Okay, I don’t know about you all, but I am just about all talked out regarding interventions, childbirth and childbirth locations. At least for now. We can find something else to scream at each other about next week.
In the spirit of Web Soup’s Palate Cleanser, I present to you…
Newborn. Clouded. Leopard. Cubs.
Dr. Isis wrote a post on how having a home birth is not a feminist choice, cited some papers to support her contention that home births are unsafe, and described the decision to birth at home as “utter nonsense,” warning readers that she will “judge you” should you choose to have a home birth, and compared these women to those who choose not to vaccinate their kids. The comment section contained a number of comments denigrating those who choose or advocate home birth.
Phew. It was a lot to take in, and hard not to take personally.
The thing is, I don’t necessarily advocate home birth. I advocate better information about the impact of hospital interventions on maternal and infant morbidity and mortality, their impact on breastfeeding success, and their impact on maternal-infant bonding and postpartum depression. I also think it’s important to question the motivations of hospitals, who have a lot of money at stake were women to start choosing birth centers or home births at a higher rate. It also seems like I need to be advocating for better information about home birth, as Dr. Isis and Dr. Tuteur have recently shared statistics suggesting that homebirth in the Netherlands is not the utopia most of us have assumed.
That said, I empathize strongly with those who advocate home birth, and I am not completely against it. And I think that comes from a number of places. For now, I just want to briefly share the emotional reasons why, because I think a better understanding of this population of women would make it easier for clinicians and those who are against home birth to have a more productive conversation with them. I’m happy to debate the evidence-based reasons another time. But when I see this population of women denigrated, called “homebirthers,” essentialized, and conflated with anti-vaxxers, I feel like something needs to be said.
Women have been historically understudied and misunderstood within medical science. Of course things are improving now, but the fact that everyone owns at least one pink thing that is supposed to support breast cancer research demonstrates, to me, how women’s health still needs better advocates. There are still people out there, publishing as late as 2003, who think menstruation happens because women need to get toxins out of their systems every month, and until at least 1977 this menotoxin was thought to wilt flowers (I PROMISE to write a post about the history of the study of menstruation soon!). Many treatments for women, like hormonal contraception and assisted reproductive technologies, are not only understudied but are not necessarily designed to understand the contexts that influence an individual’s physiology – since things like exercise and diet composition affect your hormone levels, and stress affects your fertility, this is pretty important.
Add to this the politics of reproduction. Women’s bodies often feel like a warzone – we are not in control of them, because they are a political tool. Other people get to make decisions about our bodies all the time – by making birth control more or less affordable, by making abortions legal or not, or harder or easier to get, they impact our decisions. When groups physically threaten abortion providers, and the number of abortion providers goes down, that is someone else controlling our decisions. Pregnant patients don’t even have the same rights as nonpregnant ones.
When you combine this broader lack of control, with the lack of control one feels both while pregnant and while in labor, and compound all this with how it can feel to give birth in a hospital, you can get an uncomfortable situation. Home birth represents women trying to figure out, to the best of their abilities, how to take some of that control back. Is it the best possible way to do it? Perhaps not. But perhaps this means that the people that demand that births happen in a hospital (because I tend to see people advocate only one or the other, hospital or home, and rarely do we even talk about freestanding birth centers) need to figure out how to reach out to these women.
Hospitals don’t need birth suites with more iPod docks or to promise to give you a CD full of digital photos of your infant when you are pushed via wheelchair out the door. These are the main advertisements I see for hospital birth centers these days, as though making it homey, or having a photographer, makes one hospital a better choice than another. Instead, hospitals and their staff need to convey more understanding and be ready to explain procedures to women. They have to be willing to produce birth plans with the patient that they then read and enforce as much as they can. They need to have good relationships with the people who want to support the mother, rather than antagonistic ones.
As Isis herself says at the end of her post, “We should be continuing to ask how can we make women feel empowered in an environment that offers the best chance of survival for their offspring.” My worry is that, since hospitals – at least the ones I have visited or witnessed births at myself – are not exactly prioritizing this, we’ve already lost a huge number of women. And with so few states making it legally and financially feasible for midwives to set up stand-alone birth centers that work with hospitals, women will continue to feel stuck between a rock and a hard place.
All of this is to say, I know that Dr. Isis and some of her commenters feel like this is a no-brainer, based on their read of the evidence. But many women calculate their trade-offs differently, so we need to figure out how to gently change how they make those calculations, or change what it means to give birth in a hospital.
