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Julia D.'s avatar

One day I decided to check out his writing. The first thing I laid eyes on was his stance that declining an epidural during childbirth is simply needless suffering. As someone who has done that three times and considers it one of the best decisions of my life, I disagree extremely strongly! It would be terrible if someone read his hot take and never got to experience a well-supported physiologic birth as a result. I made an immediate U-turn, like that Simpsons reaction gif, and plan to never return to his writing. No Gell-Mann amnesia here.

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dynomight's avatar

I’m interested—why do you consider it one of your best decisions?

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Julia D.'s avatar

(1/2)

I have enjoyed learning about so many interesting corners of reality from your blog that I hope my long response below is of some interest to you or other readers.

I had a very long, difficult first birth. You'd think that would be an extra reason to get an epidural. It's true that the amount of pain for that birth was in my opinion excessive, despite my reasonable preparation and supportive setting. I would have strongly preferred less pain. My subsequent two natural births had much more manageable amounts of pain.

Unfortunately, epidurals come with downsides and risks that I wasn't willing to take. And for long, difficult births, some of those risks scale, such that although the benefits of an epidural (pain relief) are greater, the risks are too.

Here are the main downsides and risks I can think of:

1. Spinal injury during placement (0.5-2.6%)

2. Medium-term back pain (10-25%). Recovery from birth is much easier without an epidural.

3. Fever (2% per hour of use). For a typical 8 hour epidural, that's a 16% chance of fever. Epidural fevers are typically low-grade, but any maternal fever triggers hospitals to separate mothers from babies at birth just in case it's due to an illness the mother has that the baby could catch. I think that since pregnancy and breastfeeding transfer maternal antibodies to the baby, babies would still be safer with their mother; but separation for fever is still typical hospital policy last I checked. Maternal-baby separation is very traumatic, especially for the baby. Most epidural users don't realize they're opting for a 16% chance of that.

4. Epidural drugs, including fentanyl, transfer to the baby. This negatively affects early reflexes, coordination, and breastfeeding. Long-term effects from drug exposure at this critical moment for the baby could be speculated, but I don't think there's strong evidence either way.

5. Labor is usually less effective with an epidural. Birth is not a straight exit for babies: they have to rotate and flex as they make their way down, in order to match the shape of the bony pelvic opening. And mom’s pelvis is most effective if the jointed parts of it can expand too, especially the sacrum at the base of the spine. For those reasons, the most physically effective and comfortable ways to labor are usually to avoid being on your sacrum, and to move around often, such as swaying or at least changing positions every 30 min, to help the baby get unstuck. If you are immobilized in bed, you can't do that. Ineffective labor that fails to progress as quickly as hospital staff would like often leads to a recommendation of Pitocin to make contractions stronger. Pitocin has even more side effects and risks than epidurals, but using either of them often leads to using the other as well. I'm convinced that if I had attempted my most difficult birth in a hospital, I would have been pushed into the Pitocin-epidural combo that so often leads to fetal distress and C-section. One exception where an epidural can make labor more effective is to compensate for the inability to relax the pelvic floor muscles. Labor is not just about contractions squeezing the baby down or the baby rotating to fit through the bony pelvis, but also the mom relaxing her pelvic floor muscles so the baby can fit between those too. Normal labor hormones and neurochemicals help with this, as do mental preparation and a supportive environment. What harms this are bright lights, noises, strangers, adrenaline, fear, hostility, paperwork, interruptions, complex questions, etc. If those things cannot be escaped during labor, an epidural can help compensate and make relaxation possible. Hospitals rely on epidurals to compensate for their difficult birthing environments.

6. Pushing is less effective with an epidural. It usually takes an extra hour. You end up attempting insensate, semi-supine, strained pushing to external direction rather than to internal cues. This results in a higher risk of pelvic floor injury and genital tearing, as well as a higher risk of needing forceps/vacuum or C-section, which come with additional downsides and risks.

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Julia D.'s avatar

(2/2)

7. Guaranteed low blood pressure, which makes IV saline to counteract that a mandatory add-on procedure for epidurals. An IV is not a huge problem in itself, but it creates vulnerability to nonconsensual medications being added to the drip (very commonly Pitocin, which has a side effect of causing postpartum depression). Even the possibility of this and the need to be vigilant against it is stressful and distracting.

