- Hey – Thanks for writing Pushed. Your argument that women do not have enough say
about what happens to them when they are giving birth did make me think about how
our society seems often to be corrupting what is supposed to be a natural event for the convenience and legal protection of health professionals.
- Really! You think so? I’m impressed that someone as young as you and who, if you pardon me for saying so, probably won’t have the experience of birth yourself would
be that interested. What parts stood out for you?
- Well, if I’m honest, it was an assigned reading project as part of a course I’m taking at School of the Future. I remember the last part the best, which is all about your advocacy for midwives and home births.
You make the point that midwives went out of favor in the U.S. in the 1930s because of medical reports that seemed to blame them unfairly for deaths in childbirth. Obstetricians had campaigns against midwives even in the 80s with bumper stickers that said “Home Deliveries Are for Pizza.” So the new generation of midwives had to start from scratch you say because there weren’t any around to learn from. Then you tell the story of Cynthia Caillagh who is the hero, who gets falsely accused of causing a woman's death in childbirth, and then gets her reputation back at the end. It’s interesting that she had a Cherokee grandfather who told her that she was fated to be a midwife even though she was really smart and was studying pre-med when she was 16.
Cynthia trains with a “traditional Cherokee midwife" for two years. Caillagh says on page 219: “She learned her skills from another midwife, who learned her skills from a midwife.. Knowledge was handed down, midwife to midwife.” This leads to your saying that over 33 years she “attended 2500 births.” This woman is a pro with special skills who is called in by other midwives because she can successfully treat even serious conditions with special diets and with herbs.
Then Cynthia is called by Julia Peters to help with her birth. We already know that Julia is going to die and that Cynthia is going to be accused of causing her death, but there is still suspense to find out what actually happened. Then we find out there is a villain in the story, Marcella Ferro, the state of Virginia's chief medical examiner, who is part of a coverup of the facts of the case and the campaign to blame the midwife. Then on page 245 you say, “On May 5, 2000, Caillagh pleaded guilty to practice of midwifery without a license, to practice of medicine without a license, and to 'abuse and neglect of an incapacitated adult.'” Now I am even more into this story and pretty angry. The idea that Cynthia abused or neglected Julia is a very bad joke.
Even though Cynthia gets off and Virginia declares “Midwives’ Day” the day after she is let go, the reader is still mad about her treatment. What Cynthia says to you on page 248 after her whole experience of having been arrested and accused as a criminal seems to be the main point of the whole book: "To truly give birth you have to surrender to the process of birth, which is to suspend a conscious awareness. You must trust the instinctive internal self. And I think we’ve come upon a generation of women who don’t know what that internal trust looks like. I think there will come a time when we will remember or will rediscover… the intrinsic value of birth under one’s own steam.”
Of course I’m a guy so what do I know about all this?
- I’m glad you got so much out of my book. How could it have been better?
- Again, if I’m honest, I found a lot of it hard to read. The Cynthia story was the one that I read without being bored at all. Not to say that all your facts and figures and histories of policies aren’t important. They are just hard to read about unless you are a health professional or pregnant with your second child and don’t want to have another cesarean section. But if I become a dad one day, you’ve definitely made me understand more about what a mother has to go through and hopefully I would be more helpful.
Wednesday, March 30, 2011
Wednesday, March 23, 2011
HW # 39 - Insights from Book - Part 2
1. “Much of the risk of cesarean emerges in the next pregnancy, 91% of which today will be delivered by repeat surgery” (Block 116).
“The uterine scar can of course rupture in a future pregnancy” (Block 116).
Description of cesarean scar being the cause of the placenta ripping open the uterus and even the bladder right after birth causing severe hemorrhaging and
major surgeries.
“Michel Odent …put a database online, where one can search studies that have connected narcotics at birth with addiction in adulthood; induction of labor with autism; and cesarean section with immune disorders. The research is far from conclusive, but it points to the large, unknown territory of the impact of medicalized childbirth” (Block 134).
“A British midwife told a researcher that the sounds women make when they’re on artificial oxytocin are hauntingly different: “It’s a panic, it’s a scream and it’s different from the noise they make when they’re working with their bodies…It sounds like someone’s being murdered.” (Block 135).
