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Highlights of, and thoughts regarding the AAP’s Policy Statement “Breastfeeding and the Use of Human Milk”.

February 29th, 2012 by avatar

On Monday, February 27, 2012, the American Academy of Pediatrics (AAP) published its revised policy statement, Breastfeeding and the Use of Human Milk.  Since presenting the best, evidence based information to our students, clients and patients is paramount, we suggest you read the publication thoroughly.  In this article I will highlight some of the key things to note.

“The AAP reaffirms its recommendation of exclusive breastfeeding for about 6 months, allowed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.”

This is current to what we’ve been teaching.  However the note at the end about “as mutually desired by the mother and infant” is encouraging with regards to the WHO’s recommendations: “Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.”   So, the AAP doesn’t go as far with regards to extended breastfeeding as does the WHO, but they acknowledge that there are benefits to breastfeeding longer than one year.

Breastfeeding rates over all have increased slightly over the last decade, but we still have a huge disparity with regards to the age of the mother, as well as the racial and socio-economic background of the mother.  Strikingly:

“Furthermore, 24% of maternity services provide supplements of commercial infant formula as a general practice in the first 48 hours after birth. These observations have led to the conclusion that the disparities in breastfeeding rates are also associated with variations in hospital routines, independent of the populations served. As such, it is clear that greater emphasis needs to be placed on improving and standardizing hospital based practices to realize the newer 2020 targets.”

That said, it would appear that we need to encourage our hospitals to become Baby Friendly.  In the policy statement, they give us the statistics on the lack of Baby Friendly compliance in the U.S.  The AAP encourages hospitals to practice the 10 Steps and says “the rate of exclusive breastfeeding during the hospital stay has been confirmed as a critical variable when measuring the quality of care provided by a medical facility.”

The publication addresses a wide range of illnesses ameliorated by breastfeeding.  It is noted whether the percent lower risk was with regards to any breastfeeding, or by number of months of breastfeeding.  Unsurprisingly, a fair number of conditions had reduced risk the longer the mother breastfed.  Please refer back to the policy statement for details.

SIDS: 

“…note that breastfeeding is associated with a 36% reduced risk of SIDS.” 

Pacifier Use: 

“Given the documentation that early use of pacifiers may be associated with less successful breastfeeding, pacifier use in the neonatal period should be limited to specific medical situations. These include uses for pain relief, as a calming agent, or as part of structured program for enhancing oral motor function. Because pacifier use has been associated with a reduction in SIDS incidence, mothers of healthy term infants should be instructed to use pacifiers at infant nap or sleep time after breastfeeding is well established, at approximately 3 to 4 weeks of age.”

Is your baby smarter because you breastfed her? The short answer is yes for infants exclusively breastfed for 3 months or longer as well as for preterm infants, however:

“Consistent differences in neurodevelopmental outcome between breastfed and   commercial infant formula–fed infants have been reported, but the outcomes are confounded by differences in parental education, intelligence, home environment, and socioeconomic status.”

Guidelines for premature infants include:

“The potent benefits of human milk are such that all preterm infants should receive human milk. Mother’s own milk, fresh or frozen, should be the primary diet, and it should be fortified appropriately for the infant born weighing less than 1.5 kg. If mother’s own milk is unavailable despite significant lactation support, pasteurized donor milk should be used.”

Maternal outcomes are also discussed – everything from breastfeeding aiding the involoution of the uterus after birth, to reduced rates of many diseases, including breast cancer and ovarian cancer:

“Cumulative duration of breastfeeding of longer than 12 months is associated with a 28% decrease in breast cancer (OR: 0.72; 95% CI: 0.65–0.8) and ovarian cancer (OR: 0.72; 95% CI: 0.54–0.97). Each year of breastfeeding has been calculated to result in a 4.3% reduction in breast cancer.”

With regards to vitamin and mineral supplements, the AAP recommends the Vit. K shot over the oral version because “the oral dose is variably absorbed and does not provide adequate concentrations or stores for the breastfed infant”.  They do, however, recommend delaying the shot until after the baby’s first breastfeeding.

Vit. D supplements are suggested for all breastfed infants upon release home because:

“Vitamin D deficiency/insufficiency and rickets has increased in all infants as a result of decreased sunlight exposure secondary to changes in lifestyle, dress habits, and use of topical sunscreen preparations.” 

