Guest Blogger: Donna Walls RN, IBCLC

Our Second Guest Blogger of 2011 is Donna Walls RN, IBCLC.  She has had many years of experience helping mothers and babies breastfeed. She lives in Dayton Ohio and works as a nurse and Lactation Consultant. If you would like to be a Guest Blogger at Childbirth Today, email us at info@birthsource.com!

Many new mothers worry about their milk supply. Do I have enough milk for my baby? In the first days after birth¸ it’s the number one question mothers ask.  In  reality for the vast majority of women, the answer is yes. There is only a very small, less than 1% chance, that a woman’s breasts lack enough glandular tissue to provide adequate breast milk for her infant.

There are some issues that can create concerns; early introduction of contraceptive hormones or some anti-depressants, unnecessary supplementation in the first days of life, infant suck problems such as tongue-tie, and exposures to environmental endocrine disruptors such as plastics and pesticides.

So what can we do to ensure a good milk supply?

Nurse your baby as soon as possible after birth, preferably within the first 60 to                      90 minutes after birth and make sure the latch is comfortable, feeling only a tugging, pulling sensation on the nipple. If you feel the latch is not good ask your nurse or lactation consultant for assistance.

Keep your baby with you in the hospital and spend as much time as you can skin to skin. Babies love the calming closeness of skin to skin and smelling the milk in your breasts can encourage early feedings.

Nurse your newborn on demand¸ whenever they show signs of hunger such as mouthing motions, restlessness, fussing sounds. Offer the breast- if they are hungry they will eat and if not, they won‘t! Forcing feedings in the first 24-28 hours is not necessary and may interfere with the natural rhythm of breastfeeding.  Colostrum is very concentrated and provides the newborn with all the nutrients they need in fewer feedings.

 Most newborns will have some shorter “snacking” feedings and some longer “meals”. They commonly eat in clusters of feeds, usually followed by a stretch of sleep. This cluster or feeding frenzy period is normal and not a sign that the mother doesn’t have enough milk- no supplementation is necessary. Establishing this request and supply system of communication between mother and baby sets the stage for a good milk supply.

What if I notice my milk supply diminishing after it is well established?

First go back to the basics. Make sure you are nursing, pumping or hand expressing at least 8-10 times a day, remember milk production is request and supply, so the more you ask you breasts to do, the more they produce!

Many foods and herbs have also been shown to enhance milk supply. Many mothers notice an increase in supply with a daily bowl of oatmeal or adding brewer’s yeast tablets to food. Traditional cultures have used barley, anise, garlic, dill, caraway and alfalfa to assist mothers in making milk for their babies.

Herbal medicines taken as teas, tinctures or capsules have also been used successfully for increasing milk supply. Some of the most common herbs used are: fenugreek, fennel, blessed thistle, goat’s rue, hops, marshmallow and nutritive herbs such as nettle, spirulina or kelp.

The drug Reglan can be prescribed for increasing supply. This drug was originally used for gastrointestinal upset but has been shown to improve lactation.

Illinois Hospital Bans Elective Deliveries Before 39 Weeks

Edward Hospital in Naperville is one of six Illinois medical centers chosen to be part of a March of Dimes pilot program calling for a halt to elective deliveries before 39 weeks of pregnancy.


According to hospital officials, a critical part of the success of this program is patient education.  In the article that appeared in the Beacon News on January 15, "As our culture shifted toward a more relaxed attitude about delivering early, it was apparent education was needed by both patients and medical staffs."


The obvious solution to the patient education need is childbirth education!  However, the education for medical staff may be a little more tricky.  Due to the limited OB curricula in nursing schools and residency programs, few nurses or physicians are trained (and therefore skilled in) the art of supporting women through what is known as physiologic birth.  Physiologic birth, formerly known as natural childbirth or normal birth, involves honoring the mechanics and hormonal responses of the body for birth, limiting interventions and medications, and enhancing the physiologic/mind/spiritual link between mother and baby.  Even though the number of interventions in childbirth has increased exponentially in the past decade in the U.S., the U.S. maternal and infant mobidity/mortality has NOT improved; rather those statistics have gotten progressively worse.  It becomes clear that an increase in intervention during childbirth does NOT improve outcomes.


