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Breastfeeding & Racial Disparities in Infant Mortality: Celebrating Successes & Overcoming Barriers

August 28th, 2014 by avatar
© mochamanual.com

© mochamanual.com

August has been designated as World Breastfeeding Month, and Science & Sensibility was happy to recognize this with a post earlier this month that included a fun quiz to test your knowledge of current breastfeeding information.  Today, we continue on this topic and celebrate Black Breastfeeding Week 2014 with a post from regular contributor, Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA sharing information about the increased breastfeeding rates rates among African American women.  Kathleen also discusses some of the areas where improvements can help this rate to continue to increase. 

Celebrating Successes

Many exciting changes occurred in 2013 in the breastfeeding world. One of the best trends was the increase in breastfeeding rates in the African American community. The CDC indicated that increased breastfeeding rate in African American women narrowed the gap in infant mortality rates.  As the CDC noted:

From 2000 to 2008, breastfeeding initiation increased…from 47.4% to 58.9% among blacks. Breastfeeding duration at 6 months increased from…16.9% to 30.1% among blacks. Breastfeeding duration at 12 months increased from… 6.3% to 12.5% among blacks.

Much of this wonderful increase in breastfeeding rates among African Americans has come from efforts within that community. In 2013, we saw the first Black Breastfeeding Week become part of World Breastfeeding Week in the U.S. Programs, such as A More Excellent Way, Reaching Our Sisters Everywhere (ROSE), and Free to Breastfeed, offer peer-counselor programs for African American women.


We can celebrate these successes. But there is still more to do. Although the rates of infant mortality have dropped, African Americans babies are still twice as likely to die. In addition, although rates of breastfeeding have increased among African Americans, they are still lower than they are other ethnic groups.

For each of the 2000–2008 birth years, breastfeeding initiation and duration prevalences were significantly lower among black infants compared with white and Hispanic infants. However, the gap between black and white breastfeeding initiation narrowed from 24.4 percentage points in 2000 to 16.3 percentage points in 2008.

Barriers to Overcome

In order to continue this wonderful upward trend in breastfeeding rates, we need to acknowledge possible barriers to breastfeeding among African American women. Here are a couple I’ve observed. They are not the only ones, surely. But they are ones I’ve consistently encountered. They will not be quick fixes, but they can be overcome if we recognize them and take appropriate action.

1) Pathways for IBCLCs of Color

In their book, Birth Ambassadors: Doulas and the Re-Emergence of Women-Supported Birth in America, Christine Morton and Elayne Clift highlight a problem in the doula world that also has relevance for the lactation world: most doulas (and IBCLCs) are white, middle-class women. And there is a very practical reason for this. This is the only demographic of women that can afford to become doulas (or IBCLCs). The low pay, or lack of job opportunities for IBCLCs who are not also nurses, means that there are limited opportunities for women without other sources of income to be in this profession. Also, as we limit tracks for peer-counselors to become IBCLCs, we also limit the opportunities for women of color to join our field. I recently met a young African American woman who told me that she would love to become an IBCLC, but couldn’t get the contact hours needed to sit for the exam. That’s a shame. (I did refer her to someone I knew could help.)

2) We need to have some dialogue about how we can bring along the next generation of IBCLCs. We need to recognize the structural barriers that make it difficult for young women of color to enter our field. ILCA has started this dialogue and held its first Lactation Summit in July to begin addressing these issues.

These discussions can start with you. Sherry Payne, in her recent webinar, Welcoming African American Women into Your Practice, recommends that professionals who work in communities of color find their replacement from the communities they serve.  Even if you only mentor one woman to become an IBCLC, you can have a tremendous impact in your community. If we all do the same, we can change the face of our field. (Note, here is a wonderful interview with Sherry as she discusses “Fighting Breastfeeding Disparities with Support.”)

3) Bedsharing and Breastfeeding

 This is an issue that I expect will become more heated over the next couple of years. But it is a reality. As we encourage more women to breastfeed, a higher percentage of women will bedshare. As recent studies have repeatedly found, bedsharing increases breastfeeding duration. This is particularly true for exclusive breastfeeding.

