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Remembering Doris Haire – A Great Leader in the Field of Maternal Infant Health

June 17th, 2014 by avatar

doris haireDoris Haire, a great leader in the campaign to improve maternal infant health in the USA has passed away.  Ms. Haire died on June 7, 2014.  She was 88 years old.  Doris was one of the first true proponents of evidence based maternity care. Throughout her professional life, Doris advocated and fought for a woman’s right to birth as the mother wanted, free of unnecessary interventions.  Doris led the way in bringing to light the conditions under which women were birthing in the USA with her 1972 essay “The Cultural Warping of Childbirth,” exposing the contemporary childbirth practices of the time.

Along with Drs. Kennell and Klauss and others, Doris sought to change the practice of isolating women from their support during labor and birth and keeping babies apart from their mothers after they were born.  Additionally, Doris also recognized the importance of professional midwives at a time when midwives barely were a blip on the radar after childbirth moved into the hospital at the beginning of the last century. Doris helped establish the first State Board of Midwifery in New York, the first of its kind in the United States which defined the practice of midwifery as a profession separate from nursing and medicine.

Doris traveled to 77 countries to learn about maternity care practices and meet with obstetric health care leaders around the world, in order to gather information that she could use to champion the cause of maternity rights and evidence based medicine here in her own country.  Doris was the Founder and President of the American Foundation for Maternal and Child Health.  Additionally, she served on many boards and committees, such as the World Health Organization, various Perinatal Advisory Committees and others, testified in front of Congress on the topics of obstetrical care and presented at obstetrical conferences around the world.  Doris also spoke at Lamaze International conferences as well.

Doris also examined how drugs are tested and used and published her research in a paper, “How the F.D.A. Determines the ‘Safety’ of Drugs — Just How Safe Is ‘Safe’?”  As a result of this publication, Doris testified at Congress and her actions resulted in changes in FDA regulation and clinical practices. Obstetricians curtailed their use of sedatives and other risky drugs being used for pain relief and millions of childbearing women and their babies have been spared from unnecessary exposure to these risks.

 Doris was also responsible for the passage of the New York Maternity Information Act, which requires every hospital to provide the information and statistics about its childbirth practices and procedures including rates of cesarean section, forceps deliveries, induced labor, augmented labor, and epidurals.

Doris Haire also wrote the following:

The Pregnant Patient’s Bill of Rights

  1. The Pregnant Patient has the right, prior to the administration of any drug or procedure, to be informed by the health professional caring for her of any potential direct or indirect effects, risks or hazards to herself or her unborn or newborn infant which may result from the use of a drug or procedure prescribed for or administered to her during pregnancy, labor, birth or lactation.
  2. The Pregnant Patient has the right, prior to the proposed therapy, to be informed, not only of the benefits, risks and hazards of the proposed therapy but also of known alternative therapy, such as available childbirth education classes which could help to prepare the Pregnant Patient physically and mentally to cope with the discomfort or stress of pregnancy and birth. Such classes have been shown to reduce or eliminate the Pregnant Patient’s need for drugs and obstetric intervention and should be offered to her early in her pregnancy in order that she may make a reasoned decisions.
  3. The Pregnant Patient has the right, prior to the administration of any drug, to be informed by the health professional who is prescribing or administering the drug to her that any drug which she receives during pregnancy, labor and birth, no matter how or when the drug is taken or administered, may adversely affect her unborn baby, directly or indirectly, and that there is no drug or chemical which has been proven safe for the unborn child.
  4. The Pregnant Patient has the right if Cesarean birth is anticipated, to be informed prior to the administration of any drug, and preferably prior to her hospitalization, that minimizing her intake of nonessential pre-operative medicine will benefit her baby.
  5. The Pregnant Patient has the right, prior to the administration of a drug or procedure, to be informed of the areas of uncertainty if there is NO properly controlled follow-up research which has established the safety of the drug or procedure with regard to its on the fetus and the later physiological, mental and neurological development of the child. This caution applies to virtually all drugs and the vast majority of obstetric procedures.
  6. The Pregnant Patient has the right, prior to the administration of any drug, to be informed of the brand name and generic name of the drug in order that she may advise the health professional of any past adverse reaction to the drug.
  7. The Pregnant Patient has the right to determine for herself, without pressure from her attendant, whether she will or will not accept the risks inherent in the proposed treatment.
  8. The Pregnant Patient has the right to know the name and qualifications of the individual administering a drug or procedure to her during labor or birth.
  9. The Pregnant Patient has the right to be informed, prior to the administration of any procedure, whether that procedure is being administered to her because a) it is medically indicated, b) it is an elective procedure (for convenience, c) or for teaching purposes or research).
  10. The Pregnant Patient has the right to be accompanied during the stress of labor and birth by someone she cares for, and to whom she looks for emotional comfort and encouragement.
  11. The Pregnant Patient has the right after appropriate medical consultation to choose a position for labor and birth which is least stressful for her and her baby.
  12. The Obstetric Patient has the right to have her baby cared for at her bedside if her baby is normal, and to feed her baby according to her baby’s needs rather than according to the hospital regimen.
  13. The Obstetric Patient has the right to be informed in writing of the name of the person who actually delivered her baby and the professional qualifications of that person. This information should also be on the birth certificate.
  14. The Obstetric Patient has the right to be informed if there is any known or indicated aspect of her or her baby’s care or condition which may cause her or her baby later difficulty or problems.
  15. The Obstetric Patient has the right to have her and her baby’s hospital- medical records complete, accurate and legible and to have their records, including nursing notes, retained by the hospital until the child reaches at least the age of majority, or, alternatively, to have the records offered to her before they are destroyed.
  16. The Obstetric Patient, both during and after her hospital stay, has the right to have access to her complete hospital-medical records, including nursing notes, and to receive a copy upon payment of a reasonable fee and without incurring the expense of retaining an attorney.

