Maternity Care vs. the way a woman's body labors

For years, perhaps decades, I have been saying and in some instances SCREAMING that the US Maternity Care system does not practice evidence-based care.  That's right, it doesn't.  Look at the CDC statistics, the 34% cesarean rate or the fact that nearly 45 other countries have better statistical data than the US when it comes to maternal and infant morbidity and mortality.

However, and this was a HUGE aha moment, when I was watching the live webcast of the play BIRTH on 9/5/11.....I discovered that there is a GIGANTIC disconnect not only between US maternity care and the evidence  BUT  US maternity care and the way women are built to labor and birth their babies!

It all became clear.  Suddenly.  Like a bolt out of the blue.  A woman's body is wanting to labor and birth the baby one way, and we/US maternity care is demanding that the labor and birth happen in a different way.  As if to say that a woman's body is wrong and maternity care is right.  That the woman's body should accommodate the maternity care and NOT THE OTHER WAY AROUND.

Once I actually said it outloud and then put it on paper, it seemed so simple.  Such a simple concept.

So while it is horrific that our maternity care is not evidence based, it is even more horrific that we do not honor and respect the work that a woman's body is trying to do, albeit as individual as we all are.  That our maternity care system is not flexible enough or educated enough to learn about all of the possible variables of normal.

 But that our maternity care system is at odds with a woman's body during labor.

One World Birth ~ the next great birth film

We have come to a pivotal point in US maternity care. A revolution has been brewing for some time now and the actual beginnings started as a buzz at the various midwifery, birth and breastfeeding conferences and to some degree online, for example on blogs. Now, just as this newborn bird incrementally tears open the restrictive interventionist shell of the maternity care egg, we see that there is a light of truth being shown on this US maternity care….a care system that exudes mediocrity.


With staggering statistics of 34% cesarean rate and humiliating maternal/infant morbidity and mortality rates as the costars of this tumultuous reality show, today’s birth celebrities (Ina May Gaskin, Michel Odent, Sheila Kitzinger, Elizabeth Davis, to name a few) venture into view to call the plays like they see them ~ "if we get birth right, we get the world right". (www.oneworldbirth.net)


The marriage of evidence-based maternity care with modern medicine is dismal at this moment. With uncomplicated pregnancies turning into complicated births, one only has to look at the factors surrounding the birth to see a path of interventionism and iatrogenic dystocia. These women then take their experiences back into the community and in trying to validate their non-informed decision making, instill fear into future laboring women. Compounding this is the impact of the media, who sensationalizes childbirth to the extreme so that the lines are truly blurred between fact and fiction.


In the 1970s, those of us who were in the birth professional spoke louder than now, literally and figuratively, regarding the policies and routines that interfered with the birth process, including the cooptation of childbirth education classes into the hospital setting. Parents must once again realize that all childbirth education classes are NOT created equally and they will not receive cookie-cutter classes regardless of where they attend classes. While it would be very unfair of me to say that all hospital childbirth education classes were guilty of the sin of omission in many details of information (mainly because I have worked for at least one hospital who didn’t have such stringent ties on their childbirth educators), I can say that for the vast majority of childbirth educators who teach in a hospital setting, an evidence-based curriculum is challenged by obstetricians and anesthesiologist who have little if any training in physiologic birth. And basically because the childbirth education department in such a hospital is NOT the huge money maker department, sins of omission occur. The whole truth is not told. Parents essentially do not get the full story.


When identified as a “patient”, a human begins to feel a certain vulnerability, a need to be cared for and a need to trust. And so an expectant mother and her partner begins to put their trust into care providers that may or may not fully understand the emotional, hormonal or spiritual piece that the expectant parents assume they know. Let’s be clear, how many women have either thought this scenario or verbalized it:


When I am ready to give birth to my child, I want the baby to come early so it can be admitted into the NICU and out of my touch for hours or days. To obtain this end, I want to have my membranes stripped in that painful procedure, be given a synthetic hormone to speed my labor and shuts down my body to make its own natural hormone. I definitely want to lay as still as I can on my back, so labor slows, the baby does not complete the cardinal movements easily and the weight of the baby and the uterine contents puts tremendous strain on the vena cava. In the presence of the resulting fetal distress, I will push and hold my breath and deprive my uterus and baby of more oxygen, thus making the fetal distress worse. At this point, my care provider will perform abdominal surgery on me to deliver my child so I can have a recovery period so much longer than with a vaginal birth and thus, my baby will go to the NICU.


Absurd? Yes. But this same scenario happens every hour of every day of every week of every month of every year. And our species is not thriving. One only has to look at the CDC statistics to see that the US is behind such countries as Qatar. It is not supposed to be that way. We are the leaders of the world. We are more innovative and smarter than that. We must do better. We must consider the expectant mother as whole being not a uterus and vagina. We need to make the scenario of the “patient” in a hospital less frightening as the power of fear and the impact of fear and the hormones surrounding fear are revealed. If that interaction was honored for what it is, and respected, and if women were supported by educated care providers who knew how to care for women regardless of their choices, AND if expectant parents were fully educated about all of the options and possible scenarios, birth would be a better beginning.


If you have not viewed the video clips available from www.oneworldbirth.net, I urge you to do so. See what is being said and take part in the conversation/ revolution. 


It is right time; the right place.

September is BOLD and BIRTHY

I have been waiting for September.  Why you may ask?  Because of the One World Birth videos today and the BOLD play on Monday.  To give you a taste of OWB, here is one of the videos that are FREE!

