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Prematurity Awareness Month – Test Your Knowledge on Our Quiz

November 25th, 2014 by avatar

Prematurity Awareness Month 2014As November comes to a close, you may have read or seen many articles on the topic of premature babies.  November is Prematurity Awareness Month, recognized in the United States and around the world.  Prematurity affects 15 million babies a year globally and the downstream health consequences to the babies are significant.  There is also a huge burden in terms of health care dollars that are required to treat the baby after birth and then potentially for many years beyond that.

In 2013, the national preterm birth rate fell to its lowest rate in 17 years.  This decrease helped us to meet the 2020 Healthy People Goals 7 years early, which is something to celebrate.  But overall, our prematurity rate is still nothing to be admired, as the United States has one of the highest rates amongst developed nations.

As childbirth educators, we are in a unique position to share information with families, including signs of preterm labor, risk factors and warning signs.  Having conversations in your classes can help families to recognize when something may not  be normal and encourages them to contact their doctor or midwife if they suspect they may be experiencing some of the signs of a potential preterm birth.  While no family wants to think that this might happen to them, bringing up the topic can help them to seek out help sooner.

Science & Sensibility has put together some resources that you can share with the families that you work with.  We also invite you to take the Prematurity Awareness Month Challenge Quiz, and test your knowledge on some basic facts about preterm birth.  See how well you do and compare your results with others also taking the quiz.

Resources to share

Go the Full 40 – AWHONN’s prematurity prevention campaign, including 40 reasons to go the full 40.

Healthy Babies are Worth the Wait – March of Dimes

Healthy People 2020 – Maternal, Infant & Child Health

March of Dimes Prematurity Report Card – Find your state’s grade

Centers for Disease Control and Prevention – Prematurity Awareness

March of Dimes Videos on Prematurity Awareness

Signs of Preterm Labor – March of Dimes Video

Preterm Labor Assessment Tool Kit for Health Professionals – March of Dimes.

How do you cover the topic of preterm labor in your classes?  What activities do you do?  What videos do you like to show?  Please share with others how you do your part to inform parents about this important topic and help to reduce prematurity in the families you work with.  Let us know in the comments section below.

 

Babies, Childbirth Education, Maternal Quality Improvement, Maternity Care, Newborns, Pain Management, Pre-term Birth , , , ,

Series: Welcoming All Families: Supporting the Native American Family

November 18th, 2014 by avatar

By Melissa Harley, CD/BDT(DONA), LCCE

November is Native American Heritage Month and LCCE Melissa Harley shares some interesting facts about the rich culture included in some of the varied childbearing year traditions observed by some of the U.S. tribes.  There are many different tribal nations, and each one has their own ceremonies and practices around pregnancy and birth.  Beautiful and fascinating stories that are each unique in their own right.  This post is part of Science & Sensibility’s “Welcoming All Families” series, which shares information on how your childbirth class can be inclusive and welcoming to all. – Sharon Muza, Community Manager, Science & Sensibility.

© Bob Zellar http://bit.ly/1EVALCk

© Bob Zellar http://bit.ly/1EVALCk

As childbirth educators of today, we must strive to have a connection to childbirth of yesterday.   As educators, we should continually be looking for ways to be welcoming of all cultures, customs, and traditions in the classroom setting and when working individually with students.  In order to achieve these goals, it is helpful to better understand how such traditions played out in years gone by.  So often, we look at birth from a very telescopic lens of the past (singling out one or two cultures) rather than looking at history from a more wide panoramic view point.  As we strive to embrace cultural diversity, we should continue to explore populations that are perhaps a little less known.    Have you considered the culture of Native Americans in childbirth and how the past compares to childbirth in our society now? According to the Centers for Disease Control and Prevention (CDC), currently, there are roughly 5.2 million American Indians and Alaska natives spread throughout 565 federally recognized tribes in the US. (CDC, 2013)  Let’s take a look at some of the commonalities that we have with our Native American ancestors and learn a little together about being welcoming, helpful, and inclusive of Native Americans in our classes today!

