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Kathy Morelli Shares Highlights from the 2014 Postpartum Support International Conference

July 15th, 2014 by avatar

Regular contributor Kathy Morelli attended the Postpartum Support International conference in Chapel Hill, North Carolina this past month.  In today’s post, Kathy shares her thoughts, some big take-aways and checks in with the keynote speakers, who share important messages on postpartum mood disorders with our S&S readers.  We all have a responsibility to increase awareness and treatment options for pregnant and postpartum women.- Sharon Muza, Science & Sensibility Community Manager.

PSI QuiltI want to shout from the rooftops that there are so many well-educated, caring and ethical professionals who are focusing on Maternal Mental Health! I was so fortunate to be able to attend this year’s Postpartum Support International 27th Annual Conference at the University of North Carolina (UNC) campus at Chapel Hill on June 18 – June 21, 2014.

PSI’s theme this year was “Creating Connections between Communities: Practitioners and Science: Innovative Care for Perinatal Mental Health.” It was a wonderful meeting where scholar-practitioners in the Perinatal Mental Health field met and exchanged information and best practices in order to hone their collective craft. Researchers, clinicians and identified survivors met and shared their professional and personal stories. PSI’s outgoing president, Leslie Lowell Stoutenburg, RNC, MS, reports that PSI had its largest attendance ever this year.

The keynote speakers were a group of experienced professionals, researchers and clinicians presenting on clinical, scholarly and advocacy topics: Dr. David Rubinow, of UNC Chapel Hill, Dr. Samantha Meltzer-Brody of UNC Chapel Hill, Dr. Marguerite Morgan, of Arbor Circle Early Childhood Services in Grand Rapids, Michigan, Ms. Joy Bruckhard of California’s 20/20 Mom Project, and Dr. Susan Benjamin Feingold, clinical psychologist, all presented about their work in the different aspects in the field of Maternal Mental Health. Advocate Katherine Stone of Postpartum Progress served as emcee at the Saturday night banquet.

Dr. David Rubinow presented on his team research regarding female hormonal fluctuations and the relationship to postpartum mood disorders in sensitive women. Dr. Rubinow is an internationally known expert in the evaluation and treatment of women with mood disorders that occur during periods of hormonal change. Regarding the team’s research, he states “Our data demonstrate that normal changes in reproductive hormones can produce affective disturbance in a susceptible group of women.” The study (Bloch et al, 2000) examined the role of endocrine factors in the etiology of postpartum depression (PPD) by comparing women with a history of PPD and without PPD. Progesterone and estriadiol was measured at baseline, addback, withdrawal, and folIow-up. 67% of the women who had PPD had a recurrence of significant affective symptoms, including a constellation of depressive and hypomanic affect, while none of the control group experienced significant affective symptoms. This indicates that women who suffer from PPD may have a trait vulnerability that isn’t present in women who do not suffer from PPD.

Dr. Susan Benjamin Feingold, the keynote speaker on Saturday evening, presented on her clinical work around the transformational nature of surviving postpartum depression, documented in her newly released book, Happy Endings, New Beginning: Navigating Postpartum Mood Disorders. Dr. Feingold presented inspirational journal entries from women in her clinical practice. She says: “ In my book, I focus on a new view of the postpartum experience and how this difficult time can be a catalyst for change, personal growth and positive transformation. Postpartum depression can be the opportunity for not only healing, but ultimately, it can be a life-changing event.”

Ms. Joy Bruckhard, MBA, of Cigna, presented on her advocacy work in as one of the founders of the Maternal Mental Health Care Collaborative in California called the 20/20 Mom Project. The 20/20 Mom Project is a national campaign and movement for moms and by moms to create specific pathways to treatment for maternal mental health disorders, to address barriers to mental health care. The 20/20 Mom Project has teamed up with Postpartum Support International, a sister non-profit to launch first-of-a-kind web-based training for clinical professionals with the aim of addressing the shortage of mental health and medical professionals who specialize in maternal mental health. Joy says: “I’m so honored to be a part of this important work. Three years ago, my worlds collided: my training through Junior League, my experience in health care working at Cigna and having had two babies myself (and perhaps mild postpartum depression), and some family experience with mental illness, I felt compelled to step up and do more.”

Dr. Samantha Meltzer-Brody, a psychiatrist at UNC Chapel Hill, presented about the ongoing stigma about using psycho-pharmaceuticals during pregnancy and breastfeeding. She expressed frustration that other medications are readily accepted for use during pregnancy, but that there is an ongoing stigma against using medications that treat the mother’s mental health.

Dr. Marguerite Morgan, LCSW, presented on her successful program with African American women at the Arbor Circle Early Childhood Services in Grand Rapids, Michigan. She emphasized that she drops her “PhD-Dr” demeanor and constantly strives to connect at a human level with the people she serves. She is well versed in Christianity and quotes biblical passages about helping oneself during dark times, thus normalizing the experience of depression to her population in an accessible manner.

