Anthropology 270 - Topics in Ethnography: Childbirth in America
Ann B. Judkins, CNM, NP, MA
Spring 2014

                                               

Syllabus 

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.

Prerequisites

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 arid 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.

Grading:

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

Texts:

Breckinridge, Mary. Wide Neighborhoods. U Press of Kentucky. 1981 Gaskin, Ina May. InaMay'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: Amazon.com or fromAddAll.com; required & important; order promptly]

Also copy on reserve in library

Anthropology 270 - Birth in America - Course Outline

Introduction 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: http://www.voutube.com, [ 06a&06b Surgery- Semmelweis] Short report assignments for Week 3 - sign up for topics during class break

Semmelweis.

-  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])

Chamberlen

-  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 Reader 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"

55"

Childbirth education: class presentations [Spring Break: March 17-21]

Changing Birth Structure Week 9: March 27 Reading: Young, Chapter 11 Video: With women 56"

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

Preconception 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.

Prenatal

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 60"

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

Birth

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 84"

Handout: Birth Plans

Birth

-  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: Everybody Loves Babies 79"

Postpartum

-  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 Presentation with discussions

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