Lying-in Transition: The Modernization and Professionalization of Childbirth in Rural Alabama 1870-1910

This dissertation will analyze the underlying reasons childbirth became professionalized, which was due to the growing demands by women for safer birthing conditions. The demand evolved out of the complex relationship among social status, race and ethnicity, and regional locations, all made possible by the modernization and professionalization of tocology that became available during the latter part of the nineteenth and beginning of the twentieth-century. The history of childbirth is a critical topic because, as previously mentioned, the maternal mortality rate in the United States in the twenty-first-century is still incredibly high for a developed nation. Women deserve safer birthing conditions. Those who assist in ushering new life into the world are responsible for protecting both mother and infant. This work will primarily focus on the transformational period of the professionalization and modernization of childbirth; however, it is critical in some instances to extend the time frame to gain a better understanding of the matter at hand. Text Summary Chapter 1 briefly introduces the art of childbirth, discussing the evolving relationship between socioeconomic groups. Additionally, the reader is introduced to the examination region, rural Alabama: specifically, Hale, Greene, Dallas, Sumter, and Marengo Counties. The region was selected for its unique socioeconomic climate. In the nineteenth-century, the field of academic obstetrics was in its infancy. Midwives and physicians had a turbulent relationship as both thought the other was intrusive and careless. However, it is necessary for a woman to be accompanied by a birth attendant during delivery to help preserve the life of both mother and child—a point that both physician and midwife agree upon. The question becomes who is better at providing healthcare to both mother and infant while preserving the cultural climate that these women so desperately want. Who knows what is best for the parturient and why becomes a focal point for this dissertation with the ultimate goal of analyzing the overall thesis. This dissertation will argue that the reason for the professionalization of childbirth was due to the growing demand by women for safer birthing conditions that developed around the evolving relationship among social status, race and ethnicity, and regional location distinctions; reform was made possible by the modernization of medicine and the professionalization of tocology available during the nineteenth- and twentieth-centuries in America. Chapter 2 will examine the socioeconomic climate of rural Alabama, specifically in Hale, Greene, Dallas, Sumter, and Marengo Counties. These counties are five of the wealthier counties in Alabama during a period of extreme poverty. From 1870-1910, Alabama had a shifting diversity of ethnicity as it experienced a period of White Flight. This period was when more Whites left Alabama than entered or resided in it, providing open opportunities to the newly freed Black population. This chapter analyzes the trends in population shift as well as the financial stance of the region. Through census data, historians can better understand the class struggles in Alabama; however, the data is imperfect, presenting obstacles at every turn. Additionally, this chapter will analyze the vital statistics presented for Alabama from 1870 to 1910 to illustrate the maternal and infant mortality rates in the state, nation, and world. Chapter 3 analyzes the question “Why Are You the Way You Are?” to understand the growing tension among society, midwives, and physicians. To attempt to answer that question, the geo-occupational configuration of the population will illustrate the high rural population and the agricultural occupations of the state’s inhabitants. Alabama’s population was mostly rural farm workers of both genders. This chapter will further analyze the causes for women working in agriculture and why that was important to childbirth. Moreover, racial ideology will be examined in relation to quality birth attendants, education, and the societal pressure to ignore the Black population through the lens of the Disappearance Hypothesis. Lastly, as statisticians examine the vital statistics of the region reformers recognize the need for intervention because of the presented statistical analysis drawing parallels between race and death rates. The question becomes how? Chapter 4 discusses The Problematic Midwife. In a rural, poor, primarily Black population, women still needed quality birth attendants. Physicians were too expensive for the majority of parturients, so they leaned on the support of Granny midwives. The women did more than catch babies as they entered the world; thus, socially, they were accepted and respected, at least until physicians began to attack their lack of education. But who was to blame- the overworked, undereducated midwife who was doing the best that she could or the overpriced classically trained physician? The midwives were victims of societal making, damned if she did and damned if she didn\u27t. Chapter 5, Along Came a Doctor, examines the medical revolution the United States underwent during the latter part of the nineteenth-century through the twentieth-century. Medical schools were evolving, and with them, a new specialized physician was looking for a better society and an increase in social and financial status. The quest for the “almighty dollar,” as Washington Irving called it, may have altered many physicians\u27 regional path and moral compass. As medical advancements stimulated change for patients within hospitals, Blacks were excluded from such services due to Jim Crow Laws. The modernization of tocology was developed to provide physicians with the skills necessary to assist in delivery; however, ethical dilemmas arose from learning techniques. Men like Dr. J. Marion Sims and Josiah Nott utilized Black women in developing medical procedures, often with little pain management, which they justified through the assertion that Blacks experience less pain than Whites. Moreover, academia struggled with the ethical dilemma of practicing their skill on pregnant women. It takes creativity to overcome this challenge to educate blossoming physicians. In conclusion, the transitional period between home and medically sanctioned childbirth deserves additional research. While scholars claim that modernizing obstetrics made childbirth safer, I argue that the more accurate assertion is that it changed childbirth. Midwives who had limited resources provided for a community unselfishly in an attempt to fulfill a need. That selfless commitment was demonized and degraded because of their race or social status. Had the Granny midwife been a White wealthy male, he would have been hailed a hero for his efforts; however, the political, social, and economic makeup of rural Alabama generated the perfect conditions to allow hatred to grow

