Talk:Unassisted childbirth

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Contents 1 readers note 2 Author's Note 3 Comment 4 Follow-up Note 5 NPOV Issues and Editing 6 Follow-up Note 7 Problems... 8 Statistics, etc. 9 Please Identify Yourself by Signing Comments with Four Tildes 10 Response 11 Follow-up Note 12 Response 13 Roadapples 14 Follow-up Note 15 Removed Tags 16 Follow-up Note 17 Co-Editor's Comments 18 Follow-up Note 19 Really *small* edit 20 Return of Siofra 21 Follow-up Note 22 TOC right

[edit] readers note

Why is the entire low risk view section is about how safe unassisted births are and then the high risk view section is about c-sections? Why? That makes no sense. It should be the view point about unassisted births. why in this article has unassisted births been put under a low risk section and then c-sections are mentioned out of nowhere in what appears as simply an attempt to point out their risk? this is a badly written article.

[edit] Author's Note

Removed Cleanup and POV templates after waiting one week for comments from parties who initially tagged the article. I will continue to review the tutorials in order to improve the presentation, and welcome comments and suggestions from others. PenneArdICS 13:01, 6 December 2005 (UTC)

[edit] Comment

Could someone try to make this article more unbiased? So many of the "facts" cited here really are highly questionable and completely unsourced-- particularly the assertion about the supposedly proven dangers of caesarean sections. The whole premise of unassisted birth is on very slippery ground, and is based on a highly sentimental view of nature. Human beings are mammals yes, but we are structurally very different from other mammals and not well-designed. In this case, the size of the average woman's pelvis relative to the size of the head of the baby that will have to pass through that pelvis makes human childbirth one of the most hazardous birthing experiences in nature. Historically speaking women and their babies died in childbirth with stunning frequency-- and this was even with the aid of midwives. Take a walk sometime in a historic graveyard and take note of all the young women who are buried there alongside their unnamed infants. There is absolutely no parallel to this in the animal kingdom. While it may be aesthetically pleasing to believe that nature is benign and we are all meant to give birth easily, the facts do not support this. While I believe this article is well-intended, it doesn't even try to examine the biology behind its claims or provide another point of view for balance. It is an opinion piece, not an objective article. Finally I believe statements and generalizations about the supposed personal qualities of people who practice unassisted birth is highly subjective and personal. It does not belong in a Wikipedia article.

Food for thought. Here's a quote with some interesting statistics, which might balance out the claim that unassisted birth is natural and safe, practiced safely for centuries by happy peasants, etc. etc. Please note that Nigeria is a part of the world where unassisted (or minimally assisted) childbirth is pretty much the norm. Factoid: they want more doctors over there: "In sub-Saharan Africa, one in every 13 women dies of pregnancy related causes during her lifetime compared with 1 in 4,085 in developed countries. Most of these casualties could be prevented if women had access to basic medical care during pregnancy, childbirth and the post-partum period. For every woman who dies, approximately 30 more endure injuries, infection and disabilities in pregnancy or childbirth; this means that at least 15 million women a year suffer from pregnancy or childbirth complications. Nigeria constitutes about 2% of the world’s population but contributes 10% of the 550,000 maternal mortality rate annually. Every minute, a woman dies from complications of pregnancy and childbirth somewhere in the world - at least 550,000 deaths per year. For each one who dies, another 30 to 50 suffer debilitating injury, infection or disease. Maternal mortality represents the greatest disparity between rich and poor countries, with 99 percent of maternal deaths occurring in the developing world,” (Mrs Idowu Ogunmayin, Program Officer Safe Motherhood, Federal Ministry of Health, Nigeria).

From Dr Barker, statistician and mother-to-be: Here I'd like to offer my thoughts on why this article doesn't seem to me to be providing a neutral perspective, and how it might be improved in this regard.

Precise definitions required.

• It sounds like there are multiple definitions of "unassisted childbirth", from "Birthing without a medical attendant" to "Birthing in solitude." Make it clear which is being used throughout this article. This may mean defining "Unassisted childbirth" as "birthing without a medical attendant (but often with a partner or other support person)", and then talking about "Birthing in solitude" as a special case.
• I expect that informed proponents of unassisted birthing will still acknowledge that there are pregnancies for which it should not be attempted. An extreme example may be where placenta praevia (complete) has been identified; then the baby physically can't get into the birth canal because the placenta is in the way. This article should include a description of when unassisted childbirth is an option and when it is not recommended. I would predict that the statement would be something like "Unassisted childbirth is only recommended as an option for low-risk pregnancies; for pregnancies where multiple risk factors have been identified, the presence of a medically trained assistant is advised." (I haven't found a wikipedia article on risk factors in pregnancy, but if one is written, it should probably be linked here.) It may also be important to add something to the effect that "It is important that the mother choosing an unassisted birth be well informed about pregnancy and birth."
• It is important to acknowledge which country or countries this article is appropriate to. Nutrition, complication rates, education levels, antenatal care, and the availability of emergency assistance may vary considerably between developed countries, and Wikipedia includes less developed countries in its audience too. Some international aid programmes report significant health improvements from training someone in a village as a birth attendant.
• Some comment on the level of ante-natal care assumed is also a good idea. Is it assumed that the mother choosing unassisted childbirth has been seeing a midwife or GP during the pregnancy? This is important because this level of antenatal care will often identify many risk factors (e.g. placenta praevia) that may make unassisted birth unadvisable, or that can then be handled so that unassisted childbirth is still a safe option (e.g. gestational diabetes; where attention to diet can prevent the baby getting abnormally large.) Is it assumed or recommended (as it is in Australia for midwife-assisted home-births) that the mother register at a nearby hospital, so that they can easily be moved if complications do arise?
• Taking these steps will help to distinguish "unassisted childbirth" from historical approaches to childbirth that had a 1% maternal mortality rate; this is important because the modern maternal mortality rate in the USA is 0.01% (See wikipedia's article on "Maternal Death") and if unassisted childbirth is confused with the historical approaches, many more people will take a negative attitude to unassisted childbirth.

