Tuesday, October 9, 2007

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Interesting thought.


Leo with astonishment that the Aragonese government has given approval to build a macro-casino, call it that, in the middle of Los Monegros
( http://www.elpais.com/articulo/ espana/Monegros/tierra/espias/casinos/elpepuesp/20071213elpepinac_14/Tes )



expected or intended that the huge center becomes the first tourist destination on the peninsula, which receives more than 25 million visitors year.



guess in the development of the project and will be thinking how to build and how they will share the benefits. My question as a psychiatrist children is how they get Aragon authorities tourists. I refer specifically to whether they think a plan that will allow the go and getting those 25 million people who are high on your holiday spending money at a casino in the middle of Los Monegros. Because let me advise them to get addicted to this volume of the most profitable game would start as children, since studies show that it is quite difficult to get a healthy and emotionally stable adult becomes a compulsive gambler. So as a child psychiatrist I can think of several fairly inexpensive suggestions to contribute to the production of 25 million addicts.



First I must be encouraged to raise any children remain an obstacle course. Nothing to streamline work schedules of parents or extended maternity leave and paternity. Instead it is recommended that pregnant women continue working until the end of her pregnancy, which will increase preterm birth and hyperactive children with attention deficit (which we now know is a condition favored by stress in pregnancy and which if not treated in time favors a range of other disorders). Moreover protocols should continue to apply to all parturients obsolete conducive to further increase the number of caesarean sections and babies spend the first hours of life away from their mothers and fathers, thus putting the link and lactation are far more difficult task of what nature has planned to increase postpartum depression and family crisis. To return to work is a source of tremendous stress and that with current pay both parents have to work to afford a place in the private nurseries will also contribute to your goal. If in subsequent years continuously sick children, need high doses of antibiotics and asthma medications is a sign that we are on the right track.




As for the school stage the guideline to follow is also quite simple: just keep doing everything possible to stop public school run by investing in it as little as possible, encouraging the best teachers feel all alone and burned. To do no more than maintain the current ratios of 20 and 22 children from three years in early childhood education teacher, including all those with special educational needs in the same classroom without any support. Of course we will continue giving priority to children newly arrived from other countries attend public schools joining in the course that touches their age and that the concert is still the place to which children are "good" families, we can be sure that this tactic also will pay off. Throughout all the education we can encourage students to engage priority is to learn to use the Internet and computers before reading a single book or having climbed one mountain.




also will help continue to bombard children with all types of advertisements on television, radio and newspapers encouraging them to ask their parents all kinds of toys and packaged foods loaded with dyes and preservatives. To fare better preparing the further proliferation for their birthdays and holidays so-called "children's entertainment centers" where can surfeit of coca-cola and worms and then fight with their friends in the ball pools.


In secondary education there is to do much more than it already is doing: Please send to 12 years at the institutes to feel as lost as possible, encourage them to smoke and drink alcohol from 13 to 14 years and teach them so they can be thin and look like boys and girls you see in the TV series and commercials. 25% of school failure is likely to be increasing.


While it is important that if a child gives signs of depression or anxiety can not be handled with the dedication and time required, much less proven professionals. Remain one of only two European countries where child psychiatry is not recognized by law is highly desirable. Just to follow with some very poor resources in the network of mental health (child and adult) that make a child if anyone needs 12 sessions of psychotherapy to an anxiety disorder will probably only get two or three, or if you have attention deficit the only treatment he is going to offer medication. Family therapies are treatment of choice for many disorders of adolescence continue to be excluded from benefits.


With all these policies is easier than ever there are more teenagers hooked on alcohol, snuff, to chat or video games. Clear that as these kids drop out of that and I have to work hard to not know where they will be able to get the money to go to the casino on vacation. Surely not then be surprised if these guys end up stealing to afford their dreams come true. Thereby also recommend them for part of the benefits of the Grand Casino de los Monegros to build more jails for children, which as you know also produce huge profits.


Finally, I insist that not even think to spend money on improving conditions for all workers, or providing better means schools and public health or social services, much less something as ridiculous as to promote responsible drinking and love to land, because we know that all that could derail his fantastic project to get 25 million addicts, as you think this casino "will be the showcase of Aragon to the world." Lest all these people end preferring a walk in the beautiful Pyrenees for a day at the casino ...

Ibone Olza
Child Psychiatrist

Sunday, October 7, 2007

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positions to facilitate delivery. About


Click to enlarge.

Birthday Sayings For 12 Turning 13

Promotion of breastfeeding.




Was the Promotion of Breastfeeding as useless as the promotion of love?

The publication of this newsletter coincides with the launch of the British edition of "Birth and Breastfeeding" (first edition: "The Nature of Birth and Breastfeeding." Bergin and Garvey. USA 1992. Second Edition: Birth and Breastfeeding. Clair view. UK 2003).

PROMOTION OF LOVE IS OLD

are not necessarily great arguments to convince anyone that love has been promoted since time immemorial. Spiritual heroes, religious leaders, philosophers, poets, moralists and philanthropists of all persuasions have used a variety of terms that encourage the expression of various facets of love. Depending on the context has been referred to compassion, altruism, devotion, charity, generosity, kindness, benevolence, gratitude, forgiveness, etc. Since the word love has a positive connotation in most languages, it should be assumed that their promotion has been effective. But when we consider human behavior for over twenty-one centuries, we need not many reasons to doubt the actual benefits of the promotion of love.

HOW TO DEVELOP THE CAPACITY TO LOVE?
This question is so simple and so basic and so necessary is, paradoxically, new. While we ignore the promotion of love is doomed to have limited effects. Today we ask the question so that the various disciplines provide answers.
Therefore, it is necessary first, go to the study of the genetic basis of our conduct. As we now know, man is one of the three members of the family of chimpanzees, along with common chimpanzees and chimpanzees dwarfs. In other words, we are - talking in terms of genetics - chimpanzees. It is noteworthy that the common chimpanzee killings carried still planned extermination of rival gangs, war to conquer territories and abduction of young nubile females. Cro-Magnon men had similar traits. The sudden disappearance of the Neanderthals after the appearance of Cro-Magnon, suggests that genocide was effective. As

