Something I think people should be aware of is how the resurgence of midwifery in the Western world is a response to our increasing negligence in taking care of expectant and birthing mothers. In the United States, my sister giving birth today is almost twice as likely to die in childbirth as her mother was thirty years ago. A few months ago Ars Technica covered a study on the reasons why, and it boiled down almost entirely to doctors and nurses neglecting their patients or even straight-up ignoring them.
https://arstechnica.com/science/2018/07/why-do-so-many-moms-...
I would absolutely urge anyone to hire a midwife to attend a hospital delivery. It's the only way to guarantee at least one professional in that room cares.
This might be true in the US but hardly in the entire "western world". Here in France you can give birth in a hospital without ever having a doctor intervening, only midwives, and it is not a new thing.
As a counter to this point there have been scandals in England (eg Morcambe Bay, but there are others) where midwives killed babies through a combination of incompetence and arrogance, creating a dysfunctional culture that promoted midwifery to the exclusion of other professions - all because they had an unrealistic belief about "normal birth".
In England it seems the safest option is to have a mid-wife led birth with medical help available. Having a consultant obstetrician available appears to decrease rates of intervention, not increase them.
Here in NZ, midwife care has taken over to the point where you can no longer get a doctor involved in your primary care at all unless you go fully private obstetric care, which isn't even available where I live.
Midwife-led care has become a weird sort of political and social issue here. It's intricately tied into a narrative about how natural childbirth is better, regardless of the evidence, and much of the culture surrounding it is basically dogma. It's also heavily gender-based - I've never heard of a male midwife here, and a lot of the muttered suggestions about the general terribleness of conventional medical ante-natal care clearly paints male doctors as the bad (or at best, uncaring) guys. There was a study released detailing that our support is not anywhere near as good as we would like to believe (see https://www.stuff.co.nz/life-style/parenting/pregnancy/birth...), which the Ministry of Health got involved in trying to quash and ultimately succeeded in having ignored. I understand the midwives' vested interest in trying to control this narrative, but the only reason I can think of for the Ministry to get involved is that they like midwife-led care because it's cheaper, or that they don't want to admit that going as far as we have down this route might not have been the best idea.
We had a terrible experience with midwife care, and if we were able to have another child (we're not, in part because of the first delivery) we would move somewhere that allowed us to have actual medical professionals involved in our care.
There's a really worrying narrative in all of this, along the lines of that doctors are either incompetent or somehow uncaring about childbirth or women's issues relating to it. Massive reduction in maternal and neo-natal death and complication rates is one of the most amazing results of modern medicine and science in general, ever. I'm still embarrassed to admit how I got sucked in by the alternative narrative despite being someone who likes to look at evidence.
Is this in the US? Are midwifes an optional thing? I've had experience with births in Australia and the UK where hospital midwifes led the process, from antenatal to birthing and postnatal.
Maybe. I’m not sure I believe that. Recall that a greater proportion of births are now coming from poorer people in worse conditions and often worse health to begin with. If you are middle class+, You’re probably at top tier rates competitive with the rest of the world.
Mortality rates are often twice as high for non whites in America likely due to wealth effects.
The US has 2 levels of obstetrics professionals -- MD/DO and Certified Nurse Midwife. CNM's are nurse practitioners with a Masters or Doctorate degree. They don't do surgery, and the smart ones don't do births outside the hospital.
In the US you also have "Professional Midwives", Doula's and Certified Professional Midwifes -- none of which have any real health care training requirements. In most other countries when they speak of midwifes, they mean nurse midwives.
> It's a matter of fairness. Riskier jobs should have higher salaries.
Interesting argument which I doubt anyone here agrees with. After all, that would mean builders, miners, street sweepers and the like would be paid the highest, midwives somewhere in the middle and us right at the bottom.
Not sure who 'us' is; HN readership is pretty diverse. I'm a scientist and earn roughly the same as a midwife in Australia.
Having said that, my first child nearly died during birth, and having a very good midwife who knew the signs, made all the right decisions, got the emergency doctors in at the right time - that service was utterly invaluable.
I'm all for the average midwife being paid somewhat more than me if it leads to more of these outcomes.
I dont see it as her claiming that riskier jobs always should be paid more than safer jobs. Only that the risk factor should have a larger impact on the salary.
> Interesting argument which I doubt anyone here agrees with.
Quite the contrary, I think everybody agrees that risk is one important factor in salary expectations.
But workforce availability is another important factor!
If more people are available to work on scaffoldings rather than in a cosy office, well, scaffoldings will pay less!