2. Cesarean births are performed much too often and can be dangerous to the mother and the baby at the time of the birth and in later years. In general, when a woman enters a hospital, even if she is healthy and nothing is wrong, she is hooked up to all these monitors and given Pitosin too quickly to speed up contractions, which causes pain and makes her need drugs, and then if the baby still doesn’t come soon enough, she will get a cesarean section. Nature is not given enough time to act, and women aren’t given ways to handle the pain without drugs.
3. “If we put women in hospitals with restrictive policies – they’re hooked up to everything, they’re expected to be in bed – of course they’re going to go for the epidural, because they’re unable to work through their pain,” (Block 174).
Use of epidural anesthesia in childbirth at large hospitals increased from 22% in 1981 to 66% in 1997 and is estimated to be 80% today” (Block 170)
“’Americans trust doctors and they trust hospitals, and they equate the two with health. What they don’t understand is that obstetricians are surgeions, and they know pathology, but they really suck at wellness.’ They are trained to sew up a tear, but not to prevent one” (Block 176)
“As doulas ‘reframe’ the birth experience for their clients, they are also shielding the hospital and its care providers from criticism and complaint. Hedley did her job so well that even though she felt her client was ‘abused,’ her client will go right back to the sambe obstetrician and hospital for her next pregnancy” (Block 160)
“Caillagh (superstar midwife) was known widely for successfully treating even serious prenatal conditions with diet and herbs, for stopping postpartum hemorrhages, and for resolving complications that would otherwise be dealt with surgically. She could turn babies who were entering the pelvis askew; ‘prolonged labbbor’ was language she never employed” (Block 223)
3. “Necrotizing fasciitis, the flesh-eating bacteria, afflicts 1.8 per 1000 surgical patients and is profoundly disfiguring or fatal” (Block 117)
OBJECTIVE: To review currently available evidence on the epidemiology and methods of management for necrotising fasciitis, with particular reference to Hong Kong.
DATA SOURCES AND STUDY SELECTION: Medline, PubMed, and Cochrane Library searches of local and internationally published English language journals, from 1990 to July 2008 using the terms 'necrotising fasciitis', 'Hong Kong', 'diagnosis', 'epidemiology', 'vibrio', 'streptococci', 'clostridia', and 'management'.
DATA EXTRACTION: All articles involving necrotising fasciitis in Hong Kong were included in the review.
DATA SYNTHESIS: The incidence of necrotising fasciitis in Hong Kong and around the world has been increasing. This rapidly progressive infection is a major cause of concern, due to its high morbidity and mortality. Up to 93% of affected patients at our hospital were admitted to the Intensive Care Unit and many still died from septic complications, such as pneumonia and multi-organ failure. Radical debridements in the form of amputations and disarticulations were considered vital in 46% of the patients. Early recognition and treatment remain the most important factors influencing survival. Yet, early diagnosis of the condition is difficult due to its similarities with many other soft tissue disorders such as cellulitis. Repeated surgical debridement or incisional drainage continues to be essential for the survival of sufferers from necrotising fasciitis. Many authorities have reported that carrying out the first fasciotomy and radical debridement within 24 hours of symptom onset was associated with significantly improved survival, which also emphasises the importance of early diagnosis.
CONCLUSION: Clinicians must adopt a high index of suspicion for necrotising fasciitis. Empirical antibiotics must be started early and repeated physical examinations should be performed, while maintaining a low threshold for tissue biopsy and surgery. The timing of the first fasciotomy and radical debridement within a window of 24 hours from symptom onset is associated with significantly improved survival.
“The uterine scar can of course rupture in a future pregnancy” (Block 116).
Description of cesarean scar being the cause of the placenta ripping open the uterus and even the bladder right after birth causing severe hemorrhaging and
major surgeries.
“Michel Odent …put a database online, where one can search studies that have connected narcotics at birth with addiction in adulthood; induction of labor with autism; and cesarean section with immune disorders. The research is far from conclusive, but it points to the large, unknown territory of the impact of medicalized childbirth” (Block 134).
