Continuing Education Module Transforming Maternity Care: Implementing the Blueprint for Action

In January 2010, Women’s Health Issues published two direction-setting reports from the Transforming Maternity Care (TMC) Project: “2020 Vision for a High-Quality, High-Value Maternity Care System” and “Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System.” This guest editorial summarizes highlights of the implementation phase of what is now known as the TMC Partnership. Major progress has been made in elevating maternity care quality to a national policy priority, increasing the availability and use of maternity care performance measures, and developing shared decision making tools for childbearing women.     

Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary

Maternity care in the United States is intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy is far from restrictive. These interventions disturb the normal physiology of labor and birth and restrict women’s ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #4: No Routine Interventions,” published in The Journal of Perinatal Education, 16(3), 2007.     

Reflections on the “Push for Your Baby” Campaign

In this editorial, a board member of Lamaze International describes the “Push for Your Baby” campaign to urge women to advocate for more evidence-based practice for better births. She also reflects on her hopes and worries about the “Push for Your Baby” campaign launched by Lamaze in May 2012. Discussing the realities of current maternity care practice, she asks how we can work with obstetric nurses and providers to have them support what most women value—vaginal birth.     

Healthy Birth Practice #3: Bring a Loved One,Friend, or Doula for Continuous Support

All women should be allowed and encouraged to bring a loved one, friend, or doula to their birth without financial or cultural barriers. Continuous labor support offers benefits to mothers and their babies with no known harm. This article is an updated evidence-based review of the “Lamaze International Care Practices that Promote Normal Birth, Care Practice #3: Continuous Labor Support,” published in The Journal of Perinatal Education, 16(3), 2007.     

A Web Application for Generation of Random DNA Sequences with a Single Open Reading Frame: Exemplars for Genetics and Bioinformatics Education

A standard genetic/bioinformatic activity in the genomics era is the identification within DNA sequences of an "open reading frame" (ORF) that encodes a polypeptide sequence. As an educational introduction to such a search, we provide a webapp that composes, displays for solution, and then solves short DNA exemplars with a single ORFTo the Editor: We wish to bring a new Web resource to the attention of CBE—Life Sciences Education readers.When being introduced to the central dogma of nucleic acid transactions, students are often required to identify the 5′→3′ DNA template strand in a double-stranded DNA (dsDNA) molecule; transcribe an antiparallel, complementary 5′→3′ mRNA; and then translate the mRNA codons 5′→3′ into an amino acid polypeptide by means of the genetic code table. Although this algorithm replicates the molecular genetic process of protein synthesis, experience shows that the series of left/right, antiparallel, and/or 5′→3′ reversals is confusing to many students when worked by hand. Students may also obtain the “right” answer for the “wrong” reasons, as when the “wrong” DNA strand is transcribed in the “wrong” 3′→5′ direction, so as to produce a string of letters that “translates correctly.”In genetics and bioinformatics education, we have found it more intuitively appealing to demonstrate and emphasize the equivalence of the mRNA to the DNA sense strand complement of the template strand. The sense strand is oriented in the same 5′→3′ direction and has a sequence identical to the mRNA, except for substitution of thymidine in the DNA for uracil in the mRNA. It is thus more computationally efficient to “read” the polypeptide sequence directly from this strand, with mental substitution of thymidine in the triplets of the genetic code table. (By definition, “codons” occur only in mRNA: the equivalent three-letter words in the DNA sense strand may be designated “triplets.”) This is the same logic used in DNA “translation” software programs.A further constraint often imposed on dsDNA teaching exemplars is that five of the six possible reading frames are “closed” by the occurrence of one or more “stop” triplets, and only one is an open reading frame (ORF) that encodes an uninterrupted polypeptide. We designate this the “5&1” condition. The task for the student is to identify the ORF and “translate” it correctly. Other considerations include correct labeling of the sense and template DNA strands, their 5′ and 3′ ends (and of the mRNA as required), and the amino (N) and carboxyl (C) termini of the polypeptide.Thus, instructors face the logistical challenge of creating dsDNA sequences that satisfy the “5&1” condition for homework and exam questions. Instructors must compose sequences with one or more “stops” in the three overlapping read frames of one strand, while simultaneously creating two “stopped” frames and one ORF in the other. We have explored these constraints as an algorithmic and computational challenge (Carr et al., 2014 ). There are no “5&1” exemplars of length L ≤ 10, and the proportion of exemplars of length L ≥ 11 is very small relative to the 4^L possible sequences (e.g., 0.0023% for L = 11, 0.048% for L = 15, 0.89% for L = 25). This makes random exploration for such exemplars inefficient.We therefore developed a two-stage recursive search algorithm that samples 4^L space randomly to generate “5&1” exemplars of any specified length L from 11 ≤ L ≤ 100. The algorithm has been implemented as a Web application (“RandomORF,” available at www.ucs.mun.ca/~donald/orf/randomorf). Figure 1 shows a screen capture of the successive stages of the presentation. The application requires JavaScript on the computer used to run the Web browser.Open in a separate windowFigure 1.Successive screen captures of the webapp RandomORF. First panel: the Length parameter is the desired number of base pairs. Second panel: Clicking the “Generate dsDNA” button shows the dsDNA sequence to be solved, with labeled 5′ and 3′ ends. The button changes to “Show ORF.” Third panel: A second click shows the six reading frames, with the ORF highlighted. Here, the ORF is in the sixth reading frame on the bottom (sense) strand. The polypeptide sequence, read right to left, is N–EITHLRL–C, where N and C are the amino and carboxyl termini, respectively. The conventional IUPAC single-letter abbreviations for amino acids are centered over the middle base of the triplet; stop triplets are indicated by asterisks (*).The webapp provides a means for students to practice identifying ORFs by efficiently generating many examples with unique solutions (Supplemental Material); this can take the place of the more standard offering of a small number of set examples with an answer key. The two-stage display makes it possible for problems to be worked “cold,” with the correct ORF identified only afterward. For examinations, any exemplar may be presented in any of four ways, by transposing the top and bottom strands and/or reversing the direction of the strands left to right. Presentation of the 5′ end of the sense strand at the lower left or upper or lower right tests student recognition that sense strands are always read in the 5′→3′ direction, irrespective of the “natural” left-to-right and/or top-then-bottom order. We intend to modify the webapp to include other features of pedagogical value, including constraints on [G+C] composition and the type, number, and distribution of stop triplets. We welcome suggestions from readers.     

