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April is Cesarean Awareness Month – Resources and a Test Your Knowledge Quiz

April 10th, 2014 by avatar

fb profile cam 2014April is Cesarean Awareness Month, an event meant to direct the American public’s attention to the United States’ high cesarean rate. 32.8% of all birthing women gave birth by cesarean in 2012. A cesarean delivery can be a life-saving procedure when used appropriately, but it takes one’s breath away when you consider that one third of all women birthing underwent major abdominal surgery in order to birth their babies.

Professionals that work with women during the childbearing year can be a great resource for women, pointing them to evidence based information, support groups and organizations that offer non-biased information to help women lower their risk of cesarean surgery, receive support after a cesarean and work towards a trial of labor after a cesarean (TOLAC) and achieve a vaginal birth after a cesarean (VBAC) for subsequent births if appropriate.

Here are my top suggestions for websites and resources every birth professional should have on their short list to share with students and clients when it comes to cesarean awareness.

1. International Cesarean Awareness Network – an international organization with almost 200 volunteer led chapters, (most in the USA) offering peer to peer support for cesarean recovery and VBAC information by way of a website, e-newsletters, webinars, online forums, Facebook groups and monthly meetings in the community.

2. VBACFacts.com – Led by birth advocate Jen Kamel, this website is big on research and helps consumers and professionals alike understand the evidence and risks and benefits of both repeat cesareans and vaginal birth after cesarean, including vaginal birth after multiple cesareans.

3. Lamaze International’s “Push for Your Baby” – is a great resource for families to learn about the Six Healthy Care Practices, what evidence based care looks like and how to work with your health care provider to advocate for a safe and healthy birth. Also Lamaze has an wonderful infographic that can be shared online or printed.

4. Spinning Babies – Midwife Gail Tully really knows her stuff when it comes to helping babies navigate the pelvis during labor and birth. Many cesareans are conducted for “failure to progress” or “cephalopelvic disproportion” when really it is a case of a malpositioned baby who needed to be in a different position. This website is a wealth of information on what women can do to help their babies into the ideal position to be born, prenatally and during labor. It includes valuable information about helping a breech baby turn vertex. This is important, because finding a health care provider who will support vaginal breech birth is like finding a needle in a haystack.

© Patti Ramos Photography

© Patti Ramos Photography

5. Childbirth Connection – This website is a virtual goldmine of evidence based information about cesareans and VBACs including a valuable guide “What Every Pregnant Woman Needs to Know about Cesareans.” There are questions to ask a care provider and includes information on informed consent and informed refusal.

6. Cesareanrates.com is a great website run by Jill Arnold for those who love the numbers. Find out the cesarean rates of hospitals in your area. All the states are represented and families can use the information when searching out a provider and choosing a facility. Jill’s resource page on this site is full of useful information as well.

7. Safe Prevention of the Primary Cesarean –  The American Congress of Obstetricians and Gynecologists along with the Society for Maternal Fetal Medicine recently published a groundbreaking document aimed at reducing the first cesarean. While fairly heavy reading, there is so much good information in this committee opinion that I believe every birth professional should at least take a peek. You may be pleasantly surprised.

Test your knowledge of the facts around cesareans and VBACs with this informative quiz:

As a birth professional, you can be a great resource for all your clients, helping them to prevent their first cesarean, providing support if they do birth by cesarean and assisting them on the journey to VBAC by pointing them to these valuable resources. You can make every day “Cesarean Awareness Day” for the families you work with, doing your part to help the pendulum to swing in the other direction, resulting in a reduction in our national cesarean rates and improving outcomes for mothers and babies. What are your favorite resources on the topic of cesareans and VBACs? Share with us in the comments section.
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  1. Patti Ramos
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Awards, Babies, Cesarean Birth, Healthcare Reform, Lamaze News, Maternal Mortality Rate, Maternal Obesity, New Research, Research, Webinars , , , , , , , , , , , ,

Childbirth Connection Joins with the National Partnership for Women & Families – Everyone Benefits

March 20th, 2014 by avatar

national partnership women family logoA favorite resource for both myself as a childbirth educator and one that I share frequently with families in my classes has long been Childbirth Connection. Since 1918, when this organization was founded and known as the Maternity Center Association, they have been a “national voice for safe, effective and satisfying evidence based maternity care.”  Childbirth Connection accomplishes this by highlighting current issues and obstacles in maternity care, sharing evidence based information in easy to read and understand downloadable handouts and partnering with other organizations, including Lamaze International to lobby for and promote evidence based care for women and their families in the childbearing year.

