After watching The Business of Being Born, Gawande's article was really helpful in understanding why things are done the way they are.
As a legacy of upright locomotion balanced with large cranium size and infant helplessness, humans have ended up with an objectively poor design for giving birth to offspring. Death during that process is “natural”.
Not everyone giving birth is a fit 25 year old with absolutely no other health issues and a desire to have several more kids.
Tsk tsk all you like about women “waiting too long” - the majority of first-time mothers over 40 have c-sections. Would my child and I have survived a natural birth? Most likely. Would I definitely not have further damaged my diaphragm, debilitating me far more than the planned c-section did (hardly at all) at a point when we could least tolerate it? My gyno, my gastroenterologist, and I decided the c-section was a much better bet for both me and my child.
In retrospect, this guy is practically the prototype of villain in healthcare. He's Eric Lander levels of villainy.
He shouldn't be considered a credible voice just out of corruption. There are many doctors who can write.
Consider his role at Partners (now "Mass General Brigham"): overseeing the growth of a notoriously money grubbing institution, run anticompetitively, despite the excellence of its providers. He has parlayed... saucy New Yorker writing into becoming the very hospital administrator who is responsible for all the fuckups he shits on.
Trust me, if he has something to say about, I don't know, fucking childbirth, it has been known to everyone for years. The difference is his presence in The Magazine New Yorkers Care About lets him omit anything shitty to say about himself and his Partners.
With all due respect your post sounds a little like a conspiracy theory without a set of good sources.
Is the claim that someone is evil even an intellectual position (versus, a religious one)? And finally but not facetiously, does being evil invalidates a technical statement they're making -- sounds like an ad hom?
what has he done that’s bad?
To put it another way intuitively, in a complicated world with so many things impacting so many other things, to have a totally uniformly random birth times or dates would essentially require some active force to smooth the times and dates out, because it is beyond implausible that absolutely nothing would have an impact. From diurnal hormone cycles, traffic cycles, preferences about surgery times, and probably another dozen things you could think of that could impact the times, it is implausible to expect that they would all be completely wrong or that they would all precisely cancel.
Uniform randomness is a very convenient mathematical fiction for making Statistics 101 problems easy enough for students to do. This is a necessary thing and it's hard to imagine how to avoid it. But in reality almost nothing is ever truly uniformly random. There's always something out there that's going to correlate it with something. It is a sad side effect of this need to simplify problems enough to be tractable by students that we end up teaching that uniform randomness is somehow the "default" distribution and the others are exceptions or something.
I don’t know much of anything about the other people in the OR, if the assistants stick to a particular group of surgeons or float. The people handling tools and gauze pads (which sounds like a dumb job but someone has to be sure that 12 pads and a clamp went into your abdomen and exactly that number came back out at the end), clamps, retraction, suction, IV and gas monitoring, etc etc. Those are somewhat specialized to the task but I don’t know if they are specialized to a surgical unit or if the same people who help with a appendectomy also assist with a finger reattachment or spinal surgery. If they do a surgery could get bumped for scheduling conflicts, or shift changes.
With the former you’d expect a normal distribution (not uniform) due to the central limit theorem - the sum of a large number of variables with some error distribution will result in a sum with a normal distribution. This isn’t math 101 but an incontrovertible fundamental finding of Calculus (and 100% applies to the real world).
The article explains the latter phenomenon though. Births are being scheduled due to C-sections. This isn’t a confluence of some interesting factors into a surprising result but the presence of one factor that overrides all others and one that has grown in popularity due to the efficacy of modern techniques.
You'd expect it, but in the real world you'd be extremely frequently wrong. Correlations in the real world very frequently end up defeating the central limit theorem in practice.
The central limit theorem, being a mathematical thing, is correct; it can't be "wrong". However, while adding together a lot of distributions will absolutely trend towards a normal distribution, it does not make very many promises about how "quickly" that will happen. In practice the real world is filled with the sort of pathologies that result in it being "very slow". Scare quoting some words here because they are rather vague in math terms and I feel bad about that, but putting real mathematical meat behind them would be beyond the scope of an HN post. Many, many, many things are not normal that "should" be, and you can make some grave mistakes in the real world if you overestimate the normality of real world distribution. I recommend Taleb's works here, if you need more details.
Says the dad of the child born at 4pm on a Friday...
Doctors are pretty much dicks, and the entire American system is massively broken.
The midwife attended from around 7pm the night before. She suggested getting a good nights sleep.
Natural births aren’t random. They are the result of lots of pushing and a little pulling.
Getting a good nights sleep is a good idea.
I can’t believe this is even a question.
Edit: My wife corrected me on this. She claims she didn’t sleep the night before, but I’m about 70% certain she nodded off quite a bit.
Allegedly this is because so many people are on vacation it's not really a safe day to have an emergency. I am not convinced by that "explanation".
The worst time is 6:30AM (or whenever half an hour before changeover is). You either get C staff and/or people who have been awake for 24 hours. The surgeon probably called that time so they could book night rates.
If you have yours at 8am, then your last meal was dinner, maybe 12-13 hours ago. If you have yours at 4pm, then you might not have eaten for 20 hours.
Not sure how it works for small hospitals.
The reason he scheduled for then was so he could still do office hours. His office closes at noon. Don't like the guy.
Congrats on the baby!
I'm an anesthesiologist. My wife needed surgery. And the surgeon is a friend of mine from childhood and needed to leave that afternoon. We had a free OR. Even then, it took 2.5 hrs to get her registered, up to the surgical floor, and to the OR.
So, maybe that doctor is a jerk, but realistically, it takes a while even if you have the inside track on everything.
Afternoon, after the first cups of coffee have worn off, and after the natural exhaustion from a long shift is not when you want to be having a C section.
Of course this doesn't mean you're wrong—it means you need to present your view thoughtfully and in a way that appeals to curiosity. That's especially important if your view happens to be right, so it's in your interest. (I'm adding this because the field around childbirth is intense and there are such strong feelings about it—justifiably.)
We detached this subthread from https://news.ycombinator.com/item?id=33437247.
I was literally 3 days ago. And "butcher shop" is nowhere close to how I describe it.
And anyway, people get surgeries all the time, how is this any different?
A Caesarean is often performed even when it is not medically necessary. Hence "why are so many babies born around 8:00 AM"? Additionally, above a certain rate in industrialized countries, they are not even associated with better birth outcomes.
> And anyway, people get surgeries all the time, how is this any different?
Because childbirth is not an injury or deformity that requires fixing (or any intervention) in the large majority of cases. Surgery should be done when medically necessary. A Caesarean has many potential side effects for the mother and the infant, and doing it just to hurry things up is (IMO) unethical.
And poking the "birth options bear" is not something you want to do unless you're really in for a fight. There are strong opinions available.