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Monday, October 29, 2012

This is Anthropology



Last year Florida Gov. Rick Scott said on a radio show,
We don’t need a lot more anthropologists in the state. It’s a great degree if people want to get it, but we don’t need them here. I want to spend our dollars giving people science, technology, engineering, and math degrees.
The Anthropology community responded swiftly with local and national attacks on blogs, newspapers, websites, and radio. To see an all-inclusive overview over the reactions to this attack on anthropology and the social sciences, click over to Neuroanthropology blog. It sparked major discussions on university listserves and on twitter and facebook.

Several students decided to create a campaign like "This is Public Health" for Anthropology. Then a graduate student at the University of South Florida, took her fellow students and colleagues’ statements on This Is Anthropology and made them into a Prezi presentation

I posted about this last year when it was going on, but I never posted the awesome Prezi on this blog! So here it is, THIS IS ANTHROPOLOGY:


You can either click through, or set it to Autoplay.


By the way, a few days after all the responses, and the fact that everyone pointed out that his daughter has an anthropolgoy degree, Rick Scott said "I love Anthropology."

It's also worth pointing out that, as the first slide in this presentation notes, "The statistics Rick Scott used to extol the virtues of STEM [science technology engineering math) education at the expense of other disciplines are brought to you by anthropologists."




Friday, October 26, 2012

Once Upon a Birth

Have you heard about Merck's Campaign to improve maternal health and save women from dying for giving life - Merck for Mothers?

Their new effort, "Once Upon a Birth," is a campaign to raise awareness about maternal health and help prevent the deaths of some 800 women around the world who die during pregnancy and childbirth every day. Melissa Joan Hart is the spokeswoman for this campaign, and shared her birth story on the Merck for Mother's Facebook page.

For every person who shares their birth story, a monetary donation will be made to Join My Village, which is a charitable initiative that helps women and girls through education, and supports safe pregnancies and deliveries. These deaths are preventable - family planning, access to health care that can recognize preeclampsia, or timely treatment for postpartum hemorrhage!

All you have to do is share your birth story! Or, if you don't want to go through Merck, there are ways to help Join My Village directly. 



This video is our way of highlighting the urgent issue of maternal mortality and demonstrating how we hope to improve the health of women during pregnancy and childbirth.

I think this is a great video, but I disagree with one aspect... I don't think research into more technologies is what is needed to save the lives of these mothers. I think it's access to quality care, reduction in structural violence, improvement in the lives of the poor and the marginalized. Gender equality, improved transportation, food, etc. Health policies that improve the social and ecological factors that keep people in poor health.



Tuesday, October 23, 2012

A Snapshot of Birth in Panama City, Panama

Dear readers,

This summer I traveled to Panama as part of a graduate course on women's health. During our time in Panama City we visited numerous health clinics, hospitals, an oncology center, health ministries, and institutes related to health issues that affect women internationally such as domestic violence, cancer, infertility and maternal health, sexually transmitted infections, sex trafficking and refugees, and more.

One of ours visits was to a maternity care hospital that was publically funded by the Social Security system. In Panama, health care is funded either by the private system (individually purchased, more pricey) or by the government. The public sector is funded through the Ministry of Health and the Social Security System. Your health care options are greater if you have the money to purchase private health insurance, but the public sector takes care of the majority of Panamanians.

We met and spoke with a doctor who assessed women for infertility and provided infertility treatment. Below is one of her exam rooms, with the sonogram machine. Notice the brown paper on the bed - this is what the hospital used because they didn't have nearly enough absorbent chux pads for all the women.

On our tour of the maternity care hospital, we were led through some of the postpartum floors. On these floors there were several "areas" which held about 14 beds in each section, side by side. This is where the women would recover from their births and be with their babies. Just to reiterate: these were not private rooms. And they were not entirely closed off to the central wide hallway where the nurses station was located. The women could walk around the hall with their babies - we saw some of them on these floors, though none of the areas were near full.  There were some great bulletin boards on these floors:
Then we went to the labor and delivery floor. From the small lobby, which was full of rocking chairs, we could see new moms standing in the hall waiting to receive their babies from the nursery through a small window in the wall. It reminded us of a fast food drive-through window! As mentioned previously, the women did room-in with their babies postpartum. On this floor there were two small postpartum areas - one for the moms with normal low-risk births, and one for moms who had been higher risk (i.e. preeclampsia).
postpartum room on the delivery floor

We didn't think we'd be able to go back into the labor and delivery area, just as we weren't allowed to enter the floors where women were recovering from surgery. But then the doctor came out and said "I have clothing for three people" and my hand shot straight in to the air. Along with me was a woman who works as a L&D nurse, and a girl who was going to be starting medical school. The three of us put on our full body scrubs - a floor-length robe that tied in the front, hair nets, and shoe covers - and giddily followed the doctor back behind the closed doors.