Maternity Thought Process Swings Toward Health

It has been brewing for several years. 
It has been spoken about in professional journals and at childbirth conferences.
And now, it is finally here.

The maternity thought process in the media and in established care facilities such as WIC and hospitals is changing and gratefully, the media is reporting it.  Jumping on the bandwagon (literally) of the Big Pink Bus for breastfeeding awareness, local communities, LLLI and WIC offices promoted World Breastfeeding Week and then Breastfeeding Month (August).

More and more hospitals are realizing that the increase in NICU admissions is NOT a good thing for fiscal management and that they are a BAD thing for society.  From coast to coast, hospitals are banning - yes, banning - early elective cesareans and early elective inductions.  To say that early elective inductions and cesareans rates had gotten out of hand is a small statement.  With the CDC confirming the US cesarean rate of 34% and also the US slipping further in maternal/infant morbidity and mortality was a clear indicator that the increase in interventions were NOT saving lives - if nothing else, contributing to the catastrophic morbidity and mortality rates.

Of course, we need quanitifying data to show us what we and Mother Nature have known since the beginning of time: vaginal birth has extensive benefits for mother and baby.  In a 2006 published report in Clinical Obstetrics and Gynecology (Buhimschi et al Advantages of Vaginal Delivery CLINICAL OBSTETRICS AND GYNECOLOGY Volume 49, Number 1, 167–183), the authors finally admit it:  Despite an impressive amount of effort and extensive research, our knowledge of parturition remains limited. Scientists have exhaustively investigated ‘‘the timing of birth’’; yet, we still have a limited understanding of the biologic mechanisms that control the events initiating delivery, and consequently, we lack tools to prevent these mechanisms from acting inappropriately.


Further the state:

Thus, it is not surprising to see that the overall rate of labor induction 

overall rate of labor induction has doubled 

as part of our efforts to ‘‘save life.’’ 

Although there is compelling evidence to suggest elective induction of labor significantly 

increases the risk of cesarean delivery 

the concept of elective primary cesarean section is not anymore a ‘‘myth.’’

While it is abundantly clear that for most care providers the ultimate goal is a safe and healthy mother/baby dyad, it is also clear that humans really do not have as firm a grip on the power of the mother's body during labor and birth NOR do we have an extensive knowledge base of the impact of the birth process on the newborn and ultimately breastfeeding.  For if we did, our statistical data would be reflective of it.

The authors' final statement does give hope to those of us who've championed evidence-based maternity care and education:  

Therefore, we all have to rely on high-quality studies that can guide our
decision-making and make obstetric practice safer for both the short- and the longterm future. We believe that establishment of clinical protocols aimed at identifying cases appropriate for vaginal delivery or for cesareans should become a clear objective of each department, and that consistent implementation of these guidelines would significantly improve maternal and infant outcomes.


Amen!

Your body, your baby, the Hormonal Orchestration

(If you are viewing this through Facebook, please go to www.childbirthtoday.blogspot.com for easier viewing of the video!)


During one of my presentations, "The Hormonal Orchestration of Birth" I reference the Fight or Flight Hormones (catecholamines/adrenaline) and Ina May Gaskin's work on sphincters. Professionals get it.  Now, in childbirth classes, I ask the support partners if they could have a bowel movement in the middle of Times Square on New Year's Eve?  The answer is "NO". 

This video is a great illustration!

What The Big Latch-On Is......and Isn't

This is World Breastfeeding Week - a week where we focus on the benefits of breastfeeding for babies and moms.  Those benefits are NUMEROUS.  And I appreciate all of the publicity, don't get me wrong.

The negative hoopla around World Breastfeeding Week and the Big Latch On is what concerns me.  So let me set the record straight and give you references to combat the bad press.

What the Big Latch On Is............
According to La Leche League, the first record for one location for simultaneous breastfeeding was from Berkeley California in 2002 where over 1000 mothers participated.   In 2006, an international record for one location was set in the Philippines where over 3700 mothers participated.  From there, the Philippines have partnered each year with other countries and in October 2010, recorded 9,826 mothers in 325 sites in 16 countries.

On Saturday, August 6 at 10:30 am local time, for one minute, women nation wide will be breastfeeding.  Information about registering your local event and the how-tos of signing up for participation in this very special event are on the La Leche League website.  Click here for the specific page.  There are also a "Rules" page and a section where forms for registering your event are located.  Want to know where in your state the events are occurring so far?  Scroll down a little farther on that page and events are divided by state and are in a table format.

Additionally on the La Leche League website, you can find a "Kit" to use to help you celebrate World Breastfeeding Week.  This kit includes professionally designed brochures to print off, planning tips, publicity tips.......if it is too late for you this year, this is a good website to bookmark for next year!


What the Big Latch-On is NOT............


The Big Latch-On is NOT going to be a distraction to any public location in which it is held.  It is not a lewd or obscene event.  It is only 60 seconds of feeding other human beings.  There will be women (of all ages) breastfeeding their children (of all ages), in an effort to reverse the public view of breastfeeding: all too often breastfeeding is the underdog of feeding babies.  The Big Latch-On strives to set the record straight - breastfeeding is the Gold Standard.

So go get your LATCH ON on August 6.  

If you are not breastfeeding a child, go and support those who will be on that day.  Don't hesitate!

And be sure to check out the Milk For Thought Pink Bus coming to a town near you!
Look at the 2011 Breastfeeding Report Card.

