Friday, July 31, 2009

The Evidence Says: Eat During Labor

It is a new month and I am starting series of blogs during August called "The Evidence Says" ~ each blog will highlight evidence-based maternity care that birth professionals may or may not be following. First, is eating during labor.

Historically, well...since the mid 1940s, women have been given nothing but ice chips (if that) during labor.

It all is due to Mendelson's Syndrome. Mendelson's syndrome is characterised by a bronchopulmonary reaction following aspiration of stomach contents during general anesthesia due to reductionof the reflexes in the thoat.. The main clinical features, which may become evident within two to five hours after anesthesia, consist of decreased oxygen in the body, and tachycardia (rapid heart beat), associated with a high blood pressure. It occurs predominantly in association with obstetric anaesthesia, particularly general anesthesia.

The thought here was that if there was nothing on the mother's stomach and she had to have an emergency cesarean that required general anesthesia (all of which is highly rare), then she would have little or no vomit and Mendelson's syndrome!

This practice has continued for years. However in March 2009, a study was published in the British Medical Journal (BMJ. 2009 Mar 24;338): "Effect of food intake during labour on obstetric outcome: randomised controlled trial." The conclusion was reached that consumption of a light diet during labor did not influence obstetric or neonatal outcomes in participants, nor did it increase the incidence of vomiting. Women who are allowed to eat in labor have similar lengths of labor and operative delivery rates to those allowed water only.

The study of 2426 participants does not tell of the overall feeling of more well-being from mothers who were allowed sustenance during labor nor does it talk about the stamina during second stage that women feel more of if they have had some nutrients during labor.

The important message here is: The conclusion was reached that consumption of a light diet during labor did not influence obstetric or neonatal outcomes in participants.

Thus, the evidence shows there is no hazard to eating and drinking lightly during labor.

Tuesday, July 28, 2009

Information Dissemination 101

Some people call it advertising.

Some people call it marketing.

Actually, advertising is a part of marketing. And for small business owners like birth professionals, marketing can be an overwhelming topic to even begin thinking about.

You may have heard the phrase "If a woman doesn't know her options, she doesn't have any". Well, the same concept can be applied to marketing as with birth. If the consumer (expectant parent, new parent, or even birth professional) does not know there are alternatives to what is usual or accepted OR if there are better places to find the information (evidence/research based), then there are basically no alternatives or better places to find information!

And in 2009, we can no longer use the same application of information dissemination that was used in 1999, or 1989 or 1979!

In 1979, for example, childbirth classes touted cloth pelvises, reel-to-reel movies, and advertised by word of mouth OR flyers if you were lucky enough to find a printer who would give you a good deal on typesetting. And, oh by the way, computers took up as much space as your kitchen. What is an internet?

In 2009, relaxation music is loaded onto iPods with small speakers, dvds with computer generated graphics of anatomy/physiology can be played on personal players and most of us can make our own business cards/brochures with our desktop or laptop computers or access an inexpensive service called Vista Print. Many of us have our own websites, blogs, Twitter accounts and Facebook pages (personal and business fan pages).

If you are still advertising like it was 1979, you may want to reconsider your marketing strategies. Expectant parents today don't think like expectant parents of 30 years ago.

As a small business owner, neither should you.

Want to know more? Look for my new book coming October 1.

Friday, July 24, 2009

So why is there a "breast is best" controversy?

Several years ago, the US government spent over $2 million on a breastfeeding campaign, yet the US has one of the lowest breastfeeding rates in all industrialized countries.

There is talk of pressure put on mothers to breastfeed. Proponents say this "pressure" is just information about the evidence.

In a 2006 interview for ABC news, Dr. Myron Peterson of the Cato Institute, a private research foundation, disagrees. "It's basically negative advertising and it's designed to frighten people," he said. "One of the worst things you can do is to force or coerce or cause a woman to breast-feed when she really doesn't want to because that's a recipe for disaster."