Last week, I polled my readers to find out what they thought were the best ways to reach non-science majors to get them to appreciate, even fall in love with, science. Here are a few things they had to say:
To be successful in a 100-level course, you have to be prepared to work hard (perhaps harder than in your non-science classes). You have to be willing to get into a different mind-set where partial credit isn’t given for well-argued answers if the answer is wrong. You have to take lots of notes, you have to do the reading.…
To find your passion in science, think about the way the world works and ask yourself why. It could be anything. Why are there different races? Is race real- as in is it just a social construct or is there a biological basis for it? Why do you pee a lot when you drink alcohol? How does a computer store data? How does a touch screen work? What are seashells made of? How are they made? If you look critically at everything in your daily life, you’ll realize it’s all science. Recapture the child-like habit of always asking how and why.
The first time through college I was a total science-phobe….
I’m now much better able to recognize the underlying assumptions that are distorting my understanding. When I came to chemistry again as an adult, I realized that one of the things that had gotten in the way of my ability to learn chemistry earlier was my completely unreflective assumption that chemistry was basically about the physical properties of liquids, and physics was basically about the physical properties of solids…. Realizing that there were different sorts of distinction in play was key to my grasping what exactly a chemistry class was trying to teach me and to adjust my big picture accordingly, which made it a lot easier to slot into place the subject matter of the course as I went through the semester….
The point an earlier commenter made about making students comfortable with the fact that the material is hard is also key. As an adult, I’m a lot more open to being wrong. I understand, at the core of my being, that a string of wrong answers is often a necessary stage for arriving at the right answer—in a way that I didn’t in high school and college. I fear that students now are even LESS prepared to cope with wrong answers than I was—test-based education has eroded their capacity to see learning as an ongoing process, not a series of predetermined outcomes. Anything that you can do to impress upon students that it’s okay—even helpful!–to be wrong (and to model for them how to use wrong answers as a pathway to better understanding) will help make them more confident.
“What do you think it takes to become science literate?”…
Understanding something about the process of science. I don’t mean the cookbook “scientific method” that shows up in textbooks, but the actual messy reality that professional scientists deal with, like the variety of evidence, something about how science is funded, and why we’re always asking, “Was that in a peer-reviewed paper?”
College assumes the ability to study independently and read not only the textbook but looking at other sources (yes, wiki can help) that give overviews and different presentations on the same topics as presented in class. A great help is to immediately review briefly the content of the class following the class session (content goes to long-term memory with review within 24 hours). Taking courses is a job, an investment in the future. We cannot predict when and where bits and pieces of the class will become relevant in whatever work we do later.
But this is just a sampling – you need to read the comment section to see the whole thing.
What I found useful about this exercise was that it gave me space to step back and think about my class. How am I supporting my students, how am I enabling good or bad behaviors? But I also wanted to think about what my students can teach me.
So, now it’s up to you, Anth 143 students. Does their advice resonate? What does it take to grab your attention, to make you trust us? How did your earlier experiences of science influence how you feel about it today? And what will it take to build a true appreciation of science in you?
This fall I teach Anth 143: Biology of human behavior for the fourth time here at the University of Illinois, Urbana-Champaign. The difference is that most of the time I will be teaching I will be behind a computer or camera lens. Undergraduates will lead in-person sections designed to help students gain the skills they need in college science courses and beyond, where the TAs and I will handle the content and assignments online. I am even creating some videos to replace lectures, and what’s exciting is that this has opened up a whole new way for me to share science with my students. I can do woman-on-the-street interviews, I can interview colleagues, I can do demonstrations or explain graphs (and yes, I’ll share some of these on the blog as well). Producing a hybrid face-to-face/online course is allowing me to make some materials more intimate and interesting than I could have produced before, back when this was a giant lecture of 750 students at once.
In the past, I have written a Frequently Asked Questions page to divert some of the hundreds of emails I receive at the start of the semester. The first question is this:
1) Q: Should I really be sending this email to my TA or professor?
A: Probably not. Go here to figure it out.
A bit harsh, perhaps, but without a firm policy I get deluged with emails from non-student accounts that look like this:
Hey, whats the textboooook
-Sent from my iPhone
Unfortunately, my unwillingness to engage with over a hundred of these emails every single week for the first three weeks leads to the following sorts of student evaluations:
This prof was a bitch. Refused to answer email. Totally cared more about her research than this class.
I can’t totally disown the first sentence, though I leave this attitude at the skating rink. But the second sentence is untrue – I do occasionally miss or forget an email, but that only happens with students from my lab who can come and find me, not those in this course. And the last comment cannot be true, because I have put my professional interests aside again and again to devote time to revamping this course, when I full well know that to get tenure I need to do more research.
So, I have been thinking a bit more about how I can balance generosity of spirit with sanity of mind. How can I convey the reality of my expectations for students in my course without their chafing at the idea that I cannot answer questions that I know they can look up?
How can I teach them to do the work I know they can do?
