Talk:Childbirth/Archive 1

Lamaze
''Due to the relatively-large size of the human skull and the shape of the human pelvis forced by the erect posture, human childbirth is more difficult and painful for the mother than that of other mammals. A variety of anaesthetics have come into use to alleviate labour pains.''

No mention of Lamaze? This is quite subtly POV. --Calieber 13:18, Nov 6, 2003 (UTC)

Added Lamaze Ich 23:02, May 2, 2004 (UTC)

Nationality
Under the "Legal Apsects" section it states... "In many legal systems, the place of childbirth decides nationality of a child". I'm not an expert, but I don't think this is very common. The U.S. is the one notable exception.


 * Yes, but please await responses here, rather than deleting text from an article. I've reverted it. Could you provide some sources to inform this discussion? JFW | T@lk  21:38, 29 Jul 2004 (UTC)


 * Why not link to more wikipedia articles... Jus soli
 * Notice the paragraph starting with "However, increasingly countries are restricting lex soli by requiring that at least one of the child's parents be a national" Jus sanguinis
 * Gotta, love this choice quote from the "Legal Aspects" section...
 * "The birth certificate is the basic document that proves that the individual is a human being."
 * I guess the billions of people out there without an official certificate aren't actually human. If they're not human, what are they?  If I forge a birth certificate for my cat, are people going to start thinking its human? I wonder if it works the same way for squirrels.  If the squirrel has a birth certificate, it becomes a member of "Sciurus griseus".  Without one, it quietly vanishes into the void.


 * You're correct, that was complete nonsense. I'm glad you've changed some things. Linking to Jus d'orange as well :-) JFW | T@lk  23:00, 3 Aug 2004 (UTC)

Spelling
One of the headings uses the spelling "Labor." However, internal mentions of the word are spelled "labour." Can we come to a consensus about which one to go with, for the sake of consistency within the article? Joyous 16:52, Aug 21, 2004 (UTC)

Circumcision: Fathers in the delivery room
Is there some source to verify that circumcision rates went down as a direct result of increased fatherly presence in the delivery room? Joyous 23:15, Sep 13, 2004 (UTC)

Sorry, I may have overstated. I was referring to the overall empowerment of parents in the whole childbirth process, as opposed to the pure medicalization of childbirth. I have adjusted my wording to reflect historical changes, including some links to articles regarding parental choice in the hospital-context changing over time. DanP 00:10, 14 Sep 2004 (UTC)

Eating the placenta
"any parents like to see and touch this mysterious organ. In some cultures, there is a custom to dig a hole and plant a tree along with the placenta on the child's first birthday -- in some populations, it is ceremonially eaten by the newborn's family."

Does somebody have a source to the fact that some cultures eat the placenta after birth? I find just the image of sitting around the dinner table eating a placenta, really kinda strange... It seems a bit unhygenic too, Anybody have any more info on this or if it's true?


 * Unhygienic? Not if it's thoroughly cooked! Perhaps the WikiCookbook should include some placenta recipes. You're right, it sounds like an urban legend. JFW | T@lk  19:18, 20 Oct 2004 (UTC)


 * Well, I'm trying to come up with a suitable recipe. I have a couple weeks maybe before I'll need it, and of course I'll put it in the wikibooks cookbook. I've already tried stir-fry; it came out kind of like tough foam rubber. (maybe overcooked) Baking did the same, but I think I really overcooked it. Note that I don't care for onions, garlic, and peppers. (I tend to use rosemary, ginger, sage, thyme, basil, oregano, cumin...) Usually I'm a pretty good cook, but it's hard to tell what to do when cooking something I rarely get a chance to cook. Maybe I should mix the placenta into some scrambled eggs. I'd probably make tacos if I had a grinder, but I'm out of luck for that. Ideas? AlbertCahalan 15:46, 12 May 2005 (UTC)


 * OK, we have a Spicy Australian Placenta recipe now. AlbertCahalan 19:58, 23 May 2005 (UTC)

It certainly isn't unhygienic! I'm appalled at the suggestion. Have you ever been to an abattoir - now that is unhygienic. I have known friends to eat their placenta - onions and garlic make it particularly tasty. Tastes a little like liver I am told. Some people believe it stops post partum haemorrage. It is reasonably common within the home birth movement in Australia. --Maustrauser 10:47, 12 May 2005 (UTC)


 * Please ask them for recipes. I need one, fast. Let me know if I can just copy it into the Wikibooks cookbook, and if I should give credit to someone. AlbertCahalan 15:46, 12 May 2005 (UTC)



FYIW the eating of the placenta is known as placentophagia 9 July 2005


 * A few years ago this actually happened on British TV in a program presented by a fairly well known professional food writer, Hugh Fearnley-Whittingstall. A family and friends ate a placenta prepared as a meal. It was a subject of a Broadcasting Standards Commission complaint, see here; http://news.bbc.co.uk/1/hi/entertainment/101944.stm. Hugh Fearnley-Whittingstall talks about it himself here on his own website; http://www.rivercottage.net/askhugh/index.jsp. I don't know if it possible to obtain copy footage of the original program. --Ben Taylor 16:34, 29 March 2006 (UTC)

"the opposite of death"?
It can be considered the opposite of death, as it is the beginning of a person's life.

There are just too many things wrong with that sentence. First of all it would deeply offend those who believe that "life begins at conception, man" and second of all, how is it relevant? It's a badly phrased semi-philosophical statement thrown in the middle of a technical article on a biological process. LeoDV


 * I have rephrased it. JFW | T@lk  20:15, 30 Dec 2004 (UTC)
 * I think it to pull out the whole opposite to death sentence
 * I disagree. I think it's fine. :P r3m0t talk 22:44, Mar 29, 2005 (UTC)
 * I say pull the sentance. It doesn't belong here.  Rocky 22:41, Jun 20, 2005 (UTC)
 * Then where does it belong? It's directly relevant because, as mentioned, many do believe that. --Kizor 08:50, 11 July 2005 (UTC)


 * I don't see the point of that sentence. It's like those "duh!" statement. —The preceding unsigned comment was added by 130.126.73.95 (talk) 06:24, 1 May 2007 (UTC).

Birth defects
Is there any connection between neo-natal alloimmune thrombocytopenia and Rh disease? My initial thought was that it sound like the same disease. Then on a second read on the article, i realised she have never had a life child before. That doesn't say much since an aborted child earlier in her life could also trigger Antibodies in her body. Anyway, a medical trained wikipedian would be more helpful since i am not even sure what i am even saying. gathima 14:48, 8 Feb 2005 (UTC)

Photo
Is anyone wedded to the photo? I think it is awful. It makes childbirth look high tch, impersonal and medical. I'll look for something better. It would be nice to have a photo of the Mum! --Maustrauser 13:02, 24 May 2005 (UTC)


 * I noticed too. That photo brings back horrid memories from before I learned about homebirth. There definitely needs to be a more reasonable photo, perhaps of a homebirth baby getting a chance to nurse before the cord is cut or the placenta is out. Keeping that awful hospital photo might be OK though, making for a rather dramatic comparison. Note that the placenta photo is similar, showing somebody with their sleeves tucked under latex gloves. You'd think the thing had Ebola! AlbertCahalan 14:53, 24 May 2005 (UTC)


 * I wouldn't call it awful, but I do think it's needlessly graphic, given that its the first thing that hits you upon opening this Childbirth article. Perhaps it might be good to move it down the page, and in its current position put something a little more personal, less blood-covered, and possibly including a mom as Maustrauser suggested. --Monger 3 July 2005 20:40 (UTC)

I have removed the photo illustrating childbirth entitled 'Caesarean section'. The vast majority (admittedly decreasing in Western Countries) of childbirth in the world is vaginally. And yet we illustrate the article with a caesarean section. I am now hunting for a decent photo. Maustrauser 07:42, 1 May 2006 (UTC)


 * Do you like the one I put up? Medicobaby 11:01, 3 May 2006 (UTC)
 * Yeah - my upload! Maustrauser 12:29, 3 May 2006 (UTC)
 * I'm concerned about the licensing on that new photo. The upload note says "permission sought and received" from the owner, but has an "I, the creator of the work, release this picture into the public domain" tag on it.    While it's a great picture, you need to resolve the licensing issues correctly as soon as possible.  Please read Image_use_policy carefully, and do so.  Thanks! Nandesuka 11:27, 3 May 2006 (UTC)
 * Fixed - I hope! Maustrauser 12:29, 3 May 2006 (UTC)
 * Nandesuka, what was wrong with the upload of that other photo of the physiological third stage? Much nicer photo than the baby being treated as some sort of chicken having its legs ripped apart?  I can't see it being a POV edit?  And the comment about endorphins seemed OK too.  What are your objections?  Maustrauser 12:48, 4 May 2006 (UTC)
 * It was accidental - I didn't realize the image was replaced, I thought he just changed the description, which was what I meant to revert. I reverted myself and went back and adjusted the descriptions accordingly. Nandesuka 15:03, 4 May 2006 (UTC)
 * No probs. Thanks, it looks good. Maustrauser 00:23, 5 May 2006 (UTC)

"Childbirth" not "Homebirth Advocacy"
I'm concerned that the very appropriate and reasonable mentions of midwives and homebirth as an alternative to hospital and doctor-assisted delivery are beginning to metastasize into inappropriate advocacy of midwifery and home birth over mainstream medical care. Wikipedia is not, and should not be, an advocacy resource. How can we clean up the article to stop the spread of this while it's still salvagable?


 * I see it the other way. You only see inappropriate advocacy because of your own position on the matter. It's the same as in politics, where a politician is simultaneously viewed as a conservative by the librals and as a libral by the conservatives. The way I see it, this article is dripping with implicit advocacy of hospital births. Just look at the cold and frightening pictures. The section on complications is without any mention of probablility; one might assume that complications are perfectly normal. The section on pain control is out of whack too; for example the word "try" implys that non-drug methods don't really work. It's also implicit that pain is bad (it is not; it is a message you should heed) and that women are not tough enough to handle this. AlbertCahalan 04:10, 26 May 2005 (UTC)

One suggestion I have is that the petty bickering where we're adding "midwife or" before every instance of "obstetrician" (or vice-versa) has got to stop. In addition to being annoying, it makes the article read like garbage. As a compromise, I'll propose that we find a term such as "person assisting the delivery" or somesuch. At the first time we use that, we mention that that can be an OB or a midwife, and then use the term for the rest of the article.

My other suggestion is that everyone please, please, please PLEASE monitor their edits for NPOV. If your edit implies that doctors hate mothers and want to multilate them, or that midwives are witches who want to gift your baby to the Devil, take a few extra minutes and re-edit it to be more neutral, OK? Nandesuka 12:48, 25 May 2005 (UTC)


 * As the one 'guilty' of adding midwife in front of obstetrician I shall defend it. The medicalisation of birth is reality and part of that has been the view that obstetricians are the providers of expert care and midwives are subservient to them.  In these articles on childbirth / homebirth etc, the word obstetrician appears first everytime, even when the activity being described is in most cases undertaken by the midwife.  This is not NPOV and simply suggest a medical heirarchy.  Obsetricians are experts in pathological conditions.  Midwives are experts in normal birth.  They work together as a team, and yet most of these articles suggest a heirarchy of skill.  This is incorrect.  I was simply evening things up with my edits.  I do NOT intend to call obstetricians 'butchers' or midwives 'saints'.  I simply want a more accurate portrayal of their relative skills and abilities, and rest assured I'm not going to go around sticking midwife first in every sentence!


