Comfort Measures ~ a vital role in childbirth education!

* You can find more articles like this at www.birthsource.com!


As you learn more and more about labor and the birth process, you will be fascinated by the number of comfort measures available to you. Each comfort measure is unique and designed to support you either physically or emotionally. You may not find complete information about all comfort measures in one place, however many of the most reliable measures are listed here.

Faith in the process, faith in the providers of care, and faith in your ability to make informed decisions about your care
Just as a marathon runner would not wait until the last moment to prepare for a major run, expectant parents should not wait either to be as prepared as possible. Emotional and physical preparation takes time and with time, comes faith in the knowledge and information you have received. You have the ability to make informed decisions based on the knowledge you have of alternatives. And carefully choosing care providers also enables you to trust in critical moments.

Active relaxation
There is definitely a difference between relaxation and sleeping. You can be tense and still fall asleep. Relaxation is a combination of rhythmic breathing and allowing tension to go out of your muscles. For some, relaxation techniques are not enough to get them to fully relax. Music therapy, massage and guided imagery may also be useful to get the expectant mother to relax.
Why is relaxation so important? More oxygen travels to both the laboring uterus and to the baby when a mother is relaxed. Also, the tension hormone, adrenaline, has the ability to slow or stop labor - depending on its level in the body. Reducing the tension in Mom can reduce the adrenaline, therefore enhancing labor!

Breathing techniques
Techniques vary based on the education and training from a childbirth instructor. Basically, breathing techniques keep you focused, maintain oxygen to both you and your baby, and give you something to concentrate on rather than the discomfort generated by the contractions. There is no one perfect set of techniques - rather it is the basic philosophy that works!
Education
Whether you take childbirth classes, do extensive reading, watch a variety of birth videos or obtain information from your care provider or, ideally, a combination of all, you should become educated as to the labor and birth process. Many mothers say that they are extremely frightened of the birth process, but that their fear and anxiety was greatly reduced with information!

Using a Trained Labor Support Person
Childbirth assistants or doulas can bring to your birth many emotional and physical advantages. These advantages include more comfort measures for your specific needs, a familiar face that stays beyond shift changes, comfort from a woman who has experienced childbirth ~ someone who can anticipate you and your coach's needs before you realize they are your needs. These women never take the place of the coach unless an expectant woman has no coach. Before choosing a doula, interview them and ask them about their experience and their philosophy of birth.

Using Gravity to Enhance Labor Try these helpful positions to keep labor moving right along! upright positions walking hands and knees using a Birthing Ball squatting supported lunge swaying or dancing with partner pelvic rocking sitting in a rocking chair

Hot and Cold Therapy
Warm rice socks or ice pack can make lower abdominal or back labor more comfortable.


Music Therapy
Soft and quite relaxation CD's and tapes enhance relaxation at home and when you go to the hospital. Take along a CD player if one is not provided by the hospital.


Frequent urination
Emptying the bladder often reduces the discomfort of a full bladder and also reduces the blockage of the birth canal often made as the bladder increases in fluid.


Counter pressure
To help with the discomforts associated with true back labor, counter pressure is often the comfort measure of choice. Your childbirth educator or doula can help you with the specific positions for counter pressure and some interesting alternatives to just pressing with the palm of the hand!


Massage
Since the touch fibers in our bodies are larger than the pain fibers, messages travel faster from the area being touched to our brains. And since our brains can only process so much information, massage can help reduce the amount of pain our brain senses. How can this be? What happens when you stub your toe? You instinctively massage it and the pain magically becomes managable. This same principle can be used during labor. Massage is also a great way of reducing the tension in the body during labor.


Aromatherapy
Fresh cut grass reminds me of Saturday afternoons as a child; certain perfumes remind us of certain people. Pick a scent that will trigger pleasant thoughts and help you maintain relaxation during labor. Lavender and Chamomile are two scents that many expectant mothers prefer.


