Q-1: "I am in your 3533 class and I have to pass a comment along to you. My friends and I agree that the classes are hard to follow with regards to the book. With most classes that we attent, the overheads corrispond to the book in an order, but the overheads that you put up sometimes don't even match the book. And times that they do, they seem to be scattered around the chapter. It would help if you could include page numbers or a note saying this isn't in the text.

Sorry to explode like this, but it's not ment to insult you, but just to make you aware. We are not the only ones who feel this way. Other than that, keep up the good work."

A-1: I appreciate your comments, I wish more students would take the time to do it. It gives me the chance to explain to my students why I do certain things.

University lectures should never, never be meant to follow the textbook. If the instructor just summarizes the book for you, anybody with an undergraduate education should be able to teach. One of the purposes of a university education, as opposed to, say, high school or vocational college, is to learn how to read independently and critically. I know that some instructors just summarize the text, and it may be easier for the student. But - very few things worth attaining are easy.

My philosophy is that students should be able to read and digest both the text and my notes, find the topics in common and the discrepancies, and ponder about them. Some of the extra material that I lecture about is meant to deepen your knowledge in certain areas. In other cases, it is to present a different point of view than that of the text and provoke thinking about controversial issues. In some instances, the extra material is meant to motivate students to ask more questions.

Occasionally, I do mention in class that certain sections in the text will not be tested, or that something I say in class is not going to be asked in an exam. For instance, you will recall that some of the detailed physiological information was left out. Other than those exceptions, I prefer to challenge students by going beyond passive absorption of what is in the text. Perhaps you were not in class at the beginning of the term, when I took time to explain why my notes do not correspond 100% with the text, or perhaps you were there but forgot what I said.

In any case, these are my reasons, and I hope you appreciate them. Thanks again for giving me your opinion. If you would like to discuss this further in person, by all means drop by my office.

Q-2: You mentioned episiotomies as an unnecessary intervention (possibly causing harm). What I was wondering is whether the risk of an episiotomy is less dangerous than a ragged tear naturally occuring during childbirth? How often do the natural tears occur, and wouldn't they cause greater pain and take longer to heal?

A-2: >Hello, glad you enjoy the course. The standard excuse for doing the episiotomy is that a so-called ragged tear is harder to stitch and heal. In fact, experienced midwives say two things: 1) tears occur when the second stage is rushed (too much hard pushing, not giving time for the introitus to open up gradually - all hallmarks of doctor-led deliveries) and 2) it is essentially not true that a straight cut heals better and faster than a ragged one. Basically, the episiotomy allows the dr. to get through it faster. Many times the cut is botched and women end up with very long, deep cuts that damage muscle and nerves, leading to months and even years of discomfort. Some have to have surgical repairs done. Some end up with so much scar tissue that sex is compromised. So, the best course of action is to prevent a tear to begin with, by allowing more time for the second stage if needed, giving perineal support and massaging the perineum with a warm oil to help it stretch without tearing.

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