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Comment by soudiere | Hacker News Reader

Imagine working with this guy on a software system. Says no to established best practices across the board "no" to version control, CI/CD, vulnerability scans, patching and all the interventions.

Gets one project off the ground by "following their gut", and it wasn't a disaster, concludes this is the way to go.

> Doctors and nurses make a big deal about things like "the cord is wrapped around the neck" when the baby isn't even using its throat to breathe yet. It still has the cord for everything they need.

This is just wildly ignorant, they're concerned about occlusion of bloodflow through the cord and/or the carotid artery.

> The morphology scans can't seem to decide if we're at 18 weeks or 19 weeks. Due dates my ass.

What are you upset about? The error margin being well within the stated limitations in current research?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844476/

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You are acting like an ignorant first rate asshole.

As example of your ignorance is your lecture about the dangers of an umbilical cord wrapped around the neck. That is, in fact, very common and it is incredibly rare for it to lead to complications. https://unmhealth.org/stories/2022/12/nuchal-cord-managing-d...

Which leads to your willful ignorance of the fact that the guy was exposed to a lot of research about problems in medicalized interventions. "This guy"'s critical experience was almost certainly running across that research. And not on his personal anecdote. I've seen enough of that research myself to know that the interventions that he's questioning really aren't equivalent to any of the software best practices in your straw man comparison.

As for an example of your being an asshole, take your question about what he's upset about with due dates. You are right that it is a medical fact that the date chosen is imprecise. He knew that as well. But you are wrong to have not noticed his story about having his wife be asked about abuse because she wasn't getting induced 2 days after her due date. That behavior on the part of the doctor is an excellent reason to get unhappy.

Now why do doctors behave that way? According to research I saw close to 20 years ago, because they really want to control when the baby comes. It is more convenient for them to have a baby come during the work week rather than interrupting their Sunday golf game, and so they pressure mothers to make that happen. They do this both by recommending medically unnecessary Caesarians, and by inducing when there is no medical need.

Which is an example of the arrogance of the medical industry that illustrates why people get upset about this.

Did you stop to consider that perhaps the reason complications are rare from the umbilical cord wrapping around the neck, is because medical professionals are actively monitoring for it and mitigating the issue?

I absolutely did consider that. Did you consider that I might actually have looked into this reasonably seriously at one point? Like, say, when I was on my way to being a father?

The link that I provided explains the characteristics of the umbilical cord that have been evolved to minimize the probability of problems. It really isn't a problem. Even in childbirths where people don't worry about the umbilical cord.

This shouldn't come as a surprise. Evolution has selected for safe natural childbirth. Unfortunately in homo sapiens there is a conflict between our recent evolutionary pressure for large heads, the needs of walking, and for safety during childbirth. And so childbirth is much more dangerous for us than for other mammals.

Modern humans also have the problem of mothers in poor health. Reasons vary from drug use, to age, to sedentary lifestyles. Of these, drug use is the most dangerous. Despite most mothers not using drugs, drug use is a factor in something like half of childbirth deaths.

Then there is the list of usual complications. Breech birth, infection, blood type incompatibility, diabetes, heart attack and so on. It is a long list. It interacts with the previous lists - for example breech birth is made more dangerous because of our large heads. Complications from knotting of the umbilical cord is very far down the list of things that go wrong.

>Did you consider that I might actually have looked into this reasonably seriously at one point

Pretty much the question I was asking.

While I don't appreciate OPs mockery around CI/CD, what they said about the unbilical cord was accurate. I don't see where the supposed lecture on dangers you mentioned came from.

The post that started this thread was mocking doctors without a proper understanding of the mechanics involved. But sure, it must be a valid criticism by someone who has done their own research.

Not something I've looked into before and I've learned that it seems like it is rare for it to cause issues.

Personally I'd still want a professional on hand to be on the lookout, your posted article links to research where 0.6% of births had the cord wrapped around 3 times and that was correlated with infant death. That's something I would think is of concern even if not of very high chance.