Water Therapies
Shower and the Labor Tub make use of heat therapy. And the Labor Tub uses hydrostatic pressure to reduce the feelings of discomfort brought about by increasingly intense contraction and the movement of the baby down into the pelvis. This increases relaxation and facilitates labor!


Focusing
A focal point: stuffed animal, photo, coach's face etc can help you keep focused on labor and relaxation, especially if you've practiced with it for months. Then it becomes a conditioned response to relax when looking at this object.


Guided Visual Imagery
Have someone read a very descriptive paragraph or story to you that could help you relax. Oddly enough, television is a form of guided imagery in that it takes us mentally from the place we are and transports us to different places. However, television does end and has commercials and this tends to break concentration.

References:

1. Bobak, I., Jensen, M. Maternity & Gynecologic Care: The Nurse and the Family. (1989) St. Louis: Mosby Publishers.
2. Nichols, F., Humenick, S. Childbirth Education: Practice, Research & Theory (2000) Saunders & Co.
3. Livingston, C. The Birth Ball Source Book.  4th edition. 2011.  Perinatal Education Associates.
4. Reeder, S., Martin, L., and Koniak-Griffin, D. Maternity Nursing: Family, Newborn, and Women's Health Care. (1997) Philadelphia: J.B. Lippincott Company.
5. Sprague, A. Water Labour., Water Birth. 4th Edition. 2011. Amazon & Kindle Editions.
6. Simkin and Ancheta. The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia. 2nd Edition 2011. Wiley-Blackwell Publishers. Amazon/Kindle Editions.

Learning Lamaze: Back to Basics!

You have been practicing the basics of Lamaze probably your whole life. Surprised? Let me explain…

Lamaze is built on the basic principle that you have the power to raise your pain tolerance through various comforting techniques. Lamaze, learning from the research of two specialists who published extensively in the 1960s, created techniques that challenged the body’s gating system. This gating system works on the principle that our pain fibers are smaller and the pain stimulation travels slower than touch. Our touch fibers are larger and thus the touch stimulation travels faster to the brain. If given a painful stimulus (stubbing one’s toe) and then rubbing the toe, the touch sensation travels to the brain faster and in greater quantity than the pain, thus closing the gate to the pain stimuli – as the brain can only take so much stimulation at one time. In turn, this enables the laboring mother to raise her pain tolerance (the variable degree of pain a person can endure) while acknowledging her pain threshold (the rising degree of pain from a particular source).

Lamaze also drew some of his knowledge from two Russian researchers who encouraged expectant mothers to practice certain techniques prenatally so that the techniques would seem almost automatic when they went into labor. These techniques included structured breathing patterns, focusing on an external source, and a relaxing touch technique call effleurage.

Breathing

All breathing begins with a Deep Cleansing Breath

Inhale-through the nose (if possible), keeping shoulders relaxed

Exhale-through the mouth, letting go of all the tension in your body

SLOW-PACED BREATHING

Rate is approximately half the number of breaths you normally take per minute; not less than 3 or 4 breaths per minute;aids relaxation and provides optimum oxygenation.

When doing the more advanced breathing techniques, return to slow-paced breathing when able.

Procedure:

Deep Cleansing Breath

Inhale (through nose if possible) to a count of 4 - In two, three, four

Exhale through mouth to a count of 4 - out two, three, four

Repeat the inhale/exhale throughout the contraction

When contraction ends, Deep Cleansing Breath

MODIFIED-PACED BREATHING

Rate is slightly faster than your normal breathing rate; not exceeding twice your resting rate; allows you to be more focused and alert.

