Monday, August 29, 2016

The Top 12 Evidence-Based Resources for Birth Professionals

With social media feeding information to our clients like a fire hose, it can be overwhelming for birth professionals (childbirth educators, doulas, lactation consultants) to discern all of the information and change curriculum or visit information to address every issue.

So with all of the information available to us, how do we choose which ones to heed and which ones to ignore? 

Top Websites for Evidence-Based Information (in no particular order, except for #1) This website was conceived by Dr. Gene Declercq and has been developed by a group of students from Boston University School of Public Health.  If you don’t know about Dr. Declercq, that should be the very first thing you Google.  He is incredibly intelligent and has been a prolific writer and disseminator of truth for several decades.  I am his
greatest fan.  Once known as the Maternity Center Association (show me a childbirth educator with over 25 years of experience and I’ll show you her Birth Atlas from MCA!) since 1918, this program is now a core of the National Partnership for Women and Families. The March of Dimes and in particular their “Healthy Babies are Worth the Wait” focuses on reducing elective births before 39 weeks. It’s all about breastfeeding – great info for both professionals and parents! The Midwives Information and Resource Service is a not-for-profit educational charity providing essential materials to assist midwives and other professionals. Fantastic website for info on cesareans and VBACs.

and of course....... Celebrating 17 years of evidence based information for both parents and professionals.

Top Books as Reference for Birth/Breastfeeding Professionals (in no particular order)

Natural Hospital Birth: The Best of Both Worlds (2011) by Cynthia Gabriel.

Optimal Care in Childbirth: The Case for a Physiologic Approach (2012) Amy Romano and Henci Goer.

The Birth Partner 4th Edition: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions. (2013) by Penny Simkin.

Pregnancy Childbirth and the Newborn The Complete Guide (2016) by Penny Simkin and Janet Whalley.

Impact of Birthing Practices on Breastfeeding (2010) by Linda J. Smith.

Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family (2014) by Diane Wiessinger, Diana West, Linda Smith and Teresa Pitman.

The Nursing Mother’s Companion 7th Edition. (2015) by Kathleen Huggins.

Is there a book you feel should be on this list?  Email me at and I’ll be happy to share it with my readers!

Monday, August 22, 2016

Why Childbirth Education IS Still Important!

Researchers agree that antenatal education (aka childbirth education) is a vital part of reducing maternal/infant morbidity and mortality rates, the rising cesarean rates and the growing fear of childbirth.  

On September 19, I have the privilege of joining five other experts in childbirth education to share with you not only why we believe that childbirth education is still important but what the evidence says.  Thanks to Injoy Birth and Parenting of Boulder Colorado, "Why Childbirth Education is Still Important" is the newest in their free webinar series.

You'll hear from Penny Simkin, Cathy Allen, Vonda Gates, Colleen Weeks, Robin Weiss and myself as we explore how to encourage expectant parents to attend classes and teaching to the adult learner, why childbirth education is for every expectant parent and how to challenge the price of ignorance, getting the physicians on board with childbirth education classes, as well as the tokophobia (fear of childbirth) and the Birth/Breastfeeding relationship.  And there will be time at the end of the webinar for you to ask questions!

Want to learn more about this free webinar from Injoy?  Click here!

This amazing webinar is free but you do have to register.  To register, click here.

Monday, August 08, 2016

Understanding an Op Ed Piece - "Get the Epidural"

Last month (July 9 2016), Jessi Klein  wrote an op-ed piece for the New York Times titled “Get the Epidural”  Here is the link to the piece - click here.

I do not normally respond to op-ed pieces because they are just that, opinions.  And I believe everyone has the right to their opinion.  This is no exception.
In her piece, Klein points out, either consciously or subconsciously, several issues that expectant women grapple with nearly every day.

In life, we are unfortunately all subject to judgement and criticism.  Is it fair?  No, especially not in the tender emotional state of pregnant women.  Strangers feel it is accepted to ask personal questions and even invade personal space by pointing at or even touching a pregnant belly.  These strangers feel that expectant women are warm and fuzzy mommies who will be accepting of a variety of social behaviors.  What strangers fail to recognize is that expectant women are still people, with emotional and physical boundaries just like anyone.  And, these same expectant women are fierce momma bears with an incredible protective instinct.  So no wonder there can be a strong push-back on invasions of personal space.

