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Preparing Mothers for Breastfeeding after a Cesarean – The Educator’s Role

April 22nd, 2014 by avatar

By Tamara Hawkins, RN, MSN, FNP, IBCLC, CHHC, LCCE

© Sharon Muza

© Sharon Muza

April is Cesarean Awareness Month (CAM).  In a post earlier this month, I shared my favorite websites for birth professionals to learn and share with students and clients about cesarean prevention, recovery, vaginal birth after cesarean along with a fun quiz to test your knowledge about cesarean and VBAC information.  Today, as Lamaze International continues to recognize CAM, LCCE and IBCLC Tamara Hawkins shares information on how professionals can help prepare women who will be breastfeeding after a cesarean to get off on the right track for a successful breastfeeding relationship. – Sharon Muza, Science & Sensibility Community Manager.

Working in New York City,  I see many women who have given birth to their babies via cesarean section. Most hospitals in my area have a cesarean rate close to 40% and 30% of those births are primary cesareans.  April is Cesarean Awareness Month and I wanted to discuss cesarean birth and breastfeeding.  As both a Lamaze Certified Childbirth Educator and an International Board Certified Lactation Consultant, I work with women both before and after a cesarean birth.  I meet mothers who could have prevented many lactation issues if equipped with a few practices to get breastfeeding off to a good start after a cesarean birth. I want to share some practical teaching tips on preparing a mother to successfully breastfeed after having a cesarean birth. In a childbirth class,  it is important to give anticipatory guidance to mothers in class who are preparing to birth about the realities of breastfeeding after a cesarean.

I recommend discussing breastfeeding after cesarean births in all portions of your childbirth class; labor and birth, newborn care and breastfeeding classes, in order to cover different aspects of breastfeeding initiation.  During the labor and birth variations class, discuss how cesarean births affect baby and mother physically and emotionally. Provide tips on how to get through the first days in the hospital such as skin to skin, rooming in, explain the normalcy of cluster feeding and give breastfeeding support resources for the mother to use once she returns home. I find giving a wealth of well researched information in class will not help a mother who may be having breastfeeding trouble several weeks later after the baby has arrived. In newborn care and/or breastfeeding class, provide additional details: latch, positioning, signs of hunger, feeding length and times, cluster feedings, care for engorgement and sore nipples. Supplement with your list of resources.

Many birth professionals report cesarean births as a common reason for delayed Lactogenesis I. I like to lay out solutions for common concerns and problems that arise for mothers when breastfeeding after a cesarean. These solutions include care for the areola/nipple complex, swelling, positioning and latch techniques, anticipating frequent feedings, feeding a sleepy baby, and caring for engorged breasts.

Solutions and Teaching Points

Insufficient glandular tissue and low milk supply

I have seen an explosion of mothers who have insufficient glandular tissue and low milk supply. During class discussions about baby’s first feeding, explain normal breast changes to expect during pregnancy such as prominent veining, dark areola/nipple complex, growth of about one cup size in breast tissue, and tenderness. These changes indicate the process of Lactogenesis Stage I – when the epithelial cells of the breasts begin to convert to milk secreting cells under the influence of the hormone prolactin. When mothers have no or very little breast growth during pregnancy this indicates a deficiency in stage I of lactogenesis. Often, this is why a mother may have trouble with milk supply and not just because she had a cesarean. It is important we make a distinction in this for the mother because if the mother is blaming herself for an unplanned cesarean and then believes the cesarean birth caused the low milk supply it can cause undue distress. I typically just present the expected breast growth information and state, “If you have not had any changes, feel free to reach out to me or speak with your health care provider about your concerns.” When a mother is empowered with anticipatory guidance, it can help her make solutions to adequately feed her baby at birth, build her milk supply and find appropriate breastfeeding support. Even if she has a cesarean, she should not expect low milk supply unless she has the markers of IGT.