And yes, I do understand that working in a office usually requires some training that not eveybody has the priviledge to afford: I'm just stating the facts, but I don't want to imply that this situation is fair.
Even if you concede that point we're left with the question of why midwifery is especially risky in Ethiopia. Do they not have access to basis safety equipment?
Paying a government-funded profession based on risk creates perverse incentives. You'd have midwives campaigning against introducing surgical gloves because they've got a family to feed and don't want to lose the risk pay.
Train drivers tend to be paid very highly, and I've heard the reason for that is a kind of risk. If something goes wrong (which it really can do catastrophically) then they shoulder the risk.
To look at it from the other side, don't apologists for capital say that the boss should collect profit (and in perpetuity too) because of the "risk" she took to start the company?
I get that you're tackling this specific argument, but it's important to remember the context too.
She makes between $56 and $85 dollars a month. Working 12 months a year, for 50 years, she'll make a total of around $42,000 dollars. It's hard to argue that is remotely fair.
Back when I worked in an office, I saw more than one coworker get carted off (heart attack) from sitting at a desk all day. These days I move around a lot and I regularly have to put on a harness for working at height, and I've never seen or heard of anyone actually falling into their pro, much less getting hurt from a fall. Heart disease is still the #1 killer in America, by a fair margin, and has been for many decades. Is my new job "riskier"?
I'm not sure I agree or disagree with the statement, but only because I'm no longer convinced that capitalism is a viable system for allocating resources. In fact, I think this is a great argument against it. Dangerous jobs often do pay more, so people who need money will take these jobs -- even though the people who are desperate for a good paycheck are also often the least able to deal with the consequences of this risk. Financial desperation makes people ignore the long term, and people simply aren't good at understanding very-low-probability events. Dangerous jobs mean people will get hurt, which further limits their earning potential, and limits economic mobility. It's a terrible feedback loop.
But then, salaries have never made much sense to me. I'm not able to look at two friends and say "Yeah, X makes 10 times as much money as Y, and deserves it". Most of the people I know doing the most worthwhile things for society are also those earning the least money.
The very word "should" implies that there should be some one valid opinion or source of truth on that matter. I'd rather take decentralized market-based approach where the prices of it is decided by all the small decisions of a lot of ordinary people rather than try and debate it in attempt to come to some agreement with anyone.
You make a tedious point that's not worth addressing, but it's important to point out that even in Midwiferey men get promoted faster than women, and get promoted higher than women.
In England in September 2016 in band 5 there were 2301 women midwives and 11 men midwives. At band 8c there are 11 women midwives and 2 male midwives.
That ratio at band 5 isn't maintained as you move up the bandings - as you increase money and management responsibility. We see more men and fewer women, despite the very much larger pool of women to chose from.
[+] [-] Causality1|6 years ago|reply
I would absolutely urge anyone to hire a midwife to attend a hospital delivery. It's the only way to guarantee at least one professional in that room cares.
[+] [-] OneFamousGrouse|6 years ago|reply
[+] [-] DanBC|6 years ago|reply
Normal birth is defined here: https://betterbirths.rcm.org.uk/resources/read/defining-norm...
Here's the Kirkup report: https://assets.publishing.service.gov.uk/government/uploads/...
Here's the RCOG response: https://www.rcog.org.uk/globalassets/documents/news/rcog-res...
The RCM dropped their campaign around "normal births" shortly after Kirkup, and launched "better births": http://www.rcmnormalbirth.org.uk/
A news report that's a nice summary: https://www.theguardian.com/society/2017/aug/12/midwives-to-...
In England it seems the safest option is to have a mid-wife led birth with medical help available. Having a consultant obstetrician available appears to decrease rates of intervention, not increase them.
[+] [-] lemming|6 years ago|reply
Midwife-led care has become a weird sort of political and social issue here. It's intricately tied into a narrative about how natural childbirth is better, regardless of the evidence, and much of the culture surrounding it is basically dogma. It's also heavily gender-based - I've never heard of a male midwife here, and a lot of the muttered suggestions about the general terribleness of conventional medical ante-natal care clearly paints male doctors as the bad (or at best, uncaring) guys. There was a study released detailing that our support is not anywhere near as good as we would like to believe (see https://www.stuff.co.nz/life-style/parenting/pregnancy/birth...), which the Ministry of Health got involved in trying to quash and ultimately succeeded in having ignored. I understand the midwives' vested interest in trying to control this narrative, but the only reason I can think of for the Ministry to get involved is that they like midwife-led care because it's cheaper, or that they don't want to admit that going as far as we have down this route might not have been the best idea.
