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Series: Journey to LCCE Certification – Countdown to the Lamaze Certified Childbirth Educator Exam

September 25th, 2014 by avatar

By Cara Terreri, BA, Community Manager for Lamaze International’s Giving Birth With Confidence blog

Cara Terreri has been documenting her path to become a Lamaze Certified Childbirth Educator since taking her workshop in August of 2012, in our series: Journey to LCCE Certification. Today ,we have another update as she prepares to sit for the exam next month.  The LCCE credentials are the gold standard for childbirth educators and Cara, along with many other men and women worldwide, are seeing the culmination of learning and preparation coming to a close with an exam date scheduled for late October.  Get an update on Cara and share your exam tips for Cara and others in our comments section. Interested in becoming an LCCE? Find out more. – Sharon Muza, Community Manager, Science & Sensibility.

© Cara Terreri

© Cara Terreri

Since my last installment, my life has taken a near 180 degree turn. Birth work still remains my professional priority and passion of course, but after a huge move out of state, I will now pursue doula work and childbirth education – as well as take the LCCE exam — in Myrtle Beach, SC. When I would have been preparing to take the exam in April in Atlanta, I was in the thick of selling my house, packing out, and preparing my family to move to the East Coast. Thankfully, Lamaze gives you the option to defer taking the exam.

With one month to go until the exam date, I am spending my afternoons and evenings poring over the pages of the Lamaze Study Guide, in particular, the “review” sections for each core competency. Reviewing key questions help me to understand my weak points (pregnancy complications and prenatal tests) and give me a tighter focal point for studying. To further boost my knowledge, I attended the fantastic Lamaze International/DONA International joint conference (“confluence”) last week – the timing couldn’t have been better! The insightful sessions echoed many of the themes throughout the Study Guide. But perhaps most important, I was able to speak directly with several LCCEs about their experience with the exam. I heard things like “fair,” “read questions closely,” “common sense,” and “you’ll do great!”

In the days to follow, I plan to take the Exam Prep Course from Lamaze, which includes a practice test. I feel fairly confident about my depth of knowledge, but this is like the extra bit of insurance I want before the big day.

Of course, taking the LCCE exam is just the tip of the iceberg for me professionally, since having relocated to a new area. Now that my kids are in school and we’re more settled, my goal is to build relationships with local educators, doulas, and lactation professionals, along with moms and families. Lots of work to do, and I’m so energized by my drive to help women and families, I want to do it all! But I remind myself that the key is to help, not help everyone. This will likely be my life’s work and because it is not my sole source of income currently, I do as much as I can that works into my stage and place in life.

Readers, I would love to hear your thoughts on the Lamaze exam! Any last-minute tips? Suggestions for studying?  How to calm those last minute jitters? And of course, positive thoughts in my (and all the exam test takers) direction would be much appreciated next month on “game day”!  I will update readers after I take the exam.  And of course, will share my results – hopefully a passing grade.

About Cara Terreri

Cara began working with Lamaze two years before she became a mother. Somewhere in the process of poring over marketing copy in a Lamaze brochure and birthing her first child, she became an advocate for childbirth education. Three kids later (and a whole lot more work for Lamaze), Cara is the Site Administrator for Giving Birth with Confidence, the Lamaze blog for and by women and expectant families. Cara continues to have a strong passion for the awesome power and beauty in pregnancy and birth, and for helping women to discover their own power and ability through birth. It is her hope that through the GBWC site, women will have a place to find and offer positive support to other women who are going through the amazing journey to motherhood.

 

2014 Confluence, Childbirth Education, Giving Birth with Confidence, Lamaze International, Series: Journey to LCCE Certification , , , ,

Black Infant Mortality and the Role of the Childbirth Educator and Doula

September 16th, 2014 by avatar

By Sherry L. Payne, MSN, RN, CNE, IBCLC, CD(DONA)

September is National Infant Mortality Month and today, Sherry L. Payne, MSN, RN, CNE, IBCLC, CD(DONA) shares what she and her organization, Uzazi Village, are doing to help reduce infant mortality in the Black community, where Black babies are disproportionately affected.  You are invited to join Sherry and her team at a reception for Doulas of Color and Allies on Friday.  See below for more information.  I plan to be there and look forward to seeing many of our conference attendees there as well. – Sharon Muza, Community Manager, Science & Sensibility.

