Thursday, December 31, 2009

The Best and the Worst of 2009

This is a short review of maternal-child health stories of 2009:

One of the top stories of the year was the controversy of the rise in the cesarean rate. Some researchers discount the fact that CDMR (cesarean delivery on maternal request) is not a factor in the rise in the US cesarean rate, while others site fear, and the media preying on those fears AND the fear of litigation with physicians as primary causes of the rise. The CDC said that cesareans triple the neonatal death risk.

In a data brief issued in November of 2009, the CDC also stated that the percentage of late preterm births for which labor was induced more than doubled from 1990 to 2006; the percentage of late preterm births delivered by cesarean also rose markedly. This gave some care providers pause ~ possibly looking at the way they intervened with their clients/patients.

Breastfeeding rates are highly influenced by the amount of medical interventions that occur during labor and birth. The rise in the IV fluid usage rate from such interventions as induction/augmentation or epidural anesthesia is in direct relationship with severe postpartum engorgement. Also, breastfeeding in public got a great deal of press ~ worldwide!

More and more studies are coming about the effects of oxytocin on various conditions including memory, autism and more.

Midwives and their practice became a huge story during 2009 with many states actively examining out of hospital births and the cost effectiveness and safety. The Big Push for Midwives gained even more support in 2009. The mission of The Big Push includes educating the public and policymakers about the reduced costs and improved outcomes associated with out-of-hospital maternity care and Certified Professional Midwives, the maternity care providers trained to provide that service.

Doulas gained another step in the journey toward third party reimbursement for their non-clinical support of laboring mothers and partners in 2009. DONA International issued a statement helping doulas obtain the necessary coding to access insurance reimbursement.
Environmental hazards such as dioxins and their influence on pregnancy health caught the eye of the media in 2009. Bisphenol A exposure (such as that in baby formula bottles) in pregnant mice permanently changes DNA Of offspring. Exposure to phthalates may be a risk factor for low birth weight in infants.
Finally, the H1N1 vaccine controversy was looked upon with some interest for pregnant women and breastfeeding mothers.
It has been a busy year for maternal child health professionals. One that has frustrated some and energized others. For 2010, what are your areas of focus? Your goals?

Tuesday, December 29, 2009

Responses to Dr Abhijoy Chakladar - Part 2

Previously, I posted (by their request) DONA International's response to Dr. Chakladar.

Shortly before Christmas, I was contacted by Dr. Chakladar, who gave me the direct link to the British Medical Journal piece. Below, is the BMJ article with my contributions in blue italics. Special thanks to Desirre Andrews of ICAN for her contributions.

Encounter with a doula: is the system failing new mothers?

Anyone know what a doula is?" I asked in the coffee room. I was met with a roomful of blank faces. Earlier, during the morning obstetric meeting, a midwife told me that her patient had a doula. "A what?" I asked. "You know," she said, "a birthing partner." I didn’t know; anyway, isn’t that the job of the partner or the baby’s grandmother?

The word doula derives from the ancient Greek for "woman of service." Recently it has been used to describe experienced women who help mothers care for newborn infants; the role now extends to attending prenatal classes and the birth itself.

Taking a strong look at birth history throughout the world, there have always been at least 3 persons at a birth: the birth attendant (midwife or physician), mother and partner. Today, in our mobile versus traditional society, birth partners along with the pregnant woman are relatively uninformed about maternity care and the birth process. In the US, only 33% or less of expectant parents attend a prenatal childbirth class. So when an expectant mother (partner) want more personalized, continuous care that involves education, emotional support and physical support during a birth, she often turns to a doula.

On this occasion an epidural had been inserted as per the birth plan, and I was called to assess the patient’s analgesia, as she complained of discomfort. I found a missed segment and planned an epidural bolus with repositioning. The doula had been present since admission, as had the husband. Both the mother and father were confident and articulate, so I couldn’t help but wonder why they needed to pay for support.

Confidence and articulation cannot or should not be put together in the same category as informed about the birth process or hospital policies/procedures. The other piece to this puzzle is that the work of labor still needs to be done. With an epidural on board a labor is often turned over to technology lessening interaction with the mother as part of the birth. A doula is often well versed in how often a mother needs to change position for optimal fetal positioning, helping the mother stay in touch with the birth process, and keep her invested emotionally.

