[HN Gopher] Immediate skin-to-skin contact with unstable newborn...
       ___________________________________________________________________
        
       Immediate skin-to-skin contact with unstable newborns improves
       survival chances
        
       Author : billyharris
       Score  : 314 points
       Date   : 2021-05-27 07:48 UTC (15 hours ago)
        
 (HTM) web link (medlifestyle.news)
 (TXT) w3m dump (medlifestyle.news)
        
       | alexmr wrote:
       | We had a preemie baby at 26 weeks in December and feel fortunate
       | our hospital (UCSF) practiced this recommendation. I was
       | surprised they could do kangaroo care that fast (was a few hours
       | after birth), but we did it then and everyday our daughter was in
       | the ICN for 4 months. I'm convinced it made a difference and am
       | sad when I hear about parents who can't do this.
       | 
       | I hope this research helps this become more standard practice.
        
       | locusofself wrote:
       | Not getting skin-to-skin contact with our daughter (and only
       | child we will have) for several days because of very minor
       | complications is something we really resent.
        
       | philliphaydon wrote:
       | Home birth, natural, c-sect, whatever works for you to have a
       | happy healthy baby.
       | 
       | We had c-sect under GA, as my wife was scared of birth and
       | c-sect, so we opted for GA. So there wasn't even an option for
       | skin to skin, or me to even be in the room during the procedure.
       | 
       | But our daughter came out happy and healthy. Wouldn't change a
       | thing.
        
       | moonbug wrote:
       | Based on this, expect US hospital prices for that service to go
       | up.
        
         | LibertyBeta wrote:
         | Who charges? We just had our second and they didn't charge at
         | all. Gave the nurses/midwives a chance to make more ready.....
         | 
         | And this was at Major CT Hospital.
        
           | sodality2 wrote:
           | The hospital may charge for this due to someone needing to
           | stay and monitor you and the baby while you hold them.
           | Ridiculous charge, certainly very rare, but that is typically
           | the justification given
        
         | joana035 wrote:
         | It should not be charged at all IMHO. And it should be a right
         | of the parents to hold their newborn in the moment they enter
         | this world.
        
           | e1g wrote:
           | OP was being sarcastic. "Skin-to-skin" contact with mum is
           | the very first thing they do after child birth, and continue
           | recommending for the entire stay.
        
             | tsjq wrote:
             | there's a lot of stories / examples about this an item in
             | the hospital bills .
        
               | [deleted]
        
               | e1g wrote:
               | You might be thinking of one story that went viral a few
               | years ago, and was amplified by the media. It was
               | successful at generating outrage and so became popular,
               | but it was not correct.
        
               | nicoburns wrote:
               | It would only be one of many ridiculous charges in the US
               | medical system. I personally think it's pretty outrageous
               | that one has to pay for medical care while giving birth
               | at all.
        
               | jaywalk wrote:
               | So the doctors and nurses involved should just deliver
               | babies for free? Does the free care apply only to
               | standard births, and then they get paid if there are
               | complications? Or is anything involving the delivery plus
               | anything arising from it provided for free?
        
               | wizzwizz4 wrote:
               | The central bank prints money (partially offset by tax).
               | Some of that money could go to basic medical care like
               | this, as it does in most other countries.
        
               | jaywalk wrote:
               | We're currently seeing exactly what happens when the
               | central bank money printer goes into overdrive, which is
               | rising inflation. Maybe we shouldn't be encouraging that.
        
               | nicoburns wrote:
               | Taxation funded healthcare seems to work pretty well. It
               | allows you to avoid the situation where individuals pay
               | significantly more due to bad luck with their health.
               | Plus you get to cut out the insurance companies' cut
               | completely.
        
               | Tabular-Iceberg wrote:
               | Some of the countries that implement universal healthcare
               | could actually use some increased inflation. So it
               | doesn't seem like a real concern in practice.
        
               | DangitBobby wrote:
               | They do actually charge for supervised skin-to-skin
               | contact after a C-section [1].
               | 
               | 1. https://www.cbsnews.com/news/doula-explains-why-
               | hospital-cha...
        
           | baliex wrote:
           | IYHO?! It's patently absurd to expect anything less
           | 
           | Edit: I'm agreeing with you but it seems absurd that it
           | should have to be opinion!
        
         | isolli wrote:
         | You're joking, but my wife gave birth to our first-born in the
         | US, and she had to wait several hours until she could hold her
         | baby because... the transportation team (whose job was to roll
         | her bed to the elevator) was unavailable due to a change-of-
         | shift.
        
         | awestroke wrote:
         | Do you have to pay to hold your newborn in the US? Land of the
         | free indeed
        
           | wyager wrote:
           | Medical is probably the single most regulated industry in the
           | US. The US landed at the worst possible system where the
           | government mostly only pays for medical for old people (where
           | the returns on expenditures are very low), but simultaneously
           | interferes a lot with hospitals and insurance in ways that
           | make the process very punishing for everyone.
           | 
           | You can get much better service for way less money if you
           | avoid the red tape and do a home birth.
        
             | PragmaticPulp wrote:
             | > You can get much better service for way less money if you
             | avoid the red tape and do a home birth.
             | 
             | My wife had unexpected complications that would have been
             | disastrous, possibly fatal if we had been at home rather
             | than a hospital for delivery. I can't imagine trying to
             | rush her from home to the hospital mid-delivery.
             | 
             | I'm forever grateful for the medical care we received at
             | the hospital during delivery. It's simply not possible to
             | deliver the same care at home.
        
             | aidos wrote:
             | We've had 2 home births now. And the 1st birth was nearly a
             | homebirth too.
             | 
             | They've all gone well for us, so I recommend them from that
             | point of view, but on the other hand, I don't recommend
             | them because I'd hate to have any hand in a situation that
             | went wrong for someone else.
             | 
             | Our last we actually delivered on our own because the
             | midwifes didn't get to us in time.
        
               | okprod wrote:
               | Very interesting. A coworker hired a professional doula
               | and their home birth went well. I'm not sure yet what we
               | would do.
        
               | choeger wrote:
               | While home birth is certainly possible and apparently can
               | be a very nice experience, I strongly suggest going into
               | a hospital for birth (you should be able to choose a
               | hospital of your liking after talking to the
               | nurses/doctors/midwifes working there). Birth is safe in
               | most cases, but complications _do_ happen. While the
               | probability is low, the possible damage is extreme.
               | Please consider the availability of experienced medical
               | professionals as a safety net for mother and child! I
               | witnessed an  "emergency" C-section after 18hours of
               | labor without any prior indications and was extremely
               | happy that professionals were literally in the next room
               | when this became necessary.
        
               | jmkd wrote:
               | As a counterpoint, home births are in general very safe
               | if recommended prerequisites have been met. Typically: 1)
               | low-risk pregnancy 2) within X minutes of suitable
               | hospital 3) higher level of monitoring in late pregnancy
               | and perhaps two midwives at birth
               | 
               | Birth - a natural process - has been commercially
               | medicalised, especially in Brasil (C-section rate >60%)
               | and the US (>30%). If giving birth at home was
               | normalised, we'd see a huge growth in natural birth and
               | an increased availability for medical staff to support in
               | emergencies if required. But the rates of emergencies
               | would actually decline too.
        
               | bredren wrote:
               | Point 1 is a big point. Lots of things make a birth not
               | "low risk."
               | 
               | Otherwise I think it's an awesome idea and encourage
               | people to consider it.
               | 
               | Birthing centers are also a great alternative. I do not
               | especially like the idea of hospitals as default places
               | of birth, but acknowledge the potential value when
               | needed.
        