The debate continues about the names of childbirth experiences.  Words that have been tossed around include “natural”, “normal”, “unmedicated”, “unassisted”, and “physiologic”.  Most regular humans do not know the difference and often use these interchangeably.  There may only be two types of childbirth:  physiologic and intervented.  Physiologic would mean that labor begins on its own (without using any medications to begin or augment the labor progress), void of interventions of any kind including medications (such as an epidural) or instrumental assistance (forceps or vacuum).  Intervented would mean a labor and birth that required an intervention, including the previously stated interventions or even a cesarean surgery.  Both have their place in modern obstetrics. 

Birth options
Expectant women should thrive in an atmosphere of freedom to make decisions about their birth experience based on the knowledge of alternatives – such is part of the motto of the International Childbirth Education Association.  Klein implied she was doing some learning and I hope that the internet is not her sole source of information.   I hope she explores books, classes and perhaps even hires a doula who can significantly add to her personal knowledge base. Expectant women who are in a solid place informationally and who can make informed decisions, have incredible birth satisfaction and some research has shown have a reduced incidence of postpartum mood disorders.

Tokophobia & Relationship Issues
Klein’s last paragraph deals with her fear of different types of pain, including pain associated with birth and breastfeeding.  She seems unsettled about her postpartum image and unsettled about adult relationships.  These are issue that may take time to resolve and are not uncommon!  With so much information at our fingertips, it is hard to discern what information is valid and what is tainted by bias.  Finding information that is evidence-based can be more than expectant women can endure.  This may be one reason why expectant women find one source of information and remain locked on that source throughout their pregnancy.  True or biased, one source is better and less time consuming than vetting multiple sources of information.  Doing intense investigation can also facilitate the fear that may be present.

Based on what I’ve said previously, I hope Klein cultivates an environment of support.  What support looks like for expectant women is entirely up to them – whether that is family support, social support, informational support, emotional support, or physical support.  All women need to feel supported during the most challenging and exciting day of their life.  To feel unsupported during this crucial time brings about feelings of resentment and isolation.  Feeling supported can promote calm and make decision-making easier.

Each woman has the opportunity to thoroughly explore all options and information and based on that education, work together with care providers to have the birth experience that they want.  Even when some of the decisions are out of their hands, women should cultivate a trusting relationship with their care providers for just those times.  

Thursday, August 04, 2016

Finding Your Path in the World of Birth & Breastfeeding!

Disclaimer: As of this writing, I am currently the President of the International Childbirth Education Association

The time has come for you to take the next step in your career.  Perhaps you are still in high school or college.  Or perhaps you are changing careers to something that fits your interest or passion?  You may have helped friends and families with their birth experiences.  Stories and research about pregnancy, birth and breastfeeding consume you.  And perhaps, you think of yourself as a "birth junkie".

Each week, I receive numerous email inquiries about how to begin a career in maternity care. Sometimes, it is a simple suggestion to change someone's major in college.  More often, it is a question of changing career fields and the need for a referral to an organization through which certifications can be obtained.

When investigating career options in the world of birth and breastfeeding, it is best to answer some preliminary questions:

  1. Do I want to specialize in either birth or breastfeeding or both?
  2. Do I want to catch babies?
  3. If I want to specialize in birth only, do I want to provide labor support or education or both? Do I want to be a nurse? Do I want to be a childbirth educator?
  4. Do I want to become a labor/birth doula?
  5. What about prenatal yoga or prenatal exercise or pregnancy massage?
  6. If specializing in breastfeeding only, do I want to teach or provide consultations or both?
  7. What about the postpartum period? Do I want to become a postpartum doula or perhaps teach newborn care classes?
Your next steps depend on the answers you have given to the questions above.

