Talk:Childbirth/Archive 2

Archive 1

Archive 2

Archive 3

Cleanup.

This article is not of encyclopedic value, and has been correctly tagged for cleanup. It is riddled with non-NPOV statements, weasel words and errors. I have started to trim it down and make it more coherent and encyclopedic. I fully appreciate this will arouse discussion, and will welcome comments. This is a work in progress, as is all of Wikipedia.

I started by defining the mechanisms of labour, and have therefore deleted duplicate and erroneous references as I see them. I took the liberty of deleting distracting comments about breech, which is well dealt with elsewhere.

I will respond to serious comments, as I have little time for soap boxes and particular points of view. I will add citations and links as soon as I find out how to do so.

Can I ask for some help with this? I am running into a lot of peripheral, and not truly scientific statements. Some are easy to deal with, some are more peripheral while not being truly germane to an encyclopedia discussion on parturition. This makes the whole article long and hard to read.

JustAnMD 19:14, 10 November 2007 (UTC)

```` —Preceding unsigned comment added by JustAnMD (talk • contribs) 18:39, 10 November 2007 (UTC)

I reverted the significant changes you made to the first stage section as it removed significant material and made it less clear to the average reader. May I suggest that you make minor changes rather than wholesale major changes at this stage. After all the article has been around a very long time and many parts have been argued over long and hard. Gillyweed 00:51, 11 November 2007 (UTC)

Thank you Gillyweed. The article might have been around for a while, but it is still convoluted, contradictory and riddled with non-NPOV. I reckon this is why it has been tagged for cleanup. I am afraid that little changes here and there will be insufficient. I will dip into this and clean up from time to time. If I take out larger sections it will be to remove verbiage and repetition. That will be self explanantory. By the way, I have been delivering high and low risk babies for 30 years, with some 20,000 completed, in the Third and the First World. So while I will give references where needed, some of the changes will be at 'Level 5' evidence level.

This is a field which is emotive and filled with more opinions than a market place. That is fine, I will apply evidence based criteria to changes. That means that some of the siller entries will have to go. This is, after all, an encyclopedia, not a personal blog.

I will be putting back some of my changes; this is not disrepectful there are so many things to correct. For example, there are no long muscles in the uterus. This I can tell you as an anatomist, but feel to google the work of Caldero-Barcia in Montevideo if you want to make a thing of it. Feel free to discuss any reversions before you revert theme please. This thing is so messy as to need some sweeping amendments. The problem with wiki's is that any point of view can be put in, and by now the thing reads like a plate of spaghetti. JustAnMD (talk) 14:56, 18 November 2007 (UTC)

JustAnMD (talk) 14:43, 18 November 2007 (UTC)

The section entitled 'well known authors' is blatant advertising and has been deleted. The deeper I get into this the more I am impressed that this article is not being treated in an encyclopedic manner, but as a forum for particular points of view. Can an Admin type fill me in on what this page is intended to do? JustAnMD 04:17, 14 November 2007 (UTC)

How can it be blatant advertising when they meet the notability criteria for WP? Could you please discuss your major changes before leaping in and making them. As I stated earlier this article has been around a very long time and many parts have been argued over long andhard. Gillyweed 07:41, 14 November 2007 (UTC)

Ok, almost done.

I tidied up complications, with reorganization and elimination of repetition. As NPOV as I can be. Some things, like 'big baby' are not complications of birth, just the cards one has to play with. Please let me know if you really hate it. JustAnMD (talk) 18:14, 18 November 2007 (UTC)

Good work. It does read much more succinctly (and accurately) now. I think we still need to add more references but other than that it looks very good. Gillyweed (talk) 19:59, 18 November 2007 (UTC)

I had some extra time, so tidied up some definitions in professional classifications. Some might be irritated with this. I removed the word 'trained' from doula. This is consistent both with my knowledge of doulas, who have no formal training program, and with the internal crosslink to 'doula'. Also tightened up the definition of midwifery and obstetricians, with distinction between lay amd registered midwives. I am a bit surprised that this has not been jumped on previously by registered midwives. JustAnMD (talk) 05:03, 20 November 2007 (UTC)

I would dispute this. Doulas are not required to have any form of certification but there are a number of training and certification programs available, and I've never met a Doula who has not gone through some sort of formal training. Even if they do not go through a formal program, this does not mean that they are not trained. I think your action could be conceived as a cultural bias towards the establishment of western medicine; just because something doesn't fit into the framework of what is recognized by western medicine doesn't mean it's not real. Western medicine favors programs and certifications that are high on "status", programs that focus on making a person jump through hoops and obtain official recognition. It tends to ignore or view as less important programs, positions, and recognition that is more based on personal trust and connection, personal experience, and decentralized notions of training. Doulas do not claim to be fully versed in medicine, so it is unfair to judge them by the same standards that you would hold people who are members of the western medical establishment to. Rather, they are held to other standards--one of the most important of which is that of forming a personal bond to the people they assist. If judged by this standard, sadly, many employees in western hospitals, including some M.D's, would not meet the standard. We must be very careful about how subjectivity can enter into our judgments! Cazort (talk) 14:49, 13 February 2008 (UTC)

Agreed. "Trained doulas" needs to be used to specify from other birth attendants who may simply have first-hand experience of childbirth. Also, doulas receive standardized training through ICEA or ALACE or other organizations. "Training" does not imply a college degree. Lcwilsie (talk) 21:35, 15 February 2008 (UTC)

Cleanup stage definitions

This section lays the groundwork for the later discussions and is the framework. I have kept to defintions, therefore. there is lots of space to discuss emotional factors, etc elsewhere. JustAnMD (talk) 15:25, 18 November 2007 (UTC)

More on this. Second and third stage have been tightened up and simplified. Once again sticking with definitions. It is a much better thing to get into options for management in a management section. Same with emotional factors.

