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Why the California Toolkit: “Improving Health Care Response to Preeclampsia” Was Created

February 6th, 2014 by avatar

by Christine H. Morton, PhD

Researcher and Lamaze International Board Member Christine H. Morton, Phd shares information about a just released Toolkit on educating professionals about preeclampsia and it’s potentially very serious consequences.  Dr. Morton discusses how you can get a copy, take a webinar introducing the features and help reduce the number of women impacted by this serious pregnancy illness. – Sharon Muza, Community Manager.

Screen Shot 2014-02-05 at 10.25.11 PMWhen my academic partner and I observed childbirth classes several years ago as part of our Lamaze International-funded research (Morton 2009, Morton et al, 2007), we noted that many childbirth educators included a list of signs and symptoms to watch out for during their initial class meeting with expectant couples.  Some of these signs and symptoms were signals of early labor (mucous plug, leaking amniotic sac, contractions) while others might portend a more serious complication such as placental abruption (bright red bleeding), or preeclampsia (blurred vision, extreme swelling, headache), or worse case scenario, fetal demise (reduced to no fetal movement).  At the time, we wondered about the seeming contradiction of classes ostensibly designed to promote confidence in women’s bodies to give birth while from the outset telling women about things to watch out for, or “warning signs.”  Some instructors advised students to post the list on the fridge or on the bathroom mirror.

Now, after five years working at the California Maternal Quality Care Collaborative, and reviewing hundreds of cases of maternal death, I understand the importance of sharing information with pregnant women (and their partners) so they can understand when a symptom or condition goes beyond normal.  I understand why it is so important for women to know their own bodies, including their normal blood pressure, so they (or their partners) can be effective patient advocates if they sense something doesn’t feel right.

It’s an important balance for educators and other birth professionals to discuss the normality of physiological birth alongside the reality that about 8-12% of women will have medically complicated births. (Creanga, 2014), (Fridman, 2013) I remember hearing from partners who wanted to know what to look out for, so they could fulfill their roles as “protectors” as well as “co-creators of sacred space,” as one educator referred to them. Screen Shot 2014-02-05 at 10.25.45 PM

Preeclampsia is the second leading cause of pregnancy-related death in California, accounting for 17% of all deaths. (Druzin et al, 2014.) Preeclampsia is a severe obstetric condition characterized by high blood pressure, which left untreated, can lead to stroke, prematurity and death of women and babies.  As part of the California Pregnancy-Associated Review (CA-PAMR), an expert committee analyzed the medical records of 25 women who died of preeclampsia.  The committee identified contributing factors, and opportunities to improve care. All of the California deaths due to preeclampsia had some chance of preventability, with nearly half having a good-to-strong chance to alter the outcome.  For every woman who dies, at least 40-50 experience severe complications requiring ICU admission and another 400-500 experience moderate-to-severe complications from preeclampsia or other hypertensive disorders.   One important factor in the deaths was delayed recognition and response to signs and symptoms of severe hypertension.

Screen Shot 2014-02-05 at 10.26.04 PMThe lessons we learned from reviewing those cases were used to inform the development of the California Toolkit: Improving Health Care Response to Preeclampsia.  CMQCC and the California Department of Public Health (CDPH), Maternal, Child and Adolescent Health (MCAH) Division collaborated to develop and disseminate this toolkit using Title V MCH funds provided by CDPH-MCAH. The goal of this toolkit is to guide and support obstetrical providers, clinical staff, hospitals and healthcare organizations to develop methods within their facilities for timely recognition and organized, swift response to preeclampsia and to implement successful quality improvement programs for preeclampsia that will decrease short- and long-term preeclampsia-related morbidity in women who give birth in California. (Druzin et al 2014).

