Tuesday, June 21, 2016

5 Tips for Keeping Social Media in Perspective as a Tool for Evidence-based Maternity Care

For many years, I have been an advocate of social media in maternity care.  I felt from the inception of the internet, that websites would be a one of the newest ways that expectant parents could learn about evidence-based birth.  With the advent of social media such as Facebook, I once again heralded this as an adjunct to childbirth education.  I am happy to report that many expectant parents use web-based learning!

However, in the recent months, social media has become laden with current events so disturbing and so evil.  Many of my colleagues are reporting mass unfollowing of individuals who are send too toxic messages through social media.  Even news outlets with social media accounts have become toxic just by reporting the current events.  Social media has become a platform for not only political stances but racial and other volatile issues.  And the atmosphere is not just “sharing”.  The atmosphere can be down-right angry.

According to the Huffington Post, 28% of people say social media influences their music choices, television viewing and products purchased.  A whopping 57% of social media users say their lives are stressful (due in part to social media).  This stress may be due to projecting a certain image of their life, stating their opinion on an issue, defending their opinion on an issue or being apprehensive about the privacy of their social media accounts.

We don’t just post pictures of a great dinner we prepared.  We are more aggressive and feel more free to say things on social media than we would face-to-face.

So how do we get back to the social media of yesteryear?  How do we return to using social media to promote, in our profession, evidence-based maternity care? 

  1. Discern why you are on social media and be honest with yourself.  For me, it is an extension of my childbirth education classes.  It is also a way to market my business and currently, promote an organization for which I volunteer. A side benefit is to keep in contact with friends. 
  2. Remember that social media is a tool or teaching strategy just like a pelvic model or chart.  It is a device that we use with which to teach.
  3. Use the “unfollow” option to limit the number of aggressive posters on your feed.  You do not have to unfriend them, just unfollow them if their posts are not something that you want to see.
  4. Regardless of how you access social media, remember there is always the option to not be active on social media.  Often, we can access social media through a computer, smart phone or tablet.  Is that too much?  Do you receive push notifications that prompt you to engage?  Then turn off the notifications or limit social media time to one device.
  5. Go “dark”.  Take a break of 2-3 days.  This can happen around a holiday, weekend or anytime!  While you may find a drop in the endorphin/dopamine rush that happens when someone “likes” your status, it may also drop your stress level and allow you to regroup and think about other aspects of your life.

Wednesday, June 15, 2016

Why is complementary and alternative medicine (CAM) called complementary and alternative medicine when in reality, it came before western medicine?

In doing research for a new book, I asked myself the above question.  So why is CAM or complementary and alternative techniques (CAT) called alternative?  One website stated because CAM or CAT fall outside of the realm of conventional medicine.  CAM/CAT complements traditional or western medicine.  Wait.  If many of the components of CAM/CAT came before western medicine, then shouldn’t CAM/CAT actually be the traditional medicine and western medicine be viewed as an alternative?

According to the Mayo Clinic, complementary medicine means that it is used along with conventional medicine.  Alternative indicates that it is a therapy used in place of conventional medicine.  Often they are used interchangeably.  Integrative medicine uses the best of conventional medicine and the best of CAM/CAT.  My best researched guess is that conventional medicine is that which has been developed mostly since WWI, including surgeries, radiation and prescription medication and treatments given by physicians and nurses in hospital settings.

Some health care professionals and researchers state that  CAM/CAT  results are difficult to
ascertain.  They are difficult to study.  So the outcomes of CAM/CAT are questionable.  Websites such as Quackwatch credit the “popularity” of CAM/CAT to the placebo effect. 

Articles claim that there is little research on why or how patients decide to use CAM/CAT or how they access information about CAM/CAT.  Let’s examine this statement.  To begin with, not all who research CAM/CAT are “patients” – they are people who are looking for a general alternative to costly medical procedures or prescription medications that have profound side effect.  Second, it is no mystery how individuals decide to use CAM/CAT or access information!  In general, I would say that those who have done their homework by reading books, magazines or internet research on CAM/CAT use CAM/CAT because they are trying to seek a more gentle solution before catastrophic surgeries, medical procedures or medications.  Let’s face it, simply by listening to a random commercial for medication on television sounds ominous.

