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Obstetricians Claim Homebirth is Unsafe…Again. Where’s The Evidence?

November 29th, 2012 by avatar

by Wendy Gordon, LM, CPM, MPH, Midwives Alliance Division of Research

Today, midwife and researcher, Wendy Gordon, LM, CPM, MPH, Midwives Alliance Division of Research, takes a look at the recent article in the American Journal of Obstetrics and Gynecology that shared the authors’ view of the appropriate professional response from obstetricians when counseling and discussing home birth with patients.  Was this article based on good science?  Accurate and accepted studies? Did the authors selectively choose their sources and ignore other research that may have supported a different viewpoint?  Wendy shares information and research that invites consideration and discussion of the validity of the authors’ opinion. – Sharon Muza, Community Manager.

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Recently, an article in the American Journal of Obstetrics & Gynecology pled with obstetricians to not support planned home birth in any way, and even suggested that those who do “should be subject to peer review and justifiably incur professional liability and sanction from state medical boards” (1).  In their strongly worded opinion, the authors (the first two of whom are, curiously, members of the journal’s Advisory Board, and four of whom are also board members of the International Society of Fetus as a Patient) make their case that physicians should provide evidence-based information to women that planned home birth is not safe, that reports of patient satisfaction are overrated, that it’s actually not cost-effective, and that a pregnant woman has a moral duty to her fetus to give up her autonomy to her doctor’s judgment on this issue.  Let’s take a look at the basis for these recommendations.

Although there are many high-quality studies of home birth on which Chervenak et al. could have based their opinions, they led with the ACOG statement (2) that rests on the findings of the Wax et al. meta-analysis (3), which relied heavily on a study that included unplanned home births in its findings of neonatal mortality rates (4).  Many strong critiques of the Wax analysis have been published (5-11), including an unbiased look from someone who has no stake in the home birth debate.  The authors cited several more poor-quality studies, as well as 52 citations of commentaries, opinions and anecdotes (some even pulled from the popular media) to build their “evidence” basis. They conveniently ignored the large and growing body of literature that continues to show that planned home birth with qualified and experienced midwives holds no greater risk of perinatal mortality than birth in the hospital, and in fact results in far fewer interventions and lower risk of maternal and perinatal morbidity.

Here are some of the high-quality studies that Chervenak et al. did not cite in developing their opinion of the “professional responsibility response”:

  • two systematic reviews (12-13) and a meta-analysis (14) of home and birth center safety studies that all show that there is no greater perinatal risk for planned, attended home births than for hospital births, and significantly fewer interventions;
  • the only large-scale, high-quality study of Certified Professional Midwives (CPMs) in the U.S. that described intrapartum and neonatal death rates as similar to other studies of low-risk home and hospital births (15);
  •  other high-quality U.S. studies that show no difference in perinatal mortality between planned home and hospital births (16-18);
  • several high-quality Canadian studies confirming no difference in the rates of perinatal death between planned home and hospital birth with much lower rates of both interventions and adverse outcomes (19-21);
  •  a huge Dutch study of over half a million births that shows no difference in perinatal mortality rates or NICU admissions between planned home and hospital births (22);
  • another Dutch study that shows no difference in perinatal mortality and lower risk of interventions and other adverse outcomes, particularly for multips (23);
  • large, high-quality U.K. studies that show no difference in perinatal mortality rates and lower risk of both interventions and adverse outcomes (24-25); and
  • a German study that shows no difference in rates of perinatal mortality and lower risk of interventions and adverse outcomes (26).

The authors then go on to discount the evidence of higher satisfaction among women choosing to deliver at home, as well as the cost-effectiveness of doing so, while presenting absolutely no evidence to the contrary.  The authors reference a study in the Netherlands where the transport rate from home to hospital is over twice that in the U.S. (and where Chervenak et al. took great liberties in interpreting the results on patient satisfaction) and a U.K. study where the costs of home and hospital birth are virtually equivalent.  While consistent, this approach to selectively reviewing the evidence and generalizing the findings to the U.S. maternity care system is disingenuous and deliberately misleading to American obstetricians and their patients.  A Washington State study of Medicaid patients planning a home birth with Licensed Midwives showed a savings of nearly $3 million, including the increased cost of those who transferred care and/or site of delivery (27).  This analysis did not attempt to account for the vast cost reductions of potentially avoided interventions, including cesareans and their complications, which would make the case for the cost-effectiveness of midwifery-led care in Washington State even stronger.  It is puzzling that Chervenak et al. did not cite this study, which is recent, took place in the U.S., was conducted by unbiased health-economics consultants, and directly addresses one of their four concerns.

