors have gotten much better at identifying problems, in some cases with sensitive early warning tests. But the converse (no detectable problem) is not the same as a positive determination of likely positive outcome, there is an unknowable fraction of cases which will become problematic.

Focusing instead on disparities like this
http://www.nationmaster.com/graph/hea_bir_by_cae_sec-health-births-by-caesarean-section
or on crazy rules like the IV tether makes a lot more sense to me than asking for a green light.


Posted by: lw | Link to this comment | 08-11-10 1:32 PM
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I feel like I would feel worse if I went to hospital and other people fucked up my birth or my baby, than if I did it myself. But I was confident that all would go swimmingly, and it did. My nerve did break at the last minute and I asked C to phone the midwives - and then realised that that was transition and she was born by the time they'd phoned back. Best bit of it was not having anyone faff about or interfere with the placenta and cord.


Posted by: asilon | Link to this comment | 08-11-10 1:32 PM
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88: In that post, she's talking about increased risk from a homebirth with an untrained attendant (a DEM, or non-nurse midwife), just to be clear.


Posted by: LizardBreath | Link to this comment | 08-11-10 1:33 PM
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but also found that planned home birth holds more than twice the risk for death from the ages of 1 week to 1 month (commonly called the neonatal period).

I wonder why this is. Hospitals better at assessing newborn health and getting them under the jaundice-light, or whatever they need?


Posted by: neonat | Link to this comment | 08-11-10 1:36 PM
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candyman candyman candyman - I check this site once in a month, and someone is WRONG.

The thing you are missing is "increased risk". That is, increased risk from home birth vs risk from hospital birth. Not, the risk from home birth versus a (presumed risk free) hospital birth.

With good precedent, the risks are:

1) if you are at home, you might have a complication which requires immediate hospital treatment and you or the baby might die.

2) if you are at hospital, you might be given an unnecessary medical treatment which kills you or the baby.

The two risks, according to good, well established and wholly replicable science, are more or less equal.

As I said in the linked thread, Caesarians are not in and of themselves signs of failure, and in my opinion the benefits of hospital-provided pain medication (summary: good for pain) are substantial. But NICE and Cochrane have both established via large metastudies that for healthy mothers having uncomplicated births, the risks are equal.


Posted by: dsquared | Link to this comment | 08-11-10 1:36 PM
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91: No. She says a DEM (direct-entry midwife) is a homebirth attending midwife -- not an untrained one.


Posted by: oudemia | Link to this comment | 08-11-10 1:38 PM
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92 was me. I typed in the wrong box.


Posted by: heebie-geebie | Link to this comment | 08-11-10 1:38 PM
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I typed in the wrong box.

Which, as it turns out, is not effective birth control.


Posted by: apostropher | Link to this comment | 08-11-10 1:40 PM
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Dsquared is here! Let's go through the catch-phrase routine!


Posted by: heebie-geebie | Link to this comment | 08-11-10 1:40 PM
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Over half our lives are spent doing things which are not effective birth control.


Posted by: heebie-geebie | Link to this comment | 08-11-10 1:41 PM
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93: But see the new metastudy referred to in 63. It seems like a peculiar enough result offhand that I'm not putting a lot of weight on it, but it's there.


Posted by: LizardBreath | Link to this comment | 08-11-10 1:42 PM
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94: I'm pretty sure DEM means 'not-a-nurse' (although 'untrained' was wrong -- they might have any sort of training, just not a nursing degree). You wouldn't call a CNM (certified nurse midwife) a DEM because they were attending a homebirth.


Posted by: LizardBreath | Link to this comment | 08-11-10 1:44 PM
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Also, I think the last paragraph of the post is being under-exclaimed-upon. She was strapped down to her bed! In the 70s!


Posted by: heebie-geebie | Link to this comment | 08-11-10 1:46 PM
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101: Did they think she would get up and leave otherwise? Was it in case they needed to perform an exorcism?


Posted by: LizSpigot | Link to this comment | 08-11-10 1:50 PM
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It's certainly worthy of exclamation. Man, I would have wanted to hurt someone for doing that to me.