In my practice the mother is the principal focus, but I address the couple together, recognising their joint experience of bringing a new life into the world. I found myself disconcerted by the doula’s presence, as I was unfamiliar with her role. To whom should I direct my explanation? If I spoke to the doula and mother, would I marginalise the father? If I spoke to the couple would this be regarded as disrespectful to the doula? She was there, after all, at the express wish of the mother, her employer. I chose to speak directly to the mother—the patient. I gave the top-up and advised that she turn to lie on her side. At this point the doula interjected to say that the mother was comfortable as she was and asked whether repositioning was necessary. I said it was for the top-up to be most effective.

Any health care professional should address the mother/father/partner. The doula can be an advocate but should never be a voice during the birth unless she is the sole support of the mother and the mother cannot speak for herself. In this situation, the doula had definitely stepped out of her role as a doula, violating the Standards of Practice and Code of Ethics. It would be interesting to see if she was certified by a doula organization, what the name of that organization is, and what said organization’s Standards of Practice are.

While documenting the procedure I was informed that the patient had decided not to move. I realised my mistake. If the mother had asked the same question, I would have qualified my answer with a description of how epidurals worked and the effects of positioning on the spread of a local anaesthetic. As the doula had asked, I had dismissed her question without explanation, compromising my care. Failure to offer sufficient justification to the doula seemingly gave sufficient justification to veto my request to reposition. In this clinical situation the presence of a doula swayed the decision making incorrectly. In retrospect, I should have confirmed everyone’s roles and established ground rules acceptable to all involved on entering the situation.

Again, this doula clearly stepped out of her role. Though conversing with the doula would have been appropriate. Getting clarification could very well help her support another family in a better way in regard to epidural use and function.

Hired birthing partners are unregulated, not part of clinical obstetric teams, and therefore should not be involved in making clinical decisions. There is no nationally recognised certification for doulas, and it is possible to work without training. Courses are available for doula training; these claim to improve understanding of what parents expect from a premium service and options regarding birth plans; to reinforce the role of doulas; and to allow a brief experience of the childbirth process. The Nursing and Midwifery Council recognises doulas solely as emotional support for mothers and as unqualified persons who cannot substitute for registered midwives.

There are several international certifications for doulas including DONA International, the International Childbirth Education Association, and CAPPA (Childbirth and Postpartum Professional Association). These are US based organizations and I would encourage you to contact the National Childbirth Trust to see what organizations are in the UK. In no way are doulas to replace midwives as doulas are not clinicians. Doula as a birth professional is still in toddlerhood. Doula as an accompanying individual is not. Women of knowledge have attended other women throughout history as part of traditional cultural practice. A doula being part of the birth team can enhance the process for care providers, staff, and the family.

Doula organisations often cite a meta-analysis published by the Cochrane Collaboration that found an association between continuous birth support and risk reductions in regional anaesthesia, instrumental delivery, and caesarean section. Most importantly, it showed a 27% relative risk reduction in mothers reporting negative ratings of childbirth experiences. Although these are positive findings, is this not what midwives are employed to do?

Hospital-based midwives in the US practice similarly as physicians. So no, this is not what midwives are employed to do. Midwives are concerned with the clinical aspect. In the homebirth or birth center environment midwives have more latitude to offer more in depth support. Often the doula is with the family throughout most of labor and delivery, whereas the midwife no matter the birthing environment is not. Doulas, ideally, are not concerned with the clinical aspect of birth, but focus on the emotional, physical and informational support.

About 1000 doulas work in the United Kingdom, offering packages that include antenatal, labour, and postnatal visits and on-call periods for a charge of between £400 ( 440; $660) and £900. In the United States in 2005 there were an estimated 100 000 doula supported births. As the trend grows here, a cynic might ask whether the doula business is actually necessary or whether it is exploiting—for profit—unspoken fears about NHS perinatal care and the seemingly limitless market for birth related products and services. The next evening I encountered a former drug user in advanced labour, with three children already in care, and birthing alone save for a midwife who was caring for two labouring woman. Sadly it seems those who need emotional support most cannot afford doulas.

