OK, I can’t resist

I am supposed to be writing a lecture right now on anatomy and physiology during pregnancy. I learned some new terms:

souffle /souf·fle/ (soo´f’l) a soft, blowing auscultatory sound.
cardiac souffle: any cardiac or vascular murmur of a blowing quality.
funic souffle, funicular souffle: hissing souffle synchronous with fetal heart sounds, probably from the umbilical cord.
mammary souffle: a functional cardiac murmur with a blowing sound, heard over the breasts in late pregnancy and during lactation.
placental souffle: the sound supposed to be produced by the blood current in the placenta.
uterine souffle: a sound made by the blood within the arteries of the gravid uterus.

Huh. Who knew? A placental souffle. Since I heard about people eating their placentas and have cooked a few souffles (placenta free, I might add) before I heard this term used for the sound of the blowing murmur, I have an ewwww moment going on here.

And, I also just wanted to point out how problematic and difficult it is that most imagery for the medical discussion of the anatomy and physiology of pregnancy is really inconsiderate of the whole woman. I have given up trying to find images where the woman’s face and/or head and/or extremities are not severed and are either present or merely disregarded.

As it is nearly impossible and too time-consuming, I am giving up. I am using these kinds of images and discussing them in context, pointing out why they are problematic:

Mothering and feminism survey

There is a mothering and feminism survey available here.

Research progress

I have been hard at work coming up with my questionnaire for my survey of local obstetricians and gynecologists about birth interventions. I am planning on posting the completed survey when I am finished, unless there are some concerns with that. I don’t think any of my subjects read my blog, so I doubt it will add any bias to the results. Besides, it’s not like these issues are new to these practitioners. It’s not like a blog post with questions about these interventions will suddenly make them relevant to their practice.

The wording of some of the questions is based on the survey in this study by Reime et al, and many others are taken directly from ACOG position statements, USPSTF evidence based conclusions, and the like.

So far the interventions I will definitely be asking about are:

Doulas (Continuous Labor Support)
Episiotomy
Vaginal Birth After Cesarean (VBAC) and Trial of Labor (TOL) after Cesarean Section
Cesearean Section Without Medical Indication (CWMI) and Cesarean Delivery on Maternal Request (CDMR)
Upright Pushing Stage
Continuous External Fetal Monitoring (EFM) vs Intermittent
Restricting Oral Nutrition During Labor (Solid and/or Liquid)

Interventions that may be included in the survey include:

Estimation of Fetal Weight (EFW) (based on 3rd trimester ultrasound)
Routine Early Amniotomy (Artificial Rupture of Membranes (AROM) )
Oxytocin (Pitocin) Augmentation of Labor

I would like to ask about all of them. We need to make sure the survey is brief enough for the subjects to want to take the time to finish, and I plan on asking multiple questions on each intervention. I think the first list is more directly a balance of evidence based medicine and patient autonomy (which is a much more difficult concept to define than I thought, but that’s a whole ‘nother post). The second list is more practices that lead to the cascade of interventions. For example, oxytocin augmentation usually necessitates continuous EFM.

I didn’t include out of hospital births, even though I think they are an important and relevant point. I wanted to only cover practices under direct control of the obstetrician. That is also why I didn’t include skin to skin contact after delivery. I think that may more depend on the hospital policies and nursing / pediatrics team.

I just need to come up with a few questions about how they keep up with the current standards of care, and then it’s time to whittle it down.

Then, I need to work on my justification. I need to talk about patient empowerment and autonomy without sounding like too much of a militant feminist. Heh, wish me luck with that.

I just gasped with joy

I recently signed up for a feminist bioethics email list serve. I know, I am a dork. I just got an email announcing another fabulous meeting I would love to go to and cannot afford to attend. The Canadian Bioethics Society is having a conference in Ontario. Here is a link to a pdf of the full program

The conference theme is “Just Evidence?” Some of the highlights:

AMS Lecture: Rosemarie Tong “Feminist Methodology and the Evidence-based Medicine Debate”

FAB panel, “Feminist Interrogations of Evidence-Based Medicine”, on Sunday June 14 10:10-11:30am.

The panel was, amazingly, organized by someone at a nearby university. I may have to look her up. Of course, I should be studying for boards. I shouldn’t be looking people up, or even fantasizing about traveling.

Reply turned post, bloggers unite! style

Thanks to a tip from Feministing, I found this column on Mother Jones about the Future of Abortion Providers. I agree with the idea that we need more feminist activists and more abortion providers. I don’t agree that calling feminist bloggers sluts is the way to do it.

Here is the reply:

Blogging and activism are not mutually exclusive. In fact, I blog, I joined Facebook because my medical school class had a group on there, and I am a member of Medical Students for Choice. I am one of those future abortion providers you want so badly. I am also a young (well, not so young, but still…) feminist.

