Homework #41: Independent Research

"What Are Mothers' Rights during Childbirth? - Health - Women's Health - Women's Health - Msnbc.com." Breaking News, Weather, Business, Health, Entertainment, Sports, Politics, Travel, Science, Technology, Local, US & World News- Msnbc.com. Web. 31 Mar. 2011. <http://www.msnbc.msn.com/id/5012918/ns/health-womens_health/>.

            This article talks about a woman who refused to undergo a caesarean, as she trusted herself to birth her 11-pound child vaginally. When the hospital required the operation, she left and found another hospital that was willing to support the vaginal birth of her child. Upon her departure the hospital sought legal guardianship of her unborn child, so that if she were to return, they would legally be allowed to perform the C-section. The article then goes on to discuss several cases where similar occurrences happened. At the end they question whether it is ethical or not to allow a mother to refuse the care.

"The Rights of Childbearing Women : Free Downloadable Brochure or Buy as Handouts :: Childbirth Connection." Childbirth Connection: Helping Women and Families Make Decisions for Pregnancy, Childbirth, Labor Pain Relief, the Postpartum Period, and Other Maternity Care Issues. Web. 31 Mar. 2011. <http://www.childbirthconnection.org/article.asp?ck=10084>.

Listed is a set of rights that a mother has during her pregnancy and childbirth. Among these rules are those such as a woman can choose her care provider, she has the right to be informed about the risks and benefits of each operation, and that she has the right to refuse or accept any treatment. However there is a side note that this last right has been legally challenged in the past couple of years.

Goer, Henci. "Why Are Women Stripped of Their Rights during Labor and Delivery?" Blog | Double X. Web. 31 Mar. 2011. <http://www.doublex.com/blog/xxfactor/still-cruel-maternity-wards>.

After giving many examples of abuse in the maternity ward, Goer begins to protest the actions. She explains her views on the subject, how she believes this abuse is a result of the doctor’s desire for convenience and fear of liability. She makes the point that in any other situation, this mistreatment would be looked down upon heavily.

"Maternal vs. Fetal Rights." Santa Clara University - Welcome. Web. 31 Mar. 2011. <http://www.scu.edu/ethics/publications/iie/v1n2/pregnant.html>.

Discussed here is the right of the woman during pregnancy. The mother has no obligation to alter her own life for her child. In no other situation would one person be forced to risk his or her own life for the sake of another’s. However some argue that the child has the right to come into the world in a healthy state. But there is a tipping point, where will the line be drawn? If women are being forced into caesareans, what other procedures around their birth can they still be legally obliged to suffer through?

Coutts, Mary C. "Maternal-Fetal Conflict: Legal and Ethical Issues." Bioethics.georgetown.edu. National Reference Center for Bioethics Literature. Web. 31 Mar. 2011. <http://bioethics.georgetown.edu/publications/scopenotes/sn14.pdf>.

This article revolves around the different risks a mother poses to her unborn fetus. It then goes on to discuss the role of the doctor in the mother’s decisions and if it is their responsibility to interfere in the mother’s actions. Court cases are also discussed such as Roe vs. Wade, limiting or expanding the rights of a woman during her pregnancy. Not only is the doctor’s relationship to the mother discussed, but also his or her responsibility towards the fetus.

"Maternal-Fetal Conflict: Ethical Topic in Medicine." UW Departments Web Server. Web. 31 Mar. 2011. <http://depts.washington.edu/bioethx/topics/matern.html>.

Discussed here is the reason for this conflict. They address the fact that the relationship between mother and fetus has begun to change; they are no longer seen as one unit, but instead two separate persons. It then continues on to answer questions such as, does a fetus have rights, and when does it officially become a person? The main point that is trying to be administered is that a mother and fetus must be evaluated separately in terms of medical procedure, and the decision should be carried out once this information is assessed.

"The Science Creative Quarterly » LEGAL RIGHTS AND THE MATERNAL-FETAL CONFLICT." The Science Creative Quarterly. Web. 31 Mar. 2011. <http://www.scq.ubc.ca/legal-rights-and-the-maternal-fetal-conflict/>.

