Just the facts: The Home Birth/Hospital Birth Conundrum Part 1

There has always been a separation between ideals in the conversation between home birth advocates and hospital birth advocates.  Lately, the separation has become wider and more volatile.  It is vital that the facts surrounding both this summit and homebirth/hospital birth be clear.

The summit was held October 20 & 21, 2011 in Warrenton VA and present were birth professionals and leaders.  These professionals and leaders included representatives from the following prestigious organizations:  MANA, LAMAZE, ACNM, AWHHON, ACOG, AAP, ICTC, NACPM, AABC, and Our Bodies Ourselves with collaboration from Childbirth Connection, The White Ribbon Alliance, JPhiego, ICM, NARM, and the Farm.  These organizations along with representatives from hospitals and universities, examined the current research regarding the entire topic of birth and the impact of where birth happens.

With passion and dedication, nine common ground statements were achieved:

STATEMENT 1

We uphold the autonomy of all childbearing women.  All childbearing women, in all maternity care settings, should receive respectful, woman-centered care. This care should include opportunities for a shared decision-making process to help each woman make the choices that are right for her. Shared decision making includes mutual sharing of information about benefits and harms of the range of care options, respect for the woman’s autonomy to make decisions in accordance with her values and preferences, and freedom from coercion or punishment for her choices.

STATEMENT 2

We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.

STATEMENT 3

We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes. This system provides culturally appropriate and affordable care in all settings, in a manner that is acceptable to all communities.  We are committed to an equitable educational system without disparities in access to affordable, culturally appropriate, and acceptable maternity care provider education for all communities.

STATEMENT 4

It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.

We believe that guidelines should:

• allow for independent practice
• facilitate communication between providers and across care settings
• encourage professional responsibility and accountability, and
• include mechanisms for risk assessment.

STATEMENT 5

We believe that increased participation by consumers in multi-stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.

STATEMENT 6

Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings.  To achieve this, we believe that all health professional students and practitioners who are involved in maternity and newborn care must learn about each other’s disciplines, and about maternity and health care in all settings.

STATEMENT 7

We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers and contributes to:

• inadequate resources to support birth injured children and mothers;
• unsustainable healthcare and litigation costs paid by all;
• a hostile healthcare work environment;
• inadequate access to home birth and birth center birth within an integrated health care system, and;
• restricted choices in pregnancy and birth.

STATEMENT 8

We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings. These data would be linked to other data systems, used to inform quality improvement, and would thus enhance the evidence basis for care.

STATEMENT 9

We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.

A full list of delegates who endorsed these statements is available at the Home Birth Consensus Summit website. 

Private Childbirth Classes Cost What???????????????

With a heightened buzz about childbirth education classes lately, one of the biggest questions I receive as a private educator is "why do private childbirth classes cost so much and what is the difference between them and the hospital"?  Whether you are a consumer (currently pregnant) or a professional, I hope this will give insight!

Hospital Based Childbirth Education Classes:
Looking at the average cost of hospital based childbirth education classes, here's what I found: the average hospital based childbirth education class is 8 hours in length (either 4 weeknights of 2 hours each or a weekend class) and cost approximately $65.  These classes have 6-15 couples (or 12 - 30 people) and include hospital policies and procedures and a tour.  Generally, hospital based childbirth education classes are taught by nurses with a knowledge of labor and delivery but who may or may not be certified by national childbirth education organizations. (important note: nursing schools do not included how to be a teacher in the curriculum).

Private or Community Based Childbirth Education Classes:
The nationwide average of private childbirth education classes is 10-12 hours in length, usually at the scheduling option of the consumer and cost approximately $200.  These classes have 1-2 couples (2-4 people) and include a wide variety of evidence-based information.  Private/community classes are taught by certified childbirth educators who may or may not be nurses.

Based on the above information, here are some quick facts:

Either type of class may be taught by someone who is OR is not certified.  It is up to to the consumer to research this.

Hospital classes generally talk about the procedures done at that facility, not the options that the laboring mother has.

Cost ~ those who teach childbirth education in either hospitals or privately make the same amount of money per hour.  Even though hospitals charge $65 per hour (65/8 = $8.12), no nurse is going to teach for nearly minimum age.  Her salary (approx. $25-$32/hour) is subsidized by the hospital and all of her teaching supplies are purchased by the hospital as well.  The educator who teaches privately and charges $200 (200/12 = $16.66) received over $16 per hour but must also purchase any and all of her teaching supplies herself.