Some call this hands off method of childbirth the midwifery model of care.  Rather than label it and cause a riff in the maternity profession, call it what it is....physiologic birth.  Stop quibbling.  And honor physiologic birth for reducing the admissions of near-term/preterm infants into the NICUs.

The article goes on to make these points:

"Based on data, hospitals participating in the 2011 March of Dimes project can expect to reduce pre-term births and admissions to the NICU by 15 to 20 percent, Crouse said. That is significant from both a health and cost perspective. The typical hospital bill for a full-term baby is about $2,000, he added. That can be 10 times higher when a baby is in the NICU."

We applaud all of the hospitals who are joining with the March of Dimes in this endeavor!  Seventeen Illinois hospitals applied to be part of the March of Dimes program. Others that were selected are Decatur Memorial Hospital, St. Elizabeth’s Hospital in Belleville, St. Joseph Hospital in Breese, Katherine Shaw Bethea Hospital in Dixon and the University of Illinois Hospital at Chicago. Also participating are five hospitals in California, Texas, New York and Florida.

Guest Blogger: Jodi Hitchcock

We welcome Jodi Hitchcock, MSW as our first Guest Blogger of 2011!  If you would like to be a Guest Blogger in 2011, email us at info@birthsource.com!

Living in the North East, the passage into a new year is often a bittersweet one.  After the hustle and bustle of the holiday shopping, eating, visiting and overall merriment, we enter into the dreaded long months of winter in its fullest.  Although we have had a substantial amount of snow and cold for several weeks now, it does not seem as foreboding when you are in the midst of the holiday cheer.  Come January 1^st, winter feels as though it will never end.

This feeling was never more intense for me than the first winter after I had given birth.  My first birth experience, my daughter who was born in October 2000 at 36 weeks gestation and after a very traumatic delivery, left me feeling a range of physical and emotional pain I had never felt before.  At that time, given what I had been through, my family, friends and doctors all dismissed what I was experiencing as “normal” and “to be expected”.  As a 23-year-old first time mom, who was I to question all of these wise and worldly individuals?  They told me it was normal… so it must be normal!  It was ok that I cried constantly, that I felt overwhelmed by the needs of my new premature baby and that I could not sleep without horrible dreams of her delivery (yet all I longed to do was sleep).  It was “normal” that I was absolutely terrified to walk down the stairs with my baby because I was certain my arms would go limp and she would tumble down the stairs.  I was living a nightmare… that I was assured was “normal”.  I wanted desperately to feel the sun on my skin and to breathe fresh air.  Unfortunately, where I live, sun is MIA for about 6 months of the year… and I was right at the start of that 6 months.  Bundling up my new baby for a crisp walk was not an option since she was considered to have a weakened immune system and she had difficulty maintaining her body temperature.  So in we stayed… a prisoner in my own home is how I felt.  I loved my baby, I think, but I also resented how her birth had left me feeling.

At that point in my life, I had vaguely heard of postpartum depression (in news reports of Andrea Yates-the mother who killed her 5 children *).  I knew that I was not capable of harming my baby, so the thought that I could be experiencing the same thing that she had never crossed my mind.  My doctors never mentioned it or screened for it… so it all must be normal, right?  WRONG!!  After 2 more children… and each postpartum period worse than the others… I finally got what I had desperately needed in the beginning; answers, a diagnosis, acknowledgement that what I was feeling was not normal and most importantly, treatment. 

As a social worker, I have been able to use my horrific personal experiences by dedicating my career to the perinatal population.  I have spent the past 6 years researching, studying and working with women and families who have experienced perinatal mood disorders (PMD’s).  My goal is to help eliminate the shame, the judgment and the fear of those suffering from PMD’s and to help educate the perinatal professional community so that women are able to receive help as soon as possible.  I am excited to spend 2011 as a guest blogger on the Child Birth Today site and I hope to offer some insight, both personally and professionally, on perinatal mood disorders.  

