Science & Sensibility

photo:Dawn Thompson, improvingbirth.org

I’d like to draw your attention to a very important study that is currently looking for participants – The Maternity Support Survey. This comprehensive study is the first to compare doulas, childbirth educators, and labor and delivery nurses, working in the United States and Canada, in terms of their approach to maternal support and care. The survey explores these individuals’ knowledge and attitudes toward current childbirth practices, technologies and support.  Now is your opportunity to share how you view your responsibilities.  This research team wants to hear from you!

The team behind the research has been working for over two years via conference calls to develop the survey and methodology.   The research team consists of Louise M. Roth, PhD, (Principal Investigator), Christine Morton, PhD (Co-PI and regular contributor to this blog), Marla Marek, RNC, BSN, MSN, PhD(c), Megan Henley, Nicole Heidbreder BSN, MA, Miriam Sessions, Jennifer Torres, and Katie Pine, PhD.  They are sociologists and nurses, working in California, Arizona, Washington DC, Michigan, and Wyoming.  To raise funds for the project, they launched an Indiegogo campaign and have been featured on the Every Mother Counts blog.  The Maternity Support Survey has been approved by the Institutional Review Board of the University of Arizona, and Louise M. Roth, PhD, is the Principal Investigator of the study.

I’m sure the readers of this blog are aware that research has shown that support during labor and delivery has a significant impact on method of delivery, maternal and neonatal morbidity, and rates of postpartum depression. Yet existing research in maternity care has largely focused on how mothers and families view their care or on the perspectives of midwives and obstetricians, with less attention to the views of individuals who provide support to women during pregnancy and birth. The Maternity Support Survey is addressing this need.

Topics that the survey investigates include: whether doulas and childbirth educators view their maternity support work as a career, how doulas and childbirth educators establish their expertise, how technology affects workload among labor and delivery nurses, how maternity support workers are affected by managed care and litigation concerns, and emotional burnout among maternity support workers.

The Maternity Support Survey has partnered with Lamaze International and the following organizations in the recruitment of participants: Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN); Birthing from Within; International Childbirth Education Association (ICEA); BirthWorks; DONA International; toLABOR (formerly ALACE); and CAPPACanada.  These organizations felt that this research was important enough to reach out to their collective members with a request for participation.

The survey launched in November 2012 – the organizations above sent emails to their members, along with monthly reminders.  By early mid January 2013, the survey had logged 1500 responses, with relatively equal numbers of each group responding.  Then, the research team decided to extend the reach of the survey to those doulas, CBEs and L&D nurses BEYOND the membership organizations.  A viral social media blitz ensued, with positive results.  Within a week, the survey logged an additional 600 responses.  As of January 21, 2013, the survey has been completed by just over 2100 respondents.  Doulas now comprise about 44%, with L&D nurses at 35% and CBEs at 33% of the total respondents.  The survey will be open through mid-March, so there is still time to share widely among your networks.  Data cleaning will happen in April, and analysis will begin in May 2013.  The researchers plan to disseminate their findings at conferences and publish in journals of interest to these occupational groups as well as in sociology and other fields.

Those of you who are members of these organizations may have already received an email with a link to the survey (and hopefully have already completed it). However, if you are not a member of one of these national organizations OR have NOT received an email from your organization inviting you to take the survey, here’s how you can share your views:

The survey is available online for US residents here.

The survey is available online for Canadian residents here.

The survey takes approximately 30 minutes to complete, and participation is entirely voluntary. The research team will NOT have any way of personally identifying you or your responses, and will not contact you for any purposes unrelated to this survey or give your information to any commercial organizations. For questions or feedback, please contact Louise M. Roth, PhD.

Sharon Muza Childbirth Education, Lamaze International, Maternal Quality Improvement, Maternity Care, Patient Advocacy, Research, Research Opportunities Childbirth Education, childbirth educators, doulas, L&D Nurses, Lamaze International Christine Morgan, maternity care, Maternity Support Survey, research

Today’s Science & Sensibility post is written by regular contributor, Kathy Morelli.  To learn more about Kathy, please check out our contributor page or visit her at her website.

Lamaze Childbirth Educators work hard to be innovative and creative when designing their childbirth classes.  Today’s post highlights a LCCE who thinks out of the box by offering couples the opportunity to enjoy a couples’ retreat weekend while taking their childbirth classes.   Teaming with her husband, Rosemarie DiMare, this couple meets families at a comfortable, romantic resort, and includes sessions for mothers led by Rosemarie and sessions for partners led by her husband, John. Read more of Kathy’s interview with Rosemarie below.- SM

I had the honor of interviewing Rosemarie DiMare, a long-term doula and childbirth educator. She and her husband,  John, recognized the importance of including the male perspective duing the childbearing years and developed a unique way of helping families open to their pregnancies and new lives as parents. Their story follows.

