psych of childbirth midterm 2

associative memory

implicit model of the world; the distillation of statistical regularities across your experiences

weasel words

vague and can be misleading (e.g. possible, might)

heuristics govern

subjective probabilities

statistics govern

objective probabilities

maternal mortality rate is ________ overall; _______ in the US and Canada, and _________ in Australia and Sweden

dropping/plateauing; increasing, decreasing

semantic memory

explicit model of the world; general knowledge that can come from experiences or culture

what determines your internal reactions?

combination of intuitive valuation and deliberate evaluation of a situation

culture is a major source of _______ learning because...

associative; it influences what we are exposed to daily and repeated exposure strengthens associations

culture determines _______, which influences _______, which then influences _________

what we are exposed to; associative memory; intuitive valuations

leading primary allegation for obstetric claims

neurologically impaired infant

babies have all their neurons by...

7th month of pregnancy

what is the rationale for the vitamin K injection?

prevent internal bleeding -- Vitamin K is a coagulant and babies seem to be born with low levels

what is the rationale for erythromycin (antibiotic) eye ointment?

prevent any infections that may have been spread when passing through the birth canal

mandated-ness of eye ointment?

mandated until 2018 but almost universally given still

most painful routine procedure for newborns

heel prick test (genetic testing)

If vitamin K is equally as effective when administered orally (it's not btw but whatever) why do we still use a shot?

concerns about parental compliance

neonates feel ________ pain than kids/adults

more (due to myelination)

intuition (system 1)

fast, parallel, automatic, associative, emotional

reasoning (system 2)

slow, controlled, effortful, rule-governed, flexible

intuitive judgments

immediately knowing something without reasoning or analysis (associative memory) (system 1)

deliberate judgments

takes time to process many factors before making a judgment (reasoning) (system 2)

availability heuristic

a cognitive bias where people assess the likelihood of an event based on how easily examples of that event come to mind, leading to overestimation of probabilities

fluency heuristic

a cognitive shortcut where people judge info based on how easily they process it, with more fluent information being perceived as more reliable

attribute substitution

the tendency when making a complex, difficult judgment, to unconsciously substitute an easier judgment. ex. "birth is very dangerous bc I can recall many examples"

words of estimative probability (WEPs)

terms used by intelligence analysts in the production of analytic reports to convey the likelihood of a future event occurring. ex. probable, possible, unlikely

the two most famous representations of birth

birth of Venus, the creation of Adam

motivated reasoning

we are motivated to attribute positive outcomes to culturally dominant values, and negative outcomes to culturally non-dominant outcomes

culturally dominant representations of birth tend to avoid...

physiological reality, vulnerability and dependency, and the animalism/emotionality of birth

accuracy motive for reasoning

motivation to arrive at an accurate, thorough explanation. leads to more cognitive effort, deeper processing, and more complex thinking strategies

directional motive for reasoning

motivation to arrive at a particular, directional explanation. leads to trying to justify a particular conclusion, undertaking a biased memory search for particular info, accessing only a subset of relevant knowledge

due date

280 days (40 weeks) from the first day of the last menstrual period

term pregnancy

between 37 and 42 weeks

pre-term pregnancy

before 37 full weeks of pregnancy

post-term pregnancy

after 42 weeks of pregnancy

membrane sweeping

a practice offered at 38 to 41 weeks: a healthcare provider inserts a finger into the cervix and performs a sweeping motion to separate the fetal membranes from the uterine wall to induce labor

when is induction offered?

41 to 42 weeks, because evidence reveals a decrease in perinatal mortality with induction

formal induction

performed by 41 weeks and 3 days of pregnancy if labor hasn't started yet

rationale for membrane sweeping

presumed to cause the release of endogenous prostaglandins from adjacent membranes and cervix, helping to initiate labor and possibly reducing the rate of formal induction

cons of membrane sweeping

can be very painful, can cause bleeding or irregular contractions, can cause rupture of the amniotic sac

most common induction methods

artificial oxytocin (pitocin), IV drop, prostaglandins, mechanical methods

prostaglandins

hormones that help to soften and dilate the cervix. more effective than oxytocin for bringing labor in 24 hrs, but may cause uterine hyperstimulation

mechanical methods of induction

balloon catheters, amniotomy, etc. cause reduced uterine hyperstimulation compared to prostaglandins, but increased maternal and neonatal infections

precautionary principle

assumed unsafe until proven otherwise

anti-cautionary principle

assumed safe until proven otherwise

prevalence of the anti-cautionary princple

not unique to obstetrics or medicine. within medicine, it is linked to medical reversals

benefits of not cord clamping

baby stays connected to the placenta and continues to receive blood and oxygen while there is a gradual transition to breathing

umbilical cord

a tube containing the blood vessels connecting the fetus and placenta.

