Friday, May 23, 2014

What Do Beach Balls, Pool Noodles and HoolaHoops Have To Do with Childbirth Education Classes?

Summer of 2014 and the summer sales are going in just about every store!  Beach balls, pool noodles, hoola hoops, ping pong balls and balloons are cheaper than normal.  

But what do these items have to do with childbirth education classes?

These are very important teaching tools!

Beach balls - A fun way to review concepts learned during a class or series of classes involves an inflatable beach ball which can be tossed around the room from class member to class
member.  To prepare for this exercise, purchase a standard, inflatable beach ball.  With a permanent marker, write one activity on each colored panel. 

You, as the teacher, verbally give a scenario to the class.  Then toss the beach ball to one class member.  Whoever catches the ball reads the activity on the section facing him/her and responds.  If you are doing a review on labor and delivery, the actions on the ball may read:

  • Choose one “labor tool” that may benefit.
  • Demonstrate a position to use or suggest.
  • Name one emotional need mother might have at this time.
  • State one way to change the environment.
  • Identify a positive affirmation to say to mother.
  • Name one relaxation technique to try.

Once the person responds to the request or performs an action, he/she tosses the ball to someone else.  Each person who catches the ball responds to the request facing him, even if someone else already responded to that request.  There is more than one possible response for each.  When you feel the particular scenario has been addressed adequately, you can go on to another scenario and continue the review. 




Pool Noodle - Especially cheap at the END of summer, pool noodles can be cut equally in thirds to be used as lumbar support when discussing comfort on traveling or in demonstrating the knee press for pelvic bone relief.  They can even be used as a massage tool option.  (You'll want one for each expectant woman and her partner because they are porous and not easily disinfected.)





Hoola Hoops - The age-old child's toy does have an important place in childbirth education class!  During the Transition Phase, mothers have a limited range of concentration and focus. This range of focus can be demonstrated by using a hoola hoop.  While there are several sizes of hoola hoops available, select one that will enable you to be inside the hoola hoop with one other person.  This is a great way to demonstrate just how small the range of focus is for someone in Transition and how intimate this phase of labor can be!




Wednesday, May 14, 2014

Hard Questions about Complacency & Spending Part 2

In 2006, the UN Foundation introduced a blog: Reproductive Health Reality Check.  The purpose of this blog was to use the power of social/web-based media to offer a "reality check on the misconceptions about reproductive health. RH Reality Check's rebuttal arsenal against the — reckless rhetoric — used by opponents of reproductive rights includes original reporting and opinion offered daily by in-house bloggers and the broader reproductive health community, longer-form weekly series, video and audio podcasts, and reference areas offering invaluable background on this important issue."  In January of 2012, RHReality Check become its own independent, 501c3 non-profit organization.

"Protection is our watchword—we are contributing to the global effort to empower people with the information, services and leadership they need to safeguard their sexual and reproductive health and rights against false attacks and misinformation."  ~ RHRealitycheck.org

Just this week, RHRealitycheck ran the story of Rinat Dray - a 35 year old mother of 3 from New York who birthed in a Staten Island Hospital.  Or she was supposed to birth there.  Instead, as the article states, the physician, who consulted with the hospital’s legal department and made the decision to violate her will and her right to refuse surgery by the forced cesarean. In her chart, the following is reported as being entered by the attending physician “The woman has decisional capacity.  I have decided to override her refusal to have a c-section.”  No additional documentation on the reason for the override has been given.  

Without knowing the entire story, it is impossible and unprofessional to make an across the board statement.  However, more and more stories of forced cesareans are being reported world-wide and it is an ominous trend.  A study also was released by Truven Health Analytics, a Michigan based company (with offices world-wide) whose mission it is to help improve healthcare quality and access and reduce costs, stated "Many C-sections are not medically necessary and since these surgical deliveries can be dangerous for both the mother and the baby, the medical community is increasingly concerned about reducing the rate of non-indicated and elective C-sections when possible."

This, then, begs the question: If cesareans are more dangerous than vaginal birth as well as being nearly $4000 more costly, why is the number of cesareans rising?  More importantly, the maternal/infant morbidity and mortality in the US is not improving.  This has become more about legal issues, convenience and fear than good, solid evidence-based medicine. Apparently, decisional capacity is no longer valid.  Patients’ Bill of Rights are void.  We no longer have partners in health care. 


Women may no longer give birth – they will be delivered.

Can we afford to be silent any longer?


