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  1. #11
    Join Date
    Aug 2010
    Posts
    1,269
    Doesn't The Netherlands have one of the highest infant mortality rates in the EU, even compared to "poorer" countries? You can't really compare it with the US (totally different health systems), but I've often heard it being used it as a "bad example" in Europe.

    Personally, homebirths are one of those "first world problems" I can't ever understand. Millions of women around the world die in childbirth or suffer immense complications while western poor little rich girls go through unnecessary risks every year because they don't feel "comfortable" on a hospital.
    Arabella, Thibault, Sophia, Alfred, Eleanor, Rémi, Charlotte, Achille, Olivia, Clement, Elizabeth, Frederick, Maud, Benedict, Adèle.

  2. #13
    Join Date
    May 2009
    Posts
    317
    @blade The information about epidurals not stalling labor is very interesting and helpful! Thanks!
    Favorite Girls' Names: Anthea, Harriet, Vera, Fairfax
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  3. #15
    Join Date
    Apr 2013
    Location
    Currently on the west side of the U.S.
    Posts
    420
    @sugarplumfairy: I'm not sure where you got that info about the Netherlands but it's not correct from what I know from my family experiences and my research. Brussels, Belgium was in the news at one point for having a higher than expected rate but that's a separate country completely. Infant mortality rates are easily found via google, you can see them for European countries here, as of 1/1/2012, and you can see the Netherlands is towards the bottom with 4: http://www.indexmundi.com/map/?v=29&r=eu&l=en

    Worldwide infant mortality rates can be see here for 2011: http://en.wikipedia.org/wiki/List_of...mortality_rate

    @marys33: Agreed, good to hear that there's a possibility that epidurals don't actually stall labor because I've always heard the opposite!
    Christine

    Pregnancy #1: lost to mc, 10/11

    Amelia Joelle arrived on 11/28/13 at 7 pounds, 4 ounces of pure beauty. Couldn't be happier to finally be mommy!

  4. #17
    Join Date
    Sep 2012
    Location
    Los Angeles
    Posts
    4,519
    @cvdutch-- the Netherlands currently has a system, as you doubtless know, where low-risk women (defined by singelton pregnancies and the lack of anatomical/physiological/medical/prior obstetric complications) are cared for by nurse-midwives, and higher-risk patients (with any of those problems) are cared for by obstetricians. This is similar to many Western European countries. What makes Holland unique, however, is the percentage of midwife-attended births which occur out of hospital. Please don't quote me on this, but it's somewhere in the order of 20-25%. This is much, much higher than other Western European countries where the percentage doesn't top 2-4% (and the US where is it less than 1.5% nationally). Previously it was upheld as a shining example of the safety of "risking out" healthy women to have a homebirth. However, since 2010 a lot of alarming new data have come out showing that the *low-risk* *healthy* group has a higher rate of baby death than the *high-risk* *sick* group. If it were the other way around, you would still have some questions about the safety of homebirth (i.e. is cherrypicking patients acceptable given that, presumably, if the same healthy women gave birth in the hospital there would be almost no baby deaths, whereas at home there are some baby deaths? How many baby deaths are OK?). But in fact it's black-n-white the opposite-- even the cherry-picked patients have worse outcomes.

    Infant mortality is a statistic that includes all deaths from hour zero of life to day 364 of life. Infant mortality will include premature babies, babies with several congenital abnormalities, babies murdered or killed in car wrecks, babies with chromosomal problems-- as well as babies injured by birth. Since the US actually out-performs every other country on the critical care of the extremely premature newborn, and since the US frequently offers "heroic therapy" in terms of operations, lengthy ICU stays, etc than other cost-conscious countries, and since the US has a larger proportion of people not willing to terminate pregnancies for congenital anomalies or chromosomal problems... and, most importantly, since the US has a much more heterogenous population than the countries of Western Europe & Aus/NZ, the US has an apparent higher infant mortality rate. The kicker, btw, is that the US counts all children born alive, even if they draw one breath before dying, as "live births," and they go into the infant mortality rate. Most Western European countries count these children as stillbirths (which I can't really wrap my mind around, honestly).

    However, this is the wrong statistic to look at if you want to just debate birth-related policy and look at intra- and post-partum outcomes. The correct statistic is *perinatal mortality,* which includes stillbirths after 24 weeks gestation up through infant deaths in the first 7 days of life. Although it's not perfect-- you'll still capture a lot of children with severe anomalies and other conditions incompatible with life which had nothing to do with the safety of how they were born-- it's much better.

    @marsy33 here are the papers if you would like to read them (unless you have an institutional login-- you said you were a master's student-- you might be stuck with just the abstracts). Note how old they are!

    http://www.ncbi.nlm.nih.gov/pubmed/12011873 [the maternal hypotension from epidural use is *definitely* a real side effect]
    http://www.ncbi.nlm.nih.gov/pubmed/9855591 [randomized controlled trial]
    http://www.ncbi.nlm.nih.gov/pubmed/18044297 [randomized controlled trial]
    http://www.ncbi.nlm.nih.gov/pubmed/14695735 [meta-analysis of 2400 patients]
    http://www.ncbi.nlm.nih.gov/pubmed/11483916 [official NIH study, demonstrating the length of the second stage increases by only ~30min]
    Blade, MD

    XY: AR
    XX: CVN

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  5. #19
    Join Date
    Apr 2013
    Location
    Currently on the west side of the U.S.
    Posts
    420
    @blade: as always, thanks for the detailed info! How do you manage to carry all of this around in your brain? That's why I didn't go on to be a doctor, my brain gets tired just reading it all.
    Christine

    Pregnancy #1: lost to mc, 10/11

    Amelia Joelle arrived on 11/28/13 at 7 pounds, 4 ounces of pure beauty. Couldn't be happier to finally be mommy!

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