Thursday, March 31, 2011

HW 41 - Independent Research

Aspect: OB/GYN’s

A) Grady, Denise. New Guidelines Seek to Reduce Repeat Caesareans. New York Times, New York Times, 21 July 2010.

In this article the author mentions that vaginal birth is better for the baby but due to c-sections that are being given that are not for medical reasons the rates of c-sections have definitely increased. This remains because after a patient has given birth through a c-section the doctor believes that it’s a risk to then have a vaginal birth. Statistics have proven that this is in fact not true. This relates to the movie “On the Business of Being Born,” which provides different scenarios where doctors make excuses to use c-sections because it is much shorter than a vaginal birth which can take hours, even days. Doctors don’t want to spend too much time on one patient so they speed up the process as much as possible. This in a sense does represent the fear of litigation placed on doctors because in the book “Born in the USA” by Wagner Marsden, he mentioned that OB/GYN feel as if they must compete with midwives so they just erase them from the competition by making false statements about their practices.

Marsden, Wagner. What Every Midwife Should Know About ACOG and VBAC: Critique of ACOG Practice Bulletin No. 5. “Vaginal Birth after Previous Cesarean Section.” Midwifery Today, July 1999.
In this article Wagner Marsden is bringing up some of the effects ACOG may have on patients and even the influence on OB/GYN. ACOG (American Congress of Obstetricians and Gynecologist) is an organization consisting of professionals who are interested in promoting the well being of the patient and the product they want to get approved. The article also mentions that there is a contradiction with that statement because they care more about the well being of the doctor before the well being of the patient. This also relates to “Born in the USA” by Wagner Marsden because the book gave different scenarios where the doctor was trying to test a new drug on a patient that had not been approved by the FDA. They didn’t care about placing the mother or child at risk; they only cared about testing the reliability of the drug and when asked about this one doctor replied that they will never know a drug is safe until they themselves prove it’s harmful. OB/GYN may feel pressured y this group called ACOG to follow their practice a certain way because it is not accepted for patients to file suit against a doctor because usually we believe that the doctor is always right.

Cantulpe, John, Fear of Malpractice Litigation. Media Health Leaders, 10 September 2010.

In this article the author is expressing some of the fears doctors face as a result of the fear of litigation or malpractice. Usually doctors do want to generally help people and do their jobs so they go into their job (handling a birth) fearful because they plan for something to go wrong. This reminds me of “The Business of Being Born” because the way midwives approach birth and the way OB/GYN’s approach birth is very different. A midwife is taught to approach birth as a ore natural process because birth is something your body does. An OB/GYN is taught to view birth as a mistake they must prevent before the mother harms the child with her body so they have to get the child out. This relates to the fear of litigation because doctors don’t want to have a lawsuit so instead if thinking about what’s best for the mother sometimes they only think about which way is best for themselves.

Brodesser-Akner, Taffy. Who Controls Childbirth-expectant moms or dads? MSNBC, 13 July 2010.

A woman wrote this article about her personal experience with birth and the way she was treated by her OB/GYN. She didn’t feel that her wishes were being respected as much as the doctors and she was the one giving birth. Despite her wishes the doctor gave her a c-section because after being given all those drugs she didn’t have the energy to give birth. The doctor began by breaking her water with a hook then giving her a c-section. This relates to “The Business of Being Born” because if the patient protested the doctor would threaten to give her a c-section, or vacuum the baby out if she didn’t push hard enough. This is wrong because doctors don’t really care about the patient they care about themselves and getting the baby out as soon as possible.

Hartocollis, Anemona. Doctors’ group fights a bill that would put fewer restrictions on midwives. The New York Times, 17 June 2010.

This article is about someone that is pushing for more independence for midwives. Some doctors agree that it’s best to have a written agreement because let’s say that a midwife took her patient to the hospital and she started bleeding uncontrollably it would be best to have a written agreement with a doctor that would help the midwife. This article relates to “Born in the USA” by Wagner Marsden because the books said that OB/GYN’s are in constant competition but I don’t feel like all doctors are that way this article provides a good example of OB/GYN who are trying to do the right thing.

B) For this project I am thinking about writing a paper about the training of OB/GYN and maybe using some historical evidence to support that the practice has changed a lot but there are still some similarities in their view of birth. I could use some of this research to support some of the factors OB/GYN’s have against them such as ACOG which doctors necessarily might not follow and how the fear of litigation causes them to practice medicine in a particular way. I can find new evidence about the rates of c-sections, episiotomies and other practices that have been used for pregnancy and birth.

HW 41 - Independent Research

Aspect: OB/GYN’s

A) Grady, Denise. New Guidelines Seek to Reduce Repeat Caesareans. New York Times, New York Times, 21 July 2010.

