Unit3c: Pregnancy and other issues

Menstrual Synchrony

1. What is menstrual synchrony?

2. Studies have documented this in college dorms (McClintock, 1971), mothers and daughters living in the same residence (Weller & Weller, 1993) & lesbian couples (Weller & Weller, 1992)

3. Research has demonstrated a possible link between Pheromones arm pit sweat and synchrony.

Pregnancy and Child Birth

1. Traditional Chinese beliefs held that childbrith was an act of extreme spiritual pollution, even though the woman gained status and some power in her husband's family.

2. Women in many parts of the world acknowledge some discomfort when it comes to pregnancy.

a. A substantial minority of women in US report nausea and vomiting early on in pregnancy.

b. feelings of heaviness, general aches and pains

c. backache

d. headaches

e. While stereotypes indicate moodiness, women's reports are mixed

f. possible higher rates of depression

g. Some women report psychological well being

3. Child birth

a. A dramatic even moderated by cultural context

b. USA women generally give births in hospitals w/emotional support of a partner. Women may be treated as a passive patient, given little information about the process and may be bullied into submission to hospital routines and procedures.

One such procedure is the episiotomy


An episiotomy is a surgical incision in the perineum (the area of skin between the vagina and the anus).

All the authoritative pronouncements in favor of episiotomy descend from a 75-year-old article (DeLee 1920) that produced not a shred of evidence in its support. http://www.efn.org/~djz/birth/obmyth/epis.html

Episiotomies are said to provide the following benefits:

Speed up the birth

Prevent Tearing

Protects against incontinence

Protects against pelvic floor relaxation

Heals easier than tears

The following have been reported as side effects of the episiotomy:


Increased Pain

Increase in 3rd and 4th degree vaginal lacerations (euphemistically called extensions)

Longer healing times

Increased discomfort when intercourse is resumed

Severe infection....Between 1969 and 1976 they caused 27% (3/11) of the maternal deaths in Kern County, California (Ewing, Smale, and Eliot 1979). A fourth woman survived, spending 23 days in the hospital. Shy and Eschenbach (1979) report on four cases in King County, Washington, between 1969 and 1977. Three women died, representing 20% of the maternal mortality rate during those years.

Literature review states that their use medically is overused, and shaky at best.

Klein et al Relation of episiotomy to perineal trauma and morbidity, sexual dysfunction and pelvic floor relaxation. Am J Obstet and Gynecol 1994;171:591-8 2. Klein et al Physicians Beliefs and behaviour during a randomized controlled trial of episiotomy:consequences for women under their care. Can Med Assoc J. 1995; 153 (6) Sept 15th. 769-79.

The latter two studies show the clear causal relationship between episiotomy and 3rd/4th degree tears. Women who were intact or had spontaneous tears had best outcomes, episiotomy the worst with respect to perineal pain, sexual and pelvic floor functioning. 52 of 53 3rd/4th degree tears occurred in presence of episiotomy (extensions). The CMAJ article shows that physicians with strong pro-episiotomy beliefs of course do more episiotomies BUT they also do more induction, augmentation, forceps and cesareans too. And they diagnose fetal distress when its not there many times more often and perineums "that won't distend"--AND their pateints have more pain and are less satisfied.

In a study done in a canadian multicenter (randomized controlled trial Klein et al. 1992) could not get doctors to abandon it. Many were unwilling or unable to reduce their episiotomy rate according to protocol.

Culturally Episiotomy serves a purpose.

Davis-Floyd (medicial anthropologist points out)

1. surgery holds the highest value in western medicine

2. Obstetrics is a surgical speciality

3. Episiotomy transforms normal childbirth into a surgical procedure

4. Allows the destruction and reconstruction of women's genitals

5. Allows men to control the 'powerfully sexual, creative, and male-t hreatening aspects of women." DeLee the original instigator used the words "tightening to virginal conditions." peritneum relaxation and the husband's knot.....

Episiotomies do not prevent tears into or through the anal sphincter or vaginal tears. In fact, deep tears almost never occur in the absence of an episiotomy. (Abstracts 1-12, 16, 19-20, 23-28)

Even when properly repaired, tears of the anal sphincter may cause chronic problems with coital pain and gas or fecal incontinence later in life. In addition, anal injury predisposes to rectovaginal fistulas. (Abstracts 11, 15, 21-22)

If a woman does not have an episiotomy, she is likely to have a small tear, but with rare exceptions the tear will be, at worst, no worse than an episiotomy. (Abstracts 1, 2, 5, 8-10, 14, 16, 24-25)

Episiotomies do not prevent relaxation of the pelvic floor musculature. Therefore, they do not prevent urinary incontinence or improve sexual satisfaction. (Abstracts 1-4, 7, 12-16)

Episiotomies are not easier to repair than tears. (Abstracts 1, 3, 9)

Episiotomies do not heal better than tears. (Abstracts 1, 5-6, 12-15, 21)

