Archive for July, 2011

NPR’s Beginnings Series Warns of the Risks of Elective Induction

July 28th, 2011 by avatar

A recent All Things Considered story that aired as a part of NPR’s Beginnings series discussed concerns over elective labor inductions and the movement by some doctors to decrease this trend in our country’s maternity care system.  From the news piece, Doctors to Pregnant Women:  Wait at Least 39 Weeks:

“Statistics show that from 1990 to 2006 the percentage of women who induced labor more than doubled, and nearly a third of women were having cesareans.” (--narrator)

“…It’s now really well-documented in national studies that the risk of the baby having to require intensive care in a neonatal intensive care unit — even the risk of infant death — is increased when the baby is born as little as two weeks before the due date,” says [Ed Donovan, pediatrician at Cincinnati’s Children’s Hospital].”

Later in the story the narrator, Gretchen Kuda Croen, goes on to explain that our nation’s labor induction rate is also hovering around 30%–a statistic that is surely well-known by Science & Sensibility readers.  To me, the two non-coincidentally identical statistics—30% labor inductions and a 30% cesarean rate*—make a glaring statement: when we try to force childbirth to occur when mom and/or baby are not yet ready, that induction is not going to work.  And, in the case of elective induction: rather than admit to this error in timing, hold our horses and let mom go home, inviting labor to start on its own on a different day, we dig in our heals, allow our own personal agendas to take over, and we end up pushing far beyond the option of a vaginal birth, and head straight to the operative suite–setting mom up for a longer and, in most cases, more difficult post-birth recovery.

And let me tell you, I don’t speak from a lofty pedestal here:  I speak from experience.  Eight years ago, my husband and I scheduled an elective induction for our first born at 38 1/2 weeks.

Thankfully for our family, everything went well:  our daughter was born healthy and strong with no cause to be admitted to the NICU.  But just because our story was uneventful, I don’t turn a blind eye to what practitioners like Jay Iams, a specialist in maternal fetal medicine at Ohio State University, are reporting.   A couple of years and plenty of education later, I came to understand the risks we had taken when we opted to electively induce the birth of our daughter “for social reasons” (we were due to move out of state two weeks after the baby’s due date).

Several doctors and medical facilities from Ohio, which are featured in this story, are touting the great achievements they are making in reducing their elective induction rates—along with their NICU admission numbers.  I would love to see this trend replicated in hospitals all over the country.  Better yet, I would love to know that women are sharing the news on this issue with other women: that labor induction for convenience sake constitutes a big gamble in terms of their child’s health and well-being.  I applaud NPR not only for broadcasting this story, but for taking on the entire Beginnings series.  To listen to more stories in this series, go here.  To read about what is being covered in this summer-long series, go here.

Other stories in this series:

Drug Given to Moms After Childbirth Sparks Controversy (misoprostol)

In Mozambique, A Fight To Keep Babies HIV-Free

In Mozambique, Grim Prospects For Mother And Child

Group Prenatal Care: Finding Strength In Numbers

A Prenatal Surgery For Spina Bifida Comes Of Age

Love It Or Hate It, Pregnancy ‘Bible’ Has A Lot To Say

Rethinking SIDS: Many Deaths No Longer A Mystery



*some studies quote rates as high as 34%



Posted by:  Kimmelin Hull, PA, LCCE




Medical Interventions, News about Pregnancy, Patient Advocacy, Pre-term Birth , , , , , , ,

Calling all lacation consultants and breastfeeding supporters!

July 27th, 2011 by avatar

Next week is World Breastfeeding Week.  Here at Science & Sensibility, we want to share with our readers examples of lactation support gone right.  We invite you to take a brief moment to reflect on a scenario in your practice in which your evidence-based guidance led a mother-baby duo to breastfeeding success.  Whether you are an IBCLC, a CLC, L&D nurse, childbirth educator, doula, medical or midwifery maternity care provider or pediatrician…please submit your story of 150 words or less to us by Wednesday, August 3.  Submissions can be sent here.  Stories will be compiled and posted on Friday, August 5.

Want to read lots of inspiring stories?  Forward the link to this post onto anyone and everyone you know who supports women in their journey to successful breastfeeding.

Posted by:  Kimmelin Hull, PA, LCCE

Blog Carnivals, Breastfeeding , , , , ,

Social Media and the Childbirth Educator: What’s all the Buzz About?