In this article the author mentions that vaginal birth is better for the baby but due to c-sections that are being given that are not for medical reasons the rates of c-sections have definitely increased. This remains because after a patient has given birth through a c-section the doctor believes that it’s a risk to then have a vaginal birth. Statistics have proven that this is in fact not true. This relates to the movie “On the Business of Being Born,” which provides different scenarios where doctors make excuses to use c-sections because it is much shorter than a vaginal birth which can take hours, even days. Doctors don’t want to spend too much time on one patient so they speed up the process as much as possible. This in a sense does represent the fear of litigation placed on doctors because in the book “Born in the USA” by Wagner Marsden, he mentioned that OB/GYN feel as if they must compete with midwives so they just erase them from the competition by making false statements about their practices.

Marsden, Wagner. What Every Midwife Should Know About ACOG and VBAC: Critique of ACOG Practice Bulletin No. 5. “Vaginal Birth after Previous Cesarean Section.” Midwifery Today, July 1999.
In this article Wagner Marsden is bringing up some of the effects ACOG may have on patients and even the influence on OB/GYN. ACOG (American Congress of Obstetricians and Gynecologist) is an organization consisting of professionals who are interested in promoting the well being of the patient and the product they want to get approved. The article also mentions that there is a contradiction with that statement because they care more about the well being of the doctor before the well being of the patient. This also relates to “Born in the USA” by Wagner Marsden because the book gave different scenarios where the doctor was trying to test a new drug on a patient that had not been approved by the FDA. They didn’t care about placing the mother or child at risk; they only cared about testing the reliability of the drug and when asked about this one doctor replied that they will never know a drug is safe until they themselves prove it’s harmful. OB/GYN may feel pressured y this group called ACOG to follow their practice a certain way because it is not accepted for patients to file suit against a doctor because usually we believe that the doctor is always right.

Cantulpe, John, Fear of Malpractice Litigation. Media Health Leaders, 10 September 2010.

In this article the author is expressing some of the fears doctors face as a result of the fear of litigation or malpractice. Usually doctors do want to generally help people and do their jobs so they go into their job (handling a birth) fearful because they plan for something to go wrong. This reminds me of “The Business of Being Born” because the way midwives approach birth and the way OB/GYN’s approach birth is very different. A midwife is taught to approach birth as a ore natural process because birth is something your body does. An OB/GYN is taught to view birth as a mistake they must prevent before the mother harms the child with her body so they have to get the child out. This relates to the fear of litigation because doctors don’t want to have a lawsuit so instead if thinking about what’s best for the mother sometimes they only think about which way is best for themselves.

Brodesser-Akner, Taffy. Who Controls Childbirth-expectant moms or dads? MSNBC, 13 July 2010.

A woman wrote this article about her personal experience with birth and the way she was treated by her OB/GYN. She didn’t feel that her wishes were being respected as much as the doctors and she was the one giving birth. Despite her wishes the doctor gave her a c-section because after being given all those drugs she didn’t have the energy to give birth. The doctor began by breaking her water with a hook then giving her a c-section. This relates to “The Business of Being Born” because if the patient protested the doctor would threaten to give her a c-section, or vacuum the baby out if she didn’t push hard enough. This is wrong because doctors don’t really care about the patient they care about themselves and getting the baby out as soon as possible.

Hartocollis, Anemona. Doctors’ group fights a bill that would put fewer restrictions on midwives. The New York Times, 17 June 2010.

This article is about someone that is pushing for more independence for midwives. Some doctors agree that it’s best to have a written agreement because let’s say that a midwife took her patient to the hospital and she started bleeding uncontrollably it would be best to have a written agreement with a doctor that would help the midwife. This article relates to “Born in the USA” by Wagner Marsden because the books said that OB/GYN’s are in constant competition but I don’t feel like all doctors are that way this article provides a good example of OB/GYN who are trying to do the right thing.

B) For this project I am thinking about writing a paper about the training of OB/GYN and maybe using some historical evidence to support that the practice has changed a lot but there are still some similarities in their view of birth. I could use some of this research to support some of the factors OB/GYN’s have against them such as ACOG which doctors necessarily might not follow and how the fear of litigation causes them to practice medicine in a particular way. I can find new evidence about the rates of c-sections, episiotomies and other practices that have been used for pregnancy and birth.

Monday, March 28, 2011

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 How a Broken Maternity System must be fixed to put Women and Children First”. Your main idea that midwives are ostracized and eliminated from the competition with obstetricians made me rethink pregnancy and birth in the U.S. made me rethink pregnancy & birth.