And look for the United States Breastfeeding Committee to announce on August 6, that August will be declared National Breastfeeding Month!

Happy World Breastfeeding Week 2011!

Happy World Breastfeeding Week!

US Cesarean Rate Now 34% ~ Healthgrades

On July 19th, 2011, HealthGrades Obstetrics and Gynecology in American Hospitals (an independent source of physician information and hospital quality outcomes) released a study of U.S. hospital outcomes between 2002 and 2009.  States included in the study where data are publically available: Arizona, California, Colorado, Florida, Iowa, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Washington and Wisconsin.


In the report, there were several key findings significant to nurses, midwives, physicians, doulas and childbirth educators:


In those states studied, 7% of women undergoing single live born deliveries experience an inhospital complication.  If all hospitals performed at the level of 5-Star rated hospital in maternity care, 32% of these complications (141,869) could have been potentially prevented.


The highest rate of C-section was found in Florida (38.6%) and New Jersey (38.0%).  The lowest rate was found in Utah (22.4%).


As they see it, quoting a 2011 Yale School of Medicine study, the rise in cesarean sections are associated with factors including: 

• Common labor practices that can lead to cesareans such as inductions or epidurals in early labor.
• Timing convenience for provider or mother.
• Increase maternal risk factors such as age, obesity and diabetes.
• Increased multiple births.
• Increasing willingness of physicians to perform cesareans.
• Limited understanding by the mother of the potential complications of cesarean births.
• Maternal request for cesarean.
• Physician fear of malpractice claims if they do not perform a cesarean.
• Established physician practice patterns.

It becomes alarmingly clear after reading the entire report, that 7 of the 9 indications can be eliminated through education....dynamic and evidence-based education of mothers and their partners and simultaneous dynamic and evidence-based education of physicians, midwives and nurses. Yet, providers continue to discourage evidence-based childbirth education either by directly discouraging expectant parents to attend such classes or assert their influence over childbirth education class materials, if the classes are in the hospital setting.




According to "Understanding the Dangers of Cesarean Birth" by Nicette Jukelevics, "women have few standards by which to choose quality coverage for maternity care.  The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization that sets standards for quality of care and service for health plans.  In its 2005 report on the state of health care quality, the NCQA found that 'consumers do not yet have access to the kind of objective information they need to make informed decisions about their care...They need to know which practices, hospitals, and health plans have systems in place to improve quality and safety and which ones make themselves publicly accountable and they need to know how to find their way to high performance providers.'"


The Listening to Mothers II Survey, a survey of over 1600 mothers,  found that US women were poorly informed about the risks of cesareans despite their belief that they should be told about those risks.  The survey went on to point out that support in pregnancy, a healthy life event, for physiologic birth is very limited.  Large proportions of the contributors reported numerous interventions with various degrees of invasiveness and risk. The survey goes on to state that "There were signs of failure to implement standards of informed consent, and many women did not have the childbirth choices or knowledge they wanted.  Most who had experienced specific consequential interventions lacked an accurate understanding of associated side effects.  In open-ended comments, many mothers described indignities and treatment that expressly violated their wishes.  Far too many indicated that they felt overwhelmed, frightened or week during this pivotal event."




The United States of America is not a third world country and our mothers should not be treated with little dignity, little education and little respect.  The invasive procedure, including cesarean sections, not only interfere with a woman's body and healing postpartum but also breastfeeding.  Breastfeeding is interfered with by separation and supplements.  It becomes clear with each passing second, with each new study or press release that United States maternity care is letting down its citizens, mothers and babies.  Families who do want less interventions and more mother-friendly evidence-based care experience policies and trends or "habits" in the health care system that are diametrically opposite of best practice.


This, along with the 20% rise in homebirths (as released by the Center for Disease Control), this is a strong and loud wake-up call for hospitals and providers.  We women, both childbearing and birth professionals, can and will seize this opportunity to shine an even large light on the non-evidence-based practice given to the citizens in the United States.




"The rising cesarean rate is a matter of deep concern for every childbearing woman today and in the future.  Even a mother with previous vaginal births is at risk for a surgical delivery.  The rising cesarean rate is a warning siren that every childbearing woman is at risk for a surgical delivery outcome.  The rising cesarean rate is not a niche issue with over 1.4 million surgical deliveries being performed in 2009.  Every childbearing woman needs to be proactive in her care toward surgical prevention," says ICAN President Desirre Andrews.


I challenge you to print off the HealthGrades 2011 Obstetrics & Gynecology in American Hospitals Report and give to at least five maternity care providers.  If it only changes the practice of one, that is one more than yesterday who will practice evidence-based medicine.

Prescription Milk

You may have seen this trailer before.  But you may want to see it again!
(if you are looking at this on Facebook, please go to www.childbirthtoday.blogspot.com to see the complete video.)

Guest Blogger: Jodi Hitchcock MSW

Perinatal Mood Disorders:  Who Should Screen?

By Jodi K. Hitchcock, MSW

I am often asked whose responsibility it is to screen a pregnant or postpartum woman for a mood disorder (or a PMD).  This seemingly simple question has a complex answer.  I can reply with whom should be screening, or with whom is actually screening, or there is even whom I think needs to be doing it.  Unfortunately, these three are rarely one and the same and that leaves many women at risk for never receiving a proper diagnosis or treatment. 

