Thursday, October 31, 2013

What I Learned from Dr. Nils Bergman in Just Four Hours

If you have never heard Dr. Nils Bergman speak in person, you need to make every effort to do so.  This mild-mannered physician who was born in Sweden and raised in Zimbabwe works as a Senior Medical Superintendent of Mowbray Maternity Hospital in Cape Town – overseeing 18,000 births per year.

Dr. Bergman was in my community recently.  I did hear him speak.  And here is part of what I learned:

During pregnancy, a baby begins to get to know the mother.  Her voice, her smell.  And immediately after birth, putting a baby skin-to-skin….mother to baby with no interference from hats, blankets or
any other clothing…babies will begin to establish the external womb, a safe and inviting place in which to thrive.  Blood sugar, respirations, blood pressure, and neuromuscular control stabilizes because the baby knows that he is safe.  Skin to skin contact immediately between mother and baby allows the baby to be colonized by the same bacteria as the mother.

When other mammals are studied, those babies who are taken out of their natural habitat – the external womb – show all of the physiologic signs of being under significant stress.  Cortisol rises (a stress hormone) and thwarts the baby’s system, decreasing stabilization.  Additionally, normal baby behaviors such as rooting and searching the breast, breathing normally, staying warm…all of these behaviors take a tragic turn for the worse.

There is no reason why most babies cannot spend a significant amount of time in skin-to-skin contact with the mother – even cesarean born babies.  And what better to help the mother and father relax and establish this amazing environment that with the presence of a doula.

Unfortunately, Dr. Bergman’s highly praising comments regarding doulas were met with “crickets”.

This amazing and safe environment allows the baby to begin its life outside the womb with a feeling of calm and safety.  Yes, there is a lot of emphasis on safety.  Early experiences establish brain function and the loving mother is key for neurodevelopment.  Studies show that what happens in early life may facilitate a risk for developing severe psychopathologies at later states in life.  Therefore, separation of the mother/baby dyad by required stays in a nursery or the baby taken away for “tests” interrupts needed neural process and becomes opposite of skin-to-skin.  Basically, maternal absence to a baby is considered toxic stress.

For the mother, when oxytocin is released in the brain, its effects are to reduce fearfulness and initiate “mothering” behaviors but also enhances a tendency toward aggression and protective force toward anyone bothering the baby. 

These tremendous links between behavior and hormones are called neuro-endocrine behaviors.

Therefore, it truly matters how we are born and also how we are nurtured after the birth.  We are defined by our relationships early on.  And separation of mother and baby is a violation of an innate agenda.

To add to my notes and thoughts of hearing Dr. Bergman, the following is excerpted from Dr. Bergman’s website www.kangaroomothercare.com ~

One of the most basic abilities, and that appears early in development, is to determine whether a sensation (or even constellation of such) is safe, dangerous or life threatening. This is seen in early fetal life, and is fully competent from 28 weeks. All the sensations in the uterus tell the fetus it is SAFE. At birth the baby is highly stressed, and this birthing stress is necessary to activate the systems that make for breathing air and coping with “life outside”. But once outside, the need for being SAFE is primary, and essentially it is only mother’s presence providing familiar sensations that achieve this. The chest of the mother is to the newborn its PLACE of care. Care means the three basic biological needs are met: mother skin-to-skin contact ensures warmth, her breasts provide nutrition, and her arms cover baby for protection. The baby is wired to respond to this place in many different ways, the two we can easily see we call self-attachment and breastfeeding. After feeding, sleep cycling is essential to establish the pathways that were fired.
When mother is absent, the newborn brain feels unsafe, it perceives danger and threat to life, and its basic needs are not provided. The brain kicks in a powerful defence reaction, which first makes a short burst of crying before shutting that down and lowering heart rate and temperature, and then shuts down all activity, reverting to the immobilization defence, similar to that of frogs and reptiles. This looks like sleep! But it is not, and it is maintained by high levels of cortisol, which make the “wear and tear” which is the primary first cause of all subsequent problems preterm infants suffer from. This is not actually sleep, so the pathways are not established. Instead, when stress is prolonged, the cortisol disrupts brain architecture, unless there is “buffering protection of adult support”.

All of our routines that are just that….routines, and not evidence-based…do more harm to our society’s future than we realize.

Tuesday, October 29, 2013

Ina May Gaskin addresses Tocophobia

I love Ted Talks and I especially love this one.  Ina May made this during the summer of 2013. Ina May Gaskin, MA, CPM, PhD (Hon), is founder and director of the Farm Midwifery Center in Tennessee. The 41-year-old midwifery service is noted for its women-centered care.


Thursday, October 24, 2013

The Evidence Says: Delayed Cord Clamping - a five part series

In Part 5 of our 5 part video series on Delayed Cord Clamping, author and childbirth educator Penny Simkin offers this great visual explanation............



Tuesday, October 22, 2013

Thursday, October 17, 2013

The Evidence Says: Delayed Cord Clamping - a five part series

Professionals and parents alike are interested in delayed cord clamping.  I have picked the five most informative video clips.  I hope you find them as interesting as I have.


Tuesday, October 15, 2013

The Lamaze Conference 2013 in Review



Social media (and the relationship with childbirth education & marketing) was THE hot topic at the 2013 Lamaze Conference - Let the Good Times Roll - held last weekend at the Astor Crown Plaza in New Orleans!