Editor's Note: the following italicized paragraph is satire.

Ask your doctor if (insert name of drug)is right for you!  Side effects can include acne, stomach upset, diarrhea, constipation, headaches, muscle pain, dizziness, nausea,  weight gain, weight loss, hair loss, stuffy nose, sneezing, sore throat, memory problems, hypertension, hypotension, blurred vision, painful erection, erections lasting 4 or more hours,  fast heartbeat, slow heartbeat, irregular heartbeat, drowsiness, sweating, dry mouth or sudden death.

By now, you are probably wondering what would be on the list of CAM/CAT.  CAM/CAT can include acupuncture, aromatherapy, biofeedback, chiropractic, herbs, homeopathy, hypnosis, massage therapy, meditation, naturopathy, osteopathic manipulative therapy, Qi gong, reiki, spiritual healing, Tai Chi, traditional Chinese medicine and yoga.  Generally speaking, each CAM/CAT seeks to see people as whole beings, not a malady or malfunctioning area of the body. CAM/CAT examines the mind-body-spirit connection and offers appropriate support.

Johns Hopkins states that nearly 40% of US adults and 12% of children use CAM/CAT.   The National Institutes of Health created the National Center for Complementary and Alternative Medicine to promote research in the area of CAM/CAT and efficacy. In a recent survey, Americans reported spending $33.9 billion (yes, billion with a “b”) out-of-pocket for practices and products.  Clearly, the American public is looking for alternatives to what they are routinely exposed to by western medicine.

The demographics of childbearing families are no different.  They, too, are doing their research on non-pharmacologic pain relief options for labor and birth.  More and more expectant women are examining the side effects of medications offered for labor and birth and systematically rejecting them for other options.  Childbirth educators and doula must become familiar with CAM/CAT used in maternity care and be ready to refer to more knowledgeable resources in their community.  The fact is that our clients will be seeking CAM/CAT practitioners and resources and we need to be aware and support our clients in finding reputable and safe practitioners and resources.

Below are some helpful resources for childbirth educators and doulas wanting to know more about CAM/CAT:

American Holistic Nurses Association http://www.ahna.org/   

Wednesday, June 08, 2016

Guest Blogger Janice Banther: Who Is the Most Important Person in the Room?

Childbirth Today welcomes guest blogger, Janice Banther. Janice is the Executive Director of Birth Behind Bars, a pioneer organization caring for pregnant inmates. Janice founded BBB in 2001, as an inmate program in two jails in Tampa Bay, FL. Janice has helped birth professionals start their own inmate programs in several states.

Not too long ago, we had a very interesting birth. Actually, all of the births are interesting and you never know what new protocol has been instituted at the hospital regarding inmates.
Many times, the inmate is not taken to the hospital where we usually go for their births. An ambulance is only called for them if the Nurse in the Medical Department of the jail is concerned about getting her to the hospital in time. Normally, they go in a squad car with the Deputy. Understandably, taking an inmate out of the jail and into an unsecured environment is a safety risk for everyone involved.

If the inmate goes by ambulance, the EMT’s can make a decision to go to a closer hospital. This can become interesting if we, the doulas, have not been told of a hospital change. In this case we do a lot more driving trying to find our mom!

Recently, one of our doulas did the “find the right hospital” in the early morning light. After she got there, the inmate was so relieved to see her. She was afraid that the doula would not know which hospital to go to. Thankfully, she was there and was able to support her. The inmate was precious in her very fast birth. Heather, the doula, was stroking the inmate’s shoulder. The inmate put her hand up as if to say stop touching me. Heather apologized and the inmate said, “No! I want you to keep doing that.” Heather put her hand back on her shoulder. The inmate reached up with her hand and then tilted her head as if she was trying to get even closer to Heather’s hand.

