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Cake day: July 4th, 2023

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  • It’s not that we don’t use mode, there are definitely times mode is used. It’s just that mean (and median as well) contain a lot more useful information about distributions that we often care about. For a normal distribution mean, median, and mode should all be identical. So why do we use mean? Because mathematically, the mean is what underpins the formula for the normal distribution, not median or mode, and when you’re talking about doing math with normal distributions mean is the thing to talk about (along with standard deviation).

    We use median a lot too, you probably just don’t hear it called median very often. The median is useful in non-normal distributions, and it defines the 50th percentile, so along with the 25%-ile and 75%-ile you’ve got your quartile distributions. We use these all the time to talk about grades in schools, or when we talk about home prices distributions in a given area, or salaries within a given field.

    We use mode too, again just by a different name most of the time. Any time you’ve asked “what’s the most common blank” you’re basically asking for a mode. When we talk about “average” income in a country, we’re usually actually talking about median or mode. Favorite animal? Answered as a mode.

    You have to use the right statistical tool for your question: unfortunately English doesn’t do a good job of conveying this without math jargon.





  • But most animals don’t leave it intact. They chew through it shortly after birth. You can’t really have a tissue that is sturdy enough to survive tension during fetal development and vaginal delivery that then instantly falls apart, so it has to be manually severed after delivery. The vast majority of mammals don’t let it stay attached for long at all, because their offspring are pretty mobile immediately after birth. From my reading of some of the random websites that recommend this, apparently it was based on the observations of a single species of higher ape (a chimp I think) that doesn’t sever the umbilical cord quickly. But when we have been severing cords as a species for generations and the vast majority of other mammals sever the cord with their teeth, I think the evolutionary biology evidence points towards severing the cord quickly.

    Now evolutionary biology isn’t a solid basis for medical practice, but we don’t really have much scientific data at all to base this on at this point. There have been reports of increased rates of serious infections from the practice, which has face validity with the fact that you’re leaving a devascularized piece of tissue attached to the vascular system of neonate with an immature immune system. Outside of infection, there has been some case reports of polycythemia (excessively high red blood cell count) and jaundice in these infants. This makes sense physiologically. While attached to the placenta there is a greater intravascular volume available to the infant, which is the entire basis behind delayed cord cutting. It stands to reason that continuing to allow that extra blood volume to enter the infant would result in polycythemia and jaundice.

    I’m not intimately familiar with the foundational literature by which the standard DCC cutoffs of 1 minutes or cessation of umbilical pulsatility were founded upon. There could be a very real argument for saying, should the time be 2 minutes? 5 minutes instead of 1? Or should we at least study it if it hasn’t been already?

    In summary, we have a piece of dead/dying tissue attached to a physiologically stressed neonate with an immature immune system. Leaving it attached for days is in contradiction to the vast majority of other mammalian labor behaviors, is inconsistent with the majority of human’s labor history, and has a clear pathological mechanism by which the commonly reported complications can be easily explained. Without some legitimate evidence to actually support benefits or disprove the risks, I think this practice should be discouraged by healthcare professionals.






  • This is an alternative birth method called “lotus birth” or more formally “umbilical non-severance” in which babies are left tethered to the delivered placenta until their cord desiccates and detaches from their body on its own, usually in 3-10 days, while applying salt to the placenta to increase the speed at which it dries. It will eventually fall off, however, after its delivery the placenta is no longer being supplied with the oxygenated blood it needs to survive, and becomes necrotic (dead). This can act as an easy entry point for infectious organisms to enter the neonate, and can result in life-threatening infections. Neither the American College of Obstetrics or the American Academy of Pediatrics have explicit guidance statements as to whether this should be recommended against. AAP has published that there have been multiple case reports of severe infections with various bacteria secondary to this practice.

    This should not be confused/conflated with Delayed Cord Clamping, which is waiting 30-60 seconds after the baby’s delivery for some of the residual fetal blood in the placenta to be delivered to the baby’s circulation to prevent anemia. This has good evidence for benefit to the baby, is recommended by ACOG, and is basically standard of care in the US.

    Source: ACOG and AAP publications, also I’m a 4th year medical student that has completed OBGYN rotations