Private or community based classes can share the latest national statistics, research and updated information about a variety of topics important to the consumer.  Some hospital educators are actually told to not share evidence based research or statistics if that goes against current hospital policy or procedure.  Such information can include information about risks/benefits of epidural anesthesia, cesarean sections, or the benefits of continuous skin-to-skin contact after birth with mother/baby or the benefits of delayed cord clamping.

What I am NOT saying here is that you will get a better education if you attend a private or community based childbirth education class.  I am also NOT saying that you will receive a tainted or substandard education from a hospital class.  What I AM saying is that you as the consumer need to research the childbirth education options in your community and find out what best suits your needs.  Do you need more information on how to choose childbirth education classes?  Click to this link for a great article with more information!

Dystocia: is there a gene for that?

On every birth professional's reading list should be Penny Simkin and Ruth Ancheta's updated and 3rd edition of The Labor Progress Handbook.

This new edition comes with even more information on the simplicity of birth, and common sense non-invasive methods to prevent or facilitate dystocia. Heavily referenced (new references have been added and others have been updated), this edition is a must have for childbirth educators who practice in the community or in a hospital setting!  Retaining the hallmark features of previous editions and meeting the needs of all types of learners, this book uses charts and  illustrations showing position, movements, and techniques and is logically organized to facilitate ease of use.  Two new chapters are included in this 3^rd edition and include research based information on third and fourth stage labor facilitation, including low-technology interventions, a complete analysis of directed versus spontaneous pushing, and additional information on massage techniques. Information on delayed cord clamping, the Gaskin Maneuver and so much more.

And new research indicates that dystocia may be in a woman's genes.

In a new study just published (Indentification of a Myometrial Molecular Profile for Dystocic Labor BMC Pregnancy and Childbirth 2011 11:74), researchers Brennan et al suggest an underlying molecular basis for dystocia in nulliparous women in spontaneous labor.  Myometrial biopsies were obtained from the upper incisional margins of nulliparous women undergoing lower segment cesareans for dystocia.  These women were in spontaneous (non-induced) labor but had received intrapartum oxytocin to accelerate labor.

This new finding suggest an important role for the immune response in dystocic labor and could provide indicators for new diagnosis and therapies for helping with dystocia.

In light of this new study, we need to be as prepared as possible to assist women with any event that needs assistance during labor and birth.  The Labor Progress Handbook is one important tool to have!

A Few Reasons Why Occupying a Hospital Won't Change Policies & Procedures

Several days ago I posted this on my Facebook page:

"What if we 'occupied' hospital parking lots?  Would that facilitate policy and procedure change?"

Several people, within just a few minutes, were ready to paint signs and begin the sit-in.  I was very surprised at the response, yet have since realized that it is through the frustration of years of "telling the truth" that this must have been a visceral response.

Occupying any location in a hospital or near a hospital for the purpose of facilitating policy and procedural change would be folly.  Why?  If you have ever worked in any type of business and tried to facilitate change, then you already know that change does not happen because someone is protesting or beating the door while yelling "you must change because we said so".

As with most change, it happens sssslllooowwwlllyyy.  It happens because more and more become educated that the "way we've always done it" is no longer desirable, gets the desired responses or is no longer useful.  It is difficult because we are creatures of habit and typically multitask - so habit enables multitaking.

Change also happens from the top of the pile.  Hospitally speaking, it happens when nurse managers, directors of nurses, administrators and the finance people all realize that this change will impact their numbers.  Yes, it is a numbers issue.  And who impacts the numbers most of all?  THE CONSUMER.

But unlike when this happened back in the 1970s, the consumer cannot take the larger responsibility of informing the professional that excessive intervention rates and unfathomable cesarean rates hurt mothers and babies rather than help them.  Exposing the facts from the CDC and World Health Organization about the maternal morbidity/mortality rates and infant morbidity/mortality rates is paramount in bringing about change.  Getting this information to the top, to those nurse managers, directors of nurses, administrators and yes, even the finance people is paramount.  While the the finance people may see early preterm births as revenue from the added intervention (cost) and admission into the NICU (cost) as a benefit, we need to also inform the consumer that professional who pay the bills on the very backs of the healthy consumers must be informed and educated.  And ultimately, stopped.

