We Need Fewer C-Sections

Question: What is the number one issue that needs to be addressed today when it comes to reproductive health? 

Judy Norsigian: In the industrialized world we have a number of problems when it comes to reproductive health and I have to say we have to distinguish the United States from other countries because other countries are not as schizophrenic about say, the subject of abortion. Most industrialized countries have relatively reasonable access to abortion. It is an incredibly important part of reproductive healthcare. It’s not the only service, but there are some women who need access to abortion for a variety of reasons and that really ought to be available and it should be covered by any health plan. We have a huge problem there, which I won’t get into right now. We also have to make sure that women have better access to contraceptives even if they can’t afford some of the more expensive ones and they have access to good information and that we do a better job educating the public about the need for what we call dual protection, protection against unwanted pregnancy if that is what we want and protection against sexually transmissible infections, not just HIV AIDS, but a host of other things, Chlamydia infections, certainly want to prevent HPV infections and those are things we really need to do a better job on. 

When it comes to maternity care we’ve actually slid backwards. In the United States it looks like our maternal mortality rate is starting to climb and certainly in some states we’ve demonstrated that. And the reasons are multi factorial, but the most important thing I want to underscore here is that this is an example where our high-tech inappropriately interventive approach has produced a downside. We’re doing way too many cesareans. It’s about one in three nationally, but we have many states and many communities where it is now 40, 50% cesarean section rate. I know in New Jersey there are hospitals that have 50 to 70% cesarean rates. This is unacceptable and of course it’s going to produce harm because cesarean section is a major abdominal surgery. Even if the surgery goes well you have all kinds of infections that occur in hospital settings. And we have an increase in MRSA, methicillin-resistant Staphylococcus aureus. MRSA infections are not often easily treatable with antibiotics and in fact some of our big guns like vancomycin aren’t doing such a good job and you need IV, intravenous antibiotics and long stays in hospitals sometimes to recover. 

This can happen after a cesarean just like after any surgery. These are kinds of things women don’t appreciate, so we’re trying to educate women to think about what are best practices in maternity care. The best way to avoid an unnecessary cesarean section is to choose a midwife, whether it is a freestanding birth center or in a hospital setting where midwives can really practice midwifery or a homebirth setting and we’ve got good data that homebirths for low risk, uncomplicated pregnancies are as safe as hospital births. That data have been in for several years now and it’s really a turf problem that we’ve got where we see obstetricians scaring women into think this is risky tantamount to child abuse, ridiculous things when women suggest that it might be reasonable to have a homebirth or a freestanding birth center birth. These are actually wiser approaches and we have been involved in producing a 14 minute DVD largely designed for Massachusetts legislators who are considering a midwifery bill right now, but it is something we hope to have on YouTube soon so that the larger public can understand from the perspective of consumers and doctors. We have no midwives speaking in this DVD. It’s only physician couples who have used midwives and other couples who are very well-educated and physicians who understand the benefits of midwifery care speaking about the benefits of the midwifery model and it’s that kind of DVD or video that we want more of the public to see so they understand that what they’re getting from mainstream sources of information is not necessarily the best thing when it comes to how to go about having a baby in this country today. 

Question: Does the recent Lancet study threaten commitments to women’s health? 

Judy Norsigian: I was speaking at a conference of reproductive health providers just yesterday where we talked about the front page article in the New York Times describing the Lancet study, which gave us our first really good news that all the things we’ve been doing, many different interventions are finally having an impact on reducing maternal mortality in developing country settings. Now about 40 to 50% of the maternal mortality is created in 6 countries and one of them is India, which of course has nearly a billion people.  They’ve done a really good job in recent decades in lowering the maternal mortality rate, so they have a big impact on the overall figure for maternal mortality worldwide. It’s a great thing the Lancet article came out. None of us at this meeting thought it would harm the investment and reduction of maternal mortality. In fact, finally we’ve got evidence that things we’ve been doing are being successful so that we should be pouring in more resource, investing more money in these approaches to reducing maternal mortality. It’s not about reducing our commitment. Now that we’ve shown this works we’re going to increase our commitment. And there are also some interesting things about this study we should not forget and that is that in places like Eastern and Sub Saharan Africa a big killer of pregnant women is HIV AIDS and so the solution is not getting women immediate obstetrical emergency coverage. It’s about getting antiretroviral to pregnant women because 60,000 deaths in that region were caused by HIV AIDS related problems. It wasn’t because a woman was in labor had obstructed labor, was hemorrhaging, had an infection and couldn’t get appropriate medical care. It was really the HIV AIDS problem. So it depends on where you are as to how you’re going to intervene in the problem of maternal mortality and pregnant women who are struggling with HIV AIDS have to really get that addressed in some cases first and foremost. 

Question: What about when it comes to the developing world? 