Rosemarie DiMare has been in the childbirth business since 1997.  She is married and has two sons, ages 19 & 16 years old.  Rosemarie became a DONA certified doula after the birth of her second son and began teaching childbirth education classes as well. In 2007, she became a Lamaze certified childbirth educator. Her inspiration was her own doula.  S&S asked Rosemarie some questions:

S&S: What was your inspiration for becoming a birth worker? 

My doula was amazing, and in 1996, I was hearing more and more about doulas; it was a new profession at the time. I really loved the idea of supporting women in their births. I wanted to give back to the community and help women in my work, and I wanted to be a full-time mom. So, in the beginning, I didn’t take many births. The first year, I only took 4 births. Within the first year of becoming a doula, I started teaching childbirth education classes.  At that point, my husband began working at home, so I could really start to do the work of birth.

S&S: Tell us about your childbirth education journey and why you chose to become a Lamaze-trained educator? 

I’ve been a childbirth educator for almost 15 years.  I have developed my in-depth childbirth curriculum over those years. I take a lot of training and I incorporate information from different sources. I noticed that prenatal couples were taking hospital-based childbirth education classes. These classes were not informing them about their choices, instead they were being told what was going to happen to them. I felt a need to educate people about their options and choices. I am not bashing hospital based classes, I just don’t see how they tell prenatal couples the whole story.  I believe that if you don’t know your options, you don’t have any, so it is important to get some education about your options.  I always tell women, plan to afford a doula,  don’t expect Dad/partner to do everything. Get some help

I certified with Lamaze in 2007.  I really felt the Lamaze philosophy connected with my philosophy. I am blessed to be associated with Lamaze.  Lamaze is about developing confidence in your body’s ability to give birth.  It is not about the breathing. Lamaze has a moderate approach. We’re not against interventions if necessary, but not everyone needs it. I believe that Lamaze reinforces my own belief that if a woman has a really good support system: a good doctor or midwife, a doula, a good partner, a good hospital or good home setting with a midwife, she has the chance to have a good birth experience. I love the Lamaze Six Healthy Birth Practices. More and more women want to have a say in their birth and are willing to go the extra mile to find and see a provider that will respect them and work with them.

S&S: How did you come to create your unique “Before Baby Arrives Weekend Getaway classes?

To me, it’s all about creating good, positive memories.   We all remember the details of the birth(s) of our children.  I wanted to help families create positive memories to empower women of future generations.

I’ve been married for 23 years. John, my husband, and I work together through our church, mentoring couples preparing for marriage. We work with couples teaching them practical skills such as how to fight fair and how to work together as a couple. We talk about finances and also cover the spiritual aspects of marriage.  It’s something we’ve been doing for a long time and it’s a lot of fun for us. And when I teach my childbirth classes at my home, of course John meets the couples and gets to talking to the Dads, who like to pick his brain about what it’s like to be a father.

One day we realized it was a very useful, needed service to incorporate both the male and female viewpoints in prenatal education. We felt we could help the Dads a lot too, during the prenatal time.

S&S: How do the breakway prenatal classes help couples open to their new family? 

We thought that it would be nice to set something up where the pregnant couple could break away from everyday life to be with their partner  and learn about the wonder of childbirth.  We wanted to deepen the experience of pregnancy for the couples and also help them focus on the pregnancy and open up emotionally and psychologically to the experience of their baby.

I started thinking about the importance of the dads and how having a baby really changes your life for the better.  We combine Lamaze-based birth philosophy with mentoring couples for marriage and parenting.   We wanted to help dads (and moms) realize being married and being a parent is, in reality,  not a 50/50 proposition, but is actually requires you to give of yourself 100%. When mom is pregnant, birthing, breastfeeding, there are lots of times partners will need to pick up the slack.   We emphasize communication and what you can do to strengthen your relationship during the transition to parenting.

We have structured, safe couples groups and also groups just for the men and just for the women,  so men and women can share their fears with their partner and also share their fears privately.

We teach the normal childbirth education curriculum and include a lot of the Lamaze research-based information about birth. And we also emphasize decision-making skills, such as how a budget needs to be totally re-arranged, how fathers need to help by protecting the circle of family life. With the men, John discusses the realities of sex after a baby arrives, educating them about how six weeks afer birth may not be enough time for healing for some women, how overwhelming breastfeeding can feel to both partners, and how a woman’s sex drive can differ from a man’s.   John says that he teaches that men need to respect, honor and love their spouses.