While I am not sure of the doula climate in the UK, I can tell you that many, many US doulas will do births free of charge, for a reduced fee, or barter. This is true for veteran doulas as well as newly trained doulas. As for 100000 (birth) doulas in US, this number is not validated. The main doula organizations combined in the US have approximately 10000 members, who may be antepartum, birth, and/or postpartum doulas.

I am disappointed by the real or perceived need for doulas. It is the medical and midwifery professions’ duty to support and advocate for mothers and families through a very special but potentially frightening experience. Traditionally, emotional support came from female relatives; more recently the modern father has stepped into this role. Partners, friends, and family—those who know the mother best—should provide this support. Sadly, this position cannot withstand chronic understaffing, shift work, midwifery care that is less than one to one, and European working time directives, making continuity of care impossible. Nor can it withstand single parenthood and increasingly detached nuclear families.

Again, I am unfamiliar with maternity practices in the UK, however I can tell you in the US that with the current (and persistent) nursing shortage, nurses, physicians or hospital-based midwives do not have the time to spend supporting individual clients through the entire birth experience. Due the availability limitation, nurses often pop in and out while the care provider is engaged with the patient maybe 30 minutes of the entire labor and delivery. Expectant parents feel the need for educated guides through a very confusing and sometimes hostile maternity climate. There is also the matter that doulas have been part of birth throughout history regardless of name.

As healthcare professionals we forget how much of an unknown the body’s processes are to the general public, that much of what we take for granted is a complete mystery to even the most confident and articulate lay people. The processes of child birth are new and anxiety provoking experiences, and what people fear most is the unknown. Combined with the often time pressured hospital environment and need for quick decisions, this takes control away from the individual. A lack of continuity in carers does not allow parents to develop trust in clinicians, as they find themselves having to start new relationships every 12 hours, diminishing the quality of communication. People seek some continuity in their support in stressful situations; perhaps doulas fill a gap in this market.

Doulas do, in fact, fill in this large gap in continuity of care ~ you are correct that beginning new trusting relationships of care providers (nurses) every 8-12 hours can be interruptive. It would be more helpful for physicians and midwives to promote prenatal childbirth education classes as was done in the 60’s and 70’s so that the body process of labor and birth is not such a mystery to either the expectant mother or her partner.

Is this a passing fad, or is there really a need for doulas? Either way, clinicians need to be aware of doulas, so that their service is not compromised by the presence of new people in clinical settings. This trend may be a sad reflection of failures in the delivery of medical and midwifery care, a sticking plaster concealing greater problems. Availability of this commercial service indicates that current social structures do not support pregnant couples adequately; healthcare professionals may not be able to support their patients as they would like to. Are we no longer able to make common sense decisions without asking a hired friend?

Nurses, physicians, midwives and other clinicians need to be educated fully about doulas, their scope of practice and code of ethics. They need to be aware of the positive contributions modern doulas make for labor/birth and during the postpartum period as well. While the need for doulas today may be a commentary of the failure of our social support system and desire for education during pregnancy/birth/breastfeeding, thank goodness doulas are available to fill that need. Most often the need is filled without conflict and better outcomes all around.

Responses to Dr Abhijoy Chakladar - Part 1

I have received alot of lengthy responses to my blog of December 12 Doulas: Newest Accessory in Lucrative Birth Biz. First, here is the response from DONA International:

Official Response to Article in BMJ – Dr. Chakladar

In response to the recent article about doulas (BMJ 2009;339:b5112, doi: 10.1136/bmj.b5112, Published 1 December 2009) by Dr. Abhijoy Chakladar

Dr. Abhijoy Chakladar recently wrote an article about doula support in the British Medical Journal (Dec 1, 09). There he questions the role and training of doulas, suggesting that midwives should be performing these duties, and that doulas may compromise care by disrupting the relationship between the medical team and mother.

As the premier doula organization, representing over 7,000 doulas, DONA International takes the opportunity to offer a rebuttal to this article.

