Monday, November 24, 2014

Birth Rocks Academy in UK

In case you missed it over the weekend, here is the link to the interview I did for Birth Rocks Academy in the UK.

Click here to read the interview.

Thursday, November 20, 2014

Obstetric Violence & Human Rights - Dr. Amali Lokugamage

I invite you to listen/view Dr. Lokugamage's lecture.  It may be the most important 15 minute video you watch this year!


Tuesday, November 18, 2014

Tips When Writing Behavioral Objectives

As a nurse, midwife, childbirth educator or doula, you may be asked to write behavioral objectives for a new program or when you become a speaker at a workshop, seminar or conference.  I have put together some helpful tips for writing these objectives.

Behavioral objectives, learning objectives, instructional objectives, and performance objectives are terms that refer to descriptions of observable student behavior or performance that are used to make judgments about learning. Whether you are a childbirth educator, doula, nurse, lactation educator or trainer, at some point you will be asked to write behavioral objectives.

While some feel that writing behavioral objectives is a waste of time, it is generally felt that using behavioral objectives allows the educator to actually see what will be covered during a specific time period and not to overwhelm the student. Using objectives help to clarify what details to include under what generalized topic area, plus allows for examination of the order in which topics and details will fall. Further, using behavioral objectives promotes creativity with
the educator when developing teaching strategies for use with all learner types.

The three parts of a behavioral objective are:

1.Conditions (a statement that describes the conditions under which the behavior is to be performed).

Behavioral objectives are about curriculum, not instruction. Therefore, the list of objectives may be preceded by the phrase, "At the end of this session, participants will be able to…"
2. Behavioral Verb (an action word that connotes an observable student behavior).
Behavioral verbs for use with curricula or CE (or continuing education unit) forms are typically upper level verbs and include classify, construct, define, demonstrate, describe, diagram, distinguish, estimate, evaluate, explain, identify, interpret, label, list, locate, measure, name, order, predict, reproduce, solve, translate.
See this link for Blooms Taxonomy and measurable behavioral verbs.  Click here.
3. Criteria (a statement that specifies how well the student must perform the behavior).
Behavioral objectives are measurable (note the four below), which means that the objective can be turned into a test question or evaluation item at a later date.

So, for someone who is writing a curriculum to include the topic of comfort measures for use during labor, a measurable behavioral objective might be:

At the end of this session, participants will be able to:

List four comfort measures that can be used during labor.

When developing a curriculum and writing objectives, it may be useful to use a format where the objectives, outline of the content, time frame and teaching strategies can be viewed simultaneously.

Most professional documents require references written in the APA Style.  APA (American Psychological Association) is most commonly used to cite sources within the social sciences. This resource, Purdue University, revised according to the 6th edition of the APA manual, offers examples for the general format of APA research papers, in-text citations, endnotes/footnotes, and the reference page. 

Friday, November 07, 2014

Not all birth advocacy comes from the usual suspects!

Meet Top RN to BSN: Your guide to the best RN to BSN programs.  This website serves all nurses and nurses to be with the means to find BSN programs and also do some education.  I was contacted by the website’s Linda Harris.  RN to BSN has created an infographic – Bringing Birth Back: The Rise of Cesareans and the Movement to Safely Prevent Them.

The infographic has contains the latest evidence-based information including the newest  US cesarean rate percentages and the WHO studies that mention a recommended percentage of 10-15%.  The complications for both mother and baby are examined, although missing is information such as the grieving process many mothers go through after having a cesarean birth and the dangers of cesareans for future generations by changing the epigenetics.   The infographic mentions “how we got there” and hints at elective cesareans on the part of doctors and women, as well as the threat of litigation.  There is even a state by state graphic which correctly lists hospital cesarean rates from 7%-70%.

The graphic does include the “6 cm is the new 4cm” information and cautions against early diagnosis of labor arrest.  Induction timing is also a focus, referring somewhat to the “Go the full 40 weeks”.  One of the biggest positives of the graphic is the attention to VBACS and the effects of (birth and postpartum) doula care.

While I understand that an infographic is a short snapshot of time, I do wish they had included the emotions ~ grieving and possible links to postpartum depression.  While the resources include the CDC, ACOG, DONA , March of Dimes, and Childbirth Connection,  a reference to the importance of childbirth education and the role it can play in cesarean prevention would have been nice.  The only reference to childbirth education came as a quote from then Lamaze International President Michele Ondeck, siting the ACOG recommended practice changes as “This is a Game Changer”. 

Truly, infographics are in the future of education.  Like handouts, infographics can be disseminated to a larger audience of individuals and create on-the-spot learning.  I applaud for educating nursing students.  This is one area where childbirth educators need to focus on for implementation of best practice.

Check out the infographic for yourself:

Bringing Birth Back

Thursday, October 30, 2014

Has the Focus of Birth Professionals Changed?

In my humble opinion: 

Many people wonder why birth professionals (childbirth educators, doulas, midwives, nurses, lactation consultants) are so passionate about their profession.  Unlike other professions, childbirth (and breastfeeding) evoke great emotion and energy in many workers.  What is the underlying cause of this emotional energy and has it changed over the years?