I removed the instructions for cord traction. God help us if any self helper tries this and gets an inverted uterus or massive hemorrhage. It is irresponsible to put such instructions in a Wikipedia, and not inconceivable that this will accrue medicolegal liablity to this page, the author, and even Wikipedia. JustAnMD (talk) 16:14, 18 November 2007 (UTC)

I totally agree that this page should not include "instructions". Descriptions, not instructions--you're right that stuff like that does not belong in an encyclopedia. Cazort (talk) 16:04, 13 February 2008 (UTC)

I agree that this article needs a lot of cleanup. I think it also could be made more accessible from the start too. The introductory paragraph is extremely technical; I think the page as a whole has a bit too technical a flavor to it and is not exactly appropriate for the general audience that would be reading it. For example, do we really need to use the words "culmination" and "gestation" in the first sentence? I also think that we need to address the "non-balanced geographic coverage" tag...childbirth practices vary widely in different countries, and this main article should focus on a balanced coverage and focus on things universal to all regions. We can relegate more specific information to other pages. Cazort (talk) 15:55, 13 February 2008 (UTC)

Removing "fact" tags

Someone removed a "citation needed" (fact) tag about the statement that epidural medication does not enter the bloodstream, and someone else added it back; I agree with adding it back. Under my interpretation of wikipedia guidelines, the only justification for removing a tag is when the material on the page speaks for itself (as in a math article) or when knowledge is common knowledge and undisputed. If that statement is true, then it can be backed up by a source and if it cannot be backed up by a source, it ought to be deleted. Cazort (talk) 18:30, 25 February 2008 (UTC)

I have been looking for a reference that epidurals do not cross the placenta, but do not have the expertise regarding what anesthetics are typically administered by epidural. I've found many studies citing an effect on the neonate with regard to breastfeeding and alertness after birth when an epidural anesthetic was used (which is suggestive of drug crossing to the neonate), but nothing that measures levels of drug in the neonate. Surely this has been measured in animal studies for some of the drugs - any MDs out there want to add to this? Lcwilsie (talk) 19:29, 25 February 2008 (UTC)

OMG! I found a study that found that one drug used in epidurals actually DOES cross the placenta. [1] The claim about epidurals not crossing the placenta may be completely wrong and needs to be removed or modified. I found this article without too much searching; I'm sure there's more out there. Cazort (talk) 13:00, 26 February 2008 (UTC) I found a second study [2] talking about transfer across the placenta. As far as I am concerned, the current statement is not only unsourced but is actually wrong and must be removed. Cazort (talk) 21:16, 26 February 2008 (UTC)

I think I agree with you. It goes to show that you can learn something new every day. Nandesuka (talk) 21:27, 26 February 2008 (UTC)

Also, I want to raise a second question...the next sentence in this paragraph seems to be a contradiction...how is it possible for a procedure to increase the rate of C-section (among other things) and still have "no adverse effect on perinatal outcome" and be a "safe and effective method of pain control." ?? This goes against common sense because it is well-established that C-sections have all sorts of undesirable risks and complications, including a higher rate of mortality of the mother! Cazort (talk) 18:30, 25 February 2008 (UTC)

And thus you've hit the motherlode of dispute among many authors of this article! Many articles do indeed conclude that it is "safe and effective" despite the stated complications. There are very few studies comparing epidural anesthetic to unmedicated birth, but rather to other pharmacological pain relief methods. I surmise epidurals are better than most other pharmacological options...though non-pharma might be safest. Lcwilsie (talk) 19:29, 25 February 2008 (UTC)

Do these authors give any justification for concluding that epidurals are "safe and effective" in spite of the increased rate of certain complications? How do they deal with this apparent contradiction? Also, if there are very few studies comparing epidural anaesthetic to unmedicated birth, then that's a pretty big gap in the scientific literature--and it probably has been discussed somewhere, so it would seem prudent to mention that this is a point of uncertainty. Sometimes the best way to avoid an edit war is to clearly outline the dispute, highlighting any gaps in the scientific literature and any reasons for those gaps. The current Cazort (talk) 12:56, 26 February 2008 (UTC)

It is never the best way of writing a Wikipedia article to promote or suggest our own theories, based on synthesis. However, if we can find reliable sources that make those arguments, and such sources are not given undue weight, then by all means cite them. Nandesuka (talk) 01:12, 27 February 2008 (UTC)

There is a reasonable discussion of the risks/benefits/details of epidural use in childbirth on the epidural page - perhaps we should avoid repeating much of that information here to keep this article succinct. Lcwilsie (talk) 14:51, 29 February 2008 (UTC)

Orgasm in childbirth.

Should this be included under "Variations" rather than as its own subheading? I don't deny that it's possible, but as it isn't mainstream perhaps it needs to receive less emphasis in this entry. It currently has more information than the section on postpartum depression which affects far more women and is more well documented. Lcwilsie (talk) 18:26, 25 February 2008 (UTC)

I wasn't quite sure where to put the section which is why I made it its own subheading. I think you're probably right that that's a better place to put it. Cazort (talk) 21:32, 26 February 2008 (UTC)

It's not quite a 'variation', is it? I agree that it's puzzling where it should go. It seems a bit dodgily sourced to me, too -- are some of those links for companies selling products? Can we get any research on the actual incidence of this? I'm worried about giving undue weight to a fringe phenomenon here, but maybe my impression of the frequency is all wrong. Nandesuka (talk) 01:37, 27 February 2008 (UTC)

I'm completely open to discussion about where on the page this material should be, but if you don't think it should be in this section then you should move it, not delete it. Cazort (talk) 21:28, 28 February 2008 (UTC)

As to whether or not it should be included, I do not understand your comment about "dodgily sourced". One of the references is a book publishing the personal accounts of 50 women. The paragraph that was deleted was very direct about the fact that the phenomenon of orgasm during childbirth has not been studied in the scientific literature. However, being ignored by science and medicine does not mean that the phenomenon does not exist, and wikipedia can and does include sources other than scientific and medical ones. This in compounded by the fact that there are some good reasons why it is highly unlikely that this phenomenon is going to be observed in a setting suitable for scientific or medical study any time soon. The book "Happy Birth Days" actually discusses this issue at length. In particular, the book explores how the presence of doctors, midwives, or other medical personnell can raise peoples inhibitions about sexual experiences. I have added the material back. If you object to its inclusion, please discuss this more before unilaterally deleting it. Thanks! Cazort (talk) 21:27, 28 February 2008 (UTC)

So, there's no information on the actual incidence of this phenomenon? If that's the case, how can we make an intelligent decision about how many column-inches (so to speak) to give it? Maybe we should ask some uninvolved editors to offer their opinions. Nandesuka (talk) 23:50, 28 February 2008 (UTC)

The point that I'm making is that (a) there is no "scientific" or "medical" evidence, but (b) there is a lot of evidence from personal accounts, and some survey evidence, but it all comes from within the natural birth community. I have seen a number of references to the book "Ina May's Guide to Childbirth", by Ina May Gaskin, citing a survey of natural birthing mothers that found that there was actually a fairly high incidence of orgasm during natural births, but I have not read that book which is why I have not added it as a source. And of course (c) there are good reasons for the lack of scientific evidence. I also still don't understand why you don't think the sources listed are valid; I feel like you have not adequately explained or addressed any of the points I made. Cazort (talk) 00:24, 29 February 2008 (UTC)

Here's another source: Times on Line Gillyweed (talk) 00:32, 29 February 2008 (UTC)

Explanation of why I added the source of the article surveying the literature about sexuality and pregnancy (K. von Sydow): there are assertions in this section that (a) orgasm during childbirth has not been studied scientifically, and (b) why it has not, and why it is difficult to study orgasm scientifically. This source explains in great depth why orgasm is difficult to study, which explains very clearly why this section needs to rely on personal accounts. This seems highly relevant, if not critical to this section. Does this make sense? Cazort (talk) 00:58, 29 February 2008 (UTC)

lots of conflict

why?