Bedsharing is a particular concern when we are talking about breastfeeding in the African American community. Of all ethnic groups studied, bedsharing is most common in African Americans. It is unrealistic to think that we are going to simultaneously increase breastfeeding rates while decreasing bedsharing rates in this community. The likely scenario is that breastfeeding would falter. It’s interesting that another recent CDC report, Public Health Approaches to Reducing U.S. Infant Mortality, talks quite a bit about safe-sleep messaging, with barely a mention of breastfeeding in decreasing infant mortality.  A more constructive approach might be to talk about being safe while bedsharing. But as long as the message is simply “never bedshare,” there is likely to be little progress, and it could potentially become a barrier to breastfeeding.


Reason to Hope

BBW-Logo-AugustDates3Even with these barriers, and others I haven’t listed, Baby-Friendly Hospitals are having a positive effect. When hospitals have Baby-Friendly policies in place, racial disparities in breastfeeding rates seem to disappear. For example, a study of 32 U.S. Baby-Friendly hospitals revealed breastfeeding initiation rates of 83.8% compared to the national average of 69.5%. In-hospital exclusive breastfeeding rates were 78.4% compared with a national rate of 46.3%. Rates were similar even for hospitals with high proportions of black or low-income patients (Merewood, Mehta, Chamberlain, Phillipp, & Bauchner, 2005). This is a very hopeful sign, especially as more hospitals in the U.S. go Baby-Friendly.

http://kcur.org/post/kc-group-fights-breast-feeding-disparities-education-support

In summary, we have made significant strides in reducing the high rates of infant mortality, particularly among African Americans. I am encouraged by the large interest in this topic and the number of different groups working towards this goal. Keep up the good work. I think we are reaching critical mass.

Additional resource: Office of Women’s Health, U.S. Department of Health & Human Services Breastfeeding Campaign for African American families.

References

Merewood, A., Mehta, S. D., Chamberlain, L. B., Phillipp, B. L., & Bauchner, H. (2005). Breastfeeding rates in U.S. Baby-Friendly hospitals: Results of a national survey. Pediatrics, 116(3), 628-634.

Reprinted with permission from Clinical Lactation, Vol. 5-1. http://dx.doi.org/10.1891/2158-0782.5.1.7

About Kathleen Kendall-Tackett

kendall-tackett 2014-smallKathleen Kendall-Tackett, Ph.D., IBCLC, FAPA is a health psychologist, International Board Certified Lactation Consultant and Fellow of the American Psychologial Association in both the divisions of Health and Trauma Psychology. Dr. Kendall-Tackett is President-Elect of the Division of Trauma Psychology, Editor-in-Chief of Clinical Lactation, clinical associate professor of pediatrics at Texas Tech University Health Sciences Center, and Owner/Editor-in-Chief of Praeclarus Press, a small press specializing in women’s health. Dr. Kendall-Tackett has authored more than 310 articles or chapters and is the author or editor of 22 books on women’s health, maternal depression, family violence and breastfeeding. Dr. Kendall-Tackett and Dr. Tom Hale received the 2011 John Kennell and Marshall Klaus Award for Research Excellence from DONA International. You can find more from her at Uppity Science Chick

 

Babies, Breastfeeding, Childbirth Education, Guest Posts , , , , , , , ,

Sleeping Like a Mammal: Nighttime Realities for Childbirth Educators to Share With Parents

August 21st, 2014 by avatar

By, Linda J. Smith, MPH, IBCLC, LCCE, FACCE

In recent days, there has been much press and discussion about a new book written by pediatricians that professes to help parents “train” their new baby to sleep through the night. The scathing criticism of the book by both parents and professionals alike are consistent with what we know about the needs of a newborn baby and their sleep and feeding patterns. Today on Science & Sensibility, Linda Smith, MPH, IBCLC, LCCE, FACCE shares accurate, evidence based information that childbirth educators and other professionals can use to talk to new families about newborns and their sleep and feeding patterns. Linda is one of the authors of La Leche League International‘s newest book; Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family.

This book written by Smith along with co-authors Diane Wiessinger,  Teresa Pitman and Diana West provides families with information to help the entire family get more sleep and do so safely, while meeting the nutritional and developmental needs of newborns. Preparing families for life with a newborn is one of the challenges we face as educators. The information Linda provides here along with the resources included in this post can help you to be sure that your information is backed by research and appropriate for your new families. – Sharon Muza, Community Manager, Science & Sensibility

How do I address sleep with my childbirth class participants?

