Anthropology 270 - Topics in Ethnography: Childbirth in America
Ann B. Judkins, CNM, NP, MA
Spring 2015



Course Description:
Medical, anthropological, and historical perspectives on the development of and current choices in childbirth in America.  Case studies of the development of birth care in specific communities in New England, Kentucky, New York City, and Hispanic Texas, as well as in western New York. The evolution of birth from a primarily social to a predominantly medical experience.  Critical and changing roles of midwifery in childbirth.  Ethnographic perspectives on paradigms, roles, institutions, instruments, etc. in relation to competing models of birth.  Choices women have in contemporary childbirth in America - including access, limitations, and current issues and developments.

Anthropology 100 or 101 or 105, or permission of the instructor

Learning Outcomes:
1) Students will learn the major models of childbirth care and their competing strengths and evolution.  They will also learn to analyze medical and birth behaviors as they express personal and social power. Students will demonstrate their understanding of these models and concepts through the writing of a midterm and a final examination.
2) Students will learn the family, community and social contexts of birth through critical examination of case studies.  Students will demonstrate their understanding of these contexts by working individually and in small group on assigned research topics.
3) Students will learn the application and power of ethnographic analysis in contemporary settings. Students will demonstrate their mastery of ethnographic analysis by making class presentations and leading class discussions on assigned research topics.

Midterm, Final Exam, class participation, and class presentations on assigned topics: 25% each.

Breckinridge, Mary.  Wide Neighborhoods. U Press of Kentucky.  1981
Gaskin, Ina May.  Ina May’s Guide to Childbirth.  Bantam.  2003
Karmel, Marjorie.  Thank You, Dr. Lamaze. Pinter and Martin Ltd.  2005  
Ulrich, Laurel Thatcher.  A Midwife’s Tale.  Knopf.  1990 (Pulitzer Prize 1991; MacArthur Foundation Fellow 1992-1997)
Young, Diony.  Changing Childbirth: Family Birth in the Hospital.  Childbirth Graphics.  1982
    [used, from: or from; required & important; order promptly]
Anthropology 270 - Birth in America - Course Outline

Week 1: January 23
Reading Assignment, due Week 3: Ulrich (all)

Introduction of instructor: clinical background and experience
Goals and expectations for class
Birth perspectives: birth as a natural process; birth as a human & social event
Ethnographic cases: Native American; West Africa (Return to Laughter); Amish; communitarian
Birth: perplexity and paradox

Development of Birth Choices
Week 2: January 30
Reading: continue to completion of Ulrich for Week 3 class
Video: follow-up on lecture: YouTube: (06b Surgery- Semmelweis)
Short report assignments for Week 3 – sign up for topics during class break

    - puerperal fever
    - Germ Theory of Disease: Pasteur and Koch
    - role of Semmelweis/struggle for women’s lives
    - scientific method (statistics)
    - strength and power of the medical paradigm
    - lack of choice/selection of patients (then and now [DC General Hospital])

    - background
    - invention isn’t always progress for all
- strength and power of the medical paradigm
- lack of choice/selection of patient

The Early American Experience
Week 3: February 6
Reading Assignment for Week 4: Breckinridge (all)
Video: American Experience - A Midwife's Tale
Class reports

Colonial America: Martha Ballard
    - paradigm of service, community, socially supported birth
    - “trivia of domestic life” to reflect on world view and personal values
    - diary, record, statistics
    - interface with the medical model realization: “no endgame” - effects for women

The Start of Professional Midwifery
Week 4: February 13
Video: [Frontier Nursing Service video/Forgotten Frontier  25”
Handout: Malawis Leader Makes Safe Childbirth Her Mission
Enlarging the Paradigm with Education and Structure
    - Urban:
        - Manhattan Midwifery School - 1925
        - Lobenstine Midwifery Clinic and School - 1931
        - public health: Maternity Center Associates (MCA) (NYC) - 1934

    - Rural: Breckinridge - Frontier Nursing Service (Kentucky) - 1925
        - origins: bringing power, money and a desire to serve
        - European model    
        - statistics

The Medical Revolution
Week 5: February 20
Reading Assignment for Week 6: Karmel (all): Class Presentation assignment for week 7 & 8 (all due on week 7)                                                                                                                                                                 

