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October is SIDS Awareness Month – Educators Can Share Information to Help Families Reduce Risk!

October 28th, 2014 by avatar

Safe to Sleep®SIDS PreventionOctober has been designated as a time to observe some solemn occasions that may affect families during pregnancy, birth and postpartum.  This month, Science & Sensibility has previously covered Pregnancy and Infant Loss Awareness Month in two previous posts here and here.  Today I would like to recognize that October is also SIDS Awareness Month.

As childbirth educators, part of our curriculum for expecting parents includes discussing SIDS, providing an explanation of what it is (and what it isn’t)  and how to reduce the risk of a SIDS death.

What is SIDS?

Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted that includes a complete autopsy, examination of the death scene, and a review of the medical history. SIDS is the leading cause of death for infants aged 1 to 12 months in the United States.  About 2000 infants die every year in the USA from SIDS. African American and American Indian/Alaskan Native babies are twice as likely to die of SIDS as white babies.

Most SIDS deaths occur in babies between 1 month and 4 months of age, and the majority (90%) of SIDS deaths occur before a baby reaches 6 months of age. However SIDS deaths can occur anytime during a baby’s first year. Slightly more boys die of SIDS than girls.

Since the USA introduced the Safe to Sleep® campaign (formerly known as the Back to Sleep Campaign) in 1994, the number of infants dying of SIDS has dropped by 50%.

What SIDS is not

  • SIDS is not suffocation nor is it caused by suffocation
  • Vaccines and immunizations do not cause SIDS
  • SIDS is not a result of choking or vomiting
  • SIDS is not caused by neglect or child abuse
  • SIDS is not contagious
  • SIDS is not caused by strangulation

What causes SIDS?

While the cause of SIDS is not known, there is more and more evidence that infants who die from SIDS have brain abnormalities that interfere with how the brain communicates with the parts of the nervous system that control breathing, heart rate, blood pressure, waking from sleep, temperature and other things.  More information on what researchers are finding as they work to identify the cause of SIDS can be found here.

What are the risk factors for SIDS?

There are several risk factors that put babies at higher risk of SIDS.  Childbirth educators should be providing this information to families during class. These risk factors include:

  • Being put to sleep on their stomachs
  • Being put to sleep on couches, chairs, or other soft surfaces or under soft coverings
  • Being too hot during sleep
  • Being put to sleep on or under soft or loose bedding
  • Being exposed to smoke in utero, or second hand cigarette smoke in the home or car, or the second hand smoke of care-givers or family.
  • Sleeping in an adult bed with parents, other children or pets especially if:
    • Bed-sharing with an adult who smokes, recently had alcohol or is tired
    • Sleeping with more than one bed sharer
    • Covered by a blanket or a quilt
    • Younger than 14 weeks of age

NOTE: If families in your classes are going to be bed-sharing with their infants, (which sometimes is the reality for new parents getting accustomed to life with baby) it is important for you to provide information about what safe bed sharing looks like.  I recommend “Sharing Sleep with Your Baby” by Robin Elise Weiss for resources to share on this topic.

What reduces the risks of SIDS?

New parents can do many things to reduce the risk of their infant dying from SIDS.  You can share this information with your classes.   These risk reductions include:

  • Always place a baby to sleep on his/her back
  • Have the baby sleep on a firm sleep surface (Not a carseat, bouncy seat or swing as your baby’s normal sleep spot.)
  • No crib bumpers, toys, soft objects, or sleep positioning products (even if they claim to reduce the risk of SIDS) in the baby’s sleep space
  • Breastfeed the baby
  • Room sharing with the baby
  • Have regular prenatal care during pregnancy
  • Mothers who refrain from smoking, drinking alcohol or using illicit drugs during pregnancy and after the baby is born
  • Do not allow second hand smoke around the baby or have caregivers or family members who smoke around the baby
  • Once breastfeeding and milk supply is firmly established and baby is gaining weight appropriately, offer a pacifier (not on a string) when baby goes down for their last sleep.
  • Do not overdress the baby for bed or overheat the room
  • Maintain all the healthy baby checkups and vaccines as recommended by the baby’s health care provider
  • Do not use home breathing monitors or heart monitors that claim to reduce the risk of SIDS.