               | souprock wrote:
               | I probably wouldn't have most of my family if I'd gone to
               | a hospital. My twins would have been a C-section, and
               | then the scar would have led to another C-section and to
               | troubles with the placenta invading the scar. Before long
               | the uterus just plain wouldn't work OK, and would
               | endanger the lives of future babies. Avoiding a C-section
               | is really important for having a large family. My 13th is
               | due in 6 weeks.
        
           | neofrommatrix wrote:
           | Yes. For caesarean they do.
           | https://www.cbsnews.com/news/doula-explains-why-hospital-
           | cha...
        
             | frankenst1 wrote:
             | "During a caesarean, many people become shaky, nauseous,
             | uncomfortable, even faint," Grant explained. "These are
             | normal physiological reactions. In order to facilitate skin
             | to skin in the OR, an extra nurse needs to be available to
             | assist."
        
               | [deleted]
        
               | tobr wrote:
               | I don't understand how that is a "mic drop" as they put
               | it in the article. If these are normal physiological
               | reactions, why would you charge extra for it? It must be
               | the request to hold your newborn child that they consider
               | not to be normal, then?
        
               | dboreham wrote:
               | Normally the baby is whisked quickly out of the OR to a
               | place that's not a tightly controlled clean environment,
               | where skin to skin contact is facilitated without charge
               | (to the father/non-birthing-close-relative, obviously,
               | since mother is still in recovery). Source: two sons born
               | this way in the US.
        
           | Spooky23 wrote:
           | You pay for a nurse or aide to be ready to intervene if
           | there's an issue in a post-caesarean situation.
           | 
           | In our case, the hospital my wife delivered in pushed skin to
           | skin heavily, but after a minute or two, I ended up holding
           | our son, skin to skin for the next 10-15 minutes becuase
           | their policy didn't allow mom to hold the baby while they
           | sutured and did their thing. Once they were done in the OR,
           | back to mom.
           | 
           | Usually this sort of absurdity on the billing front is based
           | on ways to increase Medicaid reimbursements. Since Medicaid
           | patients are usually less likely to have good primary and
           | pre-natal care, they have a high complication rate and
           | typically are a money loser for the hospital. In an extreme
           | case, an opioid addicted baby costs >$1M to deliver and
           | discharge, a tragic story all around.
        
             | prionassembly wrote:
             | > You pay for a nurse or aide to be ready to intervene if
             | there's an issue in a post-caesarean situation.
             | 
             | We had a pediatrician in the room (which is also a
             | perfectly opportunistic for the ob/gyn to score a
             | referral). OR theater was main OB/GYN (which we chose), his
             | assistant (also ob/gyn, younger and oddly published),
             | anesthesiologist, instruments clerk and pediatrician. I
             | don't think we had a nurse at all.
        
               | cycrutchfield wrote:
               | >We had a pediatrician in the room (which is also a
               | perfectly opportunistic for the ob/gyn to score a
               | referral)
               | 
               | Can you clarify what you are implying here? Kickbacks or
               | other financial incentives are generally pretty illegal.
        
               | prionassembly wrote:
               | Sure, but recommendation based on friendship is not, nor
               | does it need to be unethical if you're convinced of your
               | friend's high level of skill.
        
               | cycrutchfield wrote:
               | Got it, thanks for explaining. The phrase "score a
               | referral" made it sound like there was some untoward
               | relationship there.
        
               | drknownuffin wrote:
               | What country were you in? In the US, a nurse is highly
               | standard.
               | 
               | If you're not getting a c-section, the usual array is:
               | OB/GYN, plus or minus a resident or assistant, doing the
               | delivery and doing any post-delivery laceration repairs;
               | and a nurse who brought in instruments and is on hand to
               | assist with repositioning the mother, getting more
               | equipment, etc. In most places it's 1-2 nurses. If
               | everything is expected to be, and remains, stable a
               | pediatrician will swing by at some point to check in.
               | This isn't generally a major source of referrals for the
               | pediatrician - (a) many people have already established a
               | relationship with a pediatrician in anticipation of the
               | birth, and (b) in many reasonably sized hospitals the guy
               | who drops by is either a hospitalist or a neonatologist,
               | and they don't have an outpatient practice.
               | Anesthesiologist may drop by to start an epidural, but
               | otherwise isn't present on a continued basis.
               | 
               | If in the OR for a c-section, you'll have the OB and a
               | resident or an assist; one nurse just looking after scrub
               | and tools; a second nurse on hand for additional
               | assistance and to receive the kid for the initial clean-
               | up; an anesthesiologist handling your anesthesia;
               | plus/minus a med student or two either holding
               | instruments for the OB or speaking with the
               | anesthesiologist. If everything is and remains stable,
               | peds will swing by. If the kid is unstable or things go
               | sideways, peds +/- their resident will be on hand for the
               | delivery - a neonatologist if the hospital has one.
               | 
               | I've seen some variation in different places of course,
               | but that's pretty much par for the course.
               | 
               | (When I was in the latter part of med school I had a
               | brief fling thinking I'd do OB/GYN, so I did sub-I's in a
               | few different hospitals around the country. Thank god
               | that idea passed.)
        
               | Spooky23 wrote:
               | > Thank god that idea passed
               | 
               | Why's that? Just curious, I always find it fascinating
               | how physicians pick a speciality!
        
               | drknownuffin wrote:
               | OB is ridiculously stressful, in an antagonistic kind of
               | way.
               | 
               | 1. A good subset of patients have wildly unrealistic
               | ideas about pregnancy and delivery, and when their ideas
               | meet reality it's not always reality that wins.
               | 
               | 1.B. You will be the target of their ire whenever their
               | desires are not fulfilled, because patients seem to think
               | docs are actually in charge of something at the hospital.
               | We usually are not.
               | 
               | 2. It's wildly litigious. Their child was perfect (in
               | their imagination) before being born; then you got
               | involved, and now their child is not perfect. You must
               | have fucked something up in the delivery and ruined the
               | perfection of their child.
               | 
               | 3. Way too much family involvement. When you're doing
               | surgery, you're usually dealing with a patient's attempts
               | to understand what's going on. When you're doing OB,
               | you're dealing with the patient, the husband, the mother,
               | mother-in-law, etc. Each person will come up with their
               | own distorted vision of how things should be, and when it
               | doesn't align with reality, the doctor is an idiot who
               | doesn't know what they're doing. (Doctors are not perfect
               | - just people - but it seems like every single person
               | without medical training seems better equipped to
               | identify the proper medical course of action than a
               | physician is.)
               | 
               | 4. Lots and lots of on-call time. Lots of unexpected
               | interruptions and lots of drop-everything-and-drive-to-
               | the-hospital.
               | 
               | 5. There used to be good money in it. There isn't now,
               | which makes all of the above grate on one's nerves.
               | 
               | The results of the above really add up to demolishing the
               | spirit of OB/GYNs. Points 1-3 really make you feel like
               | you're persistently at war with patients, which is the
               | worst feeling ever. I've never been on anyone's side but
               | the patient's, and having them treat me like an enemy
               | ruins my job, and ruins my ability to _do_ my job.
               | 
               | I ultimately chose to pursue a niche thing that shares a
               | name with an existing medical specialty, but is a
               | distinct niche. I can't really identify it without doxing
               | myself, so forgive me for not.
        
           | rootusrootus wrote:
           | Could we put aside the politics? Jeez.
        