Healthy Birth Practice #1: Let Labor Begin on Its Own

As cesarean rates have climbed to almost one-third of all births in the United States, current research and professional organizations have identified letting labor begin on its own as one of the most important strategies for reducing the primary cesarean rate. At least equally important, letting labor begin on its own supports normal physiology, prevents iatrogenic prematurity, and prevents the cascade of interventions caused by labor induction. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #1: Let Labor Begin on Its Own,” published in The Journal of Perinatal Education, 16(3), 2007.     

Healthy Birth Practice #2: Walk,Move Around,and Change Positions Throughout Labor

In the United States, obstetric care is intervention intensive, resulting in 1 in 3 women undergoing cesarean surgery wherein mobility is treated as an intervention rather than supporting the natural physiologic process for optimal birth. Women who use upright positions and are mobile during labor have shorter labors, receive less intervention, report less severe pain, and describe more satisfaction with their childbirth experience than women in recumbent positions. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #2: Freedom of Movement Throughout Labor,” published in The Journal of Perinatal Education, 16(3), 2007.     

Effective Antenatal Education: Strategies Recommended by Expectant and New Parents

Antenatal education is a crucial component of antenatal care, yet practice and research demonstrate that women and men now seek far more than the traditional approach of a birth and parenting program attended in the final weeks of pregnancy. Indeed, women and men participating in this study recommended a range of strategies to be provided during the childbearing year, comparable to a “menu in a restaurant.” Their strategies included three program types: “Hearing Detail and Asking Questions,” “Learning and Discussing,” and “Sharing and Supporting Each Other.” The characteristics of each type of program are identified in this article. The actual learning methods the study participants recommended to be incorporated into the programs were “Time to Catch Up and Focus,” “Seeing and Hearing the Real Experience,” “Practicing,” and “Discovering.”     

First,Do No Harm: How Routine Interventions,Common Restrictions,and the Organization of Our Health-Care System Affect the Health of Mothers and Newborns

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the “First, do no harm” principle in a different way. New research on the potentially harmful effects of intravenous lines demonstrates that refraining from routine interventions in labor protects the safety of women and babies. A new systematic review of movement and position changes in labor shows that eliminating unfounded restrictions also protects maternal and infant health and well-being. Finally, a study of patterns of use of neonatal intensive care units reveals how the organization of the maternity care system itself can affect the health outcomes of its beneficiaries.     