Experts from obstetrics, perinatology, midwifery, nursing, anesthesia, emergency medicine and patient advocacy relied on best evidence, expert opinion and the Toolkit includes:

  • Compendium of Best Practices: eighteen articles on multiple topics around hypertensive disorders
  • Appendices: Collection of all Care Guidelines including tables, charts and forms that are highlighted in Article Sample forms for policy and procedure
  • Slide set for Professional Education: slides that summarize the problem of and the best practices for preeclampsia to be used for local education and training

Of particular interest, the toolkit addresses the management of severe preeclampsia < 34 weeks, the importance of recognition and treatment of delayed postpartum preeclampsia/eclampsia in the emergency department and early postpartum follow-up upon discharge for women who were diagnosed with severe hypertension during childbirth.  The Preeclampsia Foundation was a partner on the Task Force, and has created educational material for pregnant women and their families, in English and Spanish.  Hospitals, clinics and childbirth educators can order these materials at no cost (shipping and handling only) from the Foundation.  There is a free webinar available on February 25th introducing the toolkit to professionals.preeclampsia

Thinking back to my childbirth education observations, I am struck that the educators never mentioned preeclampsia or defined it.  Not one suggested women should know their normal blood pressure.  The Preeclampsia Foundation commissioned a report in 2012 which reviewed the top pregnancy and childbirth advice books and found that many either failed to mention the condition or contained misleading or incorrect information about preeclampsia, HELLP or eclampsia.  With hypertensive disorders of pregnancy on the rise (as well as other maternal morbidities) (Fridman et al 2013; Creanga et al 2014) it’s important for childbirth educators and birth professionals to help women understand signs and symptoms and to know what those signs and symptoms might mean.

Even as we know most women are healthy and are highly unlikely to experience a severe complication in pregnancy and childbirth, we must also acknowledge that some women do, and by leaving them out of the classes and books, we silence their reality.  As one woman noted in a research study on experiences of severe pregnancy complications said:

There’s a lot of information out there or bad information that can make you feel like you did this to yourself. But there’s every kind of woman that has gone through some sort of thing. You don’t see red flag kind of behaviors in the population of women who get preeclampsia or a lot of the other kinds of issues that can cause childbirth injury and the bad childbirth experiences. I understand the way the books put it is that they want to reassure you that it’s not going to happen to you, but the kind of flipside of that is to say that when it does happen to you, where are you then? You know? I think they set you up for PTSD, for postpartum depression. They kind of make it seem, like, “Oh hey! You’re fine. Everything’s going to be great. It’s not going to happen to you” so what are you left when it does happen? (Lisa, in Morton et al 2103).

We owe it to pregnant women to give them the information they need to understand the fullness of their pregnancy and childbirth experiences, whether normal or complicated.  The Preeclampsia Toolkit will hopefully help those clinicians who care for childbearing women better manage and reduce the severity of complications when they arise.  Since its release last month, the Toolkit has been downloaded over 1376 times in all 50 states states (plus District of Columbia and Puerto Rico) along with 5 countries; Australia, Canada, Wales, Mexico and Malaysia.  The response to this Toolkit has been incredible and it is clear that there is a need for practical tools that hospitals and clinicians can use to improve their response to hypertensive disorders of pregnancy. 

Do you share information about preeclampsia in your classes and with your clients?  How do you discuss it?  What are your favorite learning tools?  Let us know in the comments. – SM

References

Creanga, MD, PhD, Andreea A. ; Cynthia J. Berg, MD, MPH, Jean Y. Ko, PhD, Sherry L. Farr, PhD, Van T. Tong, MPH, F. Carol Bruce, RN, MPH, and William M. Callaghan, MD, MPH, Maternal Mortality and Morbidity in the United States: Where Are We Now? JOURNAL OF WOMEN’S HEALTH, Volume 23, Number 1, 2014, DOI: 10.1089/jwh.2013.4617

Druzin, MD Maurice; Laurence E. Shields, MD; Nancy L. Peterson, RNC, PNNP, MSN; Valerie Cape, BSBA. Preeclampsia Toolkit: Improving Health Care Response to Preeclampsia (California Maternal Quality Care Collaborative Toolkit to Transform Maternity Care) Developed under contract #11-10006 with the California Department of Public Health; Maternal, Child and Adolescent Health Division; Published by the California Maternal Quality Care Collaborative, January 2014.

Fridman, PhD, Moshe; Lisa M. Korst, MD, PhD, Jessica Chow, MPH, Elizabeth Lawton, MHS, Connie Mitchell, MD, MPH, and Kimberly D. Gregory, MD, MPH, Trends in Maternal Morbidity Before and During Pregnancy in California, Am J Public Health. Published online ahead of print December 19, 2013: e1–e9. doi:10.2105/AJPH.2013.301583)

Morton, C. H. (2009). A fine line: Ethical issues facing childbirth educators negotiating evidence, beliefs, and experience. The Journal of perinatal education, 18(1), 25.