Some loaded language:

• caesarean section: "the highly-accepted and frequently abused cesarean section" This line is ambiguous. Is it meant to say "frequently maligned" or "frequently over-used"? From context, the latter seems more likely, but either interpretation carries some emotional judgement of caesarean sections. Caesarean sections are held to be over-used - and this may be shown by citing the WHO recommendations for the appropriate incidence of caesarean sections versus the actual incidence of caesarean sections in (specific country.)
• medical interventions are only ever described as causing problems. It should be acknowledged that they can solve problems too. I think WHO currently advise that caesareans are appropriate for about 10% of all births.
• appropriateness of interventions in different birth scenarios: "More often than not, the emphasis in both public practice and the media is placed on the perceived risks of a natural birth versus medical intervention -- neither of which can be conclusively proven to be true in each and every individual birth scenario." This statement may confound the reader. The first half is confusing and the second half leaves the reader with the impression that the benefits of medical intervention cannot be demonstrated. It does this largely by expressing an interpretation of probability that is neither all that relevant nor all that well accepted.

We don't know which lives a given intervention saved, and which lives it cost. But most of the interventions that have remained in use for 20+ years have been clearly shown to save rather more lives than they cost, when applied in specific situations. (e.g. mother is losing too much blood, intervene by giving a blood transfusion. Maybe a fraction of one percent of mothers in that situation may die from the transfusion, due to some rare blood type incompatibility cropping up or someone really stuffing up and giving the wrong basic blood type; some mothers will die either way and some will survive either way; but in most cases mama is far more likely to survive and recover faster thanks to the transfusion.)

• apparent praise of those who choose this option: "Those who choose unassisted childbirth have a reputation for being conscientious, knowledgeable, informed people who seek the ultimate birthing experience for themselves and their children." Say rather that as a matter of safety, it is important that if you choose this option, you should be or become knowledgeable and informed about childbirth, and that for the most part those who do choose this option are conscientious about preparing for it. You may say also, then, that those who choose this option are seeking the ultimate birthing experience for themselves and their children. But if you do, you should acknowledge that different people have different ideas of what constitutes the ultimate birthing experience.

A bad birth experience is certainly unpleasant and can have lasting emotional impact. But many experts will say that any birth which leaves mother and baby safe and healthy is a success; and it would certainly be very hard to argue that a birth that did not have that result was a success. Women who prepare for birth without setting their heart on a particular way that birth should happen, but rather thinking "I'd prefer this, but it's not remotely important compared to my baby's life" are less subject to lasting emotional impact following a birth experience that isn't what they wanted. I also see a danger for first-time mothers; if they set their heart on a natural birth, and then find that it really really hurts and they just can't cope with the pain, they may later feel guilty for getting pain killers. Life deals people enough pain; new mothers don't need any more. Wikipedia should be neutral; should describe Unassisted Childbirth as something some people do, rather than something people should aspire to.

No repeating of other points of view.

• Childbirth is a major event and historically many lives have been lost in childbirth, so there *will* be groups that describe unassisted childbirth in less than completely positive fashion. At least one such source should be quoted. (e.g. "Association X described unassisted childbirth as being 'very dangerous if any natural complications arose.'")
• No acknowledgement of complications arising from any source other than medical intervention.
• No acknowledgement that medical intervention ever produces positive results.

No cross-referencing to related wikipedia articles.

• There should be a "related articles" section at the bottom of this article. I suggest that it should include links to:

   - the main childbirth article;
   - the article on Home Birth (which does a nice job of being a relatively neutral presentation)
   - the article on Caesarean Sections 
   - the category "Obstetrics"

Within the article itself, when caesarean section is mentioned, there should be a link to the article.

Statistics poorly presented, possibly flawed:

• I'm a professional statistician and I feel that the statistics presented are incomplete. In particular, it's not clear that these statistics allow for observed risk factors. Caesareans shouldn't be done for births with no evident risk factors (the concern is that they're done for births with minor risk factors, where they should be saved for births with major risk factors); unassisted births probably don't happen for many women showing signs of major risk factors. As far as I can tell, the statistics presented *don't* allow for the relative risks for the people going into the different paths.

Actually allowing for the differences in risk is quite complicated statistics. But if this adjustment isn't made, then the statistics are misleading. It is very important to be clear about whether or not the adjustment has been made. The simplest way to do this adjustment is to look at groups of women with the same risk factors. For example, "for the subset of women with no observed risk factors, which gives better outcomes? Hospital birth, home birth with medical attendants, unassisted birth?"

And then there's the subset of women with a history of past uncomplicated childbirth and no reasons to be worried about this pregnancy (the population where unassisted childbirth may perform best), and the subset of women having twins or more (where hospital outcomes are almost undoubtedly better) and the list goes on and on.

Simply looking at maternal and fetal death and disablement rates as a proportion of all unassisted births, compared to all hospital births, confounds the effects of other risk factors with the "treatment" of unassisted birth versus hospital birth. If unassisted birth is not used for high risk pregnancies, then what the numbers would really show is that it's better to have a low risk pregnancy than a random (could be high risk) pregnancy; which is (a) something we knew to start with, and (b) not something the mother-to-be has much control over.

