Final (in addition to M1 & M2 material) Flashcards
Compared to vaginal delivery, C-sections pose greater risk of what?
cardiac arrest
hysterectomy
infection
fever
pneumonia
blood-vessel clotting/hemorrhaging
higher risks for the baby
How much would Canada’s healthcare system save if the rate of first-time C-sections could be reduced to the recommended rate from the WHO?
The Canadian healthcare system could save close to $25 million
A c-section rate of 15% is what is recommended by the world health organization.
In Canada, is it generally common for women to request a c-section?
No, the number is probably very low. Very few mothers request a c section without a medical reason
Most of the mothers who had a C-section indicated that it was their healthcare provider who made the decision
Why is it likely that a women has strictly C-sections after having one prior?
Doctors perform repeat C-sections to avoid tearing the scar left on the uterus from a previous C-section (which is very uncommon, but dangerous if it does tear)
However, there is strong evidence that recommends women to have a vaginal delivery even after having a previous c-section (**example of how evidence does not typically change medical practices)
What is one of the main contributors to an increased c-section rate that is not consistent amongst all provinces in Canada?
Dystocia (term used for an extremely difficult birth)
It isn’t likely that the rates of dystocia would be so
different across the province, it is more probable that some doctors turn too quickly to the surgical solution despite evidence that longer births are common amongst multiparous ppl.
The newest generation of obstetricians in particular holds negative views of ________________ and a
preference for _____________/______________.
NATURAL childbirth
C-SECTIONS/OTHER MEDICAL INTERVENTIONS
How the gestation length of human pregnancy limited? (according to evidence)
New research suggests that the length of human pregnancy is limited primarily by a mother’s METABOLISM, not the size of the birth canal.
^^this challenges the long held notion of an evolutionary trade off between childbirth and a pelvis adapted for walking upright
This means the 2 traits that set humans apart from other primates (big brains and the ability to walk upright) could be at odds when it comes to childbirth.
What is the “obstetric dilemma?”
that the human female pelvis represents a compromise between designs most suitable for childbirth and bipedal locomotion, respectively
(supposedly) explains why humans often require assistance from other humans during childbirth to avoid complications, whereas most non-human primates give birth unassisted with relatively little difficulty
What is a problem with the “obstetric dilemma”?
THAT THERE’S EVIDENCE THAT ITS NOT TRUE
There is no evidence that hips wide enough to deliver a more developed baby would be a detriment to walking, in fact there is evidence that there is no correlation between wider hips and a diminished locomotor economy
What has been the view been for decades towards explaining the timing of human gestation and birth? Does new research align with this?
It’s been explained as a balance between 2 constraints:
1. the size of the women’s hips
2. the size of the infants brain
^^this is the “obstetric dilemma”
New research says this is not the case! Instead, the
timing of childbirth occurs when women’s bodies can no longer keep up with the energy demands of
pregnancy (that happens at around nine months)
Studies of mammals show that during pregnancy females reach their species’ “metabolic ceiling,” which refers to ________________.
Max limit of the amount of energy they can expend.
Evidence shows that gestation is determined by _______
ENERGY
Do humans and chimpanzees give birth similarly or differently?
Very similarly!
A key feature of human childbirth (thought to be only unique to humans) the arrival of the baby facing backwards relative to its mother, can also be observed in chimpanzees
“It’s clear from our observations that chimp babies are
born __________ ____________, but they give birth _________”
FACING BACKWARDS
ALONE
Noncommunicable diseases account for ______% of deaths globally and is increasing
60%
*WHO predicts a 17% increase over the next 10 years
What are the 4 lifestyle factors identified by the WHO that are driving the noncommunicable disease epidemic?
- smoking
- misuse of alcohol
- poor diet
- lack of excersise
When is the critical time for seeding our microbiome?
DURING CHILDBIRTH
**foundations for founding the baby’s bacterial ecosystem starts inside the mother during pregnancy
(bacteria is transferred from mother to baby as the baby is birthed, first intro to the world of bacteria)
What does the term “completed self” mean?
the idea that we are meant to be 90% microbial since birth
After birth, what is the next stage of microscopic transfer of microbes?
happens during skin-to-skin contact of the baby and mother (transfer of skin bacteria)
Is breastmilk part of microbe transfering?
Yes, breastfeeding gives many important things to the baby, one thing being microbes.
When a person cannot naturally breastfeed their child, what happens?
Not breastfeeding disrupts the immune system function.
According to the Microbirth film, what happens to babies born via c-section?
they have a higher risk of short-term health problems, commonly respiratory problems, and more issues with being able to be fed and are more tired.
Not being born vaginally, the baby did not get the microbes needed naturally, and instead the infants immune system has been primed with the wrong bacteria.
What is a strategy for babies who are born via c-section to still get the microbes they need?
Vaginal swabs with gauze during the last hour before the c-section and as soon as the baby is born, the gauze is rubbed all over the baby to attempt and restore important microbes
From the Microbirth movie overall, what are the most important things we can do during birth for a healthy baby?
- insure microbial seeding occurs completely at birth (preferably vaginally)
- skin-to-skin contact
- breastfeeding of long duration
^^all of these things will influence the health across a lifespan
Is the stress of labour good or bad for the baby?
It’s good.
