Wednesday, April 27, 2016

What is a Doula? Watch this!

Have you ever wanted to know about Doulas?

Have you ever needed a video to show potential clients?

This amazing video done by doula Amy Chavez is, well, perfect.

Take 20 minutes and enjoy!




 

Tuesday, April 26, 2016

Childbirth Today goes LIVE! Here's the show from April 26!

Monday, April 25, 2016

Update: New Findings on Delayed Cord Clamping

Several new studies demonstrate the benefits of delayed cord clamping in infants, particularly preterm infants.

A study in the Journal of Maternal-fetal and neonatal medicine: the official journal of the European Association of Perinatal Medicine the Federation of Asia and Oceania Perinatal Societies and the International Society of Perinatal Obstetricians, states that after implementation of a delayed cord clamping (DCC) policy, preterm singleton infants had improved temperatures, increased hematocrits and decrease in the prevalence of intraventricular hemorrhage without significant adverse outcomes.

Jelin, A.C. et al. (2016) Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants. Journal of Maternal-Fetal and Neonatal Medicine.  29(11): 1705-9.

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An interesting study from Advances in Neonatal Care: the official journal of the National Association of Neonatal Nurses tells us that DCC was the mainstay practice until the 1950s when a few studies suggested that it might interfere with active management of the third stage of labor. 

Bayer, K. (2016) Delayed Umbilical Cord Clamping in the 21st Century: Indications for practice. Advances in Neonatal Care. 16(1): 68-73.

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A study published in  Transfusion states that DCC greatly diminishes volume and thus impedes the mount of blood collectable for cord blood banking.

Alan, D.S. (2016) Delayed clamping of the umbilical cord after delivery and implications for public cord blood banking. Transfusion  56(3): 662-5.

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ACOG has not updated their Practice Bulletin/Opinion since 2014, however, they do state that a delay in umbilical cord clamping for up to 60 seconds may increase total body iron stores and blood volume in all infants .  In preterm infants, benefits include improved transitional circulation, better establishment of RBC volume and decreased need for blood transfusion.

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There is a nice website called Delayed Cord Clamping with some updates through 2015 of evidence based articles:

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And here is a nice overview of a study that followed children years later after DCC:

Monday, April 11, 2016

Childbirth Today is going LIVE on April 26!

The Childbirth Today has been very popular world wide for the past 7 years.  So on April 26 at 2:00 pm EST, Childbirth Today is going LIVE!

Thanks to the new and innovative chat app, BLAB, you will be able to find out about topics such as the "week in review" (hot topics in the maternity care community), meet new people and chat with our guests!  In a way, BLAB is a lot like Periscope but for groups!

Of course, I'll still have the same weekly update to the written blog, in cases the live chat is not your cup of tea.

So tune in on April 26 at 2 pm for Childbirth Today - we will give you the top 3 things you need to know for the week and so much more!





Tuesday, April 05, 2016

Communication during Pregnancy - How Important Is It? The New UNICEF Video Shows Just How Important!

Communication is important for anyone - but there is no more important communication than communication in the antenatal or prenatal period.  This includes information gotten in antenatal classes empowers the expectant mother and her support team to begin the role of parenting and nurturing early.  Evidence suggests that when mothers talk and bond with an unborn baby, this produces oxytocin and this has a positive impact on the baby's brain development.  And these are the types of things learned about in antenatal classes!

I hope you enjoy the new UNICEF UK Baby Friendly Video on Communication!  It is just over 13 minutes in length and would be perfect to show in a childbirth education class or at a birth doula prenatal.


Tuesday, March 29, 2016

Why I Will Not Be Referencing The University of Pennsylvania Study on Combination Induction Methods that Speed Delivery

Dr. Lisa Levine reported at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine that the combination of misoprostol and a cervical Foley was the most effective, with a mean time to vaginal delivery of 11 hours, compared with 16 hours for the drug and the catheter alone. 

In Dr. Levine’s study, the mean Bishop score at induction was 3.

“More than 20% of pregnant women undergo an induction each year – that’s almost 1 million women,” she said. “If combination methods were used for all these women, there would be more than 3.5 million fewer hours of labor. This would have a large impact on healthcare utilization. If we could find a way to shorten the length of labor without increasing the cesarean
delivery rate or neonatal complications, this would have an obvious clinical impact.”

If I am reading this correctly, and I’d like to think that I am, the bottom line is that with more inductions and “no significant difference in any of neonatal outcomes”, it is, in fact, all about the money.  With 3.5 million fewer hour of labor, this is a cost savings for health care.

While I was not in attendance during Dr. Levine’s presentation, I still do have the following questions (in no particular order):

  1. With the focus on physical significant differences, why were these mothers induced?
  2. With a Bishop score of 3/dilation less than 2, doesn’t that indicate that the mother is not a candidate for induction?
  3. In the study, it was mentioned that “oxytocin” was administered.  Do you mean “Pitocin”? If so, they are not chemically the same, so please do not use them interchangeably.
  4. Was there complete informed consent prior to induction and using the 491 women in the study?
  5.  The statement was made that there is no significant difference (physically) for mother or baby.  What are the positives? Benefits?
  6. What are the clinical implications of needing to increase the rate of induction by nearly 80%?
  7. Were the mothers in significant pain during the use of Cytotec (misoprostol)? What pain management did they use?
  8. What was the patient satisfaction rate?
  9. What do you mean by statements such as “large impact on healthcare utilization” and “practice-changing”? Does this indicate a higher concern for financials and staffing time over maternal-infant welfare?

Why is maternal/neonatal length of stay an issue?  Why is there so much rushing here?