Comprehensive and forward thinking at the time of publication, unfortunately, many mothers are still finding it hard to have all 16 points complied with during a pregnancy, labor, birth and postpartum period.

Well known, well loved and deeply respected, Doris Haines was a leader advocating for the rights of mothers and babies for more than 50 years.  She never faltered and provided unlimited energy and dedication to improving childbirth in the United States.  Doris Haire was a role model for all of us and she will be certainly missed.

Donations to celebrate her life may be made to the American Foundation for Maternal and Child Health, P.O. BOX 555, Keswick, VA 22947.

A complete list of Doris Haire’s publications may be found here.

 

Childbirth Education, Do No Harm, Evidence Based Medicine, Infant Attachment, Maternal Quality Improvement, Maternity Care, Transforming Maternity Care , , ,

The Best Practice Guidelines: Transfer from Home Birth to Hospital – Collaboration Can Improve Outcomes

April 17th, 2014 by avatar

 By Lawrence Leeman, MD, MPH and Diane Holzer, LM, CPM, PA-C

© http://www.mybirth.com.au/

© http://www.mybirth.com.au/

On Tuesday, readers learned about the history and objectives of the Home Birth Consensus Summit, a collective of stakeholders, whose goal is to improve maternal infant health outcomes and increase collaboration between all those involved in serving women who are planning home births.  The interdisciplinary collaboration that occurs during the Summits brings representatives from many different perspectives to the table in order to improve the birth process for women and babies. You may want to start with the post “Finding Common Ground: The Home Birth Consensus Summit“ and then enjoy today’s post on the Home Birth Consensus Summit’s just released “The Best Practice Guidelines: Transfer from Home Birth to Hospital.”  Today’s post was written by Dr. Lawrence Leeman and Midwife Diane Holzer, two of the members on the HBCS Collaboration Task Force, a subgroup tasked with developing these transfer guidelines.  Share your thoughts on these new guidelines and your opinion on if you feel that they will improve safety and outcomes for mothers and babies. – Sharon Muza, Community Manager, Science & Sensibility

Leea Brady was a second-time mother whose first baby was born at home. One day past her due date, an ultrasound revealed high levels of amniotic fluid, which can pose a risk during delivery. Although she planned to have her baby at home, on the advice of her midwife, Leea transferred to her local hospital.

“I knew that we needed to be in the hospital in case anything went wrong,” said Brady. “I was really surprised when I arrived and the hospital staff told me they had read my birth plan, and they would do everything they could to honor our intentions for the birth. My midwife was able to stay throughout the birth, which meant a lot, because I had a trusting relationship with her. She clearly had good relationships with the hospital staff, and they worked together as a team.”

A recent descriptive study (Cheyney, 2014) reports that about ten percent of women who plan home births transfer to the hospital after the onset of labor. The reason for the overwhelming majority of transfers are the need for labor augmentation and other non-emergent issues. Brady’s transfer from a planned home birth to the hospital represents the ideal: good communication and coordination between providers in different settings, minimizing the potential for negative outcomes.

