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

Part 2

Baby's blood volume and cord clamping:

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

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

The Lamaze Conference 2013 in Review

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

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

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

Another hot topic was research via the internet.  Andrea Lythgoe, who is a doula/birth photographer and teacher for the Midwives College of Utah spent two sessions helping attendees find, then

Andrea Lythgoe

completely understand birth research, abstracts and listed the "Dirty Dozen" - her fav 12 websites from which to gather research.  Thanks so much to Andrea for listing my website www.thebirthfacts.com as one of her favs!

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

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

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

Evidence based Research: Implementation delay or refusal?

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

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

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

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

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

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

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

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


References:

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

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

Becoming Smarter Online

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

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

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

The Cost of Not Breastfeeding: laboratory modified infant food products

Let’s face facts: human breasts were designed by the Creator for two purposes; one is to attract the male so the species continues and two, to feed the offspring of procreation.  Breastfeeding babies is normal.  There are scientific studies that show that what is eaten during pregnancy directly affects the physical and mental growth of a fetus.  Is it any wonder that what the baby eats also affects physical and mental growth?

Then what is all of the hub-bub about breastfeeding photos?  Why is something so normal and

natural looked at as the exception rather than what it is ~ normal?

There are situations when formula is necessary to feed an infant.  Such cases include but are not limited to some maternal breast reduction surgery or past history of maternal abuse.  With the surge in the number of breast milk banks, the need for adoptive parents to formula feed is on the decrease, yet still there.

But the bottom line here is that formula production is big business, not only to the production company but to hospitals as well. 

For example:

Medela announced on 9/17/13 a call to share best practices to raise awareness about premature births and effective efforts to support human milk consumption with the goal of improving infant health. One in nine babies in the United States is born prematurely--more than in most developed countries. Content of human milk can substantially improve outcomes for critically compromised and premature infants (preemies). Outstanding neonatal intensive care units (NICUs) across the country understand that a mother's breastmilk gives the baby one of the best health outcomes available.

Premature birth costs society more than $26 billion a year and takes a high toll on families. Premature babies, born before 37 completed weeks of pregnancy, are at risk of both moderate and severe health problems, as well as lifelong disabilities. Premature birth is the number one contributor to infant mortality. Human milk acts much like medicine to premature babies who are vulnerable to potentially fatal diseases such as necrotizing enterocolitis (NEC), an intestinal disease associated with a high mortality rate in the NICU, from merely being born too early.

Research shows that:

-- Length of stay was reduced from an average of 88 days to 73 days for babies fed more than 50ml/kg of breastmilk daily versus preterm formula.

-- Increasing average daily doses of human milk from less than 25 to less than or equal to 50 ml/kg/day for Very Low Birth Weight babies decreased NICU costs incurred by the hospital by $31,514 per infant.

Breastfeeding and breastmilk saves lives and saves money.  Saving money in this way is not something businesses want to do – they want to bring in more money.  Just ask why your local hospital is not Baby Friendly ~ some say it “costs too much” and some even turn down funding for BFHI because in the long run, it will cost them in less revenue.

Perhaps we should rename infant formula to "laboratory modified infant food product"?

You know like GMOs (genetically modified organism)?

So are Early (Elective) Inductions Still the Norm in Your Community?

If early (elective) inductions are still the norm in your community, they shouldn't be.  Three of the most influential groups in maternity care: the March of Dimes, AWHONN, and ACOG/AAFP have launched campaigns to not only educated expectant mothers/families but also care providers.

While an analysis of 230,000 medical records of US women giving birth from 2002 to 2008 in a consortium of 19 hospitals reported an induction rate of 44% among women planning vaginal birth (Optimal Care in Childbirth: The Case for a Physiologic Approach by Goer and Romano citing Zhang, et al. Contemporary cesarean delivery practice in the US.  American Journal of Obstetrics and Gynecology 2010; 203 (4): 326 e1-e10.)