We had a terrible experience with midwife care, and if we were able to have another child (we're not, in part because of the first delivery) we would move somewhere that allowed us to have actual medical professionals involved in our care.
There's a really worrying narrative in all of this, along the lines of that doctors are either incompetent or somehow uncaring about childbirth or women's issues relating to it. Massive reduction in maternal and neo-natal death and complication rates is one of the most amazing results of modern medicine and science in general, ever. I'm still embarrassed to admit how I got sucked in by the alternative narrative despite being someone who likes to look at evidence.
[+] [-] Pandavonium|6 years ago|reply
[+] [-] b_tterc_p|6 years ago|reply
Mortality rates are often twice as high for non whites in America likely due to wealth effects.
https://www.kff.org/other/state-indicator/infant-mortality-r...
[+] [-] sgent|6 years ago|reply
In the US you also have "Professional Midwives", Doula's and Certified Professional Midwifes -- none of which have any real health care training requirements. In most other countries when they speak of midwifes, they mean nurse midwives.
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] rich-tea|6 years ago|reply
Interesting argument which I doubt anyone here agrees with. After all, that would mean builders, miners, street sweepers and the like would be paid the highest, midwives somewhere in the middle and us right at the bottom.
[+] [-] gravelc|6 years ago|reply
Having said that, my first child nearly died during birth, and having a very good midwife who knew the signs, made all the right decisions, got the emergency doctors in at the right time - that service was utterly invaluable.
I'm all for the average midwife being paid somewhat more than me if it leads to more of these outcomes.
[+] [-] pgsandstrom|6 years ago|reply
[+] [-] pif|6 years ago|reply
Quite the contrary, I think everybody agrees that risk is one important factor in salary expectations.
But workforce availability is another important factor!
If more people are available to work on scaffoldings rather than in a cosy office, well, scaffoldings will pay less!
And yes, I do understand that working in a office usually requires some training that not eveybody has the priviledge to afford: I'm just stating the facts, but I don't want to imply that this situation is fair.
[+] [-] dmichulke|6 years ago|reply
- who takes the risk? (employer vs employee vs employer's clients vs state vs insurance)
- how transitive is the risk? (is A on the hook for B's risk as well?)
Only two dimensions but it's already a mess to think it through.
[+] [-] avar|6 years ago|reply
Paying a government-funded profession based on risk creates perverse incentives. You'd have midwives campaigning against introducing surgical gloves because they've got a family to feed and don't want to lose the risk pay.
[+] [-] claudiawerner|6 years ago|reply
To look at it from the other side, don't apologists for capital say that the boss should collect profit (and in perpetuity too) because of the "risk" she took to start the company?
[+] [-] viraptor|6 years ago|reply
I'm not sure why street sweepers would be risky. But the rest, sure. Miners are already paid quite a lot in many places.
[+] [-] Tomminn|6 years ago|reply
She makes between $56 and $85 dollars a month. Working 12 months a year, for 50 years, she'll make a total of around $42,000 dollars. It's hard to argue that is remotely fair.
[+] [-] ken|6 years ago|reply
I'm not sure I agree or disagree with the statement, but only because I'm no longer convinced that capitalism is a viable system for allocating resources. In fact, I think this is a great argument against it. Dangerous jobs often do pay more, so people who need money will take these jobs -- even though the people who are desperate for a good paycheck are also often the least able to deal with the consequences of this risk. Financial desperation makes people ignore the long term, and people simply aren't good at understanding very-low-probability events. Dangerous jobs mean people will get hurt, which further limits their earning potential, and limits economic mobility. It's a terrible feedback loop.
But then, salaries have never made much sense to me. I'm not able to look at two friends and say "Yeah, X makes 10 times as much money as Y, and deserves it". Most of the people I know doing the most worthwhile things for society are also those earning the least money.
[+] [-] golergka|6 years ago|reply
[+] [-] KON_Air|6 years ago|reply
[+] [-] Moru|6 years ago|reply
[+] [-] DanBC|6 years ago|reply
In England in September 2016 in band 5 there were 2301 women midwives and 11 men midwives. At band 8c there are 11 women midwives and 2 male midwives.
That ratio at band 5 isn't maintained as you move up the bandings - as you increase money and management responsibility. We see more men and fewer women, despite the very much larger pool of women to chose from.
[+] [-] pjmlp|6 years ago|reply
Some areas, specially consultancy agencies, do have a better M/F distribution than coding silos.