Procedure:

Deep Cleansing Breath

Inhale through nose to a count of 2 - In two

Exhale through mouth to a count of 2 - Out two

Repeat the inhale/exhale throughout the contraction

When contraction ends, Deep Cleansing Breath

PANT-BLOW BREATHING

Same rate as modified-paced breathing

Blowing softly at regular intervals creates a rhythmic pattern

The pant is an in breath and an out breath (touching the tip of your tongue to the roof of your mouth will help keep your mouth moist)

Patterns may vary: pant - 2 -3 - 4 - blow, or pant - 2 - 3 - blow

Procedure:

Deep Cleansing Breath

Take upper chest, shallow breaths follow by relaxed exhales

At regular intervals, add a slightly emphasized exhalation (a sigh)

The importance is to keep facial muscles relaxed

When contraction ends, Deep Cleansing Breath

Focusing

A focal point is an object, such as a photo, stuffed animal or even a cross stitch piece that will help you to focus on something other than the contractions and the time that labor is taking. The focal point also helps to stimulate certain positive feelings…for example if you plan on giving the stuffed animal to the baby after the birth, there may be feelings of nurturing and love and motherhood attached to the stuffed animal. If the focal point is a photo of a place you have been, there may be feelings of calmness and serenity evoked when looking at the photo. If you choose to use your husband/partner’s eyes during labor as a focal point, this can be particularly empowering as you work together and a powerful team to being this new family! Knowing and drawing strength from your partner can energize a woman even in the closing hours of a long birth!

Effleurage

Effleurage is a rhythmic stroking motion on the larger portions of the body (long bones of the legs, back, abdomen) in circular or back-and-forth movements.

In the classical sense of Lamaze, the emphasis has been on carefully designed, learned and practiced breathing techniques, abdominal massage (effleurage), choosing a "focal point" to look at during uterine contractions, counting during contractions and understanding standard hospital procedures. Dr. Lamaze believed that distractions from pain reduces the perception of pain. Therefore, most women could labor and give birth awake, aware and under their own power if they mastered his techniques in order to avoid being overwhelmed by the intensity of labor. As mentioned previously, the Gate Control Theory or Gating Theory uses touch and effleurage as a key piece for raising pain tolerance.

While these tools and techniques cannot make labor painless, it can make labor less painful by showing you just how much power you have over the pain of the contractions!

Reference:

The Lamaze Guide: Giving Birth With Confidence, 2nd Edition Judy Lothian/Charlotte Dvries, 2010 

Gisele Bundchen's New "Birth Around the World" Project

Here is the first video introducing Gisele's idea!

Update on Ingestion of Food and Fluids During Labor

Since C.L. Mendelson's report in 1946 (Mendelson C.L. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol 1946; 52: 191-205.), most anesthesiologists assumed a very conservative stance used with obstetrical surgical patients with a "nil per os" (Latin for nothing by mouth or "NPO") for maximum safety. Is a slowing of the contraction pattern due to dehydration and no food/fuel? If so, does this also contribute to a slowed labor pattern and ultimately augmentation? More importantly, does having nothing in the stomach lower gastric acidity enough to protect the esophagus from corrosion should aspiration occur? Does being NPO eliminate Mendelson’s Syndrome?

Conversely, midwives and some physicians will allow fluids, soups, crackers, etc. during the early and active phases of labor. Can fluids or food during labor, along with IV fluids lower gastric acidity by giving the acid something to break down and facilitate the contraction pattern, possibly avoiding some interventions such as augmentation? And statistically, what is the likelihood of Mendelson's Syndrome or death from pneumonia due to aspiration?

According to Joy Hawkins, M.D. of the University of Colorado Health Sciences Center, scant key scientific data exists to show that laboring women who are kept NPO are less likely to die due to aspiration than women who had some sort of food or fluids. Without food, a laboring woman's body enters into ketosis. Starvation ketosis occurs when the pregnant body is starved, especially of carbohydrates. With starvation ketosis, tissues begin to breakdown and the byproducts of this ketabolism are called ketones, which actually aggravate nausea and possibly vomiting. So does keeping a woman NPO actually potentiate Mendelson's Syndrome? Additionally during pregnancy, women experience reflux due to delay emptying of stomach contents thought to be due to higher levels of progesterone, decreased motilin levels and the growing uterus applying pressure to the digestive system including the stomach valve. Do these hormonal influences along with NPO ketosis make things worse?

