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Ebola, Fearbola, and the Childbirth Educator

November 6th, 2014 by avatar

By Rebecca Dekker, PhD, RN, APRN

ebola infographic cc cdcMany news outlets and social media venues have been disseminating information on the Ebola virus and the impact on populations both in West Africa as well as the potential impact on developed nations, including the USA.  The expectant families that you work with may have shared concerns for themselves, their children and their unborn baby with you?  How have you responded?  Did you feel like you had the information that you needed to provide them with facts to calm their concerns?  Occaisonal contributor Rebecca Dekker of EvidenceBasedBirth.com takes a look at the facts about the Ebola virus and shares resources and information applicable to pregnant and breastfeeding families that you can share. – Sharon Muza, Community Manager, Science & Sensibility

What’s the childbirth educator got to fear about Ebola? How do you address your students and clients’ fears?

Well, if you live in the U.S. or in any other country other than Africa—right now, there’s really not much to actually fear. That is, if you’re only worried about yourself and your own community.

The truth is, here in the U.S., there are so many more things that are more likely to kill you than Ebola—other infectious diseases such as influenza, motor vehicle accidents, smoking, secondhand smoke exposure, cardiovascular disease, cancer, even radon—an odorless, colorless gas that exists in many of our homes in the Southeast and can cause lung cancer—you name it, and it’s probably more likely to harm you than Ebola.

So why all the fear here in the U.S.? 

Ebola is a rare but deadly disease, and it has been ravaging West Africa. In developed countries, we feel fear because cases of the disease have finally reached our own shores, when in fact we should have paid attention much sooner to what is happening to our brothers and sisters in Liberia, Guinea, and Sierra Leone.

Does all this fear of Ebola do any good?

Personally, I believe that the fact that so much attention has been drawn to Ebola in developed countries may be a good thing. Fear here means that our governments have finally begun to put energy and resources into stopping the epidemic in Africa– not necessarily for humanitarian reasons– but to prevent the spread of this disease to us.

The Ebola epidemic that has affected parts of West Africa has been a fast-moving event that is only just now showing signs of slowing down. Researchers have conclusive evidence that this is the largest, most severe and most complex Ebola epidemic that we have witnessed since Ebola was first discovered nearly 40 years ago. The number of cases and deaths in this epidemic is many times larger than all past Ebola outbreaks combined.

Before the current epidemic, the Ebola virus had mostly been contained to small outbreaks in rural communities. This time, all of the capital cities in in Liberia, Guinea, and Sierra Leone have experienced large outbreaks.

For the first time, Ebola has entered communities like West Point, in Monrovia, Liberia. According to the World Health Organization, “West Point is West Africa’s largest and most notorious slum: more than 70,000 people crowded together on a peninsula, with no running water, sanitation or garbage collection. The number of Ebola deaths in that slum will likely never be known, as bodies have simply been thrown into the two nearby rivers.”

Ebola has been especially hard-hitting on health care workers. Health workers on the front lines are often exposed to very infectious bodily fluids—blood, vomit, and diarrhea. The fact that health care workers can be at high risk for catching and dying from Ebola was first discovered during the very first Ebola outbreaks that took place in Zaire and Sudan in 1978. Fortunately, researchers have found that proper use and training with personal protective equipment can drastically lower health care workers’ chances of catching the virus. It’s probable that the cases we saw in the U.S. among nurses were due to improper training, inadequate protection equipment, or both.

Interestingly, Ebola actually isn’t as contagious as many other infectious diseases. Measles is an airborne disease, and it is highly contagious. Someone with measles can walk through a room, and another person can walk through that same room two hours later and catch the same measles infection. For every one person who has measles and lives among an unvaccinated population, they will—on average—infect 18 more people.

© CDC

© CDC

In contrast, one person with Ebola infects two other people on average, usually people who have had close, prolonged contact with that person. And the research we have on humans so far shows that Ebola is not airborne—although there have been a few primate studies that suggested otherwise (but some researchers think that maybe the monkeys were spitting on each other!)

One reason Ebola has spread so widely in West Africa – in spite of the fact that this virus is relatively hard to catch compared to other infectious diseases—is that the countries affected are extremely poor. Many people lack running water and soap in their homes.