I don’t want to have a conversation about “kids these days,” or the problems of helicopter parents, or cell phones (or sexism in teaching, which could be another entire thread). The reality is that my students are bright, they are talented, and they are interesting. I’m sure I would enjoy getting to know them all if given half the chance.
They just happen to be non-science majors taking an enormous science course as part of their general education requirements. This is what I have come up against, again and again. Many of them are terrified and think they will fail, and they are emailing me mundane questions I know they can answer because they just want to make a connection. Many have already been convinced by someone earlier in their lives that they aren’t good at science. Many went to schools with struggling science programs, or they were taught only enough to pass placement tests. It’s not their fault that we don’t invest enough as a culture or country in science education to give teachers the tools they need to excite students about science and give them confidence in it.
There are a few big changes we’re rolling out this semester that should give the students a helping hand – the face to face sections replacing lecture will put students in rooms of 30 rather than one room of 750. I will probably hold a series of brown bag lunches through the semester where students can just sign up to come hang out with me too.
But I know these students could still use more help. And that’s where you come in.
Some of you reading are current or former students. Some are scientists by trade, and some just love to read science. What is your advice for my students? What do you think it takes to become science literate, to have success in a 100-level science course, or to find your passion in science? What would you do to convey to these students that they know and understand far more than they realize?
I want to use this post as a chance to start a real discussion – you all get the first stab at these questions, but then I’m going to invite my students over to my next post in this series. Let’s see if we can get students and SciAm readers together talking about why science is cool, and to foster a community that appreciates science.
I am starting to incorporate video in my large enrollment course for the fall, Anth 143: Biology and Human Behavior (more on that another time, and yes, I will share at least some of them with you). The video expert on campus that I met with today pointed me to this talk by Theo Gray (Ig Nobel prize winner, founder of Wolfram Research).
The video quality isn’t great, but the topic is, and I encourage you to watch the whole thing. Gray makes a number of interesting and important points about how people understand and assess risk, and how we appreciate science education and research.
At about the twelve minute point, he refers back to an amusing quote about how science is most exciting to the student when he thinks the teacher may die. He says that boys in particular are drawn to science when there are explosions (he was absolutely not saying anything about differences in abilities, or making value statements on men and women in science – this was a benign side comment within an excellent talk).
It got me thinking, and I wanted to interrogate this for two reasons. First, I imagine there are many girls who are also drawn into science with explosions. And second, I wonder for those girls (and boys) who aren’t drawn to science with explosions, what would draw them into science?
My hope is that this series of videos I am starting to make for my 100-level, general education core requirement class will draw the student in with stories, interviews, and ways where I test assumptions that students hold about the nature of being human. I wonder, is this one of the other ways we can draw non-scientists into science?
But what are other ways? Those of us who are faculty and grad students are about to return to the classroom for the fall. What would you have us do this semester to do a better job exciting men and women, people of different ethnicities, class backgrounds and sexualities?
(Also check out a few of the other TEDxUIllinois talks from last year: May Berenbaum, famous entymologist; 90s rockers Rose Marshack & Rick Valentin; Leon Dash, college of media professor, Pulitzer Prize winner and wartime correspondent.)
What I do these days is Real Science, of course, but no one told me you could study hormones and the uterus and call it Science when I was in high school. So when I asked around about how I could contribute to Scientific American’s Chemistry Day, and someone suggested I look into vaginal pH and its impact on yeast infections, my interest was piqued.
You probably know that pH is how you measure how acid or basic a solution is. And you may even remember that water is considered neutral, at a pH of about 7 along the 0 to 14 pH scale. But did anyone tell you that the vagina is acidic?
Healthy, premenopausal vaginal pH tends to range from about 3.8-4.5. (However, this may be a bit US or Euro-centric. A topic for a whole other blog post would be to examine global variation in pH: I found an article on Indonesian women that suggests a slightly higher average: Ocviyanti et al 2010.) Having an acidic vagina is a good thing, because it makes the vaginal and uterine environment less hospitable to bacteria and other foreign bodies. When the vagina is a bit more basic, say around 5 and up, it seems to be more susceptible to bacterial infections and yeast overgrowth.
A few things impact vaginal pH. First, it appears to correlate inversely with estradiol concentrations. Estradiol is the hormone that increases through the first half of the cycle and peaks at ovulation. This means estradiol is rather low from the premenstrual phase, through menses and the first week or so of the next cycle. So the vagina becomes a bit more basic during this time, as well as through perimenopause and menopause. In fact by menopause, vaginal pH nears neutral (Caillouette et al 1997).
As you might expect, putting things into your vagina with a higher pH can increase its pH as well. This is where unprotected heterosexual sex and douching come in. Semen is very slightly basic, with a pH of healthy ejaculate around 7.2-7.8. This means an acidic vaginal environment could be inhospitable to semen, but also that semen could increase vaginal pH.