Posted by: LizardBreath | Link to this comment | 08-11-10 1:51 PM
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101: It happened to Betty Draper! (Although I watched that scene with my mother, who had children at that same time, and her reaction to Betty's being tied down and gassed against her will was "Oh, bullshit" -- so I guess that isn't what they did to her.) She had the same reaction to the scene where Peggy is at the gynecologist with her legs up, while the gyno does her internal with a cigarette hanging out of his mouth and more or less blowing smoke up her twat.


Posted by: oudemia | Link to this comment | 08-11-10 1:52 PM
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Heh. In 1971, Mom had an unmedicated childbirth with me (in a hospital), wandered out to the nurse's station to bum a smoke, and then went back to bed to drop ashes on my head as she figured out breastfeeding. It was a simpler time.


Posted by: LizardBreath | Link to this comment | 08-11-10 1:55 PM
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1971! It was a very good year for birthing.


Posted by: Moby Hick | Link to this comment | 08-11-10 1:58 PM
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106: Merely the compromised second draft of 1970.


Posted by: oudemia | Link to this comment | 08-11-10 2:01 PM
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101: That really is pretty shocking. I would not have thought you could get away with that past, oh, about 1965.


Posted by: Bonsaisue | Link to this comment | 08-11-10 2:02 PM
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The study on neonatal death looks to me to be perfectly plausible but a great example of the difference between statistical and clinical significance. I know a little bit of how I speak here, as I've been about as close to neonatal death as it's possible to get without losing a baby. My oldest daughter went blue when she was five days old; she is, as far as I know, still the holder of University College Hospital's "dead on the resuscitation table" record, at nine minutes 35 seconds, with no brain damage whatever[1]. If we had been half an hour's drive from the hospital, she would have been dead for certain; conversely if she had happened to be in a hospital (say, because her mother was recovering from a Caesarian), there would have been vastly less drama. In general, at any given moment as a neonate, you're probably safer the closer (geographically and institutionally) you are to a paediatric intensive care unit.

But, deaths of born-healthy neonates in the first week are very rare indeed. It's an extremely unusual occurrence (as opposed to something like prostate cancer which millions of people get, meaning that even a small reduction or increase in risk is very important). Once you've honed down to the specific category where the risk ratio is high enough to be significant, the absolute number of cases is very small.

And at the end of the day, at some point the baby can't stay in the hospital forever, even if it is safer there. After the experience with Lucretia, we were perhaps understandably a little bit edgy about the birth of Ulrike, but after five days with the most absurdly (in retrospect) trivial case of jaundice, we realised that if we didn't express a preference, it would be quite possible for her to reach adulthood in the incubator-cot, twenty four hours of observation at a time. The doctors were visibly grateful when we raised the possibility of going home and letting the last bits take care of themselves.

[1] thanks very much, UCH, we'll never forget it.


Posted by: dsquared | Link to this comment | 08-11-10 2:05 PM
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I would have wanted to hurt someone for doing that to me.

Hence the straps, psycho.


Posted by: apostropher | Link to this comment | 08-11-10 2:05 PM
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Huh, I'd missed that you'd had a third kid. Belated congratulations.


Posted by: LizardBreath | Link to this comment | 08-11-10 2:06 PM
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Thanks. We actually went to the Great Ormond Street summer party for a few years, but we had to stop going because it was just unseemly; the whole thing was set up around helping these amazing but horribly unfortunate parents and children to cope with the hand they'd been dealt, and there was our little one, leaping around and squealing to be tickled. It really does make you think.


Posted by: dsquared | Link to this comment | 08-11-10 2:11 PM
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Yep. Thinking about serious illness or injury for my kids is one of the few things that worries me enough that I get superstitious. But we've been lucky so far.


Posted by: LizardBreath | Link to this comment | 08-11-10 2:19 PM
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In addition to the "doctors do something unnecessary and kill you" risk of being in a hospital mentioned in 93, there's also the "hospitals are sources of really really nasty diseases" issue. It's not obvious that being in a hospital is safer, and certainly it's not obvious enough that I'd disregard empirical evidence to the contrary.


Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 08-11-10 2:37 PM
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114 is true. Tonks, who comments here occasionally, blogged about coming home from the hospital with their third child and two nasty cases of MSRA infections. Months of bleaching bathrooms and kids to get rid of it.


Posted by: heebie-geebie | Link to this comment | 08-11-10 2:40 PM
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I keep misreading the post title as "A snack for lobsters" and picturing little cartoon lobsters snacking down on some Cheetos or something.


Posted by: Stanley | Link to this comment | 08-11-10 2:45 PM
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Or maybe you're the only one who got it.


Posted by: heebie-geebie | Link to this comment | 08-11-10 2:47 PM
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I knew it! And the Cheetos keep getting all soggy, and it's all a metaphor. A metaphor about the gift that is life.


Posted by: Stanley | Link to this comment | 08-11-10 3:13 PM
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101: So what was their purported reason already? In case of hysteria?


Posted by: Minivet | Link to this comment | 08-11-10 3:30 PM
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That was before epidurals, mostly, wasn't it? They might actually have been worried about weird violent reactions to sedation.


Posted by: LizardBreath | Link to this comment | 08-11-10 3:32 PM
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dsquared, while you're here, care to riff on Naomi Campbell and Charles Taylor? Or rubies and Burma? I get a lot of mileage out of your conflict diamonds bit, with all my friends trying to get themselves married and all.


Posted by: k-sky | Link to this comment | 08-11-10 3:32 PM
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I think it was one of those things where they've got a big institutional room of women in twin beds, each strapped down and in labor. "We couldn't unstrap you without the rest of the ladies getting jealous. You understand, of course" is how I imagine the question going.


Posted by: heebie-geebie | Link to this comment | 08-11-10 3:34 PM
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That was before epidurals, mostly, wasn't it?

I asked that to Mom at one point, and she thought they were pretty common at the time. I don't know if she received one or not. I know both #2 and #3 (me) were precipitous, and so they were definitely unmedicated.


Posted by: heebie-geebie | Link to this comment | 08-11-10 3:37 PM
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Here's a page saying epidurals got common in childbirth in the 1970s. I bet it was an (insane) response to having a ward full of laboring women that were sedated heavily enough to be at risk of doing something ill-judged, without enough medical personnel around to keep things secure.


Posted by: LizardBreath | Link to this comment | 08-11-10 3:43 PM
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I was born in 1970 and my mum had back labour and kept getting up to walk around and that didn't go down well. She had my brother in 1972 at home - had to change GP for that as her original one refused to be involved.


Posted by: asilon | Link to this comment | 08-11-10 3:43 PM
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Also, it seems off-handedly consistent that Walter Reed Army Hospital would not be cutting edge with the humane labor and delivery methodology. Mom chalks it up to Walter Reed being about two decades behind the times.


Posted by: heebie-geebie | Link to this comment | 08-11-10 3:52 PM
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122: My mother was induced in a big institutional room of women in twin beds, in a military hospital, in 1969. Everyone due Sat-Mon was induced on Friday morning so the doctors wouldn't have to come in over the weekend. She doesn't think much of this plan.

Don't know if she was strapped down.

I want to second the reminder that hospitals are dangerous places to be, so that spending time there adds some risks you don't face at home. None of my medical-professional relatives like going to the hospital if it can be avoided, but all of them like living within a few hours from a really good one for the times when it can't be avoided.


Posted by: clew | Link to this comment | 08-11-10 4:16 PM
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109: It was nothing as dramatic or prolonged as dsquared's incident, but we had a nasty breathing-stopping fright with my youngest due to RSV at just a few days of age. Of course, he had been at home by then (although had literally just arrived back at the hospital when it got really bad)--maybe he was exposed at the hospital, but RSV is so widespread at that time of year (my two-year old came down with a much milder case at the same time) that location was probably not relevant. It did leave me a little more prone to just get going to the hospital than my own natural inclinations would call for, and we also had a bit of an, "OK, crisis over, it's really basically just a normal bad cold now and everyone can go home now, right? We all agree, right?" dance with the hospital and doctors on the back end.

Other than being a goopy, phlegmy crying mess for a number of months during which he became affectionately known as "the baby from hell" (and which indirectly led to me becoming a hockey fan), he seems to have suffered no long-term effects.