Episiotomies are not less painful than tears. They may cause prolonged problems with pain, especially pain during intercourse. (Abstracts 1, 2, 7, 12, 14-15, 19-20)

Episiotomies do not prevent birth injuries or fetal brain damage. (Abstracts 1, 3, 5-7, 12, 14, 17-18, 27)

Episiotomies increase blood loss. (Abstracts 1, 12, 19)

As with any other surgical procedure, episiotomies may lead to infection, including fatal infections. (Abstracts 1, 12, 19, 22)

Epidurals increase the need for episiotomy. They also increase the probability of instrumental delivery. Instrumental delivery increases both the odds of episiotomy and deep tears. (Abstracts 5, 11-12, 21, 25-26)

The birth attendant's philosophy, technique, skill, and experience are the major determinants of perineal outcome. (Abstracts 2, 5-7, 9-10, 25-27)

Some techniques for reducing perineal trauma that have been evaluated and found effective are: prenatal perineal massage, slow delivery of the head, supporting the perineum, keeping the head flexed, delivering the shoulders one at a time, and doing instrumental deliveries without episiotomy. (Others, such as perineal massage during labor or hot compresses have yet to be studied.) (Abstracts 23-24, 28)

Independent of specifically contracting the pelvic floor muscles (Kegels), a regular exercise program strengthens the pelvic floor. (Abstract 13)


1. A Doula is a fmale labor and birth coach.

2. Comes from the Greek word meaning "woman caregiver of a woman."

3. Studies have shown that women who are randomly assigned a doula during labor have less pain and anxiety during labor, need less medication, have fewer c-sections, and have shorter labors and less post partum depression than women w/o doula.

4. Women who have a doula have been found to be more sensitive, loving, and responsive to their infants two months later.

Certified Nurse Midwives

1. attended only 1 percent of births in 1975

2. attending 7 percent in 1997

3. Mortality rates are lower and infant weights are higher in those attended by a midwife (even though they tend to serve those with higher risk and less education)

4. Spend more time during prenatal visits

5. Provide more education and counciling

6. provide more emotional support and are with their patients throughout labor and delivery

Controlling the Female Body

Female Genital Multilation

1. Prevalence: 80 Million women

2. Practice is followed in at least 20 African countries, and in several Arabe countries as well as the Mulsim populations of Indonesia and Malasyia.

3. 75% of Egyptian women (80% says WHO)

4. The surgery is most often performed between the ages of 4-8, but WHO reports that it sometimes is preformed on infants & the general trend is that the ages of the individuals is getting younger.

5. Young age (and it's getting younger) has been argued that this is NO longer being seen as a right of passage.

6. 19th century was endorsed by physicians in the USA and Britain as a treatment for "hysteria, epilepsy, melancholy, lesbianism and excessive masturbation" and is reportedly still (rarely) prescribed for treatment of "female masturbation and sexuality"

American Medical Association Council on Scientific Affairs. (1995) Female genital mutilation. Journal of the American Medical Association, 274(21), 1714-1716.

- Four levels of mutilation. Most involve the removal of the clitoris (clioridectomy) and labia minora, but some also include infibulation.

1. Infibulation can cause infection, hemmoraging during childbirth, the increased probability that the baby's head will get stuck on the scar tissue even with dis-infibulation (which they later restitch back up)

Lesbian's and Bisexual Women

1. Lesbian is a women who is emotionally and sexually attracted to other women

2. A bisexual women is attracted to both men and women

3. It is difficult to estimate the number of lesbian's and bisexuals because of negative attitudes toward homosexuality, but some studies report as high as 12 percent indicating some sexual attraction to other women.

Bisexual Women

1. Women often become bisexual after either being exclusively het or lesbian

2. Lesbians may move toward bisexuality because het lifestyle is the norm and it's a good cover

3. Also because nearly all Lesbian's have had some het experience (Nichols, 1994)

4. Lesbians risk ostracism from the lesbian community if they become bisexual.

5. Some use bisexuality as a transition point into the lesbian lifestyle.

6. Some just feel attracted to both sexes

7. Individuals have difficulty understanding bisexuality ("I thought you were supposed to be gay")

Attitudes towards Lesbianism

1. Homophobia is the negative reactions to homosexuality and irrational fear of homosexuals

2. 1998 study showed that nearly 60% of the sample indicated that sex between adults of the same sex is always wrong

3. Recent study of 261,000 college students (first year) 1/3 believed that there should be laws banning homosexual relationships (gender distribution 40 % males and 22% females)

4. 1998 poll of the surveyed individuals felt that homosexuals should not be allowed to legally marry or to adopt children, but 80 percent stated they felt homosexuals should have equal rights in employment and housing, and 60 percent supported health insurance and inheritance rights for gay spouses.

Women of Color face triple jeopardy

1. Communities of color may be more homophobic than the white communities (as demonstrated in research)