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Celebrate the Holiday Baby!

December 25th, 2012 by avatar

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Holidays are a time when many of us gather with with family and friends, when hearts are open, tables are full, spirits light and oxytocin flows just from being with those we care about and sharing meals and good times. For some families, babies arrive on the holiday to make the day even more special and significant then other years. For health care providers, doctors, nurses, midwives, doulas, birth photographers, lactation consultants and those that work with birthing families, holidays are often times spent away from their own friends and families so they can help women become mothers and see the birth of a family.

I have a clear recollection of being pregnant with my second daughter through the holidays of 2000. Grumpy, crabby, “done” with being pregnant, and very mad that everyone else seemed to be so festive and happy. Hard to make plans for holiday gatherings and meals, unwilling to have people over and not wanting to go elsewhere, I complained my way through each day, surprised like any other fully pregnant 40 weeker, that I would wake up each morning in my bed, “still pregnant.” I agreed to join friends for our traditional sushi rolling party that we did every New Year’s Eve, and pregnant or not, I was going to be rolling and eating sushi. Alas, baby felt like joining the party, and I went into labor New Year’s Eve. A slow labor ramp up seems to be the way my babies come, and I mildly contracted through the night, all New Year’s Day and into that night. As was the case, I seem to go from early labor to transition rather quickly and soon was pushing a baby out into the world in the pre-dawn hours on January 2nd. 01/02/01. Missing 01/01/01 by just a few hours. Missing the tax break and a New Year’s Eve baby by a day. Regardless, a memorable New Year nonetheless for myself and my family.

I sit now waiting for the call to join a client as her birth doula, as other women, clients of mine, tick the hours past the holiday celebrations, very pregnant and wondering if they too, will have a holiday baby.

As a doula for over 10 years, I have attended births on every holiday, my birthday, and my children’s birthdays, as those babies come when they want to, regardless of the plans of those of us on the outside!

I thought I would check in with those women who have given birth on a holiday like July 4th, Valentine’s Day, Christmas, New Year’s, Halloween and others to find out what their experience was like. And also ask those who themselves were born on a holiday, how has it been forever having their birthday associated with a holiday well known by many here in the US.

“I birthed on a holiday!”

Most of the women I spoke to who gave birth on a holiday had gone into labor spontaneously. Several of them had a long labor, for several days, with the baby making their appearance on the holiday. I wondered if they felt that their birth team minded not being with their family on the holiday. Everyone reported that, regardless of home birth or hospital birth, the birth team seemed very present, happy to be there and upbeat about welcoming the new baby. A few hospital birth mothers remarked at how empty and quiet the hospitals were during their births. Discharge seemed to take a bit longer and it was sometimes harder to be seen by a lactation consultant or other specialist. Some babies born on Christmas were given a green and white striped hat instead of the “normal” newborn baby hat after birth.

Many women talk about celebrating their child’s birthday on the original holiday date when the child is young, but as they get older, they have moved the celebration to a day that is not the holiday, so that friends and family are more available to join in the celebration. They shared that others seem “dismayed” that they gave birth on a holiday, expressed regrets for the child’s birth date, as if it was a bad thing.

I recall being at a birth on July 4th, and the baby was born about 30 minutes before the fireworks over the city were to happen.  The midwife and nurses turned off all the lights and we swung the mother’s bed completely toward the wall of windows, and the new family, and staff and I all watched the big fireworks show in silence, baby snuggled at mother’s breast.  I whispered in the baby’s ear later on, “Remember, these fireworks will always be to celebrate *your* special day!”

All the women I spoke to, who birthed on a holiday, made sure to comment and share that they felt it was important to have the baby pick its birth date, and be born when it is ready, even if that is a holiday. They all recognized what Lamaze speaks to when we share information in our Healthy Birth Practice, Let Labor Begin On Its Own.

The women all stated that they wanted to be sure that their child, born on a holiday, would always feel special and have celebrated, and not have their child’s birthday get lost in the shuffle of holiday celebrations.

“I was born on a holiday!”

I spoke with women who themselves were born on a holiday and they shared what it was like to have to share their birthday with a holiday that everyone was celebrating.  The folks who were born on Christmas or New Year’s shared that they frequently felt like their birthday got “overlooked” or “short shrift” in the celebrations of the season.  As a child, they often had to express their frustrations and share that they  needed their families to make their birthdays special, “If I was born in August, would you wrap my birthday gifts in Christmas wrapping?” said one woman.  Gifts often said “Merry Christmas and Happy Birthday.” One woman, born on New Year’s Day remarked; “At least I wasn’t born on Christmas!”