I think the problem with convincing people to become abortion providers is a lack of dialogue on the subject, which makes it easier for medical students (and the rest of the public with whom they interact) to dehumanize women who get abortions. Women most certainly do not talk about it in person, if you haven’t noticed. Do you know the most effective way I get involved in changing the dialogue about abortion? Through blogging and on message boards. I can talk to one medical student at a time, one person at a time face to face. I get hundreds of hits a day on my blog right now.

I agree with your cause. I don’t agree with your methods. Slut-shaming young feminists is not going to create future abortion providers. What are you doing to support MY future as an abortion provider? I am lucky to have my in laws pay for my younger son’s day care, and my mother pays my car bills, and we still struggle for me to stay in medical school. And this is with me taking out the maximum in loans. I will be graduating with about $300,000 in debt. This is not even considering the money I will have to pay in malpractice in ob/gyn on top of my loan payments.

And where is the money come to pay for abortion services? Are YOU fighting for reimbursement of abortion and contraception by insurance and Medicaid? Do you know how I stay informed and fight for issues such as that? On (gasp!) blogs!

Please, find a better way to help me out.

Wish me leg breakin’

Tomorrow night our medical school’s chapter of the American Medical Women’s Association is putting on a production of the Vagina Monologues. We will be performing in a 500 seat theater, which should be more than half full, at least, and I am going to be the narrator. I am also one of the main organizers.

Wish me luck, or to break a leg, or however it goes!

Feministing hiccup

Ang Jolie

I tried to reply to a post on Feministing. W magazine has a beautiful photo of Angelina Jolie on its cover. It is suggested, but not clear, that she is breastfeeding in the picture. All you can see of the baby is a tiny hand.

The post got a predictable flurry of comments. Celebrity + breastfeeding = hot topic. Many people commented on the original post’s use of the word “sexy”. I have tried to post a reply a few times, but there is some glitch in the server. I am afraid of multiple posts showing up on the blog entry, but I really want to comment on this. So, here is an expanded version of my reply:

Thanks for posting a pro breastfeeding post. I kind of winced at the word sexy since I knew it would cause a reaction. Angelina Jolie would be sexy if she was feeding a baby with a spoon. She would be sexy changing a diaper, too.

Breastfeeding with a human breast is problematically sexualized. So, that is a discussion to be had, since many critics of public breastfeeding accuse the breastfeeders of wanting to show off their breasts in a sexual manner, and/or say breastfeeding in public is too titillating (sorry, I had to) to allow.

I don’t think saying she was sexy was a horrible thing to say in the original post. Someone with good intentions who has feminist respect for the subject may see a beautiful woman who is doing what is natural and is confident in her choice and see that as sexy. But, unfortunately, those words do not exist in a vacuum.

(Oh, and in response to childfree_feminist: I am going to give you the benefit of the doubt and assume that you are not a teenage boy trying to get a bunch of feminists riled up, although I have my doubts. I have seen anti-breeder commenters before who self identify as feminists, so I will reply to this comment as if this was where you are coming from.
Yes, we are animals, mammals in fact. We spawn and suckle our young on our teats if we can. We eat and breathe and have sex, too. Are you pointing and saying “ooky!”? Or, as I suspect, insulting every mother in the human race for reproducing? That is how we survive as organisms. If you choose to be childfree, good for you for making that choice and I am thrilled you have that choice to make. But do me a favor and don’t insult people who choose to parent and want to and are able to do what is best for them, which is breastfeeding.)

Breastfeeding post on feministing community

I wrote a reply on a post on the Feministing community site about breastfeeding in public. Since it is also a follow up to a post from here, and includes an frustrating interesting anecdote, I figured I should post it here, too.
*************

I wrote a post on here recently about feminism and breastfeeding. I go to medical school. In our health professions dept., the nursing students were giving presentations on research projects. One group had a poster on breastfeeding. I walked up to chat them up; it’s one of my favorite topics. One of the women who DID the presentation was saying how women were ashamed to breastfeed in public or in front of relatives, and that she would never do it.

And she was one of the nursing students who worked on the poster about the overwhelming health benefits of breastfeeding and how it should be encouraged.

I told them about the same article I wrote about, which echoed one of my frequent arguments. This is a health decision, not a social decision. The article argued it in a different way – formula companies (and other people, like this nurse) focus much more on emotional issues than on medical and health issues. Shame about doing what is the best medical decision shouldn’t be as important as it is. Other social considerations, too, like the whole backlash issue (don’t talk about breastfeeding benefits, which are real, significant medical benefits, because the small percent of women who truly try and cannot breastfeed may have their feelings hurt) also dominates the conversation.

**************
Again, my disclaimer, I have all the sympathy in the world for these women. They are obviously NOT who breastfeeding activism is aimed at. The mommy wars do not need to erupt every time this topic is brought up. We need to make this a medical discussion. Health problems with breastfeeding are nothing to be ashamed of.

