Showing posts with label Top 10 and other lists. Show all posts
Showing posts with label Top 10 and other lists. Show all posts
Saturday, February 25, 2012
Reblogged: How to have a baby in graduate school
Having babies in grad school: what do you need to make it work? This article was published in ACM-W Winter 2011 newsletter, written by three women grad students (two with children, one without). The article highlights why graduate school is an excellent time to have a child, and outlines strategies for success. I reblog it here with permission from the editor, and include tags which link it to the associated Birds of a Feather session at Grace Hopper Celebration for Women in Computing 2011.
A. Holloway, C. Sadowski and L. Vega. Babies in Graduate School: Making It Happen. ACM-W CIS Newsletter: Celebrating, Informing, & Supporting Women in Computing, 2011. 3.
Babies in Graduate School: Making it Happen
by Alexandra Holloway, Caitlin Sadowski, and Laurian Vega
{fire,supertri}@soe.ucsc.edu, laurian@vt.edu
Abstract
There is never a perfect time to have a baby, but the present is always a good time. For women in graduate school, pregnancy and child-rearing present unique opportunities and challenges. In this article, we discuss ongoing perceptions about mothers in academia, including common prejudices and preconceptions. Although certain trends are helping mothers pursue a tenure-track position or re-enter the work force after starting a family, key challenges still exist for starting a family in graduate school. These challenges include maintaining both good interpersonal relations between partners and good professional relations within our graduate departments. We propose a checklist of the key ingredients for success in childbirth in graduate school—the things we found most important in our own and others’ experiences for starting a family early in academia.
Background
Motherhood is a crosscutting concern for women spanning economic, religious, and cultural groups. A known problem is the “motherhood penalty:” mothers are rated as less competent and committed to paid work than non-mothers, are given less slack about being late, and may be offered a lower starting salary [1]. In fact, within particular demographics the pay gap between mothers and non-mothers is larger than the pay gap between women and men [2].
These challenges are particularly disparaging due to their inequity; children provide a benefit for men and a penalty for women. Fathers are rated as more committed than non-fathers, are given more slack about being late, and may be offered a higher starting salary [1]. In academia, men with young babies are 38% more likely than women with young babies to achieve tenure [7]. Perhaps a partial reason for this difference is the social expectations about who will care for children. For example, a survey of more than 440 faculty in the University of California system found that women with children spend almost twice as many hours per week acting as caregivers than men [7].
Taken together, all of these statistics present a daunting picture for a women thinking about, or starting to venture into, motherhood. Recognizing the problem and educating co-workers is the first step to combating these biases against mothers. Furthermore, research has demonstrated that a mother’s ability to do science does not disappear after having a child. For example, a 2004 survey of German postdocs found that there was not a difference in scientific productivity between scientist mothers and female scientist non-mothers [5]. A similar study looking at working mothers across disciplines in the Netherlands also did not find a productivity difference between mothers and non-mothers [10]. Additionally, working mothers have been shown to have better physical and mental health, higher self-esteem, and financial stability [11].
Much of the difficulty with academia and motherhood is due to the fact that it is difficult to re-enter the pipeline once a woman drops out of the academic workforce [6, 7]. If time is taken off because of a difficult pregnancy or even just to spend time with a young infant, it can be challenging to return to academia. Some programs, such as British Daphne Jackson Fellowships, exist to help female scientists return to the pipeline after taking a leave of absence [5]. Unfortunately, programs to support mothers are not mandatory—not even paid maternity leave. Given the problems apparent at all stages in the academic pipeline, graduate school may be a particularly good time to have children before entering the tenure race.
Recently, awareness has increased of the challenges of combining motherhood with a career in academia as a whole and science in particular [3, 8]. Universities and organizations are taking some steps to improve the position of women who want to combine motherhood with a career in science. Part-time and “stop-the-clock” tenure-track options, which provide additional time before tenure reviews, are becoming more popular [5]. Progress is being made to change the landscape of women in academia.
We present this article for two purposes. The first is to start engaging in the discussions about motherhood in computer science. The second is to raise awareness on aspects of motherhood as a graduate student. With many female graduate students lacking female academic role models (not to mention role models who have children or who are pregnant), computer science as a field is particularly prone to the biases discussed above. To help raise awareness, in this article we describe personal experiences with motherhood in computer science graduate school. We start by discussing problems for women in graduate school, and then provide advice and personal experience on how we combated these problems. We then consider how computer science as a field can respond to—and support—parents in graduate school.
Time Is Ticking
Women in computer science are a rare breed. Mothers in computer science, at any stage of academia, are an even rarer occurrence. One large problem for any woman in academia having a child is the lack of communal knowledge about and support for this life-changing phase. Computer Science departments may be particularly prone to this problem, particularly at the graduate school level. For example, when one author when told her department chair that she was pregnant and needed to change teaching assignments, the response was not one of congratulations, nor condemnation—but more one of confusion: “What? Students can get pregnant?”
Graduate school involves unique time pressures. Three considerations in graduate student family life are personal relationships, financial challenges, and the ticking biological clock. We do not have any magic bullets, but we do have key considerations we wish that someone had passed on to us when our babies were “loading.”
Time == Love
Few graduate students strictly adhere to a nine-to-five schedule. Instead, we work in the evenings, nights, and weekends, playing a careful balancing game between work and personal life. This can lead to multitasking and unclear divisions between work and home life: while our code is compiling we may be heating up a bottle, running a load of laundry down to the washer, or quickly uploading baby pictures. Time is precious, and given how little of it is available, finding time to spend with a romantic partner can be vital. Given that leisure time spent with a significant other is already limited, how can we find the additional time to devote to a baby? Will having a child put too much stress on our adult relationship?
Grad_school != money
Graduate student research assistants are compensated by university fees and a living wage stipend, which is less than minimum wage when factoring in the long hours spent working. In a family composed of two graduate students and no outside support, money can be stretched thin. According to the National Association of Child Care Resources and Referral Agencies, child care for infants or toddlers costs between $4,388 and $14,647 per year [12]. To put this within the range of the authors’ graduate stipend, child care alone costs half of our pay, without even accounting for the additional costs of having a child. We ask ourselves: How can we find the money to have a baby?
Time –= 1
For many graduate students, the refrain is the same: “I will wait until my Ph. D. to have children.” Then: “I will wait until I have a faculty position.” Then: “I will wait until tenure.” For men as well as for women, advanced age can contribute to decreased fertility [13,14], a more complicated pregnancy and birth [15], and other possible complications. Further, it can take some time—in some cases, as long as a year or more—to become pregnant; then, once pregnant, the normal side effects of pregnancy, such as nausea and fatigue, can negatively affect job performance. How long should we wait to have a baby? How can can we make time to have a child?
Why Grad School?
With these very compelling constraints, why is graduate school a good time to have a baby? First, a graduate student’s schedule is malleable. Especially after coursework is complete, a research schedule is generally flexible, allowing the student to work around the baby’s schedule (and the parents to work around each others’ schedules). Not all universities support tenure programs like stop-the-clock, nor do all employers support extended time off after giving birth. However, it is possible to take a semester off after having a child.
Second, graduate students have youth—hence, energy and creativity—on their side. A young person can adapt to circumstantial challenges and can overcome obstacles more easily. Moreover, grad students are surrounded by equally young peers who can help with occasional, free babysitting to let a new mom (or dad) study or sleep. If the grad student’s parents are available, they are also likely to be younger, making it easier for them to travel and lend a hand.
Third, a grad student’s support network is more flexible. Whether due to pregnancy complications or postpartum mayhem, changing teaching assignments formally within the department, or trading schedules with a peer informally, can be easy as a graduate student.
Finally, we answer a question with a question: Why wait?
Strategies for Success
Having a new baby can be a rewarding yet challenging time for any family. In the first months, the parents are up throughout the night, frequently as often as every two hours—and that is if everything is all right. Meanwhile, meals need to be made, the house needs to be cleaned, and, perhaps most importantly, graduate work needs to move forward. These are the ingredients we have found to be key in making childbearing in graduate school a reality.
A Supportive Advisor
An advisor that supports his or her student’s decision, both in word and in deed, to have a baby is a keeper. The support can be as mild as suggesting ways in which to make sure classes are completed prior to the birth of the child; providing a flexible schedule to allow the student to work in the time between infant feedings; relaxing the deadlines, understanding that the student’s probable decrease in productivity is temporary (although one atypical new mom reported clocking in 80 hours the week after giving birth to twin girls). One progressive advisor suggested to her student that she Skype in to all of her classes after giving birth, and allowed all work to be completed from home.
If your advisor seems cool to the fact, ask outright about his or her feelings about your impending motherhood. The battle over work responsibilities will not stop at the baby’s birth but will continue until either you graduate or you move to a different advisor. If your advisor assumes you will continue producing at the pre-pregnancy level without missing a beat, one of you may end up disappointed. Think proactively.
Adequate Me-Time
With all the work that is waiting, it is easy to lose focus of what is also important: You. Not to make having a child seem insurmountable, but there are times when your child is first born when time feels like the enemy. There is just not enough of it to sleep, work, and eat. This lack of time can lead to the malaise that overworking and under-sleeping induces. There are two things that can help you re-charge and re-focus. The first is spending time telling people objectively how cute your kid is, and breathing in the new-baby smell of your kid’s hair. The second is taking time for yourself. Find time to read a book, go on a walk, play video games, go to the gym, or do whatever it is you need to do to recharge.
Although it may be difficult, realize that there are times where you might have to put your career first. There are times when your kid is sick, and he really wants to be held, but you have to get that paper edited by midnight. For one of the authors, her baby boy had just had surgery for ear-tubes earlier that day, but because there was an important networking event that night, she had to leave her child with her partner. There will be conflicts between your career and your family. Knowing that sometimes it is okay to put your career first can help with this dichotomy.
