Wednesday, March 30, 2011

HW # 40 - Insights from Book - Part 3

- 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 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.

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.

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.


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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

Sunday, February 27, 2011

HW 36 - Pregnancy & Birth Stories

Interview with my mother:

My mother said that she was extremely happy and excited about being pregnant with my older brother. She and my dad were in a new parents group that met with a “birthing instructor” once a week after work. She said the class started after dinner and ended so late that when the lights came back on after the weekly film the
future dads were all out cold – sound asleep. Meanwhile, the future moms were pretty nervous about the actual births shown in the films. She said it was an international group all giving birth at St. Vincent’s Hospital in Greenwich Village. One woman was Vietnamese. She brought in some special sticks to put between the toes of another woman whose baby was in the breach position, meaning
its feet were down instead of its head so that she would have to have surgery for a Cesarean birth instead of a natural one. The Vietnamese woman lit the sticks so that they burned without hurting the other woman’s toes. My mother said the baby turned around and did not turn back again into the wrong position. The baby was born naturally, and the parents gave all the credit to the Vietnamese woman. The future parents all got along well and met at one of the parents’ apartment after everyone had given birth. There is a really funny picture of all the babies.
One of the dads was a guitarist in a rock band called The Talking Heads and madea video with all the babies sitting up at a bar. The mothers were all told to
leave the room for the actual filming, and they refused because the babies
kept slipping off the bar seats.

My mother said my brother was born seven weeks early. She said there are some contractions that are not the real thing called Braxton Hicks contractions and she thought they were them. The contractions kept coming so my dad took her to the hospital at 6:00 in the morning. It was Easter and even though the doctor, Fernando Moreno, was not all that religious, his family was. He missed his kids’ Easter egg hunt. The nurse said that she could tell my mother was not ready to be admitted yet because she was smiling. “When the time comes, no one smiles.” They were told to walk around outside for an hour or two. My mom remembers the contractions hurting so much that she would have to sit down on the steps of houses near the hospital. When they went back inside, my dad said she wasn’t smiling. My brother was born at 11:30 at night so it was a long day. She did not want pain killers because they make the baby drowsy but she had to be given a drug to make the contractions work better. This drug makes the contractions go to a whole new level of pain, and my mom said the music from the movie Jaws kept going through her head. I guess the contractions felt like a shark coming with its mouth wide open. All the special breathing techniques were useless she said. What helped was digging her not very long fingernails into the palms of her hands. The moment the baby was born, the pain magically disappeared and she remembers the doctor saying, “What was the boy’s name you chose?” Even though my brother came early and weighed barely five pounds, he was healthy. My mother stayed in the hospital for a week with him and the day after they came home the telephone rang, and they were told to bring him back to the hospital. He had to be tested for sickle cell anemia, a disease that has no cure. Luckily, he only has the trait for it and not the disease. My mother said she was terrified and then relieved except for being told that children with the trait often have respiratory problems. Reed has not had them. That fear was just replaced by others. My mother says she watched Reed almost all night long for the first month she was so scared he might die from Sudden Infant Death Syndrome, which she had read a lot about.

When I was born six years later, my mother said she was probably more nervous than
the first time. This was because she had had five miscarriages in between. My parents were thinking about adopting a baby when my mom got pregnant again. She had to have a lot of genetic testing to find out what was going wrong. She says the problem with genetic testing is that after you’ve learned all that can go wrong with chromosomes you can’t even imagine everything going right. She still remembers the phone call at her office from the doctor telling her that I was going to be a healthy baby. She said she ate as healthily as she did for the first pregnancy but did crazy things the second time like crossing the street if someone was smoking a cigarette near her and not even having one cup of decaffeinated coffee. She went into labor on Christmas Eve and Dad and my brother had to go to the hospital early on Christmas morning. She had the same great doctor as the first time and felt really badly that he had to leave his kids on Christmas day after prying them away on Easter six years earlier. She remembers that my dad and the doctor watched football games all day long, and Reed played baseball and soccer in the hall with nurses. When it was nearly midnight, the doctor said it might have to be a Cesarian birth. She went into an operating room for surgery, but the doctor said he would like to avoid surgery by using forceps. My dad says forceps are huge and look like some kind of medieval torture instrument and that my mom was scared that they would hurt the baby’s head. A nurse said that her doctor was an artist with forceps and that the baby’s head would be perfect. I was born almost at midnight, and my brother was so happy I was a boy. He wanted to call me Bullwinkle, Wink for short.

Hearing about what it was like for my mom to have my brother and me reinforces my thinking about what a very big deal having a baby is. Nothing is ever the same for parents again so they better be prepared for it. Maybe I believe this because my parents do (although I do not follow what they think blindly), but I think that the Republicans who are trying to reverse the Roe vs. Wade Supreme Court decision so that abortion can be illegal again are crazy. Some even think women who get pregnant from being raped should have to have their babies. My dad thinks that in general men shouldn’t be allowed to have an opinion on the subject, and I agree with him. A baby needs to come into the world being wanted.


Interview with Meghan, a family friend who had her first baby in October

Meghan said that unlike my mother she was sick everyday for the first three or four months of her pregnancy. 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. A week later she was told that she did not have this condition. Later she was told she had gestational diabetes. She did have it, but fortunately it goes away after birth. After going through all the childbirth classes she found out the baby was in the breach position. She was told to swim everyday and do exercises that were hard to do in the last month. The baby did not turn around. Her feet stayed down, and Meghan had to have a Cesarean section. She said she made an appointment to have the baby the way you make an appointment to go to the dentist and never had one labor pain. She was very disappointed.