Creative positioning and latch techniques

© http://flic.kr/p/5f29EK

© http://flic.kr/p/5f29EK

We cannot expect a mother to sit straight up in a chair to nurse after a cesarean and we have to model positions to help mothers understand how to nurse laying back, in football positions and cross cradle. The side lying position for mothers who gave birth by cesarean can be hard as the mother can experience pulling on her incision as she is trying to roll on to her side.  Additionally, as she is laying in the side lying position, there can be pain, and some babies’ legs are long and can kick the incision. Depending on the available space where I teach, I can get on the floor and demonstrate how to hold the baby in multiple positions simulating being in a bed. I also discourage the use of “breastfeeding pillows.” They tend to not fit well around a mother in bed. If a mother is in a chair she’s liable to lean too far over to reach the baby who is resting on the pillow. It’s best to teach good posture in classes to prevent maternal back and neck discomfort and demonstrate having the baby up close to mother’s abdomen and breast to affect a deep latch.

Frequent feeding

Parents will receive many “tips” about breastfeeding after a cesarean delivery. Every nurse, health care provider, lactation consultant/counselor, mother, sister and friend will tell her something different about when to feed her baby. It is the role of the childbirth educator to prepare them for frequent feeds and give rationales as to why feeding a baby frequently is important.  Rather than stating a set “frequency” such as feed every 2-3 hours, I want them to understand the newborn’s normal pattern of sleep and wakefulness and how this influences their feeding behaviors. Mothers may be drowsy after a cesarean birth, particularly if the surgery followed a long labor.  They may also be in pain. Pain medication, while necessary for good pain management after surgery, can also contribute to a mother feeling sleepy. Holding her baby skin to skin will help the mother connect with her baby and relax. Both mother and baby need to be relaxed to get breastfeeding off to a good start. Explain to mothers during class that babies may want to nurse within the first hour and to wait for those cues: rooting, hands to mouth and suckling. Babies are often sleepy after cesarean births, especially if mother was pushing, had been treated with magnesium for pre-eclampsia or had been through a long induction. When a baby does not feed as often as anticipated, this will of course upset the mother and can lead to delayed Lactogenesis II.

Educators have to set expectations properly. Working on a time line, I discuss, breastfeeding in the operating room during the cesarean repair and in the recovery room. When partners are in class, teach them how to place the baby skin to skin with mom and support the baby if the mother’s arms or hands are restricted with blood pressure cuffs and IV lines. Discuss hand expression for those sleepy babies who are not rooting within 45 minutes of birth. Dr Jane Morton has a fantastic video illustrating how to express colostrum by hand. This is especially important for babies born to a mother with gestational diabetes, as these babies tend to be at risk for low blood sugar and formula supplementation.

If the baby has to go to the nursery before breastfeeding has been established, we discuss delaying the newborn bath and the rationale. When babies get a bath, not only is the vernix and amniotic fluid (which is a familiar taste to the baby) washed off, the baby will most likely cry, a lot, and fall into a deep sleep making it harder to wake for a feeding. Also, many babies are kept for a longer time in the nursery to warm up after the bath delaying skin to skin and breastfeeding. If the baby has not breastfed in the operating or recovery room, suggest the parents ask for the bath to be delayed until the next day and expect the baby to be on contact precautions. That means there may be a sign on the bassinet alerting care providers to wear gloves when caring for the baby.

Moving along the timeline, we move right into newborn sleep-wake patterns and cluster feedings. I tell them the baby is not born knowing there is a clock on the wall. There is no magic formula that says the baby should be fed 8x/day or every 3 hours or even for 15 minutes on the breast. Expect the baby to nurse 45 minutes every hour for four to five hours straight. That’s when you will really get their attention and can again discuss normal baby routines, colostrum volumes and the size of the newborn stomach.

Dealing with a sleepy baby

Babies born via cesarean can be sleepy for many reasons; exposure to magnesium sulfate and analgesia, long labors, and long second stage to name a few reasons. These babies need to be fed one way or another. Teach clients how to hand express and feed their baby at the breast. Holding the baby close to the breast, hand express 20 drops from each breast and rotate twice between each breast. Approximately 80 drops equal a teaspoon. This is the estimated amount the baby will take in during breastfeedings on day one and two of life. The mother can hand express directly into the baby’s mouth or into a spoon. I prefer a soft baby spoon as a plastic spoon can be sharp on the edges. Hand expression can prevent serious engorgement and increase likelihood of normal Lactogenesis II by stimulating release of prolactin.