However, in some communities, lack of trust and poor communication between clinicians during the transfer have jeopardized the physical and emotional well being of the family, and been frustrating for both transferring and receiving providers. Lack of role clarity and poor communication across disciplines have been linked to preventable adverse neonatal and maternal outcomes, including death.(Guise, 2013,Cornthwaite, 2008) With optimal communication and cooperation among health care providers, though, families often report high satisfaction, despite not being in the location of their choice.

Recent national initiatives have been directed at improving interprofessional collaboration in maternity care.(Vedam, 2014) This is why a multi-disciplinary working group of leaders from obstetrics, family medicine, pediatrics, midwifery, and consumer groups came together to form a set of guidelines for transfer from home to hospital. The Best Practice Guidelines: Transfer from Planned Home Birth to Hospital are being officially launched today by the Home Birth Consensus Summit and will be highlighted at a series of upcoming presentations at conferences and health care facilities.

The authors of the guidelines, known as the Home Birth Summit Collaboration Task Force, formed as a result of their work together at the Home Birth Summits.

© http://flic.kr/p/3mcESR

© http://flic.kr/p/3mcESR

“Some hospital based providers are fearful of liability concerns, or they are unfamiliar with the credentials and the training of home birth providers,” said Dr. Timothy Fisher, MD, MS, at the Hubbard Center for Women’s Health in Keene, NH and an Adjunct Assistant Professor of Obstetrics and Gynecology, Dartmouth Medical School. “But families are going to choose home birth, for a variety of cultural and personal beliefs. These guidelines are the first of their kind to provide a template for hospitals and home birth providers to come together with clearly defined expectations.”

The guidelines provide a roadmap for maternity care organizations developing policies around the transfer from home to hospital. They are also appropriate for transfer from a free-standing birth center to hospital.

The guidelines include model practices for the midwife and the hospital staff. Some guidelines include the efficient transfer of records and information, a shared-decision making process among hospital staff and the transferring family, and ongoing involvement of the transferring midwife as appropriate.

“When the family sees that their midwife trusts and respects the doctor receiving care, that trust is transferred to the new provider,” said Dr. Ali Lewis, a member of the HBCS Collaboration Task Force. She became involved with the work of the committee in part because of her experiences with a transfer that was not handled optimally. “It is rare that transfers come in as true emergency. But when they do, if the midwife can tell the family she trusts my decisions, then I can get consent much more quickly, which results in better care and higher patient satisfaction.”

The guidelines also encourage hospital providers and staff to be sensitive to the psychosocial needs of the woman that result from the change of birth setting.

“When families enter into the hospital and feel as if things are being done to them as opposed to with them, they feel like a victim in the process,” said Diane Holzer, LM, CPM, PA-C, and the chair of the HBCS Collaboration Task Force. “When families are incorporated in the decision-making process, and feel as if their baby and their body is being respected, they leave the hospital describing a positive experience, even though it wasn’t what they had planned.”

The guidelines are open source, meaning that hospitals and practices can use or adapt any part of the guidelines. The Home Birth Summit delegates welcome endorsements of the guidelines from organizations, institutions, health care providers, and other stakeholders.

References

Cornthwaite, K., Edwards, S., & Siassakos, D. (2013). Reducing risk in maternity by optimising teamwork and leadership: an evidence-based approach to save mothers and babies. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(4), 571-581.

Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014). Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009. Journal of Midwifery & Women’s Health.

Guise, J. M., & Segel, S. (2008). Teamwork in obstetric critical care. Best Practice & Research Clinical Obstetrics & Gynaecology, 22(5), 937-951.

Vedam S, Leeman L, Cheyney M, Fisher T, Myers S, Low L, Ruhl C. Transfer from planned home birth to hospital: inter-professional collaboration leads to quality improvement . Journal of Midwifery and Women’s Health, November 2014, In Press.

