Friday, May 28, 2010

My Top Fav Quotes, As Applied to Birth

I was updating my Facebook Info page the other day when I took a good look at my quotes.  So I decided to take my favorite quotations and apply them to birth!  Yes, this is a quirkie blog post!  If you are reading this on Facebook, please go to to read more posts.

Always stand on principle, even if you stand alone ~ John Quincy Adams
This has pretty much been my credo as I became a birth researcher many years ago and discovered, much to my distress, that nursing practice and maternity care does not always follow the evidence to provide optimal outcomes for mothers and babies.

"Well Behaved Women Rarely make History!"
Those of us who do stand on principle, don't expect to be famous or remembered.  We work everyday so birth can be safe for those who are birthing today and tomorrow.

"It is very Vermonty this time of year"
This is from the movie classic "White Christmas" but it refers to the cold winters of Vermont.  Unfortunately, it also reminds me of the bedside manner of many care providers today.

"Oh, Hell No" (Will Smith)
What is mentally going through my head when a client is facing an unnecessary intervention!  It does NOT come out of my mouth, however!  LOL!

"You need to be more F-L-E-X-I-B-L-E" ~ Elastagirl in The IncrediblesWhat I try to instill in my clients when talking about birth plans - yes, birth PLANS. 

"It's Guuuuuud" (Jim Carrey from Bruce Almighty)
What birth is most of the time!

"Now that is dirty" Mike Rowe from Dirty Jobs
Now some people think that breastfeeding is "dirty" or "sexual".  No people, it is food.  FOOD!  And don't even think about saying a mother should feed her baby in a bathroom - never say that to me!

"No Fear" ~ a sticker I bought.With education, there would be no fear of pregnancy, birth, breastfeeding or parenting.  We study for a driving test, why don't we study for the most important jobs of our lives?
 "If you polish a turd it is still a turd" ~ Peanut, comedian Jeff Dunham's "friend"
Um, what I think of some research and studies who spin results to suit the sponsor's agenda.

Monday, May 24, 2010

New Doula Movie!

It is exciting indeed to see a movie specifically about doulas!  Due to be released in June, this movie is 65 minutes in length and is set for world-wide distribution.  While I have my copy on order and admittedly have not seen it all, the trailer is certainly promising!

Tuesday, May 18, 2010

Evidence-Based: Important and!

The undercurrent of maternity care practice, whether one is a physician, midwife, nurse, childbirth educator, doula or lactation consultant, is the question of evidence based practice.
As defined by Childbirth Connection, evidence based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns.
For independent practitioners, implementation of new practices based on evidence may not be as cumbersome as in large facilities or institutions. Researching and rewriting current policies, procedures and practice guidelines takes dedication to the health and well-being of mothers and babies, funding, time and consensus amongst those in the approval process. These long processes are a challenge to translating the evidence into practice and prolong the adverse reactions to increased intervention and keep the US maternal and infant mortality/morbidity rates in the substandard category.

Foremost in the minds of care providers must be the fact that for most childbearing women in the US (and for that matter world-wide), pregnancy and birth are conditions of health and most women are at low risk for complications. A broad knowledge base is needed to provide care and support for physiologic birth – an instinctual and hormonally driven process. The body has the potential of producing high levels of pain-relieving opiate beta-endorphins and endogenous oxytocin, which both facilitate labor and birth, inhibits postpartum hemorrhage and promotes fierce bonding and newborn wellness.

However, lacking from 99% of nursing school curriculum and residency programs are the skills necessary to promote physiologic birth. Underused practices include skilled labor support, facilitation of labor through the use of gravity positive positioning, enhancement of Second Stage through gravity positive positioning, labor comforts including aromatherapy, relaxation and hydrotherapy, delayed cord clamping and uninterrupted skin-to-skin contact.

Although not just iatrogenic, blame can also be placed in the area of inadequate informed consent practices AND a lack of preparation by expectant women and their partners. An embarrassing average of 25% of women attend any type of childbirth education classes in the US, enabling them to remain uninformed, unprepared and uneducated. With the biased view of birth presented by the media, clients come to childbirth education class with nearly ridiculous views of their body, pain in labor and birth itself.
It is evident that women do not know their options because they often do not have credible sources of information at their fingertips. What they read in books, hear in childbirth class, or are told by their care providers often clash and send the expectant mother into confusion ~ who can she believe, who should she believe?