I can't help but feel that people are trying to censor this topic because it does not fit into their value system or because they have some sort of visceral reaction to it due to social taboos. I fail to see the nature of the controversy, because I have not seen a single reliable source denying that orgasm during childbirth is a real phenomenon. This phenomenon has been published in at least three books about natural birth. Have any of the people making the edits actually read any of those books? And furthermore, no one has addressed any of the issues I've raised here on the talk page. Cazort (talk) 01:03, 29 February 2008 (UTC)

I don't think it's so much an attempt to censor, but to figure out where best to include the information and how much weight to give it. How would you like to see it included, Cazort? Personally, I think a brief mention is adequate as the provided references can help people interested in looking into the topic further. Can we agree that while it has been reported it isn't something every birthing woman experiences? (As an aside, some people experience orgasm while horseback riding or other activites, but is it mentioned on that page?) Lcwilsie (talk) 15:00, 29 February 2008 (UTC)

Also, will someone please explain why the unpublished synthesis tag? The views put forth in the paragraph reflect a general consensus in the sources that I have listed. Cazort (talk) 01:06, 29 February 2008 (UTC)

recommendation of how to proceed

Instead of just deleting things without explanation, how about people make incremental edits to this topic to try to improve them? I know I'm not the best writer and I'm not claiming what I have up there is perfect, and it is of course biased by my own perspective and my own reading of the various sources...but how about other people read the sources and come up with their own synthesis, and then work it into the material we have? It is not my intent to cause an edit war, but I will continue to revert edits so long as people continue to just erase stuff without getting involved in a constructive dialogue. Cazort (talk) 01:13, 29 February 2008 (UTC)

How dare you so accuse - each edit had an edit summary and so quite untrue that "deleting things without explanation".David Ruben <sup>Talk</sup> 01:19, 29 February 2008 (UTC)

Apologies, I do not mean any offense! I am objecting to the idea of deleting things without adding explanations on the talk page, because there is controversy here. Cazort (talk) 01:31, 29 February 2008 (UTC)

<reset indent>AGF, and allow at least a little time for me to explain edits (and reposting x2 as repeated edit-conflict with you). If "Discussion of the phenomenon of orgasm during childbirth was completely absent from the medical and scientific literature as of 2007. The only relations between orgasm and childbirth that have been studied extensively in medicine are the ways in which women experience orgasm differently after having gone through the process of childbirth.", then that suggests that this aspect not only does not have mainstream acceptance, but also likely not even significant minority viewpoint scope (ie is "trivial minority" under the terms of WP:NPOV), and so a reasonable candidate from chopping entirely from the article. Length of the section is totally disproportionate to other aspects of this article (eg see length coverage of 3rd stage), and seems to be arguing for a cause, hence I've added "synthesis" tag. Citations do not seem (at initial glance) to fully support attached text, and as such the text is unsupported by citation and so removed:

1. hence [3] ref is on UK practice, not US as stated, and mentions the "orgasmic" experience of childbirth in terms of being intense emotion and emotional release, rather than an orgasm per se - one might similar recall a UK "real" ice cream maker having the advertising tag "Our ice cream is orgasmic" (trying to counter the sensual imagery of Häagen-Dazs's introductory adverts) but that did not consitute proof of consumers having orgasms, although the experience certainly had a "wow" factor :-)
2. then with [4], the abstract at least, describes sexuality during pregnancy & postnatally, but no mention of orgasm during labour. Of course the full article might specifically address orgasms in labour, but strange not then included in abstract. For now therefore, IMHO, ref seems off-topic (of specifically occurance of orgasm in labour) and under WP:SYNTH & WP:NOR, it and associated text removed David Ruben <sup>Talk</sup> 01:16, 29 February 2008 (UTC)

I gave an explanation of why I thought that second source was relevant, which you can find above, I'd appreciate it if you could consider and address my concern before deleting that source because, in my opinion, it is very relevant to the section. I deleted the reference to the US. But also, if you read these sources, they are not talking about an analogy to orgasm, they are talking about actual orgasm. Cazort (talk) 01:28, 29 February 2008 (UTC)

Just because something has not been studied by science doesn't mean that it is a minority or fringe viewpoint. The one source I added discusses why this topic is extremely difficult to study within a scientific framework. This is another point that I feel has not been addressed and I would appreciate it if you and/or others would address it before continuing to delete my contributions. Cazort (talk) 01:30, 29 February 2008 (UTC)

If it has not been studied or cannot easily be studied, then issues of WP:Cite to WP:Verify from WP:Reliable sources would seem to apply. Just because something is true does WP:NOT mean that it need or should be included. Further, irrepsective whether something is true or not (assuming we agreed for a moment that at least some women may have an orgasm), Wikipedia follows WP:NPOV, not the WP:SPOV (scientific in this case meaning "absolute truth") that you seem to imply should require that this issue be included in detail. So if "something has not been studied by science", then that implies that in our western science-dominanted society that there is an absence of mainstream acceptance (absence of data of course is not same as data of absence). At very least claims for this (in respect to how common, and certainly implication that most women could so have orgasms if only not repressed nor misogynistically medicalised) needs to make mention that the information in this section is from a very limited citation base that has no mainstream acknowledgement/counterpart.