Dealing with engorgement

Mothers that get engorged after a cesarean sometimes are dealing with breasts that are extremely edematous. It is important to discuss the difference of being engorged with milk versus engorged with interstitial fluid or swelling. At the time I cover the topic of cesareans in the childbirth class, I differentiate the two by describing how the breasts feel under both circumstances. I describe the breasts as feeling like a bag of marbles when it is full of breast milk and like an overfilled water balloon when it is just interstitial fluid. The care plan for each type of engorgement is a bit different. To start, emphasize on demand feedings to prevent buildup of fluid and discuss the use of Reverse Pressure Softening to remove local swelling in the areolar/nipple complex to affect a deep latch.

Breasts that appear swollen and feel soft like a water balloon need hand expression to get the milk flowing and to keep the areola soft. No application of heat is warranted with this type of swelling. Warm compresses can cause blood and lymphatic vessels in the breast to dilate and release more fluid. The goal is to reduce the swelling. After every feeding, application of cool compresses to the breasts is best. Cold therapy slows circulation, reducing inflammation, muscle spasm, and pain. The goal here is to keep the areola soft to prevent pressure building up around the milk ducts and prevention of milk flow.

Breasts that are hard with palpable alveoli are full of milk. The mother can once again use hand expression to get the milk flowing and will benefit from warm compresses to the breast for about 5-10 minutes before feeding. If her milk begins to leak, than the warmth is a good tool. If the milk does not begin to leak out, that is an indication that interstitial swelling is present and heat should not be used. Only cool compresses after feeding and/or pumping should be used in this situation.

Mothers that have cesarean births are very vulnerable to the hardships that come along 3-4 days after the birth including sore and swollen breasts, possible low milk supply and general recovery complaints that are associated with major abdominal surgery. Giving anticipatory guidance to succeed with breastfeeding amongst these possible issues and challenges are important to help mothers gain the confidence to succeed in making breastfeeding work.

After birth, a mother may have less support in her postpartum room and at home. She may even be alone most of the time during breastfeeding. After her labor and birth, it is likely she will not be able to access information stored in the left side of her brain if she is having breastfeeding difficulties coupled with fatigue and pain from birth. She will still reach out and ask questions. Very likely her first sources will be an online chat room, on a Facebook page or on a website somewhere. Childbirth educators should provide specific resources to find breastfeeding information. Share local breastfeeding and cesarean birth support groups along with the contact information for breastfeeding professionals during your childbirth classes.

I recognize that there is a lot of work to do in the birth world to bring down the cesarean birth from the current 32.8%. We can inform our students and clients with information to keep breastfeeding as normal as possible if a cesarean birth should occurred. It is our responsibility in the classroom to give our clients those tools to help them succeed in breastfeeding no matter how they give birth.

What information do you share with your clients about cesarean birth and successful breastfeeding? How do you prepare them for possible breastfeeding hurdles after a cesarean birth?

About Tamara Hawkins

tamara hawkins head shotTamara Hawkins, RN, MSN, FNP, IBCLC, CHHC, LCCE is the director of Stork and Cradle, Inc offering Prenatal Education and Breastfeeding Support. She graduated with a BSN from New York University and a MSN from SUNY Downstate Medical Center. She is a Family Nurse Practitioner and has worked with mothers and babies for the past 16 years at various NYC medical centers and the Elizabeth Seton Childbearing Center. Tamara has been certified to teach childbirth classes since 1999 and in 2004 became a Lamaze Certified Childbirth Educator and an International Board Certified Lactation Consultant.  Follow Tamara on Twitter: @TamaraFNP_IBCLC

Babies, Breastfeeding, Cesarean Birth, Childbirth Education, Guest Posts, Healthy Care Practices, Infant Attachment, Newborns , , , , , ,

60 Tips for Healthy Birth – Resources for Students and Suggested Teaching Activities

February 12th, 2014 by avatar

GBWC buttonIf you are in any way familiar with Lamaze International, hopefully you are aware of the Six Healthy Birth Practices.  Many years ago, I fell in love with these nifty “guidelines” that supported and reinforced everything that I had been teaching in my childbirth classes. These six care practices promoting safe and healthy birth each have their own list of citations of research supporting each care practice and a short, but extremely informative video to go along with each one.  As it has been a few years since the Six Healthy Birth Practices was released, Lamaze International is in the process of updating the citation sheets to source the most current information.