The importance of fostering relationships between parents and infants cannot be overemphasized, since these early relationships largely determine the future of each family and of society as a whole. The quality of emotional care received by the mother during labor, birth, and immediately afterwards is one vital factor that can strengthen or weaken the emotional ties between mother and child.[1]

DONA International is the largest certifying organization for doulas in the world. While the doula field is not currently regulated, parents and providers can find reassurance in the scope of practice that all DONA doulas agree to - and are governed by - in becoming certified through, or members of, the organization. This scope is defined as such:
Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman.

DONA International believes that doulas are an integral part of the maternity care team supporting their clients emotionally and physically. Doulas provide access to evidence-based information so their clients can make the decisions that are right for them. Doulas fill a gap and a need that currently exists in virtually every health care system around the world. As Louise Silverton, Deputy General Secretary of the Royal College of Midwives, claims in the article, “midwives simply do not have the time to provide the kind of emotional support that doulas are offering.”

Dr. Chakladar questioned whether “the doula business is actually necessary or whether it is exploiting – for profit – unspoken fears about NHS perinatal care and the seemingly limitless market for birth related products and service”. We can report with confidence that doulas are not drawn to the profession by the earning potential. On the other hand, healthcare systems, governments and the public incur an enormous burden of expense for the many interventions inherent to an otherwise normal labor, birth and immediate postpartum experience for mothers and babies due to frequently unnecessary and excessive procedures and interventions considered routine. Multiple grassroots, consumer and governmental organizations are working diligently to enlighten childbearing families and maternity care providers of the importance of evidence-based practice and informed decision-making.[2] DONA International is but one of those organizations and it is for this reason that some birthing families desire the support of a knowledgeable and experienced doula.

Dr. Chakladar questions the motivation to hire a doula by the parents referred to in the article; "Both the mother and father were confident and articulate, so I couldn't help but wonder why they needed to pay for support." The assumption in this statement is that confident and articulate people cannot benefit from the support and guidance of a compassionate professional advocate.

A doula is the cultural surrogate for the extended family that used to surround and support women in their childbearing year. Modern culture dictates that most women will give birth never having witnessed the birth of another woman nor will she be supported by women who have the knowledge and skills that their female relatives used to bring to the situation. Doulas “mother the mother,” providing continuous support and filling the void in today's under-resourced medical systems.
The hormones of labour cause a natural shift in awareness, which can greatly impede a woman’s logical and objective judgment. Partners may be insecure in their ability to fully comprehend the risks and benefits of common procedures or to effectively seek out this information during labour because of their strong emotional involvement in the process. When parents express confusion or have questions beyond what their care provider has offered, the doula helps them access additional information and validate its basis in evidence to aid in their decision making. A doula works for her client, understands her client’s motivations and goals and can therefore provide objective responses tailored to her client’s individual needs. She builds a relationship of trust and confidence with her client, something most healthcare providers simply do not have the luxury of doing.

Perhaps Dr. Chakladar’s statement, “that the kind of women who are very determined to achieve a ‘normal’ birth are more likely to hire a doula than those who do not see medicalised childbirth as a problem” contains an element of truth. The real questions are two-fold – what defines normal birth and why would not all women deserve a normal birth? An abundance of research has been carried out regarding the benefits of doula support during labor and birth and the results consistently show better maternal outcomes, reduced intervention rates, greater satisfaction and better neonatal outcomes, regardless of women’s choice for pain relief. Penny Simkin, one of the founders of DONA International, states, “Doulas can only control how we care for our clients.”[3] The individual doula’s focus is not about statistics or changing outcomes as much as it is about meeting the emotional needs of her laboring client and knowing what emotional suffering looks like so that it can be avoided.

When maternity care providers and doulas work in concert to meet the needs of the labouring mother, the best outcomes are achieved vicariously. Doulas have the advantage of becoming intimately involved with their clients, understanding their fears, desires and goals, this involvement does not encroach on the role of the medical care provider. Instead, the doula’s role fills the cultural gap that continues to grow as our worlds expand and our family structures change.