Finally arguments that something is difficult to measure (and I agree that ref abstract makes sense on this) can not be used to argue that science has failled to recognise that something is highly prevalent. The prevalance rate might indeed be very low notwithstanding that it is hard to measure - but to link these together is at heart of WP:SYNTH. To add the linkage of these ideas (hard to measure and in fact far more commonly experienced), one would need cite a reliable third party source as making the connection, otherwise it seems like personal original research. Anyway, I'm signing off tonight, so it'll be interesting to see what other editors feel about various points we have both raised :-) David Ruben <sup>Talk</sup> 01:57, 29 February 2008 (UTC)

I understand where you're coming from but it seems to me that you are making an assertion that the sole standard by which to decide whether material should be included on wikipedia is whether or not that material is in the scientific literature. I disagree with this, and the point that I've been trying to make is that this material is about as sourceable as we could reasonably expect it to be, given the sexual taboos in our society.

Also, I think that you are asserting that this material is much farther from the mainstream than it actually is, and asserting that what I wrote is a novel synthesis when it is not. One of the sources that you keep removing is [5], from the magazine Midwifery Today, not a peer-reviewed scientific article, but not a wacko fringe publication either, somewhere in between. This article discusses at length the way the medical setting inhibits the erotic aspect of the experience. The doctor's comment above, which comes from Marilyn Moran's book, is also highlighting this same issue from a different perspective. Her book also discusses the issue at length. I certainly did not come up with these ideas myself. Cazort (talk) 13:14, 29 February 2008 (UTC)

The Midwifery Today article doesn't discuss "orgasm in birth." In uses the words "orgasmic and heavenly", but that's clearly not meant to be a literal usage (unless you always want to interpret the word "hellish" in the previous sentence literally also.) The issue David is raising is not, in fact, "there must be peer reviewed scientific literature on this topic" but rather "there must be adequate reliable sources, and a believe that this is not a fringe topic being given undue weight." There are plenty of ways that one could do that. For example, let's say (hypothetically -- I'm making this up) that there were notable examples of women's literature throughout the ages discussing the phenomenon of orgasm in birth. The one could say "Orgasm during birth is a phenomenon that has been discussed by many prominent authors, even before the phenomenon of female orgasm was well-accepted by the medical establishment.<ref name="Austen>{{cite book|author=Jane Austen|title="Pride and Pemberley: Jane's Married Life"|year=1815|quote="Jane bore down on the infant, pushing. Suddenly, her body felt light, and her fear of pain evaporated. "Oh, Mr. Darcy," she cried. "I die! I die...with pleasure!". Mr. Darcy held her hand as her body shuddered."}}</ref>"

Rather, what it seems to me you are doing is searching sources to find instances of the word "orgasm" even where -- as in the midwifery today article -- it doesn't actually say anything about the topic of orgasm in childbirth. Then you're stringing them together to make an argument. In Wikipedia parlance, we call this "synthesis," and it's a disallowed form of original research.

In other words, it's not that you are relying on unscientific sources. It's that you're using sources in an inappropriate manner. Nandesuka (talk) 13:56, 29 February 2008 (UTC)

LOL at your Jane Austen analogy. About the source from midwifery today, I included that source because it discusses how the medical approach to birth can inhibit the erotic aspects of one's experience. The other articles, including the two book sources and the times article do explicitly talk about orgasm. While I do not agree that the last paragraph was speculative or original research, I think you are starting to convince me that some of the material does not belong on this page and instead belongs on other pages. Everyone who says that this topic is (rather far) outside of the mainstream is totally correct. I have been reading wikipedia guidelines and they suggest that in a situation like this, the "main" page on a topic like this should have only a short mention of phenomena outside the mainstream, and the expanded version can be included on other more specialized pages. For example, I am considering if the material in the deleted paragraph belongs more on the page on orgasm, and the material from the one source on the pages on natural childbirth or unassisted birth. Cazort (talk) 20:29, 29 February 2008 (UTC)

The life-afirming nature for a woman having given birth seems lacking from the Childbirth#Psychological aspects section which seems to deal exclusively with negative outcomes from traumatic experiences, and quite clear most women do not come away from the experience with PTSD. Indeed like many women, I suspect our Jane might seek to enlarge the Darcy family further at some point :-) David Ruben <sup>Talk</sup> 01:35, 1 March 2008 (UTC)

After a great deal of consideration, I decided to remove the statement about doctors "seeing" women have orgasms. Since orgasm is an individual experience that cannot be measured or diagnosed, it is inaccurate for someone to say they witnessed an orgasm (unless perhaps that is the woman's partner, as he/she may have more experience to recognize one). There are many experiences during labor/birth that might have similarities to orgasm (breathing patterns, groaning, euphoria, endorphin release, and so on), but in the end only the woman can say whether she had an orgasm or not. I understand the comment was referenced and speaks to the under-reporting of orgasm during birth, but I would only agree with keeping it if it was reworded to something like, "one doctor said he saw what appeared to be an orgasm" or similar. And if a woman has an orgasm but doesn't recognize it as such, is it truly an orgasm? (The whole tree falling in the forest thing.) Lcwilsie (talk) 11:38, 7 May 2008 (UTC)

I find it very odd that orgasm during birth is discussed before the pain of labour. I daresay it happens, but it's hardly as common or ineitable a part of the process as pain. Clerval (talk) 12:10, 27 November 2008 (UTC)

Possibly resolved by acknowledging there is no reputable data on this and moving it to a secondary position in the article, it is not exactly an important matter. 163.1.199.81 (talk) 13:05, 27 November 2008 (UTC)

Globalization tag

I have removed the generic globalization tag from this article. If you think the tag is deserved, please feel free to restore it -- but please also add a clear explanation right here on this talk page. Your actual concerns are much more likely to be adequately addressed if you identify them in detail. WhatamIdoing (talk) 20:02, 4 March 2008 (UTC)

Update

The article refers to a 1995 article to justify that epidurals cause longer labors. There is a 2006 study showing that it does not have this effect, even when given before 4cm dilation. There's definitely an anti-scientific bias coming through this article too. Check out www.enjoyyourlabor.com for some references. The advantages of epidurals or spinals (both regional anesthesia) over systemic anesthesia such as opiates or gas are pretty clear in studies at least regarding the infant's health. Also oxygenation was better for infants born with epidurals rather than no pain relief due to reduced stress of the mother perhaps?—Preceding unsigned comment added by Isabelnecessary (talk • contribs) 01:46, 11 April 2008 (UTC)

Which 2006 study are you referring to? I'd like to compare that to the 1995 article. Science oftens goes back and forth and it is usually due to differences in study design - it doesn't mean the previous study has been negated.