Talking about difficult topics in a childbirth class can be hard for both the eductor and the families.  No one wants to think that the unthinkable might happen to them.  But sharing accurate facts about the risks and how to reduce those risks is an important part of any childbirth curriculum.  How and when do you discuss this topic in your classes?  Do you have a video or handout that you like to share?  Please let us know in the comments section, how you effectively cover SIDS topics in your childbirth classes.

Resources for professionals

Resources for parents and caregivers

 

 

 

 

 

 

 

Babies, Breastfeeding, Childbirth Education, Newborns , , , , ,

The Role of the Childbirth Educator during a Perinatal or Infant Loss

October 14th, 2014 by avatar
Original Painting © Johann Heinrich Füssli

Original Painting © Johann Heinrich Füssli

As we continue to observe Pregnancy and Infant Loss Awareness Month, I would like to discuss a difficult topic that may come up for childbirth educators.  Last week, Robin Elise Weiss shared ways to commemorate the loss of a baby. Today, I would like to talk about when a class member experiences a perinatal loss while taking your class, or after the class is over.  If you work long enough as an educator, eventually this will be an issue that you are going to need to face.

Sometimes, you may be contacted by the family, with a somber email or phone call, letting you know that they won’t be returning to class. Other times, a family just stops coming, with no explanation, midway through a series.  You are not sure why.  Was it your teaching style?  Did they have their baby early?  Has something happened?  You will also have to consider that this family may have experienced a late term loss.

When a family does not return to class, I always suggest that the childbirth educator reach out to the family via phone or email to politely inquire and determine that all is okay.  Possibly the mother has been placed on bedrest and will need some accommodations or arrangements in order to complete her childbirth education.  Often, you will find out that something has come up and the date and time no longer work, and you breathe a sigh of relief at this information.  You may find out that their baby arrived prematurely, and you have an opportunity to connect them with resources that they may find useful while dealing with a baby in the NICU and adjusting to the new reality of having a baby weeks or months before they thought they would.  It is likely that their baby may require additional resources and have some immediate needs they had not thought about.  And sometimes, unfortunately, you learn that they have lost their baby either in utero or after birth.

If you are a successful childbirth educator, you work hard to build community in your childbirth classes, helping families to connect with each other through engaging activities and interactive learning.  The families start to see each other as resources and comrades in the transition to parenthood.  Connections are made, friendships are developed and a feeling of community is established.  You are faced with the task of sharing with the class that a family will not be returning.  They are missed and class members usually will be inquiring as to their absence.

When you learn of such a loss, I believe you have several responsibilities as a childbirth educator.  First, determine if the family is open to receiving resources that can help them as they deal with the loss of a baby.  These resources may included peer to peer and facilitated support groups in their community, counselors and therapists specializing in perinatal grief and loss, lactation consultants who can help with the transition of not needing to breastfeed, online resources to help them and more.

If there is a public funeral or memorial service, I make every attempt to attend if possible, in order to show my respect.  Sometimes this is not possible or the family has decided to keep the event private. Regardless,  I always try and promptly send a sympathy card to the family, expressing my sadness at the loss of their son or daughter.

I also politely inquire if they would like me to share the news with the rest of the class.  This information needs to be handled very sensitively.  The family may not want the news shared, and their privacy and wishes are my first priority.  But no doubt, someone in the class will soon ask where the missing family has gone.  In my experiences, the family usually has given me permission to share the information with the rest of the class.  This can be a huge challenge – finding a balance of informing the class and not creating fear and worry for them.