Supplementary fluoride is not recommended under 6 months of age.

There are many other good data points of note in this policy statement, including information on the economic benefits of breastfeeding, contraindications to breastfeeding, charting normal infant growth and specific data points on individual diseases, etc.

I’ll leave you with this concluding statement:

“Pediatricians also should serve as breastfeeding advocates and educators and not solely delegate this role to staff or nonmedical/lay volunteers. Communicating with families that breastfeeding is a medical priority that is enthusiastically recommended by their personal pediatrician will build support for mothers in the early weeks postpartum.”

…..

“Thus, infant feeding should not be considered as a lifestyle choice but rather as a basic health issue.”

How do we as educators and birth professionals address this?  We support evidence-based practices, yet at the same time we say we support a parent’s right to make an informed choice.  How will you incorporate what you’ve read here, and in the AAP’s policy statement, into your classes?

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Inclusive Classes: Maintaining a safe space for the survivors of sexual abuse.

February 27th, 2012 by avatar

Guest post by Ngozi D. Tibbs BS, CD, LCCE, IBCLC

Some days I find it hard to watch the news. We are bombarded by stories of child neglect and abuse. The stories that are particularly disturbing involve sexual abuse.  It causes one to wonder, is sexual abuse occurring more often, or is it the reporting of sexual abuse that has increased? Whatever the reasons, the stories appear to be everywhere.  I, who like you, care about families, am disturbed by the reality that children are not being protected. We have heard recently in the media where coaches, teachers, trusted neighbors and clergy are sexually abusing our children.  Scary movies are about running from the boogeyman. What happens if the boogeyman lives in your house and comes to your room every night? What if he is your father, brother, uncle or babysitter?

Our daughters and sons who survive sexual abuse grow up broken and scarred.  Trust has been stolen and shame is internalized.  Children grow into adults and many adults become parents. How do we help our mothers who come to us for guidance and support as they navigate through the sacred experience of birth?

Penny Simkin writes:

“One in four, one in three, or one in five? Who knows the actual frequency of childhood sexual abuse in our society? All we really know is that it is shockingly common, meaning that many women in midwifery or obstetric practice or in a childbirth education class are burdened with the psychosocial after effects of victimization”.

“Surprisingly, with all the sexual connotations of pregnancy, birth, and breastfeeding, virtually nothing is published in the social science or medical literature on the possible effects of childhood sexual abuse on later childrearing. Even mental health publications have failed to address this grave issue. Eating disorders, chronic pelvic pain, severe premenstrual syndrome, sexual dysfunction, various phobias and other psychosomatic disorders are known to be associated with childhood sexual abuse, but what about disorders in childrearing?” 

(Simkin, 1992, 2006)

Asking a woman directly regarding being a sexual abuse survivor is not the best approach. We must be sensitive to her desire to keep that part of her life hidden; or in some cases, a woman may not even have conscious memory of abuse (Simkin, 1992, 2006). According to Simkin and Klaus, (2004), a few symptoms that are common to survivors (but not necessarily to all) are:

  • Fears of male caregivers (or in some cases female)
  • Vaginal exams as instruments of rape
  • Nakedness or modesty issues
  • Excessive pain and tension
  • Passivity, submission, or the “easy, good patient”
  • Lack of cooperation with staff, pushing positions
  • Dependency on partner, doula, caregiver
  • Fears, repugnance of blood, secretions
  • Fear of the unknown
  • Dissociation

In a childbirth education class, we may notice the woman who is, perhaps, very uncomfortable with lying on a mat on the floor in front of strangers, or having her support person touch her in front of others. When we introduce ourselves at the beginning of class, we should also include that all of the activities are optional and no one should feel obligated to do them if not comfortable.  Comfort techniques can be practiced at home. We should also remind our participants that we are available to discuss things privately if they so choose. We can also provide a box in the front of the room for participants to write down their questions. This can be a wonderful, non-threatening anonymous way for women to share their concerns.  If appropriate, those questions can be brought to the class for further discussion.

We should familiarize ourselves with local resources, which would include support groups, mental health professionals and women’s shelters. We can keep a resource list on a table in the front of class which can include additional resources such as where to purchase baby slings, nursing bras etc… as to not single out the issue of abuse. We may have women in our classes who are not only survivors of childhood sexual abuse but who are currently in an abusive relationship. It is within the scope of the childbirth educator or doula to connect her with community resources.

