Risk of Medicine During Pregnancy and Smart Nurseries

I recently Read two articles that I found very interesting. The first article was about the FDA and how they are requiring drug companies to prevent more detailed risks of taking their medicines during pregnancy and while breastfeeding.

Prior to this new requirement, drug companies used an alphabet system to indicate risk, with ‘X’ being the most dangerous. They found that this system was a bit to broad and as a result, some drugs could not be completely categorized, or did not fit all the criteria of a particular category.

The new system, is more specific, and breaks down the risk into 3 parts: pregnancy, lactation, and fertility. This method requires drug companies to give a complete breakdown of the risk and the reactions that have resulted from taking the drug, in all three categories.

According to the article, most pregnant women in the United States take an average of three to five prescription drugs when they are pregnant, so it is important for them to know what exactly they are consuming and whether or not it will harm their fetus. The only thing that the new system does not do, is require these drug companies to carry out studies if there aren’t any on their drugs. I think requiring them to provide all the information available is a very good start, however the next move should be to get them to conduct studies and research where there is none.

The second article I read was on the smart nurseries.

In class, someone (I apologize, I do not remember who) presented on attachment between mother and infant. This article is not necessarily similar, it discusses a new monitor that parents can use to check the heart-rate and sleep patterns of their newborns. The article also shows they way advancements in technology and a continuous update in the number of  baby gadgets available can sometimes take away from the natural connection that a parent can give his/her/their child. The issue with technology, is that it is not always reliable. If your monitor isn’t charged, it will not work. If it suddenly stops working in the middle of the night, as these things sometimes do, what then do you do?

To be honest, I think baby gadgets are very useful and can relieve some of the stress that comes with parenting (unless of course you are not tech savvy in which case, you would have a difficult time figuring out these gadgets and reading their data)  however the results can not always be relied upon, especially with things as trivial as heart beat regulation and sleep in infants.


Evolving Cultures of Birth Location

Going back a few months to the discussion on birth location, today’s New York Times had an interesting article that advocates for home births in Great Britain.  In “British Regulator Urges Home Births Over Hospital for Uncomplicated Pregnancies,” it is described how Britain’s national health service has reversed a generation of guidance on childbirth to advising healthy women that it is safer to have babies at home or in a birthing center, rather than in a hospital.  According to new guidelines by the National Institute for Health and Care Excellence, an executive body of the Department of Health in the UK, women with uncomplicated pregnancies were better off in the hands of midwives than hospital doctors during birth.

The article mentions a lot of the points we discussed in our debate over birth location, such as the higher risk of unnecessary cesarean sections and epidurals.  However, the statement by such a highly regarded government health authority could have a large influence on the birth location decisions made by hundreds of thousands of British women each year.  More importantly, it reflects a change in health perspectives by developed countries regarding hospital births and the medicalization of birth.  According to the article, few developed countries have significant numbers of women opting for nonhospital deliveries: “In the United States, where a culture of litigation adds a layer of complication, only 1.36 percent of births took place outside a hospital in 2012.  Two-thirds of those non-hospital births took place at home and 29 percent at free-standing birthing centers.”

With a country like Great Britain encouraging a return to midwives and home births and birthing centers for healthy pregnancies, it may be plausible to hope for such a change in the United States.  While such a cultural change may take some time to take place, if more birthing centers were to open in the U.S., the option would be easier to consider for women looking for a nontraditional birth.  I am curious to hear what others think – do you think in the near future we could see a shift in births from hospitals to birthing centers and home births in the U.S.?

Article: http://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html?ref=health

Home Based Life Saving Skills

In our nursing program, we learn about the many ways a nurse can intervene when something unexpected occurs during a birth or a pregnancy.  For example, we learn to what instruct women to do when they call our office and note they have not felt fetal movement in a while (perhaps via phone triage).  Also, we learn different methods to alleviate bleeding/hemorrhage after delivery of a baby (like uterine massage).

I really appreciated Dr. Sibley’s Home Based Life Saving Skills talk because it is a simple way to reiterate all the nursing interventions we’ve learned and can utilize when things go left.  The pictures are phenomenal.  I was speaking with Val, and she showed me that these picture booklets are downloadable online (see below).  I really wish I had access to these last year because it would have helped with my care plans and my knowledge.  These skills are not only applicable in the home; they are applicable in any situation and includes the hospital and/or birth center.

It’s really amazing that these nursing interventions I learned are actually just “interventions” without the “nursing” because there is nothing special about them or unique to a nurse with a license.  It’s about being aware about what is happening and when you really need to see a professional.  These HBLSS empower women, families, and the community.  Dr. Foster, you should definitely introduce this website and or booklet(s) to the students in your next Developing Families course.  I think it helps bring things full circle, and there are many non-invasive, non-pharmacological ways to handle potential emergency situations.  Just pee or massage or breastfeed!

