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Let’s get on this train: Participatory medicine and the future of maternity care

September 30th, 2009 by avatar

I’ve had an interest in internet use among pregnant women for a while. It’s pretty remarkable to think about the access women have to information and collective wisdom and the potential that holds for their empowerment and informed decision making.

ePatient White PaperAlthough I had envisioned some pretty nifty things we could do with the internet to improve maternity care, I had my mind pretty well blown recently when I came across a white paper called e-Patients: How They Can Help Heal Healthcare. The paper, the brainchild of a truly visionary doctor, introduces a new web-powered paradigm of healthcare in which patients are empowered, engaged, equipped, and enabled to improve their own health and the quality and safety of the care they receive. It also provides compelling evidence that this new paradigm is already revolutionizing health care in ways we couldn’t have envisioned just a decade ago.  One of its prominent supporters recently wrote, “If you have not read the e-Patient White Paper, you do not understand the future of medicine.”

(With that said, those too busy to read the whole paper right now can get a glimpse of its significance by reading the authors’ seven preliminary conclusions, as summed up by one of the White Paper’s most outspoken advocates, Dave deBronkart.)

The White Paper contributors and advocates have recently organized as the Society for Participatory Medicine and I just became their first member from the maternity care community. Thus far, the work of the Society and its members has been decidedly disease-focused, but I see enormous potential to revolutionize maternity care by tapping into this rapidly developing field, learning from its leaders and innovators, and incorporating maternity care issues into ongoing work wherever appropriate.  I was recently invited to write a guest post at the Society’s blog about participatory maternity care (and it’s already gotten some serious attention). I hope I made my case that childbearing women have much to gain from – and contribute to – efforts to make healthcare more participatory. Now, I hope I have made my case to maternity care advocates that we need to pay attention to and, well, participate, in the Participatory Medicine movement.

Here are some ways to get involved:

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Hunting Grounds: Where to look for studies

September 23rd, 2009 by avatar

Most research studies are published in professional journals. Some journals are published by a trade group or organization, such as JAMA: The Journal of the American Medical Association, or Lamaze International’s own Journal of Perinatal Education. Some journals are freestanding, independent of any organization. A good example of this is Birth: Issues in Perinatal Care.

Some journals are “peer reviewed”. This process involves both an editor and multiple independent experts reviewing manuscripts for publication and ensuring they meet minimum standards. While not a perfect process by any means, the peer-reviewed journals are generally considered to be higher quality and more reliable sources. This category includes most of the well-known and respected journals. Journals that are not peer reviewed have an editor making all the decisions, and this editor may or may not be impartial.

So how can you, as a childbirth professional, find studies on a topic you are interested in if you don’t have any idea when or in which journal an article may have been published?

There are many indexes out there that can come in handy for just this sort of thing. Let’s look at a few of  the most commonly used ones on the internet.

Google Scholar is a division of Google that you can find in the dropdown menu under “more” at the top of the page. The search will focus on academic articles and abstracts posted on the web.

Google Scholar

EBSCO is a service that provides access to multiple databases on a wide range of topics. EBSCO access often includes CINAHL, a great database for childbirth issues. While the public can’t access EBSCO directly, it is available through a variety of places. For example, I can use my library card to access EBSCO through the Salt Lake County Library System here. Don’t have a SL County library card? Try your local public library, they may offer it online or in person. Did you go to college? Check and see if your college provides online access to alumni. If you are a current college student, your school’s library will likely have access.  Even for those who are not current or former students, most college libraries allow free access if you come into the library. Hospital libraries may also allow some access. Call first to make sure!

PubMed A service of the U.S. National Library of Medicine that includes over 17 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources. Many articles on Pubmed have been assigned a Pubmed ID number, or PMID. If you see a citation that includes a PMID, just go to PubMed and type it in for quick access.

NLM Gateway Has many different indexes all in one place. A little trickier to use but can save time if you are proficient.

If you know where the study was published, you can try going directly to the web site of the journal that published it. Often this is the way to go when you read of a study in the paper or hear about it on TV. They might say “In a recent study published in the New England Journal of Medicine….”, making it very obvious to go and search there.

When you get to the index you want to use, you’ll do a search using the key words you think will best help you locate the articles you want. My next post will cover some tips and techniques for using key words effectively.

Search results usually come up with a list of citations showing the title, authors, date and place where it was published, and sometimes an abstract. The abstract is a short summary of the study that will give you an idea if this article is a good fit or not. If the abstract does not show during the initial search, you can usually view it by clicking on the article title.

Search Results

In this example, you can click on the title of the study to view the abstract. You could also click on the “Related Articles” to view citations of other studies on the same topic. This result also gives a link to where you can find the full text of the study for free. This will not always be the case, as some journals do not share full articles online for free. But some do!

The abstract alone may be all you need to know, or you may want to read the full study. You can find the full study by visiting the journal’s web site (where it still may not be free) or by visiting a library to use the library’s access to view it for free. If you don’t have a university or medical library near you, ask a librarian at the public library if they can obtain a copy for you using interlibrary loan or another service. In my experience, librarians really know the tricks to get articles you might need.

Next time: Using key words effectively!

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Mad Birth: Are Today’s Women Better off than Betty Draper?

September 22nd, 2009 by avatar

I’m a huge Mad Men fan. For readers who aren’t familiar with the show, it depicts the goings on at a New York City advertising company in the 1960s. The show has earned critical acclaim not just for its stellar acting and story telling, but for the show’s authentic depiction of the styles, trends, and attitudes of the era.