Putting the mother or family between a rock and a hard place is our fault. There should be consistency in the evidence-based material given to women. And we should begin being consistent NOW!

Tuesday, May 11, 2010

Staying Objective When Talking About Informed Consent

As childbirth educators, doulas, lactation consultants and nurses/physicians, we all use informed consent when presenting information to our clients/patients.  To thoroughly understand the need for objectivity in presentation, one must first understand the meaning of informed consent.

What is informed consent? Informed consent, or freedom-to-choose, have become frequently used terms, not only in the current maternity/health care environment, but also in every day life. The idea of informed consent fosters learning about the birthing event that may change a woman's perception about her role as a mother and quite possibly her total self-concept. To interfere with this growing and learning process, to stifle the process of informed consent is possibly to set up a situation of sadness, anger, disillusion or feelings of failure.Informed consent is a legal doctrine in America that is defined in all 50 states as consent to treatment (for example, consent to a cesarean section/ abdominal surgery to assist in the delivery of the baby) obtained after adequate disclosure. As defined by Ethics in Medicine from the University of Washington School of Medicine, informed consent "is the process by which a fully informed patient can participate in choices about her health care. It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care."

This definition is simple in theory but complex in operation. The problem is, "What is adequate disclosure?" Adequate disclosure varies from state to state. Informed consent is defined in most states as a consent obtained after telling the patient the following:

1. What is the proposed treatment or procedure? Make sure you fully understand what is suggested and how it is done.

2. What are the benefits?

3. What are the risks?

4. What are my alternatives?

5. What would happen if I did nothing?

That being said, informed consent should go one step farther and incorporate voice inflection, facial expressions and body language when covering the above 5 steps as to not to overtly or covertly influence behaviors.  This involves knowing ones triggers and being in control when discussing trigger-producing subjects.  For example, if a care provider has deep feelings about epidural anesthesia, their voice or body language may "say" one thing while the words that they say may "say" quite another.

To be absolutely fair and present informed consent in an unbiased way, our body language should be appropriate.  Acknowledge that body language can be a powerfully persuasive tool and assess yourself for body language cues.  With an estimated 55%+ of what you say as nonverbal, what are you saying to clients/patients?  Our voice intonation tells a whopping 38% and only 7% is verbally what we really mean.  So in a normal conversation, 93% of what someone else is getting from us is NOT coming from the actual words we are using!

Yes, it is very difficult to be objective when discussing a concept that is a trigger or perhaps giving unbiased information.  But if we truly espouse the concept of freedom of choice based on knowledge of alternatives and informed consent, then it is our duty to make every possible effort to present information in an unbiased and objective manner.  It is up to our clients/patients to make decisions ~ not us.

Friday, May 07, 2010

You Tube Comes to the Rescue...Again!

As a childbirth educator who works in a variety of locations, I like to have a wide range of videos to show my "students".  Some are birthing in a hospital, some in a birth center and some at home ~ so the classes are mixed, you might say.  To give a fair and balanced view of birth, I also like my videos to be balanced. 

So when I come to the topic of Comfort Measures for labor and birth, specifically hydrotherapy and waterbirth, I like to have on hand a video that shows a waterlabor and waterbirth in the hospital.  Amazingly enough, I found this on You Tube...and of course, it is from our friends at Injoy Videos!

Enjoy and Happy Mother's Day!

Sunday, May 02, 2010

New Free Resource!!!

Have you been to  If not, you need to right now!  It is the best free resource to come along for childbirth educators in a long, long time!

A collaborative effort between Injoy Video Productions in Boulder, Colorado and Lamaze International, the interactive website provides free PDF handouts about the Six Lamaze Care Practices for Safe and Healthy Birth ~ PLUS, free video segments that you can download from their new video, seen here at the right.

Already very reasonably priced at only $9.95, Healthy Birth - Your Way is a wonderful video illustration of the six care practices.

Congrats to Injoy and Lamaze ~ what a great gift!  Thanks!