© NationalHealthyStart.org

© NationalHealthyStart.org

 

I am fresh off the trail, the Missouri Katy Trail, that is. From September 1-12th, I organized the Black Infant Mortality Awareness Walk. My goal was to walk across the midsection of Missouri talking to clinicians, academics, legislators, and policy makers along the way about the high infant mortality rates in the Black community. I chose to walk during the month of September because it is National Infant Mortality Month. I started off in Kansas City, MO and ended in St. Louis MO, walking along the Katy Trail and driving between towns. Now that the walk is behind me and the DONA/Lamaze Confluence ahead of me, its time to think about the message that doulas and childbirth educators need to hear about Black infant mortality. Black infant mortality is a silent epidemic, that is killing our babies and ravaging our communities.

If we don’t all experience equity in health care, than none of us really does.  Sherry Payne

What is infant mortality? It is a statistical term that refers to the number of infant deaths (from birth to age one) for every 1,000 live births. Infant mortality rates are used as a sensitive indicator of community health. Counties, cities, even countries depend on their infant mortality rates and their rankings to tell them how they are doing in protecting the health and wellbeing of their most vulnerable citizens. The United States currently ranks 55th in the world for infant mortality at about 6 deaths per 1,000 live births.  (CIA Factbook) That doesn’t sound too bad until you compare the US to other industrialized nations like Japan with an infant mortality rate of 2 deaths per 1,000 live births, or Canada with a rate of 4 deaths per 1,000 live births. (CIA Factbook). In fact, compared to other industrialized nations, the US does rather poorly on its infant mortality statistics.

© Jordan Wade

© Jordan Wade

What’s behind the high rates of infant deaths in the US? Well, if you look closely, you’ll see that the high numbers come from within communities of color, particularly the African-American community. In Missouri, for example, if you examine the data by race, you will find that infants in the African-American community are 2-4 times more likely to die prior to their first birthday than their Caucasian counterparts. (Missouri Foundation for Health, 2013.) According to the CDC, infant mortality rates have been dropping among all racial groups, but the difference between death rates among Whites and Blacks persist.  Audiences I spoke to all across Missouri were shocked to learn that the African-American community experiences so much more infant death. Of course, its not just Missouri, these disparities are present throughout the United States.

What are the causes of infant deaths in the Black community?  The March of Dimes lists the frequent causes of infant mortality as prematurity, and complications of prematurity.  Other causes listed in the Kansas City Fetal Infant Mortality Review Report include; low birth weight, lack of access to prenatal care, delayed prenatal care, and poor quality of prenatal care, SIDs and unsafe sleep environments.  These problems are often exacerbated by overarching systemic and structural racism that unfairly targets and penalizes African-American women.  Here in Missouri, low income women can wait up to six months or more to be approved for Medicaid, and often may not be able to start prenatal care until they are approved.  

What can doulas and childbirth educators do about Black infant mortality? Well plenty, actually. Doulas have already been shown to be effective in lowering induction and prematurity rates. (Hodnett, Gates, Hofmeyr, & Sakala, 2013.)  Doulas and childbirth educators by the very nature of their work, assist healthcare consumers in being better informed about their childbearing options. Doulas provide the one on one support that is needed by any woman to boost her confidence in her ability to endure the rigors of childbirth without excessive use of interventions that can place a mother and her baby at greater risk. Childbirth educators can ensure that women understand informed consent and know how to advocate for it. They can both prepare a woman for successful breastfeeding which is protective for sick and vulnerable infants.

But aren’t low income African-American women, the women most likely to be affected by poor birth outcomes, the least likely to interface with doulas and childbirth educators? Yes, that is true. One of the ways to solve that problem is to recruit, promote, and support candidates of color into these fields. There are plenty of women of color who want to do this work, but they often lack the resources. They need the help of allies to provide resources, scholarships, internships, discounts, etc. to assist in getting through expensive trainings. Not all women of color need financial assistance, but for those who do, it can be a formidable barrier. They also need accessible pathways into the profession. If your organization is hosting a training, communicate that within your local communities of color, so that others have a possibility of sharing in the educational opportunities. Do you have women of color as clients in your practice? Invite them to consider becoming doulas or childbirth educators when the time is right for them. They may not consider it a possibility until someone else brings it up as an option.

