Archive for June, 2010

Open Thread: “Normal Labour & Birth Research Conference”-style

June 29th, 2010 by avatar

Normal Labour & Birth Conference

As many of my readers already know, I have been invited by the organizers of the Normal Labour & Birth 5th International Research Conference to attend the meeting and blog about the proceedings. I’ve been poring over the abstracts of the conference getting extremely excited to meet the researchers and write about their work. I’ve also been hearing from readers who will be attending the conference. I can’t wait!

I’ll be writing a more “official” post about the conference soon, but in the meantime I am leaving this as an open thread. Leave a comment about whatever you’d like.

People who will be attending the conference, feel free to use the comment thread to connect with other attendees and talk about logistics (roommates, socializing, etc.). Whether or not you’re attending, let us know what you think about the conference program, tell us which sessions you are most interested in, ask your burning questions about normal birth research, or share your favorite spots in Vancouver.

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A new voice on patient safety in maternity care

June 28th, 2010 by avatar

I’ll be the first to admit—I feel a fish out of water on this blog, and am still scratching my head wondering what Amy and I must have been smoking when she invited me, and I agreed, to join Science and Sensibility as a blog contributor.

I’m not a midwife and, aside from Amy, have never met one. I’m not an obstetrician. I’ve never been to a Lamaze class. All three of my children were born in a tertiary care hospital. Doulas were discouraged by my ACOG-certified, impressively credentialed, upper middle class suburban obstetrician group that authoritatively practiced “active management of labor,” so I didn’t even bother considering one. I did have one “natural” childbirth, but not by choice (more on that later!). I was the kind of woman who, in labor with my second child and still smarting from memories of the birth of my first, loudly and repeatedly demanded an epidural from the minute I lumbered through the doors of the hospital until the minute the needle went in my back. I confess to eyeing adherents of groups like Lamaze, Bradley, and La Leche League askance as anti-establishment militant hippies—while secretly clutching my dog-eared copy of The Womanly Art of Breastfeeding and desperately stuffing cabbage leaves down my shirt during my daughter’s first painful weeks of nursing.

And then the house of cards on my perfectly controlled life all came down with the birth of my third child on October 1, 2005. A series of medical errors occurred, snowballing into a catastrophe that nearly cost my son and me our lives. I recently published a narrative in the online medical journal, Pulse recounting my birth experience and the frustrating search for answers from my doctors and the hospital afterwards . This personally traumatic event opened my eyes to the tragic shortcomings of our health care system, maternity care in particular, in a way that four years of medical school, three years of a pediatric residency, and six years in private practice as a pediatrician never did.

In the coming months, I will be blogging about issues of patient safety, patient-centered care, medical errors, and support for clinicians, patients, and families in the aftermath of an unexpected adverse medical outcome. I will speak from the viewpoint of a pediatrician and a patient who has been on both sides of the table. I don’t know all the answers, but I hope to provide some useful information and generate your thought-provoking feedback. Your comments and suggestions for future topics are most welcome.

Joking aside, thank you Amy for welcoming me on board to Science and Sensibility, and I look forward to working with you and your readers to create a safer, healthier, and more compassionate health care system for all our moms and babies.


The 6th Healthy Birth Blog Carnival: MotherBaby Edition…

June 19th, 2010 by avatar

…is up! Go check it out at Giving Birth with Confidence. What a PHENOMENAL collection of contributions about the moments, hours, and days after birth. Each of our Blog Carnivals has vastly surpassed my own expectations. I hope you’ll agree.

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Birth during times of disaster: Keeping women and babies safe

June 16th, 2010 by avatar

I am impressed and surprisingly moved by this video of a NICU evacuation drill at Beth Israel Deaconess Medical Center in Boston. Drills like these are so important for patient safety.

As the hospital CEO points out in his blog, there is a “dearth of literature on NICU evacuations”. The same is almost certainly true for labor and birth, in which evacuating hospitals means telling at least some women to give birth at home. Other potential disasters, such as prolonged loss of electricity, can mean access to anesthesia and surgical care is rationed severely, or not available at all. And of course more widespread disasters such as pandemics, natural disasters, or terrorist attacks might mean that a labor and delivery unit is closed indefinitely.

In 2006, Lisa Summers wrote about representing the American College of Nurse-Midwives (ACNM) at a government meeting discussing healthcare system preparedness for pandemic flu. In an article in ACNM’s newsletter, she shared:

They are planning for three levels of care. There are pamphlets to educate the public about how to provide appropriate home care that will meet the needs of most flu victims (hydration, isolation, comfort measures); they are working with local hospitals to assess surge capacity and their ability to meet the needs of the sickest (perhaps ventilator dependent) victims; and they are designating places such as hotel ballrooms and convention centers (places with adequate bathroom and food facilities) to be used as influenza care centers for those too sick for home care but not in need of (or who cannot be accomodated in) limited hospital beds.

Summers goes on to ask, given that one-quarter of hospitalized people are childbearing women, and pregnant women and newborns may be among the most vulnerable populations to flu infection, “What plans are being made to determine the best level of care for childbearing women? Will the influenza care centers be appropriate places to give birth?” She provides two compelling reasons that midwives should be front-and-center in efforts to address these questions:

The fact that midwives are experts in normal birth – that we are comfortable and skilled at attending a birth outside of a standard delivery room and without an OR down that hall – makes us uniquely well prepared to care for childbearing women in a disaster situation…The other important skill that midwives have honed well is that of triage of childbearing women – knowing which women are likely to safely give birth without medical intervention, and which women need IVs and an OR.

