Natural Childbirth Classes Offer No Special Benefit Part 2

If you teach childbirth education classes OR are a doula, be prepared for a flood of questions about the new Swedish study discussing childbirth education. The British Journal of OB/GYN has published the full text version of the study and the study makes some sweeping statements.

However, I will try to dissect it all down for you - first and foremost, READ the entire study. And be prepared to work with the facts about the study and the value of childbirth education. Be sure also to listen to the 5 minute interview between the co-author of the study and Belinda Phipps of the UK National Childbirth Trust.

1) The sampling is small, only 1087 women over 1.5 years and in one geographical location. This calls into question the statistical significance where broad statements are made.

2) The educators were all midwives. However, there is no mention of these midwives being childbirth educators, having taught childbirth education before, or being trained or certified by any childbirth education organization. Those who have been trained and certified as childbirth educators are well versed in the methods of adult learning/education, can provide memory hooks to aid in informational retention AND the passion to present objectively all of the information an expectant mother and her partner would need to make sound decisions based on the information.

2a) What was the belief system of the educators? Do they believe what they are teaching? Did anyone monitor voice inflections and body language?

3) Flow Chart #2 provides some significant questions about the model of education given to the "natural childbirth" classes. Omitted from the "natural classes" was the Risk/Benefit model of teaching where interventions, complications or birth plans with exploration of expectations could be discussed.

4) Also missing from the "natural classes" were the films. What films were shown? What was the tone of the films?


To me, if a study is to make broad statements that could impact a woman's birth experience, the EXACT same classes should have been taught to the expectant participants sans only the psychoprophylactic information. As a Lamaze certified childbirth educator for over 30 years, I would energetically challenge the validity of this study based on the 4 comments above.

It is important to note that this study should not be embraced immediately without further study and much tighter/more accurate models of education.

As an aside, Doulas have enjoyed nearly 25 years and over a dozen studies are still are not fully embraced.

Natural Childbirth Classes Offer No Special Benefit

A research team at the Karolinska Institute in Sweden studied data collected from 1,087 first-time mothers. Malin Bergström, a clinical psychologist who co-authored the study, said: "Our conclusion is that natural childbirth preparation with psychoprophylaxis does not reduce the need for epidural analgesia or improve the birth experience, when compared with the standard form of antenatal education."

While I am trying to get a copy of this study, I am curious about several issues: exactly what type of classes were these? How long did the classes last and was there time to practice the techniques? Who taught the classes ~ were they taught by certified childbirth educators?

These and many more questions need to be addressed, I believe, before sweeping statements like these can be made....

Health Canada Urges Caution

Health Canada is advising expectant mothers and breastfeeding women not to take the vitamin-mineral supplements Maxum Matragen or Maxum Multi-Vite by Seroyal International Inc.

Health Canada has not received any adverse reaction reports associated with Maxum Matragen and/or Maxum Multi-Vite. Pregnant or breastfeeding women who may be taking Maxum Matragen or Maxum Multi-Vite are advised to consult their health care professional prior to continuing use of these products.

Childbirth Class Trends/Cesareans Increase Problems

According to one report, "the National Center for Health Statistics estimates more than 4,317,119 babies were born in U.S. during 2007, about one percent more than in 2006. The biggest increase in birth rate (2 percent) was among women 30 to 34 years. The smallest (less than one percent) was among women 20 to 24. Among teens 15-19, the birth rate rose about one percent. Cesarean deliveries continue to rise in the U.S., accounting for 31.8 percent of all births. The rate of preterm births/low birth weight declined slightly between 2006 and 2007."

The amazing rise in cesareans is NOT according to birth researcher Eugene Declercq of Univ. of Boston, due to cesarean delivery on maternal request or CDMR. It is, statistically speaking, due to the physicians' fear of litigation.

As the expensive surgery's popularity rises (according to the LA Times), so have premature births, maternal deaths and neonatal intensive care admissions. Serious medical intervention has diminishing returns, a doctor notes. Because the average uncomplicated cesarean runs about $4,500, nearly twice as much as a comparable vaginal birth, cesareans account for a disproportionate amount (45%) of delivery costs. Among privately insured patients, uncomplicated cesareans run about $13,000.

"Cesarean birth ends up being a profit center in hospitals, so there's not a lot of incentive to reduce them," said Dr. Elliot Main, chief of obstetrics for Sutter Health, a Northern California hospital chain.

Really? Not a lot of incentive? How about the embarrassing fact that the US is still 27th or 28th in the world when it comes to infant morbidity/mortality and maternal morbidity/mortality? So the almighty dollar is more important than a mother or baby's life.

