Lecture 19

Question 1

What franction of home births in the US have “other” listed as birth attendant on their birth certificates?

Answer 1

about 1/3 of home births in the US have “other” listed as birth
attendant on their birth certificates
(other than midwife or doctor; 2/3 of those are planned; might be more because of “oops” births)

(these stats are about 10 years old)

Question 2

Is freebirth popular? how is it presentedi n the media?

Answer 2

• considered to be growing as a trend
  (e.g., from ~5,000 births in 2007 to ~9,000 births in 2012; Grunebaum & Chervenak, 2015)
• often presented by the media as ‘deviant’ behaviour
• online newspaper reports tend to attract negative public comments in which freebirthing women are described as irresponsible, selfish, stupid, and rash (McKenzie et al., 2020)

Question 3

Are the motivations for considering freebirth simple?

Answer 3

no. the motivations for considering freebirth are complex and multifaceted

Question 4

What are the thre categories for considering free birth?

Answer 4

Avoiding hospital:
- traumatic last birth
- fear of hospitals
- last baby died in the hospital
- concerned about the cascades of intervention
- fear or experience of coercion?
- risk of contracting covid

Birth preferences:
- Birth partner excluded
- access to water
- desire for certainty

Practicalities:
- lack of childcare
- previous fast labour
- distance to hospital
-no access to suitable transport

Question 5

How did covid increase free births?

Answer 5

covid increased the attempts for women to give birth at home.

Question 6

What percentage of participants in the free birth study in the UK in 2021, considering home birth>

Answer 6

In 2021, UK: 4% of respondents were seriously considering freebirthing

Question 7

What group is more likely to consider free birth?

Answer 7

Lesbian, bisexual, pansexual, and queer women were more likely to have considered freebirth than heterosexual people

Question 8

How is the choice between hospital birth and free birth influenced by where we invest our authority? Why does this make sense?

Answer 8

Hospital birth = medical knowledge

free-birthing = visceral knowledge

THis does make sense when we consider the notion of authoritative knowledge. Visceral knowledge is the kind of knowledge one cn get otu o f the viscera of the body. This is something people can put authority in as well.

Question 9

What is authoritative knowledge?

Answer 9

• the knowledge that counts
• depends on the setting and the participants

Question 10

What is the authoritative knowledge for each of the following settings?

hospital
home birth with
a certified midwife
home birth with
a traditional birth attendant (TBA)

Answer 10

hospital – medical knowledge

home birth with – mostly medical knowledge
a certified midwife

home birth without
any trained attendants
a traditional birth attendant (TBA).

– traditional midwifery knowledge

home birth without any trained attendants
- visceral knowledge

Question 11

What influences what knowledge counts when it comes to birth?

Answer 11

what knowledge counts is influenced by the social environment.

Question 12

What do you think is unique to scientific knowledge, that distinguishes it from both traditional midwifery and medical knowledge?

a) its reliance on observations
b) its reliance on a personal point of view
a) Yes
c) its reliance on statistics
d) its reliance on textbook knowledge
b) No
e) its reliance on authority

Answer 12

C

Question 13

When it comes to birth, what are the three areas that we use scientific knowledge to understand?

Answer 13

• hormones
• neural systems
• physiology

Question 14

What is oxytocin? What was it originally identified in relation to? Prior to the 1900s, what had oxytocics been used for?

What is an oxytocic?

Where does the word oxytocics come from?

Answer 14

• Originally identified in relation to birth
• Prior to 1900s, oxytocics had been used in obstetrics to produce uterine contractions
• To speed up labor, cause abortion, reduce post-partum hemorrhage
• An oxytocic – a substance or drug that speeds up labor by stimulating the uterus to contract
• oksys (Greek) = “swift”; tokos (Greek) = “birth”

Question 15

What natural remedy was used as an oxytocic for centuries?

Answer 15

An extract of ergot fungi had been used as oxytocic for centuries

Question 16

When was oxytocin discovered (year and century)? Who discovered it? Was it discovered intentionally? Where was it extracted from?

Answer 16

In early 20 c., it was discovered (by accident, in 1909, by Sir Henry Dale) that an extract of the posterior lobe of the pituitary gland from oxen produced powerful contractions of the uterus in pregnant cats and dogs

Question 17

What is the posterior pituitary? Where does it sit? How are the posteiror pituitary and the hypothalamus related?

Answer 17

this is a gland attached to the brain that interfaces with the body and produces lots of hormones.

it sits on the hypothalamus

the hypothalamus is really involved in the secretion of hormones and the pituitary is concidered to be part of the endocriesystem.

Question 18

What replaced the use of fungus ergot in obstetrics?

Answer 18

Pituitary extract (“pituitrin”) soon replaced the use of fungus ergot in obstetrics

Question 19

In what year was the chemical structure of oxytocin identified?