8. Needing to be in a hospital at all, since birth centers and home birth midwives don't offer epidurals. Going to a hospital means a painful commute during labor, and exposing yourself and your newborn to nasty hospital germs, including during unnecessary mandatory pelvic exams. Hospital environments and procedures are optimized for mitigating emergencies rather than preventing emergencies (they are an excellent place to transfer to if you are having an emergency). They unfortunately come with bright lights, noise, strangers, distracting paperwork, etc. while you're trying to relax enough to accomplish your hardest and most interior work ever. Hospitals optimize for cost savings rather than maternal relaxation and empowerment, so they offer minimal in-person support. I recommend hiring a doula to everyone, but especially if you are planning a natural hospital birth. Hospital birth workers are less patient than out-of-hospital birth workers and will often push additional interventions like Pitocin to speed things up despite the increased pain and risk they cause. For normal low-risk pregnancies, out-of-hospital births with a midwife are equally safe for the baby, safer for the mother, and have higher satisfaction rates for the mother, than hospital births. But they're mutually exclusive with epidurals.

9. Less mind-body connection. My first birth brought me the most empowering harmony between my mind and body I had ever experienced. I was deep in the zone. The pain of contractions is nothing like the pain of injury, and it helps to remember it's not an alarm that means anything is wrong. Plus it's not constant: in between 60-90 second contractions, which themselves fade in and out like a bell curve, you get minutes-long breaks where you can refocus and deeply relax. During these centering breaks, you are in minimal pain, yet are still bathed in all the blissful hormones and neurochemicals you evolved to be able to relax, cope with contractions, and complete the neurologically transformative rite of passage that is birth. The intensity of this rhythm gradually ramps up over hours so you can practice and get better at focusing deeper. It culminates in the equally instinctive, less painful, more athletic event of pushing. If you have an epidural, you miss that integrating and empowering experience.

10. Less affirmation of your needs, instincts, and sovereignty. Birthing mothers are in the neediest hours of their life, second only to when they were a newborn. Most of what they need is a comfortable setting and calmly attentive, affirming people, but everyone also has their own specifics that arise. They also need a trustworthy medical expert standing by in case that becomes necessary. Birthing mothers are the experts in what they're feeling and what positions they need to be in (especially for second and later births. It can sometimes be hard to tell the first time; a doula helps with that). How one is treated, supported, and spoken to during the neurologically plastic times of birth and postpartum have profound effects on how supported, confident, and empowered one feels as a mother for decades. That matters a lot, especially because new mothers hit the ground running with the continuity of care that only they can biologically provide their infant. If people are patient and loving in response to a laboring mother’s cries of pain, she will pass that patient, loving momentum along to her crying baby the next day and thereafter. If people affirm her instincts and decisions for her body during labor, that confidence will strengthen her attentiveness and agency in caring for her baby. Whereas if people seem uncomfortable with her expressions of labor and try to shut her up with an epidural, she may carry that embarrassment and rage into how she handles her baby’s cries. And if people talk down to her or violate her consent during birth, she may feel insulted by motherhood or traumatized and shrink from her new responsibilities. One nuance: birth can be really great and/or really traumatic in a variety of ways. If you're in a hostile situation with untrustworthy sitters, refusing to enter the “labor land” trip can be a worthwhile defense mechanism. An epidural allows you to keep your wits about you and defend yourself if no one (e.g. a doula or educated partner) will do it for you. You will miss the good, but you might miss something really bad too. And making a FULLY informed decision to get an epidural or even an elective C-section can be empowering in one aspect too, inasmuch as mothers are the ones who know their own situation best and benefit from having their sovereignty respected.

11. Less vaginal sensation. That seems like a feature, not a bug, you say? Hear me out. Birth is not sexual exactly - it's not arousing and almost no one orgasms - but there is some overlap. Kind of like how dancing has some overlap with sexuality. To get to my point, pressure inside the vagina can facilitate emotional connection. This happens with sex, and this happens even more with natural birth. It’s not really painful by the time the baby gets down to the vagina and it feels pretty memorable and exciting. This isn't a major reason to avoid an epidural, but it is usually a positive experience.

12. Less priming of maternal instincts. When you get an epidural, your brain stops producing as much of the magical labor cocktail of neurochemicals because it stops getting feedback from your body and thinks you're not in labor anymore. That has effects on matrescence and bonding. A study showed that sheep who received epidurals showed impaired maternal-infant bonding. Specifically, ewes displayed decreased licking and grooming behaviors toward lambs, as well as reduced responsiveness to lamb bleats. Humans have additional reasons beyond animal instinct to care for their babies, like personal integrity, social expectations, and CPS. But why decrease your instinctual enjoyment and motivation for this highly intensive and important job? I was on cloud nine for the first six months postpartum after my first baby because I felt super passionate about and fulfilled by being with and caring for my baby. It was totally awesome to have strong mammalian instincts and to get to completely run with them and get the brain rewards for doing that.