Native Americans and Pregnancy

Although there are some differing opinions regarding historical pregnancy and birthing traditions of Native Americans, according to historian Ellen Holmes Pearson, PhD, Native Americans were known to take exceptional care of themselves during pregnancy.  Similar to today, maintaining good health throughout pregnancy often led to an uncomplicated labor and birth.  Much regard was taken to ensure that a Native American mother’s health needs were met in a way that would support the nutritional and physical needs of both mom and baby.  From the website teachinghistory.org, Dr. Pearson states   “During their pregnancies, women restricted their activities and took special care with their diet and behavior to protect the baby. The Cherokees, for example, believed that certain foods affected the fetus. Pregnant women avoided foods that they believed would harm the baby or cause unwanted physical characteristics. For example, they believed that eating raccoon or pheasant would make the baby sickly, or could cause death; consuming speckled trout could cause birthmarks; and eating black walnuts could give the baby a big nose. They thought that wearing neckerchiefs while pregnant caused umbilical strangulation, and lingering in doorways slowed delivery. Expectant mothers and fathers participated in rituals to guarantee a safe delivery, such as daily washing of hands and feet and employing medicine men to perform rites that would make deliveries easier.”

In addition to caring for the body in pregnancy, it was extremely important for Native Americans to care for their mind and spirit.   In the Navajo communities, pregnancy and childbirth were approached as a spiritual event.  Much time and effort was spent making sure that the mother had a positive pregnancy.  Ceremonies in the Navajo community in general were very important.  Some ceremonies could last for days and days.  It was only natural that the tribes would hold Blessing Ways for expectant mothers.   Unlike many other Navajo ceremonies, the Blessing Way was not held to cure a sickness, but rather to invoke positive blessings and avert misfortune. Contrary to current use of the Blessing Way, the traditional Navajo tribes used the Blessing Way for more than just pregnancy and birth.  The ceremony was also used for blessing of the home, and also to enhance good fortune through the kinaalda (girl’s puberty rites).  Native Americans today that wish to connect with their heritage during the childbearing time often do so by being very careful about their spiritual surroundings.  It is quite important for mothers to keep their thoughts positive, and to maintain a climate of peace with those around them.  It is also suggested that mothers should avoid arguing with others during pregnancy, or to allow bad thoughts to enter their minds.

Native Americans and Birth

Native Americans were known to give birth in a simple way, with only other women in attendance as men were never allowed to see a woman give birth.   In general, Indian women likely gave birth without much assistance at all.  A midwife would at times attend the birth, along with other female family members from the tribe.  In very simplistic style, the baby would be birthed directly onto the leaves below the mother who used upright posturing for birth.   The baby would be welcomed by the earth, rather than by man’s hands.

To hasten labor and reduce pain during the birth, tribes sometimes utilized herbal remedies.   Cherokees made a tea with Partridgeberry and started consuming it several weeks before the birth.  They were also known to use Blue Cohosh to promote rapid delivery and to speed delivery of the placenta. To relieve pain, the Cherokees turned to wild black cherry tea made with the inner bark from the tree. The Koasati tribes made a tea of the roots from the plant of cotton that reduced pain for birthing women.

In some tribes, rituals to “scare” the baby out were utilized.  An elder female would often yell “Listen! You little man, get up now at once. There comes an old woman. The horrible [old thing] is coming, only a little way off. Listen! Quick! Get your bed and let us run away. Yu.”

Another common tradition in birth was the use of the rope or Sash Belt thrown over tree limbs for the mother to hold.  The traditional Navajo sash belt is made of intricate-colored sheep wool that is woven upon a wooden loom.  Some hospitals today near Indian reservations have a Sash Belt installed in the ceiling for mothers to use.

Connecting the Past and the Present

While the mothers of today might not fear that eating speckled trout will cause birthmarks, most do still have concerns  and want to take steps to ensure a healthy baby.  We see mothers avoiding large amounts of caffeine and high mercury fishes. While we don’t often see our students choosing to give birth without much assistance onto the leaves of the trees, many do still choose upright posturing.  We also see a desire at times to hasten the labor, and some mothers turn to herbal or medicinal means to help that happen.   As childbirth educators, we can at times be of comfort to our students as they prepare for the healthiest birth possible. We can connect the past with the present, allowing parent’s space to explore the traditions within their cultures while also honoring current evidence and research based maternity care.  As I say in my classes, while pointing students to the evidence associated with Healthy Birth Practice #5, those mamas from long ago knew something intuitive: that using upright positions for labor and birth made a difference!