This prompted ACOG (the American College of Obstetricians and Gynecologists) to join with 49 other

organizations through the ABIM Foundation to come up with a talking paper on why scheduling early delivery is not a good idea. Their Choose Wisely campaign hopes to reach those who still use non-medical reasons to induce early: family is in town for a short time, desire to pick a birthday, suspected large baby/macrosomia, etc.  This campaign dovetails with ACOG's Committee Opinion Number 561 April 2013 which states: Morbidity and mortality rates are greater among neonates and infants delivered during the early-term period compared with those delivered between 39 weeks and 40 weeks of gestation. Nevertheless, the rate of nonmedically indicated early-term deliveries continues to increase in the United States. Implementation of a policy to decrease the rate of nonmedically indicated deliveries before 39 weeks of gestation has been found to both decrease the number of these deliveries and improve neonatal outcomes; however, more research is necessary to further characterize pregnancies at risk for in utero morbidity or mortality. Also of concern is that at least one state Medicaid agency has stopped reimbursement for nonindicated deliveries before 39 weeks of gestation. Avoidance of nonindicated delivery before 39 weeks of gestation should not be accompanied by an increase in expectant management of patients with indications for delivery before 39 weeks of gestation. Management decisions, therefore, should balance the risks of pregnancy prolongation with the neonatal and infant risks associated with early-term delivery. However, ACOG Guidelines for Elective Labor Induction state that commonly used indications for labor induction that make the induction elective: include impending macrosomia, history of fast labors, family in town, and maternal exhaustion or discomforts.  These guidelines "while not intended to reflect or establish a standard of care", definitely includes Criteria for Initiating an Elective Induction, Implementation Suggestions as well as auditing suggestions.

AWHONN, the Association of Womens Health, Obstetrics and

Neonatal Nurses, have posted 40 reasons to go the full 40 weeks and divided the reasons into 3 categories: Finish healthy and well, Manage your risks, and Enjoy this time.  With a separate website devoted to the campaign, Health Mom & Baby, plus an iPhone/iPad app AWHONN is working hard to educate moms-to-be and reduce elective induction.  AWHONN has an Assessment and Care of the Late Preterm Infant Implementation Toolkit available for $499.  They also have Assessment & Care of the Late Preterm Infant Guideline 2010 for $53.95, and Hyperbilirubinemia in the Term and Near-Term Infant, 2nd Edition for $34.95.

March of Dimes in conjunction with the WHO have the Born Too Soon Campaign and have identified the fact that 49 countries do maternity care better than the US for infant mortality. Free to all is the Born Too Soon Global Action Report.  This 125 page report, written in conjunction with the WHO, is

designed to focus on prevention and care.  The report defined preterm birth as classified into two broad subtypes: (1) spontaneous preterm birth (spontaneous onsiet of labor or following prelabor premature rupture of membranes (pPROM) and (2) provider-initiated preterm birth (defined as induction of labor or elective cesarean before 37 completed weeks of gestation for maternal or fetal indications (both "urgent" or "discretionary"), or other non medical reasons. 

A wonderful free Toolkit, "Elimination of Non-medically Indicated (elective) Deliveries Before 39 weeks Gestational Age", developed with Federal Title V block grant funding from the California Department of Public Health; California Maternal Quality Care Collaborative and the March of Dimes.  The information in this Toolkit includes complications of non-medically indicated deliveries between 37-39 weeks as an increase in NICU admissions, transient tachypnea of the newborn, respiratory distress syndrome, ventilator support, suspected or proven sepsis, and newborn feeding problems and other transition issues.  In one very telling slide titled "What Motivates Some Obstetricians to Perform Elective Inductions", these reasons are listed: the physician convenience, physician guaranteed attendance at the birth, avoid potential scheduling conflicts, reduce being woken during the night, and "the NICU can handle it".

Other free information is available at www.prematurityprevention.org.  Registration is required but is also free and opens up to journal articles, and power points with many free downloads!

The bottom line: iatrogenic early preterm babies = NICU stays and complications = $$$ for hospitals, convenience for physicians.  Education for ALL is vital to stopping this unnecessary epidemic.

