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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 , , , , , , , ,

Marketing and Blogging with Respect; Avoid Plagiarism

August 14th, 2014 by avatar

Today on Science & Sensibility, Andrea Lythgoe, LCCE shares information on the importance of having a) a website that is created using text and images that you have the right to use; b) marketing material that does the same and c) how to share the great resources, articles and blog posts you find in your internet travels so that you are complying with the law and are respectful of the work of others.   Look for future posts in the series on using materials legally in your classroom.  Previous posts in the the Series: Finding and Using Images and Copy can be found here and here. – Sharon Muza, Science & Sensibility Community Manager

As someone who is both a writer and a photographer, typically on the topic of birth, I am happy to share my creative work online in many formats and locations.  My intent is to provide information that others find both useful and informative.  I enjoy sharing my work very much.  What I don’t enjoy is finding out that someone, someplace, on the “World Wide Web” has, with a simple copy and paste command, stolen my original work.

This theft of creative property is called plagiarism. Plagiarism is where you take the creative work of others and pass it off as your own  Content theft is when you take the work and keep the by-line intact.  In the years that I have been working as a birth professional, I have found my work copied word-for-word, or maybe slightly altered, on other web sites. I have found my pictures and images copied and used without permission. It is important for people to understand that is not OK. And it is illegal.

Writing is protected by copyright law. You cannot simply find someone who “says it better” than you think you could and use the copy and paste feature on your computer, tablet or smartphone. Not even as a placeholder until you come back and replace it with your own writing or image. If you want to have some placeholder wording as you design your site, do what the professionals do and use this.

Your business website

Your website and marketing materials need to represent YOU. They need to be who you are, and how you run your business. In these days when the birth services market is pretty well saturated in a lot of areas around the country, the only way to stand out is by selling YOU. No one else can be you. And copying someone else’s words, design or images is not who you are.  As unbelievable as it might seem, there have been circumstances where people have copied another professional’s “About Me” page, with the only change being the original author’s children’s names replaced with their own.

Maybe writing is not your strength. I can understand that. We all have weaknesses and things that we can’t do no matter how hard we try. Two of mine are chemistry and surfing! And that’s OK. You can hire someone (or if you’re lucky, use a friend or spouse who has the skills) to turn your own thoughts and ideas into nicely worded text. But you – and only you – should first sit down with paper and pen and make notes about what you want to say. Make a list of words that appeal to you – words that you feel describe the work you do, why you do it, and what experience you hope your clients will have when working with you. Write a list of facts about yourself you want your clients to know about you.  Think about how you might turn one of those qualities into a short anecdote to include in your “about me” page. Maybe this exercise will take a few days or weeks before you’re even ready to get started working with a writer who can help you turn your jumble of ideas into paragraphs. If it takes time, that is okay.

If you find you have absolutely no ideas to give to your writer, then you may need time to do some evaluating about where you want to go. In order to have a successful business, you need to have your own vision and direction for the business. In the words of a birth photographer, Leilani Rogers: “If you are lacking direction in your business and can’t articulate how you feel about things or how you want to run your business then you are not ready to own one.”

The work of articulating your business vision to your clients through the written word is not an easy one, but it is worth it. Not only will you maintain professional integrity, you will have the opportunity to carefully consider and refine your business in the process.

Your blog content

A blog is a great way to boost the search engine optimization (SEO) of your web site and keep potential clients returning to your site. It is important that your blog and any resources you post on your web site be entirely your own work. You’ll come across lots of interesting articles you may want to share with your readers, but ethically, you need to direct your readers to the original source, and not republish on your site. Giving credit, and then pasting the entire article is not enough. Republishing (or as some call it “cross posting” or “reblogging”) without permission is not acceptable. Writers create original content for many reasons and one of those is to bring traffic to their own site, and keeping readers on your site reading someone else’s material is stealing readers from them.

How to properly share an article or blog post

There are many ways to do this responsibly:

  • You can have a regular feature where you share interesting things you come across. I do this every Wednesday on my own blog.
  • Another common method is to share a small (1-2 paragraph) excerpt with your thoughts and comments on the article, and then direct your reader to the article to read more. A great example of this can be found on Evidence Based Birth here.
  • You could also contact the author of the article and ask to do a short Q&A on the article (by phone or email) that you could publish and then link to the original article. Science and Sensibility does this frequently when we feature a new study.
  • Another way to share is to use topical lists. Have a list of recommended reading on going past your due date. Another list on deciding about induction. Another about breastfeeding resources, etc. Adding a small blurb (1-2 sentences) about what the reader can expect to find there or why you included it in the list is helpful to your readers. Birth and Baby Matters has an example of a topically organized link list.

While sharing other content is helpful, writing your own content is even better! Next time you find yourself speaking passionately and knowledgeably on a topic, turn it into a blog post! Next time you write a particularly eloquent comment on a Facebook question, turn it into a blog post! Go to an interesting conference, share it with your readers like Deena Blumenfeld did. Sharing your own opinions and knowledge helps establish you as an expert in the eye of the reader. And that is a plus to potential students!

If you’ve found yourself doing it incorrectly and you have content on your site that is not your own, please immediately take it down. You can replace those posts with your own thoughts and a small teaser quote with a link in a very short amount of time. It shows that you are professional and are also complying with the law.

What if you find your original material posted elsewhere?