            -Flexner: - Report and development of the model for medical education
            - Urban: Dr. Helen B. Taussig – Johns Hopkins Pediatric Cardiac Clinic
    - Rural: Dr. Clifford Harville (Cook County Hospital, Chicago) - rural western NYS
        - formal medical model added to service, dedication, and community
        - starts to have endgame/forceps
        - forceps: introduction and subsequent disappearance of a medical tool
        - blood transfusions, Rh factor, chloroform
    - Post WWII: hospitalization model of birth
        - personal case study
        - growing dissatisfaction with hospitalization
    - Specialization of obstetrics
        - formal endgame/Cesarean Sections
        - twilight sleep
                        - interventions
Midterm Exam:
Week 6: February 27
Video: In Union 7”
Class presentation assignments reviewed for Weeks 7 and 8
    -Introduction to Grantly Dick-Read
        -rediscovery of Natural Childbirth
MIDTERM EXAM: February 27

Utilization of Birth Choices
Week 7: March 6
Reading: Gaskin, Birth Stories: All-- Be prepared to discuss what surprised you, or you found funny, strange, touching or what caused questions.  Discussion with graded participation on week 9   
Discuss Midterm Test results

Guest: Julia Miller, RN: childbirth preparation class (bring pillow; wear comfortable clothing)
Introduction to fluorescence of childbirth choices in reaction to hospitalization model
Childbirth education: class demonstration

Childbirth education: class presentations

Student Presentations
Week 8: March 13
Reading: Young, Chapters 1-6
Video: Hello Baby  55”

Childbirth education: class presentations

[Spring Break: March 17-21]

Changing Birth Structure
Week 9: March 27
Reading: Young, Chapter 11
Video: With women

Free-standing birth centers
Home birth movement
NYS Department of Health PCAP model
Families in the changing birth structure

Week 10: April 3
Reading: Young, Chapters 10 and 12
Video: Overcoming infertility 30”
Handout;  Fertility and Timing Ovulation
          Fertilility Literacy for Men in Primary Care

Preconceptual care
    - recognizing and actualizing the choices
    - what does quality care look like: what to expect; how to access
    - histories: menstrual, ob-gyn, general medical, family, social, nutritional
    - physical exam and labs
    - educational teaching: diet, exercise, folic acid, substance abuse, work issues, etc.

Week 11: April 10
Readings: Gaskin, Chapters 5, 11
Handout: Loren Eiseley, and Alice Dreger reading assignment for Week 12
Youtube:  Michel Odent Gentle Birth 1-3, The best chance of natural birth and birth of the birthing room-- for discussion week 12
Assignment for class presentation with leading class discussion, expanding on a topic that we have touched on during the semester: topic must be cleared by instructor—presentation notes to be handed in-- for week 14
Video: Life’s Greatest Miracle

Prenatal care
    - visualization of the patient
        - unique period/laser focus
        - optimal time for education, growth and change
        - motherhood
            - social/cultural variation in role perception/goal vs. crisis
            - the problem of stereotyping/inflicting practitioner’s values/stereotyping
    - visualization of health-care structures
        - practitioner support/advantage of CNM
        - maternal support
    - initial obstetric visit
        - reviewing and updating histories
        - physical exam and objective information
        - assessment: dating of pregnancy, weight, problems identified in history and
            physical exams
        - diagnostic testing: what and why
        - treatment and management
        - consultation and/or follow-up
    - subsequent obstetric visits
        - subjective evaluation
        - objective information
        - assessment
        - plan: diagnostic testing, management and treatment, patient education and
            follow-up on physical, lab and social findings
    ⁃    charts and charting

Week 12: April 17
Reading: Young, Chapters 8, 10 and 11 + Gaskin, chapters 2, 3, 6-8
Reading discussion: Loren Eiseley, “An Evolutionist Looks at Modern Man” and Alice Dreger “The Most Scientific Birth Is Often the Least Technological Birth”
            YouTube discussion Michel Odent
Video: Business of Being Born
Handout: Birth Plans

    - evolutionary/biological event (adaptation)
        - surroundings, social support, food and drink, movement/activity
        - adrenalin, stress and its results on birth process
        - birth plan
    - labor time-line
        - effacement, dilatation, and descent
        - factors: environment, pelvic structure, baby’s size & position, strength of labor,
            interference (medication, fear), unknown factors
    - pushing phase
        - descent and movements of baby
        - factors: strength of contractions & pushing, mother’s & baby’s position- medication, social support
        - what if?
        - endgame/safety-net

Post Birth
Week 13: April 24
Readings: Young, Chapters 15, 16, and 18 + Gaskin, Chapter 9
Video: Babies

    - early postpartum
        - safety
        - family and bonding
            - sensory, hormonal focus
        - breastfeeding
        -talk to your baby
        - what if?
    - late postpartum
        - birth control options
        - evolution of new role(s)

Week 14: April 24
Readings: Young, Chapters 13 & 23 + Gaskin, Chapters 13, 14
Video: TBA

Presentation with discussions

FINAL EXAM: Thursday,  May 8,  6:45-9:45