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Begin Before Birth; Reproductive Researchers Reach Wide Audiences with New Interactive Website

September 28th, 2012 by avatar

By: Walker Karraa, MFA, MA

Today’s post is by regular S&S contributor Walker Karraa who shares a resource that is geared for both providers and expectant families alike, how fetal development is influenced by the environment that babies grow in utero. SM

Researchers from the Institute of Reproductive and Developmental Biology at Imperial College London have produced a multi-disciplinary, multi-media website dedicated to educating women, partners, care providers and students about the impact of environment on fetal development. Professor Vivette Glover, Professor of Perinatal Psychobiology leads the research team who developed this site.

We have known for a long time that how we turn out depends on both our genes and our environment. What we now realize is that the influence of the environment begins in the womb, and how the mother feels during pregnancy can change this environment and can have a lasting effect on the development of her child. 

The site is beautifully designed and one of the best I have seen in terms of content, links, videos and resources. It is extremely easy to use, well-constructed, and visually stimulating. What is extraordinary about this site is the accessibility and scope of the content, the crystal clear presentation of facts, and the reach to care providers and mothers alike—in addition to a comprehensive section dedicated to school curriculum, and students of all ages interested in fetal programming, fetal development, and epigenetics.

The reader is first drawn to the Pregnancy section and its three subpages. The Mother’s Wellbeing discusses importance of nutrition, avoiding alcohol and smoking and highlights the importance of a mother’s psychological and emotional wellbeing during pregnancy. The tone is reassuring for mothers and partners, clearly and succinctly written, with links to an educational video What happens in the womb can last a lifetime, a 2:25 minute video illustrating early fetal development that features Professor Vivette Glover, developer of the site, and one of the pre-eminent scholars in the field of perinatal psychiatry and fetal development. Secondly, the What can help page offers artfully presented and clear information for how a woman may assess her mood and stress during pregnancy, and how to approach discussing symptoms with care providers. Links to resource organizations, and online support groups are provided. Finally, Stress in Pregnancy provides definitions of types of stress and the effects of stress shown in research. Again, the verbiage is easy to read, and poses difficult topics in clear yet assuring language. There is information on how stress is measured, and differences between anxiety and depression are discussed along with a description of the body’s response to stress.

The In the Womb section presents accurate educational materials on the mechanisms of fetal programming, and fetal development including a good description of the work by David Barker the Barker hypothesis, and accessible visual aids. The Baby and Child page explains the effect of stress on the baby and child, including risks of long-term developmental and behavioral problems. Father, family & friends page underscores the importance of partner and family support in mitigating stress for a pregnant woman, as well as the need for employers to consider minimizing stress by making workloads lighter and flexible.

As the reader moves down the site, the material becomes more directed to the care provider and student researcher. The Insights from the Past section reviews historical perspectives of the effects of mothers emotional state on fetal development. The Science component of the site breaks down the scientific and theoretical literature within study of evolution, epigenetics, placenta and fetal brain, and evidence from animal-based research. Citations are given throughout, with links. The Implications section provides still a deeper personal and qualitative understanding of the effects of perinatal stress in Charlie’s Story and accompanying video through which a case study of a 19 year old young man whose mother suffered severe perinatal stress is poignantly captured. Policy tools and examples for preconception and early intervention programs include the Nurse Family Partnership and links to the published papers from the NFP.

Mothers, midwives, health care providers, childbirth educators, policy makers and students would benefit tremendously from the information on this site. I look forward to hearing how you may incorporate the multifaceted site in your practice.

Educators and others, is this topic something that you discuss with the pregnant mothers you come in contact with?  Do teach about this topic to families? Might you incorporate resources from this website in your teaching?  Let us know your thoughts. – SM

Walker Karraa, MFA, MA is a doctoral student at the Institute of Transpersonal Psychology/Sofia University where she is researching transformational dimensions of postpartum depression. Walker holds an MA in Clinical Psychology from Antioch University/Seattle, and both MFA and BA degrees in dance from UCLA. Walker is a contributor for Lamaze International’s Science and Sensibility, Giving Birth With Confidence, and the American College of Nurse Midwives (ACNM) Midwives Connection. She is currently working on co-authoring a book on PTSD following childbirth with Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA, and works as Social Media Manager for Integral Leadership Review. Walker lives in Sherman Oaks, CA with her two children and husband.