I want to bring your attention to a fantastic resource guide on the Six Healthy Care Practices that Community Manager Cara Terreri put together on Giving Birth With Confidence,  the Lamaze blog for parents and expectant families.  Cara created the “Sixty Tips for Healthy Birth” series, and in six separate blog posts provides ten tips for each Birth Practice that highlights working toward a healthy birth practice that promotes physiological birth.

60 Tips for Healthy Birth – From Giving Birth With Confidence

Part 1: Let Labor Begin on Its Own

Part 2: Walk, Move Around and Change Positions Throughout Labor

Part 3: Bring a Loved One, Friend or Doula for Continuous Support

Part 4: Avoid Interventions that Are Not Medically Necessary

Part 5: Avoid Giving Birth on Your Back and Follow Your Body’s Urges to Push

Part 6: Keep Mother and Baby Together, It’s Best for Mother, Baby and Breastfeeding

Teaching Activities Using the Sixty Tips

childbirth ed classI have created several interactive teaching activities using Cara’s tips.  As each Healthy Birth Practice come up in your class, have the ten tips from the GBWC blog on strips of paper or small cards available to each family for individual work, or larger laminated cards for small group or whole class work.  Ask the families (or the class as a whole) to sort the cards into a logical order from easiest to hardest to accomplish.  They can indicate which tips have already been completed in their family and which ones might still be left to do.  If they completed the activity by individual family, facilitate a discussion as they share with the whole class.  If you conduct this activity as a whole class, this discussion will unfold naturally of course.  Alternately, they can sort the cards into the most important to least important for achieving this goal.  Or any other number of ways.

Families can build confidence that they have already successfully achieved several of the recommendations and identify things they still can do to support the type of birth they are planning.  They can also connect with other families, recognizing that everyone is working hard to be prepared.

Another way to use these tips in class is to provide the tips as a checklist and ask families to check off those that they have completed.  Ask families to challenge themselves to complete one of the items that they have not already done.  If it is a series class, you can check in at the end of the series and award a small prize to the family that has completed the largest number of tips.

A third suggestion is to ask students to add their own tips or create their own list for each Healthy Birth Practice.  Using newsprint, have one sheet for each Healthy Birth Practice, and break the class into groups, with each group working on one of the Practices, creating their own thoughts to go along with the 60 that Cara shared.

How do you see using the Sixty Tips for Healthy Birth in your childbirth classes?  Please share your ideas in our comments section so we can all learn and collaborate on great teaching ideas that help families have safer and healthier birth experiences.

 

 

 

Childbirth Education, Giving Birth with Confidence, Healthy Birth Practices, Healthy Care Practices, Maternity Care , , , , ,

Cochrane Systematic Review Supports Lamaze Healthy Birth Practice #2- Walk, Move Around And Change Positions Throughout Labor

December 19th, 2013 by avatar
Image Source: © Sharon Muza

Image Source: © Sharon Muza

Today, author Henci Goer takes a look at a new Cochrane Systematic Review; “Maternal positions and mobility during first stage labour” and finds that the results of this review support the 2nd Lamaze International Healthy Birth Practice: Walk, move around and change positions throughout labor. Families taking Lamaze childbirth classes learn how they can promote physiologic birth by using a variety of positions throughout their labor, but women don’t have to take a childbirth class to know that walking and trying different positions reduces pain and speeds up labor.  Intuitively, women respond to the needs of their baby and their body during labor.  Henci examines the review and shares some of the benefits that were found in the women who followed the 2nd Healthy Birth Practice to promote safe and healthy birth. – Sharon Muza, Community Manager.