The authors’ main argument against the proven cost-effectiveness of planned home birth is that “the lifetime costs of supporting the neurologically disabled children who will result from planned home birth” have not been factored in, nor have the supposedly increased rates of death.  If one accepts the conclusions of the enormous body of literature that finds no difference in perinatal mortality rates or other adverse outcomes between planned, midwife-attended home births and hospital births, then the pursuit of this line of reasoning is a non-starter.

The U.S. continues to lag behind many other high- and low-resource countries in accepting the evidence of the vast benefits of midwifery care.  The U.K.’s National Health Service has encouraged women to plan home births with midwives for several years; the Netherlands has always acknowledged midwives as the primary care provider in the childbearing year; New Zealand’s system similarly places midwives at the forefront of maternity and newborn care; Japan has a long tradition of midwifery-led care.  Most recently, British Columbia Health Minister MacDiarmid, accepting the evidence of safety, patient satisfaction and cost-effectiveness, has announced government support for women with low-risk pregnancies to plan a home birth, including support for physicians to become appropriately trained to attend home births (28).  But the medical associations of the U.S. continue to erect barriers to the type of interprofessional collaboration that has resulted in the excellent outcomes of these other countries.  The Chervenak et al. article is clearly intended to be yet another of those barriers.

In the centerpiece of the AJOG article, Chervenak cites himself an astounding 15 times in justifying why the rights of a pregnant woman to make autonomous decisions for herself and her baby should be relegated to her doctor’s judgment of what’s right for the “fetus as a patient,” grounded firmly, of course, in the aforementioned “evidence.”  In an astonishing disregard for shared decision-making and informed choice, Chervenak et al. state that “in a professional relationship, the physician’s integrity justifiably limits the woman’s rights by limiting the scope of clinically reasonable alternatives.”  The authors’ repeated and unusual use of the word “recrudescence” when referring to home birth, which reveals their perception of the choice as a disease or disorder, and their stubborn contempt for high-quality evidence if it disproves their opinion, exposes their intent and certainly calls into question their “integrity.”

“Professional responsibility” demands that we dare to examine the evidence that does not agree with our personal beliefs.  It requires that we allow the volumes of high-quality evidence to seep into our analysis of reality and into our presentation of true informed choice to our patients.  “Professional responsibility” demands that we examine and disclose our own personal, religious or anecdotal beliefs that may bias our interpretation and presentation of the research.  And it requires that we refuse to cloak those personal beliefs as “evidence” and “integrity” and by so doing avoid an abuse of power in relationship with our patients.

References

1. Chervenak F. A., McCullough L. B., Brent R. L., Levene M. I., & Arabin B. (2012) Planned home birth: the professional responsibility response. Am J Obstet Gynecol, Nov 13. doi:10.1016/j.ajog.2012.10.002. [Epub ahead of print].

2. American College of Obstetricians and Gynecologists. (2011). Committee Opinion no. 476. Committee on Obstetric Practice. Planned home birth. Obstet Gynecol, 117(2, part 1), 425-8.

3. Wax J. R., Lucas F. L., Lamont M., Pinette M. G., Cartin A., & Blackstone J. (2010).  Maternal and newborn outcomes in planned home birth vs. planned hospital births: a metaanalysis. Am J Obstet Gynecol, 203(3):243.e1–243.e8. doi:10.1016/j.ajog.2010.05.028

4. Pang J. W., Heffelfinger J. D., Huang G. J., Benedetti T. J., & Weiss N. S. (2002). Outcomes of planned home births in Washington state: 1989-1996. Obstet Gynecol, 100(2):253-9. http://dx.doi.org/10.1016/S0029-7844(02)02074-4

5. Carl M. A., Janssen P. A., Vedam S., Hutton E. K., & de Jonge A. (2011). Planned home vs hospital birth: A meta-analysis gone wrong. Medscape Ob/Gyn & Wom Health. Retrieved from http://www2.cfpc.ca/local/user/files/%7B1E683014-14EB-489F-99CE-B5A2185A6FC5%7D/Medscape%20%20Wax%20Critique%20-%20Michal,%20Janssen,%20Vedam,%20Hutton,%20de%20Jonge.pdf