Morton, C.H., A. Nack, and J. Banker, Traumatic Childbirth Experiences: Narratives of Women, Partners, and Health Care Providers. Unpublished manuscript. 2013.

Morton, C. H., & Hsu, C. (2007). Contemporary dilemmas in American childbirth education: Findings from a comparative ethnographic study. The Journal of perinatal education, 16(4), 25. Chicago

 

Childbirth Education, Guest Posts, Maternal Mortality, News about Pregnancy, Pre-eclampsia , , , , ,

Lessons from a Snow Field

January 23rd, 2014 by avatar

Today’s post is written by Kimmelin Hull, former community manager for Science & Sensibility.  Kimmelin shares how the lessons parents receive in their Lamaze classes prepare them well for many of life’s experiences that may lay ahead.   I can think of many things that I teach in a standard Lamaze class that can become life skills that will serve families well long after the little one has grown. – Sharon Muza, Community Manager, Science & Sensibility

source: flic

source: flic

On January 17, 2014 a group of friends were out snowmobiling in Cooke City, South Central, Montana.  At a critical moment during the sledding trip, one group member steered his snow mobile up a slope while his friends were further below.  Loosening the snow pack that overlay a weak under layer, he set off an avalanche that quickly buried one of the group members on under four feet of snow.

What does this have to do with Lamaze and childbirth?  Just wait.

Within moments of the avalanche burying his friend, one of the group members assisted in locating and extracting the buried snowmobiler with the use of an emergency beacon and a shovel.  Buried for ten minutes, the avalanche victim displayed neither respirations nor a pulse.  For all intents and purposes, he was clinically dead. Recalling CPR skills he’d learned while taking a Lamaze class with his wife, the rescuer performed cardiopulmonary resuscitation on his friend, successfully reviving him.  Many are calling this a miracle, as the combination of circumstances made it highly unlikely the man buried under snow would survive. Here is the full story.

As childbirth educators, we have the capacity to impact the lives of our clients in so many ways.  Going above and beyond teaching the stages of labor and pain coping techniques, we teach our clients self-empowerment, navigation of complex health care environments and, yes, some of us even teach life-saving skills.

While operating my childbirth preparation program in Bozeman, Montana for over 6 years, I included infant/child CPR in my class curriculum.  Having been trained previously as a first aid/CPR instructor through the American Red Cross, I had both the capacity and the motivation to incorporate these life-saving skills into my curriculum.  I can’t tell you how many of my clients thanked me specifically for that portion of the program; they felt prepared, “just in case anything were to happen” in terms of a life-threatening breathing or cardiac emergency with their soon-to-be-born baby.

source: flickr

source: flickr

An alternative to becoming trained in first aid/CPR instruction is to contract with a local instructor, inviting them to attend a single class during which they can share the easy-to-learn skill of performing CPR (the American Red Cross has simplified the training in recent years).

There are so many ways in which we can enhance our childbirth education programs.  Some instructors incorporate extensive relaxation and meditation techniques in class.  Others extend their programs to offer considerable early parenting skills training.  Others still, spend valuable time discussing perinatal mood disorders, including identifying signs and symptoms, and local treatment resources.  The Lamaze Certified Childbirth Educators training program provides the canvas for our individual teaching endeavors; we create the masterpiece that becomes our approach to evidence-based, high quality education.  These adjuncts to the “traditional” childbirth preparation class represent skills and knowledge that a person can take with him or her, and benefit from, for life.

What have you done to enhance your program?  What specific needs do the clients in your communities have? Have you enriched your Lamaze classes with add-on curriculum that has been well received by your community?  Please share your ideas in our comments section so we can all learn from your experiences.- SM

About Kimmelin Hull

Kimmelin_Hull_ProfileKimmelin Hull, the previous Community Manager for Science and Sensibility, is completing her Masters of Public Health in Maternal and Child Health degree through the University of Minnesota.  She lives in Bozeman, MT with her husband and three children, and is an active member in numerous community health coalitions all of which promote health and well-being of women and their families.