Health Services for Native Americans Today

If you live and work near an Indian reservation, you may be familiar with Indian Health Service (IHS).   IHS was established in 1955 with a goal to raise the health status to the highest possible level for Native Americans registered in a federally recognized tribe.   As childbirth educators, some of our students may seek medical attention at one of the nation’s 33 IHS hospitals or 59 IHS health centers.   Dr. Michael Trujillo, past director of IHS states in regard to IHS, “The values of human dignity, honesty, compassion, coupled with shared values of many different tribes and cultures, that have come to be spoken of as “Indian values, of listening, mutual respect, dignity, and harmony must always be at the forefront of what we do and how we do it. We must be professional in all our actions.”

This year, in accordance with the Affordable Care Act, the Indian Health Care Improvement Act was permanently reauthorized.  This provision in the current law will increase access of quality health care to Native Americans near IHS facilities as well as those who do not live near an IHS facility.  The ACA includes some very specific benefits that will impact American Indians and Alaskan Natives.  Tribes across the country are encouraging members to become familiar with the new laws, and to evaluate how the provisions can increase access and affordability to quality healthcare for their members.

Connecting our Native American clientele with quality prenatal care is extremely important.   Consider the following statistics from the CDC:

  • American Indian/Alaska Natives have 1.6 times the infant mortality rate as non-Hispanic whites.
  • American Indian/Alaska Native babies are 2.2 times as likely as non-Hispanic white babies to die from sudden infant death syndrome (SIDS).
  • American Indian/Alaska Native infants were 2.5 times as likely as non-Hispanic white infants to have mothers who began prenatal care in the 3rd trimester or not receive prenatal care at all.

What’s a Childbirth Educator to Do?

As we strive to better serve the mothers of today, first and foremost, we should recognize the importance of the history that First Nations people bring to birth.   Many Native Americans today still practice customs and traditions from years gone by.  If you currently service a population that includes American Indians and Alaskan Natives, then you may already be aware of the customs in your area.

© Ursula Knoki-Wilson

© Ursula Knoki-Wilson

To help Native Americans feel welcomed in class, ensure that visuals of contemporary Native Americans are included in your curriculum.   You might also offer a segment in your comfort measures class that specifically addresses the customs from that population.  In general, keeping language inclusive of a variety of cultures can also lead to a sense of acknowledgement and acceptance. Simply recognizing that you are aware of different cultural traditions in class can lead to parents feeling more comfortable, thus opening a door for sharing and further education.

Regardless of your target clientele, it would be helpful for a childbirth educator to become familiar with the many different traditions surrounding childbirth in the cultures around us.  A quick internet search can lead to a wealth of information that might be helpful in class.  As with any tradition or culture that you are not familiar with, education is power!  If you are on or near a reservation, perhaps reaching out to the IHS facility nearby might be an option.  Some facilities have staff members that hold workshops and courses to help the people within their tribes stay connected with tradition. In addition, it might be helpful to inform area IHS facilities that there is a childbirth educator nearby who is sensitive to the mental, physical and spiritual needs of the tribe members. It would also be advisable for childbirth educators to become aware of the provisions in the ACA for American Indians, as to be prepared with resources, if you are asked any questions in regard to healthcare for American Indians.   As childbirth educators, we are in a unique position to encourage our clients to seek quality prenatal care.  Working together with the families in our classes, we can positively impact the infant mortality rates among these populations by educating the families about safe and healthy birth practices and the options available to them.