An Amazing Partner
A pinch of prevention is worth a pound of cure. If a partner is involved, having an honest conversation with him or her, in advance, about what is expected postpartum can smooth the new-parent transition. Who is going to do the laundry? change midnight diapers? go grocery shopping? If no partner is involved, the bright side is that there will be no conflict about who will do all of these things. There is not any way that you can prepare for everything before the baby comes, but setting expectations will help. For one of the authors, having a partner who understood that she might be a mom, but her career was important, made a large difference. This meant talking about how soon she might want to return to work, what child care options were available, visiting the child care centers together, and setting some ground rules. Those rules included who pays certain bills, who gets to work which nights late, who stays home when the child is sick, and who does the grocery shopping. If a partner is not responsive to talking about these issues, parenthood, in general, can become very difficult.
A second benefit of an amazing partner is having someone who values your experience. The shock of being walked in on while expressing milk with a breast pump in a mostly male department is, to put it mildly, upsetting. Or, when people start asking you if you are planning on staying in graduate school now that you are pregnant (because pregnant women should be barefoot and cooking), you need someone at home who will let you express your feelings and then help you react. Or, when you get told for what feels like the hundredth time that, “You must have a very supportive partner,” and you realize that a man in the same position would not get told the same thing, a discussion with your partner about the (hopefully unconsciously) biased workplace is key for your own sanity.
Trustworthy Child Care
You can’t start code-slinging again when you literally have your baby in a sling. Find someone that you can trust your child with, even if it is for only a few hours. Trust is the key part in that sentence: check with friends, listservs, and websites for good home care, child care centers, and nanny shares. Talk to pregnant women; talk to both men and women swinging their toddlers in the park. They face the same decisions, and have probably investigated some of the same, or different, options. One point of advice, though: mom-networks are often sources of second-hand information (e.g., Sally says that Sue says...). Verify anything you hear.
There are many options for trustworthy child care, even though it might not feel like it: day care, live-in nanny, live-out nanny, nanny-share, au pair, and stay-at-home partner are just a few of the options. Just because you visited a child care center when pregnant and you know that it is the right place for your child, that does not mean that in six months you will still feel the same way, when you leave your kid there for the first time. Similarly, just because you like your child care solution does not mean that your child will. Anything can happen: your nanny might move (or graduate); your child care center might close down; you might realize school is too far from the center. It is important to stay adaptive and recognize that you can find alternate creative solutions.
A Support Network
Tap into your family network: your parents, your partner’s parents, and even cousins, aunts, and uncles. One of the authors was able to attend classes for a quarter by asking her partner to take her infant every Tuesday, and mother to come every Thursday for ten weeks. Ask friends. Be creative, accept help when it is offered, ask for help before it is needed, and be thankful.
Having a baby changes your outlook on life. Suddenly, your priorities shift entirely, and it can be a bit of a culture shock to realize that you have a hard time relating to the friends who have not yet had children. If they are interested and supportive of your life’s changes, bring them up to speed and include them as much as they like. But also, find other new and expectant moms that can share your experiences. Even if you are the only female graduate student you know, we promise that you are not the only mom in town. Find others who are having kids. Your ob/gyn may know of a working-mom support group, and you could ask your graduate school about any university-wide efforts.
A Positive and Grounded Outlook
As a final note in the checklist, be positive and celebrate your accomplishments as they come. Enjoy these limited years with Thesis Baby as much as possible and keep the big picture in mind. In the grand scheme of things, your child’s infancy and toddler years, and your dissertation years, are short. For many working women, compartmentalizing motherhood and academia is an ongoing battle: when working on your research, you feel like a bad mother because you are neglecting your child, yet when with your child, you feel like a bad student because you are neglecting your work. Our advice is to remember the big picture, and try not to let the guilt take over. Being a grad student is mental exercise and is as important as having a child. Both of these aspects of your life make you a complete, unique, and fascinating woman.
Making It Happen
One mother-professor, known to store expressed breastmilk in her laboratory refrigerator, quoted Gandhi: “Be the change you wish to see in the world.” The only way to change perceptions of, and biases associated with, mother-students, mother-faculty, and mother-professionals is to gently, firmly, and consistently prove these perceptions wrong. Show the world that it can be done: mothers defend their dissertations; mothers produce quality work; mothers are incredible, productive professors and industry professionals.
Conclusion
Having a child is a life-altering event, no matter when the child comes. However, being a student should not impact a mother’s decision to have a child. Computer science and engineering, to succeed as disciplines, are positioned to examine how to support students with lifestyle circumstances such as having a child in graduate school. Our generation of student-mothers paves the way for student-mothers that come after us. In this article we presented reasons having a child in graduate school are favorable yet difficult, and have presented some of the tools and strategies that have helped make our experiences with being student-parents easier. Finally, we end this article with a request from the authors to women faculty: be the kind of role model you would want to have.
References
[1] S. Correll, S. Benard, and I. Paik. Getting a Job: Is There a Motherhood Penalty? American Journal of Sociology, 112(5):1297–1338, 2007.
[2] A. Crittenden. The price of motherhood: Why the most important job in the world is still the least valued. Metropolitan Books, 2001.
[3] E. Evans and C. Grant, editors. Mama, PhD: Women Write About Motherhood and Academic Life. Rutgers University Press, 2008.
[4] G. Gehring. Mixing motherhood and science. Physics World, 15(3):18–19, 2002.
[5] V. Gewin. Baby blues. Nature, 433:780–781, 2005.
[6] M. Mason and M. Goulden. Do Babies Matter (Part II)? Closing the Baby Gap. Academe, November–December, 2004.
[7] M.Mason and M. Goulden. Marriage and baby blues: Redefining gender equity in the academy. The Annals of the American Academy of Political and Social Science, 596(1):86, 2004.
[8] E. Monosson, editor. Motherhood, The Elephant in the Laboratory: Women Scientists Speak Out. Cornell University Press, 2008.
[9] S. V. Rosser and M. Z. Taylor. Expanding Women’s Participation in US Science. Global Education, 30(3), 2008.
[10] C. Wetzels. Does motherhood really make women less productive? The case of the Netherlands. Bilbao ESPE Conference, 2002.
[11] L. Bennetts. The Feminine Mistake. Voice, 2007.
[12] Parents and The High Cost of Child Care: 2010 Update. National Association of Child Care Resource & Referral Agencies, 2010. Retrieved from http://www.naccrra.org/docs/Cost_Report_073010-final.pdf
[13] S Kidd, B. Eskenazi, and A. Wyrobek. Effects of male age on semen quality and fertility: a review of the literature. Fertility and Sterility, 72(2), 237–248, February 2001.
[14] D. B. Bunson, B. Colombo, and D. D. Baird. Changes with age in the level and duration of fertility in the menstrual cycle. Human Reproduction, 17(5), 1399–1403, 2002.
[15] E. Zasloff, E. Schytt, and U. Waldenström. First time mothers’ pregnancy and birth experiences varying by age. Acta Obstetricia et Gynecologica Scandinavica, 86(11), 1328–1336, 2007.
Monday, February 13, 2012
Choosing a birth facility in five easy steps
How do you choose where to give birth? This post attempts to answer the question of how to choose where to give birth -- where to look for data, and what questions to ask yourself.
In the region of the US where I practice, for low-risk pregnancies, there are basically two options: birth at home with a midwife, and birth in a hospital with whoever happens to be on call (sometimes this is your own doctor or midwife).
Birth at home
Choosing a safe homebirth requires forethought. I am not an advocate for unassisted birth, with no medical professional on hand to help. I think that choosing a homebirth is a big deal and requires sufficient preparation. Selecting a homebirth midwife is a lot like selecting a doula, except there is more responsibility involved in a midwife. (And, you should have a doula as well.) Here are some things to ask your midwife when you consider birth at home.
In the region of the US where I practice, for low-risk pregnancies, there are basically two options: birth at home with a midwife, and birth in a hospital with whoever happens to be on call (sometimes this is your own doctor or midwife).
Birth at home
Choosing a safe homebirth requires forethought. I am not an advocate for unassisted birth, with no medical professional on hand to help. I think that choosing a homebirth is a big deal and requires sufficient preparation. Selecting a homebirth midwife is a lot like selecting a doula, except there is more responsibility involved in a midwife. (And, you should have a doula as well.) Here are some things to ask your midwife when you consider birth at home.
- How long do you spend in prenatal visits with me? Midwives are known to spend longer in each prenatal visit with their clients than obstetricians or doctors.
- How do I prepare and educate myself for birth? Some midwives teach their own homebirth childbirth preparation classes.
- When I am in labor, when will you come to my house? How long will you spend with me in labor? Midwives vary widely on when they will arrive. Some will arrive in active labor and will provide doula-like support throughout the birth. Most will arrive at the end of active labor, in time for pushing, to help you have the baby.
- How many assistants do you have, and will they be coming to help with the labor? Some midwives send their assistant(s) first for support, and will come later. Others come with their assistants. There should be at least two trained midwives with you: one for you, and one for the baby.
- What kind of equipment do you provide? Some midwives will bring a birth (yoga) ball and/or birth stool, and may rent a tub for you to labor in.
- What kind of emergency equipment do you have in your midwifery kit, and under what circumstances do you use it? This should be standard, but should include oxygen, Pitocin, sutures, etc. The oxygen can be administered to the mother or the baby; Pitocin helps with postpartum bleeding; and sutures are used to sew up any lacerations (tears) in the mother.
- What are the factors that will cause a transfer to the hospital in labor? This is fairly standard as well. Expect answers such as labor before 36 weeks gestation (preterm baby), induced labor (ask when induction will occur), meconium in the amniotic fluid at any point in labor, baby's heart rate decelerating (measured with intermittent monitoring), bag of waters being open for over a certain amount of time (24 hours, 36 hours), and maternal fever, to name a few. Some midwives will not deliver breech babies and multiples (twins, triplets).
- How long will you stay with me postpartum, and how often will you check on me and the baby? Expect that the midwife will stay at least a couple hours postpartum, until you are settled with the baby, and will check on you frequently in the following days.
Of course, you can also ask about transfer rates (the percentage of mothers that transfer to the hospital), c-section rates, emergency intervention rates, and so on, but that may not give you a good idea of what the midwife brings to the birth. These numbers could tell you her willingness to relinquish control, or to "allow" interventions to happen to the mother, but there is a chance that all it tells you is whether she has had a run of good luck or a run of bad luck.
