History – Page 5

On Schoolwork and Writing, A Preface to a New Project

December 20, 2018 By Deena Leave a Comment

Hello my long neglected readers! I have missed you and I have missed writing for you. It’s been a transition time in my personal life and I’ve had to re-prioritize certain things. Now that I’m more settled, I have the ability to get back into my passion project, The Silent Mother. I feel that you deserve a bit of an explanation as to what’s been going on and what’s coming up next.

Back in August of this year, I did a thing that I should have done twenty-some years ago. I went back to school to finish my undergraduate degree. I failed to complete it because I burned out. Burned out on what? Research and writing, believe it or not. Twenty years ago, I didn’t have the skills to speak up and ask for help or to know how to take a break. So, I quit.

As it turns out, I kind of dig this research and writing thing. I have one more semester to go, with only two classes left to finish. From there, my hope is to go to graduate school. I’m in the midst of my application process now. My plan, should it come to fruition, is to study maternal child health, specifically in two arenas: the efficacy of childbirth education and the historical influences on maternity care.

I do love the smell of an old book. Sometimes that smell is called biblichor”.

What does this mean? It means that if we don’t know the history, we don’t know the “why” of how we engage in maternity care. If we don’t know the “why”, we can’t make improvements. The improvements I seek to make are in patient education, physician and nursing education with the results being more effective communication between patients and staff. To do this, moving into graduate school so I have the ability to do research properly, would allow me to help many more families than I do currently with my work at Shining Light.

Wish me luck on my applications! I’m optimistic, but could use all the luck and support I can get.

On Thursday, January 3rd, I’ll begin my new series on Dr. Grantly Dick-Read. For those who don’t know, he is the author of Childbirth Without Fear (1942). He is the doctor who coined the term “natural childbirth”.

What you’ll be reading in the next few months is the senior Capstone paper I wrote while finishing this BA in Religious Studies, entitled The Revealed Obstetrics of Dr. Grantly Dick-Read and the Entanglement of Faith and Medicine. In this serialized release, I’ll explore questions of faith vs. evidence based science in the context of pregnancy and childbirth. By the end of the series, I’ll look to questions on implications for current practices in childbirth education.

I do hope you stay tuned with me every Thursday for a new installment. If you’d like to support my graduate school endeavors, please do consider becoming a patron.

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The arrogance of doctors and episiotomy without consent

June 24, 2016 By Deena Leave a Comment

Part 2 of my “Dear Diary” series for Giving Birth with Confidence brings us to 1920. You can read the full, historical fiction piece here.

Episiotomy without consent

Episiotomy, (sometimes called a perineotomy) a cut from the vagina towards the anus (midline) or a bit to the side (medio-laterally), was once a routine procedure for obstetricians during the pushing phase of labor. Sounds pleasant, doesn’t it? Ok, no, not really…

So, what’s up with this episiotomy without consent, as mentioned in the “Dear Diary” story? Let me take you back in time, specifically to the Chicago Lying-in Hospital in 1920. Dr. Joseph Bolivar DeLee wrote and published a paper called, “The Prophylactic Forceps Operation”. In it, he takes childbirth from a natural, normal occurrence and makes it something pathological that requires preventative intervention. He wanted to elevate the profession of obstetrics to a higher status among other fields of medicine and he needed a reason to do so.

Labor has been called and still is believed by many to be a normal function. It always strikes physicians as well as laymen as bizarre, to call labor and abnormal function, a disease, and yet it is a decidedly pathologic process. Everything, of course, depends on what we define as normal. If a woman falls on a pitchfork, and drives the handle through her perineum, we call that pathologic, abnormal, but if a large baby is driven through the pelvic floor we say that is natural and therefore normal. If a baby were to have its head caught in a door very lightly, but enough to cause cerebral hemorrhage, we would say that it is decidedly pathologic, but when a baby’s head is crushed against a tight pelvic floor, and a hemorrhage in the brain kills it, we call this normal, at least we say that the function is natural, not pathogenic.

In both cases, the cause of the damage—the fall on the pitchfork and the crushing of the door—is pathogenic—that is, disease-producing, and in the same sense labor is pathogenic—disease-producing, and anything pathogenic is pathologic or abnormal.

See, if birth is normal, then we really only need to catch the baby, which anyone can do. We only need an OB if there is a problem – and then we *really* need one! So, DeLee created a problem that needed solving. (He sounds like a rather expert marketer to me.) One aspect of the problem he created was he wanted women to come out of childbirth looking “virginal” at their perineums. Yes, you read that correctly, “virginal”.

