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New Lamaze International Epidural Infographic – Information, Not Judgment

November 4th, 2014 by avatar

Lamaze_EpiduralInfographic_FINALAs a follow up to Henci Goer’s recent analysis of the the Cochrane Systematic Review of the just released epidural study - Early versus late initiation of epidural analgesia for labour,  I wanted to share the newest Lamaze International infographic “Is An Epidural My Only Option?” geared for expectant families.  This fact sheet provides information not only about the epidural, it shares the risks and benefits.  The infographic discusses how to reduce risks and improve outcomes when laboring people choose to use one, such as trying other things first before asking for an epidural and changing positions frequently after the epidural is administered.

Additionally, there are several suggestions for alternatives to an epidural, which some people may find really helps to minimize pain, including using a doula for labor and birth support.  Encouraging families to ask questions about alternatives of their health care providers, choosing a facility that supports alternative forms of pain relief and discussing with their partners how the partner can help them to cope during labor.

I really appreciate the strong encouragement for families to take a Lamaze Childbirth Class in order to learn more about labor and birth and the coping skills that can promote a safe and health birth for mother and baby.  My childbirth classes are chock full of positions, techniques and tips to help reduce pain, maximize comfort and promote normal birth.  We thoroughly cover pain medication options as well, and families leave confident that they can effectively ask for and receive the information they need to make a decision about what, if any, medications they will choose during labor to help with pain.

I invite you to head over and check out the new epidural infographic, consider sharing the print or electronic version and checking out all the wonderful Lamaze resources on the website for educators.  Your students and clients can find the same information on the parent site!

Which infographic is your favorite? Which one do you use and refer to most frequently?  Let us know in the comments section below.

 

Childbirth Education, Medical Interventions, Push for Your Baby , , ,

Looking Ahead to 2015 Conferences – Is Your Event Listed On Our Conference Calendar?

October 30th, 2014 by avatar
2014 conference

Sharon Muza & Jeanette McCulloch present@ Lamaze/DONA 2014

I just received, via email, my contact hour documentation from my attendance at the Lamaze International/DONA International Confluence that was held in Kansas City, MO this past September.  In addition to conferences being a wonderful place to network with colleagues, participate in engaging learning opportunities and travel and explore a new city, most conferences also offer the opportunity to be awarded the continuing education/contact hours that I need to maintain both my Lamaze certification and my DONA birth doula certification.  Both of these recertifications require renewal every three years, and I am working on my Lamaze recertification now, due by the end of December.

At the same time as I am closing out the 2014 year, I am looking at the available conferences scheduled for 2015, planning out my year, allocating both my financial resources and my available time.  I am going to be sure to plan on attending the Lamaze/ICEA Joint Conference scheduled for September 2015 in Las Vegas, NV.  I am looking for other opportunities as well!

Is your organization offering a conference or workshop that other birth professionals, including childbirth educators, doulas, nurses, midwives, physicians, lactation consultants, counselors, and others involved in maternal infant care would want to know about?  If so, please be sure to submit your organization’s event using our online submission form, so we can get it posted in our maternal health, birth, breastfeeding and postpartum conference schedule.

Take a look at what is listed now, check back regularly for new additions and start to plan what conferences are the ones that you don’t want to miss!  Let us know in the comments section what plans you have made for attending a 2015 conference. What looks exciting to you?

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October is SIDS Awareness Month – Educators Can Share Information to Help Families Reduce Risk!

October 28th, 2014 by avatar

Safe to Sleep®SIDS PreventionOctober has been designated as a time to observe some solemn occasions that may affect families during pregnancy, birth and postpartum.  This month, Science & Sensibility has previously covered Pregnancy and Infant Loss Awareness Month in two previous posts here and here.  Today I would like to recognize that October is also SIDS Awareness Month.

As childbirth educators, part of our curriculum for expecting parents includes discussing SIDS, providing an explanation of what it is (and what it isn’t)  and how to reduce the risk of a SIDS death.

What is SIDS?

Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted that includes a complete autopsy, examination of the death scene, and a review of the medical history. SIDS is the leading cause of death for infants aged 1 to 12 months in the United States.  About 2000 infants die every year in the USA from SIDS. African American and American Indian/Alaskan Native babies are twice as likely to die of SIDS as white babies.