Don and Betty Draper, with Baby Gene

Last week, the main character’s wife, Betty Draper, gave birth to her third child. While her husband, Don, sits in the waiting room drinking scotch with another nervous expectant dad, Betty is subjected to 1960′s “standard of care” obstetrics. Left alone in a labor room, she is shaved, given an enema, and then receives the crown jewel of her modern childbirth experience: medications to induce twilight sleep, which also induce a mad stupor and land Betty in restraints because of her erratic, combative behavior. As a midwife and a mother, the most difficult part for me to watch was when Betty awoke from her stupor, swaddled baby in arms, with no memory of the experience. You can watch all of the birth-related clips from the show at Jezebel.

This season, there are several feminist blogs keeping tabs on Mad Men and the various depictions of women’s rights and abuses thereof. It’s not difficult for feminists to recognize that birth in the twilight sleep era was nothing less than violence against women. But I have seen very little chatter on the blogs about the aspects of the childbirth experience that remain paternalistic, misogynistic, and violent half a century later.

Are today’s women better off than Betty Draper? Clearly, most of us are. But I believe we’ve traded a visible, blatant form of labor ward paternalism for a new paternalism and a “standard of care” that presents to women bogus assurances of safety and autonomy.

I was recently asked by Jill at The Unnecesarean to nominate one of my favorite blog posts for “Best of Week” at her blog. I sent her my choice before I had even watched last week’s Mad Men, and the timing is serendipitous. Rather than select one of the many Science & Sensibility posts I am proud of, I decided to nominate the very first blog post I ever wrote. In it, I write about my own births and those of the three generations of women in my family who birthed before me. If anyone wondered how I became so radicalized about childbirth and women’s health, just have a look at my sorry family history. And ask yourself: What will our daughters think of today’s style of “modern” maternity care, once they have the benefit of hindsight?

"Best of" Week

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Lamaze On Call Virtual Conference

September 19th, 2009 by avatar

Lamaze International Annual Conference

Can’t make it to Orlando? This year, Lamaze International is offering an at-home, at-office extension of the 2009 Annual Conference. A live Webcast of 10 conference sessions, 4 plenary and 6 concurrent sessions, the On Call Conference is an inexpensive and convenient way to learn and earn contact hours in an interactive environment. This all-new opportunity allows you to:

  • Listen to and participate in 60- or 90-minute sessions and access PowerPoint presentations—all in real time
  • Be eligible for up to 13 contact hours with no post test required
  • Share the experience with your colleagues and register as a group.

You can register for individual sessions or the entire package. The included sessions are:

PLENARY SESSIONS

Breastfeeding Made Simple
Kathleen Kendall-Tackett, PhD, IBCLC

Branding “Magic”: Can it Give Lamaze a New Image?
Sharon Dalrymple, RN, BN, Med, LCCE, FACCE

Message Therapy Research
Tiffany Fiels, PhD

Birth is Normal… But What is Normal Birth?
Penny Simkin, PT, CD(DONA)

CONCURRENT SESSIONS

Embracing Technology: Sharing the Magic of Normal Birth in an iPod Culture
Lisa Crane, MSN, RN

Cesarean Delivery on Maternal Request: Future Shock or Our Reality?
Barbara Hughes, CNM, MS, MBA, FACNM, LCCE, FACCE

Inspiration for Independent Educators
Ami Burns, CD(DONA), LCCE

Postpartum: The Neglected Phase of Childbearing
Penny Simkin, PT, CD(DONA)

¿Se Habla Español?: Providing Cultural Sensitive Childbirth Education for Latinas
Elena Carrillo, CD(DONA), LCCE, FACCE

Creating and Marketing Your Birth Related Business
Connie Livingston, RN, BS, CPCE, CD(DONA), CHBE,  LCCE, FACCE

Lamaze News

Calling All Bloggers! Announcing the Lamaze Healthy Birth Blog Carnivals

September 16th, 2009 by avatar

Earlier this month, we announced that Lamaze had released the latest revision of our Health Birth Practice Papers. These are evidence-based statements about the care practices that ease and facilitate labor, prevent complications, and protect breastfeeding and early mother-infant attachment. The response from the blogging community has been wonderful – many bloggers have already begun sharing their thoughts about and personal experiences with these practices.

We decided it’s time to bring those great blog posts together in one place, and motivate other bloggers to share their perspectives as well. Over the next couple of months, Science & Sensibility will host a series of Blog Carnivals – one for each of the Six Healthy Birth Practices. We’ll start with the first, of course: Let labor begin on its own. We’re looking for posts from a broad range of bloggers on any aspect of labor onset. Your contribution can be a personal story, an analysis of a research or media item, exploration of a common myth, advice for pregnant women, you name it. I will compile a list of contributions here at Science & Sensibility, with links to the blogs where each is posted.

Participation is easy:

  1. If you are a blogger, write a blog post on the Carnival theme (Let labor begin on its own). Post it on your blog by Sunday, October 4. Make sure the post links back to this blog post, to the Healthy Birth Practice Paper, or to the Mother’s Advocate video, Healthy Birth Your Way: Let Labor Begin on its Own. You may also submit a previously written post, as long as the information is still current.
  2. Send an email with a link to your post to amyromano [at] lamaze dot org.
  3. If you do not have a blog but would like to participate, you may submit a guest post by emailing it to me.
  4. I will compile and post the Blog Carnival here at Science & Sensibility the week of October 5.

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