In my experience, the best way to share the information is toward the end of class, with just a few minutes to go.  I respect the family’s wishes and only share the information I have been asked to share.  I tell the truth, but I don’t feel the need to go into great detail.  I answer any questions from the class as best I can and stick to the facts, while respecting the family’s wishes.  If allowed, I provide information about a service or how to contact the family.  I acknowledge that this event is hard to hear, and may bring up concerns and fears for the class members. Sometimes families get very upset or cry as they hear the news.  I provide some resources where they can get more information and support, and also suggest they speak to their health care provider about their fears.  I make myself immediately available after class and in the future to listen to their concerns if they feel the need to connect.

Sometimes a family loses a baby after the class has ended, but before a reunion (if you do class reunions, which are very common here in my area.)  If I am made aware of the loss by the family, I follow the steps above, but ask how they would like me to handle sharing with the class.  I provide this information to those in attendance at the reunion, sharing only information as allowed by the family.

If you have class email lists, or Facebook groups for your childbirth classes, be sure to find out what the parents’ wishes are regarding remaining on the list or in the group.  Some families will want to be removed and others will want to stay connected.  When in doubt, I would discreetly remove them from further communication about class activities, baby announcements or planned gatherings.

Losing a baby during pregnancy or after birth is one of the most difficult things a family can experience.  Our society does not do a great job in honoring this type of loss.  The role of the childbirth educator becomes very important when one of your class members has lost a baby.  How you handle this loss, with both the family and with other class members is critical and can impact the experience of all.  As childbirth educators, we are in a unique position to help both the family and our other students when given permission by the grieving family.

Have you had this experience as a childbirth educator?  How have you handled this situation?  Do you have any tips for other educators in case they have a similar experience?  What did you find worked?  What did you do?  Please share your thoughts and suggestions along with any resources in our comments section.

 

 

 

 

Babies, Childbirth Education, Trauma work , , , ,

Ideas for Commemorating Pregnancy and Infant Loss Awareness Month

October 9th, 2014 by avatar

By Robin Elise Weiss, PhDc, MPH, CPH, LCCE

October is Pregnancy and Infant Loss Awareness Month and Lamaze International President Robin Elise Weiss challenges all of us to make some time this month to recognize this somber topic.  Robin provides some creative ideas about how you can honor and remember those families and babies who were separated too soon in your community. – Sharon Muza, Community Manager, Science & Sensibility.

© Vicki Zoller

© Vicki Zoller

October has been identified as Pregnancy and Infant Loss Awareness Month. There are also several other pregnancy and infant groups who have specific memorials and functions that occur this month, but I’m going to focus on this as a general topic.

The beauty of being a Lamaze Certified Childbirth Educator is that I have the joy and pleasure of working with happy pregnant families the vast majority of the time. Though what most people don’t think about when they talk to a Lamaze Childbirth Educator is that we can also be a resource when pregnancy is not going perfectly, and that includes the very devastating death of a baby at any point in pregnancy or as a young baby.

This is not something that most parents-to-be want to hear about. It is something that the vast majority will try to avoid thinking about, even though it is a common fear in pregnancy and beyond. Our job as a Lamaze Childbirth Educator is not to scare them but to give matter of fact, honest information without dwelling on the negative. That said, I know that many childbirth educators do not cover this in childbirth class for a variety of reasons. 

My challenge to you this month is to consider doing any or all of the following, depending on where you are in your journey as an educator, parent, human:

  • Read a Book: There are many good books written about pregnancy loss. The vast majority are written from the view point of the parents involved, but these first hand accounts are extremely poignant and important. It can often be helpful in figuring out how to best help someone who is experiencing the death of their baby. You can also create a reading list of books for parents and one for children. If you can, consider donating a book to your local hospital or library.
  • Take a Class: Often you can find classes available, offered often by hospitals, hospice, or perinatal loss groups, during the month of October. They may be focused on birth workers, or be an in general offering. This is a great way to help build your resource list. One geared towards those who work in birth are going to be your best bet.
  • Take a Tour: Call your local hospital and ask to talk to the Labor & Delivery Nurse Manager. Tell her that you are a Lamaze Certified Childbirth Educator in the area and that you are trying to learn more about how they handle pregnancy loss and stillbirth. Ask if they will share their protocols, and talk to you about local resources. They often support groups that you may not see listed when looking locally.
  • Host a Circle: This can be a very touching but difficult thing to do. I would recommend that you find a local chaplain or counselor to co-host this with you unless you are qualified to handle various issues that may arise. Sometimes this might just be with local birth workers who need to talk about their own losses or the losses within their students or clients.
  • Host a Training: If you have a special talent, consider sharing it with others. For example, many years ago, I learned how to make foot molds and then casts from these molds. I’m the only person in town who does this and that means I go whenever someone asks me to go. There may be times I’m not available, but if I pass that information on to others, then it makes it more available to the community. You could also host a training of other sorts, like having someone come talk to a birth network about how to deal with grief and grieving in class or with your clients.
  • Host a Craft Night: This is something we are trying this year as a way to connect with the labor and delivery nurses on the front lines. A group of local doulas and childbirth educators are meeting at the hospital for a night of knitting and crocheting tiny baby hats to be given to the families who have experienced the death of their baby. It is a way for use to share and work together to make a really horrible experience a bit more personal. We are offering patterns for baby hats from very small gestation sizes through infant sizes, some basic instruction on crochet and knitting, and the hospital is providing a room and snacks.
  • Create Your Own Hats: If you need something to do that is tangible but can’t commit to being with others, you can use the patterns below to create your own stash of hats to donate to your local hospital.

I would invite you to share in the comments what’s on your reading list, other ideas you have for this month or even ideas you have that I may have missed.

Useful Links and Resources

 

 

Babies, Childbirth Education, Guest Posts, Newborns , , , , ,

Thank You Midwives! join Lamaze in Celebrating National Midwifery Week!

October 7th, 2014 by avatar

midwifery week poster 2014Please join Lamaze International and Science & Sensibility as we celebrate National Midwifery Week.  Midwives can and should play an integral part of healthy and safe birth practices here in the United States and around the world. Maternal infant health organizations and consumers alike are now aware that we have reached a tipping point.  Our cesarean rate is too high, the availability of VBAC supportive providers is dismal, the rate of inductions, particularly before 39 weeks is cause for concern, labor augmentations are commonplace and infant mortality – particularly amongst babies of color, in our country puts the United States ranking at an embarrassing 56 amongst all the other countries.

The midwifery model of care offers women and babies care by qualified, skilled health care providers who are experts at normal physiologic birth and meeting the needs of healthy, low risk, pregnant women.  The midwifery model of care respects the shared decision making process between the mother and her health care provider, the importance of the mother’s emotional health as well as her physical health and recognizes pregnancy and birth as part of a woman’s normal lifecycle, rather than an illness or pathological condition.  There is respect for the normal physiological process of birth, and the recognition that when things deviate from normal, collaboration and referral to obstetricians and other specialists is appropriate.  When midwives have the opportunity to care for more healthy low risk women, the United States might start to see some of the dismal statistics reverse, and women and babies will benefit from the new trend.

The American College of Nurse Midwives has created a consumer website, Our Moment of Truth, where women can learn more about midwifery, increase awareness and understanding of the different care options available, make informed choices about the type of care they would like to receive and even find a midwife in their area.  There is also a brochure available – “Normal Healthy Childbirth for Women and Families: What You Need to Know” to download in English and Spanish and share with your students and clients. This document and the ACNM program “Our Moment of Truth” was supported and endorsed by Lamaze International along with many other maternal infant health organizations.

The ACNM has a very nice “Essential Facts about Midwives” info sheet that contains some great statistics and information about Certified Nurse Midwives and Certified Midwives.  Midwives can catch babies in hospitals, birth centers and at home and Medicaid reimbursement is mandated for CNMS/CMs in all 50 states.  In 2012, CNMs/CMs attended over 300,000 births in the U.S.  When you add in Certified Professional Midwives/Licensed Midwives who also attend births at birth centers and homes, the number of midwife attended births goes up even further.