Research what other mothers said about their home birth. Check out The Birth Survey project, which is a self-reporting tool in which mothers can enter their own experiences and information in the months after their birth. Keep in mind that these data may be skewed because of selection bias: this is not a randomized study, and mothers choose whether or not to participate.
Finally, skip to Step 5: You are not locked in. Though it may be trickier to switch home birth providers later in pregnancy, it can be done.
Birth in a hospital
Choosing a hospital can be a hairy task. No two hospitals are alike. I hope this guide will help you narrow down your choices.
Step 1: Choose a non-profit hospital.
Nathaneal Johnson of California Watch (2010) reported that for-profit hospitals have a higher c-section rate than non-profit hospitals. And that increase in c-section rates is nontrivial: mothers giving birth at a for-profit hospital have a 17% higher chance of delivering surgically. For-profit hospitals are more likely to perform costly procedures, less likely to serve under-served populations, and less likely to have breastfeeding success.
Step 2: Figure out what's important.
Priorities the importance of the following things: cost of birth, mode of delivery (vaginal vs c-section), c-section rate, breastfeeding success, diversity of population served, infant outcomes, whether you will have a room mate, what language(s) are spoken, where your doctor/midwife practices, how many residents (trainees) there are, how close the facility is to where you will spend most of your labor, and any other factors you consider important to you.
Step 3: Do the research.
There are several ways to look at birth facts. Check out Health Grades and search for the hospitals in your area. In California, you can use California Watch to look at statistics. For example, say I wanted to compare San Francisco General Hospital (SFGH) and UCSF Medical Center (UCSF) -- both non-profit teaching hospitals in the center of San Francisco, California.
Another thing these charts do not tell you include whether or not vaginal breech birth is attempted at each hospital (it is).
Health Grades gives both of these hospitals one star for maternity (worst grade possible), but it is unclear why. So let's take a look. Figure 3 shows that San Francisco General Hospital (SFGH) and UCSF Medical Center (UCSF) each has one star. SFGH reports 64% of the cases that UCSF received in 2011 -- implying that SFGH is a smaller hospital. But here is where it gets interesting.
At SFGH, 2544 women delivered vaginally (79.62% of all women that delivered at SFGH in 2011), 12.23% (N=311) had complications related to the vaginal delivery. But the national average for complications is 8.21% so we would expect only 209 women to have had complications. So more women have complications at SFGH due to vaginal delivery than the US average.
We know that SFGH had a 11.10% c-section rate (in 2007) from Figure 1 and we will assume the same c-section rate in 2011. In Figure 3, we see that there is a 20.28% c-section complication rate. That is, of the 651 women that delivered by c-section at SFGH, 20.28% of them (N=132) had complications related to the surgery (e.g., infection, excessive bleeding, etc.). But, the national average is 4.34% so we would have expected only 29 women to have had complications. So, the c-section complication rate at SFGH is more than four times the US average.
At UCSF, 3745 women delivered vaginally (74.81%). Of these, 15.09% had complications (N=565). The national average for complications related to vaginal delivery is 8.21%, so we would have expected only 308 women to have complications. The vaginal delivery complication rate at UCSF is almost twice the US average.
Now, UCSF's c-section complication rate is a little worse than SFGH's, at 13.16%. That is, of the 1261 women that had c-sections, 13.16% of them (N=166) had complications. Since the national average is 4.34%, we would have expected 55 women to have had complications. The c-section complication rate at UCSF is three times the US average.
Health Grades does not explain the "Newborn Survival" column so we have to take it at face value, and, if possible, compare the newborn survival (text) across the hospitals we wish to examine.
Figure 1 shows the California Watch page for SFGH. Interesting things to note here: the decreasing trend of the low-risk c-section rate across three years, and the most recent reported average is 11.10% in 2007, much lower than the US average of 33%. This is very reassuring if mode of delivery is important to you and/or you wish to avoid a c-section. The Hospital Info section below tells you that SFGH is a non-profit teaching hospital that caters to under-served families, with over 60% of the patients coming from a low-income household. If breastfeeding is important, the 88.90% exclusive breastfeeding rate is a very good sign, and there is a positive correlation between beginning breastfeeding in the hospital before discharge and continuing to breastfeed for at least a few months postpartum. Finally, the (risk-adjusted) VBAC (vaginal birth after c-section) rate is a promising 30.23%.
 |
| Figure 1: Decreasing c-section rate for San Francisco General Hospital (California Watch) Click to enlarge |
Figure 2 shows the California Watch page for UCSF. You will notice that it is very similar to SFGH: relatively low c-section rate of 14.20% in 2007 (compared to the US average of 33%), even when you look at the base c-section rate: 19.47% of all mothers, even high-risk mothers, deliver surgically. About 30% of the patients are low-income, judging by the insurance carrier. The breastfeeding success rate is 74.77%, which is still very good -- three quarters of all babies born at UCSF are exclusively breastfed when they check out. The risk-adjusted VBAC rate is 24.23%, which is fairly good.
 |
| Figure 2: Information on the University of California - San Francisco Medical Center (California Watch) Click to enlarge |
Health Grades gives both of these hospitals one star for maternity (worst grade possible), but it is unclear why. So let's take a look. Figure 3 shows that San Francisco General Hospital (SFGH) and UCSF Medical Center (UCSF) each has one star. SFGH reports 64% of the cases that UCSF received in 2011 -- implying that SFGH is a smaller hospital. But here is where it gets interesting.
At SFGH, 2544 women delivered vaginally (79.62% of all women that delivered at SFGH in 2011), 12.23% (N=311) had complications related to the vaginal delivery. But the national average for complications is 8.21% so we would expect only 209 women to have had complications. So more women have complications at SFGH due to vaginal delivery than the US average.
We know that SFGH had a 11.10% c-section rate (in 2007) from Figure 1 and we will assume the same c-section rate in 2011. In Figure 3, we see that there is a 20.28% c-section complication rate. That is, of the 651 women that delivered by c-section at SFGH, 20.28% of them (N=132) had complications related to the surgery (e.g., infection, excessive bleeding, etc.). But, the national average is 4.34% so we would have expected only 29 women to have had complications. So, the c-section complication rate at SFGH is more than four times the US average.
At UCSF, 3745 women delivered vaginally (74.81%). Of these, 15.09% had complications (N=565). The national average for complications related to vaginal delivery is 8.21%, so we would have expected only 308 women to have complications. The vaginal delivery complication rate at UCSF is almost twice the US average.
Now, UCSF's c-section complication rate is a little worse than SFGH's, at 13.16%. That is, of the 1261 women that had c-sections, 13.16% of them (N=166) had complications. Since the national average is 4.34%, we would have expected 55 women to have had complications. The c-section complication rate at UCSF is three times the US average.
Health Grades does not explain the "Newborn Survival" column so we have to take it at face value, and, if possible, compare the newborn survival (text) across the hospitals we wish to examine.
 |
| Figure 3: One-star ratings in maternity care for San Francisco General Hospital and UCSF Medical Center (Health Grades) Click to enlarge |
If we wish to investigate whether there is a difference between any of the following, we can run a quick Chi-square on the data from Figure 3.
We find that indeed, there is a difference in all of these categories. Although calculating Chi-square does not give us the direction of the relationship, we can see that SFGH and UCSF both fare poorer than the national average, and that c-section births at UCSF are more than twice as likely as expected to have associated complications. Yikes! Figure 4 contains all of these calculations.
- SFGH and the national average, in terms of vaginal and c-section complications
- UCSF and the national average, in terms of vaginal and c-section complications
- SFGH and the UCSF, in terms of vaginal and c-section complications
We find that indeed, there is a difference in all of these categories. Although calculating Chi-square does not give us the direction of the relationship, we can see that SFGH and UCSF both fare poorer than the national average, and that c-section births at UCSF are more than twice as likely as expected to have associated complications. Yikes! Figure 4 contains all of these calculations.
 |
| Figure 4: All correlations for SFGH, UCSF, and the national average. |
Research what other mothers said about their birth experience at the facility you choose. Check out The Birth Survey project, which is a self-reporting tool in which mothers can enter their own experiences and information in the months after their birth. Keep in mind that these data may be skewed because of selection bias. For example, SFGH has 60% under-served population; are mothers from this group more or less likely to fill out an online survey than higher-income mothers, in the interests of science?
Ask your friends about their experiences in the facilities. One gal I know praised her birth facility for its harp music and tea time in tones that I understood to be insincere. Then she divulged that she had a room mate, and she hated the experience of someone else's baby crying in the night next to her own bed. No amount of tea could make that memory go away.
Step 4: Visit.
Knowing, on paper, that these hospitals are so similar, how can you choose the right one for you? Visit. Maybe it is a prenatal appointment with a midwife or obstetrician. Maybe it is a procedure, like lab work or the 20-week ultrasound. Maybe it is a maternity center tour. Get a feel for the dynamics of the hospital, for the nursing staff, and for the check-in and check-out procedure. Imagine arriving in labor at rush hour. Is it crazy, with papers flying and nurses pulling their hair out? Or is it a smooth and calm atmosphere? If it is a teaching hospital, ask when the new residents start their training. If their first week corresponds to your due date, and that makes you nervous, that could be a strike in the "no" column. If you are taking a tour, look around the birth room and ask what kinds of things the nurses usually try to help a mother labor. Look for answers that promote relaxation (e.g., birth ball, music player), movement (e.g., waterproof wireless fetal monitors), and hydrotherapy (e.g., bath tub, shower). Ask about routine procedures and if any of them can be skipped (e.g., pubic shaving, IV, Pitocin for labor augmentation).
Step 5: You are not locked in.
Even if you have made your choice of birth facility, or obstetrician, or midwife, or doctor -- whatever -- you are not married to that choice. You can always, always switch. Remember that you are paying good money for the services that will be rendered to you. You are hiring a medical professional. If you are unhappy with your choice, and you are unable to reconcile it (by talking about it, e.g.), you can switch. I have asked doulas, midwives, and nurses in the past: When is it too late to switch providers? The answer: After the baby has come.
Good luck, and happy birthing!