The psychodynamic approach to perinatal mood disorders was presented by Ms. Lorraine Caputo, LMFT, which addresses the mental health of women across the lifespan. Research and clinical practice indicates that a woman’s previous life experiences can have an impact on her transition to parenthood. On the lifelong care of a woman’s mental health, Ms. Caputo says: “I believe it’s crucial to help women with a history of trauma to make connections between the past and present in a way that psychodynamic treatment is uniquely poised to provide. The perinatal period is a natural time of enormous change, and in the best of circumstances will cause dysregulation, psychological transformation and re-identifications and dis-identifications with one’s own parents. And, given how entirely a pregnant woman and a postpartum mother surrenders her body to her child, childhood sexual traumas in the mother’s past can be triggered by this intense period of physical and emotional bonding with her baby. A psychoanalytic intervention that involves the development of a coherent narrative about how she was parented, and making connections between unrelenting anxiety, ruminations, self blame, and her past history can free a new mother from self doubt, guilt, and fear that she will not be a good mother. This work is done in a carefully paced way, using self reflection and the relationship with the therapist to help the mother feel safe and her powerful feelings contained and held by the therapist.”

Dr. Kelly Brogan, of Womens Holistic Psychiatry, discussed holistic clinical pathways to reproductive mental health.

Of note was the unique reproductive psychiatric sharing session, where reproductive psychiatrists came together to discuss clinical situations which they have encountered. This session was an extension of the collaborative professional LISTSERV that PSI hosts for clinical member reproductive psychiatrists.

Sessions on Healthy Postpartum Relationships were presented by both Ms. Elly Taylor and Ms. Karen Kleiman, LMFT, of the Postpartum Stress Center. Karen Kleiman has recently published her book, Tokens of Affection: Reclaiming Your Marriage after Postpartum Depression, informed from her extensive clinical experience with postpartum couples. Ms. Kleiman presented her overarching framework for treating distressed postpartum couples, identifying 8 tokens to be cultivated in the therapeutic encounter. One of the tokens she refers to as a “Token of Affection.” Ms. Kleiman notes: “Recovery from postpartum depression does not happen overnight, thus, creating a lag between the crisis and a sense of well-being for the couple. During this transitional period both partners are anxious to return to normal while they are simultaneously challenged by buried negative emotions and unmet expectations. Tokens of Affection are gift-giving gestures on behalf of the relationship. As a reparative resource, the Tokens lead the way toward renewed harmony and reconnection.”

Elly Taylor remarks: “It’s common for couples – even happily married ones – to find that the bond between them becomes stretched following the birth of their baby. This comes as a shock for most and increases the risk for perinatal mood disorders for some. But prepare for this, and its possible not only to protect the bond, but build on it as the foundation for family.” She has recently published her book about the postpartum couple’s experience called, Becoming Us, in the United States.

Included here are some closing thoughts from the incoming PSI president, Ann Smith, RN, MSN, CNM:

“PSI is the original and leading organization dealing with perinatal mood disorder which we now know affects approximately 1 in 7 moms. It’s the leading complication of childbearing. All women can be affected regardless of age, race, socioeconomic status and whether the pregnancy was wanted. When treated promptly and by someone who has familiarity with these disorders, moms get better quite quickly. PSI has training programs nationwide which train providers in evidence based treatments. Many women need a combination of medication and talk therapy to get better as quickly as possible. There are a number of medications which have been proven safe for pregnancy and breastfeeding. Support groups are also helpful.

PSI wants everyone to remember three things:

You are not alone, you are not to blame, with help you will be well.

For assistance, call the PSI Warmline at 800-944-4PPD or visit online

References

Bloch, M., Schmidt, P. J., Danaceau, M., Murphy, J., Nieman, L., & Rubinow, D. R. (2000). Effects of gonadal steroids in women with a history of postpartum depression. American Journal of Psychiatry157(6), 924-930.

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Babies, Birth Trauma, Childbirth Education, Guest Posts, Infant Attachment, Maternal Mental Health, Perinatal Mood Disorders, Postpartum Depression, PTSD, Trauma work , , , , , ,

Evidence on Water Birth Safety – Exclusive Q&A with Rebecca Dekker on her New Research

July 10th, 2014 by avatar

 

Evidence Based Birth , a popular blog written by occasional Science & Sensibility contributor Rebecca Dekker, PhD, RN, APRN, has just today published a new article, “Evidence on Water Birth Safety“ that looks at the current research on the safety of water birth for mothers and newborns.  Rebecca researched and wrote that article in response to the joint Opinion Statement “Immersion in Water During Labor and Delivery” released in March, 2014 by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics.  I had the opportunity to ask Rebecca some questions about her research into the evidence available on water birth, her thoughts on the Opinion Statement and her conclusions after writing her review. – Sharon Muza, Science & Sensibility Community Manager.

Sharon Muza: First off, is it waterbirth or water birth?

Rebecca Dekker: That’s actually good question! Research experts tend to use the term “waterbirth.” Google prefers “water birth.” So I used both terms in my article to satisfy everyone!

SM: Have you heard or been told of stories of existing water birth programs shutting down or being modified as a result of the recent AAP/ACOG opinion?

RD: Yes, definitely. There was a mother in my state who contacted me this spring because she was 34 weeks pregnant and her hospital decided not to offer waterbirth anymore. She had given birth to her daughter in a waterbirth at the same hospital two years earlier. With her current pregnancy, she had been planning another hospital waterbirth. She had the support of her nurse midwife, the hospital obstetricians, and hospital policy. However, immediately after the release of the ACOG/AAP opinion, the hospital CEO put an immediate stop to waterbirth. This particular mother ended up switching providers at 36 weeks to a home birth midwife. A few weeks ago, she gave birth to her second baby, at home in the water. This mother told me how disheartening it was that an administrator in an office had decided limit her birth options, even though physicians and midwives at the same hospital were supportive of her informed decision to have a waterbirth.