The room in which women labored was one large square with beds side-by-side all along every wall. In the center of this circle of women was the nurses station. You can sort of see what this looked like in the picture below, with the women in beds along the right and back wall, and the nurses station on the left. There were only two doctors for all the women laboring in the room, several nurses, and a few student doctors.


The labor room was maybe half way full on this day. The women laboring in the room were eerily quiet. The doctor says it is not always this way; if one woman starts to moan or yell, they all start. But on this day they were all labor completely silent. This seemed very interesting to me for a couple reasons: 1. Every single woman in this hospital receives pitocin. This is a public hospital that sees a lot of women every day, and they want to speed things up and get them moving along. So whether or not you are being induced or not, you receive pitocin for augmentation. 2. This hospital does not administer pain medication of any kind. You only receive an epidural if you are headed into a c-section. So all of these women were laboring in bed, on pitocin, with no pain medication, completely silent.

All these women are on IV's, some with additional medications for high blood pressure, and there are only 2 electronic fetal monitors for the entire labor and delivery floor. What this means, the doctors explained, is that these get rotated every two hours around the room. So a woman might only be on the EFM once during her entire labor. This is part good and part bad. It is slightly worrying to have women on these intense drugs and not be monitoring how the fetus is responding. On the other hand, since we know that that continuous EFM doesn't actually work any better than intermittent monitoring on detection of fetal distress, and that EFM actually increases the C-section rate without benefit to the baby, it is a blessing in disguise.

The women labor in this room until they feel the urge to push. Then they are checked, and if found to be 10 centimeters, they are wheeled into a separate room for delivery. There were 3 delivery rooms across a small hall from the labor room, with no doors in the door ways. Oh, I forgot to mention that these women are completely alone while they labor and while they deliver. No husbands, no family members, no doulas. The doctors had never heard of a doula, and I had to explain many times the way in which a doula was not a nurse, but like a nurse. All in Spanish, by the way. They said they understood, but I'm not sure that they did.

While the doctors were telling us all the information about L&D, a woman was pronounced fully dilated and was taken to one of the delivery rooms. So, we all went over, too! The doctors told us, as we watched from the doorway, that the deliveries are attended by the residents. The residents catch the baby and do the newborn assessment, with the assistance of a nurse. The attending doctors observe and advise in a hands-off manner. The woman who was having her baby was quietly and effectively pushing. She wasn't yelling or freaking out, and no one in the room was telling her when or how to push. She just pushed (on her back), and the doctors waited. In fact, no one spoke to her at all. It was myself and the L&D nurse who were saying things like "good job, mama" and then, when she had the baby "felicidades!"



The doctors explained that every woman in this hospital receives an episiotomy. Why? Because the students have to practice! After the mom had her baby, my colleague who was taking pictures asked the mom if she could take a photo of the baby (who was in the warmer on the other side of the room). The mom was crying happily over on the bed by herself, and said yes. Then my colleague showed her the picture on her digital camera. She was probably the only woman in that hospital to be able to "see" her newborn so fast, or have such an early picture! Goes to show what sorts of things we take for granted.

It was so exciting and fascinating to see what birth was like in Panama. In some ways it could be celebrated. The Cesarean section rate at this public facility was about 23% (more than the WHO recommends, but less than the United States), and that the hospital advocated for Vaginal Birth After Cesarean section (VBACs). VBAC is a contentious issue, and it’s nice to hear thatthis hospital is practicing evidence-based medicine on this topic. In the labor room, the doctor told me that they also advocate for the baby to room-in with the mother postpartum, and that they practice delayed umbilical cord clamping. These are practices that the U.S. is still working to implement in many hospitals.

In other ways, however, the labor and delivery process was quite behind. Women labored in beds side-by-side in one room without pain medication or the presence of loved-ones and received routine episiotomies. Being as this is a public hospital it is safe to say that an enormous number of Panamanian women are having their babies this way.

I am curious about why the hospital’s maternal mortality rate doubled in the last year from 40 to 80 deaths per 100,000. This wasn’t really answered, though I’m glad to hear that it is being researched. I found it interesting that in response to my question about the presence of midwives, the doctor we spoke with merely stated that they are not “necessary” here. I assume this is because they have doctors, so they believe midwives are not needed. This is interesting, because it is much further from the European model (where midwives see the majority of births, unless they are high risk) than even the United States.


I apologize for the delay in writing about my experience - it probably means I've left out some of the detail! Right after I returned home from Panama I was rushing around doing work on my thesis research and kept putting off the writing of this story. I hope you've enjoyed reading about it, anyway!

Has anyone given birth in Panama? I'd love to hear your experience! 



