Hacker News Reader

In Thailand a lot of woman prefer C-section in order to choose a lucky day for the birth of the child [0].

---

[0]: http://www.nationmultimedia.com/detail/national/30355415

Women have been giving birth since creation with minimal enough problems for humans to survive and succeed as a species - it absolutely is natural, no idea why you put that in quotations. Why stop at C-sections? Raise them in test tubes a la Brave New World, skip the biological process entirely. After all, it's much safer, quite possibly even zero risks on the woman's part.

The thing with C-sections is that until fairly recently, children weren't inoculated with the mother's vaginal canal microbes. Now they know better and do a smear, but that means many children failed to receive a proper immune boost when they needed it most. There's an growing body of evidence that suggests early microbial exposure is required for proper immune development and function, and that the lack of this exposure is linked to allergies and other self-inflicted immune diseases. I can't speak of any data off the top of my head, but perhaps the doctors recommending against C-sections are aware of decades of data on C-sections and childrens health?

Real natural childbirth involves “minimal enough problems” if you don’t particularly value the lives of individual babies, a significant minority of whom would die during birth or late pregnancy if we just let nature take its course.

And putting “natural” in quotes is entirely appropriate when discussing most vaginal births, even drug free vaginal births, in the first world. There’s nothing natural about 9 months of prenatal care and monitoring, careful observation of the fetal heartbeat during labor, prophylactic administration of antibiotics to women with group B strep, early delivery of women with gestational diabetes or pre-eclampsia, and the availability of c-section any time labor starts to go south. The women who end up delivering vaginally have very good outcomes, in part because a bunch of “unnatural” interventions before the moment of delivery weeded out all the women and babies who would not have done so well. If you want to see what real natural childbirth looks like, you can look at the maternal and neonatal outcomes in countries without modern health care. It’s not pretty.

We need to stop using the world “natural” as some kind of signifier for goodness. “Nature” doesn’t care that lots of tadpoles or lion cubs, or salmon fry don’t make it, and it doesn’t care that lots of human embryos miscarry or lots of babies die in birth. WE care about human babies, and so intervene.

Also, is there some reason we wouldn’t gestate fetuses in artificial wombs if that was safer for women and babies? Are we just obliged to suffer and risk our lives for no benefit? Because it’s “our place”, I guess?

At a species level yes, childbirth works fine.

Before the modern era deaths of both child and mother were very high (10%+) when giving birth.

That said, the U.S. approach to childbirth is clearly not working, with childbirth deaths at 3 times that of Canada, and higher than the rest of the developed world.

Like lots of things in USA this is tied to racism. Whites in USA have risks similar to those of other developed nations. Analysis has found that nonwhite immigrants have largely the same results as USA whites. However, their daughters have the same elevated risks as other minorities in USA. Public health experts don't have any idea why this is, so they're no closer to solving this problem than e.g. the public education system is to fixing its own racist outcomes.

> Women have been giving birth since creation with minimal enough problems

This bears no resemblence to the actual history of childbirth.

> There's an growing body of evidence that suggests early microbial exposure is required for proper immune development

Yes. But that's not linked to "seeding" which doesn't have any conclusive evidence to back that up(yet) compared to colostrum/breastfeeding[1] I'm aware of one study that has tried seeding. It's hypothesised, but needs much more research before being counted/discounted

> Women have been giving birth since creation with minimal enough problems for humans to survive and succeed as a species

Yes, but up until decent, clean deliveries with the option of c-section, and anti-biotics child birth killed 5% of mothers[2]. Bear in mind that without birthcontrol (pills or condom) most women would have about 6 pregnancies in their life time. [3] my bad maths makes that a ~1/4 chance of dying in childbirth/complications arising from.

The study that link obecity and asthma to c-section is small[4] however it is worth widening and expanding to more than scotland. Brazil would be a good target as 50+% of births are c-section.

[1]https://www.nhs.uk/news/pregnancy-and-child/breast-milk-rais... The only link I could find that wasn't selling something (either hippy nonsense or a drug)

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/

[3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865739/

[4]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055095/

TL;DR: 5% of child births were fatal to the mum, modern medicine has made that drop to <0.1%. There is some evidence that you might be fatter if you were born by optional c-section. However this is a limited study in one country.

>Yes, but up until decent, clean deliveries with the option of c-section, and anti-biotics child birth killed 5% of mothers[2]

But you are conflating very different issues. You can't give c-sections the credit for the benefits we gained from learning what bacteria are. Most women who died during childbirth died from infections, c-sections don't stop infections, hygiene and antibiotics do. You need to compare modern normal births to modern c-sections, not pre-germ theory normal births to modern c-sections.