I don't think I have to say any more...............

Poll on Natural Childbirth & An Important New Book!

I don't usually pay attention to polls. However ~

A recent online poll of expectant mothers showed that 34% became interested in natural childbirth methods because "it is how we are supposed to give birth". Over 16% said their interest in natural childbirth was because the recovery was faster. And 11% stated it was perceived as a safer method.

Natural childbirth IS catching on, even in Hollywood. Celebs who choose natural childbirth rarely make the news but the who's who list of natural childbirth advocates is growing. The most noteworthy spokesperson of natural childbirth lately is Ricki Lake (with Abby Epstein), in part due to her film "The Business of Being Born" and her new book "Your Best Birth: Know all of your options, discover the natural choices and take back the birth experience". She joins the ranks of famous moms such as Laila Ali (CBS Early Show), Melissa Joan Hart, Minnie Driver and Maria Bello (The Mummy: Tomb of the Dragon Emperor) who all experienced natural birth.

Lake and Epstein point out that while 99% percent of births in the U.S. take place in hospitals and one-third are cesareans, the vast majority of births are not high risk and may not require medical intervention. But the fear of pain combined with unnecessary hospital protocols cause many couples to narrow or relinquish their options. The authors discuss the pros and cons of such interventions as episiotomies, epidurals and electronic monitors, and encourage women to carefully question their practitioners and hospital personnel.

This may very well be one of the most important books of our time!

Breastmilk in NICU's

The National Association of Neonatal Nurses has a position paper “The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit.” The link in below.
http://www.nann.org/pdf/09nicu_milk.pdf

FDA: Hydroxycut.......Cytotec

According to a CNN report on May 1, 2009:

The FDA said it has received 23 reports of serious liver injuries linked to Hydroxycut products, which are also used as energy enhancers and as fat burners.
The reports include the 2007 death of a 19-year-old man living in the Southwest, which was reported to the FDA in March. Other serious liver problems reported included liver damage that resulted in a transplant in 2002, liver failure, jaundice, seizures and cardiovascular problems. The FDA is warning consumers to immediately stop using 14 Hydroxycut products manufactured by Iovate Health Sciences Inc. of Oakville, Ontario, and distributed by Iovate Health Sciences USA Inc. of Blasdell, New York.

In the July/August 2001 issue of Mothering Magazine, Ina May Gaskin wrote:

My review of 30 misoprostol [Cytotec] induction studies and reports representing 3,415 births was far less reassuring. I found 14 baby deaths, 25 uterine ruptures, 2 maternal deaths, and 2 life-threatening hemorrhages.4-14 Significantly, several of these complications occurred in women given a single 25 mcg dose-the smallest dose possible.15 According to one researcher, the author of several studies, "Some patients appear to be quite sensitive to misoprostol, demonstrating prolonged contraction responses after a dose of the agent, sometimes in excess of 20 hours after the drug."16


While this may not be the first occurence of such a disparity of truth, I feel betrayed as a medical professional, woman, mother, and US citizen. However, I have renewed energy to educate both the medical and expectant parent population about this disparity.

New CDC Guidelines For Pregnant Women/Swine Flu

The CDC has posted an extensive guidance page for health care providers who work with expectant mothers and who may encounter or be exposed to the Swine Flu.

Pregnant women are known to be at higher risk for influenza and complications.

If you care for pregnant women in any type of setting (doula care, childbirth education, midwifery, hospital), please read this informative information:

http://www.cdc.gov/swineflu/clinician_pregnant.htm


This does not have to be a pandemic.

Increasing Maternity Care Transparency

The Birth Survey announced today that consumer survey results rating health care providers and birth facilities are now available online at www.thebirthsurvey.com. The Birth Survey is the first ever consumer ratings website dedicated solely to providing feedback on obstetricians, midwives, hospitals, birth centers, and home birth services. The consumer reviews include overall ratings and recommendations for birth facilities and care providers, and also a seven-item set of questions on providers’ interpersonal and communication skills, facility intervention rates, and information on finding good care. A national average of ratings is also displayed to provide comparison with individual ratings.

If you are affiliated with a hospital, check it out!

If you are a nurse, or midwife, check it out!

If you are a consumer, check it out!

New Breastcrawl Video!

Common Sense is not so common therefore should it be called Uncommon Sense?

When Thomas Paine wrote "Common Sense" and published it on January 10, 1776, it created quite a stir. Arguing in the people's language and with then-present-day references, Paine set out in print to show the meaning of independence from British rule.

The same can be applied to birthing.