In a state of economy as this country (the US) is currently experiencing, all are conscious about keeping their jobs.  L/D nurses and childbirth educators are not excluded.  But it is beyond my personal thinking that especially these two groups of which I am a part of both, can continue to protect their jobs and not tell the absolute truth about the hazards of induction/medication for labor and the risks/benefits about intervention (especially cesareans).  This is called teaching informed consent and I thought it was the foundation of every childbirth education certification program.

But perhaps, as childbirth educators and nurses, need to go back and look at why we chose this profession?  At least for myself as a nurse, I chose nursing to take care of people and get them (in obstetrics) from one state of health to the next.  As a childbirth educator, the choice was similar but instead of me caring for them, I wanted them to become active in their own health care and make the choices that are best for them.

So what is the answer?  If we advocate for change from the "top" (directors/administrators) as well as from the "bottom" (parents), just as we did in the 70s, then there will be an educational squeeze play and change will occur.  Rational behavior with a side order of evidence based information, referenced to the hilt is the order of the day.  Every professional organization should talk about it.  We must insist that The Joint Commission and Magnet Recognition change/add to their definitions of quality by insisting on evidence-based best practice.

And as childbirth educators, we need to present information in the complete risk/benefit style that we all know is best practice.  We need to be bold, be true and be educated ourselves.  Our classes can still be exciting and enriching without being overly humorous (portraying to parents that childbirth is something funny) or aggressive.

This is serious business.  And we are only contributing to the statistical nightmare if we don't ramp up best practice now.

Dear Dr. Lisa, Thank you for helping!

After viewing the segment on waterbirth with Barbara Harper yesterday on the daytime talk show The Doctors, I just want to say thank you to Dr. Lisa!

The Doctors asked Barbara on their show to talk about waterbirth. After all, she is the expert and travels world-wide to educate professionals as well as parents about the gentleness and benefits and the precautions surrounding waterbirth.  She has written books.  She has created DVDs.  She has an evidence-based website with all of the evidence-based research data.  As Barbara said in a text message to me on 10/5/11 about the show: "They edited it so much and moved things around.  The taping was far worse and longer.  I actually think it was good for our side.  The truth prevails!!"

And Dr. Lisa made a great point (and I am paraphrasing): please read ACOG's opinions and then go to Barbara's website to see the research evidence from medical journals and then let the parents make the decision.  Brilliant.

It was clearly evident by her excessive body language and voice inflection/argumentative tone, that Dr. Lisa felt very threatened by Barbara's presence and the evidence which Barbara brought to the show....or tried to even over the posturing and yelling of Dr. Lisa.  This is, in fact, typical behavior when a person feels as if their territory has been invaded.

However, and let me be historically accurate, it was the midwife or sage femme who began assisting mothers with birth...back in the day...when we all wore fig leaves and lived in caves.  It was the midwife/sage femme who continued to care for the family when other children came along.  Physicians became insanely valuable during difficult births and because they are trained surgeons, when a cesarean became necessary.  However seeing that becoming a mainstay in maternity care meant more financial stability, some physicians formed a trade union called ACOG - the American College of Obstetricians and Gynecologists - and began a movement to move in on and ultimately deter midwifery care.  And more damning is that in a June 2011 story on MSN, this statement appeared:

Less than a third of the recommendations from the American College of Obstetricians and Gynecologists (ACOG) are based on gold-standard scientific experiments, researchers found.  

The rest are based on anecdotal evidence or expert opinion, which is subject to personal biases, they reported.

So if ACOG and obstetricians in general are operating on less than 33% evidence, is it any wonder why Dr. Lisa had to resort to carnival stunts by showing a dirty aquarium with a baby doll sunk in the water?  She simply does not know the evidence.

Oh, wait, this isn't the first time that they have formed a movement against wellness in maternity care.  In the early 1980's, physicians/hospitals co-opted childbirth education from the community to the hospital ("The Politics of Co-optation: strategies for childbirth educators" by Dr. Eugene Declerq. Birth 1983 Fall 167-172) .  As epidurals, inductions and the rising cesarean rate became evident, obstetricians often tell their expectant patients that childbirth education is not necessary.  In other words, don't go.  Hospitals loose revenue, and reduce childbirth education down to a one day, 4 hour class or worse yet, no classes offered at all.  And too, an informed patient/client asks questions, which take time and may cause a deviation away from the set and managed practice guidelines.