About the Authors:

leeman larry headshotDr. Lawrence Leeman, MD, MPH/Medical Director, Maternal Child Health, received his degree from University of California, San Francisco in 1988 and completed residency training in Family Medicine at UNM. He practiced rural Family Medicine at the Zuni/Ramah Indian Health Service Hospital for six years. He subsequently earned a fellowship in Obstetrics. He is board certified in Family Medicine. He directs the Family Medicine Maternal and Child Health service and fellowship and co-medical director of the UNM Hospital Mother-Baby Unit. Dr. Leeman practices the family medicine with a special interest in the care of pregnant women and newborns. He is Medical Director of the Milagro Program that provides prenatal care and maternity care services to women with substance abuse problems. Dr. Leeman is a Professor in the Departments of Family & Community Medicine, and Obstetrics and Gynecology. He is currently the Managing Editor for the nationwide Advanced Life Support in Obstetrics (ALSO) program. Areas of research include rural maternity care, pelvic floor outcomes after childbirth, family planning, and vaginal birth after cesarean (VBAC). Clinic: Family Medicine Center

Diane Holzer head shotDiane Holzer, LM, CPM, PA-C, has been a practicing midwife for over 30 years with experience in both home and birth center. She was one of the founding women who passionately created an infrastructure for the integration of home birth midwifery into the system. She sat on the Certification Task Force which led to the CPM credential and also was a board member of the Midwifery Education and Accreditation council for 13 years. She served the Midwives Alliance of North America on the board for 20 years and is the chair of the International Section being the liaison to the International Confederation of Midwives. Diane is the Chair of the Collaboration Task Force of the Home Birth Summit and currently has a home birth practice and works as a Physician Assistant doing primary health care in a rural Family Practice clinic.

Babies, Guest Posts, Home Birth, informed Consent, Maternal Mortality, Maternal Quality Improvement, Maternity Care, Midwifery, Newborns, Practice Guidelines, Transforming Maternity Care , , , , , , , ,

Home Birth After Hospital Birth: Women’s Choices and Reflections – A Research Review by Jessica English

April 3rd, 2014 by avatar

By Jessica English, LCCE, FACCE, CD(DONA), BDT(DONA)

Today’s research examines the factors that influenced women who chose home birth for the subsequent child, after their previous child was born in a hospital.  Lamaze Certified Childbirth Educator Jessica English, along with midwifery colleagues just published “Home Birth After Hospital Birth: Women’s Choices and Reflections” in the Journal of Midwifery and Women’s Health.  Jessica shares about the research, some of the findings and wraps up speaking about the role that childbirth educators can play in helping women to find satisfaction in their chosen birth location. Are you an LCCE and have published research?  Consider writing a review for S&S.  I would love to highlight our LCCEs.  - Sharon Muza, Science & Sensibility Community Manager.

As a childbirth educator and doula, I have been listening to women’s birth stories for many years. I’m honored that they trust me again and again with the details of their triumphs, frustrations, joys and sometimes outright trauma. When my agency, Birth Kalamazoo, organized a meeting in 2011 to discuss the midwifery model of care, I didn’t think much of it when the attendees introduced themselves and shared a few details about their births. After all, I knew most of them very well (having taught them or in some cases even attended their births), and I knew their stories.

But one of the midwives we’d invited to speak that day took special note of those stories. Ruth Zielinski, PhD, is a hospital-based nurse-midwife, university professor and researcher in my community. She noticed that a handful of the women who spoke mentioned that they had given birth to their first baby in the hospital, then chose home birth for later babies. She approached me after the meeting, curious about why the women might have chosen home birth after their hospital experiences. I shared my perceptions based on my experience listening to women. Intrigued, Ruth wondered if this was something we could research? Neither of us had ever seen academic research on the topic of women who chose home birth after a hospital experience. Soon enough, we had a four-woman research team in place: Ruth; myself; Kelly Ackerson, an academic colleague from Ruth’s department of nursing; and one of Ruth’s undergraduate students, an honors nursing student who was planning a career in midwifery.

Our first task was to identify the structure of the research process. How would we get the information we needed? We settled quickly on focus groups, and wrote a series of open-ended questions that we expected to elicit the participating women’s honest assessments of both their home and hospital experiences, as well as the reasons behind their decision to choose home birth. The next step was to recruit the participants. Through Birth Kalamazoo’s Facebook page, our e-newsletter and via local midwives, we invited women who fit our criteria to participate in a focus group. The primary requirement was that they needed to have had at least one hospital birth followed by at least one home birth within the past 10 years.