To learn more about how doulas and childbirth educators can positively impact infant mortality in the Black community, attend my session at the upcoming conference, “Doulas in the Hood: Improving Outcomes Among Low Income Women.” You’ll learn about programs in Missouri and other states that have created successful models that link doulas with low income women. You’ll hear what we are doing here in Kansas City to bridge the needs gap for low income African-American women, for breastfeeding support, for culture specific childbirth education, and for peer model doulas.

Do Black women need Black doulas and childbirth educators?  In a perfect world, my answer would be yes.  It is important for a woman to have a doula or childbirth educator that shares her cultural/world view and understanding of birth and parenting.  However, while there simply are not enough African-American doulas, and childbirth educators out there, those who do serve African-American clients have a responsibility to educate themselves about the issues that impact communities of color.  Examine your own internal biases (everyone has them).  Take a look at your practice.  Would it be inviting to other women of other cultures, races, and ethnicities?  Refer to Science & Sensibility’s Welcoming All Families: Working with Women of Color post from earlier this year.

Until we begin to see the problem of Black infant mortality as a problem for ALL of us, the problems will persist. If we don’t all experience equity in health care, than none of us really does.

I would like to invite any and all of the confluence attendees to join the Board of Directors of both Lamaze International and DONA International and my Uzazi team at our Uzazi Village Reception for Doulas of Color and Allies, on Friday evening, September 19th, 2014 at 7 PM.  Uzazi Village is located at 3647 Troost Ave, Kansas City, MO, 64109.  Hear about programs that are working to lower the infant mortality rate among black infants in our community and connect with others who share your concern and desire to affect change.

References

Amnesty International. (2010). Deadly Delivery: The maternal health care crisis in the USA. Published by Amnesty International.

Beal, A., Kuhlthau, K., and Perrin, J. (2003). Breastfeeding Advice Given to African American and White Women by Physicians and WIC Counselors. Public Health Reports. Vol. 118. p. 368-376.

CIA World Factbook https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

Cricco-Lizza R., (2006)., Black Non-Hispanic mother’s perception about the promotion of infant feeding methods by nurses and physicians. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, Mar-Apr; 35 (2): 173-80.

Fetal Infant Mortality Review 2013. A Program Report of the Mother and Child Health Coalition. Kansas City, Missouri.

Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. In: The Cochrane Library, (9).

Kozhimannil K, Hardeman R, Attanasio L, Blauer-Petersen C. (2013). Doula Care, Birth Outcomes, and Costs Among Medicaid Beneficiaries.
Am J Public Health 2013;103(4):e113-e121.

Lee, H., Rubio, M.R., Elo,T., McCollum, F., Chung, K., Culhane, F. (2005). Factors associated with intention to breastfeed among low-income, inner-city women. Maternal & Child Health Journal Sep; 9 (3): 253-61

Missouri Foundation for Health (2013) Health Equity Series: African American Health Disparities in Missouri. Missouri Department of Health and Senior Services, Section for Epidemiology and Public Health Practice, St. Louis, MO.

MMWR Morbidity and Mortality Weekly Report. (2002). Infant mortality and low birth weight among black and white infants–United States, 1980-2000. Centers for Disease Control and Prevention (CDC). Jul 12;51(27):589-92.

Morbidity and Mortality Weekly Review (2013). Progress in Increasing Breastfeeding and Reducing Racial/Ethnic Differences — United States, 2000–2008 Births 62(05);77-80 Retrieved from CDC: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6205a1.htm?s_cid=mm6205a1_w

National Center for Health Statistics. National Vital Statistics Reports (NVSR). Deaths: Final Data for 2011

Newborn loss. (n.d.). Neonatal death. Retrieved September 15, 2014, from http://www.marchofdimes.org/loss/neonatal-death.aspx

Van Ryn, M. (2002). Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care. Medical Care. Vol. 40, No. 1 pp. 140-151.

About Sherry L. Payne

© Sherry Payne

© Sherry Payne

Sherry L. Payne, MSN RN CNE IBCLC CD(DONA), holds a BSN in nursing and an MSN in nursing education from Research College of Nursing/Rockhurst University in Kansas City, MO. She is a certified nurse educator and an Internationally Board Certified Lactation Consultant. She presents nationally on topics related to perinatal health and breastfeeding among African-American women. Ms. Payne founded Uzazi Village, a nonprofit dedicated to decreasing health inequities in the urban core. She is an editor for the Clinical Lactation journal, and participates in her local Fetal Infant Mortality Review Board (FIMR) Board, where she reviews cases and makes recommendations for improvements. Her career goals include opening an urban prenatal clinic and birth center. She would also like to work towards increasing the number of community-based midwives of color and improving lactation rates in the African-American community through published investigative research, the application of evidence-based clinical practice and innovation in healthcare delivery models. Ms. Payne resides in Overland Park, KS with her husband , where they have nine children, six of whom were home-birthed and breastfed.  Contact Sherry for more information about her programs.