High school biology today: what the Committee of Ten actually said

This essay describes how in the 1890s the Committee of Ten arrived at their recommendations about the organization of the high school biological sciences and seeks to correct the frequently held, but erroneous view that the Committee of Ten was the initiator of the Biology-Chemistry-Physics order of teaching sciences prevalent in high schools today. The essay details the factors underlying the changing views of high school biology from its “natural history” origins, through its “zoology, botany, physiology” disciplinary phase to its eventual integration into a “general biology” course. The simultaneous parallel development of the “Carnegie Unit” for measuring coursework is highlighted as a significant contributor in the evolution of the present day high school biology course. The essay concludes with a discussion of the implications of the grade placement of the sciences for the future development of high school biology.     

Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push

Women in the United States are still giving birth in the supine position and are restricted in how long they can push and encouraged to push forcefully by their caregivers. Research does not support these activities. There is discussion about current research and suggestions on how to improve the quality of the birth experience. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions,” published in The Journal of Perinatal Education, 16(3), 2007.     

Large-Sample Variance of Fleiss Generalized Kappa

Cohen’s kappa coefficient was originally proposed for two raters only, and it later extended to an arbitrarily large number of raters to become what is known as Fleiss’ generalized kappa. Fleiss’ generalized kappa and its large-sample variance are still widely used by researchers and were implemented in several software packages, including, among others, SPSS and the R package “rel.” The purpose of this article is to show that the large-sample variance of Fleiss’ generalized kappa is systematically being misused, is invalid as a precision measure for kappa, and cannot be used for constructing confidence intervals. A general-purpose variance expression is proposed, which can be used in any statistical inference procedure. A Monte-Carlo experiment is presented, showing the validity of the new variance estimation procedure.     

Healthy Birth Practice #6: Keep Mother and Baby Together— It’s Best for Mother,Baby, and Breastfeeding

Mothers and babies have a physiologic need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and babies together is a safe and healthy birth practice. Evidence supports immediate, uninterrupted skin-to-skin care after vaginal birth and during and after cesarean surgery for all stable mothers and babies, regardless of feeding preference. Unlimited opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding,” published in The Journal of Perinatal Education, 16(3), 2007.     

Beyond Punnett Squares: Student Word Association and Explanations of Phenotypic Variation through an Integrative Quantitative Genetics Unit Investigating Anthocyanin Inheritance and Expression in Brassica rapa Fast Plants

Genetics instruction in introductory biology is often confined to Mendelian genetics and avoids the complexities of variation in quantitative traits. Given the driving question “What determines variation in phenotype (Pv)? (Pv=Genotypic variation Gv + environmental variation Ev),” we developed a 4-wk unit for an inquiry-based laboratory course focused on the inheritance and expression of a quantitative trait in varying environments. We utilized Brassica rapa Fast Plants as a model organism to study variation in the phenotype anthocyanin pigment intensity. As an initial curriculum assessment, we used free word association to examine students’ cognitive structures before and after the unit and explanations in students’ final research posters with particular focus on variation (Pv = Gv + Ev). Comparison of pre- and postunit word frequency revealed a shift in words and a pattern of co-occurring concepts indicative of change in cognitive structure, with particular focus on “variation” as a proposed threshold concept and primary goal for students’ explanations. Given review of 53 posters, we found ∼50% of students capable of intermediate to high-level explanations combining both Gv and Ev influence on expression of anthocyanin intensity (Pv). While far from “plug and play,” this conceptually rich, inquiry-based unit holds promise for effective integration of quantitative and Mendelian genetics.     

Biology Intensive Orientation for Students (BIOS): a biology "boot camp"

The Biology Intensive Orientation for Students (BIOS) Program was designed to assess the impact of a 5-d intensive prefreshman program on success and retention of biological science majors at Louisiana State University. The 2005 pilot program combined content lectures and examinations for BIOL 1201, Introductory Biology for Science Majors, as well as learning styles assessments and informational sessions to provide the students with a preview of the requirements of biology and the pace of college. Students were tracked after their BIOS participation, and their progress was compared with a control group composed of students on the BIOS waiting list and a group of BIOL 1201 students who were identified as the academic matches to the BIOS participants (high school GPA, ACT score, and gender). The BIOS participants performed significantly better on the first and second exams, they had a higher course average, and they had a higher final grade than the control group. These students also had higher success rates (grade of “A,” “B,” or “C”) during both the fall and spring semesters and remained on track through the first semester of their sophomore year to graduate in 4 yr at a significantly higher rate than the control group.     