In another hospital in my hometown, they were gearing up to start a waterbirth program this year—it was going to be the first hospital where waterbirth would be available in our city—and it was put on hold because of the ACOG/AAP Opinion.

Then of course, there were a lot of media reports about various hospital systems that suspended their waterbirth programs. One hospital system in particular, in Minnesota, got a lot of media coverage.

SM: Did you attempt to contact ACOG/AAP with questions and if so, did they respond?

RD: Yes. As soon as I realized that the ACOG/AAP Opinion Statement had so many major scientific errors, I contacted ImprovingBirth.org and together we wrote two letters. I wrote a letter regarding the scientific problems with the Opinion Statement, and ImprovingBirth.org wrote a letter asking ACOG/AAP to suspend the statement until further review. The letters were received by the President and President-Elect of ACOG, and they were forwarded to the Practice Committee. We were told that the Practice Committee would review the contents of our letters at their meeting in mid-June, and that was the last update that we have received.

SM: What is the difference between an “Opinion Statement” and other types of policy recommendations or guidelines that these organizations release? Does it carry as much weight as practice bulletins?

RD: That’s an interesting question. At the very top of the Opinion Statement, there are two sentences that read: “This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed.” But, as you will see, some hospitals do see this statement as dictating an exclusive course of treatment, and others don’t.

I have heard that “opinions” do not carry as much weight as “practice bulletins,” but it really depends on who the audience is and who is listening. In other words, some hospitals may take the Opinion Statement word-for-word and feel that they must follow it to the letter, and other hospitals may ignore it. A lot of it probably depends on the advice of their risk management lawyers.

For example, a nurse midwife at a hospital in Illinois sent me a letter that their risk-management attorneys had put together to advise them on this issue. (She had the attorney’s permission to share the letter with me). These lawyers basically said that when a committee of two highly-respected organizations says that the practice of waterbirth should be considered an experimental procedure, both health care providers and hospitals are “charged with a duty to heed that statement,” unless they find research evidence that waterbirth has benefits for the mother or fetus, and that the evidence can override the Committee’s conclusions.

On the other hand, another risk management lawyer for a large hospital system told me that of course hospitals are not under any obligation to follow an ACOG/AAP Opinion Statement. It’s simply just that—an opinion.

So as to how much weight the Opinion Statement carries—I guess it is really dependent on who is reading it!

SM: How would you suggest a well-designed research study be conducted to examine the efficacy and safety of waterbirth? Or would you say that satisfactory research already exists.

RD: First of all, I want to say that I’m really looking forward to the publication of the American Association of Birth Centers (AABC) data on nearly 4,000 waterbirths that occurred in birth centers in the U.S., to see what kind of methods they used. From what I hear, they had really fantastic outcomes.

And it’s also really exciting that anyone can join the AABC research registry, whether you practice in a hospital, birth center, or at home. The more people who join the registry, the bigger the data set will be for future research and analysis. Visit the AABC PDR website to find out more.

I think it’s pretty clear that a randomized trial would be difficult to do, because we would need at least 2,000 women in the overall sample in order to tell differences in rare outcomes. So instead we need well-designed observational studies.

My dream study on waterbirth would be this: A large, prospective, multi-center registry that follows women who are interested in waterbirth and compares three groups: 1) women who have a waterbirth, 2) women who want a waterbirth and are eligible for a waterbirth but the tub is not available—so they had a conventional land birth, 3) women who labored in water but got out of the tub for the birth. The researchers would measure an extensive list of both maternal and fetal outcomes.

It would also be interesting to do an additional analysis to compare women from group 2 who had an epidural with women from group 1 who had a waterbirth. To my knowledge, only one study has specifically compared women who had waterbirths with women who had epidurals. Since these are two very different forms of pain relief, it would be nice to have a side-by-side comparison to help inform mothers’ decision making.

SM: What was the most surprising finding to you in researching your article on the evidence on water birth safety?

RD: I guess I was most surprised by how poorly the ACOG/AAP literature review was done in their Opinion Statement. During my initial read of it, I instantly recognized multiple scientific problems.

A glance at the references they cited was so surprising to me—when discussing the fetal risks of waterbirth, they referenced a laboratory study of pregnant rats that were randomized to exercise swimming in cold or warm water! There weren’t even any rat waterbirths! It was both hilarious and sad, at the same time! And it’s not like you have to read the entire rat article to figure out that they were talking about pregnant rats—it was right there in their list of references, in the title of the article, “Effect of water temperature on exercise-induced maternal hyperthermia on fetal development in rats.”

These kind of mistakes were very surprising, and incredibly disappointing. I expect a lot higher standards from such important professional organizations. These organizations have a huge influence on the care of women in the U.S., and even around the world, as other countries look to their recommendations for guidance. The fact that they were making a sweeping statement about the availability of a pain relief option during labor, based on an ill-researched and substandard literature review—was very surprising indeed.

SM: What was the most interesting fact you discovered during your research?

RD: With all this talk from ACOG and the AAP about how there are “no maternal benefits,” I was fascinated as I dug into the research to almost immediately find that waterbirth has a strong negative effect on the use of episiotomy during childbirth.

Every single study on this topic has shown that waterbirth drastically reduces and in some cases completely eliminates the use of episiotomy. Many women are eager to avoid episiotomies, and to have intact perineums, and waterbirth is associated with both lower episiotomy rates and higher intact perineum rates. That is a substantial maternal benefit. It’s kind of sad to see leading professional organizations not even give the slightest nod to waterbirth’s ability to keep women’s perineums intact.

