Science & Sensibility

May 15th 2012 is the first annual Hyperemesis Gravidarum Awareness Day, sponsored by the H.E.R. Foundation.  H.E.R. is an acronym for Hyperemesis Education and Research, and this non-profit organization’s mission is three-fold;

·   Find a cure for hyperemesis and its complications through advanced research,
·   Provide education and support to those seeking effective management strategies for hyperemesis, and
·   Provide information on new resources and treatment options as they become available.

I had an opportunity to speak with Ann Marie King, one of the co-founders of H.E.R. Foundation, to learn more about this disease of pregnancy and what the foundation offers to affected women.  The foundation was founded in 2002 by Ms. King, her husband, Jeremy King and Kimber MacGibbon, and is 100 percent volunteer run. Ms. King told me that “women are struggling and may need help recognizing when the situation has progressed beyond normal morning sickness.  It is not a willpower issue but a disease of pregnancy.”

Hyperemesis Gravidarum (HG) is different than the “normal” nausea and vomiting that affects 50-80 percent of pregnant women, most often in the first trimester (Matthews, 2010).  In most cases, typical “morning sickness” (which can occur at any time of the day or night) resolves itself around the end of the first trimester and becomes a distant memory as women prepare to meet their baby.

Hyperemesis Gravidarum can be a serious complication of pregnancy and may require medical intervention to prevent permanent  or serious injury to mother or baby.  According to the American Congress of Obstetricians and Gynecologists (ACOG), the most commonly cited criteria for diagnosis include;

·      Persistent vomiting not related to other causes
·      A measure of acute starvation, usually large ketonuria (indicated by ketones, the byproducts of inadequate nutrition, in the urine)
·      A discrete measure of weight loss, most often at least 5% of prepregnancy weight (ACOG, 2004).

Hyperemesis Gravidarum  affects between 0.5 and 2.0% of pregnant women and accounts for over 285,000 hospital discharges in the United States annually (Wier, 2008).  Women with HG may experience dizziness, fainting, weakness, hematemesis (vomiting blood), dehydration, nutritional deficiencies and electrolyte imbalances.  In extreme cases, mothers may suffer renal failure and liver dysfunction along with other severe complications.  Babies born to mothers who have experienced prolonged HG may experience low birth weight, intrauterine growth restriction (IUGR), preterm delivery and in some cases fetal or neonatal death (Dodds, 2006).

While most cases of HG resolve before 27 weeks of pregnancy,  22% of the women diagnosed with HG continue to suffer with the symptoms all the way up to delivery (Fejzo, 2009).

Health care providers are not able to predict who will suffer from HG during pregnancy, but research indicates that women who have the following characteristics may have a higher incidence of HG:
·      Higher body weight
·      Allergies
·      Prior restrictive diet (vegetarian diet, lactose intolerant or food sensitivities)
·      Younger age at time of pregnancy (Mullin, 2012)

More research is needed to determine if HG is an autoimmune disease but some study results indicate that there may be an autoimmune component.

The impact of HG on pregnant women is significant and cannot be underestimated.  Daily function is severely impaired, and the ability to work or take care of family is limited.  Repeated hospitalizations impact the entire family and may create a financial burden with the additional medical expenses.  Depression and anxiety are more common among women who suffer from HG throughout their entire pregnancy (Mullin, 2012).   Family members and friends of women diagnosed with HG may struggle with understanding the disease and are unsure of how to offer support to those who suffer from it.

Treatment for HG includes IV hydration, antiemetics, serotonin inhibitors (a form of antidepressant medication) and in severe cases, parenteral nutrition (nutrition that bypasses the digestive system and is delivered directly into a vein). Dealing with severe cases of HG earlier in pregnancy appear to reduce the length of the overall problem.

More than 80% of women who had HG had a negative psychosocial impact.  After delivery, women who have experienced HG have been diagnosed with Posttraumatic stress symptoms (PTSS) at a rate of 18%.   Postpartum self care difficulties, impact on breastfeeding rates,  ability to care for children, more missed work or school, financial and maritall difficulties are areas where the impact of HG is observed, even though the symptoms of HG have been resolved (Christodoulou-Smith, 2011).

Childbirth educators who teach early pregnancy classes have a fantastic opportunity to support and offer resources to women who may be suffering from HG.  Referring women to local health professionals who recognize that early treatment can reduce the severity of HG can be extremely helpful.  A list of health care providers and facilities experienced in treating HG who have self identified or been referred by women suffering from HG is available on the website.