Advocates for physiologic care in labor will be pleased, although not surprised, to know that a Cochrane systematic review supports mobility and upright positioning in first-stage labor (the cervical dilation phase) (Lawrence 2013.) The review includes 18 randomized controlled trials (RCTs) comprising 3337 women not having epidurals at trial entry and 7 trials comprising 1881 women in which all participants had epidurals or combined spinal-epidurals at trial entry.

The body of data poses challenges in analysis and interpretation. Trials were published between 1963 and 2012 and conducted in 13 countries. As reviewers note, this means that they took place in highly varied cultural and healthcare contexts, equally varied expectations on the part of staff and laboring women, and with evolving healthcare technologies, all of which could influence results. In addition, comparison “treatment” and “control” groups also varied widely and overlapped among them. So, for example, one trial compared walking with remaining in bed in whatever posture, including upright postures; another compared walking with recumbent postures; and still another combined sitting and walking as upright postures and compared them with recumbent postures. That being said, here is what the reviewers found:

Compared with recumbent postures and bed care, upright postures and walking in women without epidurals at trial entry:

• Shortened first-stage labor duration by a mean difference of 1 hour 22 minutes in women overall (15 trials, 2503 women) and by 1 hour 13 minutes in first-time mothers (12 trials, 1486 women). In women with prior births (4 trials, 662 women), duration differed by only 34 minutes, and the difference just missed achieving statistical significance, that is, statistical analysis shows that the difference is unlikely to be due to chance. By comparison, rupturing membranes, commonly used to “get the show on the road,” had no effect on first-stage duration in women overall (5 trials, 1127 women) (Smyth 2013), and too few women were reported according to first-time or prior births to draw meaningful conclusions.

• Decreased likelihood of cesarean delivery (14 trials, 2682 women) by 30%. Likelihood decreased by 20% in first-time mothers (8 trials, 1237 women) and 40% in women with prior births (4 trials, 775 women), but the differences didn’t achieve statistical significance probably because aggregated numbers were too small (underpowered) and cesarean rates too low to detect a difference. By contrast, rupturing membranes increases the likelihood of cesarean surgery by 30%, a risk that misses achieving statistical significance by a whisker and probably would have achieved significance had not so many women assigned to “conserve membranes” actually had their membranes ruptured (Smyth 2013).

• Reduced use of epidural analgesia (9 trials, 2107 women) by 20%.

• Didn’t increase satisfaction or decrease complaints of pain, but only one small study (107 women) measured satisfaction, and among the three trials (338 women) evaluating pain, women reported less pain in two of them, but in the third (201 women), which comprised 60% of the population overall, participants assigned to sit or walk were not allowed to lie down at any time during first stage. Bloom et al. (1998), by far the largest of any of the trials at 1067 participants, wasn’t included in the pain and satisfaction assessments probably because they took a different approach. They asked women who walked whether they would want to walk in a future labor. Ninety-nine percent said “Yes,” which would seem a ringing endorsement of ambulation.

• Showed no evidence of increasing maternal, fetal, or neonatal harm. In fact, one small trial (200 women) reported significantly fewer admissions to neonatal intensive care.

Benefits were maintained when subgroupings of upright postures were compared with subgroupings of recumbent postures, as for example, walking compared with recumbent/supine/lateral or sitting and standing, squatting, kneeling, or walking compared with recumbent/supine/lateral.

No benefits were found for walking or upright postures (7 trials, 1881 women) in women who had epidurals or combined spinal-epidurals at trial entry. This doesn’t really mean much, though, because in some trials, substantial percentages of women assigned to walk didn’t actually do so, and in others “ambulation” was defined to be as little as 5 minutes of walking per hour.