Listening to Mothers

Health care providers/professionals need to listen to mothers.  I was shown this video several days ago and wanted to share it with you.  It really hits home.

When your childbirth class attendees go to the hospital of their choice, a tour can be overwhelming!  Here are some tips from Lamaze International about Getting the Most Out of Your Hospital Tour!


 

Fundamentals of Relaxation - Part 8 Guided Imagery

In the 8th installment of the Fundamentals of Relaxation, guided imagery is featured.  Be cautious of using guided imagery in your classes or with clients, as some religions prohibit the use of guided imagery; as one empties the mind for the guided imagery, it allows evil or the devil to go into the mind.  Always ask if there are any religious or cultural beliefs about guided imagery before beginning!



Guided imagery has a solid role in relaxation.  It plays a key role in meditation and reduction of the stress that leads to anxiety.  With the amount of misinformation regarding labor and birth and the distorted view of birth in the media, is it any wonder that more and more childbirth educators are incorporating guided imagery into their curricula to not only relax expectant parents but also displace fears?

Guided imagery makes use of a peaceful setting. Calm lighting, aromatherapy, and music can enhance

the guided imagery experience.  Together, all of these complementary alternative methods (CAMs) help create a feeling of calm, relaxation and distraction which in turn slows the pulse, lowers blood pressure and reduces the secretion of stress hormones.

Whether the childbirth educator uses a script written by someone else, a script written by them or create the guide as they go along, word selection is important to obtain the proper response.  There is no benefit in “taking” someone to the beach if they are fearful of water!  Finding out stress triggers before the guided imagery session is recommended.  Choosing words that can be articulated well may be a reason for writing one’s own script.  Also, being able to set the script to certain piece of music may also be a reason.  However, not everyone feels confident in writing scripts or feels that another’s voice may be more soothing.

Guided imagery scripting begins and ends in the same place – a generically familiar place for everyone: a beach, the forest, mountains, near a lake, etc. Taking time to describe all aspects of the senses (what is seen, smelled, heard, tasted and felt) is important.  Below are two brief sample scripts about walking in a forest.  Which one is more appealing to you?

She walked through the forest at night, heading toward the stream that ran between the trees.  She heard miscellaneous woodland creatures settling in for the night.

Or

She carefully stepped on the green mossy path, the evening dew dulling the sound of her footsteps

and adding a moisture to the otherwise piney-earthy scent.  A faint breeze with the temperature of a baby’s breath, danced across her skin.  With the full moon’s light peeking through the branches of the mature pines, she quickly made her way to the babbling brook, the sound of which was enhanced by the many rocks and branches that built mini-dams here and there.  In the distance, she heard the night song of an owl, a chorus of crickets and a lowly bullfrog adding some bass to the evening lullaby.

Imagine the second script with the scent of pine and gentle music with nature sounds?  How relaxing!

To learn more about Guided Imagery in Childbirth Education Classes, click here 

Here is a collection of 10 guided imagery scripts: click here.

I found several You Tube relaxation/guided imagery presentations.  The first has slides, the second has a video:

Fundamentals of Relaxation Part 7 - Music

Music.

Music is a powerful element.  Music sets the tone for parties and attitudes.  It can energize, relax, invigorate, and invoke so many other emotional responses.

Music has been shown to promote relaxation of tense, aching muscles and carry a person away from a stressful situation.  With many medical conditions, research shows us that music can lower blood pressure, decrease anxiety and stress (Mandel).  

For childbirth, the research demonstrates that women feel that music reduces perception of pain, increases concentration on positive techniques such as relaxation, cues breathing and distracts attention away from the pain associated with contractions(Hanser).

Music that has been used throughout the pregnancy can set the stage for the mind to be in a relaxed and meditative state, releasing stress and allowing the hormones of labor, such as oxytocin to do the work.  Endorphins are released in greater quantity when a person is relaxed!