In fact, I’m puzzled as to why keeping women’s perineums intact and uncut is not perceived as a benefit by anyone other than the women themselves. And here is the heart of declaring waterbirth as “not having enough benefits” to justify its use: Who decides the benefits? Who decides what a benefit is, if not the person benefitting? Who should be weighing the potential harms and the potential benefits of waterbirth, and making an informed decision about their options? Should it be the mother? Or should it be the obstetrician?

SM: What can families do if they want waterbirth to be an option in their local hospital or birth center and it has been taken away or not even ever been offered before?

RD: That’s a hard question. It’s a big problem.

Basically what it boils down to is this—there are a lot of restraining forces that keep waterbirth from being a pain relief option for many women. But there are also some positive driving forces. According to change theory, if you want to see a behavior change at the healthcare organization level, it is a matter of decreasing the restraining forces, while increasing the driving forces. Debunking the ACOG/AAP Opinion Statement is an important piece of decreasing restraining forces. On the other side, increasing consumer pressure can help drive positive change.

SM: Do you think that consumers will be responding with their health dollars in changing providers and facilities in order to have a waterbirth?

RD: I think that if a hospital offered waterbirth as an option to low-risk women, that this could be a huge marketing tool and would put that hospital at an advantage in their community, especially if the other hospitals did not offer waterbirth.

SM: The ACOG/AAP opinion sounded very reactionary, but to what I am not sure. What do you think are the biggest concerns these organizations have and why was this topic even addressed? Weren’t things sailing along smoothly in the many facilities already offering a water birth option?

RD: I don’t know if you saw the interview with Medscape, but one of the authors of the Opinion Statement suggested that they were partially motivated to come out with this statement because of the increase in home birth, and they perceive that women are having a lot of waterbirths at home.

I also wonder if they are hoping to leverage their influence as the FDA considers regulation of birthing pools. You may remember that in 2012, the FDA temporarily prohibited birthing pools from coming into the U.S. Then the FDA held a big meeting with the different midwifery and physician organizations. At that meeting, AAP and ACOG had a united front against waterbirth. So I guess it’s no surprise for them to come out with a joint opinion statement shortly afterwards.

My sincere hope is that the FDA is able to recognize the seriously flawed methods of the literature review in this Opinion Statement, before they come out with any new regulations.

SM: How should childbirth educators be addressing the topic of waterbirth and waterbirth options in our classes in light of the recent ACOG/AAP Opinion Statement and what you have written about in your research review on the Evidence on Water Birth Safety?

RD: It’s not an easy subject. There are both pros and cons to waterbirth, and it’s important for women to discuss waterbirth with their providers so that they can make an informed decision. At the same time, there are a lot of obstetricians who cannot or will not support waterbirth because of ACOG’s position. So if a woman is really interested in waterbirth, she will need to a) find a supportive care provider, b) find a birth setting that encourages and supports waterbirth.

You can’t really have a waterbirth with an unwilling provider or unwilling facility. Well, let me take that back… you can have an “accidental” waterbirth… but unplanned waterbirths have not been included in the research studies on waterbirth, so the evidence on the safety of waterbirth does not generalize to unplanned waterbirths. Also, you have to ask yourself, is your care provider knowledgeable and capable of facilitating a waterbirth? It might not be safe to try to have an “accidental” waterbirth if your care provider and setting have no idea how to handle one. Do they follow infection control policies? Do they know how to handle a shoulder dystocia in the water?

SM: What kind of response do you think there will be from medical organizations and facilities as well as consumers about your research findings?

RD: I hope that it is positive! I would love to see some media coverage of this issue. I hope that the Evidence Based Birth® article inspires discussion among care providers and women, and among colleagues at medical organizations, about the quality of evidence in guidelines, and their role in providing quality information to help guide informed decision-making.

SM: Based on your research, you conclude that the evidence does not support universal bans on waterbirth. Is there anything you would suggest be done or changed to improve waterbirth outcomes for mothers or babies?

RD: The conclusion that I came to in my article—that waterbirth should not be “banned,” is basically what several other respected organization have already said. The American College of Nurse Midwives, the American Association of Birth Centers, the Royal College of Obstetricians and Gynaecologists, and the Royal College of Midwives have all said basically the same thing.

How can we improve waterbirth outcomes? I think continuing to be involved in clinical research studies (such as the AABC registry) is an important way to advance the science and provide evidence on which we can base practice and make more informed decisions with. Also, conducting clinical audits (tracking outcomes) in facilities that provide waterbirth would be important for quality control.

SM: Let’s look into the future. What is next on your plate to write about?

RD: I recently had a writing retreat with several amazing clinicians and researchers who flew from across the country to conduct literature reviews with me. We made an awesome team!! The topics that we have started looking at are: induction for post-dates, induction for ruptured membranes, and evidence-based care for women of advanced maternal age. I can’t decide which one we will publish first! The Evidence Based Birth readers have requested AMA next, but the induction for ruptured membranes article is probably further along than that one. We shall see!!

SM: Is there anything else you would like to share with Science & Sensibility readers on this topic?

RD: Thanks for being so patient with me! I know a lot of people were eagerly awaiting this article, and I wish it could have come out sooner, but these kinds of reviews take a lot of time. Time is my most precious commodity right now!

Has the recent Opinion Statement released by ACOG/AAP impacted birth options in your communities?  Do you discuss this with your clients, students and patients?  What has been the reaction of the families you work with? Let us know below in the comments section! – SM.