For many inmates the comforting touch of a doula is the only nonviolent contact they have experienced in months. Many are coming from less than steady relationships on the outside.
After the birth, if the mom is addicted to drugs, then time is spent waiting to see how the baby reacts to being out of the womb and not having drugs going into their system. There is a procedure the nurses do each hour to test how baby is doing. At a certain point, in all cases of addicted babies, they are taken to NICU so they can be monitored more closely.
This mom was addicted to drugs. She cried and held her baby tight. She kept apologizing to the baby for taking the drugs and making him sick. It is not as if they found out they were pregnant and then started taking drugs. They were addicted long before they were pregnant. Just as any disease, addiction is very hard on the body, the baby, and extremely hard to stay clean. This is not an excuse; it is the facts of this terrible disease.

The baby did end up having to go to NICU. Before Heather left, she could see the signs in the baby that he was now feeling the effects of not having the drugs in his system. This is a radical departure from what the baby had been experiencing in the mother’s womb.

So, why my question, WHO IS THE MOST IMPORTANT PERSON IN THE ROOM? In this case, because of some confusion, the hospital staff was not sure about when to take the mom to NICU to see her baby and how many times they could. By this time there was a new doula that was now working with the inmate postpartum, everything is different from the protocol we are accustomed to. And we are in a hospital that we rarely go to.

The doula, Cheryl, was texting me asking questions on certain policies and what the procedure would be. It was at this time I learned a very valuable lesson. Everyone wants the best for the mom who is an inmate. You, as the doula want the best, and also the hospital wants the best for their patient (the inmate) and now their new patient, the baby. But many times things do not turn out the way you as the doula want them.

Being a doula, and “standing your ground” and saying I will not be moved and I want Plan A to be done NOW does not help the inmate who is the mother. The most important person you are working with in the room is the nurse. She is doing her job. She is the medical professional on scene. There may not be a written policy for inmates. The nurses can also be questioning what to do too.

In situations like this, instead of “standing your ground” and saying it WILL be Plan A, work WITH the nurse and the staff, not against them. You want to let them know that you recognize they want what is best in this situation and you want to help them and the new mother with this plan.

It is at this point, if you fight to get your way with the hospital you may loose your right to be a doula and to help her. Remember why are you there. It’s to help the mother, the inmate. To help her bond with her new baby. To help this baby get the best start in life.
If you spend this time fighting, and loose the privilege of being with the inmate, who will be there for the next inmate that is giving birth? That is the question you need to ask yourself.
We have found that many times, that if we don’t try to change the policy of the jail or the hospital, just our presence alone has changed many different situations and policies. I believe this is the reason why the jail we work with and the hospital and caregivers, have been more on the cutting edge of incarceration reform than many other institutions in the county.
Care for the mother first. You will be surprised how much you can influence the circumstances around you.

****Disclaimer: This blog is from the perspective of a jail, not a State or Federal prison. Protocol will vary from initiation to institution.

You can contact Janice at Janice@janicebanther.com

Friday, June 03, 2016

Eating Our Young, Chewing on Each Other – Call It What It Is

This is not an evidence-based research blog entry.  Today, I am writing some personal reflections.  And while I know it may not be as riveting as an article about pregnancy, birth or breastfeeding, in a way – it is about pregnancy, birth and breastfeeding.

All too frequently these days I hear stories of maternity care professionals….. PROFESSIONALS…..berating younger professionals, and humiliating peers.  Hey, let’s be clear. It’s all bullying.  Yes, BULLYING.  Call it what it is.  It is being cruel in order to really hurt someone.

And also, let me define maternity care professionals.  They are doctors, nurses, childbirth educators, doulas, lactation professionals  - basically anyone who provides any type of service
to childbearing families.

Let’s break this down.  You work in maternity care.  By definition, you are welcoming a new human being to the planet.  You are assisting in a miracle.  When we work in maternity care and spend a lot of time harassing or bullying another co-worker, you are taking time and brain power away from the work we are called to do.  This interferes with care.

Another way to look at it.  You are a professional.  Does cruelty to a peer or bullying sound like professional behavior?  No?  Then just stop it.

If a younger maternity care professional cannot perform, ask yourself if their orientation was enough for them.  It may have been the standard orientation, but all humans are not created equal so this younger person may need more nurturing and mentoring.