If you would like to become a nurse and work in maternity or newborn care, this would take a college education and sitting for your state's nursing board exam. A membership organization for nurses who work in maternity care is AWHONN, the Association for Women's Health, Obstetric and Neonatal Nurses.  Their website is

If you are interested in catching babies, either becoming on obstetrician or midwife is the path you should take.  Studying obstetrics and becoming a nurse midwife are both college degrees. A membership organization for nurse midwives is ACNM, the American College of Nurse Midwives. Their website is

If you desire to become a non-nurse midwife, there are several schools in the United States that offer this path.  You will want to explore your options at  You will also want to investigate your state's legal stance on non-nurse midwifery.  Should you wish to sit for the NARM exam and become a Certified Professional Midwife (CPM), please go to Other midwifery websites include MANA, the Midwives Alliance of North America ( and the National Association of Certified Professional Midwives (

Teaching childbirth education classes is an extremely rewarding career and one that is the most "schedule-able".  This may be important to you if you are attending classes for a lateral degree or caring for your young children.  While there are no standard requirements or state laws governing childbirth education, it is indeed important to choose an organization who (1) provides an up-to-date and evidence-based certification program; (2) collaborates with other organizations and entities to expand the scope of their programs and (3) has the support of a variety of leaders in the field of childbirth education and maternity care.  An initial view of the organization's website will give you a snap shot of their organization. You may find their mission and vision statements, philosophy, white papers or Position Papers and training/certification requirements.

For an overview of choosing a childbirth education organization, click here.

For a quick, side-by-side comparison of childbirth education entities (with an international reach), please click here.

I use the word "entity" above because not all of the places from which you receive training for childbirth education (or even doula training) are organizations.  Some of them are non-profit organizations and some of them are for-profit companies, where the owners profit.  

Some entities require membership for certification maintenance and some do not.  Are there benefits to organizational membership?  If you are a member of a professional organization, you may receive the following benefits:

  • A unified voice for advocacy in the field.
  • Representation in collaborative work with other professional organizations.
  • Discounts on other trainings or certifications offered by the entity.
  • Discounts on annual conferences offered by the entity.
  • Applicable clinical updates such as newsletters, journals, etc.
  • Updated information for recertification.
  • Awards and scholarships.
  • Specialized members-only areas of the website.
  • Multiple levels of professional safeguards to minimize liability or risk.

Finding your place in the world of birth and breastfeeding can be difficult at first and often take twists and turns that you may not initially anticipate.  Enjoy your time in this amazing career path!

Friday, July 22, 2016

Heat Index Over 100 F: Tips on feeling good!

This weekend may be the hottest weekend of the year with heat indexes well over 100F in many areas of the US!  Our pregnant and breastfeeding clients need to know how to cope during these blistering hot days.  

Here are some tips to help them feel good on hot days!

  1. Stay well hydrated!  Actually count the number of 8 ounce cups in a drink bottle.  It may be surprising how much (or how little) is included!  On a "normal" day, expectant and breastfeeding mothers need at least 64 fl oz or 8 - 8oz cups of water.  During the summer months and during exercise, expectant and breastfeeding mothers may need as much as 128 fl oz or a gallon of water per day!  Yes, all of that fluid may make urination a frequent item but it is so much better than the alternative!
  2. Avoid diuretics such as caffienated beverages.  Yes, that iced coconut caramel mocha looks amazing but a pregnant or breastfeeding mother will need to drink twice that in water to replace what is being excreted from the body.
  3. Stay indoors.  Especially during the hottest portions of the day which are typically 10 am to 4 pm.
  4. When outdoors, wear a large brim hat and use sunscreen, preferably a broad spectrum sunscreen - UVA/UVB.

Know the signs of Heat Exhaustion!

There are two types of heat exhaustion, water depletion (signs include thirst, weakness, headache, loss of consciousness) and salt depletion (signs include nausea and vomiting, muscle cramps and dizziness). Urine may also have a dark color and the heart may beat rapidly.  While less than heat stroke, heat exhaustion may require medical attention.  Certainly getting out of the heat and into air conditioning, resting, hydrating, and other cooling measures such as cool shower, fans or cold towels.  For more about heat exhaustion, see Web MD.

Know the signs of Heat Stroke!

