This looks much safer than the alternatives of forceps, vacuum extraction, or C-section.
The intuitive leap from "extracting cork in wine bottle" to "extracting baby in birth canal" happening during a dream is fascinating. Neurons rearranging during sleep cause the oddness of dream logic and can find unexpected correlations -- like the link he found.
On top of that, the force is spread over an area that is much more suited to withstanding that force (as opposed to the as-yet unfused parietal bones of the skull)
I bet we'd reduce the need for extreme intervention like this if we'd encourage women to deliver in more traditional positions. Prone and sedated is just about the worst possible way to have a kid.
Do you think it likely that an entire field that evolved over a period of thousands of years, has thousands of people doing the job all over the world daily, and is so common and important that there is scientific research performed on it pretty much not-stop, just missed this idea?
The field itself is fractured. Many midwives make the point that a complication free birth is not a medical event, and the majority of births are complication free. Have the medical intervention nearby for an emergency, but don't make it the default.
There is a line or argument that intervention is a self-reinforcing cycle, in that the initial intervention raises stress levels in the mother, which promotes a fight-or-flight response, which causes the birth process to regress, which increases the likelihood of more intervention, and so on. This isn't to say intervention should be avoided, but only do it if it is necessary, since it does have consequences.
> The field itself is fractured. Many midwives make the point that a complication free birth is not a medical event, and the majority of births are complication free.
Midwives are not part of the field of obstetrics, any more than sanitation workers are part of the field of engineering.
Midwives are certified medical professionals (comparable to specialized nurses or physicians' assistants), at least in the United States. You're either talking about somewhere else or you don't actually know what you're talking about.
Don't be absurd. Midwives are practitioners in the field of child birth. Some will have acquired a highly developed sense of what works and what doesn't. It is foolish to ignore their experience.
Midwives are practitioners in the field of child birth in the same way barbers used to be practitioners in the field of surgery. Yes, they engage in the practice and for a long time they were the only game in town. But it's not a systematic discipline and therefore experience isn't cumulative.
My wife's cousin is going through the program right now and will graduate with the equivalent of an MD. She's doing residency at a large hospital in Seattle and did clinical at another in Boise. When she graduates she'll be working adjunct at either another hospital up here, or through Stanford. I'm no medical expert, but I trust her experience and expertise. I'm not sure where you're information is coming from, but I think you may be misinformed.
This isn't true. Midwifery is a serious discipline and you must be licensed in the US. Also, they even have Doctors of Nurse Practice (DNP) of Midwifery at the respected Baylor [1] and other schools. I would recommend watching "The Business of Being Born" (it is on Netflix) - it is very enlightening about the safety and discipline of midwifery, and why hospital births are unnatural and in some ways incredibly unsafe.
I think you are mistaken. In Britain, the term 'midwife' means specifically a postgraduate qualification on a general nursing degree. They are certified medical professionals and have a level of specialised knowledge akin to a ICU nurse or a surgical nurse. Indeed, midwifes attend Caesarean sections, as part of the surgical team.
Not only are they serious medical professionals now, but they have been for a while. Watch the British TV show Call the Midwife. Even back in the 50s midwives were well-trained specialized nurses who dealt with serious medical issues on a regular basis.
I think you're thinking of midwives from a few hundred (or more) years ago, before the fields of medicine and nursing existed as they do today.
Yes, because obviously nurses are just there to do menial labour that it would be demeaning for doctors to do. This is the most ignorant thing I've seen you say on this website, ever.
In France they are. At least my French neighbor has what might be considered physician assistant level education in France and she would run the show during a birth. The US is very different in this regard.
Western medicine treats pregnancy and child birth like a high-risk situation, which it is. It's the same principle behind having doctors standing by at a boxing match, except the natural rate of maternal mortality in child birth is far higher than the mortality rate of even the dirtiest fight scenes.
"The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician."
The problem with such comparisons is that high-risk pregnancies won't be planned for home birth to begin with. Also, in a hospital, a physician will be called in at the first sight of any complication, so midwives won't be attending births that go wrong.