- Rachel Barker, 1 February 2006

Excellent, excellent suggestions Rachel. Thank you for taking so much time with this. I wonder if anyone else is actively watching this article? It really would be good to see it given a more balanced and honest treatment. 38.2.108.125 17:56, 3 February 2006 (UTC)

[edit] Follow-up Note

Rachel: I can see that you have put a lot of time and thought into this review, and I appreciate that. As you can see by my first note above, you are the first person to have enough interest in this topic to bother to post a comment (not to mention, add their name) -- so this project had been put on the back burner, so to speak. Wanting my first draft to be original and sincere in its reflection of a very sensitive issue, I wrote from memory of my own research and experiences, then cited sources which address all the concerns you have expressed here. This is my first time to try my hand at a Wiki article, so I fully expected it to be a learning experience, hence my invitation for comments and suggestions.

I sense a fair amount of personal bias and opinion being put forth in your own comments as a new mommie-to-be (statistian and professional doctorate, notwithstanding.) In order to honestly add many of the points you would like to see included in the article, I would need direct sources, links, and reliable info. If you would like to collaborate on improving the article, it would be helpful if you would first check out the sources listed in the article and research unassisted childbirth in depth. Many of the concerns you have presented are answered in the available lit. In the meantime, I will begin work on a rewrite to try to include points/counterpoints in order to allay the common misconceptions and fears which surround the practice of UC. PenneArdICS 09:55, 15 February 2006 (ET)

A couple of points, PenneArdICS: First of all, although it is ideal to register as a user in Wikipedia, non-registered users are permitted to participate. This should not be used as excuse to dismiss valid points, which I have made in good faith. Please read Wikipedia's policy assume good faith. Furthermore, although Rachel introduces herself as a mother-to-be she didn't say "new" mother to be; even if she was a "new mommy" this alone is not a good excuse to accuse her of bias. I do not see any bias in her response to you-- she analyzed your writing, your presentation, pinpointed some serious problems with accuracy and neutrality in your article and did a solid and courteous job. You should respond to her specific points rather than getting personal. Please bear in mind also that disagreement or criticism alone is not sufficient to accuse someone of bias. Your article would be greatly improved if you approached UC as something people do, as opposed to advocating for it. Wikipedia has a clear policy against advocacy or "soapboxing"-- please see Wikipedia:What_Wikipedia_is_not for more information. The goal is, in short, neutrality. Regarding sources, please bear in mind that if someone challenges your facts, the burden is upon you to back up your statements with sources. See Wikipedia:Verifiability for more information, and please especially note the part where it says: "The obligation to provide a reputable source lies with the editors wishing to include the material, not on those seeking to remove it." You might also want to read the sections on sources: specifically on using sources of dubious reliability and self-published resources (in other words, be prepared for challenges if your sole references are advocacy sites). Basically, the biggest problem in your article is the lack of NPOV-- neutral point of view, or neutral point of view means that articles should not be biased, and should represent differing views on a subject fairly. I am glad you are determined to work on a rewrite, but please bear in mind that the point of the rewrite should be professional balance, excellent research, and NPOV-- not advocacy, propaganda, or even allaying "the common misconceptions and fears which surround the practice of UC". 38.2.108.125 14:40, 27 February 2006 (UTC)

Some references, cribbed from Childbirth, which I feel should be considered in this article, since they evaluate verifiable risks in childbirth:

1. ↑ Safer Motherhood Fact Sheet: Maternal Mortality
2. ↑ Perinatal death associated with planned home birth in Australia: population based study. BMJ. 317(7155):384-8. Retrieved on May 28, 2005.
3. ↑ World Health Organization 2005 World Health Report, Chapter 4: Risking Death To Give Life.38.2.108.125 14:43, 27 February 2006 (UTC)

[edit] NPOV Issues and Editing

Okay, I am going to nibble at an edit, though it may take me awhile.

In the meantime I pruned the references section of commercial links (not permitted according to Wikipedia's policies) and links that do not pertain specifically to the subject at hand (there are already plenty of entries in Wikipedia about natural childbirth, breastfeeding, attachment parenting, etc.) (EDIT: It would probably be a good idea in revising to make more references within Wikipedia. I have noticed, for example, that there is an article about Jeanine Parvati Baker, one of UC's pioneers. Again, I am not especially knowledgeable about UC, but even I know that she is a highly relevant figure whose work should probably be referenced in this article.)

I agree with others who have pointed out that there are serious NPOV issues and well as reliable sourcing issues in this article. It is extremely biased. This isn't a condemnation-- the article would be fine for a personal advocacy site, but for an encyclopedia it should be more reliable. I attempted an initial edit, but found that after the opening statement, almost every statement made in this article was either POV, factually dubious, or unsourced/impossible to source.

That said, it is an interesting topic and deserves better treatment. One of the problems with writing about it though (and sourcing it adequately) is that UC is not the widespread movement that the original writer claims at all, nor does it have much in the way of historical precedent: it is very much on the cultural fringes, practiced mostly in white, western, privileged culture, and there frankly have been no objective studies of its results (EDIT: That I know of anyway, and yes I have been researching). Most of the information that is out there is anecdotal, posted on personal websites or advocacy sites which seek to promote the practice. Its not much to go on for the pruposes of a wikipedia article.

So in my rewrite, I will do my best to do my homework on childbirth and its perceived and proven risks, and see what I can do to examine why some people would choose UC and what they see in it. In places where there are disputed claims, I will try to present what both sides have to say. Rightly or wrongly, there is a dissatification with how medicine has handled childbirth, as well issues of personal empowerment eroding in the face of high technology that are certainly interesting. Siofra Heaney 12:39, 24 March 2006 (UTC)

I have removed blatantly unbalanced content. Studies cited should be named and linked to before being put back in as at the moment they are simply POV. Claims that people who choose this method of birth are regarded as better people is pure POV so without any study to back it it should be left out. The article would benefit from the actual statistics world-wide of live births with and without medical intervention, and of children who survie beyone the age of 5 under the same conditions..

