Tuesday, September 27, 2016

The World Council on Birth

The World Council on Birth is one of the most prestigious organizations we've ever seen.  Shortly after it's inception, representatives from all of the leading maternity nursing, childbirth education, doula, lactation, midwifery and physician organizations flocked to the first annual meeting!

During that amazing first annual meeting, which lasted seven days, members of the Council discussed the alarming rise in cesarean section rates, maternal morbidity/mortality rates, and infant morbidity/mortality rates.
Evidence based information on every conceivable topic was presented on both a flash drive and print version to each Council member.  It was also posted on the WCB website.  During committee discussions, great headway was made on how to implement evidence-based information in medical school/nursing school teachings, hospitals and birth centers.

The high point of the annual meeting came when one Council member demanded that the observation that everything that is done during the birth process directly impacts breastfeeding implementation, success and duration.  The entire Council rose to its feet with a 25 minute standing ovation.  Then it was back to work in committees to implement yet another stellar concept.

Since that first annual meeting, 55% of the world's medical school/nursing school, hospitals and birth centers are actively implementing the evidence-based policies and procedures, with another 22% coming by the end of the year.  Implementation includes drastic changes in practices, training of all staff in evidence-based/physiologic birth practices and mother-friendly/baby-friendly care.  Over 400 hospitals in the US alone have begun hospital-based doula programs and another 600 are actively referring to doulas in the community.  The statistics for attendance at childbirth education classes is staggering also - we have seen a jump from 34% attendance to 77% attendance in just a few short months in the US.

We are just beginning to see the fruits of their labors!  Cesarean section rates, maternal morbidity/mortality rates, and infant morbidity/mortality rates are beginning a slow but steady decline in every country.  Postpartum PTSD and PMAD and just now also beginning to decline somewhat.  We are making progress!  We ARE moving forward.

(Disclaimer: the above information about the World Council on Birth is 100% satire.  Absolutely none of it is true or accurate.  It is all made up.  It is an exaggeration.  And how disappointing!)

Monday, September 19, 2016

What the Lancet has to say about TLTL and TMTS

Acronyms have become a part of our culture, especially with texting. LOL, ICYMI, and others are part of our new vernacular.  However, two new acronyms were introduced on September 15, 2016 by the Lancet: TLTL and TMTS.  Here's what authors Miller et al had to say:

In a recent article titled "Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide", authors Miller et al have identified that we are at an intersection in maternity care: too little, too late (TLTL) and too much, too soon (TMTS).  They describe TLTL care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity in many countries, not just the United States. Also described is the concept of TMTS:  the routine over-medicalization of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. It has been found that TMTS causes human harm and increases health costs, and many times, concentrates disrespect and abuse. 

Moving from "just" a maternity issue to a global public health issue, TLTL and TMTS has at the core a lack of evidence-based maternity care (EBMC).  EBMC includes care that is humane and dignified, and delivered with respect for a woman's fundamental rights.  In the Lancet's Midwifery Series, it has been shown that women not only value appropriate clinical interventions but also timely information and support so they can make the best possible informed decisions.  Patient satisfaction with care rises when this information and support leads to a feeling of dignity and control. Yet, evidence continues to demonstrate that women are too frequently not informed of risks nor have they been given informed consent for medical interventions. Leading international childbirth education and maternal/child health organizations have been say this for decades.

A prime example is the 2010 estimation that there were 3.5-5.7 million unnecessary cesareans done.  Cesarean section is an aspect of maternity care that is globally monitored and an example of an intervention that can be either TLTL or TMTS with disparity rates in nearly every country on earth.  While cesarean rates appear to be somewhat decreasing in the US, they are rising globally.

Significant to this conversation is the failure of the medical community to embrace and put into the practice evidence-based care.  Known as the "Know-do" gap, research shows that there is a sluggish effort for implementation of evidence-based care.  A dynamic effort must be made to target providers of maternity care for dissemination of this information, while also doing an audit of action, feedback and additional targeted educational interventions.  In short, the buy-in for reducing the "Know-do"gap and improving maternity care (plus improving maternal/infant morbidity/mortality rates) must be felt at all levels of management.  

The words "move toward more respectful maternity care" should basically scare the hell out of care providers today.  The implication that today's care is not respectful to a woman's physical, mental and emotional health goes against what many of us joined the profession to provide.  It can be shocking to know that traditional practices that are the "way we've always done it" are actually harmful for women.  Denial and anger are common responses to this epiphany.