Encouraging local mental health counselors to offer perinatal support groups for women with HG may help reduce the trauma that women experience during pregnancy and in the postpartum period.  Consider speaking with your hospital or prenatal clinic about adding this feature to your programs.  Take a moment during your childbirth class to acknowledge that some women may be continuing to deal with the emotional and physical challenges of HG and let them know about local and online resources available to them.  If a LCCE or other professional was interested in having a speaker come in to class to talk about this disease, the Foundation can provide a list of available women.  The H.E.R. Foundation website includes an extensive peer support forum where women can connect online with other mothers suffering from HG if local support is not available.

If you are aware of women who have been impacted by Hyperemesis Gravidarum, consider asking them to participate in a survey and study looking at genes and risk factors for this debilitating condition.  Info on participation can be found at this link.

Share with us how this issue of Hyperemesis Gravidarum is being addressed in your community and what are your favorite resources to provide to women who may be in your classes with this challenging condition.

Sources

Bailit JL. Hyperemesis gravidarum: Epidemiologic findings from a large cohort. Am J Obstet Gynecol 2005;193:811–814.

Christodoulou-Smith, J., Gold, J. I., Romero, R., Goodwin, T., MacGibbon, K., Mullin, P., Fejzo, M., (2011). Posttraumatic stress symptoms following pregnancy complicated by hyperemesis gravidarum . Journal of Maternal-Fetal and Neonatal Medicine , 24(11), 1307-1311.

Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol 2006;107:285–292.

Fejzo MS, MacGibbon K, Korst L, Romero R, Goodwin TM. Extreme Weight Loss and Extended Duration of Symptoms among women with hyperemesis gravidarum. J Women’s Health 2009;18:1981–1987.

H.E.R Foundation http://www.helpher.org/

Kallen B. Hyperemesis during pregnancy and delivery outcome: A registry study. Eur J Obstet Gynecol Reprod Biol 1987;26:291–302.

Matthews A, Dowswell T, Haas DM, Doyle M, O’Mathúna DP. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD007575. DOI: 10.1002/14651858.CD007575.pub2.

Mullin, P. M., Ching, C., Schoenberg, F., MacGibbon, K., Romero, R., Goodwin, T. M., & Fejzo, M. (2012). Risk factors, treatments, and outcomes associated with prolonged hyperemesis gravidarum. Journal of Maternal-Fetal and Neonatal Medicine, 25(6), 632-636.

Nausea and Vomiting of Pregnancy. ACOG Practice Bulletin No. 52 American Congress of Obstetricians and Gynecologists. Obstet Gynecol 2004; 103:803-15.

Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG.Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005;11(5):527–539.

Wier LM, Levit K, Stranges E, Ryan K, Pfuntner A, Vandivort R, Santora P, Owens P, Stocks C, Elixhauser A. HCUP facts and figures: statistics on hospital-based care in the United States, 2008. Rockville, MD:Agency for Healthcare Research and Quality; 2010

childbirth education, Maternal Mental Health, news about pregnancy, Uncategorized

Science is simply common sense at its best.  ~Thomas Huxley

Science.  Sensibility.  Science and sensibility are good words.  I gravitate to these words naturally.  These words offer me security, comfort and a feeling of order in the world.  I am delighted and honored to be the new Community Manager for Lamaze International’s Science and Sensibility blog and every time I think of the name of the blog I smile, because it feels like coming home.  It defines what I think is important in the work that I do as a childbirth educator and doula.

Science and sensibility is the crux of why I became a Lamaze certified childbirth educator.  The foundation of Lamaze and the principles that guide the work of this blog and of the entire Lamaze organization are built on quality research.  I am proud when I teach The Six Lamaze Healthy Birth Practices in my own classes and I can share the citations that support each practice.  This is the kind of information that should guide informed decision-making by the families that we work with and research that should guide protocols and practice by the health care providers who families trust to care for them during the childbearing year.

I just finished teaching a three day Passion for Birth childbirth educator workshop working with men and women who are on the path to becoming Lamaze certified childbirth educators.  During the workshop, we dedicate time to discuss research.  What makes a good study?  What are reliable sources for information?  How to understand the research?  Vocabulary words like “peer reviewed” and “randomized controlled trial” and other terms are discussed.  We want new educators to feel comfortable looking at research, understanding research and being able to apply current information in their classes as they work with new families.  The workshop attendees often state that they are intimidated, scared and confused about interpreting a research study.  They are not sure how to jump in or what to look for.  Here’s where this blog, Science and Sensibility, can really shine!  Science and Sensibility can help take the mystery out of reading the current research and help new educators, experienced educators, other professionals and interested parents to feel confident about understanding articles and research that impacts new families.