have a high destructive potential, humans also have the potential for love. How can this potential for love? A combination of inputs from various scientific disciplines suggests that the capacity to love develops largely during the earliest experiences, especially in the period surrounding the birth . A synthesis of current knowledge of the behavioral effects of hormones which fluctuate in the perinatal period, supports the concept of "critical period" introduced long ago by the specialists in behavior ("ethologists"). Ethologists were the first to realize that generally exists in mammals, immediately after birth in a very short period of time not to be repeated ever again, and it is very important for bonding between mother and child. A subset of studies included in the Data Bank Primal Health Research, also suggest that the development of the capacity to love is highly influenced by events in the perinatal period.
is precisely because we are in the process of verifying that the manner in which we are born has long term consequences in terms of sociability, aggression and ability to love, we have begun to analyze the many beliefs and rituals that disturb the physiological development of the perinatal period. Most of them are interesting because they disrupt the critical stage of labor that goes from the birth of the baby to the expulsion of the placenta. We should understand that since the time when the basic survival strategy of many cultures was to exercise control over nature and other human groups, the creation of human beings more aggressive and destructive supposed advantage. In other words it was an advantage to control the ability to love, including the ability to love nature - respect for Mother Earth. Understandably, most powerful companies were those that had at its disposal the appropriate beliefs and rituals in the period surrounding birth. For millennia it has been the selection of human groups according to their potential for aggression. All of us are the result of this selective process. This explains our inability to recognize and effectively act against manifestations of impaired capacity to love.
Today, Homo sapiens must invent new strategies to survive. We are in the time Obviously we've reached the limits of the domain of nature, and that the necessary dialogue between humanity and Mother Earth calls for a substantial unification of humanity. It other words, human beings must learn to control energy through the promotion of love. Human beings must learn to make the necessary basic questions instead of directly promoting love. Scientific data can provide the necessary answers. For this reason a scientific view of love must be presented as a milestone in the history of mankind.

PROMOTING BREAST IS OLD
The promotion of breast milk is at least as old as the Scriptures. At first the question was not posed as "What is nursing a baby?". Rather, the question was "What will this child be breastfed by his mother?". In the Old Testament, Jeremiah regards maternal aversion to breastfeed. He was speaking to those who asked about convenience, when he said: "Even the sea monsters offer the breast to their descendants." The Talmud recommends that mothers breastfeed eight months to two years. The Koran recommends breastfeeding up to two years.
In another context, Julius Caesar complained that the sons of the patricians were not receiving breast milk. Jean-Jacques Rousseau, Moreover, breastfeeding became fashionable among the most elegant Parisian women of the upper classes of Europe in the eighteenth century, the movement back to nature. "The fashionable mamma" ("Mother of fashion"), an etching by James Gillray Inglés, dated 1796 (exhibited in the British Museum) illustrates the impact of the theories of Rousseau.
The promotion of breastfeeding takes different forms depending on historical context. In Renaissance art, the many paintings of the Virgin Mary breastfeeding the baby Jesus were indirectly, a non-premeditated but very effective in promoting breastfeeding. The power of religious imagery can help interpret an interesting phenomenon that occurred in Iceland, a country where mothers do not breastfeed their children for two or three centuries. Until the advent of the Reformation, the Virgin Mary had paramount importance in popular religious practices of Iceland, and during the rites of purification after childbirth, women prayed to the Virgin Mary in their local churches. In this case, the destruction of the image of Mary, may help explain why he left quickly and massively breastfeeding.
A mid-twentieth century, during the baby boom that followed World War II, developed the formulas and breast-feeding declined. A group of nursing mothers met in a suburb of Chicago and in 1956 founded the La Leche League. Its main objective was to provide information and support to breastfeeding mothers at a time when many doctors promoted bottle-feeding. It is indeed difficult to separate support for nursing mothers and promoting breastfeeding. A nursing mother always promotes breastfeeding. Today
promotion of breastfeeding is one of the priorities of Germany's largest public health promotion. In many countries, is largely in the hands of government departments. In Brazil, the PNIAM (National Aleitamento year or Incentive Mother) was established in 1981 and was included in the Brazilian constitution in 1988. This program is notable for its intensity, extension and innovation. Each state organizes training for all categories of health professionals and also for traditional healers and others in the unofficial sector of the field of health. For campaigns in the media used familiar characters faces, and the legislation included warnings about breast milk substitutes and maternal incrementaros permits. Brazil also had a very active participation in the Initiative Baby Friendly Hospital in 1998 and was accredited as such to 103 hospitals.
In China in 1995, the law mandates contained active within the health system to provide educational materials on infant feeding. This included a regulation on marketing of breast milk substitutes. In USA, the Surgeon General, officially recommended that babies must be fed only breast milk - no formula - for the first six months of life. It's great to breastfeed for six months and much better to breastfeed for twelve months. The slogan promulgated by the Surgeon General is "the breast - the best for the baby - the best for the mother" (Breast - Best for Baby - Best for Mom).
Health's performance Public may seem as effective when you consider that in our society today everyone is convinced that "Breast is best" (Breast is Best). This is the conclusion of my unofficial observation among taxi drivers in different countries. But one may wonder if these modern methods are effective and direct. There is a huge gap between formal knowledge, popular knowledge and intentions on the one hand and statistical data on the other side. In many countries the duration of breastfeeding falls much earlier than recommended by national plans. Today the goal is not to promote breastfeeding: is to understand why breastfeeding in our society is so difficult and can not continue until the recommended setting.

HOW CAN DEVELOP THE CAPACITY OF NURSING?
This question so simple, basic and necessary is, paradoxically new. While we try to ignore it, the promotion of breastfeeding will remain ineffective. Today we are able to explain that breastfeeding begins before the baby is born.
Until recently, the fact that the mother's body prepares milk secretion before birth the baby was in the domain of intuitive knowledge. Today physiologists are able to explain how the hormones secreted by the mother and baby during in labor and birth play a role in the initiation of breastfeeding.
We find several examples to explain the connections between the physiology of childbirth and lactation:

In 1979 it became known that beta-endorphin levels increase during childbirth. Also, we knew since 1977 that beta-endorphins stimulate the secretion of prolactin. This makes it possible to interpret a string of events: physiological pain of childbirth - a system of protection against the pain - and the key hormone secretion during lactation.
A Swedish study published in 1996, showed that two days after birth when the baby is feeding, the woman who has had a vaginal delivery oxytocin secreted in pulses (when the discharge is effective), compared with women who have had an emergency cesarean delivery. In addition there is a correlation between the way that oxytocin is secreted two days after birth and duration of exclusive breastfeeding.
The same Swedish team found that women with cesarean delivery had no significant increases in prolactin levels to 20 to 30 minutes after the start of the shot.
An Italian team proved that the amount of beta-endorphins in colostral milk of mothers with vaginal delivery is significantly higher than levels in colostrum of mothers who have given birth by Caesarean section. Probably one of the effects of opiates in milk create a kind of addiction to milk. It is anticipated that the greater the addiction of the newborn to the breast, longer and is easier breastfeeding.

generally easy to understand at first, when the newborn is able to find the breast, the behavior of the mother and baby are under the influence of several hormones secreted during childbirth. These various hormones secreted by the mother during the birth process are still present in the first hour after birth, all of which play a specific role in the interaction between mother and baby well as in the initiation of breastfeeding.
also other factors involved in developing the ability to breastfeed. Anyway, it is necessary to focus attention on the physiological process that is routinely disturbed by the cultural milieu.