261653 ML Algebra1 2007New parents are instantly thrust into the reality of life with a baby. As Dr. Helen Ball writes, “Sleep (or the lack of it) looms large for parents-in-waiting—and it is pointless to pretend that your sleep will not be disrupted by your new bundle of joy. His body clock, which until recently was controlled by your own, is now free-running, and a day-night pattern does not start to emerge until he is around three months old. His stomach is tiny, and he will need frequent feeds all around the clock—he cannot wait eight hours through the night to be fed just because you need to sleep. If you don’t feed him, he will cry. If he’s cold, he will cry. If he hurts, he will cry. If he misses being in close contact with you, he will cry. He doesn’t know that you will come back once you leave his sight. If he feels abandoned, he will cry frantically—it’s his only method to attract attention and bring himself to safety. If he cries frantically, it will take a long time for him to calm down and you will have to help him.”

“The experience of sleep, and of being left alone for sleep, is very different for babies than it is for adults. The more quickly you can understand your baby’s needs—for comfort, food, reassurance, contact, love—the less disruptive nighttime baby care will become, and the less anxious you will feel. Some of the decisions you make early on about nighttime baby care will affect how you manage sleep disruption and cope with your new baby.” Dr. Helen Ball

What is normal sleep?

  • Pregnant women do not sleep in long unbroken stretches, i.e., “all night.” Neither do postpartum mothers – not for many months, regardless of how they feed their babies.1 Breastfeeding mothers get more sleep than formula-feeding mothers; breastfeeding mothers who bedshare get the most sleep of all new mothers.2,3
  • Before birth, babies sleep rather randomly, not necessarily closely synchronized to their mothers’ body clock. After birth, babies sleep in short (1 to 1½ hour) cycles and need to be fed approximately hourly because of their very small stomachs.4 They do not even begin to develop day-night sleep patterns for several months, regardless of how they are fed.5
  • Frequent feeding day and night is normal, essential for the baby, yet is often called ‘inconvenient’ for parents. Let’s face it – all babies are “inconvenient.” Most of us didn’t get pregnant just to make our lives less complicated. Babies need to be touched – a LOT, day and night, and skin-to-skin.6 Touch is nearly as important to babies’ overall development as food.7 Breastfeeding is an easy way to assure plenty of touch; so is safe bedsharing.8 Most breastfeeding mothers nurse their babies to sleep and sleep with their babies at least part of the night.9