 The purpose of this blog, since it’s inception, has been to highlight current research on pregnancy, maternity care, birth, parenting and breastfeeding topics.  To share important studies, to break them down, provide a common-sense approach to the material, which is often covered in rather technical terms.  And this…this, is what really makes me feel good.  This mission is what makes me absolutely thrilled to be in the role of Community Manager.  To follow in the footsteps of the previous Community Managers, Amy Romano and Kimmelin Hull, who have worked hard to bring you the research, to highlight important studies and to demonstrate how Lamaze supports and incorporates this information and makes it available to educators, parents and the community at large in the work that it does as a leader in the childbirth education arena promoting normal birth.

My goals for this blog are to:

• Continue to profile current research.
• Present research in a matter of fact way with resources for when you want more information.
• Bring you guest bloggers who are experts in their field, inviting them to share their expertise.
• Reach out to the investigators themselves, in order to get the inside scoop on the research.
• Help you to learn more about the leaders and organizations that are on the front lines of improving care for mothers and their babies.
• Recognize that issues of pregnancy, birth and parenting are global in nature.
• Follow the science and make it understandable and relevant to you.
• Do all of this in entertaining, enjoyable ways.

I invite you to participate with me on this journey. I call on you to share your thoughts, ask your questions, and suggest topics to be explored.  Consider contributing your own ideas by becoming a guest blogger. Let me know who you want to hear from and what you want to know more about.  This blog belongs to all of us and requires the participation of many to make it as rich and successful as it has been and can continue to be.  I am excited about the possibilities and opportunities that await me and all of us.  Together, we can be sure that the science is understandable and that future educators embrace the opportunity to comprehend important research, discuss with others and share with families.

Let’s begin!

 

 

 

childbirth education, evidence-based medicine, Healthy Birth Practices, informed consent, Maternity Care, practice guidelines, Research, Science &Sensibility, sensibility, systematic review childbirth education, community, lamaze, Lamaze International, Lamaze Six Healthy Birth Practices, maternity care research, New Community Manager, Sharon Muza, systematic review

this is a guest post by Jessica Zucker, Ph.D.

Part Two: Fortifying Parenthood: Know Yourself

Part Two is about the importance of knowing yourself as a step towards developing healthy parenting practices.

Q: How can I prepare to become a parent who offers my child(ren) a different experience than I had growing up?

Awareness is essential. Having a reflective stance and carving out time to consider your attachment relationship history can have far-reaching effects on your future parenting patterns.

Research has found that their baby’s emergent attachment security is more likely when parents have been honest with themselves about the realities of their own childhood experiences. This means we need not have experienced perfect, flawless childhoods ourselves in order to ensure our future offspring with secure relationships.

What is vital, however, is having a curiosity about the realities of how you were raised, your formative relationships, and how you were impacted by your experiences- the good, the bad, and everything in between.

Reviewing our lives through a raw and honest lens will allow us to more deeply understand why we are who we are. This type of reflection is a natural springboard for cultivating additional insight, mourning difficulties in childhood relationships, and honing aspects of your person-hood that may create a more harmonious babyhood for your children.

Cultivating a sense of reciprocal intimacy in the ever-changing relationship relies, in part, on how you navigate the many feelings that arise each day. It is not a danger to the budding relationship with your child to experience complex feelings. It is what you do with these poignant moments, how you understand the feelings, and the way you react to them that matters most.

There is no more powerful a way to invoke the memory of your childhood than to become a parent yourself. And the opposite of this is true as well.

Getting a taste of what you didn’t get from your parents while parenting your newborn can stir enigmatic feelings that viscerally catch us off guard, leaving us potentially panic-stricken.

Our childhood histories don’t simply fade into the background upon becoming a parent. In fact, entering the maze of motherhood often stimulates memories seemingly long forgotten. Though they might not be consciously remembered, early experiences get stored deep in the crevices of our psyches and in the muscle memory of our bodies.

A potentially daunting task, swimming in the complicated pools of our past ensures a smoother childhood for our offspring. Research states that “experiences that are not fully processed may create unresolved and leftover issues that influence how we react to our children” (Siegel & Hartzell, 2003).

Attempting to make connections between the ways in which the past impacts the present awards us a freedom and flexibility of being with ourselves and with our children. Invariably, when we model for our children an embodiment of authentic reflexivity we provide them with opportunities for deepening connection. Developing a clearer sense of how we have been shaped by the parenting we received fosters a more conscientious parenting path.

Consistency builds healthy attachment. Predictability yields trust. Bonding strengthens connection.

Engendering these experiences in your child might require you to dig deep–to excavate your own childhood experiences with the aim of being the best parent you can be.