[edit] Follow-up Note

Siofra: I admire your courage to attempt a rewrite of the article. As I said to Rachel, many of the points presented here are valid, but I'm disappointed to see that neither she nor the others who agreed with her (besides you, of course) were willing to put forth the effort to work on the delivery, if not add their thoughts/references to the article itself. It is a challenge, as we've both noted, and even more difficult to take someone else's POV and try to present it in a way that doesn't compromise one's own views in a biased manner.

It's easy to be a sideline commentator and critic (not that I don't appreciate the feedback, both pro and con, because I do enjoy a lively discussion!) but Wiki's main draw is that it's created to be a collaborative effort, and the success of the project comes from those who are passionate enough about the subject matter to help put something special and unique together.

Personally, I think filling the article with statistics and politically correct statements would make it miserably dry and boring. Not that this is what everyone is suggesting here, but it seems to be a recurring theme. To me, that's the purpose of the reference resources, which I provided. My original piece was definitely a rough draft, intended to be a broad overview/summary of the topic itself, in the style of a classic encyclopedia article. When it comes down to it, even the assessment that the article didn't come from a neutral point of view is subject to the opinion of each individual reviewer. EDIT: As for presenting the alternatives to UC in depth, that is neither desirable nor necessary, according to Wiki guidelines. Simply asserting that there are other options and referencing back to conventional childbirth, etc., is adequate, as this is covered in article(s) of its own here on Wikipedia.

EDIT: The original reference resources [which had been completely removed by other parties rather than revised to meet Wiki guidelines] back up the statements made in the article and should be enough for those wishing to make their own comparisons and conclusions. I appreciate others' efforts to include relevant Wiki links as well. I discovered Jeannine Parvati-Baker's article after I had written this one, but was waiting until it had been updated before adding the link, as I learned she passed away the following morning after I had published the draft on UC. My highest aspiration is to have this article develop into one that is worthy of her own and others' accomplishments in this growing birth movement. Thanks to everyone for their efforts to help me learn and understand the way of the Wiki! Enjoy the weekend, Amigos PenneArdICS 19:49, 26 March 2006 (UTC)

[edit] Problems...

I see that several people are trying to make this article more informative and less biased...but I think people are unaware of some of the issues surrounding UC.

If we tried to explain (I'm pro-UC) all of the reasons that UC is safe, and circumstances that can be overcome (even complications) to make UC safe, this would become a very lengthy UC article. It's not as clear cut as 'Women with uncomplicated pregnancies can consider UC as an option.' because many pregnancy related complications can be overcome with enough knowledge...but there isn't room for all that knowledge here. It'd be too overwhelming.

It is VERY difficult to come up with factual, unbiased (in either direction) statistics on UC birth. Many women in the US (which is where I am) do not document their UC or participate in studies. UC is a private affair and not only do we face discrimination, but many of us consider our births to be private and sacred...not a statistic. There is no 'center' to report to, regardless of outcome, and there is no one that gathers statistics on UC birth in the US (which is the only place I can speak from experience on).

As for the women in Nigeria and other 3rd world nations, circumstances are drastically different in those countries, and they aren't just surrounding pregnancies, they're compounded by pregnancies. Improper nutrition, education, lack of clean water, high disease rates, all of these things complicate the woman's life, and therefore they can complicate her pregnancy and affect the outcome. Atop that, if she has a complication, she can't just hop in the car and get to the hospital like we in the US can, for her safety and the safety of her child. When that is not an option, and you are not educated enough to handle problems for yourself...add in the other problems (disease, malnutrition, etc.) and one cannot say that it doesn't adversely affect outcome, therefore skewing what true chosen UC is.

In order to keep this article from becoming a novel, a 'how to' on UC, or a long advocacy point for UC, it is a very fine line that we must walk. I'm going to try to help see if I can make this unbiased somehow, but it is very difficult to pit statistics against statistics when one side doesn't keep statistics and the other side has kept them irresponsibly, and shows UC in a negative light either due to it's own ignorance, or with malicious intent.

Technically, UC is birth without a 'qualified' attendant. Who is at the birth is unimportant. The point is that there are no medical 'professionals' of any type directing the mother in her birth, and if she chooses to have her husband, her friend, her mother, or half the neighborhood there, it's still UC because the laboring woman is the one in charge of her labor, delivery, and care. SHE is the one who makes all the decisions, without intervention from people who 'know better' but can end up complicating her birth, no matter how well-meaning they are. That's why it's called 'unassisted'. The man in the moon can catch, if she says he can...but it's all up to her.

Instinctivemama 22:07, 27 March 2006 (UTC)

[edit] Statistics, etc.

_________________________________________________________________________________________________

Using the Sahara area as an example of how dangerous unassisted birth is, is misleading. It has about the highest infant mortality rate of the world. http://www.census.gov/cgi-bin/ipc/idbsprd. What the previous person said was right on... the conditions have everything to do with it. Candidates who CHOOSE unassisted childbirth must be sure to take care of themselves very well by eating nutritiously and cutting out unhealthy habits like smoking or drinking. In the United States and other developed countries we have the resources we need to obtain optimal prenatal care. 91.1% of babies born of the 99% registered have Apgar Scores of 9 or 10. A baby who is very healthy at birth is healthy because of how well he/she was taken care of prenatally, not due to the people present at birth. The C-Section rate is at its all-time high of 27.5% due a lot to the decreased rate of VBAC probably by the choice of the mother, and 21.6% of births are induced, 25% of which have no medical indication. These statistics are straight from the CDC. http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf. Most women who CHOOSE unassisted childbirth do understand the risks and are willing to put forth the extra care to counter those risks. The most common complications of pregnancy are hypertension, pregnacy induced and chronic, and eclampsia. Eclampsia is caused by malnutrition and the management of hypertension is closely related to diet. Therefore, a woman who starts out low-risk and eats very well has a very high chance of having a successful delivery and healthy baby. It is also my opinion, that one ultrasound should be done at the typical 18-22 weeks to make sure the placenta is in a proper position and the baby is healthy in the ways you can tell by ultrasound. Blueribbonbaby.com offers great nutritional advice. Maintaining a healthy diet and taking the above precautions makes UC a safe, viable option for low-risk mothers. However, some higher-risk mothers do choose UC with a plan to manage their problems and accepting the increased risk. Oh yeah, and that whole human childbirth being so hazardous because of the pelvis and head proportion is a load of crap. If human childbirth didn't work well naturally, we would have, you know, died out a long time ago or at least not populated the world as fast as we did and are continually doing. There are cases of cephalo-pelvic disproportion, but they are extremely rare. You should look up the physiology of a woman's pelvis and the baby's skull. The bones slide around on the babies head to make it narrower for birth, while the mother's pelvic ligaments and joints loosen during pregnancy (the reason pregnant women get backaches and hip pain). Also, positioning has a lot to do with it. The lithotomy position (laying on back) makes the pelvic cavity smaller; back in the day women were forced to birth this way (when hospital births became the norm) so there probably was a higher incidence of mortality due to what actually was a pelvic problem caused by the position the women had to be in. Also, if cephalo-pelvic disproportion WAS a problem that caused death before, it makes sense that the problem would die out, because the women who died because of it didn't pass the deformity on to future generations.