Many women who are born on other holidays, like Halloween or 4th of July, share that it was great fun growing up with that birthday date, and continues to be fun into adulthood.  One woman shared that being born on April Fool’s Day was not fun, and she got pranked a lot with empty boxes wrapped as presents and other jokes.  Not something she has enjoyed, and she shared; “I felt like my birthday was always a joke!”

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“I worked with birthing women on a holiday!”

I also spoke with health care providers, who shared that they enjoyed working on holidays, that facilities were often quiet, and low key, and the birthing families that they work with seemed extra appreciative of their support on the holiday.  They often wear a little something special to make things more festive, a Santa hat, or Halloween headband or an American flag on July 4th.  Sometimes, hospitals put something special on the meal tray, a flower or decorated cookie.  They are glad to be helping in any way they can.

Conclusion

I think that family and friends, and even the public makes a lot of comments to pregnant women who may find themselves likely birthing on a holiday, adding an extra layer of stress for these women, to what can already be a time period raw with emotion at the end of pregnancy. I am glad that these women are treated well by care providers.  None of the women who responded to my small, unscientific survey said that they felt pressure to induce to avoid a holiday birth date.

I think that as educators, we can stress that babies come when they come, and recognize the additional pressures that women may feel to birth or avoid birthing on a holiday date. We can provide tips on coping with holiday celebrations and plans when “very pregnant” and honor the emotions that some of the women may be experiencing.  Reassuring women that their babies know when to be born and helping them to prepare for however things unfold is a gift we can give to our students and clients.

Have you birthed on a holiday?  Were you born on a holiday?  Do you support birthing women and frequently work on a holiday.  Please share your experiences with all the readers in the comments and let us know what your experience was.  Is anyone waiting on a baby now? Do you expect to get called to a birth? Are you working in a hospital?  On call? Finally, a huge thank you to all the professionals who give up their holidays to support the new babies coming into the world.

 

Babies, Childbirth Education, Healthy Birth Practices, Newborns, Science & Sensibility , , , , , , , , ,

ACOG’s “reVITALize” Project Wants Your Opinion!

December 20th, 2012 by avatar

By Christine H. Morton, PhD

The American Congress of Obstetricians and Gynecologists (ACOG) has undertaken the reVITALize Project and they want your help, thoughts and input. A significant revolution is underway in maternity care.  With increased attention on maternal health outcomes, the measurement and reporting of key maternal quality metrics is on the agenda of childbearing women, maternal health advocates, payers and purchasers, hospitals, regulatory agencies and maternity care clinicians.    An important element of this revolution is an effort to clearly define what we mean when we talk about pregnancy and childbirth in the data sources most utilized in developing these measures – patient medical charts, registries, electronic medical records, patient discharge data, and our vital statistics (birth certificates).

This is an important and critical opportunity for all stakeholders in US Maternity Care to contribute to the national dialogue on measuring maternal health outcomes.

From the ACOG website: 

The reVITALize Obstetric Data Definitions Conference in early August 2012 brought together over 80 national leaders in women’s health care with the common goal of standardizing clinical obstetric data definitions for use in registries, electronic medical record systems, and vital statistics. Over the course of the two-day in-person meeting and the months that followed, more than 60 obstetrical definitions were reviewed, discussed, and refined.  Data elements included: induction of labor, gestational age and term, parity, TOLAC, and more. The full executive summary of the reVITALize Obstetric Data Definitions Conference can be read here.

The public comment period for the definitions of these data elements ends January 15, 2013. To submit comments, click on one of the category links below to open the respective Public Comment form. The data elements contained within each Public Comment form have been grouped according to category; the data elements assigned to each category are listed under the category heading below. You are permitted to comment on any number of categories. You can also view an alphabetical listing of all data elements available for comment here.