“A British midwife told a researcher that the sounds women make when they’re on artificial oxytocin are hauntingly different: “It’s a panic, it’s a scream and it’s different from the noise they make when they’re working with their bodies…It sounds like someone’s being murdered.” (Block 135).
2. Cesarean births are performed much too often and can be dangerous to the mother and the baby at the time of the birth and in later years. In general, when a woman enters a hospital, even if she is healthy and nothing is wrong, she is hooked up to all these monitors and given Pitosin too quickly to speed up contractions, which causes pain and makes her need drugs, and then if the baby still doesn’t come soon enough, she will get a cesarean section. Nature is not given enough time to act, and women aren’t given ways to handle the pain without drugs.
3. “If we put women in hospitals with restrictive policies – they’re hooked up to everything, they’re expected to be in bed – of course they’re going to go for the epidural, because they’re unable to work through their pain,” (Block 174).
Use of epidural anesthesia in childbirth at large hospitals increased from 22% in 1981 to 66% in 1997 and is estimated to be 80% today” (Block 170)
“’Americans trust doctors and they trust hospitals, and they equate the two with health. What they don’t understand is that obstetricians are surgeions, and they know pathology, but they really suck at wellness.’ They are trained to sew up a tear, but not to prevent one” (Block 176)
“As doulas ‘reframe’ the birth experience for their clients, they are also shielding the hospital and its care providers from criticism and complaint. Hedley did her job so well that even though she felt her client was ‘abused,’ her client will go right back to the sambe obstetrician and hospital for her next pregnancy” (Block 160)
“Caillagh (superstar midwife) was known widely for successfully treating even serious prenatal conditions with diet and herbs, for stopping postpartum hemorrhages, and for resolving complications that would otherwise be dealt with surgically. She could turn babies who were entering the pelvis askew; ‘prolonged labbbor’ was language she never employed” (Block 223)
3. “Necrotizing fasciitis, the flesh-eating bacteria, afflicts 1.8 per 1000 surgical patients and is profoundly disfiguring or fatal” (Block 117)
OBJECTIVE: To review currently available evidence on the epidemiology and methods of management for necrotising fasciitis, with particular reference to Hong Kong.
DATA SOURCES AND STUDY SELECTION: Medline, PubMed, and Cochrane Library searches of local and internationally published English language journals, from 1990 to July 2008 using the terms 'necrotising fasciitis', 'Hong Kong', 'diagnosis', 'epidemiology', 'vibrio', 'streptococci', 'clostridia', and 'management'.
DATA EXTRACTION: All articles involving necrotising fasciitis in Hong Kong were included in the review.
DATA SYNTHESIS: The incidence of necrotising fasciitis in Hong Kong and around the world has been increasing. This rapidly progressive infection is a major cause of concern, due to its high morbidity and mortality. Up to 93% of affected patients at our hospital were admitted to the Intensive Care Unit and many still died from septic complications, such as pneumonia and multi-organ failure. Radical debridements in the form of amputations and disarticulations were considered vital in 46% of the patients. Early recognition and treatment remain the most important factors influencing survival. Yet, early diagnosis of the condition is difficult due to its similarities with many other soft tissue disorders such as cellulitis. Repeated surgical debridement or incisional drainage continues to be essential for the survival of sufferers from necrotising fasciitis. Many authorities have reported that carrying out the first fasciotomy and radical debridement within 24 hours of symptom onset was associated with significantly improved survival, which also emphasises the importance of early diagnosis.
CONCLUSION: Clinicians must adopt a high index of suspicion for necrotising fasciitis. Empirical antibiotics must be started early and repeated physical examinations should be performed, while maintaining a low threshold for tissue biopsy and surgery. The timing of the first fasciotomy and radical debridement within a window of 24 hours from symptom onset is associated with significantly improved survival.
