Re: Guest Post: Some thoughts on childbirth and death

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I assume these facts coupled with the lack of literacy lead to the frequent reinvention of heterosexual sodomy.


Posted by: Moby Hick | Link to this comment | 09- 9-19 9:15 AM
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Interesting how badly medicine overreached itself there. I wonder how MDROs and outpaient care will interact with class in future.


Posted by: Mossy Character | Link to this comment | 09- 9-19 9:54 AM
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What a lovely post, thanks Nworb!

I've been interested in how badly early European medicine affected maternal mortality for some time-- I've wanted to know how harmful in aggregate it was to confine pregnant mothers to a bed and only on their backs, but hadn't found a study that tries to assess that. The detailed link looks fantastic, I'll save it and try propagating citing papers from there.

If anyone's interested in looking now, here.

Also I'd be very interested in any discussion of the intersection between medicine and midwife delivery in Greek or Arabic medical traditions.


Posted by: lw | Link to this comment | 09- 9-19 11:43 AM
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One of the interesting bits of Betan technology in Lois McMaster Bujold's Vorkosigan Saga is the uterine replicator, an artificial womb where embryos can grow until birth. It gets pretty strongly suggested that this is an important reason why Beta is a much more egalitarian society, as opposed to the patriarchal history of Barrayar.


Posted by: Dave W. | Link to this comment | 09- 9-19 11:50 AM
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4: Came here to say this--if you're going to talk about speculative fiction considering a future where women are freed the horrors of childbirth, Bujold has to be mentioned. I'd go so far as to say that the uterine replicator is the entire point of the series (of more than a dozen books). Most of the books focus on some specific aspect of society these devices change--usually framed in the context of some wacky adventure, but, hey, that's genre fiction for you. I binged the Vorkasigan books a few years back, and stepping out of them gave me an usual sense of loss--access to this technology would solve so many problems, but for now it's just an increasingly plausible dream.


Posted by: dalriata | Link to this comment | 09- 9-19 12:27 PM
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I thought of Bujold but I didn't know if the reference would be widely picked up. Should have realised, with this crowd.


Posted by: NW | Link to this comment | 09- 9-19 12:56 PM
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I've wanted to know how harmful in aggregate it was to confine pregnant mothers to a bed and only on their backs,

Are you thinking about when women are put on bedrest, or during L&D itself? I am very curious about both questions.


Posted by: heebie-geebie | Link to this comment | 09- 9-19 1:09 PM
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Labor and delivery. Much less likely to be confined to bed if you were too poor to have your own bed and own room, midwives much less likely to confine than doctors. Of course there are no records, and no real way to disentangle this part of delivery from malnutrition and availability of clean water.

Even in the US, hospitals were more like poorhouses than clinics at the turn of the 20th century, professionalization of medicine was a fairly recent development. Semmelweis was destroyed by his colleagues in 1865.


Posted by: lw | Link to this comment | 09- 9-19 1:41 PM
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In 1930, differences in maternal mortality rates between countries were large: rates ranged from 250 deaths/100000 births in the Netherlands to ≈700 deaths/100000 births in the United States (Figure 4). By 1950, the rates in all countries were similar and by 1960 they were almost the same, ≈60/100000 births.
Where the standard economic story over that same period is convergence toward a standard set by the USA. The Third-Worldish unevenness of America in general is really interesting. (Or, rather, the evenness of other developed countries is interesting.)


Posted by: Mossy Character | Link to this comment | 09- 9-19 3:07 PM
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Why wash your hands before delivering a baby? They're just going to get dirty right away.


Posted by: Opinionated Doctor | Link to this comment | 09- 9-19 3:15 PM
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why did maternal mortality rates remain on a high plateau, albeit with spikes and troughs, from the 1850s to the mid-1930s although overall mortality, infant mortality, and mortality due to infectious diseases had started to decline by ≈1890-1900 (7)? These well-known demographic transitions are confidently attributed to a general rise in the standard of living emerging from better hygiene, better housing, better nutrition, and better general health, and are not accredited to medical care. If the above is true, why had these very factors failed to reduce maternal mortality rates between 1900 and 1935? [...] Historical data show that maternal mortality rates were lowest for home deliveries undertaken by trained and supervised midwives with no exceptions. [...] High maternal mortality was substantially reduced only by providing high-quality maternal care by the standards of the time, not by improving the diet. [...] The main factors that led to this decline seem to have been successive improvements in maternal care rather than higher standards of living.
All of which suggests that poor countries today can get a long way toward the demographic transition just by better obstetrics (which we know how to do) even without solving the middle-income trap (which we don't). Which it turns out is totally happening already, old news. Nevermind, carry on.