 

 

 

Babies, Childbirth Education, Depression, Guest Posts, Healthy Birth Practices, Healthy Care Practices, Infant Attachment, Maternal Mental Health, New Research, Newborns, News about Pregnancy, Parenting an Infant, Perinatal Mood Disorders, Postpartum Depression, Research, Uncategorized , , , , , , , , ,

Sitting on the Shoulders of Giants

September 24th, 2012 by avatar

Today we have a blog post from keynote speaker, Steven B. Frye, Ph.D.. As a reminder, today is the last day to sign up for the early bird registration for the Lamaze Conference 2012. We can’t wait to see you there!

As a full-time university professor, I know all-too-well the struggle to communicate with adult learners on a daily basis.  The act of connecting is so important in helping people create meaning out of the concepts we are attempting to pass along.  As we all remember from school, some seem to have a natural ability to connect with the masses in a near magical way.  Most of us, however, sit in the middle – our practice a mixture of great, okay, and not-so great sessions.  Here is an important concept to remember: we are not born teachers; we become teachers.  In educational psychology we talk about four types of knowledge required for good teaching: content knowledge, knowledge about how to communicate that content knowledge, knowledge about teaching and learning, and knowledge about learners (Eggen and Kauchak, 2010) It takes knowledge in all of these areas to effectively connect with learners in a way that brings about significant and life-altering learning.

This discussion reminds me of an oft-cited quote from Sir Isaac Newton where he said, “If I have seen further it is by standing on the shoulders of Giants.”   There are “giants” that do research applying to all of these learning domains to help us see further in our quest to connect with learners.  Often educators do not take advantage of the work of these giants.  After all, teachers are about “practice”. Theory and research is for those who “talk about practice”.

Here is an interesting fact about Newton’s famous quote: the idea probably didn’t originate from him!   In 1130 Bernard of Charles said, “we are like dwarfs sitting on the shoulders of giants, and so able to see more and see farther than the ancients” (Morrison, 2005, p. 73).  So the great Newton also sat on the shoulders of other giants!  In the Saturday keynote address we will explore the concept of adult learning and conceptual change, applying research and theory to practice.  It is my hope that it will cause us to think more about the giants around us who seek to help us see further than we could on our own.

Sources:

Eggen, P.D., & Kauchak, D.P. (2010). Educational psychology: Windows on classrooms (8th ed.).  New York: Pearson.

Morrison, P. J. (2005).  We are like dwarfs standing [or sitting] on the shoulders of giants.  Ulster Med Journal, 74(2), 73-74.

Lamaze 2012 Annual Conference, Research

“Should We Private Bank Our Baby’s Cord Blood?” Information That Can Help You Answer That Question

September 21st, 2012 by avatar

www.flickr.com/photos/lovemybunnies/4740682244/

I was recently asked my thoughts on private cord blood banking by a couple expecting their first child.  This was something that they were considering and wanted to know what information was out there.  I had read various articles and commentaries on private cord blood banking in recent years, but I viewed this as an opportunity to refresh my knowledge before I provided an answer to them.  I wanted to share this information with Science & Sensibility readers, so that you may use it with your classes, clients and patients as well, if you wish.

Kimmelin Hull wrote a very comprehensive post on Science and Sensibility in April, 2011, discussing “Should we, or should we not retrieve Umbilical Cord blood at all?” along with providing information on delayed cord clamping current research, and referring readers to a fantastic Journal of Perinatal Education article, Umbilical Cord Blood: Information for Childbirth Educators, written by Renece Waller-Wise, MSN, CNS, CLC, CNL, LCCE.  Kimmelin Hull’s post and Renece Waller-Wise’s JPE article were great places for me to start my exploration to be able to answer this couple.

Today’s post is not about the benefits and/or risks of delayed cord clamping.  Information on that topic has been provided previously on this site.  What I was really looking for was more information on the likelihood that private banked cord blood might be used for that child or other relatives in the future.

