HW 41 - Independent Research

I chose to investigate the birth process - from contractions to labor to birth to the first hour.

A:

1.

Medical Videos, (2010). Natural Vaginal Child Birth Delivery Video [Web]. Available from http://www.medicalvideos.us/videos/1294/

This video shows the last few minutes of labor, when the baby is pulled out of the womb. The mother is given an episiotomy and blood seems to stream out in gallons however, judging by the reaction of surrounding doctors, this is a normal response. It is correct to say that the baby was "pulled out" in this case, because the midwife clearly draws the baby out with force. Once born, the baby is wiped down from all the blood and examined.

This is a useful source because it does not only say what happens during labor, it actuallyshows what birth looks like. It gives an overall view of the end of a typical pregnancy. This video is reliable, because it just shows raw footage, with no jump-cuts, which proves that what can be seen is exactly what happened. On the other hand, the video ends quite suddenly and the viewer cannot be sure if the baby was fine and how the mother felt. It is unbiased, because it simply shows what happens, with no comments or music in the background. My only concern about this source is that it was found on a website where almost anyone can upload their own videos.

This source is perfect for my research. It allows me to actually see what I will be writing and talking about. After seeing this video, I may start looking at episiotomy through a different lens- a painful and bloody experience which looks like it may have many complications later on.

2.

  March of Dimes Foundation. (2009, September). 

  Stages of labor. Retrieved from

  http://www.marchofdimes.com/pregnancy/vaginalbirth_indepth.html

This is a very interesting source listing what happens during labor, right from the first contractions to the delivery of the placenta. It briefly explains what will happen and what the mother can do while it happens. 

This text is valuable because, unlike the video, it also covers what happens before and after the actual moment of birth. It may be somehow biased, because it was found on a website designed to help and support pregnant women, which means it would probably show birth from the best angle possible. It is presented in a positive way and only sightly mentions the possibility of complications during and after labor. It talks about episiotomy like it is nothing special and that the woman might not need it anyway, when in fact, the video discussed above makes episiotomy seem quite dangerous and not at all nice and positive.

The source is helpful because it shows a clear, basic outline of what can happen, step by step, during labor, from contractions to placenta. It gave me an overall view of what everything looks like which I can now build off of.

3.

  Sutter Health. (2008). Labor contractions. 

  Retrieved from

  http://www.babies.sutterhealth.org/laboranddelivery/labor/ld_contractns.html

This source explains what contractions really are and how they are measured and timed. It gives background information and presents information in a clear way, including a diagram and examples.

This is a very useful source as it analyzes the subject and makes it easy to understand. However, again, this may be biased, as the purpose of the whole website is to make health and pregnancy look positive and is not meant to scare the reader.

This text filled me in with anything I needed to know about contractions. This information will probably be very important later on in my research.

4.

  Dr. Hughey. (2009). 

  Delivery of the placenta. Retrieved from

 http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/delivery_of_the_placenta.htm

This source explains everything in literally 7 paragraphs. It is concise but contains a lot of information and talks about what needs to be known about the delivery of a placenta. It includes a list of symptoms which accompany the approaching delivery.

 The text is reliable as it comes from a supposedly military website. It doesn't seem to be biased, because a military obstetric website shouldn't have anything to hide about the delivery of a placenta.

This is a useful source because the placenta is, despite appearances, an important part of labor. If not delivered, it needs to be physically removed by a doctor. It gave me some important insight because I only found out about the need to deliver a placenta fairly recently (about a year or two ago which is relatively not a long time). I find it very interesting and any piece of information about it gives me food for thought.

5. 

  RelayHealth. (Producer). (2007). 

  Cesarean section. [Web]. Retrieved from

  http://media.summitmedicalgroup.com/media/db/relayhealth-images/cs.jpg

This image illustrates a Cesarean section, including labels and a brief explanation of each step. The series of diagrams show a cross section of a womb with the baby inside being cut with a scalpel, then a baby being pulled out through the slit, the placenta being removed and the final result with stitches.

This is a useful source because it shows a visual representation of a C-section. It is reliable because what is shown in the diagram is explained and not much could be done differently in a Cesarean.

This diagram shows an alternate outcome of labor which, in a way, completely excludes the need for all the contractions which happened beforehand. This image makes a Cesarean section look dangerous, with the scalpel cutting through skin so close to the baby's head. 

6.

  Larissa Hirsch. (2008, July). 

  The first day of life. Retrieved from

  http://kidshealth.org/parent/pregnancy_center/childbirth/first_day.html#

"The First Day of Life" talks about everything concerning a baby right after it is born. It addresses the mother directly, telling her what her baby will look like when she sees it for the first time, what will happen, what the doctors will do etc. It also gives advice on what the fresh mother should do and how.