LLLI | Safe Sleep 7 Infographic

Safety issues

  • SIDS (Sudden Infant Death Syndrome) and suffocation are two distinct and rare risks to infants in the early months. SIDS is a diagnosis of exclusion: there’s no obvious reason for a baby’s death. Risk factors for SIDS are well- documented, so avoiding these can help parents reduce the already-small risk: (1) smoking;10 baby sleeping prone;11 formula feeding;12 and baby sleeping unattended.13 (details below)
  • Suffocation is a more easily-preventable risk to babies than SIDS. The main risks for suffocation (entrapment) are putting the baby to sleep on a sofa with or without an adult,14 and/or a drunk/drugged adult sleeping with a baby on any surface.15 “Never bedshare” warnings don’t tell tired parents/mothers where they CAN safely feed their babies at night. A new infographic by La Leche League, “Safe Sleep Seven: Smart Steps to Safer Bedsharing,” lists seven steps that vastly reduce the major SIDS and smothering risks.
  • Prenatal smoking is very bad for babies and increases risk of SIDS at least five-fold. Smoking is a significant hazard to babies if the mother smokes during pregnancy, and smoking in the household (and everywhere) continues to be a risk to the baby after the baby is born. Smokers exhale carbon monoxide for many hours after each cigarette,16 and secondhand smoke is harmful to babies.17 Smoking is a well-known risk to adults, too.
  • Every health authority in the world recommends exclusive breastfeeding for the first six months starting in the first hours after giving birth, then continued breastfeeding while adding family foods till the child is at least two years old.18 Formula-fed babies are less arousable from sleep than breastfed babies;19 have more than double the risk of (SIDS);12 and have many other health problems.20 If families need help with breastfeeding, contact WomensHealth.gov or La Leche League International or the federal government Women, Infants and Children program (WIC).
  • Unattended babies (sleeping out of sight and sound of a competent adult) are at higher risk of SIDS and entrapment/smothering accidents. People are better monitors than electronic devices. Babies should always sleep face-up, in a safe container, and within sight and sound of a competent adult for all sleeps, naps and nights – unless they are safely tied on someone’s body or safely in someone’s arms or sleeping next to their sober, nonsmoking, breastfeeding mother on a safe surface. Baby should be lightly clothed (not overheated. One study reported swaddling as an independent risk factor for SIDS. 21).
  • Recommend that parents baby-proof the family bed, even if they think they won’t ever bedshare. Sleep happens, and exhaustion overrules common sense. No thick covers, no toys, no pets, firm clean flat mattress. Most breastfeeding mothers sleep with their babies at least part of the night, and breastfeeding mothers have the lowest rates of SIDS and other sleep-related accidents.12 Accidental bedsharing is riskier than planned bedsharing.22 A side-car attached to the bed can be a good option – baby is close enough for touching and feeding, yet separate enough to avoid rollovers and exhaled breath of smokers. A safe crib for the baby in the bedroom is safer than baby sleeping unattended in another room.
  • Adults should never lie down with a baby on a sofa or in a recliner, even “just for a minute” – the threat of suffocation, entrapment or dropping the baby is high especially when (not if) the adults falls asleep.23 If a sofa or recliner is the only option for sleep, the adult can lean back and tie the baby securely onto their chest with a scarf, shawl or soft carrier so their arms aren’t holding the baby when the adult dozes off.
  • Wearing a baby many hours a day in a soft-tie-on carrier or sling is a great way for everyone to nap, and helps baby’s motor development besides. Baby’s face should be fully visible and her head should be close enough to kiss. This babywearing guide has information on how to safely wear an infant.

The 4 big questions

1. When will the baby sleep through (longer) the night?

Probably not for many months. Welcome to parenthood! (Sorry, biology rules!)

Babies are growing faster in the early months than they ever will, and need food and comfort very often for normal physical, emotional, and psychological development. A famous scientist described the first 9 months of a baby’s “outside” life as the period of “external gestation.24” The best way to get enough sleep is for parents to plan to safely bedshare with their breastfed baby, and take naps with the baby. (see the Safe Sleep Seven and “Sweet Sleep25 for more information.)

Beware of “sleep training” programs, books and advice, which have a long sad history.26 New strong evidence of baby’s biological and emotional needs suggests that babies remain highly stressed even when the parents think sleep training “worked,” with serious long-term negative consequences for the baby. Babies cry because they need to be touched held, fed, rocked, and nurtured, and simply cannot meet their own needs for any of those comforts.

2. When will the mom sleep like she did before she got pregnant?

The research definition of “sleeping through the night” range is inconsistent and arbitrary.27 Parents can make up any definition they want when quizzed about the baby “sleeping through.” A useful (and vague) response: “Of course the baby is a good sleeper.”

3. Will parents ever have sex again?

Beds aren’t the only places where sex can happen.

4. Will parents ever get the baby out of their bed?

Babies who bedshare get their emotional needs met sooner and more fully than those who sleep separately.28 All babies are inconvenient for a while.

Where can parents get more information?

What do you talk about with families in order to prepare them for parenting a newborn? How do you find the balance between providing accurate information and not “frightening” them with the realities of newborn sleep patterns. Have you read this new book? Would you recommend this book to families who are desiring more information about how to provide a safe sleep environment for their breastfeeding newborn? – SM

