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Teaching Opportunity for Lamaze Certified Childbirth Educators During World Breastfeeding Week

June 28th, 2012 by avatar

  Lamaze International and Babies R Us are joining together to celebrate World Breastfeeding Week and we need your help.  Would you like to promote breastfeeding and share your wisdom with new parents at Babies R Us stores across the country in conjunction with World Breastfeeding Week?  Are you a Lamaze Certified Childbirth Educator?  Preference will be given to LCCEs for this exciting opportunity.  Educators,  read on and consider participating in this event, sure to be fun and worthwhile for both you and new parents.

World Breastfeeding Week is August 1- 7, 2012.  On Saturday, August 4th, selected Babies R Us stores will host a breastfeeding information session from noon-3 PM. Lamaze Educators will present a 1 hour information session on Nursing Basics for New Moms beginning at 1 PM.  As you are aware, breastfeeding is often the next challenge after childbirth, and this session is a wonderful opportunity to reach new and expectant parents in a casual yet informative gathering, helping moms and babies get their breastfeeding relationship off to a healthy start.

How New Moms Will Benefit

  • Free info session conveniently located in one of many Babies R Us locations
  • Free handouts on breastfeeding resources
  • Access to experienced Lamaze Educators who can answer questions and make referrals
  • Accurate information based on Lamaze International CBE curriculum
Benefits for Participating Lamaze Educators
  • Opportunity for you to meet expectant families in your community
  • Introduce families to all the valuable Lamaze International resources available to them
  • Join other educators and birth professionals around the world in celebrating World Breastfeeding Week
  • Help new mothers get breastfeeding questions answered accurately
  • Share best practices for new nursing moms
  • Earn up to 5 alternate credits for Lamaze contact hours towards your recertification
  • Receive handouts and material that promotes breastfeeding to new moms

If this opportunity sounds exciting and of interest to you, then please contact Stephanie Burt by email (or phone 301-275-6899) to let Lamaze know that you are interested in participating in this nationwide event.  Lamaze International continues to be a leader in the childbirth field by creating ways for new parents to receive information in easy, accessible formats right in their own communities. Don’t miss this chance to connect and help mothers and babies, while celebrating of breastfeeding with others around the world.

Please don’t forget to come back and tell us your experience in this community outreach event, reaching new moms and their babies. What a great way to support new families and share your teaching skills at the same time.

 

 

Babies, Childbirth Education, Continuing Education, Healthy Birth Practices, Healthy Care Practices, Newborns, Parenting an Infant, Uncategorized , , , , , ,

“Don’t Sleep with Big Knives”; Interesting (and Promising) Developments in the Mother-Infant Sleep Debate

      In November 9, 2011, amid much fanfare and media attention, the city of Milwaukee unveiled their latest campaign to promote safe infant sleep.

The City of Milwaukee launches their most-recent infant sleep campaign.

 

The images are disturbing to say the least—they were designed that way. “Co-sleeping deaths are the most preventable form of infant death in this community,” Barrett said.  “Is it shocking? Is it provocative?” asked Baker, the health commissioner. “Yes. But what is even more shocking and provocative is that 30 developed and underdeveloped countries have better (infant death) rates than Milwaukee.”  A campaign such as this has a noble goal: to prevent infants from dying. But does this type of campaign keep infants safe?  The tragic answer is “no.” In less than two months after this campaign was launched, two more infants had died in Milwaukee in what the press described as “cosleeping deaths.” http://www.jsonline.com/news/milwaukee/ad-campaign-unveiled-as-another-cosleeping-death-is-announced-s030073-133552808.html

On January 3, 2012, WITI-TV, the affiliate Fox News in Milwaukee reported this:

One-Month-Old Infant Dies in Co-Sleeping Incident

Medical Examiner’s Report Says Baby Was Sleeping On Floor with Three Other Children

     The second death was of a 10-day-old infant who had died while sleeping with three other children on an adult bed. http://www.fox6now.com/news/witi-20111118-sleep-message,0,4692090.story  Neither of these infant sleep locations was safe and should not be classified as “bedsharing deaths.” The sad take-away we can learn from these cases is that “simple messages,” may be headline-grabbing. But in the end, they do not communicate what parents need to know to keep their infants safe while sleeping.