Lets begin with whom should be screening.  In an ideal world, all obstetricians and midwives would include a standard PMD assessment during all perinatal visits.  Unfortunately, this rarely happens and when it is addressed, a clinical diagnostic tool is often not used.  The doctors and midwives that I have discussed this with have explained a variety of reasons why they do not routinely screen their patients.  The most common reason that has been given is that they do not know what to do with a patient whose scores indicate a high probability for a PMD.  In the area that I live, there are very few resources readily available for doctors and midwives to refer patients should they be experiencing a PMD.  Women who are on Medicaid have the most difficulty finding specialized treatment, which leaves these women particularly vulnerable to more significant problems.

Through my experience researching and working with the perinatal population, I have discovered that there is an “underground society” of professionals providing these services, but they are not well known and are rarely publicized.  I have many theories behind why I believe this is the case, but I will save those for a future post!   The bottom line is that physicians are often times at a loss for what the next treatment step should be so they skip the clinical diagnostic assessment entirely.  I am not placing blame on obstetricians or midwives, this is a much broader concern where changes need to be made at every level.

Although most hospitals now include some form of PMD education or screening as part of the discharge process, this is only a minor first step in accurate diagnosis and treatment.  The majority of women will experience some form of postpartum blues in the first 2 weeks postpartum.  If the symptoms become worse or are not getting any better at 3 weeks postpartum, it is likely that she may be experiencing a PMD and this could not be determined at discharge from the hospital.  Although a 6-week postpartum visit with a doctor is generally a standard practice, for women going through depression, anxiety, panic, etc., this can feel like a very long time to wait.  This is one of the main reasons that I feel the optimum place for a new mother to be screened is at the pediatrician office.  New babies are often seen a couple of times in the first month after birth to do weight checks (especially if they are breastfed).  A standard diagnostic test (such as the Edinburgh Postnatal Depression Scale) could be administered to the mother at each of these visits and referrals made to see a specialist or even see their own doctor (sooner than the usual 6-week visit).  In addition to diagnosis occurring sooner, having multiple assessments done in one location allows the medical professional the ability to monitor the symptoms to see if the woman is improving with time or getting worse.  The sooner a mom receives treatment for a PMD, the least amount will be needed for a shorter amount of time.  Therefore, early detection is beneficial to mom, baby and the family unit and pediatricians play a key role in this success!

About the Author: 

Jodi K. Hitchcock, MSW is a mother of 4 amazing children (ages 10, 9, 6 and 21 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!  To read more about Jodi and her personal experiences, visit her website @ www.mypostpartumlife.com

The 43 Year Active Management of Labor Project: What have we learned?

The concept of active management of labor is familiar to most maternity care professionals.  This concept was first demonstrated  at the National Maternity Hospital in Dublin Ireland in the late 1960s.

Defined, active management of labor includes two major components.  The first component is the Organizational Component, which many have stated is the most critical of the two.  The Organizational Component includes prenatal education (which includes patient/family education about the birth process and working with labor), daily physician assessment (assessing labor progress, supportive to patient throughout labor and during the postpartum period), bedside support (emotional and educational support at the bedside by staff), and peer reviews of outcomes (evaluate the effectiveness of the approach and possible process improvement).  The other component, the Medical Component, includes a rigid inclusion criteria (ensure only term, umcomplicated nulliparas are actively managed), strict diagnosis of labor (prevent hospital admission in early labor, decrease cesarean rate), early amniotomy (to assess volume and presence of meconium), frequent cervical exams (detect early dystocia and adequate process), and high-dose oxytocin (to correct dystocia with more effective contractions).  All of this with twelve hours believed to be the maximum safe duration of spontaneous labor.

Interestingly, epidural anesthesia is not a component of the active management of labor routine.  To compound this, there is some conflicting research as to the effect of epidural anesthesia on length of labor, depending on the source.  Over all,  it is well known in the literature that women who have inductions have longer labors and higher cesarean rates.

Taking a look at the state of US maternity care today, with pregnancy outcomes (specifically maternal morbidity/mortality and infant morbidity/mortality) not improving (in fact worsening) and the cesarean rate rising significantly since 1968, it is important to assess use of active management of labor prior to its efficacy.  Many birthing facilities and care providers use some of the components of active management of labor, however several items tend to be overlooked or forgotten in the implementation of the process ~ specifically, prenatal education, bedside emotional and physical support and rigid inclusion criteria.  Therefore, with these vital components not being included, any assessment of the efficacy of active management of labor would be incongruent.   Thus, active management of labor may be misunderstood by care providers and misapplied.

One only has to look as far as the Cochrane Database to obtain a summary of RCTs and evidence-based care.  No longer do we have an excuse that evidence-based maternity care continuing education opportunities are beyond reach.  And in this case, ignorance is not bliss.  Nor is it professional.  Expectant parents look to care providers to do just that ~ give care.  Our organizations charge us with providing best practice and quality care.  Conversations, albeit heated ones, exist about the best practice vs best price conundrum.  How dare we, as a society or as a country, put currency before the health of our women and children.  How can our conscience survive knowing that we compromise care, blaming it on "that's the way we've always done it", "that's what our policy says" or more acidic comments such as "if you don't do this, your baby will die" (when in fact, the baby will not die).

Our maternity care practices in the past 43 years have not yielded better results.  The outcry of those pleading for revolutionary change in maternity care are not those who are aggressive, uneducated radicals uncomfortable with 43 years of rituals.  Many are, in fact,  physicians, midwives, nurses, childbirth educators and doulas.  They are authors, speakers, researchers, university professors.

