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Paced Bottle Feeding- What is it?

Liliana Cruz, MS4, Drexel University College of Medicine

Many new moms are hesitant to see lactation consultants if they are not choosing to breastfeed their newborn, thinking that they will be shamed for formula feeding or that we only want to help breastfeeding moms. However, paced bottle feeding is a useful technique that breastfeeding and formula feeding moms alike can use to help prevent overfeeding and improve digestion for their baby.

 When using the paced bottle feeding technique, babies are positioned in an upright sitting position, and the bottle is held horizontally to their mouth. Instead of just accepting the flow from a bottle with minimal effort from the baby, which is what often happens when babies are fed laying down, baby needs to use their suckling strength to draw milk from the bottle, similar to what happens when a baby is breastfeeding. Moms are also encouraged to pause and burp their baby periodically throughout the feed to ensure that baby is only taking in as much as they need in that moment and to help smooth digestion.

We often advise breastfeeding moms to feed “on demand” or whenever their baby is exhibiting hunger cues like suckling on their hands or rooting. Babies who are fed at the breast will only take in as much milk as they can handle at that moment, often returning for a short “snack” or “dessert” after their main feed if they feel hungry again. With paced bottle feeding, formula fed babies are also only taking in as much as they need in the moment, and thus will also need to be fed in a similar on demand fashion. Feeding then becomes less about how many ounces have been consumed and more about the signals your baby is showing you.

Paced Bottle Feeding can also be useful for breastfeeding moms if they have to be away from their baby and another caregiver needs to feed the baby. Because paced bottle feeding mimics breastfeeding, babies are less prone to develop nipple confusion, an occurrence where babies start to prefer bottles to the breast due to their “easy access” flow of milk.

Thus, Paced Bottle Feeding is a technique that all moms can benefit from. We hope to encourage more moms to meet with us, even if they are not exclusively breastfeeding. Most lactation specialists will always encourage moms to breastfeed when they can, they serve as a support to all moms in feeding their baby!

Trauma-Informed Care – The Pelvic Exam

 Leila Hilal, MS4, Drexel University College of Medicine

As healthcare workers, we have a unique privilege in society; patients trust us at their most vulnerable moments and rely on us to help them reach their greatest potential in terms of their health.  Patients who have experienced sexual assault are at an even more vulnerable position when it comes to routine gynecologic exams to for cervical cancer prevention.  Trauma acts as a barrier to accessing healthcare. However, by providing patient-centered care with a trauma-informed approach, we can support our patients while providing the healthcare they need.

Within the past decade, there has been a large societal shift in the discussions around sexual assault and autonomy, best shown by the #MeToo movement.  It is a clinician’s daily choice, and a necessary one at that, to be mindful of traumas that our patients carry, whether they choose to share them or not.  In this blog, I’d like to review some of the ways to care for patients during a pelvic exam which can be a very stressful and triggering experience for survivors of sexual assault.  

The basic framework of any clinical institution should recognize the 4 “R”s established by the Substance Abuse and Mental Health Services Administration (SAMHSA) as the foundation for trauma-informed care: Realize the impact of trauma and the potential for recovery, Recognize signs and symptoms of trauma, Respond by integrating knowledge about trauma into policies, and actively Resist Re-traumatization⁴. 

 So how do we follow these 4 Rs?

 SAMHSA suggests 6 key principles to follow: Safety, Trustworthiness and Transparency, Peer Support, Collaboration and Mutuality, Empowerment Voice & Choice, and Cultural Historical and Gender Issues⁴. 

Safety:

Ensuring that the patient and staff feel safe creates a calmer trusting environment.

1)      Have a chaperone in the room 

2)      Offer a safety person to accompany patient into the room

3)       Listen carefully to concerns or questions

4)      Allow for extra time – this prevents an exam from being rushed       

5)      Use the smallest speculum possible while still optimizing viewing

6)      Use lubricant       

7)      Offer shifting of clothing rather than clothing removal

8)      Avoid potentially triggering phrases such as “spread your legs” or “stirrups”, and instead choose phrases such as “allow your legs to fall open to the side” or “footholds”.

Trustworthiness and Transparency:

By being open and honest with your patient, a rapport of trust can be established.

1)      Explain everything you will be doing in advance, and while you are doing it¹ – (but ask the patient if they would like the explanation prior to giving it).

2)      Show the tools you will be using prior to starting an exam – but ask first! This may or may not help the patient.

3)      Keep the patient covered, exposing only areas necessary for examination.

 Peer Support:

Having resources to other trauma survivors can promote healing, but this does not play a large part during a pelvic exam.

1)      Offer up trauma peer support materials at the end of an exam

 Collaboration and Mutuality:

The aim of this principle is to establish a partnership and lessen the power dynamic between the physician and patient to decrease discomfort during the exam.