July 25th, 2011 by avatar

Last week, I accompanied Cara Terreri (Community Manager of our sister site, Giving Birth With Confidence) in delivering a Lamaze-sponsored webinar* on social media for the childbirth educator.  During the webinar, we discussed common social media platforms and the question of why on earth would a person want to commit time and energy to this form of communication and interaction with others.   Because, after all, most of us working in the childbirth education arena are people-persons, right?  We love the time we spend in class with expectant parents—maybe we even enjoy taking part in a couple community awareness raising campaigns or other in-person normal birth advocacy events each year.  So, why would we want to hide behind our computer screens and “interact” with other birth professionals & pregnant women (and their partners) in lieu of face-to-face time?  Avoiding my gut reaction to respond, “Because everybody’s doin’ it,” in a nut shell, that wouldn’t be a half-bad answer.

Yes, social media is the wave of both today and the future and, as Dr. Klein et al. recently published findings to this same tune, more and more women are turning to the internet—including social media sites—to dig up information on pregnancy, birth and parenting issues.

But if you haven’t made your way into the social media scene as of yet, (okay, you’re reading this, so you must be somewhat comfortable with social media) the prospect could feel daunting.  “What is Twitter and how do I start tweeting?”  “What’s the difference between Linked In and Facebook?”  “Do I really have the time or money to sink into maintaining a blog or website—and furthermore, do I really want to?”  Those sorts of questions were addressed in our webinar, and will be addressed further in tomorrow’s post by social media gurus Hillary Boucher and Jeanette McCulloch.

But other questions remain—those I continue to grapple with:

*Does online advocacy equal real-life advocacy?
*Do online conversations and debates amongst like-minded and opposing individuals create changes in thought, opinion and practice? (Or do they just get people fired up without any real change in sight?)
*What is it about the psychology of online interaction that prompts the type of human behavior you’re less likely to see and expect when people are interacting with each other face-to-face?
*How has the use of social media improved the work of normal birth advocates?  How has it detracted from our work?

I will be addressing these topics and more at the 2011 Lamaze International conference in Fort Worth, TX.  I hope to see you there!



*If you attended this webinar and would like to receive a copy of the slides, contact Kacy Reams at kreams@lamaze.org

Lamaze Annual Confernce, Uncategorized, Webinars , , , ,

Preconception and Women’s Healthcare: An Interview with Dr. Michael Lu (Part Five)

July 22nd, 2011 by avatar

[Editor’s note:  This is the fifth and final part of an interview series between Science & Sensibility’s Walker Karraa, and OBGYN Dr. Michael Lu.  To read the interview from the beginning, go here.  For a list of resources pertaining to this interview series, go here: resources and bibliography_dr lu interview series.]



Racial Gaps, Future Research



Walker Karraa: Your work regarding the racial gap in maternal and infant mortality in the United States is profoundly important.  How might childbirth educators begin to address that, or become part of the conversation and part of the solution?  It’s a big question.


Dr. Lu: It is a big question.  It’s a hard question because right now my understanding is that Medicaid still doesn’t pay for childbirth education, right?


Walker Karraa:  Correct.

Dr. Lu: Yeah, you know that in California, about half of all births are paid for by Medicaid and for African-American women I think it’s more like 60% or 65%.  So two-thirds of all African American women are on Medicaid, which means they have no access to childbirth education unless they pay out of pocket.   So this is an access issue.  Low income women have access to WIC, but WIC is so overwhelmed that they can’t do very much in terms of nutritional, or childbirth education counseling.

In terms of mental health –it’s hard enough for my private patients with super prenatal insurance to see a good mental health professional in a timely manner, [so] think about [what happens with] the low income women with limited access.


This might potentially worsen rather than improve with Health Care Reform.  Why don’t we talk about that?  What’s the impact of the Medicaid Reform going to be on infant mortality and on the racial gap of infant and maternal mortality?  There’s very little discussion about that.  I’m all for Health Care Reform, but it’s really just health insurance reform.   Instead, let’s think through what are the components of care that really optimize women’s health, and make sure there is equal access to those components for African American women.

Shouldn’t there be universal coverage for childbirth education?  Of course if it’s only known as “childbirth education,” there might not be as much support for it.  But if that education could be broadened, which I really think it should, there may be greater support for universal coverage.
Walker Karraa: Can you share what your current research involves?