6. Gyte G., Newburn M., & Macfarlane A. (2010). Critique of a meta-analysis by Wax and colleagues which has claimed that there is a three-times greater risk of neonatal death among babies without congenital anomalies planned to be born at home. National Childbirth Trust. Retrieved from http://www.scribd.com/doc/34065092/Critique-of-a-metaanalysis-by-Wax

7. Keirse M. J. (2010). Home birth: Gone away, gone astray, and here to stay. Birth, 37(4):341-46.

8. Hayden E. C. (2011). Home birth study investigated. Nature [Epub]. doi:10.1038/news.2011.162.

9. American College of Nurse Midwives. (2010). ACNM expresses concerns regarding recent AJOG publication on home birth. [Epub]. Retrieved from http://www.midwife.org/documents/ACNMstatementonAJOG2010.pdf.

10. Romano A. (2010). Meta-analysis: the wrong tool (wielded improperly). Retrieved from http://www.scienceandsensibility.org/?p=1349.

11. Dekker R. & Lee K. S. (2012). The Wax home birth meta-analysis: an outsider’s critique. Retrieved from http://www.scienceandsensibility.org/?p=5628.

12. Olsen O. & Clausen J. A. (2012). Planned hospital birth versus planned home birth. Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD000352. doi: 10.1002/14651858.CD000352.pub2.

13. Leslie M. S. & Romano A. (2007). Appendix: Birth can safely take place at home and in birthing centers. J Perinat Educ, 16(Suppl 1):81S-88S. doi:10.1624/105812407X173236

14. Olsen O. (1997). Meta-analysis of the safety of home birth. Birth, 24(1):4-13; discussion 14-6.

15. Johnson K. C. & Daviss B-A. (2005). Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ, 330:1416. doi: http://dx.doi.org/10.1136/bmj.330.7505.1416

16. Cawthon L. (1996). Planned home births: outcomes among Medicaid women in Washington State. Olympia,WA: Washington Department of Social and Health Services. Retrieved from http://www.dshs.wa.gov/pdf/ms/rda/research/7/93.pdf.

17. Murphy P. A. & Fullerton J. (1998). Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol, 92(3):461-70.

18. Anderson R. E. & Murphy P.A. (1995). Outcomes of 11,788 planned home births attended by certified nurse-midwives: A retrospective descriptive study. J Nurse Midwifery, 40(6):483-92.

19. Janssen P. A., Saxell L., Page L. A., Klein M. C., Liston R. M. & Lee S.K. (2009). Outcomes of planned home births with registered midwife versus planned hospital birth with midwife or physician. CMAJ, 181(6):377-83.

20. Hutton E. K., Reitsma A.H. & Kaufman K. (2009). Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: A retrospective cohort study. Birth, 36(3):180-89.

21. Janssen P. A., Lee S. K., Ryan E. M., Etches D. J., Farquharson D. F., Peacock D. & Klein M. C. (2002). Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ, 166(3):315-23.

22. de Jonge A., van der Goes B. Y., Ravelli A. C., Amelink-Verburg M. P., Mol B. W., Nijhuis J. G., Bennebroek Gravenhorst J. & Buitendijk S. E. (2009). Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG, 116(9):1177-84. DOI: 10.1111/j.1471-0528.2009.02175.x.

23. Wiegers T. A., Keirse M. J., van der Zee J. & Berghs G. A. (1996). Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands. BMJ, 313(7068):1309-13

24. Chamberlain G., Wraight A. & Crowley P. (eds.). (1997). Home births – The report of the 1994 confidential enquiry by the National Birthday Trust Fund. Cranforth, UK: Parthenon Publishing.

25. Northern Region Perinatal Mortality Survey Coordinating Group. (1996). Collaborative survey of perinatal loss in planned and unplanned home births. BMJ, 313(7068):1306-09. doi: http://dx.doi.org/10.1136/bmj.313.7068.1306.

26. Ackermann-Liebrich U., Voegeli T., Gunter-Witt K., Kunz I., Zullig M., Schindler C., Maurer M. & Zurich Study Team. (1996). Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. BMJ, 313(7068):1313-18. doi: http://dx.doi.org/10.1136/bmj.313.7068.1313.

27. Health Management Associates. (2007). Midwifery licensure and discipline program in Washington State: economic costs and benefits. Retrieved from http://www.washingtonmidwives.org/documents/Midwifery_Cost_Study_10-31-07.pdf.

28. Dedyna K. (2012, Nov 3). B.C. minister among first to support home births. Times Colonist. Retrieved from http://www.canada.com/minister+among+first+support+home+births/7494815/story.html.