2014 Confluence, Childbirth Education, Guest Posts, Lamaze International, Newborns , , , , , , ,

Tweet with Us! – Share & Experience the 2014 #LamazeDONA Confluence on Twitter

September 11th, 2014 by avatar

 By Robin Elise Weiss, PhDc, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE

lamaze twitter 2014The 2014 Lamaze International/DONA International Joint Confluence in Kansas City is scheduled to convene in just one week and the excitement is palpable!  Bags are getting packed, presentations finalized and birth professionals of all backgrounds are getting ready to meet old friends and make new ones.  The content and information that will be covered in the plenary  and concurrent sessions will be new and exciting.  Today on Science & Sensibility, Lamaze International’s incoming president, Robin Weiss, a leader on our social media team, shares all the “need to knows” for getting the most out of the conference via Twitter. – Sharon Muza, Science & Sensibility Community Manager

The past few years the idea of using social media in conjunction with the conference has grown. And the 2014 Confluence with Lamaze International and DONA International is no different. Using the hashtag #LamazeDONA, you will be able to find a treasure trove of information about the conference, and even learn from the sessions – even if you aren’t in Kansas City.

If you are new to Twitter, you will simply need to sign up for a free account. This handy guide will help you to get started in five easy steps.  You can search for the #LamazeDONA hashtag.  Using this hashtag helps twitter users sort a specific conversation that is focused on the confluence and just our users.  Simply read and interact with the people who will talk on this search.

You will want to join in the discussion, tweet and retweet your favorite snippets of wisdom from the fabulous speakers.  If you are not attending, you will want to follow the #LamazeDONA hashtag as attendees tweet live from the sessions they are participating in.

Back this year is the fabulous Tweet Up! We are going to try to do two this year. The first is scheduled for Thursday at 4p.m. Meet by the registration desk. @RobinPregnancy and @KKonradLCCE will be there to walk you through a few things if you have questions or just say hello! @KKonradLCCE will also host a simple social Tweet Up, watch #LamazeDONA for specific information to join – all are invited, no personal invitations needed.

We will also have prizes for your participation when you watch the hashtag, including some for those joining in at home, so be sure to watch #LamazeDONA for directions.

A great article on Twitter etiquette for you to review prior to the confluence

You might also want to consider reading Birthswell’s helpful three part series: Twitter 101 for Birth and Breastfeeding Professionals if you are new to this fast moving and captivating social media platform.

Check out Facebook, where it is possible to follow the same hashtag, #LamazeDONA for updates as well.  Many Facebook users use the same hashtag system to share information on that platform.

 People to Follow

@LamazeOnline (Lamaze for parents)

@LamazeAdvocates (Lamaze for educators)

@donaaintl

@RobinPregnancy (Robin Elise Weiss, social media team for Lamaze International and incoming President)

@KKonradLCCE  Kathryn Konrad (preconference and concurrent presenter)

@ShiningLghtPE Deena Blumenfeld (concurrent presenter)

@Gozi18  Ngozi Tibbs  (plenary speaker)

@Christinemorton  (concurrent presenter)

@mariajbrooks Maria Brooks (Lamaze Board Member)

@jeanetteIBCLC Jeanette McCulloch (concurrent presenter)

@doulamatch Kim James (concurrent presenter)

@douladebbie Debbie Young

@mldeck  Michele Deck (plenary speaker)

@pattymbrennan Patty Brennan

@doulasrq Patti Treubert ‏

@babylovemn Veronica Jacobson

@tamarafnp_ibclc &  @storkandcradle Tamara Hawkins (S&S contributor)

@thefamilyway Jeanne Green & Debbie Amis

@gilliland_amy  Amy Gilliland (concurrent presenter)

@yourdoulabag Alice Turner (concurrent presenter)

Are you going to be live tweeting from the confluence?  Share your Twitter handle in the comments section and we can add you to our list.- SM 