If a peer seems distracted or not as on-point as usual, instead of swinging immediately into attack mode, perhaps come along side of them and find out if there is another reason for the behavior.  Let them know gently that they have lost their edge and may need to step back and reevaluate.  Be ready to give them sources of support – even you.

Bullying can be vertical (where a manager bullies someone under his/her supervision) or horizontal (where maternity care professionals  bully their colleagues).

And basically if you are a bully, you don’t need to be in the maternity care field.  For that matter, why are you in health care?

The American Nurses Association reports that between 18-31% of all nurses have encountered bullying in the workplace.  And there may be more who have not reported.

Jennifer Larson, contributor to nursingjobs.com says, “Like schoolyard bullying, workplace bullying involves a real or perceived imbalance of power and repetition of the negative behavior.  The behavior can be over, such as yelling or threatening, or it can be more insidious and passive, like refusing to cooperate or perform necessary tasks.”  She goes on to note, “Bullying can also result in harm to patients.  In a 2008 Sentinel Alert that addressed disruptive behavior. The Joint Commission noted that “intimidating and disruptive behaviors can foster medical errors and (lead) to preventable adverse outcomes.”

Additionally, in 2009, The Joint Commission began requiring that organizations establish a code of conduct that defines and distinguishes acceptable and unacceptable behaviors to maintain their accreditation. This was too little too late for many.

But what if you are an independent childbirth educator or doula or other birth professional.  Think you are exempt from bullying? Far from it.  However, be aware of the Grievance Policies that are in place in the various certifying organizations.  You may be pleased to find that international and national organizations have very little patience with true bullying.

The final question may be: what do I do if I am being bullied by someone not affiliated with a hospital or organization with a grievance policy.  Here are five steps that I’ve found helpful:

  1. Don’t react to them.  This is so very difficult but if you do react, you give them fuel to keep going.
  2. Have 1-2 people in the “business” in whom you can confidentially confide.  
  3. Be aware of your behavior.  Again, don’t give them something to use against you.
  4. Give it time.  Lots of time. If you don’t react, they’ll lose interest.  This is often easier said than done.
  5. Find delight in karma.

Monday, May 23, 2016

Summer Reading Suggestion: Cut It Out, the C-section Epidemic in America

It is summer time and you may be looking for a good book to read.  Like many birth professionals, you may want to stick with a specific genre - birth.  So here is a good....not GREAT book to consider for your summer reading time.  It is a page turner.  Yes, it's THAT good.

I did write about this book in 2013 when it was first released but feel that even now, there are valid points to be made. Cut It Out examines the exponential increase in the United States of the
most technological form of birth that exists: the cesarean section. While c-section births pose a higher risk of maternal death and medical complications, can have negative future reproductive consequences for the mother, increase the recovery time for mothers after birth, and cost almost twice as much as vaginal deliveries, the 2011 cesarean section rate of 33 percent is one of the highest recorded rates in U.S. history, and an increase of 50 percent over the past decade. Further, once a woman gives birth by c-section, her chances of having a vaginal delivery for future births drops dramatically. This decrease in vaginal births after cesarean sections (VBAC) is even more alarming: one third of hospitals and one half of physicians do not even allow a woman a trial of labor after a c-section, and 90 percent of women will go on to have the c-section surgery again for subsequent pregnancies. Of comparative developed countries, only Brazil and Italy have higher c-section rates; c-sections occur in only 19% of births in France, 17% of births in Japan, and 16% of births in Finland.

Author Theresa Morris systematically examines the reasons for the epidemic rise in cesareans as four pronged: women know very little about labor and birth and do not have complete access to unbiased, evidence-based information.  The co-optation of childbirth classes in the 1980s is the reason for this.  Yes, it may have been a "good idea" at the time to have childbirth classes move from the community to the hospital, but what many authors of the time feared would happen, has happened:  hospital based childbirth classes, generally, are a commercial for what can be expected at that facility.  Few mention broad options for childbirth, non-pharmacologic pain relief methods or informed decision making.  Secondly, care providers are constrained by their tunnel-vision training and/or their employer's risk management rules and do not or can not practice evidence-based care.  Thirdly, organizations take an inordinate amount of time to change policies, procedures and practice guidelines.  This encompasses ACOG and hospitals.  And finally, we live in such a litigious society that this hinders any type of movement forward in evidence-based quality of maternity care.