In our classes, we can find creative ways to address our understanding of this issue by weaving it into our curriculum when we discuss different comfort techniques. We can be careful to use language that is more inclusive and sensitive such as “partner” or “support person” not “coach”.  Phrases such as “listen to your body” or “surrender to your body” can be triggering (Simkin, 1992, 2006).  It is understandable that pain in labor can cause feelings of being out of control or evoke feelings that something is wrong.  Maintaining control and feeling safe are important to all mothers in labor, but especially for the survivor. As Doulas, when we help a mother write her birth plan or birth wishes, we should be mindful of those words or procedures that may involve surrendering control to others. We can help a woman regain some of the sense of control by encouraging her to express her needs in language that feels safe to her.

As I prepare to teach at my local hospital this spring, I have consulted my thesaurus to find different ways to say common words. For example, one survivor shared her discomfort with the word “contraction”. It reminded her of the physical sexual abuse pain she suffered. Often following an assault, she was plagued by a “knot” in her stomach and a strong presence of nausea. Sometimes she would even vomit.  As a result, she had grown up with a “nervous stomach” and suffered abdominal pain for many years. As her Doula, she preferred I use words such as “intensity”, “strength” and “rushes” to describe the feeling of the contraction.

As educators, we should familiarize ourselves with respected books and articles on the subject of abuse. Our mothers are looking to us for guidance and support. We may be the only person in the room who understands her needs.  April is National Sexual Violence Awareness Month. Let’s do our part by becoming advocates for children, mothers and families.

Sources:

  • Simkin, P. (1992, 2006) Birth 19(4). Excerpts adapted from When Survivors Give Birth Workshop February 2012.

Some valuable books on the subject:

  • Simkin, P., Klaus, P. (2004). When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women. Seattle: Classic Day Publishing.
  • Sperlich, M., Seng, J. (2008). Surivior Moms: Women’s Stories of Birthing, Mothering and Healing after Sexual Abuse  Eugene: OR.  Motherbaby Press.

National  Resources:

 Ngozi is a Doula, LCCE, and Lactation Consultant in Pennsylvania.

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2012 Lamaze Innovative Learning Forum Abstract Deadline

February 24th, 2012 by avatar

The abstract submission deadline for the 2012 Lamaze Innovative Learning Forum is March 5. This year, Lamaze is looking for presentations and hands-on sessions that build transferable skills among conference attendees. A select number of proposals are being accepted for this new conference format; please review the submission guidelines prior to submitting your abstract.

Share your expertise with hundreds of like-minded, passionate colleagues – submit your abstract online today!

We look forward to seeing you October 26-28 in Nashville, TN, to experience the new 2012 Lamaze Innovative Learning Forum: “Safe and Healthy Birth: The Music of Our Head, Heart and Hands.”

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Jumping to conclusions: Popular media spins an abstract into headlines.

February 23rd, 2012 by avatar

A new study has been making the rounds of the popular news sites.  The abstract – 65: Neonatal outcomes associated with intended place of birth: birth centers and home birth compared to hospitals  The abstract of the study is published in AJOG It was presented at the Society for Maternal-Fetal Medicine 32nd Annual Meeting.

It is strange that this abstract is getting so much attention. With only an abstract available it is impossible to judge the study’s merits. We look forward to the publication of the study. At this point we have to reserve judgment for later.  We simply don’t have the data available to determine the strength or validity of the study.  That said, it is amazing that the findings presented in the abstract are getting so much attention.

Here are some of the many articles, with varying perspectives, discussing it: 

I found this article to be neutral verging on steering families toward hospital birth:

 “Babies born at home were more than twice as likely to have an Apgar score of under 7 as children born in a hospital or at a birthing center, and also had double the chances of having a seizure….

The overall number of kids who had seizures was low — less than 1 percent at any location.

Prior research has shown that babies with lower Apgar scores are more likely to have complications after birth, such as needing breathing assistance, going to the ICU, having seizures or having developmental issues, Cheng said.”

Study Weighs Pros, Cons of Home or Hospital Birth: More seizures, lower Apgar scores found in home or hospital birth  

 

This article has a positive spin for homebirth:

 “But when a certified midwife was present, it seems babies born at home may fare as well as those born in hospitals, said study researcher Dr. Yvonne Cheng, an obstetrician and gynecologist at the University of California, San Francisco.