This means that in West Africa, if one family member comes down with Ebola, there’s a good chance that others in the home will become infected, especially if patients bleed and vomit profusely. Families without modern toilets and washing machines have trouble cleaning up after patients who lose control of their bowels and produce huge amounts of diarrhea. Even burying the dead can spread Ebola in these countries, because common burial rites involve washing the dead and preparing the bodies. However, news organizations are reporting that communities have begun adhering to recommendations to refrain from traditional burial practices that expose more people to the disease.

So, it makes sense that we would fear for our fellow humans in West Africa. They are experiencing what can only be described as a humanitarian crisis. What’s even more concerning is that the virus has—at least for now—crippled an already weak health care infrastructure. This has created what the World Health Organization calls, “an emergency within an emergency.” A great example of this is that pregnant women and infants cannot receive emergency care while resources are drained by the Ebola virus epidemic.

So why are some people panicking about Ebola in the U.S., where the chances of an infection are completely remote? How do we make sense of this?

Well, when it comes to understanding how people perceive risk, and why some people are panicking about Ebola in the U.S., it may be helpful to understand some basic scientific principles behind how people perceive risk.

First of all, risk is subjective. And emotions and our mood change how we interpret risk. So facts matter less when emotions take over.

Also, many people also have an inherent lack of trust in scientists and the government– both here in the U.S. and in West Africa. People often believe their own senses and own experiences more than what scientists say. Many people don’t really understand the scientific process, and have doubts about what they hear. They confuse the research evidence on Ebola with the legal system, and they think there is lots of room for reasonable doubt about whether or not Ebola is airborne, for example.

Also, it’s really important to understand that people perceive a higher risk from rare events with really severe outcomes than they do for common outcomes with less severe or delayed outcomes.

[Does this sound familiar? Just take that sentence above and think about the concept of VBAC and repeat Cesarean. Obstetricians perceive a higher risk from rare events with really severe outcomes—such as uterine rupture—than they do for common outcomes with less severe or delayed outcomes—such as serious maternal infections after a planned repeat Cesarean, or placental abnormalities in future pregnancies].

People also tend to worry more over things that we can’t control. We can control our driving, and getting a flu vaccine, and our diet, and cigarette smoking. But we can’t control Ebola, so that scares us more.

So when we bring fear and emotion into the mix, people’s risk perceptions can end up looking like they do for some people in the U.S. right now– paranoia about Ebola.

It is unfortunate that we have overblown fears of contracting Ebola in the U.S., but if we could redirect our thoughts and channel our efforts into containing the outbreak in West Africa, this is where we will make the biggest difference.

So, in summary:

  • Ebola is a rare but deadly viral infection
  • We are currently witnessing the largest Ebola outbreak in history.
  • The chances of any one of us contracting the virus in the U.S. are extremely remote
  • Fear of Ebola will hopefully trigger people in developed countries to reach out to our fellow humans in West Africa and help them fight the virus

Items of interest related to childbirth and breastfeeding

How can we help?

If you’re worried about Ebola, don’t panic but do put your concern into action. Many health and relief organizations in West Africa are in need of resources, and you can help. This blog article has a comprehensive list of charities working in West Africa right now.

Have your clients and students asked you about Ebola?  Have they expressed concern for themselves or their baby?  Have families discussed the fear of entering the hospital to birth, due to their perceived risk of the hospital as being a potential source of exposure to the Ebola virus?  Hopefully after reading this blog post by Rebecca, you can help provide the facts.  You can also direct them to the Evidence Based Birth online class “Ebola, Fearbola: Separating Facts from Paranoia” and the About.com article “Five Things Pregnant Women Need to Know about Ebola” written by Robin E. Weiss. The Centers for Disease Control and Prevention also provides a wealth of information that you can access and share with the families you work with. – SM

About Rebecca Dekker

Rebecca Dekker

Rebecca Dekker

Rebecca Dekker, PhD, RN, APRN, is the founder of Evidence Based Birth and teaches pathophysiology at a research university. She has taught continuing education classes on HIV and recently developed an in-depth class on the pathophysiology and epidemiology of Ebola (2 nursing contact hours). To learn about how Ebola is transmitted, prevented, diagnosed, and treated, check out Rebecca’s class on “Ebola or Fearbola? Separating Facts from Paranoia,” here.

