Sunday, March 30, 2008

Educate, educate, educate, advocate

In August of 1980, when I taught my very first Lamaze Childbirth Class, little did I know that I was joining a growing sorority of birth advocates. I was soon enveloped into a new world ~ a world where others cared about the emotional and spirituality of birth as well as the physical outcomes. Someone had finally put the pieces together. I felt it.

In 2004 I read the book "Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum" by Mary Kroeger and Linda Smith. This book has rock solid research to substantiate the fact that our US birthing practices are not mother friendly nor are they baby friendly. It shines the light on how many of our birthing practices are more tradition than backed by research. It also focuses on how these same traditional birthing practices often negatively impact breastfeeding ~ we sabotage our own clients/patients!

So as I look forward to my 30th year of teaching in 2010, I continue to teach and educate expectant parents on the wide range of birthing options available to them....not just those available in their community but available to all. Why? Doesn't this set some of them up for disappointment? Change will not happen because a nurse, childbirth educator, doula, doctor or midwife advocates for change. Change will happen when the consumer, the clients/patients desire and ask for the change in policy and procedures.

Just as happened back in the 1970's when the Childbirth Movement was in its hay day, we can once again educate women, empower them with data, and support them in helping to make the changes in our maternity care system. A good example of ignored data is the statement by Dr. John Kennell who has said that "If a doula were a drug, it would be unethical not to use it." His nearly 30 years of research with Dr. Marshall Klaus and others show that the providing the mother with a doula made a remarkable difference on obstetric outcomes. Doulas can empower women by answering the questions not answered by childbirth education classes, show the mother and her partner relaxation and non-pharmacologic pain relief techniques that can reduce the perception of pain by as much as 65% and so much more.

It is important to educate and stand firmly on the foundation of research. Through research, education and empowerment, women will find their joy in the childbirth experience.

Tuesday, March 25, 2008

Skin to Skin ~ why aren't we doing this?

I recently read this information written by Dr. Jack Newman:

< To recap, skin to skin contact immediately after birth, which lasts for at least an hour has the following positive effects on the baby:

  • Are more likely to latch on

  • Are more likely to latch on well

  • Have more stable and normal skin temperatures

  • Have more stable and normal heart rates and blood pressures

  • Have higher blood sugars

  • Are less likely to cry

  • Are more likely to breastfeed exclusively longer

    There is no reason that the vast majority of babies cannot be skin to skin with the mother immediately after birth for at least an hour. Hospital routines, such as weighing the baby, should not take precedence.

The baby should be dried off and put on the mother. Nobody should be pushing the baby to do anything; nobody should be trying to help the baby latch on during this time. The mother, of course, may make some attempts to help the baby, and this should not be discouraged. The mother and baby should just be left in peace to enjoy each other's company. (The mother and baby should not be left alone, however, especially if the mother has received medication, and it is important that not only the mother's partner, but also a nurse, midwife, doula or physician stay with them—occasionally, some babies do need medical help and someone qualified should be there "just in case"). The eyedrops and the injection of vitamin K can wait a couple of hours. By the way, immediate skin to skin contact can also be done after c├Žsarean section, even while the mother is getting stitched up, unless there are medical reasons which prevent it.>>

If we KNOW that babies do better skin-to-skin, and the studies show that babies do better skin-to-skin, then why are so many hospitals not using skin-to-skin?

Why aren't we doing this?

Tuesday, March 18, 2008

Why is Natural Childbirth Taboo?

Natural Childbirth ~ according to Wikipedia, natural childbirth is a birthing philosophy that attempts to minimize medical intervention, particularly the use of medications and surgical interventions such as episiotomies, forceps, vacuum and cesareans.

A recent study (2007) revealed the rates of medical intervention in childbirth in the U.S.:
• Electronic fetal monitoring- 93%
• Epidural use- 63%
• Had their membranes ruptured- 55%
• Received oxytocin to progress labor- 53%
• Received episiotomies- 52%
and Cesarean Sections in the US are at an all time high of 31.1%

Even with the use of interventions over 50% of the time, the US infant mortality/morbidity and maternal mortality/morbidity is sluggish to say the least. Evidence mounts that despite the use of interventions, we are not a healthier birthing society.

While the US is generally ignoring evidence-based practices...wait! The evidence does not support the use of medications and interventions? That is correct! Infant and maternal outcomes are better where women are allowed to labor naturally. Well, is this new information? Could it be we just have not heard about it?

In 1985, the WHO Joint Interregional Conference on Appropriate Technology for Birth came up with general recommendations based on evidence including:

  1. The psychological well being of the new mother must be ensured not only through free access to a relation of her choice during birth but also through easy visiting during the postnatal period.
  2. The healthy newborn must remain with the mother, whenever both their conditions permit it. No process of observation of the healthy newborn justifies a separation from the mother.
  3. Countries with some of the lowest mortality rates in the world have cesarean rates under 10%. Clearly there is no justification in any geographic region to have more than 10-15% cesarean rate.
  4. There is no evidence that routine electronic fetal monitoring has a positive effect on the outcome of the pregnancy.
  5. Pregnant women should not be in the lithotomy position during labour and delivery. They should be encouraged to walk about in labor and each woman must freely decide which position to adopt during delivery.
  6. Birth should not be induced for convenience and the induction of labor should be reserved for medical indications.

...........and the list goes on.