Dr. Chakladar, doulas do not want women to “feel failures if they have an epidural, or they end up having an instrumental or Caesarean birth.” DONA International and our member doulas do believe, however, that it is every woman’s right to be informed of the risks of all such interventions, both short- and long-term, that they be given the options and the support necessary to become full partners in their healthcare decisions, and that they be honored and respected physically, spiritually and emotionally in order to come away from the experience more confident and complete.

About DONA International
DONA International is the oldest and largest doula association in the world with approximately 2,800 certified birth and postpartum doulas and over 7,000 members. This international, non-profit organization supports doulas by providing quality training and meaningful certification.

For further information, please contact:
Stefanie Antunes, Director of Public Relations
p. (888) 788-DONA (3662) PublicRelations@

1- Doula Position Paper, which includes (but not limited to) Hofmeyr J, Nikodem VC, Wolman WL, Chalmers BE, Kramer T 1991& 93; Langer A, Campero L, Garcia C, Reynoso S. 1998; Martin S, Landry S, Steelman L, Kennell JH, McGrath S. 1998; Landry SH, McGrath SK, Kennell JH, Martin S, Steelman 1998.

2- Childbirth Connection,; Coalition for Improving Maternity Services (CIMS),; Lamaze International (; ICEA (
British Columbia Perinatal Health Program

3- Doulas: Making a Difference, video.
[1] Doula Position Paper, which includes (but not limited to) Hofmeyr J, Nikodem VC, Wolman WL, Chalmers BE, Kramer T 1991& 93; Langer A, Campero L, Garcia C, Reynoso S. 1998; Martin S, Landry S, Steelman L, Kennell JH, McGrath S. 1998; Landry SH, McGrath SK, Kennell JH, Martin S, Steelman 1998.
[2] Childbirth Connection,; Coalition for Improving Maternity Services (CIMS),; Lamaze International (; ICEA (
British Columbia Perinatal Health Program

[3] Doulas: Making a Difference, video.

Friday, December 18, 2009

“Normal” “Natural” “Humanized” “Good Enough” ~ What do we call childbirth in 2010?

Much of what childbirth educators have been preaching about for the last two decades is finally making its way into the mainstream media. Childbirth educators have been talking about the evidence: the evidence that shows that the increase in medical interventions during birth does not improve infant mortality/morbidity or maternal mortality/morbidity.

A Consumer Reports article from October 2008 had this to say about medical interventions during birth in the U.S.:

The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies. Such measures include:

*Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005

*Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests

*Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization's recommended national rate of 5 to 10 percent

*Electronic fetal monitoring, unnecessarily adding to delivery costs

*Rupturing membranes ("breaking the waters"), intending to hasten onset of labor
Episiotomy, which is often unnecessary

In fact, the current style of maternity care is so procedure-intensive that 6 of the 15 most common hospital procedures used in the entire U.S. are related to childbirth. Although most childbearing women in this country are healthy and at low risk for childbirth complications, national surveys reveal that essentially all women who give birth in U.S. hospitals have high rates of use of complex interventions, with risks of adverse effects.

In the face of this increase in intervention in childbirth, “normal birth” is promoted by the World Health Organization, national governments, professional bodies (such as midwifery, childbirth and doula groups) and other organizations around the world. A recent article in Nursing Inquiry (“Normal”, “Natural”, “Good” or “Good Enough” Birth: Examining The Concepts by Susanne Darra; 2009; 16:297-305) discusses the titles placed on birth processes and the confusing overlap of definitions:

To some degree, the prevalent birth culture in the US is women’s misplaced fear of their baby will die, yet they don’t worry about the risks of inducing labour. They worry that the pain will be unbearable, yet they don’t worry about the side effects of epidural anesthesia. They accept continuous fetal monitoring as safe and effective, yet they don’t worry about a medically unnecessary cesarean section.

Lamaze and other organizations and birth journalists have embraced the term normal birth with a widened range of variations of normal. Like midwives, normal birth advocates focus attention on the strength and education of the expectant parents for the normal birth scenario to be played out. Yet, how can a normal birth occur if hospital educators continue to teach to the “good enough” birth level?