In her 2004 book, The Medical Delivery Business, author Barbara Bridgman Perkins states that academia and industry (aka the pharmaceutical company) worked together to develop management of labor - not only an expectant mother's labor but the labor work force in a hospital.  An Upjohn-funded study in Britain concluded that labor induction could save hospitals money by enhancing staffing and efficiencies in their labor and delivery units.

More inductions --> more interventions --> more cesareans = more $$.  And according to Perkins, bowing to (1994) contemporary practice, ACOG softened its stance against elective induction for logistic reasons.

"Production costs" do not allow for nature to be involved.  Long labors cost man-hours, with no added benefit (revenue from induction, interventions such as continuous EFM, epidurals, cesareans).  The one-workday labor is a major incentive for managed care.  Nature not invited.

Dr. Lisa may have very well ignited (or fanned the flames) of re-forming maternity care by reformation.  Similar to what the International Childbirth Education Association published in 1972, Doris Haire's The Cultural Warping of Childbirth (where she documented the inadequate evidence supporting much of the routine technological intervention practiced in birth during the late 60's and 70's).  Sound familiar?

There should be a second edition of The Cultural Warping of Childbirth published.  The re-forming of care, the true identification of best practice, and putting the well-being of mothers and babies above increasing revenue should be paramount.  There needs to be a ROBUST conversation about the state of maternity care.

The question is: can we come TOGETHER to actually have that ROBUST conversation?

I believe the answer is YES!

So yes, thank you Dr. Lisa for reminding us about all of these things! 

Remember the Psychology of Daytime Television: Contact Information

.......and should you be moved to response to the program directly, here is contact information from our friend Jeanne Batacan:


It should prove to be a very interesting program - and according to the guest Barbara Harper may just move you to contact the website:


http://thedoctorstv.com/main/ask_our_doctors




or contact the Associate Producer justin.winters@cbs.com 


or write to the program:

The Doctors
5555 Melrose Ave.
Mae West Building, Second floor
Los Angeles, CA 90038

Remember the Psychology of Daytime Television: The Young and the Childbearing!

This Wednesday, October 5 2011, birth advocate and friend Barbara Harper will be on the US daytime talk show, The Doctors.  Filmed a few weeks ago, we have anxiously been waiting on this segment.


As we prepare to gather before our televisions on that day, please try to remember that this show is on daytime television!  Daytime television is the home of ridiculous game shows, shows where half of the US population do not know actual paternity, people dress up like chickens to win prizes and residents of imaginary towns flaunt their dirty laundry. (Wait, am I sure I am talking about DAYTIME television?)


According to Wikipedia, daytime television is  usually designed to be viewed by audiences such as stay-at-home mothers and fathers, and secondarily those viewers who might not usually carry a job, such as the unemployed, senior citizens and in some select cases, college students. For all intents and purposes however the traditional target of daytime television has been demographically 18-49 women, and as such daytime programming is hosted by women and usually pertains to women's issues and other subjects such as child care, minor health care and other issues within a home setting.


I suppose by that definition and judging from the kind of drivel they put on Daytime Television, programming must be mindless and ridiculous for this demographics to be attracted to it.  Keeping with that thought, then, does that imply that The Doctors falls into the category of drivel.


If you are following this logic train, then to be upset with the reception that Barbara is going to receive OR did receive on this daytime television show is also drivel.  However, if you look more closely at the demographics of 18-49 women, these are childbearing women!  This is also OUR target market!  Hence, we cannot ignore this drivel.


So, I propose that the entire cyber birth community begin today to flood the net even more with evidence of best practice of maternity care - statistics, quotes, videos etc.  Yes, even more than normal.


In this way, when The Doctors airs on Wednesday, and stays then forever on You Tube, all will see it as............just drivel.

Top 10 Topics for Childbirth Education Classes ~ Part 2

As a veteran childbirth educator, I am always being asked by newer childbirth educators what are the most important topics in a childbirth education class!  That can be an easy yet difficult topic.  It can be easy because there are so many topics that should be covered to adequately inform expectant parents.  Yet, this question can also be difficult because of time constraints imposed on the educator.

Below are the “last” 5 top topics of 10 frequently requested by the expectant parents:

Where can I learn more – what are good resources?

Regardless of the length of the childbirth education class, clients can always learn more!  But where do you go for information…that is evidence-based and unbiased?  Many expectant parents today turn to the internet and that is ok, but use it with caution.  ANYONE can create a website or blog, make it look wonderful, but place on it incorrect information!  