About Wendy Gordon

Wendy Gordon, LM, CPM, MPH is a midwife, mother and educator in the Seattle area.  She helped to build a busy, blended homebirth practice of nurse-midwives and direct-entry midwives in Portland, Oregon for eight years before recently transitioning to Seattle.  She is a Coordinating Council member of the Midwives Alliance Division of Research, a board member of the Association of Midwifery Educators, and teaches at the Bastyr University Department of Midwifery.

 

Evidence Based Medicine, Guest Posts, Home Birth, informed Consent, Maternal Mortality, Maternal Mortality Rate, Maternity Care, Medical Interventions, Midwifery, New Research, Research , , , , , , , , , , ,

The Quiet Underground is Quiet No More. Extended Breastfeeding is Officially Out of the Closet.

November 27th, 2012 by avatar

My first reaction to the now-infamous Time magazine cover was to groan out loud. Like many of you, I was horrified by that cover’s mean-spirited tone. If we didn’t get the message from the picture, there was also the antagonistic caption: “Are you mom enough?” It wasn’t until later that I recognized that this cover, and the controversy that followed, actually reflected a positive shift. Many things had changed since I first became aware of this topic more than 20 years ago.

In 1992, I was just finishing my post-doctoral fellowship at the University of New Hampshire and was expecting my second baby.  My first experience had gone not particularly well, so I spent months educating myself about birth, breastfeeding, and postpartum. During this time, I became friends with Dr. Muriel Sugarman. We were both on the board of a local child abuse organization in Massachusetts. Muriel was a child psychiatrist at Harvard’s Massachusetts General Hospital and an amazing ally to the breastfeeding community. She was interested in long-term breastfeeding and had collected some data. (“Long-term” was operationally defined for that study as “six months or longer.”)  We started working on it together, and bit by bit, had some findings to report.

We submitted one of our first articles on weaning ages to [a well-known journal in pediatrics].  Consistent with studies in other parts of the world, when weaning was child led, it tended to occur at ages 2.5 to 3. So far, so good.

But then there were our outliers….the babies who weaned at age 5…and a couple of babies were even older. The reviewers, all women we later learned, went completely nuts. If it had been up to them, we would have been both rejected…and flogged. (Eighteen years later, these are still the worst reviews I’ve ever received.) They hated us, our study, and mostly definitely our “weird” mothers.

I wasn’t sure what to do next, until a colleague handed me an article called, “Darwin takes on mainstream medicine.” It described how extended breastfeeding, babywearing, and cosleeping  conferred a survival advantage for moms and babies, and was presented at the American Association for the Advancement of Science meetings. That was radical stuff in the mid-1990s. I sacked our introduction and rewrote it using this framework.

The next question was where to send the revised manuscript. I called a pediatric researcher I knew in Philadelphia. He said, “Oh, I never send articles to [well-known pediatric journal]. They’re mean!” That had certainly been my experience. He recommended Clinical Pediatrics, where we got a much more positive reception. The article came out. We were happy. End of story….or so we thought.

In 1997, AAP Statement on Breastfeeding was released. Controversy swirled around that statement for months about one bit in particular: that women breastfeed for at least 12 months and “as long thereafter as is mutually desired.” I was going about my business, blithely unaware that Muriel and I were smack in the middle of the controversy. What reference did the AAP cite to support “as long thereafter as is mutually desired”? You’ve got it: Sugarman and Kendall-Tackett (1995)!

That paper taught me a lot. Ten years later, when I applied for APA Fellow, I identified it as one of the most important in my career. I learned firsthand about the intense negative stigma surrounding extended breastfeeding. I was equally amazed to discover a quiet underground of women who were defying cultural norms and nursing their older babies right under the radar of family, friends, and healthcare providers. Avery described this phenomenon as “closet nursing,” and noted that extended breastfeeding had a lot in common with revealing sexual orientation. Brave souls who chose to be up front faced marginalization—or worse.

Through much of the decade that followed publication of our article, Muriel and I, along with Liz Baldwin and Kathy Dettwyler, frequently had to write letters to courts and child protection agencies on behalf of mothers who were being investigated for child abuse. Their crime? Extended breastfeeding.