As more and more research and statistics are revealed, the pressure on care providers will increase.  For hospital policies, procedures and practice guidelines to change there must be also social and economic pressure for change.  There needs to be intense pressure from the customer of maternity care for respectful care without fear of retribution.  There should also be pressure from insurance companies to refuse reimbursement for non-evidence based care.  Unfortunately, if we cannot appeal to the care providers' hearts, we will need to hit them in the wallet.

Providing evidence- based respectful care is not impossible.  There are providers, facilities and whole health care systems that have embraced implementation and currently practice this type of health care.  Sadly, the majority do not.

The authors state that excessive, unnecessary or inappropriate use of obstetric interventions in health facilities are a cause for concern.  I believe we've been concerned and complacent for too long.  Too many women have been the victim (yes, I said victim) of this type of inadequate care.  I say it is now time to sound the alarm.

Miller, S. et al. (2016)  Beyond too little too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.  The Lancet. Published online September 15, 2016 http://dx.doi.org/10.1016/S0140-6736(16)31472-6

Monday, September 12, 2016

Discussing the New WHO Standards for Improving Quality of Maternal and Newborn Care in Health Facilities - Trying to Address the Flaws in the System

In a welcome response to the stagnate reduction in maternal/infant morbidity/mortality as well as a response to the quality of care that contributes to maternal/infant morbidity/mortality, the World Health Organization has created the new global document, "Standards for Improving Quality of Maternal and Newborn Care in Health Facilities".

This document centers around eight standards that the WHO feels should be implemented, monitored and improved based on the health care system in which it is adopted.  Not unlike the Healthy People 2010 and 2020
standards, the WHO standards define exactly what is needed to obtain high quality care during the childbirth experience.  Each standard is followed by a series Quality Statements that further define what researchers are looking for in the standard.  

While the use of the word "routine" is seen several times, it is the desire of the WHO Standards writers that evidence-based care become routine and not be the exception.  In far too many facilities world wide, evidence-based care is not practiced.  Traditional practices, perhaps years old, are the rule and not to be questioned.  This is a matter of culture and understanding.  In more industrialized nations, the use of evidence-based care has been slow to be embraced in part due to the political bureaucracy of the hospital system.  Creating, researching, reviewing, approving, and implementing new policies, procedures and practice guidelines takes time. Unfortunately, time is something that those in management positions rarely has and so the old adage, "if it ain't broke, don't fix it" becomes an unspoken mantra.  Again, unfortunately, many policies, procedures and practice guidelines do need to be updated or even recreated to ensure evidence-based care.  This is where there is a flaw in the system.

Below is a list of the Standards.

Standard 1. Every woman and newborn receives routine, evidence-based care and management of complications during labour, childbirth and the early postnatal period, according to WHO Guidelines. 

Standard 2. The health information system enables use of data to ensure early and appropriate action to improve the care of every woman and newborn.

Standard 3. Every woman and newborn with condition(s) that cannot be dealt with effectively with the available resources is appropriately referred.

Standard 4. Communication with women and their families is effective and responds to their needs and preferences.

Standard 5. Women and newborns receive care with respect and preservation of their dignity.

Standard 6. Every woman and her family are provided with emotional support that is sensitive to their needs and strengthens the woman's capability.

Standard 7. For every woman and newborn, competent, motivated staff are consistently available to provide routine care and manage complications.

Standard 8. The health facility has an appropriate physical environment, with adequate water, sanitation and energy supplies, medicines, supplies and equipment for routine maternal and newborn care and management of complications.

These standards, as do the Healthy People 2020 Initiative, help to develop a proper framework, set of definitions and standards of care.  These standards have not been created by chance, but by a comprehensive set of research standards assessing the global issue of maternal/infant morbidity/mortality.  Resources for research of the standards included The Joint Commission (US), the National Institute for Health and Care Excellence (NICE) UK, the Council for Health Service Accreditation of Southern Africa, and the Australian Commission on Safety and Quality in Health Care (2012).

Each standard carried the same characteristics of the care being safe, effective, timely, efficient, equitable and people-centered.  This is of particular interest to childbirth educator and doulas who, as part of their role today, act as guardians of labor support and informed consent.  For expectant families to truly understand if these eight standards are being implemented by their hospital or facility, education becomes the key.  Standard 4 discusses at length the importance of effective communication - communication cannot be effective if both sides of the conversation are not speaking the same language.  By same language, I don't imply English or French.  I am talking about the knowledge of labor and birth, effective and evidence-based care, and listening to the mother's preference.  When preferences cannot be granted due to medical complications, appropriate care and information must be given that is respectful and preserves dignity.