 In the same month as the Milwaukee campaign was launched, the American Academy of Pediatrics issued their new policy statement and follow-up technical report (American Academy of Pediatrics & Task Force on Sudden Infant Death Syndrome, 2011a, 2011b) on infant sleep-related deaths. In their press release, they stated that they were “expanding [the AAP guidelines] on safe sleep for babies, with additional information for parents on creating a safe environment for their babies to sleep.” http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/3/650

Poster from the Milwaukee campaign designed to warn against the dangers of bedsharing.

When I first read through this statement, it didn’t seem to differ all that much from previous statements, particularly on the issue many of us are interested in—namely, their recommendations regarding bedsharing. That recommendation did not really change. But in reading the full statement, there were some interesting, and dare I say hopeful, developments.

   The AAP Policy Statement (2011a) lists their Levels A, B, and C recommendations. A-Level recommendations are those with the strongest evidence. Number 3 of their Level-A Recommendations is that parents and infants room share, but not bedshare (p. 1031). They based their recommendation on the results of a new meta-analysis of 11 studies comparing 2,404 cases where infants died (28.8% of whom bedshared) with 6,495 healthy controls (13.3% of whom bedshared). They calculated the odds ratio and found that it was 2.89 (95% CI, 1,99-4.18).1  Based on their calculation, bedsharing increased the risk of SIDS by almost three times. But wait…..The authors noted that there was “some heterogeneity in the analysis” (p. 45). The heterogeneity in question referred to the fact that several of the studies included infant deaths that took place on a chair or couch (a situation that greatly increases the risk of infant death), not just those that took place in an adult bed with a non-smoking, non-impaired parent.

     This issue has, of course, dogged the bedsharing debate for more than a decade. The authors themselves acknowledged that this was a difficulty (Vennemann et al., 2012).

Only recent studies have disentangled infants sleeping with adults in a parental bed from infants sleeping with an adult on a sofa. This is certainly a limitation of the individual studies and hence of the meta-analysis (p. 47).

Poster from the Milwaukee campaign designed to warn against the dangers of bedsharing.

 But hopeful sign number 1: the AAP statement specifically differentiates between bedsharing and the broader term, “cosleeping,” which often includes all deaths that take place outside of a crib. I hope that this distinction will trickle down into future research studies.

 And there’s more. Vennemann et al. (2012) noted that bedsharing was much more hazardous with a smoking mother (OR=6.27; 95% CI, 3.94-9.99) than a non-smoking mother (OR=1.66; 95% CI, 0.91-3.01).  So there was still some increased risk if an infant slept with a non-smoking mother. But remember that this analysis included studies where babies died on couches and chairs. The next analysis was by age of infant. For infants <12 weeks, the odds ratio was 10.37 (95% CI, 4.44-24.21). But for older infants, 1.02 (95% CI, 0.49-2.12),  i.e., no increased risk.  Another analysis looked at whether bedsharing was routine. They found that if bedsharing was routine, the odds ratio was 1.42 (95% CI, 0.85-2.38). If bedsharing was not routine, but happened on the last night, the odds ratio was 2.18 (95% CI, 1.45-2.38). The authors noted that the risk was NOT significantly elevated in the routine-bedsharing group (although I note that there does seem to be some elevation in risk, probably due to the studies that included couch sharing).

     The next interesting issue is regarding their recommendations on chair or couch sharing with an infant. This has been a long-standing concern of mine due to the massively increased risk of infant death if parents fall asleep with infants on these surfaces. In fact, I have spoken with quite a few parents who routinely do this because they want to avoid bedsharing. Here’s what AAP says.

Because of the extremely high risk of SIDS and suffocation on couches and armchairs, infants should not be fed on a couch or armchair when there is a high risk that the parent might fall asleep (AAP, 2011a, p. 1033).

Further, they acknowledge—and seem to affirm—feeding babies in bed, but putting them in their own cribs for sleep.

Therefore, if the infant is brought into the bed for feeding, comforting, and bonding, the infant should be returned to the crib when the parent is ready for sleep (AAP, 2011a, p. 1033).  