References

1. Montgomery-Downs HE, Stremler R, Insan SP. Postpartum Sleep in New Mothers and Fathers. Open Sleep Journal. 2013;6(Suppl 1: M11):87-97.
2. Doan T, Gay CL, Kennedy HP, Newman J, Lee KA. Nighttime Breastfeeding Behavior Is Associated with More Nocturnal Sleep among First-Time Mothers at One Month Postpartum. J Clin Sleep Med. 2014;10(3):313-319.
3. Doan T, Gardiner A, Gay CL, Lee KA. Breast-feeding Increases Sleep Duration of New Parents. J Perinat Neonatal Nurs. Jul-Sep 2007;21(3):200-206.
4. Bergman NJ. Neonatal stomach volume and physiology suggest feeding at 1-h intervals. Acta Paediatr. May 10 2013.
5. Rivkees SA. Emergence and influences of circadian rhythmicity in infants. Clin Perinatol. Jun 2004;31(2):217-228, v-vi.
6. Feldman R, Rosenthal Z, Eidelman AI. Maternal-Preterm Skin-to-Skin Contact Enhances Child Physiologic Organization and Cognitive Control Across the First 10 Years of Life. Biol Psychiatry. Jan 1 2014;75(1):56-64.
7. Feldman R, Singer M, Zagoory O. Touch attenuates infants’ physiological reactivity to stress. Dev Sci. Mar 2010;13(2):271-278.
8. Hofer MA. Psychobiological Roots of Early Attachment. Current Directions in Psychological Science. April 1, 2006 2006;15(2):84-88.
9. Ward TC. Reasons for Mother-Infant Bed-Sharing: A Systematic Narrative Synthesis of the Literature and Implications for Future Research. Matern Child Health J. Jul 2 2014.
10. Zhang K, Wang X. Maternal smoking and increased risk of sudden infant death syndrome: a meta-analysis. Leg Med (Tokyo). May 2013;15(3):115-121.
11. Dwyer T, Ponsonby AL. Sudden infant death syndrome and prone sleeping position. Ann Epidemiol. Apr 2009;19(4):245-249.
12. Hauck FR, Thompson JMD, Tanabe KO, Moon RY, Vennemann MM. Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics. June 13, 2011 2011.
13. Moon RY, Fu L. Sudden infant death syndrome: an update. Pediatr Rev. Jul 2012;33(7):314-320.
14. Blair PS, Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EM, Fleming P. Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. Bmj. 2009;339:b3666.
15. Ball HL, Moya E, Fairley L, Westman J, Oddie S, Wright J. Bed- and sofa-sharing practices in a UK biethnic population. Pediatrics. Mar 2012;129(3):e673-681.
16. van der Vaart H, Postma DS, Timens W, et al. Acute effects of cigarette smoking on inflammation in healthy intermittent smokers. Respir Res. 2005;6:22.
17. Tong EK, England L, Glantz SA. Changing Conclusions on Secondhand Smoke in a Sudden Infant Death Syndrome Review Funded by the Tobacco Industry. Pediatrics. March 1, 2005 2005;115(3):e356-366.
18. American Academy of Pediatrics. Breastfeeding and the Use of Human Milk. Pediatrics. March 1, 2012 2012;129(3):e827-e841.
19. Mosko S, Richard C, McKenna J. Infant arousals during mother-infant bed sharing: implications for infant sleep and sudden infant death syndrome research. Pediatrics. Nov 1997;100(5):841-849.
20. US Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General,; 2011.
21. Richardson HL, Walker AM, R SCH. Influence of Swaddling Experience on Spontaneous Arousal Patterns and Autonomic Control in Sleeping Infants. J Pediatr. Mar 12 2010.
22. Volpe LE, Ball HL, McKenna JJ. Nighttime parenting strategies and Sleep-related risks to infants. Social Science & Medicine. 2012(0).
23. Kendall-Tackett K, Cong Z, Hale T. Mother–Infant Sleep Locations and Nighttime Feeding Behavior: U.S. Data from the Survey of Mothers’ Sleep and Fatigue. Clinical Lactation. 2010;1(Fall 2010):27-31.
24. Montagu A. Touching: the Human Significance of the Skin. Third ed. New York: Harper & Row; 1986.
25. La Leche League International, Wiessinger D, West D, Smith LJ, Pittman T. Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family. New York: Random House – Ballantine Books; 2014.
26. Middlemiss W, Granger DA, Goldberg WA, Nathans L. Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early human development. 2012;88(4):227-232.
27. Adams SM, Jones DR, Esmail A, Mitchell EA. What affects the age of first sleeping through the night? J Paediatr Child Health. Mar 2004;40(3):96-101.
28. McKenna JJ, Mosko SS. Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine. Acta Paediatr Suppl. Jun 1994;397:94-102.