13. Satisfaction rates are higher for natural birth. I imagine that is probably confounded by difficult/complicated births causing both epidural use and dissatisfaction. However: can you imagine any survey showing higher satisfaction rates for unmedicated dental surgery? No. Give me all the drugs for even an uncomplicated dental surgery, thanks. Birth is not like dental surgery. It is more like running a marathon. People who complete the marathon have higher satisfaction rates than people who needed to hop in the rescue cart to cross the finish line, whether because they got tired or their old ankle injury flared up or someone tripped them. You can still have a good or bad time either way. But most people go in aiming to complete the race if everything goes well. And most people are more satisfied by that outcome than if they had just decided to sit in the cart from the beginning.

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lin's avatar

This is interesting, and I'm happy you're happy...but if I were to do my first childbirth over I would ask for an epidural earlier, and for my future childbirth(s) I intend to ask for an epidural earlier, and if I did not have that option I would refuse to give birth again. Just for the record :P

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Julia D.'s avatar

That's valid! I'm glad epidurals are an option, and you are the best situated person to know what is best for you in each birth. I wish Cremieux had this same understanding that there are valid reasons for different women making different choices in different births.

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Zero Contradictions's avatar

I'm glad that you made this post, and it's great that you're sticking up for yourself. We now know why Cremieux is able to make so many tweets every day.

Close paraphrasing still counts as plagiarism. https://en.wikipedia.org/wiki/Wikipedia:Close_paraphrasing

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Megan Preston Meyer's avatar

This was such a nice, calm, mature way to stick up for yourself. I am very impressed!

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Crinch's avatar

I don't really care if it was plagiarism or not by any technical definition, but this drama revealed two details about Cremieux's personality:

1. They are not particularly creative, but clearly want to project creativity, so they have to borrow from more creative people. It doesn't matter if this is plagiarism or not, it's clearly a lack of personal juice.

2. Their original response to this post was borderline evil, accusing you of things you are not and exaggerating the degree to which you are combative and immature (I would say, not very), in order to silence you and generate reputational damage.

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James Valaitis's avatar

Not petty at all. Good for you 👍

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Sebastian Jensen's avatar

Brother he cited you twice

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Zero Contradictions's avatar

It doesn't matter, it still counts as plagiarism. I've learned this from experience. What Cremieux did would be considered close paraphrasing, even if he included a link at the end of the thread. Close paraphrasing is not allowed on Wikipedia, even when you include a citation footnote at the end. https://en.wikipedia.org/wiki/Wikipedia:Close_paraphrasing

If Cremieux edited Wikipedia to do similar things to what he was doing here, the admins would remove his text since it would pose a plagiarism lawsuit risk against Wikipedia. You can view the recent editing history of this article for an example. https://en.wikipedia.org/w/index.php?title=Hoarding_(economics)&action=history

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Sectionalism Archive's avatar

I wouldn't call it plagiarism, because Cremieux never claimed credit for the facts or statistics, but I would say it is very likely he pulled this from your article and the least he could have done was give you a shoutout, or simply not crash out about it and block you.

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Zero Contradictions's avatar

Cremieux literally earns money from Twitter. He's literally making money off of presenting someone else's work as his own.

Close paraphrasing still counts as plagiarism. https://en.wikipedia.org/wiki/Wikipedia:Close_paraphrasing

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Sol Hando's avatar

It’s weird how seemingly respectable people can devolve into extremely petty disputes at a moments notice. Why does Cremeuix die on this hill? He could literally just say something like;

“Ah! I apologize. I remember reading your article a few months ago and saving some parts of it in my notes. I forgot to attribute you at the time, and when I looked through my notes I thought this would make for a good twitter thread without remembering it was copied. I’m sorry about that.”

It doesn’t have to even be true, but just a plausible explanation+apology that saves face and is friendly enough. Instead he calls you a Cretin, which is hilariously unreasonable.