1)      Establish rapport before the exam

2)      Greet the patient while they are still fully dressed and sitting upright

3)      Normalize any feelings of anxiety they may have about pelvic exams

4)      Explain the importance of the exam and its utility

5)      Check in regularly during the exam to monitor the patient’s stress levels

6)      Offer up distractions during the exam (e.g., talking or music)

7)      Offer self-insertion of speculum⁵

 Empowerment, Voice & Choice:

By supporting a patient to have space to become a stronger self-advocate, the power dynamic lessens between physician and patient thereby creating a calmer and safer environment.

1)      Give the patient as must control and choice as possible

2)      Allow a female provider to perform the exam if requested

3)      Ask the patient if they have suggestions on how they would be more comfortable

4)      Before starting the exam, tell the patient that the exam will stop if they feel uncomfortable - reinforce that they are in control

5)      Ask permission before beginning the exam

6)      Be willing and ready to reschedule the exam for a later time

Cultural, Historical and Gender Issues:

Recognize any move past any stereotypes, biases or cultural barriers that may impede on a connection based on trust

 As a patient, how can you advocate for your needs?

·         If you have experienced trauma, or find pelvic exams nerve-wracking, consider letting your physician know when they schedule your pap if you are comfortable.  This allows them to be aware in advance of how you are feeling and can be more sensitive to your needs during the exam. 

·         Know that it is a common experience for women to feel nervous for their pelvic exams & pap smears – talk to friends or family who have gotten it done, and how they reduce their anxiety.

·         If you have coping methods or grounding methods that you use during anxiety-producing situations, ask your physician how you may be able to incorporate these methods into the pelvic exam if you need them. 

·         If you would rather insert the speculum yourself, ask your physician to do so and ask for proper technique.

·         If you are more comfortable with a certain gender of provider, ask for this when scheduling your appointment.

·         If you would rather not get undressed for the procedure, talk with your provider on how the exam may be performed while staying dressed.

·         If talking/having a family member or friend there/listening to music/watching a video makes you more comfortable during an exam, ask the provider at the beginning of the office visit – they will be willing to accommodate you.

·         If you do not want to be told what is happening during a pelvic exam as it is going on, let your provider know so they don’t introduce more anxiety for you.

·         Know that you can always say no to an exam or stop an exam before or during the office visit.

·         Establish a word or signal that if said or done will make your provider stop the exam until you are ready for them to continue.

·         If you have considerable anxiety during such experiences, talk to your provider about any anxiolytic medications that may be used to help you complete your screening with less discomfort.

·         Check out this post by Dr. Glomski on other tips to help prepare for a pelvic exam: Mayo Clinic Health System - Preparing for your first pelvic exam².      

By recognizing trauma and approaching patients with care and compassion, clinicians can support resilience and empower them to overcome obstacles to their healthcare.  By normalizing trauma-informed care, sensitive clinical exams can become a less anxiety-producing experience for patients knowing that they can trust their provider and feel safe to obtain the care they need.

References

 1.      Bates C, Carroll N, Potter J. The Challenging Pelvic Examination. Journal of General Internal Medicine.2011; 26(6): 651-657.

2.      Glomski, Bridget, and Hannah Miller. “Preparing for Your First Pelvic Exam.” Mayo Clinic Health System, 22 June 2021, www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/preparing-for-your-first-pelvic-exam.

3.      Sharkansky E. Sexual Trauma: Information for Women’s Medical Providers. National Center for PTSD. 2014.

4.      Substance Abuse and Mental Health Services Administration . SAMHSA™s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884 . Rockville : SAMHSA ; 2014 .

5.      Wright D, Fenwick J, Stephenson P, Monterosso L. Speculum ‘self-insertion’: a pilot study. Journal of Clinical Nursing. 2005; 14(9): 1098-2111.

 

 

 

 

 

 

 

 

 

Racism in Medicine

When people think about racism, they often think about Jim Crow laws, red lining, the time of the Civil Rights movement, and, currently, many are also thinking about police brutality and the criminal justice system. We tend to place the blame of racism on those we think condone it; your neighbor who voted for Trump, or some police officers, the government, or anyone in power. But the general public often misses one arena where race still plays a significant role through which it can be associated with significant mortality: medicine.

The community looks to doctors as people who can heal and can help. And while that may be true, time and again research has demonstrated that Black people have worse outcomes than White people when it comes to their diseases, pain management, pregnancy, and so on. Is this because most doctors are racist? Is it because pharmaceutical companies are racist?

It is tempting to look for individuals to blame, but the fault is found within the system of structural racism. Race, to be clear, is not a biological construct. It has been used throughout history to justify oppression and slavery, and this justification was often aided and abetted by doctors. These doctors made false claims that Black people were biologically different, that the way nature made them made it so that they were made to be enslaved. Combine this with the political justifications of racism, and you create a society that profits off of the subjugation of Black people.