About Linda J. Smith, MPH, IBCLC, LCCE, FACCE

© Linda J. Smith

© Linda J. Smith

Linda J. Smith, MPH, IBCLC, LCCE, FACCE, is a lactation consultant, childbirth educator, author, and internationally-known consultant on breastfeeding and birthing issues. Linda is ILCA‘s liaison to the World Health Organization’s Baby Friendly Hospital Initiative and consultant to INFACT Canada/IBFAN North America. As a La Leche League Leader and Lamaze-certified Childbirth Educator, she provided education and clinical support to diverse families over 40 years in 9 cities in the USA and Canada. Linda has worked in a 3-hospital system in Texas, a public health agency in Virginia, and served as Breastfeeding coordinator for the Ohio Department of Health. Linda was a founder of IBLCE, founder and past board member of ILCA, and is a delegate to the United States Breastfeeding Committee from the American Breastfeeding Institute. Linda holds a Masters Degree in Public Health and is currently an Adjunct Instructor at the Boonshoft School of Medicine at Wright State University in Dayton, Ohio. She owns the Bright Future Lactation Resource Centre, on the Internet at www.BFLRC.com.

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

Teaching Childbirth Education Classes While Pregnant – An LCCE Educator’s Experience

August 12th, 2014 by avatar

By Katherine Steen, BS, MAIS, LCCE

Childbirth educators may work in this field at many points in their life.  They may be childless, they may have young children or their children may be out on their own. I believe one of the most interesting times to be a childbirth educator is when you yourself are pregnant and expecting a baby.  To be teaching on the topic of labor and birth to pregnant families at the exact time that you are also preparing for your own labor and birth can create some interesting class dynamics.  I asked my friend and colleague Katherine Steen, LCCE, to share what her experience has been like teaching classes while she prepares to welcome her second little one  Here is her story! – Sharon Muza, Community Manager, Science & Sensibility

CC  (BY-NC-SA) flickr photo by J. McPherskesen: http://flickr.com/photos/jmcphers/4276103110

CC (BY-NC-SA) flickr photo by J. McPherskesen: http://flickr.com/photos/jmcphers/4276103110

As educators, we work hard to minimize bias in our teaching. However, there is no hiding the fact that teaching birth classes while pregnant changes one’s perspective. I began my career as a childbirth educator about a year after my first child was born. In January 2014, I learned I was pregnant with my second child. Here are a few of my experiences.

First Trimester

Physical Challenges

Unlike my first pregnancy, I experienced nausea this time around, which made teaching difficult at times. I did my best to nibble during teaching to ward off the queasies and wore long sleeves to hide my Sea Bands. My second biggest challenge was fatigue. I normally teach 3.5 hour classes on Saturdays in a facility where it takes me about an hour on each end to set up and clean up. By the time I got home, I was ready for a nap. Unfortunately, my 4 year old did not always share my enthusiasm for sleep. A third challenge was transportation to and from class. I was used to riding the bus or my bike 12 miles round trip since we are a one car family, but was physically unable to, thanks to the nausea and fatigue. This meant I relied on my partner to drop me off and pick me up for class each week.

Breaking the News

Because I experienced a miscarriage previously, I was hesitant to reveal my pregnancy to my students until after the first trimester. Once I revealed my pregnancy, I began to get questions from students about my choices of provider and birth place. I am hesitant to reveal things about my choices as I don’t want to impose my values on them, but if a student asks me one on one I am generally inclined to tell them the truth. At the time, I was able to say I had not decided (which was true). It was most interesting when I began having reunions for series I taught early in the year when I revealed to students that I was pregnant while teaching their series. They reassured me that they couldn’t tell how tired and nauseous I had been and were quite excited for me.