Such considerations are particularly relevant at the time of elective caesarean sections on demand and the time at our disposal many powerful ways to disrupt the physiological process of the period surrounding birth. As the fundamental questions are not taken into account, the public health campaigns are not positive in regard to the cost-benefit. None of these health campaigns public takes into account the total, almost cultural misunderstanding of the physiology of birth that leads to high rates of obstetric interventions and the widespread use of pharmacological substitutes of natural hormones. The priority now should be to rediscover the basic needs of women during childbirth.

Brazil is an ideal place to measure the gap between theory and practice, since it is characterized for having fired the cesarean rate and the institutional promotion of breastfeeding. Almeida Couto an interesting study conducted on breastfeeding women health professionals whose mission was to recommend exclusive breastfeeding for the first six months. When these experts were nursing their own children the median duration of exclusive breastfeeding was only 98 days! All these women were guaranteed a maternity leave of 120 days. It mentions a detail ² ² the report of this study: among health professionals at the university level, 85.7% had a cesarean delivery, compared with 66.7% among health professionals of technical level. A longitudinal study of weaning practices in northeast Brazil (where 99% of women breastfeeding when they leave the hospital) revealed that the average age to start "another" milk was 24 days and the average length breastfeeding among mothers began to offer "other" milk within the first month (the majority) was 65 days. It is interesting that this article does not mention the rate of caesarean sections.
China is also characterized by the high rate of Caesarean sections and intensive national program to promote breastfeeding. It is difficult to obtain accurate statistical data in China. However, during the trip I made in 2002, I heard word that many women have trouble breastfeeding. This confirms the public statement "Save the Children" in the Kunming province, that there is a growing demand for substances to stimulate milk secretion (
www.ibfan.org )
In USA, the incidence of exclusive breastfeeding for the first three months is generally below 30%. In the UK, where the population is comparatively better knowledge and commitment in terms of health, the incidence of breastfeeding at six months is 20%. With regard to breastfeeding, there is great contrast between the Scandinavian countries and Japan on one side and the rest of the world on the other. In Norway and Sweden, for example, the rate of breastfeeding at six months is about 50%. In this group of countries, obstetric intervention yet remains under control. The situation in Holland is special. It seems that Dutch women generally do not encounter difficulties when they breastfeed, but Holland is a country with a long tradition of bottle feeding, which explains the comparatively low incidence of breastfeeding in a country where many women give birth at home. Anyway, the incidence of breastfeeding at six months is about 25% compared to 15% at three months in France.
The best synthesis of the current international situation is provided by the Global Data Bank WHO on breastfeeding issues (WHO Global Data Bank on breatfeeding). Contains data from 94 countries and 65% of the world's children. According to Latest data (April 2003), 35% of these children were fed exclusively on breast milk between 0-4 months of age.

Today the priority is not to constantly repeat that "Breast is Best" (Breast is Best). Is to consider as it develops the ability to breastfeed. Is to rediscover the basic needs of women in childbirth. Public health organizations should be aware that "breast begins before the birth of the baby." Michel Odent

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What is, what is birth.


Consuelo Ruiz Vélez-Frías Midwife.


Birth is a wonderful fact that occurs spontaneously and perfectly, is the beginning of a free life, independent of any life, animal or plant and which, as with its antithesis, death the human will have very limited free disposal of both. In creation there are living beings and inert matter, things within our reach, and others that are beyond our control. Human reason suggests that all creation should follow a program, a plan that all must have been created for something, you must have a practical purpose for everything, especially for things you do alone, that nobody manufactures and usually much higher than those manufactured.


a couple of days ago I noticed that in an empty pot on the terrace had gone stiff and pimpante two leaves, precious they were and asked my friend Sophie told me that they were orange leaves, which she had put on earth an orange pipe "to see if he was something." Assuming that these two leaves grow, multiply and be able to become an orange, you can not say it was Sofia who created it. Sofia was only the agent who provided the orange pipe conditions needed land, water, air and sun for a simple pipe could develop the power, the power I had inside for taking the materials of the earth and water, power autofabricarse the moment, two leaves. But it's not so easy, make a tree, I've got, sometimes seeds in pots and some have left and others are not.

The birth of a human being is also the result of depositing a human seed, the spermatozoa within the uterus, a female body specially built to serve the human seed pot should be supplemented with another gamete, the egg, made, grown and matured in the ovaries. I am inclined to believe that everything is programmed playback beforehand because neither the egg nor the espermatoozo used alone to form a new being. First they have to mature, to lose both, half of the chromosomes contained in its nucleus. The egg has to grow, reaching 200 times greater than its original size and the male gamete has to be provided with a vibrating tail which allows it to reach the egg, penetrate it and mix and unify the two nuclei, joining the two halves chromosome of each core to complete the exact number of chromosomes that correspond to the human species.

That first cell of a new being, is called a zygote and its nucleus contains the chromosomes of mixed male and female, and those of their ancestors that have not been eliminated in the maturation. The combinations can be endless and because of them, no two individuals are exactly alike, but humanity is improving in every way. Logically, it is normal that you eliminate the worst Nature genes, the least interested in preserving. The difference between primitive man and the present is enormous and many ordinary things in modern life even dared to imagine our distant ancestors. But human knowledge is limited. From the mythical Tower of Babel, the man must understand that it can not do everything that is proposed, that even in the XXI century there are things that man is not impossible can still do that it pays to know first how to make themselves spontaneously and gauge whether a man can do it better or not, because to make them worse, to complicate, it is better to leave them as they are. The birth of human being in the background is very simple, but it depends on many factors. First, the two carriers of gametes must have reached its full development and it is desirable that they are healthy, free of faults or defects, because from this genetic material is to form another individual. To form the zygote is a necessary condition to unite closely, to amalgamate, forming a single cell, an egg and a sperm. In viviparous reproduction gametes do not work the same. You can cross, to a certain extent, different races, but you can not get a first cell of another with two eggs or two sperm.