Ultimately, it is important to keep our space open for all cultures and honor the individual traditions of the parents that attend our classes.  By becoming more educated and sensitive to the cultures around us we can better serve our clientele as a whole.  And for our Native American students, I’ll leave you with this blessing:

Earth’s Prayer
From the heart of earth, by means of yellow pollen blessing is extended.
From the heart of Sky, by means of blue pollen blessing is extended.
On top of pollen floor may I there in blessing give birth!
On top of a floor of fabrics may I there in blessing give birth!
As collected water flows ahead of it [the child], whereby blessing moves along ahead of it, may I there in blessing give birth!
Thereby without hesitating, thereby with its mind straightened, hereby with its travel means straightened , thereby without its sting, may I there in blessing give birth!S.D. Gill, Sacred Words

Note: to read more information about the images of the cradleboard welcoming home two generations of families, please follow this link to the Turtle Track organization for the full story. – SM

References

American Indian & Alaska Native Populations. (2013, July 2). Retrieved November 15, 2014, from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html

Blessingway (Navajo ritual). (n.d.). Retrieved November 15, 2014, from http://www.britannica.com/EBchecked/topic/69323/Blessingway

Holmes Pearson, E. (n.d.). Teaching History.org, home of the National History Education Clearinghouse. Retrieved November 15, 2014, from http://teachinghistory.org/history-content/ask-a-historian/24097

Infant Mortality and American Indians/Alaska Natives. (2013, September 17). Retrieved November 15, 2014, from http://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=38

Knoki-Wilson, U.M. (2008). Keeping the sacred in childbirth practices: Integrating Navajo cultural aspects into obstetric care. [PowerPoint slides].  Retrieved from Naho.ca website http://www.naho.ca/documents/naho/english/IG_Presentations2008/009KnokiWilsonUrsula.pdf

About Melissa Harley

melissa harley head shotMelissa Harley, CD/BDT(DONA), LCCE has worked with birthing women since bearing witness to the vaginal birth of her twin nieces in early 2002. She is a Native American registered in the  Cherokee Nation Tribe (OK) and the owner of Capital City Doula Services in Tallahassee, Florida.   Melissa holds certifications as a Lamaze Certified Childbirth Educator, DONA International Certified Doula and an Approved Birth Doula Trainer(DONA). She currently holds leadership positions with DONA International as a Florida state representative, and she sits on both the DONA International Education and Certification Committees.Melissa is a contributor to several birthing publications including the Journal for Perinatal Education (JPE), the Bearing Witness Series: Childbirth Stories Told By Doulas, and the sequel book Joyful Birth: More Childbirth Stories Told By Doulas.Married for 16 years and the homeschool mother of two teenagers, Melissa, values education and a life-long pursuit of learning. Her teaching style is comfortable, fun, and interactive, with an emphasis on leading the learner to have their own “light bulb” moments. As a childbirth educator and doula, Melissa most enjoys watching women become empowered to listen to their inner voice and acknowledge their own strength to birth.  Mentorship and education are both her passions, and Melissa is dedicated to fulfilling those passions by actively facilitating childbirth education classes as well as training and mentoring new doulas regularly.  Melissa can be reached at Melissa@capitalcitydoulaservices.com

Babies, Childbirth Education, Newborns, Series: Welcoming All Families , , , , ,

Practice Variation in Cesarean Rates: Not Due to Maternal Complications

November 13th, 2014 by avatar

By Pam Vireday

Pam Vireday, an occasional contributor to Science & Sensibility reviews the recent study by Katy Kozhimannil, PhD and colleagues that examined the differences in cesarean rates between over a thousand hospitals in the USA.  Consumers of maternity care quite possibly do not realize what a significant impact their choice of facility (and provider) may have on their birth outcome.  Can you think of hospitals in your own community serving similar populations of pregnant families that have drastically different cesarean rates.  Have you considered why that might be?  Do you think that the families you work with have explored this too?  Do they even have access to this information?  Read Pam’s discussion of this recent study below.  - Sharon Muza, Community Manager, Science & Sensibility.

© Patti Ramos Photography

© Patti Ramos Photography

There’s a new study out that discusses the variation in cesarean rates between hospitals in the United States. “Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: Analyses of a national US hospital discharge database“ was released late last month and has received a lot of press and discussion ever since.