What we have observed is that maternity care practices vary greatly based on many factors including how caregivers were trained, what the "we have always done it this way" practices are, how much caregivers embrace new research and how much pressure high level hospital directors dictate evidence-based care.

The concept to remember is that evidence-based care is generally mother-friendly care. The exact why of why we don't embrace it is complicated. But it shouldn't be.

If caregivers are truly in their profession to help women, to help babies be born and have the best interested of babies and mothers and families in their hearts, then evidence-based care should be the norm.

Therefore, natural childbirth should be the norm.

Perhaps it is time for all caregivers to reassess their definition of care to include "evidence-based".

Thursday, March 13, 2008

Sacred Space

While watching Animal Planet the other day, I couldn't help but notice the birth practices of animals. Most hide and make a special place in which to birth. They take great care in creating the safe and serene space where their newborns will come into this world - safe from preditors and safe from the elements.

We humans rarely take the time to make our sacred space in which to birth. If we did, I imagine that birth would take only a fraction of the time that it does. Why? Ina May Gaskin said that the cervix is basically a sphincter. Sphincters are muscles that contract and relax involuntarily and voluntarily in response to certain stimuli. Just as you would not be able to have a bowel movement in front of 4-5 of your relatives or friends, why are women expected to give birth in front of any audience. The sphincter or cervix just will not relax on demand without some effort.

Creating the sacred space for birth is a basic primal instinct. It reaches the very core of our motherhood and the need to protect our little loved one. If we do not create a space for love and acceptance of our babies, does this impact them? Does it impact us as parents? Will it have a lasting impact on us?

Only time may tell us........

Wednesday, March 12, 2008

Just the Facts, Ma'am

Perhaps you are not old enough to remember the "Dragnet" series that ran on radio and television or the movie of the same name with Tom Hanks. But what may be familiar to you is the tag line "just the facts ma'am".

When faced with the facts of childbirth today in the US, this litany of remarkable and regretable stats might make you ill:

1) the US dropped 1 level to #28 in the world for maternal morbidity and mortality.
2) the US cesarean section rate is 31.1%. And based on a study which looked at US birth certificate data, there is a significant number done under the designation of "no indicated risk". Nearly 5% of cesareans in the US are under this category.
3) infant mortality and morbidity in the US is not improving.
4) induction rates are at an all time high, often resulting in premature births.
5) risks of cesareans for both mother and baby are not being explained sufficiently to mother so they can make informed choices.
6) the only countries with higher cesarean section rates are Italy (37%) and South Korea (35%) among industrialied countries.

Has the US become the "McBirth" Society? Are we in such a hurry to live that we fail to value life?

Are we women so "tired of being pregnant" that we would rather visit our premature baby struggling in the NICU than wait a few more days until their lungs mature?

Have we become so complacent with surgery due to all of the television shows talking about plastic surgery that we see cesarean as another elective surgery?

These are tough questions. But then again, these are tough times for babies.
When will we begin to care about them?

Tuesday, March 11, 2008

Return from the CIMS Conference

According to Wikipedia: A blizzard is a severe winter storm condition characterized by low temperatures, strong winds, and heavy blowing snow. Blizzards are formed when a high pressure system, also known as a ridge, interacts with a low pressure system; this results in the advection of air from the high pressure zone into the low pressure area.

Traveling home from the CIMS Conference in Orlando took 2 days and I didn't drive. Flights were canceled to all of the locations closest to home AND to home. So I enjoyed Atlanta for 2 days then flew into Cincinnati as the flights were booked to Dayton until March 11 - today. Need to know anything about Hartsfield/Jackson Airport - I am your gal~!

Note to self: extend self-moratorium on travel from November 1 - March 1 to November 1 - April 1. That should catch all of the blizzards....

Friday, March 07, 2008

CIMS Conference in Orlando #4

Amidst the tornado warnings for central Florida and the estimated 3-8 inches of snow at home (Ohio), the CIMS Conference is going strong. After listening to Eugene Declercq this morning, Charles Mahan last night, Debra Bingham - well all I can say is wow. I feel like I have been fed by a firehose with information and it will probably take the entire flight home PLUS some to process all of the valuable information that I have gotten here.

While I have not done any Disney shopping, I have added books to my library!

Guilt-Gift Shopping is on my agenda next........

Thursday, March 06, 2008

CIMS Conference in Orlando #3

Today is Day One of the CIMS Forum or Conference and I must say that if you are not attending, you are missing a great conference. Today were all day workshops - I attended "Every Change Needs a Champion" with Debra Bingham MS RN LCCE from California. She was amazing in walking us through the steps to making change happen - very methodical and thoughtful process. I also had lunch with my friend Nicette and am looking forward to hearing Dr. Charles Mahan this evening.

Then it is out to dinner with some of my Floridian birthing friends.

Wednesday, March 05, 2008

CIMS Conference in Orlando #2

Well, after an icy start this morning I am finally in sunny Orlando. I was wondering where the sun was hiding and......I found it. It has been hanging out in FL!

Tomorrow morning begins the CIMS conference and I am exciting to be around birthing experts. I am really looking forward to hearing Nicette Jukelevics, a friend of mine and webmaster to, Dr. Charles Mahan (Dean at USF/Tampa), Eugene Declercq (you may have seen him in "The Business of Being Born" and all of the other fabulous speakers.

Conferences are not only a great way to network, but they reenergize and inspire! It will be an exciting next few days!