Childbirth Education, Guest Posts, Lamaze International, Uncategorized , , ,

January is National Birth Defects Prevention Month – Are Your Resources & Information Up to Date?

January 21st, 2014 by avatar
image: NDBPN.org

image: NDBPN.org

January is National Birth Defects Prevention Month, and this year the campaign being presented is that birth defects are “Costly, Common and Critical.”  This campaign is sponsored by the non-profit organization National Birth Defects Prevention Network (NBDPN). The NBDPN is a volunteer-based collaborative non-profit that works to capture national statistics on the numbers and types of birth defects occurring in the USA, along with coordinating research and prevention efforts.  This multi-disciplinary organization is made up of public health officials, consumers and researchers working together to reduce birth defects and their short and long term consequences. They collaborate with the Center for Disease Control and Prevention and March of Dimes as well as other well known organizations and agencies.

image: NBDPN.org

image: NBDPN.org

One in 33 babies born are affected by a birth defect.  A baby with a birth defect is born every 4 1/2 minutes in the USA and these defects are responsible for one in five infant deaths. Not all birth defects are detected prior to birth, though many are identified during an ultrasound or amniocentesis.  There are some birth defects that are not detected before the newborn leaves the hospital. All birth defects are not related to genetics, some occur randomly during fetal development and others are a result of circumstances during pregnancy. Total hospital costs of children with birth defects exceed $2.6 billion. Congenital cardiac and circulatory birth defects account for $1.4 billion of these annual hospital costs.  Defects of the heart and limbs are the most common kind of birth defects. Only reasons for 30% of birth defects are known, but ongoing research is working towards identifying the unknown causes.

If you are an educator or a provider who offers a preconception class, your class is a great opportunity to share some of the resources on birth defect prevention, so that women and their partners can do what they can to reduce the likelihood of having a child with a birth defect.  That includes a discussion about getting enough folic acid, having regular medical checkups,  making sure medical conditions, such as diabetes, are under control, testing for infectious diseases and being up to date on vaccinations. Also avoiding cigarettes, alcohol and other drugs.

image: NBDPN.org

image: NBDPN.org

The NBDPN provides information and fact sheets on a variety of topics for consumers in both English and Spanish, as well as webinars that appeal to professionals, health care providers and researchers. They are also holding a virtual conference beginning in late February, that you can attend.

If you are not a health care provider, you may not know that a family in your class is carrying a baby with a birth defect.  They may disclose this information to the class, they may share with you privately or they may say nothing.  They might not even know themselves at the time.  It is imperative that you have resources available should they ask.  You may find out after the baby is born if class members stays in touch with you or there is a class reunion.  Your families may look to you for information and support.

Resources for your students and their families

Families you work with may also appreciate referrals to counselors, therapists and local support groups, to help them deal with the emotions and stress of having a baby with a birth defect, who may spend time in the NICU and be facing significant medical care, treatment and surgeries in the future.  Having a comprehensive list prepared in advance, with the appropriate local resources, will be helpful should you have a this situation.

As childbirth educators and other professionals working with an expectant family, we have an obligation to help prepare families for when things do not always go as planned.  The relationships we develop with families during the vulnerable year of pregnancy, birth and postpartum makes our role very important in helping families be ready for whatever comes.

Have you had a family in your class who delivered a baby with birth defects? Did they let you know about the circumstances?  Before or after birth? What did you do to help this family be prepared?  What resources did they find valuable?How did this affect what you said or did in your childbirth education course? Please sensitively share your experiences with our readers in the comments section so we can all be better prepared for supporting families whose child had a birth defect and their journey did not go as planned.

Babies, Childbirth Education, Newborns, Research , , , , , , , ,

A Tale of Two Cities from a Childbirth Educator’s Perspective

January 16th, 2014 by avatar

Today on Science & Sensibility, Laurie Levy, LMP, MA, CD(DONA, PALS), CBE, shares her experiences as a childbirth educator and doula recently relocated to a new state.  Her exposures to a new birth culture and method of doing things has taken her breath away, as she settles in to supporting families in her new home.  Learn more about Laurie’s experiences below.  Have you moved around the country and been surprised at the differences in practice you found?  Why do you think there is this difference?  Please discuss with us in the comments section. – Sharon Muza, Community Manager, Science & Sensibilityimage: http://screnews.com/greer/

hospital-signI moved from Seattle to Northern California this past September.  In Seattle, I was privileged to train and teach with leaders in the birth community for many years. Couple this with the 1998 passage of the WA Every Category of Health Care Provider Statute which compelled insurance agencies in WA state to cover licensed midwives and you can see why I would use the word ‘spoiled’ to describe my experience with birth in Seattle.