With statistical data still demonstrating that the U.S. is significantly behind the rest of the industrialized nations in the world in maternal/infant morbidity/mortality, I truly fail to see the significance of this study in reference to maternal/infant well-being.  Pittsburgh childbirth educator Deena Blumenfeld E-RYT, RPYT, LCCE of Shining Light Prenatal Education says, “It’s not about mothers and babies.  It’s about staffing and hospital costs.”

Here are a few last questions:

  1. If a mother was truly given the opportunity for informed consent (with complete knowledge of physiologic birth), would she have given consent to this?
  2. The findings of the study do no significant harm, but what is defined as a good outcome  for these mothers and babies?
  3. Is forcing labor in this manner interfering with the hormonal harmony of birth?
  4. The outcomes are for the very short term.  Are there any long term side effects from rushing labor in this way?
  5. Are there no other ways a hospital can create financial savings and solve staffing issues except to promote “drive-thru” deliveries?  And at what expense to mothers and their babies?


With only 40 year’s experience in the maternity health care industry, I would like to suggest that a combination of evidence-based, comprehensive childbirth education with a focus on non-pharmacologic pain relief, doula support and midwifery care might be good alternatives to this issue.

To read more about this study, click this link:
http://www.obgynnews.com/specialty-focus/obstetrics/single-article-page/combination-induction-method-speeds-delivery/2a274510a09946072d6a5b2d2e151e2b.html  


Monday, March 28, 2016

Establishing Relevance for Childbirth Education Classes

As I collect data in preparation for writing a lengthy article about pain and pain in childbirth, two comments keep resonating in nearly every evidence-based reference article I read: (1) pain is subjective based a person’s belief and knowledge about pain and (2) pain and pain relief can be affected by education.

Sadly, not all evidence-based reference articles come out and clearly promote attendance at childbirth education classes.  One thing, however, is perfectly clear.  There is a definite and purposeful implication that antenatal education with evidence-based facts about both non-pharmacologic and pharmacologic pain relief plus basic knowledge of the physiological aspects of labor and birth have a direct impact on a person’s pain threshold, tolerance and overall reaction to the pain of labor contractions.

One of the most recent confirmations of the need for evidence-based childbirth education classes comes from the Journal of Education and Health Promotion.  Participants in the study cited expressed a true need for information – the study found that childbirth information received by mothers influenced those mothers’ sense of control and empowerment during the birthing process.  Several other studies reported that most women receive inappropriate or inadequate information about childbirth.  With only an estimated 33% of expectant women attending childbirth education classes, this comment is not surprising.

In the article “Is it realistic? The portrayal of pregnancy and childbirth in the media”, the author finds that while the media does influence who women engage with childbirth, the outcome of that engagement is not always positive.  Normal childbirth is often misrepresented by such television shows as “One Born Every Minute” or “A Baby Story”, which offer the stereotypical, sensational version of birth that entices advertisers and makes money for production through commercials. “The media producer needs a ‘hook’ or plot line to engage the viewer,” Luce et al state.  “Yet women, often unaware of the rate of experiences, continue to watch these programs as birth preparation, as media users actively seek information and entertainment and select from it to satisfy their needs.”

Websites such as the Mayo Clinic recommend attendance in childbirth education classes to demystify the entire birthing process, address fears and discuss options. Countries such as Scotland, who recognize the importance of childbirth education, have created national programs to support professionals to deliver a consistent and evidence-based set of information to all pregnant women and their support persons.  A casual Google search of “childbirth education classes” bring information not only about organizations that have an international reach (such as ICEA www.icea.org ) but also links to childbirth education classes in Japan, the UK, Canada and more.

While a Cochrane review of antenatal education claims that a review of trials found a lack of high-quality evidence and the effects of antenatal education remain largely unknown, the implication for practice is that countless articles call for a better educated expectant client, who knows options and can actively participate in informed decision making. 

The question remains: how can a client obtain the proper evidence-based education and be ready to actively participate in informed decision-making if not for attendance in childbirth education classes?

References:
  1. Beigi, N. M. A., Broumandfar, K., Bahadoran, P., & Abedi, H. A. (2010). Women’s experience of pain during childbirth. Iranian Journal of Nursing and Midwifery Research, 15(2), 77–82.
  2. Free, M. M. (2002). Cross-cultural conceptions of pain and pain control.Proceedings (Baylor University. Medical Center), 15(2), 143–145.
  3. Haines, H. M., Rubertsson, C., Pallant, J. F., & Hildingsson, I. (2012). The influence of women’s fear, attitudes and beliefs of childbirth on mode and experience of birth. BMC Pregnancy and Childbirth, 12, 55. http://doi.org/10.1186/1471-2393-12-55
  4. ICEA Position Paper: The Role and Scope of the Childbirth Educator.  Retrieved 3.25.16.
  5. Iravani, M., Zarean, E., Janghorbani, M., & Bahrami, M. (2015). Women’s needs and expectations during normal labor and delivery. Journal of Education and Health Promotion, 4, 6. http://doi.org/10.4103/2277-9531.151885
  6. Luce, A., Cash, M., Hundley, V., Cheyne, H., van Teijlingen, E., & Angell, C. (2016). “Is it realistic?” the portrayal of pregnancy and childbirth in the media.BMC Pregnancy and Childbirth, 16, 40. http://doi.org/10.1186/s12884-016-0827-x
  7. Pirdel, M., & Pirdel, L. (2009). Perceived Environmental Stressors and Pain Perception During Labor Among Primiparous and Multiparous Women. Journal of Reproduction & Infertility, 10(3), 217–223.