ACOG, American Academy of Pediatrics, Babies, Childbirth Education, Evidence Based Medicine, Home Birth, informed Consent, Maternity Care, New Research, Newborns, Research , , , , , , , ,

Happy 100th Birthday, Elisabeth Bing – Lamaze Co-Founder and Visionary Leader

July 8th, 2014 by avatar

By Dr. Mary Jo Podgurski

“If I have seen further it is by standing on the shoulders of giants.”  Sir Isaac Newton, Letter to Robert Hooke, February 5, 1675

The co-founder of Lamaze International (known first as ASPO/Lamaze), Elisabeth Bing, turns 100 years old today.  Elisabeth was a leader and advocate for mothers, babies and families long before this type of advocacy had a name.  Dr. Mary Jo Podgurski, past president of Lamaze International and long time friend and colleague of Elisabeth’s, shares some thoughts on this forward thinking woman who cared enough to take action, become a leader and then create an organization that has helped millions of families over the years achieve a safe and healthy birth.  We salute you Ms. Bing and thank you deeply! – Sharon Muza, Science & Sensibility Community Manager.

Ms. Bing and babyMs. Bing and babyMs. Bing and babyWhen Elisabeth Bing first encountered childbearing women in the London of her twenties, she was a physical therapist with an assignment that sounds alien in 2014. Postpartum women were confined to bed for 10 days, without the ability to even put their feet on the floor! Physical therapists provided exercise and massage. The creativity, drive and passion Elisabeth demonstrated in the 40s and 50s became the foundation for the Lamaze method of childbirth education that is internationally taught and respected today.

Elisabeth’s memoir, My Life In Birth, details her journey from Nazi Germany to America, and provides insight into her many years of service to pregnant women. Giving birth between the 1930s and 1960s meant a woman had few if any choices about the way her baby was born. Mentally disoriented by “twilight sleep” and strapped down for “delivery” lest the sterile field be disrupted, a childbearing woman then was more a vessel for the baby than an active participant. In time women demanded an active role in the birth of their babies. Elisabeth was on the cutting edge of change. With Marjorie Karmel, author of Thank You, Dr. Lamaze, she was a revolutionary with the vision to see a consumer movement poised to create a very real difference in the way women gave birth. Elisabeth was the catalyst for that movement.

1996

1996

When I first spent a weekend with Elisabeth in her New York apartment, she was entering her eighties but was still teaching childbirth education twice a week. Her studio was perfect. Baby pictures were prominently displayed, childbirth posters lined the walls, and the atmosphere was relaxed, comforting and empowering. When asked, Elisabeth explained that pregnant women’s concerns were unchanged. Yes, she told me, the climate in hospitals had changed. Now Lamaze classes were common but medical interventions like epidurals continued to disrupt normal, natural birth. The obstacles were altered but the need for informed choices was ongoing. Women, Elisabeth said, still needed the truth.

Teaching 1978

Teaching 1978

Elisabeth turns 100 today, July 8, 2014. Consider her amazing reach. I am one small piece of her heritage. I’ve been honored to personally learn from this amazing, dynamic mentor for nearly 25 years. Her book, Six Practical Lessons for an Easier Childbirth, was my bible as I approached my first birth in 1976. That baby, my daughter Amy Podgurski Gough, is also a certified Lamaze childbirth educator. Between the joy of my first birthing experience and the births of Amy’s three babies, I’ve been blessed to teach thousands of women and their partners. Like most childbirth educators, I am deeply in Elisabeth’s debt.

Much has been written about Elisabeth’s contribution to childbirth education. A facet of her personality seldom discussed, however, is her insight surrounding collaboration. Her initial work in co-founding ASPO/Lamaze (now Lamaze International) in 1960 created a not-for-profit organization composed of parents, childbirth educators, health care providers and other health professionals. From the start, she discovered the strength of working with a group of people as opposed to standing alone. During the last keynote presentation Elisabeth presented at a Lamaze International national conference, I listened, mesmerized, as she prophetically discussed the need to talk with “insurance companies” as a way to continue her dream of teaching as many women as possible. Her commitment to excellence, to advocacy, and to childbearing women and their partners remains fierce in spite of the passage of time.

1982 ASPO/Lamaze Conference

1982 ASPO/Lamaze Conference

Elisabeth has been called the “mother of childbirth education” and she deserves that title. Her legacy guides all childbirth educators. When I picture her, I envision a physically tiny women with a spirit so powerful one forgets her stature. I look into her clear, bright eyes and see her pure white hair, pulled back into a pony tail with a blue ribbon. I sit in her kitchen sipping tea and drinking in her intelligence. Her cat purrs at our feet. My daughter Lisa is across the table, equally transfixed. I lean in, anxious to remember every moment of this encounter. She smiles, and her eyes light with purpose. I share my personal plans for starting a teen outreach. Elisabeth listens deeply, then offers advice I still adhere to twenty years later.

Elisabeth is an icon, a woman of vision and our true mother. To me she is a dear, precious friend. On July 8th, I will travel to New York City and enter her kitchen again, cognizant of the immense gift Elisabeth’s life has been to all who care about women, birth, and the future. One cannot measure her full worth; I know her wisdom echoes in the mission of every childbirth educator who follows in her footsteps. Thank you, Elisabeth!