Childbirth educators say expectant women and their support partners are increasingly making music a part of their births and to even put together playlists for different stages of birth. Tina Cassidy, author of "Birth: The Surprising History of How We Are Born," (Atlantic Monthly Press, 2006) said it's natural for women to want music around them during labor. "If you go way back into history, singing was always a part of giving birth," Cassidy said.  Today's moms are using music in a variety of ways in the delivery room, bringing everything from meditative CDs or relaxation music on iPods to help them relax, to Salt-N-Pepa to help them, literally, "Push It." “It has been known for several decades that music in childbirth can promote relaxation, especially if the mother and her partner practice with the music during the pregnancy,” says Regina, a nurse who teaches childbirth classes.  “When you practice the techniques covered in class with the same music week after week, you condition yourself to automatically relax when you hear that music.   Other music energizes you and that type of music is perfect for the second stage of labor…better known as pushing phase.” If a mother is relaxed during labor and birth, logic and research shows that labor outcomes are better, with less stress for both mother and baby.  Less stress means more oxygen available and therefore less fetal distress and higher Apgar scores. If you are considering making a play list, here are some songs that already DO appear on expectant mothers’ playlists.  Of course, you can find your own, but this is a good place to begin! Click here for a Childbirth Playlist!  Most are available on iTunes. The video below is a great video created by Julie Samms RN and blends music with birth art to share the benefits of music during labor and birth.  This would be an ideal video to give to your clients as homework for deeper understanding.

References: 


Hanser, S. et al  (1983).  The effect of music on relaxation of expectant mothers during labor.  Journal of Music Therapy, 20(2), 50-58.

Mandel et al.  (2013) Effects of music therapy and music assisted relaxation and imagery on health - related outcomes in diabetes education: a feasibility study. Diabetes Education  July.

Smith et al. (2006) Complementary and alternative therapies for pain management in labour. Cochrane Database Systematic Review.

Fundamentals of Relaxation - Part 6 - Yoga

One of the CAMs (complementary and alternative medicines) used in pregnancy is yoga.  Research demonstrates that yoga improves birth weight, decreases preterm labor, and decreases IUGR either in isolation or associated with PIH, with no increased complications.  The various styles of yoga used for health purposes typically combine physical postures or movement, breathing techniques, and meditation.  Ranked in the top 10 of CAMs used by adults, yoga enjoys a strong following around the world ~ especially with expectant and new mothers.

I had the opportunity to email with Cheryl MacDonald, BA (Hons) CYT E-RPYT Principal Yoga Teacher Glasgow West Studio: YogaBellies Women Baby & Yoga Centre.  I asked her some questions as she is the Director of YogaBellies, an international yoga training and certification organization.

Connie: Briefly, what are the benefits of prenatal yoga for the mother?

Cheryl: As much as mum may have wanted to become pregnant, it can still create a number of conflicting emotions when those two little lines appear on the pregnancy test. Practicing yoga during pregnancy can help mum work through these emotions, stay flexible and healthy and become positive about birth and parenting.

Yoga during pregnancy is about so much more than safe asanas (postures), it’s about bonding with baby, staying strong and flexible for birthing and accepting where you are at and that life isn't just about you any more. It's a valuable life lesson.

Connie: Are there benefits of prenatal yoga for the baby?

Cheryl: Absolutely! A happy and relaxed mum equals a happy and relaxed baby. Every time mum stops to take care of herself, to relax and renew and become strong and healthy, this makes her baby's chances of health and happiness even better. The fact is that yoga actually makes you happier. The ‘love hormone’ Oxytocin helps you to relax and reduces blood pressure and cortisol levels. This is the hormone we produce during birth, breasfeeding and love making. The most important things is not to force yourself (or baby) to do anything you don't feel comfortable with. It's important to listen to your body's signals.

Also, in a study of 65 women with depression and anxiety, the 34 women who took a yoga class twice a week for two months showed a significant decrease in depression and anxiety symptoms, compared to the 31 women who were not in the class.

Connie: If someone has already had their baby, what are the benefits of yoga during the postpartum?

Cheryl: From a purely physical perspective, post natal yoga helps to rebuild the pelvic floor and abdominal muscles and to ease any lower back pain in a gentle but effective way.