This is a natural law that we have no choice but to accept. On second thought, I think that it is prepared on purpose for the new being has at his disposal two different people, physically and mentally, perhaps because life is going to need them. Theoretically, the sex you get, among animals, and between human instinct for love. Females of most quadrupeds cover left by the male if they are in heat. I learned a lot about breeding viviparous and the birth of the queen of my parents, "Butterfly", which started one day the tail of a cat bite because he did not want to stay pregnant. Among viviparous animals there is always a procession prior to fertilization and naturally in the human species should have. It is true that in the course of history, women have not always been able to choose the father of her children, but in modern times, in civilized countries, we did the majority of women who wanted a son, not of any but from that to which we loved, precisely because we wanted to have the qualities that we had Call me attention, had we fall in love this man and wanted a son like him.

man in love I think there are a large percentage of admiration, you start by loving what you like, what seduces, that little by little, sometimes unwittingly be making a grab the idea that we admire the becomes known friend, the friend, companion, companion, boyfriend, fiance boyfriend, husband and future father of our children. Naturally, this process has classic alternatives, depends on many factors and is therefore highly variable and not without surprises, but in the end, at least one hand there is the desire to be "forever" about be loved and when creams that we have achieved because we live, eat and sleep on it, your family and friends beside us support o. tolerate us, women, I know from personal experience, if we are truly in love, we still want to have you over us, forever more, we want to have a child who is like him, in which differences are excusable, and due to the influence they have had our own genes into the making of the child.

[...] A newborn is always or almost always, the fruit of love and therefore deserves to be treated with respect. I had a hard time attending the birth of a woman abandoned, abused, alone, for whatever reason. I did not know how to behave, or to talk with her. Nor could pretend to know his situation, although he knew and to treat labor as the others, because every birth and every woman is different. The only thing the same in all births is the joy that gives birth to a child seeing alive and well, consider a pure eyes, seems innocent wonder if they're going to let live, as if they're going to hesitate to do so. These early looks made me forget the moment, the sleepless nights, days without eating, walking, the various concerns that carried the birth, when there were no factories of births, when each delivery was an important event for all and was responsible in First, a humble midwife. Of course, with the proper knowledge of ethics and obstetrics and to be gracefully, like many colleagues of mine who were honored with a beautiful profession, unfortunately endangered and very different from what was traditionally, as a result of their own Nor is the woman before.

The birth has lost its status as a pleasant family event which was described for millennia, but despite efforts to do so, it has not been universally accepted as a dangerous disease that should be avoided and look for another system indispensable for repopulation of our planet. Perhaps not the most important in the birth of human beings, the potential future shortage of soldiers for the wars and workers for agriculture and industry, but that "no one knows why! smile that has made millions and millions of mothers with newborns, looking ecstatic, the face your baby, forgetting, suddenly suffering, worries and pains. It is true that every newborn "bring a loaf under his arm, quite the contrary. As-bearing species have been progressing, childbirth and care offspring has become more difficult and complicated, which is no less a paradox. In humans, the most developed among the viviparous animals, has reached such an extent that the Women give up, willingly or forced by circumstances to conclude personally for normal physiological function that normally provides the equipment and adequate system, just in the earliest stage, the easier and more rewarding the whole process.

is shocking is not capable of giving birth alone in the middle of a woman of childbearing age, able to ovulate, conceive and stay in your uterus and nurture with his blood, through the placental system, for 280 days that is, until its full development, a human embryo. It is recognized that the woman is a being similar to the male, but not exactly like him. In all living beings there sexual dimorphism due to which, at first glance, differences are appreciated, as the existence of some bodies that make the two sexes are complementary in the important task of reproduction. Both sexes have organs, tissues and organs such, when it comes to carrying out vital functions. Nobody would admit that healthy women not able to breathe, swallow, walk, think, speak, move, as does the man under the same conditions. The physiological functions are carried out completely, from the beginning to the end, nothing is left unfinished. The bolus which makes chewing food, the stomach is responsible, through digestion converting into chyle, so that nutrients can enter the blood through the small intestine, while the bulk is responsible for collecting and depositing waste into the rectum for evacuation through the anus. Normally, the digestion is done well, whether you eat at home, at work, at a restaurant or a banquet, and of course men and women make digestion completely and such because their digestive systems are very similar. Of course there indigestion, digestion cuts, diarrhea, constipation, etc.. But do not depend on sex but of different reasons that are often analyzed and explained.

However, there is no explanation why a healthy pregnant woman can not give birth at home or wherever, in the same exact conditions that make their other physiological functions. It is understood that the man can not conceive, birth or breastfeeding because it has no suitable organs for it, because its mission is different. But the primary mission of the woman should be giving birth, when all born with a genital tract, especially prepared for this purpose. My opinion is that the major complication of childbirth is supine ignorance of what is, what the birth, talking about their rights, first of all would know what happens in the body of the woman who has a son , natural what happens, if it can or should intervene active at birth, as we participate in other functions of life. No one disputes the right of women to open windows and balconies to air out your house and she does it thinking that the air will be healthier and she and her family will breathe better, and to bring the beans to soak and cook the vegetables to steam. From time immemorial human beings have explored ways to make easier and more enjoyable necessary functions and the woman has had a major role in this effort to make things easier. No physical or moral reason to relegate women to the role of inert matter of being ignorant and incapable in a physiological function that relates directly, which is her personal and spontaneously who must carry it out, anyone can do it better than she was born deliberately prepared for that.

is shameful that in the XXI Century, women do not know what is delivery, how and why it stops and the best, easiest and most enjoyable way to do it, still has gynecologists think that "women not have to know anything, because that's why we're us. (sic) I do not know if "we" referred to gynecologists or boys. There is no reason to be unfit for all women and Birth "of course, to attend the birth as if it were a disease, gynecology, that is, by doctors specializing in diseases and female nurses, midwives denom that without a school and a specialization in generic hospital. Nor is the disappearance of the professions especially dedicated to delivery. The obstetrician and midwife professions, nor the disappearance of the Maternity, making the delivery as it is: a disease. The least we can claim, mothers and babies, is that we explain the reasons for such change, we are not treated as subnomales, unable to act as intelligent beings, not more lies told on serious matter.

