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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.
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.
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