The second paper of the series does review and compare several aspects in comparison to natural birth:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Sorry for being naive but:

"A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives. "

Is this a real risk of vaginal child birth? And how risky is it?

Yes, vaginal birth increases the risk compared to c-sec. However unlike what GPs wording suggests you don't go full throttle like a toddler learning to sleep without a diaper, it's more like a few droplets. If you had it during pregnancy already, chances are higher it'll continue after birth. In most cases it stops after a few weeks, but it can be permanent, so it will happen every now and then, when you're sneezing hard etc. You can get it under control with exercising.

You can look up further information from your country's health institutions, usually including numbers on how prevalent it is where you're from. Being older when giving birth, being obese and some other factors do increase the risk.

This is a real risk of vaginal birth. Long term complications of vaginal birth are not usually studied (this may be related to an ongoing issue in the medical community in failing to address women’s health). For example, painful sex has been reported in a quarter of women 18 months after birth. Painful sex is common in 90% of women in the shorter term after giving birth. Women overwhelmingly experience at least one complication within 6 weeks after birth and are recommended to wear adult diapers as the uterus continues to expel. Women also report at least one long term health complication about a third of the time. (https://en.m.wikipedia.org/wiki/Postpartum_period)

(Edit: this doesn’t differentiate between vagina and c-section, but for example I’ve seen in passing that vaginal birth causes more issues with incontinence and painful sex)

The majority of incidence of female incontinence is attributed to child birth. It's a very high risk that no one like to talk about...mostly because who cares about women? And who cares if they pee themselves for the rest of their lives? They're alive aren't they?

I'm not joking, when I talked to my doctor about this they totally dismissed this concern in a manner that suggested that women should just be fine with a diminished quality of life after child birth. That that's just the way it is and should be and if you don't like it, then don't have kids.

"A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives."

Not specifically only for those reasons, my wife always wanted a c-section birth due to the risks with vaginal birth and recovery times.

I would imagine the recovery times for c-section are longer

Possibly not always true.

Women are fairly frequently given episiotomies. This is intended to prevent vaginal tearing, which is far more harmful than a clean cut and much harder to repair and much more likely to leave a bad scar. Scars in the genitals can be pretty unpleasant. Scar tissue in female genitals tends to not want to cooperate with that whole sex thing.

Furthermore, sutures in the genitals make it impossible to comfortably or safely sit. They can become infected or tear open when you are using the toilet. You are typically given a stool softener to try to reduce the odds of tearing your sutures post partum.

Taking care of sutures in the outer genitals is inherently challenging. You can't see them without help of a mirror and they are difficult to reach for purposes of tending to them.

I imagine sutures across the lower abdomen are, in many cases, a piece of cake compared to that.

The rate has fallen a lot in some countries, so there are large differences (https://patient.info/doctor/episiotomy-and-tears).

The main reason it has fallen is that there’s little difference in short or long term consequences, and non-selective use of it is associated with higher incidence of severe trauma.

https://www.cochranelibrary.com/content?templateType=full&ur...

Perhaps I wasn't clear: Some percentage of vaginal deliveries will involve either vaginal tearing or an episiotomy. Both of these involve trauma and sutures.

When a woman has sutures in that area, bowel movements can rip them out. Both bowel movements and urination can contaminate the wound with bodily wastes.

So a woman having any stitches at all between her legs for any reason whatsoever is highly problematic.

Is an epidural assumed in all this discussion? The mothers I know who didn’t have the epidural didn’t have these nightmare symptoms, while those who did or had a C section were worse off.

(I’m assuming competent medical staff and follow up, but I realize that’s a difficult one in the US and elsewhere)

I have had two vaginal deliveries. They both involved an episiotomy. I have never had an epidural. Both deliveries were completely drug free.

Episiotomy: A surgical cut to the vaginal tissue to prevent tearing.

Epidural: Spinal pain block.

Totally unrelated procedures.

What you think about artificial womb? Would you prefer to make forced birth one month earlier, when baby is small, and then raise it in artificial womb for month or two?

https://gizmodo.com/for-the-second-time-researchers-have-use...

I have never heard of this before. I'm not going to give an opinion off the cuff on something I know nothing about.

What would an epidural have to do with tearing and episiotomies?

Higher rate of complications during birth, more interventions (instruments), which in turn are associated with tearing/episiotomy. The implication that this never happens without an epidural is wrong of course.