Five focus groups followed, each with four participants and two researchers (one who asked the questions and one who took field notes). The focus groups were transcribed verbatim by members of the research team. After each focus group, team members conferred to make sure that we were in agreement about the themes that were starting to emerge. After the fifth focus group, we agreed that no new themes were emerging and we had reached “saturation of the data.” Led by Ruth and her student Casey Bernhard, the research team identified five themes that summarized what the mothers had shared. A sixth focus group of women (one from each prior focus group) provided “member checking” – we shared the themes we’d identified and asked them to verify whether or not they were in keeping with what they had heard during the focus groups.

The resulting research, “Home Birth After Hospital Birth: Women’s Choices and Reflections,” is published in the current issue of the Journal of Midwifery & Women’s Health.

Some Key Findings: Women’s Choices and Reflections

To summarize, five recurring themes were identified from the women’s reflections on both their hospital and home births: choices and empowerment; intervention and interruptions; disrespect and dismissal; birth space; and connection.

Choices and empowerment. The women in our groups reported that with their hospital births they felt they did not actually have much choice in the direction of their care. Although a few women in the study had generally positive hospital experiences, most reported feelings of disempowerment and limited choices associated with their hospital birth and more meaningful choices and feelings of empowerment with their home births.

Interventions and interruptions. During their hospital births, women experienced significantly more interventions compared to their home births. Many of the women in our study perceived these interventions as unnecessary. They commented on timetables, hospital “agendas” and interruptions both during the birth and postpartum period for their hospital births.

Disrespect and dismissal. Many of the women in our study said they felt that their hospital-based providers tended to focus more on anatomical parts and the medical process of birth, rather than on them as whole people. With their home births, they reported a much more holistic model with great respect for their decisions.

Some women who wanted to continue care with both a home birth provider and a hospital-based provider (known as “dual” or “concurrent” care) were dismissed from their hospital-based practice when they revealed that they were planning a home birth.

Birth space. Universally, women reported feeling more comfortable laboring in their own homes, surrounded by only the people they chose to invite into that space. Several women mentioned the appeal of having their older children with them for the birth, or at least having that option.

Connection. When women in our study reported positive hospital births, they also spoke of their positive connections to their providers. For both home and hospital settings, women said that feeling a sense of trust and connection to their doctor or midwife was important and even helped them to feel more comfortable with the process of birth. That theme of connection extended to women’s reflections that during their home births they also generally felt more connected to their bodies, to their babies and to other family members.

Reflections and Implications for Childbirth Educators

As an experienced Lamaze Certified Childbirth Educator and doula, I wasn’t surprised by the findings of our research. The reflections of the women participating were very much in keeping with the stories I have heard for almost a decade from my students, clients and even random women (and men!) who want to share their experiences. It does help me, however, to see the themes identified so clearly. I can envision sharing this research with women who are choosing a home birth for a second, third or fourth baby after a prior hospital birth. It may be validating to them to see many of their own feelings and reflections mirrored in other women’s experiences.

When I think about limitations of this study, I think about the natural differences between first and subsequent births. First births are often longer and more complex, with second and later births often shorter and more straightforward. Could that have influenced women’s feelings of empowerment? As an educator and doula, I also have observed that, after their first baby, many women in general feel more assertive and empowered to take control of their choices for their later birth experiences, whatever the birth setting.

In fairness to the hospital environment, it’s also important to remember that our study was limited to women who felt compelled to make a change for subsequent births. Women who have had very positive, respectful, low-intervention hospital births often choose that same setting for future babies, and their voices were not represented in our focus groups.

Our research may also have been influenced by the specific birth culture in Southwest Michigan. For example, women in our area sometimes want to receive care from both a hospital-based provider and a home birth midwife, but they are typically discharged from their hospital-based practice if they reveal they are planning a home birth. I know this isn’t the case in all areas of the country, and I can’t help but wonder if it’s due in part to the lack of licensing for Certified Professional Midwives (CPMs) in our state. Fellow LCCEs and doulas in states where CPMs are licensed have shared that women in their communities may have easier access to this kind of dual care. I think this issue merits further exploration, with research comparing the home birth experiences of women in various states where CPMs are licensed, unlicensed and specifically outlawed.

As I analyze our results with my childbirth educator hat on, I keep mulling the impact of feelings of safety and comfort on oxytocin. When women feel safe, nurtured, supported and comfortable, we know that the hormones of labor work more efficiently. Did the women in our study have more straightforward births at home in part because the environment allows their bodies to work optimally? I have given talks to labor and delivery nurses on ways they can boost oxytocin in the hospital environment, and as a doula trainer I also address this issue with new doulas. For many women, the home birth setting is inherently designed to maximize oxytocin.

