Lecture 20

Question 1

Is birth a spontaneous process? Can it be voluntarily produced? Can it be voluntarily disturbed?

Answer 1

Birth is a spontaneous process
One cannot voluntarily produce a spontaneous process
But one can voluntarily disturb it

Question 2

If you want to help the childbirth process, what conditions should you avoid?

Answer 2

What tends to decrease oxytocin release
* Bright lighting
* Noise
* Discomfort
* Feeling frightened
* Unpleasant, painful sensations * Tension
* Questions, interruptions * Being observed

Question 3

If you want to help the childbirth process, what conditions should you provide?

Answer 3

What tends to increases oxytocin release
* Dim lighting
* Peace and quiet
* Comfort
* Feeling safe
* Pleasant touch
* Relaxation
* No interruptions
* The absence of observers
- this is a sticky point with the scientific method because it relies so heavily on observation

Question 4

What is the concern with doing manipulation of the placenta?

Answer 4

if you do any manipulation of the placents the concenr is that part will betach and stay inside which can cause infection.

Question 5

What is the third stage of labour?

Answer 5

Placenta expulsion
* Contractions continue after baby is born

• Placenta is usually born within half an hour after baby
• Oxytocin reaches its highest peak in this period
• This stage is particularly sensitive to disturbance and presents the greatest risk for post-partum
  hemorrhage

(conversations, congratulations, photos, phone calls, everyone touching the baby)

Question 6

What is the importance of oxytocin in stage 3? What implications does this have for the conditions we should create or avoid in stage 3?

Answer 6

stage three we really need to have these hormones released. There is the most secretion meaning this is one of the stages that is probably most reliable to disruption. Because this stage relies on the greatest amount of oxytocin. It should be the most relaxing and least disruptive. Even less than during the labour. This is where the post partum hemmorage can happen. Some of the most unfortunate lakc of knowledge happens during stage 3. If you use pitocin here you suppress the natural release

Question 7

When is the birth over?

Answer 7

not until the placenta is born

Question 8

Explain the scientific method. (3 main points)

Answer 8

• A body of techniques for investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge
• To be termed scientific, a method of inquiry must be based on empirical and measurable evidence subject to specific principles of reasoning
• “a method or procedure that has characterized natural sciences since the 17th century, consisting of systematic observation, measurement, and experiment, and the formulation, testing, and modification of hypotheses” (Oxford English Dictionary)

Question 9

What is the scientific method for obtaining knowledge defined by? What is the paradox of scientific knowledge? Is this true for all observation?
Is the paradox limited just to birth?

Answer 9

The scientific method for obtaining knowledge is defined by its reliance on
* Observation
* Measurement
* Experiment

To the extent that being observed alters the process of human childbirth, the scientific method in its current form is limited in how much knowledge it can yield about undisturbed birth

• Observation and measurement change what we observe and measure
• However, introspective observation may be different (to some extent)

Paradox not limited to birth (e.g., spontaneous thought)

Question 10

When we talk about the paradox of scientific knowledge are we referring to the object act of observing?

Answer 10

no. its not so much about the objective act of observation, its more about the subjective experience of being observed. This can influence the release of oxytocin

Question 11

In what was did the book on birth and human evolution pedal the myths of chilbirth?

Answer 11

“The mechanism of giving birth, however, differs greatly in humans and other mammals.”

In humans, things are different. Rarely can a human female give birth without assistance at all, except in extreme circumstances, and the result can be potentially catastrophic for the child as well as for the mother.”

If women were alone during childbirth to handle the whole process of reproduction the way other mammals do, mother and child would probably perish, and the human species would have disappeared or, rather, would never have appeared.”

Question 12

What is something to keep in mind when you see books about labour and evolution?

Answer 12

something the keep in mind when you see books about labour and evolution is are they pedalling the myth of human exceptionalism?

Question 13

What is the myth of human exceptionalism? (3 points)

What readings for the final do these myths correspond to?

Answer 13

• humans are unique among all animal species because they are the only animals that receive and provide mechanical assistance to each other during childbirth
  - reading 2.5
• the mechanism of human childbirth is unique among all animal species because human babies are the only animals to be born facing away from the mother’s face (which requires mechanical assistance)
  - - reading 2.3 and 3.4
• wider hips in human females allow for easier births but reduce the efficiency of walking or running upright (the ‘obstetric dilemma’)
  - Readings 2.1 & 2.2
• human babies are born helpless and underdeveloped because human pregnancy is shorter compared to the pregnancies of other mammals to allow our babies to be born before their head gets too big to pass through the birth canal
  - Readings 2.1 & 2.2

Question 14

What solutions does traditional midwifery tend to emphasize?