At a meeting with some of my new colleagues, I joked that I sound like I am saying, “And one time, at band camp…” when I talk about typical Seattle birth practices.  In the seven hospitals in the metro Seattle area, it was common to see moms moving about the halls with telemetry units.  Occasionally you would even see a woman out of bed and moving with an epidural in place. Vaginal exams were limited after the amniotic sac had ruptured. Babies were not routinely separated from their mothers.  The NICU came to the birth room if needed in most cases.  Mothers were encouraged to hand express colostrum to help a baby with unstable blood sugar. Babies were born directly on to their mother’s chest in some cesarean births. Hospitals competed for patient’s maternity care dollar offering ever improving birth suites with each remodel. Tubs, showers, mood lighting and comfortable spaces for partners to rest were expected in birth spaces. VBACs were encouraged. Mother-baby friendly hospitals were the rule not the exception.

Births in my new community

I recently attended my first series of births near my new home and, while these experiences are only a thumbnail of a much bigger picture, I found the differences in environment to be very stark indeed.  In fact, few of the practices I saw lined up with Lamaze International’s Six Healthy Birth Practices.  I am not a Pollyanna. I know that Archie Cochrane awarded obstetrics the “wooden spoon” in 1979 for being the least evidence based medical speciality.  I have talked with nurses from other states who tell stories about mothers being confined to bed after their water breaks for fear of a cord injury or other such superstitious practices. Still I was surprised at what I saw and have been thinking about the challenges that will face me here as I start teaching childbirth education in my new home.

My intent is not to malign any of the practitioners who I met.  In fact, I found that virtually every staff member that I observed wanted the best for their clients and were trying to make the best of a less-than-ideal situation. To protect confidentiality, I have combined information from several births and changed insignificant details, though I have not fictionalized any of the practices.

Healthy Birth Practice 1: Let labor begin on its own & Healthy Birth Practice 4: Avoid interventions that are not medically necessary

My client had some complications and I believe most practitioners would agree that the benefits of an induction outweighed the potential drawbacks. While I have no issue with that, I question why a provider would offer to break a mother’s amniotic sac when she was only 3cm and clearly not in labor.  There was no discussion of possible complications, no discussion that this practice sometimes slows labor or does nothing rather than speeds it up (Smith, et al 2013.)  AROM did nothing to progress my client’s labor and after 9 hours and 5 vaginal exams, she spiked a fever. This led to antibiotics, Tylenol and a spiral of other outcomes that I will address later.

Healthy Birth Practice 2: Walk, move around and change positions throughout labor

My client wanted to move around in labor but was being continuously monitored.  Her window-less room measured 10’ by 8’. She and her family spent a full 24 hours in this room. No one offered a telemetry unit which would allow her greater mobility and when she asked, was told that the L&D floor had one telemetry unit, but the cord to connect the device to the EFM machine was missing. My client requested to shower, and the only shower on the floor was down the hall, none of the rooms had their own.  Showers were also not allowed when Pitocin was being used.

Healthy Birth Practice 3: Bring a loved one, friend or doula for continuous support

I have to say on this point the facility did pretty well. Like most hospitals, they had a practice of only allowing one support person in the room when an epidural is being administered and during cesarean birth.  My client had her epidural reinserted repeatedly.  I was only asked to leave the room once and was allowed into the surgery after much pleading and crying by the mom.

Healthy Birth Practice 5: Avoid giving birth on your back and follow your body’s urges to push

My client was asked to do a “pushing trial” to see if the physician could reduce the anterior lip that seemed to be holding up progress.  She pushed on her back as that was the only position her provider was comfortable with and, as you will see below, she was unable to support herself in other positions.

After 24 hours, we did end up in a room that had its own toilet.  Few other rooms did.  None of the rooms had a tub and clients were not allowed to bring one in.  The standard was communal bathrooms for women in labor, one shower for the entire unit and no refrigerators anywhere to store patient food for use during labor.