“It’s not just about where you deliver, but perhaps who you deliver with,” Cheng said.

Home births are known to be associated with fewer obstetric interventions — that is, women in labor at home receive fewer epidurals and less pain medication.

Women must weigh the benefits of home births against the risks to make an informed decision about where to give birth, Cheng said.”

Midwives make homebirth safer for babies  

 

 This article seems to treat the study in a neutral manner:

 “Women who have home births or plan to deliver at home have lower rates of cesarean delivery; however, their babies are more likely to have neonatal seizures and lower Apgar scores if a certified midwife is not in attendance, according to research presented here at the Society for Maternal-Fetal Medicine 32nd Annual Meeting.”

Home Births Associated With More Seizures, Lower Apgar Scores

 

This one uses bad data to back a claim:

“…recent evidence suggests that while the absolute risk of planned home births is low, such births carry a neonatal death rate at least twice as high as that of planned hospital births. Neonatal death occurred less than once in 1,000 hospital births, compared with two in 1,000 home births, said an American Journal of Obstetrics & Gynecology meta-analysis published in September 2010.”

Home births rise despite higher neonatal mortality rate: Although the vast majority of deliveries occur in hospitals, more women who want a less institutional experience are opting to give birth at home.

This AMA article is citing the Wax et al study.  Science and Sensibility has discussed the vast array of errors and misinformation in the Wax study on four separate occasions:

Others have cited Wax et al, although not explicitly such as this one: Homebirths up Dramatically, but are they safe?

There were numerous letters written to AJOG with regards to the flaws in the study, as well.  So, to have the Wax et al study brought up again is inappropriate and poor science.  It feels to me like a scare tactic or propaganda.

Given that we don’t have all the information, I question the journalistic integrity with which the articles above are written.  It’s always a good headline – about the dangers of home birth.  It’ll get links clicked, newspapers sold and running commentary on social media sites.  However, without proper analysis of the data things are potentially misrepresented.  Once we gain access to the full study, Science and Sensibility will be able to respond appropriately.

Some questions we hope to answer:

  • What data were used? How strong is the data set?
  • Many home births are not reported as such, so data will be lacking.  How is this accounted for?
  • Does the legal status of a homebirth midwife impact outcomes?  Especially because the author states that CNMs have better outcomes than do CPMs or DEMs. We are not aware of research that supports this.
  • Is it considered homebirth if the mother was transferred from home to hospital mid-labor if her intention was to have a home birth?

For more on recent perspectives on homebirth please visit the Homebirth Consensus Summit.

Let’s get the discussion going here.  What are your thoughts on homebirth?

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On Birth and Bleeding – Part 2

February 21st, 2012 by avatar

A Guest post by Lucy Juedes LCCE

Third Stage Components for Discussing with Caregivers

It will be important for the caregiver to share his/her perspectives and usual care of the third stage with expectant parents, as well as what the parent might expect from colleagues and the policies of the birth site.  This helps the mothers/parents to better understand the suggested practices.  Perhaps the caregiver might be strongly leaning towards an active approach to placenta delivery even if the mom wants a more expectant approach.  The mom does not have to agree with the caregiver’s reasoning, but she will understand more as she advocates for what she feels is best for herself and her baby.

So, in an effort to help parents understand the third stage, here are the possible components of third stage management.  Moms and birth partners can use these components to ask about specifics, particularly if the caregiver uses the general terms of “active” or “expectant management” of the third stage of labor.  Here are some specifics to assist in asking your questions.

Oxytocin:  In hospitals in theUS, oxytocin (via IV drip or intramuscular shot) is generally administered after the placenta is expelled.  Ergotamines and prostaglandins are often second- and third-tier uterotonic choices, based on the need and characteristics of the situation.  If a mom is planning a homebirth, ask if the midwife has these medications for emergencies or as back-up.  A uterotonic could also be used proactively to decrease the amount of bleeding, as described earlier in current research.  If the mom does not use a uterotonic, the caregiver and mother will have to be more vigilant so that her uterus does not get soft and she bleeds.

Breastfeeding & skin to-skin contact:  Immediate, baby-led breastfeeding has already been shown to be the best care practice in terms of infant feeding.  The physiological approach allows the mom more undivided attention to get to know her baby and begin observing for feeding cues.  It is also very helpful in terms of placental expulsion and uterine contraction.  If the baby is not breastfeeding, manual or oral nipple stimulation can help bring about oxytocin and contractions, helping to get the uterus back down to size from a more physiological perspective.