© ospreyobserver.com

© ospreyobserver.com

Science & Sensibility and Lamaze International would like to let Elisabeth Bing know what a great organization she created, and how it has impacted so many.  Please leave some wishes for a happy birthday in our comments section and if you wish, share what Lamaze means to you (as an educator, a birth professional, a mother, a father, or a health care provider).  Lamaze International will make sure that every wish is printed and sent on to Elisabeth for her to enjoy!  That will certainly touch her heart!  Please, leave your wishes, stories and memories below. – SM

About Dr. Mary Jo Podgurski

MARY JO PODGURSKIDr. Mary Jo Podgurski is the Director of The Washington Health System Teen Outreach and President and Founder of the Academy for Adolescent Health, Inc. Her undergraduate education is in nursing and education, her master’s work was in counseling, and her doctorate is in education. She began volunteering with pregnant teens in the 70s and has created numerous youth development and education programs using reality-based, interactive educational techniques that are evidence-based and empower youth.

Dr. Podgurski became interested in child abuse prevention as a way to lower teen pregnancy and authored the book Inside Out: Your Body is Amazing Inside and Out and Belongs Only to You, and runs a body-positive, child-centered, interactive, child abuse prevention program.

Dr. Podgurski has presented over 500 workshops locally, nationally and internationally.  She is proud to be an adjunct faculty member in the Education Department of Washington and Jefferson College where she created and teaches the course: Teaching and Dealing with Sexuality in Schools in 2010.

Dr. Podgurski’s certifications include LCCE and FACCE (Fellow in the College of Childbirth Educators) from Lamaze International as a certification as both a sexuality educator and a sexuality counselor from AASECT (American Association of Sexuality Educators, Counselors and Therapists), certification through Parents as Teachers, and certification as a trainer in the Olweus Bullying Prevention Program. She is a past president of the Lamaze International Board of Directors.

Dr. Podgurski has received numerous awards, including the UPMC Dignity and Respect Champion Award in 2011, the Three Rivers Community Foundation Social Justice Award and the Washington County Children and Youth Champion for Children Award in 2009. She was the 2008 Washington County NAACP Human Rights Award recipient and the 2004 Washington County recipient of the Athena Women of Wisdom Award. She was awarded the 2004 NOAPPP (National Organization on Adolescent Pregnancy, Prevention and Parenting, now Healthy Teen Network) Outstanding Professional Award. In May of 2014 she was inducted into the Washington County Historical Society’s Washington County Hall of Fame for her contributions to the community through education of family planning and adolescent health.

Mary Jo and her partner Richard are the parents of three adult children and are blessed with three grandchildren.

Babies, Childbirth Education, Guest Posts, Lamaze International, Lamaze Method, Lamaze News , , , ,

One of a Kind: An Interview with Dr. Meltzer-Brody about UNC’s Inpatient Mother Baby Psych Unit

June 19th, 2014 by avatar

As Postpartum Support International’s 2014 Annual Conference kicks off this weekend in Chapel Hill, NC, regular contributor Kathy Morelli shares her interview with Dr. Samantha Melzter-Brody as Kathy learns more about the only inpatient psychiatric Mother-Baby Unit in the USA.  Perinatal mood and anxiety disorders affect up to 1 in 7 mothers, and at times, inpatient help is what is needed to properly serve the mother and her family.  This unique five bed unit is offering this inpatient care to help mothers get treatment for their perinatal mental health illnesses.  Learn more about this groundbreaking clinic in Kathy’s interview with Dr, Meltzer-Brody. – Sharon Muza, Community Manager, Science & Sensibility.

© Dr. Meltzer-Brody

© Dr. Meltzer-Brody

Dr. Samantha Meltzer-Brody has developed a substantial career as a psychiatrist in the areas of Reproductive/Maternal Mental Health. She is an Associate Professor and Director of the Perinatal Psychiatry Program at the University of North Carolina, Chapel Hill. It’s a comprehensive clinical and research program that includes a five bed inpatient psychiatric Mother-Baby Unit, the first and only of its kind in the United States. UNC’s unit is based on the standard of care psychiatric Mother-Baby Units in Europe and Australia.

In addition, Dr. Meltzer-Brody is scheduled to be the Keynote Speaker on Saturday, June 21st at the Postpartum Support International (PSI) 2014 Conference hosted at the University of North Carolina at Chapel Hill Center for Women’s Mood Disorders. At PSI, she’s speaking about the psychopharmacological treatment of perinatal mental illness.

As a mental health clinician, I admit it took me a while to feel comfortable with the idea that women who are pregnant or lactating who are in need of psycho-pharmaceuticals can do well on them. Now I know there’s a risk-benefit analysis that women should be empowered to employ. Many women in my practice are extremely opposed to taking any medications suggested for their mental health (even when not pregnant or not lactating), so this is a topic with many facets. Each woman is an individual and each woman should talk to her doctor about what’s best for her situation. I’m attending the PSI conference and looking forward to learning more.

Kathy Morelli: How did you become interested in your particular niche, Reproductive/Maternal Mental Health?

Dr. Samantha Meltzer-Brody: First of all, I want to say that I love being a part of the Reproductive Mental Health field.
There are many different roles in the area of Reproductive and Maternal Mental Health, not just one. There are many different types of people needed to work in this area and fill these many different roles. I love that we all can work together, helping each other.

When I began working at the University of North Carolina (UNC) at Chapel Hill, there was no formal women’s mental health program in place. Our women’s mental health outpatient clinic was created at a grassroots level, beginning in the clinics on Wednesday mornings. I was fortunate as UNC Chapel Hill functions with a wonderful collaborative and interdisciplinary atmosphere, so the psychiatry program and the obstetrics program were able to dovetail nicely. In addition, in 2006, our new chair of the psychiatric department arrived, Dr. David Rubinow, who is an international expert in women’s reproductive mood disorders, thus, the time was ripe to create our interdisciplinary Perinatal Outpatient Clinic.