Research indicates that pregnant women frequently do not have adequate information to make an informed decision about cord blood banking. (Fox, et al, 2007).   Additionally, the information sources for childbirth birth educators are frequently the private blood banks or their designated representatives, adding in the potential for bias. (Cord Blood Registry, 2009; Wolf, 1998, 1999) Interestingly, in the state of Washington, where I live, the state requires practitioners to provide information on cord blood donation and banking. (but not on delayed clamping.)

Revised Code of Washington (RCW) 70.54.220  All persons licensed or certified by the state of Washington to provide prenatal care or to practice medicine shall provide information to all pregnant women in their care regarding:

(1) The use and availability of prenatal tests; and

(2) Using objective and standardized information: (a) The differences between and potential benefits and risks involved in public and private cord blood banking that is sufficient to allow a pregnant woman to make an informed decision before her third trimester of pregnancy on whether to participate in a private or public cord blood banking program; and (b) the opportunity to donate, to a public cord blood bank, blood and tissue extracted from the placenta and umbilical cord following delivery of a newborn child.

Nationwide, 26 states have legislation on providing cord blood information. This legislation is intended to guide health care providers and inform parents about their options concerning donation and banking.  You can access this information on a state by state basis here. In Washington, exactly what information should be provided is not spelled out.

Stem cells are available from a variety of sources, but umbilical cord stem cells are the easiest to collect, collection is painless, and according to studies can be done before or after the placenta is delivered. (Gonzalez-Ryan, VanSyckle, Coyne, & Glover, 2000; Percer, 2009). The stem cells are quickly available to be used. But, according to one study, approximately 50% of all cord blood collection samples contain an insufficient volume of blood.  (Drew, 2005).

Private cord blood banking is often marketed as “biological insurance” for potential problems with that child in the future. “Autologous transplant” is where the cord blood is given back to the child it was taken from.  The chance that a child will need its own cord blood is extremely small; a 1:400 to a 1:200,000 chance over the child’s lifetime (Sullivan, 2008). In the case of some illnesses, it would be unwise to transfer the same cord blood cells as they are considered “contaminated” with the very disease that is hoping to be cured.

There is not a lot of research on the period of time that a collected cord blood sample would be viable after storage, and no research on viability over the course of the average human lifespan.

Private cord blood banking is not without significant expense and cost.  Collection and initial processing can run approximately $3000, and then there is an annual fee that can run several hundred dollars for storage each year after that.

Private cord banking services are not regulated, either on the federal level or by the state, so without oversight, regulations and a quality assurance program managed by a third party, consumers may find themselves dealing with programs that could not be financially viable over the long term or may not be handling or storing stem cell products appropriately.

What do various organizations say about private cord blood banking?

 American Congress of Obstetricians and Gynecologists (ACOG)

ACOG has a statement on Umbilical Cord Blood Banking and in their recommendations and conclusions they state:

  • If a patient requests information on umbilical cord banking, balanced and accurate information regarding the advantages and disadvantages of public versus private umbilical cord blood banking should be provided. The remote chance of an autologous unit being used for a child or a family member (approximately 1 in 2,700 individuals) should be disclosed.
  • Discussion may include information regarding maternal infectious disease and genetic testing, the ultimate outcome of use of poor quality units of umbilical cord blood, and a disclosure that demographic data will be maintained on the patient.
  • Some states have passed legislation requiring physicians to inform their patients about umbilical cord blood banking options. Clinicians should consult their state medical associations for more information regarding state laws.
  • Directed donation of umbilical cord blood should be considered when there is a specific diagnosis of a disease known to be treatable by hematopoietic transplant for an immediate family member.
  • Obstetric providers are not obligated to obtain consent for private umbilical cord blood banking.
  • The collection should not alter routine practice for the timing of umbilical cord clamping.
  • Physicians or other professionals who recruit pregnant women and their families for for-profit umbilical cord blood banking should disclose any financial interests or other potential conflicts of interest.

American Academy of Pediatrics

The American Academy of Pediatrics also has a policy statement out on cord blood banking.  Their recommendations are similiar to ACOG.

  • Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood (ie, premalignant changes in stem cells). Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood. Although not standard of care, directed cord blood banking should be encouraged when there is knowledge of a full sibling in the family with a medical condition (malignant or genetic) that could potentially benefit from cord blood transplantation.
  • Cord blood donation should be encouraged when the cord blood is stored in a bank for public use. Parents should recognize that genetic (eg, chromosomal abnormalities) and infectious disease testing is performed on the cord blood and that if abnormalities are identified, they will be notified. Parents should also be informed that the cord blood banked in a public program may not be accessible for future private use.
  • Because there are no scientific data at the present time to support autologous cord blood banking and given the difficulty of making an accurate estimate of the need for autologous transplantation and the ready availability of allogeneic transplantation, private storage of cord blood as “biological insurance” should be discouraged. Cord blood banks should comply with national accreditation standards developed by the Foundation for the Accreditation of Cellular Therapy (FACT), the US Food and Drug Administration (FDA), the Federal Trade Commission, and similar state agencies.
Online Resources on Cord Blood Banking to Share with FamiliesParents Guide to Cord Blood Foundation

American College of Nurse–Midwives—“Cord Blood Banking—What It’s All About” (from 2008 Journal of Midwifery & Women’s Health53[2], 161–162)

National Marrow Donor Program—“Cord Blood Donation: Frequently Asked Questions”

compiled by Renece Waller-Wise

I will provide this information to the family who asked me.  I will encourage them to talk to their doctor or midwife, and determine if it is appropriate for them to consult with a genetic counselor, to address family history and other information that may make it more likely for this child or another family member to need collected cord blood.

I would also provide information on the timing of umbilical cord clamping and suggest they discuss with knowledgable providers and the potential bank, the likelihood of an adequate collection when cord clamping is delayed.

After receiving this information from a variety of sources, I trust the parents will be able to make a decision that feels appropriate to them and I will feel that I have provided evidenced based sources that they found useful in their decision-making process.

How do you answer the question “Should we private bank our baby’s cord blood?” What do you say?  What have been your favorite resources on this topic?  Please share information that you feel we can all benefit from.  I welcome your discussion.

References

American Academy of Pediatrics:Policy Statement: Cord blood banking for potential future transplantation.  PEDIATRICS Vol. 119 No. 1 January 1, 2007 pp. 165 -170 (doi: 10.1542/peds.2006-2901)

American Congress of Obstetricians and Gynecologists. (2008) Umbilical Cord Blood Banking. ACOG Committee Opinion No. 399. Obstet Gynecol 2008;111:475–7.

Cord Blood Registry. (2009). Cord blood spotlight: Childbirth educator’s guide, 1(2), 1–4.

Drew, D. (2005). Umbilical cord blood banking: A rich source of stem cells for transplant. Advance for Nurse Practitioners, 13(Suppl. 4), S2–S7.

Fox, N. S., Stevens, C., Cuibotariu, R., Rubinstein, P., McCullough, L. B., & Chervenak, F. A. (2007). Umbilical cord blood collection: Do patients really understand? Journal of Perinatal Medicine, 35, 314–321.

Gonzalez-Ryan, L., VanSyckle, K., Coyne, K. D., & Glover, N. (2000). Umbilical cord blood banking: Procedural and ethical concerns for this new birth option. Pediatric Nursing, 26(1), 105–110.

Percer, B. (2009). Umbilical cord blood banking: Helping parents make informed choices. Nursing for Women’s Health, 13(3), 216–223

Sullivan, M. J. (2008). Banking on cord blood stem cells. Nature Reviews Cancer, 8, 554–563

Waller-Wise, Renece. (2011) Umbilical cord blood: information for childbirth educators. Journal of Perinatal Education, 20(1), 54–60, doi: 10.1891/1058-1243.20.1.54

Washington State Legislature, Revised Code of Washington 70.54.220 Practitioners to provide information on prenatal testing and cord blood banking. http://apps.leg.wa.gov/rcw/default.aspx?cite=70.54.220  Accessed September 21, 2012.

Wolf, S. (1998). Cord blood banking: A promising new technology. Neonatal Network, 17(4), 5–6.Wolf, S. (1999). Storing lifeblood: Cord blood stem cell banking. American Journal of Nursing, 99(8), 60–68.