Paine argued that it is ridiculous for an island to rule a continent. I submit, in many cases, it is ridiculous to have careproviders with little or no training in normal birth to be "managing" women who are candidates and seek normal birth.

America was not a "British nation"; it was composed of influences and peoples from all of Europe. Since it is well documented that every pregnancy is different and every birth experience is different, physicians and midwives should not practice by standing orders.

Even if Britain was the "mother country" of America, that made her actions all the more horrendous, for no mother would harm her children so brutally. The real truth about inducing too early and the detrimental effects it has on newborns, the long term side effects of epidural anesthesia on women and their babies, and the dangers of the rising cesarean rate.... ok, nuff said.

The distance between the two nations made governing the colonies from England unwieldy. Careproviders who are trained in crisis intervention are worlds away from normal birth. While in a small percentage of labors, intervention is necessary and often life-saving, birth is not a crisis waiting to happen. For God's sake, teach the careproviders to help women birth normally!

Britain ruled the colonies for its own benefit, and did not consider the best interests of the colonists in governing them. Between careproviders who don't seem to want to accept that babies come when they want to and not on a schedule, and insurance companies that want to drive the birthing boat, women are left with fighting for the options they deserve to know about.

"A long habit of not thinking a thing wrong, gives it a superficial appearance of being right, and raises at first a formidable outcry in defense of custom."

The above is a direct quote from Paine's pamphlet, "Common Sense". How does this compare to policies on electronic fetal monitoring, being hydrated and nourished during labor, application of medication to induce or augment labor, episiotomy, length of labor, etc.

Frankly, the comparison is frighteningly similar.

Happier, Healthier Children with Breastfeeding

Perhaps it is because I breastfed my two, very well adjusted, intelligent children.
Perhaps it is because I have been a birth advocate for 29 years.
Perhaps it is because I know the biology, and psychology behind it all.

No matter the "perhaps", it still amazes me that we have to spend billions of dollars and study something like breastfeeding and spending time mothering our children to validate the impact and importance of it.

Take the recent results from a 29 year study from the University of Queensland Mater Hospital.

"I'm not sure that it's the breastfeeding, or whether the breastfeeding is a marker for the kind of attention the mother wants to pay to the child, but we're seeing children who are happier, healthier, with better mental health in children who are breastfed," says Dr. Jake Najman.

Monitoring began in 1981 when the mothers turned up for their first pregnancy clinic visit at the Mater Hospital, then at the child's birth, five days later, at six months of age, five years of age, and then when they turned 21.

Dr Najman's team invited 8,400 mothers at the beginning of 1981, who gave birth to 7,223 children, who have been followed up ever since.

It is so simple. Breastfeed and mother your babies. Love them. Care for them. And watch the impact that will have on society.

Take a Break And Observe the Beauty of Nature

Let Me Introduce You to ~ Perchlorate

First it was BPA....then Melamine....now rocket fuel or perchlorate in inant formula.

However, this is not new! While the article everyone is talking about comes from the March 18, 2009 issue of the Journal of Exposure Science and Environmental Epidemiology, finding perchlorate in infant formula, our food and our water is regretfully not a new occurance.

Being the wife of a rocket scientist (really!), I found that perchlorates are the salts from perchloric acid. These salts occur naturally in our water supply (in ground water in as many as 35 states and in cow's milk where cows ate plants watered with crops exposed to water with percholates) and via manufacturing - specifically for rocket fuel. They have been used by the medical community for nearly half of a century to treat disorders of the thyroid. Their impact on newborn infant brain growth and development is not known and difficult to estimate, according to the CDC. Read the CDC pamphlet on human consumption of perchlorate.

According to testimony on April 25, 2007 by Robert Brackett PhD on the FDA's ARole in Measuring and Assessing Perchlorate Levels in Food and Beverages before the Committee on Energy and Commerce, US House of Representatives:

Consumers should not view the low levels of perchlorate in the foods tested as an indicator of the "risk" of eating certain foods, particularly when many of the foods are important components of a nutritious and balanced diet. Some of these food items are also important sources of iodine. Until more is known concerning perchlorates occurrence in foods, FDA continues to recommend that consumers eat a balanced diet, choosing a variety of foods that are low in trans fat and saturated fat, and rich in high-fiber grains, fruits, and vegetables.

Perchlorate has been found in liquid and powdered infant formula brands. A list of liquid infant formulas previous identified with perchlorate as an ingredient is found on the site of the Journal of Clinical Endocrinology and Metabolism.