However, some websites can be a great beginning place:

www.birthsource.com has over 1200 articles for parents (as well as professionals) that are evidence-based and unbiased!

www.thebirthfacts.com is a website that features links that take the visitor directly to the research.

www.childbirthtoday.blogspot.com is blog powered by Perinatal Education Associates, Inc. and has a lot of great info, mainly for birth professionals.

www.mothersadvocate.org  was created by a joining of Injoy Videos and Lamaze International.  Here your students can find free videos and professionally made handouts - free!

www.motherfriendly.org is the website for CIMS ~ the Coalition For Improving Maternity Services.  This can point you in the direction of other great websites world wide.

www.scienceandsensibility.org is powered by Lamaze International and is a blog with great research and articles.

www.vbac.com is a woman-centered, evidence based resource from author and researcher Nicette Jukelivics.  The information there is for both parents and professionals.

http://us.cochrane.org/evidence-based-healthcare-resources is the mecca for evidence-based health care resources.

What can my partner do to help me during labor/birth?

Labor support, both emotional and physical, is essential during birth.  The partner may not be “wired” to know instinctually what to do at select times in labor.  A great solution is a childbirth class geared specifically to comfort measures and partners!  If this is not available, a great secondary solution is the book The Birth Partner – Revised 3^rd Edition: A Complete Guide to Childbirth for Dads, Doulas and all Other Labor Companions.  It is currently available through Amazon for $11.55. A fantastic investment!

What about herbs during pregnancy and then herbs and placenta encapsulation after the birth?

If you as a childbirth educator are not qualified to speak to herbal remedies or placenta encapsulation, it is best to contact an expert in these two areas and invite them to either be a guest speaker or help you put together FAQ sheets.  Many health care professionals do not have backgrounds in herbal medicine and the FDA does not do research in this area. Contact a local midwife for their herbal contact – or it might be them! Likewise placenta encapsulation is a relatively new arena and thus you may have to send your clients to www.placentabenefits.info for more research and referrals.

What does labor/birth have to do with breastfeeding?

You may be the one to cover this information and what better resource to base your presentation on than Impact of Birthing Practices on Breastfeeding by Linda J. Smith (also available on Amazon).  Through this amazing research based book, you will find all of the links between labor/birth and breastfeeding that are available today, including location of the birth, medications, interventions and the power of labor support in breastfeeding.  Also in this book are the references for all of the statements made.  Some of the research may amaze and challenge you!

Childbirth education classes should never be “cookie cutter” in style…that is, they should not be repeated word for word during each series.  Childbirth education classes should be geared specifically to the educational needs of the students.  This can be simply accomplished as one hospital has done (Miami Valley Hospital, Dayton Ohio) – during the first class they give a handout that is to be completed and turned back in at the end of that first class.  This handout asks the students for their specific areas of interest and concern – both the expectant mother and the partner.  In this way, a hospital class can be interactive and personal.

Top 10 Topics for Childbirth Education Classes ~ Part 1

As a veteran childbirth educator, I am always being asked by newer childbirth educators what are the most important topics in a childbirth education class!  That can be an easy yet difficult topic.  It can be easy because there are so many topics that should be covered to adequately inform expectant parents.  Yet, this question can also be difficult because of time constraints imposed on the educator.

Below are the first 5 top topics of 10 frequently requested by the expectant parents:

Should I really go to childbirth education class?  If so, how do I choose which one?

Jamilla Walker RN
Author of
The Labor LadyGets Pregnant

Childbirth classes are designed to provide factual answers to questions. The classes should the parents a complete understanding of the process of birth and techniques that will help them through that process. Childbirth education is far more than learning to relax and breathe through contractions. When we understand the birthing process then we are better able to work with our bodies and not against them.

Choosing an Educator  It is important to take the time to inquire about the qualifications of a childbirth educator prior to attending their classes. Certified childbirth educators should go through an intensive training course and demonstrate competency in teaching and in childbirth. Parents should not be afraid to ask for references or to see past course evaluations.  Note: they don’t teach how to be a teacher in nursing school.  So because a childbirth educator is a nurse, doesn’t always mean she is a good educator.

When choosing a class, determine whether the class is consumer oriented or provider oriented. Consumer oriented classes tend to encourage expectant parents, the consumer, to take an active role in choosing the options desired for the birth. Provider oriented classes tend to inform parents as to the care and procedures they can expect from the hospital and your doctor during childbirth, sometimes with little emphasis on alternatives.