Most SIDS deaths occur in babies between 1 month and 4 months of age, and the majority (90%) of SIDS deaths occur before a baby reaches 6 months of age. However SIDS deaths can occur anytime during a baby’s first year. Slightly more boys die of SIDS than girls.

Since the USA introduced the Safe to Sleep® campaign (formerly known as the Back to Sleep Campaign) in 1994, the number of infants dying of SIDS has dropped by 50%.

What SIDS is not

  • SIDS is not suffocation nor is it caused by suffocation
  • Vaccines and immunizations do not cause SIDS
  • SIDS is not a result of choking or vomiting
  • SIDS is not caused by neglect or child abuse
  • SIDS is not contagious
  • SIDS is not caused by strangulation

What causes SIDS?

While the cause of SIDS is not known, there is more and more evidence that infants who die from SIDS have brain abnormalities that interfere with how the brain communicates with the parts of the nervous system that control breathing, heart rate, blood pressure, waking from sleep, temperature and other things.  More information on what researchers are finding as they work to identify the cause of SIDS can be found here.

What are the risk factors for SIDS?

There are several risk factors that put babies at higher risk of SIDS.  Childbirth educators should be providing this information to families during class. These risk factors include:

  • Being put to sleep on their stomachs
  • Being put to sleep on couches, chairs, or other soft surfaces or under soft coverings
  • Being too hot during sleep
  • Being put to sleep on or under soft or loose bedding
  • Being exposed to smoke in utero, or second hand cigarette smoke in the home or car, or the second hand smoke of care-givers or family.
  • Sleeping in an adult bed with parents, other children or pets especially if:
    • Bed-sharing with an adult who smokes, recently had alcohol or is tired
    • Sleeping with more than one bed sharer
    • Covered by a blanket or a quilt
    • Younger than 14 weeks of age

NOTE: If families in your classes are going to be bed-sharing with their infants, (which sometimes is the reality for new parents getting accustomed to life with baby) it is important for you to provide information about what safe bed sharing looks like.  I recommend “Sharing Sleep with Your Baby” by Robin Elise Weiss for resources to share on this topic.

What reduces the risks of SIDS?

New parents can do many things to reduce the risk of their infant dying from SIDS.  You can share this information with your classes.   These risk reductions include:

  • Always place a baby to sleep on his/her back
  • Have the baby sleep on a firm sleep surface (Not a carseat, bouncy seat or swing as your baby’s normal sleep spot.)
  • No crib bumpers, toys, soft objects, or sleep positioning products (even if they claim to reduce the risk of SIDS) in the baby’s sleep space
  • Breastfeed the baby
  • Room sharing with the baby
  • Have regular prenatal care during pregnancy
  • Mothers who refrain from smoking, drinking alcohol or using illicit drugs during pregnancy and after the baby is born
  • Do not allow second hand smoke around the baby or have caregivers or family members who smoke around the baby
  • Once breastfeeding and milk supply is firmly established and baby is gaining weight appropriately, offer a pacifier (not on a string) when baby goes down for their last sleep.
  • Do not overdress the baby for bed or overheat the room
  • Maintain all the healthy baby checkups and vaccines as recommended by the baby’s health care provider
  • Do not use home breathing monitors or heart monitors that claim to reduce the risk of SIDS.

Talking about difficult topics in a childbirth class can be hard for both the eductor and the families.  No one wants to think that the unthinkable might happen to them.  But sharing accurate facts about the risks and how to reduce those risks is an important part of any childbirth curriculum.  How and when do you discuss this topic in your classes?  Do you have a video or handout that you like to share?  Please let us know in the comments section, how you effectively cover SIDS topics in your childbirth classes.

Resources for professionals

Resources for parents and caregivers

 

 

 

 

 

 

 

Babies, Breastfeeding, Childbirth Education, Newborns , , , , ,

Epidural Analgesia: To Delay or Not to Delay, That Is the Question

October 23rd, 2014 by avatar

By Henci Goer

Unless you have been “off the grid” on a solitary trek, surely you have read and heard the recent flurry of discussion surrounding the just released study making the claim that the timing of when a woman receives an epidural (“early” or “late” in labor) made no difference in the rate of cesarean delivery.  Your students and clients may have been asking questions and wondering if the information is accurate.  Award winning author and occasional Science & Sensibility contributor Henci Goer reviews the 9 studies that made up the Cochrane systematic review: Early versus late initiation of epidural analgesia for labour to determine what they actually said.  Read her review here and share if you agree with all the spin in the media about this new research review. Additionally, head on over to the professional and parent Lamaze International sites to check out the new infographic on epidurals to share with your students and clients.- Sharon Muza, Science & Sensibility Manager. 