Practice variation is a serious problem in obstetrics (Arcia 2013). Women are often far more at risk for a cesarean in certain hospitals than in others, even when the hospitals serve the same geographical area and population (Arnold, January 2013 and August 2012).

Of course, care providers protest that some hospitals have higher cesarean rates because they serve higher-risk patients. This is a valid point, but it still doesn’t explain the wide variation in rates between many hospitals (Clark 2007).

For example, in a press release about the new study, the mother’s risk status and diagnoses did not explain the variation in cesarean rates between hospitals:

“We found that the variability in hospital cesarean rates was not driven by differences in maternal diagnoses or pregnancy complexity,” said [lead study author] Kozhimannil. “This means there was significantly higher variation in hospital rates than would be expected based on women’s health conditions. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”

Other key points highlighted included:

  • Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
  • Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
  • Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.

This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level. 

Perhaps now we can stop playing the mother blame-game when we talk about cesarean rates? (Declerq 2006, Oganowski 2011)

This study is not the first to show that the culture of a hospital, its policies, and its routine practices all help determine how likely a woman is to “need” a cesarean in that hospital.

For example, Cáceres 2013 found that even after adjusting for socio-demographic and clinical factors and including only NTSV (Nulliparous, Term, Singleton, Vertex) pregnancies, the cesarean rate varied significantly between Massachusetts hospitals, “suggesting the importance of hospital practices and culture in determining a hospital’s cesarean rate.”

In addition, a 2014 consensus statement from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine notes, “Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed.”

Preventing cesareans when possible is important because while cesareans can be life-saving at times, they present more risk for maternal infection, bleeding and blood clots, and more neonatal breathing problems (Liu 2007, Visser 2014).

Notably, a large case-control study in U.K. maternity units found that delivery by cesarean was a strong risk factor for severe sepsis (Acosta 2014). Other research has found a high rate of maternal complications (Pallasmaa 2010) and poorer neonatal outcomes (Kolås 2006) associated with cesareans.

In addition, a cesarean’s potential negative effect on future pregnancies is important (Silver 2012). One American study found that the rate of an abnormal placental attachment increased in conjunction with the rise in cesarean delivery rate (Wu 2005), while a Canadian study found that a prior cesarean was associated with an increased risk for adverse neonatal outcomes in subsequent pregnancies (Abenhaim and Benjamin 2011).

Bottom line, it matters where and with whom a woman gives birth in order to lessen the risk for complications, both now and in the future.

But many women naively choose their care provider for pregnancy based mostly on convenience and location, not realizing that their chances of surgical birth may vary greatly depending on which hospital and caregiver they use (Arnold 2014, Arnold January 9 2013).

Childbirth Connection, a leading consumer education site, points out:

Research suggests that the same woman might have a c-section at one hospital but a vaginal birth if she gave birth at another, just because of the different policies and practices of those hospitals. One of the most effective ways to lower your chance of having a c-section is to have your baby in a setting with a low c-section rate.

Yet it is not always easy to find out the cesarean rates of local hospitals in some areas. For example, the health departments of Missouri, South Carolina, and Washington D.C. do not make hospital-level cesarean rates available to consumers.

Hospitals remain largely unaccountable for high cesarean rates, although we are beginning to see marginal progress in some places towards more accountability (Gentry 2014 and Dekker 2014). In the meantime, however, thousands of women are undergoing cesareans, many of which might be preventable with changes in clinical practices (Boyle 2013).

And even when a cesarean is truly necessary, there can be large discrepancies in complications afterwards between hospitals (Alonso-Zaldivar 2014). It’s not just about how many cesareans are done, but also about which hospitals have the best outcomes when a cesarean is done. Without more information, how is a woman to know which hospital to choose?

Bottom line, more transparency and accountability are needed. As the lead author of the study states:

Women deserve evidence-based, consistent, high-quality maternity care, regardless of the hospital where they give birth…and these results indicate that we have a long way to go toward reaching this goal in the U.S.

*To search for hospital-level cesarean rates in your area, see www.cesareanrates.com or the 2014 Consumer Reports article (subscription required) rating hospitals in 22 states.