I think it is safe to say that in the 1970s when I began teaching became a nurse and subsequently also became involved in childbirth education, the push of childbirth education was
to come along side women who desired less interventions and a more natural (or physiologic/non-interventive) childbirth.  Educators taught women that their gut feelings about physiologic birth were not wrong, what the evidence said, and gave them the tools to achieve that goal.  The empowerment of women in the 70s enabled educators to thrive and achieve those goals.

Somewhere in the mid-1980s, childbirth education relaxed the emotional energy expended and reaped the benefits of the past.  But in sitting back, this allowed a more interventive style of childbirth to emerge and then we were looking at the 1990s with an increase in epidurals, assistive deliveries (forceps and the miti-vacuum extractor), and an increase in cesarean rates.  By the 2000s, we tried to catch up and began movements such as “evidence based information” in childbirth education and later, in social media, but it was too late.  The perception that “drive thru” deliveries that were scheduled, induced, medicated and sometime surgical became the optimum.  Few were mindful of what all of this was doing to moms, babies and future generations.  Women just wanted the uncomfortable last 3 weeks of pregnancy to end, to hold their babies after little/no pain, and to get back to work.

Questions began to arise in 2010.  Why is the cesarean rate so high?  If women are designed physically to give birth, what is the reason for the 32.8%+ cesarean rate?  Why are only 33% of women attending childbirth education class?  What is the medication given during labor/birth doing to our mothers and babies?  Can we curb elective early birth – why don’t we wait the full 40 weeks?  Are future generations going to be affected by birth practices now?  Will women lose their gut instincts about labor and birth? Will women lose their physical ability to give birth (epigenetics)?

Many birth organizations such as AWHONN, ACNM, MANA, APPPAH, Lamaze and ICEA began asking these questions.  Forward thinkers such as Marsden Wagner and Michel Odent wrote landmark books explaining the research and forecasting the future.  Videos and movies such as “The Business of Being Born”, “Pregnant in America”, “Laboring Under An Illusion” and “Birth by the Numbers” allowed the public to be exposed to the questions we birth professionals were also asking.  And this year, “Microbirth”, put it all in perspective: if how we are born affects how our health manifests itself, we must take that as a mandate to let birth alone and allow humans to reach the potential for which they are destined.

The answer then, is yes – the focus of birth professional has changed.  We have gone from “freedom fighter” to someone “sounding the alarm”.  Birth is much more than having a mother choose her position during labor.  How we treat mothers and babies during pregnancy, labor, birth and the postpartum will forever change us as human beings.  It can be a change for the positive or the negative.  Right now, we are on a slippery slope to the negative. 

It is time for a change.

It is time for those of us who know the research, the facts, the truth – whatever you want to call it – to come together in one strong voice.  Does that mean we become the protectors of future generations?

Become informed.  You be the judge.

Friday, October 10, 2014

Conquering Tocophobia with Haptotherapy

Tocophobia or severe fear of childbirth is rising in frequency.  More than 6% of women, and some men, experience tocophobia during pregnancy.  This leads to an increase in obstetric interventions including preterm birth, emergency cesarean section, or cesarean section at maternal request.  Severe postpartum fear of childbirth and trauma anxiety has also been reported.

Studies, primarily in Europe, over the past decade demonstrate an increase in evidence that Haptotherapy might be effective in reducing fear of childbirth in pregnancy women.  What is Haptotherapy and is there a way childbirth educators can incorporate aspects into their classes?

Haptonomy is a typical Dutch form of therapeutic assistance therapy discovered by Dutch physiotherapist Frans Veldman, and first used in oncology.  Haptotherapy is the field of application of Haptonomy.  Haptonomy is being in connection with someone in a non-judgmental way.  Practitioners work to establish an environment of acceptance and calm, peace and tranquility so that the client can let go and begin trusting their own inner wisdom.  It involves listening, accepting, sharing.  In some instances, touch relaxation or simply holding hands leads to the calming of the client and activating their inner resources. The goal is for the client to develop inner security, self-awareness and self-confidence.

The most recent Dutch study is examining a standard haptotherapeutical treatment for pregnant women (and their partners)  with severe fear of childbirth, implies teaching a combination of skills in eight one hour sessions. The internet group follows an eight-week internet course containing information about pregnancy and childbirth comparable to childbirth classes. The control group has care as usual according to the standards of the Royal Dutch Organisation of Midwives and the Dutch Organization of Obstetrics and Gynaecology.

Included are singleton pregnant women with severe fear of childbirth, age >= 18 year, randomised into three arms: (1) treatment with haptotherapy, (2) internet psycho-education or (3) care as usual. The main study outcome is fear of childbirth. Measurements are taken at baseline in gestation week 20-24, directly after the intervention is completed in gestation week 36, six weeks postpartum and six months postpartum. Secondary study outcomes are distress, general anxiety, depression, somatization, social support, mother-child bonding, pregnancy and delivery complications, traumatic anxiety symptoms, duration of delivery, birth weight, and care satisfaction.

Sessions include a getting to know each other opportunity, awareness and presence in pregnancy, identification of cause of fear of childbirth,  desensitization of body anatomy as well as hospital procedures through education, practicing correct pushing techniques, working with contractions and dealing with labor pain, labor rehearsals, and finally introduction to birth of the placenta and first days postpartum.

Haptotherapy has dynamic similarities to childbirth education classes.  One might even call them “old school” childbirth education where educators had the time to take the time to listen to the clients and their partners and confront fears one by one.

They say you cannot go home again, but it looks like we are….with a different name.