My session on adding social media to enhance learning and marketing with childbirth education programs lead the weekend that saw several other speakers either focusing completely on social media or having some portions of their presentation feature social media. From Facebook, to Twitter, Blogs, to hashtags to LinkedIn, registrants left with useble skills for adding social media to their education arsenal. Even the closing speaker, Amber McCann, regaled the benefits of social media.

Tweeters tweeted via #Lamaze13 and #LamazeNOLA to keep both attendees and those at home updated on all of the action!

Another hot topic was research via the internet.  Andrea Lythgoe, who is a doula/birth photographer and teacher for the Midwives College of Utah spent two sessions helping attendees find, then
Andrea Lythgoe
completely understand birth research, abstracts and listed the "Dirty Dozen" - her fav 12 websites from which to gather research.  Thanks so much to Andrea for listing my website www.thebirthfacts.com as one of her favs!


Another hugely popular topic was Breastmilk Sharing, presented by Rebecca Law LCCE, FACCE, RN, IBCLC from Texas.  Breastmilk sharing is not a new concept but the access to social networking has taken it outside the realm of families and small circles of friends to strangers, states, and countries apart!

Melinda Delisle LCCE from Pocket Pregnancy and Birth of a Family LLC shared "What Live Classes Offer that Digital Ones Can't" - almost an antithesis to the underlying theme of the conference. Tackling the problem of diminishing attendance at childbirth education classes, Melinda shared the results from the Listening to Mothers' Surveys I, II, and III as well as lessons learned from her fantastic website, app and blog.  It is so true, education through social media, no matter how effective it is, will never replace person to person childbirth education!

We all look forward to the next conference, scheduled for September 2014 in Kansas City!  Get your BBQ on and I'm sure we'll all have a great time!





Monday, October 07, 2013

Evidence based Research: Implementation delay or refusal?

While updating The Birth Facts recently, I was once again surprised and delighted to see the vast amounts of evidence based research for physiologic birth.  Yet in the same instance, I was dismayed that these practices with such carefully conducted studies have yet to be implemented in US hospitals, which is my immediate frame of reference - yet I am also aware of the fact that these practices are not completely implemented in hospitals in other countries (thanks to posts from FB friends).

Refusal or delay in implementation of evidence-based research is a huge question.  Not necessarily why it takes so long (delay) - it is usually within a hospital setting with humans and both of those factors make for lengthy decision/discussions.  Refusal is a whole different perspective.  And begs the question: why would an institution (not to mention individuals) which stands for health and well-being, refuse to implement evidence-based research into practice?

If, as Freeman stated in his piece "Why general practitioners do not implement evidence: qualitative study", Evidence is not implemented in a simple linear way, as some definitions of evidence based practice imply, but in an evolving process whereby reciprocal contributions from the doctor and the patient over time influence how evidence ultimately is used, then it would seem that our foremothers in childbirth education were correct and it is the consumer/patient/expectant mother who will be the driving force in making informed decisions that will influence evidence-based practice implementation.

However, if that consumer/patient/expectant mother is not enlightened regarding the evidence and also their own power for practice change, then further delay in implementation will be seen.

Perhaps birth professionals have been going at this all wrong?  Or at least partly.  Through social media and classes, we disseminate evidence-based information, perhaps we should also be disseminating information on how the consumer can make the changes happen....and faster?  Yet we must not only say that consumers are change agents but give expectant mothers and families ideas of how to positively influence their care environment.  

Forty years ago when the first real consumer movement in birth occurred, women were empowered by others on how to be a change agent.  I am not just talking about burning a bra here and there, but encouraging them to speak up if something was not right.  A movie frequently shown in childbirth education classes in the 70s and 80s was "Nan's Class".  The movie followed a Lamaze Childbirth Educator, Nan, and the six couples in her class.  I will never forget lines from that movie: "If things aren't right, speak up!" she would tell her class.  

A father states, “Childbirth is not an experience of illness, it's an experience of health.” Nan reaffirms his idea through her attitude and the way she presents information.

IMHO, we birth professionals have taken a giant step away from empowerment under the guise of "let the consumer decide".  While that is fine, and the way it should be, birth professionals need to marry the evidence-based information with fundamentals of empowerment.


References:

Freeman, A. and Sweeney, K. (2001)  Why General Practitioners Do Not Implement Evidence: a Qualitative Study. British Medical Journal November 10; 323(7321): 1100

Shilling T. and Bingham, S. (2010) Revisiting the Classics in Childbirth Education. Journal of Perinatal Education. 19(3): 73–78.


Thursday, October 03, 2013

Becoming Smarter Online

Childbirth Educators are typically juggling several tasks at the same time. And one source of frustration in juggling tasks is the use of online tools such as a computer, smartphone or tablet.

Because the generation that is currently attending childbirth education classes (Gen Y or Millenials) are so online savvy, we must develop skills for online promotion of our classes as well as actually providing childbirth education topics online.  A blog post I wrote earlier this year focused on why childbirth education has to change....or at least add online learning.  I've even spotlighted a guest blog post regarding online childbirth education classes.  Yet, we all need to become more tech savvy and integrate social media and tricks into our daily practice.

Let's begin then, with working with Google.  Do you have a gmail account?  Then this video, will help with that important first step in streamlining email.