Do you ever encourage your students and clients to look at the cesarean rates (and rates of other interventions which may lead to cesareans) of the hospitals they are considering birthing in.  Please share your experience in our comments section. – SM

References

Abenhaim, H. A., & Benjamin, A. (2011). Effect of prior cesarean delivery on neonatal outcomes. Journal of perinatal medicine39(3), 241-244. PMID: 21426242

Acosta, C. D., Kurinczuk, J. J., Lucas, D. N., Tuffnell, D. J., Sellers, S., & Knight, M. (2014). Severe Maternal Sepsis in the UK, 2011–2012: A National Case-Control Study. PLoS medicine11(7), e1001672. PMID: 25003759

Alonso-Zaldivar, R (2014, August 27). Study: Wide hospital quality gap on maternity care. Retrieved from http://www.fosters.com/apps/pbcs.dll/article?AID=/20140827/GJLIFESTYLES/140809539/0/SEARCH.

Arcia, A (2013, February 3). What is practice variation in obstetrics and why should I care? Retrieved from http://www.cesareanrates.com/blog/2013/2/3/what-is-practice-variation-in-obstetrics-and-why-should-i-ca.html.

Arnold, J (2012, August 22). Practice variation in New Jersey: 27 miles and 28 percentage points. Retrieved from http://www.cesareanrates.com/blog/2012/8/22/practice-variation-in-new-jersey-27-miles-and-28-percentage.html.

Arnold, J (2013, January 9). Practice variation in East Los Angeles cesarean rates. Retrieved from http://www.cesareanrates.com/blog/2013/1/9/practice-variation-in-east-los-angeles-cesarean-rates.html.

Arnold, J (2013, January 7). Practice variation in West Virginia: 60 miles and 54 percentage points. Retireved from http://www.cesareanrates.com/blog/2013/1/7/practice-variation-in-west-virginia-60-miles-and-54-percenta.html.

Arnold, J (2014, March 13). Three miles/Cinco Kilometros. Retrieved from http://www.cesareanrates.com/blog/2014/3/13/three-miles-cinco-kilometros.html.

Boyle, A., Reddy, U. M., Landy, H. J., Huang, C. C., Driggers, R. W., & Laughon, S. K. (2013). Primary cesarean delivery in the United States. Obstetrics & Gynecology122(1), 33-40. PMID: 23743454

Cáceres IA, Arcaya M, Declercq E, Belanoff CM, Janakiraman V, Dohen B, Ecker J, Smith LA, Subramanian SV (2013). Hospital differences in cesarean deliveries in Massachusetts (US) 2004-2006: the case against case-mix artifact. PLOS One, 8(3):e57817. doi: 10.1371/journal.pone.0057817. PMID:23526952

Clark SL, Belfort MA, Hankins GD, Meyers JA, Houser FM (2007). Variation in the rates of operative delivery in the United States. American journal of obstetrics and gynecology, 196(6):526.e1-526.e5.  PMID: 17547880

Caughey, A. B., Cahill, A. G., Guise, J. M., & Rouse, D. J. (2014). Safe prevention of the primary cesarean delivery. American journal of obstetrics and gynecology,210(3), 179-193. doi: 10.1016/j.ajog.2014.01.026. PMID:24565430

Declercq, E., Menacker, F., & MacDorman, M. (2006). Maternal risk profiles and the primary cesarean rate in the United States, 1991–2002. American journal of public health, 96(5), 867. PMID: 16571712

Dekker, R (2014, October 29). U.S. hospitals held accountable for C-section rates. Retrieved from http://www.birthbythenumbers.org/?p=1731

DePoint, M (2014, October 22). Maternal diagnoses doesn’t explain variation in cesarean rates across US hospitals. University of Minnesota, School of Public Health. Retrieved from http://sph.umn.edu/maternal-diagnoses-doesnt-explain-variation-cesarean-rates-across-us-hospitals/.

Gentry, C (2014, May 14). FL still C-section hotspot. Retrieved from http://health.wusf.usf.edu/post/fl-still-c-section-hotspot.

