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EMDR Part Three: Listening to Women; Personal Experiences of EMDR for Treating PTSD

February 28th, 2013 by avatar

In this series about EMDR (Eye Movement Desensitization and Reprocessing), Part One looked at qualitative research evaluating EMDR as treatment for post-traumatic stress disorder (childbirth onset). In Part Two, EMDR clinicians weighed in on their feelings about the safety of EMDR during pregnancy. When those EMDR posts were published, I received a lot of behind the scenes feedback from women who either loved or hated their experiences with EMDR; there didn’t seem to be a middle ground!

Women Thrive When They Learn Emotional Skills Istock/GoldenKB

I felt these women’s voices need to be heard (many thanks to Sharon Muza, S&S Community Manager, for her gracious agreement!) The results are here: four interviews conducted with four real women who suffered from trauma in the perinatal period and tried EMDR.

It’s unfortunate these lovely women suffered extreme emotional turmoil at such an important time in their life; when they were working and hoping to build their emergent family and when they were primarily responsible for the safety and care of their infants.

Through sharing their stories, all women indicated to me that they hope that their voices will contribute to the collective movement to incorporate mental health care into the overall care of women and their families in the childbearing year.

Characteristics of Their Trauma

All of the women interviewed experienced trauma in the early postpartum period. Three suffered specifically from birth trauma; all experienced a severe perinatal mood disorder. Three of the women additionally were coping with complex, long-term, multi-layered emotional trauma, stemming back to abuse in childhood.

All of the women interviewed were seeing licensed therapists who incorporated EMDR into their overall treatment plan for trauma. Some asked to have their identities masked, so identifying details and names are obscured, but the overall personal statements and feelings are preserved.

They are empowering to all of us in that ALL of them valued their mental health and were brave enough to seek professional help!

Personal Healing Processes

The women interviewed are all emotionally mature adults. They’re aware of their life situations and the impact of trauma on their well-being. They’ve worked hard to explore and develop life-long skills and methods of managing their emotions. Thus, these are all women who are proactive, sophisticated and intelligent about their emotional healing processes. Before they used EMDR, all of the women had already incorporated many forms of healing into their personal self-care plans.

Their self-care plans included: long-term psychotherapy, journaling, expressive therapies such as art, music and movement, yoga, exercising, gardening, cognitive behavioral therapy, goal setting and medication. One woman indicated she was in so much pain from long-term, severe, past abuse she had seriously discussed electroconsulsive therapy with her psychiatrist. So, when their trusted therapists suggested trying EMDR, specifically designed to treat trauma, all the women agreed.

Personal Perinatal Traumatic Events:

In their own words, the women share their individualized, personal perinatal trauma experiences below.

Birth Trauma:

Kim (not her real name) shares her traumatic birth story:

“My son was born after an easy pregnancy but a complicated birth. I’d very nearly had a vaginal birth; the nurses could see the top of his head, but it was turning to the side each time I pushed. After nearly 2 hours of this, I underwent a c-section because I had spiked a fever and things were not progressing. During my c-section, I was overcome by anxiety and completely paralyzed by fear.

I literally thought I was dying as my son was being born, yet due to the panic, I was unable to verbalize this fear to anyone.

I spent that time shaking and having what I thought were my last panicked thoughts and breaths. It was the the most afraid I’ve ever been in my entire life, and also the most alone I’d felt, despite being surrounded by others.

After the surgery, I wasn’t able to hold my son for 3 hours. I spent the time in recovery, scared that something were wrong and nobody was telling me. I am still not sure of the reason for the delay.

My maternity leave felt long, due to postpartum anxiety and depression and a baby who barely slept and I cried nonstop some days. I felt like a terrible mother who was unable to console her child or enjoy him. I felt tremendous guilt. In addition to the emotional aspects, my c-section scar was not healing properly, so I felt as if I were constantly making a 30-mile trek (newborn in tow) to my ob-gyn’s office for checkups. “

Birth Trauma Layered on Childhood Trauma:

Karen (not her real name) said:

“My very traumatic birth triggered already active memories of severe childhood abuse, parental suicidal attempts in front of me, active alcoholism & substance abuse in the family and severe childhood neglect.”