Following My Own Advice

When it came time to pick a provider, I had a different perspective than in my first pregnancy. Not only were my needs and interests different at this point in my life, but I had a wealth of knowledge about evidence based maternity care and a broader perspective on the variations of pregnancy and birth to consider. In interviewing providers, I brought a copy of the Groopman-Hartzband Medical Mindset Spectrums (a worksheet created by Kim James and Laurie Levy, adapted from Your Medical Mind: How to Decide What is Right for You, by Groopman and ) to discuss and asked about experiences/protocols for long, slow labors, premature rupture of membranes, and pregnancies that proceed into the 41st week. When a concern arose during off hours, I found myself thinking about what I would say to my students if they were in my position. Would I tell them to page their provider or call in the morning?

Second Trimester

Increased Empathy and Concern

While I physically felt better in my second trimester, the reality of our parallel life experiences continued to factor into my teaching. The first change I noticed was that I had much more empathy for pregnancy discomforts and decision making challenges. Suddenly the reality of my students became more real for me and I found myself physically feeling their twinges. I had so many opportunities to access pregnant women, postpartum families, and their scary (and wonderful) stories and my attitude toward their experiences was split.

On the one hand, I felt increasing non-attachment to their birth choices. Whereas previously I had felt disappointed when a birth did not meet a student’s expectations or when families at a reunion struggled with breastfeeding or had highly interventive births, I began to hear beauty and joy in birth stories that did not go according to plan. As long as a family was satisfied with the experience, I considered it a success. I began to envision alternate realities for my own birth and come to terms with the idea that it could go any number of ways and still be a great experience.

On the other hand, my concern and empathy for those who had scary experiences was magnified. For example, when one of my students gave birth prematurely, the situation seemed so much more relevant to me as our due dates were only a few weeks apart. Or when a family shared the story of their baby’s lengthy NICU stay due to oxygen deprivation during the birth process, my heart was heavy.

I also began to lead a postpartum support group during this time and took to heart the pregnancy, breastfeeding, and birth challenges the women in the group faced. In all of these situations, I simply did my best to hide the tears that sometimes arose without warning and tried to focus on supporting their journeys. It was good practice for me to minimize sharing my personal experience and encourage the mothers to tap into their intuition and share ideas with each other.

Third Trimester

Don’t forget to eat, drink, pee, and sit down!

Once again, teaching was physically challenging. I began to place a chair or birth ball close to the front of the room in an effort to remind myself to sit down periodically. I filled my plate at the beginning of each class with the snacks the students brought and made sure my water bottle was close at hand. I often found myself joking with students as we met in the restroom during every break as well as before and after class.

CC  (BY-NC-SA) flickr photo by mandaloo: http://flickr.com/photos/mandaloo/4762404381

http://flickr.com/photos/mandaloo/4762404381

Figuring out what to wear while teaching was also a challenge. Even before I was pregnant, I taught in short sleeves year round because I have no control over the temperature at my sites. Lately, keeping cool has been even more challenging because this summer has been quite warm by Seattle standards. I went through several sizes of maternity khakis and finally decided they were too hot. I switched to skirts, but discovered how difficult it is to demonstrate lunges without flashing the class. I started having my doula/cbe observers demo for me in addition to assisting students. I cannot quite bring myself to teach in shorts, though I did resort to sandals a few times. And then there was the day I discovered I had outgrown all my bras.

Brain Farts

Between teaching two series at once (something I rarely do) and being pregnant, I had any number of moments when I found myself asking my students if we talked about something in a previous class because I honestly couldn’t remember. And forgetting the words for things. Like what’s that pushing position when you are not quite sitting, not quite lying down? Well, at least I showed them what it looks like. And then there was the week I read the snack schedule wrong and reminded the families to bring snack a week early. Thank goodness my students are on top of things and e-mailed me to clarify.

Memories

One last thing that I didn’t anticipate was how I would start to remember more clearly my postpartum experience as my pregnancy progressed. One evening, I found myself describing some of the physical and emotional realities of that difficult time in far greater detail than I am usually capable. I paused to look at my students’ faces and saw pure shock. I want to adequately prepare them for the challenge that awaits as well as the range of experiences that are normal during postpartum, but I don’t want to scare the pants off them. I ended the class and nobody moved. Somehow I came up with a quick, confidence boosting statement and they began to gather their things. Did I go too far? My trusty observer seemed to think they would recover.