Childbirth Education, Continuing Education, Evidence Based Medicine, Guest Posts, Maternal Mortality, Maternity Care, Newborns, Research , , , ,

Tweet with Us! – Share & Experience the 2014 #LamazeDONA Confluence on Twitter

September 11th, 2014 by avatar

 By Robin Elise Weiss, PhDc, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE

lamaze twitter 2014The 2014 Lamaze International/DONA International Joint Confluence in Kansas City is scheduled to convene in just one week and the excitement is palpable!  Bags are getting packed, presentations finalized and birth professionals of all backgrounds are getting ready to meet old friends and make new ones.  The content and information that will be covered in the plenary  and concurrent sessions will be new and exciting.  Today on Science & Sensibility, Lamaze International’s incoming president, Robin Weiss, a leader on our social media team, shares all the “need to knows” for getting the most out of the conference via Twitter. – Sharon Muza, Science & Sensibility Community Manager

The past few years the idea of using social media in conjunction with the conference has grown. And the 2014 Confluence with Lamaze International and DONA International is no different. Using the hashtag #LamazeDONA, you will be able to find a treasure trove of information about the conference, and even learn from the sessions – even if you aren’t in Kansas City.

If you are new to Twitter, you will simply need to sign up for a free account. This handy guide will help you to get started in five easy steps.  You can search for the #LamazeDONA hashtag.  Using this hashtag helps twitter users sort a specific conversation that is focused on the confluence and just our users.  Simply read and interact with the people who will talk on this search.

You will want to join in the discussion, tweet and retweet your favorite snippets of wisdom from the fabulous speakers.  If you are not attending, you will want to follow the #LamazeDONA hashtag as attendees tweet live from the sessions they are participating in.

Back this year is the fabulous Tweet Up! We are going to try to do two this year. The first is scheduled for Thursday at 4p.m. Meet by the registration desk. @RobinPregnancy and @KKonradLCCE will be there to walk you through a few things if you have questions or just say hello! @KKonradLCCE will also host a simple social Tweet Up, watch #LamazeDONA for specific information to join – all are invited, no personal invitations needed.

We will also have prizes for your participation when you watch the hashtag, including some for those joining in at home, so be sure to watch #LamazeDONA for directions.

A great article on Twitter etiquette for you to review prior to the confluence

You might also want to consider reading Birthswell’s helpful three part series: Twitter 101 for Birth and Breastfeeding Professionals if you are new to this fast moving and captivating social media platform.

Check out Facebook, where it is possible to follow the same hashtag, #LamazeDONA for updates as well.  Many Facebook users use the same hashtag system to share information on that platform.

 People to Follow

@LamazeOnline (Lamaze for parents)

@LamazeAdvocates (Lamaze for educators)

@donaaintl

@RobinPregnancy (Robin Elise Weiss, social media team for Lamaze International and incoming President)

@KKonradLCCE  Kathryn Konrad (preconference and concurrent presenter)

@ShiningLghtPE Deena Blumenfeld (concurrent presenter)

@Gozi18  Ngozi Tibbs  (plenary speaker)

@Christinemorton  (concurrent presenter)

@mariajbrooks Maria Brooks (Lamaze Board Member)

@jeanetteIBCLC Jeanette McCulloch (concurrent presenter)

@doulamatch Kim James (concurrent presenter)

@douladebbie Debbie Young

@mldeck  Michele Deck (plenary speaker)

@pattymbrennan Patty Brennan

@doulasrq Patti Treubert ‏

@babylovemn Veronica Jacobson

@tamarafnp_ibclc &  @storkandcradle Tamara Hawkins (S&S contributor)

@thefamilyway Jeanne Green & Debbie Amis

@gilliland_amy  Amy Gilliland (concurrent presenter)

@yourdoulabag Alice Turner (concurrent presenter)

Are you going to be live tweeting from the confluence?  Share your Twitter handle in the comments section and we can add you to our list.- SM 

About Robin Weiss

robin weiss head shotRobin Elise Weiss,  PhDc, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE, is a childbirth educator in Louisville, KY. She is also the President-Elect of Lamaze International. You can find her at pregnancy.about.com and robineliseweiss.com

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The Roadmap of Labor: A Framework for Teaching About Normal Labor