But the author, surprised to be talking to someone who instead of sharing their own birth story actually rephrased the main idea of the text s/he spent months giving birth to asks, "Really, which parts were most effective or important for you?" When you answer, "Well, in the last third of the book you focused on educating people about the medicalization of birth, which connected to some of the atrocities revealed to the readers in the first half of the book. But let me be more specific."
1. “Another key strategy for midwives must be to push for autonomy-recognition that midwifery is an independent health care profession with its own certification, licensure, and state boards- and for an egalitarian relationship with doctors “ (Pg. 125).
2. “Fear of litigation is a highly selective excuse used by some obstetricians when there is something which is not obstetrician friendly such as planned home birth (over which they have no control and no profit) (Pg. 151).
3.”Maternity care will become fully integrated into social and family services only when it has escaped the hospital” (Pg. 189).

At this point, realizing that s/he's having a unique conversation with a serious reader of her/his book, the author asks - "But what could I have done to make this a better book - that would more effectively fulfill its mission?" You answer, "Well, let's be clear - your text sought to provide (narratives, historical analysis, journalistic analysis, policy analysis) from the perspective of a (Woman giving birth) 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 have more narrative from obstetricians and midwives about the differences in their beliefs and maybe some obstetricians that are not cold. 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 fear of litigation that is placed on doctors and makes them more fearful & the treatment that some obstetricians inflict upon their patients. In fact, I'm likely to have a midwife hopefully if I give birth one day as a result of your book." The author replies, "Thanks! Talking to you gives me hope about our future as a society!"

Tuesday, March 22, 2011

HW 39 - Insights from Book - Part 2

The book focuses on some of the atrocities we could never imagine with doctors, the amount of pressure they face and some of the things they do to get a drug approved by the FDA. The sad part is that sometimes the doctors are not telling the patients the dosages they are being given and even the drug and this has lead to many deaths of both the child and mother. Interviewer: “But should we wait until after we learn it before we say it is safe? Dr. Goldberg: It’s a catch-22. If you don’t use it, then you don’t learn” (Pg. 82). The main idea is that doctors use these pills and other medications on pregnant women as a test, they don’t actually know the effects but they feel that if the FDA won’t approve they have to make them. This is unsafe and dangerous because the doctor is not informing the patient of the kinds of medications they are being given that are potentially harmful to the child.

In the second 100 pages the book compares some of the differences between obstetricians and midwives. I do feel that obstetricians and midwives have a totally different approach to pregnancy. Midwives view birth as something your body does and obstetricians view it as a surgical procedure rather than something natural.


3. List 5 interesting aspects of pregnancy and birth discussed in the second hundred pages that you agree deserve wider attention (include page number).

1. Midwifery should be an available option because it is statistically proven to be safer than going to an obstetrician (Pg. 111).
2. Men are intimidated by midwives because other women are going to a woman for advice and men feel excluded from birth. With obstetricians it’s more of a man’s world because there are more male obstetricians than female, with nurses which are mostly women (Pg. 101).
3. Women need to feel confident of their situation, and that they can do it before they actually give birth. In a hospital setting the woman has less control of what’s happening to her body (Pg. 105).
4. Doctors do not like companies regulating their practices, such as the FDA (Pg. 97).
5. Inducing labor is a very risky process that leads to many different complications. Doctors use it for their benefit rather than the benefit of the “patient” (Pg. 93).
4. Independently research one crucial factual claim by the author in the second hundred pages and assess the validity of the author's use of that evidence.



I decided to research some of the rates of inducing labor during pregnancy. The rates of labor induction have risen from 0% of deliveries to more than 22%, between 1990 and 2006. Having a C-section is more common than a natural birth. Pregnancy has become more medicalized because more women are having their labor induced but this is more for the doctor’s benefit because they want to get out as soon as possible. (http://www.time.com/time/health/article/0,8599,2007754,00.html)

Monday, March 14, 2011

HW 38 - Insights from pregnancy & birth book - part 1

1. The book is designed to show some of the corruptions behind the obstetrics and gynecological care at hospitals. The system is changing and women no longer have rights when it comes to giving birth and hospitals can’t protect them because doctors are facing issues themselves.

2. The essential question of the book seems to be: “The system of birth is seriously flawed but what can we do to improve women’s experiences with birth in the United States?” “This book will show that by embracing a medical model of birth and allowing obstetricians control of our maternity care, we Americans have accepted health care for women and babies that is not only below standard for wealthy countries but often amounts to neglect and abuse” (Pg. 5).

3. The book is trying to express why obstetrics and gynecology are so sacred and why women are almost always referred to hospitals rather than having the option of a midwife. For example having a midwife is not an option in some cities. “Obstetricians ‘attend’ 90 percent of births and have a great deal of control, essentially a monopoly, over the maternity care system” (Pg. 5).