Tuesday, November 8, 2011
Grace Hopper '11 checklist: Five things to do at GHC11
Grace Hopper Celebration of Women in Computing is basically a giant lady-party in which all of the conference attendees are gorgeous, brilliant, and interesting. But you already know this, because I have blogged about Grace Hopper in my post about do-overs next time I go, and in my post from my attendance in 2009. That is not totally right -- it is not just a party. It is an opportunity to showcase your work, learn about other women's research, find out ways to bring more women into our field and make it more woman-friendly, meet new people, and build lasting relationships.
Here are the top five things that I wish to get out of attending Grace Hopper Celebration this year, in 2011.
5. Reconnect with old friends
It has been a year -- in some cases, more -- since I have seen old acquaintances, friends, and mentors. From my first room mate, to the professor that has changed how I see myself as a researcher, to the group of 200 women that have given me the gift of working with my rockstar undergraduate student, I look forward to seeing these ladies again.
4. Find a collaborator
Researching alone can be dismal. Would it not be fun to meet someone with similar interests, in which we can complement each others' strengths? I have this rosy dream about collaborating on a paper with someone I had met once (maybe twice) at Grace Hopper.
3. Meet a new mentor
My career will soon be in flux: next year, I will be dissertating while on the academic job market. (Note: Even though Blogger doesn't think "dissertating" is a word, it totally is.) I imagine I will be in need of new guidance -- of help finding appropriate job openings, navigating the complicated job-seeking and application system, and finding the best way to present myself to particular universities. What better place to meet someone that can potentially help me than at Grace Hopper?
2. Make a new mentee
(Note: Blogger doesn't think "mentee" is a word, but if it isn't, it should be. It's who mentors advise!) As a senior graduate student in her final throes, maybe -- maybe -- my experience can be valuable to someone. I have an undergraduate degree with two majors, I worked in industry for 3 years, I had a baby pre-advancement in graduate school, and I work in a highly interdisciplinary field doing research of my own invention. I write grants, I write blog posts, I invent eHealth learning methods, and I play video games. Surely I could be a resource to somebody!
1. Say thanks
I am pretty lucky that in four years of attending Grace Hopper, I have never paid for the visit myself. In three years, I have never paid for child care. In two years, I have contributed to the program at Grace Hopper, hosting sessions and panels. I feel privileged that I have helped shape the community of women that I am about to see again, meet, or just observe. So, at Grace Hopper this year, I plan to say thanks for accepting me as a part of the package of women in computing, of technical women.
If you will be at Grace Hopper Celebration of Women in Computing in Portland, please find me and say hello! I will be tweeting as @lexyholloway.
Here are the top five things that I wish to get out of attending Grace Hopper Celebration this year, in 2011.
5. Reconnect with old friends
It has been a year -- in some cases, more -- since I have seen old acquaintances, friends, and mentors. From my first room mate, to the professor that has changed how I see myself as a researcher, to the group of 200 women that have given me the gift of working with my rockstar undergraduate student, I look forward to seeing these ladies again.
4. Find a collaborator
Researching alone can be dismal. Would it not be fun to meet someone with similar interests, in which we can complement each others' strengths? I have this rosy dream about collaborating on a paper with someone I had met once (maybe twice) at Grace Hopper.
3. Meet a new mentor
My career will soon be in flux: next year, I will be dissertating while on the academic job market. (Note: Even though Blogger doesn't think "dissertating" is a word, it totally is.) I imagine I will be in need of new guidance -- of help finding appropriate job openings, navigating the complicated job-seeking and application system, and finding the best way to present myself to particular universities. What better place to meet someone that can potentially help me than at Grace Hopper?
2. Make a new mentee
(Note: Blogger doesn't think "mentee" is a word, but if it isn't, it should be. It's who mentors advise!) As a senior graduate student in her final throes, maybe -- maybe -- my experience can be valuable to someone. I have an undergraduate degree with two majors, I worked in industry for 3 years, I had a baby pre-advancement in graduate school, and I work in a highly interdisciplinary field doing research of my own invention. I write grants, I write blog posts, I invent eHealth learning methods, and I play video games. Surely I could be a resource to somebody!
1. Say thanks
I am pretty lucky that in four years of attending Grace Hopper, I have never paid for the visit myself. In three years, I have never paid for child care. In two years, I have contributed to the program at Grace Hopper, hosting sessions and panels. I feel privileged that I have helped shape the community of women that I am about to see again, meet, or just observe. So, at Grace Hopper this year, I plan to say thanks for accepting me as a part of the package of women in computing, of technical women.
If you will be at Grace Hopper Celebration of Women in Computing in Portland, please find me and say hello! I will be tweeting as @lexyholloway.
Friday, September 23, 2011
Five do-overs since my first Grace Hopper Celebration for Women in Computing
Grace Hopper Celebration for Women in Computing is an annual event bringing together thousands of women from different technical computing specialties and at different stages of their career. Attendees include undergraduates considering computer science as a major, graduate students choosing their research direction, recent graduates looking for a job, women in industry, professors, researchers, and recruiters. It is a diverse, funky, exciting, inspiring, and nurturing environment of two thousand women, all of whom are smart, brilliant, beautiful, and different in their own right.
This year will be my fourth time attending, which makes me a Grace Hopper veteran. I first heard about Grace Hopper Celebration from my room mate from CRA-W Grad Cohort -- a similar but much smaller mentoring program for graduate student women -- when I asked my room mate how on earth she knew all these people. She was saying "Hi," calling people by name, and giving hugs to everybody!
"How do you know everyone already?" I asked her.
"Some women I know from last year's Grad Cohort," she replied. "But some women I see basically twice a year: at the Grad Cohort and then again at Grace Hopper Celebration."
"What's that?" I asked. Casually hiding her surprise that I had neer heard of Grace Hopper Celebration, she explained it to me, and that night in our hotel room I looked it up and bookmarked it.
When Grace Hopper Celebration came around that year, my advisor asked if there are any women that would like to go, because our university was a sponsor and received a few spaces for student attendees. Of course, I replied immediately in the affirmative, and off I went!
Now that I have been three times to Grace Hopper Celebration (this year will mark my third time as a contributor) and twice to the CRA-W Grad Cohort, I can look back on my first Grace Hopper Celebration visit a bit critically.
My first year, Grace Hopper Celebration was held in Keystone, Colorado, a small resort town situated in the mountains among an aspen forest. The trees were just starting to turn in ones and twos: blots of color among a sea of green leaves. I was driven from the airport in a shuttle and looked out onto the picturesque landscape with wide eyes. I was young, impressionable, and pregnant.
Yup, I was about 24 weeks along in my pregnancy. I knew I was carrying a boy, and I had just returned from a trip abroad -- a delayed honeymoon -- before having time to buy clothes that fit me. My belly had just started getting too big for my pants. It happened so suddenly that I was ill-prepared, wardrobe-wise, for the change in my figure. I was a hot mess, unbuttoning my jeans and praying that my fitted t-shirts did not bust into holes stretched over my growing belly. When my mother saw me at the airport on my return from Grace Hopper, she was shocked at my fashion sense, but at the time, I figured that is just an extension of the typical graduate student lifestyle. Right? Please tell me I am right.
Anyway, back to the point -- I could have done a better job. As an early(ish) graduate student, my main role was to be receptive to mentoring and to meet people that would help me in my career path. I see that now, in hindsight, but at the time I did not recognize these goals. Here were my top five mistakes from the first year. Every year I go back, I get a do-over and do my best to avoid these.
Do-Over #5. Eat lunch and dinner.
At CRA-W Grad Cohort, one of the rules was that no two women from the same university could sit together at lunch. You had to learn to network, and to meet other women. But here, at Grace Hopper Celebration, there was no such rule, and even if there was, there is no way to enforce it with 2000 attendees. So attendees would sit with the people they knew more often than not, and I, seeing this social norm, followed suit. Not a good idea. Now I know that it is best to sit at a table where you know no one. Even better: sit at a table where you know no one, and everyone is different from you. Is everyone older? They have more experience. Is everyone younger? Maybe they have questions. But if everyone is exactly like you, there is no way you can broaden your experience. Challenge yourself.
Do-Over #4. Use the room mate.
I was at Grace Hopper Celebration on an underwriter scholarship, and, like all scholarship recipients, I had a room mate. Actually, in this year, we were in a three-room cabin in the mountains of Keystone, Colorado, and I had two house mates. My house mates were amazing. They asked me about pregnancy and married life, about the proverbial work-life balance (as if there is one), about what I will do once I have the baby (hint: stay in school). On our last night in Colorado, we all went shopping to the outlets nearby and my lovely room mates bought me a shirt that actually covered my entire front. Maybe it is silly, but I was moved.
But most of the day, my house mates (who knew each other) would be off on their own, and, in pregnancy-related discomfort (more on this later), I left them to themselves. I did not go to see their posters at the poster session; I did not ask for introductions to other women; I did not sit with them and their colleagues at lunch. But this was wrong. Use your room mate (or room mates, if you are lucky enough to have two) -- use them as mentors if they are more experienced at Grace Hopper Celebration than you are; use them as friends if they are new like you; use them as a sounding-board for your elevator pitch for your research.
My room mates approached me on the second day and said, with a sly grin, "We are thinking of taking a drive up to the summit, instead of one of the sessions. Are you in?" I considered for a moment, wondering if it is OK to skip sessions, and if we could leave the conference grounds without arousing suspicion among the organizers. Hesitating a little, I said that it sounds like great fun, and that I would certainly come.
As we arrived to the summit, the weather shifted dramatically, from cool and clear autumn to cold and foggy winter. Not another person and not another vehicle was within sight: it was just us. It began to snow in large, fluffy flakes. The electricity in the air made our hair stand straight up, and lightning bolts noiselessly crashed all around us. We giggled and photographed and huddled in our insufficient jackets -- and bonded. We formed relationships which would survive the test of time and geography -- relationships we could later fall back on in our professional and personal lives, because we had this shared experience.
Do-Over #3. Couch potato networking.