Helen (not her real name) said:

“I was working on birth trauma at the start of the EMDR, but later on, abuse, illnesses, and marital distress. I was mainly focused on the birth trauma I had experienced when I used EMDR.”

Postpartum Traumatic Event Layered on Childhood Trauma:

Jessica Banas explained her perinatal trauma as such:

“I was traumatized by my childhood with my father. He was very emotionally abusive. Seeing him overdose (on a drug called GHB) the first night my parents were to supposed to have been watching my infant son for me, so I could rest, felt like the ultimate betrayal. Once again, not only were they NOT there for ME, but I had to SAVE them (again) instead!!!”

Women’s Experiences Show Us Moms with PTSD Suffer Co-morbid Perinatal Depression & Anxiety

It is fascinating and sad that all three women with pre-existing trauma stated their prior trauma was re-triggered by a perinatal traumatic event (traumatic birth or other traumatic event postpartum). And all four suffered from severe postpartum depression and anxiety after their traumatic perinatal event. A woman’s mental health is an important aspect of the childbearing year.

As discussed in a previous blog post, one in four women suffers depression at some point in her life, and women are more likely to suffer depression during and shortly after pregnancy than at any other time (Nonacs, 2006). Ruta Nonacs, MD (2011), editor-in-chief of Massachusetts General Hospital’s Center of Women’s Mental Health’s website estimates annually in the US, there are about 4 million births, and about 950,000 to 1,000,000 mothers suffer from depression either during or after childbirth every year. 

Having a personal history of a mental illness in her lifetime, such as depression, anxiety, PTS/PTSD, OCD or bipolar disorder (remember, this is whether it was diagnosed & treated or undiagnosed & untreated) increases a woman’s risk of postpartum depression. A previous history of previous postpartum depression increases a woman’s risk of a recurrence to 50 – 80 % risk of recurrent PPD, as compared to a 10- 20% risk factor without having had a prior episode.

It’s important to note that the women’s constellation of PTSD symptoms intensified and they developed severe postpartum depression and anxiety.

Jessica eloquently states how important women’s mental health is to the postpartum period:

” One important symptom of my PTSD that complicated and worsened my PPD was when my infant son would cry and interrupt my ruminations of my father Od-ing. I’d get angry….that would trigger thoughts of wanting to harm my son and cause me great anxiety and incredible guilt…..there were many times I was too afraid if I went to tend to him, I’d treat him harshly, or hurt him This created such a sense of worthlessness and shame, I thought of suicide one night. Instead, I told my husband and we reached out and got help.

It is a very important aspect of PTSD in that I am personally aware how detrimental it is on PPD. My PPD rapidly escalated after getting PTSD. And one seemed to feed on the other. Getting treated for BOTH issues was very important.”

Women’s Experiences Show Us the EMDR Outcomes

Two very positive experiences

Kim’s Experience with Traumatic Birth & Postpartum Anxiety & EMDR

Kim, who suffered from birth trauma and postpartum anxiety, had a positive experience with EMDR. Here is her story of healing.

Kim said that her therapist incorporated EMDR into her current psychotherapy sessions. She said she hadn’t realized that she’d been suffering with PTSD until almost a year after the incident. She says she discovered her anxiety was stemming from a traumatic birth experience at a therapy session:

Kim says:

“…of course I’d had PTSD from thinking I was dying while my son was being born! My anxiety, which had a lot to do with waiting for something terrible to happen to me or my son, started to make sense in light of this new revelation.”

Kim experienced the EMDR itself as calming. She held tappers in her hands while her therapist led her through visualizations. Her therapist warned her that EMDR could be emotionally triggering and if she needed to call her, she was welcome to do so. And it was triggering for Kim. After her first session, she suffered from an anxiety attack and had to call her therapist, and received the help she needed.

Ultimately, Kim’s overall experience with EMDR was emotionally freeing and healing.