Epidural infographic oneArticles have been popping up all over the internet in recent weeks citing a new Cochrane systematic review- Early versus late initiation of epidural analgesia for labour, concluding that epidural analgesia for labor needn’t be delayed because early initiation doesn’t increase the likelihood of cesarean delivery, or, for that matter, instrumental vaginal delivery (Sng 2014). The New York Times ran this piece. Some older studies have found that early initiation appeared to increase likelihood of cesarean (Lieberman 1996; Nageotte 1997; Thorp 1991), which is plausible on theoretical grounds. Labor progress might be more vulnerable to disruption in latent than active phase. Persistent occiput posterior might be more frequent if the woman isn’t moving around, and fetal malposition greatly increases the likelihood of cesarean and instrumental delivery. Which is right? Let’s dig into the review.

The review includes 9 randomized controlled trials of “early” versus “late” initiation of epidural analgesia. Participants in all trials were limited to healthy first-time mothers at term with one head-down baby. Five trials further limited participants to women who began labor spontaneously, three mixed women being induced with women beginning labor spontaneously, and in one, all women were induced. Analgesia protocols varied, but all epidural regimens were of modern, low-dose epidurals. So far, so good.

Examining the individual trials, though, we see a major problem. You would think that the reviewers would have rejected trials that failed to divide participants into distinct groups, one having epidural initiation in early labor and the other in more advanced labor, since the point of the review is to determine whether early or late initiation makes a difference. You would think wrong. Of the nine included trials, six failed to do this.

cc photo bryanrmason http://flickr.com/photos/b-may/397189835

cc photo bryanrmason http://flickr.com/photos/b-may/397189835

The two Chestnut trials (1994a; 1994b) had the same design, differing only in that one was of women who were laboring spontaneously at trial entry and the other included women receiving oxytocin for induction or augmentation. Women were admitted to the trial if they were dilated between 3 and 5 cm. Women in the early group got their epidural immediately while women in the late group could have an epidural only if they were dilated to 5 cm or more. If late-group women were not dilated to 5 cm, they were given systemic opioids and could have a second dose of opioid one hour later. They could have an epidural when they attained 5 cm dilation or regardless of dilation, an hour after the second opioid dose. Let’s see how that worked out.

Among the 149 women in the trial that included women receiving oxytocin (Chestnut 1994b), median dilation in the early group at time of epidural initiation was 3.5 cm, meaning that half the women were dilated more and half less than this amount. The interquartile deviation was 0.5 cm, which means that values were fairly tightly clustered around the median. The authors state, however, that cervical dilation was assessed using 0.5 increments which meant that dilation of 3-4 cm was recorded as 3.5. In other words, women in the early group might have been dilated to as much as 4 cm. The median dilation in the late group was 5.0 cm, again with a 0.5 cm interquartile deviation. Some women in the late group, therefore, were not yet dilated to 5 cm when their epidural began, and, in fact, the authors report that 26 of the 75 women (35%) in the late group were given their epidural after the second dose of opioid but before attaining 5 cm dilation. The small interquartile deviation in the late group tells us that few, if any, women would have been dilated much more than 5 cm. Add in that assessing dilation isn’t exact, so women might have been a bit more or less dilated than they were thought to be, and it becomes clear that the “early” and “late” groups must have overlapped considerably. Furthermore, pretty much all of them were dilated between 3 and 5 cm when they got their epidurals, which means that few of these first-time mothers would have been in active labor, as defined by the new ACOG standards.

Overlap between early and late groups must have been even greater in Chestnut et al.’s (1994a) trial of 334 women laboring spontaneously at trial entry because median dilation in the early group was greater than in the other trial (4 cm, rather than 3.5) while median dilation in the late group was the same (5.0 cm), and interquartile deviation was even tighter in the late group (0.25 cm, rather than 0.5 cm). As before, dilation was measured in 0.5 cm increments, which presumably means that women in the early group dilated to 4-5 cm would have been recorded as “4.5,” thereby qualifying them for the “early” group even though they might have been as much as 5 cm dilated.

Based on my analysis, I would argue that there was no clinically meaningful difference in dilation between early and late groups in either trial.