     Unfortunately, this statement does not acknowledge that it’s quite easy to fall asleep in bed: 70% of mothers in our study who fed their babies in bed said that they fall asleep there (Kendall-Tackett, Cong, & Hale, 2010). And many a new parent would argue that that is precisely the point. There needs to be some recognition of, and planning for, that contingency.  But other than that, I am happy to see this recommendation included.

     The final point that I would like discuss is the role of breastfeeding in SIDS prevention, and how bedsharing has a role in sustaining breastfeeding. For example, Helen Ball (2007) found, in her longitudinal study of 97 initially breastfed infants, that breastfeeding for at least a month was significantly associated with regular bedsharing.

     We, in the breastfeeding world, have been saying this for a very long time (Academy of Breastfeeding Medicine, 2008; McKenna & McDade, 2005; McKenna & Volpe, 2007). But now the SIDS researchers are saying it too. For example, Vennemann et al. (2009) found that breastfeeding reduced the risk of SIDS by 50%. (Yes, this is the same Vennemann whose meta-analysis was cited above.) Regarding breastfeeding, Vennemann et al. (2009) said the following.

We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages (p. e406).

     Peter Blair and colleagues (Blair, Heron, & Fleming, 2010) went further and highlighted the role of bedsharing in maintaining breastfeeding. (Peter Blair is also a co-author on Vennemann et al., 2012.)

Advice on whether bed sharing should be discouraged needs to take into account the important relationship with breastfeeding (p. 1119).

     So I am hopeful that we may be reaching a possible accord on this issue. While the AAP will probably never come straight out and recommend bedsharing, it would be helpful if they acknowledged that it will likely continue, and that our role is to help all parents sleep as safely as possible–either with or near their infants. Such a statement is possible. I’d like to close with the words from the Canadian Paediatric Society (Canadian Paediatric Society & Committee, 2004/2011).

Based on the available scientific evidence, the Canadian Paediatric Society recommends that for the first year of life, the safest place for babies to sleep is in their own crib, and in the parent’s room for the first six month. However, the Canadian Paediatric Society also acknowledges that some parents will, nonetheless, choose to share a bed with their child…..

The recommended practice of independent sleeping will likely continue to be the preferred sleeping arrangement for infants in Canada, but a significant proportion of families will still elect to sleep together…….

The risk of suffocation and entrapment in adult beds or unsafe cribs will need to be addressed for both practices to achieve any reduction in this devastating adverse event (emphasis added).

Do you talk about safe sleep in your classes? How do you address the risks and benefits of bedsharing?  Have new parents come to you after birth expressing concern about where their newborn is sleeping?  Share your experiences with talking to new parents about parenting a sleeping newborn, always a big discussion topic in the first weeks and months. – SM

 _____________________

[1]An odds ratio of 1.0 indicates no increased risk. Above 1.0 means increased risk. The higher the number, the worse the risk.

_____________________

References

Academy of Breastfeeding Medicine. (2008). ABM clinical protocol #6: Guideline on co-sleeping and breastfeeding. Breastfeeding Medicine, 3(1), 38-43.

American Academy of Pediatrics, & Task Force on Sudden Infant Death Syndrome. (2011a). Policy Statement: SIDS and other sleep-related deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), 1030-1039.

American Academy of Pediatrics, & Task Force on Sudden Infant Death Syndrome. (2011b). Technical Report: SIDSand other sleep-related deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), e1-e27.

Ball, H. L. (2007). Bed-sharing practices of initially breastfed infants in the first 6 months of life. Infant & Child Development, 16, 387-401.

Blair, P. S., Heron, J., & Fleming, P. J. (2010). Relationship between bed sharing and breastfeeding: Longitudinal, population-based analysis. Pediatrics, 126(5), e1119-e1126.

Canadian Paediatric Society, & Committee, C. P. (2004/2011). Recommendations for safe sleeping environments for infants and children. Retrieved from http://www.cps.ca/english/statements/cp/cp04-02.htm#Recommendations

Kendall-Tackett, K. A., Cong, Z., & Hale, T. W. (2010). Mother-infant sleep locations and nighttime feeding behavior: U.S. data from the Survey of Mothers’ Sleep and Fatigue. Clinical Lactation, 1(1), 27-30.