Posted by: JP Stormcrow | Link to this comment | 08-11-10 4:25 PM
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Whoops. I just had drinks with a doctor friend and totally forgot to bring up this thread, which I had intended to do. It's not her specialty anyway, I guess (she does radiology stuff). My bad, internet friend people.


Posted by: Stanley | Link to this comment | 08-11-10 9:18 PM
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Anecdata: my mom delivered her last two babies out of the hospital - one at home, one in a fancy hotel (we lived too far from a hospital for comfort that time). The former had the prolapse mentioned above, but the truly excellent midwife recognized the situation, made my mom stop pushing, and cut the cord mid-delivery. He was gray when he made it out, but he made it.

My complaint on the hospital delivery scene is trivial compared to the travails of the deliverers, but I'll complain anyway. I found that the aftercare for fathers was, in a word, pathetic. After my wife's emergency c-section, I was in shock. Shakes, nausea, blurred vision, cloudy thinking, all that good stuff. The most love I got from the after-care nurses was a packet of saltines and a cup of water.


Posted by: dob | Link to this comment | 08-11-10 9:25 PM
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dquared!

Congrats on the new dictator in training.


Posted by: rob helpy-chalk | Link to this comment | 08-11-10 9:51 PM
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Even though the risks might be equal in magnitude, given that home delivery is an unusual choice the self-blame involved in any bad outcome might be considerably worse.


Posted by: Eggplant | Link to this comment | 08-11-10 9:54 PM
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83: Heh. Ung's gf is planning a home water birth in their bathtug. She also is not vaccinated.


Posted by: Di Kotimy | Link to this comment | 08-11-10 10:28 PM
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Wait. UNG is having another kid? Has this already been discussed?


Posted by: Parenthetical | Link to this comment | 08-11-10 10:42 PM
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Wait. UNG has a bathtug? My stupid stationary bath won't pull anything.


Posted by: Moby Hick | Link to this comment | 08-11-10 10:44 PM
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Good for home births and for combining your commute with the morning shower.


Posted by: teraz kurwa my | Link to this comment | 08-11-10 11:35 PM
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re: home births

When my brother was born, if it had been a home birth my mother would certainly have died.* Mere anecdote, but I suspect it's enough for me to want to push for a hospital birth in most circumstances.

* and this was kid no. 3, where the previous labours had been quick and problem free.


Posted by: nattarGcM ttaM | Link to this comment | 08-12-10 12:31 AM
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And congratulations to dsquared above on the new baby.


Posted by: nattarGcM ttaM | Link to this comment | 08-12-10 12:46 AM
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I had a bathtug when I was about three or four. It was made from a solid block of wood painted blue and yellow with a red funnel. It was one of my favourite toys.

and this was kid no. 3, where the previous labours had been quick and problem free.

Any labour can go wrong. In the bad old days women could have any number of trouble free deliveries and then it would all go to shit. My grandmother lost her fourth baby in some perinatal situation that was never explained to me.


Posted by: chris y | Link to this comment | 08-12-10 1:10 AM
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Also, I'm pleased to see dsquared multiplying. If there's still a country by the time they grow up they can take over the economics profession and knock some sense into it.


Posted by: chris y | Link to this comment | 08-12-10 1:11 AM
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Also, another piece of anecdata, when I was readmitted for the second time due to fuckups with my thryoid surgery, they thought I might need an emergency operation. So they kept me nil by mouth for somewhere between 48 and 72 hours. Fuckers only started giving me a drip after I complained for about the 10th time, on, iirc, the Thursday morning, that I hadn't eaten or drunk anything since I'd been admitted on the Tuesday afternoon.

So I can empathise.

It's quite a good form of rapid weight loss, though...


Posted by: nattarGcM ttaM | Link to this comment | 08-12-10 1:13 AM
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If it wasn't for socialism, you could have gotten the drip faster.


Posted by: Robert Halford | Link to this comment | 08-12-10 1:22 AM
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They won't give you anything to drink, IME, when you come round from a general anaesthetic either, which is when you're thirstier than you thought possible.