Conversely, in today's US hospital there is an undercurrent of what some call sabotage on the part of nurses toward breastfeeding mothers. Regardless of policy and practice standards, nurses are still giving exclusively breastfeeding babies water, glucose water, pacifiers or formula. Could this not be construed as a recipe for disaster also?

Here are some well-known and not-so-well known facts about breastfeeding:

1) Breastfeeding is cheaper by 1/3. Ref: San Diego Breastfeeding Coalition.

2) Breastmilk contains the perfect nutrition for the age of the child as he/she grows plus antibodies to protect from illness and diseases. Ref: World Health Organization.

3) It is not the mothers who consciously decide to use formula that feel guilty or are unhappy about it. It's the ones who tried to breastfeed, but didn't have the support they needed to keep going. First these mothers feel guilty, then they may get angry. They were denied their right to make an informed decision and have that decision respected. Ref: Bright Future Lactation Resource Centre Ltd.

4) Obstetrical practices sabotage breastfeeding and bonding opportunities. Ref: Dr. Marsden Wagner

5) Breastfeeding mothers have a lower instances of certain breast and ovarian cancers. Ref: US Department of Health & Human Services

6) Breastfed babies have less chance of SIDS. Ref: US Department of Health & Human Services

7) Breastfeeding has NUMEROUS benefits for babies...and mothers. Ref: American Academy of Pediatrics.

8) A to Z: 26 Benefits of breastfeeding Ref: La Leche League International

9) Breastfeeding rates in 1999-2006 were significantly higher among those with higher income (74%) compared with those who had lower income (57%). Breastfeeding rates among mothers 30 years and older were significantly higher than those of younger mothers. Ref: CDC/NCHS Data Brief

10) The impact of medical interventions during the birth of a baby significantly impacts initial bonding, and breastfeeding. Ref: Impact of Birth Practices on Breastfeeding (available 10/1/2009)

As a maternity researcher for over 30 years, I find the evidence irrefutable. The key is to do as well with marketing the hard evidence as the formula/pharmaceutical companies did marketing their products.

Thursday, July 23, 2009

Perhaps 2009's Most Important DVD

I have blogged about "Laboring Under An Illusion: Mass Media Childbirth vs the Real Thing" before...however, just as a gee whiz kind of post.

Now, I have seen it 3 times and I am convinced that this is one of the most important DVDs of 2009 that has as its theme US maternity care. Differing from recent DVDs such as "The Business of Being Born", "Orgasmic Birth" and "Pregnant in America", Laboring Under An Illusion uses comparing and contrasting to make the point - the media shows a very skewed view of birth for the ratings and profit.

Childbirth educator and anthropologist Vicki Elson examines over 100 video clips and compares them to the educational DVDs shown, for example, in childbirth education classes. The comparison is startling and dramatic. Elson does not make the conclusion for the viewer, but does allow the viewer to come to their own conclusion. This is a very big part of what makes this a dynamic film and one that is a tremendous catalyst for conversation about birth in the US society.

Are you the kind of person who, when watching a childbirth segment on TV, yells at the TV hoping for more sanity in the presentation? If so, then this is for you.

Do you educate expectant parents or maternity care professionals and want to illustrate the impact of media on the birthing process in our society, this DVD is for you.

Are you a student or professor of sociology, nursing, psychology, social work, anthropology, or any topic that has to do with humans? This DVD is for you.

Are you an expectant parent, grandparent, moms group leader, LLL leader? This DVD is for you.

In essence, you need to see this video.

Tuesday, July 21, 2009

WHO Statistics & ACOG Guidelines Published

The World Health Organization has issued the World Health Statistics 2009, which is a compilation of data from the 193 member states with summaries of progress towards the health-related goals and targets.

In addition to the myriad of statistical data in the report, the ranking of nations by maternal mortality rate (per 100,000 live births). The listing below indicates how many deaths/100,000 live births.

