Tuesday, November 30, 2010

Why We Need To Take Pregnancy & Mother/Baby Health Seriously

Day after day, we talk on blogs, Facebook, Twitter or in community groups about the need to make childbirth classes more accessible to expectant families.  We explore ways to market our classes.  We discuss the strategies we use to teach.

As the year 2010 begins to close and a new year is on the horizon, we need to ramp up our efforts and make turn our talking into doing.

In the US, the Healthy People 2020 has many of the same objectives that were written in the Healthy People 2010 edition.  Why?  Because we didn't meet the objectives.  We didn't better maternal deaths in this country, didn't improve access to prenatal care, didn't increase the number of women attending childbirth education classes, and we didn't reach the breastfeeding objectives.

However, we still do not stress the importance of prenatal care ~ we care too much which celeb is expecting and what she is wearing.  We still allow physicians to tell our clients that the clients don't need to attend childbirth education classes or even Doulas as the epidural will take care of the pain even tho epidurals often contribute to a cascade of interventions with a wide variety of side effects...and not all of them good.  These women still present in labor with little knowledge of their bodies, the physiology of the birth process, the response of the body to labor and the importance of skin-to-skin contact and breastfeeding immediately following birth.

We still have nurses and residents who receive little or no information on how to support women who choose to have natural childbirths.  In the long term, this has forced some women to seek out homebirths ~ some in states with no regulation of certified professional midwives.  Since these states have no legislation or licensing, homebirth is neither legal or illegal - it is alegal, meaning that all is well as long as nothing happens.  If something should happen, the midwife can be arrested.  And if there is no legislation or licensing or quality of information regarding homebirth, the unsuspecting public has no way of knowing if their midwife has proper education, training, mentoring, or carries the proper equipment.  This, then, puts mothers and babies in more risk.

If we spent money on helping employers have worksite lactation programs, OR lunch-time childbirth education, OR train more professionals about facilitating normal birth OR helping more hospitals become baby friendly, OR promoted state legislation that would guarantee the safety of homebirth in ALL states, rather than making "What to Expect When You Are Expecting" into a movie, I just feel more women and babies would benefit.

I just feel we need to take pregnancy and mother/baby health more seriously.

Monday, November 15, 2010

Psychoprophylaxis: Not Just For Dads or Partners with Tocophobia!

New research, presented in a doctoral thesis from the Swedish Medical University Karolinska Institutet, shows that psychoprophylaxis can help men with tocophobia (fear of childbirth). The thesis, which is to be presented on Nov. 12, also shows that although psychoprophylaxis generally has no effect on the experience of childbirth for women or men, its actual use during delivery seems to reduce the risk of emergency C-section.


If this is a true translation of the thesis, then in my humble opinion, it is contradictory on so many levels.  


The psychoprophylactic method or PPM was an integral part of the Lamaze Techniques from early on, especially as it was a part of the original name of Lamaze.  Lamaze was previously known as ASPO or ASPO Lamaze, with ASPO being short for the American Society of Psychoprophylaxis in Obstetrics.  And while the article/thesis goes on to point out that the psychoprophylactic method generally has no effect on the experience of childbirth, all one has to do is research Lamaze or the psychoprophylactic method to find a myriad of research to substantiate its effectiveness.


But let's break it down.  Psycho means mind and prophylaxis means prevention.  Thus the psychoprophylactic method prevents the mind from dwelling on the intensity of the contractions my giving the mind something else to do (breathing, effleurage, focusing, guided imagery etc).  Additionally, learned techniques of the psychoprophylactic method are also comfort measures that documentable medical research has shown to be highly beneficial in reducing the sensation of pain during labor and birth.


In today's society, the element of fear, as discussed in this thesis is one of the overriding factors in women allowing interventions during labor and birth: fear of the unknown, fear of pain, fear of unpleasant outcomes.  While NO ONE can promise a lack of unpleasant outcomes, the use of psychoprophylactic methods can assist in the woman remaining in control ~ which research has shown to be important to a woman's perception of her childbirth experience.  Again and again, evidence exists that demonstrates that women who were active participants in their birth process were much more satisfied with the experience than women who expected to rely on their physicians and on interventions including medications.


The doctoral student, Malin Bergstrom, also stated "This is important, as these men are easily neglected, and if they don't receive help the chances are that they won't tell anyone about their fears. Apart from the personal effect this has, it is also possible that this affects their relationship with the mother and child."


My question is why are not the MOTHERS the focus of this study?  


Yes, it is vital that partners of childbearing women become prepared for birth and their fears and anxiety alleviated.  


However, with only less than 33% of expectant mothers OR partners attending childbirth education classes, it seems only right to include the mothers who will be in labor.  


What about the studies that show that fear, stress and anxiety in the laboring mother has a profound effect on the labor and health of the baby?


Childbirth is a safe and normal life event.  Childbirth is NOT a health crisis.  Neglecting to address birth in both educational and informative ways is a sin of which too many are guilty.



Tuesday, November 09, 2010

Risky Business ~ 27 Years of Coopted Childbirth Education


When Eugene DeClercq wrote in the fall of 1983 in the Birth Journal,  "The Politics of Co-optation: Strategies for Childbirth Educators", I was riveted to my seat as I read.  This man seemed to have a direct vision to the future.


Now, 27 years later, I am convinced that he did.

