Tuesday, February 09, 2016

CDC USBC Webinar: Tracking Breastfeeding and Care (mPINC) Scores

Editor's Note: This is just one in a series of free webinars from the Center for Disease Control and the USBC.  If interested, please follow their directions to sign up for future webinars!


Friday, February 05, 2016

"Oh Honey, I'm too Old to be Thinking About Childbirth"

Have you ever told someone what you do for a living?  You are a childbirth educator or doula.

If the person with whom you are speaking is of childbearing age, you might get the following responses:

"I'm taking childbirth classes!"


If the person with whom you are speaking is past the age of childbearing, you might get the following responses:

"hahahahahaha" (with a somewhat eerie sneer)

"Oh Honey, I'm too old to be thinking about THAT!"

Most of the time, when I get the latter two responses, I cringe a little.  This is an example of how our society is morphing into something different than it used to be.  There are fewer and fewer "wise women" of our tribe, sharing valuable information with those women of childbearing age.  Where, then do young women receive their birthing information?  Those who do receive information, often receive it from friends, families, and the internet.  And while each of those sources may be good, they may also not be up-to-date or evidence-based. Women may also relay on television shows or books, and while these also may be good, they may also be inaccurate.  After all, the idea behind television is to sell products.  The pregnancy/birth episodes must be high powered and full of tragedy so you'll watch the commercials, too.  Let's face it, 85% of birth experiences are not (from the observer's point of view) high powered or full of tragedy.

Michel Odent has stated that we as human beings are losing the capacity to give birth.  We are witness to evolution in action.  Epidemiologically speaking, since the capacity to love is shaped at birth, all of the interventions that prohibit this loving circuitry to begin functioning (labor interventions, removing babies from their mothers at the moment of birth, increase in cesarean sections, disruption of the newborn microbiome,  reduction in breastfeeding) changes the DNA expression of those babies.

But what about the research?  We read about this stuff all of the time, right?

It may take years for a hospital to assimilate changing policies to correspond with evidence-based information.  Further, it may take decades for medical/nursing schools to incorporate these findings in their curricula.  Few nursing schools now incorporate the concept of a (normal, natural) physiologic birth in their programs.  Yes, nurses are well equipped in the event of an emergency and yes, that is important.  Yet if a nurse has never seen a woman begin labor naturally or move through the stages of labor normally, does that nurse have the skill set for support during labor?  If a physician has never attended a birth where a mother chose the hands and knees position to push her baby into the world, will that physician be able to support that mother's choice?  Ina May Gaskin has voiced concern that we are losing the ability to help women with physiologic birth.

Birth is a sacred moment.  Suzanne Arms, a long time birth advocate has said, "We must transform how we bring human beings into the world and care for each childbearing woman and mother-baby pair from conception to the first birthday, when they are one biological system and the baby’s developing brain and nervous system are laying down patterns for a lifetime.”

None of us are too old too pass down the truth.  None of us are too old to help that next generation of parents to realize the power of nature.  Nature created birth the way it is for a reason.  As newborns lay down patterns for life during the "fourth trimester" or the "external womb", we must give them the perfect environment in which to do that.  It is our gift to future generations.

Tuesday, February 02, 2016

Five Points Presented in the New Joint Statement from MANA and CfM

Last week, the Midwives Alliance of North America and the Citizens for Midwifery creted a joint statement on Water Immersion During Labor and Birth.  

This joint statement was based on a new study, which was based on 18000 births, 35% of which were waterbirths.

The joint statement focused on the following: 
  1. Benefits for mothers
  2. Benefits for babies
  3. In 6521 waterbirths, no deaths were attributed to being born in water.
  4. May reduce unnecessary interventions and support physiologic birth, which may be especially
    beneficial to women of color
  5. Includes guidelines for safety
One of the most important points of the joint statement, and also of the ICEA Position Paper on Water Labor/Water Birth is the implication for informed/shared decision making. When expectant parents are well-versed in their childbirthing options and their health status and work in concert with informed care providers, it becomes a win-win situation.

To read more about the joint statement, click here

Monday, January 25, 2016

Important New Findings on Skin to Skin and Medications During Labor and Birth

Yes, skin to skin contact is vital during the first hour after birth.....and beyond.  But what are the ramifications of the use of common labor drugs on skin to skin contact?  See this video from the Healthy Children Project and Kajsa Brimdyr, PhD, CLC.