You may be familiar with Childbirth Connection as the organization that has been conducting and publishing the landmark Listening to Mothers Surveys and Reports since the first of the LTM reports was published in 2002.  These comprehensive reports questioned mothers about their experiences from preconception through the postpartum period and shed light on many issues – including how much of the care women are receiving is not based on evidence and how limited many of the choices women are given for options while receiving care.  Information discovered through the surveys and published in the LTM reports has been enlightening and sometime shocking, as it highlighted the “real life” experiences of women around the country – who are experiencing maternity care currently in the USA.

Earlier this year, Childbirth Connection announced that they are becoming a core program of the National Partnership for Women & Families, a Washington DC based organization founded in 1971, whose mission is to improve health for women and families, and make the nation’s workplaces more fair and family friendly.  Each organization brings different strengths to the collaboration. Childbirth Connection has a long history of clinical and research focus programs based on evidence based care, while the National Partnership has long established relationships with policy makers.  The fit is a natural one that will benefit American women and mothers and improve maternity care in the USA.

One of the first publications released by Childbirth Connection, under the umbrella of the National Partnership for Women & Families, was a report; “Listening to Mothers: The Experiences of Expecting and New Mothers in the Workplace.” This report was prepared from information gathered during the most recent LTM III survey.

Some key findings from this report include:

  • Holding a job during pregnancy is the new normal.  In fact, women are the primary or sole breadwinner in over 40% of families with children.
  • Women often need minor adjustments on the job to protect their health during pregnancy. 71% of women needed more frequent bathroom break and 61% of women needed some schedule modification or time off in order to attend crticial prenatal health care appointments.
  • Pregnant women’s need for accommodation often goes unspoken and may be unmet, or are often denied.  Many women do not speak up out of fear of repercussions, refusal or uncertainty about how their request will be viewed.
  • Less economically advantaged women are in greater need of accommodation than more advantaged women. Women of color, lower educated women and women who held part time jobs needed more accomodation.
  • Upon returning to work, new mothers experience bias, lost pay, loss of responsibilities and other actions, including losing their job altogether. More than one in four women reported experiencing bias from their employers due to perceptions of their “desire, ability, or commitment” to doing their jobs.
  • Breastfeeding remains a challenge for employed new mothers.  58% of women reported that breastfeeding while employed presented obstacles, including employers not providing an appropriate clean and private location or adequate breaks in which to express milk.

childbirth connectionAs childbirth educators, the women in our classes most likely are working outside the home and many will return to work after having their children.  These are issues that they will face no matter where they are located in the USA, and as educators we can sympathize with their situation and provide concrete resources to help them problem solve solutions.  The National Partnership for Women & Families/Childbirth Connection should be on the short list as a great resource for these women.  We can also share our own tips, encourage discussion amongst the families and help prepare them for some of the above challenges that they may face.

Congratulations to Childbirth Connection on this new opportunity!  I am looking forward to reading and sharing future work done by your organization and in cooperation with the National Partnership for Women & Families.  Educators and others – what information do you feel is important to share with your families about working while pregnant, returning to work after birth and maintaining the breastfeeding relationship once your students are working again.  Comment with your suggestions, advice and resources, so that we can all offer the best information to all families.

References

Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, A. (2013). Listening to Mothers III: New Mothers Speak Out. New York, NY: Childbirth Connection.

 

 

 

 

 

 

 

Babies, Childbirth Education, Maternal Quality Improvement, Maternity Care, Transforming Maternity Care , , , ,

Do We Need to Turn Up the Volume on Lamaze’s Healthy Birth Practices? What The Listening to Mothers III Survey Tells Us.