Which brings us up to the present time. Yes, the Time magazine article said mean things. But look at it this way: extended breastfeeding is being discussed in a mainstream publication. In addition, thanks to social media, the “quiet underground” is quiet no more. I’ve been amazed at outpouring of support from both celebrities—and ordinary moms—speaking opening and positively about extended breastfeeding. It was something I couldn’t even imagine in 1995. I think it’s safe to say that extended breastfeeding is officially out of the closet.

In closing, I’d like to suggest that we all owe a debt of gratitude to Drs. Ruth Lawrence and Larry Gartner, and the other brave members of the 1997 AAP Committee on Breastfeeding. Their statement did much to move extended breastfeeding out of the margins and into the public square (and Muriel and I were happy to have a small part in that). We still have a ways to go. But let’s take a moment and savor this small victory.

And to the members of the 1997 AAP Committee, I say this: We, the quiet underground, salute you!

The two articles published from that data set are:

Kendall-Tackett, K.A., & Sugarman, M. (1995). The social consequences of long-term breastfeeding.  Journal of Human Lactation, 11, 179-183.

Sugarman, M., & Kendall-Tackett, K.A. (1995). Weaning ages in a sample of American women who practice extended nursing. Clinical Pediatrics, 34(12), 642-647.

 About Kathleen Kendall-Tackett

Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA is a health psychologist and board-certified lactation consultant. Dr. Kendall-Tackett is Owner and Editor-in-Chief of Praeclarus Press, a new small press specializing in women’s health. She is a research associate at the Crimes against Children Research Center at the University of New Hampshire and a clinical associate professor of pediatrics at Texas Tech University School of Medicine in Amarillo, Texas. She is Editor-in-Chief of the journal, Clinical Lactation, a Fellow of the American Psychological Association, and is president-elect of the APA Division of Trauma Psychology. www.KathleenKendall-Tackett.com

 

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Lamaze International Webinar: “Arming Women with the Tools to Push for the Safest, Healthiest Birth Possible.”

November 20th, 2012 by avatar

An invitation from Linda Harmon, Lamaze International’s Executive Director.  Please consider joining this interactive webinar and learn how you can help women “Push for Their Baby!” I know I am going to be online and participating!  Won’t you join me! – SM

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You play an important role in helping pregnant women achieve the safest, healthiest birth possible. Throughout pregnancy and birth, women need strong partners so they can get the maternity care that meets their unique needs.

Lamaze’s Push for Your Baby effort is aimed at helping women work in partnership with their care providers to achieve the best outcomes. And, we know there’s much work to be done. Certain birth practices, such as the overuse of cesarean surgery, early induction and confinement to bed can make it harder for women to have a safe and healthy birth.

As part of our initiative, we’re pleased to invite you to join an upcoming educational webinar for nurses and childbirth educators, which will offer one nursing contact hour and one Lamaze contact hour (with the purchase of a post-webinar quiz).

 

 

Push for Your Baby Nurse & Educator Webinar
Arming Women with the Tools to Push for the Safest, Healthiest Birth Possible
Friday, November 30, 2012
1:00 – 2:00 p.m. ET

During this webinar, we’ll discuss evidence-based research in maternity care, and introduce the latest tools to help nurses and educators support moms-to-be in navigating maternity care decisions. We’re excited to take this opportunity to support your important role in helping women recognize the challenges in maternity care and encourage them to speak up and push for better care for themselves and their babies.

Featured speakers include:  

  • Tara Owens Shuler, M.Ed., CD (DONA), LCCE, FACCE, Lamaze President and Director of Continuing Education, Special Projects, & Lamaze Childbirth Educator Program, Duke AHEC Program
  • Amy Romano, CNM, MSN, Co-Author, Optimal Care in Childbirth: The Case for a Physiologic Approach
  • Jessica Deeb, RN, LCCE, and new mom

At the conclusion of the presentation, we will open up for a discussion and brainstorming session where we encourage you to share the real challenges you face in helping women get the best maternity care. Our mutual work is important to the health of women and babies, and we look forward to engaging with you on this initiative.

We hope you will join us for this exciting event! Register online to attend.

Best,

Linda Harmon
Executive Director/CEO
Lamaze International

P.S. Stay tuned for additional webinars in 2013 on hot topics and controversies in maternity care.

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Free Webinar: Strong Start For Mothers & Newborns – Reducing Early Elective Deliveries

November 19th, 2012 by avatar

Science & Sensibility would like to let readers know of another free webinar opportunity that is coming up at the end of the month.  The Medicaid and Medicare Services (CMS) Innovation Center is offering an hour webinar titled “Strong Start For Mothers & Newborns – Reducing Early Elective Deliveries” for interested professionals who work with expectant mothers.