Dr. Robert Galser, M.D. of the University of Pennsylvania Medical Center says that we cannot afford to speculate as aspiration is a very real problem, especially for the mother who has general anesthesia with a cesarean section. Although Mendelson's research was mainly on rats and rabbits, it is suggested that IV's help to prevent ketosis while keeping stomach contents at a minimum. Currently, there is no evidence that moderate levels of ketosis are harmful to the fetus. Penny Simkin found that of several stressors in labor, being NPO was minimally stressful compared to not being active in labor.

In 2009, Maharaj (European Journal of Obstetrics, Gynecology and Reproductive Biology, September) stated that while the incidence of aspiration pneumonitis is rare, “it is the fear of the birth-attendant to bear full responsibility if a patient inhales gastric contents when giving in to demands for liberal fluid and food regimes during labor that governs practice. While the bulk of evidence supports fluid intake in labor, there are insufficient published studies to draw conclusions about the relationship between fasting times and the risk of pulmonary aspiration during labor.”

Singata, Tranmer and Gyte wrote in a 2010 Cochrane Database Systematic Review of restricting oral and fluid intake during labor (five studies and 3130 women), that the evidence “shows no benefits or harms” and that there “is no justification for the restriction of the fluids and food in labour for women at low risk for complications.

So is restricting food and fluids during labor a technocratic ritual or based on research? Since the basis for the restriction had the foundation of research in the 1940's when general anesthesia was the standard for cesarean sections, have we not progressed from there to the point where a significantly fewer number of women are exposed to general anesthesia for childbirth, with an even significantly fewer number of women aspirating acidic vomitus during anesthesia? Is this another case of "this is how we've always done it?"

Pushing ~ What you need to know...

For most of labor, women feel like an observer instead of a participant. This feeling changes dramatically when the cervix reaches 10 centimeters dilated and 100% effaced. At this point the cervix is said to be “complete” and pushing can begin without fear of causing the cervix to swell or bruise (which can happen if pushing begins BEFORE the cervix is completely dilated or effaced). The dynamics of pushing can be divided into 3 parts: position, breathing and effort. Positions: Techniques such as pushing while on a toilet, relaxes the perineal muscles while supporting the long bones of the upper legs. Psychologically, moms relax their bottoms when on the toilet and this become important during the Second Stage. Many mothers will sit at a 30-40 degree angle or C-Position in the birthing bed. Any farther back or even a lying down position will work against gravity and often prolong the pushing part of labor. Squatting either at the side of the bed or with the aid of a squatting bar encourages rapid descent, requires less physical effort and increases the diameter of the pelvis. Some moms may even do early squat pushing on egg-shaped birth balls. You work with gravity in a squat. The hands-and-knees position is good for trying to turn a posterior baby, helps with fetal distress and takes the pressure off of the perineum. Many midwives say that this position is the best when there is suspected shoulder dystocia. During a rapid birth, you may be instructed to side-lie, with your partner or assistant supporting the leg on top. This position slows descent somewhat, lowers the need for episiotomy and helps maintain good oxygen to the baby. Breathing: Continuous Breath Holding, also known as purple pushing refers to holding the breath so long and with such force that the small capillaries in the cheeks and face burst. Purple pushing produces Valsalva's Maneuver. Valsalva's Maneuver occurs with prolonged breath-holding ~ longer than 6 clock seconds. With prolonged breath-holding, there is an increase in the heart rate and the blood pressure. Immediately, a reflex of slower heart rate occurs. All of this disrupts the blood flow to the uterus and ultimately to the baby. This disruption in blood flow indicates a disruption in oxygen flow, which ultimately shows up on the fetal heart monitor as fetal distress. There is no clear evidence that closed glottis pushing (Valsalva's Maneuver) shortens second stage, decreases fatigue or minimizes pain. It has otherwise been suggested that bearing down for a prolonged period with a closed glottis alters the effectiveness of the contractions, leading to inefficient contractions and failure to progress. Click here for more of this article...