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The Birth of the New Millennium


THE RISE IN THE NEW MILLENNIUM
Marsden Wagner MD, MSPH
Former Director of the Department of Maternal and Child Health of the World Health Organization



HISTORY The delivery has always belonged to the world of women. It has always been midwives to assist women in childbirth. The word midwife, "midwife" in Old English means "with woman" "Sage femme", the French term, means "wise woman" and its origin goes way back in time. The current word to describe Danish midwife, "jordmor" means "Mother Earth" and its use dates back to Viking times.
From the beginning, midwives have developed a central role in the world of women, not only with acts that go beyond the maternity care, but also acts that encompass much more than health care. When I visited Povungnituk, a native Inuit people in far northern Quebec, Canada, I saw this myself. Canadian health authorities had decreed that all women were pregnant Inuit fly very far south from his home, several weeks before the due date for giving birth in large hospitals. As a result of this policy, we lost the tradition of Inuit midwives, which involved the gradual destruction of their culture. The Inuit protested and managed to change this measure.
With the new policy, midwives were sent north to educate Inuit women as midwives and allowed the low-risk pregnant women gave birth in their villages. When I visited Povungnituk this project had already been running a couple of years. Midwives who taught there told me that although his program was only prenatal care, perinatal and postnatal, after a year of education, noted that Inuit women began to come to them with their problems of women, such as, abuse by husbands. Again, midwives were taking their crucial role in the lives of village women.

two hundred years ago, men began to invade the maternity care. Gradually there was a profound change with a great paradigm shift about the birth and care delivery. Midwives have always understood that the woman in the throes of childbirth should remain in the center with the midwife who assisted at his side, not only to monitor the progress of your delivery, but also support social and psychological. However, men need to be in the center and control and manage everything that goes on around them. As a result, obstetricians birth control today and we can find, for example, the extreme situation: the "active management" of birth, where "active" means that the doctor develops an active role and the woman in labor is all less active, since it is completely stripped of control over their own labor.
The midwifery is based on the belief that the birth process in humans is part of nature and that, clearly, has evolved over millions of years. Midwives believe that most women are able to give birth with minimal support and assistance. However, men rely on machines, not the bodies of women. One of the fundamental aspects of midwifery is the expected calm and alert, with consciousness. This is not part of the male world and has been replaced by the anxious need to "do something" for those who do the delivery, preferably with machines. This trend started at the beginning of the invasion male birth, when a Scottish surgeon barber hid his invention, the forceps, under her skirt (had to change his clothes to get admission in childbirth) and started to remove her babies .
medical confidence in the technology and lack of confidence in the nature has led, unsuccessfully, a number of attempts during the twentieth century of improvements in social and biological evolution. The doctors have replaced midwives in low risk deliveries that science only proved that midwives are safer. The hospital replaced the households in low-risk deliveries only for science to conclude that the home is as safe and to implement a series of interventions clearly unnecessary. The hospital team took the place of the family and labor support for science only to find that birth is safer if the family is present. The lithotomy position shifted to vertical positions for the sole purpose of science to conclude that the vertical positions are by far more secure. The examination of the newborn in the first 20 minutes replaced maternal contact that science only recognized the need to create a link at that time. Artificial milk replaced breast milk with the sole purpose of science to realize that breastfeeding is superior. The central nest replaced the mother so that science will find that staying with her is, of course, the better. The incubator replaced the body of the mother in the care of children under weight for science eventually came to the conclusion that Kangaroo care is better in most cases.

Another twist on the paradigm of the concept of birth that goes even further is the one that concerns life and death. Midwives have always understood that birth is part of life and how life has no guarantees. The mortality rate in the world is 100%. Nowhere in the world there perinatal mortality rates that approach zero. However, since for the two great enemies doctors are pain and death, as part of its attempt to deal with maternity services, began to promise to women and their families a painless delivery and a perfect baby. As a result, the public has lost the understanding and acceptance that sometimes happens that babies die. If you play to be God, I blame natural disasters. The epidemic of litigation against obstetricians in many countries is partly a consequence of the promise of a perfect baby and legitimate feelings of disappointment in the family when the baby is born with disabilities or even die.
After the Second World War came the technological age. If we can reach the moon, of course we can save all the babies if we all births in hospitals with all the technology available. Despite having no scientific evidence, then or now, that hospitals are safer for women without complications during pregnancy, childbirth, moved to the hospital and started the stampede toward high technology. So spread the use of many interventions, including the application of new drugs such as diethyl-estilbesterol (DES) and thalidomide and new machines such as ultrasound and electronic fetal monitoring, without adequate scientific evaluation. In the 70
the serpent entered the garden of high-tech hospital births. We found that both thalidomide and DES caused defects in babies. Gradually began to realize that the fall in perinatal mortality was mainly due to social factors such as improvements in housing, better nutrition and family planning, to the extent that the alleged role of saving the lives of babies who had held the doctors and hospitals, was in the basic medical background factors such as antibiotics or blood transfusions safe and not any high-tech interventions, as intended. The women's movement became aware about how motherhood had been stolen and started a reaction against the medicalization of childbirth and dehumanization.
The 80's saw the recognition of what evolved as two different concepts about maternity care: the medical model advocated by doctors, and social model, supported by most midwives, scientists and many perinatal health professionals. It concluded that the medical model works well for illness and accidents, but that does not fit within the cycles of life as birth or death.

The scientific assessment of maternity services was going strong and revealed startling truths about the use of technology as an example, that the routine use of electronic fetal monitoring increased sharply unnecessary cesarean section rates. The fundamental change from standard practice always equal to the evidence-based practice had begun. The World Health Organization consensus conferences organized and developed recommendations on appropriate perinatal technology, based on evidence. The Oxford Group Perinatal Epidemiology published a text that became a milestone, "Effective Care in Pregnancy and Childbirth", using only the best scientific evidence. And increasingly, the evidence tended to support the need to expand the medical model to include the social model as well.
Without this constituted a surprise to anyone, there was a strong reaction from the medical establishment. All these events accounted a serious confrontation with the medical monopoly of maternity care provided for so long. The control, status, and in many cases, the financial benefits that impact on the obstetricians were in danger. Began a fierce struggle.
The 90's witnessed the continuation of the struggle and its acceleration in many places. Gradually, the evidence-based medicine became the goal, including obstetric organizations, at least on paper. Centered maternity care in the family arrived in places where the medical model still had the control in the form of curtains and rocking chairs in the delivery room, and putting all the technological machinery behind the curtains and calling it "Birthing Center." However, elsewhere, as in Germany, developed rapidly independent houses deliveries (outside hospitals) and everywhere increased the number of independent midwives. In the UK, parliamentary debates leading up to the maternity services support some background whose main idea was to better medical and social mix. In New Zealand, a new law has treated the midwives with medical doctors specializing in general in terms of responsibilities and salary. Most women choose to have their own midwife during pregnancy and childbirth. In Japan, the independent delivery homes hospitals increased in number everywhere.
However, in other countries, the medical model retained its hegemony. Normal births attended by obstetricians in the United States and Canada, a system that doctors and midwives in most countries consider insane. The rate of caesarean sections in Brazil continued to increase until it became a 100% in some hospitals and 50% of all births in some states. In many countries, including USA, Canada, Ireland, Italy or Australia, there was a witch hunt by doctors who accused the midwives who were then arrested and tried.
proclaimed
The medical model the use of high technology in maternity care in rich countries was real progress, but the scientific evidence in these countries suggested otherwise: He had fallen cerebral palsy rate in the last 30 years, had not reduced the rate of low birth weight in 20 years and had not reduced the maternal mortality rate in 10 years and yet had a probable slight increase in some countries like the U.S. or Brazil. There was a slight decline in perinatal mortality rate in 10 years not due, however, no decrease in fetal mortality itself, but a slight improvement in mortality neonatal intensive care associated with neonatal and obstetric care not to. THIS