 The effects of structural racism in our country have created environments that continue to create worse living conditions for Black people, Indigenous people, and People of Color. Our nation’s history has led to segregated communities that suffer from less access to healthy food, to quality education, to stable jobs, to healthcare, and to community programs that can offer support and resources. What does this mean? It means that the combination of these factors causes people of color to be more likely to not have access to adequate medical care for diseases that are direct consequences of structural racism.

This all leads to one crucial point: race is a social determinant of health. Black women are twice as likely to die of breast cancer than white women, they are four times as likely to die after childbirth, Black children are less likely to be given pain medications, Black people with kidney disease suffer worse outcomes than their white counterparts. The list goes on. So how can doctors combat racism in medicine?

This is a more difficult question to answer. On the one hand, change comes at an individual level. Having uncomfortable discussions with friends and colleagues ensures we call out problematic behavior when we see it, and also makes us more likely to recognize our own biases. But how do we promote change at the institutional level? At the national level? Medical students, doctors, and other health professionals must begin to actively engage in local government and politics, as well as politics at the national level, to advocate for the dismantling of the structures built on racism. We must amplify the voices of our Black patients and other patients of color.

Urooj Khalid, MS4

Drexel University College of Medicine

Why are women more predisposed to autoimmune conditions?

 Since the age of 17, I have been curious about autoimmune conditions. I had experienced drug lupus in the past. I was told that it was due to my acne medication at the time; however, I always wondered if maybe there was a correlation to my biological sex. Furthermore, in medical school we were told that women were more predisposed to autoimmune diseases. But why? Why did having two XX chromosomes make you a risk factor for conditions like RA or Lupus?

 Well.. did you know that researchers have speculated a correlation with having two XX chromosomes and autoimmune diseases? There are genes on one X that can initiate an autoimmune reaction, and females happen to have two of those. They are essentially getting a double dose of that specific gene. Since males have X and Y, they do not get that double exposure from the X chromosome. Furthermore, Females go through something called X inactivation. One of their X chromosomes will be inactivated in a cell causing the other one to be predominant. The X that is inactivated can now be seen as foreign to the body and provide itself as an antigen. When this happens, the body can form an immune response and hence a possible autoimmune disease. In fact, the process I just described is suggested to a potential cause for Lupus

 There are other possible causes for Lupus. I will describe one more. It is suggested that there are genes expressed on one X chromosome, CD40LG and CXCR3, that become overexpressed when one of those X’s fails to inactivate. There are still studies being done to further assess this theory. It is speculated that proper X inactivation may help decrease disease progression.

 It is also suggested that hormonal changes can exacerbate an autoimmune disease. Hormonal changes may not be the cause of a skin condition like Psoriasis; however, it is speculated that hormonal changes can make the skin more sensitive. The endocrine system and skin are closely linked, and an imbalance could increase the severity of Psoriasis.

 In addition, Rheumatoid arthritis and Sjogren’s syndrome are thought to be linked to hormonal changes as well. With RA, there are issues with the bones and joints. It is suggested that around menopause, a decrease in estrogen and progesterone can decrease protection of the bone and joints making RA more severe. Sjogren’s Syndome is also thought to be linked to a decrease in estrogen.

Now that hormones are thought to be a link, pregnancy and puberty are a concern. These are times where hormonal imbalances occur. With pregnancy, those changes can last until at least one year post pregnancy. It is also thought that a mother carry a baby could face a decreased immune system making autoimmune issues more likely. As far as puberty goes… a study done in Taiwan observed an increase in juvenile SLE in girls compared to boys. It is also suggested that there is an increase of multiple sclerosis for girls after the onset of puberty.

I’ve learned something new today, and I appreciate the review article on the prevalence of autoimmune disorders in women that was published in the Cureus Journal of Medical Science in May 2020.

 Sabrina Billings MS4

Drexel University College of Medicine

 

 

 

Angum F, Khan T, Kaler J, Siddiqui L, Hussain A. The Prevalence of Autoimmune Disorders in Women: A Narrative Review. Cureus. 2020;12(5):e8094. Published 2020 May 13. doi:10.7759/cureus.8094

 

Miscarriage: The deafening silence that follows

I remember like it was yesterday. The tiny fingers that curled up into fists, fists literally clinging onto life. The tiny baby was delivered at 22 weeks, a stillborn. I was helping with the delivery and was able to cut the umbilical cord. Never would I imagine my first time cutting the cord would be in this situation. I remember hearing the mother’s pain through her screams and tears. As the healthcare providers, we helped in the delivery and aftercare of the labor. Afterwards, I was struck how there was no discussion or conversation with the mother who just lost her child. We closed the doors after the delivery and in turn closed the door on the traumatic experience that just occurred. I remember when my aunt herself had a miscarriage. Her family and friends all empathized with the loss but could not understand why my aunt was still feeling sad and depressed after many months after the incident. I saw my aunt spiral into a deeper depression as she could not find any support after miscarriage. Unfortunately, these are not isolated reactions to miscarriage in society.