           | gambiting wrote:
           | Wait, you have to pay to have a baby in the US?
           | 
           | The wealthiest country in the world cannot even pay for the
           | birth of its own citizens?
           | 
           | I can understand arguments for private healthcare etc....but
           | making people pay to give birth is insane.
        
             | linuxftw wrote:
             | The US spends all of it's money that should be going to
             | infrastructure and services on killing people overseas. We
             | use migrant labor to produce crops below minimum wage, so
             | large corporations can send Europe cheap produce.
        
             | rootusrootus wrote:
             | Tell me where it is completely free. And I don't mean paid
             | for via taxes.
        
               | gambiting wrote:
               | No offense, but that's such a weird way of looking at it.
               | Even in the US every reasonable adult would say that
               | driving on public roads is free, right? But roads are
               | maintained from taxes so how dare you call them free!!!
               | It's the same thing here - other countries just pay for
               | their citizens giving birth from taxes. The cost to you
               | as a citizen is zero. No it's not free, someone pays for
               | it. But I never used the word free anywhere, so I feel
               | like you want to have an argument for the argument sake.
        
               | rootusrootus wrote:
               | > every reasonable adult would say that driving on public
               | roads is free, right?
               | 
               | No? I certainly don't. I'm constantly aware of how much
               | we don't spend on roads.
               | 
               | Any conversation trashing the US for not having
               | healthcare that is free-at-point-of-sale is meaningless
               | without discussing the larger system.
               | 
               | What can I say, I get tired of Europeans trashing the US
               | using singular metrics as if they're a meaningful
               | reflection of policy.
               | 
               | You want to get into a more interesting conversation,
               | let's talk about how the US citizenry is essentially
               | subsidizing the universal healthcare that many other
               | countries enjoy. That's not some political talking point,
               | either, it's legitimate.
        
               | gambiting wrote:
               | >>No? I certainly don't. I'm constantly aware of how much
               | we don't spend on roads.
               | 
               | Let me ask this then - is there _anything_ in the world
               | you would call free, or do you avoid the word out of
               | principle?
               | 
               | >>Any conversation trashing the US for not having
               | healthcare that is free-at-point-of-sale is meaningless
               | without discussing the larger system.
               | 
               | I think you are purposefully trying to drag me into a
               | discussion about a point I didn't make, I merely
               | expressed surprise at the fact that United States of
               | America, the wealthiest nation in the world, cannot even
               | pay for the births of its own citizens. No statement
               | anywhere about healthcare as such. If you want to read
               | into it in my comment, then that's on you.
               | 
               | >>You want to get into a more interesting conversation,
               | let's talk about how the US citizenry is essentially
               | subsidizing the universal healthcare that many other
               | countries enjoy.
               | 
               | Let's have that discussion then, please, I'm curious to
               | hear your thoughts.
        
           | tialaramex wrote:
           | Sure
           | 
           | https://www.vox.com/2016/10/4/13160624/medical-bills-
           | birth-d...
           | 
           | "Skin to Skin after C-Sec" $39.95
           | 
           | [C-Sec here means Caesarean section, a relatively safe
           | surgical procedure to delivery a baby via an incision in the
           | mother's abdomen. Although mostly safe, and certainly
           | preferable to situations where vaginal delivery would incur
           | an undue risk to mother or baby, C-Section is undesirable
           | because it increases the rate of complications both that
           | time, and in any subsequent pregnancy. But it's very common
           | in the US, for a variety of reasons.]
        
             | agumonkey wrote:
             | _facepalm_
             | 
             | how long until they try to give everyone the best service
             | according to their budget. one arm holding 30$, two arms
             | 40$, full cuddle 70$
        
             | prionassembly wrote:
             | I think the whole rhetoric about C-sections needs to be
             | adjusted for a time where many older women are having
             | babies. There's a kind of narrative about optimal
             | pregnancy/childbirth/early care that seems to make sense
             | for 27-year-olds who will sneeze and squeeze out their baby
             | and shoot milk at the thought of their baby. But that's
             | increasingly not the norm.
             | 
             | More generally: declining birth rates are one of our top-
             | ten societal problems if we think 50-100 years ahead; part
             | of addressing it is changing the conversation around
             | pregnancy in one's late 30s and even early 40s. From
             | watching TV shows it would seem by age 35 your shot is
             | shot.
        
       | dools wrote:
       | Lots to be learned about the microbiome, and how vaginal birth,
       | breastfeeding and skin contact feeds that. The trend towards
       | caesarian births and formula feeding countervenes this trend in
       | health research.
        
         | ed25519FUUU wrote:
         | Everything about birth is incredible. For example it's
         | extremely common to defecate while giving birth. Oh no lots of
         | germs and bad for baby right? Actually the exposure helps
         | jumpstart the infants gut biome.
         | 
         | And in the 1930s they were trying to figure out why there's a
         | type of sugar in breast milk which the infant can't digest. Why
         | the weird evolutionary waste? It turns out these
         | oligosaccharides are there _to feed not the baby but the good
         | bacteria in the gut_. The incredible and amazing mother
         | anatomy. Amazing in so many levels.
         | 
         | https://www.nature.com/articles/d42473-018-00007-1
        
       | williesleg wrote:
       | Where's Michael Jackson and Jimmy Kimmel?
        
       | alephnan wrote:
       | Reminded me of the Behavioral Despair experiment on the
       | psychology of hope
       | 
       | https://en.m.wikipedia.org/wiki/Behavioural_despair_test
        
       | newobj wrote:
       | Is this news? This was the crunchy stuff we did when my son was
       | born ~13 years ago. It seemed like crunchy 101 then, shrug.
        
         | OJFord wrote:
         | Was your son born ' _unstable_ '?
        
       | barrenko wrote:
       | Newborns can die from lack of food, water or touch.
        
         | philliphaydon wrote:
         | Huh, you should never give a newborn water...
        
       | neilpmas wrote:
       | I'm sceptical of single study medical research and especially
       | that which involves the crazily political world of birth. It
       | might be better to wait until the Cochrane collaboration does a
       | meta analysis on multiple studies before anyone changes what they
       | are currently doing.
        
         | tediousdemise wrote:
         | Crazily political indeed.
         | 
         | Every SUV-driving MLM Starbucks mommy with 5 homeschooled
         | children will rally against anything science says about safe
         | medical practices, including (but not limited) to childbirth.
         | 
         | Science doesn't care about your opinions, Karen.
        
         | drknownuffin wrote:
         | Skin-to-skin for children has been studied for a few decades,
         | and the consensus is strongly in its favor, after a pile of
         | studies have all pointed in the same direction.
         | 
         | This study isn't "skin to skin care is good." This study was
         | aimed to answer the question, as contextualized, "We have
         | established that skin-to-skin care for healthy children is good
         | (pile of studies); for unhealthy children that have been
         | stabilized is good (pile of studies), but is it good for kids
         | that are still unstable? (controversy)"
         | 
         | "I'm skeptical of a single study" is only a valid criticism if
         | you're familiar with the body of scientific literature.
         | Otherwise, what you're actually saying is, "I'm skeptical of
         | results that pop magazines and press releases have only
         | surfaced to my attention once" - which is a shoddy mechanism
         | for curating your knowledge.
        
           | irremediable wrote:
           | Your response is great. Thanks for sharing information about
           | the literature and way more context.
           | 
           | > Otherwise, what you're actually saying is, "I'm skeptical
           | of results that pop magazines and press releases have only
           | surfaced to my attention once" - which is a shoddy mechanism
           | for curating your knowledge.
           | 
           | At the risk of nitpicking, this seems like a good principle
           | to follow? Like, assuming skeptical means "I won't instantly
           | buy into this being as great as the pop magazine claims"
           | rather than "I will strongly presuppose that this is untrue
           | because it was in a pop magazine".
        