Tuesday, March 15, 2011
HW # 38 - Insights from pregnancy & birth book - part 1
Pushed by Jennifer Block
1. The first chapter - Arranged Birth - talks about the speeding up the birth process by doctors and hospitals using artificial hormones and painkillers and gadgets instead of waiting for spontaneous labor. The second chapter – The Short Cut – is about cesarean births and how common they are even when they aren’t emergency births. The third chapter – Denied Birth – is about babies in the breach position (feet down instead of head) and how they are almost all born by C sections and about VBAC (vaginal births after cesarean births) which are mostly discouraged.
2. “Why (the American birth experience) is far from optimal, how it came to be this way, and what it means for women, families, and society at large.”
3. “We are in the midst of an epidemic of patently unnatural birth: most labors are started or propelled by artificial hormones, and nearly one-third of American women are giving birth by major abdominal surgery. The norm is moving very far away from what’s normal.” “ We know if we take our otherwise healthy patient…release her cuffs, and bands, unplug the probes and sensors, and turn off the Pitocin and morphine, 9 times out of 10 her body will birth a baby with minimal interference or injury, especially if she has the one-on-one support of a skilled caregiver.”
4. Having breach babies born the natural way with legs hanging out sounds more dangerous than having them by C-section. Giving women in labor Pitocin sounds as though it is getting way out of hand. The idea that the pain that the Pitocin causes is the reason a lot of women want drugs to kill the pain makes sense. Are fetal heart monitors really not that useful? (I think one saved my life.)
Unassisted births sound too dangerous. (I would hate to be there.)
5. The author uses all kinds of evidence to back up her thesis that there is too much invasiveness with births. There is a very long “Notes” section in the back documenting all the points made in the chapters. The evidence of practices not based on the statistics is the most interesting, for example, the fact that women have to sign a consent form to have VBAC (vaginal birth after cesarian), but not a double cesarean, which can be more dangerous.
1. The first chapter - Arranged Birth - talks about the speeding up the birth process by doctors and hospitals using artificial hormones and painkillers and gadgets instead of waiting for spontaneous labor. The second chapter – The Short Cut – is about cesarean births and how common they are even when they aren’t emergency births. The third chapter – Denied Birth – is about babies in the breach position (feet down instead of head) and how they are almost all born by C sections and about VBAC (vaginal births after cesarean births) which are mostly discouraged.
2. “Why (the American birth experience) is far from optimal, how it came to be this way, and what it means for women, families, and society at large.”
3. “We are in the midst of an epidemic of patently unnatural birth: most labors are started or propelled by artificial hormones, and nearly one-third of American women are giving birth by major abdominal surgery. The norm is moving very far away from what’s normal.” “ We know if we take our otherwise healthy patient…release her cuffs, and bands, unplug the probes and sensors, and turn off the Pitocin and morphine, 9 times out of 10 her body will birth a baby with minimal interference or injury, especially if she has the one-on-one support of a skilled caregiver.”
4. Having breach babies born the natural way with legs hanging out sounds more dangerous than having them by C-section. Giving women in labor Pitocin sounds as though it is getting way out of hand. The idea that the pain that the Pitocin causes is the reason a lot of women want drugs to kill the pain makes sense. Are fetal heart monitors really not that useful? (I think one saved my life.)
Unassisted births sound too dangerous. (I would hate to be there.)
5. The author uses all kinds of evidence to back up her thesis that there is too much invasiveness with births. There is a very long “Notes” section in the back documenting all the points made in the chapters. The evidence of practices not based on the statistics is the most interesting, for example, the fact that women have to sign a consent form to have VBAC (vaginal birth after cesarian), but not a double cesarean, which can be more dangerous.
Tuesday, March 1, 2011
HW 37 - Comments
To Eloise
You wrote three highly detailed birthing posts. I found them all interesting but the first one was the zinger! Bill Hill is not your run of the mill midwife. I think your best line(and there were several of these)was, "When Bill speaks about the birthing of his wife he said,'she just pushed it out, but I did most of the work', when previously he had stated that if there aren't complications all there is to do is catch it. I believe such contradiction and prejudice towards the strength of his wife comes from the fact that she left 3 weeks after the birth of their second daughter." Its as though his wife said to him, "You did all the work so you keep them." It seems really tragic that she left him and her two babies. I'm sure has a point about hospitalsbeing a sometimes negative part of the "birthing industry." On the other hand, if there are complications, it's obviously better to be in a hospital. Even in this country, when a lot of poor people had babies at home, a lot of the mothers and babies died. The section about your own birth in France was really interesting too. My mother wishes she could have had my brother and me in France. The services are so good. She was lucky that she worked for the French American Foundation here when my brother was born and had a year of paid maternity leave. I think you wrote the way you talk, and this makes the writing lively. You just need to edit it more and I think you meant "relevant" when you said of "prevalent."
