User:MatthewNadybal/sandbox

Kelli's Peer Review

 * 1) I think your layout of a plan to alter this article is good. You have clear topics to add that can aid in your research. Also, each of your topics has at lease one citation which shows progress.
 * 2) I think the next step should be a breaking down of these articles and what information from them you will use to improve the article. By breaking down the contents of the sources, you will be able to find holes and maybe subtopics that you're missing.
 * 3) I definitely think that a es/wgs perspective can be added to this article. While it does include some of the ailments that occur under this form of medicine and how there is some lack of access, it doesn't describe some of the structural race and gender problems that we have learned about in class. I could see information on LGBTQ people being added too if there is data on it. Non heterosexual women don't seem to be addressed at all in the current article.
 * 4) I like how the topics that should/could be added are already laid out with the sources attached to them making the future article writing easier, I should include this in my article sandbox

Rose's peer review response: Hey Kelli! Thank you for your peer review. Your suggestion about using sources to explore subtopics was useful, because we have been using other wikipedia articles to gain an idea of how to form headings and subheadings. We need to research further into the LGBTQ2S perspective in this article, but we are unsure as to whether we were going to implement that perspective in the article. However, we are implementing an ES/WGS perspective into the article by address the numerous human rights violations conducted on pregnant women in the early 1900's and how medicine has improved since then.

-Haris Peer review-
Hi I think this topic is very interesting. I am sure there alot more impacts from Obstetric medicine. However it might be useful to dive into possible negative effects of effects in general in the perspective of ES/WGS scholars.

Matthew's peer review response: The feedback out peers provided helped me to see some gaps in information that we are missing. For example, in our sources it described how female minorities are more likely to be under-insured or uninsured. This data is relevant to the topic and can be described while still remaining neutral. Obstetric Medicine- This articles covers the topic of medicine as it regards to pregnant women. As we have learned in module 2, America has seen a medicalization of pregnant women driven by a capitalistic economy. https://www.ncbi.nlm.nih.gov/pmc/journals/2890/

After looking at other medically related pages on wikipedia, some of the basic areas we should cover for Obstetric medicine is history, the scope of the diseases it covers, and medical training. As we do more research in these topics we will find more subtopics that relate specifically to obstetric medicine. For HISTORY, https://pmj.bmj.com/content/78/919/311. Global aims of obstetric medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935022/ .SCOPE, https://www-sciencedirect-com.ezproxy.lib.calpoly.edu/search/advanced?docId=10.1016/j.ajog.2014.09.013. ETHICS, https://ebookcentral.proquest.com/lib/calpoly/reader.action?docID=217774&query= and https://onlinelibrary-wiley-com.ezproxy.lib.calpoly.edu/doi/full/10.1111/j.1467-9566.2006.00480.x.

Add goals on Talk page.

More sources. Medicalisation of pregnant women, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122835/, http://www.euro.who.int/__data/assets/pdf_file/0007/277738/Childbirth_myths-and-medicalization.pdf?ua=1

ethics https://plato.stanford.edu/entries/ethics-pregnancy/

Lack of access to medical care https://www.ncbi.nlm.nih.gov/books/NBK217704/

[Diagnostic tests], [Examinations], [PostPartum Care], [Professional requirements]

Obstetric Medicine, similar to maternal-fetal medicine, is a subspecialty of general internal medicine and obstetrics that specializes in process of prevention, diagnosing, and treating of medical disorders in pregnant women. It is closely related to the specialty of maternal-fetal medicine, although obstetric medicine does not directly intervene with the health of the foetus. The practice of obstetric medicine, or previously known as "obstetric intervention", primarily consisted of the extraction of the baby during instances of duress, such as obstructed labour or if the baby was positioned in breech.

Obstetric physicians may provide care for chronic medical conditions that precede the pregnancy (such as epilepsy, asthma or heart disease), or for new medical problems that develop while the pregnancy is already in progress (such as gestational diabetes, and hypertension). By the 19th century, obstetrics had become recognized as a medical discipline in Europe and the United States. Formal subspecialty training in obstetric medicine is currently offered in Australia, New Zealand, the United States, and Canada.