Friday, January 22, 2016

What does the Soap "General Hospital" have to do with the latest breastfeeding in public controversy?

Note: I admit I do not watch the show "General Hospital".  But I do know lots of women of all ages who do watch soap operas frequently!

Soap operas have been a part of the human tapestry for many years. From as far back as Charles Dickens, serials have influenced society both in positive and negative ways. These shows have a tremendous following all over the world with the vast majority of viewers being women. Traditionally, viewers were those that were stay-at-homers, however since VCRs and DVRs, the viewership has extended to those who are not stay-at-homers.

A 2014 study observed that social, cultural and economic values found in soap operas are mostly portrayed as negative. And the time allotted for such negative values is more than the positive values, the frequency of the negative content is double than the positive content of a five day soap per week. 

Soap operas can and have been used as change agents.  At first, in the 1930s, serials were named "soap" operas as they were vehicles through which manufacturers such as Proctor and Gamble could advertise their soap products directly to the woman of the house.  Worldwide (and yes nearly every country has their own soap operas!), these serials continue to influence us.

Which brings us to the current dilemma apparently smoldering on ABC's General Hospital.
General Hospital's Olivia

According to soap blogger Hope Campbell, the character Olivia was nursing Leo in public and Mayor Lomax (who is female) had Olivia arrested.  It was first claimed that the charge was verbal abuse, but, according to the blog, most viewers realize it was due to breastfeeding in public.

So, Soap Shows Blog ran a pole to see what viewers thought of this story line. “Out of about 6,000 votes, 79% of you thought Olivia had every right to breastfeed in public. After all, breastfeeding is a natural act, and when a child is hungry, he should not have to wait to eat.  A very small 8% thought Olivia should have had a bottle of pumped milk on hand when she has to bring her baby to work. You have nothing against breastfeeding, but thought nursing during a business meeting was completely inappropriate.” Another 13% didn't care, considering Olivia's odd behavior in the recent past.

This group of viewers may have already had their view of breastfeeding in public - we cannot be sure.  But what we can be sure of is that soap operas not only sell products but bring these types of social issues to the forefront of our thinking.  In Kenya, it is the peace between tribes. In Peru, it might be that working hard pays off with rewards.  And it may even influence how we feel about HIV/AIDS.  
Homebirth on The
Young and the Restless

Here in the US, soap operas are shown as part of daytime television however in the UK, the same shows are built into the prime time hours.  This opens up a larger range of views, including men and children. Famed British childbirth educator Sheila Kitzinger was once interviewed by a scriptwriter who was adding in a home birth to one of the soap opera scripts. The writer, who had given birth successfully at home herself, wrote about a beautiful and uncomplicated homebirth.

An unlikely partner in perinatal education, soap operas may be an influencer that we have not tapped into as yet.  When other types of media are marginalizing, childbirth and breastfeeding, soap operas may be a viable partner in educating the expectant and new parent population.

Anitha K (2014) Socio, Economic and Cultural Impact of Soap Operas on Home Makers (A Study in Andhra Pradesh). Journal of Mass Communication and  Journalism  4:189. doi:10.4172/2165-7912.1000189

Tuesday, January 19, 2016

The Top Ten Things to Know About the Zika Virus and Pregnancy

  1. What is the Zika Virus?Zika is a rapidly spreading, mosquito-born virus, which has been on the radar since the first known outbreak on the island of Yap in Micronesia in 2007.
  2. What is the history?The Zika Virus was first identified in Brazil in May of 2015.  While the disease itself is usually mild with fever, rash, conjunctivitis,  and aching joints which begin to develop 2-7 days after being bitten by an infected mosquito. 
  3. How can Zika affect pregnancy?Zika can have devastating effects when the infection manifests itself during pregnancy.  Researchers from the CDC have been working with Brazilian scientists.  They have found the Zika infection in the placentas, brains and amniotic fluid of babies who have either been diagnosed with microcephaly (http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html  or died in the womb.
  4. Is Zika in the US?According to the CDC (Centers for Disease Control), the Zika has not been transmitted to the United States, however the species of mosquitoes (Aedes genus) that is biologically capable of transmitting the virus are present in the US.  During the week of January 10 -14, 2016, cases of Zika showed up in Texas, however it was confirmed that those people
    had been traveling in El Salvador in November.
  5. Where is it now?The warning about the mosquito-borne illness encompasses 14 countries and areas, which include: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela and the Commonwealth of Puerto Rico. This could increase.
  6. Is there a treatment or vaccine?No. 
  7. What can be done if a person has Zika?General recommendations for those who develop Zika are to get plenty of rest, drink fluids to prevent dehydration and take acetaminophen (Tylenol) or paracetamol to reduce fever and pain.  It is recommended to NOT take aspirin or other non-steroidal anti-inflammatory drugs.
  8. Is there direct person to person infection?No. According to the CDC, during the first week of infection, the virus has been found in the blood and can pass from an infected person to another mosquito through mosquito bites.  An infected mosquito can spread the virus to countless others.  Prevent others from becoming sick by avoiding mosquito bites during the first week of the illness.
  9. What about travel and Zika?The CDC recommends that pregnant women of any trimester should consider postponing trips to areas where the virus has been identified.  The CDC has set up a special portion of their website to assist those who are traveling with special Zika information.
  10. Where to learn more-

