Tuesday, August 25, 2015

Childbirth Education- Do you really need to go to class?

This is a guest blog from my dear friend Kathy Bradley - her expertise has helped countless families have the best birth possible.  Now she shares her thoughts for your clients!

Kathy Bradley
Founder, Childbirth Concierge
Often times I hear pregnant moms say “I don’t need to go to childbirth class I am going to use an epidural” and it is probably one of the biggest misconceptions about childbirth class that exist.  Before the electronic era and wide spread use of pain medication for pain control, the common way expectant parents could learn about what was going to happen to them during birth was to attend a childbirth class.  Over the years the childbirth education classes have seen a decline in attendance, yet  a lot of people spend more time and resources researching how to remodel a bathroom or kitchen than learning about bringing a baby into the world.

Today offers a lot more options.  With YouTube and the internet, one doesn’t even need to leave their home or put down their hand held device to get advice and information on giving birth. And it is true that babies will come into this world without their parents taking a class on “childbirth”, after all childbirth classes didn’t exist 100 plus years ago as we know them and babies still arrived.  Fast forward to a very busy society where 80% to 90% of laboring patients use epidural and c-section rates are the highest they have ever been across the United States. 

Learning from a childbirth expert what you can do to increase your chances of a positive birth experience is worth your time and money.  Most hospitals offer some type of class, but it is also very popular to see other classes offered in the community.  For those with busy schedules, private classes are the perfect option and are not as expensive as you might think.   Most classes whether group or private cover when to got to the hospital, what to expect, stages and phases of labor, basic terminology, comfort measures, interventions.  Some classes include newborn care and breastfeeding. The hot topics usually are pain medications.  In my 24 years of experience there are generally three types of thinking when approaching pain control;

1. I definitely want an epidural.

2. I will wait and see if I need one.

3. No thank you, I do not want one.

There is no right or wrong answer, only you can decide, but I also encourage you to stay open about options.  For example if you are planning on an epidural learning about when the better time to get an epidural can help you to decrease your chances of a C-section.  Most moms don’t realize that the number one way to decrease their chances of a C-section is to wait until active labor to come to the hospital. We call this the 511 rule - contractions at least 5 minutes apart, lasting 1 minute long, for at least 1 hour.

If you are planning on not having an epidural, have you thought about what it takes?  Do you have good labor support?  Have you thought about hiring a doula?  Key to laboring without an epidural is movement, use of hydrotherapy and comfort measures, and understanding all the ins and outs of labor.  Do you understand when an epidural can be beneficial? Yes, even for those “natural” mamas, sometimes interventions can be helpful in unique situations. Being prepared and not afraid makes a world of difference.

Birth planning and birth itself is not 100% black and white.  The more you are educated and understand the value in good communication with your nurses, midwives and doctors the more satisfied you will be even if the need arises for a C-section. 

Your childbirth educator is the expert that you can ask all kinds of questions to and bounce things off that you have read or heard. 

It’s is your birth, and education is key!

For additional information contact Kathy Bradley, IBCLC at 321-213-1112 or Kathy@childbirthconcierge.com

Kathy Bradley, CD, ICCE, IBCLC has been involved with perinatal education and health care since 1989. As the founder and executive director of the former Childbirth Enhancement Foundation, she developed partnerships and training programs for community based doula programs with 14 hospitals.  She is owner of Childbirth Concierge and holds a degree in Communication and Public Relations. As an Internationally Board Certified Lactation Consultant, Childbirth Educator, Certified Doula, and she serves on the Council of Licensed Midwifery for Florida Department of Health. During her career Kathy has made numerous appearances on TV programs focused on women and children’s health as well as developed many training programs for para professionals and health professionals.  She worked with mom and babies at Winnie Palmer Hospital in Orlando, FL for 14 years and has been in private practice since 1991. 

Monday, August 10, 2015

How ICEA, VBAC.com and ICAN Collaborated For A Free Project for Parents and Birth Professionals

On August 10th at 10 am EST, ICEA (the International Childbirth Education Association), VBAC.com and ICAN (the International Cesarean Awareness Network) jointly announced the launch of the new joint project, the VBAC Project.

Researched and written by noted birth researcher and cesarean/vbac expert, Nicette Jukelevics,
this project is the first of its kind.  The most up-to-date evidence based information regarding cesareans and VBAC are put together in modules for parents as well as birth professionals.  With professional design, it is the hope that this free project will have a major impact on childbirth practices.