Tuesday, October 16, 2012

Current Research Round-Up

I haven't done a link round-up in a while, mostly due to the fact that I can barely keep up with reading my google reader blogs, let alone blog about them! But I am always reading and always following the latest research. Here is some of what I've come across lately:


Robin Elise Weiss wrote about really interesting research that found that you can actually determine the gender of the fetus at 6 weeks! It's called the Ramzi's method. In using this data, Dr. Ramzi Ismail concluded that at six weeks gestation, 97.2% of the male fetuses had a placenta or chorionic villi on the right side of the uterus. When it came to female fetuses, there were 97.5% of the chorionic villi or placenta on the left side of the uterus. Robin writes,
"This is amazingly accurate and has nothing to do with actual visualization of the sex organs, which is impossible this early in pregnancy. Parents want to know the sex of their baby for many reasons, including to figure out how to manage a pregnancy when there may be certain sex linked diseases complicating it. Though the author encourages this to be used as a soft marker to be used between the physician and patient when earlier knowledge can help the team with decision making.
The biggest advantage here is that the use of 2D ultrasound does not pose the risks that other methods do to the pregnancy. It can also easily be incorporated into the first trimester screenings and the results are immediately available. This can also prevent the waiting times that can cause much anxiety for families.

Though this is not widely used anywhere currently, parents wishing to know the sex of their baby may be trying to figure this out any way. If you have an early ultrasound and are not trained, you may misinterpret the results, even if you can clearly see the screen. You would be better off asking the person doing the ultrasound which side the placenta is on, than trying to guess yourself."
But she cautions that "it would be wise not to make decisions that are irreparable because of this knowledge. I'm not even sure if I'd paint a nursery with this answer."
 
 Can't find the actual article for this, just the abstract.  What it says is that there were fewer prefeeding cues observed in infants who were exposed to Pitocin than those who weren't, especially hand-to-mouth cues. Pitocin-exposed infants also had what the authors called "a low level of prefeeding organization," as evidenced by frequency of 8 prefeeding cues.

Another article demonstrating that it's not patient-requested C-sections that is driving the increasing cesarean rate. Authors found that those judged to have selected an elective cesarean were significantly older and had babies with a lower gestational age than women with a nonelective cesarean section. No significant differences between the two groups were found with respect to maternal weight, length of stay for the mother or baby, newborn birthweight, or special care nursery days. Overall, the prevalence of nulliparous women judged to have had a patient-initiated elective cesarean was found to be low and is not likely to be substantially contributing to the rising proportion of cesarean births.

An article on outcomes of Inuit births in Canada. The authors' conclusions are:  The success of the Innulitsivik midwifery service rests on the knowledge and skills of the Inuit midwives, and support of an interprofessional health team. Our study points to the potential for safe, culturally competent local care in remote communities without cesarean section capacity. Our findings support recommendations for integration of midwifery services and Aboriginal midwifery education programs in remote communities.

Only 3% of babies were Baby Friendly in 2010. The researchers in this study basically called all maternity hospitals in the US and asked to be connected to the maternity service. Then the person answering the maternity service phone was asked: "Is your hospital a Baby-Friendly hospital?" They found that Although the Baby-Friendly Hospital Initiative was established over 20 years ago, most US maternity staff responding to a telephone survey either incorrectly believed their hospital to be Baby-Friendly certified or were unaware of the meaning of "Baby-Friendly hospital."

This research is begging for follow-up studies. What do the maternity staff thing Baby Friendly means? Why do they think they are or they aren't BF?  Why are IBCLC's only correct 89% of the time in knowing if their hospital is BF?

Thursday, October 11, 2012

Are Doulas a Form of Complementary and Alternative Medicine?



Last week we discussed medical pluralism and complementary and alternative medicine (CAM) in an anthropology course. CAM is hard to define, but basically brings to mind chiropractors, acupuncture, massage therapy, homepathy, Reiki, dietary supplements, yoga, meditation, traditional chinese medicine, etc. The 2007 National Health Interview survey found that approximately 38% of adults use CAM. Alternative medicine is used instead of conventional medicine, while Complementary medicine (or therapies, treatments, etc) are used in conjunction with conventional (bio) medicine.

Kaptchuck (2001) writes “any therapy deemed unacceptable by the mainstream can find a receptive home in CAM,” all that is required is that they can be described as alternative (202).  Harvey (2011) builds on this point, also emphasizing that “it gathers or is granted meaning from what it is not (Western) as if having no meaning-making, capabilities or significance of its own” (48).

As we were discussing CAM, one of my classmates asked me to talk about being a doula. When asked, I was a little bit thrown off. Is a doula really a CAM practitioner? Doulas are non-medical. I don't consider myself "medical" but could certainly fit into a form of "therapy," as I provide psychosocial support. After all, is yoga and massage medical? They're definitely therapeutic. And am I "alternative" or am I "complementary"? Well, no one really uses a doula INSTEAD of biomedicine, generally in addition to it, so perhaps doulas are complementary.