McKenna, J. J., & McDade, T. W. (2005). Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing, and breastfeeding. Paediatric Respiratory Reviews, 6, 134-152.

McKenna, J. J., & Volpe, L. E. (2007). Sleeping with baby: An internet-based sampling of parental experiences, choices, perceptions, and interpretations in a Western Industrialized context. Infant & Child Development, 16, 359-386.

Vennemann, M. M., Bajanowski, T., Brinkmann, B., Jorch, G., Yucesan, K., Sauerland, C., . . . the GeSID Study Group. (2009). Does breastfeeding reduce the risk of sudden infant death syndrome. Pediatrics, 123, e406-e410.

Vennemann, M. M., Hense, H.-W., Bajanowski, T., Blair, P. S., Complojer, C., Moon, R. Y., & Kiechl-Kohlendorfer, U. (2012). Bedsharing and the risk of sudden infant death syndrome: Can we resolve the debate? Journal of Pediatrics, 160, 44-48.

 About Kathleen Kendall-Tackett

Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA is a health psychologist, IBCLC, and Fellow of the American Psychological Association. Dr. Kendall-Tackett is Editor-in-Chief of Clinical Lactation, President-elect of the American Psychological Association’s Division of Trauma Psychology, clinical associate professor of pediatrics at Texas Tech University Health Sciences Center, and owner of Praeclarus Press. More information on the mother-infant sleep debate can be found at http://praeclaruspress.com/sense-sensibility.html

Babies, Breastfeeding, Childbirth Education, Guest Posts, Infant Attachment, Newborns, Parenting an Infant , , , , , ,

Delivery By Cesarean Section And Risk Of Obesity In Preschool Age Children; Research Review

June 21st, 2012 by avatar

Today’s guest post is written by Dr. Mark Sloan, pediatrician and author of Birth Day: A Pediatrician Explores the Science, the History and the Wonder of Childbirth.  Dr. Sloan takes a look at the study released in May, 2012 examing the relationship between Cesarean deliveries and obesity in preschoolers. – SM

I don’t recall learning much about childhood obesity in my early-1980s pediatric residency. This was partly due to the fact that obesity wasn’t all that common—only about 7% of kids fell into that category at the time—and partly because the solution seemed obvious, and not quite worthy of medical attention. “Join a baseball team, kid,” my senior resident once told an overweight boy with asthma. “And you,” he said, pointing an accusatory finger at the boy’s mother. “Stop buying cookies, okay?”

Creative Commons photo by LouLou-Nico

One thing I did learn a lot about in residency, though, was cesarean section. The U.S. cesarean rate topped 20% for the first time, up from 6% just a decade earlier.  I spent a steadily increasing amount of time in operating rooms, waiting for an obstetrician to hand me a baby.

We all thought the rise in cesareans was a good thing—think of the lives saved, the brain damage avoided, we told ourselves.  If anyone had suggested cesarean birth might be creating long-term health problems for those “saved” babies, we would have scoffed. And had anyone suggested that it might lead to a lifetime of obesity, we’d have laughed them right out of the hospital.

But here we have it: The cesarean rate is now 50% higher than it was in 1980. (Hamilton BE, Martin JA, & Ventura SJ. 2011)  The rate of childhood obesity has tripled. (Ogden C. & Carroll M., 2010) Is this just a coincidence?

Theories abound as to the cause of the childhood obesity epidemic. It’s all those sodas and sports drinks laden with high fructose corn syrup. Or it’s sugary, fatty, super-sized fast food. Or video games, the loss of Physical Education at school, bad parenting, unsafe neighborhoods, too little sleep, too much schoolwork, or all of the above. Just about any variable you can think of has been scrutinized for obesogenic potential.

And now, thanks to Dr. Susanna Huh and her research team at Harvard University, we can add cesarean section to the list of suspects.