For birth studies where antibiotics are used during labour and c-sections, there can be negative impacts on the child long-term
There is a 20% increased risk of _________ and ___________ if born through c-section as well as ___________.
asthma and type 1 diabetes
BMI increase (obesity epidemic?)
**however, association does not mean causation!!
Is the occiput anterior position and head rotation unique human birth?
NO
There is evidence that it happens the exact same way in chimpanzee births
Do all chimpanzee births occur by the mother picking up the baby right away.
No, not in all cases. It is likely that there
are at least some cases in which wild chimpanzee
mothers deliver their baby by DROPPING IT, without
immediate lifting.
(not dangerous to drop the chimpanzee, as they often give births in their nests which is padded)
It has been observed that chimpanzees give birth in the _____________, the same way as humans.
Fetus emerged in an occiput anterior position
It has been suggested that the occiput anterior emergence pattern accounts for the uniquely human aspect of birth, which is thought to reveal that human birth is __________________________.
Attended by other individuals, such as midwives, and mothers actively seek assistance in childbirth.
*This is questioned as primates give birth in solitude and there is evidence that chimpanzee births occur in the occiput anterior position.
What did male P. Cambelli hamsters do during the birth proccess of their female partner?
- licked amniotic fluid before birth
- mechanically assisted with the delivery
- opened an airway by clearing the nostrils
- licked and sniffed the pups immediately after birth
- ate the placenta
**all evidence that paternal hamsters mechanically assist with delivery and provide parental care during birth.
Describe what Amber was told by medical professionals in the Pennsylvania case
After an ultrasound, the doctors decided that the baby was too big to deliver vaginally (about 13lbs) and that a c-section was needed.
(she already had given birth to 6 babies babies vaginally, each close to 12 pounds, and had faith in her body)
What was the outcome of the Pennsylvania case? Why is it controversial?
Amber did not follow the doctors advice to have a c-section and went to another hospital.
Meanwhile, the hospital’s lawyers obtained legal
guardianship of her unborn child —> a court allowed the hospital to force Amber into surgery if she returned to that hospital
At the other hospital, Amber had an easy natural birth.
She didn’t know about the first hospital’s action
until her husband was told by a reporter.
What is the most common obstetric intervention?
Electronic Fetal Monitoring (EFM)
A process where electronic instruments are used to record the heartbeat of the fetus and contractions of the mother’s uterus
When was Electronic Fetal Monitoring (EFM) introduced? What did EFM promise?
Was introduced in the late 1960s
EFM promised that it would reduce (by half) the incidence of:
1. cerebral palsy
2. mental “retardation”
3. peri-natal mortality
Describe how useful EFM is as fetal surveillance technology?
- interpretations of fetal heart tracings are highly subjective
- there is very little agreement among experts as to the
interpretation of “non-reassuring” tracings - “false-positive” predictions of fetal distress are almost guaranteed
- USING IT INCREASES C-SECTION RATES
Increased use of EFM results in what?
higher c-section rates, without improving outcomes for babies
If there is a late deceleration on a fetal heart monitor (EFM) what could this possibly indicate?
Could indicate fetal distress if late decelerations are repetitive or severe
What does it mean when EFM is referred to as the “tool to blame”?
EFM is commonly used in BRAIN INJURY LITIGATIONS.
used by expert witnesses who testify as when (the exact moment, based on the tracings) the baby sustained irreversible neurological injury
Heavily relied upon to support counterfactual claims that a poor outcome (e.g., brain injury) could have been avoided
Is the prevalence of Cerebral Palsy (CP) positively correlated with C-section rates?
NO. There is no correlation of CP cases increasing as c-section rates have increased over time.
Think about the graph (blue and red line).
What is counterfactual reasoning?
Reasoning about “what might have been”
Is the basis for assigning blame for harmful outcomes
or giving credit for beneficial out comes
Often takes the form of if/then statements or questions
(ex. “If you had been paying attention, you wouldn’t have gotten hurt.” OR “If Alice had not been treated with the experimental drug, would she have survived?”)
What does counterfactual reasoning rely on?
It relies on COUNTERFACTUALS = mental representations of alternatives to the past, often activated automatically in response to negative affect
Counterfactual reasoning can be highly problematic because of what bias?
HINDSIGHT BIAS (the “knew it all along” way of thinking)
Describe hindsight bais
the “knew-it-all-along” effect
- Knowing that an event (outcome) has occurred increases its perceived predictability (or perceived likelihood)
- It is accompanied with over-confidence in the certainty of one’s judgements: people are unaware of the effect that outcome knowledge has on their perceptions of predictability
- Situations that (after the fact) lend themselves to straightforward causal explanations evoke greater hindsight bias than situations that are more ambiguous
What is hindsight bias linked to?
linked to the availability heuristic (which allows us to think quickly by relying on information that comes to mind fast or is most available to us —> often incorrect)
Is it common for cerebral palsy to be caused by birth asphyxia?
No. This is a myth. It is not very common for CP to be caused by birth asphyxia (lack of oxygen and blood flow to the brain)
Most acute severe hypoxia follow intrapartum hypoxic events like uterine rupture or placental abruption, not CP.
Are CP causes well understood?
CP’s causes are NOT well understood but most are thought to preceded labour and birth (genetic, inflammatory, preterm)
What is a major cause of caesarean escalation?
Cerebral palsy