*I now know that Andrea Yates did not have postpartum depression, but did have postpartum psychosis.  This is a much more severe mental illness that can lead to infanticide and/or suicide and is extremely rare.

About the Author: 

Jodi K. Hitchcock, MSW is a mother of 4 amazing children (ages 10, 8, 6 and 16 months) and the stepmother to a wonderful 14 year old.  She currently works 24 hours a day as a stay-at-home mom to those lovely children.  In addition, Jodi works as an independent consultant providing perinatal support, education and outreach to mothers, couples and families experiencing PMD’s.  In addition, she conducts training seminars and provides outreach education to other perinatal professionals.  After experiencing a variety of PMD’s during and after her pregnancies, Jodi is able to provide a unique combination of personal and professional knowledge to the people she works with.  Jodi especially loves to work with pregnant women who are experiencing or are at risk to experience a PMD so that she may empower them through education and prevention techniques so that they may have the best possible birth experience!

The Evidence Says: Friedman’s Curve Essential to Reducing Cesarean Rate

For nearly 60 years, the (Dr. Emanuel) Friedman’s curve has been the gold standard by which maternity care givers have managed a woman’s labor.  It is one of the very first things that physicians and nurses learn in school.

The curve, depicted in graph form, shows the progress of labor where cervical dilation and fetal descent are plotted on a vertical axis.  Along the horizontal axis is the element of time.  Like a mathematical graph, the Friedman’s curve is divided into stages and phases of labor.  When there is a disparity in the slope of the curves, labor is termed dysfunctional.

Studies done during the first decade of this century demonstrate that the parameters to determine if labor is progressing need to be expanded.  The reasons for expansion may be the increase in medical technology, specifically the rise in epidural anesthesia and subsequent inactivity during labor which can prolong the labor.  A study published in 2004 in the Journal of Obstetrics, Gynecology and Neonatal Nursing (Cesario, S. Reevaluation of Friedman’s Labor Curve: a pilot study.  2004 Nov-Dec; 33(6):713-22) suggested  “With the availability of technology to assess maternal and fetal well-being, labor should be allowed to progress past the rigid 2-hour time limit for the second stage of labor artificially imposed on women in some childbirth settings. More emphasis should be placed on the nursing assessment techniques used to reassure the family and health care practitioners that labor is progressing safely and the nursing interventions that may have an impact on the length of each stage of labor.”

From an article on Birthsource.com, current definitions of labor protraction and arrest may be too stringent, Dr. Jun Zhang of the National Institute of Child Health and Human Development, in Bethesda, Maryland said at the 2002 annual meeting of the Society for Maternal-Fetal Medicine. "And the long-accepted Friedman curve may not be an accurate description of normal labor progression, according to a new analysis of data from 1,329 nulliparous women aged 18-34 undergoing singleton, vertex presentation deliveries following spontaneous labor," said Dr. Zhang.

Based on the speed of overall labor progression and current cervical dilation, Dr. Zhang and his colleagues calculated the expected traverse time for the cervix to reach the next centimeter and the expected rate of cervical dilation at each phase of labor. "Our curve is very different," Dr. Zhang said, pointing out that on his curve the average was 5.5 hours for progression from 4 cm to 10 cm, compared with 2.5 hours on the Friedman curve.

"We also didn't see a deceleration phase," he said, noting that in 1978 Friedman modified his curve, but the distinctive sharp upturn remained, as did the deceleration phase. "Our data suggest that most women enter active labor at different times, mostly between 3 cm and 5 cm dilation, and even in the active phase the speed of progression varies from person to person," he further explained. The median time for cervical dilation to progress from 4 cm to 5 cm in the present study is 1.7 hours. And for fetal descent, it could take 3 hours to progress from station +1 to +2, and an additional half hour from station +2 to delivery, he added. "Therefore, the definition of protracted descent or arrested descent appears to be too stringent in current practice," according to Dr. Zhang.  Read more…

Dr. Zhang again calls into question the use of the Friedman’s curve in 2006 and refines insight into labor progress, the diagnostic criteria for labor protraction and arrest disorders.