For what it's worth, the Netherlands was well knowm for a long time because we defaulted to midwife supervised hone birth with effective escalation in case of complications.
Up until I think 10 or so years ago we had one of Europe's best delivery success rates with that.
After that it seems that hospital deliveries became a safer choice and we've had relatively bad percentages since then because we culturally still value home births highly.
"Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians."
and
"We included all planned home births ... and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives ... We also included a matched [my emphasis] sample of physician-attended planned hospital births (n = 5331)."
Your first point is spot-on. Home births are bound to be statistically more successful because they are (usually) only planned for low-risk pregnancies.
However, the increased death rate in the Oregon study is
a) localized to that state, and
b) attributed to an overabundance of uncertified midwives:
> But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.
In other words, there are a lot of "birth attendants" practicing midwifery in Oregon who aren't necessarily CNMs (certified nurse-midwives) or CMs (certified midwives) -- which is perhaps closer to the barber acting as surgeon analogy.
The average woman who plans to have a homebirth is having a complication free pregnancy, and anecodotally, everyone I know who has had one it has been for their 3rd or higher birth after complication free deliveries in hospitals.
You can't compare those numbers, they aren't the same populations of pregnant women.
You would be surprised. The cultural norm (not scientific, mind you) to have women give birth on their backs in reclining position was French royalty and aristocracy, according to our birthing coach. Why that continued into modern medical practice is unclear, and many women are in so much pain, they do not question. Doulas, or birth coaches, try to tell you early to force yourself to stand or hold yourself on arms and knees on the bed, if possible.
As you know, any field is constantly advancing and sometimes it returns to an older idea and uses it in a new way. This is happening in obstetrics right now. It isn't that the downsides of sedated, prone births were "missed" so much as that they were part of the best birth technology of the time and innovation and changes in viewing that technology do not happen quickly. That model is now being replaced by births that combine medical advances with the mother's natural abilities more effectively.
Every scientific advancement must be preceded by a time when that advancement was not known or known but not used, no matter the age of the field.
[edit] Part of it is that the patriarchal doctor wants to be "in charge" of the situation and treat childbirth like some kind of medical operation.
(This is not to say that modern medicine saves many children's and mother's lives. A modern, optimal, approach is to have a traditional birth with ready access to a hospital for a c-section, etc if necessary.)
No, the modern optimal approach is to have a birth in a giant hospital so 1) you don't risk leaving the medical decision of whether intervention is necessary to someone without medical training; and 2) you don't risk the time lag of transferring to a hospital when a distressed baby is getting more brain damage from a lack of oxygen with every second that goes by.
Why haven't any researchers run a trial to compare the two and revolutionized this area of medicine after pronouncing dramatically better results for the traditional way?
Because the ethics committee is never going to sign off on an experiment that has even a hint of risk to mother or child who aren't already at greater risk from a lack of intervention.
It's the same reason you don't conduct Phase I clinical trials of new chemotherapeutic agents with people who don't already have cancer.
Birth is already risky enough. "Let's science that, to see which has the best outcome," while a completely rational approach not only to decreasing harm, but also to increasing health, just isn't going to fly.
They have, in the UK when you have your first appointment with the midwife they encourage you to consider it as an option. If you decide to do this you will then be assigned an experienced midwife who will attend the birth at your house, will monitor the situation for complications and will have an ambulance on standby at the first hint that things are not progressing normally. Also, if there is any hint of complications at all during the pregnancy you will be strongly recommended to have a birth in the hospital.
Do you think it likely that an entire field that evolved over a period of thousands of years, has thousands of people doing the job all over the world daily, and is so common and important that there is scientific research performed on it pretty much not-stop, just missed this idea?
Yes. Perhaps not all medical people personally, but as an institution, the medical field totally did.
That leads to another useful heuristic: since the people currently practicing in a field are making money, the current practices and norms in any field are always wrong.
The research is often there, but not read or understood by the practicing doctors. I found the book “Expecting Better”[1] to have a great analytical approach to the existing research.
The article talks several times about this device's application in under-developed countries where 'traditional positions' are already quite common.