Yoga helps to balance hormones and stabilizes the endocrine system. By practicing yogic relaxation techniques, we can balance cortical activities and the nervous and endocrine systems, reducing the body`s reaction to stress. As a result, the body produces less adrenaline, noradrenaline and cortisol, (all stress hormones) and mum feels much more balanced and stress free.

Also, prenatal depression studies indicate clinical depression alleviates by half if only we can talk to a friend who listens to us and oxytocin is shown to increase when we receive empathy.  The social aspects of getting out to perinatal yoga classes either before or with baby help mum and baby socialize with other mums around them.

Remember oxytocin is about being personal in ways that give our time together significance and shape moments of laughter and pleasure.  Follow the instinct to reach out and strengthen ties with invitations to share together and enjoy your pregnancy and life.  

There is ample evidence, that oxytocin and another hormone known as vasopressin are critical for the bonding process, especially as it relates to social and reproductive behaviour. Both chemicals help encourage bonding and maternal behaviour.

Connie: Can prenatal yoga be modified if a mom has a complicated pregnancy or is on bedrest?

Cheryl: Absolutely. But it is very important to make sure your yoga teacher has a credible qualification in specialist perinatal yoga. It's important to find a yoga teacher that's right for you and if you're new to yoga, YogaBellies classes cater for all levels and make you feel comfortable wherever you are in your pregnancy or your yoga journey. Our teachers are fully qualified in teaching yoga for pregnant women accredited by the IYN and IPTI. If your prospective teacher does not hold a reputable Yoga Teacher Training qualification, look elsewhere!

 This is a video of me and a bit about what we do. 

Connie: Now, talk a little about you and your company and bringing YogaBellies to the US/Canada!

Cheryl: We have almost 100 franchised YogaBellies teachers across the world - but not yet in Canada or the USA! We are always looking for inspiring women to spread the YogaBellies message of women helping women. We offering training in four main paths: Yoga for women at every stage of life, yoga for children (YogaBelliesKidz), Birth ROCKS (our birth preparation program) and YogaBellies Mummy therapies (our specialist perinatal massage therapists.) You can find out more about YogaBellies and joing us here www.yogabellies.co.uk or find us on facebook at www.facebook.com/yogabellies.

Fundamentals of Relaxation Part 5 - Breathing

In spite of the new technology associated with labor and birth, women are still fearful.  Fear may come from hearing stories, reading articles, or simply by not knowing the full truth about the events of the birthing process.  An important aspect of relaxation for fear is breathing.

Any source that addresses fear, stress or anxiety will also address breathing.  Breathing is an effective and easy way to reduce stress and fear by decreasing the body’s reaction to the stress.  Slow, rhythmic breathing has been shown to lower blood pressure, reduce heart rate, and reduce the secretion of stress hormones such as cortisol. Relaxed breathing also balances O₂ and CO₂ levels and decrease muscle tension.

Behaviors for coping with severe fear of childbirth or SFOC were related to six domains of childbirth education relaxation: concentration or focusing, support from family or doula, breathing, relaxation and perception of control.  Since breathing helps to maintain focus and relaxation and hence perception of control, breathing seems to be a foundational skill to learn.

For decades, Lamaze has taught patterned breathing to offset the intensity of the contractions. Since Lamaze has become as synonymous to breathing as Kleenex is to tissues, many expectant parents come to childbirth class, regardless of the method, to learning breathing.  While Lamaze still offers instruction on breathing, it is not so much how one breathes as that one does breathing effectively.