I never thought about the power obstetricians had and reading the book made me a little more skeptical because there are certain things obstetricians are not allowed to do for fear of litigation and for a bond of silence between doctors. If a doctor finds something that is not right, maybe a patient being abused by a doctor they would be reprimanded for standing in rather than trying to help the patient. This is the same with doctors if there is something going on with another doctor one doctor is not allowed to testify against another out of fear of being fired. It’s sad the position a doctor is placed in.

4. *That women should not be pressured into being given drugs even without their knowledge.
*Doctors should actually stay with the women while they are in the process of dilating and having contractions so they understand the situation before they come into it.
*A doctor should need to provide statistics about the number of patients that have been given c-sections, episiotomies, and general statistics from the doctor they choose.
*Women should be allowed to choose whatever kind of birth they would like to have, because in some states there may be more obstetricians than midwives.
*The fact that doctors have an unspoken bond of silence toward one another and are not allowed testifying against another doctor who may not be giving patients the proper treatment.

5. The book gives statistical data to support each of the topics the author is referring to throughout the book. I can trust this information because the statistics speak for themselves; however the book continues restating the same point multiple times. The text does not convince me because I didn’t know that some of these things existed in our society but the book doesn’t make me want to become more motivated to make a change it seems like the author is saying that this is the way it is and that’s that.

Wednesday, March 2, 2011

HW 37 Comments on Birth & Pregnancy Stories

From Megumi,
I found your post really interesting. The post made me re-think about the difficulty and feelings that comes across people during the process of birth. A line in particular that I liked was, "When she became pregnant it was no longer about herself, it was about “I have a baby growing inside of me, what I need to do to take care of this child?” She also began talking about how through raising children you are able to reflect and change some of the things you were brought up with." This is a pattern I notice with the people I interviewed as well. I think its because a new life brings joy but also a responsibility. And, raising a child is no easy task so mothers always learn a few life lessons along the way. This makes me wonder if there is such a thing as an 'ideal' way to raise a child if the parent is also in a way learning from the new life.

From Ben,
I really liked your decision to choose three women who had experienced the processes of pregnancy and giving birth in order to gain multiple perspectives on a similar situation. One of your lines that was most interesting to me was, "So she believed that having children would be the best option, and another thing she mentioned was that she didn’t want to have kids too young and she didn’t want to have them when she was too old so then was the perfect time to have children." One of the reasons this caught my eye is because I have a similar belief, and also because it sparks questions such as, "Statistically speaking, what are the best ages to have a child?" Your post certainly got me thinking about even more aspects of pregnancy and birth, great job!

From Berenise (Mentor),
I really found your post interesting, interviewing three different types of women and being able to see their different takes on birth. Birth is an amazing experience and a part of a mother or even woman's life. I loved how you placed a question at the end which said, "How do you become prepared to actually care for a baby? How do parents know what they should and should not do for the care of their child?". In reality you really think you can prepare but not actually prepare until you go through it because every child is different, every birth is different and no one can actually give you step by step instructions for how to care for a child, or even the process of birth.

From Angela (Protege),
What I liked most about it was that it is true it did help her realize and accept having a natural birth. your post is really interesting and it made me realize the difficulties that people have going through the process of birth and pregnancy

_________________________________________________________________________________
For Megumi,
I enjoyed reading the account of your birth and it’s interesting that you mentioned the experience a person has with giving birth. I have always wondered what makes someone more experienced with giving birth than the next person and that is something I hope to learn in this unit. I also liked the line: “Living in Japan, my mother was affected by the assumptions people made about marriage and birth. This made me wonder if the culture here, in America, affects our decisions about pregnancy and birth as well.” I do believe the cultures in our society do influencec the way we view the process of pregnancy and birth because we follow the cultures of our society. I enjoyed reading your blog.

For Ben,
I think it was really interesting that you told a story of the way things were before your mom found out she was pregnant. I really liked this line: “This might be because she had a good man and friends who were by her side the whole time, a gift which should not be taken for granted considering the amount of people who are not so fortunate.” In the interviews I conducted I noticed that most people said that when you have a child it should be planned, meaning you should have a stable career and marriage before having a baby. The woman I interviewed mentioned that she also had a baby because she was in love. It seems like in our society pregnancy should be planned, but even some of the babies that were not planned are still accepted. I also liked how you showed a positive account of teen pregnancy. Teen pregnancy is usually associated with the child being raised by a single parent, never enjoying life. This account was shocking as well a good to hear that the father of the child stuck through it because not many men are ready to stand up for their responsibilities. I really enjoyed reading your blog.