And in December of 2010, Zhang again questions existing practice by the study gathering data from over 62,000 birthing women.  Their conclusions were as follows:

"Judging whether a woman is having labor protraction and arrest should not be based on a research definition of an average starting point or average duration of labor," the researchers write. Instead, an upper limit of what is considered 'normal labor' should be used in patient management. "As long as the labor is within a normal range and other maternal and fetal conditions are reassuring, a woman should be allowed to continue the labor process."

The differences they observed could be due to the fact that women giving birth are older and heavier, on average, than they were when Dr. Friedman's labor curves were developed, the researchers note; "these factors are known to affect labor progress and duration."

Therefore, based on several large studies and over a decade of research, the evidence says that the rate of cervical dilation accelerated after 6 cm, and progress from 4 cm to 6 cm was far slower than previously described. Allowing labor to continue for a longer period before 6 cm of cervical dilation may reduce the rate of intrapartum and subsequent repeat cesarean deliveries in the United States. Clinging to the original Friedman’s Curve may “cause” an increase in cesarean section.

Referenced:

"The Length of Active Labor in Normal Pregnancies," by Leah I. Alberts,CNM,PhD: Melissa Schiff, MD; and Julie G. Gorwoda, CNM,MSN. Obsterics & Gynecology. 87(3):355.359, March 1996.

“Contemporary patterns of spontaneous labor with normal neonatal outcomes” by Jun Zhang MD and others.  Obstetrics & Gynecology. 2010 Dec;116(6):1281-7.

The Evidence says: Childbirth Education Is A Vital Part of Maternity Care

The Healthy People 2020 initiative for Maternal Child Health is supported by clinical recommendations from the US Preventive Services Task Force (USPSTF).  The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).

The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements."

In reading through the Healthy People 2020 initiatives, it is plain to see that many of the initiatives could be accomplished with comprehensive childbirth education classes, taught by certified childbirth educators, and enthusiastically and positively promoted by physicians and midwives early in the pregnancy of every woman.

The very fact that Healthy People 2020 initiative MICH-12 calls for an increase in the proportion of pregnant women who attend a series of prepared childbirth classes is proof enough that childbirth education classes are important.  Numerous studies (available with abstracts) are listed on the US National Library of Medicine/National Institutes of Health website www.ncbi.nlm.nih.gov, extolling the virtues of childbirth education classes in improving maternity care.  However, not all providers of childbirth education classes devote curriculum to the dissemination of evidence-based information.

The U.S. maternity care system, with the escalating cesarean section rate, increase in near term newborns from an increase in elective inductions,  and a standard of maternity care that is intervention based rather than health based, is truly at a cross roads.  We can no longer sit back and debate whether maternity care is evidence-based.  We have seen that over and over again, in most cases, it is not.

Judith Lothian wrote in the winter 2009  issue of the Journal of Perinatal Education, “It is a challenge to present the “best evidence” when hospitals provide care that is decidedly not evidence-based. Childbirth educators and nurses too often feel pressured to encourage women to comply with hospital policies and routines or are pressured to withhold information or present information in ways that do not challenge women's prior thinking. Our mandate to assist women in making informed decisions, including making them aware of their right to informed refusal, creates never-ending dilemmas for many childbirth educators (as well as many nurses, midwives, and physicians). It is extremely difficult to move from principles to practice!”

What can be done to “fix” this seemingly impossible situation?

We need only to take a brief visit back to the 1960s and 1970s when maternity care faced similar challenges. 

1)      Childbirth education must be taken back by certified childbirth educators (either nurses or non-nurses).  Not all nurses have the qualities to be an educator; conversely, not all educators need to be nurses.  Medical schools and nursing schools prepare the students for crisis intervention and rarely prepare students to work with the laboring female body in a physiologic manner.  To this end, those who teach childbirth education absolutely must be trained and certified by organizations who will give them the knowledge of physiologic birth.