Darra refers to the work of Winnicott (1953) and the theory of the “good enough mother” from which the good enough birth is derived. The good enough birth is a birth planning on the reduction in medical interventions within the dynamic and unpredictable process of childbirth. Using Winnicott’s theory, therefore, mothers are capable of adapting and coping with the challenges of losing control in labor ~ allowing for others to be in control (enabling disempowerment).

Counter to this way of thinking comes Marsden Wagner from his landmark writing “Fish can’t see water: the need to humanize Birth” International Journal of Gynecology and Obstetrics 75: s25-37.

Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women---half of all people---that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society.

By medicalising birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman's state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result it that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what 'non-medicalised' birth is.

Why is medicalised birth necessarily dehumanizing? In medicalised birth the doctor is always in control while the key element in humanized birth is the woman in control of her own birthing and whatever happens to her. No patient has ever been in complete control in the hospital---if a patient disagrees with the hospital management and has failed in attempts to negotiate the care, her only option is to sign herself out of the hospital. Giving women choice about certain maternity care procedures is not giving up control since doctors decides what choices women will be given and doctors still have the power to decide whether or not they will acquiesce to a woman's choice.

There is, therefore, a tremendous disconnect between what is evidence-based information that is taught by childbirth educators and written about in journals such as midwifery journals or the Journal of Perinatal Education, and that which is embraced by the medical community.

Of this, Wagner also writes:
Another reason for the gap between evidence and practice is the excuses often given by physicians for why they reject evidence in their medical practice. These excuses include: the evidence is out of date; collecting evidence is too slow and prevents progress; I use clinical judgment and my experience; using anecdotal 'horror stories' to try to prove the need for an intervention which the evidence has found unnecessary; quoting evidence which is of poor and/or inadequate quality; 'trust me, I am a doctor'; 'stop doctor-bashing'; evidence erodes physician autonomy. In addition to these excuses, in maternity care common excuses include: our women have smaller pelvises (no evidence), our babies are getting bigger (no evidence), our population is not as homogenous (no evidence).

So perhaps the term should be physiologic birth? The definition of physiologic birth is essentially the midwifery model of care: every pregnancy and every birth is different and unique in its own normal/natural way. Care should respond to the physiology of birth and include emotional and physical support of the mother and her immediate partner. The mother should be educated so that she can respond to labor in her own way.

Case in point: Joy Szabo who moved 6 hours away from her home to get the VBAC she wanted and needed. Why should mothers have to fight for physiologic birth?

To this, Wagner would comment:

The final solution is to evolve new social and political forms for the medical profession and for medical care. Maternity care needs turning around so that, instead of drifting away from physiology and from the social and cultural environment, the process moves toward respecting and working with nature and with the woman and family, turning control of medical care over to the people.

So 2010 should be the year of the Childbirth Educator? A renewing of vows to educate with evidence-based information both the expectant parent population and the nursing/medical population who are admittedly busy yet are in desperate need of this information. While as a group, childbirth educators make up only a small portion of the US population, we are a passionate and committed and unique group of individuals.

"Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has." - Margaret Mead

Tuesday, December 15, 2009

Your Birth Business part 5 (last part) Social Media Marketing

There have been alot of changes in technology. Have you been following? Chances are if you are reading this blog, you have been following. To reach target markets today, using social media marketing such as websites, blogs, Facebook, Twitter and now Linked In can be extremely useful.

Here are some helpful tips for each of the social media listed above. Additional information can be found in Creating and Marketing Your Birth Related Business.

There is no doubt about it, having a website adds credibility to your practice! Let me clarify that by saying an active website adds credibility. An active website is updated frequently, daily or weekly. New things to do or read are added to bring visitors back repeatedly...and stay! A static website or one that is not updated frequently will only be visited when someone is in need of your services or products. Need a professional-looking website or hosting? Click here.

The word blog began as a contraction of the words web and log. It is a wonderful way of sharing more detailed information, links, and even videos. As a birth professional, you can focus on the hot topic of the day and provide a forum for discussion, or take a topic important to your practice and expand on it - providing evidence-based information for all who read it.
Need an easy-to-create blog? Click here.