A second pair of trials, one a mixed trial of spontaneous labor onset and induction and the other all induced, also had the same design in both trials (Wong 2005; Wong 2009). All women were less than 4 cm dilated at first request for pain medication. In the early group, women had an opioid injected intrathecally, i.e. the “spinal” part of a combined spinal-epidural, and an epidural catheter was set. At the second request, an epidural was initiated. In the late group, women were given a systemic opioid. At second request, they were given a second dose of systemic opioid if they hadn’t reached 4 cm dilation and an epidural if they had dilated to 4 cm or more. At third request, they were given an epidural regardless of dilation. Women who had no vaginal exam at second request and were given an epidural were “assumed,” in the authors’ words, to be dilated to at least 4 cm. What were the results?

Wong (2005) included 728 women, some beginning labor spontaneously and some induced. You may already have noticed the flaw in the trials’ design: Wong and colleagues confused the issue by considering intrathecal opioid to be equivalent to epidural anesthetic in the early group, although women didn’t actually receive anesthetic until their second request for pain medication some unknown time later. So far as I know we have no evidence that opiods, spinal or epidural, have any effect on labor progress. As to dilation at the time of epidural initiation, 63% of women in the so-called “early” group were either determined or assumed to be at 4 cm dilation or more while in the late group, some unknown proportion were less than 4 cm dilated either because they got their epidural at third pain medication request regardless of dilation or they were assumed to be at 4 or more cm dilation at second request, but weren’t assessed.

Wong (2009), a study of 806 induced women, was set up the same way but reported data somewhat differently. Early-group women were administered a spinal opioid at a median of 2 cm dilation and an interquartile range of 1.5 to 3 cm, which means that values in the middle 50% of the dataset ranged from 1.5 to 3 cm. We have no information on dilation at the time they received their epidural. The median dilation at which late-group women had their epidural initiated was 4 cm with an interquartile range of 3 to 4 cm, that is, in the middle 50% of the dataset ranged from 3 to 4 cm dilation.

As with the Chestnut trials, dilation at time of epidural initiation in the two Wong trials must have overlapped considerably between groups. And, again, few women in the late epidural group would have been in active labor. The Wong trials, however, muddy the waters even further by considering spinal opioid to be the same thing as epidural anesthetic, and while the authors were careful to use the term “neuraxial analgesia,” the Cochrane reviewers made no such distinction.

This brings us to Parameswara (2012), a trial of 120 women that included both spontaneous onset and induced labors. This trial defined the early group as women less than 2 cm dilated at time of epidural initiation and the late group as women more than 2 cm dilated. That’s all the information they provide on group allocation.

Last of the six, we have Wang (2011), a trial of 60 women in spontaneous labor. All women were given intrathecal anesthetic plus opioid. The early group was started on epidural anesthetic plus opioid 20 minutes later whereas the late group had their epidural initiated when they requested additional pain relief. No information is given on dilation at time of epidural initiation. Not only do we have no idea whether early and late groups differed from one another, women in both groups received neuraxial anesthetic at the same time.

In summary, “garbage in, garbage out.” No conclusions can be drawn about the effect of early versus late epidural administration from these six studies.

The other three studies are a different story. They achieve a reasonable separation between groups. Luxman (1998) studied 60 women with spontaneous labor onset. The early group had a mean, i.e., average, dilation of 2.3 cm with a standard deviation of + or – 0.6 cm while the late group had a mean dilation of 4.5 cm + or – 0.2 cm. Ohel (2006) studied a mixed spontaneous onset and induced group of 449 women. The mean dilation at initiation in the early group was 2.4 cm with a standard deviation of 0.7 cm, and the late group had a mean dilation of 4.6 cm with a standard deviation of 1.1 cm. Wang (2009), the behemoth of the trials, included 12,629 women who began labor spontaneously. The early epidural group had a median dilation of 1.6 cm with an interquartile range of 1.1 to 2.8 and the late group a median of 5.1 cm dilation with an interquartile range of 4.2 to 5.7. Cesarean and instrumental delivery rates were similar between early and late groups in all three trials, so had reviewers included only these three trials, they would still have arrived at the same conclusion: early epidural initiation doesn’t increase likelihood of cesarean and instrumental delivery.

We’re not done, though. Wang (2009) points us to a second, even bigger issue.