And they all are asking the same question: What have we learned?


Resources:


Listening to Mothers I & II

Boylan, P.C. Active management of labor: results in Dublin, Houston, London, New Brunswick, Singapore and Valparaiso.  Birth 1989 16: 114-9.

Declercq, E. Macdorman M., Menacker F. Recent trends and patterns in cesarean and vaginal birth after cesarean (VBAC) Deliveries in the US.  Clinical Perinatology 2011 June 38(2) 179-92.

Declercq, E. Macdorman M. Zhang J. Obstetrical intervention and the singleton preterm birth rate in the US 1991-2006. American Journal of Public Health 2010 Nov 100(11) 2241-7.

Declercq, E. Macdorman M., Menacker F. Neonatal mortality risk for repeat cesarean compared to VBAC in the US 1998-2002 birth cohorts.  Maternal and Child Health Journal 2010 Mar 14(2) 147-54.

Florence DJ, Palmer, D. "Therapeutic choices for discomforts of labor" Journal of Perinatal and Neonatal Nursing 2003 Oct-Nov 17(4) 238-49

Impey L. Boylan P. Active management of labor revisited.  British Journal of Obstetrics and Gynecology. 1999 106:183-7.

James D.C. "Routine obstetrical interventions: research agenda for the next decade." Journal of Perinatal and Neonatal Nursing.  2011 Apr-Jun 25(2): 148-52

Nil Nocere

This post is actually a quote from Dutch professor of obstetrics G. Kloosterman:

Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character.  The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine - nil nocere [do no harm].


Kloosterman, G. (1982) "The universal aspects of childbirth: Human birth as a socio-psychosomatic paradigm" Journal of Psychosomatic Obstetrics and Gynecology 1(1) 35-41 page 40.

Free New App for Breastfeeding

Hot off the press is the new LactMed App for iPhones and Androids.


LactMed, part of the National Library of Medicine's (NLM) Toxicology Data Network (TOXNET®), is a database of drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives are provided to those drugs where appropriate. 


All data are derived from the scientific literature and fully referenced. Data are organized into substance-specific records, which provide a summary of the pertinent reported information.


To download this App, go to the iTunes App Store or scan the QR code here below to learn more.

Apple Dumplings ~ from a UK Midwife!

Perhaps the first music video about breastfeeding!

What if......we substituted Childbirth Educator for the word Anesthesiologist?

There was an article that was written recently about the disparity in understanding between maternity health care providers, focusing on anesthesiologist.  In playing with the word anesthesiologist, I wondered what the article would look like if I substituted the word childbirth educator or education.  Here's how it turned out.  What are your thoughts?


********************************************************************

"Childbirth educators are pivotal in so many areas of the hospital, yet their work and expertise are not well understood, especially in labour and delivery settings," said Dr. XXXXXX, XXX Fellow at XXXX  Centre and resident physician at the University of XXXX and lead investigator of the study. "This study is the first-of-its-kind that explores specifically how childbirth educators and their labour and delivery colleagues perceive the childbirth educators role, and the potential impact of these perceptions on interprofessional dynamics and team collaboration in labour and delivery."

The study, co-supervised by Dr. xxx, vice-president of education at St. xxxas Hospital, and Dr. XXXXXXXXXXX  with the XXXXXX  Institute of xxxxx  Hospital and The xxxx Centre, was recently presented at the first International Conference on Faculty Development in the Health Professions in (city)  at  xxxxx  Hospital.

Health providers in the labour and delivery units at two urban teaching hospitals in Toronto were interviewed. Participants (ranging from midwives, nurses and obstetricians, as well as childbirth educators, all with different levels of experience) were asked a series of in-depth questions to determine their understanding of the childbirth educators's role during labour and delivery, the childbirth educators process, and the type and amount of education and training they had received around childbirth education management.

On analysis of the data, a number of important themes emerged: 

• Lack of understanding of the complexity of the childbirth education process during labour and delivery. While midwives, nurses and obstetricians appreciated the role of their childbirth educator colleagues, particularly in the provision of labour pain relief and anesthetics for C-sections, many reported that their understanding of the actual process of childbirth education was limited.
  
  
• Lack of training about childbirth education: Many nurses and midwives received little formal training about the childbirth education process in school or during their clinical placements. Similarly, most obstetricians had very little postgraduate exposure to formal childbirth education training. The study also revealed that opportunities for structured communication between all labour and delivery health professionals (ex. to discuss cases or to debrief after an adverse event) were infrequent and therefore, a missed opportunity for team learning and quality improvement. 
  
• Childbirth educators’ membership in the labour and delivery 'team': Nurses, midwives, obstetricians and other members of the obstetrical team spend countless hours with the patient throughout the entire labouring process. In comparison, the study found that the childbirth educators had less involvement in decision-making processes, even when they could have had useful and important input into a patient's care. The study found that this misunderstanding and the often peripheral position of the childbirth educators on the team, led to isolation of the childbirth education s in their work, which had implications for effective communication, collaboration and the safe delivery of care. 
  
• Imbalances and tensions between health professionals: The study found that some engrained stereotypes and historical tensions were present between different health professions. Instances of hesitation to question other professionals about decisions related to patient care were sometimes borne out of fear, or were due to inadequate training and knowledge. 
  "This study tells us that as health professionals, we have an immense amount of work to do in order to build a culture of true interprofessional teamwork and to provide the necessary training and supports to ensure that we deliver the best possible patient care, " .

World Breastfeeding Week 2011!