             | drknownuffin wrote:
             | Thank you.
             | 
             | I think it's a poor mechanism because "appeared once in a
             | pop magazine" isn't a good signal for knowledge curation
             | regardless of whether you assign it a positive or negative
             | weight; especially when the original comment implied (to my
             | reading) "the topic has only surfaced once, therefore the
             | existing knowledgebase is only one study."
             | 
             | The existence of a single study in pop literature is a very
             | poor predictor of whether the study was accurate or not,
             | and a very poor predictor of whether there are other
             | studies on the topic. So I think it a mistake to substitute
             | "it has come to my attention once" for "it has only been
             | studied once."
        
               | OJFord wrote:
               | It is however a very good indicator that the pop
               | portrayal is inaccurate though!
               | 
               | At least this is ' _med life_ style news ', arguably not
               | really 'pop', by the time this hits, I don't know, 'ifl
               | science' or whatever, Techcrunch for general
               | science/medicine, I wouldn't count on 'with unstable' in
               | the headline, or perhaps even the body.
        
         | powerapple wrote:
         | The conclusion may be 'keeping baby warm' increases the
         | survival rate. I agree with you, these researches are too
         | vague, there are so many parameters, correlation maybe.
        
           | mirekrusin wrote:
           | They sniff like little piggys on the breast and suck it. It
           | must be traumatic coming out of womb and very comforting when
           | getting the breast.
        
       | mensetmanusman wrote:
       | It's not unsurprising reading about western doctor's historical
       | skepticism of this practice.
       | 
       | Reading about the history of child birth in the U.S. over the
       | last century is messed up. No wonder we have such high mortality
       | rates still.
       | 
       | I remember having to change hospitals in Boston because they were
       | proud of the fact that 50% of the births were c-sections...
        
       | MarketingJason wrote:
       | I wish we could have experienced this. Our OBGYN didn't catch
       | (after we insisted) that the baby was breach. After 2 hours of
       | labor we were rushed to an emergency c-section.
       | 
       | I'm thankful that my wife did get a little skin-to-skin but it
       | was not immediate and it was for maybe 5 minutes before they were
       | seperated. I think we got to see our baby about an hour later.
       | 
       | The whole experience during and after was horrible but I'm not
       | sure if we or the hospital could have handled it better other
       | than if we had insisted more strongly that the position felt
       | wrong weeks before delivery.
        
       | pella wrote:
       | imho: correction of the side effects of "evidence-based medicine"
       | 
       | related-satire:
       | 
       | "Satirical paper puts evidence-based medicine in the spotlight"
       | 
       | "A spoof paper about mothers kissing their children's 'boo-boos'
       | draws attention on social media."
       | 
       | https://www.nature.com/news/satirical-paper-puts-evidence-ba...
       | 
       |  _" The paper's underlying message is in line with the journal's
       | philosophy, says Miles, who is also senior vice-president of the
       | European Society for Person Centered Healthcare in London and
       | Madrid. In medicine, he notes, scientific research is only one
       | type of knowledge, which must sit alongside other forms, such as
       | professional medical experience, and not above them. "Over-
       | reliance on science is a very dangerous thing," Miles says. Next
       | month, the journal will publish another article unpacking the
       | lessons contained in the satirical paper, he adds."_
        
       | jonathanlydall wrote:
       | Interesting.
       | 
       | Our baby arrived 10 weeks premature and although it wasn't
       | immediately after birth (as I'll explain why below), the hospital
       | strongly encouraged the kangaroo care as mentioned in the
       | article, which mom did daily until we could take our baby home.
       | 
       | In a week it will be a full year since birth and the baby is in
       | no way behind developmentally compared to other 10 month olds
       | (when adjusting age due to prematurity). So although anecdotal, I
       | can believe this can be a very helpful practice.
       | 
       | Due to arriving mid-pandemic and because neither of us had COVID
       | tests prior to the unexpectedly premature birth, we weren't
       | allowed to visit the baby in the NICU until our tests came back
       | negative, which was about 30 hours later. I wasn't even allowed
       | to be with mom during delivery, but the doctor did allow me to
       | see the baby for a couple of minutes from a distance and under
       | the proviso that I touched nothing in the NICU (including things
       | like walls, windows, doors, handles, etc).
       | 
       | Anyway, somewhat superfluous information at the end there, but it
       | was quite an experience and I'm just happy everything turned out
       | fine.
        
         | prionassembly wrote:
         | We had a 35-week baby stay a couple of weeks in the NICU too.
         | Our maternity ward was far less paranoid over COVID, and we got
         | to hold the baby _during_ the C-section and for a while
         | afterwards. Baby is just two months (unadjusted) and it 's
         | already annoying to always be explaining adjusted age and where
         | people should be counting from for developmental placemarks.
         | 
         | I find as a father that sometimes the only way I can soothe the
         | baby (mom breastfeeds and has to sleep during the daytime) is
         | to take my shirt off and place him on my chest. I can almost
         | code one-handed this way. I think babies somehow imprint to
         | your smell or taste.
        
           | syntaxing wrote:
           | Totally hear you but the bright side is that they catch up
           | extremely quickly. My kid "caught up to average" within
           | around nine months or so.
        
           | jonathanlydall wrote:
           | Yes! I just read this to my wife and we had to laugh a little
           | as the adjusted age thing has definitely been a bug bear at
           | times.
           | 
           | At this point when people ask our child's age, we almost
           | always just say the adjusted age as it's easier, especially
           | with my wife's gran who doesn't speak English as her first
           | language and then is worried about her being behind
           | developmentally.
           | 
           | In regards to the bonding, for me it's a feeling like no
           | other to have your baby see you and mom as the greatest two
           | people in the whole world.
        
         | bredren wrote:
         | I'm so glad to hear your 10 month old has been making out well.
         | 
         | My wife and I are weeks away from our first.
         | 
         | While very lucky--our close friends and family have not had
         | serious encounters with covid, We've been most affected by
         | regulations that have interrupted what would have been normal
         | parts of a couple's first pregnancy.
         | 
         | I'm sorry to hear you were not allowed to be with the mom
         | during delivery. And that you were delayed in visiting the nicu
         | by those tests.
         | 
         | That must have been very difficult.
         | 
         | I remember being told I wouldn't be able to be there with my
         | wife for the first ultrasound. I attended via FaceTime.
         | 
         | I was a little more accepting of the circumstances at the 28
         | week, but still not happy about it.
         | 
         | One of the bigger bummers has been having no I'm person social
         | interaction with other new parents approaching the same life
         | stage. It's just not the same over zoom and it feels like a
         | pretty big miss.
         | 
         | Always trying to keep these things in perspective. As of now
         | I'll be there for the birth, and really just want a good
         | outcome after all.
        
           | jonathanlydall wrote:
           | Congratulations and I'm glad to hear that things seem to be
           | good as could be hoped for considering the pandemic.
           | 
           | With everything else that happened I kind of forgot about not
           | being allowed to join for check ups and ultrasounds, it
           | definitely sucked.
           | 
           | Fortunately they made an exception on the day of the birth
           | (where we made an appointment only because my wife was
           | feeling uncomfortable), otherwise I probably wouldn't have
           | been with my wife at all before she was rushed off to
           | theatre.
           | 
           | Good luck and enjoy.
        