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Alex C.'s avatar

Human nature, I guess. See the excellent book, "Mistakes Were Made (but Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts" by psychologists Carol Tavris and Elliot Aronson. I sometimes wish I could make all my friends, relatives, and colleagues read this book, so that they might finally see themselves for who they really are.

https://www.amazon.com/Mistakes-Were-Made-but-Not/dp/0544574788

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Sol Hando's avatar

Thank you for the recommendation. I’ll add it to my list

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dynomight's avatar

I think it's honestly amusing how textbook Crem's reaction is: https://en.wikipedia.org/wiki/DARVO

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ZFC's avatar

Obviously and blatantly over the academic plagiarism line, no more Harvard pres/Trump appointed overseer for him!

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Edmund's avatar

Stick to your guns. Cremieux repackaged your work as their own and when called on it, is attempting to bully you. Shameful.

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Dylan Black's avatar

Genuine question (just from the screenshots). It seems pretty clear that Cremieux copied your introduction on aspartame. But it’s more or less a series of facts about a molecule that no one came up with, it’s pretty similar to the Wikipedia, and at least some of the figures are screenshots of other papers.

Is this plagiarism? For example, if I were to entirely plagiarize the equations of a math textbook on some common subject, is that also plagiarism? Or rather, is plagiarism even bad when it’s a list of factual information about a molecule that contains no original work, plus some molecular diagrams?

Again, genuine question, not trying to be sarcastic.

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dynomight's avatar

I think "a series of facts" is a pretty absurd way to look at it. What is non-fiction writing? Unless you're doing novel research, it's choosing the right facts, and putting them in the right order. (Also, choosing the right words, which Cremieux stole. Also, I'll note that I modified many of those figures from the other papers.)

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Dylan Black's avatar

Yeah I totally get where you’re coming from, and absolutely, nonfiction writing (particularly research papers) have to choose facts, present them cogently and in a good order. I guess I’m more coming from the perspective of having written a lot of introductions to papers, where like, despite dripping with citations to prior literature, the facts are generally presented in a bullet-point-plus kinda format, you know? And they all sound damn near identical.

Of course, the fun fact about MSG, the specific framing of Diet Coke and all the numbers, the “it never goes to your bloodstream,” like yeah that part is plagiarism.

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dynomight's avatar

I think the line for what constitutes plagiarism is blurry. For example, it could happen over time that in some field all the papers sort of converge on presenting the same facts in the same order. In that case, I don't think the 500th paper to do that would be guilty of plagiarism, just using "common knowledge".

(But while the boundary is blurry, I feel this case isn't even close to that boundary.)

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Dylan Black's avatar

I basically agree with that. And yes, it’s pretty clear in this case, my question was more general

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dynomight's avatar

I think the story is similar in math. If a long series of papers or textbooks converged on using the same equation (or sequence of equations), that could eventually come to be considered "common knowledge".

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Inn Suu's avatar

That's the internet for you. And that's why I, provisionally, admire you, Dynomight. You're putting this GREAT content out there. One of the most interesting websites. I'm lucky to have found you. Those stealers, like the bizarre faux arguments against copyright, have no idea what it means to be original. I have no qualms with your bitching about this. Put it on record.

There is, however, the precipice. It's all the website theft/regurgitation in other names that must surely be going on that we don't notice. Cretins are easier to spot. Better thieves outnumber them. Alas.

You will remain one of the better distractions.

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Jochen's avatar

sometimes you have to stand up for yourself even if it’s uncomfortable 🫶👍

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manavortex's avatar

I'm sorry this happened to you, and thank you for flagging it up. <3

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Viva's avatar

My two cents:

1) I don't think much of the concept of plagiarism to begin with - ideas are meant to be repeated and shared. This goes doubly so for informal contexts like Tweets. And tenfold so for cases where the original source has been cited and the essence of the complaint is a sophistic "the AP style guide says you have to paraphrase XYZ amount" kinda violation rather than any actual attempt to mislead about or hide the original source.

2) Nevertheless this is a totally valid and fair post - even if I find accusations of "technical plagiarism" unimpressive, there's nothing wrong with highlighting the case in a measured way so people can judge for themselves. You haven't done anything to overly villainize or unfairly malign Cremieux in the original post.

3) Cremieux's response here seems oversensitive and not very level-headed, to a degree that's kind of surprising. Maybe it's because in this milieu "sloppy paraphrasing" is seen as a grave crime but it's still unbecoming. At the same time, being short-fused in one instance - although embarrassing - doesn't really affect my overall view on someone.

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Virginia Postrel's avatar

I don't know the parties involved but I know writing and plagiarism and that is plagiarism. Also, I drink a lot of Diet Coke.

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dynomight's avatar

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