There are very few studies comparing epidural use to unmedicated birth; most compare epidural to other forms of pain relief. The research is also compounded by the fact that there may be differences in the populations of women who do/don't receive epidural (for example, a woman who strongly opposes having any pain medication may be more educated about labor and more willing to be an active participant in labor; some women receive epidurals when they are already fatigued from a long painful labor and this may contribute to longer labors). The purported downstream effects of epidurals (increased need for instrumental delivery or C-section) are complicated and difficult to truly separate as being related or not to the use of epidurals. The jury is not out on this topic, and may never be.

Also, it's difficult to assess the effect of analgesia medication on newborns, as there are no true controls (twin studies) and a baby is only born once (can't monitor differences between baby's responses after birth with and without medication). There doesn't appear to be any data saying that use of epidural analgesia during labor has significant negative consequences on the newborn, but this is not the same as saying it is completely harmless or has no effect.

I'm of the opinion that much of this discussion belongs on the epidural article, not here.

Please add references where appropriate, or note where they are needed if you feel the bias is unscientific.Lcwilsie (talk) 14:50, 7 May 2008 (UTC)

It would be very interesting to have a historical note about the ancient use of psychotropic drugs as pain relief. Also the advent of ether and chloroform. Would be nice to have a timeline. —Preceding unsigned comment added by Isabelnecessary (talk • contribs) 01:46, 11 April 2008 (UTC)

I agree. I think that it is very important to discuss historical issues, something currently missing from this article. This is particularly important for things like chloroform which obtained widespread use, and had widespread problems associated with them. The article on chloroform discusses this, so it would be a good place to start to look there and examine its sources. Cazort (talk) 15:34, 19 September 2008 (UTC)

Under: Pain > Non-medical pain control...

I am a registered nurse in training, and taking maternal-child at this time. I notice that the article mentions how some women give birth "in a squatting or crawling position to more effectively push during the second stage and so that gravity can aid the descent of the baby through the birth canal." I wanted to edit in a little more clarification in place of "to more effectively push" since we just had a *certified* doula teach us about birthing positions. However I'm not ready for editing in so much information just because I learned it. I have no references besides my textbook and class lectures. We were taught that lying on the back is about the worst possible position for birthing (second to hanging upside down) for a couple of reasons. #1 Occiput anterior is the preferred presentation for the baby with a laboring mother. Lying on one's back during labor tends to make the baby fall to a posterior presentation... and right along mom's backbone (ouch). #2 Lying on one's back tilts the pelvic ring so that it does not present the baby's head with the widest opening possible, making it a necessity to hike the mother’s legs practically to her ears, and leading to more incidents of shoulder dystocia among other things. Turning a natural event into an almost purely medical procedure has made birthing harder for mothers today in western cultures, IMO. Eyknough (talk) 03:03, 17 September 2008 (UTC)

Welcome to Wikipedia. If you don't want to edit the article directly, propose your changes in the talk pages first. A textbook would be an appropriate reference, though class notes (or "what so-and-so said") would not. In re-reading the section you indicate, I think the mention of birth positions is inappropriate (what does that have to do with pain control?) and should be moved, with your additions, to a section on birth positions or to the mechanics of birth section. Lcwilsie (talk) 14:09, 19 September 2008 (UTC)

Hmm, it sounds to me like from what you're descrbing, there is a relationship between birth positions and pain. If you have a reliable source backing up that relationship then I think it would be good to have a sentence or two describing that relationship in the pain section. There currently isn't really anywhere in the article that discusses birth positions, so I think it would be good to create such a section somewhere. Often, the best way to add new information is not to add a big block paragraph, but rather, to add a few sentences to different sections of the article, where it is most relevant and flows most naturally. Don't be too afraid of editing; if people think they can find a better way to organize your ideas, they will do so. The most important thing is to have good references for your work. Cazort (talk) 15:11, 19 September 2008 (UTC)

If we do create a section on childbirth positions, which i would recommend doing, I would like to incorporate the material from several articles that are relevant: this article discusses maternal choice in positions, and this article discusses upright and squatting positions and the evidence supporting upright positions. Other articles: [6], [7], [8]. There are also articles that seem directly relevant to the relationship between childbirth position and pain, such as [9] I can incorporate this stuff into the article, it will just take time. Cazort (talk) 15:22, 19 September 2008 (UTC)

surfactant, oxytocin

The importance of the lung surfactant-protein and oxytocin should be mentioned in the childbirth aricle. (Sorry, my English is not good enough, so somebody else has to do the job)

When the lung is developing, its inside (pulmonary alveolus) will be covered by a substance (surfactant protein); after 30th week of pregnancy. When the lung is developed to functionality, there is so much surfactant, that it will circulate also into the mothers blood. When the concentration exceeds there a certain concentration, then the mother´s body will develop antibody-substances against the surfactant. These antibodys starts the release of oxytocin and thus the birth;

Oxytocin has several funcions: a) it starts the contraction => it starts the birth-process b) it continues the contractions, to remove the placenta c) it stops the blood flow after the birth d) it is called ´love-hormone´ because it promotes the strong love between (here) mother and child. (Mothers who have no natural birth might need longer, to love their child. [Oxytocin is also released during a female orgasm and will thus strengthen a partnership]) e) it will also influence the memory-system. Thus a mother will forget the strong pains of a birth, very soon. —Preceding unsigned comment added by 79.209.76.232 (talk) 06:55, 5 November 2008 (UTC)