 * Having said that, we both probably need to be careful from a cultural perspective. I am aware that in the US, midwives are generally subservient to obstetricians and are more accurately called 'obstetric nurses' in most cases.  Only a few practice true midwifery, and yet are called midwives. --Maustrauser 13:09, 25 May 2005 (UTC)


 * From a practical perspective, then, are you OK with picking a neutral word to cover both doctors and midwives, defining it early, and using it consistently throughout the article, then? In doing that, we get to avoid the entire issue. Nandesuka 14:23, 25 May 2005 (UTC)


 * I think "someone" will do. Remember, it might be neither. For my last son, it was just family. Even in a hospital, the placenta might be sent to be examined by a lab technician, or a nurse could take care of the matter. AlbertCahalan 04:10, 26 May 2005 (UTC)


 * Yes indeed. I think this is a good suggestion. --Maustrauser 07:44, 26 May 2005 (UTC)


 * Uh, yes. Hospitals have recently started to claim that you can have the comfort of a midwife-attended birth and the safety (ugh) of a hospital. Of course, packing up and traveling to an unfamiliar place is not quite the same. When you arrive, they may decide to direct you to the regular birth area anyway. (there, you may see women laboring in the halls because the rooms are too crowded) Hospitals are trying to compete, mostly with each other, but also with true midwives. Hospitals have discovered, to their horror, that people are using the new services in sufficient numbers to negatively affect hospital finances. Meanwhile, true midwifery is once again legal in 37 states and the number keeps growing. AlbertCahalan 04:21, 26 May 2005 (UTC)


 * Show me the medical/biology courses the midwife has taken, and his/her grades in each course, or alternatively, their degrees, and maybe I'll consider them as having some sort of skill. Until then, my trust is staying with the hospital, since there is actually accountability.  I don't see those medical pictures as "cold" (sounds awfully POV), rather that they are taking the proper steps to ensure the health and wellbeing of the mother and child.  Look at the figures for life-expectancy and number of deaths in birth (either of the mother or child) in the past and now, and try telling me with a straight face that midwifery is the way to go. -- brian0918  &#153;  16:36, 26 May 2005 (UTC)


 * No problem, OB. :-) To start, there are many types of midwife. One can be a Certified Midwife (CM), Certified Nurse-Midwife (CNM), Certified Professional Midwife (CPM), Direct-Entry Midwife (DEM), Lay Midwife, Licensed Midwife (LM), and so on. As for accoutability... many hospitals now insist that you sign something that states your acceptance that the doctors are contractors, not employees of the hospital. Many doctors now refuse to pay malpractice insurance, preferring to place assets into places that are protected from bankruptcy proceedings. So, your plans for a lawsuit over an imperfect baby might not work out as well as you were hoping. Ensuring the health and wellbeing of the mother would require that the baby nurse ASAP, but this is not done. Ensuring the health and wellbeing of both mother and baby would require that narcotic drugs not be given to the mother. Looking at life-expectancy in the past is silly: poor nutrition, little winter heat, poor handling of sewage, and even poor sanitation in hospitals. Actually, the death rate for births increased when mothers started birthing in hospitals. Puerperal fever or "childbed fever" was a common cause of death for hospital births; today it goes by the term "hospital acquired infection". Today you stand a 5% to 10% chance of picking up an infection from a hospital stay in the USA. But anyway, have a look at the stats you were hoping I wouldn't find. Yow! Your chance of dying is 3x greater at the hospital! (1983-1989, Texas Department of Health statistics) Take a look at this evidence too. AlbertCahalan 18:08, 26 May 2005 (UTC)


 * AlbertCahalan, your statistics are extremely biased and misleading. Sorry, but I find all of your comments and edits to be heavily POV and evangelistic. Advocacy is not what Wikipedia is about. "Your chances of dying are 3x greater in a hospital" is a statement that fails to take into account the fact that midwives routinely refuse high risk clients (for insurance reasons), and people who homebirth generally tend to be affluent, well-educated, healthy, well-fed, unlikely to be first-time parents, unlikely to have health problems, etc. People choose homebirth generally because they are already unlikely to have complications-- a diet of expensive organic produce and a few years of yoga and rock-climbing also does not hurt. Hospitals, on the other hand, have to admit EVERYONE, including those who are likely to have complications, including the highest risk populations (i.e., drug addicts, alcoholics, women who have had no prenatal care or who have been abused) and also the 10% of attempted homebirths who, despite their low-risk affluent status, develop complcations, and often need emergency caesarean sections. 38.2.108.125 16:32, 1 February 2006 (UTC)


 * Good to see anonymous users attacking other Wikipedians. You have made a splendid range of assertions without any references.  What country are your talking about?  USA, Britain, NZ, Canada, Slovakia, or are you making gross generalisations for the world?  A recently published study in the British Medical Journal (Tracey et al, Oct 2005) showed that in Australia it was safer to birth in small birth centres rather than large hospitals REGARDLESS of the health status of the woman.    In Australia midwives take on high risk patients simply because obstetricians will not allow the women to birth in the manner that the women want.  So your assertion that midwives refuse high risk patients is nonsense in Australia.  Further, the best practise is not midwifery and homebirth versus obstetricians and hospitals as you infer.  It is collaborative care which provides the best outcomes for the woman and child.  Could you please provide evidence for your comments regarding affluence, low risk, and homebirth transfers requiring emergency caesarean sections?  Maustrauser 12:05, 2 February 2006 (UTC)


 * I take great exception to your accusation that I am "attacking" anyone. That is not what I have done, and I feel you are seriously out of line. I suggest you read the Wikipedia policies and guidelines on civility and assuming good faith. I know this is an emotional topic, but some respect on both sides would not be remiss. You have also missed my point: namely that comparing stats from hospitals vs. Home births is deeply misleading as it ignores the fact that people who homebirth (whether they use midwives or not, and regardless of where they live) typically do so because they have reason to believe that they are at a low risk of complications-- this may be different in Australia, but I personally am amazed that a responsible midwife would take on a high-risk pregnancy which might result in maternal or infant death. Regardless of this, my point still stands: Hospitals usually are where people who have complications end up-- this affects their statistics. Therefore: saying that you are 3x more liekly to die giving birth in a hospital and concluding that this means that hospitals are dangerous places, is not a logical, accurate, or responsible way to intepret the statistics. I am effectively making the same point made by Nandesuka 16:02, 27 May 2005 further down. As for the statistics regarding hospital transfers-- this is the current rate in the United States. I found these stats in a study I read recently, and would need to dig for the exact reference. Complications happen even in the best of cases (I experienced this personally) and people often go to the hospital when things are not working out at home. If the result is a healthy birth, most people would see that as a good thing. As for affluence:  access to better health care (including prenatal care), better insurance, better food, leisure time for excercise and wellness classes, better education (i.e., awareness about ones own body and what might be happening in it), better access to resources in general usually does translate into healthier mothers and babies. Granted this is a greater issue in the US (and the developing world) where access to healthcare and other resources is a pressing issue (in varying degrees). Affluent women are much less likely to have complications, and when they do, much more likely to discover problems earlier and have the resources to address them most effectively. 38.2.108.125 14:17, 3 February 2006 (UTC)


 * "Data collected in this region in 1983 suggested that 35% of these women changed to hospital based care either before or during labour, and a more detailed prospective study of all planned home births in 1993 found a total transfer rate of 43%.(8) Women were classified as having booked for a home birth when a community midwife had accepted a woman for home delivery and had this arrangement accepted by her manager and supervisor of midwives at any stage in pregnancy, irrespective of any later change of plan. Reverse transfers (women arranging to have a home birth after initially making confirmed plans for hospital delivery) were uncommon. The one transfer of this nature associated with perinatal death was grouped with the other booked home births. Perinatal mortality associated with planned home births was calculated with an assumed predelivery transfer rate of 40%. Ford et al found a transfer rate of 19% in one inner city practice that provided substantial medical support for women requesting home birth between 1977 and 1989." --Ford C, Iliffe S, Franklin O. Outcome of planned home births in an inner city practice. BMJ 1991;303:1517-9. Not the source I had originally sited, but easily found in Google. I also found this : (Anderson, Rondi E., Aikins Murphy, Patricia. Outcomes of 11,788 Planned Home Births Attended by Certified Nurse-Midwives, A Retrospective Descriptive Study. Journal of Nurse-Midwifery, Vol. 10, No. 6, Nov./Dec., 1995) "This study describes the outcomes of 11,788 planned home births attended by certified nurse-midwives (CNM's) from 1987 to 1991. A retrospective survey was used to obtain information about the outcomes of intended hospital transfers, as well as practice protocols, risk screening, and emergency preparedness. Ninety nurse-midwifery home birth practices provided data for this report (66.2% of identified nurse-midwifery home birth practices). It is estimated that 60-70% of all CNM-attended home births reported in national statistics data during this period were represented in this survey. The overall perinatal mortality was 4.2 per 1,000 including known third trimester demises. There were no maternal deaths. The intrapartum and neonatal mortality for those intending home birth at the onset of labor was 2 per 1,000; the overall neonatal mortality for this group was 1.3 per 1,000. When deaths associated with congenital anomalies were excluded, the intrapartum and neonatal mortality rate was 0.9 per 1,000; the neonatal mortality was 0.2 per 1,000. The overall transfer rate, including antepartum referrals, was 15.9%. The intrapartum transfer rate for standard risk-assesment criteria, only delivered low risk women at home, and were prepared with emergency equipment necessary for immediate neonatal resuscitation or maternal emergencies. This study supports previous research indicating that planned Home birth with qualified care providers can be a safe alternative for health lower risk women." I can dig some more, but it sounds like 10% is actually a pretty low and conservate transfer rate comparatively speaking. 38.2.108.125 14:28, 3 February 2006 (UTC)


 * Since when does "evidence" on a site called texasmidwives.com count? That would be like saying "the time cube is real, see here."  Show me peer-reviewed medical journal articles, please.  (You can start with PubMed)  -- brian0918  &#153;  20:52, 26 May 2005 (UTC)


 * Excuse me, you think the Texas Department of Health is biased or clueless??? Perhaps you suspect that the texasmidwives.com site has falsified this? (an outrageous charge, so you must prove it) I'm not about to purchase journals for you. If you choose not to believe the state of Texas, how about the WHO? (that's the World Heatlh Organization, a part of the United Nations) The WHO has repeatedly suggested that the USA move more towards a midwife-based system of childbirth support. WHO statistics show clearly that the European countries with the highest rates of midwife usage have the lowest rates of serious problems. Every country in Europe that beats the USA has midwife usage of at least 70%. Anyway, if you will believe neither the Texas Department of Health nor the World Health Organization, then I can not help you. AlbertCahalan 22:48, 26 May 2005 (UTC)


 * Provide sources for everything you've just said, please. Just cite the source of the original Texas health dept study, and sources for all of your WHO statements.  Thanks. -- brian0918  &#153;  23:25, 26 May 2005 (UTC)


 * Brian the debate is not, nor should it be obstetricians versus midwives. Both are essential.  There is significant and growing evidence showing that for healthy women, midwifery care is best and for women with complications obstetric care is best.  It is 'horses for courses'.  I assume that you know that aphorism.  Can I suggest that you look at "Pursinging the Birth Machine - The Search for Appropriate Birth Technology", by Marsden Wagner (UCLA trained paediatrician and neonatologist).  This book provides much of the statistical and research evidence that you seek, including the WHO statistics.  Your local library will have it.--Maustrauser 01:30, 27 May 2005 (UTC)


 * What is wrong with the hospital when it comes to healthy women? How does one even determine whether or not the woman is healthy without first going to the hospital/consulting a trained medical professional?   -- brian0918  &#153;  01:13, 27 May 2005 (UTC)


 * Firstly, midwives are trained professionals. In Australia it is a 3 year University Course followed by 12 internship.  So women meeting with midwives are meeting wtih trained medical professionals.  Secondly, you miss the philosophical distinction between hospitals and birth centres (or home birth).  Hospitals for every other human condition is for sick people.  Birth is not an illness.  It is a normal part of life.  Attending a hospital or an obstetrician indicates immediately that "something can go wrong."  Birth, is a very 'cerebral activity' for women and women need to feel safe.  Being told that something may go wrong at any moment requiring major abdominal surgery fails to keep adrenaline at bay.  For more information on the interplay of hormones involved in birth and the affect of hospitals on women, I suggest you follow up some of the work undertaken by the French Obstetrician Michel Odent.  A search on Google will find many references to his research.--Maustrauser 01:30, 27 May 2005 (UTC)


 * If something goes wrong, it's better to be in a hospital than to realize when it's too late that you're going to have to call an ambulance and lose precious time. To claim that women have adverse reactions to hospitals because you claim they see hospitals as places to treat the sick is ridiculous.  I can just as easily say that people see hospitals as sanitary places run by professionals trained for such situations, with the proper equipment to handle such situations as well as any complications that may arise, and whether or not it is true that people believe this, it remains true that hospitals staff such professionals and have such equipment. -- brian0918  &#153;  01:54, 27 May 2005 (UTC)


 * Sure, if something goes wrong, it is better to be in a hospital. That's a big "if" though, and hospital interventions bring problems of their own. Hospitals are indeed places to treat the sick. In the USA, the CDC estimates that you stand a 5% to 10% chance of getting a new infection just by being a hospital patient. The risk varies from 2% to 29% at hospitals in the British Isles, averaging 9%. That's a risk that you shouldn't take lightly, considering that you can get some pretty exotic germs in the hospital. (the home may have more germs, but your body is well-prepared for them) Study after study has shown that doctors often don't wash their hands, even when they know they are being watched. I just saw a recent study showing that airborne germs are very easily carried from room to room on clothing, being caught and rereleased as the cloth moves. AlbertCahalan 02:50, 27 May 2005 (UTC)


 * A mother with your worries would indeed have difficulty delivering at home. A decent midwife will help to correct this, knowing to give up if the fear is hopelessly ingrained. A fearful mother will hold back, sometimes to the point of preventing delivery. A mentally prepared and healthy mother is very unlikely to have any trouble at home. Getting the right mental attitude is virtually impossible in a hospital. The mother is almost certain to end up on drugs of some sort, with an IV, and generally "out of it" while being poked and prodded. Complications are to be expected in such a case. AlbertCahalan 02:50, 27 May 2005 (UTC)


 * I dearly hope that someday you will experience a gentle and happy childbirth, planned or not. Hopefully you won't call 911 to ruin it, or make some dangerous attempt to prevent the birth. AlbertCahalan 02:50, 27 May 2005 (UTC)


 * Brian, DON'T PANIC! Childbirth isn't as difficult and as dangerous as you appear to fear.  All 'emergencies' in Childbirth (even the worst - Uterine Rupture) can be handled by midwives until they get the woman to hospital.  Are you aware how long it takes an operating theatre to be prepared for an emergency caesarean (which in 90% are not true emergencies - in the sense of life and death)?  A minimum of 30 minutes, assuming staff and obstetrician are immediately available.   This is plenty of time for most women to be transferred to hospital (at least in Australia - I can't speak for the US).  So kick back, relax and have a good red wine. --Maustrauser 06:56, 27 May 2005 (UTC)

OK, let's look at what the Texas Department of Health actually has to say. Basically, I no longer believe any of AlbertCalahan's numbers, because they appear to have no connection with reality. He cites a neonatal death rate of 0.1%. This is so far removed from reality that it beggars description. Here are some actual statistics from Texas. I apologize for the formatting:

YEAR OF BIRTH  #BIRTHS  PNTAL DTH    NNTAL DTH   FETAL DTH 1989           312,279  3,708 11.8   1,598 5.1   2,110 6.7 1990            321,041  3,554 11.0   1,467 4.6   2,087 6.5 1991            322,065  3,375 10.4   1,350 4.2   2,025 6.2 1992            325,104  3,432 10.5   1,455 4.5   1,977 6.0 1993            326,267  3,302 10.1   1,403 4.3   1,899 5.8 1994            325,521  3,191 9.7    1,272 3.9   1,919 5.9

(Source: Perinatal Mortality in Texas, 1998-1994).