Dr. Lu: The big research I’m doing right now is with the National Children’s Study.  It [involves following] 100,000 kids from before birth up to 21 years of age.  We’re going to their homes to collect air, water and sewer samples.  We’ll be at the birth of every child to collect placenta [samples], cord blood, etc.  Including 4,000 right here in Los Angeles [from] six different neighborhoods.  We’ve got kids living right next to the Port of Long Beach, or the oil refineries, or next to interstate interchange–what are all the environmental influences on their health?  There is still so much that we don’t know about the causes and prevention of childhood diseases like autism, diabetes, asthma, etc. — can we do a better job in terms of preventing them?  I think the National Children’s Study has the potential to give us a lot more information that would help inform in programs and better practices.


In terms of racial disparities, (through the NIH, Community Child Health Network) we have been creating these Best Baby Zones around the country. It’s a place-based-systems approach to addressing the problem of high infant mortality in this country.  In 12 communities from Harlem to West Oakland, we would do whatever it takes to really improve child and family health–with the goal of closing the gap of infant mortality in ten years. Whatever it takes means not only improving health care quality, but working on improving educational development, economic development, community development.  It’s basically transforming an entire community. So I’m pretty excited about it, but again, [it is] very hard work and very transformative work.


And then lastly I was just appointed by Kathleen Sibelius, Secretary of Health and Human Services,  to chair the Secretary’s committee on infant mortality.   The last chair was working under a different administration, so I think the environment may be more favorable for us to make some of our recommendations and have a greater impact.  I’m trying to think through what some of those recommendations might be, for example–how do we redesign Healthy Start so [that it has] greater impact?  With all of the discussion around health care reform, around Medicaid and so forth—a lot [of that currently] focuses on the elderly.  So little national discussion has been about how all of this is going to impact maternal mortality and infant mortality.  And we know it’s going to have a big impact– so what recommendations can we, as a committee, make to the secretary to make sure that we put safe guards in place?

Walker would like to thank Dr. Lu and his assistant Louise Ino for their time and support, and Kimmelin Hull for editorial assistance.

[Editor’s note:  Science & Sensibility would like to thank Dr. Michael Lu for taking the time to discuss his past, present and future work in obstetrics and preconception care.  Thank you, also, to Walker Karraa, for bringing us this fascinating and most informative interview.  Indeed, as childbirth educators, we are compelled to consider our current and future professional role in the health of childbearing women and their families
—and the ways we might expand our expertise to keep pace with the educational needs of this large segment of our population.]




Michael C. Lu, MD, MPH is an associate professor of obstetrics & gynecology and public health at UCLA.    Dr. Lu received his bachelor’s degrees from Stanford University, master’s degreefrom UC Berkeley, medical degree from UC San Francisco, and residency training in obstetrics & gynecology from UC Irvine. He is widely recognized for his research, teaching and clinical care. Dr. Lu received the 2004 American Public Health Association Young Professional Award for his research on health disparities. He recently served on the Institute of Medicine Committee (IOM) on Understanding Prematurity, and is currently serving on the IOM Committee to Reexamine IOM Weight Guidelines. He is a member of the Centers for Disease Control and Prevention Select Panel on Preconception Care, and a lead investigator for the National Children’s Study in Los Angeles.  Dr. Lu teaches obstetrics and gynecology at the David Geffen School of Medicine at UCLA, and maternal and child health at the UCLA School of Public Health. He has received numerous awards for his teaching, including Excellence in Teaching Awards from the Association of Professors of Gynecology and Obstetrics. Dr. Lu sees patients at the faculty group practice in obstetrics and gynecology at UCLA Medical Center, and has been voted one of the Best Doctors in America since 2005. Dr. Lu was recently appointed by Secretary of Health and Human Services Kathleen Sebelius to chair the Secretary’s Advisory Committee on Infant Mortality.

Dr. Lu Presentation: http://dhsmedia.wi.gov/main/Viewer/?peid=8650dbb4-6b3b-4770-ab78-9fb3ebc0427b


Posted by:  Walker Karraa

Maternal Mortality, Maternal Mortality Rate, Series: Preconception Care, Uncategorized , , , , , , ,

Preconception and Women’s Healthcare: An Interview with Dr. Michael Lu (Part Four)

July 21st, 2011 by avatar

[Editor’s note:  This is the fourth part of an interview series between Science & Sensibility’s Walker Karraa, and OBGYN Dr. Michael Lu.  To read the interview from the beginning, go here.  For a list of resources pertaining to this interview series, go here: resources and bibliography_dr lu interview series.]