About Robin Weiss

robin weiss head shotRobin Elise Weiss,  PhDc, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE, is a childbirth educator in Louisville, KY. She is also the President-Elect of Lamaze International. You can find her at pregnancy.about.com and robineliseweiss.com

2014 Confluence, 2014 Confluence, Childbirth Education, Confluence 2014, Continuing Education, Guest Posts , , , , , ,

Series: Welcoming All Families; Working with Women Pregnant after Infertility

September 9th, 2014 by avatar

Continuing the Science & Sensibility occasional  series: Welcoming All Families, Certified Nurse Midwife Emalee Danforth examines the research on perinatal and postpartum mental health on the family who arrives in your classroom or office with a history of infertility.  As the childbirth educator, you (and the rest of the class) most likely will not be aware of the families with this specific history, unless the family chooses to share privately or in the class group.  The educator needs to understand and recognize the increased risk of perinatal and postpartum mood disorders these families face.  Childbirth educators should evaluate their language and stories to be sure that they are providing sensitive and appropriate language and examples that welcome and apply to those whose path to parenthood might not be the same as other families in your class. – Sharon Muza, Community Manager, Science & Sensibility.

By Emalee Danforth, CNM

© Wikipedia

© Wikipedia

Infertility, defined as the inability to conceive after 12 months of timed intercourse or donor insemination (Practice Committee for the American Society of Reproductive Medicine, 2013), is a common experience. While estimates range, approximately 6-15% of the United States population will experience infertility (Chandra, Copen & Stephen, 2013) with higher rates possible when viewed from the global perspective (Mascarenhas, Flaxman, Boerma, Vanderpoel & Stevens, 2012).

The majority of research on the experience of pregnancy and parenting following infertility examines only those who have conceived using IVF (in vitro fertilization, also referred to as ART, assisted reproductive technology). This group of patients is easy to identify and therefore study, but represents only a portion of those who have experienced infertility. Additionally, study designs have often excluded those with multiple gestations, those with same sex partners, and those who have utilized donor gametes. In everyday life, all of these types of clients will cross the path of a care provider or childbirth educator and each has a unique experience. The available research can outline some of the known characteristics of persons who have conceived via IVF after infertility but caution should be applied to generalizations.

The Psychology of Pregnancy after Infertility

There is a particular psychology of infertility that can transfer to pregnancy, childbirth and postpartum. The emotional hallmark of infertility is anxiety (Bell, 2013). Once pregnant, this worry does tend to persist through the pregnancy and heighten as the due date approaches. The level of general anxiety appears similar to those who have conceived spontaneously, but pregnancy-focused anxieties are heightened in previously infertile women, especially those who experienced prolonged treatment failure and high infertility-related distress (Hammarberg, Fisher & Wynter, 2008). McMahon et al. (2011) points out that “the relatively low correlation between pregnancy-focused anxiety and state anxiety…confirms that pregnancy-focused anxiety needs to be considered as a separate construct from more generalized anxiety” (p. 1394) and that this phenomena may be due to a particular reproductive history rather than individual personality factors.

Infertility is also known to be associated with elevated rates of depression (Cousineau & Domar, 2007). However, evidence is consistent that once pregnant, ART women and men experience lower levels of depressive symptoms than those that have spontaneously conceived (Hammarberg et al., 2008). This may be related to higher rates of psychosocial factors that are protective for perinatal mood disturbance in ART expecting women and men including higher socioeconomic status, higher education, higher quality and longer lasting intimate relationships, being older than average and having a planned conception (Fisher, Hammarberg & Baker, 2008). This same study posits that “it is possible that this low rate of distress is reflecting an almost elated mood, in which the pregnant state and family formation achieved after a long period of anticipation and via intrusive and disruptive interventions are somewhat idealized”(p.1110). Indeed, Hjelmstedt, Widstrom, Wramsby & Collins (2003) found that ART women experienced pregnancy in a less negative way and were also less worried about possible “loss of freedom” in their future lives as parent compared to the spontaneous conception control group.