It was my client’s intention to hold off on pain medications until after six centimeters (active labor.)  We were creative but a 24 inch movement radius, lack of access to a tub or shower and continuous pitocin led to an epidural earlier than planned. There were some complications with the block and it needed to be replaced several times, and the final medication level was so significant that the mother had absolutely no ability to move her legs on her own at at all.

Healthy Birth Practice 6: Keep mother and baby together – It’s best for mother, baby and breastfeeding

I already gave away the ending – this mother gave birth by cesarean section.  The operating suite was a fairly good size and I was allowed in the operating room as a doula.  Baby was born immediately yelling and pinking up.  Mom got to see her newborn over the blue screen but baby was immediately brought to the warmer.  I heard the pediatrician say “This baby looks so great I am going to leave!” Even with all of that, routine procedure was for baby to be recovered in a separate room.  Staff would give baby all of her injections, weigh and measure her and bathe the baby before returning the baby to mom’s recovery room.  Standard procedure.  Baby was away from her for a full hour before they had any more than a cursory hello.

After the birth, my client asked that I let her family know that she and the baby were healthy.  The extended family seemed very calm when I told them the good news.  They were unconcerned because they had already seen the baby.  I turned around to see into the nursery where one of the grandmothers was cuddling the baby in a rocking chair.  The extended family was holding the baby before the mother.

Thoughts for the future

Upon leaving, the attending physician told my client, “There is no reason for you not to have a vaginal birth next time.  Just not here.”  Apparently, there has been no change in policy about VBACs even with the recent change to the ACOG guidelines (ACOG, 2010).  This hospital has a VBAC ban.

I am not trying to demonize the health care providers or nurses.  I don’t believe that anyone enters maternity work with the idea of oppressing women.  I do believe they were doing the best they could within this system.  This hospital does have plans to address the facility issues but those will take quite some time and hundreds more women will labor and birth before those changes are made.  Probably more important, I wonder how long it will take for a cultural shift even with floor plan improvements.

Jerome Groopman, M.D. in his book How Doctors Think discusses at length how medical providers – and really all of us – make the same errors of logic and repeat them over and over.  So, while I am all for cheerleading and encouraging parents to advocate for themselves, ask for change in the system, understand the evidence for various practices, I also know that most people have a hard time hanging onto their personal power in a medical setting having been socialized to defer (see another Jerome Groopman book, Your Medical Mind) to their provider.

I am much more interested in preparing parents with real world expectations about what practices actually take place in their local birth community. The childbirth classes that I teach here will by necessity be different from what I taught in Seattle. Best practices are just that, but navigating the realities of what is and still having a positive birth experience vary from locale to locale.

To truly prepare parents, it is imperative that I include curriculum about what really makes up informed consent.  Research may tell us one thing, but choice of provider, provider’s preferences and the personal values of the birthing woman all figure into what makes up this slippery thing called “informed consent.” I have found that many expecting parents have never made a health care decision together and have never discussed their values around health care.  Exploring values and how they relate to medical decision making must also be included in childbirth classes to adequately prepare parents. This self-knowledge is not limited to the labor as it will serve parents well as together they navigate future medical decisions for their child.

And finally, parents need concrete tools and classroom practice talking to providers about their wants and desires.  ‘What the brain fires it wires,’ neuroscience tells us. By tools, I mean a concrete list of conversation starters. For example, “I hear what you are suggesting.  I would like to tell you a bit more about where we are coming from.  We would like delayed cord cutting because we value an unrushed separation)” (James, et al, 2012). The role play speaking values and truth in a safe classroom environment can help make parents more likely to actually do this during the stress of prenatal visits and labor ( Arrien, 1993).

I am so grateful that I get to work as both a doula and a childbirth educator.  I gain so much information from each role that helps improve my work when I am wearing the other hat. I know that not every childbirth educator can attend births but I would encourage educators who can, to do so, and also to work in concert with doulas and other childbirth professionals to find out what is really happening in their area.  Additionally, surveying past students to find out if our presented curriculum addressed the real needs of parents as they progressed through labor can help educators to adapt what we teach to meet those needs.

I am confident that the families that I work with both as a childbirth educator and a doula will benefit from my experiences of what is possible and together we can encourage change to practices that are more in line with best practices in obstetrical care.