Here in the US, I know people take birthing classes on a variety of topics, but HBLSS information should be available (or taught) to people as well…although I don’t know how likely someone will remember information in a crisis or almost-crisis situation.  I can see if being helpful to teach in those American Indian communities that are far from facilities.

There are multiple editions of HBLSS on the website.

American College of Nurse-Midwives.  (2014).  ACNM Publications.  Retrieved from http://www.midwife.org/ACNM-Publications


Changing Birthrates in the U.S.

After our class conversation about the demographic transition and the attempt to control population growth in Iran, I came across an interesting article in The New York Times that applied the same concepts to the United States: “U.S. Birthrate Declines for Sixth Consecutive Year; Economy Could Be Factor.” (http://www.nytimes.com/2014/12/05/us/us-sees-decline-in-births-for-sixth-year.html?ref=health)  This article was reporting how the number of women in the U.S. who gave birth dropped in 2013, down slightly from 2012 but down 9% below the high in 2007.  It quoted several demographers that related the drop in American fertility rate to the state of the economy.

An economic relationship with the number of children born each year is well explained with the concept of the demographic transition:  as a country’s economy develops, women have fewer children.  This is generally due to the fact that as a country becomes more developed, children’s health outcomes improve, and the risk of a child dying becomes reduced.  Additionally, more developed countries tend to have fewer agriculturally based economies and more professional jobs, so it becomes less economically sensible to have numerous children for economic purposes like working in a farm, and more sensible to have fewer children with the high costs of education.

This article introduces a more complex idea on the idea of the demographic transition: what happens to birthrates when developed countries have economic ups and downs?  William Frey, a demographer at the Brookings Institution argues “On just about every demographic indicator involving young adults, whether it’s marriage, buying a home or delaying childbearing, it’s all been on hold since the beginning of the recession.  I think it’ll come back up, and each time new numbers are coming out, I think maybe this will be the moment.”  However, what I found to be one of the most interesting points of the article is how much later in life women are having children.  While the teenage birthrate has dropped substantially, and the birthrate for women in their 20s has been declining as well, births to older women are on the rise.  The report found a 14% increase in births to women ages 45-49.  So it is certainly possible that as countries develop, the birthrate not only drops, but that women will wait longer to have children as well.

Pain Tolerance In Asians

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

Sexual Violence Survivors and Birth

Not sure if others have, but I have been following quite closely the recent news about rape allegations at the University of Virginia. Today’s news stated that Rolling Stone magazine retracted their article which featured the horrible account of one student’s sexual assault in 2012. As shocked as I was to hear this, I have found myself reading several articles about the situation which led me to start thinking about how this might relate to our class. We are all aware of sexual violence and I’m sure this topic has been addressed in classes we have taken or has affected us to some degree in our lives.

As I started looking around for “sexual violence and birth”, I found that it is common that sexual violence survivors will have symptoms of the trauma re-emerge during labor. I want to clarify that this is not directed specifically at women having babies that resulted from sexual assault, but, in general, sexual violence survivors who later in life go through labor. There are many factors of the experience that can trigger memories or nightmares of the prior attack from vaginal exams to constantly rotating hospital staff. Some have described their experience of labor in hospitals as “strangers standing over them.” Whatever it is, the personal care (or lack thereof), the painful experience (pain that might be similar to the traumatic experience), or the exposure of a woman’s body and her vulnerability, many sexual violence survivors go through this experience without the support or recognition of this re-traumatization.

While we addressed obstetric violence in class and have touched on sexual violence in general, I think its interesting to think about how prior events could be triggered during the experience of labor. It brings me to wonder about how this affects populations around the world. I guess I wanted to share my findings and see what others have to say about this topic. There’s a great article below from a nurse who did a study on helping survivors of sexual abuse through labor. Thoughts?

Burian, J. (2014) Gentle Birth. Helping Survivors of Sexual Abuse Through Labor. Retrieved from http://www.gentlebirth.org/archives/abuselbr.html.