Delivery
• Cesarean Delivery
• Date of Delivery
• Forceps Assistance
• Malpresentation
• Perineal Lacerations
• Placenta Accreta
• Primary Cesarean Delivery
• Repeat Cesarean Delivery
• Shoulder Dystocia
• Spontaneous Vaginal Delivery
• Vacuum Assistance
• Vaginal Birth After Cesarean
• Vertex Presentation

Gestational Age & Term
• Preterm
• Early Term
• Full Term
• Late Term
• Post Term
• Estimated Date of Delivery
• Gestational Age (calculation formula)

Labor
• Artificial Rupture of Membranes
• Augmentation of Labor
• Duration of Ruptured Membranes
• Induction of Labor
• Labor
• Labor After Cesarean
• Non-Medically Indicated Induction of Labor or Cesarean Delivery
• Number of Centimeters Dilated on Admission
• Onset of Labor
• Pharmacologic Induction of Labor
• Physiologic Childbirth
• Pre-Labor Rupture of Membranes
• Spontaneous Labor and Birth
• Spontaneous Onset of Labor
• Spontaneous Rupture of Membranes

Maternal Indicators: Current Co-Morbidities and Complications
• Abruption
• Antenatal Small for Gestational Age
• Any Antenatal Steroids
• Clinical Chorioamnionitis
• Depression
• Early Postpartum Hemorrhage
• Oligohydramnios – HOLD; Pending Further Revision
• Polyhydramnios – HOLD: Pending Further Revision

Maternal Indicators: Historical Diagnoses
• Chronic Hypertension
• Gravida
• Maternal Weight Gain During Pregnancy
• Non-Cesarean Uterine Surgery
• Nulliparous
• Parity
• Plurality
• Positive GBS Risk Status
• Pre-Gestational Diabetes

How to Submit Effective Comments

In order to make the process as productive as possible, please keep the following in mind when commenting:

• Be clear. Clearly identify the issues on which you are commenting and explain your reasons for your position.
• Be concise. Although there is no minimum or maximum requirement for comments, it is best to keep your comments short and to the point.
• Suggest alternatives. If you identify a problem with the proposed definition on which you are commenting, consider suggesting an alternative.
• Spread the word. If you know others who can provide helpful comments, please direct them to www.acog.org/revitalize  for more information.

What happens to comments after they are submitted?

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All comments received during the Public Comment period will be reviewed and logged for consideration and careful review by reVITALize leadership. The leadership teams are comprised of both clinical and operational members. Comments will be reviewed and responded to accordingly and will help to form the basis for any additional changes that need to be made to the refined definitions prior to final approval. Should comments require further clarification, the individual submitting the comment may be contacted during the review period to obtain any clarifying information needed to make an informed and appropriate decision regarding a potential revision.

Thank you for your help in making this initiative a success! Any questions or concerns should be directed to QI@acog.org

ACOG, Evidence Based Medicine, Guest Posts, Legal Issues, Maternal Quality Improvement, Research, Research Opportunities , , , ,

What Is the Evidence for Perineal Massage During Pregnancy to Prevent Tearing?

December 18th, 2012 by avatar

By Rebecca Dekker, PhD, RN, APRN of Evidence Based Birth

Do you talk about perineal massage with your students, clients and patients and state that perineal massage during pregnancy will/will not reduce tearing during birth?  today, Rebecca Dekker, of Evidence Based Birth takes a look at the research on perineal massage during pregnancy and provides information on the outcomes for women who practiced this and those who didn’t.  Does the research support what you have been saying? – Sharon Muza, Community Manager

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Tearing during childbirth is a common occurrence among women who have a vaginal birth. In studies where the use of episiotomies was restricted, the rate of spontaneous tearing was recorded to be anywhere from 44-79% (Soong and Barnes 2005; Dahlen, Homer et al. 2007). Studies have consistently shown that women are more likely to experience tearing during a first vaginal birth and with forceps and vacuum assistance (Aasheim, Nilsen et al. 2011).

Spontaneous tears can be classified as first, second, third, or fourth degree tears. First degree tears involve only the perineal skin, while second degree tears involve both the skin and the perineal muscle. Third degree tears involve the anal sphincter, while fourth degree tears involve the anal sphincter and tissues. Third and fourth degree tears happen at 0.25% to 2.5% of spontaneous vaginal births (Byrd, Hobbiss et al. 2005; Groutz, Hasson et al. 2011).

Women are more likely to have a third or fourth degree tear if they are giving birth vaginally for the first time, if a baby is in the posterior position or has a heavier birth weight, and if forceps, vacuum, or episiotomy are used (Christianson, Bovbjerg et al. 2003; Groutz, Hasson et al. 2011; Hirayama, Koyanagi et al. 2012).