It is a useful source because, for a change, it talks about the baby and not as much about what is happening to the mother. It is biased though, because, like some of the others, it was found on a blog for new moms who need positive encouragement and do not want to hear too much about the negatives.

I found this  page fascinating, as I see giving birth as the biggest possible miracle of life (however cliché that may sound). This source was helpful to me because it describes what a baby looks like and how it behaves right after it is born. This is important in the first hour after birth, which is also what I will be investigating.

B:

I am still not sure what I might do for the final project. I would love to visit a hospital and look at real births but I'm not sure if that would be possible. I hope to get some new ideas after listening to Dr Moritz tomorrow.

HW 40 - Insights from Book - Part 3

You find yourself at a cocktail party with the author of the book you just finished reading. To demonstrate that you really read it, you say,


-"Hey - thanks for writing "Born in the USA". Your main idea about how there are hidden themes behind a Cesarean section besides delivering a baby made me rethink pregnancy & birth."


-"Really, which parts were most effective or important for you?"


-"Well, in the last third of the book you focused on how obstetricians perform C-sections to avoid being sued , which contradicted the first 2/3rds of the book. But let me be more specific:
1. In chapter three, you clearly state that obstetricians mainly do C-sections in order to have a convenient schedule, "It means that they can split their time between seeing patients in the office, doing gynecological surgical procedures in the hospital, and attending births, on a timetable of their choosing, and reduces the chance that they will be required to attend births at inconvenient times." (38)
2. However, in chapter 7, you wrote that "The decision to do a C-section (…) is often based not on medical need but on a desire to avoid litigation." (154) Even though the two statements do not necessarily exclude each other, they are contradicting.
3. The thesis about doing C-sections to avoid litigation seems strange, taking into account your statement from p.38 "Put simply, C-section, even when it is 'elective' increases the chance that the woman and/or baby will die.". If this is the case then why would obstetricians insist on continuing to perform elective C-sections? Having a bigger chance of killing the mother and/or baby also increases the possibility of ending up in court."


-"But what could I have done to make this a better book - that would more effectively fulfill its mission?"


-"Well, let's be clear - your text sought to provide narratives and data analysis from the perspective of a doctor who is aware of what patients think/expect, for the book-reading-public to better understand pregnancy & birth in our culture. Given that aim, and your book, the best advice I would give for a 2nd edition of the text would be to include even more real life stories and examples. I found that, reading this book, these where the parts which most attracted my attention. But I don't want you to feel like I'm criticizing. I appreciate the immense amount of labor you dedicated to this important issue and particularly for making me think about the consequences of inducing labor, how Cytotec can kill rather than help speed up labo, & that the atmosphere and stress when giving birth is very important for the mother and the baby. In fact, I'm likely to be more careful about obstetricians and choosing my own specialist when I, myself, become pregnant, as a result of your book."


-"Thanks! Talking to you gives me hope about our future as a society!"

HW 39 "Born in the USA" Part II

Born in the USA - How a broken maternity system must be fixed to put women and children first.

1. 

a) In the second half of the book, the author talks more about midwives and their practices. In "The Business of Being Born" we heard two opposing views: doctors talking about how home births may have their consequences and that giving birth in a hospital is much more safe, and midwives promoting natural home birth, arguing that women should have control over their labor. In his text, Wagner agrees with the midwives and shares their point of view. What interested me most in this chapter is the reason why stressless births go by more smoothly, "Any intervention that increases a laboring woman's fear or anxiety will interfere with, slow down or even stop the birth process" (Wagner 104). He explains that this is because the part of the nervous system which controls labor is the parasympathetic system. Stress, on the other hand, wakes up the sympathetic system, which, being the opposite, shuts down the parasympathetic system, making labor more difficult. This was also mentioned in the film, however was not explained as well as in the book, and I think I wouldn't have understood it if I hadn't read the book beforehand.

b) What the author mentions in the book and keeps bringing back is the continuing conflict between doctors and midwives. The movie however, does not show all the hate between the two professions. "In many cases, these attacks on midwives are simply attempts by doctors to eliminate the competition" (Wagner 115). This is not exactly what is shown in the movie. We can see a disagreement, however the movie just shows opposite points of view. The author of this book shows us what the whole business looks like behind the scenes.

2. The first chapter in the second half of the book is entitled "Where to be Born". In it, the author talks about the pros and cons of giving birth at home versus in a hospital. He highlights the fact that midwives and home births are often seen as a crime for no apparent reason and shows an example, "They ordered the midwife and her children to stay in the living room while they ransacked the house. Ms. S was not permitted to leave the living room to see what the police were doing" (Wagner 127). The author criticizes the fact that midwives are seen as criminals and I have to agree with him. Choosing the type of birth is a woman's right and no one should take that away from her, neither doctors or the police and midwives are only there to allow for home births to take place. 