Growing Obstetric Violence

Hey Guys,

After our class discussion on obstetric violence and recent test, I was interested to see if scholars in the United States have adopted the term. When going through journals in search of articles about obstetric violence I did not find an article specifically using the term ‘obstetric violence’ in context of the United States. However, I did find an article from The American Journal of Bioethics, “Obstetricians and Violence Against Women” that focuses on how some obstetrical practices mirror and perpetuate the attitudes of abusive men and violence against women. The practices referenced in this article are obstetrician response to alcohol use during pregnancy and court-ordered medical treatment. Author Sonya Charles argues throughout the article that “forced medical treatments is a form of violence against women.” She states that abstinence-only approach to alcohol use during pregnancy and certain medication use overstates the risk of alcohol use to manipulate women in attempt to control their behavior. Charles also references Gavaghan’s “You Can’t Handle the Truth” quoting: “To continue preaching total abstinence because of a fear that women will misunderstand the truth, or regard a reassuring message about low-level consumption as a “green light” for unrestrained overindulgence, is patronising and paternalistic to a degree that is hard to reconcile with any real respect for autonomy and informed decision-making” (Gavaghan 2009, 303). In the case of court-ordered medical treatment “obstetricians use the power of the state to keep women under medical surveillance and/or perform medical treatments on behalf of the fetus against the women’s wishes.” Charles links these two OB practices to abusive men through “ideas of male supremacy, control of women, and violence against women” and “patriarchal and misogynistic attitudes.”                                                                                                                 When I did a more general Google search I came across a website article “We need to talk about obstetric violence”, from 2014, that spoke about examples in California, Ireland, and Australia. Similar to the obstetrician and violence article, this article discusses the force of medical practice on women and women’s lack of decision-making over births and their bodies. It will be interesting to see how widely the term “obstetric violence” is adopted and used among different cultures, especially among developing and industrialized countries.Do you guys think this is a term or if there is a definition that will be universally used?

For reference the definition of obstetric violence from the Venezuela article is: “the appropriation of the body and reproductive process of women by health personal, which is expressed as dehumanized treatment, an abused of education, and to convert the natural process into pathological ones, bringing with it low of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women”

“Obstetricians and Violence Against Women” http://www.tandfonline.com/doi/full/10.1080/15265161.2011.623813                       “We need to talk about obstetric violence” http://www.dailylife.com.au/news-and-views/dl-opinion/we-need-to-talk-about-obstetric-violence-20140930-3gydt.html




Semester Reflection & Future Directions

Throughout the semester, this course has taught me much about the importance of birth as well as its concern within the public health sector. One important idea that I feel I’m taking from this course is that birth affects everyone. For most, they either take part in the birth practice by having a baby of their own, their partner does, their parent or sibling does, and so on. For this reason, I feel it is of great importance that we all acknowledge and work to reduce problems facing birth across the globe. One such application of this idea I came across while researching for my presentation topic, postpartum depression. While it is to the most part overlooked, postpartum depression can affect fathers as well as mothers, and to those having a surrogate carry and delivery their baby as well as those going through the birthing process themselves. Paternal postpartum depression is most affected by their partner having postpartum depression. New statistics note that rates of paternal depression when a partner also suffers from the disease ranges from 24% to 50%, a significant percentage of the population. In this way, one’s actions, feelings and state of wellness affects not only themselves but those around them, such as their partner or children. However, many people are unaware of the intricacies involved with the birthing process, from before to during pregnancy and even its affects after delivery of the baby. For this reason, I think it is imperative that public health officials work to increase knowledge and awareness surrounding the importance and necessity of healthy birth practices to ensure health outcomes of babies and their mothers. While this is a big undertaking, what specific steps can we take to increase awareness and knowledge about birth and its importance as a public health necessity?



Goodman, J. (2003). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1): 26-35. DOI: 10.1046/j.1365-2648.

Country perspectives on Chlorhexidine program

Hey class, I wanted to add on to my presentation by giving you a little insight about what countries like Nepal, Nigeria, and Madagascar feel about the chlorhexidine program to combat neonatal infections.  This intervention is simple, cheap, and growing in accessibility in developing countries with high neonatal death rates.  Below are a couple of links to videos that help illustrate this.  The first link is a video about Nigerian health workers who travel to Nepal to learn about the chlorhexidine program, its utilization, and ways in which to implement community health workers to spearhead the program.  The second link is a panel of government and community health workers from Nepal, Nigeria, and the United States who talk about product feasibility and effectiveness, ways to promote political support (which we know from our class is highly beneficial for greater recognition of a health issue), and new methods to facilitate cultural compliance to the product.



Life Expectancy and Early Motherhood

I’ve ad this notion floating around in my head since the beginning of the semester when we watch a Walk to Beautiful and discussed early mother hood. My notion is that in countries with a lower life expectancy (and assuming that people often die way before the nation’s expected life expectancy age) there is a sort of need to have children earlier. Ethiopia for example has a life expectancy of 58.74 years old while the US has a life expectancy of 80.51 for females. That’s a difference of nearly 22 years. Assuming a lot of women don’t actually make it to this age Ethiopian women would have less time to have and care for the same number of children as American women even though they tend to have more children than American women. I feel like this explains a need to have children sooner so that you are alive long enough to raise them and help them through the early years of motherhood. However, I do recognize that having children young is  a part of why these women have lower life expectancies.