Creative Commons photo

Huh’s team studied 1,255 mother-child pairs recruited between 1999 and 2002 as part of Project Viva, a longitudinal prebirth cohort of mothers and babies in eastern Massachusetts. A trained research assistant conducted in-person visits with the mothers during pregnancy, and with mothers and babies shortly after delivery, and at 6 months and 3 years after birth. At each visit the children’s length, weight and skin-fold thicknesses were assessed.

Their results: Children born by cesarean section were twice as likely to be obese at 3 years of age than those born vaginally. (Huh, SY, Rifas-Shiman, SI, Zera, CA, Edwards, JWR, Oken, E, Weiss, ST, & Gillman, MW, 2012) This relationship held up even after adjusting for factors like the mother’s weight, ethnicity, age, education, and parity, and the baby’s gender, gestational age, and birth weight.

The Huh study wasn’t designed to look at the reasons for the increased risk of obesity associated with cesarean birth, but the Harvard team suggested several possibilities:

  1. The most likely culprit is the known alteration of the gut microbiota—the sum total of all the micro-organisms found in the healthy human bowel—caused by cesarean birth. The microbiota of vaginally-born babies is populated by bacteria acquired from the birth canal and maternal rectum. In cesarean-born babies, who do not traverse the birth canal, the microbiota is dominated by bacteria from the skin and the hospital environment. In general, cesarean-born babies have an abnormal gut microbiota: too many carbohydrate-loving Firmicutes bacteria and too few obesity-preventing Bacteroidetes species, compared with the microbiota found in vaginally-born babies. This same gut microbiota profile is associated with obesity in adults; the link between the two appears to be low-level bowel inflammation triggered by the abnormal microbiota, which alters how food is absorbed  from the gut and processed within the body.
  2. The second possibility is that cesarean birth is just a stand-in for something else that’s happening at the same time. In discussing their findings, Huh and colleagues speculate about antibiotics routinely given to women during the course of a cesarean. Antibiotics given during pregnancy may temporarily alter the newborn gut microbiota, but research results are mixed as to whether this is a significant, lasting effect.
  3.  It’s possible that all of this has nothing to do with the gut microbiota. There are maternal and placental hormones, and immune and inflammatory factors, surging in a mother’s (and baby’s) bloodstream during labor. These, obviously, are missing to some extent if she never completes labor, and are largely absent if a cesarean is performed before labor starts. The lack of a normal maternal stress response to labor could adversely impact the development of the newborn immune system, theoretically leading to the gut inflammation associated with obesity.
  4.  Differences in mode of feeding may be involved as well. The study’s cesarean babies breast-fed for a significantly shorter time than did the vaginally-born babies. Though the authors don’t comment on this, early weaning is also associated with alterations of the infant gut microbiota.

My best guess: the cesarean-obesity link is likely a big mash-up of all of these, plus other factors no one has yet even dreamed of. Further research by Dr. Huh’s team and many others in the coming months and years will hopefully clarify the picture.

In the meantime, the risk of future obesity is one more factor maternity care providers and their pregnant clients should weigh before deciding on how a baby will be born.

Would you be likely to share this connection between mode of delivery and childhood obesity with  your students when teaching about benefits and risks of cesarean section?  Do you think if more families knew about this connection, they might make different choices surrounding the labor and birth of their baby and avoid interventions likely to increase their risk of a cesarean birth.  Is this information just one more thing that blames mothers for things that are out of their control?  Please share your thoughts in our comment section. -SM

References

Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National vital statistics reports; vol 60 no 2. Hyattsville, MD: National Center for Health Statistics. 2011.

 Huh, Susanna Y, Rifas-Shiman, Sheryl L, Zera, Chloe A, Edwards, Janet W Rich, Oken, Emily, Weiss, Scott T, & Gillman, Matthew W. (2012). Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study. Archives of Disease in Childhood. doi: 10.1136/archdischild-2011-301141

Ogden Cynthia, & Carroll Margaret, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Health and Nutrition Examination Surveys (2010). Prevalence of obesity among children and adolescents: United states, trends 1963-1965 through 2007-2008. Retrieved from CDC/National Center for Health Statistics website: http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm

About Mark Sloan

Mark Sloan has been a pediatrician and a Fellow of the American Academy of Pediatrics for more than 25 years. Dr. Sloan graduated from the University of Notre Dame in 1975, received his medical degree from the University of Illinois, Chicago, in 1979, and completed his pediatric training at the University of Michigan. Since 1982 he has practiced with the Permanente Medical Group in Sacramento and Santa Rosa, California, where he was Chief of Pediatrics from 1997 to 2002. He is an Assistant Clinical Professor in the Department of Community and Family Medicine at the University of California, San Francisco. Dr. Sloan’s first book, Birth Day: A Pediatrician Explores the Science, the History and the Wonder of Childbirth was published in 2009 by Ballantine Books. His writing has appeared in the Chicago Tribune, the San Francisco Chronicle, the San Francisco Examiner, and Notre Dame Magazine, among other publications. Dr. Sloan can be reached through his blog.

Babies, Cesarean Birth, Childbirth Education, Guest Posts, New Research, Research , , , , , , , ,

“What To Expect When You’re Expecting” A Lamaze Certified Childbirth Educator Reviews The Film

June 19th, 2012 by avatar

Guest post by Ami Burns, CD(DONA), LCCE, FACCE

 ”What To Expect When You’re Expecting” authored by Heidi Murkoff and contributer Sharon Mazel, is now in its all-new fourth edition, with over 17 million copies in print, and been a perennial favorite on The New York Times’ bestseller list for years.  According to USA Today, WTEWYE has been read by 93 percent of women who read a pregnancy book. In May, “What To Expect When You’re Expecting; The Movie” was released, directed by Kirk Jones, and starring Cameron Diaz, Jennifer Lopez, Elizabeth Banks, Matthew Morrison, and others.  Over the years, the material and presentation style of the book have been questioned as potentially creating more fear and questions then providing reassurance and confidence to pregnant women.  When I heard that the movie had been released, I asked Ami Burns, a Chicago-based birthed professional to see the movie through the eyes of a Lamaze Certified Childbirth Educator.  - SM

SPOILER ALERT: If you plan to see the film “What To Expect When You’re Expecting,” you may want to read the review after you see the film.

What did I expect before buying my ticket to What To Expect When You’re Expecting, the film inspired by Heidi Murkoff’s book? To be honest, not much.  I’m not a fan of the book, and I assumed the movie would be another Hollywood portrayal of birth as an emergency, or featuring bumbling dads who don’t know what to do, along with a mom screaming, telling him what an idiot he is as she purple pushes her baby out. 

I knew I had to leave my judgement at the ticket counter if I was going to review the movie with my “childbirth educator/doula” hat on, not my “Matthew Morrison is hot so it won’t be a total waste of money if the movie stinks” one.

Lamaze International has the Six Healthy Birth Practices that offer evidence and research which provides a solid foundation for promoting safe and normal birth. Would What To Expect touch on even one? I was curious to find out.

Before I get to answer the question of how well WTEWYE does in following the Healthy Birth Practices, it’s worth noting that as far as childbirth education in general, the only mention comes during a short scene at the doctor’s office when the mom and dad to-be played by Cameron Diaz and Matthew Morrison see a flyer about The Bradley Method. Diaz says Morrison needs to learn it, but we never hear anything else about it, or see anyone take a birth class – Bradley, Lamaze or any other – throughout the movie.

So, let’s take a look at each care practice and see how WTEWYE stacks up against each one.

1.    Let Labor Begin On Its Own

I was pleasantly surprised that the women all went into labor naturally – one mom even has a strong contraction on live television. The dad played by Chris Rock talks about walking and having sex to start labor. There’s no mention of induction or augmentation, and one mom’s water breaks as she’s walking around. Nice!

2.    Walk, Move Around and Change Positions Throughout Labor

There are a few scenes that show the moms in hospital beds,  but at least they’re upright. A mom leans on the wall as her husband rubs her back, and the character played by Brooklyn Decker – a young mom of twins who has the perfect pregnancy —  labors on a birth ball at home.

3.   Bring a Loved One, Friend or Doula for Continuous Support

Just like there’s barely a mention about childbirth education, doulas aren’t mentioned either. Labor support isn’t talked about in general, but the fathers are very supportive during the births.