Answer 14

Low-tech solutions
Where two ways of doing something are thought to exist, choose the one that involves less technology

Question 14

How does traditional midwiery use low tech solutions for weighing the baby?

Answer 14

less technology is using a fish hook to measure a baby. This is the same as the scale they use to measure fish. It’s less accurate but babies seem to cry a lot less and it requires less tech

Question 15

What norms does traditional midwifery tend to reject/ what does it emphasize?

Answer 15

Variability and uniqueness; rejection of medical norms

Question 16

What are Some examples of medical norms that are rejected or resisted by traditional midwifery?

Answer 16

• How long pregnancy should be (due dates are a lot less focused on in trad. midwif.)
• Speed of dilation (Phase 1)
• When it is too early to push (sometimes the body can begin pushing in an involuntary way and trad. midwif. are not as strict)
• When to start pushing
• How long Phase 2 should be
• How long can pass between water breaking to baby born
• How long Phase 3 should be

Question 17

What is the difference between traditional midwifery knowledge and indigenous knowledge?

Answer 17

traditional midwifery info can be transferred from one country to another etc. That is different form inidgenous knowledge which tends to be local

Question 18

What is Indigenous knowledge?

Answer 18

• local knowledge
• knowledge that is unique to a given culture or society
• historical continuity with pre-colonial and/or pre-settler societies
• strong link to territories and surrounding nature
• distinct language, culture and beliefs
• acquired through interaction with one’s physical environment and other people (in contrast to the more symbolic/abstract knowledge most Western industrialized societies promote)

Question 19

What does the national midwifery council of midwives say about Indigenous midwifery?

Answer 19

“Indigenous Midwifery care is a pathway that supports the regeneration of strong Indigenous families by bringing birth closer to home—by restoring the emphasis on birth as normal, rather than approaching it as an illness in need of treatment.”

Question 20

What is the story of the woman who refused to be evacuated in Nunavut?

Answer 20

For decades Inuit women in northern Quebec had to travel far south, far from family and support, to give birth. That changedi n 1986 when the North’s first midwifery clinic opened in Puvirnituq

women in rural areas were being forced to evacuate to give birth in large hospitals.

In the mid-1980s, a woman named Anni Tulugak refused to travel south to give birth and instead stayed in Puvirnituq.

Since then:
3,000+ babies have been born at the Puvirnituq maternity centre C-sections rate: 2% (90% of births happen in the Nunavik region) Perinatal mortality < 1%, roughly the same as the Canadian average

Question 21

What did the Indigenous midwife say about her practice?

Answer 21

Akinisie Qumaluk loves her small and skilful hands.
“We always make sure that the baby’s head is down,” said Qumaluk.

“But if the baby’s head is up … I was taught to turn babies … gently, gently guiding that head down, down to where it is supposed to be.”

“I always talk to the babies inside. ‘Hey, we’re going to turn your head down. You’re going to have to help me because you cannot be born this way,’” she told CBC Radio.

“I know that the babies inside can hear my voice. They can listen.”

Question 22

Is the involvment of people other than he mother and the baby in the process of giving birth common across all cultures?

Answer 22

no. It is common across many cultures but:

unassisted birth is the cultural ideal among some cultures:
* San (!Kung) hunter-gathers of South Africa (the Kalahari desert)
* Angagen people, Papua New Guinea * Bariba people, Benin (North Africa)

Question 23

What is the birth paradox?

Answer 23

Scientific knowledge suggests that
* birth is crucially dependent on the “shy hormone” oxytocin
* privacy, quiet, and seclusion are important conditions for successfully and safely birthing our babies

Question 24

If oxytocin is “shy” why have many cultures and societies developed customs and practices that generally reduce the sense of privacy, quiet, and seclusion during birth?

Answer 24

Some theories
The involvement of people other than the mother and baby during childbirth may serve to:
1. Provide mechanical assistance during birth that increased our species’ survival chances (i.e., it improved birth safety) (This is just a theory.)

2. Increase the bond between the baby and those other people who were involved in the baby’s birth (i.e., it increases the child’s survival chance by creating additional substitute parents)
3. Decrease the bond between mother and baby for purposes that may benefit the survival of the group

Question 25

What is the cultural evolution of knowledge? (3 points)

Answer 25

• Our customs, cultural practices, and traditional knowledge have evolved through a cultural selection process
• Similarly to natural selection, certain cultural practices and beliefs have proven to be more beneficial than others and have thus become adopted, while others have been abandoned
• We should always ask (ourselves): Are these customs still beneficial? And if so, who are they beneficial to?