Morris points out that if our intervention rate (including cesarean sections) is rising, the maternal/infant mortality/morbidity rate should be dropping.  It isn't.  In other words, the more that is done to women, more mothers and babies are dying in America.  But Morris doesn't leave you stranded.  She thoughtfully points out a road map for change.

I suggest we all get on the road to change.

"Cut it Out: The C-Section Epidemic in America" is available through Amazon.  Hardcover is $30 but for those of us who don't like to wait, it is $9.99 on Kindle.  Happy reading!

Monday, May 16, 2016

HG Awareness Day ~ May 15....and every day!

Hyperemesis Gravidarum Awareness Day was Sunday May 15.  
However, it should be EVERY day!

In 1979, a young twenty-three year old was expecting her first child.  During her first trimester, she experienced the typical morning sickness.  At the cusp between second and third trimester, this young woman developed severe nausea and vomiting.  The severity was overwhelming to the point that she had to bring a “barf bag” with her wherever she went.  When she (a med-surg nurse) brought it to her obstetrician’s attention, he turned a blind eye, said hyperemesis gravidarum didn’t really exist, it was all in her head and handed her “water pills” to relieve the pitting edema in her calves, ankles and feet.  Fortunately, this young woman gave birth vaginally and had a healthy baby girl.  However, on the day of discharge from the hospital, her obstetrician told her that she would not be able to breastfeed because the water pills had dried up all of her milk.

According to Medscape, hyperemesis gravidarum (HG) is the most severe form of nausea and vomiting in pregnancy, characterized by persistent nausea and vomiting associated with ketosis, dehydration and weight loss (>5% of prepregnancy weight). This condition may cause volume depletion, electrolytes and acid-base imbalances, nutritional deficiencies, and even death. Severe hyperemesis requiring hospital admission occurs in 0.3-2% of pregnancies.

The HER Foundation (Hyperemesis Education & Research Foundation: www.helpher.org) is a non-profit organization that has been dedicated to HG support, education, research and advocacy since 2003.  The HER Foundation says there is no clear etiology for HG and it could even be due to multiple causes. When first recognized several centuries ago, HG was thought to be caused by toxins, ulcerations or an infection.  In the 20th century it was decided that HG was a psychological condition.  Today, lab tests can be done to confirm hyperemesis gravidarum.  These tests include urinalysis for ketones and specific gravity, serum levels of electrolytes and ketones, TSH and free T, and hematocrit levels to name a few. 

The only FDA approved drug for treating nausea and vomiting in pregnancy is pyridoxine or Vitamin B6.  Herbals such as ginger may also be helpful, but not in all cases.  In severe cases, antiemetics, corticosteroids or antihistamines may also be used.  Nutritional supplementations either by IV or directly into the GI system may help with nutritional deficiencies.

There are several handouts available from the HER Foundation and the University of Southern California:

Remember that young nurse from 1979?  She went on to become a childbirth educator so that other mothers could be aware of HG.  She also successfully breastfed her first baby, thanks to the local La Leche League.  That young woman was me. 

Tuesday, May 10, 2016

Childbirth Today Vlog for May 10!

In today's Vlog, we chatted about last week's Maternal Mental Health Day and noted that former Postpartum Support International President Birdie Gunyon Meyer will be a guest on the May 24th show.  She had trouble accessing the Vlog last week.

We also talked about International Day of the Midwife May 5 and how a Time Magazine article written by the program officer of the Bill and Melinda Gates Maternal, Newborn and Child Health Foundation stated that midwives are essential to Global health.  They are.  The research shows it. Unfortunately, we are just slow in embracing this!

Below is a portion of the interview with Jennifer Shryock, owner of Family Paws Inc. and her discussion about integrating babies into families that already contain pets.  Learn about Jennifer's upcoming speaking events and her international conference coming in July!

It is only a partial interview as the Blab platform is a beta version and prone to glitches.  It is also on my YouTube Channel (https://www.youtube.com/user/thebirthfacts) - as are the other two interviews and shows plus much more!  Enjoy!