Practically speaking, of course, areas vary, and doctors sometimes recommend a hospital delivery mainly because it’s going to be easier for them rather than because it’s medically necessary. But post-partum infections tend to be a lot lower with home deliveries*, and post-partum depression rates tend to be lower, because the woman feels in control of delivery.

*In a hospital, you’re encountering everyone else’s germs. At home, it’s just yours and your family’s, and you’ve likely already got immunity to them which you pass on to your infant via breastmilk.

The facts have a well known liberal bias.

Nice research.

Yes, birthing is natural. But so is dying in childbirth. It’s not acceptable to me to reject the help that modern medicine can give to a difficult and often dangerous process.

On the other hand, women are misled when they are told that a cesarean is an easier way to go, all other things being equal. Just the greater risk of infection ought to be enough to deter a mother from choosing a cesarean she has no special reason to need. I narrowly got to avoid the cesarean in my second, also high-risk pregnancy, and the recovery was much easier in every way. A doctor who does more than — is it 20%? — of cesareans, unless he specializes in high risk pregnancies, is probably out of line, and is not doing all his patients a favor.

Back to the point at hand: I thought I had read an article a while back comparing in detail what USians get for their healthcare money, showing that we spend a hell of a lot for not much, compared to other people. And, hell, arguing by anecdote might be good for the arguer’s blood pressure (whoops, isn’t that what I just did?), but for policy decisions, I want science and principle, not stories and bombast.

They should be required to spend a couple of days observing postpartum women on a maternity ward.

I guess we should all be glad that you didn’t go into medicine. I’m an OB/GYN, and have been out of residency for 20 years now. It’s a good thing that I, and most of my colleagues, have more patience than you do. While labor can be long and tedious, most of us try to do cesarian sections for actual obstetric indications.

Note that I said “most.” Yes, there are some lazy docs who are quick to cut. Some of the recent increase in the cesarian rate, though, is patient driven–mthere are many women don’t want to labor and come to the doctor’s office asking for cesarians. Another part of the increase is due to studies which show an increased risk of uterine rupture in women with previous cesarians who choose to labor in subsequent pregnancies. Many doctors and patients are unwilling to shoulder such a risk.

As for fetal heart rate monitoring–its use has not decreased the rate of cerebral palsy, it is true (which means that most CP is a “pre-existing condition”, and not the result of labor). But it has decreased the rate of intrapartum (during labor) fetal death, and acute neonatal asphyxia, both the result of sudden catastrophic events. Having a nurse monitoring the heart rate every five minutes with a fetoscope or doppler would be as effective, if hospital budgets would allow for one-on-one nursing. They don’t.

There are many people who can’t intepret FHTs properly. We do know what normal fetal heart tones look like during labor–when it comes to “abnormal” tones, though, there is a high false positive rate (normal babies with abnormal tracings). But catastrophically bad tones almost always bring about catastrophically bad outcomes unless an intervention is performed.

As for moving patients from a labor room to an OR–in most hospitals, the obstetric OR is part of the labor area, so this takes moments. No matter how close you may live, you can’t get from home to an operating room as quickly. If you were to experience massive intrapartum bleeding, as with a placental abruption, this could be the difference between life and death.

Anyways, for location of births, the US is not an outlier in the western world. The Netherlands, which strongly promotes home birth, has about a 30% rate. The next highest rate is in the UK, which has a home birth rate of about 2%. The rest of the West, us included, is in the less than 1% category.

You can’t discuss universal health care with right-wing zombies. They love eye-catching headlines (like this story) but can’t see beyond them to–for instance–the millions of women who every year throughout the civilized world (Canada, the U.K., France, Germany, etc., etc.) deliver safely and without having to mortgage their homes or go without proper pre-natal care.

Here in Canada, we do indeed often have long waits in the E.R., there are people who can’t find a G.P. and there can be long waits for elective surgery. BUT, if you think I would give up my universal health care to move to the States, I’ve got a bridge in Brooklyn that I’d be happy to sell you. In other words: NOT.

I could personally regale you over a nice meal and a good glass of wine with my good and bad experiences in the Canadian health care system, but once again, I would never, ever consider moving to the States and give up what is essentially an excellent system.

I would consider moving to France for a number of reasons (and that fact that they have great health care would be one of them). But the States, jamais de la vie! (never).