Judy Norsigian: Well in less industrialized countries there is no question that if we don’t support the health of women who are the mothers of children in future generations and very often they do double, triple duty. They’re working in the fields. They are taking care of the home. They are the ones who have to put food on the table. They don’t get access to education. We know now that the single most important thing we can do is make sure that young girls stay in school, that they get an education. That will more than anything else help them improve their own ability to be healthy, their ability to have healthy pregnancies, to be mothers who aren’t stranded with few resources and families they can’t feed. This would be the most important thing we could do and it means overcoming a lot of sexism, a lot of very negative attitudes about women and the need to put women in powerful positions in communities. Women are often not allowed leadership positions in government, community, state, national. These things have to change and when we see change there we see usually a trickledown effect in that women do better. The communities do better. Children do better. Overall health improves. 

Recorded on April 20, 2010

One in three babies is delivered via Caesarian section. "This is unacceptable and of course it’s going to produce harm."

China's "artificial sun" sets new record for fusion power

China has reached a new record for nuclear fusion at 120 million degrees Celsius.

Credit: STR via Getty Images
Technology & Innovation

This article was originally published on our sister site, Freethink.

China wants to build a mini-star on Earth and house it in a reactor. Many teams across the globe have this same bold goal --- which would create unlimited clean energy via nuclear fusion.

But according to Chinese state media, New Atlas reports, the team at the Experimental Advanced Superconducting Tokamak (EAST) has set a new world record: temperatures of 120 million degrees Celsius for 101 seconds.

Yeah, that's hot. So what? Nuclear fusion reactions require an insane amount of heat and pressure --- a temperature environment similar to the sun, which is approximately 150 million degrees C.

If scientists can essentially build a sun on Earth, they can create endless energy by mimicking how the sun does it.

If scientists can essentially build a sun on Earth, they can create endless energy by mimicking how the sun does it. In nuclear fusion, the extreme heat and pressure create a plasma. Then, within that plasma, two or more hydrogen nuclei crash together, merge into a heavier atom, and release a ton of energy in the process.

Nuclear fusion milestones: The team at EAST built a giant metal torus (similar in shape to a giant donut) with a series of magnetic coils. The coils hold hot plasma where the reactions occur. They've reached many milestones along the way.

According to New Atlas, in 2016, the scientists at EAST could heat hydrogen plasma to roughly 50 million degrees C for 102 seconds. Two years later, they reached 100 million degrees for 10 seconds.

The temperatures are impressive, but the short reaction times, and lack of pressure are another obstacle. Fusion is simple for the sun, because stars are massive and gravity provides even pressure all over the surface. The pressure squeezes hydrogen gas in the sun's core so immensely that several nuclei combine to form one atom, releasing energy.

But on Earth, we have to supply all of the pressure to keep the reaction going, and it has to be perfectly even. It's hard to do this for any length of time, and it uses a ton of energy. So the reactions usually fizzle out in minutes or seconds.

Still, the latest record of 120 million degrees and 101 seconds is one more step toward sustaining longer and hotter reactions.

Why does this matter? No one denies that humankind needs a clean, unlimited source of energy.

We all recognize that oil and gas are limited resources. But even wind and solar power --- renewable energies --- are fundamentally limited. They are dependent upon a breezy day or a cloudless sky, which we can't always count on.

Nuclear fusion is clean, safe, and environmentally sustainable --- its fuel is a nearly limitless resource since it is simply hydrogen (which can be easily made from water).

With each new milestone, we are creeping closer and closer to a breakthrough for unlimited, clean energy.

The science of sex, love, attraction, and obsession

The symbol for love is the heart, but the brain may be more accurate.

  • How love makes us feel can only be defined on an individual basis, but what it does to the body, specifically the brain, is now less abstract thanks to science.
  • One of the problems with early-stage attraction, according to anthropologist Helen Fisher, is that it activates parts of the brain that are linked to drive, craving, obsession, and motivation, while other regions that deal with decision-making shut down.
  • Dr. Fisher, professor Ted Fischer, and psychiatrist Gail Saltz explain the different types of love, explore the neuroscience of love and attraction, and share tips for sustaining relationships that are healthy and mutually beneficial.

Golden blood: The rarest blood in the world

We explore the history of blood types and how they are classified to find out what makes the Rh-null type important to science and dangerous for those who live with it.

Abid Katib/Getty Images
Surprising Science
  • Fewer than 50 people worldwide have 'golden blood' — or Rh-null.
  • Blood is considered Rh-null if it lacks all of the 61 possible antigens in the Rh system.
  • It's also very dangerous to live with this blood type, as so few people have it.
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There never was a male fertility crisis

A new study suggests that reports of the impending infertility of the human male are greatly exaggerated.

Sex & Relationships
  • A new review of a famous study on declining sperm counts finds several flaws.
  • The old report makes unfounded assumptions, has faulty data, and tends toward panic.
  • The new report does not rule out that sperm counts are going down, only that this could be quite normal.
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