Basically, you are cherry picking sources that, as near as I can tell, are just making things up. I will not allow such garbage to stay in this article.

Nandesuka 15:48, 27 May 2005 (UTC)


 * First of all, it is not "so far removed from reality that it beggars description". Note that your numbers are NOT percentages. You need to move the decimal point. Second of all, I only used Texas as an example. The 0.1% was an international number, taken from about the midpoint of the highly-developed countries on the WHO list. The USA is at the bottom of that part of the list, and of course Texas is in the USA. Plus I gave 1983-1989 numbers, while you chose mostly different years and didn't separate out the different types of birth provider. Let's take the reasonable assumption that most births are in the hospital, so using my 0.57% rate. Now let's take the 1989 neonatal death rate from your chart, which is 0.51%. (not 5.1%) Hey, that's a better number than mine! Don't be so damn quick to revert next time. Generally I've been grabbing the first numbers I come across, not the nicest ones I could find. (Iceland would be the nicest - they didn't have any deaths) I did do some hunting specifically for the WHO numbers, because the WHO is kind of the standard for worldwide health statistics. BTW, note that even your 1994 number (0.39%) is over twice as bad as my 1983-1989 midwife number (0.19%), which in turn is twice as bad as the better European countries. (making your number 4x as bad) AlbertCahalan 02:00, 28 May 2005 (UTC)


 * Nandesuka, what you have done (NPOV marking) is not right. Since you appear to be new here, I'll try my best to be really nice about explaining this. Try to forgive me if I fail. We all make mistakes sometimes. I certainly do. Yesterday you messed up your statistics horribly, being off by a decimal point and confusing the neonatal death rate with the perinatal death rate. It happens. You then accuse me of cherrypicking statistics at best and even suggest that the statistics are fabricated, which was not the calmest thing to do. I guess you were suspicious from the start too, with my statistics conflicting with what you thought to be obvious and common sense. I hope I was reasonably polite in pointing out the errors you had made. The proper response would be to accept that you had made an error and apologize for reverting. I, and many others, have a lot of respect for someone brave enough to admit their own error. I know it isn't easy, especially when you are trying to "win". (just get it over with; it even makes you feel better)


 * See NPOV Flag section below. AlbertCahalan 14:08, 28 May 2005 (UTC)


 * So now I see that you have marked the article as having a NPOV dispute. Huh? There was a factual dispute, which is something different, but I hope you can admit that your report definitely uses per-1000 numbers instead of percent. (mine did too, until I converted it in expectation of such confusion &mdash; perhaps the per-million numbers should be converted too) While I think I would be justified in removing that tag based on the fact that you have only an extinct factual dispute on the talk page, I think I'd rather not make anybody suspicous just now. (Can anybody point me to the point of view that is in dispute?) I hope you will remove that soon. Else, I guess I will have to file a complaint of some sort or hold a vote. Alternately, I could provide the POV dispute. I think I see one now, in a part of the article which I have not yet edited. AlbertCahalan 12:47, 28 May 2005 (UTC)


 * See NPOV Flag section below. AlbertCahalan 14:08, 28 May 2005 (UTC)

Lewis Mehl source

Well, brian0918 demanded (via revert, which is not nice) to see a reference for Lewis Mehl. Fortunately brian0918 had earlier been kind enough to provide a link to PubMed. Searching on "mehl l" finds the study and a followup. The author has published a number of other interesting articles as well; the Tasered mother one is kind of famous I think. Hopefully this link to the abstract isn't going to expire. Notice that the midwives came out slightly ahead even after the worst 50% of the doctors were eliminated from the comparison. (more fetal distress and placental problems with the doctors)
 * where: Women Health. 1980 Summer;5(2):17-29
 * title: Evaluation of outcomes of non-nurse midwives: matched comparisons with physicians.
 * authors: Mehl LE, Ramiel JR, Leininger B, Hoff B, Kronenthal K, Peterson GH
 * PMID: 7210691 [PubMed - indexed for MEDLINE]

That's pretty damning I think.

AlbertCahalan 03:11, 27 May 2005 (UTC)

It's not damning at all. It's consistent with the idea that a professional, licensed midwife understands his limits, and transfers patients with risk factors or complications to the care of doctors when appropriate. Basically, according to your logic, nurses at elementary schools are more competent than hospitals, since zero percent of the 8 million children(*) who received first aid from school nurses died, while 10%(*) of the 894,444(*) children who were hit by trucks at school and then transferred to a hospital died.

(*) number completely made up for illustration.

In other words, it's called risk because there's a higher chance that something may go wrong. It is not surprising to anyone with a brain that doctors see higher negative outcomes if they are seeing the mothers with a higher risk. Your weird implications that birth is a beautiful thing where nothing can possibly ever go wrong if we just let nature take its course aside.

Nandesuka 16:02, 27 May 2005 (UTC)


 * Where did you ever get the idea that I suggested "nothing can possibly ever go wrong"? Also, you misunderstand the study. Patients were matched up according to risk factors in advance. Attempted midwife births that ended up in the hospital were counted toward the midwives, so the doctors weren't getting any extra disasters counted against them. This is 100% justified; a qualified midwive knows when to call it quits and seek a caesarian section. The point is to measure outcomes for starting conditions that are identical except for the choice of place to start the birth. AlbertCahalan 02:09, 28 May 2005 (UTC)

For what it's worth, check out Outcomes of planned home births with certified professional midwives: large prospective study in North America (Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, PL 6702A, Ottawa, ON, Canada K1A OK9 2 Safe Motherhood/Newborn Initiative, International Federation of Gynecology and Obstetrics, Ottawa, Canada). Published on PubMed Central.

"Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States." 7/10/2005

- I'm new here, so I'm not sure how this works, but I vote for the above study to be mentioned and linked to in the article, in addition to the mention of the much older study that found a greater incidence of neonatal mortality. I believe the above-mentioned study is larger and better controlled, as well as more current. Anotherlink is http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom -- Jazapp310 08:29, 25 January 2007 (UTC)

Third stage - placenta
Nandesuka, I don't intend to get into a revert war over the placenta inspection description. But I must say I am surprised by your claim that it is the obstetrician who delivers the placenta. I was under the impression that it was the woman!

Are you Australian? It is my experience in Australia that it is the midwife's job to inspect the placenta to ensure that it is intact. Next to no obstetricians do this task. How shall we manage these cultural differences? --Maustrauser 13:19, 25 May 2005 (UTC)

NPOV Flag
Nadesuka, you have decided to put up the NPOV flag. Would be kind enough to put in concise point form your concerns, rather than simply raising the flag. Do you not like Albert's statistics? He seems to have explained them clearly. --Maustrauser 12:41, 28 May 2005 (UTC)


 * I think Albert has been perfectly open and straightforward that his objective is to advocate midwifery, that he thinks hospitals cause infection and death, and that if a woman has complications in childbirth, it's probably her own fault for not having the right attitude. I think regardless of the statistics (and here I'll acknowledge I was wrong in reading the percentages – although I find it funny that Albert doesn't like the more recent numbers from Texas showing that hospital births overall are slightly safer than homebirths) the bias in his position comes through loud and clear, in every single sentence he has added to the article.  Every single one. --Nandesuka 19:36, 28 May 2005


 * Credit me for resisting the urge to directly point out that, in study after study, the doctors come out 2x to 3x worse. I simply gave the raw objective facts; the reader may draw their own conclusion. Completely eliminating these facts from the article would be hiding something. Why should we hide the truth? AlbertCahalan 01:58, 29 May 2005 (UTC)


 * Factually, hospitals both cause and cure infection. (makes perfect sense: hospitals are full of sick people) Do you dispute this? I've seen numbers from the CDC in the USA (5% to 10% of hospital patients get new infections), from the UK and Ireland (2% to 29% depending on hospital, averaging 9%), and from similar studies in other countries. (there are lots of these studies; it's been a hot topic) Of course you must go to the hospital if your condition is serious enough to merit taking the risk of additional infection. If you have a a foot-first baby or the placenta over the cervix, you probably should get a caesarean section. AlbertCahalan 01:58, 29 May 2005 (UTC)


 * I certainly don't believe that "if a woman has complications in childbirth, it's probably her own fault for not having the right attitude". This could be a cause, if she tenses up and resists the birth. More likely she is very unlucky, in bad health to begin with, or being attended to by someone who can't resist the urge to intervene. AlbertCahalan 01:58, 29 May 2005 (UTC)


 * Your more-recent Texas numbers do not show that hospital births overall are slightly safer than homebirths. Remember, my number for midwives was 0.19%. (you had 0.39% as your best number, which includes both birth settings) If we make the big assumption that the midwife numbers did not change over the years, the doctors improved from being 3x worse to being only 2x worse. Lovely. I like using the older numbers for everything, so that we don't make the mistake of crediting the hospital with improvement that came from better nutrition. Perhaps people change their eating habits in response to fad diets, unemployment, etc. Who can tell? So we must compare similar years; your 1989 number is the only one that overlaps with my 1983-1989 range. AlbertCahalan 01:58, 29 May 2005 (UTC)


 * Don't forget Dr. Lewis Mehl's study. That multi-author peer-reviewed study showed a 3% rate of "birth injuries" in the hospital. This would be stuff like cracked skulls, pinched nerves, forceps scars, etc. AlbertCahalan 01:58, 29 May 2005 (UTC)


 * Wait a second... you think I added the stats to the "Complications of birth" section just for the purpose of advocating midwifery? (That would explain your "Conversely..." text.) No, I added the numbers because we needed some numbers. Back when you had the decimal point wrong, you didn't think "What the heck???", did you? That's the problem. Complications are rare, but people think they are pretty much normal. So my primary reason for adding the numbers was to express how likely it is that problems will occur. One should be aware of the potential problems, but one should also keep things in perspective. I suspect that people believe complications are common because that's what sells ratings on TV births. When neighbors chat, they tend to discuss disasters. You don't walk over to your neighbor and tell him about how you had an absolutely normal day the week before last August. So the stats need to be there for that purpose. While I'm at it, I may as well compare countries or birth environment. It would also be reasonable to briefly list the major risk factors: smoker, very young, very old, obese, malnourished, alcoholic, diabetic, and so on. Anything else that would help give people a dose of reality? You might die, and the baby might die, but the chances are very low. AlbertCahalan 02:32, 29 May 2005 (UTC)


 * Do you think for a New York minute that if I, for example, added a link and a paragraph about the Western Australia study that shows statistically significant poorer outcomes in midwifed homebirths vs. hospital births, he'd let that stand?  Don't make me laugh.   --Nandesuka 19:36, 28 May 2005


 * Given your own edit history, I would be suspicious. Given the degree to which I've been asked to justify things, I'd have to return the favor. The only study I've ever heard of that put hospitals ahead was one that counted unplanned unassisted births with the midwives. These would be the women who try to push the baby back in while screaming for emergency help, the ones too drugged up to realize they are giving birth, etc. AlbertCahalan 01:58, 29 May 2005 (UTC)


 * I have already proposed a methodology for cleaning up the article that I think was reasonable (and I think you thought that too, Maus): mention midwives vs. OBs as an option early in the article, and then spend the rest of the article discussing aspects common to both.  Throwing in cherry-picked stats and hysterical language ("disfiguring and disabling" in respect to episiotomies, which might be done because of an incompetant doctor or midwife, or might, y'know, be done to save the life of an infant) adds absolutely nothing useful to this article.  If we're going to leave hysterics and the cherry-picked statistics in the article, then I think it's super-important for readers to realize that they're getting a political pamphlet rather than impartial information.  Thus, the NPOV flag. --Nandesuka 19:36, 28 May 2005


 * Your proposal covered the annoyance of repetitive "midwife or obstetrician" text. It did not cover the problem of the case when the description of something is different for midwife and obstetrician. AlbertCahalan 01:58, 29 May 2005 (UTC)


 * "disfiguring and disabling" is not just in respect to episiotomies. It covers both mother and baby. It counts cases like my mom's own birth; she can not raise one of her arms above horizontal because a motor nerve was crushed by forceps. AlbertCahalan 01:58, 29 May 2005 (UTC)