Read the article from the Journal of Exposure Science and Environmental Epidemiology

A needed paradigm shift

Ok, so that is really old verbage. But the concept is still necessary. Or perhaps it is a cultural shift. Labor is what it is. For some women it is short and quick and wonderful, and sometimes it is long and tiring and wonderful too. So here is what needs to shift:

Fear ~ the fear of normal birth on the part of both expectant women as well as physicians. Women today are petrified of the pain associated with labor, with the process of labor and with the entire concept of childbirth. Physicians may fear litigation and for some, ok....for many, litigation drives a physician's practice bus.

Education ~ the educational process WORLD WIDE needs to improve for all people about pain in childbirth and how that differs from the pain we normally feel: labor pain tells us things and not necessarily that something is wrong. Women need to be better educated about birth, comfort measures and the side effects of interventions - including the long term side effects such as the emotional trauma. And finally, physicians need to be educated in normal birth and allowed to practice freely - with the knowledge and compassion that they want to practice with.

Mindset ~ our society's mental attitude toward birth needs to change. Labor is not a crisis waiting to happen and having a baby is not just an everyday occurance. Women remember and continue to process their births years....and decades....after the birth date. Pain in labor is not a curse by God ~ rather it is a blessing that tells us where we are in labor and what we should do as far as physical movement or comfort measures such as laboring in water. Finally, litigation should not be the end-all-be-all for a less than perfect outcome. Unrealistic expectations will be quelled with education.

Elective Cesarean ~ info has a price

I stumbled upon www.electivecesarean.com this afternoon.

Had to chuckle - it is run by a journalist - but that wasn't the part that was funny.

You have to register with the site for $5 to get any of the information.

Is Ignorance Really Bliss...or ?

I have been unscientifically studying the attitudes of expectant parents for some time, in regards to attendance at childbirth class. While we health care professionals have dialed down the number of classes in the series from seven (1980s) to four (2000s), the number of expectant parents attending our convenient drive through classes has dropped well below 33% of all parents giving birth.

Emma Dalton-Brown writes in the Jamaica Gleaner News, she basically doesn't WANT to know about birth, not from a class or even from a video.

The Listening to Mothers Survey II reports that, although most women who attended childbirth classes stated they were more confident in their ability to give birth, a majority of the mothers also reported they had more trust in their hospitals (60%), were less afraid of medical interventions (58%), and had greater trust in their caregivers (54%) after attending classes (Declercq E. R, Sakala C, Corry M. P, Applebaum S. Listening to mothers II: Report of the second national U.S. survey of women's childbearing experiences. 2006 New York: Childbirth Connection.). Eighty-eight percent of the mothers reported a better understanding of their maternity care options (Declercq E. R, Sakala C, Corry M. P, Applebaum S. Listening to mothers II: Report of the second national U.S. survey of women's childbearing experiences. 2006 New York: Childbirth Connection.). The Listening to Mothers II report did not examine whether there were differences in knowledge and decision-making actions between women who attended classes and those who did not.

There is still merit in Childbirth Education classes ~ we just have to take the time to attend. Just as new parents will have to take time to parent their baby, love their baby, feed their baby, stimulate their baby, educate their baby, play with their baby. Be certain a full and happy life is full of the right things....

31.8%

The US birth rate rose to unexpected highs.

The US cesarean birth rate is 31.8%. Nearly 1 in 3 mothers are likely to be candidates for the surgical procedure therefore 1 in 3 babies may be candidates for complications of the birth by surgery. This rate is higher than most countries in the world, double the recommended rate by the World Health Organization and a 50% increase over the last 13 years.

CIMS, the Coalition for Improving Maternity Services, has released a press release calling for more transparency in maternity care. Read the Press Release here.

What do you think? Share your thoughts...........

BMJ says eat during labor

A study released today in the prestigious British Medical Journal may help to put to rest (finally), the controversy surrounding whether or not laboring women should be allowed to eat in labor!

The previous study done in 1976 was the standard siting Mendelson's Syndrome as a reason for not allowing snacks during labor.

While not a large study (only 2426 participants), the outcomes showed no significant outcomes as far as risks for eating or not eating during labor.

This is a truly significant study for all nurses, midwives, physicians, doulas and childbirth educators to embrace!

The Case Against BF ~ Part 2

Official outrage is mounting in regards to the article titled "The Case Against Breastfeeding". The United States Breastfeeding Committee has krafted a letter that will be sent to the editor of the Atlantic Magazine.

Here is their well written press release and how to write your own letter to the editor of the Atlantic.

Speak out now....your voice needs to be heard!

See the interview with Dr. Nancy Snyderman and Hanna Rosin on NBC's Today. Listen carefully!

Visit msnbc.com for Breaking News, World News, and News about the Economy