         | thanatos519 wrote:
         | Congratulations!
         | 
         | My kid was also a preemie and got kangaroo care alternating
         | with being wrapped in a UV-emitting blanket. Now he is 8 and
         | still blows me away every day with his kindness, smarts, skills
         | and ... uh ... argumentation. :)
         | 
         | The benefits of kangaroo care are worth studying, but the
         | results of the study are about as unexpected as the 'your cats
         | love you back' study.
        
           | CPLX wrote:
           | > the 'your cats love you back' study
           | 
           | Hold on, your cats love you back?
        
             | thanatos519 wrote:
             | I don't remember which study it was, but a quick search
             | will find quite a few, e.g.
             | https://www.inverse.com/science/how-do-i-know-if-my-cat-
             | love...
        
       | mberning wrote:
       | There is a lot of "woo woo" crap in the child birth industry. All
       | the way from hardcore "all natural" proponents to traditional
       | "hospital birth no matter what" people. Unfortunately this causes
       | a lot of anxiety and second guessing on the part of new parents.
       | I really didn't appreciate the quasi-relgious or cult-like
       | guidance we received on breast feeding our son, only to have him
       | lose 15% of his body weight and not gain it back until we
       | supplemented with formula.
        
       | jeduehr wrote:
       | I will say this is something we've known for a while:
       | https://pubmed.ncbi.nlm.nih.gov/27885658/
        
         | mhb wrote:
         | This is not what the study addressed - the study is about
         | contact with premature babies which is typically withheld until
         | they are stable. The outcomes are better if the skin-to-skin
         | contact is initiated before they are stable.
        
         | PragmaticPulp wrote:
         | Yes, and it's standard practice in hospitals.
         | 
         | Additionally, our doctor prescribed a certain quota of skin-to-
         | skin contact daily for the first several weeks after birth.
        
           | drknownuffin wrote:
           | Skin-to-skin is standard. Skin-to-skin for _unstable
           | neonates_ is not, which is the debate in the medical field
           | and the question that the study sought to answer.
        
       | reacharavindh wrote:
       | Interesting to read this here. When my son was born (naturally,
       | normal weight, fully healthy, and around expected due date), the
       | midwife in Denmark had educated us about the Danish way of
       | handling the birth - as soon as the baby comes out, they
       | literally put the baby on mom's chest, and leave us(parents, and
       | baby) alone in the room for about an hour. Nothing needs to be
       | done other than the baby being in care of it's parents! They
       | believed it helps the baby form a natural bond, but also
       | acclimate to the outside world better than being whisked away and
       | cleaned.
       | 
       | It was such a lovely experience. One of the many things I am
       | thankful to Denmark for.
       | 
       | Several things that I was surprised to learn while going through
       | this in DK.
       | 
       | 1. Childbirth is handled by midwives (Jordemothers) instead of
       | doctors. Doctors are brought only when medication or any
       | treatment is necessary.
       | 
       | 2. Child birth is considered a natural process and never
       | treated/thought of as a sickness or medical condition. This is
       | reflected in the whole process.
       | 
       | 3. The social healthcare system works great. It changed my
       | perspective even more. Not having to think about hospital bills
       | or insurance leaves us parents to enjoy the arrival of our little
       | one.
       | 
       | 4. If everyone in the country, regardless of their current
       | financial condition gets such an experience for their childbirth,
       | I will gladly pay my taxes, and never complain. Healthcare should
       | not be a business imho.
        
         | mensetmanusman wrote:
         | The U.S. experience used to be this way, but about 100 years
         | ago the medical industry realized they could make a lot of
         | money off of child birth (our last bill was $40k).
         | 
         | The hospitals released advertisements scaring women from voodoo
         | (read: black) women/midwives helping with birth so that doctors
         | and surgeons could take over, it worked fantastically. The
         | doctors eventually chained women to beds and tested various
         | chemicals to 'cure' their pain that resulted in profound
         | unintended consequences.
         | 
         | This history is still with us, and creates a lot of uncanny
         | valley experiences. I.e. treating pregnancy like a disease.
         | 
         | When we gave birth during covid, I had to use an elevator to
         | get to my wife. When the elevator door opened, a group in
         | hazmat exited with a patient clearly dying of covid.
         | 
         | I was like: "are you fucking kidding me, this is still where we
         | give birth in this country..."
        
           | Accujack wrote:
           | >but about 100 years ago
           | 
           | It wasn't really an issue for the most part until laws were
           | changed in the early 70s - by Nixon.
           | 
           | That was when for profit health care took over here.
        
           | hallway_monitor wrote:
           | We did it in the hospital too but there's nothing stopping
           | you from using a midwife at home right?
           | 
           | Another thing that seems to be pushed a lot is epidurals.
           | They expect everyone to get one and are very surprised when
           | someone does not want it.
        
             | hahahasure wrote:
             | The epidural costs $6000. A 10 minute procedure.
             | 
             | I saw my wife before and after an Epidural so I could not
             | dispute it's effectiveness.
             | 
             | But I generally can't see a reason why we need to spend 12
             | years in school to learn how various needles and rules of
             | thumbs work.
             | 
             | Only the US has such an education burden, and only does the
             | US have such a strong physician cartel to mandate it..
             | 
             | Edit, and even with midwives you will be hitting max out of
             | pocket with 1 night stay.
        
             | kevin_thibedeau wrote:
             | Then you have to deal with the circumcision sales pitch.
        
               | jjeaff wrote:
               | We never heard even the slightest hint of a sales pitch
               | for circumcision. A single question of whether we were
               | planning to do it or not was all.
        
               | Stratoscope wrote:
               | In fact, we had an _anti-circumcision_ pitch. They showed
               | a video of the process. It was horrible and makes me
               | queasy just remembering it.
        
           | ezekg wrote:
           | Midwives are the way. My first child's prenatal and birth was
           | < $5k, born at home.
        
             | spockz wrote:
             | Amazing. In the Netherlands it is free. You get a midwife,
             | hospital and medical staff when required. You get a box of
             | goods for the first days of baby care. We get 4-6 weeks
             | paid leave as a father and 16 as a mother. There is help in
             | the house for about a week to take care of baby and mother
             | and do checkups.
             | 
             | The only thing you pay a symbolic amount of money for is
             | some to borrow tools like bath chairs.
             | 
             | Probably some pain meds require a contribution but you
             | never pay the whole thing.
             | 
             | Children up until 18 are insured on your own insurance
             | policy without additional fees.
             | 
             | It must be hell to live in a cold place as the US where
             | everything costs tons of money out of pocket.
        
               | brnt wrote:
               | Parental leave in the Netherlands, both for women and
               | man, is the lowest in the EU. By a wide margin. So, while
               | we get some things right, leave and the conseqences that
               | implies for the carreer of the mother is not something we
               | can boast about.
        
           | Fomite wrote:
           | There is no "U.S. experience" because of the absolute mess of
           | our healthcare system. There are birthing centers that work
           | very much like the process described above.
        
         | klipt wrote:
         | > Childbirth is handled by midwives (Jordemothers) instead of
         | doctors.
         | 
         | Is midwife a female-only profession or are there male midwives
         | too?
        
           | OJFord wrote:
           | Are you objecting to 'mother' in the Dutch as if 'wife' in
           | the English doesn't imply the same?
        
             | gameman144 wrote:
             | I didn't read that as objecting to anything, it looks like
             | an honest question...
        
               | OJFord wrote:
               | Fair enough. The quote made it seem like 'That's so non-
               | PC why do you call it that' to me, so I was just pointing
               | out it's not any different in English, quoting the Dutch
               | is redundant!
        