While it might be noteworthy to include some of this information, the oxytocin information is dubious. Many mothers would take exception to the idea that they "forget" the labor pain. Lcwilsie (talk) 19:34, 30 April 2009 (UTC)

Photos

There seems to be some contention over the illustrations on this article. I'd like to propose that we have photos depicting both vaginal and caesarean birth. Any comments? Nandesuka (talk) 14:52, 29 December 2008 (UTC)

I've taken the liberty of copying the photo discussion from my talk page and placing it here:

I would hazard to suggest that over 95% of the world's population are not born by caesarean section. Therefore it is not a representative picture of childbirth. Gillyweed (talk) 04:19, 29 December 2008 (UTC)

There's no need to "hazard" a guess. In the US, in 2006, 31.1% of all childbirths were by c-section. In (eastern) China, as of 2002, over 20% of all births were by C-section, and the rate was rising. Rates in the UK and Canada are likewise over 20%, and even in the developing world there are countries where the rates are well beyond the WHO's recommended overall rate of 15%. Playing statistical games to minimize the prevalence of this extremely common procedure does a great disservice to women everywhere. It's perfectly appropriate for us to have photos of both vaginal and caesarian births. Nandesuka (talk) 16:16, 29 December 2008 (UTC)

Making this image the first one in an article about childbirth does a great disservice to women everywhere wbo have natural births. There is a concerted effort by government health bodies across the world to reduce c-sections, so why place an abnormal and not-recommended way of birthing (except for around 15% of women) as the first photo in the article? Is there a photo of a leg in a cast in an article about femurs? Why show a medical procedure as the first image? As you point out above, the WHO recommends a C-rate of 15% and yet the indication of a c-birth in the first paragraph of the article suggests that this is the predominent way of giving birth. If the photo must remain then it should be placed further down the article. C-sections are not normal, they are the exception. Gillyweed (talk) 22:11, 29 December 2008 (UTC)

As I said, I certainly think we should also have a photo of natural childbirth, and we can be flexible about the ordering. But excising photos of an extremely common form of childbirth just because it doesn't fit ones preconceived notions of (imagined) gender duties is not acceptable. Nandesuka (talk) 00:02, 30 December 2008 (UTC)

There are currently no photographs or videos graphically depicting child birth in this article. File:ChildBirth.jpg, and File:Childbirth_labor.jpg should be included in the article.93.96.148.42 (talk) 05:19, 21 July 2012 (UTC)

"Materninty Ward"?

--Ktstar23 (talk) 23:44, 18 January 2009 (UTC) There is no citation for the end section about the supposed FOX TV show "Maternity Ward" that apparently is semi-based upon forced abortions? I think this section should be removed, as even if there is such a thing, there is no citation at all, and such a show really has no place in an article describing childbirth.

Totally agree. Off-topic and does not cite references. Removed.69.159.186.107 (talk) 03:46, 19 January 2009 (UTC)

The mechanics of vaginal birth

I notice this section describes the fetus' forehead as being the usual presentation. In nursing class, we learned that an occipital presentation is most beneficial (and most common). It presents the most flexible part of the skull to more gradually stretch the birth canal. Remember cone head babies? It's not from a forehead presentation! And what is up with spelling maneuver like that? So many extra voueals! :-D Eyknough (talk) 06:25, 27 January 2009 (UTC)

Water Breaking

Sorry, I'm a young male, but I was wondering what exactly it means when a woman's, "water breaks." ya know. I've heard this phrase before but couldn't find any easily accessible information on it within either the Pregnancy or the Childbirth pages. —Preceding unsigned comment added by Makeswell (talk • contribs) 06:16, 21 October 2009 (UTC)

I think this may be what you're after: Rupture of membranes Jammycaketin (talk) 13:42, 30 November 2009 (UTC)

Collecting stem cells

This section seems more like regurgitation of stem cell bank marketing than a presentation of facts on the real usefulness of collected cells to the donor. —Preceding unsigned comment added by 41.185.113.61 (talk) 12:32, 12 May 2010 (UTC)

Citation

This article was cited in the Italian website

http://www.ansa.it/web/notizie/rubriche/mondo/2009/12/10/visualizza_new.html_1645225521.html

A man in london gave birth to his son exploiting the wikipedia knowledge.

Maybe this could be useful in some way or if there is a page "How Wikipedia contributes to people life" :) —Preceding unsigned comment added by Wayl (talk • contribs) 12:38, 11 December 2009 (UTC)

History and practices

The article could use more information on the history of childbirth practices throughout the world, and on the diversity of present-day practices. -- Beland (talk) 06:00, 27 July 2010 (UTC)

Info from Enema

I think that this (I quote from Enema with added wikification) "In his early-modern treatise, The Diseases of Women with Child, François Mauriceau records that both midwives and man-midwives commonly administered clysters to labouring mothers just prior to their delivery." Though this is from 1668 it's still relevant and applicable..

Where should this info go in the article? I was thinking of adding the following but I don't know where in the article it should go

"Applying an enema prior to attempting the act of birthing is useful in that there is no feces in the colon obstructing the birth canal. It is generally considered a good idea to have a few enemas even before getting pregnant just to get comfortable with the procedure in a private setting." --Juxo (talk) 09:18, 31 July 2010 (UTC)

Edit warring over 'dystocia' section?

Can someone explain why this is being edit-warred over? Is it just something that got caught in the crossfire over the other uncited, editorializing issues? As near as I can tell it's proper in both tone and content (although it was missing a citation, which I provided). Nandesuka (talk) 03:58, 5 June 2011 (UTC)

Data on Labor Lengths

The average length of various stages of labor currently have "average" lengths attributed to them (Stage 1: 20hrs, Stage 2: 8hr). Citation is needed. Recently, the citation for the "20 hour" assertion links to this link. However, the linked site does not give basis for this assertion either.