Beyond Beyoncè: Five lies the media tells you about birth

As a birth journalist, I receive hundreds of pregnancy, birth and breastfeeding news alerts each day. About 85% of them are about celebrity pregnancies.  That leaves approximately 15% new stories, read by both parents and professionals,  that contain some modicum of truth.  Or do they?

What both parents and professionals see in the media (news, podcasts, internet, television shows and movies), to some degree, take away from the natural body instincts for birth and parenting.  Here are some examples:

•      Childbirth is a dangerous event.   Studies from across the globe confirm that childbirth is inherently safe.  The WHO indicates that there may be only 10-15% of birth events in need of cesarean birth to maintain safety.
  
•      Babies will drown during a waterbirth.  If you carefully examine the physiology of this event (water birth), you will see that since the baby is going from one water environment to another, and the umbilical cord is still attached there is no chance for drowning.  However, should the baby be brought up from the water and air is touch the face, this helps to initiate breathing and yes, if the baby is put fully back down in the water, that may cause a problem.
  
•      The pain of childbirth is excruciating.  That actually depends on the situation.  Many times, pain is exacerbated by other situations: fear of the unknown, being alone, tension, reduced food and fluid intake, and sometimes just a simple low tolerance to pain.  In all of these cases, knowledge gained through childbirth education classes will help – not cure – the experience of pain in childbirth.
  
  
•      Interventions during childbirth, including epidural anesthesia, are bad.  Again, knowledge is power.  With any medical procedure, from starting an IV to performing an episiotomy, there is risk.  However, the risks (all of them) must be weighed against the benefits (all of them) and vice versa.  This takes a birth team of skilled and knowledgeable people!  Another point to add here is that if the medical staff only know one way to handle a birthing situation, then all women in that birthing situation will be handled that one way.  It is how the staff are taught.  It is ingrained in then that THIS way is the BEST way….which may or may not be accurate.
  
•      Because you are birthing in the US, you can be assured of accuracy, safety and a better birth outcome that most countries.  We Americans still have a LONG way to go in terms of the maternity care field.  While we don’t have the highest cesarean rate in the world, it is still over 33%.  Our maternal/infant mortality and morbidity statistics rank us lower and lower each year amongst other countries, sometimes as low as 51^st place.

Regardless of whether you are a parent expecting a baby, or a birth professional, you need to know the facts, physiology and truth about pregnancy, birth and breastfeeding.  Read and read and learn, ask questions!  Go beyond Beyoncè to get the facts!

Waterbirth in a Hospital ~ yes you can!

Here is a visual of how you can have a waterbirth in a hospital setting.  The most difficult obstacle is often the uninformed hospital staff.  They typically don't teach about waterbirth in nursing or medical school.

Hospitals and Waterbirths

Hear from waterbirth expert Barbara Harper.

One World Birth ~ the next great birth film

In case you've not been following the progress of this amazing film maker, check out the launch video!

Physiologic Birth Is Front and Center in the Media!

The end of 2011 and the beginning of 2012 spark excitement in the birth world! Two separate organizations honor two women who daily, stand up for physiologic birth and women/baby centered maternity care: Ina May Gaskin and Robin Lim.




For those of you who may not have seen Ina May Gaskin receive the Rightlivlihood Award earlier, here is the video.







And if you missed Robin Lim receiving her award at the CNN 2011 Hero(es) of the Year Ceremony, the link to that segment is not available for embedding at this time but is available by clicking here.


These awards and videos are important to share on any and every social media.  Expectant parents are constantly being bombarded by information about alternative means of giving birth and raising a baby.  We must, as birth professionals, share in the duty and honor of dispelling myths and sharing the truth.