September 2nd, 2014 by avatar

By Penny Simkin, PT

Regular contributor, Penny Simkin developed the roadmap of labor as a teaching tool.  Today, Penny shares how she uses the roadmap of labor to help families in her childbirth classes to understand normal labor from a physiological standpoint. She hopes that her students will take away an understanding of comfort and coping mechanisms along with recognizing the emotions a mother might be experiencing and how a partner can help with both the physical and emotional aspects. Penny is one of the Plenary Speakers at the upcoming Lamaze International/DONA International Confluence scheduled for later this month in Kansas City, MO.  Read how Penny, a master childbirth educator, with this handy tool, helps parents understand what to expect  during labor and birth. – Sharon Muza, Community Manager, Science & Sensibility

Introduction

© Sarah Sweetmans

© Sarah Sweetmans

Childbirth educators strive to provide timely, accurate, woman-centered information. We adapt our content and teaching methods to the time allowed, and the variety of learning styles, educational levels and cultural backgrounds of our students. We hope to build trust in the normal birth process, and instill the confidence and competence necessary for parents to meet the challenges of childbirth, and also to communicate effectively with their maternity caregivers.

In this paper I describe a teaching aid, the roadmap of labor, and some ideas to help guide parents through normal childbirth, from early labor to active labor, transition, and the resting, descent and crowning-to-birth phases of the second stage. The discussion of each stage and phase includes what occurs, women’s and partners’ common emotional reactions, and advice on comfort measures and ways to work together to accomplish a safe and satisfying birth.

I do not describe how I teach about routine or indicated interventions, complications, pain medications, or surgical birth. Aside from space limitations, the real reason lies in my firm belief that when expectant parents appreciate the pure unaltered (and elegant!) physiological process of labor, they have more confidence that birth usually goes well, and they may feel reluctant to bypass it (with induction or cesarean) or alter it unnecessarily. Normal labor becomes the clear standard against which to assess the benefits and risks of specific interventions and the circumstances that increase or decrease their desirability.

If I combined the discussion of straightforward labor with complications and common procedures (along with their risks, benefits, and alternatives), parents would have a fragmented and confused perception of childbirth and an almost impossible burden of separating normal from abnormal, and elective from indicated procedures. All these topics must be covered, however, if parents are to participate in their care, whether labor is straightforward or not. Therefore I teach these topics in subsequent classes, using normal birth as the reference point. I also follow this approach in some other writings.1,2

Initiation of labor, the six ways 
to progress and signs of labor

There are some key concepts that childbirth educators can use to raise parents’ awareness and appreciation of events of late pregnancy and normal birth and how they can help the process flow smoothly. Parents need to understand these concepts well, so they can use the roadmap of labor to best advantage, and play a more confident and active role in labor.

For example, before introducing the roadmap, the teacher should inform parents about the hormonally- orchestrated processes in late pregnancy that prepare for birth, breastfeeding, and mutual mother-infant attachment. This is important because teachers face two common challenges: first, parents’ impatience to end the pregnancy due to discomfort, fatigue and eagerness to hold their baby; and second, the possibility of a long, discouraging pre-labor phase.

These challenges make parents more accepting of induction or vulnerable to the belief that there is something wrong. Parents need to understand that labor normally begins only when all of the following occur:

• The fetus is ready to thrive outside the uterus (breathing, suckling, maintaining body temperature, and more).
• The placenta has reached the point where it can no longer sustain the pregnancy.
• The uterus is ready to contract, open and expel the baby.
• The mother is ready to nourish and nurture her baby.

If parents understand that fetal maturity is essential in initiating the chain of events leading to labor, they may be more patient with the discomforts of late pregnancy, and less willing or anxious to induce labor without a medical reason.

The six ways to progress to a 
vaginal birth

Progress before and during labor and birth occurs in many ways, not simply cervical dilation and descent, which is what most people focus on. Labor unfolds gradually and includes six steps, four of which begin weeks before labor and involve the 
cervix. The cervix moves forward, ripens, effaces and then dilates. When parents understand that a long pre- or early labor is accomplishing necessary progress – preparing the cervix to dilate – they are less likely to become anxious or discouraged that nothing seems to be happening. The two other steps involve the fetus: the fetal head repositions during labor by flexing, rotating, and moulding to fit into the pelvis; and lastly, the fetus descends and is born.

Three categories of signs of labor

By placing these in the context of the six ways to progress, parents may be better able to recognize the differences between pre-labor (often called ‘false labor’) and labor.