Twitter is another way of reaching large groups (your followers) of people. Short bursts of information (140 characters) are only visible for short lengths of time ~ thus necessitating frequent Tweeting. They can, however, be visible longer, if you have Twitter posted on Facebook, your blog and your website. Want to join Twitter? Click here.

Linked In
Linked In is a business-oriented social networking site founded in December 2002 and launched in May 2003 mainly used for professional networking. According to their website, LinkedIn is the world’s largest professional network with over 50 million members and growing rapidly. LinkedIn connects you to your trusted contacts and helps you exchange knowledge, ideas, and opportunities with a broader network of professionals. Visit their learning center by clicking here.

One of social media's biggest players, Facebook is a social utility that can connect you in a wide variety of ways with friends, family, class mates, clients ~ just about anyone! There are two important things to remember about Facebook: just about anyone can see your status updates and just about anyone can see whatever personal information you post on your Facebook page. That being said, be smart when using Facebook! Want to set up an account? Click here.

Saturday, December 12, 2009

Doulas: Newest Accessory in Lucrative Birth Biz

(Blogger's note: words in italics are quotes directly from the BBC article)

The December 2 article from the BBC titled "Doulas: Holding Hands or Stepping on Toes" has been picked up by a number of news agencies. It is circulating and generating alot of interest and conversation.

But one doctor would like to see more debate about the role of these women, who have no medical training and whose work is at present unregulated by an outside body.
Writing online in the British Medical Journal, anaesthetist Dr Abhijoy Chakladar says doulas are taking over roles that midwives should be performing and may even be compromising care by disrupting the relationship between the medical team and mother and affecting clinical decisions.

While it is a truth that sometimes doulas enter into doula work with their own agendas at the forefront and do disrupt the relationship between the medical team and mother and affect clinical decisions, it is also true that nurses, midwives and physicians do the same. With the agenda of avoiding litigation, being more efficient by observing 3-4 active laboring patients from the nurses station via EFM, care providers limit the freedom of mothers who have uncomplicated labors and sometimes actually cause complications.

Jean Birtles, head of British Doulas, says there are birthing assistants who may be doing just that.

The opposite is also true of doulas, nurses, midwives and physicians: that they LISTEN to laboring women, respond to laboring women and have uncomplicated outcomes. Generally the doulas do answer to their certifying organization, many of which have grievance committees and investigation protocols. I am not sure what Dr. Chakladar wants by an "outside body".

So there is a perceived "fault" on both sides. Neither is pure.

However, whether doulas do in fact decrease interventions remains a moot point, as it is possible that the kind of women who are very determined to achieve a "normal" birth are more likely to hire a doula than those who do not see medicalised childbirth as a problem.
The issues surrounding the relationship between doulas and clinicians are part of a broader discussion about how polarised the childbirth debate has become, according to Dr Chakladar.

Dr. Chakladar, an anesthesiologist, thinks that all 25+ years of research about the effectiveness of doula care is a moot point. I think not.

Rather, I believe that while there is some polarization in the childbirth debate, it is because of a lack of information in nursing schools and residency programs about normal birth. As it should be, nurses and physicians are taught crisis management for those situations when crisis management is necessary and expertise is required. However, birth is not a situation of crisis. Nearly 85% of the time, birth is a normal and natural event that requires little intervention.

Regretfully, in the short time nurses and physicans are in the obstetrical clinical rotation, they do not have the time to learn how to work with a natural and uncomplicated birth. They literally are not trained to work with a non-crisis. The old adage "if you see everything as a nail, all you will use is a hammer" applies.

Instead of enabling Dr. Chakladar's theory of polarization in the childbirth debate to continue, I say we should teach all nurses and all physicians (regardless of where they are in their careers) how to work with women who have normal, uncomplicated labors. To that end, if you are reading this, watch for the new program Evidence Based Maternity Care: Turning Aha Moments into Practice in January from Perinatal Education Associates. This program is applicable for hospital nurses in labor/delivery, childbirth educators, doulas, physicians, midwives, nursing schools, and residency programs.

If you are interested in having this program at your facility, please contact us. We'll add you to the growing list of places where we will be presenting it in 2010!