I guarantee you a huge percentage of the women who die every year giving birth are not 'prone and sedated'. They are (if they're lucky) in a rural clinic, with a midwife who may or may not be terribly skilled. If she _is_ skilled, it's because she has decades of experience watching mothers and babies die, and has learned many lessons in very painful ways.
This device seems to provide a means for those midwives to assist in cases where labor simply isn't progressing (and believe it or not, that still happens, despite all the 'traditional positions' in the world).
That's a very 20th century view of birthing positions and certainly not in poorer countries. Clean equipment, good pre-natal care and general excellent health plus some good luck are needed more.
"Outcomes in these maternity centers were so good that Dr. Araujo began to study what the traditional midwives did, and ended up incorporating hammocks, more patience, and upright positions for birth into the hospital"
These two sentences follow: 'This system functioned efficiently until his death; it has since been dismantled due to lack of support and interest on the part of the younger obstetricians who replaced him. While it existed, this system was an excellent example of Graham's "partnership paradigm" or what Brigitte Jordan has called "mutual accommodation" between biomedical and indigenous systems.'
i.e. The traditional methods are occasionally acknowledged but rarely adopted.
Fair enough. It's true that I have bias, my wealthier friends who give birth are 'over-educated and academic', and the understanding of a natural birth is a given, while ideally being as close as possible to a good hospital in case of complications. The time I've spent in developing countries, it's just anecdotal to me that a midwife is the first call for a pregnant woman rather than an obstetrician.
> my wealthier friends who give birth are 'over-educated and academic', and the understanding of a natural birth is a given
That's a little bit like the crazy parents who won't vaccinate their kids. We've done such a good job with immunization that they've never seen the consequences of ignoring it, so they pick up woo-woo theories about autism and ignore all medical science.
http://www.ncbi.nlm.nih.gov/pubmed/15546805
--- abstract --
Autism spectrum disorder (ASD) is a spectrum of behavioral anomalies characterized by impaired social interaction and communication, often accompanied by repetitive and stereotyped behavior. The condition manifests within the first 3 years of life and persists into adulthood. There are numerous hypotheses regarding the etiology and pathology of ASD, including a suggested role for immune dysfunction. However, to date, the evidence for involvement of the immune system in autism has been inconclusive. While immune system abnormalities have been reported in children with autistic disorder, there is little consensus regarding the nature of these differences which include both enhanced autoimmunity and reduced immune function. In this review, we discuss current findings with respect to immune function and the spectrum of autoimmune phenomena described in children with ASD.
-- end quote ---
The immune system in new-born babies and young children is immature and under-developed.
> my wealthier friends who give birth are 'over-educated and academic', and the understanding of a natural birth is a given
This is what happens when over-educated people take first-world problems to the extreme and turn them into third-world problems. Like a highly-educated acquaintance of my brother's who married a sherpa and is now upset that he won't accept her working outside the home.
> The time I've spent in developing countries, it's just anecdotal to me that a midwife is the first call for a pregnant woman rather than an obstetrician.
My father (who works in international development and has long specialized in maternal health) has spent much of his life trying to disabuse women in developing countries (like his native Bangladesh) of this habit.
> Prone and sedated is just about the worst possible way to have a kid.
There are a lot of people responding to you repeating the claim that we encourage women to deliver prone, and one who says they normally do it lying on their backs. Personally, culture has given me a strong impression that supine is normal and prone would be bizarre. Where's this "prone" idea coming from?
"The brothers went to great length to keep the secret. When they arrived at the home of a woman in labour, two people had to carry a massive box with gilded carvings into the house. The pregnant patient was blindfolded so as not to reveal the secret, all the others had to leave the room. Then the operator went to work. The people outside heard screams, bells, and other strange noises until the cry of the baby indicated another successful delivery."