So, I agreed to speak about these thoughts I was having about being a doula and perhaps being complementary medicine. It's true that many people who hire doulas do so because they feel they haven't received appropriate care from biomedicine/conventional medicine. Often, CAM is sought because biomedicine is not meeting some health need. Alternative therapies attempt to “address what orthodox biomedicine seems both unable and unwilling to address” (Nairandas 2011:69). Also true is the fact that people who hire doulas also tend to be into massage, yoga, acupuncture, chiropracty, and other forms of CAM.

I struggled with this topic, though, because I had never considered myself a CAM practitioner before. This was what my professor found the most interesting. Perhaps I hadn't thought of myself that way because I do get hired mainly by people who, even if they desire a natural birth, are still birthing in the hospital and are not the hippie crunchy granola new age people one associates with users of CAM.
I think after considering this for a while I have come to the conclusion that yes, a doula is a form of complementary medicine. It is a form of mind-body therapy. Like acupuncture, for example, it doulas are seeking legitimacy by proving their worth and efficacy through randomized control trials. Further, doulas can on occasion be paid by health insurance, also a fight that CAM undergoes.

The only place I could find a clue about doulas as CAM was at this Integrative Medicine blog where the blogger mentions doulas and health insurance.

To many, it might seem obvious that doulas are CAM, especially if they've never heard of them. But to me, because I work in biomedical settings, it seems hard to separate what I do from conventional medicine. Perhaps a midwife and/or doula at a home birth seems more alternative.


What do you think? Is a doula a complementary and alternative health practitioner?



Our CAM and medical pluralism readings:

Baer, H. A., C. Beale, R. Canaway, and G. Connolly 2012 A Dialogue between Naturopathy and Critical Medical Anthropology: What Constitutes Holistic Health? Medical Anthropology Quarterly 26(2): 241–256.
Baer, H. A. 2002 The Growing Interest of Biomedicine in Complementary and Alternative Medicine: A Critical Perspective. Medical Anthropology Quarterly 16(4): 403-405.
Harvey, T. S. 2011 Maya Mobile Medicine in Guatemala: The “Other” Public Health. Medical Anthropology Quarterly, 25: 47– 69.
Kaptchuk, T. J. and D. M. Eisenberg 2001a Varieties of Healing. 1: Medical Pluralism in the United States. Ann Intern Med 135(3): 189-195.
Kaptchuk, T. J. and D. M. Eisenberg 2001b Varieties of Healing. 2: A Taxonomy of Unconventional Healing Practices. Annals Of Internal Medicine 135(3): 196-204
Micozzi, M. S. 2002 Culture, Anthropology, and the Return of "Complementary Medicine". Medical Anthropology Quarterly 16(4): 398-403.
Thompson, J. J. and M. Nichter 2012 Complementary & Alternative Medicine in the US Health Insurance Reform Debate: An Anthropological Assessment is Warranted. Topic paper prepared for the SMA 'Take A Stand' Initiative on Health Insurance Reform.
Barnes, L. L. 2005 American Acupuncture and Efficacy: Meanings and Their Points of Insertion. Medical Anthropology Quarterly, 19: 239–266.
Green, G., H. Bradby, A. Chan, M. Lee 2006 “We are Not Completely Westernised”: Dual Medical Systems and Pathways to Health Care among Chinese Migrant Women in England. Social Science & Medicine 62(6): 1498-1509.
Kaptchuk, T. J. 2011 Placebo Studies and Ritual Theory: A Comparative Analysis of Navajo, Acupuncture and Biomedical Healing." Philosophical Transactions of the Royal Society B: Biological Sciences 366(1572): 1849-1858.
Langwick, S. 2010 From Non-Aligned Medicines to Market-Based Herbals: China's Relationship to the Shifting Politics of
Traditional Medicine in Tanzania. Medical Anthropology 29(1): 15-43.
Naraindas, H. 2011 Of Relics, Body Parts and Laser Beams: The German Heilpraktiker and his Ayurvedic Spa. Anthropology & Medicine 18(1):67-86.
Thompson, JJ, and M Nichter 2007 The Compliance Paradox: What We Need to Know About "Real World" Dietary Supplement Use in the United States. Alt Ther Health Med 13(2):48-55.
Yuehong Zhang, E. 2007 Switching between Traditional Chinese Medicine and Viagra: Cosmopolitanism and Medical Pluralism Today. Medical Anthropology 26(1):53-96.

Thursday, October 4, 2012

Born in the Caul... by C-section

Hopefully these photos aren't too graphic for you... I think they're pretty amazing! What it looks like to be born in the caul - by Cesarean section!




Did you know being born in the caul is considered lucky?

View images of a baby born vaginally in the caul.
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