 * Specifically regarding the issue of episiotomies, one must realize that they are routine for many doctors. If they were saving infants, then we'd expect to see that reflected in the death statistics. Instead we see the opposite. There is lots and lots of research showing that the vast majority of episiotomies are unneeded. The wound takes about 2 months to heal, while a normal birth takes a week or two. The long-term damage can cause anal incontinence, loss of sensation, future tearing, and so on. As for the baby, did you know that the intact vaginal opening serves a purpose? It effectively performs a Heimlich maneuver on the infant. AlbertCahalan 01:58, 29 May 2005 (UTC)

Obstetricians
Maustrauser, I thought your last edit (rewording the obstetrician section to parallel the midwife section) was very good. Thanks. The reason I had used the word "physician" rather than "surgeon" is that obstetricians are not necessarily surgeons (although many are). See, e.g. http://www.abog.org/women/defs.html. Nandesuka 13:25, 22 July 2005 (UTC)


 * Although obstetricians "are experts in dealing with abnormal births and pathological labour conditions", this is on top of understanding normal births, not instead of. They are also experts at spotting potential complications during labour, and can be present at a perfectly normal labour as a precaution. I'm planning to add something along these lines as it is not clear from the current section, which implies that they may be only present in difficult births. Stephen B Streater 08:07, 1 May 2006 (UTC)


 * Yes, they do understand normal births but they are not 'expert' in them. They simply do not have the time to become expert in normal births.  They are experts in abnormal conditions.  Midwives are experts in normal birth.  I think the distinction has to be made clear.  Obstetricians in Australia do NOT need to attend any normal births in their training - if all the births they attend end up caesareans then that is OK.  Midwives have to attend 40 normal births (excluding caesareans etc) to qualify.  Also, in your edit, please ensure that obstetricians and midwives are seen as a team - not as competing professions.  Maustrauser 08:21, 1 May 2006 (UTC)


 * OK - I cut this down before adding it. Stephen B Streater 09:02, 1 May 2006 (UTC)

New Graphic
Dear interested folk, what do you think of the new graphic supplied by Stevertigo? I must say it has some educative role and that's what I don't like about it. It continues the old furphy (oz slang) that birth is done on the back. Much evidence shows that giving birth on the back is the WORST way to give birth, as it closes (rather than opens) the vagina and it puts additional force on the coccyx, causing additional pain. I am inclined to remove it, but before I do, I would like other comments. Ta. --Maustrauser 10:07, 2 August 2005 (UTC)
 * You are certainly right about the positioning, but I think the image has a very good illustrative value and should remain. The article needs to better discuss birthing positions, though I'm sure it was written somewhere around here.  violet/riga (t) 10:19, 2 August 2005 (UTC)
 * Re-orienting the image to be vertical feels like a fine compromise. Nandesuka 12:09, 5 August 2005 (UTC)
 * Maustrauser, I reverted the vertical image because it seems to be broken -- it won't display for me on two separate machines with different browser types. Nandesuka 14:49, 8 August 2005 (UTC)
 * Anyone else having any problems? It works on my Mac running Safari and on my ancient work computer a - pentium thing with Explorer? --Maustrauser 06:14, 9 August 2005 (UTC)
 * Is it possible that an older, working version is in your browsers' cache? Nandesuka 11:49, 9 August 2005 (UTC)
 * I guess it could have been. I hope I have now managed to fix it. --Maustrauser 12:34, 12 August 2005 (UTC)
 * Yep, looks great! Thanks.  Nandesuka 12:58, 12 August 2005 (UTC)

Goo
Does the word "goo" really belong in an encyclopedia? This is in the "second stage" small heading. Dawhitfield 20:11, 9 August 2005 (UTC)
 * Fixed. The word is 'Vernix'.  Feel free to make the changes yourself next time! --Maustrauser 12:33, 12 August 2005 (UTC)


 * "Goo" is well-understood. I think the point of a good encyclopedia is to be informative, so "goo" is an excellent word to use. AlbertCahalan 02:02, 14 August 2005 (UTC)

Lamaze Institute For Normal Birth links
Am I being too parsimonious / grumpy about removing the links to "Lamaze Institute for Normal Birth" that User:68.48.134.184 keeps adding? It probably wouldn't have even shown up on my radar but that she's adding them to every article that is even tangentially related. My feeling is as follows: (1) the main lamaze site has a link to the Institute for Normal Birth right up top. So I don't see the point in adding another link here where we're already linking to Lamaze. (2) I can see linking to the institute from directly relevant articles, such as Natural childbirth. (3) In other cases, I'd kind of like an explicit statement of the relevance of the link within the article, so that we have some reassurance that it's not just POV pushing.

What's the consensus here? Am I being too prickly, or reasonable? --Nandesuka 02:18, 19 August 2005 (UTC)


 * I agree that links added in a spamming spree may be removed without discussion. It can stay on pages like natural childbirth and pages on the Lamaze technique, but I generally penalise spammers by removing those as well. We're not a link repository. JFW | T@lk  02:36, 19 August 2005 (UTC)

Death
felt this article was too morbid, with excessive mention of medical intervention and mentioning death 10 times. I don't dispute his assertion, but he could have raised this here first, and has shown no interest in fixing the problem itself.

It is easy to forget that a normal delivery is typically uneventful, and this article does indeed mention the numerous things that can go wrong, from abnormal presentation to eclampsia. For this article to be encyclopedic, it needs to mention both a physiological birth and the many potential complications. Perhaps toning down the "death" bit may be a good idea. JFW | T@lk  15:03, 9 September 2005 (UTC)


 * Childbirth is a controversial issue. Who should attend a birth (Midwives or Obstetricians), what is an appropriate setting for birth (hospital/birth centre/home), what interventions are justified and in what circumstances. Underlying this is the philosophical question of how birth is seen (a natural event, or a dangerous medical procedure). People have passionate views about the subject, both midwives and Obs livelihoods depend on these choices. But the intensity of the debate also reflects the strength of feeling which exists surrounding an enormous event.


 * The article is IMO strongly slanted towards the medical approach, emphasising risks, using the word death 10 times. There is no discussion of the high CS rate in the US. Water birth does not get a mention. The single reference sighted is a study which shows home birth to be more risky than hospital birth, without any discussion as to why this study gave results contradicting the majority of other studies on this subject. There is a lack of links to the wealth of resources that exist on this subject.
 * I think the article should be updated to explain the controversies surrounding the subject and put forward the arguments of both sides and include references and links to both sides.
 * Amnonc 16:35, 9 September 2005 (UTC)


 * restoring the POV tag since the article still has a strong medical POV, and until this

is fixed readers should be made aware of the controvosy, and should refer to the discussions earier on on this page.
 * Amnonc 21:48, 9 September 2005 (UTC)


 * I agree that there are many things missing from this article, but it is not POV - it's just lacking many details. I've therefore removed the tag.  The best thing we can do is create a To-do list (I'll create it if you are not aware of the procedure) and we can then work through it.  violet/riga (t) 22:17, 9 September 2005 (UTC)


 * In addition to the significant clean-up I referenced below, I have attempted to remove some POV while respecting both sides. Danlovejoy 23:09, 9 September 2005 (UTC)

I have deleted the phrase "Not all complications lead to death...". What does "not all" mean? 99%? 90%, 0.1%?. I find it quite strange that this article mentions death five times more than the article on Automobiles, which are responsibe for far more deaths in the developed world. It does in my opinion reflect a medical emphasis on pathology. Now I have nothing against doctors, even when they insist on reverting my edits :-). And someone needs to rescue the situation when things wrong. But Wiki is not a medical manual, but is intended for the wider public including expectant parents, should not be written in such a way as to make them feel there is an axe over their heads. So Drs, lets have a little menshlichkeit here. -(unsigned)
 * OK, but now we have this travesty: "Not all complications affect only the fetus." What does that even mean?
 * I have to say that this anti-medical POV is unseemly. Childbirth is a wholly medical event. While it is also spiritual, emotional, and not very dangerous at all, it is STILL a medical event with a nonzero chance of complications and difficulties. And EVEN IF there are NO complications, it's still a medical event with medical implications. If your objective here is to promote your POV rather than improving Wikipedia, I'd like to ask you to reconsider. Danlovejoy 02:35, 13 September 2005 (UTC)
 * Saying that "Childbirth is a wholly medical event" is a POV, which would not be shared by many supporters of Natural Birth. We should have a Controvosy section to explain the different sides of this debate. I agree that the "Not all complications affect only the fetus." should probably be removed.
 * Amnonc 13:05, 13 September 2005 (UTC)

While the (1990 WHO estimated) risk of childbirth is 1 per 1800 births in developed countries, it is 1 per 48 births in developing countries. Of every 100,000 women who go into labor in Afghanistan, 1,900 die. African women are 175 times more likely to die in childbirth than Western women, and their overall chance of dying in childbirth and pregnancy is 1 in 16. Wikipedia is not meant to be an encyclopedia for the privileged only. Nor should the article neglect history (as it seems to at present); for before the advent of appropriate peripartum sanitary measure and other relatively recent advances, childbirth was a significant killer of women. - Nunh-huh 21:50, 12 September 2005 (UTC)
 * A discission of the historical evolution of birth in different societies would be valuable. Birth today in the developed world is certainly much safer than it was a few generations ago.

Amnonc 13:05, 13 September 2005 (UTC)
 * Be careful about drawing conclusions from this. Today we have good nutrition, including widely available fresh greens and fruits. Today we have a safe and reliable water supply. Today we don't usually have cold and drafty houses in winter. If mom is healthy, baby will probably be healthy. AlbertCahalan 04:43, 25 September 2005 (UTC)
 * An article about childbirth isn't the same as one on "childbirth today" or "childbirth in the developed world". - Nunh-huh 04:12, 15 September 2005 (UTC)


 * I totally agree (as I did above) that this was alarmist. Why are your attacking "Drs"? JFW | T@lk  21:48, 12 September 2005 (UTC)
 * I'm not attacking doctors (even when the revert my edits), and some of my best friends are Drs, but I do think that an overly medical bias with a focus on the relatively rare compilcations is POV.
 * No hard feelings :-) Amnonc 13:05, 13 September 2005 (UTC)

I have revised the "Complications" section completely, and retitled it. I have tried to maintain an evenhanded tone, provide sources for claims, and always make clear that "medical care" does not mean "sitting in a hospital bed", but can refer to midwife/home care as well. That being said, I disagree with this obsession about getting the word "death" out of the article.
 * By "obsession" do you mean an opinion which differs from your own?

Death is a major and not unusual risk of childbirth without proper medical care.
 * Your own figures show that maternal mortality is under 0.03% in the North America. And the figures for Canada and many other countries are much better than those of the US.

This is an encyclopedia, not a support group for white upper-middle class American women, the group that traditionally has the least to worry about.
 * What do you have against "white upper-middle class American women"? Is it the fact that they are women, have birthed babies amd know more about birth then you will ever know? Is this why when epeterso, who has birthed two babies, did some very good edits on the pain section of the article you saw fit to rewrite them because you know better. Isn't this just really a male control thing?

Our purpose is not to comfort expectant mothers but to provide accurate and unbiased information.
 * But your choice of information is clearly biased. Under your revised section on Risks and complications, you neglect to mention the number 1 risk: Cesarean section (which now accounts for 26% of births in the US), and neglect to mention that infant mortality in the US is amongst the worst in the developed world.

If we can do that and comfort them at the same time, great, but if our methodology becomes to simply wave our hands and assert, without citing any statistics or reputable sources, that the risk of death in childbirth is "very rare," then we are deceiving the very people who are relying on us to provide them with accurate and verifiable information.
 * By your own figures death rates in the developed world are under 1%. But you removed my original text saying "Although birth is safe in the vast majority of cases, complications can occur. In rare cases these complications can be life-threatening.", removing the "Although birth is safe in the vast majority of cases" part of the sentance. Do you think that 99% of birth represent a minority of cases? Do you really think that you edit makes the article less one sided? Your edits make the article present birth as an extremely dangerous thing. This may be your POV, but it is contradicted by the figures and sources you present.