The connection theme that arose in our study is also closely tied to oxytocin. In attending hospital births as a doula, I try to facilitate moments of connection between a woman and her care providers. Penny Simkin’s landmark research on women’s lasting birth memories also points to the importance of such relationships. (Simkin, 1991) Connection comes very naturally between a doula and her client, and often between a home birth midwife and a laboring woman as well. Those connections can be more difficult in a busy hospital environment where a woman is working with a nurse she has likely never met, and often with a provider who is one of many in a busy practice, and who may have several other patients in labor. Can we make more space within our medical system for nurture, if not for the emotional benefits then for the biological effect on the chemical balance in women’s bodies?

In addition to the connection challenges, the themes identified in our research also point to other weaknesses inherent in the medical model of birth. As an educator, I’m already thinking about how I can use these findings to help prepare families for more positive hospital-based experiences. How can they navigate the system to help prevent some of the pitfalls many of these women experienced during their hospital births? I believe so strongly that meaningful change in our system begins with families who speak up for what they need and want for their births. Childbirth educators are on the front lines to help educate families about what a positive, healthy birth experience can look like, and to prepare our students to advocate within the system they’ve chosen to support them.

As leaders in our birth communities, educators can also directly work for change by talking with nurses, midwives and physicians about what women are looking for in their births. Respectfully discussing both the points of dissatisfaction and satisfaction mentioned in this study can help reinforce positive behaviors and change those that may be detrimental to women and to birth. Many of the things women say they want for their births are strongly supported by quality scientific evidence. Take kangaroo care as an example. Ten years ago, a woman in our community might have said in this focus group that she wanted a home birth in part because her hospital providers refused to allow uninterrupted skin-to-skin contact for a few hours after the birth. Today, we have a hospital in our community that is a national leader in kangaroo care for all families and another that is trying to reach that benchmark.

Change is slow, but childbirth educators can help make it happen! Better birth is not just an issue of physical health and emotional well being, it is also financially beneficial to hospitals to flex to provide the compassionate, evidence-based care that will keep families within their system, coming back for subsequent births.

However, the intention of our research was not to dissuade women from home birth. For those who continue to choose that setting for later babies, it may be helpful for educators, doulas, midwives, physicians and others within the maternity care system to understand the factors that motivate them to make that informed choice for their families.

Would you share this research with your childbirth education students and expecting families?  How would you use it?  Do you think that the conclusions are valid?  Do you see things differently? Discuss with us in the comments section. – SM

References

Bernhard, C., Zielinski, R., Ackerson, K. and English, J. (2014), Home Birth After Hospital Birth: Women’s Choices and Reflections. Journal of Midwifery & Women’s Health. doi: 10.1111/jmwh.12113

Simkin, P. (1991). Just Another Day in a Woman’s Life? Women’s Long‐Term Perceptions of Their First Birth Experience. Part I. Birth, 18(4), 203-210.

About Jessica English

jessica english-bw head shotJessica English, LCCE, FACCE, CD(DONA), BDT(DONA) is a Lamaze Certified Childbirth Educator, birth doula and DONA-approved birth doula trainer. She is the owner of Birth Kalamazoo, which offers birth and postpartum doula services, natural childbirth and breastfeeding classes, birth photography, in-home lactation consulting and renewal groups for mothers. She is currently producing a short film about birth, due out in the fall.

Childbirth Education, Guest Posts, Home Birth, Maternity Care, Midwifery, New Research, Research, Transforming Maternity Care , , , , , ,

Childbirth Connection Joins with the National Partnership for Women & Families – Everyone Benefits

March 20th, 2014 by avatar

national partnership women family logoA favorite resource for both myself as a childbirth educator and one that I share frequently with families in my classes has long been Childbirth Connection. Since 1918, when this organization was founded and known as the Maternity Center Association, they have been a “national voice for safe, effective and satisfying evidence based maternity care.”  Childbirth Connection accomplishes this by highlighting current issues and obstacles in maternity care, sharing evidence based information in easy to read and understand downloadable handouts and partnering with other organizations, including Lamaze International to lobby for and promote evidence based care for women and their families in the childbearing year.