            Miscarriage is one of the most common complications of pregnancy, occurring around 15% of all clinically recognized pregnancies. One in four women experience miscarriage in their lifetime. Many women following the loss of their child feel grief, sadness, and depression. These mental health issues are only exacerbated by society’s lack of consideration and belief that no loss has occurred. Mental health issues that these childless mothers face are perpetuated in this way. As healthcare professionals, we must do better and continuously monitor our patient’s moods and behaviors following their loss. Mental health services should immediately be offered to women who experience the loss to normalize their feelings and help mitigate any long-term consequences.

Ammarah Spall, MS4

Drexel University College of Medicine

Intimate Partner Violence And The Role Of The Healthcare Professional

Intimate partner violence is characterized by behavioral patterns that include physical abuse, emotional/psychological abuse, sexual abuse, threats, intimidation, stalking and deprivation5. These behaviors are normally perpetuated by one’s former or current intimate partner. According to the national coalition against domestic violence, an average of 20 people are physically abused by their intimate partners every minute. This means that approximately 10 million people in the US experience some form of intimate partner abuse annually3. Statistics shows that 25% of women and 7.6% of men will be victims of domestic violence in their lifetime4. IPV can happen to people of all ages, educational and cultural backgrounds.

The consequences and prevalence of intimate partner violence nationally makes it a health crisis that needs to be addressed and prevented. Unfortunately, most victims of intimate partner violence do not report the case to the appropriate authorities but often find excuses to justify the actions of the abusers. Research shows that health care professionals, especially Physicians can play an important role in detection, intervention and prevention of IPV due to the unique relationship they have with patients4.This is why it is important that physicians screen their patients for domestic abuse. Screening creates an opportunity for healthcare workers to educate their patients on the dangers and consequences of domestic abuse on their health.

Due to the sensitivity of domestic abuse, it is essential for physicians to be very discreet in their assessment when screening for it. Studies have shown that patients are more likely to open up about their feelings if asked in confidence away from family and in a nonjudgmental, respectful manner. There are two different ways of screening- written survey and oral screening using either direct or indirect questions. Since some people may be offended when isolated to be screened privately for domestic violence, it is recommended that physicians introduce the conversation with statements such as “Because violence is very common, I ask all my patients about their experience with violence”. Direct questions are preferred mostly in a situation when domestic violence is already suspected based on the observations made by the physician.

The response from the physician after a patient opens up about domestic abuse, is also very important. A nonjudgmental and supportive statement is essential to create a congenial atmosphere for the patients to explore solutions. The immediate concern for a physician should be the safety of the patient. Victims of domestic violence are at higher risk of death when they leave their partners, so it is important that they determine the best time to leave the relationship in order to ensure their safety. In states that physicians are not mandated to report intimate partner violence, the best way to help patients is to offer them resources that can help them plan for ways to ensure their safety, educate them on the physical and psychological effects of IPV and refer them to access services that are available to them.

Akua Boadu (MS4)

Drexel University College of Medicine

 

Resources

1. Lizdas C Kristen, Durborow Nancy, O’flaherty Abigail, Marjavi Anna; Compendium of State Statutes and Policies on Domestic Violence and Health Care, 2010, https://www.acf.hhs.gov/sites/default/files/fysb/state_compendium.pdf
2. Pennsylvania Coalition Against Domestic violence, 2018, http://www.pcadv.org/Learn- More/
3. National Coalition Against Domestic Violence, 2018, https://ncadv.org/statistics?gclid=Cj0KCQjw1q3VBRCFARIsAPHJXrFq0k5XaHQoXI W0zdld_NG1rMC02xsc1JPcPViYv65UafLDOe8NXwcaAtgBEALw_wcB
4. Cronholm Peter, Fogarty Colleen, Ambuel Bruce, Harrison Leonard Suzanne; Intimate Partner Violence, 2011, https://www.aafp.org/afp/2011/0515/p1165.html
5. Guidelines for the Health Care of Intimate Partner Violence, 2004, http://domesticabuse.stanford.edu/screening/law.html
6. https://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html

Honoring Marilyn J. Smith and the 35th Anniversary of ADWAS

 March 25, 2021 marks the 35th anniversary of the first organization created to support and empower survivors of domestic and intimate partner violence within the Deaf community. Abused Deaf Women’s Advocacy Services (ADWAS) started in the basement of Marilyn J. Smith, a hearing survivor of rape, following the murder of a local d/Deaf woman by her spouse. Smith was inspired to act after learning that many in the Deaf community had known of this woman’s abuse but had not known how to get help or report it. Since then, ADWAS has grown into a nationwide model to address the needs of male and female survivors of abuse in the Deaf community and to educate the general public about related issues. In honor of the 35th anniversary of ADWAS, I’ve included 30 facts and 5 resources on domestic and intimate partner violence in the Deaf community, highlighting the continued importance of their work.