Now, should virginal conditions be restored? Did not nature intend women should be dilated in the first labor so that subsequent children will come easily? Are not the lacerations normal?

I do love The Oatmeal dearly. I play Exploding Kittens with my kids 🙂

Right. Moving on…

DeLee makes a big leap and says,

We can take direct action to save the fascial and muscular structures of the pelvic floor, in addition to practicing the measures just mentioned for preserving the connective tissues of the upper pelvis. By incising the fascia at its most vulnerable point, and reuniting it after delivery, we are almost always, not invariably, able to eliminate all damage to the pelvic floor.

Except that this is not an evidence based statement. He makes a huge assumption to justify this new method of birth which is fully controlled by the doctor while the mother is unconscious during her labor with a “Twilight Sleep” birth. So, the mother is unable to consent to anything being done to her body.

I can’t even begin to tell you how angry that makes me. Informed consent/refusal are one of the core topics of my childbirth classes. We, as women and mothers, need and deserve respect. A lack of informed consent for any medical test, procedure or medication shows a profound lack of respect for the mother from the medical care providers.

DeLee’s writing firmly illustrates the “doctor as god” concept. This is the idea that the doctor knows best in all cases and should not be questioned. His entire paper reads as self-indulgent with an air of superiority. He speaks of how he can “save” mothers and babies with his techniques. His arrogance is profound.

As for the forceps operation—in skillful hands the danger is nil. By means of the head stethoscope we are able to recognize danger to the infant from asphyxia, and since the resistances of the soft parts are gone, there is no compression on the child’s brain. We should not blame the operation for faults made in its performance.

So, where does this leave us? Thankfully, in 2016, where you can affect the outcome of your birth and avoid unnecessary medical interventions. These tips will help.

Mothers need to know their legal rights during childbirth and advocate for them.
Mothers should feel comfortable asking questions of their doctors and midwives.
Partners play an important support role physically, emotionally and intellectually. Their advocacy is of the utmost importance during pregnancy and birth.

I am grateful that we are beyond the days of Twilight Sleep. However, we still have a long road ahead. Some mothers still have episiotomies and other medical procedures done without consent and are treated disrespectfully during labor by some staff members. Hopefully, you and I, dear reader, can make birth better for our daughters when their time comes to be mothers years from now.

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Chloroform, Childbed Fever and Historical Fiction

May 23, 2016 By Deena Leave a Comment

http://www.marycassatt.org/Mother-and-Child,-1900.html

I am writing a new historical fiction series for Lamaze‘s blog, Giving Birth With Confidence, entitled, “Dear Diary”. The people are fictitious, but their experiences reflect common ones for their time period. The series will continue monthly until we reach the end of the 20^th century. What you find below are some expanded details from the story which I have written.

You can read the first “Dear Diary” post here. “Dear Diary” – Birth Stories of the Past: Albert Jr., Born May 12, 1900

Chloroform

Chloroform’s first known usage during childbirth was in 1847 by a Scottish physician, Dr. James Young Simpson. Queen Victoria used the drug during her labor with Prince Leopold in 1853 and 1857. It was administered with a cloth over a wire framed mask. A few drops were sprinkled onto the cloth and the mother would breathe it is, feeling it’s effects shortly thereafter. There were no dosages or limits, or testing, for that matter. Some maternal fatalities with use of chloroform did occur. Chloroform and Ether were the earliest form of medical pain management.

Childbed fever

http://www.abpischools.org.uk/res/coResourceImport/modules/infectiousdiseases_timeline/en-images/Semmelweiss.jpg

Childbed fever was the common term for puerperal fever. It’s a fever caused by uterine infection after childbirth.

Although the germ theory of disease was proposed in 1546 by Girolamo Fracastoro, and Louis Pasteur and Robert Koch working in 1850’s – 1880 provided strong evidence to support germ theory, the theory wasn’t widely adopted by physicians.

Ignaz Semmelweis, in 1847 was the first to link puerperal fever to physicians. Physicians would go from performing autopsies, gloveless and without washing their hands, to delivering babies in a ward, one woman after another. Thus spreading germs and disease not only from corpse to mother, but also from mother to mother.

Semmelweis’s pleas to his colleagues to wash their hands, were ignored, even though Semmelweis’s students, having washed their hands, reduced their cases of childbed fever from 18% to 1%. Joseph Lister continued working on aseptic medical practices in the late 19^th century. Physicians were slow to adopt these new antiseptic practices until the early 20^th century.

The births in the inaugural “Dear Diary” post take place before the era of aseptic medicine. As we move forward in time, we’ll explore new advances and maybe a setback or two.

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Your generous donation allows me to keep writing.

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