Possible signs of labor

These include: nesting urge; soft bowel movements; abdominal cramping; and backache that causes restlessness. These may or may not continue to the clearer signs of labor and may be associated with early cervical changes.

Pre-labor signs

The most important of these is the first one:

  • Continuing ‘nonprogressing’ contractions (that is, over time,
the pattern remains the same; they do not become longer, stronger or
closer together)
  • Possible leaking of fluid from the vagina
  • Possible ‘show’ – bloody mucus discharge from the vagina

With these signs, the cervix is probably not dilating significantly, but is likely to be ripening and effacing (steps two and three of the six ways to progress).

Positive signs of labor

The most important of these is the first one:

  • Continuing, progressing contractions, i.e. contractions that become longer, stronger, and closer together (or at least two of those signs). These progressing contractions cause cervical dilation (steps four and five of the six ways to progress), which is the clinical definition of labor.
  • Spontaneous rupture of the membranes (SRM), especially with a gush of fluid. This happens before or at the onset of labor in about 8% of women at term.3 It most often happens late in labor. SRM is only a positive sign of labor 
in conjunction with continuing progressing contractions.

The roadmap of labor

I have created a visual guide to labor progress using the metaphor of a road map. It shows key labor landmarks, and appropriate activities and measures for comfort as labor progresses (see Figure 1).4 Parents can use it during labor as a reminder of where they are in the process and what to do. Teachers can use it as a tool for organized discussion of normal labor progress, and as a backdrop for discussing laboring women’s emotional reactions, and how partners or doulas may assist. Health professionals can use it to help parents identify where they are in labor, adjust their expectations and try appropriate comfort measures.

© Penny Simkin

© Penny Simkin

Normal labor pathway

The roadmap portrays three pathways. The main brick road represents normal labor and shows helpful actions, positions, and comforting techniques to use as labor progresses. The twists and turns in the brick road indicate that normal labor does not progress in a straight line; the large turns between three and five-to-six centimeters and between eight and ten centimeters indicate large emotional adjustments for the laboring woman, and present an opportunity to discuss emotional support and comfort measures for the partner or doula to use. After ten centimeters, the woman’s renewed energy and confidence are represented by the second wind sign. Along with discussion of emotional support and comfort measures, the teacher can offer perspective and practical advice for partners and doulas, to use both when the woman is coping well and when she feels challenged or distressed.

The roadmap provides a clear and effective way to teach about normal labor. It keeps the discussion focused purely on the physiological and psychological processes, without inserting discussions of pros and cons of interventions, complications, or usual policies and hospital practices that alter labor.

Image Source: © Sharon Muza

Image Source: © Sharon Muza

Once parents have a solid understanding of normal labor, the teacher can explain usual care practices and possible options for monitoring maternal and fetal well being during labor. She can also discuss labor variations or complications and treatments with medical (including pain medications), surgical or technological procedures. With this approach, parents are better equipped to discuss risks, benefits and alternatives, because they can distinguish situations and conditions that are more likely to benefit from the intervention from those in which the intervention is optional, unnecessary, or harmful.

Planned and spontaneous rituals

The normal labor road suggests measures to use for distraction, comfort, and progress. Distraction is desirable for as long as it helps. The Relax, Breathe, Focus sign reminds parents to use this pre-planned ritual for dealing with intensifying contractions when distraction is no longer possible. Parents need to rehearse these rituals in childbirth class (i.e. slow breathing, tension release, and constructive mental focus) and use them in early labor. They set the stage for the spontaneous rituals that emerge later in labor (as women enter active labor), when they realise they cannot control the contractions or continue their planned ritual, and give up their attempts to do so, though sometimes after a stressful struggle. Spontaneous rituals replace the planned ones. They are not planned in advance – they are almost instinctual – and almost always involve rhythmic activity through the contractions – breathing, moaning, swaying, stroking, rocking, or even letting rhythmic thoughts or phrases repeat like a mantra.

The three Rs

The spontaneous rituals usually involve the three Rs: relaxation (at least between contractions), rhythm, which is the most important, and ritual, the repetition of the same rhythmic activity for many contractions. In order to give herself over to spontaneous instinctual behavior, the woman needs to feel emotionally safe, uninhibited, accepted unconditionally by partner and staff, and to be mobile in order to find comfort.