2)      Childbirth education must be community based so that the freedom of sharing unbiased, evidence-based information is preserved.  Fear of job loss is evident in areas where childbirth education is taught by hospital employees.  Failure to conform to non-evidence based mandates ultimately result in sanctions or job loss.

3)      Childbirth education must be taught with a standard of credibility, excellence and adherence to the evidence, regardless of the organization of certification.

4)      Childbirth education must have at its core the right of every pregnant women to base her decision-making during pregnancy, birth and parenting on informed consent.  With journals dedicating entire issues to informed consent, numerous conference devoting speakers to teach about informed consent and federal acts/professional practice guidelines defining and mandating informed consent, the inconvenient truth is that not every American woman has the opportunity to exercise this right during childbearing.

5)      Childbirth education must strongly advocate for women as it did in the 1960s and 1970s.  Childbirth education must NOT be adversarial. We must use a variety of marketing strategies to campaign for healthier mothers and babies through evidence based maternity care.  We must shine the light of truth on the fact that U.S. maternity care is not evidence based; that it is based on old information, convenience and intervention. 

Contact your certifying organization and ask them what their Strategic Plan for 2011 entails. This is the best way to know if your organization is working toward this goal.  Then, take these five “musts” and see how you can incorporate them into your community.

The Evidence Says...Returns!

Early in 2010, I began a series of blogs called "The Evidence Says".  It examined several widely known practices and the differences between the practices and the evidence.

Several readers have asked me to do the series again this year...with different topics.  So in the next few weeks, we will take a look at some of the Healthy People 2020 initiatives and how they will impact hospital practices.  We'll also look at the facts surrounding both the initiatives AND the practices ~ how do the current practices differ from the research?

It will be interesting to read...and research!

Happy New Year all!

Questions about Birth & Christmas.....

If you are reading my blog via Facebook, please go to www.childbirthtoday.blogspot.com to view the video.

What really was Mary's EDD?

Did she feel contractions?  Did she have back labor?

Did Joseph help her with her breathing?

How long was the Second Stage of Labor?

Did they have a lotus birth?

What would've been Jesus's Apgar score?

Did Jesus latch on right away?


And finally, have you viewed The Social Network Christmas?  Merry Christmas to all !

Follow Up to Previous Article

Several subscribers have asked for more information about the test to determine if a cesarean is necessary - a blog I posted earlier today.


I went to the Obstecare website and found this information, along with their reference page:


http://www.obstecare.com/Clinicalsolution.htm


Hope this helps!

New Test to Determine If Cesarean is Necessary

Just as the CDC issued the 2009 Cesarean Section Statics ~ we are now at 32.9%, up from 32.3%, a Swedish company, Obstecare, has developed a test that measures the amount of lactic acid in the amniotic fluid.


In a press release issued today (Dec 22,2010) by a New Jersey Law Firm, "if high levels of lactic acid are present, it is doubtful that the mother will be able to deliver the baby vaginally, as lactic acid at certain levels begins to inhibit contractions. The test could help end difficult labors earlier by indicating that a C-section is necessary."  The press release also said "For the mothers that endure prolonged hours of labor only to have a Cesarean section (C-section) in the end, a new test performed at the early stages of labor could indicate that a C-section should be performed."



Could this become standard for all obstetricians to use before labor and delivery?

Seasonal Emoticons

It is true.  This blog entry has nothing to do with childbirth.  BUT it has everything to do with those really cool emoticon trees, snowmen and other art done with your computer key board.

Wanna make a snowman?

 __[-]__
.. (*>*)
. (.. : .. )
.( .. : . . )


Or perhaps a Christmas tree?

