Thursday, 18 January 2024
Drugs and commercialised medicine......
Friday, 1 September 2023
More On Matters Maternal
I read what used to be called a tweet on the platform that used to be called Twitter, in which someone argued that scheduled elective caesarian section deliveries are a part of a woman’s right to choose.
I wrote a number of linked tweets about it because it got me thinking about the importance of labour and vaginal delivery in preparing the newborn for entry into the world. Typically for my threads on the spot marked X, it sank without a trace. Hence this post.
I had been doing some research into foals born with neonatal maladjustment syndrome.
As a prey and flight species, foals need to be up and about quickly, and the mare wouldn’t do well if the long legged, hoofed foetus was trying to gallop whilst in the womb or birth canal.
In utero, the production of a neurosteroid acts as a sedative on the foal, making it largely quiescent.
Production of that neurosteroid is switched off during the twenty to forty minutes of the second stage of labour, which prepares the foal for almost immediate standing, suckling and maternal bonding, and movement.
If delivery is too quick, or via caesarian section, the foal can remain in a sedated, dissociated state.
Vets found that mimicking the constriction of the birth canal for twenty minutes had the effect of reviving the foal, presumably by stopping the production of the neurosteroid.
Human infants are very different obviously but there’s a mass of evidence that delivery via caesarian section is associated with a range of neonatal health issues including respiratory morbidities, asthma, acute lymphoblastic leukaemia, and neuro-developmental impairments.
Add in the increased maternal risks, and some researchers and health professionals are now arguing that the trend to elective, scheduled caesarian section must be reversed.
A caesarian section may be as the result of an emergency, or scheduled when natural delivery is contraindicated for reasons of maternal or foetal health.
It is elective when there’s no physical danger but a woman, for whatever reason, elects to undergo surgery to deliver her baby.
Caesarian sections are now performed in more than 1 in 5 births globally and the rate has risen steadily in all regions since 1990 –correlating with the global rise of the neo-liberal Medical-Industrial Complex. (MIC)
I don’t have data on how many of those caesarian sections are performed because of a proven health risk to mother and/or foetus, but the fact that the increase is at a time of claimed improvements in wider maternal / foetal health parameters suggests it is a combination of: women being talked into it by private medical providers; overstretched and underfunded public health services trying to improve efficiency, eg predicting demand and reducing the hours/days pregnant women spend in the care of medical staff; and/or because of the fear of labour and the effects of vaginal delivery.
Regionally, the lowest rate of caesarean section is in sub Saharan Africa at 5%.
The highest is in Latin America and the Caribbean, at 43%.
At current rates of increase, by 2030, 28.5% of women world-wide will have a CS and the projected rise in east Asia is from a current rate of 45% to 63.4%.
The rate in the United States for all hospitals is 32.9%; and in 2005-2015 the rate rose by 50%.
Elective caesarian section rates are higher among people of colour: 36% of Black, 33% Native American, and 31%of Asian and Pacific Islander babies. (2018-20)
Brazil has a rate of 55.5% overall but 84% in private hospitals which cater to the rich.
In NZ, in 2020, it was 31%; in Australia - 38%.
The lowest rates in countries in the affluent global north are in Iceland, Israel and Norway.
All surgery carries risks which have to be balanced against the benefits. Surgery, in effect, inflicts degrees and types of harm in order to save lives, cure or slow diseases etc.
Caesarian section is known to involve an increased risk for mothers of haemorrhage, infections and blood clots.
90% of women who have a caesarian section for the first delivery will have one for all subsequent deliveries and each one increases risk of uterine rupture – scar tissue is never as strong.
Caesarian section has long been statistically associated with a range of neonatal health issues including respiratory morbidities, asthma, acute lymphoblastic leukaemia, and neurodevelopmental impairments.
The latter is thought variously to be caused by exposure to toxins from general anaesthesia, the acquisition and composition of microbiota in neonates which occurs in passage through the birth canal, and oxytocin levels.
Given the increase in autism spectrum disorder (ASD) globally since 1990, and the rise in deliveries via caesarian sections, there has been research into possible links, some of which have concluded that the correlation is compelling enough to avoid unnecessary caesarian sections.
With the rise of the medical-industrial complex which now dominates medicine, studies that might bring the MIC’s profit-centred and ethically dodgy practices under scrutiny, struggle to get funding and/or the findings are suppressed in various ways.
Thus possible links between ASD and birth via caesarian section are dismissed as being statistically insignificant, and researchers and health professionals calling for a reversal of the trend to more and more elective caesarian sections are not listened to.