May 14th, 2013 by avatar

Childbirth Connection’s Listening to Mothers Initiative just released the Listening to Mothers III (LTMIII) results late last week.  For the third time in the past 11 years, this organization has gone out and queried women on a variety of topics related to pregnancy, birth, postpartum and breastfeeding.  They have questioned thousands of women to accurately assess how the actual experiences hold up against what we know to be best practice and evidence based maternity care. I have relied on the past two survey results frequently during my professional career in maternal health and am thrilled to have the new survey results now available.

I thought it would be interesting to run some of the LTMIII results through the filter of Lamaze International’s Healthy Birth Practices.  The Healthy Birth Practices were most recently updated by Lamaze in 2009, and consist of six simple, evidence based practices that greatly contribute to keeping birth safe and healthy for mothers and babies. Each easy to remember practice has its own short video that parents can watch that talks about that specific care practice and safe alternatives.  Additionally, each Healthy Birth Practice has an accompanying Practice Paper with all the citations for the peer-reviewed, gold standard research that supports that particular practice.

Some useful links and information upfront

Listening to Mothers I

Listening to Mothers II

New!  Listening to Mothers III

Survey Questionnaire 

Major Study Findings

Interesting facts before we get started

While the LTMIII survey only looked at 2400 women,  please be aware that one percentage point change in results would represent approximately 40,000 mother/baby pairs, based on a US birth rate of around 4 million births a year.

35% of women had not intended to be pregnant at the time of this pregnancy, including 5% who stated that they had never intended to become pregnant at all.

52% of those planning to get pregnant did have a preconception meeting with a health care provider, (which could be viewed as a wonderful time to determine if this health care provider might be a good match for their maternity care needs.)

85% of women based their maternity care provider on insurance requirements or restrictions.

78% of women worked with an obstetrician (this has dropped over the course of the three studies.)

9% of women worked with a family practice doctor

8% of women worked with a midwife who practiced in a hospital, as one of the requirements of the study was that the mother was having a hospital birth.

The average length of time spent actually in a prenatal appointment, with health care provider or their nurse was 32 minutes.  (OB: 31 min, Family Practice/MW 35 min.) I was pleasantly surprised that it was this long, I expected less.

Over the course of the three studies, the cesarean rate of study participants went up, (24% to 31%), the VBAC rate went down and labor augmentation was cut in half from 53% to 26%.  More women used nitrous oxide for pain relief during their labor in the most recent study (6%, up from 2% in the first study)

30% of the women chose not to ask a question that they wanted answered at least once during their prenatal appointments.

Overall, women were unable to make choices in line with the Healthy Birth Practices, and did not know that deviating from these practices was not evidence based and resulted in increased interventions.

Let’s see how things stack up

Healthy Birth Practice 1: Let Labor Begin on Its Own

http://flic.kr/p/C21Dk

Research shows that in the absence of medical issues, mothers, babies and labors do best when labor starts spontaneously on its own. The final few weeks of pregnancy are vital for the putting the “finishing touches” on baby and helping to make the transition to life on the outside as smooth as possible.

41% of all women surveyed attempted a medical (involved a care provider) induction and of those induced, 74% were successful, (the woman went into labor) for an overall medically induced labor rate of 31%

Reasons why women were induced

  • 44% were full term
  • 19% wanted to get the pregnancy over
  • 11% wanted to control the timing of birth
  • 16% were induced for a large baby (note: the average weight of these babies induced for suspected macrosomia was 7 lbs 15 ounces.)
  • 18% were induced for being “overdue” (note: the average gestational age of those babies induced for being overdue was 39.9 weeks)
  • 18% were induced for a maternal health problem

Interestingly, 26% of women had their due date changed toward the end of their pregnancy; 66% of those were given an earlier due date and 34% were given a later one.