There are two sides to this argument. Some feel that if a fetus has rights, then the state is obliged to protect these rights and the fetus. As the fetus develops, it slowly becomes more of a person and gains more rights. However the fetus is still dependent on the mother throughout the gestational period. This would in fact mean that the fetus is a part of the mother’s body, thus giving her all rights to the fetus. The conclusive answer is determined by which theory the person holds their beliefs.

"Forensic Implications and Medical-legal Dilemmas of Maternal versus Fetal Rights." Http://www.ncbi.nlm.nih.gov/. Institute of Psychiatry, Law, and the Behavioral Sciences, University of Southern California, Los Angeles, USA. Web. 31 Mar. 2011. <http://www.ncbi.nlm.nih.gov/pubmed/9729816>.

Each situation differs in terms of maternal vs. fetal rights. In a situation that is most invasive to the mother, she thereby earns the superior rights. However it also depends on the doctor’s ethics, if they believe that the mother or fetus’s rights are more highly valued. When taken to court, they must weigh in both the fetus’s right to a healthy life, but also the mother’s right to privacy; this is called the “balancing test.”

            I believe for this topic it would be most productive to do more research and write a paper about it. While it would be extremely interesting to go and talk to people about their views on maternal and fetus rights, I presume it would be a more sensitive topic. According to each of these sources there are many court cases that have dealt with maternal and fetus rights, which would be very interesting to read and interpret. I would look at the different situations mentioned here, whether it be induction or court ordered C-section:  basically anything that alters the natural birth process and that the mother has refused. A lot of the sources talk about two different sides or theories, one in which the mother has superior rights, and one in which the fetus does. Both theories are extremely interesting and I would try to evaluate both and assess their validity. The articles additionally spoke of many women’s personal experiences, which I think would be helpful to further draw upon. The best evidence is that of someone who has experienced itself. To do this I will look on different pregnancy blogs, perhaps the one mentioned in Pushed, used by Jennifer Block to receive feedback about modern pregnancy. With this paper I hope to obtain and share a more in depth understanding of the rights of women and fetus during pregnancy and childbirth. 

Homework #40: Insights from Book Part Three

Hey - thanks for writing Pushed. Your main idea about how women are pressured into unnatural procedures during the natural process of birth really made me rethink pregnancy and birth, something that I saw no problems in before.

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

Well, in the last third of the book you focused on midwives and society’s battle against their practice, tying it in with the rights of women in the birth process, which added another angle to the first 2/3rds of the book. But let me be more specific:

You shared with us the hopes of a midwife, who wishes that the structure around birth will evolve again, closer to its natural state: “’I think there will come a time when we will remember or will rediscover -perhaps it will be so distant that we’ll feel we have discovered – the intrinsic value of birth under one’s own steam. Maybe we have to evolve back to a place where we realize all of this is folly. That we can’t control health in the ways we think we can. And that in fact the most important and valuable thing we can give ourselves is a woman under her own steam, bringing her babies forth,’” (p. 248). I believe this was definitely one of the main points of the second half of the book. There will come a time when we realize that birth is not something to be controlled, but instead a natural process that we must leave to its own devices. This reflected well off of the previously discussed cesarean sections and induced labors in the first two thirds of the book.

Then you continue with how the rights of the women and the rights of the child compare, something that has definitely developed over time along with the intervention of hospitals: “’These issues are not just problems of fetal rights, they’re not just problems relating to pregnancy. They’re also profoundly about race and class and our legal system’...And they are profoundly about how we treat women. Paltrow reframes the debate: ‘The question is not when do fetuses have rights, but at what point in pregnancy do women’s civil rights end?’” (p. 257). This ties in well with the abuse of mothers we see in the first two thirds of the book. Whom are we really protecting? It seems that everything is done in the interest of the baby, but when has the mother become worthless? As a conscious being, it seems only fair that the mother have rights at all times, as the child can not yet make decisions for itself.