The theme of this year's World Breastfeeding Week is "Talk to Me! Breastfeeding a 3D Experience".  When we look at breastfeeding support, we tend to see it in two-dimensions: time (from pre-pregnancy to weaning) and place (the home, community, health care system, etc). But neither has much impact without a THIRD dimension – communication!

Every year, breastfeeding advocates and parents celebrate world wide Breastfeeding Week during August 1-7!
Even with global exclusive breastfeeding rates on the rise, the momentum to promote and continue to promote breastfeeding is a wise decision!

Read more.......

Healthy Babies Are Worth the Wait! New from March of Dimes

Another great resource for childbirth educators and doulas: the first educational stop on the pregnancy journey!

The March of Dimes' new campaign, Healthy Babies are Worth the Wait, informs health professionals and the public about the complications and health risks related to inducing a pregnant woman before 39 weeks gestation.

Through this new campaign, the March of Dimes aims to raise awareness among women and medical providers of the importance of having a full-term birth and allowing for natural labor, if possible.  

For more information and resources related the MOD’s 39 weeks campaign, visit:  http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html.

Food Guide Pyramid --> My Plate!

If you are viewing this on Facebook, please go to www.childbirthtoday.blogspot.com to see complete blog post.

Out with the old Food Guide Pyramid and in with the new My Plate!

The USDA has created a more user friendly and easier to comprehend way of looking at our nutrition and have replaced the Food Guide Pyramid with the new My Plate graphic.  Designed to help everyone eat better and be healthier, the USDA have also added some great resources to add to your childbirth education class materials or doula client information!

Check it out ~

Daily Food Plan for Moms
Daily Food Planner/Tracker
Moms with Special Nutritional Needs: Allergies, etc.

While not as Baby Friendly as the Surgeon General would like, there is info on nutrition and breastfeeding:

Breastfeeding Nutrition

What about food safety?  Click here

Need more info about nutrition and pregnancy and breastfeeding?  They have great resources too!

Remember, it is NEVER too late to talk to your expectant clients about the impact of dietary changes on the development of their baby(s)!  Even if you begin interacting in the closing weeks of the third trimester, share the My Plate with them.  It may make a world of difference!

Follow up: FDA oks Birth Pools

The FDA has released birth  pools from "detention" and will continue their investigation. For right now, they are NOT classifying them as Medical Devices, which is best for midwifery community and all women seeking a non-medicated birth. 


~ Waterbirth Solutions

10 Simple Truths About Childbirth ~ #5

If you are viewing this on Facebook, please go to www.childbirthtoday.blogspot.com to see entire post.  Thanks!

Many people are followers and few are leaders.  This is true both in childbirth related organizations and society as a whole.  Not only does it apply to "politics" but also how birth is viewed.  

Birth is an organic, normal, natural and physiologic process.  Like other body functions, birth typically does not need intervention.  However, occasionally, like other body functions, intervention is beneficial...in fact necessary for positive outcomes.

Whatever your role in the birthing community ~ care provider or care receiver ~ think twice about being a sheeple....that is, following the crowd.  Doing what has always been done because it appears ok.  The reality is, at the end of the day...or at the cliff's edge, it may appear ok, but it may not be ok!  

Oh, and another thought.  Be careful whom you do follow.

Birth Pool Accessibility Now in Question

If you are a birth professional, you will know how quickly the news about the FDA making accessibility to birth pools in the U.S. harder went viral today (5/26/11) .   The following is  information from long time expert and waterbirth advocate Barbara Harper: 




"In my personal conversations with a woman(Patricia Jahnes) in the "Office of Compliance- Center for Devices and Radiological Health" (that's where they put us) I was told in no uncertain terms that pregnancy is classified as an "illness" and "birth is a medical event" and therefore ANYTHING that is used during this time is considered a "device" and therefore needs approval by the FDA". ! BH


There is a flaw here in their (the Office of Compliance) reasoning.  A huge flaw.  So if one arm of the U.S. government believes that pregnancy is an illness and birth is a medical event and anything that is used during this time is considered a device that needs to be approved by the FDA, then what about Foley catheters used for Foley Inductions rather than for urinary flow?  What about Cytotec that is used frequently but not approved for use during pregnancy and birth?  And what about the inconvenient truth that both the electronic fetal monitors and the Apgar scoring system were never intended to be used in the manner that they are today?


I realize that these may be the difficult and unpopular questions.  However, I also realize that many of a woman's options and choices in pregnancy and childbirth are under attack.  


And therefore since one arm of the U.S. government believes that pregnancy is an illness and birth is a medical event and anything that is used during this time is considered a device that needs to be approved by the FDA, what is the next option/choice to go? 

10 Simple Truths About Childbirth ~ #4

‎"Men fear most what they cannot see" ~ perhaps that is why they fear childbirth? But all they really have to do is....look.


Fear is by far one of the driving forces behind the increase in medical intervention in childbirth.  "Men" meaning humankind, fear what they cannot see.  And since a good visual is not available for what is happening in the uterus and in the most dangerous 4 inches in an infant's life - the journey through the birth canal - then fear takes over.


Yet as much as we intervene in childbirth in the U.S., research continues to show with the rise in intervention rates, the rate of maternal morbidity and mortality/infant morbidity and mortality is still extremely poor.  In fact, 40 other countries have better statistics than the US in spite of the fact that the US spends more money on maternity health care.


But as the quotation says,  perhaps all one has to do is to look and they can "read" a laboring women.