She goes on to say:

“Up until the EMDR, I was unable to speak about my c-section at all. I couldn’t see anything related to the birth experience (with or without c-sections involved) on television, either. If I caught a glimpse of a birth on TV, I cried. I had a lot of anxiety on the few occasions I tried to watch A Baby Story on TLC, as a test to see how I felt watching another woman’s experience.

After EMDR a few times, I became more comfortable thinking about and processing my experience, and even eventually talking about it with others. I no longer viewed my scar as something horrible and ugly. Having EMDR gave me back my confidence because it helped me stop seeing myself as a failure (because I needed a c-section instead of birthing vaginally). “

Kim would recommend EMDR to another person trying to recover from trauma, but with some warnings about the emotional response.

Jessica’s Experience of Postpartum Traumatic Event, PPD, Suicidal Ideation & EMDR

Jessica, who experienced the trauma of her father’s overdose while her parents were supposed to be watching her baby, had a positive experience with EMDR. Here is her story of healing:

Jessica said that her therapist incorporated EMDR into her current psychotherapy sessions. Her therapist suggested she try something “new” that would remove the sting of the trauma from her mind. Jessica was skeptical but thought she’d give it a try.

Jessica says:

“The EMDR was pretty much wrapped around by talk therapy in that we’d start out by talking and end up by talking… EMDR took the emotional ties from the traumatic memories away. I no longer find myself reliving any of those memories that were treated with EMDR. I no longer feel any emotional pain from the OD event. I have no loss of sleep, anger, depression, or any anxiety over that event.”

Jessica says she did not find the EMDR emotionally triggering at all, but many childhood memories came flooding back. .

“Not at all…frankly, I thought it was lame at first (wiggling a finger in my face? REALLY?) and had no hope it would have ANY effect at all. Once we (quickly) healed the OD trauma, memories from my childhood did come flooding back! I found that to be very interesting! Fortunately, my childhood was not as terrible as many, so I could handle this phenomenon.”

Jessica recommends EMDR:

“…as long as the person is seeing a well trained, compassionate therapist! EMDR helped me and I have gone on to suggest it to other people who were in pain as I was….those people have been healed by EMDR as well….I find it a useful treatment and extremely non-invasive compared to other treatments!!”

Two very negative experiences

Karen’s Experience with Birth Trauma, Past Trauma, PPD, PPA & EMDR

“My experience was physical and emotional and in both cases negative. I felt physically ill, vertigo, nausea. Disorientation, short-term memory loss, headache. Emotionally, it was detrimental as it brought up my most difficult trauma and I felt completely triggered. I tried to hang in there with the process, but only did a few sessions. The EMDR sessions were not processed with in-between traditional talk therapy sessions. The EMDR made my symptoms worse, my anxiety worse, and the neurological side-effects were horrible. While my therapist did a wonderful job at regrouping,  after we decided to stop doing it, I actually went up on my medications and saw her 2x a week for a while. It was just too much. What I think had happened to me was more resurfacing of old memories that I had compartmentalized in years of talk therapy and medication. I actually think I needed a medication adjustment when I was so desperate for relief. “

Karen would not personally recommend EMDR to another.

Helen’s Experience with Birth Trauma, Past Trauma, Postpartum Mental Health Complications & EMDR

“My therapist suggested the EMDR may be helpful for both traumas (birth and childhood). I had 6 sessions that were each an hour long. Some of this process was also traditional talk therapy in between the EMDR. I found EMDR not helpful in treating my traumas.”

“It was extremely triggering and the therapist pushed me into a lot of it. She would try to help me regroup by taking deep breaths and little breaks in between. But I always felt drained after each session and even more triggered with PTSD.”

Helen would not recommend EMDR for another person:

“I do not think I would personally recommend EMDR to another person for a trauma. I believe the therapist shoved me into it too soon and left me for days swirling in the emotions of that. I have heard it can be wonderful and healing for others. For me, it triggered too much to soon and my experienced left me more traumatized. I can’t think of those (EMDR) coping skills and techniques without feeling overwhelmed with memories.” 