Design of Paper-Based Visual Analogue Scale Items

Paper-based visual analogue scale (VAS) items were developed 100 years ago. Although they gained great popularity in clinical and medical research for assessing pain, they have been scarcely applied in other areas of psychological research for several decades. However, since the beginning of digitization, VAS have attracted growing interest among researchers for carrying out computerized and paper-based data assessments. In the present study, we investigated the research question “Which different design characteristics of paper-based VAS items are preferred by women and men?” Based on a sample of 115 participants (68 female), our results revealed that the respondents preferred a paper-based VAS item with a horizontal, 8-cm long, 3 DTP (“desktop publishing point”) wide, black line, with flat line endpoints, and the ascending numerical anchors “0” and “10”, both for women and men. Although we did not identify any gender difference in these characteristics, our findings uncovered clear preferences on how to design paper-based VAS items.     

“What if students revolt?”—Considering Student Resistance: Origins,Options, and Opportunities for Investigation

Instructors attempting new teaching methods may have concerns that students will resist nontraditional teaching methods. The authors provide an overview of research characterizing the nature of student resistance and exploring its origins. Additionally, they provide potential strategies for avoiding or addressing resistance and pose questions about resistance that may be ripe for research study.

“What if the students revolt?” “What if I ask them to talk to a neighbor, and they simply refuse?” “What if they do not see active learning as teaching?” “What if they just want me to lecture?” “What if my teaching evaluation scores plummet?” “Even if I am excited about innovative teaching and learning, what if I encounter student resistance?”

These are genuine concerns of committed and thoughtful instructors who aspire to respond to the repeated national calls to fundamentally change the way biology is taught in colleges and universities across the United States. No doubt most individuals involved in promoting innovative teaching in undergraduate biology education have heard these or variations on these fears and concerns. While some biology instructors may be at a point where they are still skeptical of innovative teaching from more theoretical perspectives (“Is it really any better than lecturing?”), the concerns expressed by the individuals above come from a deeply committed and practical place. These are instructors who have already passed the point where they have become dissatisfied with traditional teaching methods. They have already internally decided to try new approaches and have perhaps been learning new teaching techniques themselves. They are on the precipice of actually implementing formerly theoretical ideas in the real, messy space that is a classroom, with dozens, if not hundreds, of students watching them. Potential rejection by students as they are practicing these new pedagogical skills represents a real and significant roadblock. A change may be even more difficult for those earning high marks from their students for their lectures. If we were to think about a learning progression for faculty moving toward requiring more active class participation on the part of students, the voices above are from those individuals who are progressing along this continuum and who could easily become stuck or turn back in the face of student resistance.Unfortunately, it appears that little systematic attention or research effort has been focused on understanding the origins of student resistance in biology classrooms or the options for preventing and addressing such resistance. As always, this Feature aims to gather research evidence from a variety of fields to support innovations in undergraduate biology education. Below, we attempt to provide an overview of the types of student resistance one might encounter in a classroom, as well as share hypotheses from other disciplines about the potential origins of student resistance. In addition, we offer examples of classroom strategies that have been proposed as potentially useful for either preventing student resistance from happening altogether or addressing student resistance after it occurs, some of which align well with findings from research on the origins of student resistance. Finally, we explore how ready the field of student resistance may be for research study, particularly in undergraduate biology education.     

Preparing for the First Birth: Mothers' Experiences at Home and in Hospital in Australia

The aim of this research was to explore the experiences of a group of first-time mothers who had given birth at home or in hospital in Australia. Data were generated from in-depth interviews with 19 women and analyzed using a grounded theory approach. One of the categories to emerge from the analysis, “Preparing for Birth,” is discussed in this article. Preparing for Birth consisted of two subcategories, “Finding a Childbirth Setting” and “Setting Up Birth Expectations,” which were mediated by beliefs, convenience, finances, reputation, imagination, education and knowledge, birth stories, and previous life experiences. Overall, the women who had planned home births felt more prepared for birth and were better supported by their midwives compared with women who had planned hospital births.     

What Started Your Labor? Responses From Mothers in the Third Pregnancy,Infection, and Nutrition Study

Many behaviors and substances have been purported to induce labor. Using data from the Third Pregnancy, Infection, and Nutrition cohort, we focus on 663 women who experienced spontaneous labor. Of the women who reported a specific labor trigger, 32% reported physical activity (usually walking), 24% a clinician-mediated trigger, 19% a natural phenomenon, 14% some other physical trigger (including sexual activity), 12% reported ingesting something, 12% an emotional trigger, and 7% maternal illness. With the exceptions of walking and sexual intercourse, few women reported any one specific trigger, although various foods/substances were listed in the “ingesting something” category. Discussion of potential risks associated with “old wives’ tale” ways to induce labor may be warranted as women approach term.