Relativistic model for nuclear matter and atomic nuclei with momentum-dependent self-energies

The Lagrangian density of standard relativistic mean-field (RMF) models with density-dependent meson-nucleon coupling vertices is modified by introducing couplings of the meson fields to derivative nucleon densities. As a consequence, the nucleon self energies, that describe the effective in-medium interaction, become momentum dependent. In this approach it is possible to increase the effective (Landau) mass of the nucleons, that is related to the density of states at the Fermi energy, as compared to conventional relativistic models. At the same time the relativistic effective (Dirac) mass is kept small in order to obtain a realistic strength of the spin-orbit interaction. Additionally, the empirical Schroedinger-equivalent central optical potential from Dirac phenomenology is reasonably well described. A parametrization of the model is obtained by a fit to properties of doubly magic atomic nuclei. Results for symmetric nuclear matter, neutron matter and finite nuclei are discussed.Comment: 14 pages, 7 figures, 5 tables, extended introduction and conclusions, additional references, minor corrections, accepted for publication in Phys. Rev.

Hot Nuclear Matter in Asymmetry Chiral Sigma Model

In the frame work of SU(2) chiral sigma model, the nuclear matter properties at zero and finite temperature have been investigated. We have analyzed the nuclear matter equation of state by varying different parameters, which agrees well with the one derived from the heavy-ion collision experiment at extreme densities and reliable realistic(DBHF) model at low density region. We have then calculated the temperature dependent asymmetric nuclear matter, also investigated the critical temperature of liquid gas phase transition and compared with the experimental data. We found that the critical temperature in our model is in the range of 14-20 MeV.Comment: 21 pages, 10 figures, to be published in Nuclear Physics

Nuclear surface properties in relativistic effective field theory

We perform Hartree calculations of symmetric and asymmetric semi-infinite nuclear matter in the framework of relativistic models based on effective hadronic field theories as recently proposed in the literature. In addition to the conventional cubic and quartic scalar self-interactions, the extended models incorporate a quartic vector self-interaction, scalar-vector non-linearities and tensor couplings of the vector mesons. We investigate the implications of these terms on nuclear surface properties such as the surface energy coefficient, surface thickness, surface stiffness coefficient, neutron skin thickness and the spin-orbit force.Comment: 30 pages, 15 figures. Submitted to Nuclear Physics

In-medium Production of Kaons at the Mean-Field Level

The in-medium mass and energy of kaons and antikaons are studied within the Relativistic Mean Field approach and compared with predictions from chiral models by taking care of kaon-nucleon scattering data. Implications for the subthreshold production of kaons and antikaons in heavy-ion collisions are discussed. We find only small corrections due to in-medium effects on the mean-field level for the relevant production processes for kaons. The production of kaons is even less favourable at high density due to repulsive vector interactions. We conclude that one has to go beyond mean-field approaches and take fluctuations and secondary production processes into account to explain the recently measured enhancement of kaon production at subthreshold energies. The situation is different for antikaons where in-medium effects strongly enhances their production rates. We also see strong in-medium modifications of the annihilation processes of antikaons and Lambda's which might be visible in flow measurements. At high density, we predict that the threshold energy for antikaon and Lambda production and annihilation become equal leading to similar numbers of antikaons and Lambda's in the dense zone of a relativistic heavy ion collision.Comment: 32 pages, 5 Postscript figures, uses Revtex and epsf.st

Hyperons in a relativistic mean-field approach to asymmetric nuclear matter

Relativistic mean-field theory with $\delta$ meson, nonlinear isoscalar self-interactions and isoscalar-isovector cross interaction terms with parametrizations obtained to reproduce Dirac-Brueckner-Hartree-Fock calculations for nuclear matter is used to study asymmetric nuclear matter properties in $\beta$-equilibrium, including hyperon degrees of freedom and (hidden) strange mesons. Influence of cross interaction on composition of hyperon matter and electron chemical potential is examined. Softening of nuclear equation of state by the cross interactions results in lowering of hyperonization, although simultaneously enhancing a hyperon-induced decrease of the electron chemical potential, thus indicating further shift of a kaon condensate occurence to higher densities.Comment: 11 pages, 7 figures, 3 tables, published in Phys. Rev.