[edit] Please Identify Yourself by Signing Comments with Four Tildes

Quick note for folks who are new to Wikipedia: If you are not a registered user, please sign your comments with four tildes-- this makes it possible for people reading to sort out who is making what point. Cheers! 38.2.108.125 15:06, 27 March 2006 (UTC)

[edit] Response

Siofra: I am glad someone who is more neutral is willing to take the plunge on rewriting this article. Kudos to you for your efforts!

Regarding the point made "It is VERY difficult to come up with factual, unbiased (in either direction) statistics on UC birth": well folks, that is a pretty significant problem if you are going to write about this in Wikipedia. You can't just run around making claims, especially about the safety of UC, without any sources or backup *in Wikipedia*. Or rather I should say another writer challenging your claims is justified in requesting that *you* give sources, and is justified in deleting your claims if you cannot. This isn't just my opinion, it really is Wikipedia policy.

This said, I think a simple short article that approaches UC as something that people do is possible to write. Without writing a dissertation, you could say , for example "Advocates of UC believe [fill in the blank with unproven, unsourced idea about childbirth] and report in their accounts that such-and-such a risk is not an obstacle and can be managed naturally. This claim however is questioned by medical professionals who report... etc."

Saying that something that is widely documented as a risk factor is not a risk at all, without any sources to support the claim, is not something you can claim is a proven fact unless it actually is proven-- and by your own account, above, it isn't.

However, saying that UC Advocates *believe* that the perceived risk is exaggerated or not as important as claimed is a very different matter-- if it's what they believe, it is what they believe. That is something that can be stated as a fact. Qualifying controversial claims (think of this as pointing out where the controversy is rather than as a personal compromise) can be done easily with one sentence. Presto: you have a much more NPOV article.

I would recommend writing up a simple outline of what UC is (clarifying by the way what is exactly meant by "unassisted" since I am hearing several different things in this discussion), what it believes, who popularized this practice (Who is JP Baker? how did this grow out of the natural childbirth movement? what started this? etc.), and (if it can be accurately stated) how widespread the practice is. If there have been *any* impartial studies, mention them. Then there should be a section called "Controversy" which outlines what concerns people outside of the movement have, including, yes, medical professionals. (Sorry UC advocates, but this is relevant information). Then follow it up with sources, including at least two or three that are critical of the practice.

I think this should be possible. 38.2.108.125 15:05, 27 March 2006 (UTC)

[edit] Follow-up Note

User #38.2.108.125: While neutrality is a fundamental aspect of this Wiki piece, editing an article on an unfamiliar subject is treading dangerous waters. I can see adding some text which would assert another POV, but some of the edits to my own words changed the meaning considerably and switched the bias to the other side of the issue, IMHO. Also, the removal of ALL of my original reference sources gave the appearance that I had nothing to back up my statements whatsoever -- that was a completely irresponsible act, if not direct sabotage. I should have been informed of the need for correction on this Discussion Page first and foremost before a major edit like that was made.

I have learned much about neutrality over the past month or so, through Wiki's guidelines and through the discussion here, and have been working on the article with help from other friends familiar with the subject matter as well. There is still much to do, but I believe that the piece is a good start in that it is and has always been a brief introduction (i.e., simple, short article) to the choice of Unassisted Childbirth. I am in the process of reviewing other articles to see how direct referencing is done, with and without quotes, to substantiate the research summarized in the text.

Sincere Thanks again to everyone for their contributions -- I'd like to request that future posters please refrain from implying that UC advocates such as myself have no interest or desire to present this subject from a neutral point of view. I'm still learning the ropes as a Wiki newbie, monitor this discussion board on a regular basis, and am applying my newfound knowledge as best I can.

Vayan con Dios, Amigos PenneArdICS 17:32, 27 March 2006 (UTC)