Book References:

Siegel, D. J. & Hartzell, M. (2003). Parenting from the inside out: How a deeper understanding can help you raise children who thrive. New York: Penguin Books.

Siegel, D. & Payne Bryson, T. (2011). The whole-brain child. New York: Random House.

Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner (2008). S. D. Stone and A. E. Menkin (Eds).

 New York: Springer Publications.

Wallin,D. (2007). Attachment in psychotherapy. New York: The Guilford Press.

Wiegartz, P. (2009). The pregnancy and postpartum anxiety workbook. Oakland, California: New Harbinger Publications.

Web Reference:

Early Moments Matter: PBS Toolkit

http://www.earlymomentsmatter.org/

Dr. Jessica Zucker is a clinical psychologist in Los Angeles specializing in women’s reproductive and maternal mental health with a focus on transitions in motherhood, perinatal and postpartum mood disorders, and parent-child attachment. Jessica studied at Harvard University and New York University. She is an award-winning writer and a contributor to The Huffington Post and PBS This Emotional Life. Dr. Zucker is currently writing her first book about mother-daughter relationships and issues surrounding the body (Routledge). Jessica consults on numerous projects pertaining to the motherhood continuum.

Web: www.drjessicazucker.com
Twitter: @DrZucker

Authoritative Knowledge, Babies, guest posts, Infant Attachment, Maternal Mental Health, Parenting an Infant, Uncategorized Attachment, babywearing, Kathy Morelli, Parenting an Infant

This is a guest post by Jessica Zucker, Ph.D.

Part One: Fortifying Parenthood: Infant Attachment

Part One is about managing expectations about infant attachment and how to foster the infant bond

Infant attachment: Easier than we think

Parents are often burdened by internalized expectations surrounding attachment. Cultural pressures seep into our pores, clogging our hearts and minds with a million different ideas of how we “should” raise our children.

Super Mommy messages drain the life force out of genuine connection and intuitive responsiveness. Cultural pressures egg women on to embody unattainable perfection from head to toe, leaving us feeling compass-less and insecure when we need to trust ourselves most.

Laying the groundwork for healthy attachment relationships with our children may be easier than we think.

If we strip away the external frills, media hype, and ever-present “shoulds” of baby-dom we can plunge into the basic elements that make up healthy connection and fruitful development.

Let’s focus our energies on the burgeoning relationship with our children rather than culturally-bound trends handed down from generation to generation. We find presence of mind is the most powerful conduits for connection with our children.

What follows are some enriching tidbits about attachment and simple steps you can take with the aim of laying a foundation of emotional health in the relationship with your child.

Q: What is attachment

Attachment is the process, as well as the quality, of the relationship an infant forms with caregivers. Attachment can occur with biological and adoptive mothers, fathers, stepparents, grandparents, and any other consistent person in the child’s life.

A baby’s initial relationship experiences with primary caregivers creates the infrastructure for subsequent relationships, How the child views connection, how she experiences her self, and the world around her, is influenced by her early relationships.

With repeated experiences of predictable care, the infant learns about trust and security. Growing up in an environment infused with safety and intentionality ensures healthy social and emotional development.

“Children with a history of secure attachment show substantially greater self-esteem, emotional health and ego resilience, positive affect, initiative, social competence, and concentration in play than do their insecure peers” (Wallin, 2007).

Q: What are some concrete ways to set the stage for my child(ren) to experience a secure attachment?

Research shows it is the quality of the infant-caregiver interaction rather than the quantity of care that establishes the health in the attachment bond.

In other words, the caregiver’s sensitivity to the infant’s gestures and expressions during interactions is of paramount importance.

Repeated instances of feeling cared for results in a child’s establishment of behavioral expectations for future interactions, inside and outside of the home. Optimally, she learns to expect that people can provide safety, spontaneity, and continuity.

Research shows the number of hours spent together is not necessarily equated with security of attachment. For example, if a mother is home with her child full-time feeling depressed, notably overwhelmed, and appreciably disconnected from her infant, the distressing quality of their interactions may deleteriously impact the child’s sense of poise and/or interpersonal security. Thus, having a nuanced sense of what makes you feel the most present with your child will benefit the emotional health of your family.

The caregiver-infant patterns of communication hold great potential in establishing a secure attachment. Consistent maternal attunement facilitates the infant’s ability to freely explore the world around her, engage in spontaneous play, and rely on the caregiver to provide loving responses.

Security is further felt when the caregiver illustrates thoughtful actions and mindful behaviors.