Conclusions

As we can see from real women’s experiences, EMDR was extremely triggering to two of the women, but resolved emotional distress well for the two other women. Again we are reminded that one size does not fit all when it comes to treating mental health.

The women’s experiences indicated that when working with EMDR for trauma, even experienced and trusted therapists encountered strong triggering responses in their clients. In these instances, these therapists needed to know how to appropriately re-group and therapeutically support their clients either in the session and/or be appropriately available outside of scheduled sessions.

It was not appropriate for a therapist to urge a client to try or keep using EMDR if the client did not really want to, or if the client was having an overall non-therapeutic effect.

As we can see from these real women’s experiences, the treatment of post-traumatic stress has the potential to be devastating to the client as far as awakening or re-triggering compartmentalized past emotional distress.

In this small article and small example, it is interesting to me that the four women who volunteered to share their stories in this small had extreme reactions to EMDR, none neutral. These results reinforce my usual conservative approach to managing emotional distress, that is, if one is suffering from debilitating mental and emotional distress, it is best to consult with a licensed professional.

What I find empowering about these interviews is that ALL of these women VALUED their mental health and were brave enough to seek help. Fight the stigma! Don’t be afraid to get help!

Author’s Note: None of these women were or are my clients. I sought out non-clients for the purpose of these interviews.

References

Nonacs, R. (2006). A deeper shade of blue. New York: Simon and Schuster.

Birth Trauma, Cesarean Birth, Childbirth Education, Depression, Do No Harm, EMDR, Evidence Based Medicine, Maternal Mental Health, Perinatal Mood Disorders, Postpartum Depression, Pregnancy Complications, PTSD, Research, Trauma work , , , , , , , ,

Parents’ Singing to Fetus and Newborn Enhances Their Well-being, Parent-Infant Attachment, & Soothability: Part Two

February 26th, 2013 by avatar

Regular contributor Penny Simkin discusses the research around parents’ singing to their babies in utero and the post birth benefits.  She also shares how birth professionals can encourage clients, patients and students to start this practice during pregnancy.  Part one of this two part series can be found here. – Sharon Muza, Community Manager, Science & Sensibility

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What is the research evidence for postnatal benefits to parents or babies  of singing to the baby before birth?

• Fetuses can sense audio vibrations and rhythms early in pregnancy. Later in pregnancy they hear and distinguish various sounds. (4)
• They recognize their parents’ voices after birth (1)
• Newborns prefer their parents’ voices over the voices of strangers (1)
• Repetitive prenatal reading of one story by one parent every day for weeks results in the newborn’s recognition of and preference for that story. (2)
• Fetuses respond to music by calming, becoming active, changes in FHR (depending on the music) 5,6)
• Premature babies are calmed by calming music. (7)
• Newborns and young babies are calmed by familiar music, as demonstrated by the universal use of lullabies.

Combining these findings, a proposal

In light of all that has been learned about babies, I think we can combine it all into a simple approach to enhance bonding, soothe the baby, empower parents with their own unique tool that no one else, even the experts, can do as well as they. (8) I propose that we who provide care and education for expectant parents urge them to do the following at around 30-32 weeks’ gestation (or earlier or later):

Simple steps to singing to the baby in utero and after birth

1. Choose a song that you like and is easy for you to sing. It might be a lullaby or a children’s song, but it does not have to be. It can be one of your favorite songs or a popular song of the day.

2. Sing it every day. Both parents can sing it together, but each of you should also sing it alone much of the time. It can be played with a musical instrument some of the time, but it also should be played without an instrument much of the time.

3. When your baby is born, after the initial lung-clearing cry, sing the song to your baby. The baby can be in your arms or with a nurse in the warmer. If your baby is crying, try to sing close to his/her ear or loud enough that he/she can hear it at least during the pauses to take a breath.

4. Continue singing it every day, especially during times when your baby is crying (and has been fed; don’t use it as a substitute for feeding!)

5. Sing it when bathing or diapering your baby, when soothing or helping your baby go to sleep.

6. Sing it when your baby is upset and you can’t pick her up, such as when driving in the car and you can’t stop or take the baby out of the car seat; or at a checkup if the doctor is doing something painful.