It is therefore surprising that after birth, ART women experience postpartum depression at similar rates to the rest of the childbearing population (Hammarberg et al., 2008). Fisher et al. (2008) found significantly higher rates of admission for ART women in Australia for postpartum mood disturbances despite their more elevated mental state antepartum. This may be because after a long struggle with infertility and undergoing invasive and costly procedures, ART women feel “a low sense of entitlement to complain or to express any doubts, uncertainty, or mixed feelings about the realities of motherhood (Fisher et al., 2008, p. 1111).” However, once the baby or babies are born, ART women must adjust to motherhood and cope with the demands of a newborn just as any other mother. The combination of idealization of motherhood and lack of preparation for the experience of ambivalence can cause mental distress postpartum. In addition, the higher frequency of birth complications among ART women including preterm birth, cesarean section, low birth weight and multiple gestation (Hammarberg et al., 2008) all can have an additive effect on the stresses of motherhood.

There is evidence that ART women experience the process of emotional attachment to the fetus differently from those with spontaneous conception. Fisher et al. (2008) found that ART women thought about their fetus as much in early pregnancy as the general population of mothers did in advanced pregnancy. In late pregnancy, ART women had significantly more intense and protective emotional attachments to the fetus than women who spontaneously conceived. McMahon et al. (2011) found that with age taken into account, there was a strong association between ART conception and more intense maternal-fetal attachment. This is likely the result of extended anticipation of parenthood, investment in the process of conception and intimate awareness of the biology and timing of conception.

© infertile.com

© infertile.com

There remains a dearth of information on the experiences of ART women during childbirth. There exists one recent prospective multicenter study out of Finland on this topic (Poikkeus et al., 2014) which finds that dissatisfaction with childbirth was similar between ART women and controls with singleton pregnancies. The factors that have been previously found to be related to risk for a negative childbirth experience still remained true for both groups: low educational level, inadequate social support, dissatisfaction with her partner or spouse, untreated fear of childbirth and antenatal depression. Also recalled intolerable pain in birth and giving birth by emergency cesarean section increased dissatisfaction with birth. The authors’ conclusion was that dissatisfaction with childbirth was not related to mode of conception but rather lay with the underlying individual psychosocial and obstetric factors of each patient.

Recommendations for Care

While the body of research on the experience of women pregnant after infertility remains emergent, we can use what we know to help guide the most optimal and sensitive care for this population. Firstly, it is important to remember that this group is often invisible, particularly in the childbirth education classroom. The question “how many months did it take you to conceive?” or the unwitting quote from Ina May Gaskin “What got the baby in is what will get the baby out” will land quite differently on the ears of a woman who has gone through ART. In the clinical setting most if not all patients will share their mode of conception, but in the setting of CBE it may be kept private and language usage should be sensitive to this.

The within-group differences in an ART population can also be significant. A woman who needed help getting pregnant due to a very low sperm count in her male partner and conceived on her first round of IVF will likely have a different experience and outlook than a woman who has gone through multiple rounds of failed IVF for unexplained infertility and a miscarriage before having a term pregnancy with an egg donor. Each woman will be having her own unique experience.

The combination of early and intense attachment to the fetus as well as increased levels of pregnancy specific anxiety for ART women points to the need for frequent reassurance and quite possibly increased frequency of care, particularly in the first trimester and prior to quickening. Sensitive care during pregnancy can help transition a client, if appropriate, from a sense of herself as “high risk” and under specialty care to generalist obstetric or “low risk” midwifery care. Bell (2013) suggests that this reassurance will help women “slowly grow to trust in the process which is pregnancy, and … gain a sense of accomplishment and fulfillment as they continue to gestate” (p.51).

Promoting physiologic birth is the goal for all women including ART women. ART women are more likely to have protective social factors such as greater age, income, education and more stable relationships that can help increase satisfaction with childbirth but concurrently more likely to have characteristics such as older age, multiple gestation and preterm birth that lead to higher rates of obstetric intervention, which leads to a decreased satisfaction with childbirth. Working with each client’s individual strengths and limitations will help best prepare her for birth. For many women, feeling like they are active participants in their childbirth care and decision making is critical to their feeling of satisfaction. Involvement in this process may help a client regain a sense of control that may have been eroded during invasive and intensive infertility treatments.

While baby blues and postpartum depression and anxiety should be discussed with every client, understanding more about the psychology of ART women can help guide a practitioner to have a nuanced and sensitive discussion with these clients. A skilled provider or childbirth educator will be able to recognize and honor the joy and gratefulness that an expecting woman or couple feels after conceiving through ART, but also understand that this is likely layered with pregnancy-specific anxiety, a desire to regain some sense of control over one’s body or birth, and a vulnerability to postpartum mood disturbances. Anticipatory counseling including statements such as “some women who give birth after successful IVF treatments are surprised by the many ups and downs of caring for a newborn and may not have anticipated any negative feelings” or “no matter how glad you are to become a mother, it is normal to experience fatigue and feelings of ambivalence.” can help new parents allow their full range of feelings to surface. When mothers feel safe to share their feelings, more prompt identification and treatment of depression and anxiety is possible.