4.    Avoid Interventions That Aren’t Medically Necessary

Again, I am happy to report no talk of induction or planned cesarean section – even for the mom carrying twins. Elizabeth Banks’ character, who comes prepared with a birth plan, eventually chooses an epidural, reaches 10 cm, but the doctor suggests a cesarean section since the baby’s heart rate is low. Her husband holds her hand during the operation.

5.  Avoid Giving Birth On Your Back, and Follow Your Body’s Urges to Push

Here I am on the 5th Healthy Birth Practice and still impressed!  One mom uses a squat bar, another pushes semi sitting, and Decker’s character not only only gives birth to twins vaginally, she literally sneezes one of the babies out.

6.    Keep Your Baby With You – It’s Best for You, Your Baby and Breastfeeding

While the labor and birth experiences were good, the fimmakers could have done a much better job with this one. Banks’ character owns a store, The Breast Choice, even before she conceives, but we don’t see any of the new moms nursing – or even bottle feeding, for that matter. I was disappointed that one of the last scenes in the hospital is of two dads talking as they watch their babies – and many others – in the nursery.

I’m also glad the filmmakers showed some of the realities of pregnancy – mainly Banks’ character, who is expecting the “perfect glow,” but instead has hemmorhoids, sore breasts and incontinence – and isn’t afraid to be honest about it.

So, I didn’t expect much going in, but overall found What To Expect When You’re Expecting a breezy, romantic comedy that didn’t make the childbirth educator in me cringe.

Did you see the movie? What are your thoughts? Would you recommend this movie to your classes? Could you use clips of this movie in your classes as teaching moments?  Have your students and families been to see this and brought up the film  in class?  What has been their opinions?  Let’s share ideas and thoughts on how we as educators can be better prepared to respond to comments and observations by families we work with.

 About Ami Burns

Ami Burns, CD(DONA), LCCE, FACCE, is the founder of Birth Talk. In addition to teaching, she uses her media background to promote healthy birth. Ami produced the Telly Award-winning 50 Years of Childbirth Education for Lamaze International, and writes for numerous websites, including allParenting.

Breastfeeding, Childbirth Education, Evidence Based Medicine, Films about Childbirth, Films about Pregnancy, Guest Posts, Healthy Birth Practices, Healthy Care Practices, Maternity Care, Uncategorized , , , , , ,

Spotlight on Dads: Part Two, Paternal Postnatal Depression

June 14th, 2012 by avatar

Part Two of Kathy Morelli’s interview with William Courtney, PhD, LCSW, about Paternal Postnatal Depression – Consequences and Support.  Part One: Paternal Postnatal Depression – Signs and Causes can be read here.

What are the consequences of men’s postpartum depression? How does it affect the children and the family?

Left untreated, we know that postpartum mood disorders often worsen – and they can ruin a man’s marriage or his career, and can lead to serious financial problems.

Istock/gabyjalbert

Probably the biggest problem with men’s postpartum depression is not the depression itself, but the fact that too many men try to go it alone – and they don’t get treatment. That’s the worse thing they can do. Left untreated, we know that postpartum mood disorders often worsen – and they can ruin a man’s marriage or his career, and can lead to serious financial problems.

Suicide is the most tragic consequence of depression. In the United States, suicide rates are 4 to 12 times higher for men than women. Three U.S. men kill themselves every hour of every day. And men’s depression doesn’t just lead to suicide. Men with depression are twice as likely to die from any cause compared to those men who aren’t depressed. That’s why I call depression “men’s silent killer.”

Research consistently shows that a father’s postpartum depression has a negative and long-term impact on the psychological, social, and behavioral development of his children – especially boys. We see this in children as young as two, all the way through adolescence, and into young adulthood. This remains true, regardless of whether the mother is depressed. If both parents are depressed, the child’s development is even more severely disrupted.

The important thing to remember is that all of the negative consequences of men’s depression are avoidable. With proper treatment and support, men can fully recover from PPND.

What can a woman do to help her partner get help? Can paternal postnatal depression be treated?