ACNM has created a fun video highlighting midwives and the care they provide.  I have also collected of a few of my favorite videos about midwives that you might enjoy viewing and sharing.

Mother of Many from emma lazenby on Vimeo.

What are you doing to celebrate and honor midwives this week?  Do you talk about the midwifery model of care in your childbirth classes and with your doula clients?  What resources do you like using to help your students understand the scope of practice and benefits of working with midwives?  Share with others in our comments below.

Babies, Childbirth Education, Healthy Birth Practices, Home Birth, Midwifery, Newborns , , , , , , ,

Breastfeeding & Racial Disparities in Infant Mortality: Celebrating Successes & Overcoming Barriers

August 28th, 2014 by avatar
© mochamanual.com

© mochamanual.com

August has been designated as World Breastfeeding Month, and Science & Sensibility was happy to recognize this with a post earlier this month that included a fun quiz to test your knowledge of current breastfeeding information.  Today, we continue on this topic and celebrate Black Breastfeeding Week 2014 with a post from regular contributor, Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA sharing information about the increased breastfeeding rates rates among African American women.  Kathleen also discusses some of the areas where improvements can help this rate to continue to increase. 

Celebrating Successes

Many exciting changes occurred in 2013 in the breastfeeding world. One of the best trends was the increase in breastfeeding rates in the African American community. The CDC indicated that increased breastfeeding rate in African American women narrowed the gap in infant mortality rates.  As the CDC noted:

From 2000 to 2008, breastfeeding initiation increased…from 47.4% to 58.9% among blacks. Breastfeeding duration at 6 months increased from…16.9% to 30.1% among blacks. Breastfeeding duration at 12 months increased from… 6.3% to 12.5% among blacks.

Much of this wonderful increase in breastfeeding rates among African Americans has come from efforts within that community. In 2013, we saw the first Black Breastfeeding Week become part of World Breastfeeding Week in the U.S. Programs, such as A More Excellent Way, Reaching Our Sisters Everywhere (ROSE), and Free to Breastfeed, offer peer-counselor programs for African American women.


We can celebrate these successes. But there is still more to do. Although the rates of infant mortality have dropped, African Americans babies are still twice as likely to die. In addition, although rates of breastfeeding have increased among African Americans, they are still lower than they are other ethnic groups.

For each of the 2000–2008 birth years, breastfeeding initiation and duration prevalences were significantly lower among black infants compared with white and Hispanic infants. However, the gap between black and white breastfeeding initiation narrowed from 24.4 percentage points in 2000 to 16.3 percentage points in 2008.

Barriers to Overcome

In order to continue this wonderful upward trend in breastfeeding rates, we need to acknowledge possible barriers to breastfeeding among African American women. Here are a couple I’ve observed. They are not the only ones, surely. But they are ones I’ve consistently encountered. They will not be quick fixes, but they can be overcome if we recognize them and take appropriate action.

1) Pathways for IBCLCs of Color

In their book, Birth Ambassadors: Doulas and the Re-Emergence of Women-Supported Birth in America, Christine Morton and Elayne Clift highlight a problem in the doula world that also has relevance for the lactation world: most doulas (and IBCLCs) are white, middle-class women. And there is a very practical reason for this. This is the only demographic of women that can afford to become doulas (or IBCLCs). The low pay, or lack of job opportunities for IBCLCs who are not also nurses, means that there are limited opportunities for women without other sources of income to be in this profession. Also, as we limit tracks for peer-counselors to become IBCLCs, we also limit the opportunities for women of color to join our field. I recently met a young African American woman who told me that she would love to become an IBCLC, but couldn’t get the contact hours needed to sit for the exam. That’s a shame. (I did refer her to someone I knew could help.)

2) We need to have some dialogue about how we can bring along the next generation of IBCLCs. We need to recognize the structural barriers that make it difficult for young women of color to enter our field. ILCA has started this dialogue and held its first Lactation Summit in July to begin addressing these issues.