Private or Group Class   Once they have choosen the childbirth educator, then they should determine whether to have private instruction or be part of a group class. Private instruction allows for more flexibility and individualization. Classes are arranged around their schedule and greatly benefit those who are not able to attend the weekly group classes. Moreover, private classes can benefit those who may have apprehensions about being involved in group activities. Also, private classes allow personal questions to be asked that otherwise may not ask in a group setting. Some private classes are taught in the comfort of their home. This especially benefits those women on bed rest. Private classes will cost a little more, but it may be worth the difference.

Group classes greatly benefit those who prefer to meet other women or couples who are also pregnant. Group discussions on issues related to childbirth are common and oftentimes invigorating. Many hospitals offer group classes so parents can become familiar with the policies and procedures of the hospital in which they plan to give birth. This affords  them opportunity to know what options are available and what they can expect during their hospital stay. Since the class members have similar due dates, they may even see them in the hospital during or after the birth. These friendships can last long after the birth of the baby.

Types of Classes   There are a variety of childbirth classes available to you. The most common is the basic childbirth preparation course consisting of at least 12 hours of instruction. There are also weekend courses that can help those on a busy schedule. The refresher course benefits those who've previously given birth and the teen course is especially designed to address the needs of pregnant teenagers. Some childbirth educators also offer hourly consultation for those who have questions to ask but don't necessarily want a structured course. This, however, is not advised for first-time moms or teenagers. Take the time to review the contents of each course to determine which course is best suited for you.

Bottom line:   Know who all of the childbirth educators are in your community and what method they teach.  Be able to give referrals freely to Lamaze childbirth educators,  independent educators, hypnobirthing educators, Bradley teaching couples, hospital classes, etc.

Pregnancy wellness and the impact on labor/birth

Length of childbirth education classes often dictate what topics and to what extent topics are covered.  Unfortunately today, expectant parents feel like they cannot afford the time to take childbirth education classes – they are just too busy.  In answer to this feeling, hospitals have shortened and shortened childbirth classes to where some classes are only 4 – 8 hours long: one day.  Some educators call these brief experiences “drive through” classes, because the exposure to information is so incredibly brief.

Topics usually on the chopping block first are those of pregnancy wellness, nutrition, exercise and stress reduction – and their impact on labor and birth.  Wait….if all of these topics impact labor and birth and are left out of a curriculum …..are educators short changing parents?  This is a bold statement, but the answer is YES.

How to teach this topic?  Explore the new My Plate information on nutrition (http://www.choosemyplate.gov/foodgroups/downloads/MyPlate/SelectedMessages.pdf) ,  exercise (http://www.mayoclinic.com/health/pregnancy-and-exercise/PR00096), and stress relief during pregnancy http://womenshealth.about.com/cs/pregnancy/a/mispregstress.htm.  Evaluate what you can actually teaching within the time boundaries of your class and what you can afford to put into handout format.  Be a good resource for community based referrals also such as pregnancy exercise or pregnancy yoga classes!

What will labor really be like?

This topic can include the Stages and Phases of labor, cervical dilation and effacement, pelvic station, cardinal movements, intensity of labor contractions, time variations within the stages and phases, emotional and spiritual changes in the laboring mother, physical changes in the laboring mother….this can be a really inclusive topic!  Be certain to include the topics of fear and pain.  These are two elephants in the room that are fed healthy diets by many cable TV shows about pregnancy and birth.  The pain of labor must be differentiated from, for example, the pain of a headache or muscle strain.

How to teach this topic?  You can use a variety of teaching strategies including lecture, interactive discussion, handouts and visuals such as charts, models and videos.

What are my options?

For many women, childbirth is their first experience in a hospital.  It might also be their first healthy experience with a hospital – if family or friends have been previously admitted into a hospital when sick or injured.  It is vital to address the fact, prior to exploring options, that pregnancy is an experience of health.  It is not like other events of hospitalization where one is ill.  Therefore, a laboring mother and her partners’ options are greater.  Options include choice in physical comfort (such as positions, labor apparel worn, massage/touch etc), support (including partner support, doula support, family support and genuine emotional support from hospital staff), coping strategies (including breathing, relaxing, guided imagery, focusing, touch/effleurage, aromatherapy, water therapy, music, spiritual support), educational support (proactive reading and attendance at childbirth education classes).