Oooh, a good eToC

*Squeal!*

I am such a nerd. I love a good email Table of Contents alert. One of the first things I did when I got accepted to medical school was access the library website and check out the journal access. EBSCO! Wheeeeee!

Well, I have been signed up to get free access articles from BioMed Central since before that. One open access journal that is one of my favorites is The International Breastfeeding Journal. This week they have several interesting articles, including:

Breastfeeding and feminism: A focus on reproductive health,
rights and justice. Miriam H Labbok1, Paige Hall Smith, Emily C Taylor.
I need to find a way to go to that symposium next year.

Women’s liberation and the rhetoric of “choice” in infant feeding debates, Bernice L Hausman.

I am off to read them now. I just took my pharm test yesterday, got a migraine, threw up a bit (while driving! great!), slept for more than 12 hours, missed school today, passed the test (whee!), made breakfast for the family, finished a project for an MPH class, and now have some “spare” time to read “recreational” material.

The first article is just an announcement about the Breastfeeding and feminism symposia at the UNC Chapel Hill School of Public Health. Ooh, I wish I went to med school there! A trip to the 2009 meeting is what I want for my birthday.

The second article is divine. I love how Hausman compares the “choice” discussion to that of choice and reproductive rights.

“Another Enfamil web page discusses “It’s Your Family’s Decision”: “Only mom and dad know
what will work best for their family. So, be confident in the choice that you make. The best way to deal with people who question your choice is to simply tell them, politely but firmly, that you have discussed how to feed your baby with your baby’s doctor. Feel good about your decision and be confident your baby is getting the essential nutrients he needs” [2]. Reading this I imagine what discussions of abortion would be like in the same register: “Look, I’ve discussed my decision to terminate this pregnancy with my doctor and she agrees it’s a good idea, healthy for me. It’s the right decision for my family as well. I’m confident in this decision, so you need to butt out.” To anyone familiar with the abortion debates, it’s clear that infant formula makers champion a rhetoric around “choice” that used to be a common approach to abortion rights but which is difficult to promote publicly today. “

Love it! She comes close to my argument, which is this decision (breastfeeding, and other birthing decisions) is a health decision, not a social decision. She writes:

“Any decision a woman makes about reproduction thus becomes vaguely connected to her “rights” as a consumer, rather than her rights as a human being [3].”

She also examines the defensiveness over choosing the “right” choice and being a “good” mother, and appealing to emotional topics like love rather than health advantages.

Another great quote:

“In breastfeeding advocacy we see how much economic self-sufficiency makes breastfeeding a difficult practice to sustain for most women [5]. This is why, in my view, the structure of market work is one thing that must change in order to accommodate true maternal freedom, which would involve a relatively unconstrained ability to breastfeed one’s children.”

Yes, breastfeeding and mothering are not and should not be seen as opposing women’s economic freedom. In the way our employment paradigm is structured today, it is hard to breastfeed and work. I pumped at two jobs for more than a year, combined. I was able to bring S to work with me for six months, which was an incredible opportunity for both of us, and I worked from home 3 days a week with Zach. Most women do not have that kind of flexibility.

“Infant feeding choices—whether made by “heart” or “head”—are practiced in the context of the social, cultural, and economic forces that structure most people’s daily lives and intimate decisions. It is our responsibility, as feminists, to identify the constraints that reveal the “choice” itself to be not so much a choice but a class privilege, and then to figure out how to challenge the status quo that makes it so.”

Hear, hear!

Screeching to a halt

My summer vacation will end Monday morning when I return to class. I will be an M2 (jargon for a second year student in medical school), with new hard classes like pharmacology *shudder*, plus the added responsibility of being an officer in a few clubs and two MPH classes. Oh, and I am going to try out working for the notes service a few hours a week.

I have already started having nightmares.

I am doing research for a grant writing class (my MPH classes started earlier this summer). I found out that the author of many studies on midwifery care and maternal inequalities is affiliated with the University of Miami Jackson Medical Center, which is where I want to do my residency. I am excited about trying to find her. I am hoping she can come and give a talk about doing research in women’s health.

I am also thrilled to see this kind of a paragraph in an article about women’s health, especially obstetrics. I love seeing examples that feminist does NOT equal anti motherhood:

“From a feminist perspective, research on childbirth and women’s
health is a means to social change, conducted in partnership
with women and for their benefit.51 Feminists try to make
the research process cooperative and transparent by including
women’s and community groups on research advisory boards
to help formulate research questions, design studies, and
interpret their results. Sometimes women are asked directly
what they want and need from health care, and interventions
are designed on the basis of their responses, rather than on
researchers’ preconceived objectives. A feminist perspective
could add an important new dimension to research on midwifery
care of the poor by involving women as partners as
well as subjects.”

from Midwifery Care of Poor and Vulnerable Women, 1925-2003, by Raisler and Kenndey, J Midwifery Womens Health 2005;50:113–121