Let us by all means address any bias in the article responsibly, but please keep in mind that our mission is to inform, and not to advocate. Nandesuka 17:39, 14 September 2005 (UTC)
 * Nandesuka, I see from your user page that you have contributed over 2500 edits to the Wikipedia. That is commendable. But let me suggest that you take a brief break from the keyboard and go outside. There is a whole world out there. There are human beings, both men and women. Talk to them. Listen to what they have to say. You may find the experience suprisingly enjoyable. And you will learn things you would not have learned from a whole lifetime surfing the net.
 * Good luck, Amnonc 10:57, 16 September 2005 (UTC)


 * Amnonc, I will not respond to every issue you raise here, because I don't think that's the way forward to reach consensus; in particular, I will not rise to your personal attacks; I suggest you read the Wikipedia policies and guidelines on assuming good faith and civility, and leave it at that. I believe that both my edits and my explanations for them are fairly comprehensive.  However, I'll specifically address one point you seem to consistently miss:  This article is about childbirth, not about childbirth among white, upper-middle class women in the United States.   Making blanket statements such as "[B]irth is safe in the vast majority of cases" when 1 in 48 women in the third world die during childbirth is irresponsible in the extreme.  To make that statement by itself, without providing more information and context, is to show disregard for both the truth and for the lives of those women.  I have absolutely no objection to noting that birth is safer for women in the western world, and safer for white women than for women of color, and safer for people who have access to quality medical care, and in fact my rewrite addresses most of those points, giving specific statistics, with references.  I have a strong objection to trying to make unsourced blanket statements that obscure the real risks of childbirth.  I have a strong objection to statements that implicitly value of the health and safety of women in the developed world above those with less access to quality medical care.  Please try to broaden your perspective a little bit.  Regards, Nandesuka 12:10, 16 September 2005 (UTC)


 * Hi Nandesuka once more. I must admit that I was impressed by your concern for the welfare of Women in the third world. It shows that you posses a higher degree of human sensitivity than I imagined you had. I had a look at your edit list expecting to find many articles on the third world, Starvation, the AIDs epidemic, exploitation of third world peoples by multinationals, imperialist governments etc. But I was suprised to find none of these, and instead to see your main contributions seemed to concern vidio games, and more recently your election to the rank of editor (congratulations). Returning to the Birth article: The whole article is highly US-centric. But you only part of the US-centricity you objected to was the sentance I inserted on the safety of birth. So I suspect that when you objected to the statement that Birth is safe in the vast majority of cases, you found that the figures for western countries showed that birth is in fact safe, so you decided to draw in countries where war, extreme poverty and malnutrition have vastly increased the motality rates of Birth, and turn this into a North South debate.
 * I must admit to being very ignorant about video games, and maybe I will read some of your articles about them one day. But I understand that a lot of them are about killing imaginary opponents. Could this be connected with your great interrest in the subject of death? But you will I am sure not need me to point our that death for real human beings is a much more serious business than death in vidio games.
 * Back to the subject of Childbirth: The objections I raised earlier about your selection and interpretation of statistic have not been answered. Also the section on childbirth risks and complications is quite substantial and really should have its own article, where it can be developed further, don't you think?
 * Amnonc 00:09, 18 September 2005 (UTC)
 * Ammonc, Please refrain from Personal Attacks. Nandesuka's other interests have no bearing here, and you essentially concede the point by attacking in this way.
 * "so you decided to draw in countries where war, extreme poverty and malnutrition have vastly increased the motality rates of Birth"
 * Ammonc, 1.1 billion people worldwide live in extreme poverty. Extreme poverty, war, and malnutrition are the NORM, not the exception. Now, that's true regardless of my personal edit history, which I'm sure you will find lacking.
 * I will concede that for the relatively small number of women who live in first world countries, childbirth is usually uneventful.
 * Once again, I'd ask you to reconsider your advocacy here. Wikipedia is not a soapbox.Danlovejoy 01:11, 18 September 2005 (UTC)
 * In the majority of cases birth is uneventful in the 3rd world.


 * Amnonc, would you care to point to a specific inaccuracy or problem with my rewrite, or are you just going to continue to argue ad hominem? Nandesuka 00:59, 18 September 2005 (UTC)


 * I'll recap a few of the points I made above. I have not had time to check your figures but they seem right. The problem lies with their selection and interpretation. For instance you give the figure of 1 in 3700 in North America, (how did you calculate this?). But a full table would show that the Maternal mortality rate in the US is three times higher than in Canada, and that the rate in some areas (e.g Washington State) is higher than in some third world countries. Inclusion of historical data would show that Maternal mortality in the US has increased since the early 1980s.
 * The horrific figures you quote of a 1 in 48 Maternal death rate represent a holocast of ghastly proportions. But even in the 3rd world birth is safe for the other 95% of women, and in the developed countries, access to health care vastly increases the safety even in the minority of cases when nature fails.
 * Back to the "Ad Hominem" question: Looking at the history of this article, and the talk page, you have shown an intollerence of anyone who is critical of what you consider the mainstream approach to birth (actually only mainstream in the US). For instance you attacked AlbertCahalan for "petty bickering", later telling him " I will not allow such garbage to stay in this article". You have repeatedly reverted or rewritten edits not to your liking, for instance on 12th September you revoked one of my edits with the comment "this is where I draw the line". The result is that I am not inclined waste precious time making contributions to this article if these contibutions will be obliteratade by your good self withing a short time. And this probably applies to other people with much more to contribute to me. Perhaps this is the way you prefer things.
 * Amnonc 23:13, 19 September 2005 (UTC)

(I'm un-indenting because this is getting hard to read). Thanks for asking some specific questions instead of just questioning my ability to make useful contributions because I like videogames. In answer to your first question, I did not calculate the 1 in 3700 figure, I referenced it; if you look at the citation in the article (labeled [1] ), you'll see it points to http://www.safemotherhood.org/facts_and_figures/maternal_mortality.htm, where there is a table. giving the figures I used, among others. I agree with you that whenever one includes statistics and figures, there is a risk of selection bias. I believe I took a reasonable tack: I presented the worst average number, the best average number, and a common in-between number that our readers would likely care about ("average mortality rate during childbirth in all developed countries"). I didn't give more specific statistics because (1) the more specific the statistic we use the less informative it is ("mortality rates in Upper Sasketchewan between March and April of 2002") (2) safermotherhood.org seems like a credible, neutral source. I could have gone looking for different statistics, but why? What's the motivation? Note that one could go in either direction: one could find countries where the rate is better than 1 in 3700, or one could find countries where the rate is worse than 1 in 48. I thought that presenting a summary of the safermotherhood.org figures was a reasonable choice. If you believe that safermotherhood.org is not a credible source, then we can pick a different source; the World Health Organization publishes data every year. You won't like their numbers any better, I suspect.

I agree with you that birth is "safe" if you eliminate from consideration all of those women for whom birth is not safe. I didn't do that, because it is not appropriate. I also agree that access to health care vastly increases the safety of birth, which is why my edit says "The most important factors affecting mortality in childbirth are adequate nutrition and access to quality medical care". Look, there is a continuum of ways in which one could write this paragraph. Let me present a spectrum of alternatives:


 * 1) "Childbirth is a deadly event. bringing sorrow and agony to those who are subjected to it.  Only the clinically insane would willingly undergo this disgusting trauma."
 * 2) "Childbirth is very dangerous."
 * 3) "Childbirth is very dangerous.  In some parts of the world as many as 1 in 116 women perish during childbirth."
 * 4) "The risk of maternal death during childbirth in developed nations is comparatively low; only about 1 in 1800 mothers die in childbirth (only 1 in 3700 in North America). In the third-world, it is a much riskier proposition: on average 1 in 48 women die during childbirth.[1] The "natural" mortality rate of childbirth — where nothing is done to avert maternal death — has been estimated as being between 1,000 and 1,500 deaths per 100,000 births.[2]"
 * 5) "Childbirth is safe.  In North America, only 1 in 3700 women are at any real risk of harm."
 * 6) "Childbirth is safe. Complications are extremely rare."
 * 7) "Childbirth is safe; nature looks out for Her daughters and helps them bring life into the world in perfect comfort and with no risk.  In extremely rare cases, women die during childbirth: these deaths are almost always iatrogenic in nature, or because the woman failed to trust nature and her body."

Obviously, I have put my edit in the middle to show how reasonable and perfect it is (just kidding). But let's look at all of these position. Numbers 1 and 7 are giving interpretations of the risk, and expressing extreme points of view, besides. They describe the risks in absolute terms ("is a deadly event" / "is safe"), and they provide no references to back up the claims. Numbers 2 and 6 use slightly less POV language, but still provide no references. Numbers 3 and 5 present statistics, but are clearly engaged in selection bias, sharing only the statistics which support they axe they are trying to grind. Number 4 &mdash; my text &mdash; was written as an attempt to (a) present the best and worst case statistics and (b) avoiding making value judgments about whether childbirth is "safe" in an absolute sense, since different readers may have different risk-seeking or risk-averse behaviors. The article describes the risk of childbirth in the west by comparing it to the risk in the third world. I included the reference to the "no medical intervention" childbirth mortality rate because it illustrates the effects of access to proper medical care.

Regarding my edits to the article and how they affect your contributions: this is a Wiki. That means that anyone can edit anything, and anyone can revert anything. You recently said that I was elected to the post of "editor" above; that's not quite right. I was chosen to be an admin. Being an admin, generally, has no bearing on my ability to edit articles. You are an editor. I'm an editor. Everyone who has participated on this talk page is an editor. There is nothing intrinsically more worthy about my writing than about yours, or vice-versa. In terms of our ability to edit this article, we stand on an equal footing. You can make changes, I can make changes. You can revert my changes, and I can revert your changes. In fact, over the past month, you've made plenty of changes to the article that I haven't reverted, because I thought they were good writing. I don't "own" this article, and if people think my edits (or my reversions of your edits) are stupid, I'll find that out very quickly.

Editors can sometimes get in to "edit wars" or "revert wars" where they constantly change an article back and forth between 2 versions. This is usually considered a bad thing. So a better route is typically to try to reach consensus on the talk page of an article. You'll note that when I made my recent changes, I posted what I thought was a summary of them here, intending to spark a discussion. I will ask you, once again, to assume good faith on my part. I'm not trying to talk people out of childbirth. I'm not trying to advertise for your local teaching hospital. I'm not trying to depress women and control them. I'm trying to provide them with accurate, unbiased information. If you think the tone of what I've added is still wrong, or if you take issue with specific claims, let's talk about them and try to come to a compromise that is acceptable to both of us (and to all the other editors on the article). I will not get prickly if you attack my writing on its own terms; constructive criticism is how we improve our writing. I will get prickly if you continue to attack my writing because of your inaccurate preconceptions about what kind of person I am. You mentioned that the entire article outside the risks section has a first-world bias, and that I didn't update anything outside of the risks section to talk about childbirth in the third world. This is absolutely correct; I haven't had time to do that yet. Maybe you could take a crack at making the article less western-centric? I think that would be a really interesting direction in which to take things. What do you think? Nandesuka 12:18, 20 September 2005 (UTC)
 * I do come across many women who are terrified of birth, terrified that something will happen to their baby. I must admit that I am not neutral on this question. I want woment to be confident and informed when they approach birth. According to even the worst statistics you have presented birth is safe for both the mother and the baby in the vast majority of cases. I believe the excessive focus on death in this article is scare-mongering. It is not just a question of the relative emphasis of the different sections of the article, but of how things are stated. In attempting to show the reasonabless of your choice of words you set up a straw man in the form of an alternative wording "Childbirth is a deadly event. bringing sorrow and agony to those who are subjected to it." Was this sentance composed by a psychopath? Or just someone who spends too much time in front of computers and video games and too little time with other members of the human race?
 * You said that we stand on an equal footing in terms of our ability to edit the article. This is incorrect as you obiously have far more time and access to the internet than I do, and far less inhibitions than me when it comes to reverting other peoples contributions. I have done what I could to try to make this article a bit more humane, and I have failed because my most important edits have been reverted or rewritten to the extent that the article is more threatening than it was before I started. So you win. I will not waste more time composing text which will be reverted. I just hope that people looking for information about birth, be they "upper middle class white american women" or people of other gender, race class and nationality, steer well clear of this article and find other sources of information which are more accurate, balanced, supportive and humane.
 * Amnonc 23:17, 26 September 2005 (UTC)
 * At the bottom of every single page, every time you submit a change, is the following notice: If you do not want your writing to be edited mercilessly and redistributed at will, do not submit it.  I have edited your contributions diligently and fairly, and discussed my reasons why in detail here.  I will continue to do so.  On a personal note, I'm sure that you're a very nice person in real life, and not at all given to endlessly insulting others, dishonestly impugning their experience and motivations, and implying that people with whom you have honest disagreements are psychopaths.  Perhaps you could take some of the civility that you no doubt apply in your everyday social situations and bring it here with you next time you decide to contribute.  It would make the atmosphere so much more &mdash; to use a word you favor &mdash; humane.  Regards, Nandesuka 12:28, 27 September 2005 (UTC)
 * Feel free to put back the NPOV dispute marker. It's crossed my mind. It appears that a couple very persistant POV pushers are running this show, blocking out any attempt to modernize this article out of the Western 1980's. One even mentioned a feeling of being under siege by homebirthers, which should be a big hint that it's him pushing the odd POV. (not that a bunch of English-writing people with net access can do much about "Western", or that the audience would be any different, but at least we can advance the article by a couple decades) AlbertCahalan 23:46, 27 September 2005 (UTC)

Clean up
I have cleaned up a lot of wording - a lot still needs to be done. Almost everything should be written in Active voice ;-). Please watch for spelling problems, awkward wording, etc.. Also, I have moved "Professions associated with Childbirth" down below the actual childbirth (event) information. It makes no sense for that section to be above the stages of labor. It bothers me that so many edits can be made by so many active partisans on both sides, yet the writing does not improve. Please take the time to write well. If you are too rushed or flushed to write well and edit your writing, perhaps you should come back when you have more time to write. Danlovejoy 23:06, 9 September 2005 (UTC)

Much better!
I have to say I read this page a few weeks ago and it made my blood boil. Just to be clear on who I am, I'm a woman active in the unassisted birth movement. I'm neither a wacko nor a hothead, though, and I have done hundreds of hours of research on birth, as well as birthed two babies of my own, one in a hospital and one unassisted in my dining room. This article is MUCH better now than it was just a few weeks ago, but I have a few quick suggestions:

Please consider making the "complications" sections a separate article, and indicate that these are considered "complications" in medical settings. Most of the complications you list in the bottom "Other complications" section are usually iatrogenic, and thus cannot actually be considered normal complications of *human* birth.