1. Ireland
2. Sweden
3. Switzerland, Bosnia/Herzegovina, Denmark
4. Spain, Germany, Iceland, Israel, Kuwait, Australia, Austria, Czech Republic
5. Slovakia, Slovenia
6. Netherlands, Hungary, Japan
7. Norway, Finland, Canada, Croatia
8. Poland, United Kingdom, Malta, Belgium
9. New Zealand
10. Former Yugoslav Republic of Macedonia, Cyprus
11. USA, Portugal, Lithuania, Bulgaria

With a national cesarean rate of 33%, high induction rates (22%), and routines that are meant to ensure healthy pregnancy outcomes for all, none of these technologies seem to be making a dent in the maternal mortality rate. The fact is that 30 countries (including Hungary, Croatia, and Malta) appear to be handling obstetrics better than the good ol’ USA.

Ironically on the heals of the WHO report, is the new American College of Obstetricians & Gynecologists (ACOG) practice bulletin #107 scheduled to be published in the August 2009 issue of Obstetrics & Gynecology. Noting that the nation’s induction rate has more than doubled in the last 19 years, ACOG states that “the risks must be weighed against the benefits to the woman and the fetus.”

“Cervical ripening is the first component to labor induction. If the cervix is not sufficiently dilated, then drugs or mechanical cervical dilators should be used to ripen the cervix before labor is induced. Once the cervix is dilated, labor can be induced with oxytocin, membrane stripping, rupture of amniotic membrane, or nipple stimulation. Misoprostol (bloggers note: Cytotec), a medication for peptic ulcers is a commonly used off-label drug that both ripens the cervix and induces labor. The ACOG guidelines indicate that inducing labor with misoprostol should be avoided in women who have had even one prior cesarean delivery due to the possibility of uterine rupture (which can be catastrophic).”

The Guidelines go on to itemize out the examples in which “labor induction is indicated (but are not limited to) gestational or chronic hypertension, preeclampsia, eclampsia, diabetes, premature rupture of membranes, severe fetal growth retardation and postterm pregnancy.”

Take a look at how induction of labor can not only affect the woman’s mind/body/spirit during labor but also afterwards PLUS the effect such practices have on the newly born. According to the March of Dimes, oxytocin that makes the contractions stronger may also lower the baby’s heart rate necessitating the need for continuous fetal monitoring, which can restrict movement by the mother and hinder completion of the cardinal movements which facilitates labor. Women who have inductions and their babies are at increased risk of infection and the baby’s may experience a decrease in oxygen due to cord compression (March of Dimes). The effects of an induced labor on initiation of breastfeeding are innumberable.

It is not impossible to change protocols and policies and see dramatic changes in statistics AND improve pregnancy outcomes. In the late 1990’s a certain Midwestern hospital created a pilot program to reduce that hospitals’ cesarean section rate (then 27%). In this program were two vital parts: a Cesarean Section Review Committee (CSRC) and a Hospital Based Doula Program. The CSRC was comprised of physicians, nurses, childbirth educators and doulas. On a monthly basis, the committee would review all of the cesareans performed at that hospital. If the committee deemed a cesarean questionable or unnecessary, a letter would be sent to the physician. In Hospital Based Doula Program, doulas were hired directly by the expectant parents and had 1-2 prenatal visits, plus 1-2 postpartum visits and the doula during the entire labor. The results? Within 18 months, this hospital reduced its cesarean section rate to 11%. Patient satisfaction was astronomically positive.

How much more plainly do the statistics need to be

Technology (and policy arrogance) is not working.

Tuesday, July 14, 2009

Nothing to do with childbirth but.....

But this is a great example of advertising! How many people will view this video, some because they love babies, some because they are amazed at how the editing was done.

Who is cute!

Monday, July 13, 2009

World Breastfeeding Week August 1 - 7, 2009

I have been looking for an excuse to use this photo ~ given to me by a dear friend who is NOT a birth professional but aware of my passion for birth and breastfeeding!

With only 18 days left until World Breastfeeding Week, you may want to start your own campaign! With the amazing free downloads available from The World Breastfeeding Week website, you quickly have posters, videos, research, and press materials at your fingertips!