"Mothers have the legal right to make their own health care decisions, but that right, more often than not, is not upheld. Denial of medical care for mothers who want to labor for a VBAC has put healthy mothers and babies at risk for several health complications associated with repeat cesarean sections." says author Nicette Jukelevics. "VBAC was deemed a reasonable and safe option to a routine repeat cesarean by the National Institutes of Health decades ago (1981). But, in recent years, misinformation about its safety and lack of clear national practice guidelines have succeeded in virtually eliminating VBACs in many hospitals." 

A collaboration such as this, with the health and well-being of mothers and babies at the center of the collaboration, demonstrates that health care professionals can come together in the spirit of cooperation to promote evidence-based maternity care.  Without collaborations such as these, professionals will lack the tools to empower mothers to make informed decisions in their care. Further, projects such as the VBAC Project will impact care on many levels and may also impact the skyrocketing maternal/infant morbidity and mortality rates.

Nicette has a strong history as a birthing professional. Nicette is a childbirth
educator,  researcher  and author of 
Understanding the Dangers of Cesarean Birth: Making Informed Decisions. For over 30 years Nicette had the privilege of helping thousands of expectant families to prepare for childbirth, VBAC and early parenting. She has presented on cesarean and VBAC issues at national conferences and for advanced doula trainings across the U.S. She has served on the boards of CIMS (the Coalition for Improving Maternity Services), the International Childbirth Education Association, and DONA.  She is a published author in print articles, fact sheets, books, and online.  
In 2013, the Coalition for Improving Maternity Services presented her with the CIMS Advocate Award for her commitment to spreading awareness of Mother-Friendly care through direct communication and outreach.

I salute my long time friend Nicette and her accomplishment with the VBAC Project.  To view the project and download all of the modules and ebooks for free, you can visit www.vbac.com, the ICEA website or ICAN's website.

Monday, August 03, 2015

Do You Teach Childbirth Education Classes or Are You A Childbirth Educator?

So,  I am stepping out of my comfort zone by asking this question:

Do you teach childbirth education classes or are you a childbirth educator?

Is there a difference?  Yes, quite a bit.  Let's explore.

If you are someone who teaches childbirth education classes, the following may be true:

  1. Someone has given you the opportunity to add teaching childbirth education classes to your existing job.
  2. The curriculum has been decided already and given to you.
  3. Your teaching strategies, models, charts and videos are also predetermined.
  4. The classes you teach meet at the same location(s), times and dates.
  5. You enjoy the interaction between yourself and your students.
  6. Teaching is a very nice part of your job.

If you are a childbirth educator, the following is most likely true:

  1. You feel a passion for all things birth. You doubt whether you could ever do anything else with your life. It's a calling.
  2. You are trained and certified by a national childbirth education organization.
  3. Most of your time on a computer is spent learning about the new evidence-based information.
  4. You have created or modified your own curriculum; picked out or created models, charts and class manuals/handouts; and previewed your videos.
  5. You know you teach what feels like 24 hours a day: a teachable moment in the grocery line or when someone notices the birth business decal on your car.
  6. Social media is a great forum for education of expectant parents and professionals.
  7. In social settings, you are known as the "baby lady". 
  8. You have stacks and stacks of birth related journals, books and articles.
  9. Your children grow up knowing the internal side views of pregnant bodies and perhaps think that all uteri are made of blue or multi-colored yarn.
  10. Your partner/husband can repeat parts of your classes to help their friends or co-workers.

So let me know.  Do you teach childbirth education classes or are you a childbirth educator?

Wednesday, July 29, 2015

Important Links for The Big Latch On and World Breastfeeding Week!

Whether you want to celebrate The Big Latch On this coming week or World Breastfeeding Week all of next week (August 1-7), here are links to media packets!

Why celebrate breastfeeding? Because human breastmilk is the perfect food for human babies. 

Plus everything we doing during the labor and birth process impacts breastfeeding success.  You cannot address one without the other!