 

Babies, Childbirth Education, Delayed Cord Clamping, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, informed Consent, Journal of Perinatal Education, Newborns, Research, Third Stage, Uncategorized , , , , , , , , , ,

It Takes a Professional Village! A Study Looks At Collaborative Interdisciplinary Maternity Care Programs on Perinatal Outcomes

September 19th, 2012 by avatar

The  Canadian Medical Association Journal, published in their September 12, 2012 issue a very interesting study examining how a team approach to maternity care might improve maternal and neonat aloutcomes.  The study, Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes  is reviewed here.

The Challenge

Photo Source: http://www.flickr.com/photos/jstownsley/28337593/

The number of physicians in Canada who provide obstetric care has declined in past years for reasons that include increasing physician retirement, closure of rural hospitals, liability concerns, dissatisfaction with the lifestyle and a difficulty in accessing maternity care in a variety of settings.  While registered midwife attended births may be on the rise, midwives in Canada attend less than 10% of all births nationwide.   At the same time as the number of doctors willing or able to attend births decline, cesarean rates are on the rise,  causing pressure on the maternity care system, including longer hospital stays both intrapartum and postpartum, which brings with it the associated costs and resources needed to accommodate this increase.

The diversity of the population having babies in many provinces is increasing, presenting additional challenges in meeting the non-French/English speaking population, who are more at risk for increased obstetrical interventions and are less likely to breastfeed.

The Study

In response to these challenges, the South Community Birth Program was established to provide care from a consortium of providers, including family practice physicians, community health nurses, doulas, midwives and others, who would work together to serve the multiethnic, low income communities that may be most at risk for interventions and surgery.

The retrospective cohort study examined outcomes between two matched groups of healthy women receiving maternity care in an ethically diverse region of South Vancouver, BC, Canada that has upwards of 45% immigrant families, 18% of them arriving in Canada in the past 5 years.  One group participated in the South Community Birth Program and the other received standard care in community based practices.

The South Community Birth Program offers maternity care in a team-based shared-care model, with the family practice doctors, midwives, nurses and doulas working together .  Women could be referred to the program by the health care provider or self refer.  After a few initial standard obstetrical appointments with a family practice doctor or midwife occur to determine medical history, physical examination, genetic history, necessary labs and other prenatal testing, the women and their partners are invited to join group prenatal care, based on the Centering Pregnancy Model.  Approximately 20% of the first time mothers choose to remain in the traditional obstetric care model.  10-12  families are grouped by their expected due date, and meet for 10 scheduled sessions, facilitated by either a family physician or midwife and a community nurse.  Each session has a carefully designed curriculum that covers nutrition, exercise, labor, birth and newborn care, among other topics.  Monthly meetings to discuss individual situations and access to comprehensive electronic medical records enhanced the collaboration between the team. Trained doulas, who speak 25 different languages, also meet with the family once prenatally and provide one on one continuous labor support during labor and birth. The admitting midwife or physician remains in the hospital during the patient’s labor and attends the birth.

After a hospital stay of 24-48 hours, the family receives a home visit from a family practice physician or midwife the day after discharge. Clinic breastfeeding and postpartum support is provided by a Master’s level clinical nurse specialist who is also a board certified lactation consultant.  At six weeks, the mother is discharged back to her physician, and a weekly drop in clinic is offered through 6 months postpartum.

The outcomes of the women in the South Community Birth Program were compared to women who received standard care from their midwives or family practice physicians.  Similar cohorts were established of women carrying a single baby of like ages, parity, and geographic region, and all the mothers were considered low risk and of normal body mass index.

The primary outcome measured was the proportion of women who underwent cesarean delivery.  The secondary outcomes measured were obstetrical interventions and maternal outcomes (method of fetal assessment during labor, use of analgesia during labor, augmentation or induction of labor, length of labor, perineal tramau, blood transfusion and length of stay) and neonatal outcomes (stillbirth, death before discharge, Apgar score less than 7, preterm delivery, small or large for gestational age, length of hospital stay, readmission, admission to neonatal intensive care unit for more than 24 hours and method of feeding at discharge).