[edit] Response

"Also, the removal of ALL of my original reference sources gave the appearance that I had nothing to back up my statements whatsoever -- that was a completely irresponsible act, if not direct sabotage." No actually this is not vandalism. The links have been removed due to lack of relevance; my edit is fully supported by wikipedia's policies. You have had plenty of time to work on the page and respond to discussion, but you did not do so, therefore I removed the links. I have the right to do this under Wiki's rules. This is how Wiki works. The appropriate response is not to revert, but to find more relevant links. Please familiarize yourself with how wikipedia works-- all articles are communal; no one person "owns" anything. Your work can and will be amended. Please note what it says right on the edit page in Wikipedia (in bold!): "If you don't want your writing to be edited mercilessly or redistributed by others, do not submit it." Also please assume good will and refrain from throwing around accusations that are groundless. (Example: your accusation that I am "implying that UC advocates such as myself have no interest or desire to present this subject from a neutral point of view." is groundless-- I have said nothing about your intentions or about YOU or about the intentions of UC advocates. I have commented ONLY on the article as it stands right now. There is a difference.) As a gesture of *my* goodwill, and to prevent this from descending intoa revert war (which you appear to be instigating), I will leave those references alone for now, but I would strongly urge you to find references that are more relevant to the subject and replace them. References about breastfeeding really are not relevant to this topic-- lots of people breastfeed who do not give birth unassisted. Do you see the point? Once again, you must expect your article to be changed and edited by others. Expect other points of view to be inserted and represented (where valid and relevant of course). Its not "your" property, and nobody needs your permission to participate or make edits. (Your statement: "I should have been informed of the need for correction on this Discussion Page first and foremost before a major edit like that was made." No. Sorry, but that is NOT how wikipedia works. Please read the policy. Nobody has to inform you or ask permission, or seek prior approval before editing. This is a group effort. Nobody ever owns any article.) Please do not take this process personally because it is not. Its simply editing. Now let's shoot for some good NPOV. It should be possible. 38.2.108.125 16:22, 28 March 2006 (UTC)

[edit] Roadapples

I am just going to post briefly here because unfortunately I see a flame war brewing. It is, I think, completely unnecessary.

First of all, PenneArdICS: Please don't take what I am about to say personally, because really I do respect you and I applaud your seriousness about this subject. I think and NPOV article is possible.

However.

38.2.108.125 is entirely correct to point out that removing some of the links due to irrelevancy is a perfectly valid edit in Wikipedia. Although you may feel that this is your territory or your article, in reality and in Wikipedia, nobody owns an idea. Once you post something here it is fair game for editing. (Btw I have looked over the edit history and note that a few people made edits in that area, including me. I even gave really clear reasons why. Really, this is how Wikpedia works. One person makes an edit, then another, then another, then someone else tosses in something new, and someone else refines it further. Its all a part of the process.)

Although it is certainly in good form to discuss changes no editor needs another editor's permission or approval to jump in and make a change which they genuinely feel is needed. I would strongly encourage you to read carefully Wikipedia's definitions of what constitutes vandalism-- and especially what does not.

Some other points: Wikipedia has rather firm statements about assuming good will, refraining from personal attacks, and avoiding what are called "revert wars". Erasing someone's edit simply because you don't like it is not in good form. Reverting is usually reserved for edits that really are made in bad faith or that are openly disruptive (e.g., blanking out a whole article, inserting insults or advertisements, spamming). If you disagree with an edit, the thing to do is either a.) address the edit with a real improvement, i.e., come up with links that are more relevant or b.) State why you feel the edit was not correct i.e., why these links are in fact relevant. Make whatever changes you want of course, but respect the rights of others to do the likewise.

Bear in mind: I do not necessarily feel that the links posted are *completely* irrelevant but Wikipedia does have a policy about keeping external links pared down to what really strengthens and illuminates the article and avoiding what they call "link farming". Check out Wikipedia statements regarding sourcing for more information. Right now these look like superfluous links that don't really support the topic. It is not inconceivable that this could change as the article progresses. If the article were fleshed out a bit to include a statement (for example) that advocates of UC are closely tied to lactation activism or attachment parenting as a philosophy (I am not assuming that this is the case, of course, but I could imagine this), then these links might become more relevant and useful, though I would still urge more internal linking and feel at this stage that keeping the article focused would be more productive.

Finally on the subject of making accusations: If you don't want people accusing you of not being open to a neutral point of view, please think twice before you dismiss reasonably expressed dissenting points of view as "bias" or accuse people of sabotage if they edit your work. I am doing a lot of research right now and really hope to contribute to this article, but if we don't all approach this with genuine commitment to neutrality on what is, by any definition, a controversial topic on which people of good will may reasonably disagree, this isn't going to work.

I think you will find if you give me a chance that I will have much to contribute that will probably make you very happy. However, I make no promises in advance to toe anyone's line or to discredit perfectly reasonable research or sources just because they don't support a particular point of view or agenda.

You may earnestly believe that all medical research about childbirth is pernicious and evil, but I think that's at the very least an extreme point of view that not many people would share. I am happy to present it fairly, of course if that is a core belief of the UC movement, but please expect some qualifying remarks and some balance. (Example: I may say that UC advocates "maintain" such and such rather than present an unsupported or controversial belief as established and indisputable fact. That's fair. I might also qualify some hard-hitting medical research by pointing out that UC is a grassroots movment and that doing research on mothers and babies is often problematical even under the best of circumstances. That too is fair.)

My personal goal is to create an article that fairly represents what UC is based on and what is concerns are as well as to present some of the genuine concerns (which can be sincere even if one doesn't agree with them) that other childbirth experts (including experienced mothers!) may have. If we aren't allowed to bring up the latter, then the article will remain biased. My participiation in revising this article is based upon being treated as an equal. If this is not possible, something is wrong.

Cheers. Siofra Heaney 01:42, 29 March 2006 (UTC)

[edit] Follow-up Note

Thanks to you both for your responses. Please don't misunderstand me; I do not believe that *I* own this article. I am well aware that it is a collaborative project, as I have stated clearly here in the past, and welcome your comments and suggestions -- and of course, responsible edits. There have indeed been several statements which allude to the idea that myself and others who advocate UC may be too biased to write or assist in revising this article, however, and I simply asked that those type of comments cease before the discussion does deteriorate into a flame/revert war.

For the record, I did not "revert" to the old article or links verbatim -- I made some revisions to the last paragraph which had been removed in accordance with the NPOV suggestions made here, and reinserted it in order to show that the original article did indeed have substance. I replaced the reference resources (yes, even the breastfeeding book has relevant information on birthing without interference) in the correct format. Those unfamiliar with the subject matter would not know that, which is why I warned against the wisdom of removing anything without prior discussion here.