She also points out that all hazards preparedness should involve educating the public about safe home birth and assessing the surge capacity of birth centers.

In addition to Summers’ article, the ACNM also offers a number of other resources on All Hazards Preparedness, including a handout for women who may be vulnerable to giving birth unexpectedly remote from a skilled provider or prepared birth setting. (Whether it’s because of a terrorist attack or the epidemic of roadside births due to the closure of community-based maternity units.) The handout notes that childbirth education classes and prenatal breastfeeding education, along with infant CPR classes, are essential to preparedness, and gives step-by-step instructions for supporting a woman to give birth at home, including how to handle the most common complications.

I’d love to know, what are the hospitals in your communities doing to prepare labor and delivery units for events such as fires, floods, and loss of electricity? Does anyone have a video of an L&D drill similar to the NICU drill from BIDMC? And how are your health departments preparing for disasters that render hospitals unsafe or inaccessible for childbearing women? How many of my readers have contacted their health departments to offer assistance for childbearing women and newborns in disasters?  (Confession: although I’ve been meaning to for ages, I haven’t!)  Do any of you teach about disaster preparedness in prenatal classes?

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No more excuses: video trains hospital staff in the whys and hows of skin-to-skin after birth

June 13th, 2010 by avatar

[Editor’s note: This is a guest post from former Lamaze International President, Jeannette Crenshaw. When Jeannette told me about the video she reviews in this post, I knew I wanted to highlight it as part of the Sixth Healthy Birth Blog Carnival.

I recall  one birth I attended as a midwife, I had to negotiate with the nurse about how long we would “let” the mother and baby remain in skin-to-skin contact after birth. Her reason for wanting to disrupt skin-to-skin time? “I have to put the baby in the computer.” Her job (completing birth documentation) was interfering with her job (safeguarding the health and wellbeing of the mother and baby).

Hospital routines are the #1 reason mothers and babies are denied skin-to-skin contact after birth. Changing this  harmful practice is possible, but it takes a commitment to quality and systems improvement.  Now that the Joint Commission is measuring hospital perinatal quality by the proportion of babies exclusively breastfed at discharge,  hospitals need concrete tools to retrain staff and change delivery room culture. Hospitals: it seems like this video may be $39.00 well spent. – AMR]

Skin to Skin in the First Hour After Birth:
Practical Advice for Staff After Vaginal and Cesarean Birth (DVD)

Executive producer and videographer: Kajsa Brimdyr, PhD, CLC; executive and content producers: Kristin Svensson, RN, PhD (cand.) and Ann-Marie Widström, PhD, RN, MTD.
$39.00 at Healthy Children

scan0004A new DVD from Healthy Children Project should be mandatory viewing for every labor and delivery nurse and birth attendant. It will help maternity health professionals in hospital settings to implement the best practice of uninterrupted skin to skin care beginning immediately after birth until after the first feeding. This is a “how to” DVD, with the practical advice health professionals need to provide clinical care to mothers and babies who are skin to skin immediately after a vaginal or cesarean birth.

The 40 minute DVD, set to original music by J. Hagenbuckle, has 3 content sections, and a section with a complete list of references. The first section describes the short and long term benefits of skin to skin care for newborns and mothers. It shows the 9 stages healthy newborns experience while skin to skin during the first hour after birth—from the birth cry (stage 1), through suckling (stage 8), and sleep (stage 9). The narrator emphasizes the individual way each baby moves through the 9 stages.

The second section shows how to provide care for mothers and babies while they are skin to skin, after a vaginal, and the third, after a cesarean birth. Both sections begin with health professionals teaching pregnant women about immediate skin to skin care prenatally, and on admission to the hospital—which “sets the stage” for immediate skin to skin contact as a normal part of the birth process. After the vaginal birth, the clinician immediately places the baby on mom’s abdomen. After the cesarean birth, the nurse immediately places the baby on mom’s chest, above the sterile field and drapes, as the doctor continues the surgery and the anesthesiologist monitors the mother. The baby’s father is at mom’s side in both segments. Nurses remove birth fluids as they dry the baby—delicately addressing the common concern that babies should first be “cleaned up” at a warmer. Nurses remove wet blankets, place the baby skin to skin, and cover mom and her baby with warmed blankets. Both sections show competent nurses assessing the newborn, providing care, and supporting the mother and baby as the baby moves through the 9 stages of skin to skin.

I strongly recommend this DVD (only $39.00) for staff in any maternity setting. Childbirth educators will find the first section of the DVD a great addition to their prenatal childbirth and breastfeeding classes (although Breastfeeding—A Baby’s Choice, 2007, may be a better choice). Staff who are working to help their hospitals achieve Baby-Friendly designation will find this DVD useful for training. The narrator uses, for the most part, simple and non-clinical language and the video of mothers and babies will quickly engage the viewer. The DVD’s producers met their objective: “to assist staff in providing behaviorally appropriate, individualized, baby adapted care for the full term newborn using the best practice of skin to skin contact in the first hour after birth”.


Healthy Children Project. (Producer). (2007). Breastfeeding—A Baby’s Choice [DVD]. Available from http://www.healthychildren.cc/

Jeannette Crenshaw, MSN, RN, NEA-BC, IBCLC, LCCE, FACCE is a member of the graduate faculty at the University of Texas at Arlington College of Nursing and a family educator at Texas Health Presbyterian Hospital Dallas. She represents Lamaze on the United States Breastfeeding Committee (USBC) and coordinates the Lamaze Breastfeeding Support Specialist Program. She has published articles and presented nationally and internationally on a variety of topics, including evidence based maternity care.

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