These discussions can start with you. Sherry Payne, in her recent webinar, Welcoming African American Women into Your Practice, recommends that professionals who work in communities of color find their replacement from the communities they serve.  Even if you only mentor one woman to become an IBCLC, you can have a tremendous impact in your community. If we all do the same, we can change the face of our field. (Note, here is a wonderful interview with Sherry as she discusses “Fighting Breastfeeding Disparities with Support.”)

3) Bedsharing and Breastfeeding

 This is an issue that I expect will become more heated over the next couple of years. But it is a reality. As we encourage more women to breastfeed, a higher percentage of women will bedshare. As recent studies have repeatedly found, bedsharing increases breastfeeding duration. This is particularly true for exclusive breastfeeding.

Bedsharing is a particular concern when we are talking about breastfeeding in the African American community. Of all ethnic groups studied, bedsharing is most common in African Americans. It is unrealistic to think that we are going to simultaneously increase breastfeeding rates while decreasing bedsharing rates in this community. The likely scenario is that breastfeeding would falter. It’s interesting that another recent CDC report, Public Health Approaches to Reducing U.S. Infant Mortality, talks quite a bit about safe-sleep messaging, with barely a mention of breastfeeding in decreasing infant mortality.  A more constructive approach might be to talk about being safe while bedsharing. But as long as the message is simply “never bedshare,” there is likely to be little progress, and it could potentially become a barrier to breastfeeding.


Reason to Hope

BBW-Logo-AugustDates3Even with these barriers, and others I haven’t listed, Baby-Friendly Hospitals are having a positive effect. When hospitals have Baby-Friendly policies in place, racial disparities in breastfeeding rates seem to disappear. For example, a study of 32 U.S. Baby-Friendly hospitals revealed breastfeeding initiation rates of 83.8% compared to the national average of 69.5%. In-hospital exclusive breastfeeding rates were 78.4% compared with a national rate of 46.3%. Rates were similar even for hospitals with high proportions of black or low-income patients (Merewood, Mehta, Chamberlain, Phillipp, & Bauchner, 2005). This is a very hopeful sign, especially as more hospitals in the U.S. go Baby-Friendly.

http://kcur.org/post/kc-group-fights-breast-feeding-disparities-education-support

In summary, we have made significant strides in reducing the high rates of infant mortality, particularly among African Americans. I am encouraged by the large interest in this topic and the number of different groups working towards this goal. Keep up the good work. I think we are reaching critical mass.

Additional resource: Office of Women’s Health, U.S. Department of Health & Human Services Breastfeeding Campaign for African American families.

References

Merewood, A., Mehta, S. D., Chamberlain, L. B., Phillipp, B. L., & Bauchner, H. (2005). Breastfeeding rates in U.S. Baby-Friendly hospitals: Results of a national survey. Pediatrics, 116(3), 628-634.

Reprinted with permission from Clinical Lactation, Vol. 5-1. http://dx.doi.org/10.1891/2158-0782.5.1.7

About Kathleen Kendall-Tackett

kendall-tackett 2014-smallKathleen Kendall-Tackett, Ph.D., IBCLC, FAPA is a health psychologist, International Board Certified Lactation Consultant and Fellow of the American Psychologial Association in both the divisions of Health and Trauma Psychology. Dr. Kendall-Tackett is President-Elect of the Division of Trauma Psychology, Editor-in-Chief of Clinical Lactation, clinical associate professor of pediatrics at Texas Tech University Health Sciences Center, and Owner/Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. Dr. Kendall-Tackett has authored more than 310 articles or chapters and is the author or editor of 22 books on women’s health, maternal depression, family violence and breastfeeding. Dr. Kendall-Tackett and Dr. Tom Hale received the 2011 John Kennell and Marshall Klaus Award for Research Excellence from DONA International. You can find more from her at Uppity Science Chick

 

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