That tragedy of co-optation has come true.  First seen as a marketing gold mine, hospitals jumped on the childbirth education providing wagon with unimaginative speed.  Some chose to have their nurses obtain certification by childbirth organizations, while some handed the labor/delivery nurses a script (not even a curriculum) with exactly what should be said.  Others hired certified educators specifically for the task ~ in some communities these educators where nurses.  In others, the only requirement was childbirth education certification.  Add to the low cost of hospital based childbirth classes free car seats and steak dinners (popular in the 1980s), and why would anyone register for a childbirth class taught by an independent or community educator who charged more and offered less?

You do not have to be a nurse to be a great childbirth educator.
Many nurses are not good childbirth educators.
Nursing schools do not prepare you to educate.

As the decades rolled by, the essence of prepared childbirth ~ education, relaxation and happier/healthier moms and babies began to wane.  Intervention rates rose as did the maternal/infant morbidity rates nationwide.

Some hospitals put pressure on childbirth education departments to keep their revenue high and their budgets in the profit margin, while watering down the curriculum to appease those that have a final say over what is said in the classes.  In many hospitals, those people are the physicians.  To counter this, some childbirth education managers together with their educators, created binders with topics covered in class and the documentation/evidence based research that substantiated what was said…often from obstetrical journals.

Am I totally against hospital-based childbirth education classes?  The answer is an emphatic NO.  I have taught childbirth education for many hospitals à those that espouse to teach childbirth education from the risk/benefits point of view and whose managers are not afraid to back their educators when the educators teach evidence-based, current information.  Yes, those hospitals do exist!

Colateral damage to this co-optation tale are the alarming number of press releases lately of hospitals discontinuing classes or downsizing or retooling their childbirth education departments.  Guess what?  Childbirth education classes are not money makers.  Who knew?

The victims of this economic conundrum are not only the expectant parents who lose the option of convenient childbirth education classes, but also the newborns who may suffer the consequences of domino effect of lack of education.

As Linda J. Smith said in her book Impact of Birthing Practices on Breastfeeding:

“Solid scientific evidence shows that minimizing interventions in birth and policies that preserve normalcy are associated with faster, easier births; healthier, more active and alert mothers and newborns; and mother-baby pairs physiologically optimally ready to breastfeed.  In addition to the quantifiable evidence is the cumulative wisdom of women who know that normal childbirth and breastfeeding go together.”

The time has come for a resurgence in independent and community based childbirth education.  As when I began teaching in 1979, the road is not a smooth one and if you decide this is a road for you to follow, be prepared to work hard, market hard, and don’t be boring. You don’t have to have flashy charts, an expensive pelvis, or costly videos.  I began with homemade charts & handouts (hand drawn as there were no computers), a knitted uterus and a doll from the local toy store.  Parents learned.  Parents were educated.  And mothers surged through labor and birth with a sense of empowerment, being in control and preserving the sacred space for birth.

Tuesday, November 02, 2010

Teaching With The 6 Healthy Birth Practices ~ Begin the Wave!!!!!!

As a childbirth educator, I am always looking for the highest quality (and, admittedly the most economical) supplemental class materials for my clients.  In the past, I have borrowed from others but mostly created my own.  Now there are professionally developed print handouts and video segments that are free to any childbirth educator, no matter what your organizational affiliation is.


The Lamaze Healthy Birth Practices That Support Normal Birth are located on two websites, depending on your learner needs.  The Mother's Advocate website has a unique collection of professional handouts ~ the Six Steps to a Safer Birth, which can either be printed/downloaded as one 18 page PDF or individually.  This website also has 12 additional handouts including a listing of references, which comes in really handy if you are asked to support what you teach/say with evidence-based research.  PLUS, this website has FREE access to video segments that go along with the Six Steps.  If you have a program such as Real Player, you can download these video segments directly to your computer and then show these to your clients.  If this is not possible, you can purchase a DVD with all of the segments for $12.95 (US) from Injoy Videos.


Lamaze International also have the same information as listed above (except the video for sale). Common sense tells us and research confirms that the Six Lamaze Healthy Birth Practices featured in these video clips and print materials are tried-and-true ways to make birth as safe and healthy as possible.  


The only things holding women back from practicing all of the Healthy Birth Practices are hospital policy/procedure committees catching up with current evidence-based information AND a woman's trust in her own body.  All too often, when policies/procedures lag behind current research, this can interfere with not only expectant mothers being granted requests for normal birth care but also the employed care providers being made aware of the current research.  Too often, care providers rely on their employer to supply them with the updates on research.  A lack of research communication within a facility can severely slow down the access expectant mothers have to current evidence-based care.


Womens' fear about childbirth and lack of trust in their own bodies are fed not only by the lack of information or answers to questions from childbirth educators, but also the constant message from the media (particularly the cable birth shows) that birth is always a crisis that needs intervention and that the most dangerous journey a baby will take is the 4.5 inches down the birth canal.


Sadly, when all of these factors are working in harmony, the result is a stagnation in maternity care, a stagnation in the improvement of maternity care and a health care quagmire.


By disseminating the Six Healthy Birth Practices to not only maternity health care professionals but also expectant parents, we can begin the wave of change.  But just as in any crowd where the "real" wave starts, if some people in the line choose not to continue the wave, it will often not continue.  Don't be the weakest link ~ no matter what your organizational affiliation, print off and refer to the free information as listed above.


Be the wave...be the change...