The Big Latch On:

When: Friday July 31 & Saturday August 1
Where: Your Community

Website: www.biglatchon.org
Host an event: http://biglatchon.org/hosts/easy-steps-to-hosting
LatchOn Rules: http://biglatchon.org/hosts/big-latch-on-rules
Find your local Big Latch On event: http://biglatchon.org/locations
Facebook: www.facebook.com/GlobalBigLatchOn

Twitter: @BigLatchOn 


World Breastfeeding Week:

When: August 1-7
Where: Your Community

Website: www.worldbreastfeedingweek.org
Social Media Kit: http://worldbreastfeedingweek.org/pdf/wbw2015-socialmedia.pdf 
WBW Photo Contest: http://worldbreastfeedingweek.org/pcresults.shtml
Facebook: https://www.facebook.com/pages/WABA-World-Breastfeeding-Week/252424138273454?fref=ts&ref=br_tf
Twitter: @wbw2015


Tuesday, July 28, 2015

How Your Rants on Social Media May Cost You Your Next Client or Job - 7 Tips (actually 8) to Make Sure It Doesn't

You are soooooooooooo done with that hospital and their policies!

Your social media rant is full of &%$#**.

Your memes ooze with sarcasm.

Could your personal integrity as seen on social media just cost you that doula interview?  

Does that hospital wonder about your rants and consider that before hiring you?

The answer to both of these questions is YES!

Forbes magazine made this statement in 2013.  Imagine what it must be like today!

To help job seekers better understand the role of social media in their job search, CareerBuilder.com conducted a survey last year that asked 2,303 hiring managers and human resource professionals if, how, and why they incorporate social media into their hiring process.
First they found that 37% of employers use social networks to screen potential job candidates. That means about two in five companies browse your social media profiles to evaluate your character and personality–and some even base their hiring decision on what they find.
The above statistic now stands at over 90% - that's right, 90% of potential employers use social media to vet applicants.  The employers not only evaluate the posts of potential applicants but also grammar, spelling, word structure, and photos posted.  In addition to all of that, employers and potential clients also look at religious affiliations and political affiliations.
So what platforms to employers/clients use the most?  Most will look for you on LinkedIN, so you will need a strong and positive appearance there.  Next is Facebook.  Least used are Twitter and Instagram (no, this isn't a green light to air dirty laundry on Twitter and Instragram!).
What does that mean to the birth professional, childbirth educator, massage therapist, doula or lactation consultant?
Here are 7 tips to ensure that social media vetting does not remove you from consideration:
1. Always present a professional image.  Always.  Always.
2. Be thoughtful before you post a rant or make a negative comment.
3. Monitor your privacy settings often on any platform.
4. Remember that HIPAA applies to social media (see ICEA's Position Paper on Social Media and HIPAA).
5. If in doubt about a post, delete it.
6. Don't say anything on social media you wouldn't say in person to 500 of your friends.
7. Save caustic rants for your diary or your mirror.
8. Understand that what you put on the internet, stays on the internet!

Thursday, July 16, 2015

Discouraging Childbirth Classes, Balking at Doula Care: Is ThisThe Dumbing Down of Expectant Women?

Perhaps I see this because I’ve been involved in birth since the 70s, but I am starting to feel that the discouraging of expectant parents to attend childbirth education classes or seek out doula care is a step in the process of dumbing down expectant women.

Here’s why I think the way I do:

1970s – women were in the middle of the Women’s Movement, discovering our voice and asking….no DEMANDING what we wanted.  For some, this meant equal pay, for others, no bras. 
For many of us, it was somewhere in between.  However, the most productive thing, IMHO, that came out of the 70s was the raw education of childbirth.  We as educators did teach the truth.  We taught the evidence.  We taught innovative ways to achieve “natural” childbirth.  The question was, if we are teaching “natural” childbirth, then the use of interventions made it “unnatural”, right? Great strides were made because the consumer was knowledgeable and asked for what she wanted: her husband or partner to be with her during labor and birth, letting labor begin and progress on its own, be in upright and gravity positive positions to facilitate the cardinal movements during labor.

1980s – every childbirth educator wanted more women to be reached through education.  Some of us who had taught as part of a community based program rejoiced with the fact that childbirth education classes were moving to the hospital setting.  The hospital would be responsible for providing a spot for classes and also the cost of marketing the classes.  All the childbirth educator had to do was show up and teach.  No more dragging all of our equipment, lending libraries and charts to class each night.  That was all provided by the hospital.  Along with marketing OB program with freebies such as free carseats and free steak dinners, you could take your childbirth class right here – and also take a tour of the area that you would be birthing your baby.  The catch word of the day was “co-opted”.

But somewhere between 1986 and 1991, a move began to monitor what was being said in the hospital childbirth classes.  Slowly, more information about what could be expected at that facility wove its way into the curriculum.  Topics such as good nutrition for optimal health, exercise, and practicing relaxation were replaced by in-class hospital tours.  This was important because now, there were not separate labor rooms and delivery rooms.  Birthing chairs were being replaced with specialized beds that could be used for labor, delivery, recovery and postpartum - LDRPs.  Certainly parents needed to see that area.