What is perineal massage?

It is thought that massaging the perineum during pregnancy can increase muscle and tissue elasticity and make it easier for a mother to avoid tearing during a vaginal birth. Typically, women are taught to spend about 10 minutes per day doing perineal massage, starting at about 34-35 weeks of pregnancy. Women are taught to insert 1-2 lubricated fingers about 2 inches into the vagina and apply pressure, first downward for 2 minutes, and then sideways for 2 minutes. The massage can be done by the woman or her partner, and sweet almond oil is sometimes used for lubrication (Labrecque, Eason et al. 1999).

What is the evidence for perineal massage?

In 2006, Beckmann and Garrett combined the results from four randomized, controlled trials that enrolled 2,497 pregnant women. Three of these studies involved only women without a previous vaginal birth (mostly first-time moms). One study enrolled women with and without a previous vaginal birth. All four of the studies were of very good quality.

Beckmann and Garrett found that women who were randomly assigned to do perineal massage had a 10% decrease in the risk of tears that required stitches (aka “perineal trauma”), and a 16% decrease in the risk of episiotomy—but these findings were only true for first-time moms.

It is important for you to understand that this is a 10% reduction in relative risk, and relative risk is different than absolute risk. Let me give you an example. Say you are a first-time mom, and let’s pretend your absolute risk of perineal trauma is 50%. A 10% decrease in relative risk means that your absolute risk decreases by 5% (because .5 X .1 = .05). So for you, doing perineal massage reduces your absolute risk of perineal trauma from 50% to 45%.

*As a side note, all of the numbers I am reporting below are changes in relative risk.

Importantly, for second-time moms who had already had a vaginal birth, prenatal perineal massage did not reduce the risk of perineal trauma (any tearing requiring stitches). However, second-time moms who massaged did report a 32% decrease in the risk of ongoing perineal pain at 3 months post-partum.

Surprisingly, Beckmann and Garrett found that the more frequently women used perineal massage, the less likely they were to see any benefits. Women who massaged an average of 1.5 times per week had a 17% reduced risk of perineal trauma and a 17% reduced risk of episiotomy. Women who massaged between 1.5-3.4 times per week had an 8% reduced risk of perineal trauma.

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Interestingly, women who massaged > 3.5 times per week experienced NO benefits and had a longer pushing phase of labor by an average of 10 minutes. So basically the finding was: the less frequent the massage, the better off the outcomes. However, this finding was unexpected, and the researchers had a hard time explaining it. I think we should interpret this result with caution, because in the largest clinical trial on perineal massage (included in Beckmann and Garrett’s review), Labrecque et al. (1999) found that the more often women did the massage, the more likely they were to avoid any tears.

Other results: 

There were no differences between women who did prenatal perineal massage and those who did not with regard to:

  • • First degree tears
  • • Second degree tears
  • • Third or fourth degree trauma
  • • Use of forceps or vacuum during delivery
  • • Sexual satisfaction 3 months post-partum
  • • Pain with sexual intercourse 3 months post-partum
  • • Uncontrolled loss of urine or bowel movements 3 months postpartum

Wait, I’m confused. You say that there was a significant decrease in perineal trauma requiring suturing. But there was no difference in 1st, 2nd, 3rd, or 4th degree tears. How can this be?

It’s important for you to understand that perineal trauma is an “umbrella” category that means all types of trauma requiring stitches, including episiotomies. Perineal massage during pregnancy decreased the overall risk of perineal trauma (the umbrella outcome), but the effect was too weak to see any difference with each of the individual outcomes (first degree, second degree, etc.). Also, the researchers think that the overall decrease in perineal trauma may have been due to the decreased episiotomy rate in the perineal massage group.

Why would perineal massage during pregnancy reduce the rate of episiotomies, but not tears?

The researchers guess that the women who were trained in perineal massage were highly motivated to birth with an intact perineum, so maybe they were more likely to refuse an episiotomy. Fewer episiotomies would then mean fewer incidents of trauma requiring stitches.

So what can we learn from the evidence?