I am not talking about EFMs or vaginal exams.  


I am talking about physical presence, verbal cues and emotional signals from women in labor.  


Study how she moves - left alone, a labor woman moves in perfect syncrony with her body to promote the cardinal movements of the baby: those miraculous movements that the baby initiates as the journey of birth begins.  Not signaled by the mother or caregiver, the baby instinctually knows how to move, bend and extend in order to fit through the tight spaces of the pelvis.  The mother will also move, bend and extend, crouch, squat, stand, sit, kneel, sway, lean and walk as if listening to a birth song...dancing to this song to bring her baby into the world.


Likewise, she may also "sing" along with this birth song...verbalizing as best as she can the effort going into this work.  It may be in the form of talking, moaning, singing, yelling, groaning, or talking in soft, loud or angry tones.  With each phase/stage of labor, her verbalizing changes, signalling the change from one phase to another.  Her verbalizing tries to match the intensity of the contractions and the work her body does.


As her verbalizing changes in intensity, so do her emotions.  From calm and expecting, to intense and working, to fierce and with effort, a laboring woman's emotions also change to match the work she does.  As the contractions become stronger in an effort to push the baby from the uterus to the loving arms on the outside, the emotions (and endorphins) match this strength.  With the protective fierceness that exists down deep in all mothers, a laboring woman expresses her emotions verbally, on her face, in the tone of her words and in her physical actions.


If we as caregivers take the time (albeit precious) to be fully present at a birth and watch with careful eyes the emotions, movement and verbal cues given by laboring mothers, then as we learn what is normal (and what isn't), birth will no longer be a fearful experience.  But we absolutely must know the normal before we can truly deal with the abnormal.  Then our morbidity and mortality statistics will be more reflective of the maternity care we all want to achieve.


While this has spoken more about the fear that caregivers have of birth, I will soon write Simple Truth #4a - about the fear that pregnant women have surrounding birth.  That also must be addressed.

The New Birthsource Lamaze Childbirth Educator Program!

In the spring of 1979, my husband and I sat in a Lamaze Childbirth Education Class in Lompoc, California.  While I was a nurse, normal and natural childbirth was something new to me.  We were taught about crisis intervention and all of the modern technology of the day, but this was totally new.  I was incredibly inspired by our educator, Linda Richardson (I believe that was her last name).  The spark of childbirth education had been ignited.

During the birth of our first daughter in April of '79, I experienced the Lamaze techniques and some of the same feelings we saw in the birth film (reel to reel ~ LOL) "Nan's Class".  As I held my beautiful daughter in my arms, counted her fingers and toes like all new parents, I knew my destiny.  I wanted to be an educator!

Several month later, I called Linda only to find that ALL of the Lamaze Educators in the local area were leaving, as their husbands were all military and it was time for new assignments.  They all helped me complete the educator program, including my own Seminar taught by Harriet Palmer in Fresno.  In August of 1980, I taught my first Lamaze childbirth education class, under the observation of one of the other educators.  I was hooked!  I soon became an LCCE and then a charter FACCE.

When our second daughter arrived in 1986 at Cape Canaveral Hospital in Florida, I had been teaching for seven years and really got an opportunity to "practice what I preached".  Her amazing birth reinforced that normal, natural childbirth was possible, even in a hospital setting; that there were care providers who believed in the power of women and the normalcy of birth!  Her birth strengthened my focus and further dedicated me to education.

During the 31 years since certification, I have taught in many states (as my husband was also in the Air Force), locations (adult schools, colleges, military hospitals, civilian hospitals, churches, and privately).  As I checked the mail yesterday, that same thrill came to me as I opened the envelope from Lamaze International containing the welcome letter and certificate for the new Birthsource Lamaze Childbirth Education Program!

While to many it may just be a natural progression - the sage femme becomes the educators' educator - to me it is an honor and privilege to be an active part of such a respected and prestigious organization that has stood for education, advocacy and maternity reform for so many years.

I guess now I too can say.....Thank you Dr. Lamaze.
And thank you to my daughters, who unknowingly played such an important part of my career!
And to my husband, who stood by me, cheering all the way.

10 Simple Truths About Childbirth ~ #3

I have begun the series "10 Simple Truths About Birth".  You can respond on Facebook, or directly on my blog at www.childbirthtoday.blogspot.com.  

Truth #3:    Many of today’s expectant women are passive, uninformed and fearful

In a discussion several days ago with another seasoned birth professional, we came upon the theory that the reason why so many women present in childbirth class passive, uninformed and fearful is because they may not have had the same type of role models as in the past.  

Rather than strong family members giving birth and being empowered parents, expectant mothers of today are influenced by the media, and the half truths, misinformation and sometimes, out right lies that are told.

When it comes to books, many women are familiar with the main stream books that are trendy and hip but contain, again, misinformation and half truths.  Rather than look for the evidence-based information, they are relying on celebrities and even some of my own maternity/obstetrical colleagues to provide a non-biased view of birth.  Unfortunately, expectant women who rely on these sources lose in the long run.

Likewise, if expectant parents rely on television, they will also lose.  Few if any televised shows about childbirth/breastfeeding present unbiased and/or evidence-based information.  Case in point:  

Please also view this:





And finally, this opinion:





Thank you to American Baby and "Better" for helping to promote the importance of childbirth education classes.   Where do the majority of the expectant parents you know get their information?