How to teach this topic?  A firm foundation of comfort measures meshed with an equally firm foundation in anatomy and physiology of labor/birth leads to a conversation of informed consent.  This powerful topic, informed consent, lays the ground work for patient satisfaction in the entire birth experience.  Research shows that the degree to which a laboring woman feels that she is a vital role in the decision making process of labor/birth, increases her satisfaction with the process and positively impacts her parenting.  Lecture, guest speakers (other parents), videos, group discussion/brainstorming, and handouts may all be utilized.

What can I expect when laboring/birthing in the hospital?

The reality of nurses carrying multiple patient loads is a topic that needs to be covered in any childbirth education class.  This is a reality that may not be on every expectant parents’ radar.  Likewise, typical/routine interventions such as electronic external or internal fetal monitoring, medication for induction/pain management, mechanical induction methods, and the latest evidence-based information regarding routine birth/newborn procedures.  It is quite possible for a rousing discussion of “why do they still do that if it is not evidence-based” might follow any lecture situation on routine birth/newborn procedures.  Keep your objective teacher hat ready and avoid letting your personal/professional biases show.  Let the evidence speak for itself.

How to teach this topic?  Not only do you need a great objective teacher hat but also a great poker face for this group of topics.  Here, more than anywhere else, your biases will show.  The separation between a childbirth educator and a great childbirth educator is the great childbirth educator presents the topics with the current, up-to-date evidence-based research and the class members have no idea of any bias.  Borrowing from the Fox News Channel motto “we report, you decide”, would be a good way of keeping professionally focused on this topic.  If you have a strong bias and poker faces are not your strong suit, use videos (such as Healthy Birth Your Way – free download at http://injoyvideos.com/mothersadvocate/videos.html), handouts (see same website for excellent handouts) plus group discussions….as long as you feel comfortable coping with hot topics and charged personalities.

More on Delay Cord Clamping ~ Got Evidence? Parts 3 & 4

(if you are viewing this blog on Facebook, please go to www.childbirth today.blogspot.com to view the video)


Need evidence about delay cord clamping? This is from Dr. Nick Fogelson, the Academic OBGYN on delay cord clamping - he talks the evidence. This is Part 3 & 4 of grand rounds.

More on Delay Cord Clamping ~ Got Evidence? Part 2

(if you are viewing this blog on Facebook, please go to www.childbirth today.blogspot.com to view the video)


Need evidence about delay cord clamping? This is from Dr. Nick Fogelson, the Academic OBGYN on delay cord clamping - he talks the evidence.  This is Part 2 of grand rounds.

More on Delay Cord Clamping ~ Got Evidence? Part 1

(if you are viewing this blog on Facebook, please go to www.childbirth today.blogspot.com to view the video)


Need evidence about delay cord clamping? This is from Dr. Nick Fogelson, the Academic OBGYN on delay cord clamping - he talks the evidence.

Delayed Cord Clamping ~ Not just a fad

(if you are viewing this blog on Facebook, please go to www.childbirth today.blogspot.com to view the video)


A review of current medical literature (2005-2010) finds overwhelming recommendations that late cord clamping can be advantageous for newborns by improving iron status and does not increase the risk of postpartum hemorrhage (Cochrane Database Syst Review. 2008 Apr 16;(2):CD004074.). A 2007 article in the Journal of the American Medical Association found that delay clamping in full term babies is beneficial to the newborn and the increase in polycythemia was benign. (Journal of the American Medical Association 2007 Mar 21;297(11):1241-52. Hutton EK, Hassan ES “Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials”.)

When looking at the effect of placentofetal transfusion on cerebral oxygenation in preterm infants, delayed clamping of the umbilical cord actually improved cerebral oxygenation in these infants in the first 24 hours. (Pediatrics. 2007 Mar;119(3):455-9).

Finally, an article in the British Medical Journal addressed concerns that delayed cord clamping could not only increase polycythemia but also cause hyperbilirubinaemia (abnormally high levels of red blood cells and bile pigments in the bloodstream, often leading to jaundice). However, trials show this is not the case. (British Medical Journal 2007, August 17 18;335(7615):312-3. Weeks, A. “Umbilical Cord Clamping After Birth”).


If you want to show your clients this same video, download it to your laptop or notebook by using Real Player.  Or if you do not wish to do that, use your fetal doll model with cord and placenta to show them a live demonstration of the same.  What a tremendous learning opportunity!

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

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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!