Later in the 1990s, there seemed to be more and more women who had stalled labors about 5-6 cms. Before examining if women were being fed and hydrated, Pitocin was the choice to stimulate labor.  And because when you administer Pitocin to a mother and the medication crosses the placenta to the baby, mothers needed to be monitored with the external or in some cases, the external fetal heart monitor.

Because of the Dublin study of 1992, active management of labor (amniotomy, Pitocin, monitoring) with a suspected outcome of 12 hours of labor presented itself.  I don’t think it was ever quite replicated like it was in the Dublin study because on its journey across the pond from Ireland to the US, a key component dropped off into the ocean: continuous labor support.  Answering that call was DONA and ICEA with birth doula training programs.  Standing firmly on the research by Drs. Marshall Klaus and John Kennell, doulas enjoyed a boon in the mid to late 1990s.  Doulas closed the education gap left by abbreviated and shorter childbirth education classes and women began to come into their own once again.

Childbirth classes became shorter and shorter in the hospital setting and educators were told that parents were asking for these shorter “express” classes due to the busy life style of the new century.  More and more vital content was extracted from curriculum until all you needed to know about labor and birth was available in just four hours on a Sunday afternoon.  In some cases, expectant parents were actually discouraged from taking childbirth classes or hiring a doula. 

During the 2000s, there was pushback for the lack of content available in childbirth education classes.  With the advent of the internet, childbirth education organizations such as ICEA, CIMS, ICAN,  Lamaze International and Maternity Center Association (now Childbirth Connection), stepped up to reach a larger audience with website, Facebook, and other social media showcasing evidence based maternity care.  A larger focus was made on the fact that “best practice” is evidence-based.  However, in many settings in the US (and other countries as well), “best practice” is not what is being presented.  “Tradition” is what IS being practiced. “That is the way we’ve always done it” became the standard, albeit “the way we’ve always done it” might be 25+ years old in the evidence.

There is no denying that medical interventions have saved countless lives.  However, 85% of pregnancies and labors can proceed without major complications.  Only 15% need intervention.  Have we over the past few years tried to dumb down expectant parents to fall in line with traditional practice?  Have we put in harm’s way women and children for the sake of shorter classes, dysfunctional active management of labor, elective inductions or cesareans?  Have we answered the question of fear of childbirth with medication rather than rationalization and education?

We cannot sit on our laurels as we did in the 1980s and enjoy the fruits of the labor without striving for consistently evidence-based best practice for every woman.  Women need to be free to make informed decisions based on their first-hand knowledge of alternatives.  We as professionals owe it not only to the women we care for but also to the babies who will be our next generation.

Keep educating in every way you can. 

Use every means available. 

For it is not the birth professional banging on the hospital door that creates change. 

It is the informed and educated consumer.

Tuesday, July 14, 2015

Evidence-based Benefits of Attending Childbirth Education Classes: 7 Validating Studies

Pregnancy brings a myriad of questions.  These questions include:

“Should I attend childbirth classes?”
“I have limited time – is there an express class I can take?”
“Perhaps I can take a class online.”
“My doctor said I don’t really need to attend since I am getting my epidural.”
“Childbirth classes are not covered by insurance.”

Researching is emerging again about the benefits of antenatal/childbirth education classes.  Previously, expectant parents attended classes as part of a traditional routine of all expectant parents to gain familiarity with the process.  In the 1980s, when a large majority of childbirth education classes moved into the hospital setting, attendance at classes served as an introduction to the hospital policies and procedures.  However, today the research is showing definite physical and emotional benefits of childbirth education classes.

 1. Physical exercise and perceived stress/depressive symptoms lessened  in postpartum with physical activity facilitated through childbirth education classes.

A 2014 study from Poland demonstrated the benefits of physical activity promoted by childbirth education classes. Declared physical activity during pregnancy was linked to lower levels of stress experienced by women and less severe depressive symptoms after childbirth, especially in the group of childbirth classes participants. In this study, 100 women completed the Edinburgh Postnatal Depression Scale.


Kowalska, J. et al (2014) Physical activity and childbirth classes during pregnancy and the level of perceived stress and depressive sympptoms in women after childbirth. Psychiatrica Polska Sept oct 48(5) 889-900.