Sacred Trust of 24/7


Walker Karraa: Do you use doulas, or do a lot of your patients use doulas?


Dr. Lu: I do, oh absolutely.


Walker Karraa: How is that?


Dr. Lu: It’s been good.  I think it’s been real good.  Usually my patients just mention they have doula and I usually say great and I see them on labor and delivery.  In some instances they alleviate some of my guilt for not being at the bedside.


Walker Karraa: Is that hard?


Dr. Lu: Yeah. I had a patient that came in Easter Sunday.  My own family was going to do an egg hunt.  We had hidden the eggs and everything–but she was a VBAC patient.   When I came in to check on her she was still maybe around five centimeters or so.  I didn’t know how fast she was going to go.  And then I was torn.  Should I stay because she’s a VBAC?  I knew I should stay, but on the other hand, my two daughters, ages eight and five, they’ve been waiting for this Easter egg hunt.  It’s an important moment.  A precious moment and I wanted to be home.  But on the other hand I know the success of that VBAC very much depends on support.


Walker Karraa: Did she have a doula?


Dr. Lu: No she didn’t have a doula.  And so I ended up going home.  The whole time I was feeling extraordinarily guilty.  She forgave me; I mean she understood.  But you know that this is not optimal care. I knew in my heart it wasn’t optimal care.  The way the current system is designed, you’re on call 24/7 for your patients.  That’s something that I haven’t reconciled because I know that there’s something sacred about that bond with your patient.  The way it’s actually set up, you’re coming in at 3:00 in the morning, and you’re distracted.  Or if you have another meeting that you have to go to, or if you have an office full of patients that are getting frustrated because you are in delivery–this might actually start to create these sort of instances for you to do the things that may not be in the patient’s best interest, such as talking them in to do a scheduled c-section instead of VBAC so that you can actually free up your schedule–so you wouldn’t be called in on Easter Sunday!


Walker Karraa: But the intention is not malice.


Dr. Lu: No it’s not malice; that’s why I keep saying it’s not just an individual problem.  It’s a system flaw.  It’s not just about asking the individual OB to work harder, but it’s asking the system to work smarter.  So this is where the teamwork approach actually comes into play.  I think doulas are much better trained in terms of providing support during labor than obstetricians are.  Most of us didn’t sign up to stay by the bed side.  We signed up for obstetrics.  You know that obstetrics is actually a surgical specialty? OBs are trained to screen for disease, to treat complications, etc.  They’re not really trained to provide nurture and support.


And by the way, we had an in-house attending OB, and with my VBAC patient on Easter…


Walker Karraa: Let me guess, the mom said no way?


Dr. Lu:  Well I couldn’t even say, “I’m passing you off to the attendee.”  The attendee could have easily supported her labor and delivery–just somehow the expectation was that no, you don’t pass her off to just the on-call attendee.  That’s your patient.  She’s under your watch.


Walker Karraa: That’s a lot of pressure.


Dr. Lu: It is a lot of pressure and that’s why I think sometimes people are increasingly critical of the doctor’s role, like the increase in caesarean, etc.  But that’s what the system has set them up for.  I still believe that most OBs are driven for the right reasons.  They really want the best outcomes for moms and babies but sometimes they’re just pretty ill-equipped to deliver that.  That’s where I think it’d be great to get some conversation going in our field, in our world.  We’re all united for one common purpose, how do we do that better?


Walker Karraa: You talked about the sacred trust of 24/7 between patient and doctor.  I wonder if somehow that is the same sacred trust that leads women to agreeing to a c-section?


Dr. Lu: I know I could talk my patient into anything, and most OBs know that.  But that’s a misuse of that trust.  Yet there is that sacred trust.  I don’t know how to change that culture.  Maybe the trust is misplaced.  And this is what I haven’t figured out, if we replace the OB with a team, can you have trust in a team the same way you have a trust in your OB?


Posted by:  Walker Karraa


[Editor’s note:  In tomorrow’s final installment of this series, Walker and Dr. Lu discuss racial gaps in maternal outcomes and the need for future research.]

Doula Care, Preconception Care, Research, Series: Preconception Care , , , , , , ,

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