Here I sit with one more class to teach before taking some time off to welcome baby. I will not miss spending two hours every Saturday schlepping my materials up three floors and moving furniture. I will miss building rapport with students and am looking forward to three class reunions in a few months.

What has been your experience of teaching while pregnant? What are the joys and challenges for you? Please share your experiences and discuss with me in the comments section.

About Katherine Steen

© Katherine Steen

© Katherine Steen

Katherine Steen, BS, MAIS, LCCE, has been teaching childbirth classes since 2012. She currently teaches for the Great Starts program of the Parent Trust for Washington Children in Seattle, WA. Prior to the birth of her daughter, she spent 10 years working as an educator in zoological parks. In addition to teaching birth classes, she loves to cook, garden, read and spend time outdoors. Her current fitness endeavors are water aerobics and prenatal yoga. She is expecting her second child in September 2014.

Childbirth Education, Guest Posts, Lamaze International , , ,

It’s World Breastfeeding Week! Test Your Knowledge of Evidence Based Breastfeeding Information

August 7th, 2014 by avatar
© Annie Stoner

© Annie Stoner

In recognition of World Breastfeeding Week 2014, Science & Sensibility invites you to take this quick little quiz on breastfeeding information to check how up to date you are on current, evidence based breastfeeding practices.  As discussed in our earlier post this week, celebrating World Breastfeeding Week, childbirth educators play a key support role in providing families with accurate breastfeeding information as part of a thorough childbirth education curriculum.

Staying up to date with the newest information can be difficult to do.  But it is imperative.  There are many sources of misleading or inaccurate breastfeeding information available, and students and families should rely on childbirth educators to help with providing the proper resources.  Take our quick quiz to see if you can answer some questions on breastfeeding information that has changed in the past few years. Follow the links provided with each answer if you need more information! Then share in the comments section below what you do to stay current on breastfeeding topics. What are your favorite breastfeeding continuing education resources?  Let us know!

 

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

World Breastfeeding Week 2014 – Breastfeeding: A Winning Goal for Life

August 5th, 2014 by avatar

wbw2014-logo3August 1-7, 2014 is World Breastfeeding Week and this year’s theme is Breastfeeding: A Winning Goal for Life.  This year’s theme builds upon the Millenium Development Goals (MDGs) developed by the United Nations and global partners.  Breastfeeding plays a critical role in achieving all eight of the MDGs.  The World Alliance for Breastfeeding Action created a dynamic and clear graphic demonstrating how increasing global breastfeeding rates has the ability to impact every single one of the MDGs.

With this in mind, the World Breastfeeding Week theme, “Breastfeeding: A Winning Goal for Life” calls on celebrants to “Protect, Promote and Support Breastfeeding: It is a Vital Life-saving Goal.”  The theme recognizes the critical role that excellent support plays in achieving this goal and childbirth educators are right up there as one of the critical players, as childbirth educators are prepared and qualified to help new families learn about breastfeeding in their childbirth education classes.

Lamaze International supports getting breastfeeding off to a good start with the sixth Healthy Birth Practice: “Keep mother and baby together – It’s best for mother, baby and breastfeeding.”  Your role as a childbirth educator in normalizing breastfeeding, providing prenatal instruction on breastfeeding basics and sharing additional breastfeeding resources for families to utilize after their baby arrives contributes to the Millenium Development Goals with each and every family  you reach.

wbw2014-goals

Childbirth educators, along with doctors, midwives, labor & delivery nurses, lactation consultants, doulas, and others help support families in reaching their breastfeeding goals, and celebrate breastfeeding with every mother and new family they reach. Breastfeeding is a team effort and everyone plays a critical role.

Have you shared World Breastfeeding Week information with your families that are in your childbirth education classes?  Can you recall the times when a family followed up with you and thanked you for the evidence based information that you provided in their childbirth class, helping them to be prepared to breastfeed their baby after birth. What you do matters every day to mothers and babies and that includes the efforts to share accurate information about breastfeeding and breastfeeding resources with your students.  Thank you, childbirth educators, for making a difference. For more information about World Breastfeeding Week 2014, check out the World Alliance for Breastfeeding Action website.

 

Babies, Breastfeeding, Childbirth Education, Healthy Birth Practices, Lamaze International, Newborns, Uncategorized , , , , ,