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blhack

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?

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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.

Lots of women I know elect to have C-sections.

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.

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.

The case linked below started off with an attempt at a normal vaginal delivery. Based on your comment, you might think it admirable that the doctors didn't consider doing a c-section and continued to try vaginal deliver for around 60 hours - but then had to do a c-section and the baby had severe brain injury.

"Specifically, the family alleged the hospital did not properly estimate the weight of the fetus, even though the ultrasound estimate was more than the average weight. The family also asserted that the hospital failed in assessing the safety of vaginal delivery, which constituted malpractice. Finally, the family claimed the hospital did not recognize the deteriorating fetal heart rate pattern, which showed decelerations and a rising baseline. The family stated that if the hospital and its staff adhered to the appropriate standard of care, the infant’s injuries could have been prevented.

Through careful monitoring, the physicians would have noted that delivery via cesarean section was viable — and, in fact, the most appropriate option. This is reinforced because despite the administration of labor-inducing drugs, delivery had not occurred after 60 hours. This timing should have concerned the physicians and care providers, and they should have re-evaluated their initial course of treatment. Absent any evidence indicating otherwise, the abnormal 60-hour labor period could easily have injured the fetus. Whether the physicians acted negligently while monitoring the fetus’ heart rate would likely have been a significant material issue in this case. However, the family presented strong evidence that the care providers were negligent based on the totality of the circumstances and obvious disregard of cause for concern."

It's easy to have opinions when you don't have responsibility for people's lives.

https://www.reliasmedia.com/articles/145690-birth-injury-lit...

Uh, nope, that's exactly a situation where a C section is warranted. That's not what I was referring to by an "elect" C section.

The WHO has long emphasized that the expected rate of necessary C sections is 10-15%. The US is sitting at around 30%, 2-3x the desirable rate. Some of that is doctors trying to avoid malpractice suits (it's harder to get sued for doing too much), but some of that is convenience for doctors or moms.[0] Those are the cases I'm concerned about.

[0] https://www.usnews.com/news/healthiest-communities/articles/...

Thats fair, I didn’t pick up on your use of the word “elective”. But vaginal births have twice the incidence of urinary stress incontinence, overactive bladder and pelvic organ prolapse. There is also a risk of tearing of the vagina, and even tears that extend into the anus [2]. If I could choose a surgery that would prevent tearing of my genitalia, at the cost of money pain and possibly other complications somewhere away from my genitalia, I might well choose that - one might even say that a woman should have the right to choose.

It seems weird that we think that the WHO, an organization run mostly by men [3] would somehow know the “correct” rate at which women should risk urinary incontinence and genital injuries - why wouldn’t we let the patients decide with the assistance of their doctors?

[1] https://jamanetwork.com/journals/jama/fullarticle/2718794 [2] https://www.mayoclinic.org/healthy-lifestyle/labor-and-deliv... [3] https://apps.who.int/gb/gov/en/composition-of-the-board_en.h...

This is true. My aunt chose to have all of her children by C-section, and this was over 30 years ago.

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.

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.

Not unique to Arizona. It's rather common throughout the country now.

> 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.

Except for the bills part

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