The review leaves some questions open: Can mobility be used to treat delayed progress? Should women with ruptured membranes be allowed to walk? What about women at risk for fetal compromise? To the first question, it makes sense to encourage walking and upright positioning as a first-line measure to treat progress delay. The alternatives, rupturing membranes and oxytocin augmentation, have potential harms while walking and position changes don’t. To the second, when upright, gravity would tend to bring the presenting part downward to block the cervical opening, thereby protecting against umbilical cord prolapse. A common sense approach might be to monitor fetal heart tones throughout a contraction upon the woman first assuming an upright position and repeat whenever she returns to an upright position after lying down. To the last question, studies would need to be done, but rupturing membranes increases risk of fetal compromise by releasing the fluid that prevents umbilical cord compression (you can’t compress a liquid), and augmentation increases contraction intensity, which also could increase risk of compromise in a vulnerable fetus.

The true benefits of mobility are almost certainly much greater than the review shows. This is because RCTs are analyzed according to “intent to treat,” that is, participants are kept with their assigned group regardless of their actual treatment. To do otherwise would negate the point of random assignment, which is to avoid bias; however, when substantial percentages of participants receive the treatment of the other group, as is the case with many of the mobility RCTs, it both diminishes differences between groups and makes it harder to detect a significant difference between them. This was a problem in all the mobility RCTs, not just the ones where women already had regional analgesia on board. Again, take Bloom et al. (1998): among women assigned to walk, 22%—approaching 1 in 4—never walked at all, and of the women who did, the mean time spent out of bed was an hour mostly because of policies that kept them in, or returned them to, bed.

The reviewers conclude:

[W]e believe wherever possible, women should be informed of the benefits of upright positions, encouraged and supported to take up whatever positions they choose, they should not have their freedom of movement options restricted unless clinically indicated, and they should avoid spending long periods supine (p. 23).

It isn’t enough, though, to advise women that it’s a good idea to stay mobile and stay off their backs unless staff follow through on not restricting freedom of movement. As matters currently stand, conventional hospital labor management couldn’t do a better job of restricting mobility if that were its intended goal. To turn that around, hospitals would need to:

• Provide an environment conducive to mobility, including ample space for moving around and props such as birth balls, rocking chairs, and cushions,

• Provide comfort measures such as hot and cold packs, private showers, and soaking tubs to reduce and delay use of epidural analgesia,

• Train staff in encouraging and providing physical assistance in changing positions, in the use of mobility props, and in how to provide emotionally supportive care,

• Welcome doulas who can share the burden of providing physical and emotional support,

• Use intermittent listening to fetal heart tones except when continuous monitoring is medically indicated,

• Reserve IVs for medical indications, which would mean allowing women oral intake of fluids and calories, and

• When mobility-inhibiting interventions are required or the woman desires an epidural, minimize their impact by such measures as telemetry monitoring, inserting IV catheters in the forearm rather than the hand or wrist or using saline locks instead of IVs, and encouraging women with epidurals to assume upright positions and change positions periodically.

In other words, promoting mobility in labor is the proverbial tip of the iceberg. Floating below is the vast bulk of providing physiologic care. That won’t be easy for a number of reasons.

For one thing, medical research principles require that investigators define the intervention under evaluation precisely and maximize compliance with its administration. But this is the direct opposite of women doing what instinctively feels best in an environment that encourages their experimentation and is free from elements that inhibit or restrict them. We have no trials that compare this style of care with conventional medical-model management, which means we don’t have data showing the true degree of harm arising from confining and circumscribing mobility in labor or the magnitude of the benefits to be gained with promoting it. Without that knowledge, there is little incentive to change.

For another, in the topsy-turvy world of medical-model research, maternal movements and physiologically normal behaviors are framed as “interventions.” This means that being up and around and having the freedom to labor in the positions of the woman’s choice has to prove itself, not confinement to bed and positioning restriction. What is more, to institute change, the “intervention” must prove itself superior according to medical model concepts of improved outcomes, or conventional management stands, however much that management lacks an evidence basis. This explains how Bloom and colleagues could entitle their trial “Lack of effect of walking on labor and delivery” despite walking having no harms and 99% of women who walked wanting to do so again in a future labor.