10 Simple Truths About Childbirth ~ #2

 Today I begin the series "10 Simple Truths About Birth".  You can respond on Facebook, or directly on my blog at www.childbirthtoday.blogspot.com.

Truth #2:  US maternity care does not practice evidence based care.

The US Maternity Health Care system does, in fact, not practice evidence based care.  A close look at the statistical data on maternal morbidity and mortality/infant morbidity and mortality shows a very bleak picture of our outcomes based on an interventive based care plan.  In fact, in their new initiative, Childbirth Connection states that “the largely healthy and low-risk population of childbearing women and newborns experiences 6 of the 10 most common hospital procedures. One out of three babies is born via cesarean section, the most common operating room procedure in the United States. Best evidence supports more judicious, restrictive use of maternity care procedures, and suggests that overuse is contributing to significant excess harm and costs.´

There is obviously a disparity between evidence based care and the care practices in the US.  But, as Childbirth Connection also asks, how can you make a change if you don’t know what you are aiming for?”  Exactly!

The scope of change will never happen with birth professionals standing at the hospital doors, banging, and yelling “You must change because we say so and because it is right”.  As stated in another “Truth”, hospitals are indeed companies or businesses wanting to make a profit.  Change will not happen necessarily because the literature says that is the thing to do….especially if “what we’ve always done” is working….mirroring the old adage: If it ain’t broke don’t fix it.

It is broken.  Research is beginning to come to the surface about our broken system.  A report issued by the California Pregnancy-Related and Pregnancy Associated Mortality Review shows that deaths from pregnancy-related causes, usually occurring at the time of birth, have risen dramatically in the U.S., in spite of the increased use of technology and the increase in cesarean section rates.  In fact, the study that was released on April 26, 2011 stated that the increase in cesarean sections were a major contributor to the increase in deaths from pregnancy-related causes.

But again, what does evidence based maternity care look like?  What is staffing, what services?  Is there a comprehensive childbirth education program and if so, what do those classes look like, certification?  What about a hospital based doula program?  Again, the Childbirth Connection asks for an essential package to answer these questions and many more.

I especially like Childbirth Connection’s call for a revival and broaden reach of childbirth education through expanded models and innovative teaching modalities.  

This in turn, will foster and promote a true cultural shift in attitudes toward childbearing.

10 Simple Truths About Childbirth ~ #1

    Today I begin the series "10 Simple Truths About Birth".  You can respond on Facebook, or directly on my blog at www.childbirthtoday.blogspot.com.

Truth #1:  Birth is healthy and normal, complications are the exception.

Mother nature says it.  The World Health Organization says it. Many maternity health care professionals such as physicians, midwives, nurses, childbirth educators and doulas say it.

Birth is healthy and normal. 

Anyone can find proof.  See abstracts of journal articles at the website for the US National Library of Medicine/National Institutes of Health or the Cochrane Database.  Read about it in books such as The Official Lamaze Guide: Giving Birth With Confidence, 2^nd Edition.

Interfering with the normal physiological process of labor and birth in the absence of medical necessity increases the risk of complications for mother and baby. So why is nature seen as abnormal and interventions seen as “normal”?  One educator shared on Facebook that it was the media and cultural brainwashing.  Some believe it is the process of accustomization – where we are slowly and methodically lead to believe that intervention is beneficial and good – see my previous blog and video spot from the US television show, "The Doctors".  Sadness was the emotion that came to me as I viewed this.  This was not an instance of misinformation or omit evidence.  What they did on that show was lie about the risks of the use of epidural anesthesia.  How sad.

It is vital that we continue (and in some cases, begin) to teach from a risk/benefit view…evidence-based information…best practice. The Joint Commission requests this practice.

How to do that?  Lamaze has established the Six Health Birth Practices: avoiding medically unnecessary induction of labor, allowing freedom of movement for the laboring woman, providing continuous labor support, avoiding routine interventions and restrictions, encouraging spontaneous pushing in nonsupine positions, and keeping mothers and babies together after birth without restrictions on breastfeeding ~ skin to skin.  Well established documentation of the evidence accompanies these Birth Practices.  Lamaze has partnered with Injoy Video Productions to make professional quality handouts and free videos available to everyone.

Many birth professionals who receive formal training such as physicians and nurses may have never thought of birth as anything else than a crisis waiting to happen. That concept is not taught in the medical schools and nursing schools of the U.S.

Do not be afraid of speaking the truth.  The paradigm shift needs another a kick start.

Questions to Ponder

These are questions I've been wondering about for a while....actually quite a while.

If birth is natural and normal, then why isn't intervention of any kind (with the exception of emergent cesarean) seen as the non-norm?

Why are those who seek natural, healthy, normal birth seen as "odd" or labeled with everything from "crazy" to "granola crunchers"?

If, as the research demonstrates, all medication crosses the placenta and affects the baby, then why are women more fearful of THAT than the few minutes of pain/hour of labor?

The female breasts are put there to nourish a newborn.  Why is these seen as the non-norm?

Why are those who breastfeed their babies seen as "odd" or labeled with everything from "crazy" to "granola crunchers"?

If, as the research demonstrates, breastmilk is THE perfect source of nutrition for babies, then why are women more fearful of THAT than the additives in formula?

Mmm, I see a pattern here.  Do you?

View this...then read that.

View this segment from U.S. television:






Then read this:

http://www.scienceandsensibility.org/?p=2379#respond 


Thanks to Kimmelin Hull for a brilliant rebuttal.  Also read some of the comments if you would like to write the Doctor's TV Show.