The theme for the 2009 World Breastfeeding Week is "Breastfeeding~a vital emergency response. Are you Ready?" The focus is to reinforce the vital role that breastfeeding plays in emergency response worldwide. Sub-optimal breastfeeding practices are responsible for 1.4 million deaths of children under 5 years in low-income countries and settings world wide.

Plus a staggering 1/5 of neonatal deaths could be prevented by early initiation of exclusive breastfeeding within the first hour of life.
The purpose of the 2009 World Breastfeeding Week is to to draw attention to the vital role that breastfeeding plays in emergencies worldwide; to stress the need for active protection and support of breastfeeding before and during emergencies; to inform mothers, breastfeeding advocates, communities, health professionals, governments, aid agencies, donors, and the media on how they can actively support breastfeeding before and during an emergency; and to mobilise action and nurture networking and collaboration between those with breastfeeding skills and those involved in emergency response.
Also at the World Breastfeeding Week website are the winners of the WBW Photo Contest and an important handout on the Myths vs. Realities of breastfeeding!
Don't delay - download your free materials today! Need more WBW supplies? Check out the balloons, stickers and tshirts at Noodle Soup!

Wednesday, July 08, 2009

Gosh Darn It: The Continued Admission of Guilt

The Pittsburgh Post-Gazette is rerunning an article you may have seen in 2006.

The article points out several issues we "birth people" have known about for some time. I guess the reason why I am so surprised/appalled/amazed is that they are admitting it!

The following are italicized excerpts from the article. The exclamations are my own.

Driven by soaring liability-insurance premiums for their obstetrics units, hospital groups are adopting policies to discourage or prohibit births induced before the minimum 39 weeks recommended by maternal and child health experts, unless medically necessary. They are curtailing the use of drugs such as the hormone oxytocin to start or speed up contractions, which in too-high doses can lead to ruptures of the uterus, fetal distress and even death of the infant. And they are limiting the use of forceps and vacuums that can help coax babies from the birth canal but also lead to injuries such as bone fractures and nerve damage.

First, why does it take higher insurance premiums/fear of litigation to discourage induction prior to a baby being full term (unless medically necessary)? Why cannot the reason be respect for the growth of the baby? Respect for the mother who may encounter an unplanned cesarean due to a failed induction? And to even use the word coax in talking about forceps and vacuum shows ignorance on the part of the author. The baby is probably trying to stay IN the uterus because he/she knows it is dangerous out here!

With communication breakdowns at the root of 85 percent of all adverse events reported in obstetrics units, hospitals are also taking steps to ensure better teamwork, such as making sure electronic fetal monitors that trace baby's heartbeats are interpreted the same way by both doctors and nurses.

Oh, my....

"The OB is its own little world in a hospital setting, and 99 percent of the time it's a happy and nice place," says Kathy Connolly, assistant vice president of risk management at the insurance-management unit of Premier Inc., an alliance of 1,500 nonprofit hospitals. But obstetricians don't always adhere to guidelines for elective induction set by groups like the American College of Obstetricians and Gynecologists. They often schedule deliveries around their own office hours or travel plans, and don't always take the time to document care in patient records, increasing hospital liability, she says.

The written word is odd. Ms. Connolly might have the voice inflection such as "Those pesky folks, do they need another time out?"

There was good news though.....

Salt Lake City-based Intermountain Healthcare began requiring doctors to obtain special permission to induce delivery earlier than 39 weeks. Intermountain, which operates hospitals in Utah and Idaho, reduced elective inductions at less than 39 weeks to 5 percent of all births today, from 27 percent before the program started in 2001.

Then it is back to the admission of guilt....

"Pitocin is used like candy in the OB world, and that's one of the reasons for medical and legal risk," says Carla Provost, assistant vice president at Baystate Medical Center in Springfield, Massachusetts, who notes that in many hospitals it is common practice to "pit to distress" -- or use the maximum dose of Pitocin to stimulate contractions.