• There are at least 500,000 members of the American Deaf community, a culturally distinct group of people who share American Sign Language (ASL) as their primary language.

• To be Deaf (capital D) is to be a part of a cultural identity, not simply a person with deafness and not a person with a disability.

• American Sign Language (ASL) does not have the same grammar and sentence structure as English; thus the importance of having a certified interpreter is paramount, especially of instances of healthcare and legal matters.

• Individuals who are deaf and hard of hearing are 1.5 times more likely than their hearing counterparts to be victims of relationship violence, including sexual harassment, sexual assault, psychological abuse and physical abuse, in their lifetimes (Porter & Williams, 2011).

• Although it is commonly reported that 25% of women in the general population experience domestic violence in their lifetime, estimates within the Deaf community are closer to 50% (Anderson & Leigh, 2011).

• Since the beginning of the COVID pandemic and stay-at-home mandates, the number of domestic and intimate partner violence cases have risen in both the hearing and Deaf communities. According to statistics from The National Deaf Domestic Violence Hotline (NDDVH), contacts between the months of January and May 2020 had already surpassed the total number of contacts received during the entirety of 2019.

• Emotional abuse is the most common form of intimate partner violence reported by people who are deaf, with lifetime rates exceeding 25% (Pollard, Sutter, & Cerulli, 2013).

• Reports of physical abuse are at least as common among individuals who are deaf, if not slightly more so, than in the general population.

• Pollard et. al (2013) also noted that sexual violence and forced sex is much more frequently experienced by individuals who are deaf than their hearing counterparts. This is consistent with previous findings regarding sexual abuse among d/Deaf adults.

• According to Pollard et. al (2013), there was a higher proportion of males that reported experiences of intimate partner violence in the Deaf community than in the general population.

• Anderson and Leigh’s (2011) survey of deaf female college students resulted in surprisingly high rates of intimate partner violence perpetration reported by these women.

• Domestic and intimate partner violence in the Deaf community often includes isolation (from friends, family, and appropriate services), intimidation (aggressive or threatening signing style), shame (showing disgust toward Deaf culture), and manipulation (gaslighting).

• Economic abuse can occur by abusers withholding survivors’ Social Security Disability Income checks, creating financial reliance on the abuser for survival.

• Within the Deaf community, there is a “double code of silence” related to domestic and intimate partner violence because services are typically not culturally sensitive or accessible for deaf survivors and because the deaf community has historically misunderstood or minimized these issues (Rems-Smario, 2007).

• A recent study on intimate partner violence among deaf female college students found that more than 50% of survivors did not label their experiences of psychological aggression and physical assault as abuse, even when these experiences included severe harm (e.g., death threats, choking) (Anderson & Kobek Pezzarossi, 2012).

• Anderson & Kobek Pezzarossi (2012) also noted that a majority of deaf intimate partner violence survivors did not label sexual coercion by a partner as an abusive act.

• Healthcare providers often omit screening for intimate partner violence along with sexual histories of women with disabilities due to the incorrect assumption that individuals with disabilities are not sexual (McRuer & Mollow, 2012).

• Under the Americans with Disabilities Act and Rehabilitation Act, hospitals and other medical facilities are required to provide appropriate in-person and/or remote sign language interpretation services as well as textual English communications to patients and/or companions who are deaf or hard of hearing.

• Many deaf and hard-of-hearing people do not know sign language, and they comprise populations that also experience inequities in access to health communication, health care, health research, and health-related careers.

• Most d/Deaf individuals experience obstacles to understanding written health materials due to differences in language and development compared to hearing individuals (Glickman, 2013).

• Research suggests a fourth-grade median English reading level among d/Deaf high school graduates (Gallaudet Research Institute, 2003), significantly below the average seventh-to-eighth grade reading level among hearing high school graduates.

• In addition to these general English literacy concerns, nearly 50% of d/Deaf individuals also have inadequate health literacy—6.9 times more likely than hearing individuals due to insufficient health education (McKee et al., 2015).

• Health-related vocabulary among d/Deaf sign language users is similar to non–English-speaking US immigrants (McEwen & Anton-Culver, 1988), and “many adults deaf since birth or early childhood do not know their own family medical history, having never overheard their hearing parents discussing this with their doctor” (Barnett et al., 2011)

• Survivors may avoid seeking treatment due to valid concerns about confidentiality  including reduced anonymity within the Deaf community and unease about Deaf providers or ASL interpreters who belong to the same social circles as their clients (Barber, Wills, & Smith, 2010).

• Members of the Deaf community have also been subjected to historical mistreatment by behavioral health researchers and providers. Early literature on the “psychology of deafness” described d/Deaf people as emotionally and cognitively deficient compared to hearing people (Pollard, 1970)

• Historically, individuals with deafness have also been described by individuals in the medical community as “language impaired, immature, impulsive, concrete, aggressive, [and] less intelligent” (Pollard, 1970).