         | blhack wrote:
         | This sounds exactly like the process my wife and I are going
         | through in the US right now.
         | 
         | I've never heard of pregnancy being treated like an "illness"
         | (??).
         | 
         | Midwives are also extremely common here.
         | 
         | Granted I live in Arizona, and I know much of HN lives in SF.
         | So maybe this is unique to Arizona in some way?
        
           | throwkeep wrote:
           | Not unique to Arizona. It's rather common throughout the
           | country now.
        
           | dieortin wrote:
           | Except for the bills part
        
           | ACS_Solver wrote:
           | I know that in Russian culture, pregnancy is often treated
           | somewhat like an illness. Not in the sense that it's bad, but
           | it's commonly believed the pregnant woman needs a lot of bed
           | rest, should avoid any physical activity more strenuous than
           | walking, etc. In the last trimester, the woman is treated
           | similarly to someone recovering from a major surgery. Medical
           | supervision is handled by a doctor throughout the pregnancy.
           | 
           | This is in complete contrast to the thread starter's Danish
           | approach, or the approach where I am in Sweden. Women are
           | encouraged to remain physically active, to only abstain from
           | very major activities (think skydiving or marathon running),
           | and to generally keep doing things as long as they're
           | physically comfortable. Midwives handle everything from the
           | first checkup until labor, a doctor only gets involved if
           | there's something that requires a doctor's skills in
           | particular.
        
           | in_cahoots wrote:
           | The country's c-section rate is somewhere near 33% when most
           | estimates say it should be around 15%. That's a pretty good
           | indicator of systematic over-medicalization.
        
             | whall6 wrote:
             | Lots of women I know elect to have C-sections.
        
               | [deleted]
        
               | lolinder wrote:
               | My understanding is that that is often because doctors
               | fail to educate them sufficiently on the cons. The
               | recovery from a C-section is worse, the outcomes are
               | worse for both mother and child, future children are
               | likely to be more difficult. There's not much reason to
               | recommend an elect C-section in most cases (certainly not
               | 33% of cases) except that the doctors get to bill for it.
        
               | GloriousKoji wrote:
               | I would not call it a "good amount" but I know women who
               | elected for C-sections because they attribute too much
               | value and significance to the date of birth.
        
           | jacobolus wrote:
           | > I know much of HN lives in SF
           | 
           | SF has more options for different types of prenatal/delivery
           | medical experiences than most regions of the US, and has been
           | ahead of the trend for years. My 2 kids were delivered by
           | midwives in a hospital focused on respecting parents' choices
           | to the extent possible.
        
           | pasquinelli wrote:
           | My first kid in 2008 in Chicago wasn't like this, my second
           | in 2012 in Portland was. I'd say America is adopting the
           | approach; maybe it fully has by now.
        
         | pumaontheprowl wrote:
         | 2.8 million people die during childbirth every year. It's
         | absolutely a medical condition. And you should absolutely have
         | a doctor there.
        
           | kkwteh wrote:
           | Where did you get the 2.8 million figure? Wikipedia says "an
           | estimated 303,000 women killed each year in childbirth and
           | pregnancy worldwide", which isn't the same.
           | 
           | https://en.wikipedia.org/wiki/Maternal_death
        
           | economusty wrote:
           | Thanks for saying this, most do it in the hospital because if
           | something goes wrong we want to have the best chance of
           | saving mom and child.
        
         | lcfcjs wrote:
         | Here in America, we have GoFundMe.
        
         | syntaxing wrote:
         | I'm in the US and most hospital does the same now. They call it
         | the golden hour where it's just an hour of skin to skin just
         | like you mentioned with no baby health routine until after
         | such.
        
           | afavour wrote:
           | ...and despite it being essentially a time period where the
           | hospital leaves you alone, you still get billed for it.
        
             | throwkeep wrote:
             | Well, the bed and room itself is a limited resource of the
             | hospital and it's one of their expenses.
        
               | wycy wrote:
               | It's not just your time in the bed/room, there's often a
               | line item on your bill for skin-time. On top of that, you
               | pay for your time in the room.
        
               | LightG wrote:
               | Of course ... but it's incredibly sad to read how it is
               | even a part of the thought process of childbirth in some
               | countries.
        
               | pmiller2 wrote:
               | > ... the thought process of _capitalism_ in some
               | countries.
               | 
               | FTFY.
        
             | chaps wrote:
             | Why is this getting downvoted? They bill for this
             | _specifically_. This isn 't the same thing as a damn
             | hotel.. this site, I swear..
        
             | recursive wrote:
             | Have you heard about hotels? They bill me for a full day,
             | and barely even communicate with me all night long?
        
               | afavour wrote:
               | When you stay at a hotel do you receive a specific line-
               | item in your bill for being time spent lying in bed with
               | your partner?
        
               | stickfigure wrote:
               | I'm pretty sure there are places in rural Nevada that
               | work exactly like that.
        
         | tootie wrote:
         | It's pretty common in the US as well although not the norm. I
         | think it's kinda dumb to be honest. Just get an epidural. My
         | wife was induced twice due to risk factors and got two
         | epidurals. We still got to cuddle them new born. We also had to
         | bottle feed the first week pretty heavily to stave off jaundice
         | although they were mostly breast fed afterwards.
        
           | souprock wrote:
           | No, don't get an epidural. Pain has a purpose. It guides you
           | to minimize injury. Be thankful you can feel pain.
           | 
           | There are people with genetic defects that prevent feeling
           | pain. These people constantly injure themselves.
        
             | sfink wrote:
             | They are constantly giving birth? That seems like a much
             | more relevant medical condition. (But yes, I get your point
             | -- it's just that it's not relevant when you're conflating
             | burning a finger with giving birth.)
             | 
             | Pain definitely does have a purpose. It alerts you to
             | things you may need to know about. Once you're alerted, its
             | purpose is mostly lost. And many, many people living with
             | chronic pain can tell you that sometimes the message is
             | worse than the cause. The fact that complete absence of
             | pain is a problem in no way supports your imperative to not
             | get an epidural _during childbirth_.
             | 
             | I agree that getting an epidural before handling sharp
             | objects is unwise.
        
             | tootie wrote:
             | Lol, you know epidurals only last as long as they're
             | administered right? As soon as the baby and placenta are
             | out, they stop the flow and feeling starts coming back
             | pretty quickly. The doc can also adjust the level of meds
             | on the fly to allow enough sensation to facilitate pushing.
             | And mom just stays in a hospital bed until it's safe
             | anyway.
        
               | souprock wrote:
               | It's not just about injury after the birth. It's about
               | injury during the birth.
               | 
               | As soon as the baby and placenta are out, it's too late
               | to avoid injury during childbirth. It is no longer
               | possible to let pain be guidance for minimization of
               | injury. The chance was missed.
        
         | quux wrote:
         | Do they assist in cutting the umbilical cord and delivering the
         | placenta before leaving the parents and baby alone?
        
           | reacharavindh wrote:
           | Yes, I think the midwife gave me (father) a choice to cut the
           | umbilical cord. I didn't want to, so she did it, and also
           | removed the placenta, and sutured the mother(while the baby
           | was in mom's chest). Once the suture was complete, the
           | midwife and the helper nurse went out of the room and said
           | they are available immediately if we needed them. That hour
           | went like a minute :-)
        
         | thorin1 wrote:
         | It's exactly the same in Canada. It was a great experience and
         | we were so happy that we could be with our baby 100% of the
         | time.
        