After the baby was born, she felt extremely depressed even though she loved her baby
tremendously. She was angry with herself for feeling that way and had to have some
medication. She did not tell anyone except her husband about the way she felt, and she pretended to everyone else that everything was fine. Finally, after about three months she felt normal again, and now finally she is really having a good time with her baby. Meghan’s experience just is more evidence that having a baby is not something that you do lightly. Not only does it change your life forever, but a lot can go wrong that you can’t anticipate. It’s a huge responsibility and right now I can’t imagine being ready for it.


Interview with our neighbor

Our neighbor had a girl at the same time my mother had me. She is Brazilian and has
always had asthma. For some reason her asthma is worse in New York than it was in
Brazil. When she was pregnant, she had several bad attacks and ended up in the hospital. She also had to stay home to lie down at the end of her pregnancy because the doctor wasafraid that she would have a miscarriage. After taking birthing classes, she ended up having a Cesarean birth because of the umbilical cord being wrapped around the baby’s neck. Like Meghan, she was extremely disappointed. She also ended up with an infection in the incision and had to go back to the hospital

The baby had something for the next three months called colic, which meant that she cried for hours without stopping every night. She and her husband almost went crazy and had no sleep. On top of that it was the terrible winter of 1994. There was so much snow and ice that it was hard for her to go out during the day. She and my mother would take turns lunch with one another, and even though they live next door it was hard to get past all the piles of snow and ice. She felt like a prisoner especially knowing that it was summer in Brazil.

This is another experience to confirm my thinking that if you are going to have a baby you had better be ready for anything, and you probably shouldn’t be under 30. I think you should have a lot of experiences to get you ready for the anything that can and probably will happen and also so that you don’t resent your loss of sleep and freedom.

I would be interested in finding out more about Caesarean section births vs natural births.

Thursday, February 17, 2011

HW 35 - Other Peoples' Perspectives 1

Of the people I asked about their perspectives on birth, everyone said that they did not want to think about having children for a long time. The two girls and three guys said they wanted to wait until they were in their thirties and the third guy said he wanted to wait until he was in his forties. The reasons for waiting ranged from wanting to have a good career to feeling like they need to have a lot of experience to be able to be good parents. They also said they would need to be making a good income because children cost a lot of money. They have seen what they cost their parents. One girl said she would not even want to have children unless she met someone she thought would be a great father. She also said she had read that early marriages especially with children usually end in divorce.

Regarding the stage of pregnancy the girls said they would not look forward to getting huge and being scared about the pain of childbirth. One girl said she thought that today when most women want to have a career and would also need to work for the family to have enough money having a baby is a huge decision and that it is a much bigger decision for a woman than for a man. The guys did not have much to say about the stage of pregnancy. One said he was glad he was male and did not have to worry about getting pregnant. A girl who heard him say this said, “I hope you are the subject of an experiment gone rogue and that you will be the first man to get pregnant. You won’t realize that you are pregnant until it is too late to have an abortion and you will be having triplets.”

Regarding avoiding getting pregnant, they all believed in being careful about birth control if they were in a serious relationship. Not one of them is in a serious relationship. They are also not against abortion. I asked if they thought it is more important for a baby to be wanted than to be born to a woman who was not ready to be a mother. They all thought it was important for a baby to be wanted. One girl said her parents are Catholic and that her mother is not against abortion even though her grandmother (her mother’s mother) is. No one thought that Roe vs. Wade should be reversed so that abortions would be illegal because women would continue to have them anyway. One of the girls knew that when abortions were illegal, there were dangerous abortions performed and some girlds died. One of the guys said that he didn’t think that men should be against abortion since they were not the ones who had to go through pregnancy and having a baby change their lives. When I said that having a baby should change the father’s life too, he said “Oh yeah. Guys our age and even five years older aren’t ready to be thinking about being dads." Obviously this makes birth control/abstinence highly important.

Monday, February 14, 2011

HW # 34 - Some Initial Thoughts On Birth

In the article “Mothers-to-Be Are Getting the Message” about how a text messaging program called text4baby can help educate pregnant women and new mothers
on taking care of their babies, the reason it says a program like this is needed is that “the United States ranks 30th in the world in infant mortality rates – between Poland and Slovakia.” It also says that “28,000 children born in the U.S. each year die before their first birthday – and many more face disabilities and serious life-long health problems, often because they are born prematurely or at low birth weights.” This probably sounds surprising to middle and upper middle class white people. Black people know all about it. My father’s sister who grew up in Detroit got pregnant in high school. The baby died. She didn’t tell anybody about it until she was six months pregnant. Then her mother took her to a doctor but that was a late time to start getting medical care.

I bet that most of the 28,000 babies who die in this country have poor mothers and a lot of them are minorities. This makes sense because if the mothers were white and middle class it would be some kind of emergency or embarrassment for America. The two reasons I can think of that causes all these deaths are the education system and the health care system. If girls have better education, they are not going to want to get pregnant in high school. If there is free health care the way there is in a lot of other countries the girls or women can have regular doctors. Poor people don’t have regular doctors. A lot just go to emergency wards of hospitals if they are really sick, hurt or dying. Having this text4baby health care advice for pregnant women and mothers sounds like a great idea but especially for poorer people who don’t have regular doctors and who don’t buy a lot of books to tell them what to do.

Questions I would like to explore in this unit:

How is the health care for pregnant women who are poor in countries with low infant mortality rates?

What is the health care like for babies once they are born in countries with low infant mortality rates?

A lot of black children have been raised by their grandmothers. I don’t know if this is still happening as much as it was when my dad was growing up. Is it? (My father’s sister is bringing up her grandchild because the father of the child who was her son is dead. The mother disappeared.)

Is a reason why male conservatives are so against abortion that they want to be able to control women?

What percentage of babies are born as a result of an unplanned pregnancy and how do their grades as they grow up compare with babies whose parents had the intention of having them?