Understanding the prevalence of infertility and its psychological effects can help the childbirth educator, nurse, clinician or other birth professional provide sensitive and optimal care to the often invisible population of women or couples who are pregnant following infertility treatment.

Have you had families with a history of infertility in your childbirth classes?  As clients? What if anything did you do different to be sure to meet the needs of these families?  Can you share how you have handled this in your classroom environment?  Did your families choose to let you know?  Your thoughts and comments are valued in our discussion section below. – SM

References

Bell, K.M. (2013). Supporting childbearing families through infertility. International Journal of Childbirth Education, 28(3), 48-53.

Cousineau, T.M. & Domar, A.D. (2007). Psychological impact of infertility. Best Practice & Research Clinical Obstetrics and Gynaecology, 21(2), 293-308. doi: 10.1016/j.bpobgyn.2006.12.003

Chandra, A., Copen, E.E. & Stephen, E.H (2013). Infertility and impaired fecundity in the United States, 1982-2010: Data from the National Survey of Family Growth. National Health Statistics Report, 67, 1-18.

Fisher, J., Hammarberg, K. & Baker, G.(2008). Antenatal mood and fetal attachment after assisted conception. Fertility and Sterility, 89(5), 1103-1112. doi: 10.1016/j.fertnstert.2007.05.022

Hammarberg, K., Fisher, J. & Wynter, K. (2008). Psychological and social aspects of pregnancy, childbirth and early parenting after assisted conception: A systematic review. Human Reproduction Update, 14(5), 395-414. doi: 10.1093/humupd/dmn030

Hjelmstedt, A., Widstrom, A-M., Wramsby, H. & Collins, A. (2003). Patterns of emotional responses to pregnancy, experience of pregnancy and attitudes to parenthood among IVF couples: A longitudinal study. J Psychosom Obstet Gynecol, 24, 153-162.

Mascarenhas, M.N., Flaxman, S.R., Boerma, T., Vanderpoel, S. & Stevens, G.A. (2012). National, regional, and global trends in infertility prevalence since 1990: A systematic analysis of 277 health surveys. PLOS Medicine, 9(12), 1-12. doi: 10.1371/journal.pmed.1001356

McMahon, C.A., Boivin, J., Gibson, F.L., Hammarberg, K., Wynter, K., Saunders, D. & Fisher, J. (2011). Age at first birth, mode of conception and psychological wellbeing in pregnancy: Findings from the parental age and transition to parenthood Australia (PAPTA) study. Human Reproduction, 25(6), 1389-1398. doi: 10.1093/humrep/der076

Poikkeus, P., Saisto, T., Punamaki, R., Unkila-Kallio, L., Flykt, M., Vilska, S., Repokari, L. … (2014). Birth experience of women conceiving with assisted reproduction: A prospective multicenter study. Acta Obstet Gynecol Scand 2014; doi: 10.1111/aogs.12440
Practice Committee for the American Society of Reproductive Medicine (2013). Definitions of infertility and recurrent pregnancy loss: A committee opinion. Fertility and Sterility, 99(1), 63. doi: 10.1016/j.fertnstert.2012.09.023

Toscano, S.E. & Montgomery R.M. (2009). The lived experience of women pregnant (including preconception) post in vitro fertilization through the lens of virtual communities. Health Care for Women International, 30:11, 1014-1036. doi:10.1080/07399330903159700

About Emalee Danforth

Danforth Emalee head shotEmalee Danforth is a Certified Nurse-Midwife working in Seattle, WA. She practices at University Reproductive Care, the University of Washington’s infertility and reproductive endocrinology clinic. Previously she spent 5 busy years practicing full-scope midwifery in the hospital setting. She holds a BSN from the University of Michigan and an MSN from the University of Washington. She is also a co-facilitator of Maybe Baby, a resource and support group for LGBT persons on the path to parenthood.