KM: The Mother-Baby Unit at UNC Chapel Hill is the only Maternal-Baby Psychiatric Unit in the United States. I’d love to know more about how the idea came about to develop the Mother-Baby Unit at Chapel Hill. 

SM-B: At UNC, we found there was a high demand for reproductive psychiatry in our outpatient mental health clinics. We have clinic locations in a variety of settings and we found that there was a certain percentage of patients to whom we couldn’t deliver much needed proper care in the outpatient setting nor on a general inpatient psychiatry unit. The Mother-Baby Unit was developed to serve the needs of women experiencing severe perinatal mental illness in a safe and specialized setting to meet the needs of women at this vulnerable time.

As the collaborative team discovered and documented the needs of our patients, we were able to work together at UNC to engage hospital administration at higher levels. We were very fortunate to have a number of champions for this idea within the healthcare system. Initially, we piloted our inpatient program by designating two beds for perinatal patients on a geropsychiatry unit. We developed specialized programming for the perinatal patients and began to get an enormous number of referrals. Eventually, we were able to document that we needed an expanded and completely separate perinatal psychiatry inpatient unit and were able to obtain the support of hospital administration at UNC to launch a new program. And that’s how we became the only Mother-Baby inpatient unit in the United States.

At UNC, we feel it’s critical to have a unit to meet needs of mothers and babies. We feel you can’t mix all the different types of psychiatric populations together. We were able to remodel existing inpatient unit space to create the new unit on a relatively small budget. It’s extremely difficult for the family when a new mom becomes mentally ill and requires hospitalization. Our Mother-Baby Unit helps families through this difficult time by providing family care. It’s extremely rewarding to provide whole care that positively impacts the entire family. We are a state hospital committed to serving the population of the state. Indeed, there’s a state mandate to care for the people of the state, and we take that very seriously.

Keep in mind that our Mother-Baby Unit is a psychiatric care unit, not a respite or spa facility. To be admitted, the patient must meet the criteria for psychiatric inpatient hospitalization, such as suicidal ideation, a heightened bipolar episode or postpartum psychosis or inability to care for self. Most of our patients have suicidal ideation at the time of admission. The average length of stay (LOS) is seven days. Compare this average LOS in the US to the average LOS in a Mother-Baby Unit in Australia of 21 days. We also have a growing number of referrals for women presenting with postpartum psychosis.

When a mother and her baby comes to stay with us, it’s required that a family member, such as the grandmother or father or other identified care provider accompanies the baby on the unit. This is because the babies don’t stay overnight as the health insurance companies in the United States won’t pay for babies to stay overnight. But we work as best we can with the family, in order to preserve the mother’s sleep time for her mental health and also preserve the healthy attachment with her infant. Sleep is especially important when a person is suffering from a mental illness.

In the units, we have bassinets and breast pumps available for the patients and their babies. The nurses’ interaction with the babies vary based on the needs of the particular mother.

Our treatment plans focus on several psychosocial areas of concern. We focus on maternal mood, impaired mother-baby attachment issues, the relationship with the partner and on improving what the partner and family understands about what has happened. To serve these needs, we run several targeted groups: a maternal mental health group, a mother-infant attachment group and a partner group for fathers. But the treatment is individualized; it’s tailored to meet the needs of the family. Due to the typical short length of stay allowed by insurance companies in psychiatric units in the United States, the emphasis is on teaching self-help skills and tools to the patient and family. Such skills and tools are mindfulness, biofeedback, breathing, trigger identification, and post-discharge planning.

KM: There is so much stigma around the diagnosis of mental illness and perhaps more so around perinatal mental illness. Research shows that individuals suffer from both externalized and internalized stigma around a diagnosis of mental illness, much more so than a physical medical condition. So, there’s already stigma about depression and anxiety….it’s already difficult to come forward and then even more so for women to come forward about how they feel, as new mothers and with a baby. There’s shame associated with not coping and also fear about having the baby taken away.

Do you believe there is unconscious stigma around mental illness? Have you seen this phenomena in your work?

SM-B: Stigma is a huge and well documented issue in perinatal mood disorders. It’s very hard and terrifying for people to admit to having a mental illness, especially during the transition to motherhood. There are so many fears around hurting the baby. It’s documented that actual harm to the baby is quite rare, but when it happens, of course it’s a tragedy and the media sadly sensationalizes the event. Plus there is enormous personal shame. Research and clinical experience indicate this shame around feeling emotionally ill and then being diagnosed with a mental illness is exaggerated during the perinatal period. New mothers can feel so insecure and inadequate in their new roles. The stigma, shame and guilt issues are important and need to be part of the therapeutic sessions.

KM: There is so much contradictory information about how hormones, breastfeeding, formula feeding can affect a woman’s self-esteem and mood. Some studies suggest that breastfeeding is protective of depression, yet clinically, some women feel better when they choose to discontinue breastfeeding.

In layman terms, what are your thoughts about the relationship between breastfeeding and postpartum mood disorders? What are some of your guidelines for clinicians to follow regarding the choice of infant feeding method for a woman and her family?