During pregnancy, massage of the perineum can reduce the risk of tearing requiring stitches, but this benefit is only seen in moms giving birth vaginally for the first time. It is thought that most of the decreased risk of perineal trauma was due to a decrease in the episiotomy rate. In the largest study included in this review (Labrecque et al., 1999), there was an overall episiotomy rate of 38%. In the U.S., 25% of women have an episiotomy during a vaginal birth (Declercq, Sakala et al. 2007), and rates are even lower for some providers.  It is possible that these research findings might not apply to birth settings where episiotomies are extremely rare.

Second time moms who use perineal massage will not see any decrease in their risk of tearing, but they may reduce their risk of ongoing perineal pain at 3 months postpartum.

So in summary, for first-time moms only:

Perineal massage during pregnancy

Decreased risk of episiotomy

Decreased risk of trauma requiring stitches

If women choose to use perineal massage during pregnancy, there is no consensus on the amount of massage needed to reduce the risk of tearing.

Questions for discussion: Do you recommend prenatal perineal massage to others? Have your thoughts about this intervention changed after reading this article? 

References

Aasheim, V., A. B. Nilsen, et al. (2011). “Perineal techniques during the second stage of labour for reducing perineal trauma.” Cochrane Database Syst Rev(12): CD006672.

Beckmann, M. M. and A. J. Garrett (2006). “Antenatal perineal massage for reducing perineal trauma.” Cochrane Database Syst Rev(1): CD005123.

Byrd, L. M., J. Hobbiss, et al. (2005). “Is it possible to predict or prevent third degree tears?” Colorectal Dis 7(4): 311-318.

Christianson, L. M., V. E. Bovbjerg, et al. (2003). “Risk factors for perineal injury during delivery.” Am J Obstet Gynecol 189(1): 255-260.

Dahlen, H. G., C. S. Homer, et al. (2007). “Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized controlled trial.” Birth 34(4): 282-290.

Declercq, E. R., C. Sakala, et al. (2007). “Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.” J Perinat Educ 16(4): 9-14.

Groutz, A., J. Hasson, et al. (2011). “Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium.” Am J Obstet Gynecol 204(4): 347 e341-344.

Hirayama, F., A. Koyanagi, et al. (2012). “Prevalence and risk factors for third- and fourth-degree perineal lacerations during vaginal delivery: a multi-country study.” BJOG 119(3): 340-347.

Labrecque, M., E. Eason, et al. (1999). “Randomized controlled trial of prevention of perineal trauma by perineal massage during pregnancy.” Am J Obstet Gynecol 180(3 Pt 1): 593-600.

Soong, B. and M. Barnes (2005). “Maternal position at midwife-attended birth and perineal trauma: is there an association?” Birth 32(3): 164-169.

About Rebecca Dekker

Rebecca Dekker, PhD, RN, APRN, is an Assistant Professor of Nursing at a research-intensive university and author of www.evidencebasedbirth.com. Rebecca’s vision is to promote evidence-based birth practices among consumers and clinicians worldwide. She publishes summaries of birth evidence using a Question and Answer style.

Childbirth Education, Evidence Based Medicine, Guest Posts, Research , , , , , , , ,

Professional Perspectives Part III: Advocacy, Postpartum Doulas and Childbirth Education

December 13th, 2012 by avatar

By: Walker Karraa

Regular contributor Walker Karraa has written an excellent three part series on Perinatal Mood and Anxiety Disorders (PMAD) and what the childbirth educator or birth professional can do to help women get the help they may need when dealing with mental illness during the prenatal and postpartum period.  Walker interviews experts in the field who all offer concrete steps, activities and resources so that educators and others can do to be more prepared to discuss this important subject with students and clients.  Today, Walker interviews Jennifer Moyer, an expert in the field of postpartum psychosis who is an active mental health advocate, and has had personal experience with postpartum psychosis after her son’s birth. Here you can find Part I and Part II of the series.– Sharon Muza, Community Manager.

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“Childbirth professionals have a unique opportunity to reach a tremendous number of women and families as most pregnant women participate in some type of childbirth class.” —Jennifer Moyer


 

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As many of you know, I am a big proponent of qualitative research methods. The lived experience of a phenomenon offers a depth of data that objectivist methods simply cannot collect. Researchers in women’s reproductive health have been on the forefront of the understanding and implementation of research that listens to mothers. In the same way, I wanted to offer Science and Sensibility readers the voice of a mother, postpartum doula, and advocate who has lived it—experienced postpartum psychosis (PP) and not only “survived”, but transformed the adversity into a path to helping others.