…………(¯`O´¯)
…………*./ | \ .*
…………..*♫*.
………, • '*♥* ' • ,
……. '*• ♫♫♫•*'
….. ' *, • '♫ ' • ,* '
….' * • ♫*♥*♫• * '
… * , • Merry' • , * '
…* ' •♫♫*♥*♫♫ • ' * '
' ' • Christmas . • ' ' '
' ' • ♫♫♫*♥*♫♫♫• * ' '
…………..x♥x
…………….♥




For ALL of the cool designs and secrets, visit 


http://facebook-emoticons-symbols.blogspot.com/2009/04/basic-symbols-key-alt.html

Unsuspecting Doulas

If you are aware of randomized control trials or the Cochrane Review, then you already know the years...no, decades of research documenting the profound benefits of doula care before, during and after labor/birth.

Take a moment, however, to examine the very simple and amazing impact of doulas ~ companionship.

Mankind was never meant to experience life alone.  From the very beginnings, we were given friends, companions, helpmates, mates...the list goes on.  Why?  Because sometimes life is difficult.  Life is a challenge or series of challenges and really, who wants to experience those challenges alone?  Often a challenge not only stretches us physically, but emotionally and spiritually as well!  And when those challenges approach the "overwhelming" point, there is definitely strength in numbers!

But if you have ever breathed, you have already experienced doula care in some form or another.  Here are some examples of doulas in our every day life:

When you were about 2 and wanted your mom or dad to be with you in the bathroom, especially when you flushed.


On the play ground when you were 5.  It was funner to have a playmate than play alone.


In 4th grade, it was nice to have a buddy to go to run errands for the teacher in school than walk through those scary halls alone.


Sleep-overs in middle school and high school.


In football, it is wonderful to have someone block for you!


The first time you put gas into a car.


Freeways have signs that say HOV ~ high occupancy vehicles.


Even a friend who proof-reads a paper for you.


While these are just a few of the "go with me", "help me" moments in life, I am certain you have some of your own. We live in towns and communities.  We are meant to be in contact and friendship with others.  They help us and we help them.

So yes, there is evidence-based proof that doula care is beneficial for positive outcomes in labor and birth.  But deep down in your heart, you know that having a compassionate companion with you during an exceptional life experience makes that life experience easier.

You know that investing in another not only brings joy and calm to that person but to you too.

Your life is richer and so is theirs.

So is it really any wonder why doulas make a difference?

Congratulations to DONA ~ the new introductory video!

If you are viewing this on Facebook, please go to my blog, www.childbirthtoday.blogspot.com!   And if you have RealPlayer on your computer, you can easily download this video for future use.

The 3 1/2 Minute Cheer For Your

For all of the childbirth educators and doulas I have trained in the past 14 years or so....I can't always be there to cheer you on.  And if I didn't lead your seminar or workshop, you also may need some support!  I have found that many people need this, especially in the winter time...when the sun is not out as much and when we cannot go out as much to clear our heads and our hearts.

I found this video on You Tube and found it very encouraging - so I thought I would share it with you.  If you see this blog notification on Facebook, please go to my blog at http://www.childbirthtoday.blogspot.com/ to see the video!

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.

Have you seen this trailer? Formula Fed America...

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.

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.

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...

Do you use Aromatherapy? If not, consider this...