Maia sings to her sister in utero ©Penny Simkin

If parents feel they can’t sing or are too embarrassed to do it, I suggest choosing a poem that has a nice rhythmic meter, and recite that to the baby. I recommend Mother Goose Rhymes or poems in books by AA Milne, such as “When We Were Very Young” and “Now We Are Six;” or Shel Silverstein’s “Where the Sidewalk Ends” and others.

Film clips showing baby’s reactions to familiar songs 

Recent students in my birth class took my suggestion to heart, singing “Las Mañanitas,” from their Mexican culture, to their unborn baby frequently. The dad would lie with his head on the mother’s pregnant belly as they sang. They even videotaped sessions while the mother was having a non-stress test that showed the baby’s heart rate steadying when the dad was singing, and rising when he was not.  We also see the dad singing to their sweet little daughter right after the birth. Though she cries pretty hard when being suctioned and rubbed with blanket, she calms down with his singing.

I’ve just completed a film for children (9). In the film, we see 4 year old Maia singing  ”Twinkle, Twinkle, Little Star” to her baby sister before birth and again right after birth. Neve, her sister, calms down when she hears Maia singing the familiar song.

Enjoy these heartwarming scenes in the video below.

Conclusion

Maia sings to her newborn sister ©Penny Simkin

In conclusion, when parents sing one (or possibly a few) songs repeatedly to their child, before and after birth, it is a once in a lifetime opportunity to build a unique, meaningful and fun connection with their baby. The child already knows and loves the song as sung by his/her parents more than any other song, sung by anyone else. Parents always have their voice with them and can use it to comfort, soothe, and play with their child for years to come. Parents have the opportunity prenatally to give their baby a gift that becomes a gift for them as well.

Singing to the baby before and after birth is a lovely and very special thing to do. Would you consider introducing this ritual to your students, clients and patients?  Have you already done so?  How has it been received?  Do you have any stories about parents who have practiced this connection? Please share in the comments section, I would love to hear about it.  If we all get the word out to expectant families, it could have a very positive impact.

References:

  1.  Brazelton B. Cramer B. (1991)The Earliest Relationship: Parents, Infants, and The Drama Of Early Attachment . Da Capo Press Cambridge, MA.
  2. De Casper A. 1974, as described in Klaus M, Klaus P, Kennell J. 2000. Your Amazing Newborn. Da Capo Press, Cambridge, MA..
  3. Odent M. 1984, Birth Reborn. Pantheon Books: New York
  4. Klaus M, Klaus P, Kennell J. 2000, Your Amazing Newborn. Da Capo Press, Cambridge, MA.
  5. Verny T, Kelly J. (1982)   The Secret Life of the Unborn Child. Dell: NY
  6. Chamberlain D. (2013) Windows to the Womb. North Atlantic Books: Berkeley, CA.
  7. Lubitzky R, Mimouri F, Dollberg S, Reifen R, Ashbel G, Mandel D. 2010. Effect of music by Mozart on energy expenditure in growing preterm infants. Pediatrics 126;e24-e28. DOI: 10.1542/peds.2009-0990.
  8. Simkin P. (2012) Singing to the baby before and after birth.  International Doula 19(3):30-31
  9. Simkin P. (2013) “There’s a Baby: A Children’s Film About New Babies.” PassionflowersProductions: Seattle.

 

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

Free Lamaze Webinar: Childbirth Education – A Collaborative Role for Nurses and Doctors

February 22nd, 2013 by avatar

 

Join us for a Webinar on Thursday, February 28,  from 12 p.m. to 1 p.m. EST.  

Lamaze International and OB Consult are collaborating on a joint education initiative to provide evidence-based and complimentary educational services to OB nursing staff and physicians on their role in supporting patient childbirth education and participation, resulting in enhanced physician-patient relationships, engaged mothers, and healthier babies.  This Webcast officially launches this new collaborative initiative.

Childbirth preparation has been an integral part of the birth experience for centuries, in the beginning as experiential learning when births occurred in the home and then in the 50s and 60s as part of a formal curriculum in physician offices, hospitals and the community.