• As recently as the 1970s, the majority of mental health practitioners working with d/Deaf individuals were practicing without special training or knowledge of Deaf culture or ASL.

• Despite recognition that this practice was unacceptable, to this day the number of resources for d/Deaf survivors of domestic and intimate partner violence are limited. Currently, there are approximately fifteen deaf–specific organizations for survivors of abuse in the U.S., with goals of expanding numbers and locations.

• For that reason, many survivors who are deaf or hard of hearing continue to seek assistance at local organizations where providers are likely unfamiliar with ASL and d/Deaf cultural norms, thus putting them at a disadvantage when trying to establish healing relationships.

• By educating ourselves on the specific obstacles facing survivors of domestic and intimate partner violence among the d/Deaf community, we as providers can begin to work towards more equitable and just care for some of our most vulnerable patients.

If you or someone you know is a survivor of domestic or intimate partner violence, the following resources are available, with specific emphasis on those that are equipped to support survivors in the d/Deaf community:

1. Abused Deaf Women’s Advocacy Services, an organization that empowers Deaf and DeafBlind survivors of domestic violence, sexual assault and harassment to transform their lives, while striving to change the beliefs and behaviors that foster and perpetuate violence. https://www.adwas.org/
2. DeafHope, a grassroots organization whose goal is to provide accessible support and empowerment to Deaf women who are survivors of domestic and sexual violence. http://www.deaf-hope.org/
3. Deaf Anti-Violence Coalition (DAVC), a national organization committed to ending power-based personal violence, including but not limited to: domestic violence, intimate partner violence, sexual violence, stalking, and human trafficking within Deaf communities. https://www.deafantiviolencecoalition.com/
4. The National Domestic Violence Hotline (NDVH): Email: deafhelp@thehotline.org; TTY: 1-800-787-3224; Video Phone: 1-855-812-1001; Live Chat: www.thehotline.org
5. National Resource Center on Domestic Violence has operated https://vawnet.org/, an online network focused on violence against women and other forms of gender-based violence.

 

Resources:

-       Anderson ML, Leigh, IW. Intimate partner violence against deaf female college students. Violence Against Women. 2011;17(7):822-834.

-       Anderson ML, Kobek Pezzarossi CM. Is it abuse? Deaf female undergraduates’ labeling of partner violence. J Deaf Stud and Deaf Edu. 2012;17(2):273-286.

-       Barber S, Wills D, Smith MJ. Deaf survivors of sexual assault. In Leigh IW (Ed.), Psychotherapy with deaf clients from diverse groups, 2nd ed, 2010. Washington, DC: Gallaudet University Press.

-       Barnett S, Klein JD, Pollard RQ, et. al. Community participatory research with deaf sign language users to identify health inequities. Amer J Pub Heal. 2011;101(12): 2235-2238.

-       Gallaudet Research Institute. Literacy and deaf students. 2003. [web] http://gri.gallaudet.edu/Literacy/reading.

-       Glickman NS. Introduction: what is deaf mental health care? In Glickman NS(Ed.), Deaf mental health care. 2013. New York, NY: Routledge.

-       McEwen E, Anton-Culver H. The medical communication of deaf patients. J Fam Practice. 1988; 26(3): 289–291.

-       McKee MM, Paasche-Orlow Mk, Winters PC, et al.  Assessing Health Literacy in Deaf American Sign Language Users. J Health Comm. 2015; 20 (2): 92–100. doi:10.1080/10810730.2015.1066468.

-       McRuer R, Mollow A (Ed.). Sex and disability. 2012. Durham, NC: Duke University Press

-       Pollard RQ Jr. 100 years in psychology and deafness: A centennial retrospective. J Amer Deaf and Rehab Ass. 1970;26:32-46.

-       Pollard RQ Jr, Sutter E, Cerulli C. Intimate partner violence reported by two samples of deaf adults via a computerized American sign language survey. J Interpers Violence. 2014;29(5):948-965. doi:10.1177/0886260513505703.

-       Porter JL, Williams LM. Auditory status and experiences of abuse among college students. Violence Vict. 2011;26(6):788-98. doi: 10.1891/0886-6708.26.6.788.

-       Rems-Smario, J. Domestic violence: We can’t ignore it anymore. NADmag. March/April 2007;16-18.

Samantha Innis, MS4

Drexel University College of Medicine

Breastfeeding Tips for New Breastfeeding Parents

 As a fourth year medical student pursuing OB/Gyn, I had the opportunity to do a lactation rotation. I was given one-on-one training from two incredibly knowledgeable IBCLCs. The main take away from this rotation is that something as natural as breastfeeding does not come naturally for many. Here are some useful tips for new breastfeeding parents:

•  Be patient! You and your baby are both learning something new. It may take a couple of days before you feel confident with breastfeeding.