Lastly, I found that your definition of vaginal birth to be quite mind altering, as we see that it is not a procedure, but nature: “I asked Paltrow whether vaginal birth is a procedure that can be denied. ‘I would argue it’s not. It’s not a procedure,’ she said. ‘And as is often the case with claims of fears of liability and institutional protection, those fears have very little foundation in reality,’” (p. 261). All of the roles that the hospital plays in pregnancy tend to be those of interference because something is going wrong. Natural childbirth however does not need this intervention; it can thrive on its own. Doctors can clearly not refuse to support the natural process of childbirth, while the mother is not allowed to refuse their intervention. It is the mother’s body and should therefore be up to her how she is treated, especially considering the consequences highlighted in the first two thirds of the book.

"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 journalistic analysis and policy analysis with a few narratives, from the perspective of a well-educated researcher 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 add a little more narrative and perhaps your own personal ideas, rather than letting the facts speak for themselves. While facts are hard data, they become much more interesting to read when tied in with deeper analysis and narrative. 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 risks of hospital intervention, such as cesarean and induction, and the harsh ruling against midwifery and natural birth in our society. In fact, I'm likely to have birth differently as a result of your book. I had always imagined going to the hospital as a child, deeming midwives “old-fashioned”, however now I feel that I could not see myself going to a hospital unless it is absolutely necessary.

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

Homework #39: Insights from Book Part Two

Block, Jennifer. Pushed: the Painful Truth about Childbirth and Modern Maternity Care. Cambridge, MA: Da Capo Lifelong, 2007. Print.

• Discusses C-sections much more in depth, both the surgical procedure and effects on the mother.
• Arranged birth and how it has changed the dynamics around the hospital.
• The science of each procedure i.e. episiotomy, c-section.
• How pitocin has developed throughout medical history and its role in the birthing process.
• Vaginal birth after cesarean and doctors’ attitudes around the subject.

            In the next pages that I read, the topic switched from “arranged birth”, as in induction and planned cesarean, to women whom birth was denied at the hospital. A small percentage of women have breech babies, meaning the child is not positioned head down in the uterus. This can be extremely dangerous for the child, therefore causing doctors to plan cesareans. However Pushed discusses the risk of cesarean and tells stories of successful breech births performed by midwives. Lastly, Block writes about VBAC – vaginal birth after cesarean, and women’s battle with that. This I found a bit more interesting than before, because neither topics are very heavily discussed. It seems crazy that a doctor would not heed to his patient’s preference, but instead decides what would be most convenient for him or her. If a mother wants to take the risk of VBAC, then she should be allowed it. Pushed has clearly proven that she is just as much risk having a repeat cesarean. I believe that when the mother is comfortable with the choice, then the best outcome will result.

           

• “As obstetrics becomes more didactic, women who are determined to avoid unnecessary surgery are shunning the hospital altogether and planning to give birth at home. ‘It’s a matter of trust for most of these women,’ says Bennett. ‘The reason they’re having HBACs is because they don’t trust the hospital.’” (p. 95)
• “The women online are months, or even years, out from their cesareans, yet many are still coming to grips with them. And when they get pregnant again, they are often being told they must have another surgery; that their uterus could rupture and the baby could die.” (p. 92)
• “An unmedicated birth in an environment where a woman feels comfortable, where she’s adequately supported, where she has a degree of privacy that allows her brain and her uterus to do the dance that we understand very poorly called labor, is a physiological birth. And once you start messing with any one of those factors, put her in hospital with noise and light, take away her privacy, you down a slippery slope toward industrial birth.” (p. 105).
• “ ‘Our results show how a medical intervention or treatment that is effective when applied to sick individuals in emergency situations can do more harm that good when applied to healthy populations.’” (p.114).
• “The truth is however, that we don’t know what our true maternal morality rate is. The U.S. Centers for Disease Control and Prevention acknowledges that pregnancy-related deaths are underreported by as much as three times.” (p. 119)

            I decided to check the fact that maternal mortality rates are underreported in the United States, as I found that surprising. I never really considered them to be that high, as we live in a first world country with such advanced technology. I would never have reflected on the fact that the US would try to cover up a number, because it never would have been significant enough to. However after researching a bit online, I came across a prenatal yoga studio that had written about it:

“In 1998, the CDC estimated that the US maternal death rate is actually between 1.3 and 3 times what is typically reported in vital statistics records because of under-reporting of such deaths. There are potentially many more pregnancy-related deaths than those reported and accounted for. Ina May Gaskin points out that: “Reporting of maternal deaths in the United States is done via an honor system. There are no statutes providing for penalties for misreporting or failing to report maternal deaths.” ¹

I find it really interesting that there are no guidelines for reporting maternal deaths. Do they have less worth than other deaths in our society? Is it more important that the child survived, rather than the mother? It was very good of Block to bring this up, as I believe it clues us in to a lot of things. She exposes how secretive and manipulative the industrialized birth system actually is. By not reporting maternal deaths, it ultimately creates the image that the hospitals are succeeding in their tactics, and that it is therefore safe to access them. Women may see the birthrate and think, wow, the horror stories I have been hearing maybe are not so entirely true, or maybe they really are a rarity. Of course the hospital is important for when cesareans and induction are necessary, however they are performing these operations in unnecessary circumstances. A lot of these maternal deaths are probably covered up to avoid negative media about the practices of the hospital, which of course would lead to more home births and midwifery use.

The yoga site linked to a list prepared by Ina May that may also be interesting to read:

http://www.rememberthemothers.net/Fact%20Sheet%202005.pdf

¹ "The US Has One Of The Worst Maternal Mortality Rates In The World. Why?" - Prenatal Yoga Center. Web. 22 Mar. 2011. <http://prenatalyogacenter.com/blog/the-us-has-one-of-the-worst-maternal-mortality-rates-in-the-world-why/>.

Homework #38: Insights from Pregnancy and Birth Book 1

Pushed by Jennifer Block is set up around the pressure a new mother experiences while bringing a child into this world. It begins with a discussion of how birth has become planned and moves on to discuss the ways that we choose to shorten birth and make it more convenient.

            Through this organization, Block attempts to answer the question “how has birth become more industrialized?” She discusses the unnatural nature of our birthing industry, while generally avoiding the all natural. This is an extremely interesting question to answer as I find that we never really question our birthing system. As a child I always thought the idea of a midwife was odd and old fashioned, but once hearing about how abnormal our actual system is, my mind has changed. Hospitals are treated like factories, pumping out babies in as little time as possible.

            Block tries to push the idea that mothers have little control over theirs births: they are being pushed for the convenience of the doctor. Doctors are inducing labor so that it comes at a time that fits them best and are performing episiotomies for supposed “harmful births.” I find this whole system disturbing. Block shows statistics where the doctors actually intervene in healthy births and end up creating problems. It is completely unfair to the mothers because it is their time, their body, but the doctors treat them as flawed machines.  I do not understand why these people became doctors if they are not there to do the best for their patients. They should be happy that they are not needed when there is a healthy birth, rather than trying to make themselves needed.

            After reading this much of the book, there are a number of things that I believe are worth knowing about pregnancy and birth. Firstly, probably the most important thing, is that a natural birth is painful, but doable. Many women have successfully given birth completely naturally and it is not something that people should shy away from. Another important thing to realize, is that rushing labor can lead to a lot of problems. I think there are actually a lot of people out there to whom speeding up labor appeals to, however they do not realize the risks that can come with it, such as it resulting in a cesarean section. What I also found interesting was that doctors perform so many episiotomies. The female skeleton is made for child bearing, so it seems ridiculous that doctors would use that as an excuse to perform this surgical cut, which actually heals much slower than natural tearing. It also appears that doctors feel completely fine with inducing and having it result in a cesarean section because they then do not have to deal with a lawsuit. Only if the baby is damaged do they have to worry about anything. This just seems a bit sad, that they disturb a process that would have done fine on their own and that there is barely a case against it. Lastly, a due date is just a midpoint in a curve. It is an estimation of when the baby will be born, leaving a couple of weeks before and after. However in the medical world now they tend to set this date in stone, resulting in forced induction. It is important to realize that the baby will come out when it is ready.

