PSYC of childbirth final tehe

what is the gist of the georgia case?

Jesse Mae Jefferson, religious beliefs that the lord would heal her body therefore no medical intervention, told she had a complete placental previa and that the baby would die; court order authorized hospital to give c section without her consent, Supreme Court upheld it. she delivered uneventfully without surgical intervention

what is the gist of the Pennsylvania case?

Amber Marlowe, doctors told her she needed a c section because baby was ~13lbs, she had delivered 6 other massive babies naturally prior, hospital obtained legal guardianship of unborn child and court allowed hospital to force surgery, she delivered uneventfully without surgical intervention at another hospital

how does ultrasound technology work?

sends pulses of sound waves into tissue to measure density; greater difference in density, greater the echo

what are some issues with ultrasounds?

sonographic signal is mostly lost from acoustic absorption, can produce false positives and misses

what is electronic fetal monitoring (EFM)?

interprets fetal heart tracings and mothers contractions to attempt to detect fetal distress

what was promised when EFM was introduced?

it would reduce by half the incidence of cerebral palsy, intellectual disability, and peri-natal mortality

what are some issues with EFM?

interpretations of tracings are subjective, very little expert agreement about what non-reassuring tracings are, false positives of distress are a given at >99% (allegedly.), and it increases c section rates without improving outcomes for babies

what is the relationship between EFM and brain injury litigation?

used by expert witnesses to testify as to the exact moment (not really) moment that a baby sustained irreversible neurological injury

as c section rates ___________, cerebral palsy incidence _____________.

rose dramatically; stayed the same.

what is counterfactual reasoning?

reasoning about what might have been generally using if, then statements: e.x. if you hadn't gotten a c section, you wouldn't hate your child

what is the hindsight bias?

the tendency to believe, after learning an outcome, that one would have foreseen it; the knew it all along effect

what is the myth of cerebral palsy causation?

counter to popular belief, it is only very rarely caused by hypoxia and most causes are thought to precede labour.

cerebral palsy is a major cause of c sections. are they actually associated?

no lol

what was roe v wade?

US Supreme Court decision that legalized abortion nationwide (the right to choose to end pregnancy)

what was dobbs v Jackson?

overruled roe v wade :(

progression of abortions in canada 1800s

British outlawed abortions after the quickening -> New Brunswick followed -> British made all abortion illegal -> upper and lower canada followed w criminalization laws -> criminal code of canada declared all abortions illegal nationwide

progression of abortions in canada 1900s

1969 criminal code amendment legalized gay people, contraception, and some abortions -> they could take place in a hospital as long as pregnancy posed danger to pregnant person as determined by a three-doctor therapeutic abortion committee -> abortion caravan march -> r v morgentaler

what was the issue with the therapeutic abortion committees?

they were highly biased, for marginalized groups (especially indigenous people) sometimes conditional on sterilization

what was r v morgentaler?

homeboy administered safe and illegal abortions, NO jury would make him guilty they sent him to jail anyway, the court case was a Supreme Court ruling that legalized abortion fully under charter right of security of the person

does a fetus have human rights?

Tremblay v daigle: fetuses are not legal persons until they are fully born

r v sullivan: person cannot be charged with murder or homicide in demise of a pregnancy

consent rights: every adult who is capable of consent to health care has:

the right to give consent or to refuse consent on any grounds even if refusal will result in death; the right to select health care on any grounds; the right to revoke consent

what is the general rule for consent?

a health care provider must not provide any health care to an adult without the adult's consent except under sections 11-15

what is the exception to the consent rule?

urgent or emergency health care: a provider may do something without consent if it is necessary to provide it immediately to save their life etc

what is the spectrum of childbirth experience?

medical knowledge and hospital birth to visceral knowledge and free birthing

what is authoritative knowledge?

the knowledge that counts depending on the context: medical knowledge in the hospital vs midwifery knowledge at home vs visceral knowledge in a freebirth

in the very contextually relevant setting of the UK in 2021, how many respondents were considering freebirth?

4%

what is a demographic of people more likely to consider freebirth (ALLEGEDLY) than the norm?

LGBTQ+ people

what does traditional midwifery tend to emphasize?

low tech solutions, variability and uniqueness in birth, the rejection of medical norms

what does indigenous midwifery value?

bringing birth closer to home, restoring emphasis on birth as normal rather than pathologizing it

the Puvirnituq maternity centre

very very low c section rate, low perinatal mortality (the same as Canadian average)

what is the myth of human exceptionalism?

humans are unique to other species

the myth of human exceptionalism: childbirth

humans are the only animals that receive and provide mechanical assistance to each other during birth, human babies are the only animals to be born facing away from mother's face, obstetric dilemma

what is the obstetric dilemma?

the attempt to explain why human babies are born less developed than other primates: pregnancy is shorter to allow head to pass through narrow birth canal, birth canal cannot be any wider because that would impede bipedal walking (our brains low-key too big fr)

do all cultures involve other people in birth?

no - unassisted birth is common across many, but not all, cultures (e.x. some African peoples)

what is the birth paradox?

birth is crucially dependent on oxytocin which is secreted optimally in private, quiet areas, but almost all cultures have developed practices that reduce the privacy/quiet/seclusion during birth

three theories as to why other people may be involved in childbirth

provide mechanical assistance to increase survival chances; increase bond between baby and other people present at birth (create substitute parents); decrease bond between mother and baby for purposes that may benefit survival of group (what)

are humans the only animals where babies are born facing the mother's spine?

no! chimpanzees do it too, and they do it unassisted - challenge human exceptionalism, challenge theory for creation of midwifery

why did we think that babies being born facing the spine facilitated midwifery creation?

inconvenient to pick up baby coming out backwards, midwifes help pick it up and nurture it immediately (the monkeys low-key dropped their children)

argument that human birth is unique in 3 ways (what are the ways)?

mechanism of birth (the way the baby adapts itself to and passes through pelvis); difficulty of labour; behaviour during and after labour

what do male hamsters do?

lick babies, lick amniotic fluid, eat placenta, groom babies, babysit the children, assist delivery, open airways, etc

what is the problem with the obstetric dilemma?

there is no evidence that wider hips are detrimental to walking; human gestation is actually a bit longer than other primates and our babies are a bit bigger

what is the EGG hypothesis?

energy, gestation, growth: the baby is born when mothers can no longer put more energy into gestation and fetal growth

how long would labour be for babies to be born as developed as other primates?

16 months

why does increasing pelvis size not actually influence bipedal walking?

would only need to increase by 3cm - there is naturally this much variation anyways among women

what does the metabolic ceiling have to do with gestation?

hypothesized that babies are born when the mother's metabolic ceiling is exceeded: it is reached at 6 months, and exceeded at 9 months

how have diet changes potentially impacted developmental stage that baby is born at?

changes in diet may mean bigger babies and not enough time for evolution to catch up

when does the baby's microbiome start?

during gestation

how much microbial are we?

90%

what are the three primary seeding events for an infant's microbiome?

passing through the birth canal (number 1), breastfeeding, skin to skin contact

what are the benefits of a strong and diverse microbiome?

stronger immune system

what's cool about breast milk and the microbiome?

breastmilk contains sugars that are indigestible for babies but that are crucial for microbes

what are short term health problems occurring from c section?

respiratory problems, harder to feed and therefore lower blood sugars, more tired, bypass mothers vaginal bacteria, too swag

what are some longer term outcomes from c sections?

immune system being primed by the wrong bacteria, behavioural problems, celiac, diabetes, obesity, mental illness, probably autism tbh, epigenetic consequences (passes down negative stuff to THEIR children), increased risk of disease