Finally, powerful forces line up against instituting the sweeping changes that would be required to convert to mobility-friendly care. Inertia is one. People will generally resist change even when it benefits them personally, which in this case it doesn’t. Economics is another. The costs of maintaining a 24/7 obstetric analgesia service demand that most women have epidurals while any renovation expenses, such as providing private showers, soaking tubs, or telemetry monitoring, would not be reimbursed. Hospital culture is perhaps the biggest obstacle of all. “This is the way we’ve always done it” and “what is must be right” are potent impediments to improvement. Specifically, so long as reducing cesarean rates isn’t a shared, strongly-held goal—and a cursory glance at hospital cesarean rates shows that it isn’t in most hospitals—motivation to change will be low.

All of this is to say that reform won’t be easy, not that it can’t be done, and, I would add, the wellbeing of mothers and babies obliges us to try. In that interest, can we crowd source strategies? Are any hospitals in your community mobility friendly? What are their practices and policies? Have any of you been involved in projects to increase mobility in labor, and if so, what went well and what would you do differently?

References

Bloom, S. L., McIntire, D. D., Kelly, M. A., Beimer, H. L., Burpo, R. H., Garcia, M. A., & Leveno, K. J. (1998). Lack of effect of walking on labor and delivery. N Engl J Med, 339(2), 76-79. http://www.ncbi.nlm.nih.gov/pubmed/9654537?dopt=Citation

Lawrence, A., Lewis, L., Hofmeyr, G. J., & Styles, C. (2013). Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev, 10, CD003934. doi: 10.1002/14651858.CD003934.pub4 http://www.ncbi.nlm.nih.gov/pubmed/24105444

Smyth, R. M., Markham, C., & Dowswell, T. (2013). Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev, 6, CD006167. doi: 10.1002/14651858.CD006167.pub4 http://www.ncbi.nlm.nih.gov/pubmed/23780653

 

Evidence Based Medicine, Guest Posts, Healthy Birth Practices, Healthy Care Practices, New Research, Push for Your Baby, Research , , , , , ,

Midwives Alliance of North America (MANA) Invites You to Research Home Birth!

October 31st, 2013 by avatar

This past weekend I attended the Midwives Alliance of North America (MANA) annual conference; Birthing Social Change in Portland, OR. The conference was attended by more than 300 midwives and their supporters. I thoroughly enjoyed the variety of general sessions and the concurrents I attended. Eugene DeClerq, (did you know he is an LCCE!) a principal investigator on the Listening to Mothers project and the genius behind the Birth by the Numbers website, was brilliant as usual in sharing all kinds of data about the state of birth in the USA. Another keynote speaker, Melissa Cheyney, PhD, CPM, LDM, Division of Research Chairperson for MANA, provided members with an update on the MANA Stats Project. The MANA Stats Project is a multi-year registry collecting data mostly about out-of-hospital births, though some Certified Nurse Midwives are using it for tracking both home and hospital births as well.

At the conference, two much-anticipated research studies were announced. You can learn more about the articles and MANA stats in a recent post at the MANA blog here. Science & Sensibility is looking forward to sharing a review and information about these studies with you here on our blog in the early part of next year, when they are released in the Jan/Feb 2014 issue of the Journal of Midwifery and Women’s Health.

The MANA Stats registry is currently collecting more than 1,000 records per month, mostly from midwives who attend out of hospital births in the United States. The first set of records – representing more than 20,000 births – is currently available to researchers. According to Melissa Cheyney, “These datasets include some of the only U.S. data that exists regarding physiologic, low-intervention labor and birth — data that are becoming more and more rare due to the increase in “routine” interventions in the hospital setting.”

As the data set grows and more records are added, the power and possibility of exploring information contained gets even more exciting. Did you know that the data is being made available to researchers interested in conducting some analysis? Could this be you? Professionals may think that they need to be affiliated with a large research institution, but that is not the case.