68% of women had a late third trimester ultrasound to estimate fetal weight

Healthy Birth Practice 2: Walk, Move Around and Change Positions in Labor

http://flic.kr/p/6PqM3M

Women with the ability to move and change positions are able to use this movement to help cope with the pain of labor.  Access to water in the form of a shower or tub can be a valuable coping technique.  Having access to intermittent fetal monitoring or telemetry movements can facilitate movement and promote labor progress for many women.

Only 43% of women walked around after being admitted to the hospital in labor

40% of women used position changes and movement for non-pharmacological pain relief

Healthy Birth Practice 3: Bring a Loved One, Friend or Doula for Continuous Support

Many women will thrive in labor if surrounded by a caring, supportive birth team.  Adding a skilled birth doula to the team has been shown in many studies to improve the outcome of birth and reduce interventions and cesareans.  While more and more birthing women are aware of a doula, many are still not having one in attendance at their birth.

99% of mothers had at least one support person present, (most often this was a partner, then a family member or friend)

6% women used a doula

75% of mothers were aware of what a doula does and of those 75% who knew, 27% would have liked a doula supporting them at their birth.

Healthy Birth Practice 4: Avoid Interventions That are Not Medically Necessary 

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

Although research shows that routine and unnecessary interference in the natural process of labor and birth is not likely to be beneficial—and may indeed be harmful—most U.S. births today are intervention-intensive.

98% of the women had at least one ultrasound during pregnancy and 70% had three or more over the course of their pregnancy

68% of women had a late third trimester ultrasound to estimate fetal weight.

83% of women had some type of pain medication

67% had an epidural or spinal, and 92% of those who did reported this to be “very helpful” or “somewhat helpful.”

62% of women surveyed had an IV during labor

51% of women had one or more vaginal exams in labor. (I was surprised at this, I would have suspected higher)

47% had bladder (Foley) catheters

31% of women had a labor augmented with pitocin

50% of birthing women had their labor either induced or augmented with pitocin

20% had their membranes ruptured artificially (AROM)  after labor began

36% of women had their labor started or augmented by AROM

1% of women requested and had a maternal request cesarean for non-medical reasons

40% of women drank fluids during their labor

21% of the women ate during labor

85% of women birthing vaginally did so without forceps or vacuum

87% of women responding had at least one of the five big interventions (attempted labor induction, epidural, pitocin augmentation, assisted delivery with vacuum or forceps or cesarean.

60% of the women had at least two of the above five interventions listed above

Healthy Birth Practice 5: Avoid Giving Birth on Your Back and Follow Your Body’s Urges to Push

http://flic.kr/p/p3jx

Women push most effectively when permitted to push in the positions that feel best for them.  Allowing the baby to “labor down” even after reaching full dilation until moms feel the urge to push can help women to push a baby out quicker and under their own steam.  Pushing in positions that allow the pelvis to open as much as possible and making space by getting the sacrum out of the way can help promote descent during pushing.

68% of women surveyed birthed on their backs

23% birthed in a semi-sitting position

8% gave birth in a position off their back, either side-lying, squat or hands & knees

Healthy Birth Practice 6: Keep Mother and Baby Together; Its Best for Mother, Baby and Breastfeeding

Experts now recommend that right after birth, a healthy newborn should be placed skin-to-skin on the mother’s abdomen or chest and should be dried and covered with warm blankets. Any care that needs to be done immediately after birth can be done with your baby skin-to-skin on your chest.  This early time together promotes breastfeeding, helps stabilize the newborn’s temperature and blood sugar and also offers a unique chance for high levels of natural oxytocin that promote bonding and help with immediate postpartum bleeding.

47% of mothers responding had their baby in their arms within the first hour

40% of mother-baby pairs were not skin to skin when they were first held

33% of all babies were with hospital staff the first hour

60% of mother-baby pairs roomed in together

18% of babies spent time in the NICU

25% of babies spent their days with mom and their nights in the nursery

49% of mothers who stated that they intended to exclusively breastfeed were given formula samples or offers.

