Thursday, November 29, 2012

No Woman, No Cry ~ Jennie Joseph

Midwife Jennie Joseph takes a brief look at the under-served access to prenatal care.


Wednesday, November 28, 2012

They All Want You To Ask The Hard Questions But They Don't Want To Hear The Answers

It isn't easy being an advocate for evidence-based maternity care.  

Why? Because it an advocate speaks the truth...the evidence-based truth.

On the surface, the "they" we all encounter want to have best practice.  They want to jump through all of the hoops to be a Local Leader or Credentialed, Certified or Approved.  Being an advocate involves asking
"them" the hard questions.  Hard questions such as why is that a practice guideline or what evidence is used to substantiate it.  But rarely do "they" want to hear that "their" best practice is not evidence-based, in the best interest of mothers and babies.

"They" also really don't want their decisions or practices questioned even though they want transparency and want everyone's opinion to be heard and respected.  Of course, that is the statement that they repeat over and over but do not embrace and do not own.

Being an advocate is a lot like being a mirror.  "They" don't want to see their reflection.

Perhaps it is because their reflection is not one that actually solves any problems.  As mentioned before in countless entries of this blog, the statistical data on childbearing in the United States is not one that we can be proud of.  Our breastfeeding statistics are slow to improve but not at the rate that logic would have it.  When you examine the research, as was recently done in the outstanding book, Optimal Care in Childbirth: The Case for a Physiologic Approach, the research does not hold up both types of care models currently being used, the medical model and the physiologic care model.  To quote authors Romano and Goer, "The two models also diverge in whose needs and concerns take precedence.  The medical model centers around the doctor and institutional staff."..."In marked contrast, the physiologic care model puts the woman at the center.  Mother and baby form a single, inextricable unit; what is good for the mother becomes, by definition, good for the baby."

Seems simple enough right?  We need to put the health and well-being of mothers and babies first. Ignore the law suits and the economic incentives of long labors, the use of medication/anesthesia or admissions to the NICU.  Wasn't the fact that now with the Internet and easy access to the Cochrane Database and National Institute of Health, the era of evidence-based practice was to be the panacea of all of the problems with maternity care? Well, it hasn't been.

In searching for encouragement, I stumbled upon a rather lengthy excerpt from Optimal Care in Childbirth: The Case for a Physiologic Approach.  They write: "We, along with other advocates for maternity care reform, expected that evidence-based medicine would be the antidote to opinion-based practice.  Science, not what a Lancet editorial scathingly called "GOBSAT" - Good Old Boys Sat At Table - would dictate care practice." Yet contrary to our hopes, even the evidence has been used to substantiate medical management model.  But all is not lost, as I was beginning to feel and have seen others feel.  Romano and Goer continue, "Despite the deck being stack against physiologic care, we must not give up.  The stakes are too high.  The financial costs of medical management to society are enormous - just reducing the cesarean surgery rate to the World Health Organization recommended 15% would save $3.4 billion dollars annually.  The human cost is also enormous.  As a result of overzealous use of technology in labor and birth, millions of women and babies have suffered, and all to many have died.  Without a doubt, being a change-maker is likely to be frustrating and difficult, but when the health and wellbeing of childbearing women, babies, and society is at stake, no effort is too great, no accomplishment that forwards that goal too small."

I encourage you to read or reread Optimal Care in Childbirth: The Case for a Physiologic Approach as I did.  Shove the apathy out the door.  Grasp the mirror firmly in both hands.  Let's go.

Tuesday, November 20, 2012

Extrapolating: A "SMH" Moment for Childbirth Education!

I recently came across this photo on my Facebook newsfeed. 
I sat there a few minutes and, in a mindset that my high school Algebra teacher would have loved, tried to reverse the statistics.  If 2/3 of the guidelines for medical practice that OB/Gyns use is not based on evidence- based science, that means that only 1/3 of the guidelines for medical practice that OB/Gyns use IS based on evidence- based science.

Then I went on to apply this to a human relationship:  if your partner in a relationship was only honest with you 1/3 of the time, would you stay in that relationship?

Wow, I thought, that really changes the perspective!  And if a person WOULD stay in a relationship like that, WHY?

Extrapolating, why would you want to stay in a relationship where someone lied 66% of the time?  And why would they lie 66% of the time anyway?  To make themselves look better?  To lure you? To protect themselves from....? To hide what they are doing?  Are they too afraid to admit they don't know the truth?

Now, return from that tangent and refocus on maternity care.  Here are the facts:

  1. 23% of discharges from US hospitals are childbearing women/newborns.
  2. The preterm birth rate has only enjoyed modest decline - .1% over the last year.
  3. Low birthweight births continue to rise.
  4. The US maternity morbidity/mortality stats are not improving.
  5. The US infant morbidity/mortality stats are not improving.
  6. The US cesarean rate is still climbing.
  7. The state of non-nurse midwifery is out of control (I am not implying legislative control, here).
  8. The number of "drive through" childbirth education classes are increasing.

Since "we" are not practicing evidence-based maternity care and since "our" statistics are worse than 40+ other nations in the world...




Extrapolating again, why would you want to stay in a practice where someone lied 66% of the time?  And why would they lie 66% of the time anyway?  To make themselves look better?  To lure you? To protect themselves from....? To hide what they are doing?  Are they too afraid to admit they don't know the truth?