To Naima
You intervieweed three different young women, and it's interesting that they all have different views about having a baby. I think the most powerful line is this one from Beinda:"I want to have kids because I feel like it’s a struggle that I have to face that will make me stronger. Every woman in my family has been an independent mother, and I feel like I will too. Its not what I want, its just a pattern I've noticed." This response sounds so depressing to me. You said that using the term "independent" parent instead of "single" parent might indicate a "more empowered sense of the possiblities of single parenthood." I think that raising a child is a two - person job and that having two parents usually makes life easier. The fact that Belinda calls having kids a struggle she has to face and that she thinks she will probably have to do alone because that seems to be the way it happens in her family is too bad. It sounds fatalistic, and I hope she'll be the one to break the one - parent cycle. You said yourself that you wished you had prepared some different questions. I think it might have been interesting if you had asked them about what they wanted to do with their lives before having children.
-------------------------------------------------------------------------------------
From Mom
I'm glad that hearing about your birth and your brother's birth has made you think about "what a very big deal having a baby is." I think that perhaps I emphasized to you how terrifying the experience was and not enough how wondrous it was. The fact is that there is much to be scared about. Modern moms and moms-to-be read so much that they can't help but be concerned about all that they do while pregnant and all the things that can go wrong even if the odds are against them happening. There will always be someone who says to you when pregnant that we make too big a deal of having babies today. "Just think about all the women who used to have babies in the fields and then go right on working." The truth is that the fatality rate was a lot higher then for mothers and babies. Also many modern day women go to college and work and have careers. They don't consider themselves primarily baby makers. When the time seems right or when the situation is a stable one, having a baby is the most
joyful experience imaginable. Nothing is more rewarding or entertaining than one's own (or adopted) baby. The love is so strong though that when anything goes wrong, even minor things, the emotional pain is terrible. Most of us know people who have had big things go wrong. As you know, your former coach and his wife had a baby with a rare disease called Angelman Syndrome. Her brain will never fully develop, and she will never talk. Even with completely normal children the responsibility is just so great that most parents hope that their children will have their own full lives before deciding to have children themselves -- for their sakes and their children's.
From Dmitry
The bad luck of your mother's doctor was amazing. Not only did she take him away from his family on Easter but also Christmas. I guess watching football games with your dad wasn't so bad. The part about "Maple Syrup Urine Disease" really "stuck" with me. It is part comical due to the name, and part sad due to the seriousness of the disease. The way you structured the stories really kept my attention and intrigued me the further I read along. One experiment that I would like somebody to conduct would be to test if the "motherly connection" is different at all with a baby born naturally and a baby born via caesarean section.
From Eloise
Devin I think you made a very valid point, parents should really take into consideration the huge amounts of work that entail child care. I even neglected these thoughts with all my interviews. I like how you tied all your interviews back to the focal point that you grasped from your inquries. I want to know why you think women should have children when they are 30, their bodies can have them with more facility at a younger age. I think your strongest line was "Then she was told she had something called Maple Syrup Urine Disease (you can’t make this stuff up), which if not treated could cause coma and death for the baby.". I think that this line had great character and I could really hear your voice. I belive to make this part stronger you could have illustrated the point with more fluidity rather than just stating and then this happened and then this. I thought over all this was an interesting piece, you should just read over your work before publishing ! :D
From Naima
You wrote three highly detailed birthing posts. I found them all interesting but the first one was the zinger! Bill Hill is not your run of the mill midwife. I think your best line(and there were several of these)was, "When Bill speaks about the birthing of his wife he said,'she just pushed it out, but I did most of the work', when previously he had stated that if there aren't complications all there is to do is catch it. I believe such contradiction and prejudice towards the strength of his wife comes from the fact that she left 3 weeks after the birth of their second daughter." Its as though his wife said to him, "You did all the work so you keep them." It seems really tragic that she left him and her two babies. I'm sure has a point about hospitalsbeing a sometimes negative part of the "birthing industry." On the other hand, if there are complications, it's obviously better to be in a hospital. Even in this country, when a lot of poor people had babies at home, a lot of the mothers and babies died. The section about your own birth in France was really interesting too. My mother wishes she could have had my brother and me in France. The services are so good. She was lucky that she worked for the French American Foundation here when my brother was born and had a year of paid maternity leave. I think you wrote the way you talk, and this makes the writing lively. You just need to edit it more and I think you meant "relevant" when you said of "prevalent."