The average length of stage is difficult to time as the Stage I is classically defined as "the onset of labor until dilation is complete". Problematically, the "onset of labor" varies largely especially in "early latent" labor. I would propose two alternatives:

1. Modify the statement to reflect that the length of labor varies, especially in "early latent" labor. There is good data to support this assertion (Zhang 2000, Zhang 2006, Friedman 1955). 2. Find a source article that reflects some recorded observation that proposes an average. The American Pregnancy Association cites the textbook Williams and gives some ranges for normal "early" labor and normal "active" labor here.

Thoughts? — Preceding unsigned comment added by Westcoastmd (talk • contribs) 21:13, 6 December 2011 (UTC)

"fetus"

The article reads like it was written for medical school geeks. Nobody calls a baby in child birth a "fetus." Is wikipedia supposed to be accessible or only relevant to the "professional" community? — Preceding unsigned comment added by 67.193.245.94 (talk) 06:26, 14 December 2012 (UTC)

Transclusion from Dystocia

The content of the Dystocia section had been copied from Dystocia and had got a little out of sync. I've therefore transcluded the appropriate portion of that page to avoid this happening again. Lineslarge (talk) 21:48, 14 July 2012 (UTC)

The main article for Dystocia is now named Obstructed labour. Should the section be renamed? - - MrBill3 (talk) 11:04, 30 August 2013 (UTC)

Stage I and Stage II of Labor

It appears that latent labor was removed from the "First Stage of Labor" Technically, Stage I of labor includes "latent" and "active" phase Stage II is from completely dilated until expulsion of the fetus I guess something to add to the to-do list. — Preceding unsigned comment added by Westcoastmd (talk • contribs) 05:25, 4 January 2013 (UTC)

Merged.Westcoastmd (talk) 22:35, 30 August 2013 (UTC)

Non-medically indicated Labor inductions and c-section incidence of complications

Instead of deleting all re induced birth from the lead could you please just provide the reference links. You can use the news articles to find them quickly. I don't have access to journals. Here's the short sentence you deleted:

Induced birth before 39 weeks is associated with increased chances of health and developmental problems, and learning difficulties.32cllou (talk) 18:54, 12 July 2012 (UTC)

Here are working links to the news articles: http://abcnews.go.com/Health/birth-37-38-weeks-linked-lower-math-reading/story?id=16683067#.T_lQWfVLFh7

http://www.dailymail.co.uk/health/article-2167986/At-37-weeks-baby-called-premature.html 32cllou (talk) 18:57, 12 July 2012 (UTC)

Please review our guideline on reliable sources for medical claims. Primary studies like the ones you are proposing do not belong in this article, we use literature reviews and other high quality secondary sources to build our articles. Also, you should not put material in the lead that does not belong there, such as these details, per WP:LEAD. Details such as this belong in the body the article, such as in the complications section. Yobol (talk) 23:02, 12 July 2012 (UTC)

It's reliable, with Pediatrics, and Obstetrics & Gynecology as references both finding the same general problem. Belongs in the lead because 20% (CDC) are induced. Plus many C-sections are elective. It's quite short, and needs to be in the lead because it will lead for a section of text below. I work on text for below.32cllou (talk) 00:29, 13 July 2012 (UTC)

The refs of the new section do not work.Doc James (talk · contribs · email) (please reply on my talk page) 03:28, 13 July 2012 (UTC)

And these refs were put back in [10], despite violating WP:MEDRS, WP:SYNTH, etc. Sigh. Yobol (talk) 03:48, 13 July 2012 (UTC)

Good job of moving and adding needed text Yobol. Looks like refs work now i'll check again Doc.32cllou (talk) 03:50, 13 July 2012 (UTC)

Per above objections as well as those on WT:MED, I have again removed inappropriate primary sources that are trying to WP:UNDUEly speak to concerns about early induction based on inappropriate sources. No one disagrees that there are risks involved with induction earlier than 39 weeks, but we have to appropriately place those in context of the risks of not doing them in mothers or fetuses that have medical conditions, which is not appropriately discussed in detail here. Please find an appropriate review article that places these risks (and benefits!) in context and we can consider such a discussion back in. Yobol (talk) 15:23, 13 July 2012 (UTC)

You're biased, since benefits outweigh current practice harms by miles evidenced by the current American College of Obstetricians & Gynecologists (ACOG) policy. Hospital staff held to strict ACOG best practice for mother and fetus see the incidence of induced drop 90% (28% to 3%) meaning there are very few relative medical conditions to help mom and fetus compared to harmful current practice. Your conflict of interest is glaring.

Finding the review you require is easy since ACOG list harms to pre term induced. Read it, now have to find it again. I didn't use it because the primary was more specific to the main harms, and included slow learning as children. But sorry to your interests because ACOG's list of harms was much longer. I'll be Back with the ACOG reference (I can then cite the primary along with the ACOG review) and reinstate all known acknowledged facts.32cllou (talk) 16:26, 13 July 2012 (UTC)

Here it is, though I'm not sure how to give you the direct link. The source is from www.ACOG.org, but the paper is published by a collaboration between the March of Dimes and some CA agency. You get the PPT best by searching google "American College of Obstetricians and Gynecologists cautioned against elective delivery by induction or Cesarean before 39 weeks" and bringing up the PPT presentation. Here's links to similar but fully usable see long list of specialists contributors references covers benefits too: http://www.patientsafetycouncil.org/uploads/CMQCC_MOD_Bryan_Oshiro_10-18-10.pdf and http://www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf

I look forward to your corrections proper additions to the article.32cllou (talk) 18:42, 13 July 2012 (UTC)

PS I don't mind write additions about harms and hospital experiences, and you can write about the benefits.32cllou (talk) 19:03, 13 July 2012 (UTC)

Possible relevant MEDRS sources: http://www.ncbi.nlm.nih.gov/pubmed/19687492, http://www.ncbi.nlm.nih.gov/pubmed/21575797, http://www.ncbi.nlm.nih.gov/pubmed/21861252. It appears to me that we can use a sentence in this article, but the majority of this discussion belongs on the labor induction page. I should also caution 32cllou to comment on the content, not the contributor. Further accusations of conflict of interest should be directed at the appropriate location, such as WP:COIN, and not used as a bludgeon on the talk page to try to gain an advantage in a content dispute. Yobol (talk) 21:31, 13 July 2012 (UTC)

Sorry for the jibe. No attempt to address content. It is a waste to bicker.