Standard 6 is nearly a mandate for birth doula care.  What else can I say?  The research for the last 30+ years screams the benefits of doula care for the expectant/laboring/postpartum mother!  Why oh why are we so....very...slow...to embrace that which improves outcomes and patient satisfaction?  What is the medical community afraid of?  Yes, afraid?  Is it financial?  My feeling has always been that if a hospital had a doula program, they could market that in an incredible way and become the hero of the community based on maternal satisfaction alone.  And we all know who drives the medical referral bus in families - yes, mothers.  It is one of those magical moments that hospitals are missing.

To read more and get your FREE copy of the WHO Standards of Care, click here.

Wednesday, September 07, 2016

Being Creative in Marketing Your Business – It’s a Jungle Out There!

Marketing a small business is so different from marketing just ten years ago!  Technology has grown by leaps and bounds and has changed the landscape of marketing dramatically. Marketing in 2016 needs to include not only print media (business cards, print advertising), but electronic media (Facebook, Twitter, Instagram).  This can either cause creative juices to flow OR completely stymie someone.  Not all of us are marketing experts….some
of us are truly challenged.  There are some tips to help even the most novice marketing person.

Tip #1 – realize your true value to your prospective clients.  Be honest and write it down.  This will give you content to use when you are in creative mode.

Tip #2 – plan your marketing budget.  This should be a percentage of your annual income and will be used over the course of the year.  Be sure to save some in case you find something absolutely amazing late in the year!

Tip #3 – create your style.  Select a font that you will use almost exclusively, a logo, a company tag line, and even colors.  This will make you recognizable immediately, no matter what the message that you are promoting!

Tip #4 – identify your target market.  Know who will be using your products or services.  Then study how they learn and to what they respond.  What is the age group and what medium do they use for learning?  Once you have answers to these questions, this will provide you with a basic pathway of how to spend your marketing dollars.

Tip #5 – Do you need more specific details about marketing?  Wish there was a workbook that you could use to walk you through the entire process?  Consider Creating and Marketing Your Birth RelatedBusiness !  This book was written by a childbirth professional (me!) and a marketing expert Heather Livingston BA, BBA, MBA (my daughter!).  The first edition has helped nearly 7,000 birth professionals make marketing efforts more meaningful and beneficial for the business.  This new second edition has even more tips and tricks that are proven to bring more clients and more business.  With easy to use concepts and worksheets after each chapter, this may be a wise edition to your business library!

Order yours today!  Or visit our exhibit booth at the ICEA Annual Conference to get a signed copy!

Monday, August 29, 2016

The Top 12 Evidence-Based Resources for Birth Professionals

With social media feeding information to our clients like a fire hose, it can be overwhelming for birth professionals (childbirth educators, doulas, lactation consultants) to discern all of the information and change curriculum or visit information to address every issue.

So with all of the information available to us, how do we choose which ones to heed and which ones to ignore? 

Top Websites for Evidence-Based Information (in no particular order, except for #1)

www.birthbythenumbers.org This website was conceived by Dr. Gene Declercq and has been developed by a group of students from Boston University School of Public Health.  If you don’t know about Dr. Declercq, that should be the very first thing you Google.  He is incredibly intelligent and has been a prolific writer and disseminator of truth for several decades.  I am his
greatest fan.

 www.childbirthconnection.org  Once known as the Maternity Center Association (show me a childbirth educator with over 25 years of experience and I’ll show you her Birth Atlas from MCA!) since 1918, this program is now a core of the National Partnership for Women and Families.

www.marchofdimes.org The March of Dimes and in particular their “Healthy Babies are Worth the Wait” focuses on reducing elective births before 39 weeks.

 www.kellymom.com It’s all about breastfeeding – great info for both professionals and parents!

www.midirs.org The Midwives Information and Resource Service is a not-for-profit educational charity providing essential materials to assist midwives and other professionals.

www.vbac.com Fantastic website for info on cesareans and VBACs.

and of course.......

www.birthsource.com Celebrating 17 years of evidence based information for both parents and professionals.

Top Books as Reference for Birth/Breastfeeding Professionals (in no particular order)

Natural Hospital Birth: The Best of Both Worlds (2011) by Cynthia Gabriel.

Optimal Care in Childbirth: The Case for a Physiologic Approach (2012) Amy Romano and Henci Goer.

The Birth Partner 4th Edition: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions. (2013) by Penny Simkin.

Pregnancy Childbirth and the Newborn The Complete Guide (2016) by Penny Simkin and Janet Whalley.

Impact of Birthing Practices on Breastfeeding (2010) by Linda J. Smith.

Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family (2014) by Diane Wiessinger, Diana West, Linda Smith and Teresa Pitman.