According to Web MD, the symptoms of heat stroke include core body temp of 105F, dizziness or fainting, seizures, confusion, and disorientation.  It is imperative to call 911 or seek medical attention immediately while trying to cool the body!

The best advice is to stay in where it is cool and hydrate!  The hot weather will pass and soon cooler weather will be on its way!

Monday, July 18, 2016

Celebrating World Breastfeeding Week August 1-7

August 1-7 is traditionally celebrated as World Breastfeeding Week!  World Breastfeeding week is an annual celebration in more than 120 countries, with 540 events world-wide and nearly 410,000 participants.  Organized by WABA, WHO and UNICEF in 1992, WBW promotes the value of breastfeeding for mothers as well as children.

Start planning now as to how you’ll bring this forward into your community.

The objectives of this year’s celebration are
1) To inform people about the new Sustainable Development Goals (SDG) and how they relate to breastfeeding and Infant and Young Child Feeding;
(2) To firmly anchor breastfeeding as a key component of sustainable development;
(3) To galvanise a variety of actions at all levels on breastfeeding and IYCF in the new era of the SDGs;
(4) To engage and collaborate with a wider range of actors around promotion, protection and support of breastfeeding.

Available on the website are downloads of the WBW logo with subtitles in many languages, Action Folders in many languages,  as well as WBW 2016 Posters in many languages.

Find logos, Action Folders and Posters here:

Thursday, July 14, 2016

That Moment When A Doctor Says He Won’t Refer To Your Childbirth Classes

A childbirth educator receives a phone call from a local physician.  He proceeds to tell her that he no longer will be referring his patients to her childbirth classes (or doula service).  His reasoning is that her clients ask too many questions.  They know the risks and benefits of multiple procedures (such as induction) and often refuse certain procedures (not inappropriate refusals).  This is bothersome to him and keeps him from practicing medicine the way he desires.

Some who read this blog post will say that I am making up the scenario.  Well, unfortunately, I am not.  This event really happened in 2016.

At first glance, this scenario might truly make this childbirth educator/doula question her practice.  She may feel that she is doing something wrong.  She may feel guilty.

But why?

Clearly, the physician in this scenario played all of his cards in one turn.  What did he really say?

He said:

He will no longer refer any of his obstetric patients for childbirth educator or doula care.

It makes the physician uncomfortable that patients who attend this educator’s classes or become her doula clients are exceptionally educated either before or during their time with her.  Yes, patients can learn on their own via books, friends, family, or the internet.  The patients also have a brain that can reason.  If a procedure sounds as if it could interfere with natural hormonal orchestration of childbirth, which can also stimulate hormones essential to bonding and mothering.

Because of this knowledge of evidence-based information, this physician feels threatened and anger.

When they question or appropriately refuse (such as in the case of induction for convenience rather than clinical reason), again, the physician feels threatened and angry.

The fact that patients have evidence-based information and ask questions indicates that the physician is expected to practice according to the evidence.  This may be contrary to the way he has been practicing: the way he was taught or the way he wants to practice, as the latter meets his personal needs.  His needs.

Since the physician is concerned about his own needs being met, the needs of his patients are of no concern to him as long as the outcome of the birth experience is not medical tragic.  What the woman wants and what may actually be best for a truly positive birth outcome is of no interest to this physician.

What is the takeaway from this for the childbirth educator?

  • The quality of education that this person provides is evidence-based, and empowers her clients.
  • Her clients are empowered to own the information.
  • Her clients are acting like consumers and are asking for practices changes that are in alignment with the evidence. 
  • Even though the physician does not refer to her, there are numerous other ways to market the childbirth education classes or doula services. 
  • Clients who want to attend these classes or have these services have the right to change care provider.
  • It is their birth.
  • It is their birth.
  • It is their birth.

This educator/doula should not give up.  She is obviously doing her job very effectively.  Initially there might be some hurt, but after careful consideration, she will find that it is all about the physician and not her.

Additionally, this is one reason why we must, as childbirth educators and doulas, have in our skill set arsenal a strong understanding of marketing and social media.  We may not be able to depend on others to refer clients to us.  We have to let expectant parents know that we are out there!  We must let them know that there is information to be learned, techniques to be mastered and options to be exercised.