The motto ‘Rhythm is everything’ means that if a woman has rhythm during contractions, she is coping, even though she may vocalize and find it difficult. The rhythmic ritual keeps her from feeling totally overwhelmed. The goal is to keep her rhythm during contractions in the first stage. Once in second stage, however, rhythm is no longer the key. The woman becomes alert and her spirits are lifted. An involuntary urge to push usually takes over and guides her behavior.

The role of the partner in labor

The partner helps throughout labor, comforting the mother with food and drink, distraction, massage and pressure, assistance with positioning, and constant companionship. Sometimes a doula also accompanies them, providing continuing guidance, perspective, encouragement, and expertise with hands-on comfort measures, positions, and other techniques gained from her training and experience.2

The role of an effective birth partner includes being in the woman’s rhythm
– focusing on her and matching the rhythm of her vocalizations, breathing or movements – by swaying, stroking, moving hand or head, murmuring softly in her same rhythm. Then, if she has difficulty keeping her rhythm, and tenses, cries out or struggles – as frequently occurs in active labor or transition – her partner helps her get her rhythm back, by asking her to focus her eyes on their face or hand and follow their rhythmic movements. This is the take-charge routine, and is only used if the woman has lost her rhythm, is fearful, or feels she cannot go on. Partners who know about this are less likely to feel helpless, useless or frightened. Simple directions, given firmly, confidently, and kindly (‘look at me,’ or ‘look at my hand’), rhythmic hand or head movements, and ‘rhythm talk’ with each breath (murmuring, ‘Keep your rhythm, stay with me, that’s the way…‘) are immensely effective in helping the woman carry on through demanding contractions. During the second stage, rhythm is no longer important; now the partner encourages her bearing-down efforts and release of her pelvic floor, and also assists her with positions.

The motto “Rhythm is everything” means that if
 a woman has rhythm during contractions, she is coping, even though she may vocalize and find it difficult.

The detour for back pain

A second pathway, a rocky, rough road, represents the more difficult ‘back labor’, which may be more painful, longer, or
more complicated than the normal labor pathway. Fetal malposition is one possible cause. The measures shown for back labor are twofold: reduce the back pain and alter the effects of gravity and pelvic shape to encourage the fetus’s movement into and through the pelvis. It helps a woman endure a prolonged or painful back labor if she and her partner use appropriate comfort measures, and if they know that dilation may be delayed while the baby’s head molds or rotates to fit through, or that changing gravity and pelvic shape may give the extra room that the baby needs to move into an optimal position.

The epidural highway

© J. Wasikowski, provided by Birthtastic

© J. Wasikowski, provided by Birthtastic

This third pathway represents a dramatically different road – smooth, angular, man- made, more comfortable – but it comes with extensive precautions and numerous procedures, monitors, and medications, which are necessary to keep the epidural safe. The woman adopts a passive role while the staff manage labor progress, and monitors the mother’s and fetus’s well being closely. The excellent pain relief and chance to sleep are the usual rewards. Discussion of how to work with an epidural in order to optimize the outcome is beyond the scope of the paper, but the basic principle is: treat the woman with an epidural as much as possible like a woman who does not have one! This essentially means,‘Keep her cool. Keep her moving. Keep her involved in the work of pushing her baby out. And don’t assume that if she has no pain, she has no distress! Do not leave her alone.’

Conclusion

The roadmap of labor provides a useful framework for teachers to explain the psychological and physiological processes of labor, and a variety of activities for comfort and labor progress for women and their partners to use. By focusing on the normal unaltered process, parents learn to separate the norm from the numerous interventions that alter the process, sometimes for the better, sometimes for the worse. The intention is to give them confidence that they can handle normal labor and to participate meaningfully in decision-making when interventions are suggested.

Do you use the roadmap of labor as a teaching tool in your childbirth classes or with your clients?  How do you use it?  I would love to hear the innovative ways that you have found to incorporate this valuable tool in your classes.  Please share with Penny and all of us in the comments section. – SM

References

1. Simkin P. Moving beyond the debate: a holistic approach to understanding and treating effects of neuraxial analgesia. Birth 2012;39(4):327-32.

2. Simkin P. The birth partner: a complete guide
to childbirth for dads, doulas, and all other labor companions. 4th edition Harvard Common Press; 2013.