The best way to prevent PPND in men, is to address the potential causes mentioned above before they occur.

So, if a man has a history of depression, he should see a mental health professional before his child is born and anticipate the possibility of depression postpartum.

If he and his partner have a difficult relationship or poor communication, they should see a marriage or couples’ counselor before their child is born.

If the father has economic concerns about supporting his family, rather than avoid or put off thinking about this, he should look at his finances and set up a budget ahead of time; this will do a lot to relieve his stress.

Similarly, if he and his partner don’t have a lot of social support, they should try to develop and increase their support network before their baby is born.

Here are some other suggestions:

  •  Attending hospital-sponsored parenting classes, particularly if the father-to-be is anxious about becoming a dad.
  •  Devising strategies for shared childcare responsibilities. The father, for example, may handle a nighttime feeding by using formula or pumped breast milk.
  •  Hiring domestic help if it’s affordable or asking a family member to baby-sit once a week.
  • Understanding that sex lives change with the birth and may not return to normal for a year or more.
  • Joining a support group for new fathers or reading about depression on websites such as SadDaddy.com, which includes a screening test for men.

How do societal beliefs about manhood influence men’s postpartum mood disorders?

Men were taught as boys to never cry – and often punished when they did. So, it’s no surprise that research shows that men are more likely than women to try to hide their depression – which only worsens it. Men are also taught to be tough, self-reliant and never ask for help. This makes it difficult for men to get the support and professional help they need to recover. It also means they have fewer friendships & smaller social networks than women do – which sometimes leaves them without anyone when their partner becomes a full-time mother.

Men with traditional ideas about how men should be are at greater risk of depression – and cope less effectively with it – than less traditional men. What really pains me, is that men often try really hard to adhere to these social conventions about manhood. But the truth is, for a man to admit he’s depressed isn’t unmanly or admitting defeat; it’s admitting there’s hope. And, it’s taking charge of his life.

Do changing social expectations of fathers contribute to men’s postpartum depression?

We’re expecting fathers to be more involved in parenting than ever before, but dads are unprepared. While most dads want to be involved, they don’t really know what that looks like.

The fact is, most men in the United States had dads who were completely uninvolved in parenting. That leaves new dads uncertain about what to do. That uncertainty can quickly lead to anxiety – and we know that anxiety postpartum often leads to depression.

For many men, being a dad means being the provider – the economic provider. And when they can’t do this as well as they think they should, they often feel like they’ve failed. Their self-worth is based on their net-worth. And if they believe they’ve failed as the breadwinner, that can quickly lead to anxiety and depression. A recent and very large study found that U.S. fathers who were unemployed were nearly seven times more likely to be depressed.

How do you prepare your childbirth classes for the possibility that it may be the dad who suffers from a postpartum mood disorder?  Do you have resources available for those men and families that may face this as part of their post-birth reality?  Please share your ideas and thoughts on this topic in our comment section.

About Dr. Courtenay

Dr. Courtenay received his Ph.D. from the University of California at Berkeley and is a Licensed Clinical Social Worker. He has served on the clinical faculty in the Department of Psychiatry at Harvard Medical School and the University of California, San Francisco, Medical School. He is the author of Dying to Be Men (Routledge, 2011). In 2004, he received the “Researcher of The Year” award from the American Psychological Association and the Society for the Psychological Study of Men and Masculinity.

References

Goodman, J. H. (2004). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1), 26-35.

Kim, P. & Swain, J. E. (2007). Sad dads: Paternal postpartum depression. Psychiatry, 4(2), 36-47.

Paulson, J. F. & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. Journal of the American Medical Association, 303(19), 1961-1969.

Paulson, J.F., Dauber, S. & Leiferman, J.A. (2006). Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Pediatrics, 118(2), 659-668.

Paulson, J.F., Keefe, H.A., & Leiferman, J.A. (2009). Early parental depression and child language development. Journal of Child Psychology and Psychiatry. 50(3), 254-262.

Ramchandini, P. G., Stein, A., O’Connor, T. G., Heron, J., Murray, L., & Evans, J. (2008). Depression in men in the postnatal period and later child psychopathology: A population cohort study. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 390-398.

 


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