In a 2011 article in the Journal of Perinatal Education, author Judith Lothian gives these guidelines for using breathing in labor:

• Breathing is easily subject to conscious control. Therefore, controlled breathing is easy to learn.
• Slow, deep breathing is particularly effective. The “right” way to breathe is whatever feels right. There are no rules related to how many breaths per minute, whether to breathe through the mouth or nose, or whether to make sounds. The key here is that the breathing is conscious, not automatic.
• As labor contractions get stronger and the work of labor gets harder, speeding up the breathing and making it shallower is sometimes, but not always, more effective.
• Focusing on something, either with eyes closed \or open, can help maintain the rhythm of the breathing.
• Using conscious breathing in everyday life, either to relieve stress or to increase body awareness and mindfulness, is excellent practice for labor. It is an excellent life skill.
• Conscious breathing works best in combination with many other comfort strategies. In Lamaze classes, women no longer spend large amounts of time practicing breathing. Women move, change position, slow dance, sway on birth balls, learn massage, and identify the countless other ways they normally relax and find comfort. Each of these comfort strategies can be used in combination with breathing.
• In restrictive environments, breathing may be one of very few comfort strategies available for women in labor. It is one coping strategy that cannot be taken away.

References:

Lothian, J. (2011) Lamaze Breathing: What Every Pregnant Woman Needs to Know.  Journal of Perinatal Education.  20(2), 118-120.

Salomonsson, B.  (2013). Self-efficacy in pregnant women with severe fear of childbirth.  Journal of Obstetrics, Gynecologic and Neonatal Nursing. 42(2): 191-202.

Turankar, A. et al (2013) Effects of slow breathing exercise on cardiovascular functions, pulmonary functions and galvanic skin resistance in healthy human volunteers – a pilot study.  The Indian Journal of Medical Research.  May 137(5): 916-21. 

Fundamentals of Relaxation Part 4 - Mindfulness

Our culture is so busy.  Instant news on TV.  Instant communication via cell phones.  Instant food either through drive-thru or by microwave.  We are just busy, and juggling several things all at once!

But are we really enjoying the moment?  Are we at peace?

The answer to both questions is probably “no”.  How can we enjoy the moment when there are 10,000 thoughts going through our minds?  How can we be at peace when we are either living in the past (thinking about what has happened) or living in the future (thinking about what will happen)?

According to the website, Franticworld.com, “mindfulness has now become one of the hottest topics in mental health. One study, in the Journal of Clinical Psychology, has shown that it increases happiness and well-being, while a major study in Psychological Science revealed such changes help regular meditators live longer, healthier lives. Other research has shown that it improves memory, creativity, and reaction times. It also boosts the immune system and lowers blood pressure.”

What is mindfulness?  Originally from the Sanskrit meaning awareness, mindfulness practice or meditation is a way to slow the brain chatter, stop juggling life, reduce stress and improve overall mental health.  In 2011, the National Institute of Health’s National Center for Complementary and Alternative Medicine released a study showing improvement in overall brain function (via MRI) in the participants of mindfulness  meditation.  Being mindful means to observe thoughts and feelings almost as if from a distance, without judging.  It means to live in the moment and be aware of all of your senses.  Mindfulness also involves quieting the “monkey mind” (bouncing from one thought to another).  Quiet moments and meditation can increase mindfulness significantly.  With eyes closed, focusing on just one thing, such as the breath, can calm the mind and body and bring on the sense of mindfulness.

Think it sounds very “crunchy” and “granola”?  In a January 23, 2013 Associated Pressarticle, a pilot program for mindfulness meditation was highlighted.  Who is in this pilot program for stress reduction? US Marines!  

"Some people might say these are Eastern-based religious practices but this goes way beyond that," said Jeffery Bearor, the executive deputy of the Marine Corps training and education command at its headquarters in Quantico, Va.. "This is not tied to any religious practice. This is about mental preparation to better handle stress."

What role does mindfulness play in pregnancy and childbirth?  The adrenal glands provide the hormones (adrenaline- triggers the "fight-or-flight" response, cortisol-promotes natural resistance and longevity, and DHEA-improves physical condition) necessary to deal with the day-to-day experiences. However, when we allow the stresses to become extreme, the adrenal glands become overworked, thus causing a cascade of physical and emotional trauma to the body. This can be even worse for the pregnant body!  A study from 2009 reported that women practicing mindful yoga in their second trimester reported significant reductions in physical pain.    

The University of Oxford Medical Sciences Division is currently involved in a study exploring a Mindfulness Based Childbirth and Parentingprogram. 