Strong Start for Mothers and Newborns is an initiative to reduce early elective deliveries prior to 39 weeks and to offer enhanced prenatal care to decrease preterm births.

flickr.com/photos/crincon/957539112/

Leaders in the field of reducing premature births will present information on the importance of reducing early elective deliveries.  They will also discuss how the health of both newborns and mothers can be improved by a reduction in early elective deliveries and share best practices that work toward this goal.  The speakers include representatives from American Congress of Obstetricians and Gynecologists (ACOG), March of Dimes, Health Care Providers and Insurers/Payers.  Success stories will be shared so that programs across the country can work toward reducing early elective births.

The webinar is being held on Wednesday, November 28, 2012 from 3:00- 4:00 PM ET

Please use this link and sign up to register.

Speakers include:

 Erin Smith

Patient Care Models Group

CMS Innovation Center

 

Hal C. Lawrence, MD

Executive Vice President

American College of Obstetrics and Gynecologists

 

Scott D. Berns, MD, MPH, FAAP

Senior Vice President & Deputy Medical Director

March of Dimes

 

Kenneth Brown, MD, MBA, FACOG

Medical Director

Woman’s Hospital (Baton Rouge, Louisiana)

 

Kathleen Simpson, PhD, RN, FAAN

Perinatal Clinical Nurse Specialist

Mercy Hospital (St. Louis, Missouri)

 

Vi Naylor

Executive Vice President

Lynne Hall

Quality Improvement Specialist

Georgia Hospital Association

 

Stephen L. Barlow, MD

Vice President & Chief Medical Officer

SelectHealth (Murray, Utah)

If you have questions or need more information on the Strong Start initiative or registering for this webinar, visit the Strong Start webpage or email us at StrongStart@cms.hhs.gov.

 

Childbirth Education, Continuing Education, Healthy Birth Practices, Healthy Care Practices, informed Consent, Maternal Quality Improvement, Maternity Care, Neonatology, Newborns, Pre-term Birth, Webinars , , , , ,

Lamaze International Wants YOU! Job Openings and Volunteer Opportunities

November 15th, 2012 by avatar

 

By J. Howard Miller, artist employed by Westinghouse,
poster used by the War Production Co-ordinating Committee
[Public domain], via Wikimedia Commons

Lamaze International wants to share some opportunities for paid positions and volunteer tasks that you may be interested in.  Lamaze International is a leader in childbirth education offerings and is well respected amongst consumers and professionals alike.  Do you want to get more involved?  Work with leaders in the field and make a positive contribution to improving birth outcomes with your efforts?

Lead Nurse Planner- Compensated Position

Lamaze International is searching for a Lead Nurse Planner to work as an independent contractor to manage its ANCC Accredited Approved Provider Unit for continuing nursing education. This is a prime opportunity for an experienced nurse planner who would like to take an active role in high-level planning for Lamaze educational activities, including development of content, objectives and evaluations and reporting, working hand-in-hand with education related committees/task forces and the education staff team. For more information on the requirements, detailed job description and compensation, please click here. Interested applicants should submit a letter describing qualifications and a current resume to Linda Harmon, Executive Director at director@lamaze.org by December 15, 2012.

Volunteer Positions

Nurse Planner- to serve on the Approved Provider Planning Committee, contact Kacy Reams

Giving Birth With Confidence Blog guest writers – contact Cara Terreri, Giving Birth With Confidence community manager

Social Media Networkers- If you hang out on Twitter, Facebook or your own blog, consider helping out Lamaze International as well, Please contact Tim Hendrickson to express your interest.

Translators –  familiar with Spanish, Russian, Mandarin, Czech and Romanian languages, to update Lamaze Care Practice Papers.  This position earns recertification hours! Contact Jeanne Mendelson.

Inside Childbirth Education Content Contributors- Share your tips and success stories! Contact the Inside Childbirth Education editor.

Certification Exam Item Writers – If you are an LCCE, consider submitting exam questions to the Certification Committee for review and receive recertification hours.

If any of these paid or volunteer positions are something that peaks your interest, please inquire and consider giving of your time and energy!  Lamaze International and the parents that rely on our evidenced based information will surely benefit.  Check out the Lamaze International link for more information on ALL these positions.

 

 

Childbirth Education, Continuing Education, Lamaze News, Social Media , , , ,