You may be familiar with Childbirth Connection as the organization that has been conducting and publishing the landmark Listening to Mothers Surveys and Reports since the first of the LTM reports was published in 2002.  These comprehensive reports questioned mothers about their experiences from preconception through the postpartum period and shed light on many issues – including how much of the care women are receiving is not based on evidence and how limited many of the choices women are given for options while receiving care.  Information discovered through the surveys and published in the LTM reports has been enlightening and sometime shocking, as it highlighted the “real life” experiences of women around the country – who are experiencing maternity care currently in the USA.

Earlier this year, Childbirth Connection announced that they are becoming a core program of the National Partnership for Women & Families, a Washington DC based organization founded in 1971, whose mission is to improve health for women and families, and make the nation’s workplaces more fair and family friendly.  Each organization brings different strengths to the collaboration. Childbirth Connection has a long history of clinical and research focus programs based on evidence based care, while the National Partnership has long established relationships with policy makers.  The fit is a natural one that will benefit American women and mothers and improve maternity care in the USA.

One of the first publications released by Childbirth Connection, under the umbrella of the National Partnership for Women & Families, was a report; “Listening to Mothers: The Experiences of Expecting and New Mothers in the Workplace.” This report was prepared from information gathered during the most recent LTM III survey.

Some key findings from this report include:

  • Holding a job during pregnancy is the new normal.  In fact, women are the primary or sole breadwinner in over 40% of families with children.
  • Women often need minor adjustments on the job to protect their health during pregnancy. 71% of women needed more frequent bathroom break and 61% of women needed some schedule modification or time off in order to attend crticial prenatal health care appointments.
  • Pregnant women’s need for accommodation often goes unspoken and may be unmet, or are often denied.  Many women do not speak up out of fear of repercussions, refusal or uncertainty about how their request will be viewed.
  • Less economically advantaged women are in greater need of accommodation than more advantaged women. Women of color, lower educated women and women who held part time jobs needed more accomodation.
  • Upon returning to work, new mothers experience bias, lost pay, loss of responsibilities and other actions, including losing their job altogether. More than one in four women reported experiencing bias from their employers due to perceptions of their “desire, ability, or commitment” to doing their jobs.
  • Breastfeeding remains a challenge for employed new mothers.  58% of women reported that breastfeeding while employed presented obstacles, including employers not providing an appropriate clean and private location or adequate breaks in which to express milk.

childbirth connectionAs childbirth educators, the women in our classes most likely are working outside the home and many will return to work after having their children.  These are issues that they will face no matter where they are located in the USA, and as educators we can sympathize with their situation and provide concrete resources to help them problem solve solutions.  The National Partnership for Women & Families/Childbirth Connection should be on the short list as a great resource for these women.  We can also share our own tips, encourage discussion amongst the families and help prepare them for some of the above challenges that they may face.

Congratulations to Childbirth Connection on this new opportunity!  I am looking forward to reading and sharing future work done by your organization and in cooperation with the National Partnership for Women & Families.  Educators and others – what information do you feel is important to share with your families about working while pregnant, returning to work after birth and maintaining the breastfeeding relationship once your students are working again.  Comment with your suggestions, advice and resources, so that we can all offer the best information to all families.

References

Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, A. (2013). Listening to Mothers III: New Mothers Speak Out. New York, NY: Childbirth Connection.

 

 

 

 

 

 

 

Babies, Childbirth Education, Maternal Quality Improvement, Maternity Care, Transforming Maternity Care , , , ,

Remembering Dr. John Kennell and His Great Contributions to Mothers and Babies Worldwide

September 5th, 2013 by avatar

It was with great sadness that I read about the death of Dr. John Kennell on August 27, 2013 in Cleveland, OH.  Dr. Kennell, a pediatrician and researcher, had a long history of contributions to the field of maternal infant bonding and attachment, especially at birth and in the early postpartum period  

Every time a mother opens her arms to receive her newborn baby on her chest (in line with Lamaze Healthy Care Practice #6) at the moment of birth it is a credit to the work of Dr. Kennell and his colleagues, especially his longtime collaborator,  Dr. Marshall Klaus.  Dr. Kennell examined and researched the connection (both physiological and emotional) of the newborn and its mother.  As a result of his research, the practice of separating mothers from their babies for hours or even days after birth has all but disappeared in the USA and many places around the world. Prior to Dr. Kennell’s work, little was understood about the newborn’s innate need to be close to and kept with its mother as it made the transition to life on the outside.