Today there are three types of maternity care: high-tech assistance very medicalized, focused on the doctor that provided by midwives, marginalized, for example, United States, Ireland, Russia, the Republic Czech, France, Belgium and Brazil, with the model of a social approach with midwives predominantly stronger and more autonomous and lower rates of intervention that we find, for example, in the Netherlands, New Zealand and the Scandinavian countries and a mix of both ways of looking at motherhood, as countries like the United Kingdom, Canada, Germany, Japan, Australia and Spain. In the Third World-style services are medical model in the large cities, while services still remain social model rural areas where the medical model is not yet penetrated.
The struggle between these two conceptions of labor and globalization has intensified in recent times. A review of obstetric practices that are made in Spain serves to illustrate the type of maternity care currently provided.
The scientific evidence is clear: the delivery is safer if a person assisting him throughout the process of labor, third stage and delivery. But this is not the case of English hospitals, where midwives, nurses and physicians share care delivery and, when shift changes, a new team does not know the woman suddenly appears. Science has proven that routine fetal monitoring during labor does not reduce perinatal mortality. Only leads to too many unnecessary Caesarean sections. However, the fetal routinely practiced in most English hospitals during childbirth. Routine intravenous fluids are not necessary during normal labor and interfere with the important need for women to facilitate their delivery through movement. However, medication routine IV applies in most English hospitals. The scientists tested more than 20 years ago that put a woman on his back in the second stage of labor is the worst of all possible positions, but women are placed in this position in virtually every hospital Spain.
cutting to open the vagina during delivery (episiotomy) is never needed more than 20% of deliveries and science has found to cause pain, increased bleeding and cause long-term sexual dysfunction. For all these reasons, make too many episiotomies have been properly labeled as a form of genital mutilation in women. The episiotomy rate of 89% in Spain is a scandal and a tragedy.
Regarding surgical delivery, not more than 10% of babies need the use of forceps or vacuum to be born, but in English hospitals 18% of babies born to these surgical instruments is not without risk. Drawing on the best scientific evidence, the World Health Organization has recommended that no more than 10% of caesarean sections in general hospitals and not more than 15% in specialized hospitals which tend to shift special cases. However, in Spain there is a 23% Caesarean section in public hospitals and 31% in hospitals private. These data reveal the number of caesarean sections three serious issues about obstetric care in Spain. 1) There are unnecessary cesareans 36.000 each year in Spain, they do run serious risks to all those women and their babies and also are a waste of a lot of money. 2) 40% of women in Spain did not give birth to their children because they are extracted by these means and surgical instruments. It is ridiculous to think that 40% of women in Spain are unable to give birth. 3) Women with fewer economic resources generally have a poorer health and therefore a priori more obstetric complications than women who attend private hospitals. For this reason, women who give birth in public hospitals need more caesarean sections than women who give birth in private hospitals. The fact that a higher percentage of cesarean section in private hospitals than in public in Spain can only be explained by the need for private hospitals and doctors to make more money.
In view of hospital maternity care as aggressive intervention in Spain with such unnecessary and dangerous, not surprising that many women prefer to give birth at hospitals. The relevant question is not whether the extra-hospital birth is safe, but whether the hospital births in Spain without risk.
observed the gap between obstetric practices and scientific evidence of this in Spain and other industrialized countries, there are two key issues for the attempt to improve maternity care: who attend low-risk deliveries? What is the best place for low-risk deliveries?

Who will attend low-risk deliveries?


Midwifery Midwives are right in the middle of the struggle between two ways of viewing the birth. And the key issue of midwifery is autonomy. Are midwives can practice midwifery genuine respect nature and women's bodies, which facilitates the delivery type that enriches and empowers women and that allows the birth belongs to the realm of women and the family? Do you really midwives are "with women?" And are merely assistants to obstetricians?
autonomy of midwives has gone through a strange cycle of evolution in the last 200 years. Before the men invaded the domain of childbirth, postpartum women and their midwives were independent. As the medicalization of childbirth progresses, both midwives and women in labor are increasingly losing autonomy until women no longer have control over their own birth and midwives become in little more than a slave of physicians.
reaction then arises when women and midwives begin to reclaim their autonomy. Although everyone knows the power of the medical profession, where women and midwives joined forces and organized, are more powerful and gain more and more independence. In some cases, midwives and parturients recover their full autonomy, and with it control of maternity services and their own birth. Today, there are places in the world that illustrate all stages of this evolution, which generally progresses to the autonomy of midwives attending women in childbirth, independent, in a system combines the best of the medical model and social model of birth.
A considerable scientific research has proven 4 major advantages of independent midwifery, midwives are safer in cases of low-risk deliveries, perform fewer unnecessary interventions, they are cheaper and provide greater satisfaction.
First, we can not doubt any longer that midwives are the safest birth attendants in low-risk deliveries. A meta-analysis of 15 studies comparing births attended by doctors and midwives found no differences in outcomes in women or babies, except that midwives had fewer babies with low birth weight. Two randomized studies conducted in Scotland, and 6 made in North America concluded that no increased adverse outcomes in cases of births attended by midwives.
The most enlightening about the safety of midwife-assisted delivery, published in 1998, examined all births in the U.S.: about 4 million births. We selected only non-multiple births (one baby delivery), vaginal and excluding cases with social risk factors and / or medical and compared the outcomes of births attended by midwives with those treated by doctors. Compared with births attended by physicians, births assisted by midwives as a result gave an infant mortality rate 19% lower neonatal mortality by 33% lower and an index of low birth weight 31% lower.