The supposed lecture was:

> This is just wildly ignorant, they're concerned about occlusion of bloodflow through the cord and/or the carotid artery.

And no, this is not an accurate lecture. Most of the time that particular lecture is delivered by doctors who actually know it is not an issue, but want to scare patients into being in hospital for other reasons.

As for the post that started this thread, I have a context that you don't. I recognized the circle of ideas that would have been in that natural childbirth class. And so had context for where they would come from.

Thread started with OP claiming that doctors were worrying over something which is completely safe.

OP was then corrected as to the mechanics of the situation.

Yes, it might be relatively rare for the complications to occur.

Yes it is your choice if you have issues with medical care and choose to stay away.

None of this changes the reality that OP was talking nonsense and your response is pure speculation and anecdote.

Of course he hasn't. Imagine talking to this guy in the delivery room. "Evolution has selected for safe child birth, nuchal cord isn't a problem".

At that point every professional in the room is thinking "How do we get this guy the fuck out of here".

I'm certainly an asshole, and drunk, but at least I can read and look up studies on pubmed.

What are you even arguing about nuchal cords? They're common and we should ignore them? Who cares that the "complications" are fetal death?

You read some papers 20 years ago? Care to share any of them?

How confident are you about your hand waving claims around sunday golf games? Have you bothered to review the clinical literature around hour of birth and outcomes? Have you considered it may be related to the hospital being better staffed & rested during the day vs at night?

People have so many weird superstitions around childbirth. I guess if there's no harm, the doctors should be willing to accommodate. When you bring your car in for service, you'd never tell the mechanic "I ask that you only use Snap-On wrenches, only work on one part at a time, and NO AIR TOOLS!" But, when it comes to medicine, they have a list of requests about how the doctor should do his work. "You be you" I guess.

you'd never tell the mechanic, "...and NO AIR TOOLS!"

Oh, yes, I most certainly would. This is a great example of the tools being there for the convenience of the practitioner, not for your convenience or comfort (I'm sure the reader can draw parallels to child birth on their own).

When you, the mechanic, put the wheels back on you will use a torque wrench and torque the nuts to the proper values. Just I like I used to do 30 years ago when I was a mechanic. Because no one should find out at the side of the road that the air gun torques those puppies to 146ft/lbs, and you're not getting them off with that weenie little wrench that came with the car.

If your mechanic doesn't at minimum use a torque-limiting extension when putting lug nuts on you need a new mechanic. Even Walmart uses torque wrenches for that. Source: am a torque-wrench-using non-automotive mechanic, used to work in Walmarts shop.

OTOH, childbirth is a somewhat special case because it's effectively a prolonged surgery process, and standard practice 'till recently effectively denied personhood to the mother. Now we can have differing opinion on the degree this process should be streamlined and optimized for convenience of healthcare practitioners, but if the hospital does ask the patient for their preferences wrt. procedures and standars of care (and/or is required by law to do so), then it's just wrong (and possibly illegal) to then completely ignore those preferences.

This is yet another case where staff is optimizing short-term efficiency by burning long-term trust in healthcare system of entire generations.

>> Doctors and nurses make a big deal about things like "the cord is wrapped around the neck" when the baby isn't even using its throat to breathe yet.

>they're concerned about occlusion of bloodflow through the cord and/or the carotid artery.

Yep. Our #5's cord was looped 3 times. He was born with no vitals but staff was able to resuscitate him. He was effectively dead for the intervening time.

I don't disagree but "established best practices" have an enormous range from no brainers to obvious cargo cult bullshit. For every dev rightly suggesting people use CI/CD I've met 10 that twitch at the slightest suggestion that maybe we don't need whatever half baked library their favourite medium blogger or tweeter is raving about this week.

I think it's stupid to disregard a doctor's advice, but as someone without a medical degree you really have no good way of knowing whether you're getting the healthcare version of "use version control" or "I just used Svelte for 5 minutes and it's the best thing ever!!!!!!!". You just have to roll with it like you'd roll with a shit dev over someone who's never written a line of code in their life.

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