Results

There was more incidence of diabetes and previous cesareans in the comparison group but the level of alcohol and substance use was the same in both groups.  Midwives delivered 41.9% of the babies in the birth program and 7.4% of babies in the comparison group.

When the rate of cesarean delivery was examined for both nullips and multips, the birth group women were at significantly reduced risk of cesarean delivery and were not at increased risk of assisted vaginal delivery with forceps or vacuum.

Interestingly, the birth program women who received care from an obstetrician were significantly more likely to have a cesarean than those receiving in the standard program who also received care from an obstetrician.  More women in the birth program with a prior cesarean delivery planned a vaginal birth in this pregnancy, though the proportion of successful vaginal births after cesareans dd not differ between the two groups.

The women in the community birth program experienced more intermittent auscultation vs electronic fetal monitoring and were more likely to use nitrous oxide and oxygen alone for pain relief and less likely to use epidural analgesia (Table 3).  Though indications for inductions did not differ, the birth program women were less likely to be induced.  More third degree perineal tears were observed in the birth program group but less episiotomies were performed.  Hospital stays were shorter for both mothers and newborns in the community program.

When you look at the newborns in the birth program, they were at marginally increased risk of being large for gestational age and were readmitted to the hospital in the first 28 days after birth at a higher rate, the majority of readmissions in the community and standard care group were due to jaundice. Exclusive breastfeeding in the birth program group was higher than in the standard group.

Discussion

The mothers and the babies in the community birth program were offered collaborative, multidisciplinary, community based care and this resulted in a lower cesarean rate, shorter hospital stays, experienced less interventions and they left the hospital more likely to be exclusively breastfeeding. Many of the outcomes observed in this study, especially for the families participating in the South Birth Community Program are in line with Lamaze International’s Healthy Birth Practices.  There are many questions that can be raised, and some of them are are discussed by the authors.

Was it the collaborative care from an interdisciplinary team result in better outcomes?  Was there a self-selection by the women themselves for the low intervention route that resulted in the observed differences?  Are the care providers themselves who are more likely to support normal birth self-selecting to work in the community birth program? Did the fact that the geographic area of the study had been underserved by maternity providers before the study play a role in the outcomes? Did the emotional and social support provided by the prenatal and postpartum group meetings facilitate a more informed or engaged group of families?

I also wonder how childbirth educators, added to such a model program, might also offer opportunity to reduce interventions and improve outcomes  Could childbirth educators in your community partner with other maternity care providers to work collaboratively to meet the perinatal needs of expectant families?  Would bringing health care providers interested in supporting physiologic birth in to share their knowledge in YOUR classrooms help to create an environment where families felt supported by an entire skilled team of people helping them to achieve better outcomes.

Would this model be financially and logistically replicable in other underserved communities and help to alleviate some of the concerns of a reduction in obstetrical providers and increased cesareans and interventions without improved maternal and newborn outcomes? And how can you, the childbirth educator, play a role?

References

Azad MB, Korzyrkyj AL. Perinatal programming of asthma: the role of the gut microbiota. Clin Dev Immunol 2012 Nov. 3 [Epub ahead of print].

Canadian Association of Midwives. Annual report 2011. Montréal (QC): The Association; 2011. Available: www .canadianmidwives.org /data/document /agm %202011 %20inal .pdf

Farine D, Gagnon R; Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada. Are we facing a crisis in maternal fetal medicine in Canada? J Obstet Gynaecol Can 2008;30:598-9.

Getahun D, Oyelese Y, Hamisu M, et al. Previous cesarean delivery and risks of placenta previa and placental abruption.Obstet Gynecol 2006;107:771-8.

Giving birth in Canada: the costs. Ottawa (ON): Canadian Institute of Health Information; 2006.

Godwin M, Hodgetts G, Seguin R, et al. The Ontario Family Medicine Residents Cohort Study: factors affecting residents’ decisions to practise obstetrics. CMAJ 2002;166:179-84.

Hannah ME. Planned elective cesarean section: A reasonable choice for some women? CMAJ 2004;170:813-4.