If you would like a photograph of a normal woman birthing a baby normally, I am sure I can find a volunteer. I did not take pictures at my own births, but I know plenty of women who have clear pictures. It would be a lot more accurate than this hospital shot. After all, this page is about *human* childbirth, not American hospital childbirth, is it not?

Finally, can you please link/cite your source for this statement: "The duration of labour varies wildly, but averages some 13 hours for women giving birth to their first child ("primiparae") and 8 hours for women who have already given birth." I would be surprised if the average duration of normal (non-intervened-with) primpara labor is usually this short. In some American hospitals upwards of 90% of women are induced as a matter of course, and thus duration statistics that include these births are not accurate in terms of *human* birth -- only in terms of American medical birth.

Thanks for making the changes you have -- it is much less biased now that in its original form.

Cord clamp photo/discussion
The American College of Obstetricans has disavowed the dangerous practice of early cord clamping/cutting as shown in this picture.


 * More recent studies also seem to be proving the benefits of delaying cord clamping/cutting. Should this be added?

for example refers to a review of all studies. --Speedevil 09:39, 2 September 2007 (UTC)

How about a better picture also of a newborn with its cord intact and placenta nearby?
 * I agree. Regarding the other photo in the article, large scrubbed up teams of medical personel wearing face masks and sterile gloves, machines that go "beep" and the mother draped in green does reflect the way many women give birth and in my opinion should probably remain. But I would also like to see photos of births in more homely settings, and using different positions (squatting, birth stools etc.), water births, birth in tribal societies. So if you can get any great pictures which are not copywrited, then please upload them.
 * By the way, your edits on pain were really good.
 * Amnonc 08:55, 14 September 2005 (UTC)


 * Oh yeah. I'll tell you what the green cloth or paper is for: pure psychological control. I'm 100% serious. Got a legit alternative reason? The green stuff communicates "this place is special, we know best, we are in charge" to the layperson. I was even told, straight to my face, that the cloth had something to do with creating a sterile environment. Mind you, the lady was pooping and had not been washed. I didn't have a facemask. There wasn't any special doorway to stop germs. There was plenty of germ-collecting clutter in the room. There were people going in and out visiting other patients. Sterile? It beat a gas station restroom I guess! Lots of other things as well can be at least partially explained as psychological control. I guess it discourages the patient or spouse from leaving the hospital or getting violent. AlbertCahalan 22:51, 27 September 2005 (UTC)

Male experts on birth
Am I alone in thinking most of this article is extremely male in approach, there is the mechanics of birth, the risk, the legal aspects, everything is covered except for one small detail: The Mother! (You know, the woman who actually births the baby). Even in the photograph, the mother is covered by green drapes, and the medical team occupy the centre stage. And where the woman is mentioned, it is like the description of an alien from another planet. The section on social aspects of birth is mainly about the father (yes it is nice when fathers play a role). And the section on "Psychological aspects", contains only three sentences:


 * Childbirth is a stressful event. Some women report symptoms compatible with post-traumatic stress  disorder (PTSD) after birth. Postnatal depression and postpartum psychosis develop in some women

The opening sentence is a sweeping generalisation which is incorrect in many cases. And it begs the question "For whome is childbirth stressful?", and "Why?". The whole section is a list of problems which sometimes develop, and that's it. Nothing about the joy of birth, the meaning of birth in a woman's life, or the spritual aspects of birth.

Is Wikipedia supposed to be a manual for Doctors? Or should this article encompass all aspects of birth, including the main protagonist? Are there any mothers out there who can fix these problems? And are our male editors and sysops prepared to resist the temtation to revert or rewrite beyond recognition everything they write? Amnonc 00:29, 18 September 2005 (UTC)


 * Wikipedia could do with more female editors, and especially ones that can relate to the experience of having a baby. I also agree that the photo is inappropriate - it ridiculously medicalises a physiological birth (I'm quite with Amnon on this one).
 * As for Wikipedia being a manual for doctors - the article should encompass all aspects of birth, and the medical viewpoint is important here. This is not because doctors necessarily have the final word on everything (although they would like to sometimes), but because they are simply the ones who do the caesareans, control the haemorrhage, suture the episiotomy and assess the neonate. To marginalise the role of medical professionals (midwives, maternity nurses and doctors) would do injustice to the subject.
 * By the way, Amnon was a man's name when I last checked. JFW | T@lk  16:22, 19 September 2005 (UTC)


 * Hi JFW, I agree that medical professionals have a crucial role when nature goes wrong. And I would even go as far as to say the "surgical" photo should probably remain as it does represent the kind of birth many women experience, but it should be complimented by other birth pictures in differnt settings. I once read a book by Dr Yehudi Gordon and Janat Balaskas which contained some beutiful and inspiring photographs. Probably copyright material though. I am not for eliminating the medical side of the article, but I do think it should be broadened.
 * Amnonc 23:28, 19 September 2005 (UTC)

I am not familiar with the Gordon/Balaskas book. I think we are in agreement that the article should focus on physiological birth, with adequate attention paid to the medical monitoring of birth (quite common, e.g. with CTG) and medicalised forms of birth (quite common, e.g. forceps, vacuum, caesarean, malpresentation) as well as complications (e.g. perineal tears, haemorrhage, uterine rupture). The vast majority of the world's population will never meet an obstetrician. I'm from a country where home births are very common, and my clinical tutors have emphasised the normalcy of physiological birth. JFW | T@lk  14:50, 20 September 2005 (UTC)

Clean up - social aspects
Various clean-ups. Two potentially controversial changes:
 * Removed the "age is counted from conception" in some cultures. I don't think it matters in a childbirth article. The text is clear that this method of counting is not universal.
 * I have also gutted social aspects because most of it was very poorly written and I have some significant concerns about when and where men are involved with childbirth. Can we say that before the 60s, men were not involved in most cultures, but after the 60s, they are? This seems like a very myopic/US-centered view. If we re-add it, can we get some references for this and a significant re-write? Danlovejoy 02:19, 23 September 2005 (UTC)
 * I put the recently added picture (the smiling, nursing new mother) back into the article in the "social aspects" section (I made it a little smaller -- it was kind of overwhelming before, I thought). We should probably concentrate on this section next, in my opinion. Nandesuka 22:06, 27 September 2005 (UTC)
 * IMHO both places aren't so hot. It belongs right where the text mentions that a person should nurse the baby after birth. It fits perfectly there. AlbertCahalan 22:28, 27 September 2005 (UTC)
 * Could we please find a creepier picture!? Holy cow! If you want to present a NPOV view of unassisted birth/ home birth that shows it is safe, normal, and happy for most mothers, this is not the picture. I'm sure the mommy is beautiful in every day life, but in this picture, she's bloody, the baby is purple and wrapped in incontinence sheets. Mommy's mostly naked, sweaty, sprawled awkwardly, and she looks like she's been through hell and back. Her exhausted smile taken from STRAIGHT ABOVE does not help matters. Is this the picture you want representing home birth to all of us uptight hospital-born suburbanites? Really? Danlovejoy 05:18, 28 September 2005 (UTC)
 * Dear my, I just don't know what to say. I think you're being sarcastic, and that you think the photo is creepy. Yes? Maybe you haven't seen too many hospital births. There too, you will find blood. As for purple, look at the adjacent photo from a hospital. It's even more purple, though probably that's only a matter of elapsed time. Probably they looked about the same when they came out. Whenever my wife is about to give birth, I look at that purple hospital baby to help prepare me for the shock of a normal birth. It's easy to forget just how purple a normal baby is. (the ill ones are very pale, not purple or pink) In hospitals too, mommy gets naked. Maybe you think a dress would be appropriate? That would prevent nursing. Another reason for the nudity is the heat! A laboring mom is doing something extremely athletic. She will probably rip off her clothes at the very minimum. I've heard of some women wanting to suck on ice. My wife demands an ice-cold wet rag on her head, which is more than I'd want after a hard run! AlbertCahalan 02:32, 29 September 2005 (UTC)
 * Regarding the supposedly awkward sprawl: perhaps the baby is still attached. If so, nursing will help to deliver the placenta. AlbertCahalan 02:34, 29 September 2005 (UTC)


 * Horrible picture. JFW | T@lk  15:01, 28 September 2005 (UTC)
 * Because...? You think it's horrible because of the photo itself, or because of what you think it represents? It's in focus and filling the frame. It's not half as cold and terrifying as the other two we have. It illustrates breastfeeding after a birth, which matches up nicely with the text. I guess I'd rather not have a crib in the background; having a baby sleep next to a (healthy!) mom will reduce SIDS risk. Still, at least she's holding the baby right after birth. The baby isn't lying alone on a hard warmer table being poked and prodded. AlbertCahalan 02:32, 29 September 2005 (UTC)
 * Albert - really. It's a horrible, horrible picture. I don't care what it represents. It's not even technically competent. And with lots and lots of context, it's understandable. But it's a viscerally repellent photo. It distracts from the rest of the article. As soon as the reader reaches this point on the page, that is ALL he/she is going to see. Step outside yourself for a moment and try to see it as an average Wikipedia browser would. I'm sure this mom has pictures in the same set that are much, much better. Perhaps she was going for shock value. Danlovejoy 05:40, 29 September 2005 (UTC)
 * If you want to talk about "horrible" and "viscerally repellent", Exhibit A is the hospital baby photo. It's covered in blood. It's very purple. It's splayed out with one arm limply draped across the face. It has something being jammed into it's nose, a leg being cruelly pinched, and the cord being cut. There's an uncomfortable-looking piece of equipment against the baby, probably to monitor oxygen. (Why monitor? Because we can.) Doesn't that just draw your eyes, stick in your mind like a traffic accident victim, make you feel sick to your stomach, and make it hard to read the rest of the page? I nearly cried the first time I saw it. Compassionate humans can't bear to see a baby treated that way. Exhibit B is the caesarean photo from Brasil. There, a weird social issue (not wanting to be like a low-class forest dweller) makes for an extremely high rate of patient-requested caesareans. What you're seeing is almost certainly an act of conspicuous consumption. AlbertCahalan 17:40, 29 September 2005 (UTC)
 * Since you completely ignored my assertion that it's a horrible, horrible, picture, and turned your argument to a completely different picture, I take it you agree with me. I'm not vouching for any other pictures here. Perhaps they're both horrible. What I know FOR SURE, is that most Wikipedia readers will find the picture in question quite revolting, as I do.
 * Take them both down, as far as I'm concerned. I'm not defending the "medical view" or the "homebirth view," I want this article to inform Wikipedia readers. The picture you're defending is a distraction from that mission. Danlovejoy 21:51, 29 September 2005 (UTC)
 * I suppose "horrible" is relative. Judging the image in comparison to the others, it is certainly not horrible. It's the nicest of the three. By some standard, sure, they are all horrible. By some other standard, they are all lovely. If you think images distract from wikipedia articles, simply adjust your web browser settings. Web browsers will typically let you delay loading images and/or let you block images from a specific site. Try a right-click on any wikipedia image, or look in a "preferences" or "settings" menu entry. (side effects: pages will load faster and you'll be protected from the goatse.cx man) AlbertCahalan 23:46, 29 September 2005 (UTC)
 * The argument that Wikipedia editors should not, in fact, "edit", because users can adjust their browser settings is so strange that I've changed my mind. I'll no longer revert anyone who removes that picture (or the hospital photo) from the article. Nandesuka 01:05, 30 September 2005 (UTC)
 * This is no different from refusing to use 72-point text for the visually impared. There are browser solutions. I think it's strange to argue that pictures detract from an article. Those who would strip out pictures as being distracting are in a tiny minority. If Danlovejoy really finds images to be harmfully distracting, he now has a solution that doesn't affect other wikipedia readers. Most everyone else likes to see pictures. I could justify removing pictures if any were strongly redundant or if we had well over a half dozen. (like 8, or 11, or similar) I wish we had such luxury to pick and choose. AlbertCahalan 03:26, 30 September 2005 (UTC)
 * I'm confused about why you think that babies born in hospitals aren't held or don't nurse after birth. How many (non-cesarean) hospital births have you been to? At least in the US, standard practice in most hospitals I've been in is that the baby is held by the mother immediately, nurse if they are able, and sleep with the mother if that's what the mother wants. I get the feeling that you may have had a bad hospital experience, and if so you have my sympathies, but I think you might be making some unwarranted generalizations. Nandesuka 02:47, 29 September 2005 (UTC)
 * While I certainly think my hospital experience was bad, I don't think it was non-standard. Look at the hospital baby photo we have. The baby is born. Why isn't the mom holding it? AlbertCahalan 02:56, 29 September 2005 (UTC)
 * I don't know why. I wasn't there.  Would you accept one photograph of a homebirthed mother who wasn't holding her baby as evidence that homebirthed babies are ill-cared for?  Nandesuka 03:07, 29 September 2005 (UTC)
 * When I had a homebirth with a couple midwives, the baby was immediately placed on the mom's tummy to nurse. We didn't even stop to cut the cord; that waited until after the baby was completely fed. (and long after the placenta was out) Probably there exists at least one hospital in the world that allows this, but it sure wouldn't be normal. AlbertCahalan 03:15, 29 September 2005 (UTC)
 * As I indicated above, I don't think you should be generalizing from your experience. I've never seen a (non-crisis) vaginal birth where the baby wasn't immediately placed on the mother's belly.  In the births I've seen, they're then moved across the room for a brief evaluation, and quickly returned to cuddle and nurse.  Perhaps we can find some "best practices" documents on MEDLINE that discuss this issue, since generalizing from either of our experiences in the article is original research and not appropriate for an encyclopedia. Nandesuka 03:19, 29 September 2005 (UTC)
 * Expanding on the above, the international "Baby Friendly Hospital Initiative" certifies hospitals that support certain principles; among them evangelizing breastfeeding and encouraging mothers and infants to stay together 24 hours a day. Today, there are 50 hospitals that are certified.  That's not a lot, but the movement has had noticeable impact beyond the certified hospitals.  Many, many hospitals are aware of the principles of this movement and support and implement them, even if they haven't sought certification under the program.  The percentage of women of women who breastfeed immediately after birth in hospital environments has been climbing steadily over the past 20 years .  Much of this is due to better informed women, and some of it is due to the fact that competent ob/gyn's and pediatricians fully understand the importance of early breastfeeding and bonding &mdash; just as much as competent midwives and doulas do.  Nandesuka 03:41, 29 September 2005 (UTC)
 * The American Academy of Pediatrics recommends that infants be placed immediately against their mothers' skin immediately after delivery, until the first feeding is accomplished. . This recommendation is evidence-based (see Righard L, Alade MO. Effect of delivery room routine on success of first breast-feed. Lancet. 1990;336 :1105 –1107, .)  The Academy of Breastfeeding Medicine (a physicians' breastfeeding-supporting organization) publishes protocols which recommend early skin-to-skin contact, assigning apgar scores while giving the infant to the mother, and delaying non-critical "bookkeeping" such as weighing until after breastfeeding, if possible. .  So at least in American hospitals, I would say that any hospital that didn't immediately put a (undistressed, healthy) baby on a mother's tummy is going against the prevailing best practices.  Unless you're willing to argue that you believe that most hospitals ignore the American Academy of Pediatrics, I don't see a terribly huge difference between the recommended hospital environment and the recommended homebirth environment for the common case.  I can't say things are the same in other countries, of course.  But I suspect we can find similar recommendations for physicians in most Western countries. Nandesuka 03:57, 29 September 2005 (UTC)