Posted by: Mossy Character | Link to this comment | 09- 9-19 3:44 PM
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Re: Heebie's take and abortion

I remember once in a dicussion at LG&M, CassandraLeo (I think it was) noted that the risk calculus around abortion that was used to decide the cutoff date (end of second trimester) has changed dramatically. At the time, it was chosen based on "is it riskier for the mother's health to abort, or to continue?" And as it turns out, the risk to mother's health from abortion, has gone down and down and down, where the risk for continuing to delivery, hasn't dropped anywhere near as much.

In short, it's even more indefensible to prohibit pre-extrauterine-viability abortions, then it was when Roe v. Wade was decided.


Posted by: Chetan Murthy | Link to this comment | 09- 9-19 7:42 PM
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I'd go so far as to say that the uterine replicator is the entire point of the series (of more than a dozen books).

I wouldn't maybe go quite that far but it is certainly a very important bit of technology and critical to the plot of several of them: and pretty much all the Vorkosigan books have the effect of technology on reproduction as an important plot element in some form. Barrayar, Cetaganda, The Mountains of Mourning, Brothers in Arms, Mirror Dance, Labyrinth, Komarr, A Civil Campaign, Diplomatic Immunity, Gentleman Jole, and (in a more minor role) The Warrior's Apprentice.


Posted by: ajay | Link to this comment | 09-10-19 1:51 AM
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My friends at NARAL asked me to tell you what it was like before Roe vs. Wade. They asked me to tell you what it was like to be twenty and pregnant in 1950 and when you tell your boyfriend you're pregnant, he tells yuo about a friend of his in the army whose girl told him she was pregnant, so he got all his buddies to come and say, "We all fucked her, so who knows who the father is?" And he laughs at the good joke.

They asked me to tell you what it was like to be a pregnant girl--we weren't "women" then--a pregnant college girl who, if her college found out she was pregnant, would expel her, there and then, without plea or recourse. What it was like, if you were planning to go to graduate school and get a degree and earn a living so you could support yourself and do the work you loved--what was it like to be a senior at Radcliffe and pregnant and if you bore this child, this child which the law demanded you bear and would then call "unlawful," "illegitimate," this child whose father denied it, this child which would take from you your capacity to support yourself and do the work you knew it was your gift and your responsibility to do: What was it like?


Posted by: Opinionated Ursula K. Le Guin | Link to this comment | 09-10-19 2:40 AM
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I have a faint faint memory of Pepys sleeping with servants instead of his wife because he was afraid of the risk to his wife's health. Was it actually Donne? Or was Donne faithful (and his wife dead of bearing)?


Posted by: clew | Link to this comment | 09-10-19 12:29 PM
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That's a pretty good rationalization.


Posted by: Moby Hick | Link to this comment | 09-10-19 12:37 PM
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Pepys. Certainly not Donne. But Pepys's wife did not, for some reason, appreciate his solicitude.


Posted by: NW | Link to this comment | 09-10-19 1:16 PM
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If you pick the maid who is only 18, it's utilitarian because birth is safer when the mother is that after


Posted by: Moby Hick | Link to this comment | 09-10-19 1:22 PM
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After s/b age.


Posted by: Moby Hick | Link to this comment | 09-10-19 1:23 PM
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After s/b age.


Posted by: Moby Hick | Link to this comment | 09-10-19 1:23 PM
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6: That didn't stop you from name-dropping Mary_Midgley? I hadn't heard of her, but I like that she was apparently mean to Richard Dawkins.


Posted by: politicalfootball | Link to this comment | 09-10-19 1:44 PM
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Midwives still have better outcomes for low-income women and WOC than hospitals. With non-poor white women, self-selection makes it too hard to say anything with certainty, but Medicare recipients at birth centers have comparable outcomes to private insurance clients at hospitals (in case it's not clear, those are very reliable proxies for low- and high-income). Medicare recipients at hospitals have much worse outcomes than the privately-insured.

I know there's a much more interesting psychological discussion to be had, but I need to go oversee dinner.


Posted by: JRoth | Link to this comment | 09-10-19 4:31 PM
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Midwives still have better bumperstickers.

My siblings and I were all delivered by midwives, which was pretty controversial at the time. I am a fan.


Posted by: Witt | Link to this comment | 09-10-19 4:59 PM
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Should that be Medicaid?


