The snoring going on next to me isn't helping. It's 4:17AM, I've been up since 1:30. But, I've done a lot of work on a couple of papers that are due in the next few weeks. I couldn't do the ones that actually required me to read textbooks, or journal printouts, but since I've got quite a few on the 'puter on PDF, I was able to get a decent amount done. Other than that, I'm not sure why I couldn't sleep tonight - I didn't even drink too much caffeine!
I had insomnia earlier this week as well, that one was all the nagging things I needed to do running through my brain, and so I sat up, grabbed a pack of post-its, and made notes. I went RIGHT back to sleep after that. In the AM I woke to my bedside dresser COVERED in barely legible post-its. I spent the rest of the week pulling them off and throwing them away as I finished the task listed there.
That reminds me, I need to pay bills.
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Sunday, October 14
Saturday, October 13
Saturated?
by
Amanda Aaronson
on Sat 13 Oct 2007 09:19 AM PDT
All this literature review is making me realize that their has been a decent amount of research - although in reality it is far from saturated - into labor interventions and their associated risk.
What does seem to be missing is the study of the need for a pediatric team at delivery, low initial Apgar scores, and what can increase the risk of these two. Most research seems to identify "no significant neonatal morbidity". A.k.a. "we may have broken the process, but we could fix it and baby was fine in the end". Of course first thing to do is to prove why these initial moments are clinically important, which is hard to do in this day and age where most people have come to believe that this is part of the "normal" process. I'm not sure this is within the scope of my dissertation. Again, it's something that I will start to set up to evaluate when I'm done. At this point, I remain on track to piggy back my dissertation on my advisor's existing research. But I can continue to work the literature and set things up to do it when I'm done. Friday, October 12
From the Guru to the Gunk
by
Amanda Aaronson
on Fri 12 Oct 2007 08:57 PM PDT
Having read Ellice Lieberman's work at some length now, I'm still convinced of her goddess status - a midwife in doctor's clothing? Probably not, medical intervention is acknowledged by her to be overused, but there is still an acceptance of it in places that wouldn't follow a true midwifery model.
But that's okay, it gives her "street cred" - in that as an MD, she can pass off info that a midwife could not, unfortunately. But I haven't heard back from her yet. I did follow up my first e-mail with a "just in case the first try went to your SPAM folder" addendum. So there's the Guru update. Now for The Gunk, aka what I see as sloppy research. I'm reading an article about clavicular fracture in "normal" labor and delivery. To the authors, it appears (thought it was not clearly defined) that that means "vaginal". Over 12 years, and out of over 27 thousand births, they had 403 infants "diagnosed" with clavicular fractures. Of those, they only used 87! They excluded infants who were not occiput anterior (now, I would think that malpositioning would be a risk factor for clavicle fractures), and who did not have a fetal weight estimate done on sonogram (so the expectation of "big baby" was already set up - my guess is that the management of that labor would be less than "normal"). Additionally, their diagnostic criteria for clavicular fracture included:
Findings include significant relationships between clavicular fractures and maternal height, duration of second stage of labor, fetal weight estimation (but not actual birth weight, weird, no?), and birth length. None of this makes intuitive sense to me. In the end, they acknowledge no way to accurately predict clavicular fracture risk, and that it is a very small risk. Could be interesting to follow up some day, though, take a look at variables that were intentionally eliminated here. Reference: Kaplan, B, Rabinerson, D, Avrech, O.M., Carmi, N., Steinberg, D.M., & Merlob, P. (1998). Fracture of the clavicle in the newborn following normal labor and delivery. International Journal of Gynecology & Obstetrics, 63, 15-20. Tuesday, October 9
Resilient Families, Surviving Adversity
by
Amanda Aaronson
on Tue 09 Oct 2007 08:47 PM PDT
This is in tribute to G&E, M&A, S&K and all the other families undergoing family stress at the hands of medical crisis.
I was talking to a dear friend about surviving, coping, and adapting - as an individual as well as as a family - in the face of loss... and I found some particularly pertinent info in some reading we had to do for my Family Theory class. Per F Walsh in her 2003 article entitled "Family Resilience: A Framework for Clinical Practice", family members may cope with health crises in different ways. Stages of grief may be moved into and out of by different members at different times. Further, gender differences may result in a widening gap between family members. Men tend to withdraw or become angry, whereas women tend to reach out and express emotions. All of this leading to a feeling of being out of sync with ones family, and particularly a spouse/partner. Feelings of loss of control can result in members attempting to control each other - creating some sense of control, albeit an unhealthy one. This may be especially true in men who don't like to demonstrate loss of control (over ones own emotions in particular). Open communication, negotiations, and "collaborative problem solving" are crucial elements to resiliency in families. Walsh said specifically Each family must find it's own pathways through adversity, fitting their situation, their cultural orientation and their personal strengths and resources.(P. 13)Another element to this article that I liked was the discussion of not trying to "bounce back", rather moving to "bounce forward". You can never go back to where you were... but you CAN find a healthy new normal, and become yourself, and your family again, within it. Reference: Family Process, 2003 Vol 2, no. 1, pg. 1-19. Friday, October 5
Contacting the Guru
by
Amanda Aaronson
on Fri 05 Oct 2007 04:39 PM PDT
I sent an e-mail today to Ellice Lieberman. She's a Harvard professor in the School of Medicine. She practices at Brigham and Women's hospital. Most importanly, she's published quite the body of work regarding risks associated with epidural analgesia.
Lieberman E, Davidson K, Lee-Parritz A, Shearer E. Changes in fetal position during labor and their association with epidural analgesia.A small handfull of these are available in free full-text for anyone interested in tracking them down and reading them. I'm actually nervous to hear back from her! |
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