There’s a lot of teaching time and sharing time but the weekend also has some downtime built-in, to let the couples take the time they need for themselves. It is truly a retreat, to replenish, to open to the beauty of childbrith and to gain new skills for parenting.

 S&S: Do you have any final thoughts you’d like to share?

I’d like to say if there are any other CBE couples out there who want to plan such an inclusive class experience, do it, you’ ll know if it’s a total fit for the two of you.  You can put together your curriculm and your props, and help couples to cope with pregnancy, birth and the transition to parenting in a holistic way.

Have you thought of a childbirth education retreat weekend?  Are you thinking outside the box when and where you offer your childbirth classes?  Do you teach in an unusual location? An uncommon format?  Combine your curriculum with something else to meet the needs of pregnant families?  I would love to highlight your unusual classes in a future blog post if you would drop me an email to let me know a bit about you. – SM

About Rosemarie & John DiMare  

Rosemarie & John DiMare have been married for 23 years and have two sons. They live in central New Jersey,  where they mentor couples through pregnancy, birth & the transition to parenting. Visit them at their website Mother to Mother Services.

Kathy Morelli Childbirth Education, Guest Posts, Healthy Birth Practices, Healthy Care Practices, informed Consent, Uncategorized childbirth classes, Childbirth Education, childbirth educators, Kathy Morelli, lamaze, Lamaze International, rosemarie dimare

The other day, while looking through my issues of Birth for something else, I ran across a commentary* written by Lamaze teacher Betsy Adrian on why she was leaving the field after five years. She writes:

I realize now that my feelings of burn-out are much more than simply boredom with repeating myself for five years. What lies at the root of my feelings is the conflict between what I believe and what I felt I had to teach. I realized that I have had absolutely no impact on how people have babies. In fact . . . things are worse now for laboring women than when I started five years ago! Fetal monitoring is taken for granted, IVs are always started, almost everyone gets the “deluxe” high-risk treatment, whether they need it or not. . . . The cesarean rate is nothing short of alarming . . . . All of the things that I felt optimistic about early on are actually less likely to occur in a delivery experience now. I believe that childbirth is a unique experience of personal growth for a woman and her partner and that it should take place according to her needs and desires. Birth should never be “routine.” . . . [I]t became ultimately impossible for me to stand up in front of a class and expound on the virtues of fetal monitoring, IVs, being confined to bed, lithotomy position or limited nursing. I can’t do it anymore. I can’t even be “objective” and present both sides of each issue, as I have religiously done in the past. I did not arrive at my opinions irrationally. I read all the pertinent studies in fetal monitoring and IVs . . . and birthing positions. And the evidence is overwhelmingly against these routine procedures. Yet I knew that almost every one of my clients would experience all of these things anyway. I also knew that continuing to teach meant remaining in the good graces of my hospital and that if I became very vocal or militant about my opinions I would lose my source of income. . . . Sadly, I am done with childbirth education. . . . I can’t do it—not if my real purpose has to be to socialize women into accepting poor care, and that’s what we have been doing in too many cases.

Now here is the kicker: this commentary was written 30 years ago. How many childbirth educators could write the exact same commentary today? If a goal of childbirth education is to give women the information and tools they need to make decisions that best promote safe, healthy birth, clearly, we are not achieving it. The “alarming” cesarean rate Adrian cites is 35% at one hospital in her area. Thirty years later, the U.S. national average is 33%, and some hospitals have rates double that or more. Adrian attributes the failure to hospital-based childbirth education, closing with:

My ultimate hope is that childbirth education will move out of hospitals, back into the community where it belongs. Then we can devote ourselves completely to our clients, and not to the doctors and hospitals.

Is the problem simply that educators have to please their employers? I think this is an issue, but not the only one. I taught Lamaze classes independently from 1980 into the 1990s, yet, like Adrian, I quit because I could no longer stand watching my students lie down on the railroad track despite all I could do to tell them there was a train coming. And if hospital-based classes aren’t the only problem, what else is? More importantly, what more could—no, should—childbirth educators be doing about it, including hospital-based educators? What are your thoughts and ideas?

Reference
Adrian BK. Childbirth educator burn-out. Birth and the Family Journal 1981;8(2):101-103.

[Editor’s note: Excerpt from Birth contained in the post is used with permission by the publisher.]

Posted by:  Henci Goer

Henci Goer Childbirth Education Betsy Adrian, Birth journal, Childbirth Education, childbirth educator burnout, childbirth educators, Henci Goer