Travel with us through time to see how the trends in childbirth and childbirth education can impact the care that pregnant women and their families experience in the 21st century.

  • Is childbirth education a passing fancy or an integral part of the childbirth experience?
  • How can physicians, nurse midwives and nurses work together to create a safe and satisfying birth experience for all involved?

Learn about evidence-based strategies that you can put into place now and in the future to educate all stakeholders in the experience of birth.

This presentation is open to all OB department staff, including OB-Gyns, OB department managers, OB nurses, lactation consultants, educators, doulas and the rest of the OB team.  This includes YOU!

This presentation features our own Michele Ondeck, RN, MEd, IBCLC, LCCE, FACCE,  Lamaze International President-Elect and Margaret “Peggy” M. DeZinno, BS, RN, LCCE, an OB-Gyn risk management specialist.

This is a great opportunity to learn more about the Lamaze International and OB Consult cooperative venture, and clarify the importance of your role in supporting families and babies as part of the OB team.

Find more information on the Lamaze International Webinar page. Register now by following this link.

For more info, questions about registration or webinar content, please contact OB Consult at 717.399.6658 or ceb@ob-consult.com

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Space is limited.
Reserve your Webinar seat now at:
https://www1.gotomeeting.com/register/245111544

 

Childbirth preparation has been an integral part of the birth experience for centuries, in the beginning as experiential learning when births occurred in the home and then in the 50s and 60s as part of a formal curriculum in physician offices, hospitals and the community.
Travel with us through time to see how the trends in childbirth and childbirth education can impact the care that pregnant women and their families experience in the 21st century.
•     Is childbirth education a passing fancy or an integral part of the childbirth experience?
•     How can physicians, nurse midwives and nurses work together to create a safe and satisfying birth experience for all involved?
Learn about evidence-based strategies that you can put into place now and in the future to educate all
stakeholders in the experience of birth.

 

Title:

Childbirth Education – A Collaborative Role for Nurses and Doctors

Date:

Thursday, February 28, 2013

Time:

12:00 PM – 1:00 PM EST

Babies, Childbirth Education, Continuing Education, Evidence Based Medicine, Lamaze International, Maternal Quality Improvement, Webinars , , , , , , , , , , ,

“Choosing Wisely” in maternity care: ACOG and AAFP urge women to question elective deliveries.

February 21st, 2013 by avatar

 

http://flic.kr/p/4v3Zeh

Last April, the ABIM Foundation, with Consumer Reports and other partners, drew national attention to overuse of ineffective and harmful practices across the health care system with their Choosing Wisely campaign. As part of the campaign, professional medical societies identified practices within their own specialties that patients should avoid or question carefully. Today, the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Family Physicians (AAFP) have joined the campaigndrawing national attention to the overuse and misuse of induction of labor. ACOG and AAFP are telling women and their maternity care providers:

Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.

Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable. 

(“Favorable” means the cervix is already thinned out and beginning to dilate, and the baby is settling into the pelvis. Another word for this is “ripe,” and doctors and midwives use a tool called the Bishop Score to give an objective measurement of ripeness. Although ACOG and AAFP do not define “favorable,” studies show cesarean risk is elevated with a Bishop Score of 8 or lower in a woman having her first birth and 6 or lower in women who have already given birth vaginally.)  

Much work has already been done to spread the first message. Although ACOG has long advised against early elective deliveries, a confluence of quality improvement programs and public awareness campaigns have made it increasingly difficult for providers to perform non-medically indicated inductions or c-sections before 39 weeks.

But as the public and the health care community have accepted the “39 weeks” directive, concern about unintended consequences has grown. Christine Morton, a researcher at the California Maternal Quality Care Collaborative and regular contributor to Science & Sensibilitysums up concerns shared by many, including Childbirth Connection:

It is possible that this measure may sensitize stakeholders to the wrong issue: timing of birth rather than the fact that it is generally best when labor begins on its own.  Additionally, is it possible that 39 weeks could become the new “ideal” gestational age, because it will be assumed that 39 completed weeks is the best time to be born?