It is my understanding that Wikipedia strongly suggests major revisions be thoroughly discussed first before action is taken, and removing every single relevant resource, most on the basis of incorrect formatting, is irresponsible, IMHO. That act alone no doubt influenced the subsequent opinions and commentary that we have seen here. Yes, the reasons were given for removing the references, but after-the-fact. I did get confused and think the notes were on the history/edit page, rather than here on the Discussion page, however -- but perhaps that was after comparing pages from Siofra's edits -- nevertheless, I did follow your notes to revise them accordingly.

No, I had not been monitoring this page every single day since it was first published because there was absolutely no activity for the next two months after the first drive-by templates were placed. It is not true that I did not respond, although I did refrain from addressing some of the anonymous comments, because I wanted to be sure of the writer's intention. As soon as I caught the first comment on the Discussion page, I responded, not defensively as presumed, but with my personal view of the situation. I did not personally "accuse" Rachel of bias any more than she "accused" me -- I simply made the same observation that she was making, namely, that there may have been non-neutral points of view coming from both corners.

I requested follow-up and collaboration and didn't even realize that all the anonymous responses at that time were from User#38.2.108.125 -- didn't even think to compare the numbers until you said you were the one who initially removed the references. No offense intended -- I really had no idea you were still hanging around and thought it was another drive-by w/o follow-up. I didn't realize you were also one and the same person telling others to "sign" their posts after telling me that it was not a problem for people to post anonymously (which, btw, I didn't object to in the first place, but you're right, it does help to clarify who's saying what, if not legitimize or validate their intentions.)

Anyway, I'm thrilled to have you both continue to help out with this project, but consider lending us a fake username to work with, User#38..., so we can all be on friendlier terms -- I'm no good with numbers ;) It's great to have some objective points of view, if you don't mind working with me as someone who has been there, done that, within the system and without. I have the experience, and I've done my homework on this subject by reading innumerable references from the "other" side -- as with UC research, which is limited in scope, it's often difficult to tell which studies are skewed, biased, or basically anecdotal.

So, in that respect, I agree with User#38... that this subject is best presented as a simple short article on something people *do*, which was my original intent. I don't agree that it's necessary to include a section on "Controversy" -- I don't see that included in the conventional childbirth articles, but maybe I missed something. What I don't want to perpetuate is the biased notion that UC is practiced only by the radical fringe. If we can't do that by keeping it short and simple, then this is liable to be a long & difficult road to revision. Just curious - what exactly are Roadapples? :)

I'm glad Siofra (and User#38...) is making a point to take time to research this thoroughly -- I have been at it for the past twenty years, and now I am in the process of learning the technical end of Wikipedia by reviewing similar articles in style and content. I am being slow and deliberate, not because I object to incorporating your suggestions, but because there is much to learn. I did think it was important to restore the references in the proper format, and again, the books, websites, and organizations listed support the practice of a natural, unhindered birth. FYI, UC did not grow out of the natural childbirth movement; it predates it by a long shot. Jeannine Parvati Baker was an advocate, but one of many who supported the movement, and I did not feel it was necessary to elaborate on that within the article.

I'll be back to review the comments more closely and try to respond in more detail, if needed. Just wanted to let you know that I appreciate everyone who has contributed to this discussion and hope that we can continue to work together to make this an article worthy of the Wiki! Enjoy the weekend, Amigos! Penne 65.35.224.96 12:12, 31 March 2006 (UTC)

[edit] Removed Tags

As no comment has been made on my restructure after one week I have removed the tags. Maustrauser 21:48, 8 April 2006 (UTC)

[edit] Follow-up Note

Greetings to Maustrauser & Quickening! The improved layout should be pleasing to our regular contributors -- your efforts are appreciated. Although the tags have been removed, I hope that everyone will still feel free to collaborate in improving upon the overall content of the article. I have to admit that I have been coming directly to the Talk pages to check on followups this past week, and did not see the new changes to the article itself. I'm assuming that your edits are simply composed of the format changes, along with additional text in the "Higher risk view" and "Prevalence" sections. The former has been edited to reflect the WHO statement which actually notes the rate of cesareans (rather than required sections) in developed countries. References from the article have also been provided to clarify the various controversies over this practice. Please let me know if this change is agreeable. Welcome to the discussion group! PenneArdICS 12:31, 10 April 2006 (UTC)

[edit] Co-Editor's Comments

Thank you for the greetings. You will find me loitering around many of the childbirth articles. I'll look through your edits when I have some time after work, but most look pretty good so far, although I think the extensive focus on caesarean is better off in the caesarean section article than here. Could you please sign your contributions with four tildes please. You might also wish considering changing your view of yourself from 'author' to editor. Author professes some kind of ownership whilst editor suggests that you are one of the team. Anyway, it's great to see this article being written. Cheers, Henry Maustrauser 22:47, 10 April 2006 (UTC)

Me again. I think the article is getting there, but I think we need a more concise and focussed discussion regarding the low risk and higher risk perceptions of UC. I also do not like the length of discussion of caesarean in the high risk section. It just doesn't make sense. It should be in the caesarean article, not here. My point about CS is the view of the WHO that the 'natural rate' of CS is about 10%. Therefore regardless of obstetric fashion about 10% of women will require CS. If the woman is unassisted then knowing when a transfer to hospital for a CS is required is far more difficult. Further, whilst a midwife attending a home birth can deal with a PPH because she is carrying drugs, UC support people cannot deal with it. These points need to be covered for this to be a balaced article. I'd like others views before I make editorial changes. Oh, finally, I think there are far to many links and we could be drifting into link-spamming here. I don't see why Purebirth Australia needs two links... Maustrauser 11:51, 11 April 2006 (UTC)

I thought the caesarean section (Oh dear, did I just make that unintentional pun?) is too long and doesn't really get to the heart of the issue-- it makes it sound like this is an either UC or caesarean. It isn't irrelevant, but the primary questions people reading this article might have would have would be more along the lines of "Why totally unassisted? What's wrong with natural childbirth with a sympathetic doctor/midwife? Is it wise or responsible to just give birth by yourself in the bathtub when so many things could go wrong? Why not be someplace where, if there is an emergency, you can do something about it quickly?" Maustrauser makes excellent points.