The new photo has a number of things in its favour. There are no green drapes in sight. Yes there is blood in the photo, as there is in any birth. Yes, the mother looks exuasted, sorry but birth is hard work. I am not qualified to comment on the aesthetics of the photo, but I do think that it gives a different perspective missing from the other two photos. Amnonc 15:47, 2 October 2005 (UTC)

RV Pain Discussion
AlbertCalahan - I'm sorry to offend (I really am!), but in my opinion, your last edit was not encyclopedic, so I have reverted it. We have had an enormous amount of consensus-building working here and I think you're blowing that apart by saying pain is caused by being poorly positioned in birthing or doing it wrong. I also think discounting medical pain control completely is POV.

I'd also like to see some substantial research to back up the "birth orgasm." That's pretty sensationalistic. If I'm over the line here, someone please slap me down. Danlovejoy 19:24, 25 September 2005 (UTC)


 * First of all, I do not say that pain is only caused by poor position or "doing it wrong". I also do not completely discount medical pain control. Pain is however a sensation that one should be happy to have. There are people who, by genetic defect, do not feel pain. They get injury after injury because they are without this natural warning signal. If you block pain, you join their ranks for a time. AlbertCahalan 23:23, 25 September 2005 (UTC)


 * Second of all, about the birth orgasm... I suspected somebody would be shocked. It's real. Yes, you can enjoy giving birth. (my wife does, though no orgasm yet) Probably I should fill in the birth orgasm article or get somebody from the Unassisted Childbirth Forum to do so. Well, here you go:
 * a book review and table of contents
 * mentioned in passing here
 * mentioned in passing here
 * midwife saying not to get people expecting one here (implying that some women do have them)
 * mentioned here
 * a birth story that includes orgasm
 * another birth story that includes orgasm
 * possibly another birth story that includes orgasm, but English language ability is suspect
 * a better birth story exists, but I didn't bookmark it and Google isn't being nice to me today
 * Birth orgasms actually make sense. There you have an intensely emotional experience with something rather large in the vagina. Hmmm. Also remember that people have very different experiences with pain. Uh, I trust you know that S+M exists, and is reportedly enjoyed by both parties. So even if birth were always painful, that wouldn't rule out an orgasm. Plus you have the people who simply don't find birth painful. Really! I met a lady who fell asleep for all but the last moment. I certainly wouldn't suggest that birth orgasms are the norm, or that any given woman could experience one if she isn't "doing it wrong".
 * AlbertCahalan 23:23, 25 September 2005 (UTC)


 * Hi Albert - you stated "Pain is however a sensation that one should be happy to have." The Wikipedia is not in the business of "should." It's simply a source for what "is." It's great that there are women who don't experience significant pain during childbirth, but that is certainly not the norm.


 * Perhaps I can reword that. Please assume good faith. You should not argue "but that is certainly not the norm" when I never claimed that it was. AlbertCahalan 01:11, 26 September 2005 (UTC)
 * I do assume good faith. People who act in good faith can still act out of unconscious prejudice or bias. People who act in good faith can still disagree, and as far as I can tell, that is what's happening here. Danlovejoy 03:08, 26 September 2005 (UTC)
 * I would ask that you point to peer-reviewed medical literature for both the "painless birth" and "birth orgasm." What you have cited so far is anecdotal - and anecdotes are not evidence.
 * I'd still like to see this Danlovejoy 03:08, 26 September 2005 (UTC)
 * Anecdotes are a type of evidence. They would not be sufficient to prove that a particular birth experience is the norm, but they are entirely sufficient to prove that it exists. You are (or should be) trying to prove that no mother experiences a painless birth or a birth orgasm. I need only provide one single example to show that this is not true; I have generously provided more than one. AlbertCahalan 01:11, 26 September 2005 (UTC)
 * I believe you are mistaken about the level of evidence one should present to be included in an article. I can produce innumerable anecdotes of alien abductions, faith healings, and ghost sightings, I can not provide any credible evidence of such. When we're dealing in a controversial subject that is highly subjective (what constitutes an orgasm?) I believe we should be dealing with a very high level of evidence. Danlovejoy 03:08, 26 September 2005 (UTC)
 * Oh boy. We'll have to delete the happiness and pain articles now, and probably orgasm too, because nobody can really prove these feelings exist. This isn't like arguing over the Earth being round or flat. If a person says they feel a certain way, you generally take their word for it unless there is some clear motive for lying or some clear indication of stupidity. Things like "pain", "lonely", and "orgasm" are all about the viewpoint of the observer. AlbertCahalan 05:58, 26 September 2005 (UTC)


 * My great concern here is that rather than providing unbiased information about childbirth, this article is becoming a soapbox for a larger and larger number of homebirth advocates. Wikipedia is not a soapbox.


 * You only see the bias of the other side. It so happens that homebirth is common in many parts of the world. It is also regaining popularity in the USA. Heck, I didn't even mention homebirth in that edit. Don't put words in my mouth. AlbertCahalan 01:11, 26 September 2005 (UTC)
 * Your links were to unassisted homebirth sites. I'm concerned not just with your edits, which seemed to have an anti-medical bias but with those others are making here. To be honest, the edits you made about pain seemed kind of preachy to me.
 * I'm assuming you're acting in good faith. If I believed that most women dreaded childbirth unnecessarily, I would certainly want that info included in the Wikipedia. Just for the record - I don't believe either way. I don't really have an opinion on the matter. Danlovejoy 03:08, 26 September 2005 (UTC)


 * Never minding the issue of childbirth, an orgasm doesn't seem too likely with hospital staff standing around observing and giving orders. So it should be unsurprising that references to birth orgasms are not to be found on hospital birth advocacy sites. One of the links I provided did however mention asking a doctor about the experience, with the response being that he'd seen it on rare occasions. AlbertCahalan 05:58, 26 September 2005 (UTC)
 * I try to be informative and helpful, not preachy. My wife assures me that the section on pain must mention position. It really is important. The flat-on-back position also leads to thrombosis, tearing, reduced oxygen to the baby, and failure to progress. People end up in this stupid position because they think it's just the way things are supposed to be. Few people wish to be the weirdo. AlbertCahalan 05:58, 26 September 2005 (UTC)
 * I suggest that you purchase a good midwifery book and read it. "Heart & Hands" by Elizabeth Davis is quite good, and probably more medical that you would expect. AlbertCahalan 05:58, 26 September 2005 (UTC)


 * I stand by my revert and will post an RfC. Danlovejoy 00:30, 26 September 2005 (UTC)


 * Who will count the votes? AlbertCahalan 01:11, 26 September 2005 (UTC)
 * Hopefully new commenters will help us develop a consensus rather than create a win/lose situation. But If I "lose", I'll still be your friend. ;-) Danlovejoy 03:08, 26 September 2005 (UTC)

I am not sure what is meant by a "Birth Orgasm", whether it exists, and if it does whether it is common enough to warrent inclusion in this article. That said, the term "Fetal Ejection Reflex" first described by Dr Michael O’Dont is a graphic description of the power and involuntary nature of the 2nd pushing stage. Albert made a important point about how pain can often be changed and reduced by changing position, and it is a shame Dan reverted it. On balance I would suggest keeping Alberts edit, but without the "Orgasm" bit. Amnonc 22:28, 26 September 2005 (UTC)

Neatly avoiding the hopeless task of defining what exactly an orgasm is: "Some mothers experience very pleasurable sensations and muscular contractions which they believe to be orgasms." That should do I hope. AlbertCahalan 03:51, 27 September 2005 (UTC)
 * That's pretty good text. One question that we should answer is how many is "some"?  I'm positive there is research showing that changes in position can help alleviate pain (see, e.g., Gupta JK, Hofmeyr GJ. .  Is there any on what percentage of women experience birth orgasm-like sensations?  I don't doubt that the phenmomenon exists, I just don't want to mislead the reader &mdash; "some" covers all sorts of territory from "49.9%" down to "there were these 3 women it happened to, once." Keep in mind that it is official Wikipedia policy to only publish material that is verifiable. Nandesuka 12:11, 27 September 2005 (UTC)

Anaesthetist's viewpoint
I've read through this article and also the discussion and wish to point out some personal views. I am an anaesthetist (anesthesiologist if you prefer) who specialises in obstetric anaesthesia. I am also a parent.

(1) Some fortunate women find labour and delivery painless. Others prepare themselves to expect the pain of contractions and can manage these without any help except a supportive companion. I wish them nothing but success. Some women, on the other hand, cannot tolerate the pain of childbirth, and they ought to be free to request (and have provided) excellent analgesia without stigma.

(2) Childbirth may be perceived as "over-medicalised". I support women who wish to deliver at home or in another location of their choice, and I support their other choices (midwife-led care, freedom of mobility, labour in water, free access to food and drink, unhurried delivery of placenta, etc., etc.). On the other hand, I have been personally involved in life-saving care of women (and their babies) who have suffered from eclamptic disease, haemorrhagic disease, embolic disease, obstructed labour, cord prolapse, malpresentation, uterine rupture, puerperal sepsis and other diseases of pregnancy, who would probably have died outwith the hospital setting. On the third hand (!), there is a population of women who desire and embrace the convenience and comparative ease of a planned caesarean section. If we insist women must be free to deliver how they wish, surely the wishes of these women ought to be respected?

In my opinion, the essence of good maternity care is that the mother and the baby should both be alive and well at the end. We are so good at providing that now that maternal deaths are exceptionally rare in the UK (see the triennial reports of the Royal College of Obstetricians and Gynaecologists). The price we pay for that safety is the "medicalisation" of childbirth. It seems to be forgotten that childbirth is potentially lethal for mother and baby, and doctors are vilified for "interfering" with childbirth.

Do we do too many episiotomies? Almost certainly. Too many caesareans? No doubt about it. Too much augmented labour/ induction/ artificial rupture of membranes? Without question.