3. 

> I think the aspect of stress during labor (p.104) deserves wider attention. If articles on the topic were published, people would, or should, start paying more attention to women in labor, and obstetricians would start looking at giving birth as something that happens a woman does rather than an illness she is going through.

> What also struck me as important was the list of rights that all patients, including pregnant women, have. The first, and probably most important, right which is mentioned by the author is the fact that a patient has the "autonomy in making all medical decisions, including the decision to refuse treatment" (Wagner 173). I think every woman should know these rights by heart before she goes into labor, or even before her first obstetrician's appointment.

4. The topic of inducing labor with Cytotec scrolls on throughout the whole book. Wagner wants to make the reader believe that Cytotec is one of the worst things a doctor can do to natural labor, unless it is necessary, which should be only around 10% of all births. The author repeats that Cytotec is a drug which has not been approved by the FDA (Food and Drug Administration). I did research to find out if what the author is saying is actually correct and found out that Cytotec is, indeed, not approved due to lack of data and research considering dosage of the drug "More research is needed into the safety and best dosages of Misoprostol [Cytotec]." (Hofmeyr)

What I found shocking was that, researching the safeness of Cytotec, I came across a link saying "cytotec - Buy Online Here! No prescription needed." (http://prime-result.com/search.php?r=med&q=cytotec) This link scared me, after all I have read about the drug. If 'medicine' like this spreads so easily, should we start worrying about psychopaths randomly injecting mysterious drugs into our veins on the streets of New York City?

Bibliography:

Wagner, Marsden. Born in the USA - How a broken maternity system must be fixed to put women and children first. 1st ed. Los Angeles, CA: University of California Press, 2008. Print.

Hofmeyr, GJ. "Vaginal misoprostol for cervical ripening and induction of labour." Cochrane Reviews. The Cochrane Collaboration, 29 May 2009. Web. 21 Mar 2011. <http://www2.cochrane.org/reviews/en/ab000941.html>.

Homework 38 - Homework 38 - "Born in the USA - How a broken maternity system must be fixed to put women and children first."

I am reading "Born in the USA" by Marsden Wagner. It is a book discussing the norms of giving birth in the States and criticizing American obstetric standards.

The book is divided into 9 chapters, each describing a different aspect of pregnancy and labor. A chapter begins with a brief introduction of the subject which is then followed by many examples and the author's experiences and data.

The topic of this book addresses and answers the question if the maternity system in the USA is well structured and how it compares to systems in other countries. According to the approach of most American obstetricians is far from appropriate. They do not treat women like they are deserved to be treated, often miss out important information and lead women in a way that is convenient for doctors themselves and not the patients. This would be unthinkable in most European countries where when it comes to pregnancy and labor, the woman always comes first. 

The major picture that the author is trying to depict is that the maternity system in the US is certainly not what it should be, and not how it used to be in the past. Wagner tries to make the reader realize that what is happening in this country in terms of gynecology is wrong and ought to be changed before all women and babies are killed by irresponsible, self centered obstetricians. In the first few chapters, the author managed to convince me and make me share his point of view. The proof and examples of stories he quotes make me believe that what is happening in hospitals during labor mostly should never take place anywhere in the world, and definitely not in one of the most civilized countries like the one we live in.

One of the aspects that the author and I agree is that obstetricians should never, under any circumstances induce labor when unnecessary simply to avoid having to rush to the hospital at inconvenient hours. I can't even imagine how someone ever came up with such an idea. The process interferes with the normal course of pregnancy and we should not interfere with nature, unless it really is an emergency.

Another idea that struck me as important and with mention is the issue of an increasing number of cesarean sections being performed on women, instead of vaginal birth. The most surprising thing is that many women chose giving birth through an operation rather than doing it naturally, like it has been done over centuries. What most of them do not know is that when performed without a medical explanation and not in an emergency, a cesarean section can be dangerous and sometimes even fatal. Women, however, want to avoid all the pain and stress of labor and simply want to have it done and over with. This is, again, a way of altering the nature of giving birth for another person's convenience, this time the mother's. Giving birth, however, is a very important moment in the life of a mother, while a c-section takes away the whole process. My mom always says that the moments when she saw me or my brother for the first time, right after giving birth to us, although painful, were the two most beautiful moments of her life. Through this example, I cannot imagine how a woman would chose not to experience such an important happening of her life. 