Our lives begin to end the day we become silent about things that matter.  Martin Luther King, Jr.

Monday, May 12, 2014

Asking the Hard Questions about Complacency and Spending in US Maternity Care

After reading the article "Why are Cesarean Sections so common when most agree they shouldn't be" from Public Radio International, it got me to thinking.

If, as the article said,  Cesareans relieved the labor and delivery units from mayhem and unpredictability, introduced order and efficiency, contributed clear profits to the hospital, and provided an alternative method of delivery for doctors worried about medical malpractice suits associated with complicated vaginal births then is the same true for other non-evidence based interventions such as clear liquids only during labor, routine IVs, routine fetal monitoring, routine episiotomy, and more?


Is complacency the real reason why women experience routines or traditions in care?  

Is the reason why this complacency was not revealed is that in the 1980's, childbirth education moved from being community-based to becoming hospital based, where the same hospital mentioned above had control over what was being taught?  

So if you don't let women know they have options and a voice, they won't ask for the type of care that interferes with order and efficiency and profits?

Even with joint resolutions between organizations and the massive dissemination of evidence-based research to the general childbearing public as well as professionals, there is still a lag time between the publication of evidence and putting it in practice.

"I could tell you that hospital committees hold up the progress toward evidence-based care", said one nurse, who asked to remain anonymous for fear of losing her job.  "I could also tell you that policies are only there on paper and they are no good unless the care providers want to change practice.  Therein lies a huge barrier to change."  According to the WHO Report, the United States had the third highest number of unnecessary Cesarean sections in the year 2008, costing the country an estimated $687 million. "So where did those millions of dollars go?" asked the same nurse.

Healthcare in the US and in many other parts of the world is in a frenzy.  Health care costs are rising yet the maternal/infant morbidity and mortality rates are not improving. In terms of the use of cesarean section worldwide, low and some middle income countries should improve accessibility to this intervention which could reduce adverse maternal and perinatal outcomes. At the other extreme, in high and in some middle income countries, excessive use of this surgical procedure could result in added morbidity and no discernable benefits.

Therefore, we have seen and heard that women in the US (and other countries) are victims (if you will) of complacency and money.  It is not about them giving birth, one of if not the most important day of their lives.  It is not about ensuring the long term safety of the society.  It is not about "first do no harm".  

Perhaps it is time for a substantial portion of childbirth education to return to being community-based.

Perhaps it is time to bring the evidence about physiologic birth to more professionals.

Perhaps it is time to be the change we want to see happen?




Resources:
WHO Health Systems Financials

Why are Cesarean Sections so common when most agree they shouldn't be" from Public Radio International

Wednesday, May 07, 2014

The Evidence Says................US maternity care is at a dangerous crossroads!

US cesarean rate is 32.8%.

WHO reports that women dying during childbirth is up 136% since 1990.

Hospitals are reducing or eliminating staffing for childbirth education classes.


Statistical data on maternity care points strongly at racial disparity. African-American women are four times more likely than white women to die of childbirth related causes. The infant mortality rate among African Americans is three times that of whites, and pre-term and low birth weight rates are double. (2010 report from Amnesty International "Deadly Delivery")

Midwifery care continues to be held down.

Obstetricians are retiring early or switching to gynecologic care due to increasing malpractice costs.

A woman birthing in America has decreasing options.

Water labor/birth safety is again questioned and in many facilities, tubs are being uninstalled due to lack of use.

The number of babies exclusively breastfeeding at 3 and 6 months is low.



In short, US maternity care providers generally (there ARE exceptions) do not practice evidence based care.   Yet according to The Pregnant Elephant in the Room: The US Maternity Care Crisis, a typical birth in the US costs upwards of $35,000.  A typical birth in the Dutch health care system is approximately $6000.  Author Laurie Foster CNM, MSN asks some very vital questions: "In light of the changes taking place in the American health care system, what is being done to improve the quality of care, cost, and outcome of the most important medical event in human life?"  She goes on to ask: "Why do American women routinely get major abdominal surgery? What is driving the maternity care crisis in the US?"

Who is afraid of the answer?  And just what is the answer?  I agree with Foster: "The US must improve outcomes and decrease costs.  There is a clear solution: increase the percent of births attended by midwives and employ the midwifery model of care as the evidence-based standard."

The evidence in the research shows this to be true.

Don't just celebrate midwifery, doulas or childbirth education for one day, one week or one month.  

Do it every single day!