Positive behaviors to reinforce secure attachment include:

• narrating for your child the events of the day as you move from one activity to the next,
• prolonged gazing and smiling, cuddling and comforting, skin to skin gentle touch,
• calmly and consistently tolerating the variety of emotional states your baby exhibits as she begins to take in the world around her.

Babies often feel distressed and unequipped to modulate their changing feelings. Infants depend on the attachment figure to help them manage and tolerate their emotional experiences. This requires caregivers to “bear within herself, to process, and to re-present to the baby in a tolerable form what was previously the baby’s intolerable emotional experience” (Wallin, 2007).

Ideally, during the initial months of your baby’s life, she learns that caregivers are able to gracefully navigate challenging moments with love and understanding.

Caregiver consistency, responsiveness, and sensitivity yields infant flexibility, resilience, and a sense of attachment security.

Q: How do the earliest moments between infant and caregiver impact future relationships?

Healthy development and attachment security flourish when resonant, competent, attuned, loving, and consistent parental behaviors mark the initial months of a baby’s life.

Babies bask in a comforting balance between connection and exploration as a direct result of environmental safety and trustworthy role modeling.

Sensing that the world is a safe place reinforces self-confidence, trust in others, and a feeling that love and growth are generative.

Conversely, when infants experience their caregiver as threatening or regrettably unstable, fear of closeness can prevail.

Our internal compass for establishing and navigating relationships is initially arranged through seminal infant-caregiver interactions.

Simply put, when early life feels melodic and predictable, the world and others in it feel approachable. The template for how we come to understand what it means to be in relationship with others is set up during infancy and into toddlerhood. These formative relational patterns persist as we journey into adolescents and adulthood.

Book References:

Siegel, D. J. & Hartzell, M. (2003). Parenting from the inside out: How a deeper understanding can help you raise children who thrive. New York: Penguin Books.

Siegel, D. & Payne Bryson, T. (2011). The whole-brain child. New York: Random House.

Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner (2008). S. D. Stone and A. E. Menkin (Eds).

 New York: Springer Publications.

Wallin,D. (2007). Attachment in psychotherapy. New York: The Guilford Press.

Wiegartz, P. (2009). The pregnancy and postpartum anxiety workbook. Oakland, California: New Harbinger Publications.

Web Reference:

Early Moments Matter: PBS Toolkit

http://www.earlymomentsmatter.org/

Dr. Jessica Zucker is a clinical psychologist in Los Angeles specializing in women’s reproductive and maternal mental health with a focus on transitions in motherhood, perinatal and postpartum mood disorders, and parent-child attachment. Jessica studied at Harvard University and New York University. She is an award-winning writer and a contributor to The Huffington Post and PBS This Emotional Life. Dr. Zucker is currently writing her first book about mother-daughter relationships and issues surrounding the body (Routledge). Jessica consults on numerous projects pertaining to the motherhood continuum. Visit Dr. Zucker’s website at  www.drjessicazucker.com

Twitter: @DrZucker

Authoritative Knowledge, Babies, guest posts, Infant Attachment, Parenting an Infant, Uncategorized babywearing, Kathy Morelli, parenting

As regular readers know, Lamaze has been searching for a new Community Manager for this blog. It’s been a rigorous process with many fantastic applicants, each of whom would have brought the blog in great new directions. We had to make a choice and we are thrilled to introduce officially our new Science & Sensibility Community Manager, Sharon Muza, BS, CD(DONA), BDT(DONA), LCCE,  FACCE.

Sharon has been an active childbirth professional for over 9 years, teaching Lamaze classes and providing doula services to hundreds of couples through her private practice in Seattle, Washington.    She is an instructor at the Simkin Center, Bastyr University where she is a birth doula trainer and a trainer with Passion for Birth, a Lamaze-Accredited Childbirth Educator Program.  Sharon is President of REACHE, an annual conference on current childbirth topics in the Seattle area, a co-leader of the Seattle Chapter of the International Cesarean Awareness Network, and a former board member of PALS Doulas.  Sharon enjoys active online engagement and facilitating discussion around best practice, current research and its practical application to community standards and actions by health care providers, and how that affects families in the childbearing year.  Please join me in giving Sharon a very warm welcome!

Deena Blumenfeld, RYT, RPYT, LCCE, Lisa Baker, BSc (Hon), BEd, LCCE and Kathy Morelli, LPC each deserve round of applause for their wonderful contribution during their one-month stints as “Guest Community Manager” over the past three months.

Many thanks to each and every reader and contributor who adds essential value to the Science & Sensibility community!

Linda Harmon, MPH

Lamaze International, Executive Director

Lamaze news, Science &Sensibility New Community Manager, Sharon Muza