Unit3: Pregnancy and other issues

Lecture 2

Menstrual Synchrony

Pregnancy and Child Birth

1. Traditional Chinese

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

3. Child birth

4. Episiotomy

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.

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:

· Infection

· Increased Pain

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

· Longer healing times

· Increased discomfort when intercourse is resumed

· Severe Infection

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

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.

Culturally Episiotomy serves a purpose.

Davis-Floyd (A Medical Anthropologist Points Out)

What does the research say about Episiotomies [The following are quoted]?

· 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.

· 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.

· 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.

· Episiotomies do not prevent relaxation of the pelvic floor musculature. Therefore, they do not prevent urinary incontinence or improve sexual satisfaction.

· Episiotomies are not easier to repair than tears

· Episiotomies do not heal better than tears.

· Episiotomies are not less painful than tears. They may cause prolonged problems with pain, especially pain during intercourse.

· Episiotomies do not prevent birth injuries or fetal brain damage.

· Episiotomies increase blood loss.

· As with any other surgical procedure, episiotomies may lead to infection, including fatal infections.

· 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.

· The birth attendant's philosophy, technique, skill, and experience are the major determinants of perineal outcome.

· 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.)

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

Episiotomy Links:

Episiotomy: Ritual Genital Mutilation in Western Obstetrics

Episiotomy - Iatrogenic Perforation of the Vaginal Wall with Rectovaginal Fistula - Medical Illustration: click enlarge

Episiotomy Journal References: These references were used for the lecture.

Episiotomy: An interesting article, but it is based upon some older references. Prevalence has greatly reduced since 1983.

Doula’s

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

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

Certified Nurse Midwives

Controlling the Female Body

Female Genital Mutilation

Prevalence: 80 Million women

Practice is followed in at least 20 African countries, and in several Arab countries as well as the Muslim populations of Indonesia and Malaysia.

Practiced in America (not frequently, but has been)

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

Female Genital Mutilation [FGM]: Informative Links

Referenced Overview: Good resource, but presents a specific point of view

One account of FGM: FGM is practiced in a variety of ways. This is one example of how it’s culturally practiced

World Health Organization Website: WHO provides the latest overview of the practice

WHO Fact Sheet: Excellent resource for term papers.

WHO Prevalence Statitics: As of May 2001

Islamic Ruling on Male Circumcision and FGM:

Lesbians and Bisexual Women

· Lesbian is a women who is emotionally and sexually attracted to other women

· A bisexual women is attracted to both men and women

Attitudes towards Lesbianism

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

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

· 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)

Women of Color face triple jeopardy

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