The story of the forceps is both extraordinary and disturbing, because it is the story of a life-saving idea that was kept secret for more than a century. The instrument was developed in the seventeenth century by Peter Chamberlen (1560-1631), the first of a long line of French Huguenots who delivered babies in London. It looked like a pair of big metal salad tongs, with two blades shaped to fit snugly around a baby’s head and handles that locked together with a single screw in the middle. It let doctors more or less yank stuck babies out and, carefully applied, was the first technique that could save both the baby and the mother. The Chamberlens knew that they were onto something, and they resolved to keep the device a family secret. Whenever they were called in to help a mother in obstructed labor, they ushered everyone else out of the room and covered the mother’s lower half with a sheet or a blanket so that even she couldn’t see what was going on. They kept the secret of the forceps for three generations. In 1670, Hugh Chamberlen, in the third generation, tried and failed to sell it to the French government. Late in his life, he divulged it to an Amsterdam-based surgeon, Roger van Roonhuysen, who kept the technique within his own family for sixty more years. The secret did not get out until the mid-eighteenth century.
It's worth pointing out that this is why we have patents. Inventors disclose how their inventions work, in exchange for a legally enforced temporary monopoly.
Try keeping a secret since the widespread adoption of the Internet. Paradoxically, we now have trade secrets laws to help inventors help keep inventions secret, so they can obtain a patent, so they can reveal how the inventions work.
That's exactly my point! Musk almost certainly wouldn't be able to keep employees or visitors from spilling his secrets, if it wasn't for the laws that are in place to protect trade secrets [1]. I'd contend that it only makes sense to argue for patents on an information dissemination basis in the absence of laws to protect trade secrets.
There's some irony in that plastic bags wrapped around the head are normally a suffocation risk for children, yet used in this manner could potentially be a lifesaver.
This reminds me of an idea I've had. I think it'd be nice if there were a website where experts from a certain field could go and post their problems. Then knowledgeable people working in other fields with other backgrounds could weigh in on their problem and provide possibly novel solutions.
I have always thought that you don't necessarily need to be in a field in order to be able to provide new insights into issues.
The problem is the signal-to-noise. You get cross-field insights sometimes, but they are very rare and more often come from someone who is actually versed in both fields. The majority of the time you'd spend fielding hare-brained ideas.
> InnoCentive is a Massachusetts-based open innovation company that accepts by commission research and development problems in a broad range of domains such as engineering, computer science, math, chemistry, life sciences, physical sciences and business and frames them as "challenge problems" for anyone to solve. It gives cash awards for the best solutions to solvers who meet the challenge criteria.
Instead of posting their problems, I think it'd be more effective to have explanations of current theories intended for people who don't understand it at all. You'd establish a single rule: the expert isn't allowed to expect full comprehension from the layman.
It would be, really, university for people interested in mental tinkering and disinterested in certification of any kind. A salon, perhaps.
Clearly the real solution is to insert the air hose from an impact wrench into the uterus, past the baby, to inflate the uterus and blast the baby out. This way the pressure isn't just on the baby's head.
Bad jokes aside, an opera was recently written (and performed - as part of the Ig Nobel ceremony!) about this device and its inventor, titled "The Blonsky Device".
When I went to the doctor's office for a shot as a child, they offered me a choice: you can get the shot in the arm like the doctor would prefer, or you can choose to get the shot in the leg, but then the doctor has to go get a bigger needle. This could work the same way. You can forgo the bag, but then we have to put you in the centrifuge.
We need more collaboration between engineers and the field of medicine. I'm reminded of Tal Golesworthy, an engineer who did a TED talk or two about how he collaborated with his doctors to design a cardiac implant that fixed his dilated aorta. He had some very insightful comments about the development process and his doctors' opinions of different approaches coming from outside the medical community.
The baby is attached to the placenta, which remains in the womb, via the umbilical cord and gets oxygen this way during the birth process. Once the baby is fully out it starts breathing (the first cry). Then the placenta is delivered.
Safe my big ol' butt. You're inflating something against baby's head and pulling on it. You're also losing tactile feedback that you'd get by direct contact with baby, which may cause you to inadvertently pull harder than you intended to.
It's to replace the vacuum extractor or forceps. Nobody uses any of these tools if you can do it by hand. Both have their own risks (and forceps are going away because the skill required is high and not enough doctors know how to do it to teach new doctors).