Kolås, T., Saugstad, O. D., Daltveit, A. K., Nilsen, S. T., & Øian, P. (2006). Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes. American journal of obstetrics and gynecology,195(6), 1538-1543. PMID: 16846577

Kozhimannil KB, Arcaya MC, Subramanian SV (2014). Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: Analyses of a national US hospital discharge database.  PLoS medicine, 11(10):e1001745. doi: 10.1371/journal.pmed.1001745. PMID: 25333943

Liu, S., Liston, R. M., Joseph, K. S., Heaman, M., Sauve, R., & Kramer, M. S. (2007). Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. Canadian medical association journal176(4), 455-460. PMID: 17296957

Oganowski, K (2010, January 13). The C-section blame game: I’ve reached my boiling point. Retrieved from http://birthingbeautifulideas.com/?p=1245.

Pallasmaa, N., Ekblad, U., AITOKALLIO‐TALLBERG, A. N. S. A., Uotila, J., Raudaskoski, T., ULANDER, V., & Hurme, S. (2010). Cesarean delivery in Finland: maternal complications and obstetric risk factors. Acta obstetricia et gynecologica Scandinavica89(7), 896-902. PMID: 20583935

Phend, C (2013, March 5). C-Section rates vary widely between hospitals, study finds. MedPage Today. Retrieved from http://abcnews.go.com/Health/section-rates-vary-widely-hospitals-study-finds/story?id=18656847.

Silver, R. M. (2012, October). Implications of the first cesarean: perinatal and future reproductive health and subsequent cesareans, placentation issues, uterine rupture risk, morbidity, and mortality. In Seminars in perinatology (Vol. 36, No. 5, pp. 315-323). WB Saunders. PMID: 23009962

Visser GH (2014). Women are designed to deliver vaginally and not by Cesarean section: An obstetrician’s view. Neonatology, 107(1):8-13. PMID: 25301178

What every pregnant woman needs to know about Cesarean section (2012). Childbirth Connection. Retrieved from http://www.childbirthconnection.org/pdfs/cesareanbooklet.pdf.

What hospitals don’t want you to know about C-sections (2014, May). Consumer Reports. Retrieved from http://consumerreports.org/cro/2014/05/what-hospitals-do-not-want-you-to-know-about-c-sections/index.htm.

Wu, S., Kocherginsky, M., & Hibbard, J. U. (2005). Abnormal placentation: twenty-year analysis. American journal of obstetrics and gynecology192(5), 1458-1461. PMID: 15902137

A version of this post originally appeared on www.wellroundedmama.blogspot.com

About Pam Vireday

Painting by Mary Cassatt, 1844-1926. (public domain) Image from Wikimedia Commons.

Pam Vireday is a childbirth educator, writer, woman of size, and mother to four children. She has been collecting the stories of women of size and writing about childbirth research for 17 years. She writes at www.wellroundedmama.blogspot.com and www.plus-size-pregnancy.org.

 

Cesarean Birth, Childbirth Education, Evidence Based Medicine, Guest Posts, Medical Interventions, New Research, Research , , , , ,

Lamaze International Online Classes for Parents Expands Offerings!

November 11th, 2014 by avatar

Screen Shot 2014-11-10 at 5.16.54 PM

The Lamaze International Strategic Framework 2014-2017 that resulted from in-depth strategic planning meetings held earlier this year with the Board of Director and Lamaze Management resulted in many forward thinking, comprehensive and courageous goals, including plans to “innovate education and expand to the childbearing years” by:

  • reaching more women earlier and more frequently throughout childbearing years,
  • expanding delivery methods for online education (e.g., virtual classes, Facetime consults, and mobile apps), and
  • developing a strategy to broaden outreach at the electronic level and cultivate moms ‘up’ the ladder for more personalized services and training.

As part of fulfilling this mission, Lamaze International is pleased to announce that three online childbirth education classes are developed, online and open for business.  The first class to go live was ”Safe and Healthy Birth: Six Simple Steps,” a class designed to help families prepare for birth by presenting six simple practices shown to greatly improve birth outcomes for both mothers and babies. The next two were recently added – VBAC: Informed and Ready and Breastfeeding Basics: From Birth to Back to Work.