Cord clamping:  There is evidence, and the WHO recommends, to wait until the umbilical cord stops pulsing before it is clamped and cut.  This usually means waiting 3 – 5 minutes (WHO recommends 2 – 3 minutes), after which time the partner can tell that the cord has stopped pulsing and slackens.  In these first few minutes, the baby receives the last 20% or more of his or her blood volume, which helps with iron levels.  There might be an increased chance for jaundice later, which can be treated by taking the baby outside in the sun, without sunscreen on, or taking the baby to the hospital for exposure to phototherapy.

Controlled cord traction and counter traction:  When this is done, it must be done carefully, and the caregiver should never pull on the cord without pushing the uterus up with the other hand.  The mom could also bear down during this process, or might practice her focusing and relaxation strategies for these last few contractions.  The caregiver will examine the placenta to make sure all of it and its membrane has been expelled.  This is a more active approach.

Uterine massage:  This is done after the placenta is out.  The caregiver or the mom rubs or kneads the mother’s abdomen until the uterus hardens, then the massage is ended.  This massage is done regardless of approach and is a part of good postpartum care.  The uterus must become and remain smaller and hard so that the blood vessels close to the appropriate degree.  Afterpains are associated with placenta expulsion and uterine shrinking, particularly with experienced mothers.  The mom might prefer to do this massage herself and can ask the caregiver to show her how.

The above information has been combined from a variety of sources:  ACOG, Armbruster, Burke, Gaskin, Goer, ICM/FIGO, Lothan & DeVries, Simkin et al., Walsh, and WHO.

Additional Thoughts – Risk Factors?  Too Much Bleeding? 

Risk Factors

One of the most important things for parents to know is that there are risk factors for a postpartum hemorrhage.  Some of these risk factors are associated with the interventions used and the outcomes of stages one and two of labor.  In class, when we discuss third stage management, we can refer back to interventions that increase the likelihood of postpartum bleeding:  inducing or augmenting contractions with oxytocin, prolonged induction, episiotomy, forceps/vacuum, and cesarean surgery.  (Goer)

Other pregnancy, labor, maternal, or fetal characteristics are associated with increased bleeding as well:  rapid labor, use of magnesium sulfate, previous postpartum hemorrhage, preeclampsia, intra-amniotic infection, overdistended uterus (twins, macrosomia, hydramnios), Asian or Hispanic ethnicity, and chorioamniotis.  (ACOG; Burke)  Many of these risk factors the mother can do nothing to change.  Others, she might have some ability to influence – this knowledge might help her focus even more on strategies to keep labor physiological from the start.

Begley et al. shared something to be noted. “Anecdotally, midwives experienced in expectant management say that only women who have had a normal, physiological labor should have expectant management of the third stage.”  (25)  The natural oxytocin levels of these women will be high throughout, and these high levels would help with uterine contraction in the third stage.  The moms can weigh the risks of any blood loss, possible transfusions, and additional uterotonics.

Conversely, it could be that the most appropriate candidates for active management of the third stage are those who have already experienced active management of the earlier stages of labor.  The Prendiville study was the only study that included both women who seemed to receive a more expectant care in the first two stages of labor and those who received a more active approach.  Some of these actively managed first/second stage mothers were induced with pitocin, had epidurals, had a previous postpartum hemorrhage, etc.  All of these mothers were randomly assigned to active versus expectant care groups for the third stage of labor.  However, after five months the protocol was modified due to higher than expected blood loss by the expectantly managed group.  Some of these women needed at least some active management and were switched to fully active management.  Then, the trial was halted early because of potential harm due to too much blood loss in the expectant arm:  the sample size was meant to be 3,900 and the researchers stopped after 1,695 participants.  In the hospital where women with a variety of risk were served, there was a significant difference of more third stage blood loss in expectantly managed mothers as compared to those actively managed.

Lastly, regarding risk, the above factors are ones that we are aware of.  However, most of the time a postpartum hemorrhage cannot be predicted — some analysts suggest up to 90% of the time.  Hence, public health experts prefer a focus on prevention among a wide range of women.  (POPPHI/USAID)

And for all moms, how much blood is too much blood to lose?