No. That wouldn't be direct contact, and is, again, more likely to cause injury because you're not getting good kinesthetic feedback. What I'm talking about is what the L&D doctor did when my daughter was born a couple months ago to aid my wife, who was exhausted and in pain: manual manipulation of the vaginal opening, and carefully inching baby's head forward using nothing more than his fingers.
As it turned out, this doctor some work delivering babies in Africa in third-world conditions, and only low-tech solutions were available. Things that American hospitals aren't fond of, like having mom stand up and move around, eat and drink to keep her strength up, and finding a birthing position comfortable for the mom, like squatting, hands and knees, whatever her body is telling her to do.
This device is better than forceps only that it is less likely to crush a skull, but it still carries a risk of breaking baby's neck.
Forceps also have the risk of injuring the baby in other ways. Part of Sylvester Stallone's face is paralyzed because of forceps used during his delivery.
>The current options in those cases are forceps — large, rounded pliers — or suction cups attached to the baby’s scalp. In untrained hands, either can cause hemorrhages, crush the baby’s head or twist its spine.
Really? you mean these things are going to be available at WalMart so that untrained people can use them?
I really cannot see this being adopted. how are you going to slip this thing past the cervix and pubic bone? The whole reason that you need this thing in the first place is that there is literally zero room there. Also, the inflation is going to cause an even larger object to have to move through the birth canal thus exacerbating the original problem.
How are you even going to know if you have it on completely? you really cannot see in that tight space.
What about fetal distress? I cannot imagine that this thing squishing their entire cranium would bode well for distress which leads to many potential complications.
Maybe most importantly is the fact that this device would likely prevent the infant from ingesting the very important birth canal bacteria which colonized as flora in the baby's gut. c-section births lack this as well and they are at much higher risks for many things because of it.
This is a poor replacement for vacuum extractions (suction cup method) IMO. Maybe in developing countries it could be helpful (MAYBE safer for untrained midwives), but I doubt even that, given it's own disadvantages.
"I really cannot see this being adopted. how are you going to slip this thing past the cervix and pubic bone?"
This is a typical HN top comment dismissal. It works with corks, it works with his basic prototype, it works with medical training dummies and it works with the 30 Argentinian women in live births but a comment dismissing it as being impossible is the top HN comment. Unbelievable.
You use a naive argument to attempt to refute one point of my whole comment (which contains several reasons this will not work) and call the whole thing garbage? Yours is the typical HN top comment dismissal, not mine.
On top of this, your criticism is not even valid. Let me explain why.
You clearly have never given birth with or even assisted in an obstructed delivery? Corks, prototypes, and dummies are not made to fit as tight as an obstructed birth canal and do not even try to replicate this scenario.
If you've read the article carefully, and paid attention to the details you would know the live births used are no evidence that his will work when it is actually needed.
>So far, the device has been safety-tested only on 30 Argentine women, all of whom were in hospitals, had given birth before and were in normal labor.
So the diameter of these women's birth canals were far larger than typical obstructed ones because they had given birth before. They also were in normal labor. There would be far more room available to use this device when it is not actually needed. Try shoving something like this down and around a curved surface with an obstruction preventing it's passage. The material would have to be very stiff, but to curve properly around the head and face, it would have to be very flexible. These things are mutually exclusive. Even if you managed to get it worked into place eventually (without it folding over someplace) it would take a fairly long period of time to work it into place. Suction is very quick to attach and is often used when that baby is already in distress (needs to come out in a hurry).
Here are some more reasons this won't work.
Sizing. Babies craniums are vastly different sizes. Either they will need 8 sized of these hanging on the wall, or the inflation part will have to allow for dramatic size differences. If there is only one size, and the baby's head is small, you are increasing the size of the object that needs to pass through the canal by a large margin (Actually adding to the problem). I suppose that big hospitals could have 8 sizes of these on hand, but not third world midwives.
If there is enough room for this thing to fit on, there is enough room for the Dr or midwife to just use their hands. This is far better anyway as they will have far more tactile feel.
The intuitive leap from "extracting cork in wine bottle" to "extracting baby in birth canal" happening during a dream is fascinating. Neurons rearranging during sleep cause the oddness of dream logic and can find unexpected correlations -- like the link he found.