The Wang (2009) trial, as did all of the trials, limited participants to healthy first-time mothers with no factors that would predispose them to need a cesarean. The Wang trial further excluded women who didn’t begin labor spontaneously. Nevertheless, the cesarean rate in these ultra-low-risk women was an astonishing 23%. Comparing the trials side-by-side reveals wildly varying cesarean and instrumental vaginal delivery rates in what are essentially homogeneous populations.

© Henci Goer

© Henci Goer

© Henci Goer

© Henci Goer

Comparing the trials uncovers that epidural timing doesn’t matter because any effect will be swamped by the much stronger effect of practice variation.

Analysis of the trials teaches us two lessons: First, systematic reviews can’t always be taken at face value because results depend on the beliefs and biases that the reviewers bring to the table. In this case, they blinded reviewers from seeing that two-thirds of the trials they included weren’t measuring two groups of women, one in early- and one in active-phase labor. Second, practice variation can be an unacknowledged and potent confounding factor for any outcome that depends on care provider judgment.

Conclusion

So what’s our take home? Women need to know that with a judicious care provider who strives for spontaneous vaginal birth whenever possible, early epidural administration won’t increase odds of cesarean or instrumental delivery. With an injudicious one, late initiation won’t decrease them. That being said, there are other reasons to delay an epidural. Maternal fever is associated with epidural duration. Running a fever in a slowly progressing labor could tip the balance toward cesarean delivery as well as have consequences for the baby such as keeping the baby in the nursery for observation, testing for infection, or administering prophylactic IV antibiotics. Then too, a woman just might find she can do very well without one. Epidurals can have adverse effects, some of them serious. Comfort measures, cognitive strategies, and all around good emotionally and physically supportive care don’t. Hospitals, therefore, should make available and encourage use of a wide range of non-pharmacologic alternatives and refrain from routine practices that increase discomfort and hinder women from making use of them. Only then can women truly make a free choice about whether and when to have an epidural.

After reading Henci’s review and the study, what information do you feel is important for women to be aware of regarding epidural use in labor?  What will you say when asked about the study and timing of an epidural?  You may want to reference a previous Science & Sensibility article by Andrea Lythgoe, LCCE, on the use of the peanut ball to promote labor progress when a woman has an epidural. – SM 

References

Caughey, A. B., Cahill, A. G., Guise, J. M., & Rouse, D. J. (2014). Safe prevention of the primary cesarean delivery. American journal of obstetrics and gynecology210(3), 179-193.

Chestnut, D. H., McGrath, J. M., Vincent, R. D., Jr., Penning, D. H., Choi, W. W., Bates, J. N., & McFarlane, C. (1994a). Does early administration of epidural analgesia affect obstetric outcome in nulliparous women who are in spontaneous labor? Anesthesiology, 80(6), 1201-1208. http://www.ncbi.nlm.nih.gov/pubmed/8010466?dopt=Citation

Chestnut, D. H., Vincent, R. D., Jr., McGrath, J. M., Choi, W. W., & Bates, J. N. (1994b). Does early administration of epidural analgesia affect obstetric outcome in nulliparous women who are receiving intravenous oxytocin? Anesthesiology, 80(6), 1193-1200. http://www.ncbi.nlm.nih.gov/pubmed/8010465?dopt=Citation

Lieberman, E., Lang, J. M., Cohen, A., D’Agostino, R., Jr., Datta, S., & Frigoletto, F. D., Jr. (1996). Association of epidural analgesia with cesarean delivery in nulliparas. Obstet Gynecol, 88(6), 993-1000. http://www.ncbi.nlm.nih.gov/pubmed/8942841

Luxman, D., Wolman, I., Groutz, A., Cohen, J. R., Lottan, M., Pauzner, D., & David, M. P. (1998). The effect of early epidural block administration on the progression and outcome of labor. Int J Obstet Anesth, 7(3), 161-164. http://www.ncbi.nlm.nih.gov/pubmed/15321209?dopt=Citation

Nageotte, M. P., Larson, D., Rumney, P. J., Sidhu, M., & Hollenbach, K. (1997). Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. N Engl J Med, 337(24), 1715-1719. http://www.ncbi.nlm.nih.gov/pubmed/9392696?dopt=Citation

Ohel, G., Gonen, R., Vaida, S., Barak, S., & Gaitini, L. (2006). Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial. Am J Obstet Gynecol, 194(3), 600-605. http://www.ncbi.nlm.nih.gov/pubmed/16522386?dopt=Citation

Parameswara, G., Kshama, K., Murthy, H. K., Jalaja, K., Venkat, S. (2012). Early epidural labour analgesia: Does it increase the chances of operative delivery? British Journal of Anaesthesia 108(Suppl 2):ii213–ii214. Note: This is an abstract only so all data from it come from the Cochrane review.