History and Current Status
Obstetrics gains its origins from the observation that, through out historical record, women have accompanied other women during the birthing stage of their pregnancy. Similar findings can be observed in Anthropological research of tribal birthing practices, ancient Egyptian depictions, and even scriptures in the Old Testament illustrate the presence of a woman figure, be it doctor or relative, present among the birthing of a baby.

During the 17th Century, doctors were weary about the connection between midwifery and medicine, and thus failed to acknowledge it's credibility. The practice of women assisting women through labor was viewed as uneducated. However, as time progressed, a new perspective amongst pregnant patients grew, where by they sought for mid-wives to deliver their babies. For example, in Wales and England, under 1% of people delivered their babies at home, which was a testament to the rise of midwives, that led to the present day professional field of Obstetrics. The roles of physicians in the process in delivering babies expanded as 17th century aristocrats utilized the best medical practitioners they could find.

Midwife Act 1902
The purpose of the act was to improve training for midwives as well as regulating their practice. This meant that women who wanted to identify as "midwives" had to do so under the certification and verification of the Act. Penalties would incur on women who fraudulently claimed certification, with imprisonment possibly going up to 12 months. The caveat to this act was that a woman could practically engage in midwife duties, however they could not give them self the title of midwife or imply that they were affiliated with the title. However, the basis of the act was the acknowledgement of the field, creating an environment for people to gain professional knowledge about the field. This act was significant in leading to the present practice of obstetric medicine as it created a pathway for women to begin practicing with pre/post natal care, leading to the discovery of numerous methods in obstetric medicine.

Obstetrics in the 1900's
During this period, the medical field was still grappling with the idea of obstetrics and midwifery which was deemed which were activities that were thought to be practiced by uneducated females, as they were unable to form a connection between medicine and midwifery. These circumstances led to the mistreatment of pregnant women, who were often made to partake in experimental procedures and untested treatments, which led to harm on mothers and the fetus.

Lack of Access
Maternal mortality is an ongoing issue that is rising among pregnant women. A challenge facing many pregnant women is the lack of access to specialized obstetric care, often resulting in untimely deaths and a increasing rate of maternal morbidity. This lack of access offered to women has resulted in an outreach programs attempted by clinicians to reach women who are currently suffering from the consequences of reduced accessibility. This increased awareness is emerging during a time of "obstetric transition", where research is noticing a notable shift in patterns from instances of high maternal mortality to patterns of lower maternal mortality. These patterns depict instances of high maternal mortality associated with implicit obstetric cause, while instances of low maternal mortality are related to factors such as maternal age, non-communicable disease (NCD) and indirect causes of maternal death (not directly linked to obstetric care).

The total cost of having a child in a hospital is can total several thousand dollars, which can be an expensive hurdle depending on an individual's socioeconomic status. Many countries lack the funding required to provide women from low-income households with prenatal care needs. This poses a problem for many women who are uninsured, or do not have access to adequate insurance. For women who are completely uninsured, their only source of prenatal care can be from charities and programs run by public funds, which is not a reliable source of prenatal care that has to be done regularly. In the United States, women who are poor, Black or Hispanic, or uneducated are most likely to be uninsured due to their increased likelihood to work in service jobs or work part time. When considering couples who have children in their early 20's, with an annual income of $19,800, having a child that on average costs $4,800 is a financial burden. Numerous insurance companies do not cover maternity care, which indicates that possessing insurance does not immediately clear couples of debt.

[Produce more information regarding racial reasons for lack of access]

Early obstetrics
During the 18th century, common methods of resolving obstructed labor often resulted in high mortality of the infant. These methods included pulling on the legs of the baby or using breeching hooks. WIlliam Smellie revolutionized child birth by writing works on how to use forceps in the assistance if childbirth. The practice of using forceps proved to be much more effective and less damaging to the baby.

Medicine

By the 20th century, medicinal drugs were used to treat pregnant women, or to provide them with prenatal care. By the 1950's, women were having given contraceptive pills to begin regulating their hormones and fertility, which effectively allowed couples to have planned pregnancies. By the 21st century, women were being given medication for the induction and augmentation of labor,

Common Ailments
Treating the ailments of pregnant mothers requires a unique approach, since medicines commonly used may have an adverse affect on the fetus. Some common ailments include, but are not limited to :


 * Hypertension (high blood pressure).
 * Pulmonary disease.
 * Gestational diabetes.
 * Lupus.
 * Blood clots.
 * Heart disease.