Tuesday, 9 September 2014
Don't sugar-coat it
- massive private and increasing public debt;
- loss of democratic control over national institutions and resources;
- increasing economic hardship among the unemployed and the working poor which is impacting on the most vulnerable, especially children;
- appallingly high and skewed incarceration rates;
- increases in diseases of poverty and metabolic disorders;
- an over-reliance on various forms of extractive industry, the bulk of the profits from which go off shore or to a tiny proportion of the NZ population; and
- an agricultural and horticultural sector that is incapable of feeding its domestic population at all, let alone cheaply.
- First, attack your critics, in this instance endocrinologist Robert Lustig who, Rich claimed, "exaggerates the role of sugar", is "melodramatic". and has been called "hysterical".
- Second, reduce complex arguments to a simplistic parody and mock them.
- Third, say that, in any event, it's not the industry's fault because they're only doing what the market wants them to do.
- Fourth, say it's people's own fault for choosing to eat too much of the wrong things and to exercise too little.
- Finally, say government cannot legislate to force people to make good choices in terms of what they buy or how much they exercise.
Friday, 30 May 2014
A Parable For Our Times: with apologies to real sharks
Once upon a time there was a little shark who wanted to be a Great White when he grew up. Because he was a clever and devious hunter he grew to be a very big little shark. He was not content to dominate the sharks in his part of the ocean and set off towards the zone of the Great Whites – the shark elite whose ranks he thought he was big enough and vicious enough to join.
This elite of Great Whites allows certain other smaller sharks to scavenge the edges of their kill zone and if they are well fed, they may even let an enterprising little shark dart in to seize some prey for itself, but if a little shark starts to act like one of the Great Whites, or threatens their interests, they'll turn on him.
The big little shark desperately wanted to be a part of the Great White elite but to them he was just a scavenging pest. When he started to muscle in on their kill zones, they decided to destroy him. He managed to escape and fled south but they were in a blood frenzy and pursued him across the oceans as far as the great southern ocean where he found some quiet waters in which to rest and gather his strength.
The local sharks seemed a pretty dopey bunch and were easily bribed with a few fish to let him take up residence in their waters. Once rested, he took to his usual tactic of scattering around large amounts of fish offal to boost his reputation as the biggest predator in the neighbourhood and managed to gather a number of scavengers around him.
But, unbeknownst to him, there was a Great White in residence – cleverly disguised as a dolphin. This shark in a dolphin suit alerted the Great White elite to the big little shark's presence in his waters, and a kill squad was sent to finish him off.
Using all his skills, the big little shark managed to escape the kill squads and found himself a spot where he could defend himself. He thought that if the Great White elite was never going to let him become one of them he would be as much of a nuisance to them as he could – especially to the resident Great White.
He looked around for allies. There weren't many as the waters had been so depleted of fish they could not support much in the way of predators, but he managed to find some prey species which were swimming around in an agitated and fearful state.
He devised a cunning plan. He also disguised himself as a dolphin (a very large one it must be said) and persuaded the prey fish that he and his dolphin school would protect them from the Great White and its gang of scavengers if the prey fish would act as a diversion. They were to present themselves as a target while he and his school would sneak up behind the Great White and ram him – that being the way dolphins attack sharks. Once deprived of their devious leader, the scavenger gang could be chased away by the dolphins and all would be well.
The fish were so anxious for some leadership they totally forgot to question how come this particular dolphin had such huge teeth, not to mention the fact that dolphins also eat fish.
After a lot of discussion, the prey fish agreed to band together to create a big enough shoal to attract the resident Great White's attention. The Great White duly sniffed out the prey and headed in for the kill. To the horror of the fish there was no sign of their dolphin protector. Once the Great White had killed and eaten as many of the fish as he could catch and his scavengers had finished off the rest, he turned and found himself confronting the big-little shark.
"That was my gift to you," the big little shark said. "Proof of my good intentions. I want to stay here in these waters and if you let me I can promise you more prey, especially lots of tasty young juveniles. They can see right through your disguise because frankly it's wearing a bit thin, but they think I'm a real dolphin."
The Great White thought a while and being a very pragmatic sort of shark who didn't get to where he was by useless displays of overt aggression, agreed to let the big little shark stay, as long as he delivered a regular tribute of the tasty young prey he'd promised.
And if he became too much of a nuisance, the resident Great White thought, there is more than one way to kill a shark.
The End.