Given the obvious emphasis to reduce elective pre 39 weeks c-section and induced birth by the ACOG and that Agency formal review of the literature, such Policy makers findings and judgements, heavy media coverage, and strongly beneficial hospital results are additions to the article additions.

Doesn't appear your first two refs cover 39 and less weeks, or fetal / neonate problems. Your third suggestion works but http://www.patientsafetycouncil.org/uploads/MOD_39_Weeks_Toolkit.pdf has more relevance, reviews more research, and is supported by the ACOG.32cllou (talk) 00:11, 14 July 2012 (UTC)

Made it more clear the issue is with pre term elective induced and cesarean that medical policy makers are working to strictly enforce re guidelines to avoid.32cllou (talk) 11:19, 14 July 2012 (UTC)

added disambiguation. appeared to have been removed since 7/2012 Westcoastmd (talk) 23:49, 30 August 2013 (UTC)

References and Archive

I added MiszaBot auto archiving for threads over 180 days, leaving 7 threads and search function to the archive box.

I also have worked on the formatting of the references. In doing so I noticed two things. Many references don't meet WP:MEDRS and the overall article could use some work for encyclopedic nature. If someone has a good introductory obstetrics text the essential factual information could be edited to good effect. Many of the viewpoints on various aspects are well done and referenced but a good solidly sourced outline of the basic process would contribute greatly to the quality of the article.

Of note regarding references it is important to include the access date for many of the sources as they change for example the WHO fact sheet 110 and the Cochrane Summaries. - - MrBill3 (talk) 11:02, 30 August 2013 (UTC)

Agree. Appreciate improved reference formatting. Thanks MrBill. Westcoastmd (talk) 22:30, 30 August 2013 (UTC)

Anybody familiar with MiszaBot know why the auto archiving isn't working? - - MrBill3 (talk) 19:04, 3 September 2013 (UTC) Woops, maybe I found my error and fixed. I'll check back in 24h. - - MrBill3 (talk) 19:08, 3 September 2013 (UTC)

Perineal shaving section removed

This section (with typos fixed) has been removed; please give your reasons.

At one time shaving of the perineum, the area around the vagina, was common practice due to the belief that hair removal reduced the risk of infection, made an episiotomy (a surgical cut to enlarge the vaginal entrance) easier, and helped with instrumental deliveries. It is currently less common, though it is still a routine procedure in some countries. A 2009 Cochrane review found no evidence of any clinical benefit with perineal shaving. The review did find side effects including irritation, redness, and multiple superficial scratches from the razor. Gandydancer (talk) 22:30, 30 August 2013 (UTC)

I removed it as it is irrelevant to topic referencing an outdated historical practice. To include this level of content would be burdensome to the article. What about pre-labor enema? cleanse? other cultural practices? Westcoastmd (talk) 22:34, 30 August 2013 (UTC)

I can see from your edits that you are knowledgeable and doing a great job of improving the article, however I tend to disagree here. The ref states that worldwide it is still routine and apparently Cochrane found enough to do a review. This suggests to me that it is appropriate for the article. Gandydancer (talk) 22:48, 30 August 2013 (UTC)

Thank you for your comments. I will restore the original text. Westcoastmd (talk) 22:55, 30 August 2013 (UTC)

Thanks. I'm sure open to other comments and deleting it again if there is agreement. Say, while I have your attention, what do you think of the dystocia section? IMO it is terrible, and btw, it seems to be word-for-word the same as the main article. I would think that something that does not sound like a medical text would be much better. I'd also like your opinion on this from this site: [11]

Dystocia is thought to account for 30% of all C-sections in the USA, including as many as half of those performed on first-time mothers. If you consider that many women who deliver their first baby by cesarean end up scheduling repeat C-sections, the diagnosis of dystocia might be at least indirectly related to 50% to 60% of all cesareans.

Maybe the problem lies not with the women diagnosed with dystocia but with how doctors define the term. Women today are held to a half-century-old labor standard called the Friedman curve, one of the first things obstetrics students learn in their training.

Emanuel Friedman wasn't yet 30 when he plotted the eponymous scale in 1953, during his residency training in obstetrics and gynecology in New York. Friedman found that, on average, it took 2½ hours for the cervix to dilate from 4 to 10 centimeters.

"In the last 50 years, the Friedman curve pretty much dictated obstetric practice, at least in the United States," says Jun Zhang, an epidemiologist at the National Institute for Child Health and Human Development. Gandydancer (talk) 01:39, 31 August 2013 (UTC)

Yes, I'll take a look at it as well. What is the "main article"? Sorry I must have missed it. While I am interested in accessibility as well, an encyclopedic entry on a subject matter that is inherently medical will, to some extent, read like a medical text. It's unavoidable. Anything less and the piece appears to lose neutrality. The above quote included, I'm afraid. 174.31.250.31 (talk) 19:50, 27 September 2013 (UTC)

Do not remove infobox

As pertaining to the recent revert; Please do not remove the infobox, and if you Gandydancer have suggestions concerning new images please bring them up here and consensus can be reached. CFCF (talk) 23:37, 14 December 2013 (UTC)

That's not an infobox; it's an image with captions. An infobox is supposed to have key information points in standard summary form. An infobox for a book would list the original publisher and date, the author, number of pages, and other information standard for books. An infobox on a person would give birth and death dates, spouse, etc. The "infobox" you've added contains no such collection of key points; it's merely illustrations shoved to the start of the article and given captions. The illustrations need not be placed at the start of the article. --EncycloPetey (talk) 04:40, 15 December 2013 (UTC)