But some women need those procedures, and they need to not be made to feel a failure if they do. Equally important is that my patients not perceive me as a twisted doctor determined to intervene at every step in what is a "natural" process. Preacherdoc 05:49, 9 May 2006 (UTC)Preacherdoc


 * Thank you Preacherdoc. You state that we have too many episiotomies and too many caesareans and basically too many interventions.  I think we all agree on that.  But then you also state: "there is a population of women who desire and embrace the convenience and comparative ease of a planned caesarean section. If we insist women must be free to deliver how they wish, surely the wishes of these women ought to be respected?"  Of course their wishes should be respected, but are they informed wishes?  Are they aware that the death rate for women is on the rise again (in Australia) at least because of the increase in caesarean?  Are they aware of the increased morbidity from interventions?  I suspect that many of the women supposedly chosing caesarean for 'convenience' are completely unaware of the risks of caesarean.  In Australia a caesarean section must be about the only type of medical procedure funded by the taxpayer that does not require a medical reason for it to be performed.  Of course caesarean sections and other interventions save lives, but they can also ruin lives when the procedure is not required.  Maustrauser 12:31, 9 May 2006 (UTC)


 * Maustrauser, thanks for your comments. First, I must say that I was not aware that the maternal death rate in Australia is increasing! The maternal death rate in the UK has risen very slightly over the last couple of triennial reports. This is well within the limits required to reach statistical significance. I would need to see convincing figures before I would accept this remark, and I would certainly hesitate to ascribe it to the "increase" in caesarean sections. Next, the convenient caesarean. I disagree with women who choose to have planned caesareans rather than attempt a vaginal delivery. However, I have a colleague who has recently taken this option (for the second time), and I assume she knows at least as much as any doctor about the risks involved. Of course, she is not typical of the "average" parturient, but it seems at best ingenuous of you to assert that just because a woman doesn't agree with what you would choose for her, she must be ill-informed. Finally, over-medicalisation. A close friend who is also an anaesthetist gives some of her free time to a charity, and has recently spent a month in West Africa anaesthetising women with rectovaginal fistulas created by perineal tearing in childbirth. Such women are considered unclean by their husbands and in some instances are forcibly removed from their family homes. Some women had walked over 100 miles to the hospital. The repairs were quick and overwhelmingly successful, but all of those women could have been spared this situation by an episiotomy and perineal repair at the time of childbirth. The women of West Africa have no choice, but if we abandon medicalised childbirth, this is just one scenario we will be potentially facing: we will have thrown out the baby (pardon the metaphor) with the bathwater.Preacherdoc 02:46, 10 May 2006 (UTC)Preacherdoc


 * The Perinatal Statistics Unit at the University of New South Wales is currently crunching the data. There is an increase in maternal mortality but I have to admit that it is uncertain whether it is attributable to the increased caesarean rate.  It is postulated that this is likely to be the reason given that it closely mirrors the dramatic increasae in caesareans.  30% in most private hospitals and some are nearing 60% in some which seems quite an indictment on the maternity profession - midwives and doctors!    We need to be careful using anecdotal evidence to support our views, but I am not certain that your colleagues choice of a caesar is based on information or based upon fear.  It is a well known phenomenon amongst midwives in Australia that they have 'harder' births than the average woman and it seems to be based upon  them having 'too much information' rather than too little.  So information is a fine balance and the labour progress relates to the amount of support the woman has from other women at the birth... I am NOT against the use of appropriate interventions at birth, just unnecessary ones when the evidence shows how quickly the wrong intervention leads to a cascade of interventions culminating in a caesarean.  What wonderful work your colleague is doing in West Africa.  However, I am not convinced that an episiotomy would solve their problem - I hazard to suggest it is caused by FGM in the first place.  Fix that and then I reckon the majority of fistulas would never happen.  Cheers Henry Maustrauser 04:04, 10 May 2006 (UTC)


 * Your "colleague who has recently taken this option" probably did so for reasons entirely unrelated to risk. (no matter if she admits it to herself of not) Some people feel a very strong need to be in control of their schedule. She obviously has a career. Though I detest the idea of a planned caesareans, I have to admit that being able to mark an X on the calendar is an upside to the matter. It would probably be embarrasing to go to some other hospital, and very embarrasing to labor and birth in front of all her colleagues. Birth in front of your colleagues probably ranks about the same as having your colleagues closely watch you poo, have sex (various types), pick a huge booger from your nose, etc. No wonder she planned a caesarean. AlbertCahalan 04:43, 10 May 2006 (UTC)


 * Preacherdoc, thanks for eloquently summarizing a very interesting point of view. Nandesuka 12:42, 9 May 2006 (UTC)

photos
what's the deal with the first image? is that a water birth or something? and the last one doesn't really work at all, it's hard to even see exactly what's going on. i know someone will rip my head off for this, but neither seem very representative or illustrative. at least one diagram would be better than some bizarre new age-y art photography. Joeyramoney 00:34, 5 June 2006 (UTC)


 * Yes, it is post waterbirth. Perhaps you have better images that you wish to offer.  Ones that are illustrative and are also appropriate for an encyclopaedia.  Having attended no shortage of non-medical births, both images are representative of a successful natural birth.  Feel free to pop over to caesarean to see some more blood and guts photos. Mirasmus 02:57, 5 June 2006 (UTC)

Fictional explanations?
Should there be a section on fictional explanations (perhaps by culture) for "where babies come from"? For example, The stork is pretty easy, but the others would need good citations. --Goldfndr 02:35, 25 June 2006 (UTC)
 * Storks
 * Pelican
 * Cabbage Patch
 * Watermelon seed

Weasel words?
The following section has a lot of weasel words, and should be improved or removed:

"Many families view the placenta as a special part of birth, since it has been the child's life support for so many months. Many parents like to see and touch this mysterious organ. In some cultures, parents plant a tree along with the placenta on the child's first birthday. The placenta may be eaten by the newborn's family, ceremonially or otherwise." sstackho

Hard stats on pain management?
Howdy, I'm an expecting father and I was very much looking forward to learning about the costs and benefits for various methods of birth and pain reduction. How and to what degree does an opiate passing through the placenta harm my baby? How and to what degree does an epideral reduce the likelihood my baby will breastfeed? For some reason, trying to find answers to these simple questions is a minefield of weasel words. All I want is to know what's best for my wife statistically, so we can be informed and she can make the best decision for herself. 207.172.172.221 03:01, 13 August 2006 (UTC)

tidbit cut from article
This tidbit is unsourced and to my mind irrelevant to an encyclopedia (not to a book of records, though). I've cut it from the article but I'm leaving it here. -- stillnotelf   is invisible  02:47, 23 August 2006 (UTC)

In November 2004 Aleta St. James, a 56 year old single mother gave birth to twins conceived through in vitro fertilization. In 2005, a 67 year old Romanian woman gave birth by cesarean to one surviving twin.

Some parts read like a huge advert for doulas.
Look, I'm very much a fan of the birth movement, but this is going too far. Whilst it is fine to mention that some women find doulas useful during labour and birth, we have to remember that the large majority of human births do not happen in developed western countries and most often the non-medical people attending a birth are either female relatives or the baby's father. To suggest otherwise is simply parochial.


 * My understanding is that you're more likely to get a doula in developing countries and mid-wives in developed ones. Bear in mind that a doula doesn't need to have any training. The oldest grandmother in the village would likely perform the doula role in many third world births, is it not? Poweroid 17:27, 13 September 2006 (UTC)

Yes and no. The recent doula movement in more developed countries is something quite apart from traditional childbirth attendants in less developed countries. They may perform the same role, but it is misleading to use the term doula given the current understanding of its meaning and the context of its meaning which are very culture specific. Plus, you are unlikely to pay the "village grandmother" for her services attending a birth so the comparison is weak.


 * User:Mongo deleted the section mentioning doulas in the "professions associated with childbirth" section. I've put it back with some modification.  I tried to discuss this with Mongo but his/her page is protected.  Certainly in Australia doulas are becoming more and more common and thus fit as a profession associated with childbirth. Maustrauser 00:07, 20 September 2006 (UTC)

Why is this article twice tagged?
It may need a few citations in places, but there is a long list of references in the article so I don't understand why the tag which says otherwise. Professor marginalia 23:08, 10 January 2007 (UTC)
 * The article is probably twenty references short of where it should be (and in terrible shape). It's a common response from editors to add that tag to a mess, and missing many critical refernces. WilyD 16:04, 17 January 2007 (UTC)

Birth "experts"
I am sorry to see that you did not agree with my edit that had changed the definition of midwives. From "Midwives are experts in normal birth." To: "Midwives are professionals who attend normal birth."

Why? This is not an insult to midwives, just a recognition of the reality that midwives themselves espouse. The following sentences convey this well. "Midwives believe that childbirth is a normal process that is best accomplished with as little interference as possible. Midwives are trained to assist at birth..."

I noted in my edit that mothers themselves are the TRUE experts in normal birth. Do you disagree? I think it is vastly unfair and misleading to call anyone else an expert. PomegranateMary 17:02, 17 April 2007 (UTC)


 * Fair enough question. 1. Midwives are professionals who attend normal births AND abnormal births.  Midwives are there at Caesarean sections.  Midwives are there when the ventouse is used.  Midwives are there at still births.    However, as a profession they claim to be experts in normal birth and not experts in abnormal birth - that is the role of obstetricians.  Midwifery training is all about 'normal birth' and observing when it is no longer normal and requires expert assistance.  2. The view that mothers are the TRUE experts in normal birth is accurate to a degree - when the mother is well read, well supported, emotionally balanced and understands the sheer variety of experiences that birth may bring.  Very few mothers are like that, unfortunately.  Most mothers from my observation are anxious and more than happy to hand their power over to the 'medical fraternity' to manage their birth as a medical crisis.  How you describe mothers is a wish, not a reality.  Sadly. Gillyweed 22:35, 17 April 2007 (UTC)
 * Okay. So if midwives CLAIM that they are the experts at normal birth then they are? Don't OB's claim to be experts in normal birth also? And what's normal, anyhow? Actually, it is the midwives job to be on the look-out for what's considered "abnormal."  2. Mothers do NOT need to be well read, well supported, emotionally balanced and highly experienced to be the true expert for birth. Her body was designed to give birth. It's that simple. Everyone else only learns by watching and learning from HER. This article ought to reflect that. PomegranateMary 20:17, 18 April 2007 (UTC)
 * I don't believe that many Obs consider themselves experts at normal birth. They can't be.  Few ever sit through an entire labour and birth and see a 'normal birth'.  They see themselves as experts at dealing with things when they 'go wrong'.  As for remark (2), I still believe what you are claiming is a wish and not a reality.  Whilst I agree that women's bodies are well evolved to give birth, even the WHO considers that 10% of women will require a C-Section.  I'd be delighted if your view was reality.  But sadly it isn't. Gillyweed 22:04, 18 April 2007 (UTC)
 * The reality is, as you stated, that, "Most mothers from my observation are anxious and more than happy to hand their power over to the 'medical fraternity' to manage their birth as a medical crisis." However, you can not assume that the practice of these mothers is one based on true necessity. If it were, then in the absence of midwives, doctors, and hospitals the human race would be on the verge of extinction within a few generations. You have no reason to say that my view is a wish and not a reality. The history of mankind is based on the fact that women were giving birth long before there were midwives. Midwives know what they do ONLY by observing women give birth. So how can the student know more than the master? Further, my own experience has been proof that women can give birth easily and well without any experts even in this age and Western culture. Personally, I am not interested in supporting the status quo that expects women to hand over their power. Are you? Wouldn't it be better if we simply stated the way things are- instead of furthering the lines that some professions use as advertisements? Mothers are the experts of normal, natural, spontaneous birth- Not midwives. PomegranateMary 15:51, 19 April 2007 (UTC)
 * I think we agree more than we disagree. I agree that 'inherent' in women is an ability to give birth, and (if they look deep enough and can ignore the fear-mongering of the media), birth is an eminently achievable and empowering event.  BUT, to paraphrase, no woman is an island.  They live within a society that believes that birth is fraught and difficult AND we know that at least ten percent of births need assistance of some kind.  Women are inculcated from an early age that birth is dangerous.  And for ten percent it perhaps is. It is these ten percent that I am particularly interested in.  I believe underlying your view of birth (given your edits on the unassisted childbirth article) is that if we stop meddling in birth then women will be fine.  I disagree.  There are a range of pathologies that the birthing woman cannot deal with and no matter how 'expert' she sees her role, requires someone with greater expertise than she.  She needs someone who has seen a cord prolapse before, someone who knows how to deal with PPH, someone who can cut an abdomen.  She needs an expert and for the vast majority of births, that expert will be a midwife and for a smaller number, the midwife will hand call in a specialist obstetrician to handle the most complex stuff.   An expert midwife will do nothing and sit in the corner of the birth room and wait and let the woman do what she can.  She will not interfere or intervene except when required.  This is a partnership.  If you can gain consensus from the other regular editors of this page that a woman is "the expert" on birth, then I will accept your change.  Gillyweed 23:23, 19 April 2007 (UTC)

Proposed WikiProject
A WikiProject for pregnancy and childbirth related articles has been proposed. For more information and to express interest, please visit WikiProject_Council/Proposals. Thanks! --Ginkgo100talk 16:15, 18 August 2007 (UTC)

Standard birth position
I just read through the article and was curious. What is the current standard birth position? Contrary to what television would have us believe, lying flat on her back is more difficult for the mother but easier for the doctor, and sitting down is impossible. What is the actual posture used to give birth? 84.63.68.198 19:08, 29 August 2007 (UTC)
 * There is no standard birth position. Active birth suggests being vertical, on your hands and knees, squatting, or sitting on a birth stool.  Sitting down is not impossible on a birth stool.  The woman should give birth in the position that best suits her needs. Gillyweed 22:46, 29 August 2007 (UTC)