Wednesday, November 14, 2012

What Parents Need and What They Want in Childbirth Classes: Is there a disconnect?

My experience as a Lamaze Certified Childbirth Educator has given me the opportunity to teach in a variety of venues.  I began teaching at an adult school affiliated with a high school in a rural California, to a community college on the Atlantic coast of Florida, to private classes in Los Angeles, to volunteer teaching on an Air Force Base, to teaching for three hospitals, and finally back to private teaching now in Ohio.  From my Lamaze Seminar Trainer, Harriet Palmer, I learned that being able to empower women and families through research based information (or the truth) was the most valuable teaching tool.  And even though I had to leave one of the hospitals because I wanted to teach the truth and resisted censorship, I can still look myself in the mirror and be proud of the educator that I am.  I personally and professionally have fought against co-optation.

Birth professionals who have been active since the 60s and 70s will no doubt remember the writings of Eugene Declercq in the Birth & Family Journal (now the BIRTH journal) and Polly Perez and myself in Lamaze's Genesis, pointing out the side effects of co-optation....when former community based childbirth education classes become part of the hospital revenue stream.  The fear then was that childbirth education classes would be censored, restricted, condensed and basically not resemble anything close to childbirth education.  They would be, in a sense, what to expect from THE HOSPITAL while you are in labor.

The time arrived and co-optation did occur as predicted and in most (yes, I say most because there are still a few hospitals who value evidence-based uncensored childbirth education classes) cases, there have been censorship, restrictions, and condensed versions.  In most situations, labor and delivery nurses are asked to teach childbirth education classes and I must tell you that nursing school does not prepare you to teach childbirth classes.  While it does prepare you to do snippets of education at the bedside, childbirth education is another animal altogether.  And in many cases, these labor and delivery nurses are not required to become certified childbirth educators in order to teach classes.

Why does this all of this matter?  It matters for several reasons:

  • Co-opted childbirth classes are not in the best interest of the expectant parents.
  • Certification DOES matter.
  • Teaching informed decision-making and evidence-based information impacts everyone.
  • Birth matters to the baby.
  • Birth matters to the mother/parents.

Midwives are particularly suited to add childbirth education to their repertoire of services as they have had the emergent and normal/physiologic side of childbirth in their education....nurses typically do not receive the normal/physiologic information in their classroom studies.  Midwives can take the time to teach and explain thus empowering their clients to achieve and enjoy this once in a lifetime birthing opportunity; to not be rushed through a process which can leave a lasting imprint on a woman's heart and soul.

Educating expectant parents of today takes more skill and cleverness, resourcefulness and constant marketing.  Today's parent needs to be exposed to something nearly 10 times before acting on it, as opposed to the 3-4 exposures for parents in the 1980s.  Educators must make their classes timely, evidence-based and truly innovative to meet the ever changing learning needs of parents.  Parents still need the information, the evidence and the facts, but they need all of this in a concise package with minimal fluff and tricks ~ otherwise they get very bored very fast.

Get certified.

Become well-versed in social media marketing to reach the parents of today.

Write your own curriculum - tedious, yes but more valuable than you can ever imagine!

Evaluate your curriculum including the dates of the evidence for topics as well as the teaching strategies.  

Remember we aren't in Kansas anymore Dorothy and the bottom line is we can't teach like we are!

Tuesday, November 13, 2012

Becoming a Midwife!

Everyone needs to view this incredible and wonderful video! Please share and forward!

Friday, November 09, 2012

Midwive's Diner!

If you have NOT seen this short video, you need to right now!  So cute and innovative!  Great analogy and wonderful introduction to midwifery care.  Kudos to the creators of Midwive's Diner!

Tuesday, November 06, 2012

Call The Midwife

If you have not yet seen this delightful and engaging series on PBS/BBC, please follow it on You Tube!

Thursday, November 01, 2012

Taking A Look At Mindfulness Guided Imagery as an Add-on to Relaxation

Research shows that relaxation during labor and birth allows for a dramatic reduction in the stress reaction.  When subjected to stress (of any kind) or fear, be it real or anticipated, body changes take place that trigger a defense mechanism and institutes the fight or flight mechanism.  The fight or flight mechanism is started by the autonomic (or involuntary) nervous system and includes body changes such as an increase in respirations and mild/moderate rapid heart rate.  With this stress response, females have a strong tendency to take flight or flee.  Obviously this is not practical during labor/birth.

Most of us teach about the Fear-Tension-Pain Cycle as first described by Dr. Grantly Dick-Read in the late 1950s.  Fear (due to lack of education and practical knowledge), leads to tension in the body – tension in the muscles of the body uses oxygen that would have normally been made available to the fetus and the uterus.  This, in turn, decreases the efficiency of the uterine contractions and thus slows or in some cases, stops the labor process.  Tense striated muscles contribute to an increased in lactic acid build up that impinges on pain receptors, magnifies pain perception and increases fatigue. Fatigue decreases the pain threshold, further increasing pain perception and reduces the laboring mother’s ability to conserve energy for the expulsive efforts needed during the second stage of labor.

Conscious relaxation and practicing coping techniques may be some of the first items removed from childbirth education curricula when timing in the class becomes an issue.  However, initiating a relaxation response to contractions or pain stimuli can decrease metabolism, slow down the heart rate, calm breathing, reduce blood pressure and relax muscles – all of which has a positive effect on the baby, mother and labor.   Click here to read entire article