References

Arrien, A. (1993). The four-fold way: walking the paths of the warrior, teacher, healer, and visionary. New York, NY: Harper.

James, K., Levy, L. (2012, October). Doubters, believers and choices, oh my. Concurrent session presented at the Lamaze International Annual Conference, Nashville, TN.

Smyth RMD, Markham C, Dowswell T. Amniotomy for shortening spontaneous labour. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD006167. DOI: 10.1002/14651858.CD006167.pub4.

Vaginal birth after previous cesarean delivery. Practice Bulletin No. 115. American College of Obstetricians and Gynecologists. Obstet Gynecol 2010;116:450–63.

About Laurie Levy

Laurie LevyLaurie Levy, LMP, MA, CD(DONA), CD(PALS), CBE is a licensed massage practitioner, birth doula and childbirth educator, human anatomy and physiology instructor, and mother of three rambunctious boys.  Laurie has presented at the 2011 Lamaze InternationalConference and hopes to sit for the LCCE exam in 2014.  She can be reached through her website, laurielevy.net

Childbirth Education, Evidence Based Medicine, Guest Posts, Healthy Birth Practices, informed Consent, Maternity Care , , , , ,

Science & Sensibility Wants You to Write for our Blog!

January 14th, 2014 by avatar
image: aimislam.com

image: aimislam.com

My name is Sharon Muza, and I am the current Community Manager of Lamaze International’s blog Science & Sensibility. In this capacity, I would like to extend an invitation to all of you, to consider becoming a contributor to Science & Sensibility.  I would like to ask each of you reading today, to consider sharing your wisdom, your expertise and your experiences with all of the Science & Sensibility community.  Science & Sensibility is a multi-disciplinary blog launched in April 2009 by Lamaze International to improve knowledge of evidence-base maternity care among Lamaze Certified Childbirth Educators and other birth professionals and advocates.  It is one of the leading online resources for up-to-date news and analysis of research and policy issues affecting childbearing women.

Our mission on this blog is to share research about healthy pregnancy, birth and postpartum, We do this by:

  • Presenting new research and helping readers to better understand the information
  • Reviewing books and films on topics relevant to the field of infant and maternal health
  • Interviewing experts that we all want to hear from, on relevant topics
  • Sharing innovative and effective teaching ideas
  • Introducing resources and tools that readers can use to do their jobs more effectively

Our readership consists of Lamaze Certified Childbirth Educators, other perinatal educators, midwives, doulas, lactation consultants, nurses, doctors, therapists, counselors and consumers from around the world.  I can tell you, after doing this job for almost two years, that our readership loves to engage, learn and participate in process improvement to work towards safer and healthier births for all women and babies.

What is your area of expertise?  What topics are you an expert in?  What is your area of research that you want us all to know about?  Do you enjoy breaking down studies in order to better understand them?  What are you doing to help mothers and babies?  Do you have ideas that you are just bursting at the seams to share?  If so, I invite you to contact me so we can discuss potential opportunities for contributing to the blog.

The list of past and current contributors is diverse and consists of many experts and leaders in a variety of fields. It also consists of a lot of regular people, like you and I, who have something important and different to share.  Everyone likes to learn and grow by being exposed to new information and ideas.  I am happy to offer editing support and other assistance to help you, if you having something to share but are hesitant about writing.official experts

If you enjoy putting pen to paper (or fingers to keypad, as that is what really happens today) and sharing thoughts and information on topics relevant to this blog, I would be delighted to hear from you.  If you have ideas for future posts or topics that you would like to see covered (by someone else), I would love to hear from you. I am happy to find just the right expert to do the job.  If you have suggestions on how we can continue to share research and evidence based practices with all those working to improve outcomes during the childbearing year, let me know.  I would be delighted to introduce our readership to some fresh voices, new ideas and perspectives on the topics that matter to us all.

Won’t you consider becoming a contributor to the blog, or sharing your ideas that help shape our future topics?  We are looking for those who will submit one post and others who want to join our regular contributor panel, offering wisdom on a regular basis.  I extend a warm invite to you and look forward to your responses.  Please reach out to me now.

Childbirth Education, Lamaze International, New Research, Research, Science & Sensibility, Uncategorized , , , , ,