Answer 19

• The chemical structure of oxytocin was identified (in 1953), and then artificially
  synthesized

Question 20

Since what year has oxytocin been sold as a proprietary medication?

Answer 20

• Since the 1950s, synthetic oxytocin has been sold as proprietary medication

Question 21

What were (~1980s, Roberto Caldeyro-Barcia Former President of the International Federation of Obstetricians and Gynecologists) thoughts on pitocin?

Answer 21

“Pitocin is the most abused drug in the world today.”

Question 22

Explain endogenous oxytocin.

Where is it synthesized?
Where is it stored?
Where is it secreted?
what does it act as in the body? ( 2 things)
Where can oxytocin also be released?

Answer 22

• Synthesized by oxytocin-producing cells in the hypothalamus
• Stored and secreted by the posterior pituitary gland
• Acts as a hormone in the body (released in the blood stream)
• Acts as a neurotransmitter (signaling
  substance) in the brain
• Oxytocin-producing neurons in the hypothalamus also release oxytocin throughout the brain

Question 23

Is synthesized and endogenous oxytocin the exact same? Why or why not?

Answer 23

even though at the molecular level, oxytocin is the same, it is not entirely the same.

if its released by the pituitary into the blood stream, it is released in the body AND the brain so its the same molecular but if its in the brain its a neurotransmitter ans in the body its a hormone.The synthesized version can only be released into the body.

Question 23

How does oxytocin play a role in our social lives?

Answer 23

oxytocin plays a role in our social lives, (it tunes us more to social cues as a neurotransmitter), makes us feel close to people etc. Its also a big part of breastfeeding. When milk first starts flowing, once breastfeeding has been established, oxytocin is what facilitates milk to start coming out. What happens is there are certain cues that make milk be released. Like the sight of your baby, the soudn of your baby crying. This is only tree after the first couple of weeks when breastfeeding has been established.

Question 24

Where is oxytocin released? 4 things

How does this relate to synthesized vs endogenous oxytocin?

Answer 24

Released in a number of subcortical structures including:

NAcc
Amygdala
Hippocampus
Brainstem

all of these subcortical structures influence the body in many ways, and when the oxytocin is released by the pituitary the influence in the body is different than when it is injected through IV. When something is released through the blood stream, it is released in pulses. With the release of oxytocin there are pulses that are released, not a drip. This may have different effects on the uterus.

Question 25

Excluding birth and breastfeeding, when do people release most oxytocin?

a) when they feel self-accomplished and independent
b) when they feel secure and placid
c) when they feel competitive and stressed
a) Yes
d) when it’s dark and dangerous
e) in bright light, when we are highly alert

Answer 25

B

Question 26

What is the fight or flight reaction brought on by?

Answer 26

Pain
Cold
Hunger
Danger
Challenge

Tense
Alert
Self-possessed
Performance-oriented
Competitive
Strong and enduring
Controlling
Independent
Energy-burning

Question 27

What is the calm and connection reaction brought on by?

Answer 27

Touch
Warmth
Fullness
Sexual activity
Social interaction Security

Relaxed
Contemplative
Happy
Companionable
Placid
Sensitive
Emotional
Dependent
Growing and healing

Question 28

Who described oxytocin as a shy hormone? What did he say about it?

Answer 28

Michel Odent

“Birth is an involuntary process and one cannot help an involuntary process. The point is not to disturb it.”

Question 29

Is birth an entirely involuntary process?

Answer 29

“Going in Labour” and “First Stage” of labour
- involuntary contractions of the uterus
Involuntary release of oxytocin, prostaglandins, and other hormones

“Second Stage” of labour
- could be completely involuntary (the fetus ejection reflex)
- could be a combination of involuntary contractions and voluntary “pushing” efforts

is it really an involuntary process? for the most part

Is it really impossible to help birth’s involuntary process.
A: it is posible: avoid conditions that decrease the release of oxytocin, provide conditions that increase the release of oxytocin

Ultimate conclusion:
Birth is a spontaneous process
One cannot voluntarily produce a spontaneous process.
but one can voluntarily disturb it.

Question 30

What did Michel Odent say about pushing in the second stage?

Answer 30

odent said that pushing in the second stage is unecessary (ejection reflex)

Question 31

What musle are we using when we push in labour?

Answer 31

when you push during labour, the diaphram is actually being used. THe diaphram is a muscle that sits between the lungs and the gut (and the uterus). This muscle is actually mostly involved in breathing. But also because it sits between the gut and the uterus, it can also put pressure down on the gut and the uterus. This is also a muscle that is used in wiehgt lifting

Question 32

What is the role of adrenaline in birth? What kind of effect does adrenaline have in stage 2?

Answer 32

• suppresses oxytocin
• can slow down labour during birth’s “first stage” (dilation)
• can speed up labour during birth’s “second stage” (fetal expulsion) (adrenaline has an oposing effect during stage one and stage 2)