During the course of Grace Hopper Celebration, my baby, whom I called Galahad ever since knowing I was pregnant, grew as well. I would like to think it is because of my rock hard abs that, one day into the Celebration, I started getting rib pain. My ribs were expanding to fit my high-carried fetus and I was in pain from the pressure in my ribcage from about noon until I went to bed every night. I did not tell anybody (except my amazing room mates) because I had never enjoyed complaining, especially to strangers. Even strangers that are there for the express purpose of caring for and mentoring me.
Half the day, my ribs would hurt so much that I could not sit up. Sometimes I would go back to my room and lie down; other times, I would sprawl out sideways on one of the low arm chairs in the conference area and try not to moan. Both of these were missed networking opportunities. Now I see that it is OK to sprawl in pain rather than attend a session, as long as I am doing something to further my career.
See, I had no idea where my academic career was going. Here I was, not even half-way through my first pregnancy, not even two years through grad school, and with no idea where my research interests were. Every class I took was fascinating for the first three weeks; every project I undertook was interesting only for the first half. I knew I was a fantastic teacher but had never undertaken any serious research project. I knew I wanted to be a professor eventually -- but a professor of what? How do you find the one thing that really turns you on?
These are all questions that, though they cannot be answered by someone else, they can point you and your mind and heart into a direction. Other women's experiences can influence how you experience yourself. Maybe I am getting a little hippy-dippy. But my point is that I was not using this time to the best of my abilities. I could have been meeting women in a higher position than myself and asking for advice; I could have been meeting my future mentor; I could have been learning with others, rather than suffering alone!
Do-Over #2. Tell your secret.
Maybe it was the pregnancy hormones talking, but I posted an anonymous advertisement on the bulletin board:
I had only told my room mates, and mentioned it once at lunch. One of the women, another student, lit up: "Do you have maternity leave at your university?" I answered honestly that I did not know. She persisted: "You know, it should be covered by the union. They bargained for it just last year. It is brand new this year. You should look it up." After lunch, she and I both went to the computers and found the relevant sections. She was glad to help me, and I was glad for the help, because until then, I had never considered my rights and my future as an employee of the university.
It was not until the last hour of the last day, when several of us were loading the bus, that I told one more person about my pregnancy. She was a young woman with a large baby, and introduced herself as a professor. We chatted briefly about pregnancy, and exchanged information. It seemed so natural and inconsequential at the time -- especially as I had such a reverence for professors because of what I now see was mild impostor syndrome -- but I was calmed by her easy nature and friendly manner. This small event which I had put out of my mind as an impossibility because of the difference in rank, this easy exchange of words and information, this event was probably the best thing that happened to me at Grace Hopper Celebration that year. Today, the professor who befriended me continues to mentor and support me through my final years of graduate school. I told my secret to the best person I could possibly meet.
Do-Over #1. Meet the speakers.
I had attended a great many talks, but one in particular still speaks to me today. It was a talk I had heard before, at CRA-W, given by a graduate student that had changed direction several times in the course of her studies. She was explaining the same feelings I was having: She would take an introductory class and enjoy it immensely, but not enjoy the follow-up class. It took her a long time to find a dissertation topic. She explained several ways that dissertation topics come into existence: the extended course project, the advisor's list of unfinished work, the stroke of genius, and others. She struck me as someone I would love to be friends with -- but she was so smart! so accomplished! What would I have to offer by speaking with her?
Wrong, wrong, wrong!
Now that I am also a speaker at Grace Hopper Celebration, I know that speakers are people too. I love it when people attend my talks, and I love it even more when they stay afterwards to tell me that the talk was useful to them, my nervousness did not show, or even that my animation skills in the slides were top-notch. Which, I assure you, they are not. I love it when people tweet about my talk. I love it when people come to ask me for advice, or ask for my contact information in the case they have questions about something I said. I love just knowing that someone, somewhere, was affected by my talk.
I did approach this particular speaker, and I told her that I had heard her talk before and I really admired her. She was surprised: "What, me?" Laughing heartily, she chatted with me about grad school, clearly expressing that she considered us equals. She and I are still friends today.
Since then, I make it a point to meet every speaker that inspires me. Even if she is the president of some fancy corporation, or the first author of an influential paper, or simply the woman that said something that really resonated with me. I introduce myself and say, "What you said just now, I really took to heart. Thank you for a great talk." If we happen to meet again, I can say, "We met at Grace Hopper last year. I loved your talk." This usually leads to an invitation to join her lunch table, which -- by the way -- I always gladly accept.
This year will be my fourth time attending, which makes me a Grace Hopper veteran. I first heard about Grace Hopper Celebration from my room mate from CRA-W Grad Cohort -- a similar but much smaller mentoring program for graduate student women -- when I asked my room mate how on earth she knew all these people. She was saying "Hi," calling people by name, and giving hugs to everybody!
"How do you know everyone already?" I asked her.
"Some women I know from last year's Grad Cohort," she replied. "But some women I see basically twice a year: at the Grad Cohort and then again at Grace Hopper Celebration."
"What's that?" I asked. Casually hiding her surprise that I had neer heard of Grace Hopper Celebration, she explained it to me, and that night in our hotel room I looked it up and bookmarked it.
When Grace Hopper Celebration came around that year, my advisor asked if there are any women that would like to go, because our university was a sponsor and received a few spaces for student attendees. Of course, I replied immediately in the affirmative, and off I went!
Now that I have been three times to Grace Hopper Celebration (this year will mark my third time as a contributor) and twice to the CRA-W Grad Cohort, I can look back on my first Grace Hopper Celebration visit a bit critically.
My first year, Grace Hopper Celebration was held in Keystone, Colorado, a small resort town situated in the mountains among an aspen forest. The trees were just starting to turn in ones and twos: blots of color among a sea of green leaves. I was driven from the airport in a shuttle and looked out onto the picturesque landscape with wide eyes. I was young, impressionable, and pregnant.
Yup, I was about 24 weeks along in my pregnancy. I knew I was carrying a boy, and I had just returned from a trip abroad -- a delayed honeymoon -- before having time to buy clothes that fit me. My belly had just started getting too big for my pants. It happened so suddenly that I was ill-prepared, wardrobe-wise, for the change in my figure. I was a hot mess, unbuttoning my jeans and praying that my fitted t-shirts did not bust into holes stretched over my growing belly. When my mother saw me at the airport on my return from Grace Hopper, she was shocked at my fashion sense, but at the time, I figured that is just an extension of the typical graduate student lifestyle. Right? Please tell me I am right.
Anyway, back to the point -- I could have done a better job. As an early(ish) graduate student, my main role was to be receptive to mentoring and to meet people that would help me in my career path. I see that now, in hindsight, but at the time I did not recognize these goals. Here were my top five mistakes from the first year. Every year I go back, I get a do-over and do my best to avoid these.
Do-Over #5. Eat lunch and dinner.
At CRA-W Grad Cohort, one of the rules was that no two women from the same university could sit together at lunch. You had to learn to network, and to meet other women. But here, at Grace Hopper Celebration, there was no such rule, and even if there was, there is no way to enforce it with 2000 attendees. So attendees would sit with the people they knew more often than not, and I, seeing this social norm, followed suit. Not a good idea. Now I know that it is best to sit at a table where you know no one. Even better: sit at a table where you know no one, and everyone is different from you. Is everyone older? They have more experience. Is everyone younger? Maybe they have questions. But if everyone is exactly like you, there is no way you can broaden your experience. Challenge yourself.
Do-Over #4. Use the room mate.
I was at Grace Hopper Celebration on an underwriter scholarship, and, like all scholarship recipients, I had a room mate. Actually, in this year, we were in a three-room cabin in the mountains of Keystone, Colorado, and I had two house mates. My house mates were amazing. They asked me about pregnancy and married life, about the proverbial work-life balance (as if there is one), about what I will do once I have the baby (hint: stay in school). On our last night in Colorado, we all went shopping to the outlets nearby and my lovely room mates bought me a shirt that actually covered my entire front. Maybe it is silly, but I was moved.
But most of the day, my house mates (who knew each other) would be off on their own, and, in pregnancy-related discomfort (more on this later), I left them to themselves. I did not go to see their posters at the poster session; I did not ask for introductions to other women; I did not sit with them and their colleagues at lunch. But this was wrong. Use your room mate (or room mates, if you are lucky enough to have two) -- use them as mentors if they are more experienced at Grace Hopper Celebration than you are; use them as friends if they are new like you; use them as a sounding-board for your elevator pitch for your research.
My room mates approached me on the second day and said, with a sly grin, "We are thinking of taking a drive up to the summit, instead of one of the sessions. Are you in?" I considered for a moment, wondering if it is OK to skip sessions, and if we could leave the conference grounds without arousing suspicion among the organizers. Hesitating a little, I said that it sounds like great fun, and that I would certainly come.
As we arrived to the summit, the weather shifted dramatically, from cool and clear autumn to cold and foggy winter. Not another person and not another vehicle was within sight: it was just us. It began to snow in large, fluffy flakes. The electricity in the air made our hair stand straight up, and lightning bolts noiselessly crashed all around us. We giggled and photographed and huddled in our insufficient jackets -- and bonded. We formed relationships which would survive the test of time and geography -- relationships we could later fall back on in our professional and personal lives, because we had this shared experience.
Do-Over #3. Couch potato networking.
During the course of Grace Hopper Celebration, my baby, whom I called Galahad ever since knowing I was pregnant, grew as well. I would like to think it is because of my rock hard abs that, one day into the Celebration, I started getting rib pain. My ribs were expanding to fit my high-carried fetus and I was in pain from the pressure in my ribcage from about noon until I went to bed every night. I did not tell anybody (except my amazing room mates) because I had never enjoyed complaining, especially to strangers. Even strangers that are there for the express purpose of caring for and mentoring me.
Half the day, my ribs would hurt so much that I could not sit up. Sometimes I would go back to my room and lie down; other times, I would sprawl out sideways on one of the low arm chairs in the conference area and try not to moan. Both of these were missed networking opportunities. Now I see that it is OK to sprawl in pain rather than attend a session, as long as I am doing something to further my career.