The second Choosing Wisely statement aims to mitigate these unintended consequences. Inducing with an unripe cervix significantly increases the chance of a c-section and its many associated harms. Women considering induction for a non-medical reason deserve to know about these excess risks, and should question whether it is worth any non-medical benefits of elective delivery they perceive or expect. Lamaze International has spoken to the importance of letting labor begin on its own, as it is the first topic in the Six Healthy Birth Practices.

But will the new message lead women and care providers to think that delivery is indicated once a woman’s cervix is ripe? Through the Choosing Wisely campaign ACOG and AAFP have made powerful statements acknowledging that scheduled delivery is unwise if the baby or the woman might not be ready for birth. Although gestational age and the Bishop score are tools to estimate readiness for birth, the best indicator of readiness is still the spontaneous onset of labor at term, the culmination of an intricate interplay of hormonal signals between the fetus and the woman. Anytime we intervene with the timing of birth we have to weigh the potential benefits and harms of overriding that process in the context of the fully informed preferences and values of women.

This summer, our collaboration with the Informed Medical Decisions Foundation will culminate in the release of our first three Smart Decision Guides. These evidence-based, interactive decision support tools will help women learn the possible benefits and harms of scheduled delivery versus waiting for labor to start on its own and to weigh these based on what is most important to them. These tools help women choose wisely – to identify when an option is not appropriate or safe for them, and to thoughtfully weigh options when there are both pros and cons to consider.

Interested in learning more about shared decision making in maternity care? Sign up for a free webinar on March 13 sponsored by the Informed Medical Decisions Foundation to hear more about what clinicians, consumers, employers, and others thinking about the importance of maternity care shared decision making.

 

ACOG, Childbirth Education, Evidence Based Medicine, Guest Posts, Healthcare Reform, Healthy Birth Practices, Healthy Care Practices, informed Consent, Maternal Quality Improvement, Medical Interventions, Practice Guidelines, Pre-term Birth, Webinars , , , , , , , , , ,

Parents’ Singing to Fetus and Newborn Enhances Their Well-being, Parent-Infant Attachment, & Soothability: Part One

February 19th, 2013 by avatar

Regular contributor Penny Simkin shares her experiences with parents who sing to their baby in utero and then continue after birth and looks at what the research says about this practice in this two part blog piece.  Part two can be found here. Join me in reading about some unique situations that Penny shares as she explores this opportunity for parents to bond with their unborn child.  - Sharon Muza, Science & Sensibility Community Manager.

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People have sung to their babies forever. Every culture has lullabies and children’s songs that are passed down through the generations. New ones are written and shared and the custom goes on –a rich part of the fabric of human civilization. These songs are designed to relax babies, calm their fears, or entertain and amuse them throughout childhood. As we have learned more about the life and capabilities of the fetus, we have realized that the fetus can hear clearly for months before birth, and also can discriminate sounds and develop preferences for some sounds over others. Furthermore, at birth, newborns respond to familiar sounds by becoming calm and orienting toward the source of the sound, and even indicate their preferences for familiar voices and words over the unfamiliar.

Newborn babies prefer their parents’ and other familiar voices over those of strangers (1), and they prefer hearing a story that their mother had read frequently in utero rather than an unfamiliar story or the familiar one read by someone other than their mother (2).  Fetuses hear, remember, have preferences, respond to, and discriminate among differences — in sounds, music, voices.

These exciting findings have inspired educators to advocate prenatal learning through recordings played through a mother’s abdomen (of languages, music, and other things). They have inspired birth activists and baby advocates to provide a safe enriching environment for the fetus. Advocates of prenatal bonding emphasize communication between parent and unborn child as a powerful way to strengthen the bond.

I’d like to offer my take on this phenomenon and urge everyone who works with expectant parents to tell them about some unique and heart-warming benefits of singing or reciting rhymes to their unborn babies.