Our results reveal suggestive evidence of species-specific behavior in human mothers at the first contact with their full-term infants and suggest that a re-evaluation is required of the present hospital policies which regulate care of the mother and infant. (Klaus, 1970)

Additionally, Dr. Kennell helped clarify the importance of families connecting with their babies who did not survive or died shortly after birth.  Suggesting that time to hold, examine, and say goodby to a baby who passed away was helpful in processing grief and coming to terms with their loss,  has changed how stillbirth and neonatal death is handled in our hospitals.  For babies who are in the neonatal intensive care unit, the importance of promoting mother-infant bonding and attachment is now recognized as a critical part of the care plan.

Dr Kennell’s research has caused hospitals to completely change the methodology of the birth and postpartum experiences for the babies born in there facilities, supporting contact during the first hours and instituting a “rooming-in” policy that allowed mothers and babies to stay together during the postpartum stay.  Even NICU facilities are accommodating parents with couches that turn into beds right on the units, near the babies needing care special care.

These observations suggest that there may be major perinatal benefits of constant human support during labor. (Rosa et.al. 1980)

Dr. Kennell was one of the very first scientists to research and investigate the benefits of continuous labor support for birthing women, and along with Dr Klaus, Penny Simkin, Annie Kennedy and Phyllis Klaus, founded Doulas of North America, which later became DONA International, a well respected, worldwide doula organization committed to training both birth and postpartum doulas and providing a doula for every woman who wants one.  Since being established in 1992, DONA International has certified over 8000 birth and postpartum doulas and has members in over 50 countries around the world.  Many, many thousands of women have birthed with the support of doula, enjoying the benefits observed by Drs. Kennell and Klaus when they first started their research, and documented again and again since then; shorter labors, lower cesarean rates and reduced interventions. (Kennell, et. al. 1991)

If a doula were a drug, it would be unethical not to use it. – John Kennell, M.D.

 

© http://flic.kr/p/tvZYD

Dr. Kennell was the co-author of several books, including ”Bonding: Building the Foundations of Secure Attachment and Independence” and “The Doula Book: How a Trained Labor Companion Can Help You Have A Shorter, Easier and Healthier Birth.” as well as a goldmine of research papers.  He was known for his gentle, caring and compassionate nature as well as his brilliant mind and wonderful sense of humor.

Please join me in extending the deepest sympathies of birth professionals everywhere, to Dr. Kennell’s wife, children and their families during this time of loss.  The memory of this esteemed doctor will live on in the work we all do to improve the childbirth experiences of women everywhere.  I am grateful that I have the chance to continue in some small way, the legacy of the brilliant contribution that Dr. Kennell made to women and babies worldwide.  Dr. Kennell’s family has requested that in lieu of flowers,  donations be made to DONA International or HealthConnect One. Dr. Kennell’s full obituary can be found here.

Please share  in the comments section, the impact that Dr. Kennell’s work has had on you.  He was very important to all of us.

References

Kennell, J., Klaus, M., McGrath, S., Robertson, S., & Hinkley, C. (1991). Continuous emotional support during labor in a US hospital. JAMA: the journal of the American Medical Association265(17), 2197-2201.

Klaus, M. H., Kennell, J. H., Plumb, N., & Zuehlke, S. (1970). Human maternal behavior at the first contact with her young. Pediatrics46(2), 187-192.

Sosa, R., Kennell, J., Klaus, M., Robertson, S., & Urrutia, J. (1980). The effect of a supportive companion on perinatal problems, length of labor, and mother-infant interaction. New England Journal of Medicine303(11), 597-600.

 

 

He is a featured speaker on this DONA International video. In it, Dr. Kennell

“If a doula were a drug, it would be unethical not to use it.” 1998
The Essential Ingredient: Doula

shares his great respect for the doula’s role in establishing a strong foundation for mothers and babies.

 

Our hearts go out to Dr. Kennell’s family, especially his wife Peggy. The family has asked that in lieu of flowers, donations be made to DONA International or HealthConnect One, which were his passions. Further details about how to make donations in his honor will be available on our website soon.

 

Rest in peace, Dr. Kennell. Thank you for all of the gifts you offered up to the world. Our lives are transformed because of you.

Babies, Breastfeeding, Childbirth Education, Doula Care, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Infant Attachment, Maternal Quality Improvement, Maternity Care, Newborns, Transforming Maternity Care , , , , , , , , ,