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Childbirth Pseudoscience

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We've attended a number of antenatal classes lately.  One major focus of these is the labour process, explaining methods of relaxing and how to help manage pain.  We were taught breathing exercises, focussing on breathing out (similar to coping techniques for an asthma attack).  Various active labour positions were shown to us, as the TV sterotype of lying on your back with legs akimbo is pretty much the worst position for childbirth.

One major benefit of these classes is that it gave me the sense that I have an active and beneficial role to play, rather than just sitting there like a lemon for hours holding Katherine's hand saying muttering vague sympathies and wondering if the bloke's role should be to pace up and down the corridor smoking cigars...

I digress.  So far, the advice given is all good common sense stuff that's well backed up physiologically.

However, some other advice about pain relief made my sceptical eyebrow raise.  The teacher at the NCT (National Childbirth Trust) class recommended arnica tablets as a pain relief (though the NHS classes made no mention of this).  I didn't think any more of it until Katherine bought some on a shopping trip with a friend.  They turn out to be a homeopathic remedy (i.e. sugar pills).  All the research I can find shows them to be nothing more than placebos as would be expected if you think about it (for example - http://archsurg.ama-assn.org/cgi/content/full/133/11/1187).  Now you might think that a placebo has a strong effect (and indeed it is), but at over £5 for a small tub of tablets it's just a plain rip off.  I may as well give Katherine some mints.

Another method of pain relief that is on potentially dodgy scientific ground is TENS, which consists of a small machine with four electrodes on wires that are placed on particular places on your back.  The machine sends pulses at certain frequencies that are said to "block" your pain transmitting nerves (though why this has no effect on other nerves with jobs such as motor or temperature sensing I have no idea).  This was recommended by both the NCT and the NHS.

The research into the effectiveness of TENS for childbirth seems inconclusive.  I'm not sure I quite believe the pain blocking theory of operation, but perhaps a better theory is that TENS performs a bit of neurological slight of hand.  The tingling sensation could be enough to distract the brain.  The human brain can only process so much information at once, so the pain is felt less strongly.

It is (to me) quite surprising given how much TENS was emphasised by the teachers as a good therapy (especially by the NHS who really should know better about clinical trials).  However, neither therapy seems to do any harm, which is why I think they're both recommended.  I guess a few good placebos are better than nothing.

I think it mostly comes down to the fact that childbirth is not a very predictable or controlled process.  It's different for everyone, lasts wildly varying lengths of time, different people have different pain thresholds, etc.  Bascially, there are far too many differences to make a good control group for a double blind trial into obstetric pain relief with good methodology.  You can't even test the same person through two labours with and without the pain relief because so many other factors will be different that the results would be meaningless.

Lent 2008

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Last year I avoided crisps and chocolate for 40 days.  This year I decided on fizzy drinks and caffeine. Before last Wednesday I was drinking about a dozen cans of Coke a week, sometimes more when stressed.  Then I went cold turkey. After a couple of days feeling lethargic, I'm now sleeping better, feeling more awake during the day, am less irritable and I can concentrate better.  I'm thinking of doing without caffeine and fizzy drinks on a semi-permanent basis.  I'm eating a little more, but I think that's just my body trying to make up for the lost calories. Overall I'd say this is a win! Happy Valentine's Day to everyone.
I gave blood last night for the second time in my life.  It all went well, the test droplet sank like a stone (meaning I've got plenty of iron in my blood), so there's now another bag of B negative available to the NHS. My left arm was hurting like hell last night which wasn't good.  Also, I felt really rubbish this morning.  I just could not get out of bed and ended up oversleeping by three hours.  I ended up taking the morning off work because I didn't feel like I was safe to drive. Feeling a lot better now though, and I hope it benefits someone.
Got my blood donor card on Saturday. It turns out I'm B rhesus negative, which puts me in a 2% minority within the UK population. They sounded keen to have me back. Yay me!
I donated blood for the first time in my life last night. A relatively painless process, though I've been a little achy all over since, particularly in my arms and legs. I awoke this morning with backache too, though I think that's unrelated. The donation took place in a local church hall. As I was lying there being drained I noticed a sign on the wall stating:
Soft balls only on Sunday. If you want a hard ball, ask an adult.
The mind boggles. Anyway, I think the National Blood Service slogan "Do Something Amazing" is perhaps a little overstated, but I hope someone benefits from my donation. I shall be returning in four months to do my bit again.
It's pretty cold outside. I nearly froze my ears off cycling to work this morning (though that's my own fault for putting my woolly hat in the wash last night instead of putting up with the smell). I'm from the North of England originally (Liverpool to be more precise) and as such, I think I handle cold better than most people I meet down here in sunny Guildford. In fact I often feel too hot (I feel too hot now in the office during a quiet lunchtime). My good friend OJ used to work at the same company as I do. He's from Australia, so there were times when I would be out at lunchtime in a t-shirt and shorts and he would be in his thick winter coat and a scarf to keep warm. Given he was brought up in a much warmer climate, this is totally understandable (though I still laughed at him!). What I don't understand is that whilst walking around town just a few minutes ago, I saw a few women dressed as though it is summer. Short skirts, the lot. Do they actually feel the cold or have they just learned to ignore it because (for them) it's better to look good than be warm? Or following OJ's reasons for feeling cold, are they from some frozen arctic wasteland and therefore used to a much colder climate? Most women I know seem to feel cold more than I do. My fiancée often uses me as a hot water bottle at night to warm her frozen feet. My mum (who was born in the same hospital as me and lived in the same house for 21 years) used to complain about being cold indoors, turning the heating on when I was sweating. Due to this anecdotal evidence, I grew up believing (probably incorrectly) that women feel cold more than men do, so who are these women who can wander around wearing next to nothing in mid December? I'm confused!

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