            Block uses lots of evidence in Pushed, which makes the text extremely factual. She uses personal experiences told to her, such as small anecdotes, but also addresses lots of statistics. While it is interesting to hear the facts, the data can be a bit overwhelming. The book becomes a list of facts and studies rather than her own thoughts. Everything seems extremely reliable and true, however it does not always make for the most engaging read. 

Homework #37: Comments

From Sarah: Natalie: I really liked the contrast between all three of your interviewees. I found this line to be very insightful, "She feels deep compassion for the mother and the family and tries to achieve the perfect environment for the baby to come into and for the mother to thrive in. As sacred as she tries to make birth for the woman, she said that after becoming a midwife, she “realized how normal birth is.” " I was reading an article online about how woman have the instinct to give birth and yet we completely undermine this and go forward with different techniques. I wonder though if c-sections and hospital births were to become obsolete would the death rate rise? Is natural birth enough for the survival? Or would survival of the fittest become part of the picture?


From Casey: Natalie,
I loved the structure of your post; it was very easy to follow and coherently organized. I was struck by the line, "As sacred as she tries to make birth for the woman, she said that after becoming a midwife, she 'realized how normal birth is.' Birth is a completely natural thing that society makes too much of a fuss over. 'If we leave women alone- and simply support the woman and her family, provide education and safety – things will turn out ok.'" 
I wonder how this midwife explains (in light of this statement) the complications or lack of resources in the home that have led to injury or death of the baby/mother? All of your interviewees seemed like amazing people; perhaps the idea of a pregnant woman is favorable because what is going on in them is amazing.

From Lindsay: "I channeled that energy and it helped me make it through. I also didn’t have any choice to give up... matt and I both sweetly remember our midwife tucking the three of us in bed after the births – it’s the moment when we truly were grateful to be at home. We all just snuggled up and stared at one another in a quiet room. It was quite profound.” 

The three women that you interviewed provide a very interesting timeline of our perceptions and ideas around birth, from your first interviewee who talks about her mother's generation giving birth in the 50's, practially unconcious, to two new mothers who 15-20 years later than your first interviewee had so much more access to information about and support for natural births.

I think that as you go through this unit, I will be interested to see how you can refer back to these interviews, but also be critical of how they represent the experiences of three middle/upper class white women.
From Bjorn: "It is possible that we are the only ones that convince ourselves that birth is this natural disaster that we need to alter to fit our human needs." 

I really like how this sentence is so powerful and provocative, nothing bad about the americans, but it really makes a double-sided statement: that giving birth is a natural disaster and number 2 that americans are willing to try everything to make life more comfortable.
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To Casey: "Additionally, actions speak far louder than words. Saying “Good luck” or “I hope you have a healthy baby” or “you’ll do fine” obviously does not stick in one’s mind or help as much as throwing baby showers, building baby furniture, preparing meals, or just being there for emotional support."

I think this is a really interesting point that you bring up. When we meet someone who is pregnant we tend to say congratulations or wish them the best, but we do not perform any actions to create a more positive experience. While it is of course positive reinforcement, like you said, will they really remember? But maybe what we really need to be asking is: why do we feel obliged to say these things? We do not actually know that the person will do fine, and if it's not something they're going to remember, then perhaps we shouldn't say anything at all. I believe if we truly care, then an action is necessary. Just as you proved in your writing when a meal was prepared or furniture was built. Or possibly if we said these things less, when we actually said good luck to a pregnant woman, they would know we meant it.

To Sarah: I thought this line was interesting: "However she joked that being pregnant made her feel like a queen, anything she wished for was someone else’s command."

We treat pregnant women so differently, but why? Is it because we want the best for the baby, this fresh new life coming into the world? Or are we really concerned with the mother, the pain she is going to feel? I believe most times people think about the baby when they do favors for the mother and no longer see her as her own person. One of my interviewees talked about how uncomfortable she felt with people touching her stomach, when they normally wouldn't have. I think this furthers the point that people see women as simple objects when they are pregnant. Everything is done in hopes that it will better the experience of the child on its journey into our world. People are consumed with the idea that this new impressionable life will appear, more than the place from which it comes.