I think my interest in parents singing to their babies prenatally began in the 1980s when I first read Michel Odent’s book, “Birth Reborn”(3). Odent is a French physician who has always been ahead of his time. He had a unique and original maternity care program at his hospital in Pithiviers, France. His book had a great influence on my understanding of normal birth, and the book is still worth reading today, along with all his subsequent ones. One lovely aspect of his program is particularly relevant to the topic of this blog post. The program included a weekly singing group at the hospital, attended by pregnant women, their partners, families with young babies, the midwives, and Odent himself. The group was led by an opera singer who believed singing to be important for fetuses, babies and those who care for them. Odent’s account inspired me to invite Jamie Shilling, a folk singer who had recently taken my birth class, to bring her guitar and her baby to my classes a half hour early each week and sing with the expectant parents. That went on very successfully for several class series, then the groups decided to combine and carry on in a monthly sing- along for expectant parents and new families, in a private home –Although the groups  eventually disbanded, they provided many parents with opportunities to sing together and connect with their babies and each other in relaxing and peaceful surroundings. A high point during that time was when Michel Odent came to Seattle to give a conference and he agreed to come to one of our sing-alongs. See the photo of Jamie leading the group of expectant and new parents, with Michel Odent and myself participating. He taught us the song, “Little Black Cat” in French.

© Penny Simkin

I couldn’t help but think during those times, how the unborn and new babies must love hearing their parents singing. Seeing the parents caressing the mother’s belly as they sang was heartwarming. That happened  in the mid- 1980s, when much research on the capabilities of the unborn and newborn baby was beginning to be published. Recalling those special gatherings, I have always suggested to my students in childbirth class that they sing to their unborn babies, or play their favorite recorded music, with the thought that the baby will remember it and be soothed by it after birth.

But it was one couple, whom I served as a birth doula, who took my suggestion to another level, and showed me much more about the value of singing to the unborn baby. They were having their second child, hoping for a VBAC. When they discovered that they were having a boy, they decided to give their baby the song, “Here Comes the Sun” and sang it to him often during pregnancy. The VBAC was not possible, and as the cesarean was underway, and the baby boy, crying lustily, was raised for the parents to see, the father began belting out the baby’s song. Though the mother didn’t have a strong voice under the circumstances, she also sang. The baby turned his head, turned his face right toward his father and calmed down while his father sang. Time stopped. As I looked around the operating room, I saw tears appear on the surgical masks.

It’s a moment I’ll never forget, and it was that event that taught me the value, not only of singing prenatally, but also, singing the same song every day. Not only does the baby hear his or her parents’ voices, not only does he or she hear music, but the baby also gets to know one song very well. Familiarity adds another feature to this concept, because we know that fetuses have memory and prefer the familiar. Think for a moment about what this might have meant to our cesarean-born baby –suddenly being removed from the warmth, wetness, and dimness of the womb with its mother’s reassuring heartbeat, into the cold bright noisy operating room. The baby’s transition to extrauterine life is hectic and full of new sensations. He cries reflexively, but perhaps also out of shock and discomfort. Then he hears something familiar – voices and music and the sounds of words that he has heard many times before – something he likes. He calms down, and seeks the source of this familiar song. Everyone present is moved by this gift to the baby from his parents.

I’ve become passionate about this idea as a way to enhance bonding between parents and babies, but also as a unique and very practical measure for soothing a fussing baby or a sick baby who can’t be held or breastfed. Please join me on Thursday, for Part Two on this topic when I will continue the discussion including research evidence that supports this concept: practical suggetions for childbirth professionals to share with expectant parents; and some very endearing film clips of families singing to their babies.

References:

1. Brazelton B. Cramer B. (1991)The Earliest Relationship: Parents, Infants, and The Drama Of Early Attachment . Da Capo Press Cambridge, MA.

2. De Casper A. 1974, as described in Klaus M, Klaus P, Kennell J. 2000. Your Amazing Newborn. Da Capo Press, Cambridge, MA.

3. Odent M. 1984, Birth Reborn. Pantheon Books: New York 

Cesarean Birth, Childbirth Education, Doula Care, Guest Posts, Infant Attachment, Newborns, Parenting an Infant, Vaginal Birth After Cesarean (VBAC) , , , , , ,