Aromatherapy is the use of pure essential and absolute oils derived from plants. The word "aromatherapy" was first used in the 1920's by a French perfumer named Rene Gattfosse. The use of the word "therapy" gives the impression of the need for treatment of an illness. Aromatherapy is the use of essential oils from plants. Aromatherapy oils can not only be used as inhalants but they can also be massaged into the skin. The essential oils used in aromatherapy are concentrated extracts taken from the roots, leaves, or blossoms of plants. Each essential oil contains its own mix of active ingredients, and this mix determines the healing properties of the oil.  Some oils promote physical healing-for example, some are able to relieve swelling. Others are used for their emotional value, such as lavender, as they may encourage relaxation or make a room smell nice. The essential oil derived from orange blossom, for example, contains a large amount of ester, an active ingredient thought to induce a calming effect. It is not fully understood how or why essential oils produce the effects that they do. One obvious way that essential oils work is through the sense of smell. This sense is incredibly powerful-according to some estimates, about 10,000 times stronger than any other sense. The "smell" receptors in your nose communicate with two structures that are embedded deep in your brain and serve as storehouses for emotions and memories. These structures are called the amygdala and hippocampus. When essential oil molecules are inhaled, they affect these parts of the brain directly. Researchers believe that stimulation of these structures can affect our physical, emotional, and mental health. It is also known that breathing in essential oils can affect the respiratory system. For example, certain oils from the eucalyptus plant are able to clear sinuses and prevent respiratory infections. Thus, the reason why Halls Mentholyptus and Vicks are so popular during cold and flu season. Aromatherapy massage is a popular way of using essential oils, because it works in numerous ways at the same time: it produces benefits from absorbing the oils into the skin, from inhaling the oil's vapors, and from the physical therapy of the massage process itself. We have two new aromatherapy lines now at www.birthsource.com.  Cappriccio Aromatics is a unique blend of aromatherapy oils made especially for women in labor - there is the Early Labor Blend, Active Labor Blend, Transition Blend and Stage 2 Pushing Blend!  Also, we carry a limited supply of the Aura Cacia line!  Just click on the Aromas & More category on our website for all of the latest additions!

Striking The Right Cord in CBE Classes

One of the thoughts that hovers in my mind a lot is: why don't more expectant parents attend childbirth education classes.  Now, I am of the belief that expectant parents will get something out of any childbirth education class they attend ~ but is the information more "harmful" than helpful is my next question.


This is not to insinuate that any childbirth educator teaches harmful things.  No, please don't misconstrue.  Perhaps I should say it is the way that certain topics are presented, the time spent or NOT spent on other topics...this is what can be harmful.  


Here are some examples:


Susie The Childbirth Educator has been teaching independent classes for nearly 15 years.  Her feelings is that since labor and birth basically do not change, what she presents in her classes does not have to change either. Babies still come out either vaginally or by cesarean surgery.  Susie does not change the curriculum to fit the needs of the individual learners in the class and side-steps specific questions when her well-learned clients ask about some of the events happening in the birth world such as placenta encapsulation or delayed cord clamping.  Susie's answer is "those are questions to ask your careprovider".


Bev The Childbirth Educator has been teaching classes in a hospital environment for 6 years.  She learned much of how she teaches from the other educators in her department and what she teaches from the curriculum presented to her.  Her classes sound very much like this: "When you arrive, we'll take you upstairs and we'll help you get settled into one of our rooms".  "We will hook you up to the EFM to get a reading to make sure that the baby is tolerating labor properly".  "Once the cervix has dilated to 10 cms (not centimeters but "cms"), your nurse will give you permission to push".


Both Susie and Bev have essentially disempowered the women and their partners in their respective childbirth classes.  How? Susie, by not staying current in childbirth education, displays an air of "it doesn't matter".  She then counts on the care providers' 6-10 minute appointment with the expectant parents to fulfill this educational gap, which may or may not happen.  Parents may then put their questions in the "its too hard to learn about" pile and may not show up at the next class. Bev, on the other hand, disempowers those in her class by implying that the mind/body/spirit connection between mother/partner/baby is not functioning and that medical intervention of some kind is necessary for the baby to move down the most dangerous 4 inches in the world ~ the mother's birth canal.  Fear, then, may keep expectant parents from continuing the class series.


Ok, the last comments may have been a bit dramatic, I agree.  But do you see how important words and how they are crafted during a childbirth class can make a desired or undesired impact on not only the thought processes but also the emotions and confidence of expectant parents?


I challenge you, as childbirth educators, to take a strong look at your curriculum AND how you phrase topics in your childbirth class.  I challenge you to take a look at one topic at a time and figure a way to make that topic more empowering.  When you do this, you will find that the responses to your classes will be well worth your time!