See, I had no idea where my academic career was going. Here I was, not even half-way through my first pregnancy, not even two years through grad school, and with no idea where my research interests were. Every class I took was fascinating for the first three weeks; every project I undertook was interesting only for the first half. I knew I was a fantastic teacher but had never undertaken any serious research project. I knew I wanted to be a professor eventually -- but a professor of what? How do you find the one thing that really turns you on?
These are all questions that, though they cannot be answered by someone else, they can point you and your mind and heart into a direction. Other women's experiences can influence how you experience yourself. Maybe I am getting a little hippy-dippy. But my point is that I was not using this time to the best of my abilities. I could have been meeting women in a higher position than myself and asking for advice; I could have been meeting my future mentor; I could have been learning with others, rather than suffering alone!
Do-Over #2. Tell your secret.
Maybe it was the pregnancy hormones talking, but I posted an anonymous advertisement on the bulletin board:
Looking to connect with other pregnant graduate students and those with kids.I added my e-mail address and hoped for the best. The truth is that I did not know what I was looking for. Support? Advice? Encouragement? I did not have any concrete questions but I wanted to know that I was not alone, that my experience was not unique. In some ways, I suppose, I wanted validation. I wanted someone to say, "I know things will get rough, but you can do it, because I did it." Though I did receive a few notes, mainly by other participants pinning replies to the same bulletin board, I never replied to them, in part because I did not know what I wanted to say, and in part because I did not want to give away my secret.
I had only told my room mates, and mentioned it once at lunch. One of the women, another student, lit up: "Do you have maternity leave at your university?" I answered honestly that I did not know. She persisted: "You know, it should be covered by the union. They bargained for it just last year. It is brand new this year. You should look it up." After lunch, she and I both went to the computers and found the relevant sections. She was glad to help me, and I was glad for the help, because until then, I had never considered my rights and my future as an employee of the university.
It was not until the last hour of the last day, when several of us were loading the bus, that I told one more person about my pregnancy. She was a young woman with a large baby, and introduced herself as a professor. We chatted briefly about pregnancy, and exchanged information. It seemed so natural and inconsequential at the time -- especially as I had such a reverence for professors because of what I now see was mild impostor syndrome -- but I was calmed by her easy nature and friendly manner. This small event which I had put out of my mind as an impossibility because of the difference in rank, this easy exchange of words and information, this event was probably the best thing that happened to me at Grace Hopper Celebration that year. Today, the professor who befriended me continues to mentor and support me through my final years of graduate school. I told my secret to the best person I could possibly meet.
Do-Over #1. Meet the speakers.
I had attended a great many talks, but one in particular still speaks to me today. It was a talk I had heard before, at CRA-W, given by a graduate student that had changed direction several times in the course of her studies. She was explaining the same feelings I was having: She would take an introductory class and enjoy it immensely, but not enjoy the follow-up class. It took her a long time to find a dissertation topic. She explained several ways that dissertation topics come into existence: the extended course project, the advisor's list of unfinished work, the stroke of genius, and others. She struck me as someone I would love to be friends with -- but she was so smart! so accomplished! What would I have to offer by speaking with her?
Wrong, wrong, wrong!
Now that I am also a speaker at Grace Hopper Celebration, I know that speakers are people too. I love it when people attend my talks, and I love it even more when they stay afterwards to tell me that the talk was useful to them, my nervousness did not show, or even that my animation skills in the slides were top-notch. Which, I assure you, they are not. I love it when people tweet about my talk. I love it when people come to ask me for advice, or ask for my contact information in the case they have questions about something I said. I love just knowing that someone, somewhere, was affected by my talk.
I did approach this particular speaker, and I told her that I had heard her talk before and I really admired her. She was surprised: "What, me?" Laughing heartily, she chatted with me about grad school, clearly expressing that she considered us equals. She and I are still friends today.
Since then, I make it a point to meet every speaker that inspires me. Even if she is the president of some fancy corporation, or the first author of an influential paper, or simply the woman that said something that really resonated with me. I introduce myself and say, "What you said just now, I really took to heart. Thank you for a great talk." If we happen to meet again, I can say, "We met at Grace Hopper last year. I loved your talk." This usually leads to an invitation to join her lunch table, which -- by the way -- I always gladly accept.
Saturday, November 13, 2010
Two reasons Facebook is killing information retrieval and collaboration
There are two problems plaguing Facebook and having a grossly detrimental effect on information retrieval and collaboration. If you see Facebook as more than a lolspeak haven, and use it to communicate information to your friends, like I do, you may be seeing the same problems.
Facebook is killing information retrieval
The first problem is that, like many of my online friends, the majority of my interaction with Facebook is through status updates and sharing links to interesting stories. Some of these links are particularly compelling or memorable for me: months later, I wish to retrieve these links, and revisit the site. Perhaps there was an interesting article that was germain to my current research, or that helped articulate a point.
Unfortunately, link retrieval on Facebook goes like this:
Facebook is killing collaboration
The second problem with Facebook (or at least, the second problem that I address here) is a direct fallout from the information retrieval problem. Say I share a link to a blog post, such as this one. Those in my friends list are shown this link, and can "like" it, comment on it, or share it with their friends. Conversations, including the "like" action and actual comments, about the post happen directly below my link, as replies. However, readers of my blog that are not friends with me on Facebook are thus prevented from contributing to the conversation. Moreover, if a friend shares my story on her feed, there is a possibility of further conversation on that node, totally disconnected from the conversation on my node. To keep track, I should either "like" or comment below any shared articles to be notified of replies. There is no way to consolidate the conversations.
The real problem is that Facebook is a closed system. That is, only members of Facebook can contribute to its content. I am generalizing here, and not even touching ads and the recent privacy concerns and the way that, magically, other sites suddenly know a lot about my friends and their interests. As it's a closed system, it is difficult if not impossible to selectively make public certain content without compromising privacy. In particular, I cannot tell the world about what my Facebook friends think about my work, because their comments are published on Facebook. And their friends cannot tell me what they think of my work, because they lack the permissions to post on my wall. Oops! It is a privacy catch-22.
What Facebook should do
The solution to these two problems can take many different turns.
First, Facebook should provide a search function and an easier way to access one's own content. Period.
Second, Facebook and Blogger (or other blogging tools) can add a way to publish comments from Facebook to Blogger and vice-versa. That is, if someone comments on a link to this article on Facebook, there should be an option for anonymization (if necessary) and publishing to Blogger. That way these comments can reach more of the general reader population.
What I should do
I do not really know how to proceed. I would love to be able to post here on my blog some of the lovely feedback and serious discussions I have had over Facebook, but one, I would need to get permission or properly anonymize each comment; two, I would need to enter each one by hand as a comment (which would be both tedious and, well, lame); and three, I would need to be able to find them, which brings me back to the first problem above.
Instead, I will solicit advice here, and silently stew in my progressively-escalating annoyance with Facebook's downright unusable information retrieval system and lack of cross-system collaboration support.
Facebook is killing information retrieval
The first problem is that, like many of my online friends, the majority of my interaction with Facebook is through status updates and sharing links to interesting stories. Some of these links are particularly compelling or memorable for me: months later, I wish to retrieve these links, and revisit the site. Perhaps there was an interesting article that was germain to my current research, or that helped articulate a point.
Unfortunately, link retrieval on Facebook goes like this:
- Click on my name to go to my profile and wall.
- Search the page in my web browser for the text I think I put in the link text.
- Finding nothing, scroll to the bottom and choose "Older posts."
- Wait.
- Repeat steps 2--4 until either I find the link, or I get bored.
This problem is compounded if the information I wish to retrieve is embedded as a reply to someone else's status update or link. These events are archived on Facebook, and displayed back to me, as "Dynamic Doula commented on So-and-So's status" or "wrote on So-and-So's wall." If I am unsure where the embedded information is, on whose wall I wrote, or on whose link I commented, I have to traverse all of these links. Click, read, realize it is not the correct one, go back, and start again on step 2, because all of the "Older posts" have been re-minimized and only the newest posts are displayed.
Information retrieval on Facebook is cumbersome. I wish there were a way I could easily and quickly search all of the things I have ever written, both on my wall and on others' walls, and in discussion groups within individual applications. How many times have I linked, for example, a story about a birth? Where are all of my links to blog posts? Where is that amazing conversation we had about children in academia? These things are nearly impossible to find, as they have disappeared into the informational Facebook abyss.
The second problem with Facebook (or at least, the second problem that I address here) is a direct fallout from the information retrieval problem. Say I share a link to a blog post, such as this one. Those in my friends list are shown this link, and can "like" it, comment on it, or share it with their friends. Conversations, including the "like" action and actual comments, about the post happen directly below my link, as replies. However, readers of my blog that are not friends with me on Facebook are thus prevented from contributing to the conversation. Moreover, if a friend shares my story on her feed, there is a possibility of further conversation on that node, totally disconnected from the conversation on my node. To keep track, I should either "like" or comment below any shared articles to be notified of replies. There is no way to consolidate the conversations.
The real problem is that Facebook is a closed system. That is, only members of Facebook can contribute to its content. I am generalizing here, and not even touching ads and the recent privacy concerns and the way that, magically, other sites suddenly know a lot about my friends and their interests. As it's a closed system, it is difficult if not impossible to selectively make public certain content without compromising privacy. In particular, I cannot tell the world about what my Facebook friends think about my work, because their comments are published on Facebook. And their friends cannot tell me what they think of my work, because they lack the permissions to post on my wall. Oops! It is a privacy catch-22.
What Facebook should do
The solution to these two problems can take many different turns.
First, Facebook should provide a search function and an easier way to access one's own content. Period.
Second, Facebook and Blogger (or other blogging tools) can add a way to publish comments from Facebook to Blogger and vice-versa. That is, if someone comments on a link to this article on Facebook, there should be an option for anonymization (if necessary) and publishing to Blogger. That way these comments can reach more of the general reader population.
What I should do
I do not really know how to proceed. I would love to be able to post here on my blog some of the lovely feedback and serious discussions I have had over Facebook, but one, I would need to get permission or properly anonymize each comment; two, I would need to enter each one by hand as a comment (which would be both tedious and, well, lame); and three, I would need to be able to find them, which brings me back to the first problem above.