• Be prepared — your baby will want to feed a lot! Breastmilk is digested easier than formula, so breastfed babies tend to feed more often. Also, your baby will go through growth spurts where they are feeding much more frequently for a couple of days. This is all normal and your milk supply will adjust to your baby’s needs.

• Breastfeeding is all about demand and supply. The more breastmilk you remove from your breasts through breastfeeding or pumping, the more milk your breasts will make. In order to establish and maintain a solid milk supply, you need to breastfeed and/or pump 8 or more times per day. In the first few weeks, you will be feeding at least 10-12 times per day.

• The best latch is a deep latch. The way to get a deep latch is to use your hand to form a C shape and hold your breast in a “breast sandwich,” tap your baby’s top lip with your nipple and then bring your baby’s head to the breast when they open their mouths wide. Their chin, cheeks, and tip of the nose should be touching your breast. A deep latch will feel comfortable. Shallow latches tend to be very painful and can lead to cracked and sore nipples.

• Feed your baby when they start exhibiting early hunger cues. A crying baby will be frustrated and difficult to latch. So, try to feed your baby before this happened. Feed your baby when they start to smack their lips, looking around for your nipple, or sucking their hands.

•  If you are trying to latch your baby, but they are hungry and crying and refusing to latch, try giving them a small amount of milk in a bottle first. Offer less than ½ an ounce of either pumped breastmilk or formula to help soothe the baby. Once they are calm, try latching your baby.

• Avoid pacifiers for the first month. They can make babies skip feeds for two reasons: 1) it tricks your baby’s body into thinking it does not need to feed and 2) they use their energy to suck on the pacifier and they may be too tired to latch after. Feel free to introduce them a little later.

• Be confident in your milk supply! Your body will make enough milk to feed your baby. You know you are producing enough milk when your baby is gaining weight appropriately (about 1oz per day), peeing, pooping, and are relaxed and calm after a feed. Your breasts may feel softer, too!

• When in doubt, latch your baby. If your baby is acting fussy, latch them. If they are showing you they are hungry, latch them. You can never overfeed a breastfeeding baby because they take what they need from the breast. Sometimes, they will want to latch just to be close to you and get Mom cuddles. Other times, they want to use you as a pacifier. And sometimes, they just want a snack. Follow your baby’s cues.

• Breastmilk has amazing healing qualities! If you have sore and/or cracked nipples, express a few drops of breastmilk, spread around your nipple and areola, and let it air dry.

• Take care of yourself! Drink plenty of fluids, eat nutritious foods, and sleep whenever you can. Lactating mothers need a high calorie intake (~2500 cal/day!). Focus on high protein foods, whole grains, fruits, and vegetables. Also, keep granola bars or other snacks where you breastfeed. You can eat, drink, and feed all at the same time.  If your partner can help with a feed at night, it is okay for you to sleep for a 4-hour stretch and feed or pump when you wake up.

•  Don’t be shy about asking for help. Adjusting to life a newborn is tough!

 Looking for more tips?

Here are some informative (and credible) resources for all of your breastfeeding and pumping questions:

La Leche League - www.llli.org

Kelly Mom - www.kellymom.com

Cassandra Mitchell, MS4

Drexel University College of Medicine

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Quick! Cover His Eyes!

“Quick, cover his eyes! There’s S-E-X on the screen,” shouted my father upon seeing Jack and Rose kissing in the backseat of a station wagon in the movie Titanic. An 18-year-old at the time, I groaned, as once again, the panicky, familiar hands of my mother came down like a curtain of darkness. Being immigrants from Iran who married at a young age, my parents felt it best that I kept my “innocence” until I married. If I hadn’t been privileged enough to learn about these topics at school, I would have known nothing about sexual health or anything related therein.

For years, I thought of my parents’ practice as quaint and isolated. However, when I took a college course on human sexuality, I was stunned to realize that my parents’ desire to keep me effectively ignorant about sex was pervasive. Many people experience stigmas and are misinformed regarding such topics. Lack of accurate education has been a harmful factor in many people’s lives. In medical school, we were educated on the palpable discomfort that may occur while eliciting sexual histories from patients who, reacting to the created atmosphere, might be equally reluctant. In contrast, when patients realized that I was explicitly receptive during these conversations, they spoke comfortably and openly, which, most importantly, was beneficial to their care.

Despite my parents’ culturally-bred ignorance towards sexual health, I still believe that today’s sex education is severely lacking. During my clinical rotations, I saw several patients from both ends of the socioeconomic spectrum who were clearly misinformed about certain topics of sexual health. One female patient had come to us wondering what might be causing her private part to bleed once every month. Another male patient had never heard of a condom or its benefits before. Although intrinsic risk factors such as levels of education and cultural background can impact one’s fund of knowledge regarding these topics, there are still many extrinsic factors we can work to improve.