Gotcha, makes sense when I think about it. But it's tough to say MN a given case whether complications wouldn't have occurred without the epidural. Sigh, it's a tough call.

Depends.

If you have a tear (1/4 chance) it can take longer to heal, but it's not as debilitating in the short term. It doesn't affect your ability to get out of bed, as much.

However a bad tear will have long lasting impact on your life. Incontinence, infection, painful sex, amongst a whole host of other problems.

C-section has a higher risk of infection, There is significant muscle damage to, which limits your ability to lift and sit up. In terms of pain (emergency c-section compared to a 4b tear, the wife says the c-section was easier to recover from. )

You would imagine wrong.

Smoothly cut, cleaned and expertly closed up wounds heal a lot faster than ripped tissue that doesn't even get properly cleaned because it's in there somewhere.

Don’t be so sure. I can’t find good research comparing the two, but it seems generally held that CS recovery times are longer. I see NICE quoted as saying no risk difference between the two methods but longer recovery times for CS (https://www.theguardian.com/politics/reality-check-with-poll...).

If we perfect the art of surgery to a point where it's painless/seamless/benign it won't even be a question, it seems so much more efficient and clean. Open, extract, close.

There are a number of factors which make natural childbirth better, the mother recovers much quicker, a day or two vs weeks. There are things that happen during vaginal childbirth with hormones released by mother and child which do not happen with c-sections, like the bacteria which transfers from mother to child which is essential for gut function.

The baby is also prepared for birth during the process and is more awake and able to suckle faster with natural birth.

https://www.mamanatural.com/natural-birth/

You are describing some idealized optimum vaginal birth. Those are not the norm. I've spoken to one woman who indicated she recovered rapidly from one birth. It was her first child. She attributed it to youth. Subsequent births were harder on her.

I've had two children. Both births were relatively uncomplicated vaginal births with episiotomy. It took me 5.5 weeks to stop bleeding after the first one. It took me six months to regain the weight I lost while throwing up for 8 months. Etc.

I had unusually good medical care. I was relatively well educated for a young woman. Etc.

I did have an undiagnosed serious medical condition complicating things. Medical staff came to get me off the floor after people in the waiting room harangued them about ignoring what a terrible state I was in and I got an admission of error on the part of staff to some degree. They had dismissed my complaints as "You don't know what pain is. You have another 8 hours to go." without checking me. No, I did not have 8 hours to go.

Although I have also read that vaginal flora may be good for the baby, you are conveniently overlooking the fact that it can also be bad for the baby. C-sections are sometimes recommended to protect the baby from the mother's STD -- for example, if she goes into labor while having an active herpes flare.

I'm pro vaginal birth. I'm not thrilled at the high rate of C-sections. But I don't think you do any good by so completely distorting the facts.

Women need substantial support to successfully birth a healthy baby with minimal complications for mother and child. We still tend to fall short on giving women adequate support. So, in essence, I'm not willing to argue that any particular woman was wrong to choose C-section for herself.

https://www.medicalnewstoday.com/articles/264473.php

https://www.cdc.gov/std/pregnancy/the-facts/std_pregnancy_br...

Idealized is much better than that. I knew a lady who slept through labor, waking up just a few minutes before birth. There are even women who have birth orgasms.

A lot of that seems like unsupported woo which appeals to the sort of people wishing to rebel against the science / chemical / medical mainstream. That doesn't make it true or untrue. It reads exactly like someone who has decided what is true went to find evidence to share to support the claim.

You can pick any position at random and find a wealth of evidence to support your claim.

From a source in the above article:

>Although these new findings and proposed potential mechanisms are novel and exciting, further exploration and replication in larger cohorts of children ... are needed.

Most scientific results are not intended to be consumed by ordinary folks to instruct their final decisions. They are almost always only evidence, not containing any decisive conclusions.

My wife is in the medical field, and she’s the one who explained the advantages to natural birth. There are definitely advantages which have been proven, fewer complications and quicker recovery. I think patients should still make the choice given the information.

There's no evidence for bacteria transfer, and some children have been harmed by mothers taking vaginal mucus to transfer bacteria after a c section.

Don't bother pointing out that those cases are abnormal, and the mothers have diseases...

OTOH, you seem to argue that since you couldn't find any papers on that, doctors and media must be lying and c-section is just better. That sounds an awful lot like the typical conspiracy theorist.

> A lot of 30+ women decide they don't want to piss their pants and have painful intercourse for the rest of their lives.

I heard of that child once that died after it got the flue shot. We all should stop vaccinating now.