The Nursing Mother’s Companion 7th Edition. (2015) by Kathleen Huggins.

Is there a book you feel should be on this list?  Email me at info@birthsource.com and I’ll be happy to share it with my readers!

Monday, August 22, 2016

Why Childbirth Education IS Still Important!

Researchers agree that antenatal education (aka childbirth education) is a vital part of reducing maternal/infant morbidity and mortality rates, the rising cesarean rates and the growing fear of childbirth.  

On September 19, I have the privilege of joining five other experts in childbirth education to share with you not only why we believe that childbirth education is still important but what the evidence says.  Thanks to Injoy Birth and Parenting of Boulder Colorado, "Why Childbirth Education is Still Important" is the newest in their free webinar series.

You'll hear from Penny Simkin, Cathy Allen, Vonda Gates, Colleen Weeks, Robin Weiss and myself as we explore how to encourage expectant parents to attend classes and teaching to the adult learner, why childbirth education is for every expectant parent and how to challenge the price of ignorance, getting the physicians on board with childbirth education classes, as well as the tokophobia (fear of childbirth) and the Birth/Breastfeeding relationship.  And there will be time at the end of the webinar for you to ask questions!

Want to learn more about this free webinar from Injoy?  Click here!

This amazing webinar is free but you do have to register.  To register, click here.

Monday, August 08, 2016

Understanding an Op Ed Piece - "Get the Epidural"

Last month (July 9 2016), Jessi Klein  wrote an op-ed piece for the New York Times titled “Get the Epidural”  Here is the link to the piece - click here.

I do not normally respond to op-ed pieces because they are just that, opinions.  And I believe everyone has the right to their opinion.  This is no exception.
In her piece, Klein points out, either consciously or subconsciously, several issues that expectant women grapple with nearly every day.

In life, we are unfortunately all subject to judgement and criticism.  Is it fair?  No, especially not in the tender emotional state of pregnant women.  Strangers feel it is accepted to ask personal questions and even invade personal space by pointing at or even touching a pregnant belly.  These strangers feel that expectant women are warm and fuzzy mommies who will be accepting of a variety of social behaviors.  What strangers fail to recognize is that expectant women are still people, with emotional and physical boundaries just like anyone.  And, these same expectant women are fierce momma bears with an incredible protective instinct.  So no wonder there can be a strong push-back on invasions of personal space.

The debate continues about the names of childbirth experiences.  Words that have been tossed around include “natural”, “normal”, “unmedicated”, “unassisted”, and “physiologic”.  Most regular humans do not know the difference and often use these interchangeably.  There may only be two types of childbirth:  physiologic and intervented.  Physiologic would mean that labor begins on its own (without using any medications to begin or augment the labor progress), void of interventions of any kind including medications (such as an epidural) or instrumental assistance (forceps or vacuum).  Intervented would mean a labor and birth that required an intervention, including the previously stated interventions or even a cesarean surgery.  Both have their place in modern obstetrics. 

Birth options
Expectant women should thrive in an atmosphere of freedom to make decisions about their birth experience based on the knowledge of alternatives – such is part of the motto of the International Childbirth Education Association.  Klein implied she was doing some learning and I hope that the internet is not her sole source of information.   I hope she explores books, classes and perhaps even hires a doula who can significantly add to her personal knowledge base. Expectant women who are in a solid place informationally and who can make informed decisions, have incredible birth satisfaction and some research has shown have a reduced incidence of postpartum mood disorders.

Tokophobia & Relationship Issues
Klein’s last paragraph deals with her fear of different types of pain, including pain associated with birth and breastfeeding.  She seems unsettled about her postpartum image and unsettled about adult relationships.  These are issue that may take time to resolve and are not uncommon!  With so much information at our fingertips, it is hard to discern what information is valid and what is tainted by bias.  Finding information that is evidence-based can be more than expectant women can endure.  This may be one reason why expectant women find one source of information and remain locked on that source throughout their pregnancy.  True or biased, one source is better and less time consuming than vetting multiple sources of information.  Doing intense investigation can also facilitate the fear that may be present.

Based on what I’ve said previously, I hope Klein cultivates an environment of support.  What support looks like for expectant women is entirely up to them – whether that is family support, social support, informational support, emotional support, or physical support.  All women need to feel supported during the most challenging and exciting day of their life.  To feel unsupported during this crucial time brings about feelings of resentment and isolation.  Feeling supported can promote calm and make decision-making easier.

Each woman has the opportunity to thoroughly explore all options and information and based on that education, work together with care providers to have the birth experience that they want.  Even when some of the decisions are out of their hands, women should cultivate a trusting relationship with their care providers for just those times.