Thursday, December 10, 2009

Your Birth Business, Part 4D ~ Getting Your Name Out There

What do you want to be when you grow up? A doula, a childbirth educator, a midwife, a birth journalist, a researcher, a speaker at birth conferences?

No matter what route you choose in this exciting and ever-changing profession, you will have to get your name out there. Here are five quick ways to get your name out there even if you are on a budget:

1. Make a plan of “attack”. Identify what type of “advertising” you will do and where it will go. From business cards to print ads in magazines, make a plan!

2. Business cards are a great and inexpensive way to introduce someone to your business, services &/or products. The ease of designing your own has increased exponentially in the last few years with companies such as Vista Print. For my printing needs, they are my new best friend. With easy online templates, I can create a colorful business card or postcard in no time! And since they have a “second side” option, you can add more info to this little marketing gem.

3. Your vehicle is exposed to hundreds of thousands of individuals each year. Why not market to them? If the budget allows, try vanity license plates, car magnets (see Vista Print again!), or window decals. Because the exposure in a vehicle is brief, marketing this way should also be brief and catchy! Resist bumper stickers with fine print and long messages.

4. Complete the Social Media Circle of website-blog-Facebook-Twitter. All of these have the potential of being free to begin, even websites. But linking them together in a highly interactive format is the key!

5. Be recognizable ~ frequently. I recently was at a meeting and another birth professional walked in and said, “I didn’t know if you were going to be here but then I saw your car in the parking lot. I saw ‘birthsource’ and knew you were here.” I have both my logo on a window decal on my car plus my license plate says BRTHSRC.

Need more marketing tips? Read Creating & Marketing Your Birth Related Business!

Tuesday, December 08, 2009

Just for Fun...

To take a momentary break in the blog series: Your Birth Business, I went outside and shot this video just for you! (if you see this on Facebook, click to my blog for the video). ENJOY!

Thursday, December 03, 2009

Your Birth Business Part 4C ~ Email Power!

Email Power? Other than responding to queries or sending email, what type of power does email have?

Advertising power!

Most email programs, such as Outlook and Yahoo, have something called a signature or signature file. This signature comes up every time (automatically) an email is sent...whether it originates with you (the sender) or is a response to someone who emails you.

When you find the signature component on your email program, be certain to click all of the appropriate features, such as "use signature on outgoing mail" and "use signature on response mail".

Second, decide on what to place in your email signature. Most people put their names, positions in a company, credentials, etc. Today, more and more people are adding the website address(s), blog address, Facebook and/or Twitter to the signature. This is a GREAT idea as it is a constant reminder to the receiver of your email as to how to find you.

Additionally, most business persons also add their email (even though this may be redundant) and their phone numbers. Phone numbers are an important addition to an email signature because this, like website urls and Facebook, is a constant and consistent reminder of how to reach you.

Write out our signature first to see how it would look. It might look something like this:

Sally Werksalot
President, BirthnBabies Lactation Consulting Service, LLC
1-555-555-2229 (555-BABY)
"Only mothers can think of the future-because they give birth to it in their children."- Maxim Gorky

The last line of the signature is generically called a coolsig. A coolsig is a quotation or emotional line that gives the reader insight into the sender. Obviously, a coolsig with a negative angle will give the receiver an negative view of the sender. So if you add a coolsig, perhaps use your business tag line!

This final word about emails has really nothing to do with signatures. It has to do with responding to emails. Everyone likes to be heard...most like to be validated for what they say or write. If you receive an email, from a friend, colleague or customer/client...if nothing else, respond that you did receive their email. This is obviously not true for junk mail. Responding to a friend, colleague or customer/client is just the polite thing to do...yes, Virginia there is etiquette on the internet. Now, if you have a Spam Filter who is an over-achiever and your find a plethora of unanswered emails (that need responses) in your spam box, ANSWER THEM and explain that you do have an over-achieving spam filter and that you just NOW found their email.

So make your signature file today! One more way to promote you and your business!

For more marketing and advertsing tips, don't forget to get that special birth professional in your life a copy of the new book,