After reviewing the extensive evidence of the safety of midwives, a paper recently published in an obstetric journal concluded: "The scientific literature search fails to finding a single study showing worse outcomes with midwives than doctors low-risk women. " The evidence shows that primary care provided by midwives is as or even safer medical care.
The second advantage of doctors and midwives on primary care at delivery is a drastic reduction in the rates of unnecessary invasive procedures. Scientific evidence shows that compared with births attended by physicians, attended by midwives, according to statistics presented amniotomy much less, much less use of intravenous fluids or medication, unless routine electronic fetal monitoring, less use of narcotics, less use anesthesia, including epidural block for labor pain, less induction and acceleration of labor, fewer episiotomies, fewer forceps, fewer removals for suckers, fewer caesarean sections and vaginal deliveries after cesarean.
data showing the relationship between midwifery and lower rates of intervention suggests a hypothesis: the degree of reduction in the rate of unnecessary interventions on the degree of autonomy of midwives. For example, in U.S. hospitals where midwives have little autonomy, the rate of caesarean sections in a recent year was 24%, while the same year in the U.S., independent birthing homes where midwives have more independence , the rate was 12%, and even that same year, planned home births in the United States, where the midwife has a range Overall, the caesarean section rate was reduced to 6%. In randomized trials conducted recently in Scotland, the decline in rates of assistance to be given to midwives compared with physicians was irregular, with a significant reduction in some interventions but not others, suggesting that the possibility of midwives to reduce the interventions is influenced by the surrounding doctors in the hospital.

The third advantage of using midwives as the primary delivery assistance for the majority of deliveries is cost reduction. Although it varies from one country to another, in general, midwives' salaries are almost always considerably lower than those of doctors. And, of course, lower intervention rates that occur with midwives also means a greater savings. This information about the economic cost reduction has also been revised in the case of midwifery in industrialized countries where, for example, a study found savings of U.S. $ 500 per case of births attended by a midwife.

Another advantage of the assistance of midwives, often maligned by those who prefer to follow the medical model is the satisfaction with the assistance of the pregnant woman and the mother. The way to address this stage by the midwifery places its emphasis on the importance of women's satisfaction. The evidence in the scientific literature is overwhelming: care by midwives is, according to statistics, more satisfying for the woman and her family in a very meaningful.
[...]

Where does low-risk childbirth? Extra-hospital childbirth homebirth

have always been and always will be women everywhere who choose home birth and need a midwife to assist. However, at present, as a result of decades of propaganda about how dangerous it is delivery by doctors, who in turn need the security of hospitals There are many women who have fallen into the myth that home birth is dangerous.
It is incredible that some organizations still practice the same obstetric official policy against home birth who signed back in the 70's. At that time, planned home births did not differ from non-hospital births unplanned and abrupt, of course, had a high mortality due to birth in taxis, etc. Back then, when they split deliveries planned at home, it was proved that perinatal mortality rates obtained as or lower than the low-risk hospital births. A large scientific literature documents this, including situations in which the person attending home birth is a nurse midwife or a midwife shortcut. A meta-analysis of the safety of home birth, published in 1997, demonstrates conclusively the safety of home birth and includes an excellent review of the literature. Many physicians and their organizations continue to believe in the risks of childbirth outside the hospital organized, either in a house or home deliveries and reject the undeniable evidence that the expected deliveries outside the hospital in case of low-risk women are insurance. Unfortunately, many obstetricians continue citing anecdotal horror stories and scripts unscientific situations what would happen if, for example, delivery occurs outside the hospital? Since most physicians do not has never attended an extra-hospital childbirth, their questions of "what if?" containing several false statements. The first idea is assumed that at birth, things happen quickly. In fact, with very few exceptions, things happen slowly during labor and delivery and emergency where seconds count are extremely rare and, as discussed below, often in these cases, the midwife deliveries at home or at home can take charge of the emergency.

The second false claim that when problems arise there is nothing that a midwife outside the hospital can do, only can be expressed by someone who has never seen the midwives in non-hospital births. A well-trained midwife can often anticipate problems and prevent them from happening in the first place, since you are providing constant care from you to you to the laboring woman, not as in hospitals, where it is common that nurses or midwives can only keep an eye on an occasional basis to the various women in labor for which they are responsible. If problems arise, with few exceptions, the midwife outside the hospital can do everything that can be done in the hospital, even giving oxygen, etc. For example, when the baby's head out, but the shoulders get stuck, there is nothing you can do in the hospital that certain maneuvers with the woman and baby, that can also perfectly midwife outside the hospital. The latest successful maneuver for these cases of shoulder dystocia in the medical literature collection named for a midwife attending home that first described (Gaskin maneuver).
The third false claim is that the hospital can act faster. The truth is that even in more private care, the health of women is not even in the hospital most of the time during labor and has to be told by the nurse when problems arise. The time spent moving the hospital doctor is the same it would cost to get a woman is giving birth at home or in a home delivery. Even in the case indicated a cesarean, it takes about 20 minutes on average to prepare for surgery in the hospital, locating the anesthesiologist, etc. and during these 20 minutes, both doctors, like the woman in the house or home births are on the way to hospital. This is the reason why it is so important to good cooperation between the extra-hospital midwives and the hospital when she called the center to inform them of a shipment, and the hospital will not lose any time to prepare to receive the mother. All this gives reasons for there are no data to support a single anecdotal case scenario "what if?" used by some doctors to scare the public and politicians about the extra-hospital birth.
often lectured at conferences of Obstetrics and when I start talking about home birth, I can feel the bad vibes in the room. Already have an idea and do not want to be confused by the evidence. In such cases usually asks the audience if anyone in the room who has ever witnessed a birth planned at home to raise your hand and without surprise me, no one raises his hand. Then I quote a paragraph from a medical textbook published in 1968: "The doctors have never seen a birth at home and feel competent to argue against, are similar to those geographers who described a bunch of countries that have never visited.

So the real question about home birth is not security but the regard to freedom and the sacredness of the family. For more than 80% of women who have no medical complications during pregnancy, childbirth at home is planned perfectly safe choice. Any physician, hospital or medical organization that is to deter a home birth is, in essence, denying the basic right of women to control their own reproduction, which includes the freedom to choose where to give birth. The Childbirth is one of the most important events of family life as the family decides to have a home birth, you must honor the sacredness of the family. The attempt by some obstetricians to gain control of supervision of midwives and scare women and families on non-hospital deliveries is not an issue about safety, but an attempt to protect their territory and scientifically unjustified to maintain its monopoly on maternity care.

Woman Masterbate With Fruit

perinatal mortality.