Harris, S., Janssen, P., Saxell, L., Carty, E., MacRae, G., & Petersen, K. (2012). Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes. Canadian Medical Association Journal, doi: DOI:10.1503 /cmaj.111753

Ontario Maternity Care Expert Panel. Maternity care in Ontario 2006: emerging crisis, emerging solutions: Ottawa (ON): Ontario Women’s Health Council, Ministry of Health and LongTerm Care; 2006.

Reid AJ, Carroll JC. Choosing to practise obstetrics. What factors influence family practice residents? Can Fam Physician 1991; 37:1859-67.

Thavagnanam S, Fleming J, Bromley A, et al. A meta-analysis of the association between cesarean section and childhood asthma. Clin Exp Allergy 2008;38:629-33.

 

 

Babies, Breastfeeding, Cesarean Birth, Childbirth Education, Evidence Based Medicine, Fetal Monitoring, Healthy Birth Practices, Healthy Care Practices, Maternity Care, Medical Interventions, Midwifery, New Research, Research, Uncategorized , , , , , , , , , , , , , , ,

Early Bird Prices for 2012 Lamaze Innovative Learning Forum Ends 9/24! Are You Registered?

September 18th, 2012 by avatar

 

The 2012 Lamaze Innovative Learning Forum is scheduled for October 26-28 in Nashville, TN and now is the time to sign up for this exciting learning and networking opportunity. This year’s conference theme is “Safe and Healthy Birth: The Music of Our Head, Heart and Hands” and Lamaze International is offering a new approach, which includes more opportunities for interaction among attendees with lower costs and less time away from work and family. Contact hours good for Lamaze, Nursing, ACNM, IBCLC re-certifications will be awarded for attendance at this continuing education event.

The internationally recognized General Session speakers include Ina May Gaskin, (Birth Works, Why Don’t More People in the U.S. Know it?), Dr. Jack Newman, (The First Hour),  Steven B. Frye, (Adult Learning and Conceptual Change: Putting Theory to Practice), and Abby Epstein, (The Accidental Birth Advocate).

In between general sessions, you will be treated to Interactive Learning Sessions, where the topics of Maternal Safety, Infant Safety and Evidenced Based Teaching and Practice will be highlighted in the categories of Head, Heart and Hands.  Leave these sessions full of ideas to take back with you and implement to make your classes, client relationships and professional knowledge more effective and useful to all.

Morning Learning Sessions, Exercise Sessions, Film and Poster Presentations and a full Exhibit Hall present additional opportunities to learn, shop, connect and participate in all the 2012 Lamaze Innovative Learning Forum has to offer.

The social event of the conference, “Papas and Mamas Sing For Healthy Birth” Benefit Concert is a partnership between Lamaze International and Attachment Parenting International to benefit and celebrate healthy birth scheduled for Saturday evening.  The concert will feature Grammy winner Delbert McClinton and The McCrary Sisters.

You can save $145 dollars on the forum registration fee if you register by Monday, September 24, 2012, when “early bird” registration closes. This represents significant savings and a great value for your continuing education and conference dollars.

Choose to attend the pre-Forum workshops and attend a Lamaze Childbirth Education Seminar facilitated by DUKE AHEC or the Lamaze Evidenced-Based Nursing Care: Labor Support Skills Workshop facilitated by Judith Lothian and take advantage of the bundled registration fee for the specialized workshops and the 2012 Forum, saving yourself $100 in the process.

Stay a few extra days in Nashville and treat yourself to a DONA International Birth Doula Workshop led by Patricia Predmore, DONA International Birth Doula Mentor. Attendance at this workshop and the Forum saves you $50 over purchasing the two registrations separately.

Click here to register for the conference and get “early bird” rates when you register to attend by September 24, 2012.  You can also connect with other Forum attendees to find a roommate or two to share in your hotel costs at the beautiful Sheraton Nashville Downtown Hotel and take advantage of the special Lamaze Forum room rate.  You do not want to miss the childbirth education event of the year.  Sign up now.

 

Babies, Childbirth Education, Conference Schedule, Continuing Education, Evidence Based Medicine, Films about Childbirth, Films about Pregnancy, Healthy Birth Practices, Healthy Care Practices, Lamaze 2012 Annual Conference, Newborns, Push for Your Baby, Uncategorized , , , , , , , , , , , , ,