There is even an app for that!  Be sure to check out the Mindfulness for Pregnancy app on iTunes for $2.99.

When teaching about birth, explore teaching from a mind/body/spirit perspective.  Childbirth class becomes the perfect launching pad to teach mindfulness not only for pregnancy and birth but also as a continued lifestyle.  Peace, rebalancing, and inner wisdom have been shown to reduce both physical and emotional complications.  In many countries that have better maternal/infant outcome rates than the US, the midwifery model of care dominates – midwives do provide care based on the mind/body/spirit perspective.  Perhaps we need to learn from our history and from the present of others, to improve our future.

Follow Jon Kabat Zinn, who wrote the forward for Mindful Birthing: Training the mind, body and heart for childbirth and beyond,  through Breathscape Guided Meditation.

References:

Bardacke, N. Mindful Birthing: Training the mind, body and heart for childbirth and beyond.  HarperOne Publisher.

Beddoe et al.  (2009)  The effects of mindfulness-based yoga during pregnancy on maternal psychological and physical distress.  Journal of Obstetric, Gynecologic and Neonatal Nursing.

Vieten, C. and Astin, J.  (2008) Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study.  Archives of Women’s Mental Health.

Uvnäs Moberg, K. The Oxytocin Factor: Tapping the hormone of Calm, Love and Healing.  Da Capo Press.

Vieten, C. (2011) Mindfulness for Moms: The Basics.  Psychology Today Webblog. http://www.psychologytoday.com/blog/mindful-motherhood/201105/mindfulness-moms-the-basics

Fundamentals of Relaxation Part 3

In this 8 part series , we are going to explore the fundamentals of relaxation, how each type works, the benefits and a little history.  We humans do not relax enough – we believe that sleeping or watching television is relaxation….nothing could be farther from the truth.  And it is so important to both mother and baby during pregnancy!

Meditation refers to a large variety of practices that produce relaxation and mindfulness, building positive energy, developing compassion and kindness.  Used for centuries, meditation has been shown to not only clear the mind, but also ease health issues such as hypertension, anxiety and depression. 

Those who meditate may use music, aromatherapy or other complementary therapies to help shut

out the world and focus only on that which is positive and good.

Meditation can be spiritual in nature; prayer or meditating on the word of God can be helpful in times of stress.  With a relaxed position, and some aromatherapy, focusing on one thing (such as the word of God), helps to free the mind from all of the chatter that many of us have.

Here are six steps to successful meditation:

1) Meditate regularly day and time
Many people find that meditating in the early morning hours before the beginning of the day is the prime time to do meditation.  It sets the intention for the day for positiveness and clears the mind for the events of the day.  Some people meditate more than once a day – remember that if you do, keep it regular both in time of day in length!  It can be as refreshing as a 20 minute power nap!

2) Set an environment
You do not need a formal environment for meditating, however having some of the same items close by such as crystals, a rosary, incense or similar will contribute to the relaxation process and encourage classical conditioning (Pavlov).  When you see a set focal point (see #7), smell a certain scent of aromatherapy or incense or hear certain music, this may hasten relaxation success.  (Build your own playlist for meditation! For a list of songs for relaxation and meditation, click here.

3) Be comfortable when you meditate
You can sit in a chair or couch or use a two part cushion system that allows for a comfortable lotus position.  You can also lie down, but often, it may feel so relaxing you might fall asleep!

4) Meditate for the same length of time - use an app timer
Meditate for the same length of time each time.  To do this, you can set a timer, on your phone for example, with an app such as Insight Timer by Spotlight Six Software.

5) Deep abdominal relaxing breathing
Different from the “Lamaze” type chest breathing done in labor, abdominal or belly breathing can be very powerful and simple.  This type of breathing relaxes you  and reduces the risk of hyperventilation.

6) Focus 
Either use a focal point, candle or guided imagery to enhance stillness and quiet the mental chatter that clogs our minds and floods our thoughts.

Handouts:

University of Wisconsin Integrative Medicine

From Urban Mindfulness

Great video for beginners!