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Registration Closes September 15th for October’s Lamaze Certification Exam

September 4th, 2014 by avatar

finger rememberRegistration for the October 2014 Lamaze exam will close September 15th 2014.  The Lamaze exam is being held in locations worldwide October 23-25, 2014.  Passing the Lamaze exam is one component for those individuals on the path to Lamaze certification.  Candidates for the exam will have successfully completed all the requirements in one of the three pathways and all that remains is the final step; sitting for and passing the exam.

You may be interested to know that the Lamaze Certification exam is the only childbirth educator exam that is accredited by the National Commission for Certifying Agencies.  Regular contributor Judith Lothian wrote a wonderful piece for Science & Sensibility this past spring, on the science behind the exam and what makes it the gold standard in the world of childbirth education certification.

My exam experience

I remember very clearly taking the Lamaze exam many years ago, when I first became certified.  My local test site at the time happened to be at a local airfield.  When I checked in for the exam I was handed ear plugs along with scrap paper and a pencil.  There was so much air traffic, planes of all sizes, taking off and landing right outside on the runway, vibrating the windows and sometimes the entire building.  I can laugh at it now, and I think I laughed at it then.  I was the only Lamaze registrant and took my exam amongst many flight students.  The “background noise” must have helped, I did well and passed the exam.  I know that test site is no longer in use, so future exam takers won’t face the same situation.

What I do remember about the exam is that 3 hours given for the exam felt like an ample amount of time.  There are 150 multiple choice questions and  I did not feel rushed. I had time to go through all the questions and return to those I was unsure of and then check over all of them one more time.   I felt like it was a fair exam.  A firm exam but very fair.  I recall the questions definitely

The Lamaze study guide is a very helpful tool for preparing for the exam, even for experienced educators.  If you have not yet acquired your study guide yet, you can order it here.  The study guide is available in both English and Spanish. The Lamaze exam is based on 7 competencies

The exam is based on 7 competencies

Competency 1: Promotes the childbearing experience as a normal, natural, and healthy process which profoundly affects women and their families.

Competency 2: Assists women and their families to discover and to use strategies to facilitate normal, natural, and healthy pregnancy, birth, breastfeeding, and early parenting.

Competency 3: Helps women and their families to understand how complications and interventions influence the normal course of pregnancy, birth, breastfeeding and early postpartum.

Competency 4: Provides information and support that encourages attachment between babies and their families.
Competency 5: Assists women and their families to make informed decisions for childbearing.

Competency 6: Acts as an advocate to promote, support, and protect natural, safe and healthy birth.

Competency 7: Designs, teaches, and evaluates a course in Lamaze preparation that increases a woman’s confidence and ability to give birth.

Some tips for studying and taking the exam.

Definitely consider using the study guide.  It can help you with being up to date with current best practices and covers topics in all the competencies.

Consider setting up study groups – either virtually (post in the comments here if you are looking for a study buddy) or locally in your community.  Having the support of others who are going through the same thing can really help make it a fun and enjoyable process.

Get a good night’s rest the night before the exam

Enjoy a nice healthy breakfast with a good source of protein (personally, I need a very robust cup of coffee as well!)  Maybe even take yourself out to your favorite breakfast place for a great meal.

Do something grounding in the hours before the exam.  A yoga session, a massage or a walk or run outside in the fresh air can be just the thing you need to get the jitters out and feel confident.

Remain calm and confident before the start of the exam.  You have studied, you are prepared and you are ready. Some deep breaths and a few shoulder rolls and stretches before you start will have you alert and ready to begin.

Take your time going through the exam.  The three hours allotted should be adequate.  The exam software makes it easy to move around the exam, answer the ones you know and go back to the ones you wanted to wait on.

Check your work one more time thoroughly before you leave the testing site.

Celebrate your success at completing the process and settle in to receive your results in December. Be proud of the work it took to get to this point.  Know that you are going to be an excellent childbirth educator teaching the principles of safe and healthy birth to families in your community.

Conclusion

If you, too, want to become a Lamaze Certified Childbirth Educator, but have not yet started on the journey, click here to find out how you can become certified.  There are pathways for new educators, experienced educators and midwives/student midwives.  Then hop over to our workshop page and find a workshop near you.

Remember to get your registration in and good luck on the exam.  Looking for that virtual study group – post in our comments section.  Come back after the exam and tell us how you thought it went.  If you have taken the exam before, share some tips and information to help those sitting this fall.

Photo credit: creative commons licensed (BY) flickr photo by The Secret History GRSG: http://flickr.com/photos/rmdemsick/5065345783

 

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