The Perfect Addition to A CBE or Doula's Lending Library

(If you are reading this as a Note on Facebook, please go to www.childbirthtoday.blogspot.com to see the interview!)


The new Parent Talk Game is the perfect addition to any childbirth educator or doula's lending library!


The brainchild of real-life parents Juliette and Michael Reynolds, The Parent Talk Game is designed to start the conversation about having children and raising them!  This game is 100% interactive and wonderfully imaginative ~ working with over 150 multiple choice cards, trump cards and a great blue/pink game board.


Listen to my interview with game creator, Juliette Reynolds!

Reflections from the 2010 Lamaze/ICEA Mega Conference

It was indeed humbling to be in Milwaukee this past weekend, attending the Lamaze/ICEA Mega Conference.  To be in the very city that birthed organizational birth some 50 years ago was thrilling.  Sharing that feeling with nearly 700 other childbirth professionals of varying ages and experience levels, too, was inspiring. 

As I sat amidst the glitz and glam of the 50th Anniversary luncheon ~ complete with recognition of past organizational presidents (minimal at best), and a multi-media celebration with an interview with Lamaze founder Elizabeth Bing, I couldn't help but reflect on those wo/men in birth who had made the Top 10 on my list.

Now absent from the festivities was Harriet Palmer, the ASPO (American Society for Psychoprophylaxis in Obstetrics) trainer who lead my educator seminar some 30 years ago in Fresno.  Not in attendance was Alice Berman, the voice of ASPO/Lamaze during the transitional period from ASPO to Lamaze and editor of Genesis.  Missing from the crowd was Polly Perez, a tireless volunteer in those transformational days of Education, Advocacy and Reform! However, I did catch a glimpse of two icons at the table in front of me: Joyce Difranco and Sandra Apgar Steffes, nor the dedicated Sigrid Nelson Ryan. These two women made a huge impact on the history of birth as they were two of the most prolific writers of birth in the 80's and 90's when childbirth was but cutting its new teeth!  Another childbirth educator and writer from the 1980's and beyond too was missing ~ Sherry Lynn Jimenez.  Absent was Eugene Declerqc, the champion of the independent educator in the 1980s when childbirth education was being co-opted into the hospital setting and in many aspects watered down.  And there was no mention of Sharron S. Humenick and Francine Nichols, who penned the quintessential Biblical-equivelant text for childbirth educators--> Childbirth Education: Practice, Research and Theory. The Journal of Perinatal Education was the brainchild of Nichols and Humenick, one of its editors.

While there are countless more who have inspired us throughout our careers, it would have been great to acknowledge their years, and decades of hard work, sweat and tears for a cause we all embrace.  From "Nan" the educator featured in one of the only childbirth films of the 70s, Nan's Class, to Dr. Roberto Caldeyro-Barcia [an internationally renowned research perinatologist, Director of the Latin American Center for Perinatology and Human Development, a unit of the World Health Organization, and President-Elect of the International Federation of Gynecologists and Obstetricians (FIGO)] to Ricki Lake, who catapulted birth back into common day conversation, recognition would have been welcomed. And last but not least, where was the accolades for Doris Haire, whose book The Cultural Warping of Childbirth was stunning for the birth community as was her testimony on April 17, 1978 before the Subcommittee on Health and Scientific Research of the Committee on Human Resources of the U.S. Senate, her testimony on July 30, 1981 before the Subcommittee on Investigations and Oversight of the Committee on Science and Technology of the House of Representatives, and her 1982 report "How the FDA Determines the 'Safety' of Drugs — Just How Safe is 'Safe'?"  As Estelle Cohen of the Alliance for the Improvement of Maternity Services points out, "Mrs. Haire has called the administration of drugs to women in labor and delivery "obstetric roulette." The section on obstetric drugs in her 1982 report ought to be read by every expectant mother because most of our births are still not drug-free."

We do need to honor the work that these amazing men and women have done to bring us where we are today and inspire us to continue our work tomorrow. I challenge you to Google the names I have listed here - it will make for some really good reading, I guarantee it!