wharton's jelly

a gelatinous, mucoid connective tissue found within the umbilical cord that protects the umbilical vessels from compression and torsion. changes its structure with cooler temperature and provides a physiological clamping action

history of cord clamping

first records from the late 1600s. early explanations for the practice included avoiding blood loss from the baby before closure of the umbilical vessels and to "protect the bed linens"

early 20th century cord clamping

general anesthesia with chloroform was used during birth, so the cord was immediately clamped to stop chloroform from passing to the baby

cord clamping now

became an obstetric standard of care in the 1960s. promoted as a tool to prevent postpartum hemorrhage

active management of stage 3 of labor

administration of pitocin, early cord clamping/cutting, controlled traction of the umbilical cord

statistical evidence for cord clamping

immediate cord clamping does not decrease postpartum hemorrhage rates, cord traction may not be important

uterotonic drug

possibly the only stage 3 intervention shown to reduce hemorrhage

placental transfusion

the natural transfer of blood from the placenta to the baby during the first few minutes after birth. can be enhanced through delayed cord clamping

benefits of delayed cord clamping

increase in blood volume of the newborn, increase in red cell volume, higher birth weight, lower rate of iron deficiency

canadian guidelines for cord clamping

delaying for 60 seconds recommended because it may cause jaundice in the baby

medical knowledge

mostly procedural, somewhat semantic

scientific knowledge

mostly semantic, somewhat procedural

semantic (declarative) knowledge

forms and changes based on the "evidence" we are exposed to (the evidence could be biased or faulty)

procedural knowledge

forms and changes based on what we frequently do, and the system of incentives and punishments that are part of our environment

evidence-practice gap

it takes a long time for science to influence medical practice, and it only does so partially. clinical articles are more likely to examine new possible practices than preexisting standards of care

archie cochrane

criticized the lack of reliable evidence behind many commonly accepted healthcare interventions and advocated for randomized controlled trials. led to the cochrane library database of systematic reviews

levels of knowledge

expert opinion --> studies --> appraisals and reviews

incentives and disincentives that influence obstetrics

personal, professional, duty of care, financial, medico-legal

odds of obstetrics lawsuits

most lawsuits don't go to trial, but of those that do, ~75% are in the OB-GYN's favor

fetus legality

the fetus doesn't become a person until it is fully born and functioning independently from the mother. however, the law might recognize its existence as starting before birth for legal purposes

regarding the fetus as a second patient

OB-GYNs currently recognize fetuses as a separate entity from the mother. canada uses tort litigation for medical injuries, so this could create a conflict between practitioners and pregnant women who refuse treatment

negative impacts of lawsuits on OBGYNS

majority say that their thinking/actions are affected by threat of lawsuit; extremely negative experience; can sow distrust in patients and colleagues

BC Supreme Court ruled that medical care providers...

had 2 patients and owed a duty of care

Much of medicine is _______ based

theory

why do researchers approve practices before extensive testing done?

researchers look at surrogate outcomes instead of actual end points

what are some ethical tensions when a recommended treatment is declined?

autonomy, beneficence, nonmaleficence

does duty to the fetus restrict autonomy?

no! the fetus is not a person, therefore there is no legal obligation to it from the mother or doctor

anchoring effect

a cognitive bias where individuals rely too heavily on the first piece of information (the "anchor") when making decisions, even if it's irrelevant

intention to verify if a statement is literally true...

activates evaluation of metaphorical truth

what is processing fluency

subjective ease or difficulty with which a cognitive task is accomplished

effect of consistency and fluency on confidence is a source of...

bias

what does system 1 govern

impressions, intuitions, response tendencies

system 1 is

automatic

what can system 1 not do

rule governed computations or explicit negation

what influences processing fluency?

quality of how a problem is presented, complexity of language, good/bad mood, presence/absence of contextual support and priming

what is robust bias a failure of

joint failure of system 1 and 2

robust bias

relying on a subjective impression to estimate an objective quantity in the presence of an obvious biasing factor

intention to evaluate a particular stimulus attribute automatically...

activates assessments of other dimensions

framing effects

the way information is presented affects how we process and absorb it

what does associative activation coherence induce?

confirmatory biases in favour of proving a hypothesis

what are clinical recommendations based on

likelihood of benefit vs harm

what, outside of the clinician, can also be coercive?

hospital policies and guidelines

what is automatically evoked by a stimulus, and what does it include? (associative coherence)

elements often attributed to high-level inferences, such as possible causes and counterfactual alternatives.

associative coherence

the tendency to find coherence between seemingly unrelated ideas, events, or concepts, even if the connections are not logical, to form a coherent story

blocking and discounting effects

possible cause of an event is ignored when the event is attributed to another cause

two failures causing errors of judgement

automatic operations of system 1 generate faulty intuition; controlled operations of system 2 fail to detect/correct system 1 errors

Priming research has found links between...

verbal representations, emotions, facial expressions, motor responses, visual perception, conscious and unconscious goals

Judgement as a combination of items of information

biases are the over/underweighting of information aspects relative to accuracy/logical consistency

3 features of associative processes that account for major biases of judgment and choice

associative coherence, attribute substitution, processing fluency

which carries more weight: patient autonomy or caregiver beneficence?

patient autonomy

what are some examples of coercion in clinician-patient relationship?

magnifying risk estimates, exaggerating benefits/withholding risks, demeaning a woman for putting fetus at risk, threatening CPS/stating woman is a bad parent, threatening to withdraw care

emergency c sections can result in...

weaker scar tissue with a greater chance of future rupture due to higher incision

how many practices were categorized with unknown effectiveness

half