Improving Cervical Insufficiency Diagnostics: Designing a Device to Measure Uterine Cervical Stiffness; A Healthy Baby, What More Could I Want? Framing Obstetric Violence as a Form of Sex-Based Violence

Obstetrics is a unique field of medicine in that despite how ubiquitous its effects are on the whole population, it is drastically underfunded and under researched. In 2020, three related categories of 1) pregnancy, 2) preterm, low birth weight, and health of the newborn, and 3) maternal health received a combined $1.4 billion ($550, $444 , and $407 million respectively). In comparison, neurosciences alone received $10.1 billion, nearly 10 times the other three categories combined. As a result, little progress has been made in the field: preterm birth rates have more or less held steady from 1981 to 2016, ranging narrowly between 9.4% (1989) and 12.8% (2006). This culture of a lack of attention given to obstetrics propagates down to the individual patient level: women rarely talk about their pregnancy and birth experiences when it doesn’t reflect the idyllic image seen in pamphlets at a doctor’s office.

The technical portion of my thesis involved designing a device to measure cervical stiffness – a metric that has been suggested to be predictive of cervical insufficiency. Research suggests that in cervical insufficiency, the cervix mechanically weakens to the point where a fetus can no longer be supported in utero. Currently, the clinical standard to measure cervical stiffness is digitally, through the use of fingers, then evaluated in comparison to areas of the face. No alternative has been clinically approved. With the current methods to diagnose cervical insufficiency, studies estimate that 25 interventional procedures would need to be performed for a single patient to benefit; hence, dozens of likely unnecessary procedures are performed on pregnant women. With my project collaborator Emily Boland, and advisors Dr. Will Guilford, Dr. Donald Dudley, and Dr. Christopher Ennen, the aim is to design a quick, cost-effective, easily disinfected, and minimally painful tool to measure cervical stiffness.

In my STS research, I explore how obstetric violence can be framed as institutionalized, sex-based violence. Women’s accounts of trauma during childbirth rarely emerge in public discussion. Kukura hypothesizes that women often doubt whether their injuries are worthy of complaint, regardless of whether this is due to shame, perceptions of stigma, or a lack of awareness about what to expect during labor and delivery. My research involves analyzing accounts of abuse in childbirth to reveal how medical personnel inflict obedience upon laboring women. One of my major findings is the “dead baby card” – a coercive strategy threatening that whatever the birthing mother was refusing to do would kill her baby. Examination of how being “a good mother” ideas of altruism, and putting the needs of their children first, physicians use motherhood as a weapon for compliance with the underlying assumption that being a good mother is valued more than being an autonomous woman. Patients may be portrayed as bad mothers if their complaints of obstetric violence frame them as putting their birth experience above the health of their baby.

My STS research and technical project demonstrate that to improve patient experience and outcomes in obstetrics requires not only technical advancement of diagnostic methods and treatments, but for medical personnel and industries to adjust attitudes and social interactions with these patients. Together, my technical and STS portions exemplify the importance of exploring these topics that are so rarely publicly discussed. Obstetrics is incredibly intimate by nature, thus practices need to acknowledge the vulnerability required of the patient. My technical project acknowledges patient experience by designing our device to be used as part of a regular pregnancy check up; the device fits within a speculum. Yet, as demonstrated with my STS research, many social interactions between doctors and patients reflect mistreatment and disrespect that technological innovation will not mend. Hence, it is crucial to explore patient experiences in obstetrics from multiple angles and consider how the system functions as a whole. In my future career as a physician, I hope to place respect for the patient first in all treatment decisions and interactions. This project has revealed the need to educate patients about what to expect and what is considered “normal” in obstetrics. I would encourage all patients to join support groups and talk with others about their experiences and options to ensure their proficiency in health literacy and treatment options.

School of Engineering and Applied Sciences

Bachelor of Science in Biomedical Engineering

Technical Advisor: William Guilford, Donald Dudley, Christopher Ennen

STS Advisor: Kathryn Neeley

Technical Team Members: Emily Boland