3. Marowitz A, Jordan R. Midwifery management of prelabor rupture of membranes at term. J Midwifery Womens Health 2007;52(3):199-206.

4. Simkin P. Road map of labor. Childbirth Graphics; 2003. Available from: www.childbirthgraphics. com/index.php/penny-simkin-s-road-map-of- labor-interactive-display.html

About Penny Simkin

penny_simkinPenny Simkin is a physical therapist who has specialized in childbirth education and labor support since 1968. She estimates she has prepared over 11,000 women, couples and siblings for childbirth, and has assisted hundreds of women or couples through childbirth as a doula. She has produced several birth-related films and is the author of many books and articles on birth for both parents and professionals. Her books include The Labor Progress Handbook (2011), with Ruth Ancheta, The Birth Partner (2008), and When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse of Childbearing Women (2004), with Phyllis Klaus. Penny and her husband have four adult children and eight grandchildren. Penny can be reached through her website.

Copyright © NCT 2014. This article first appeared in NCT’s Perspective journal, edition March 2014.   http://www.nct.org.uk/professional/research

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Early Bird Registration Closes August 1 for the 2014 Lamaze & DONA Confluence!

July 29th, 2014 by avatar

confluence header

This year’s Confluence (the special term being used to describe the 2014 conference hosted jointly by Lamaze International and DONA International in Kansas City, MO is shaping up to be simply an outstanding experience for all the attendees.  The confluence committee has put together an outstanding line up of speakers for the general sessions.

Pre-Conference Events

In the days  leading up to the confluence, attendees can register to participate in several different pre-conference events.  Choose from a three day Lamaze Childbirth Educator Seminar – one step on the path to becoming a Lamaze Certified Childbirth Educator.  This workshop is taught by the Denver-CPAC Lamaze-Accredited Childbirth Educator Program.  Take in the wisdom and experience of midwife Gail Tully, of Spinning Babies fame as she leads participants through a half day program designed for doulas, educators, doctors, midwives and L&D nurses.  Learn strategies and skills to teach to students and use with laboring women, when a malpositioned baby is interfering with the normal progression of labor and birth.   Patty Brennan, author of “The Doula Business Guide: Creating a Successful Motherbaby Business” leads a four hour business development workshop on establishing and growing a successful birth business and all that a birth pro needs to be successful.  Our final pre-conference offering is a full day “Evidence Based Nursing: Labor Support Skills” workshop designed especially for clinicians who want to help support safe and healthy birth through non-pharmacologic pain management strategies and hands on labor support skills. This workshop is taught by the amazing Kathryn Konrad.

Captivating General Session Speakers

Penny Simkin, Eugene DeClercq, Michele Deck, Katharine Wenstrom and Ngozi Tibbs are the plenary speakers at this year’s confluence and I could not be more excited.  These leaders in the field each bring their own diverse background and perspective to the confluence, while having the common goal to improve maternal infant health.  Learn more about the general session speakers and their background in this Science & Sensibility post.

Concurrent Sessions (focusing on four different tracks)

This year, there are four tracks of concurrent sessions!  Choose the track that most interests you or mix and match the concurrent sessions to customize a program that meets your individual needs.  Our four tracks are:

  • Evidence based teaching and practice
  • New and emerging research in the field of childbearing
  • Using technology and innovation to reach childbearing women
  • Supporting the needs of childbirth professionals

Enjoy the presentations of both seasoned presenters back again to share their wisdom and welcome those presenting for the first time, full of fresh and exciting perspectives and ideas.

Social Events

LCCEs attend the DONA Conference Photo Credit HeatherGail Lovejoy

Photo Credit HeatherGail Lovejoy

Half the fun of attending a professional conference is the opportunity to network and socialize with both new friends and old. The 2014 Confluence is no exception.  The Wine and Dine Event scheduled for Saturday evening at the beautiful Amigoni Urban Winery will include a custom designed wine tasting and gourmet dinner.  Your ticket includes RT transporation, to make it easy to enjoy the evening with a minimum of stress.