Instead, I will solicit advice here, and silently stew in my progressively-escalating annoyance with Facebook's downright unusable information retrieval system and lack of cross-system collaboration support.
Wednesday, November 3, 2010
Teaching Childbirth: Top 5 Tools of the Trade
How did people --- doctors, midwives --- learn about childbirth in the past, and how is it done currently? Of course, illustrations depicting what was assumed and known about the female reproductive system have been around for centuries. My interest is in three-dimensional models. I will outline a few in the post below.
#5: The antique dolls
These 19th-century dolls were used to teach midwives about the mechanics of childbirth [1]. They were typically made from leather, catgut, and porcelain. These dolls have limited stretch, mobility, and, frankly, realism, although the attention to detail is present (check out the stretch marks). The baby is unable to pass through the vaginal canal in these models; instead, a panel on the stomach opens and the baby is lifted out.
There are other dolls, made out of other materials. Most interestingly is the crochet doll shown below. Benefits of crochet is that it is stretchy; on the other hand, it is hardly realistic (unless you add copious amounts of pubic hair, as shown).
#4: The Made-in-China childbirth skills training model
Four models in one package are now available for purchase by the general public, so if you ever wanted your own special vagina, this is your chance [3]. This package includes a cervical check model, a childbirth model with fetus, and a perineum cutting simulation. Wait, what was that? Oh, yes, an episiotomy model. Known as "the unkindest cut," episiotomy is a surgical incision in the perineum. The idea is that such a cut will help the baby be born faster, will prevent tearing, and will be easier to sew up. Although the baby usually does flop out after the perineal opening is widened, the incision typically tears further, creating both a cut and a tear. And it has been shown that a clean cut is just as easy to sew up and is just as quick to heal as a natural tear. Episiotomy is a topic of great debate (and great ridicule) in the West, including the US and most European countries. But in China, the episiotomy rate ranges between 65% to 93% with a mean of 82% in 2001. By comparison, the US episiotomy rate was found to be around 33%; the UK rate, the lowest in any European country, was 13%.
#3: The $50,000 pelvis named SIMone
SIMone is probably the most comprehensive pelvis money can buy. You can practice birthing scenarios at your heart's delight with this amazing computerized model [5]. SIMone's makers suggest that this pelvis also imitates sounds of maternal distress. I am not quite sure where the speakers are; to be honest, if a pelvis started moaning and crying, I may moan and cry too.
#2: The UK model pelvis and associated childbirth training
This model pelvis and newborn is used to teach obstetricians and any doctor that works around newborns. The doctors train in delivering the baby in different complicated situations (e.g., shoulder dystocia), and are required to complete this training annually [2]. The doctors may benefit from this training (at least temporarily) because they practice real techniques in real time with a real audience, which simulates the intensely stressful situation that the doctors might encounter with a real woman.
This is actually pretty cool, and I am glad to see some rigorous training being done with these models.
#1: The Japanese Robotic Vagina
Oh, the Japanese. They come up with amazing things, like the boyfriend arm pillow for women, the woman's lap pillow for men, and Le Trung's perfect woman named Aiko. Now, we cut to the chase, eliminating the middle-man: the robotic vagina.
I must say that I searched far and wide for a reputable source for the robotic vagina, but came up with pages of URLs of the form "Japanese Robotic Vagina: Now Making Childbirth Even More Horrifying." A still picture makes little sense; you have to see the video. With the sound off. Those servo motors are ridiculously loud.
Conclusion
With the exception of the early birth dolls, which contained a full body and an expressionless face, the models of modern-day have, at best, only a torso, a highly realistic and anatomically correct vagina, and sometimes stumps for legs. Why is this unsettling? Well. Pregnant women, and women in labor, frequently complain about doctors not really seeing them as people. Doctors come in, look at the belly, look at the chart, bark some orders, and leave. "He didn't even look at my face," women complain, without loss of generality to gender of the physician. This fragmentation between woman and her body, between woman and her genitalia, transcends the physician boundary and permeates women. Women describe their bodies as outside themselves. "The uterus contracts," they say, de-emphasizing that the uterus is part of themselves [6].
Using this faceless, limbless, body-less model of a vagina, and training doctors to look only there, with total disregard to the rest of the woman as a person, perpetuates the notion that women are invisible: only the reproductive tract is important, and only the product of the production model of childbirth (i.e., the baby) is important. But to many women in Western society, the experience of birth is just as important as the outcome (the healthy baby). If we, women, are treated by what amounts to medical superiors as a limbless abdomen, we are made to feel insignificant.
Of course, building a full-body model, complete with a face capable of emotion, is prohibitive. But perhaps incorporating sensitivity to the concerns and emotions of women in labor into the training, when using these models, will make a step in the right direction. Perhaps it will help.
References
[1] Wright, A. (2009) Birthing Dolls. ProfoundlySuperficial (blog), May 24, 2009. Accessed 11/3/2010
[2] Bavley, A. (2008) KU Hospital First in Nation to Use Course for Childbirth Emergencies. The Kansas City Star via NursingLink, August 14, 2008. Accessed 11/3/2010
[3] Childbirth Skills Training Model. Accessed 11/3/2010.
[4] Graham, I. D., Carroli, G., Davies, C. and Medves, J. M. (2005), Episiotomy Rates Around the World: An Update. Birth, 32: 219–223. doi: 10.1111/j.0730-7659.2005.00373.x
[5] Gynecological Models, Obstetric Models, and Childbirth Models. Accessed 11/3/2010
[6] Martin, E. (1987) The Woman in the Body. Beacon Press, Boston.
#5: The antique dolls
There are other dolls, made out of other materials. Most interestingly is the crochet doll shown below. Benefits of crochet is that it is stretchy; on the other hand, it is hardly realistic (unless you add copious amounts of pubic hair, as shown).
#4: The Made-in-China childbirth skills training model
Four models in one package are now available for purchase by the general public, so if you ever wanted your own special vagina, this is your chance [3]. This package includes a cervical check model, a childbirth model with fetus, and a perineum cutting simulation. Wait, what was that? Oh, yes, an episiotomy model. Known as "the unkindest cut," episiotomy is a surgical incision in the perineum. The idea is that such a cut will help the baby be born faster, will prevent tearing, and will be easier to sew up. Although the baby usually does flop out after the perineal opening is widened, the incision typically tears further, creating both a cut and a tear. And it has been shown that a clean cut is just as easy to sew up and is just as quick to heal as a natural tear. Episiotomy is a topic of great debate (and great ridicule) in the West, including the US and most European countries. But in China, the episiotomy rate ranges between 65% to 93% with a mean of 82% in 2001. By comparison, the US episiotomy rate was found to be around 33%; the UK rate, the lowest in any European country, was 13%.
#3: The $50,000 pelvis named SIMone
SIMone is probably the most comprehensive pelvis money can buy. You can practice birthing scenarios at your heart's delight with this amazing computerized model [5]. SIMone's makers suggest that this pelvis also imitates sounds of maternal distress. I am not quite sure where the speakers are; to be honest, if a pelvis started moaning and crying, I may moan and cry too.
#2: The UK model pelvis and associated childbirth training
This is actually pretty cool, and I am glad to see some rigorous training being done with these models.
#1: The Japanese Robotic Vagina
Oh, the Japanese. They come up with amazing things, like the boyfriend arm pillow for women, the woman's lap pillow for men, and Le Trung's perfect woman named Aiko. Now, we cut to the chase, eliminating the middle-man: the robotic vagina.
I must say that I searched far and wide for a reputable source for the robotic vagina, but came up with pages of URLs of the form "Japanese Robotic Vagina: Now Making Childbirth Even More Horrifying." A still picture makes little sense; you have to see the video. With the sound off. Those servo motors are ridiculously loud.
Conclusion
With the exception of the early birth dolls, which contained a full body and an expressionless face, the models of modern-day have, at best, only a torso, a highly realistic and anatomically correct vagina, and sometimes stumps for legs. Why is this unsettling? Well. Pregnant women, and women in labor, frequently complain about doctors not really seeing them as people. Doctors come in, look at the belly, look at the chart, bark some orders, and leave. "He didn't even look at my face," women complain, without loss of generality to gender of the physician. This fragmentation between woman and her body, between woman and her genitalia, transcends the physician boundary and permeates women. Women describe their bodies as outside themselves. "The uterus contracts," they say, de-emphasizing that the uterus is part of themselves [6].
Using this faceless, limbless, body-less model of a vagina, and training doctors to look only there, with total disregard to the rest of the woman as a person, perpetuates the notion that women are invisible: only the reproductive tract is important, and only the product of the production model of childbirth (i.e., the baby) is important. But to many women in Western society, the experience of birth is just as important as the outcome (the healthy baby). If we, women, are treated by what amounts to medical superiors as a limbless abdomen, we are made to feel insignificant.
Of course, building a full-body model, complete with a face capable of emotion, is prohibitive. But perhaps incorporating sensitivity to the concerns and emotions of women in labor into the training, when using these models, will make a step in the right direction. Perhaps it will help.
Note
There are many other childbirth models available for purchase both by hospitals and by individuals. This list is not intended to be exhaustive.
References
[1] Wright, A. (2009) Birthing Dolls. ProfoundlySuperficial (blog), May 24, 2009. Accessed 11/3/2010
[2] Bavley, A. (2008) KU Hospital First in Nation to Use Course for Childbirth Emergencies. The Kansas City Star via NursingLink, August 14, 2008. Accessed 11/3/2010
[3] Childbirth Skills Training Model. Accessed 11/3/2010.
[4] Graham, I. D., Carroli, G., Davies, C. and Medves, J. M. (2005), Episiotomy Rates Around the World: An Update. Birth, 32: 219–223. doi: 10.1111/j.0730-7659.2005.00373.x
[5] Gynecological Models, Obstetric Models, and Childbirth Models. Accessed 11/3/2010
[6] Martin, E. (1987) The Woman in the Body. Beacon Press, Boston.