SM-B: At the UNC Perinatal Psychiatry Program, we love to educate organizations that support new moms that women have psychiatric needs. We enjoy the opportunity to educate and influence breastfeeding groups with information about the unique needs of the perinatal population of women with mood disorders. Our feeling is that setting up breastfeeding as an all-or-nothing construct is a set up for feelings of failure for some new moms and can lead to exacerbation of psychiatric symptoms.
It would be great to see the prescription for sleep as a recognized treatment for new moms. And, for mothers with a perinatal mood disorder, to define successful breastfeeding to include one bottle nightly so that mom can sleep for an adequate block of time. This is important for the mom’s brain health.

We also want to emphasize that mothering is not a competitive sport. Our goal is a healthy mother and a healthy baby. Whether or not a woman breastfeeds shouldn’t be colored by judgment of right versus wrong or success versus failure. We need to keep in mind that the goal is that the baby must be fed, even when the mother is suffering from a severe perinatal mental illness.

One thing we do know is that sleep deprivation exacerbates depression anxiety and mood disorders. So we try to help women who wish to breastfeed increase the odds of successful lactation without significant sleep deprivation. We encourage women and families who wish to breastfeed to continue but also set up some guidelines to help the mothers heal mentally and emotionally. We don’t see breastfeeding as an all or nothing activity. At UNC, we say that there can be a combination of breastfeeding and formula feeding in order to support the needs of both mom and baby. We feel that breastfeeding has many benefits and that it’s not an all or nothing equation. We want to enable women with perinatal mood disorders to continue to breastfeed but also help them succeed at mothering, in a way that’s realistic and healthy for them.

KM: Dr. Meltzer-Brody, thank you so very much for your time! You’ve shared enlightened information and guidelines for perinatal clinicians and expanded the definition of mothering to be more inclusive. I look forward to seeing you at the conference at UNC!

What are the health care providers and clinics doing in your area to support the needs of women suffering from perinatal mental illness?  Do you think that your community would benefit from such an inpatient clinic?  How could this become a reality around the country, so all women are served as they should be, with the professional help and treatment they deserve?- SM

Babies, Depression, Guest Posts, Infant Attachment, Maternal Mental Health, Newborns, Perinatal Mood Disorders, Postpartum Depression , , , , , ,

Every Day Should Be Maternal Mental Health Awareness Day! What Educators Need To Know!

May 27th, 2014 by avatar

Friday_may_campaignMay is Maternal Mental Health Awareness month, when agencies on the local, state and federal level along with private and public organizations promote campaigns designed to increase awareness of perinatal mood disorders.   While it is good to increase awareness of the symptoms, sources of help, treatment options and impact of perinatal mood disorders on parents, families and communities during the month of May, the focus really needs to be 365 days a year!  Over 4 million babies are born every year in the USA.  Pregnancy and birth happen every single day to women and families.  Perinatal mood disorders affect women and their families every single day!

Recently, the tragic death of three young children in Torrence, CA was in the news and the children’s mother was arrested on suspicion of murdering her three daughters.  While many details have yet to be made public, this was a new mother  whose youngest child was just two months old.  This woman may have been experiencing a crisis as a result of a postpartum mood or anxiety disorder (PPMAD).

Take this quick ten question quiz and test your knowledge of perinatal mood disorders.  Then read on to find out more and what you can do to help the families that you work with.

While PPMAD can affect a mother during pregnancy or the first year postpartum, there are some risk factors that may increase the likelihood of a woman experiencing this complication:

The above list is from the resource: Postpartum Progress

There is a wonderful three minute video from the 2020 Mom Project that explains more about why so many women are not receiving the help they need. This video was released by the National Coalition for Maternal Mental Health. We do not have the infrastructure in place that screens every woman or enough skilled providers who can recognize the symptoms and provide or refer to suitable treatment options.

Some typical (but not all inclusive) symptoms of Postpartum Mood and Anxiety Disorders

  • Are you feeling sad or depressed?
  • Do you feel more irritable or angry with those around you?
  • Are you having difficulty bonding with your baby?
  • Do you feel anxious or panicky?
  • Are you having problems with eating or sleeping?
  • Are you having upsetting thoughts that you can’t get out
  • of your mind?
  • Do you feel as if you are “out of control” or “going crazy”?
  • Do you feel like you never should have become a mother?
  • Are you worried that you might hurt your baby or yourself?

Childbirth educators and others who work with women during the childbearing year have a responsibility to discuss, share, educate and provide resources to all the families they work with.  Ignorance is not bliss, and the more we discuss the symptoms, risk factors and resources that are available to help families in need with those we have contact with, the fewer women will suffer in silence and go without the help they need.

Resources for Women and PartnersPostpartum Progress

 Postpartum Psychosis Symptoms (in Plain Mama English)

Postpartum Support International 1-800-944-4PPD

 National Suicide Prevention Lifeline 1-800-273-TALK

Mother to Baby (formerly OTIS)

Medications & More During Pregnancy & Breastfeeding.

(866) 626-6847

Text-4-Baby Health Info Links

How do you talk about perinatal mood and anxiety disorders in your classes?  What activities do you do to convey this information effectively?  Do you bring up this topic again at the childbirth class reunions you attend?  Can you share what works well for you so that we can all learn?  What have your experiences been in helping women and their partners to be knowledgeable and informed? What do you do to be sure that every day is Maternal Mental Health Awareness Day?

 

Babies, Birth Trauma, Breastfeeding, Childbirth Education, Depression, Infant Attachment, Maternal Mental Health, Paternal Postnatal Depression, Perinatal Mood Disorders, Postpartum Depression , , , , , , , , , ,