About
perinatal mortality
Isabel F. Castle

The argument used to justify the high level of obstetric interventions is the successful reduction of perinatal mortality of mothers and babies have occurred during the last century.
births now take place in home or in birthing centers staffed by midwives with little or no use of invasive measures have an excellent rate of maternal and child health, and in some respects similar than hospital births attended by obstetricians and midwives based on technology harder. Rate interventions is significantly lower in the case of home births. Problematic deliveries can not do without obstetrical assistance did not exceed 10%, according to estimates by the World Health Organization. These are the ones who at one time would be included within the group of risk of death.
This proves that the best current knowledge of the physiology of birth, both the mothers and the personal assistant is an important factor that has improved the conditions under which women give birth. In Pithiviers hospital where the procedure is not performed any more than in poor obstetric emergencies, perinatal mortality is lower than the rest of France. That women
several centuries ago to give birth naturally and assisted by his instinct and his more experienced neighbor actually means that respect both the privacy and freedom of the mother as her own dignity and parenting skills to carry out the process. However, the perinatal mortality was higher than now ... but no higher than the general population, often hit by epidemics. Postpartum infections were carried mother and babies with painful frequency.
however, attributed to the merit of obstetrics total decline in perinatal mortality would mean leaving out some other variables that have influenced significantly. Might as well be attributed to antibiotics vaccines and all the credit for the decline of epidemics which decimated again and again the people of our forefathers, when a rigorous analysis shows that the intervention of other variables were much more decisive in improving public health.
And the most important variable was, undoubtedly, hygiene. The health factor that contributed most to the dramatic reduction of infectious disease occurred from the late nineteenth century was not the introduction of antibiotics, but the installation of piped water networks and sewage in European cities, as well as the pasteurization milk. Do not forget that in Europe, until recently centuries, the contents of the home latrines were thrown into the streets of towns and villages, creating an unhealthy environment and conducive to infection.
According to René Dubos (1), infant mortality from infectious diseases in developed countries fell by 90 by 100 several decades before the implementation of control measures in medicine "antimicrobial"-antibiotics and vaccines. The incidence of cholera, diphtheria, dysentery and typhus, for example, declined significantly after the introduction of running water and sewers for wastewater disposal, well before the use of antibiotics and vaccination campaigns, who started from the 30's. In the U.S., for example, diphtheria killed 900 children per million in 1900, but only 200 in 1938. However, vaccination campaigns did not begin until 1942. Scarlet fever dropped from 2,300 deaths per million children in 1860 to 100 in 1918, but the sulfonamides were not available until the late 30's, and vaccination does not begin until the 60's, where cases had been reduced to a dozen per million, approximately.
As concerns the delivery assistance, ignorance of the importance of soil on the microbial transmission resulted in high mortality of mothers and babies, too higher in hospitals than at home. In fact, we can say that the beginnings of obstetrics as a medical specialty were followed by a significant increase in perinatal mortality, at least in regard to hospital births. This increase was mainly due to two causes: the passion of the physician to intervene the way it was in the recently invaded a woman's body, and the total absence of sepsis.
In the eighteenth and nineteenth centuries was practiced obstetrics in hospitals was a true reflection of the position occupied by women in society and of the opinion that men / doctors had it. At the dawn of obstetrics women became a docile and entertaining area experimentation. Physicians more "active" practiced bloody and risky operations to parturients, of doubtful efficacy and safety (2): artificial dilatation of the cervix with deep incisions in the neck, cesarean vaginal, manual dilation, dilation instrumental section of the symphysis pubic cesarean (died almost all) breech extraction of the fetus with hooks or handles, etc.
can say that the current trend humanizadota delivery is not new, but it began with obstetrics. Part of the obstetricians, the "conservatives" - were alarmed at the dealings of his colleagues "active." Dr. Boer, for example, stated: "It seems as if nature had left the work of parturición for obstetric techniques." The Babil from Garate English published in 1765, the New naturally through aiding women in childbirth sets dangerous operation without hands or instruments. Dr. Ahfeld, in 1888 warned: "Hands off the uterus" so bloody
A delivery care, coupled with total lack of hygiene resulted in a high mortality, in part because physicians practicing autopsies on women died from childbed fever, and then attended deliveries without washing their hands. Infections spread easily and women suffering serious injuries during childbirth, dying like flies. When in the nineteenth century discovered the doctor's role in the microbial transmission, and Dr. Holmes advised his colleagues to observe scrupulous cleanliness in the care of the mother, a violent controversy broke out in Europe that lasted for tens of years, during obstetrics which few bother to take hygiene measures. Assume that the doctor could act transmitter was more than could be accepted. Dr. Holmes suffered the ridicule and marginalization of the majority of his colleagues and hygiene measures taken took years. More women died. Once
known and accepted the existence of microorganisms and the importance of simple hygiene measures to wash and disinfect their hands led to the parturients mortality decreased significantly. But we must remember that in Paris, for example, only a century ago, in 1884, only five hospitals had running water.
addition to health problems at birth, the frequency and number of pregnancies, often unwanted, the hard work of mothers of large families also took care of the countryside and animals, poor sanitation and heating housing, natural food fluctuations over the seasons, and the difficult position of women within an oppressive society to put it in a situation at least somewhat precarious to deal with the frequent maternity. This did not prevent, however, that many women had six, eight or more children without complications in childbirth.
Dr. Wagner, a former commissioner of the WHO on maternal and child health, said in this regard: "For the past twenty years the perinatal mortality has declined dramatically, and the doctors attributed to births take place in hospitals. There is no evidence that this is true. The scientific evidence is that fewer babies die because there is better nutrition, better health in women, better housing conditions and something very important, because women have fewer children and have them when they want them through family planning. This is probably the best reason that fewer children die than twenty years ago. The explanation lies in what women do, not doctors.
The "Having a child in Europe", WHO, concluded "no scientific evidence shows that none of these explanations (the medicalization of childbirth) has been cause of mortality reduction, although in all cases it has been said that the reduction shown by the success of the intervention ... The perinatal mortality began to decline long before the arrival of these medical resources and apparently, the latest technology simply has joined the trend further, rather than produce it. "researcher Marjorie Tew
public in 1990 a seminal book: Safer Childbirth: A critical history of maternnity care, which results from a research aimed at its beginning to show that the increased security levels at birth was associated with the relocation of the hospital births. The study was conducted at a time when almost everyone believed safer childbirth in hospital at home, simply because access to health care and technological resources. However, his discoveries changed the whole course of his research. Dr. Tew
studied the relationship between the evolution of care delivery in Europe and the figures for death rates, and the surprise was that found that the transfer of hospital deliveries was consistent with increased rates maternal and infant mortality. Between 1958 and 1970, excluding high-risk births, perinatal mortality in hospital was 17.2 per 1000 births and 6.0 per 1000 births at home.

Marjorie Tew's conclusion is that obstetric intervention can save the lives of individual women and babies, but when operating in low-risk cases, this intervention significantly increases the risk of complications. The conclusion is that home birth is as safe as in hospital for low risk women, but in the hospital for low risk women would be exposed to increased complications during and after childbirth.