Jennifer Moyer has unique insight into mental health as a recovered mom herself. She overcame postpartum psychosis, a life threatening mental illness, which she was struck with when her son was eight weeks old. She has focused her efforts on being a mental health advocate in the area of perinatal mental health in order to help others experiencing mental illness related to childbearing.

Jennifer also has experience as a postpartum support and education consultant, a certified postpartum doula and a speaker on mental health issues.

WK: The recent Felicia Boots tragedy in the UK has brought media attention to the dangers of untreated perinatal mood disorders, specifically postpartum psychosis (PP). What are your thoughts as to the multiple factors that contribute to a tragedy such as this? 

Jennifer Moyer: I believe there are several factors that contribute to tragedies associated with perinatal mood disorders.  One of the factors is the ignorance about the difference between postpartum depression and postpartum psychosis, which is usually the disorder associated with infanticide.  In my experience with postpartum psychosis, I was completely unaware that postpartum psychosis even existed despite having an educated and proactive pregnancy.  I think many mothers are in the same situation.

Another contributing factor is that providers often do not provide education on the warning signs or risk factors of perinatal mood disorders making it difficult for a mother or her loved ones to recognize what is happening.  Of course the lack of preventative screening also causes a mother at risk from receiving early intervention.

There are other factors as well but I believe these are the primary obstacles contributing to unnecessary tragedies.

WK: Can you describe the sequelae of postpartum psychosis (PP)? 

Jennifer Moyer: An aftereffect or secondary result of postpartum psychosis is different for each mother but, in general, I have found that it changes the mother forever.  In my case, postpartum psychosis came on sudden and unexpectedly.  Once I was stabilized, the trauma I had experienced prior to my diagnosis left me with serious post-traumatic stress.  It also shattered the positive and strong bond I had with my son prior to the onset of postpartum psychosis.  It caused me to question my ability has a mother for a very long time.  The lack of understanding about my condition as well as lack of support from someone, who had experienced postpartum psychosis, lengthened my recovery and made it much more difficult.

Postpartum PsychosisPostpartum Psychosis is a rare illness, compared to the rates of postpartum depression or anxiety. It occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately .1% of births. The onset is usually sudden, most often within the first 4 weeks postpartum.Symptoms of postpartum psychosis can include:

  • Delusions or strange beliefs
  • Hallucinations (seeing or hearing things that aren’t there)
  • Feeling very irritated
  • Hyperactivity
  • Decreased need for or inability to sleep
  • Paranoia and suspiciousness
  • Rapid mood swings
  • Difficulty communicating at times

The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode.

source: Postpartum Support International

WK: How might childbirth professionals integrate an understanding of PP and other perinatal mood disorders in classes? 

Jennifer Moyer: I believe education on perinatal mood disorders should be included in every childbirth class.  In fact, when I worked as a Postpartum Support and Education Consultant, I did a presentation on perinatal mood disorders in every childbirth class conducted at a hospital in my area.  By educating the mother and her partner about the risk factors, symptoms and proper treatment, early intervention occurred when a case did occur.  My involvement helped educate the childbirth professionals, which led to them ultimately address perinatal mood disorders on their own in their classes.  To me, the goal is to educate as much as possible so that the information can be passed on to women and their families.  Childbirth professionals have a unique opportunity to reach a tremendous number of women and families as most pregnant women participate in some type of childbirth class.

WK: How would you describe the stigma of perinatal mental health disorders and its impact?

Jennifer Moyer: The stigma of perinatal mental health disorders prevents women from getting help when they need it.  Often because of the stigma and lack of understanding, women are often afraid they will lose their child (children) if they do seek help.  The stigma of perinatal mental health disorders is devastating to families and communities. When families and the community are not educated about perinatal mental health disorders, it makes it difficult for the disorders to be properly addressed, treated and prevented.  I have heard of way too many cases of the mother losing her children because of the lack of understanding and education of perinatal mental health disorders in the community.

WK: What do you see as the most significant barriers to treatment for women with PMADs?

Jennifer Moyer: I believe the most significant barrier is the lack of proper education and training of health care professionals.  Another barrier is the failure of the providers, who are not properly trained, to refer the women to perinatal mental health resources or if no resources available in the area, to consult with an expert in perinatal mental health.  So many women are improperly treated.  I know of many cases where the woman contacted her doctor for assistance and were only prescribed an antidepressant, often over the phone, and received no further direction or support.  So it goes back to education or, in the case of the primary barrier, the lack of education.