         | swman wrote:
         | I resonate with #4. I'm in US, so healthcare is tied to
         | employer. My first job ever paid 12/hr and I did not have
         | health care and it was a part time job, so I'm glad I could
         | rely on my mother's health insurance until age 26 (thanks
         | Obama).
         | 
         | I got my first "real" job after spending a year trying to find
         | a full time job after graduating college, during which I was
         | working that 12/hr job. Even at the new job which paid 80k a
         | year, I had to pay $30/paycheck ($60/mo) towards healthcare.
         | Thankfully never had to use that insurance while I worked
         | there.
         | 
         | Now at my current place I get HDHP (high deductible health
         | plan) and when I messed up my leg the hospital I went to didn't
         | even have crutches in their inventory.. got wheeled out to my
         | car and I had to drive to a pharmacy to purchase crutches.. it
         | was horrible, and I couldn't imagine what this situation must
         | be like for someone without insurance.
         | 
         | Anyway the worst part is that I still ended up paying about
         | $1500 out of pocket, because the 1st X-Ray was covered, but the
         | next two were $600 each....... $40 crutches ..............
        
           | reacharavindh wrote:
           | I am very sorry for what you went through.
           | 
           | I lived in the US for 6 years, and worked at above average
           | tech company and had excellent healthcare benefits through
           | employer. I must admit it blinds people to say "country's
           | messed up healthcare system is not my problem" because my
           | employer took care of it :-(
           | 
           | Before my move to Europe, I risked living in the US for a
           | month without health Insurance, and I was very anxious about
           | it. I can't imagine what most Americans who don't have that
           | luxury of employer benefits feel daily.
           | 
           | It's silly to think that the richest country on earth by far
           | does not have a decent healthcare system that covers all of
           | its citizens.
        
             | carlmr wrote:
             | >it blinds people to say "country's messed up healthcare
             | system is not my problem" because my employer took care of
             | it :-(
             | 
             | This is something I never understood. If your employer is
             | in power of your health insurance, how free are you?
        
               | johncessna wrote:
               | I'm not saying it's a good system, but I'm not following
               | your logic here. If the government is in power of your
               | health insurance, how free are you? I can change my
               | employer a lot easier than I can change my government.
        
               | jschwartzi wrote:
               | But when you change employers you risk losing access to
               | your healthcare. Whereas if government pays for the
               | health system you can maintain continuity of care, which
               | can be essential to treat various psychiatric and medical
               | conditions. Imagine if, because you got a new job, your
               | lease on an apartment were canceled and you had to go
               | find a new place to live? That's what our healthcare
               | system is like and it's maddening.
        
               | johncessna wrote:
               | I'm not defending the system, I was trying to point out
               | the absurdity of the parent's statement.
               | 
               | To your point, the affordable health care act addressed
               | the issue with not being able to get insurance due to
               | preexisting conditions. In the US you're required to have
               | healthcare insurance. You can buy it yourself, get it
               | through your employer, or, assuming you qualify, get it
               | from the government.
        
               | Retric wrote:
               | You can generally keep paying for the same health
               | insurance for to 18 or 36 months after leaving a job via
               | COBRA except in cases of gross misconduct. It can be
               | shockingly expensive though.
               | 
               | https://www.dol.gov/sites/dolgov/files/legacy-
               | files/ebsa/abo...
        
           | philsnow wrote:
           | > I could rely on my mother's health insurance until age 26
           | (thanks Obama)
           | 
           | I don't know the particulars of what law enabled this, but I
           | used my dad's health insurance until I was 26 as well, before
           | Obama's first term.
        
             | kritiko wrote:
             | Are you from Massachusetts? In that case it was Mitt
             | Romney's healthcare reform.
        
         | doggodaddo78 wrote:
         | I just watched the Frontline episode on the Healthcare Divide
         | where US safety-net hospitals (accept anyone hospitals of last
         | resort) have been closing or being sold to vulture investors
         | who buy, trim costs, and sell them at the cost of reduced care.
         | 
         | For-profit healthcare should be like for-profit prisons:
         | illegal.
        
           | OJFord wrote:
           | I'm not sure about that, I live in the UK with public
           | healthcare and optional private for-profit; I think that's
           | fine.
           | 
           | Non-profit replacing the public is an interesting idea
           | though, I've never heard that suggested before, people
           | usually just argue about public being available or not. (And
           | invariably quite pointlessly since neither side will budge!)
        
         | M5x7wI3CmbEem10 wrote:
         | how do you manage getting around the hospital system? seems
         | overwhelming with having a different language, and it isn't as
         | simple as going to the ER I assume
        
         | rootusrootus wrote:
         | This is the experience we had 8 and 10 years ago, and I live in
         | the US. I'm sure some people have had bad experiences, but
         | there are exceptions to every rule.
        
         | yupper32 wrote:
         | According to a recent study reported by Reuters, child birth in
         | a hospital settings is far safer:
         | https://www.reuters.com/article/us-health-homebirths-newborn...
         | 
         | Skin-to-skin contact immediately after birth is pretty common
         | in hospital settings now.
         | 
         | You shouldn't care about it all being a "lovely" or "natural"
         | experience. You should care that everyone gets out safely.
         | Birth can be a brutal and deadly affair.
        
           | gffrd wrote:
           | What's wrong with it being a lovely experience?
           | 
           | Couldn't we assume that OP's hierarchy includes the "everyone
           | gets out safely" box having been ticked?
           | 
           | This is like saying cars should not be enjoyable because they
           | exist purely to move us around.
        
           | baby wrote:
           | Country A infant mortality rate in 2021: 2.86 deaths per 1000
           | births.
           | 
           | Country B infant mortality rate in 2019: 5.75 deaths per 1000
           | births.
           | 
           | Guess which country is which.
        
         | gambiting wrote:
         | Had a baby 3 weeks ago in the UK, it was the same. Baby was
         | immediately on mum's chest.
        
         | jedimastert wrote:
         | My wife had a couple of complicating factors, so we had doctors
         | involved from the get-go. Fun fact for the unaware: if you're
         | predisposed for diabetes or just unlucky, you get gestational
         | diabetes because pregnancy does WILD things to hormones.
         | 
         | But we've had instant skin to skin (after a quite o2 check, but
         | within minutes) for both pregnancies, even the "urgent"
         | c-section (not quite "emergency", but better safe than sorry,
         | story for another time).
        
         | prionassembly wrote:
         | > 1. Childbirth is handled by midwives (Jordemothers) instead
         | of doctors. Doctors are brought only when medication or any
         | treatment is necessary.
         | 
         | This is perfectly rational in the context of publicly-funded
         | healthcare; for many mothers (younger and in optimal health)
         | pregnancy has little complications. On the other hand, we
         | really benefited from high-intensity pre-natal care with
         | frequent ultrasounds, as we were able to increase our kid's
         | chances of survival with lung development-accelerating
         | steroids.
         | 
         | What I mean is that it's a wonderful cost-saving tactic which
         | doesn't imply better care. In Brazil we have MDs handling sore
         | throats in overloaded ERs, and it might be more cost-effective
         | to have teams of RNs in a more distributed proactive fashion. I
         | still can't think of a case where, individually, I would prefer
         | a RN rather than a MD handling my sore throat. Billionaires
         | might even have MDs clipping their toenails to care for fungi.
        