Let's clarify that. Pit to Distress is referring to the practice of increasing the dosage of pitocin until the baby shows distress on the electronic fetal heart monitor and the mother immediately becomes a candidate for an emergent cesarean.

In plain terms, the practices of the physicians cause fetal distress and make operative delivery urgent, life-threatening and painful.

Gary Hankins, professor at the University of Texas Medical Branch at Galveston and chairman of the practice committee of ACOG, says doctors can cite hospital policies in declining to do preterm elective deliveries, which are sometimes requested by mothers tired of being pregnant.

The article ended with the above paragraph. Why do doctors have to use the hospital policies as a crutch to decline early/elective induction? Why don't they tell mothers the truth about the beauty of the uterus and the give they are giving their baby by providing an optimum living and growing environment for them....that with each passing day, they give their baby an even better advantage at life and health.

Not to mention the risk factors with elective induction.

Thursday, July 02, 2009

The Childbirth Song

I take childbirth very seriously. It is my passion, my vocation, my profession, my job. I am a birth activist, researcher/speaker, teacher, mentor and journalist.

However, every once in a while, everyone has to have a good laugh.

Truthfully tho, this is really funny. Enjoy! I watched it about 6 times and kept the laughter going!

Wednesday, July 01, 2009

The Shift Has Begun ~ The Time is Now!

The shift has begun. The evidence is proving what many of us have been say for years, decades. The plain bare truth is that the evidence is showing that many health care providers in the maternity health care field are not practicing evidence-based care.
A study published in the British Journal of Obstetrics and Gynecology in April (116(5):626-36) of this year examined the rising induction rates for labor and birth. Researchers (from the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI) searched MEDLINE and the Cochrane Library between 1980 and April 2008 using several terms and combinations, including induction of labour, premature rupture of membranes, post-term pregnancy, preterm prelabour rupture of membranes (PROM), multiple gestation, suspected macrosomia, diabetes, gestational diabetes mellitus, cardiac disease, fetal anomalies, systemic lupus erythematosis, oligohydramnios, alloimmunization, rhesus disease, intrahepatic cholestasis of pregnancy (IHCP), and intrauterine growth restriction (IUGR).
After extensive examination, researchers recommendations for induction of labour for post-term gestation, PROM at term, and premature rupture of membranes near term with pulmonary maturity are supported by the evidence.
Induction for IUGR before term reduces intrauterine fetal death, but increases caesarean deliveries and neonatal deaths. Evidence is insufficient to support induction for women with insulin-requiring diabetes, twin gestation, suspected fetal macrosomia, oligohydramnios, cholestasis of pregnancy, maternal cardiac disease and fetal gastroschisis.
Likewise, a report issued in Evidence Report/Technology Assessment in March of 2009 (176: 1-257) stated the evidence regarding elective induction of labor prior to 41 weeks of gestation is insufficient to draw any conclusion.
And finally, a study published in Pediatrics (June 2009, 123(6):e1064-71.) showed elective cesarean delivery is consistently associated with increased intrapartum and neonatal mortality, risk of admission, and respiratory morbidity compared with planned vaginal delivery and has no advantage over emergency cesarean delivery in terms of mortality. Neonatal morbidities are lower after elective cesarean delivery than emergency cesareans only with term births. Their data provide evidence that elective cesareans should not be performed before term.
To add to this information, a study last month in Obstetrics and Gynecology (113(6):1239-47) demonstrated that even when controlling for confounders, there was an association between primary cesarean delivery and insurance status regardless of hospital type. The cesarean delivery rate of women with private insurance delivering in private hospitals was 30.4% compared with a cesarean rate of 21.2% in Medicaid patients delivering in public hospitals.
The evidence IS clear.
The time is now to be accurate and vocal about the practices that are not evidence-based and are therefore posing possible harm to mothers and babies, to breastfeeding and to new families. Post is on websites, blog it, Twitter it. Disseminate the information...NOW.