Posted by: Mossy Character | Link to this comment | 09-10-19 5:00 PM
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I am a Medicaid?


Posted by: Moby Hick | Link to this comment | 09-10-19 5:07 PM
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Are you ok?


Posted by: Mossy Character | Link to this comment | 09-10-19 5:11 PM
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Probably.


Posted by: Moby Hick | Link to this comment | 09-10-19 5:17 PM
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Probably enough to get private insurance?


Posted by: Mossy Character | Link to this comment | 09-10-19 5:23 PM
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Because apparently you should get that before giving birth.


Posted by: Mossy Character | Link to this comment | 09-10-19 5:24 PM
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30

I have nice private insurance.


Posted by: Moby Hick | Link to this comment | 09-10-19 5:26 PM
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She was a wonderfully lively and witty philosopher. I suppose she was there because I wanted in a bloggish way to explain how I came to think about these things.


Posted by: NW | Link to this comment | 09-11-19 11:12 AM
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I'd go so far as to say that the uterine replicator is the entire point of the series

I don't think you can easily support that reading. She's clearly interested in exploring the roles of disability and privilege in society also, at least as it starts. Not the only series she goes there, either.


Posted by: | Link to this comment | 09-11-19 12:06 PM
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I hate Dawkins, but I also hate people who use the word "scientism". Maybe I hate everyone? Except for the people at Marvel Studios for making hours of fine entertainment.


Posted by: Walt Someguy | Link to this comment | 09-11-19 12:26 PM
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I like "scientician".


Posted by: Moby Hick | Link to this comment | 09-11-19 12:27 PM
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New Scientist this week is advertising a cruise round Hawaii with Richard Dawkins: you too could pay £9,000 to be locked on a boat for a fortnight with a bunch of Dawkins superfans, including, if you count the man himself, his superest fan of all. I don't know if there's a discount for booking early.


Posted by: NW | Link to this comment | 09-11-19 1:49 PM
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I can save the money and just put needles in my eyes.


Posted by: peep | Link to this comment | 09-11-19 1:56 PM
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You could probably do the National Review cruise for cheaper pain.


Posted by: Moby Hick | Link to this comment | 09-11-19 1:59 PM
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I think the replicators are to some extent a McGuffin. Nothing actually goes wrong with or inside them. The central plot development is after all the poisoning of Miles in the womb, not in a replicator.

There is the delivery in replicators of all the raped women's foetuses in Barrayar itself, which is an occasion for Aral Vorkosigan to Get Shit Done. I think it's implied that all the raped prisoners who became pregnant, or most of them, handed the babies over rather than aborting them: the replicators do in this sense sidestep the Judith Thompson violinist problem in that the mother can be entirely free of the foetus without killing it. But that point is not developed or dwelt on.

Pregnancy, motherhood, and family are all absolutely central to the stories. But the reproductive technology which drives plots is surely the kinds of evil genetic work on Jackson's Hole, and, to some extent, the plagues from Cetaganda, though they are largely indistinguishable from magic and I never entirely grasped just what was so genetically wonderful about the Haut.


Posted by: NW | Link to this comment | 09-11-19 2:00 PM
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36: Most people don't have what it takes to stick needles in their own eyes. That's why you need to leave it to professionals! On a cruise! How fun!


Posted by: Walt Someguy | Link to this comment | 09-12-19 2:08 PM
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Bujold's last few Barrayar books have about turned me off the whole series, because they read to me to be tripling down on "Egalitarians find it easy to move to an aristocracy as long as they get to be the aristocrats" (something Cecelia says early when one could think she was still critical of aristocracy, though even then narrativium meant she never had to *lose* anything to demonstrate her egalitarianism.)


Posted by: clew | Link to this comment | 09-12-19 2:23 PM
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That is a reasonable criticism of what I have always thought was the greatest weakness of the books - their increasing unrealism about what an autocracy is actually like. The egalitarian-Beta aspect which is so prominent in the beginning fades to almost nothing; the regent is wise and just and ready to give up his power; the Good Tsar never acts unjustly; two out of the three men in charge of the secret police turn out to be really incorruptible ... and so on. But there is so much wit and verve that I'll keep reading. I think of Bujold as a master of bas-relief: she somehow makes three dimensional characters appear from entirely generic and unconvincing backgrounds.


Posted by: NW | Link to this comment | 09-12-19 10:58 PM
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35. They ought to pay you to go. Serious money.


Posted by: chris y | Link to this comment | 09-13-19 5:23 AM
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