Sng, B. L., Leong, W. L., Zeng, Y., Siddiqui, F. J., Assam, P. N., Lim, Y., . . . Sia, A. T. (2014). Early versus late initiation of epidural analgesia for labour. Cochrane Database Syst Rev, 10, CD007238. doi: 10.1002/14651858.CD007238.pub2 http://www.ncbi.nlm.nih.gov/pubmed/25300169

Thorp, J. A., Eckert, L. O., Ang, M. S., Johnston, D. A., Peaceman, A. M., & Parisi, V. M. (1991). Epidural analgesia and cesarean section for dystocia: risk factors in nulliparas. Am J Perinatol, 8(6), 402-410. http://www.ncbi.nlm.nih.gov/pubmed/1814306?dopt=Citation

Wang, F., Shen, X., Guo, X., Peng, Y., & Gu, X. (2009). Epidural analgesia in the latent phase of labor and the risk of cesarean delivery: a five-year randomized controlled trial. Anesthesiology, 111(4), 871-880. http://www.ncbi.nlm.nih.gov/pubmed/19741492?dopt=Citation

Wang, L. Z., Chang, X. Y., Hu, X. X., Tang, B. L., & Xia, F. (2011). The effect on maternal temperature of delaying initiation of the epidural component of combined spinal-epidural analgesia for labor: a pilot study. Int J Obstet Anesth, 20(4), 312-317. http://www.ncbi.nlm.nih.gov/pubmed/21840705

Wong, C. A., McCarthy, R. J., Sullivan, J. T., Scavone, B. M., Gerber, S. E., & Yaghmour, E. A. (2009). Early compared with late neuraxial analgesia in nulliparous labor induction: a randomized controlled trial. Obstet Gynecol, 113(5), 1066-1074. http://www.ncbi.nlm.nih.gov/pubmed/19384122?dopt=Citation

Wong, C. A., Scavone, B. M., Peaceman, A. M., McCarthy, R. J., Sullivan, J. T., Diaz, N. T., . . . Grouper, S. (2005). The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med, 352(7), 655-665. http://www.ncbi.nlm.nih.gov/pubmed/15716559?dopt=Citation

About Henci Goer

Henci Goer

Henci Goer

Henci Goer, award-winning medical writer and internationally known speaker, is the author of The Thinking Woman’s Guide to a Better Birth and Optimal Care in Childbirth: The Case for a Physiologic Approach She is the winner of the American College of Nurse-Midwives “Best Book of the Year” award. An independent scholar, she is an acknowledged expert on evidence-based maternity care.  

Cesarean Birth, Childbirth Education, Epidural Analgesia, Guest Posts, informed Consent, Medical Interventions, New Research, Systematic Review , , , , , , ,

Mary Jo Podgurski, EdD, LCCE, Receives National Award for Work With Teens

October 21st, 2014 by avatar

Mary Jo Podgurski, RNC, EdD, LCCE, FACCE has been selected to receive the 2014 Carol Mendez Cassell Award for Excellence in Sexuality Education by the Healthy Teen Network.  Dr. Podgurski will be in Austin, Texas on Wednesday, October 22nd to accept the award at this year’s Healthy Teen Network conference: Synergy: Achieving More Together.

© Mary Jo Podgurski

© Mary Jo Podgurski

The Healthy Teen Network builds capacity among professionals and organizations through education, advocacy, and networking so that they can assist all adolescents and young adults, including teen parents, to have access to the services and education that allow them to make responsible choices about childbearing and family formation, and are supported and empowered to lead healthy sexual, reproductive, and family lives.

Dr. Podgurski could not be more deserving of this award. Her impact on the lives of the young people lucky enough to have been exposed to or participated in one of Dr. Podgurski’s programs is profound.  This woman is has a heart of gold.  At the top of Dr. Podgurski’s CV is the following statement, which so clearly speaks to what drives and shapes her work and her heart:

Perhaps the most important biographical fact needed to know about me deals with joy. I am blessed to spend my days interacting with young people and I treasure every moment; I believe deeply in their wisdom. My primary mantra is simple: Each person is a person of worth. Actually that tenet translates well to my primary value – that all must be respected, regardless of age, size, race, ethnicity, sexuality, sexual orientation, gender, gender identity, socio-economic status, education, religion, or position in society. My papa was my spiritual guide and he taught me that we are “all in this together.”   

