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Posts Tagged ‘Childbirth’

Childbirth: More Difficult Than You Think

March 27, 2009

If you were to ask teens in a sex education class about childbirth in America, most would agree that it is a relatively safe and easy procedure with practically no side effects. But childbirth is not nearly as risk-free in other places, especially in Ethiopia, Tanzania, and other countries in sub-Saharan Africa.

A devastating factor called an obstetric fistula can wreak havoc on young and adult women who give birth in poor, rural countries that lack doctors and nurses, sanitary facilities, roads, and methods of transportation.

A recent article in Science Times provides an excellent explanation of an obstetric fistula. Times reporter Denise Grady describes how a fistula develops after women experience complications during childbirth: “Obstructed labor can kill the mother [and baby] or crush her bladder, uterus, and vagina between her pelvic bones and the baby’s skull. The injured tissue dies, leaving a fistula: a hole that lets urine stream out constantly through the vagina. In some cases, the rectum is damaged and the stool leaks out.”

Young girls ages 13 to 17 are most vulnerable to obstetric fistulas. They are often married off soon after their first menstrual period, usually to older men in the community, and because of poor diet and nutrition, their bodies and bones are not strong enough to withstand normal labor. Exacerbating the problem, most of these young women live in rural areas—miles, hours, and even days from an urban medical clinic or hospital—and there is no transportation other than dusty carts and ancient buses to take them where they can have a safe delivery. There is no help when these women go into prolonged labor. The baby usually dies in their uterus and they develop fistulas.

Unless the fistulas are repaired by skilled surgeons, these young women leak urine and feces through their fistulas, some continuously. Most are ostracized from their homes and villages and often forced to live in huts they have made themselves. If married, their husbands usually leave them to marry another woman.

The only consolation to this terrible problem is that the operation to close the fistula is 90-percent effective. Grady reports that a charitable group—the African Medical and Research Foundation—brings skilled surgeons to Dodoma, Tanzania, to operate and train doctors and nurses from other places in Africa on how to repair fistulas.

But the person who’s done the most to shed light on the fistula/childbirth problem, and to bring help to young African woman, is 83-year-old Australian obstetrician/gynecologist Dr. Catherine Hamlin. She and her late husband, Reginald, also a surgeon, emigrated from Australia to Ethiopia more than 45 years ago to start a school of midwifery. Instead, after seeing the fistula problem, they pioneered the first operation to repair them and opened the first and only world center dedicated to providing free fistula repair, the Addis Ababa Fistula Hospital.

Hamlin tells the story of founding the hospital and the Fistula Foundation, which raises funds to support and expand its work, in her book The Hospital by the River.

The Fistula Foundation released a DVD, A Walk to Beautiful, that is tailor-made for high-school classroom use. This unforgettable film runs over an hour and is divided into six sections, which makes it very appropriate for classroom viewing and discussion. (We will give away a free copy of the video to the first five educators who comment on this post!)

Why should we talk about the problem of obstetric fistula among African women in our classrooms? Studying childbirth in places like sub-Saharan Africa might make our students more appreciative of the great progress we’ve made in medicine in the U.S. Some may become more understanding of international health problems, more empathetic about the needs of teens in poorer parts of the world, and more willing to contribute to others’ well being.

A high school health class might decide to hold a car wash or bake sale to raise funds for Addis Ababa Fistula Hospital. A student might be so inspired by the film that he or she might become an ob-gyn and spend a part of his or her life repairing fistulas and educating young women about their dangers in one of Dr. Hamlin’s hospitals.

Now that indeed would be beautiful.

The Octuplets: A Lesson Plan

February 12, 2009

Octuplets: The word is such a rarity that it isn’t even included in the spellcheck of Microsoft Word. A certain woman and the worldwide media have put it on the map. Surely, as educators, you must have heard the buzz about the multiple births in the hallways and classrooms of the schools where you teach.

Whoever Nayda Suleman, the mother of the octuplets, really is or isn’t, she’s surely handed sexuality educators the teachable moment of the semester. I suggest you pause whatever curriculum you are using and capitalize on this opportunity to talk to your students about a wide variety of issues triggered by Suleman, a single mother of six who gave birth to eight babies, all conceived through in vitro fertilization.

But I don’t suggest that you focus your students’ attention on Suleman’s behavior or that of her medical doctor. Rather, I suggest that you use the following lesson plan, which I created after reading Ellen Goodman’s column, “Eight Is More than Enough.” The ideas in Goodman’s column provide an excellent basis for a lesson plan.

In her column, Goodman cites the following issues raised by Suleman’s births. She says the issues are “everything that we don’t really want to talk about in terms of pregnancy and child rearing”:

  • marital status,
  • money,
  • individual choice,
  • responsibility and
  • technology.

These issues should become central to your discussion with students. You could divide your students into five groups, and give each student one of the issues. Next, you could ask them to brainstorm together and then write down the pluses and minuses of each issue if someone was having a baby. For example, with marital status, the group might discuss the pluses and minuses of having a child as an unmarried teen, a single adult woman (with or without a job) or a committed couple in a marriage or long-term partnership.

The question of the appropriate age to conceive a child would certainly come up in the conversation among students. (My guess is that the students would conclude that having a child as a high-school student or a single parent would be immensely difficult.)

Individual group work around the other issues that Goodman suggests would enlarge and enrich the classroom conversation. Putting the students’ contributions to each issue on an easel-sized piece of paper and placing them up around the room would lead to a rich discussion about the heart of pregnancy and child rearing.

Goodman also asks another set of questions, which students could answer.

  • Does anyone have a right to tell anyone else how many kids to have?
  • Can only people who can afford children bear them?
  • If you are heterosexual female, do you need to have a husband to have a baby? (This might have already arisen under the discussion of “responsibility” in the first phase of the exercise.)

I might ask each student to answer each question individually and then hold a class discussion, with everyone chiming in and elaborating on his or her opinion.

A possible homework assignment might be for each student to browse the Internet and write a short paragraph about one of the following topics:

  • The history of the infertility movement;
  • The cost of having a single birth and/or multiple births to an individual family and to society;
  • Cost savings of providing family planning to poor women (which was stripped from the stimulus bill); and
  • The ethics of implanting multiple embryos and of destroying embryos.

I have tried to keep students away from giving their own opinions about the ethics of Suleman’s and her medical specialist’s behavior. This kind of discussion can cause some parents displeasure, if they hear about it. If the conversation reduces itself to a quarrel between those who support Suleman and those who do not, students will avoid the larger questions on bearing children. But students may want to talk generally, as a windup, about how or how not to regulate infertility treatments.

As a coda, it would worthwhile to review all forms of contraception. Students tell us so often that lessons on contraception are too dry and clinical to remember. A discussion of the methods against a backdrop of the octuplets’ birth might just be the perfect way for students to realize the profundity of bearing and raising a child. They may come away from the discussion with a better respect for the medical gift of contraception and a greater comfort with using contraception when and if they do decide to have sex.

If you decide to follow this lesson plan—amending it, of course, to suit your students’ ages—let us know if it flies. We shall put your feedback in another post. In the meantime, thanks, Ellen Goodman, for your thoughtful and good ideas!