All researchers applying for the data are required to have what’s known as “IRB approval,” meaning an academic institution willing and able to ensure that the research design appropriately protects the subjects’ confidentiality. However, MANA has a unique program in place that allows non-academic researchers to access the data. The program connects mothers, advocates, and others interested in research with researchers that can provide support and mentorship. You can learn more about this program – called “ConnectMe” – here 

It would be wonderful if a Lamaze Certified Childbirth Educator with the skill and abilities to do some analysis joined forces with researchers through the “ConnectMe” program and this information could be published in a professional journal! The possibilities are endless. Do you think this could be you?

It was interesting and exciting to spend time with all the midwives who are working every day to to help women and babies experience safe, healthy births and are practicing the Lamaze International Six Healthy Birth Practices that we know leads to better birth outcomes.

For more information for researchers to learn more about the dataset and how to apply, click here.

Childbirth Education, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Home Birth, Midwifery, New Research, Research, Research Opportunities , , , , , , , , ,

Lamaze International Releases Valuable Cesarean Infographic For You To Share!

October 10th, 2013 by avatar

Lamaze International has long been a leader in providing resources for both parents and birth professionals that promote safe and healthy birth for women and babies.  Evidence based information, appealing handouts, useful webinars for both parents and professionals, continuing education opportunities and more can all be found within the Lamaze International structure.  In May, 2012, Lamaze International released  (and later went on to be a co-winner for the 2013 Nonprofit PR Award for Digital PR and Marketing) the Push For Your Baby campaign, which encouraged families to “push for better” and “spot the best care,” providing resources to help parents wade through the overabundance of often inaccurate information swimming past them, and make choices that support a healthy pregnancy, a healthy birth and a healthy mother and baby.

Today, as I make my way to New Orleans, to join other professionals at the 2013 Annual Lamaze International Conference, “Let the Good Times Roll for Safe and Healthy Birth,” Lamaze International is pleased to announce the release of a useful and appealing infographic titled “What’s the Deal with Cesareans?” In the USA today, 1 in 3 mothers will give birth by cesarean section.  While, many cesareans are necessary, others are often a result of interventions performed at the end of pregnancy or during labor for no medical reason.  For many families, easy to understand, accurate information is hard to find and they feel pressure to follow their health care provider’s suggestions, even if it is not evidence based or following best practice guidelines.

Families taking Lamaze classes are learning about the Six Healthy Birth Practices, which can help them to avoid unnecessary interventions. Now, Lamaze childbirth educators and others can share (and post in their classrooms) this attractive infographic that highlights the situation of too many unneeded cesareans in our country.  Parents and educators alike can easily see what the risks of cesarean surgery to mother and baby are, and learn how to reduce the likelihood of having a cesarean in the absence of medical need.

In this infographic, women are encouraged to take Lamaze childbirth classes, work with a doula, select a provider with a low rate of cesarean births, advocate for vaginal birth after cesarean and follow the Six Healthy Care Practices, to set themselves up for the best birth possible.  This infographic clearly states the problem of unneeded cesareans, the risks to mother and baby, and provides do-able actions steps.

It is time for women to become the best advocate possible for their birth and their baby.  With this appealing, useful and informative infographic poster, families can and will make better choices and know to seek out additional information and resources.

Educators and other birth professionals, you can find a high resolution infographic to download and print here.

Send your families to the Lamaze International site for parents, to find the infographic and other useful information on cesarean surgery.

For Lamaze members, log in to our professional site to access this infographic and a whole slew of other useful classroom activities, handouts and information sheets.

I am proud to say that I am a Lamaze Certified Childbirth Educator, and that my organization, Lamaze International, is leading the way in advocating for healthier births for mothers and babies through sources such as the “What’s the Deal with Cesareans?” infographic and other evidence based information and resources.  Thank you Lamaze!

What do you think of this infographic?  How are you going to use it with the families you work with?  Can you think of how you might incorporate this into your childbirth classes or discuss with clients and patients?  Let us know in the comments section, we would love your feedback!  And, see you at the conference!

 

 

Babies, Cesarean Birth, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, informed Consent, Lamaze International, Lamaze International 2013 Annual Conference, Maternal Quality Improvement, Maternity Care, Medical Interventions, Newborns, Patient Advocacy, Push for Your Baby , , , , , , , , ,