To douche is to cleanse the vagina, usually with a stream of liquid. There are now also wipes available. Some, but not all, data suggest African-American women have different attitudes about douching than Caucasian women, and douche more frequently (Hansen Cottrell 2006).
Yet aside from its use as an insult (or, in the case of my roller derby team, a battle cry when a particular jammer is up), the term douche probably didn’t make it into regular conversation that often… until recently. Summer’s Eve, a brand of feminine cleaning products that includes douches and wipes, has gotten into some trouble with their most recent advertising campaign. Their talking hand ads portray racial stereotypes (and have since been pulled), and their historical ad, in the words of a recent feministing commenter, help remind women that to many we are just “a vagina with legs.”
With these videos, young and old alike (the extended version of the “historical” one played at the opening of Harry Potter) now have the impression that douching and feminine wipes are a way to show your vagina some love.
They are not.
A quick Google search turns up several reputable websites with good medical information, all of which recommend against douching. A quick Google Scholar search reveals empirical science articles that demonstrate at least two main reasons douching is unhealthy. First, many douching products are more basic than a healthy premenopausal vagina. Second, douching products and feminine wipes contain fragrance, which can irritate the sensitive skin of the labia, vulva and vagina.
Both of these issues serve to disrupt normal vaginal flora. And when you disrupt the normal flora, the benign bacteria who live in your body all the time and whose presence tends to outcompete the bad stuff, you get more of the bad stuff. This can lead to an increased risk of bacterial vaginosis (Brotman et al 2008, Holzman et al 2001) and yeast infections, and BV in particular can increase the risk of pre-term birth (Hillier et al 1995).
Now, some douche products claim to be pH-balanced, and Summer’s Eve is one of them. But I cannot find for the life of me what that actual pH is. Is it pH-balanced to skin (around 5.5)? Is it pH-balanced in that it is neutral (7)? Both of those would indicate that it is too alkaline for the vagina.
But even if we assume that feminine cleansing products are at a low enough pH to not disrupt the vagina’s acidity, you still have fragrance. And not only are a significant number of people now allergic to the main fragrances used in consumer products (Buckley et al 2001), fragrances can be inherently irritating to the skin around the genitals in those who aren’t allergic. Allergic reactions to fragrance can initiate or worsen vulvar disease (Margesson 2004).
Let your vagina clean itself. It is acidic for a reason, and no, it’s not supposed to smell like a flower. It’s supposed to smell like a vagina.
Brotman, R., Klebanoff, M., Nansel, T., Andrews, W., Schwebke, J., Zhang, J., Yu, K., Zenilman, J., & Scharfstein, D. (2008). A Longitudinal Study of Vaginal Douching and Bacterial Vaginosis–A Marginal Structural Modeling Analysis American Journal of Epidemiology, 168 (2), 188-196 DOI: 10.1093/aje/kwn103
Buckley, D., Wakelin, S., Seed, P., Holloway, D., Rycroft, R., White, I., & McFadden, J. (2000). The frequency of fragrance allergy in a patch-test population over a 17-year period British Journal of Dermatology, 142 (2), 279-283 DOI: 10.1046/j.1365-2133.2000.03298.x
Caillouette JC, Sharp CF Jr, Zimmerman GJ, & Roy S (1997). Vaginal pH as a marker for bacterial pathogens and menopausal status. American journal of obstetrics and gynecology, 176 (6) PMID: 9215184
Cottrell, B. (2003). Vaginal Douching Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32 (1), 12-18 DOI: 10.1177/0884217502239796
Hillier, S., Nugent, R., Eschenbach, D., Krohn, M., Gibbs, R., Martin, D., Cotch, M., Edelman, R., Pastorek, J., Rao, A., McNellis, D., Regan, J., Carey, J., & Klebanoff, M. (1995). Association between Bacterial Vaginosis and Preterm Delivery of a Low-Birth-Weight Infant New England Journal of Medicine, 333 (26), 1737-1742 DOI: 10.1056/NEJM199512283332604
Holzman, C., Leventhal, J., Qiu, H., Jones, N., & Wang, J. (2001). Factors Linked to Bacterial Vaginosis in Nonpregnant Women American Journal of Public Health, 91 (10), 1664-1670 DOI: 10.2105/AJPH.91.10.1664
Margesson, L. (2004). Contact dermatitis of the vulva Dermatologic Therapy, 17 (1), 20-27 DOI: 10.1111/j.1396-0296.2004.04003.x
Ocviyanti, D, Rosana, Y, Arifin, Z, & Darmawan, F (2010). Effect of contraception on vaginal acidity among Indonesian women Indonesian Journal of Obstetrics and Gynecology, 34 (2), 69-72