The UC POV is that childbirth is natural and complications are unlikely or are actually caused by medical intervention; the "higher risk" POV might touch on how human childbirth is a bit more complicated than it is among other mammals, and might touch on some of the complications people have expressed as concerns (This could be done with links to other articles in Wikipedia-- I believe there are articles about infant and maternal mortality, pre-eclampsia, etc. Although most reasonable people would agree that C-sections are overdone and too often for all the wrong reasons, they have saved lives and prevented serious health problems. This section doesn't have to be long.

Hmmm what else? I agree there may be too many links. The link to La Leche League doesn't make sense to me-- they are an advocacy group for breastfeeding, not UC. Philosophically they are certainly on the same page with UC folk, but there are other articles on breastfeeding in Wikipedia. For what it is worth, I was tempted to put up a link to the Hathor Cow Goddess comic strip, but decided against it because although it is topical, it doesn't really help the reader learn about UC.

Just thoughts! 66.30.237.235 02:00, 21 June 2006 (UTC)

[edit] Follow-up Note

Happy to see you back, Maustrauser! Hope you enjoyed the long weekend (if you're in a spot o' the world which takes a break for the Easter holiday.) Really appreciate the latest suggestions and have made a few editorial changes within the Talk section which I hope meet with approval. I was hoping to give the others a chance to toss in their two cents, but I'm afraid they may have lost interest in this project. Of course, they could be like me and have other obligations which demand time as well. I hope you don't mind the relaxed pace here.

I agree with you that the info on cesarean runs a little too long for this article, but I thought I'd provide some of the background for editorial review and see what everyone had to say. As for meeting L&D emergencies, according to Gregory White's "Emergency Childbirth" -- most, if not all, complications in labor and delivery can be met successfully if addressed within thirty minutes or so of encountering the problem. As to the degree of difficulty in diagnosing certain conditions, that can only be speculated, since a mother's natural instincts in determining and correcting a problem are often overlooked and/or circumvented.

As an example, PPH (Postpartum Hemorrhage) can be handled entirely without drug intervention, but it would be rare to find a natural solution implemented by conventional medical practitioners. Based on my own experience in the ER with PPH as a direct result of an OB's lack of competence and integrity, breastfeeding stops the bleeding faster than a hefty dose of Pitocin! Neither the OB on call nor the nursing staff were aware of its effectiveness until I suggested and demonstrated it as an alternative to the artificial method being proposed.

Years before that, I was transferred at the midnight hour, fully dilated, and endured an unnecessary cesarean by my midwife's backup OB (this was later confirmed by the other partners in the clinic,) which may explain why I saw a need to clarify the idea of "required" sections with the WHO's published "rate" of cesarean along with an explanation of what actually fuels those statistics (none of which can be conclusively confirmed as "natural" or necessary from what I understand.)

I believe this is relevant information needed to address the commonly-held beliefs surrounding the perceived risks (both high and low) of unassisted childbirth, but again, I agree that the delivery of the content needs some work. Unfortunately, I don't have a copy of White's text handy (which is used by emergency personnel, police, firemen, etc., in birthing situations) but will look for some direct references which should provide some valuable information and insights for use in this section as well.

Thanks also for the reminder to sign my notes -- I completely forgot to do that last time. If you don't mind, I'd be pleased if you would add a header to new comments so they show up in the Table of Contents above. Makes it a bit easier to navigate the page, enabling others to quickly determine where one note ends and another begins. Enjoy your week, Amigo! PenneArdICS 12:31, 18 April 2006 (UTC)

[edit] Really *small* edit

Just popped in to update the US Cesarean statistics which are now at 29.1% instead of the previous listed 23%

Source: CDC C/section rate for 2004

http://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths04/prelimbirths04health.htm

[edit] Return of Siofra

Hi there! I'm back. Sorry for vanishing and My deepest apologies for dropping the ball. It wasn't personal-- its just that my professional life got very chaotic and stressful, and a lot of my best laid plans went very awry.

I just wanted to say that whoever reworked this article did an admirable job. I think the NPOV issues are resolved and it is of to a fine start. I really like the balance of the article-- its informative, and covers different points of view in a way that isn't distracting.

Somewhere in my research I came up with some interesting resources about the history of childbirth an at what point in human history birth became less solitary and more social for the sake of the mother's survival (birth being much riskier for human beings than for any other species). I wouldn't ant to clutter the article with too much history or analysis, but maybe a reference in there might be appropriate.

Anyway, good work! Siofra Heaney 00:57, 20 June 2006 (UTC)

[edit] Follow-up Note

Better late than never, I say :) I've been focusing on other projects myself and haven't been able to get back to this one in a while. I'm also satisfied with the preliminary results thanks to your own and others' input, and look forward to seeing our work evolve into a full-fledged article in the future. I'll be interested to learn how and why human birth came to be perceived as "much riskier" than any other species. My individual experience doesn't bear that out. Glad you had some time to stop over and share your impressions -- hope things are working out better for you in your professional endeavors these days!

Enjoy the week, Amiga PenneArdICS 13:56, 10 July 2006 (UTC)

[edit] TOC right

Hello every body, I have moved the Table of Conents to the right. If nobody likes it please feel free to change it back.--Arjun 21:36, 7 November 2006 (UTC)