Posted by: chris y | Link to this comment | 08-12-10 1:24 AM
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||

Do we have to support this candidacy, then?

After initially denying the allegations, Arizona House candidate Ben Quayle (R), son of former vice president Dan Quayle, admitted on Tuesday that he used to post comments on a Web site called "Dirty Scottsdale" several years ago, Politico reports.

The site's founder, Hooman Karamian, alleged in a Monday post on TheDirty that Quayle was "one of the original contributors" to the site, which featured sexy photos of women and "chronicled the city's clubs and nightlife and [was] the predecessor to the popular gossip website TheDirty.com."

Karamian said Quayle posted under the name "Brock Landers," an apparent reference to the fictional sidekick to porn star Dirk Diggler in the film "Boogie Nights." Quayle had a featured section on the site, Karamian said, called "Brock's Chick," in which he sought to "find the hottest chick in Scottsdale." He added that "Without Ben, there would be no TheDirty.com." Quayle acknowledged Tuesday that he did contribute to the site in an interview with Phoenix's 12 News.

|>


Posted by: chris y | Link to this comment | 08-12-10 2:14 AM
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re: 143

I last had a general only about 2 or 3 weeks ago, and, I think I got to drink quite soon after. Certainly within half an hour. Although I imagine it may vary depending on what they were doing.


Posted by: nattarGcM ttaM | Link to this comment | 08-12-10 3:11 AM
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I suspect both the time before you get a drink and how thirsty you are may depend on how long you're under. Unfortunately they both seem to vary in in a direct relation.


Posted by: chris y | Link to this comment | 08-12-10 3:16 AM
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Wait. UNG is having another kid?

His gf is under that impression, anyway. And she has very comprehensive plans. But, no, she's not pregnant (to my knowledge) or anything. I rather suspect UNG is stringing her along on this point, actually. But if they really do, I guess it will be born in a bathtub and then never vaccinated.


Posted by: Di Kotimy | Link to this comment | 08-12-10 3:59 AM
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87: the striking difference between 2007 and 2010 is that dsquared tends not to say things like "I also of course have a banker's natural suspicion of anyone who doesn't appreciate the premium applied to things which pay off right now and more or less for certain over things which pay off maybe, at some point in the future" in 2010.

Things like "as a banker, I have a much clearer understanding of the superiority of an immediate payoff over a possible future benefit" don't sound quite so good nowadays.


Posted by: ajay | Link to this comment | 08-12-10 4:00 AM
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I last had a general only about 2 or 3 weeks ago, and, I think I got to drink quite soon after.

I thought a cigarette was customary.

148.last: Bankers have done pretty well on the immediate payoff front. Shareholders, governments, etc., not so much.


Posted by: Not Prince Hamlet | Link to this comment | 08-12-10 12:16 PM
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And yay return of dsquared!


Posted by: Not Prince Hamlet | Link to this comment | 08-12-10 12:16 PM
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I'm a labor and delivery nurse in Manhattan at a hospital with a c/sec rate of about 40%, and my children were born at home.

We do indeed get babies out within 8 minutes due to fetal heart rate decelerations. Those babies almost always have APGARs of 9/9, indicating that we are miracle workers and saved the babies from certain death. Or, the "decels" picked up on the monitor weren't diagnostic of any problem affecting the baby's need for resuscitation at birth.

I say almost, because sometimes the doctor doesn't cut the skin incision long enough and they can't get the baby out easily. Those babies don't do as well. This usually happens with patients the doctor likes, because a smaller incision is considered preferable cosmetically.

Yes, that's right, your doctor might not like you.


Posted by: Shamhat | Link to this comment | 08-12-10 4:23 PM
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Lies! My doctor loves me!


Posted by: Di Kotimy | Link to this comment | 08-12-10 5:24 PM
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Hee. After posting that comment my dear-old-friend who-is-now-a-doctor-and-who-way-back-when-I-shot down-because-I-was-already-involved-with-UNG-even-though-I-really-adored-the-doctor sent me a friend request on FB. My doctor really *does* love me!


Posted by: Di Kotimy | Link to this comment | 08-12-10 7:31 PM
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