In the United States, sex education in schools varies significantly across districts. Many schools operate without state-guided health education curricula, leaving decisions up to individual districts (Maziarz et al. 2020). Ultimately, our country’s goal should be to standardize the sex education system we have in place and to identify and implement the programs that stand out from others in terms of efficacy.

A good starting point would be to identify barriers to discussing sexual health topics in the U.S. education system. A 2020 scientific article titled “Is there a gender difference in U.S. college students’ desire for school-based sexuality education” explores the reasons for why there are increased female to male ratios in sexual education courses (King et al. 2020). A survey was sent out and the results showed that many men felt they knew enough about sex already. Further, if they were to take sexual education classes, they would rather it be under the guise of an anonymous online course.

Similar studies have shown that students would learn very little from their parents regarding these topics, and often relied on their friends or the internet to gather information (Sprecher et al. 2008). This raises even more red flags regarding how we present the information to our students. Hopefully, it will spark a series of further discussions on ways to improve the mediums of education.

Ariya Mobaraki, MS4

Drexel University College of Medicine

References

1.    King, B. M., Burke, S. R., & Gates, T. M. (2020). Is there a gender difference in US college students’ desire for school-based sexuality education? Sex Education, 20(3), 350-359. https://doi.org/10.1080/14681811.2019.1668762

2.     Maziarz, L. N., Dake, J. A., & Glassman, T. (2020). Sex Education, Condom Access, and Contraceptive Referral in U.S. High Schools. The Journal of school nursing : the official publication of the National Association of School Nurses, 36(5), 325–329. https://doi.org/10.1177/1059840519872785

3.    Sprecher, S., G. Harris, and A. Meyers. 2008. “Perceptions of Sources of Sex Education and Targets of Sex Communication: Sociodemographic and Cohort Effects.” Journal of Sex Research 45 (1): 17–26.

President Biden: Promise of better Health Insurance on the Horizon?

Emma Schanzenbach, MS4

One of the most hotly debated subjects in popular American politics is Health Insurance. In 2010, President Obama heavily supported the Affordable Care Act (ACA), to the point it was dubbed “Obamacare” by critics and allies alike. Now, in 2021, eleven years after the ACA was passed, many are looking to President Joe Biden to expand upon, and save, the ACA from some of its most vocal detractors.  

According to the Biden campaign’s website, the Biden Healthcare Plan promises to: one, give every American access to affordable healthcare, two, decrease the complexity of the healthcare system while still maintaining quality, three, stand up to prescription drug corporations, and, four, ensure healthcare as a right (1). While they are, indeed, lofty campaign promises, Biden has implied that he would veto a “Medicare for All” bill if it came across his desk (2). In contrast to this, his campaign website supports the passage of a public option, like Medicare, under the second tenet of his campaign healthcare promise (1). This would allow anyone, no matter their financial situation, to choose a public option over a private insurance or employer-based insurance plan (1). As it stands now, it is unclear what President Biden’s exact messaging on health insurance will be. If the American people are to take his campaign promises at face value, there would still be many hurdles a “similar-to-Medicare for All” insurance would have to clear before passage.  

If a public option were to pass, it seems unlikely that the option would remain completely public. For this to occur, the government would have to have a highly functioning department to handle this operation. When the ACA website first launched, the website crashed from the overwhelming traffic it received. The Obama administration had to pull tech executives to revamp the website, a task they luckily felt excited to get behind. A public option office would likely go through much of the same issues that the ACA website experienced. Additionally, President Biden has decided to move forward with a COVID-19 relief plan that was largely produced by two major insurance lobbying groups: America’s Health Insurance Plans and the Blue Cross Blue Shield Association (3). Their plan relies on subsidizing ACA plans, some of the most expensive plans on the market, which will likely allow them to increase the massive profits they made during the pandemic (4). Instead of a much-needed chance for change, with health insurance lobbyists involved, the future for a public option seems grim.  

In conclusion, despite the hope many Americans feel now that President Trump and his administration have left the office, the hope must be that of a reserved type. The Biden campaign promises were most likely empty, without real substance behind them. If Americans want a public health care option, they will have to band together and fight for it. This is the only way we will be able to create a more just and fair healthcare system. For if 2020 has taught Americans anything, it is to not rely solely on the government to mount a response to any sort of public health crisis. 2020 has taught us, in fact, that we can only rely on each other to hold elected officials accountable and create any sort of real, meaningful change.  

 

1. https://joebiden.com/healthcare/ 
2. https://www.cnbc.com/2020/03/10/biden-says-he-wouldd-veto-medicare-for-all-as-coronavirus-focuses-attention-on-health.html 
3. https://www.jacobinmag.com/2021/01/joe-biden-public-option-health-insurance-plan 
4. https://www.nytimes.com/2020/08/05/health/covid-insurance-profits.html