Comorbidities and Treatments in United States Youth with Chronic Musculoskeletal Pain

Introduction: Chronic musculoskeletal (MSK) pain has been associated with chronic illnesses and high rates of pain medication use, often in referral centers, European populations, or studies focused on single drug classes. We aimed to characterize patterns of comorbidities and treatments associated with chronic MSK pain in a nationally-representative sample of US youth. Methods: We used the National Ambulatory Medical Care Survey (2002-2015) and National Hospital Ambulatory Medical Care Survey (2002-2011), which contain cross-sectional data for US outpatient visits. The study included all visits for youth age 8-24, excluding those with malignancy or sickle cell disease. We compared comorbidities and drugs ordered in visits for chronic MSK pain with (1) visits for any reason besides MSK pain and (2) visits for acute MSK pain, using chi-square tests and logistic regression, adjusting for several covariates. Results: Chronic non-psychiatric diseases were more common among visits for chronic MSK pain (32.0%) in comparison to both visits for acute MSK pain (17.9%) and visits for other reasons (18.8%). Nonsteroidal anti-inflammatories were less commonly ordered at visits for chronic MSK pain in comparison to acute MSK pain (adjusted odds ratio [aOR]: 0.63, 95% CI 0.50-0.80). Opioids, gabapentinoids, and alternative medicine were each ordered more commonly at visits for chronic MSK pain in comparison to visits for acute MSK pain and other visits. Conclusion: US youth with chronic MSK were more likely to have chronic non-psychiatric medical conditions compared to youth without pain. Additionally, opioids, gabapentinoids, and alternative medicine were ordered more often in chronic MSK visits, which warrants further study

Relativistic Mean-Field Theory and the High-Density Nuclear Equation of State

The properties of high-density nuclear and neutron matter are studied using a relativistic mean-field approximation to the nuclear matter energy functional. Based on ideas of effective field theory, nonlinear interactions between the fields are introduced to parametrize the density dependence of the energy functional. Various types of nonlinearities involving scalar-isoscalar ($\sigma$), vector-isoscalar ($\omega$), and vector-isovector ($\rho$) fields are studied. After calibrating the model parameters at equilibrium nuclear matter density, the model and parameter dependence of the resulting equation of state is examined in the neutron-rich and high-density regime. It is possible to build different models that reproduce the same observed properties at normal nuclear densities, but which yield maximum neutron star masses that differ by more than one solar mass. Implications for the existence of kaon condensates or quark cores in neutron stars are discussed.Comment: 26 pages in RevTex, 12 PostScript figure

Optimization of relativistic mean field model for finite nuclei to neutron star matter

We have optimized the parameters of extended relativistic mean-field model using a selected set of global observables which includes binding energies and charge radii for nuclei along several isotopic and isotonic chains and the iso-scalar giant monopole resonance energies for the $^{90}$Zr and $^{208}$Pb nuclei. The model parameters are further constrained by the available informations on the energy per neutron for the dilute neutron matter and bounds on the equations of state of the symmetric and asymmetric nuclear matter at supra-nuclear densities. Two new parameter sets BSP and IUFSU* are obtained, later one being the variant of recently proposed IUFSU parameter set. The BSP parametrization uses the contributions from the quartic order cross-coupling between $\omega$ and $\sigma$ mesons to model the high density behaviour of the equation of state instead of the $\omega$ meson self-coupling as in the case of IUFSU* or IUFSU. Our parameter sets yield appreciable improvements in the binding energy systematics and the equation of state for the dilute neutron matter. The importance of the quartic order $\omega-\sigma$ cross coupling term of the extended RMF model, as often ignored, is realized.Comment: 22 pages, 11 figures, Nucl. Phys. A (in press

Analysis of Chiral Mean-Field Models for Nuclei

An analysis of nuclear properties based on a relativistic energy functional containing Dirac nucleons and classical scalar and vector meson fields is discussed. Density functional theory implies that this energy functional can include many-body effects that go beyond the simple Hartree approximation. Using basic ideas from effective field theory, a systematic truncation scheme is developed for the energy functional, which is based on an expansion in powers of the meson fields and their gradients. Chiral models are analyzed by considering specific lagrangians that realize the spontaneously broken chiral symmetry of QCD in different ways and by studying them at the Hartree level. Models that include a light scalar meson playing a dual role as the chiral partner of the pion and the mediator of the intermediate-range nucleon-nucleon interaction, and which include a "Mexican-hat" potential, fail to reproduce basic ground-state properties of nuclei. In contrast, chiral models with a nonlinear realization of the symmetry are shown to contain the full flexibility inherent in the general energy functional and can therefore successfully describe nuclei.Comment: 47 pages, REVTeX 3.0 with epsf.sty, plus 12 figures in separate uuencoded compressed postscript fil