Our body has built up a large store of blood during pregnancy, called by some a vascular reserve.  It is physiologically necessary for us to expel some of it during the time period from right birth into the next few weeks.  If the mother loses around 500 mL, she is likely to feel similarly to how she might feel when giving blood, and will need to sit or lie down, eat, and rest.  If a mother has one or more of the risk factors shared above, though, she might lose closer to between 1,000 – 2,499 mL of blood at birth.  Many experts use a threshold of 1,000 mL for healthy women in affluent societies, noting that they can tolerate blood loss of around 1,000 mL without decompensating.  (Walsh)  Goer shares that, According to William’s Obstetrics, the obstetric bible, healthy postpartum women don’t begin to show actual symptoms of excessive blood loss until they have lost around 1500mL.”

Another factor is that a mother might have other responsibilities in addition to caring for her newborn.  Is this her first child or does she have others at home?  Is she caring for an older adult?  Is she married, engaged, dating, or single?  Will she be going back or seeking paid work and if so, is that sooner or later?  Breastfeeding also requires a lot of physiological resources from the mother.  It is important to help expectant mothers and their birth partners situate their ideal birth into their daily lives.  All of these considerations can help mothers be more prepared both for birth and for life with their newborn.

Active Management and Lamaze’s 6 Healthy Birth Practices

 

Lamaze’s Healthy Birth Practice 4 is “Avoid interventions that are not medically necessary”.  It will be important to know both non-labor risk factors and take into account how the labor and delivery of the baby was managed.  If there was moderate to high intervention in the birth of the baby or if there are other risk factors present, she is more likely to bleed more.  If this is a concern for her, active management techniques are likely to help lessen any bleeding.  If there was no to low intervention in the birth of the baby and there are no other risk factors present, the mom and baby may benefit more from an expectant approach to expelling the placenta.  In all of this the mother is the person to consent to or refuse any interventions.

 

Lamaze’s Healthy Birth Practice 6 is “Keep mother and baby together – It’s best for mother, baby and breastfeeding”.  Here, according to the research, the benefits of the active approach is a decrease in bleeding; with some mothers severe bleeding is prevented.  Less bleeding means more energy that the mom can devote to recuperating and breastfeeding.  And according to one study there was no difference between the two approaches in breastfeeding rates upon leaving the hospital.  The benefits of the expectant approach is less disturbance and distraction of the mother from her baby in that key time right after birth, as well as increased natural oxytocin that helps with bonding.

Three Bigger Picture Thoughts

For mothers planning birth center births or homebirths in the US, in accord with the ICM/FIGO joint statement, they, too, should be offered active management of the third stage of labor.  The key word here is offered.  This is not regimented, but it is also not to be overlooked.  It also means that the homebirth or birth center caregiver should be able to purchase, store, carry, and administer uterotonics as part of their standards of practice.

I began this topic with the stated goal of preventing postpartum hemorrhage.  It seems clear that, from a public health/greater good perspective, data supports the standard offering of active management to prevent excessive bleeding in situations when the mom’s labor has already been managed using an active approach or where there are other known risk factors.  It also is somewhat supportive of the offering of active management of the third stage of labor even when there are no risk factors present.

However, if the overall goal is preventing postpartum hemorrhage, then the leaders who set hospital policies could also reconsider the use of several other practices that are known risk factors of increasing postpartum hemorrhage.  One such practice is induction rather than waiting the 42 weeks.  Recent efforts to limit births to at least the 39 week mark has probably helped.  Another practice is a focus on providing pain medication and continuous monitoring/IVs rather than encouraging doulas or providing continuous staffing who could provide natural comfort help.  Other routine practices at hospitals probably have an effect, such as routine use of continuous electronic monitoring, IV, and withholding of food.

Lastly, I am positive that evidence-based Lamaze Certified Childbirth Educators can be pretty helpful for many expectant moms and birth partners.  We have the time to answer questions, and to answer the questions behind the questions.  We understand the background behind specific practices.  We know the alternatives, and there is always an alternative.  We can help the moms and birth partners figure out what they want and how to make it most likely.  Though Lamaze childbirth classes, they are already getting used to parenthood, and the baby hasn’t even made it topside yet.

References

 

Lucy Juedes is an LCCE and created Birth Prep Basics, serving the needs of growing
families in Southeastern Ohio. She is also the mother of three young children.
Prior to this she worked in public relations and marketing.

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