2.    Of those who attend childbirth education classes, there was a higher patient satisfaction with birth experience and self as emerging new parent.  Classes significantly influenced the psychological well-being of the pregnant women.
Jakubiec, D. et al. (2014) Effect of attending childbirth education classes on psychological distress in pregnant women measured by means of the General Health Questionnaire. Advances in Clinical and Experimental Medicine: Wroclaw Medical University. Nov-Dec 23(6): 953-7
Bahrami, N. et al.(2013) The effect of prenatal education on Mother’s quality of life during first year postpartum among Iranian Women: A RCT International Journal of Fertility and Sterility. Oct 7(3): 169-74.

3.    Attending childbirth education classes and learning about breastfeeding has a positive influence on breastfeeding during the first month.
Initially, 90% of women breastfed their infants, with no differences between the groups. During the first month, the risk of cessation of any breastfeeding was three times as high among non-attendees and twice as high among women who attended 1-4 classes compared with those who attended 5 or more classes. The risk was, however, similar in the three groups from the end of first month onwards.
Artieta-Pinedo, I. et al (2013) Antenatal Education and Breastfeeding in Cohort of Primiparas.  Journal of Advanced Nursing July 69(7) 1607-17

4.    In childbirth education class, attendees learn about the impact of fluids and food (or the restriction thereof) on the labor process.
“The concern with oral intake in labor is that it risks death from aspiration should general anesthesia be required. We quantified that risk using cesarean data from U.S. studies. The primary (first) cesarean rate in 2006, the latest year for which we had this statistic, was 24%, of which all but a few percent would have been during labor. In the Netherlands, where women are freely permitted oral intake, the mortality rate from aspiration during cesarean surgery is 0.9 per 100,000. Using 24% as a proxy rate for intrapartum cesareans, multiplying it by the percentage of cesareans done under general anesthesia in the U.S. (15%), and multiplying that result by 0.9 per 100,000, the likelihood that a fed woman having an intrapartum cesarean under general anesthesia will die of pulmonary aspiration is 3.2 per 10 million. To put this number into perspective, in 2003 she would have been twice as likely to die of aspiration during cesarean surgery than to be killed by a lightning strike (1.6 per 10 million), but she would have been 8 times more likely to die in a plane crash (26 per 10 million) and nearly 200 times more likely (543 per 10 million) to die in a car crash. She would also be nearly 900 times more likely to die of an elective repeat cesarean (2800 per 10 million).”
Goer H., and Romano A. (2012) Optimal Care in Childbirth: The Case for a Physiologic Approach. Classic Day Publishing.  Passage from chapter 11, Routine IVs Versus Oral Intake in Labor: “Water, Water Everywhere, Nor Any Drop to Drink”. 

5.    Wisely participate in the decision making process, especially with interventions such as labor induction
Study results suggest attendance at prepared childbirth classes can be an effective source of information regarding elective labor induction and influential in women's decisions regarding whether or not to have elective labor induction. Women perceive prepared childbirth classes positively and find the information provided valuable.
Simpson, K. et al (2010) Patients’ perspectives on the role of prepared childbirth education in decision making regarding elective labor induction. Journal of Perinatal Education. 19(3) 21-32

6. The Internet is widely used as a source of information amongst participants of antenatal classes, both male and female.
Approximately 95% have used it at some point to find information during pregnancy, but the majority (approximately 90%) had no knowledge of websites run by not-for-profit organisations and preferred commercial websites. Relevance to clinical practice.  Instead of disregarding the use of the Internet as a source of information during pregnancy, midwives should keep up to date and give their patients links to high-quality sites.
Lima-Perieira, P. et al. (2012)Use of the Internet as a source for health information amongst particpationts of antenatal class.  Journal of Clinical Nursing Feb: 21 (3-4).

 7. Antenatal classes or childbirth education classes should not be limited to short classes or one solely focused class.
At the time of this research, consideration was being given to designing a comprehensive birth and parenting program that straddled the birth experience—that is, the program would provide five or six prenatal and two or three postnatal sessions. This structure proved to be difficult to implement for logistical and financial reasons, so it did not proceed. The results of this research demonstrate that further work is required with this concept.  Finally, findings from this study add to the increasing amount of research reporting on educative strategies that meet men's needs during the childbearing year. Men should no longer be seen as adjuncts but as an integral part of the childbearing experience. Their needs require consideration.
Svensson, J. et al. (2008) Effective Antenatal Education: Strategies Recommended by Expectant and New Parents.  Journal of Perinatal Education. Fall 17(4): 33-42.