US Centers for Disease Control - website with facts and information; pdf fact sheets.

European Centre for Disease Prevention and Control - website with facts and information; pdf fact sheets.

Medical News Today -article with detailed facts.

Travel Notices:
United States:  http://wwwnc.cdc.gov/travel/

Monday, January 11, 2016

2016 Purchasers' & Users' Guide to Birth Balls

Today, expectant parents and childbirth educators alike are faced with decisions when selecting a birth ball.  Should a round or peanut shaped ball be selected?  Should the ball be purchased online, or at a local discount/fitness store?  Should the ball have sand in the bottom to keep it from rolling around or not?  These decisions can be overwhelming.

When selecting a birth ball, the following should be taken into consideration:

Purpose of the ball: 
Round birth balls are great for sitting on.  While doing so, the body is in a tripod
position, opening the pelvis and allowing for potential rotation of the baby's head into a proper position. Additionally, the "give" of the birth ball makes sitting easier, while the tripod positioning encourages proper posture (relieving some lower back discomfort in the pregnant woman). Round birth balls can also be used to lay or lean over while standing at the side of the bed or even on all fours on a flat surface such as yoga mat or bed.  Being in the all fours position allow the baby to float out into the sling that the abdominal muscles make, giving the opportunity to the baby to rotate from a posterior to an anterior birthing position.  Additionally, this position further takes pressure off of the back during back labor or just the normal discomforts of pregnancy.  The Peanut birth ball has been shown to support the mother in a deeper squat than the round ball, facilitating the second stage of labor.  The Peanut ball also proves to be effective during epidural anesthesia and has been shown to significantly reduce the time in labor, while providing comfort for the laboring woman!

Size of the ball:
The size of the round ball is chosen based on the height of the laboring mother.  Generally, woman who are less than 5' 4" are best served by a 55 cm ball; women who are less than 5' 9" prefer the 65 cm ball and those who are taller than 5' 9" should use a 75 cm ball.  The importance is that the legs are at a right angle when the expectant mother is sitting on the ball
(see photo above).  If the peanut ball is to be used for a supported squat, a 50 cm ball would be appropriate for an average sized woman, while a 60 cm ball for a taller woman.  If used for supporting the leg during an epidural, 40 cm balls would be appropriate for an average woman and a 50 cm ball for a larger woman.

Most hospital risk management departments agree that birth balls should be made of latex-free (to eliminate possible allergic reactions to latex) and slow deflate material to minimize injury during use.  Additionally, birthing balls should be weight tested to ensure that the ball will adequately support the user.

Another recent concern in birth ball selection is the addition of sand in the bottom of birth balls, specifically round ones. While there have been no research studies to confirm or deny the following factors, anecdotal information from childbirth educators and doulas were used to make
the list below.  

Factors to consider when deciding to use birth balls with or without sand include:

  • Birth balls with sand in the bottom reduce the effectiveness of freedom of movement when on the ball.
  • Birth balls with sand typically have a thinner wall, increasing the likely hood of rapid deflate if punctured.  Birth balls without sand have a thicker layer of PVC to prevent this from happening.
  • Birth balls with sand add resistance when the pregnant woman gets up from a sitting position, causing her to possibly be off balance and a fall risk.
Great care must be taken by the childbirth educator, doula or birth facility in the selection and purchase of a round or peanut birthing ball.  

For further information, you may contact www.birthsource.com, info@birthsource.com or call (937) 312-0544 or read The Birth Ball Source Book.