 * Kidney disease.
 * Seizures.
 * Thyroid problems.
 * Bleeding disorders.
 * Asthma.
 * Obesity in pregnancy.
 * Depression
 * Ectopic pregnancy
 * Anemia
 * Preeclampsia (related to hypertension)

Antepartum depression
A common ailment of pregnant women is antepartum depression. Depression can cause pregnant women to have poor nutrition or inadequate strength to nurture herself and her baby. The result of this can be problems in development and health of the fetus. The use of medicine to treat antepartum depression is a subject for debate, since some research indicates that the use of antidepressants during pregnancy can lead to physical malformations and long term health problems of the baby Other forms of treatment include support groups and psychotherapy.

Gestational Diabetes
Gestational diabetes is observed by elevated glucose levels in pregnant women who have never had diabetes. This form of diabetes occurs when placental hormones interfere with insulin produced by the mother, resulting in an excess of glucose in the blood. The excess glucose will cross the placenta and cause the baby's pancreas to produce extra insulin and store the excess glucose as fat. Gestational diabetes is treated by a diet and exercise regiment the goal of maintaining lower levels of glucose in the body.

Hypertension
Gestational Hypertension is characterized by high blood pressure during pregnancy. Chronic hypertension can lead to a severe condition called preeclampsia, which can result in damage to organs. Hypertension can cause the placenta to not receive enough blood and starving the fetus of oxygen. Hypertension is treated in pregnant mothers by adjusting their diet to contain less fat and salt, consuming enough water, and getting regular exercise.

Obesity During Pregnancy

Maternal obesity is a rising epidemic amongst pregnant women, that is detrimental to both the health of the baby and the mother. Obesity leads pregnant women to develop gestational diabetes and preeclampsia, and increase the risk of stillbirth and numerous congenital anomalies. Beyond the immediate risks during pregnancy, the obesity of the mother tends to create a predisposition for the baby to have the inclination to develop conditions like heart disease and diabetes. During pregnancy, the rate at which nutrition is absorbed and conveyed to the fetus affects its physiology and metabolic regularity. Nutrition available in either abundance, or scarcity, both affect the overall outcome of the fetus, thus creating a precursor for future health developments. Typical treatment includes monitored consumption of food, as well as moderate exercise.

Puerperal Sepsis
Puerperal Sepsis is a bacterial infection that affects the genital tract, commonly occurring after the birth of a baby. The symptoms typically appear one day after pregnancy, however symptoms may appear earlier if the woman is suffering from prolonged damage to the membranes in the vaginal tract. This was a leading factor in maternal mortality, as 80%-90% of women in some hospitals did not survive after receiving their diagnosis due to the rapidly spreading nature of the infection. Malnourished women, or with women with anaemia were susceptible to the infection. Some common symptoms included, but were not limited to: fever (temperature of 38°C or more), chills and general malaise, lower abdominal pain, tender uterus, sub involution of the uterus purulent, and foul-smelling lochia.

Pregnancy and HIV
HIV positive women who become pregnant require special types of treatment in order to prevent transmission from mother to fetus. Antiretrovirals are medications that reduce the viral load of the HIV virus in the mother's fluids and blood. Reduction of the viral load reduces the chance of the baby to become infected

Ethics
Many ethical issues arise around whether the mothers right to autonomy may have adverse effects on the fetus. These types of situations have been described as maternal autonomy vs. fetal rights. In the case of Angela Carter, In re A.C., a court order to perform an emergency cesarean section resulted in the death of the severely premature fetus and the terminally ill mother. In addition, obstetricians and pediatricians face challenges when a pregnant HIV positive woman refuses to treatment to prevent transmission from mother to baby. In these cases, mothers have the right to refuse treatments during pregnancy, but may subsequently face custody battles from the state to prevent the transmission of HIV via breastfeeding.

Another important field of discussion is what types of clinical trials are appropriate for pregnant mothers. When a drug designed to benefit the health of the mother is being tested, the potential benefits of the drug may only be explored if the risk to the fetus is minimal. However, the concern is how severe must a health condition must be to justify exposing the fetus to any sort of risk. Clinical trials on pregnant women are forbidden if the drug is not designed for the benefit of the mother or fetus.