WK: Recently, the study The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond (Domar, Moragianni, Ryley & Urato, 2012) attracted attention regarding the safety of using SSRI medication in pregnancy. Would you like to respond to the study directly?

Jennifer Moyer: I am not a medical professional so I cannot respond in depth but from a lay person’s perspective, this information can cause many pregnant women from seeking help, if they are experiencing any perinatal mental health issues.  My understanding is there is always a risk/benefit analysis when it comes to medication so education about options is so important.  In my opinion, it seems that medication is often the only intervention presented rather than a more complete and balanced plan of treatment, which may include medication when necessary. Educating women about their options should always be a priority but if the health care professionals are not properly educated in perinatal mental health, how can they educate anyone else?

WK: What suggestions do you have regarding how childbirth organizations can encompass perinatal mental health into training curriculum and practice? 

Jennifer Moyer: Offering and requiring specific training on perinatal mental health for all members would increase awareness, education, treatment and most importantly prevention.  Offering continuing education and ways of implementing mental health into their practice would help eliminate stigma and, when necessary, increase referral and treatment to perinatal mental health professionals.

WK: What can we do to increase the understanding that a woman’s mental health is part of maternal health?  

Jennifer Moyer: Although the old saying “if mom is not happy, no one is happy”, puts pressure on moms, it does stress the importance of maternal health.  The health of mothers is critical to society and communities everywhere.  The more mental health is talked about, the better understanding will occur.  As you probably have realized from my previous responses, I am a huge proponent of education.  I believe it is the key to decreasing stigma and bringing about positive changes in the health of women both mentally and in general.

Next Steps

In what ways can childbirth educators participate in bringing about positive changes within this paradigm? How can health care professionals learn more about how the role mother’s mental health plays in so many of the dynamics of the new mother and child(ren). Would you be interested in a webinar on this topic?  Where do you as a birth professional go for more resources, information and teaching tools on the topic of postpartum mental health?

About Jennifer Moyer

Jennifer Moyer has various media experience including her personal story being published in the February 2002 issue of Glamour Magazine resulting in a guest appearance on CNN’s The Point. She was also interviewed for an article appearing in the December 2002 issue of Psychology Today. Jennifer is a member of the National Perinatal Association, the National Alliance on Mental Illness, Mental Health America, The Marcé Society, the National Association of Mothers’ Centers and Postpartum Support International. Jennifer is also now a member of the International Association for Women’s Mental Health.

Please contact Jennifer through her website or by emailing her at jennifer@jennifermoyer.com. Jennifer blogs at: www.jennifermoyer.com/blog

Walker would like to thank Jennifer Moyer, Nancy Byatt, D.O., MBA, and Julia Frank, MD, and the Listserv of the Marce Society for their assistance with this article.

Childbirth Education, Depression, Guest Posts, Infant Attachment, Maternal Mental Health, Newborns, Perinatal Mood Disorders, Postpartum Depression , , , , , , , ,

Lamaze International Webinar: Social Media for Childbirth Educators! Are You Signed Up?

December 12th, 2012 by avatar

There is an exciting and free webinar offered by Lamaze International tomorrow, December 13, 2012 and I wanted to make sure that you were signed up!

http://flic.kr/p/5uhL7d

Social Media for Childbirth Educators presented by: Kathryn Konrad, MS, RNC-OB, LCCE, FACCE will be an opportunity to learn about, discuss and explore the different methods of communicating with today’s parents.  What forums and venues do young families use to gather information and how can you harness the power of social media to build your business, market your skills and interact with the families you are working with?  Even if you are already familiar with this topic, you will be sure to learn a few new tips and discoveries that can only enhance your skills.

The specifics:

Social Media for Childbirth Educators Webinar

Date:  Thursday, December 13, 2012

Time: 1:00 PM – 2:00 PM EST

Reserve your Webinar seat now!

You may also receive 1 Lamaze Contact Hour, and one Nursing Contact Hour upon purchase and completion of a quiz. This is optional, the webinar is free.

Come back and let us know your thoughts, what you are excited to try and how you use (or will use) social media to help you in your business practices!

Please contact the Lamaze International office with questions about registering, contact hours or other webinar focused needs.  See you online!

 

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