29% of newborns were supplemented with water or formula during the hospital stay

Summary

After reading through the LTMIII report, I found myself discouraged by the current results.  It was clear that women were making choices and/or being informed by their care providers to choose practices that have long been known to create a cascade of interventions, do not improve outcomes for mothers or babies and are not evidence based.  For the majority of the women who responded to this survey, the Healthy Care Practices are still a pipe dream and not a reality in their hospitals and with their current providers.  I know change comes slowly, and it can take years for protocols to catch up with the evidence but frankly, after reading the summary of how things did or did not change over the course of the three studies I was still shocked.

Have you had a chance to go through the study yet?  What were your thoughts?  Anything surprise you?  Can you share a bright point that you noticed?

Join us later this week as I examine what the LTMIII survey had to say about childbirth education and how women are receiving pregnancy and birth information and from where.

 

 

 

 

Breastfeeding, Cesarean Birth, Childbirth Education, Doula Care, Epidural Analgesia, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Lamaze International, Maternal Quality Improvement, Maternity Care, Medical Interventions, Midwifery, New Research, Newborns, News about Pregnancy, Research, Transforming Maternity Care, Uncategorized , , , , , ,

Listening to Mothers III – Just Released Study Shows How Much Work There is Still to Do

May 9th, 2013 by avatar

Childbirth Connection has just released the Listening to Mothers III study today, and will holding a press conference shortly to share the results.  I plan to listen in and read the study thoroughly to see what the mothers have to say!  Look for a complete post early next week evaluating the current state of pregnancy care, labor, birth postpartum and breastfeeding and how it stacks up to Lamaze International’s Six Healthy Birth Practices.  In the meantime, consider joining the press conference, or reading this new study.  You can also check out the previous two LTM studies to see if things have changed.

Listening to Mothers I

Listening to Mothers II

New!  Listening to Mothers III

Babies, Cesarean Birth, Childbirth Education, Depression, Healthcare Reform, Healthy Birth Practices, Healthy Care Practices, informed Consent, Maternal Quality Improvement, Maternity Care, Medical Interventions, New Research, Research , , , , , ,

Health Care Leaders to Unveil Findings From National Survey of New Mothers That Reveal Deficient Maternity Care Quality and Need for More Consumer Engagement and Shared Decision Making

May 8th, 2013 by avatar

This Thursday 1-2 pm ET, you are invited to speak with national health care leaders about findings from Listening To Mothers III — the third in a series of major national studies that examines women’s maternity experiences from before birth through the postpartum period. Among many other findings, the survey reveals the overuse of risky procedures and the fact that many women feel pressured to undergo them.

Listening to Mothers III is the third in a series of landmark, national studies that poll American women about their maternity experiences. This online press conference will highlight new findings about the American maternity experience, including:

  • Exposure of women and babies to the overuse of risky procedures, and underuse of beneficial practices;
  • Women’s experience of pressure to undergo consequential and costly procedures;
  • How informed women are about the risks of those procedures;
  • Failure of the health system to provide shared decision-making processes for major decisions;
  • Trends across the three national Listening to Mothers surveys.

http://flic.kr/p/tvZYD

Leading national health experts representing clinical quality improvement, employer, and consumer perspectives will discuss major findings. The in-depth report describes many experiences from before pregnancy through pregnancy, childbirth, and the postpartum period. Harris Interactive conducted the survey of 2,400 women who gave birth from July 2011 through June 2012.

What

The American Birth Experience: Results From Listening to Mothers III

Who

Leah Binder, President & CEO, The Leapfrog Group

Maureen Corry, Executive Director, Childbirth Connection

Eugene Declercq, Assistant Dean, School of Public Health, Boston University

Carol Sakala, Director of Programs, Childbirth Connection

Thomas Westover, MD, Co-Chair, New Jersey Hospital Association Perinatal Safety Collaborative, Assistant Professor, Maternal & Fetal Medicine & OB&GYN, Robert Wood Johnson Medical and Cooper Medical School

When

Thursday, May 9, 2013; 1-2:00 pm EDT

Details

Please use this link to register for this online press conference at:

If interested in an advance copy of the report, contact Kat Song 

Childbirth Education, Healthcare Reform, Maternal Quality Improvement, Maternity Care, Research, Webinars , , , , , , , ,