Anthropology 270 - Topics in Ethnography: Childbirth in America
Ann B. Judkins, CNM, NP, MA
Spring 2016


             
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 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.

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.  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: Amazon.com or from AddAll.com; required & important; order promptly]
        Also copy on reserve in libaray

Anthropology 270 - Birth in America - Course Outline

Introduction
Week 1: January 21
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); Cuna Indians of Panama
Birth: perplexity and paradox 
                
Development of Birth Choices
Week 2: January 28
Reading: continue to completion of Ulrich for Week 3 class/when done start Breckinridge all due wk 4
Video: follow-up on lecture: YouTube: http://www.youtube.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 for 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 for patient
- forcep

The Early American Experience
Week 3: February 4
Reading Assignment for Week 4: Breckinridge (all)
Class reports given
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 11
Video: Forgotten Frontier  25”
Handout:” Malawis Leader Makes Safe Childbirth Her Mission” Discuss in light
      of  Mary Breckenridge Demonstration Project wk 5
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 18
Reading Assignment for Week 6: Karmel (all) to be finished for wk 7: Class Presentation assignment for week 7 & 8
(all due on week 7)    Discussion:” Malawis Leader Makes Safe Childbirth Her Mission”
            -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 hospital controlled birth
    - Specialization of obstetrics
        - formal endgame/Cesarean Sections
        - twilight sleep
        - interventions


Midterm Exam: discussion of test format scheduled next wk.
Week 6: February 25
Video: In Union 7”
Class presentation assignments reviewed for Weeks 7 and 8
    -Introduction to Grantly Dick-Read
        -rediscovery of Natural Childbirth
Next week wear comfortable clothing and bring a pillow…Childbirth Prep Class
MIDTERM EXAM: February 25
               Scheduled last half class period

Utilization of Birth Choices
Week 7: March 3
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 10
Reading: Young Chapters 1-6 due wk 9

Childbirth education: class presentations

[Spring Break: March 14-18]

Changing Birth Structure
Week 9: March 24
Reading: Young Chapter 11 due wk 10
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: March 31
Reading: Young Chapters 10 and 12 due wk 11
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 7
Readings: Gaskin Chapters 5, 11
Handout: Loren Eiseley, Alice Dreger, Maura Judkis readings, 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: 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 13-14
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 14
Reading: Young Chapters 8, 10 and 11 and Gaskin chapters 2, 3, 6-8
Reading discussion: Loren Eiseley, “An Evolutionist Looks at Modern Man” , Alice Dreger “The Most Scientific Birth Is Often the Least Technological Birth”, Maura Judkis “Live Birth Performance”
            YouTube discussion Michel Odent “Gentle Birth” (1-3)
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 21
Readings: Young Chapters 15, 16, and 18 and 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

Presentations

Week 14: April 28
Readings: Young Chapters 13 & 23 and Gaskin Chapters 13, 14

Presentation


FINAL EXAM: Thursday,  May 5,  7:00-9:30