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

Host an event:
LatchOn Rules:
Find your local Big Latch On event:

Twitter: @BigLatchOn 


World Breastfeeding Week:

When: August 1-7
Where: Your Community

Social Media Kit: 
WBW Photo Contest:
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, 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.

Thursday, July 09, 2015

Fathers & Childbirth

This blog post is a guest post from childbirth educator and author, Nancy Houser.

I remember having a conversation in the mid-80’s with my Dad.  He was an only child but was blessed to become father to five children.

A new father and his child
My parents experienced childbirth when the delivery room was deemed, “no man’s land”, and fathers were relegated to “Father’s Waiting Room”, mandatorialy remaining until notified of the birth of their child.  Contrary to what most believe, the Father’s Waiting Room consisted of a few chairs, perhaps the daily newspaper, and eventually a television that received 3 channels that were off the air at midnight!

Today, childbirth classes provide knowledge and support to expectant fathers, however classes were not available when my parents birthed.  I am a Bradley childbirth educator and was curious to know my Dad’s views on childbirth. Dad indicated he was nervous and excited each time they went to the hospital.  Nervous and concerned for mom’s well-being; excited and anxious to view their baby, and discover whether a boy or girl.

Dad stated the only childbirth info they ever received over the 14 years of birthing children was viewing drawings in a medical text with a nurse one time.  Aside from that, they just went to the hospital when they thought it was time.  I asked Dad to describe being in the Father’s Waiting Room.  He said it was difficult to remain calm; the “not-knowing” was difficult and frightening at times.  Each time a nurse opened the door, all eyes were upon her, hopeful…then disappointed when his name was not called.  Once, Dad was even told to “go home, sleep, come back tomorrow.”  Dad said, “I did go home, called your grandmother to update her, tried to sleep but could not.  I recall saying quite a few prayers for the woman I love and our baby.”

During one of my pregnancies, I invited Dad to an OB appointment to experience hearing his grandchild’s heartbeat.  At that moment, the look on his face will forever remain one of my favorite memories!  His expression was one of amazement, shock, and pure joy! His response was simply, “Wow!”

Dad never desired to be present at any of his grandchildens’ births.  However, he did hold almost all of them within hours of birth.  He indicated expectant fathers should learn all they can regarding childbirth, believing it is a privilege to experience the birth of your child with the woman you love, to hold him when just moments old vs. viewing him through the nursery window as he once did.

Dad did not witness the birth of his children, but by choice became an actively involved parent changing cloth diapers (with pins) and bathing his children during an era when that was unheard of!  Even when his vision was impaired by glaucoma, Dad still changed cloth diapers of his grandchildren.  His active involvement in our lives and those of his grandchildren and his unconditional love for each of us exemplifies the true meaning of being a father.  Dad wasn’t perfect, he did the best he could, and to you Dad, my heartfelt thanks and love!!

About the Author:
Nancy Houser is a Bradley Childbirth Educator, certified since 1982; Certified Birth Doula, Postpartum Doula, and best of all, the mother to five amazing children and grandmother to two adorable granddaughters! Her heart is in Ohio, but her current home is in Northern Virginia!

Wednesday, June 24, 2015

The Circle of Maternity Care: pregnancy-birth-postpartum. Why do we keep breaking the circle?

Nearly every time I attend a maternity conference, I realize that we are STILL in crisis.  There is a huge crisis in maternity care in nearly every corner of the world.  That crisis is that we break the circle of maternity care: pregnancy-birth-postpartum.

In few cases, there is continuity of care. However for the vast majority of women, there is no continuity from preconception to breastfeeding.  The medical community continues to fiercely treat us separately: mind, body, spirit, mother, baby.  If it makes so much more sense to have this circle of caring, why don't we do it?

Preconception is virtually ignored, however a search of the medical literature demonstrates that a healthy and planned preconception period leads to healthier pregnancy outcomes. Likewise, a healthy pregnancy plan also increases the likelihood of healthier pregnancy outcomes.  As eloquently pointed out in her book "Impact of Birthing Practices on Breastfeeding", Linda J. Smith defines the ways that our birthing practices are negatively (and positively) impacting breastfeeding.  Likewise, how we treat women during pregnancy and during the postpartum period can influence their outcomes, especially for those suffering from pregnancy mood and anxiety disorders. A glitch in the system often greatly impacts the mother-baby dyad.  We cannot afford to do this to our society.

I have put the call out before, and it needs repeating.  Childbirth educators & doulas together need to lead the way in preserving the circle of care.  We need to step up our education of expectant parents.  Armed with the evidence, such as in the ICEA Position Papers, educators and doulas need to work together in our communities with lactation consultants and postpartum doulas to enhance the circle of care so that the circle is maintained and is recognized as valuable.

When women have the information, they will feel more comfortable asking for clarification. Give a list of valuable websites such as Childbirth Connection where the research has already been done and it is a reputable/research-based resource.

One person cannot alone make a change in maternity care.  But together, professionals can move to educate women so that they will be asking for information and for change!

Monday, June 22, 2015