This is another “fill in the gap” post! I didn’t go into costs for domestic violence a lot in my presentation due to time, but domestic violence is very costly. The costs of domestic violence in 1995 exceeded $5.8 billion, which breaks down into $4.1 billion in direct medical and mental health care costs and nearly $1.8 billion in indirect costs of lost productivity. In 2003, the costs exceeded $8.1 billion, a sum which consisted of $460 million for rape, $6.2 billion for physical assault, $461 million for stalking, and $1.2 billion in the value of lost lives. However, all of these numbers can be considered underestimates because the costs of the criminal justice system are not factored in. On the same token, a study that surveyed 3,333 randomly selected women aged 18 to 64 found that the total adjusted health care costs for women who disclosed physical abuse were 42% higher than for women who had never experienced abuse. Furthermore, women who had disclosed non-physical types of abuse had total annual healthcare costs that were 33% higher than woman who had not experienced any type of abuse. So, yes. Domestic violence is very costly, whether you’re treating visible symptoms of abuse or non-visible symptoms of abuse. This alone should spark more collective effort for screening and treatment, but I suppose it’s just such a sensitive issue that people are still hesitant regardless of the facts.

Centers For Disease Control and Prevention. (2014). Intimate partner violence. Retrieved from http://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html

De Boinville, M. (2013). Screening for domestic violence in healthcare settings. Retrieved from http://aspe.hhs.gov/hsp/13/dv/pb_screeningdomestic.cfm#

I left a lot out of my powerpoint in the interest of time (although we still had a lengthy discussion afterwards lol), so I didn’t mention child maltreatment very much. But someone inquired about the relationship between domestic violence and child maltreatment. These two issues, unfortunately, overlap very strongly. Children who are exposed to domestic violence, even a little bit, are at a very high risk of exhibiting negative emotional and psychological behaviors. There is also evidence to suggest that abused children grow up to become abusers themselves, which compounds the problem. But specific to child maltreatment, mothers who are abused suffer numerous consequences that will affect the mother/child relationship. Mothers may become depressed, anti-social, have attachment problems, etc. This makes them unable to adequately care for their children. In addition, abusers who abuse their partners/spouses are also more than likely abusing the children. This results in a very ugly and dangerous family situation. To me, domestic violence is very much it’s own detrimental cycle. The abuse itself, in addition to the consequences of abuse, are also risk factors for abuse once again. It’s like it never ends, but it can with serious attention and effort.

Centers For Disease Control and Prevention. (2014). Intimate partner violence. Retrieved from http://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html

Lien, H. (2003). Child protection in families experiencing domestic violence. Retrieved from https://www.childwelfare.gov/pubs/usermanuals/domesticviolence/domesticviolenceb.cfm

Pain is a concept we talked about very early in this semester. We explored how childbirth experiences tend to be portrayed negatively in American culture / sitcoms and how it is very much exaggerated. I think we pretty much came to the conclusion that pain tolerance differs from person to person. This also seems to be a truth at which even researchers have arrived because they seem to find it a little difficult to adequately measure pain. It’s just so subjective. Nevertheless, I became curious about it because we recently had our pain lecture in Fundamentals class, and an Asian girl in the class said she felt that Asians had high pain tolerance. She said that she had never taken pain medication. I was really shocked at her admission, especially when I thought about the horrible pain I experience during menses – Motrin is my best friend! Based on this, I decided to take a peek at the literature about pain tolerance in Asians. Surprisingly, pain tolerance in Asians is under the radar in terms of research. I couldn’t find much about it. I did find a source that talked about it being important for Asians to be quiet during childbirth, but this does not suggest higher pain tolerance necessarily. I also found this literature review (http://rheumatology.oxfordjournals.org/content/38/12/1184.full) that compared the level of pain tolerance in Asian patients with the pain tolerance in European patients following upper abdominal surgery. It found that Asian patients required less postop analgesia than the European patients. The review contends that this could be due to cultural and psychological factors such as Asians being more prepared / expected to tolerate more pain or differences in pain perception. However, the pain scores between the two groups were similar throughout treatment (although it was not indicated how they were obtained), so the results do not seem very conclusive. Regardless, the Asian patients did exhibit a higher pain tolerance, but there’s still much more room for study on this topic. I wonder if any of this translates into childbirth experiences?

Njobvu, P., Hunt, I., Pope, D., & Macfarlane, G. (1999). Pain amongst ethnic minority groups of south asian origin in the united kingdom: A review. Rheumatology, 38(12), 1184-1187. doi: 10.1093/rheumatology/38.12.1184

I didn’t know suctioning newborns was considered a controversial practice. I’m actually surprised because it seemed to me that most hospitals suctioned newborns once they’re born. At Dekalb Medical, a bulb syringe in the crib is part of their safety protocol and must be charted as present, along with the newborn’s security band, patient bands, etc. Apparently though, suctioning can induce adverse effects in the newborn such as bradycardia and apnea, and this practice may not even be as effective as people think. This study (http://www.sciencedirect.com/science/article/pii/S0140673613607758) compares the use of bulb suctioning a newborn with wiping the newborn’s mouth and nose with a towel. According to this study, both methods essentially have the same outcomes. However, more serious aspiration such as meconium aspiration was excluded from the study. So, suctioning still has a place in the care of newborns, but it is a practice that may need to become less prevalent.

Reference:

Kelleher, J., Bhat, R., Salas, A., Addis, D., Mills, E. C., Mallick, H.,…& Carlo, W. (2013). Oronasopharyngeal suction versus wiping of the mouth and nose at birth: A randomised equivalency trial. The Lancet, 382(9889), 326-330. doi: 10.1016/S0140-6736(13)60775-8

The presentation about pregnant incarcerated women raised some pretty interesting questions about motherhood in prison. It’s something I never considered until that one presentation. The idea of sort of creating a “home-like” prison environment where mothers can be with their children is a little bit controversial for me. On the one hand, mothers can be with their children and continue to develop healthy relationships without the trauma of prolonged separation, which is great. But on the other hand…to me it almost seems like having a privilege that other people who commit the same minor crime, but do not have children, would not have. I wonder if that’s fair?

However, this could be a case where the benefits to the child and family overrule the other questions about fairness and justice. This article (http://aspe.hhs.gov/hsp/prison2home02/hairston.htm#Parent) discusses the effects of incarceration and reentry on children, families, and communities. If one scrolls down or clicks on the “Parent-child Relationships and Children’s Care” section, one will find that there are a lot of problems associated with separation due to incarceration. But the interesting part is even the mindset of the incarcerated may play a major role in the problems surrounding family breakdown, rather than just the separation itself. Overall, I think this article makes a strong case for at least increased visits for families in prison (as well as mothers), but perhaps also gearing toward a prison structure that’s more conducive to preserving the family.

Reference:

Hairston, C. F. & Addams, J. (2001). Prisoners and families: Parenting issues during incarceration. Retrieved from http://aspe.hhs.gov/hsp/prison2home02/hairston.htm