Just the facts: The Home Birth/Hospital Birth Conundrum Part 2

In Part 1, we took a  look at the Home Birth Summit from October of 2011. 

But a question still begs to be answered: If there was consensus amongst organizations, why is there still a conundrum?  Conflicting stories based on equally conflicting studies published in journals continue to flood the news.

“A new study (published in the BMJ) in England shows little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals versus those who gave birth with midwives at home or in birthing centers.”

Or

“A study published in the BMJ, which was conducted by researchers from Oxford University has revealed that first time expecting mothers who opt to have home deliveries are at greater risk than those who opt for obstetric or midwifery unit.”

Ironically, they are talking about the same study in the same journal.  Why the difference? 

It leads us to the five basic reasons for the conundrum:

Media Influence
Media spin has a damning effect on childbirth, here in the US and world wide.  Documented in her video  Laboring Under an Illusion, Vicki Elson exposes the drama-seeking Hollywoodism and stretching of the truth in our every day viewing.  Seeing this, and not being exposed to the truth, leads to accustomization ~ where we begin to believe what we see because we are accustomed to seeing it!

Education Gap in Professional Training
A second reason for the conundrum is Statement 9 in the Home Birth Summit Consensus document:  “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”.  In reality, this is not done in our major universities, medical schools and nursing schools.  If it was embraced and taught, then all of the things that certified childbirth educators teach their classes or the information discussed by doulas would not be new information to nurses, physicians, and yes, even some midwives.

Fear of the Unknown
Childbirth is not a foreign event for women.  However, since we are such a mobile society, we are not routinely exposed to family and friends having babies.  Hence we have lost the ability to tap into the inner wisdom.  Dr. Amali Lokugamage  discusses finding the inner wisdom in her book The Heart in the Womb.  She states that “fear of childbirth really does prevent women from discovering their inner wisdom.”  Women with this fear (fear of the unknown, fear of pain, fear of disaster, etc) look to others to “solve” their problem.  To the rescue is modern medicine, and the discouragement of childbirth education classes or doula services.  It is viewed that with information and an informed support person, labors will be more difficult for the medical staff.  It boils down to whose birth is it anyway?

Incongruent ways of reading research
As demonstrated by the Summer of 2010’s Wax home birth meta-analysis , definitions make or break a study and the efficacy of the information in the study.  For example,  as Amy Romano pointed out the definition of neonatal death was different.  In the Wax study of 9,811 homebirths, neonatal death was defined as death of a live-born infant between 0 and 28 days.  In the Ank de Jonge study of 321,307 homebirths, the definition was the death of a live-born infant between 0 and 7 days.  The latter is also the definition used by the World Health Organization.  Wax also had no requirement for home birth eligibility.  The Dutch study defined who was eligible based on national guidelines – to ensure that homebirths are healthy and at very low risk for complications.

Professional Obstacles
I really didn’t know how else to phrase this contributor to the conundrum but there are professionals who are, either informed or uninformed, against homebirth.  Period.  No discussion.   Heidi Anne Deurr, MPH said in her recent article for OBGYN.net titled “Home Birth Consensus Summit: Much Ado About Nothing?”:

While the intentions and words involved in the statement might be well-meaning, the merit of the summit and its consensus statements is questionable.  For one thing, ACOG has come out against home births.

Legal liability certainly has a hand in this last contributor to the conundrum.   As pointed out in Statement 7 of the Home Birth Summit Consensus, the legal system needs repair and there needs to be adequate access to homebirth and birth center births within an integrated health care system.

In reviewing the above five conundrum contributors, the bottom line, in my humble opinion, is consistency in research and education about the research.  We must talk the same language with the same numerical values and the same definitions.  If studies and research varies so greatly, no congruent statement can be made about any issue.  Second, practitioners of all kinds should be educated about this research and work together for healthy mothers and babies.  To do otherwise, is to ignore “First Do No Harm.”

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.