The online classes are presented in an interactive, engaging format with unlimited access for parents, so they can complete the class(es) at their own pace. The classes are meant to be used as an important beginning point in a families’ complete prenatal education. They provide vital information, and throughout the online course, families are encouraged to find a comprehensive in person Lamaze class in order receive a thorough preparation for childbirth. Parents are informed that to be fully prepared for labor, birth, breastfeeding, and postpartum, it’s important to attend a good quality childbirth course. There are links to the “Find a Lamaze Class” portion of the parent website.

The online classes can be accessed on a computer (desktop or laptop), tablet or smartphone and learning can take place at a convenient time and place for each individual family.  There are interactive activities and discussion forums to connect with other participating families.  Fun quizzes are spaced throughout the course to help with the retention of information.

Safe and Healthy Birth: Six Simple Steps

Knowledge is power! It’s our goal to help you prepare for one of the most important days of your life – baby’s birthday! This course presents six simple practices that research has shown to greatly improve birth outcomes for both mothers and babies. These practices have been developed by Lamaze International and are based on recommendations by the World Health Organization. Lamaze has simplified the scientific facts into six healthy birth practices to make it easy for you to choose the safest care, understand your options, and steer clear of care practices or unnecessary interventions that may not be the best for you and your baby.

After completing this course, learners will be able to:

  • Discover how the Lamaze Six Healthy Birth Practices can simplify your labor and birth
  • Find out how your care provider and support team can make a difference
  • Learn about common medical interventions
  • Alleviate fears and learn ways to manage pain
  • Build your knowledge and confidence to make informed decisions

Breastfeeding Basics: From Birth to Back to Work

As comforting and healthy as breastfeeding can be, it is not always easy in the first few weeks while recovering from birth. If you find yourself struggling, know that hard work in the early weeks pays off as you and your baby learn to breastfeed. Having realistic expectations about how breastfeeding will go in the early weeks will help you to meet your breastfeeding goals. With the information in this class, you can prepare to get breastfeeding off to a great start and look forward to the many benefits that breastfeeding can provide to you and your baby.

After complete this class, learners will be able to:

  • Recognize the Benefits of Breastfeeding to Mother and Baby
  • Understand how milk supply works
  • Learn about the mechanics of breastfeeding, latch and positioning
  • Recognize good feeding and if baby is getting enough milk
  • Manage nighttime breastfeeding
  • Be prepared for what to do if there is a recommendation to supplement/pump
  • Prepare for returning to work

VBAC: Informed and Ready

This class will help you understand the facts, benefits, and risks of all your delivery options including a vaginal birth after cesarean (VBAC), and set you up for the best chance of success. Prepare yourself and learn how to simplify your labor and birth by participating in this interactive online course.

After completing this class, learners will be able to:

  • Understand the risks and benefits of both VBAC and repeat cesarean birth
  • Recognize the qualities of a VBAC supportive health care provider
  • Identify a strong support team for your  VBAC birth
  • Develop and practice coping and comfort techniques that will help during your VBAC labor
  • Write a VBAC and cesarean birth plan that reflects your informed preferences

International Cesarean Awareness Network (ICAN) has collaborated with Lamaze International to offer all ICAN members a 15% discount on the VBAC class, to help them feel better prepared as they plan for their subsequent birth after a cesarean.  To learn more about ICAN and become a member, in order to take advantage of this discount, follow the link to the “Join ICAN page.”

Additional courses planned include “Labor Pain Management: Techniques for Comfort and Coping” -scheduled to go live next month and an early pregnancy class in the early part of 2015.

Offering online classes serves to increase name recognition of the Lamaze International brand and create demand for in person Lamaze classes offered by LCCEs around the world.  Programs like this position Lamaze as the leader in childbirth education. Additionally, families that do not have Lamaze educators in their community can take advantage of the evidence based information and skills offered in the classes.  Educators can follow the class links above and sample all of the courses in a preview segment.

Breastfeeding, Cesarean Birth, Childbirth Education, Healthy Birth Practices, Lamaze International, Pain Management , , , , , ,

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 , , , ,