Monday, November 1, 2010
Non-negotiable: Two things that will help you labor longer, better
The following items are (in my opinion) the top two non-negotiable things that will help a woman labor, especially if her goal is natural childbirth in a baby- and mom-friendly hospital.
Non-Negotiable Item 1. Drinking in labor.
Eating in early labor is a given. For many women, early labor comes on slowly and lasts an average of 12 hours. Contractions are mellow and irregular. Women and their partners are advised to rest, to walk, to eat, to smooch, and to enjoy this last bit of baby-free time in their lives.
In early labor, mom is preparing to run a marathon. She is stretching her strongest muscle: the uterus. Would you run a marathon on an empty stomach? Of course not. Eat. Eat carbs. Eat some protein. Eat whatever sounds good to you. If nothing sounds good to you, try some toast.
Eating in active labor is a bit harder. If mom is at home, and she is hungry, she should eat. At the hospital, eating may be restricted or downright forbidden.
Now, this is the non-negotiable part: After every contraction, take a sip of water.
Especially if it is your intention to have a hospital birth naturally, with no drugs and minimal interventions, drinking water is key.
In many Baby-Friendly™ birthing facility hospitals (such as the ones in my area), the standard procedure is, upon admission, to start a heparin lock, or hep-lock. A hep-lock is a needle and a catheter with a lid on it. The needle goes in the vein, and the rest of it is taped to the arm so that it stays put when mom moves around. Depending on the obstetrician, the IV fluids are negotiable, and mom and her partner can ask that nothing is hooked up to the hep-lock until something is needed.
The doctors' argument for a hep-lock is that if there is an emergency situation later in labor (e.g., in transition) that the IV has already been started, as it can be more difficult to find the vein in a stressful situation. Some activists argue that having a hep-lock started creates emergency situations: a doctor is more likely to intervene when the vein is open than if the extra work to start the IV still needs to be done.
Times that IV fluids are needed (and required) include, in order of severity, when mom is severely dehydrated and unable to drink, when mom requests an epidural, and when preparing for a Caesarean section [3]. Notice that I say that these are required cases of IV fluid use. Some obstetricians give IV fluids routinely. In routine cases, I suggest you argue for a hep-lock, or no intervention at all, if possible.
The reason I harp on routine use of IV fluids so much is fourfold. First, the IV and associated IV pole hinders mobility. It is harder to move around and change positions, harder to find comfortable positions, harder to engage in hydrotherapy (i.e., bath tub or shower), when wheeling around a pole. Second, in many cases, when IV fluids are being administered, women become over-hydrated; if there is glucose in the IV, the baby often shows signs of hyperglycemia before birth followed by hypoglycemia after birth. Third, in many cases, when IV fluids are being administered, women are prevented from eating and drinking, "just in case." I discuss this in the paragraphs that follow. Fourth, and finally, an IV is an often-unnecessary intervention, so I disagree on principle. Any intervention, especially an unnecessary one, adds to a passive maternal mindset, making her feel that labor is something that is done to her, against her control, rather than something that she is doing.
Back to drinking water. Drinking during labor prevents dehydration, thereby helping to prevent routine use of IV fluids.
Although it is impossible to name the cause and the effect, the association exists: Women who were advised to eat and drink in labor had a lower rate of instrumental birth (13% for those that ate and drank, vs 24% for the women that did not) [1]. Some doctors do not allow women to eat or drink in labor for various reasons, such as aspiration in the possible case of surgery, but the aspiration myth has been debunked again and again [2]. We are just waiting for obstetricians to get on the bandwagon.
Non-Negotiable Item 2. The "cleansing breath."
The "cleansing breath" (pictured to the right) is a breathing technique originally taught in Lamaze childbirth education classes [4]. It is also known as the "relaxation breath" and the "good-bye breath." The basic idea is relaxation during (and between) contractions. When she feels a contraction coming, the mother takes a deep breath, visualizing her entire body going limp when she exhales. This prepares her body for the contraction ahead. The contraction comes, taking her whole focus. When she feels the contraction is leaving, she takes another deep breath and exhales, breathing away the contraction, and issuing it a much-needed farewell. Keep in mind there are only about 314 contractions in one full first-time labor. Each cleansing breath gives a welcoming hello and a parting good-bye to one of these 314.
Follow up the cleansing "good-bye" breath with a sip of water. Eat, drink, and be mobile in labor. In particular, drink to stay hydrated. Birth partners, take note! Offer a sip of water after every contraction. Breathe to stay focused and relaxed at the onset of a contraction, and breathe to say good-bye after the contraction fades.
This discussion may have gotten you thinking about your own hospital's policy: What does your birthplace do routinely, and what leeway do you have with your birth plan? Check out this online list of questions to ask your obstetrician and hospital or birth center. Strike up a conversation with your OB. And remember that the object of the game is to be well-informed and well-intentioned.
References
Non-Negotiable Item 1. Drinking in labor.
Eating in early labor is a given. For many women, early labor comes on slowly and lasts an average of 12 hours. Contractions are mellow and irregular. Women and their partners are advised to rest, to walk, to eat, to smooch, and to enjoy this last bit of baby-free time in their lives.
In early labor, mom is preparing to run a marathon. She is stretching her strongest muscle: the uterus. Would you run a marathon on an empty stomach? Of course not. Eat. Eat carbs. Eat some protein. Eat whatever sounds good to you. If nothing sounds good to you, try some toast.
Eating in active labor is a bit harder. If mom is at home, and she is hungry, she should eat. At the hospital, eating may be restricted or downright forbidden.
Now, this is the non-negotiable part: After every contraction, take a sip of water.
Especially if it is your intention to have a hospital birth naturally, with no drugs and minimal interventions, drinking water is key.
In many Baby-Friendly™ birthing facility hospitals (such as the ones in my area), the standard procedure is, upon admission, to start a heparin lock, or hep-lock. A hep-lock is a needle and a catheter with a lid on it. The needle goes in the vein, and the rest of it is taped to the arm so that it stays put when mom moves around. Depending on the obstetrician, the IV fluids are negotiable, and mom and her partner can ask that nothing is hooked up to the hep-lock until something is needed.
The doctors' argument for a hep-lock is that if there is an emergency situation later in labor (e.g., in transition) that the IV has already been started, as it can be more difficult to find the vein in a stressful situation. Some activists argue that having a hep-lock started creates emergency situations: a doctor is more likely to intervene when the vein is open than if the extra work to start the IV still needs to be done.
Times that IV fluids are needed (and required) include, in order of severity, when mom is severely dehydrated and unable to drink, when mom requests an epidural, and when preparing for a Caesarean section [3]. Notice that I say that these are required cases of IV fluid use. Some obstetricians give IV fluids routinely. In routine cases, I suggest you argue for a hep-lock, or no intervention at all, if possible.
The reason I harp on routine use of IV fluids so much is fourfold. First, the IV and associated IV pole hinders mobility. It is harder to move around and change positions, harder to find comfortable positions, harder to engage in hydrotherapy (i.e., bath tub or shower), when wheeling around a pole. Second, in many cases, when IV fluids are being administered, women become over-hydrated; if there is glucose in the IV, the baby often shows signs of hyperglycemia before birth followed by hypoglycemia after birth. Third, in many cases, when IV fluids are being administered, women are prevented from eating and drinking, "just in case." I discuss this in the paragraphs that follow. Fourth, and finally, an IV is an often-unnecessary intervention, so I disagree on principle. Any intervention, especially an unnecessary one, adds to a passive maternal mindset, making her feel that labor is something that is done to her, against her control, rather than something that she is doing.
Back to drinking water. Drinking during labor prevents dehydration, thereby helping to prevent routine use of IV fluids.
Although it is impossible to name the cause and the effect, the association exists: Women who were advised to eat and drink in labor had a lower rate of instrumental birth (13% for those that ate and drank, vs 24% for the women that did not) [1]. Some doctors do not allow women to eat or drink in labor for various reasons, such as aspiration in the possible case of surgery, but the aspiration myth has been debunked again and again [2]. We are just waiting for obstetricians to get on the bandwagon.
Non-Negotiable Item 2. The "cleansing breath."
The "cleansing breath" (pictured to the right) is a breathing technique originally taught in Lamaze childbirth education classes [4]. It is also known as the "relaxation breath" and the "good-bye breath." The basic idea is relaxation during (and between) contractions. When she feels a contraction coming, the mother takes a deep breath, visualizing her entire body going limp when she exhales. This prepares her body for the contraction ahead. The contraction comes, taking her whole focus. When she feels the contraction is leaving, she takes another deep breath and exhales, breathing away the contraction, and issuing it a much-needed farewell. Keep in mind there are only about 314 contractions in one full first-time labor. Each cleansing breath gives a welcoming hello and a parting good-bye to one of these 314.
Conclusion
This discussion may have gotten you thinking about your own hospital's policy: What does your birthplace do routinely, and what leeway do you have with your birth plan? Check out this online list of questions to ask your obstetrician and hospital or birth center. Strike up a conversation with your OB. And remember that the object of the game is to be well-informed and well-intentioned.
References
[1] Scheepers, H. C., Thans, M. C., de Jong, P. A., Essed, G. G., Le Cessie, S. and Kanhai, H. H. (2001), Eating and Drinking in Labor: The Influence of Caregiver Advice on Women's Behavior. Birth, 28: 119–123. doi: 10.1046/j.1523-536X.2001.00119.x
[2] Ludka, L. M. and Roberts, C. C. (1993), Eating and drinking in labor: A literature review. Journal of Nurse-Midwifery, 38(4): 199–207. doi: 10.1016/0091-2182(93)90003-Y
[3] Midwifery Today E-News. (1999), Heplock or IV? Midwifery Today E-News, 1(37). September 1999.
[4] Hurprich, P. A. (1977), Assisting the couple through a Lamaze labor and delivery. MCN: The American Journal of Maternal/Child Nursing, 2(4): 245.
[3] Midwifery Today E-News. (1999), Heplock or IV? Midwifery Today E-News, 1(37). September 1999.
[4] Hurprich, P. A. (1977), Assisting the couple through a Lamaze labor and delivery. MCN: The American Journal of Maternal/Child Nursing, 2(4): 245.
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