Exhibitors

When I attend conferences, I always make sure to leave plenty of time to browse the exhibit hall.  I love to see what new and innovative products are available for my doula and CBE practice.  Exhibitors from all over come to share what is hot and what is helpful and I love being able to ask questions about services from these experts and try out and examine all kinds of items useful for my business.  The list of exhibitors is long and full of well known companies who you will love to connect with in the Exhibit Hall.  For a list of those currently exhibiting, see our exhibitor list on the Confluence website. New exhibitors are being added, so check back frequently and be sure and stop by and say hi!

Register Now

There are many reasons to attend the 2014 Lamaze and DONA Confluence in Kansas City, MO September 18-21.  Take advantage of early bird pricing by registering by August 1 so that you can save some money and feel confident that all your continuing education and networking needs will be met by attending this fabulous Confluence.  See you in Kansas City!  Register now!

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5 Business Practices of Successful Childbirth Educators

June 26th, 2014 by avatar

by Robin Elise Weiss, PhDc, MPH, LCCE, FACCE

Robin Weiss, childbirth educator and president-elect of Lamaze International shares some very smart business tips for being a successful childbirth educator, regardless of whether you work for a large hospital system or teach independent classes. Check out her advice below and share your own suggestions in our comments section. – Sharon Muza, Community Manager for Science & Sensibility

Being in childbirth education is an amazing profession. As a childbirth educator, we are privileged to be with families as they learn and prepare for one of the most exciting journeys of their lives, that of giving birth. Many childbirth educators began this path as a calling, and have had to stumble through the business aspects. It can be difficult to separate the calling from the business.

The good news is that there are five things that you can do that will greatly improve your business acumen and help you become successful in all facets of your profession.

1) Get educated

A formal education in childbirth prepares you to teach and for your certification examinations. However, other than quick mentions of finding clients and paperwork, there is often little information given towards having a business and running it well. There are many questions that you might have from settling on a business name, incorporating, taxes, license fees, or office space. These are questions that have widely varying answers, but that are very specific to where you live and how you practice. Finding a local resource for education is an imperative. Many groups that are willing to help small business owners, like SCORE. They offer free classes and counseling to help you get started.

2) Have back up

Back up in this case refers to your certifying organization. Having an international organization behind you will open many doors. While a hospital of doctor’s office may not know you, the name of an organization such as Lamaze International is well known. The people that you are applying to work with know of the high standards that Lamaze International sets forward in their educators.
There are also special benefits to being a member of a professional organization. This can include referrals for clients in your area, continuing education, conferences, and other things of professional interest. In addition to these benefits, there is also the satisfaction of being with like-minded people.

3) Give Referrals

Referrals may seem like something that does not fit in this list. But following the old adage of it being better to give than to receive is only partially true. I would amend it to be that when you give, you also receive. Keep a local resource list handy and feel free to give it away to anyone who would like it. Also be quick with personal referrals for those with complementary business practices. Think about lactation consultants, doulas, midwives, and doctors in your area. Be sure to ask the person to whom you give the referral to say that you sent them. This shows others in the area that you appreciate their services. Consider asking for their cards to pass out when asked for referrals.

4) Be present

Attend all of the local functions that you are invited to attend or that you can apply to attend. This can include baby fairs thrown by hospitals, guest speaking for various groups from nursing education to mothers’ groups. Being seen in public and having lots of people get to know you is beneficial. It has two benefits, 1) to get to know others in the community and to give back, and 2) to let people know about your services.

5) Be prepared

You should always be prepared with at least two things: your business cards and your elevator speech. Multiple business cards is a no brainer. Don’t be so thrilled with your cards that you are afraid to give them out. (I did this when I first started!) Give them out like candy. Need to give another mom your number for a play date? The back of your card works as a great white space!
Your elevator speech is a 1-2 minute long summary of what you do. Be prepared so that the next time someone asks you what you do for a living, you can quickly and confidently tell them. You can practice this after writing it out at home if that helps you. Some childbirth educators say that they’ve even made a video to watch themselves give this mini-speech to help make it more natural.

In the end, do not let the business side of your calling be a barrier. There are ways to build this side of your skill set and to be both a great childbirth educator and a great businessperson, with just a few steps.

About Robin Weiss

robin weiss head shotRobin Elise Weiss is a childbirth educator in Louisville, KY. She is also the President-Elect of Lamaze International. You can find her at pregnancy.about.com and robineliseweiss.com

Childbirth Education, Continuing Education, Guest Posts, Lamaze International , , ,