To Naima
You intervieweed three different young women, and it's interesting that they all have different views about having a baby. I think the most powerful line is this one from Beinda:"I want to have kids because I feel like it’s a struggle that I have to face that will make me stronger. Every woman in my family has been an independent mother, and I feel like I will too. Its not what I want, its just a pattern I've noticed." This response sounds so depressing to me. You said that using the term "independent" parent instead of "single" parent might indicate a "more empowered sense of the possiblities of single parenthood." I think that raising a child is a two - person job and that having two parents usually makes life easier. The fact that Belinda calls having kids a struggle she has to face and that she thinks she will probably have to do alone because that seems to be the way it happens in her family is too bad. It sounds fatalistic, and I hope she'll be the one to break the one - parent cycle. You said yourself that you wished you had prepared some different questions. I think it might have been interesting if you had asked them about what they wanted to do with their lives before having children.
-------------------------------------------------------------------------------------
From Mom
I'm glad that hearing about your birth and your brother's birth has made you think about "what a very big deal having a baby is." I think that perhaps I emphasized to you how terrifying the experience was and not enough how wondrous it was. The fact is that there is much to be scared about. Modern moms and moms-to-be read so much that they can't help but be concerned about all that they do while pregnant and all the things that can go wrong even if the odds are against them happening. There will always be someone who says to you when pregnant that we make too big a deal of having babies today. "Just think about all the women who used to have babies in the fields and then go right on working." The truth is that the fatality rate was a lot higher then for mothers and babies. Also many modern day women go to college and work and have careers. They don't consider themselves primarily baby makers. When the time seems right or when the situation is a stable one, having a baby is the most
joyful experience imaginable. Nothing is more rewarding or entertaining than one's own (or adopted) baby. The love is so strong though that when anything goes wrong, even minor things, the emotional pain is terrible. Most of us know people who have had big things go wrong. As you know, your former coach and his wife had a baby with a rare disease called Angelman Syndrome. Her brain will never fully develop, and she will never talk. Even with completely normal children the responsibility is just so great that most parents hope that their children will have their own full lives before deciding to have children themselves -- for their sakes and their children's.
From Dmitry
The bad luck of your mother's doctor was amazing. Not only did she take him away from his family on Easter but also Christmas. I guess watching football games with your dad wasn't so bad. The part about "Maple Syrup Urine Disease" really "stuck" with me. It is part comical due to the name, and part sad due to the seriousness of the disease. The way you structured the stories really kept my attention and intrigued me the further I read along. One experiment that I would like somebody to conduct would be to test if the "motherly connection" is different at all with a baby born naturally and a baby born via caesarean section.
From Eloise
Devin I think you made a very valid point, parents should really take into consideration the huge amounts of work that entail child care. I even neglected these thoughts with all my interviews. I like how you tied all your interviews back to the focal point that you grasped from your inquries. I want to know why you think women should have children when they are 30, their bodies can have them with more facility at a younger age. I think your strongest line was "Then she was told she had something called Maple Syrup Urine Disease (you can’t make this stuff up), which if not treated could cause coma and death for the baby.". I think that this line had great character and I could really hear your voice. I belive to make this part stronger you could have illustrated the point with more fluidity rather than just stating and then this happened and then this. I thought over all this was an interesting piece, you should just read over your work before publishing ! :D
From Naima
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