Dr. Mary Jo Podgurski is the Director of The Washington Health System Teen Outreach and President and Founder of the Academy for Adolescent Health, Inc. Her undergraduate education is in nursing and education, her master’s work was in counseling, and her doctorate is in education. She began volunteering with pregnant teens in the 70s and has created numerous youth development and education programs using reality-based, interactive educational techniques that are evidence-based and empower youth. Teen Outreach programs have reached over 18,000 students annually through in-school sexuality education in all 14 Washington County school districts. Since the Outreach began she and her team have taught over 231,000 young people in-school comprehensive sexuality education in four counties and 38 schools in Western PA. The Outreach has mentored over 7,000 young parents and trained over 10,000 peer educators. She directs a monthly Adolescent Advisory Board of 75 teens, maintains an active peer educator group (since 1995), and produces original teen educational dramas through the Real Talk Performers. The Outreach’s Ambassador for Respect Program was created in 2006 and models respect throughout the county; the 2013-2014 focus was Respect for Older Adults and the 2014-2015 theme is Smash the Stereotypes.

© Mary Jo Podgurksi

© Mary Jo Podgurksi

During 2010, Dr. Podgurski introduced her Real Talk for Real Teens™ trainings on sexuality education for school staff; these trainings provide activities, lesson plans, and PowerPoint presentations for 5th and 6th graders, middle school and secondary school students. Her educational/mentoring programs for pregnant and parenting teens (PPT) reach over 150 young parents annually in three counties. The PRIDE (Parenting Responsibly with Dignity and Empowerment) PPT Program and a program for expectant teen fathers entitled REAL Dads: Strong Fathers, Strong Families Program involve intensive, weekly mentoring contact with professional staff and young parents. The PPT Program averages an 85 – 94% high school graduation rate; over the last decade students in the program have experienced a 3% or less repeat pregnancy rate. The ECHO (Educate Children for Healthy Outcomes) early intervention program she created in 1999 provides intensive educational mentoring on a weekly basis for youth in grades 7 – 12. Founded on the evidenced-based antecedents for early childbearing (history of abuse, internal and external poverty, foster placement, and generational teen pregnancy) ECHO served 581 at-risk young women between 1999-2009. Only three of those young people experienced a pregnancy and all three were 17 or 18. ECHO clients are typically seen for 4 – 5 years. ECHO is currently being evaluated with help from Susan Philliber Associates.

I have had the privilege of meeting Mary Jo several times over the years at various childbirth functions and conferences.  The magic that this wonderful woman possesses is clear from the minute you meet her.  If you are lucky to spend some time with her, her, you cannot help but see her special powers!  When you talk to Mary Jo, she makes you feel like you are the most important person in the world.  You are heard, listened to and valued.

nonnie podgurskiMary Jo dreams big and makes things happen!  The depth and breadth of what she has accomplished is so expansive. In addition to her extensive program development history, she is an accomplished author, with works that include Inside Out: Your Body is Amazing Inside and Out and Belongs Only to You, a body-positive, child-centered, interactive, child abuse prevention program, is a result of her experience with survivors. Her publications include Games Educators Play One and Two, and What’s Up as YOU Grow Up?  In 2014 she authored a cutting edge children’s book on the challenging topic of gender/gender identity. Nonnie Talks about Gender is unique, interactive, and pertinent to today’s culture. Her latest books are Real Talk for Real Teen Parents: A Real Life Workbook for Young Parents, and Real Talk for Real Teens: #communicate, an interactive collection of scenarios to inspire adult/teen communication.  Mary Jo Podgurski is also a Lamaze Certified Childbirth Educator and a Fellow in the Academy of Certified Childbirth Educators.

Mary Jo Podgurski, please accept my personal congratulations and those of the entire Lamaze International organization, as you accept the 2014 Carol Mendez Cassell Award for Excellence in Sexual Education.  We could not be more proud of you and we honor the work you are doing.  It is making a difference in the lives of many.  Thank you for all you do.

 

 

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