What also deserves public attention is the idea of the American College of Obstetricians and Gynecologists (ACOG) not publicizing important data or omitting information for their own benefit. People deserve to know the truth and they expect to find real information about pregnancy and labor in organizations like ACOG and it is no use when such groups cannot be trusted.

What also is an issue in the American maternity culture is the loss of midwives attending pregnancies. When labor has no complication, the presence of an obstetrician is almost redundant. Wagner even presents a good comparison for this: "(…)having an obstetrical surgeon manage a normal birth is like having a pediatric surgeon babysit a normal two year old". Midwives are appropriately taught how to attend labor and receive birth and there is usually no need for a surgeon to be present during low-risk labor. 

Most of the evidence the author uses in his book is either anecdotal and based his life experiences or statistics and data most of which come from sources quoted in a bibliography. Each bolder statement or statistic is followed by a sub-number which refers to an explanation or source, found at the end of the book. His accounts of meetings with doctors and his experiences seem very truthful, however, just like any other personal knowledge, it should not be trusted without supporting data. Wagner does include sources for most of his statements, thus most of the information in this book is trustworthy.

Even though this is not the type of book I would normally read, I feel like I will learn a lot from it. Also, I will have to get used to books like these since this is mostly what I will be expected to read as a college student…

HW 36 - Pregnancy & Birth Stories

I interviewed my parents, both at the same time. I had an idea it would provoke further discussions and sharing opinions I wouldn't have heard by simply just asking them questions. 

I started off asking my mom if her pregnancies (she is a mother of two) affected her relationship with my dad or other members of our family. Firstly, she answered that it didn't have that much of an impact, but then my dad joined in. He disagreed with her completely and said that the pregnancies made him, personally, feel much closer to our mom and that he was glad that this was the case. After hearing this, my mom changed her mind and agreed that having a child is definitely bonding. 

My parents felt that having children was simply a natural step in their lives. Although their first child (my brother) was, in a way, unexpected, they were thrilled to have him and, less than four years later, they had me. 

I also asked them if the pregnancies changed their opinions and views. My mom said that the pregnancy itself didn't really affect her life but having children and raising them obviously did. She mentioned that children change how you see the world; "you start looking at everything from a different perspective. You start realizing things you never would have thought of before". However, I felt that having children did not affect my mom as much as my dad. He said that when he saw my brother or me for the first time, he suddenly felt more mature and responsible. He was also incredibly proud of my mother for putting up with the pregnancy and for going through with it so well. That being said, my mom asked dad whether he felt that, even though it was mom carrying the baby, it was also him who was pregnant. He admitted that yes, he felt like the responsibility during those 9 months was equally his as well as my mom's. This seemed strange, but I suppose it is one of those things you can't understand unless you experience them yourself. My parents agreed that pregnancies were a challenge and test for the both of them. When asked if dad helped mom during the whole process, from pregnancy to after labor, they started talking over each other, listing all the things he did to keep mom from doing almost anything around the house. He tried his best to make her feel like a queen. 

During her first pregnancy, my mom attended a school of childbirth. The courses consisted of practical parts, which included breathing and relaxation techniques, and theoretical classes, about the stages during pregnancy etc. My mother memorized everything carefully from start to finish, but when it came to giving birth to her first child, she had the type of pain you couldn't do anything about. All the breathing techniques she learned didn't help when she was giving birth to my brother. 4 years later, when she was pregnant with me, she already remembered the classes she had taken before and did all the exercises at home. When giving birth for the second time, everything went better than before. She had contractions just as they were explained to her in the school of childbirth and used all the breathing and relaxation methods she had learnt before. 

I was born exactly on the day when it was planned. I was a perfect baby. When a midwife placed me on my mom's chest, the first thing I did was hug her and quietly lie there. My brother, on the other hand, is always in a rush to do everything. This was also true when he was being born. First off, he was born a week earlier than expected. Then,  "when they put him on my chest, the first thing he wanted to do is push away and crawl off to somewhere else. He can never stay in one place for too long. Ever." said my mom with a tut followed by laughter. She always describes holding each of her children for the first time as the best, most beautiful moments of her life. And she always mentions this with tears in her eyes. 

Listening to my parents talking about having children, to them discussing different issues and having similar views was a great experience. It showed me, and ensured me in the fact that I have a charming family and loving parents who would do anything for me. I think this is what a model family should look like in our culture. The example of my parents shows a "standard" approach to having children. Still, since I was born in Poland and my whole family is fully Polish, I presume certain aspects of pregnancy and childbirth are slightly different in America than what I think and believe in. 

Which brings me to my exploration question:

How are my (Polish) images on pregnancy and having children different to what is commonly believed in, in the US?