           | gregmac wrote:
           | I'm not sure why you're talking as if these are mutually
           | exclusive?
           | 
           | I'm in Canada, where midwives are publicly funded, but still
           | not that common (there's a waitlist and not everyone gets
           | in). The midwives have hospital privileges, and are basically
           | the "primary care provider" (instead of an obstetrician or
           | family doctor). They still do ultrasounds, and if there was a
           | concern, they can turn over care to a MD.
           | 
           | We actually did the birth in the hospital, and were just
           | alone in the room with 2 midwives the entire time (no nurses
           | / doctors involved). Our midwife did warn us that if a
           | complication became up - especially at the end - that the
           | room could get very busy very fast if they had to call in
           | people, but thankfully that didn't happen.
           | 
           | We have a friend that had their kids at home. The midwives
           | notify the hospital and ambulance service this is happening.
           | They actually had to go to the hospital for one kid who had a
           | complication, and my understanding is the ambulance was there
           | very quickly and things were turned over to the medical team
           | for birth, then after everything was ok, care turned back to
           | he midwife a few hours later.
        
           | mikepurvis wrote:
           | Surely frequent contact with a lower-cost specialist who is
           | trained to monitor for situations requiring escalation very
           | much implies better care?
           | 
           | Maybe I'm misreading your tone, but it sounds like you're
           | dismissing midwifery as being only about cost savings. I
           | don't think that's true at all (parent of three; we did a
           | midwife for the younger two), but even if that was a major
           | motivation, it's like saying SpaceX is only about cost
           | savings. The cost savings are a game changer in terms of
           | access/frequency/etc.
        
           | reacharavindh wrote:
           | > What I mean is that it's a wonderful cost-saving tactic
           | which doesn't imply better care.
           | 
           | I don't agree.
           | 
           | It is not mutually exclusive to have a midwives dealing with
           | childbirths and Doctors providing excellent care when needed.
           | The midwives perform the scheduled ultrasound and if there
           | was any inkling of complication, they would have immediately
           | involved a Doctor into the process(I was told so, but my son
           | didn't need any). This way the Doctors are engaged only when
           | necessary thereby increasing chances of better care and not
           | wasting their time handling sore throats or clipping rich
           | people's toe nails.
        
         | durandal1 wrote:
         | We had 2 children within the last 5 years, both born at
         | Stanford, Palo Alto, and both were immediately put skin to skin
         | after birth, so I don't think it's unique to Denmark.
        
           | cultofmetatron wrote:
           | Palo alto is not typical of America. Its one of the richest
           | places in the country for one along with having a high
           | percentage of liberal/educated people.
           | 
           | IN America you have to be upper middle class at minimum to
           | have the same standard of living as the bottom tier in
           | Scandinavian countries.
        
             | ARandomerDude wrote:
             | Doubtless, you're leaving soon then...
        
             | calvinmorrison wrote:
             | I always assumed poor people had midwifes
             | 
             | Source: born in a house not a hospital like my whole family
        
         | franze wrote:
         | Our midwife literally threw the doctor out of the room:
         | "Everything is ok. You go now!" The doctors know that the
         | midwife is in charge and respect this.
        
         | t0mas88 wrote:
         | It goes like this in the Netherlands as well. Typically with
         | only a midwife, and a nurse if you want pain reduction
         | medication because the midwife is not allowed to handle that.
         | The exception is if there are medical indications like an early
         | birth (I think before week 36), then a doctor would be present
         | from the start.
         | 
         | Home births are a choice and a lot of people make that choice
         | because it is a less stressful environment. We were told that
         | the Netherlands has an above average amount of home births
         | compared to the rest of Europe.
         | 
         | However for my daughter we were offered an even nicer option:
         | There are special "non medical delivery" rooms in the hospitals
         | around here. It looks and feels much more homely than a
         | hospital room, has some normal chairs in it, the walls aren't
         | white, it has a nice bathroom. You go there with your midwife
         | that you already know from all the checkups. The process is
         | like you describe it in Denmark, they indeed give you a lot of
         | time to relax before and after.
         | 
         | But there is one thing different from home birth: It is right
         | across the hallway from the medical delivery rooms, with full
         | baby-ICU capabilities less than 10 seconds away and a red alarm
         | button to press when you need medical help immediately. That
         | was for us a comfortable feeling, because if things don't go
         | right the natural way, you really don't want to be 15 minutes
         | away from the hospital by ambulance.
         | 
         | Luckily we didn't need any of it, but the fact that it's there
         | when needed feels safe.
        
           | reacharavindh wrote:
           | It is reassuring to hear that Netherlands works more or less
           | the same. Today is my first day in the Netherlands(moved here
           | from DK) :-)
           | 
           | Just to add, we also had the exact situation as you
           | described. An annex physically close but separated from the
           | hospital. The child birth rooms are similar to normal room
           | with a "help please" button. I'd also take this close
           | proximity to the hospital over home births. Just in case
           | something unexpected occurs and medical help is needed.
        
         | mattlondon wrote:
         | Same in the UK. Literally _immediately_ as the kid came out he
         | was on my wife 's chest... umbilical still connected and
         | everything.
         | 
         | They banged on and on about the importance of "skin on skin" in
         | all the ante-natal stuff. Even for the father they say skin on
         | skin is beneficial. Apparently it promotes oxytocin for both
         | parties.
        
         | njovin wrote:
         | I had a similar experience in the US with a large private
         | healthcare provider at a large regional hospital. They did some
         | quick health checks but then quickly left the baby with my wife
         | and I for skin-to-skin time. This was planned ahead of time and
         | encouraged by the nurses and doctors.
         | 
         | I'm not sure if it's become commonplace across the country but
         | our care was impeccable and the nurses and doctors were happy
         | to recommend and support as natural a birth as possible.
        
           | xen2xen1 wrote:
           | I've heard / overheard from multiple women from multiple
           | states that birthing has changed and the baby is put on mom
           | as immediately as possible, to the point it seemed odd from
           | my experience 20 years ago. Doctors in the states have read
           | all this too and things have changed.
        
         | kazen44 wrote:
         | using midwives is quite common in most European countries. in
         | some countries people usually bear there children at home
         | instead of in the hospital as well.
        
           | snikeris wrote:
           | My son would probably be dead if we didn't give birth in a
           | hospital. The cord was wrapped around his neck three times
           | and he wasn't breathing when he came out. A small team of
           | doctors (angels) came in and saved his life. An hour or so
           | later, they had to do it again.
           | 
           | It was a short part of their work day, but made all the
           | difference for us.
        
             | gibrown wrote:
             | Don't know your specific circumstances and it sounds like
             | it was kinda a rough birth so sorry. I will say that the
             | cord wrapped around the neck is super common and something
             | midwives deal with all the time.
        
           | reacharavindh wrote:
           | Yes, this way of care was new to me as I have only lived in
           | India and the USA prior to moving to Denmark. It simply makes
           | sense to have midwives be the specialized practitioners for
           | this normal natural human care.
        
         | jeeeb wrote:
         | This sounds very similar to our experience in the public
         | hospital system in Australia.
         | 
         | With both our sons the process was mostly handled by midwives
         | including a lot of the pre and post natal checkups. The births
         | were done naturally and immediately afterwards mum was given
         | the baby to skin cuddle. They didn't wash the baby and we were
         | advised not to bath the baby for the first few days even.
         | 
         | Mum was also given the option of how long she wanted to stay in
         | hospital (anything from 6 hours to 4 days if I recall).
        
         | gibrown wrote:
         | We had both our kids at a birth center in the US (actually both
         | born in the same room three years apart) and it was a great
         | experience. There are certainly cases where you can't but I
         | really liked not being in an overly medical setting. Also (as a
         | new exhausted Dad) taking that first nap in the same bed your
         | baby was just born in and your wife is beside you wide awake...
         | magic. Then about 6-8 hours later we are back home for when my
         | wife was ready to crash as the hormones wear off.
        
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