With a simple Google search, or by using sites like Copyscape, it is very quick and easy for incidents of plagiarism to be caught. Back when I taught at a midwifery college, if I suspected a student of plagiarism, I could generally find the source within a minute or two. Using someone else’s creative property is not flattery; rather it is hurtful, disrespectful and illegal.

If you are a writer and find that someone has posted your work without permission, your first step will be to contact the site owner and request it be removed. A firm approach suggesting an alternate way to share the information, with a deadline helps them to know you mean business.

If that is ineffective, you may be able to file a DCMA Takedown request with the site’s host. This is a U.S. law, but many hosting companies internationally still comply. You’ll need to determine where they host their site. I find the database at www.whois.com to be helpful with this. Then do a web search for the hosting company’s web site. Most sites have a Takedown request form on their page. Depending on the hosting company’s policies, they may take down just the content you reported, or they may take down the infringer’s entire site! (Another reason to stay on the right side of copyright law!)

Resources to help create a unique website

10 Rules for Writing About Me Pages - Great list of things to do – and what not to do! – and lots of examples.

Four Steps To Finding Your Writing Voice
 - Excellent advice from a middle school English teacher. Her whole site is full of good tips, so browse around!

How to Write Effective Website Content - Pretty much exactly what the title says. Make sure you read all the way down to the “best practice tips”, because that’s where the best tips are.

How to Decide What to Blog About - I love the focus on the reader’s experience and needs in this one.

Blog Topic Generator - This is an interesting tool, it gives you some interesting titles if nothing else.

Have you found an effective and legal way to share information with others via your website and blog?  Have you found your own material used without permission?  How did you handle it and how did it make you feel?  Please share your ideas, thoughts, resources and suggestions in our comments section. – SM

About Andrea Lythgoe

Andrea Lythgoe

Andrea Lythgoe

Andrea Lythgoe is a doula, hospital-based Lamaze childbirth educator, birth photographer, and former instructor at the Midwives College of Utah. She is the author of the website UnderstandingResearch.com where she aims to help those just beginning to read research to understand the language of research. Her interest in research started while attending the University of Utah, where she made ends meet by working on a large randomized controlled trial and earned a degree in community health. Andrea served on the Board of Directors for the Utah Doula Association for over 10 years. She lives and practices in the Salt Lake City, Utah area. Andrea can be reached through her website.

 

 

Childbirth Education, Guest Posts, Series: Finding and Using Images and Copy , , , ,

Non-Drug Pain Coping Strategies Improve Outcomes

July 17th, 2014 by avatar

 Today, contributor Henci Goer reviews a recently published study in the journal Birth, that compared the outcomes of births in women who received non pharmacological pain management techniques with women who received the “usual care” treatment.  The researchers found that maternal and infant outcomes were improved.  Take a moment to read Henci’s review to get a glimpse at the results and her analysis.- Sharon Muza, Science & Sensibility Community Manager

© Patti Ramos Photography

© Patti Ramos Photography

In 2012,  the Cochrane Database published an overview of systematic reviews of forms of pain management that summarized the results of the Cochrane database’s suite of systematic reviews of randomized controlled trials (RCTs) of various pain management techniques. Reviewers reached the rather anemic conclusion that epidurals did best at relieving pain—no surprise there—but increased need for medical intervention—no surprise there either—while non-drug modalities (hypnosis, immersion in warm water, relaxation techniques, acupressure/acupuncture, hands on techniques such as massage or reflexology, and TENS) did equally well or better than their comparison groups (“standard care,” a placebo, or a different specific treatment) at relieving pain, at satisfaction with pain relief, or both, and they had no adverse effects (Jones 2012). Insofar as it went, this finding was helpful for advocating for use of non-drug strategies, but it didn’t go very far.

Fast forward two years, and we have a new, much more robust review: Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis. Its ingenious authors grouped trials of non-drug pain relief modalities according to mechanism of action, which increased the statistical power to determine their effects and avoided inappropriately pooling data from dissimilar studies in meta-analyses (Chaillet 2014). The three mechanisms were Gate Control Theory, which applies nonpainful stimuli to partially block pain transmission; Diffuse Noxious Inhibitory Control, which administers a painful stimulus elsewhere on the body, thereby blocking pain transmission from the uterine contraction and promoting endorphin release in the spinal cord and brain; and Central Nervous System Control, which affects perception and emotions and also releases endorphins within the brain.

Overall, 57 RCTs comparing non-drug strategies with usual care met eligibility criteria: 21 Gate Control (light massage, warm water immersion, positions/ambulation, birth ball, warm packs), 10 Diffuse Noxious Inhibitory Control (sterile water injections, acupressure, acupuncture, high intensity TENS), and 26 Central Nervous System Control (antenatal education, continuous support, attention deviation techniques, aromatherapy). Eleven of the Central Nervous System Control trials specifically added at least one other strategy to continuous support. More about the effect of that in a moment.

Now for the results…

Compared with Gate Control-based strategies, usual care was associated with increased use of epidurals (6 trials, 3369 women, odds ratio: 1.22), higher labor pain scores (3 trials, 278 women, mean difference 1 on a scoring range of 0-10), and more use of oxytocin (10 trials, 2672 women, odds ratio: 1.25). Usual care also increased likelihood of cesarean in studies of walking (3 trials, 1463 women, odds ratio: 1.64).

Compared with Diffuse Noxious Inhibitory Control strategies, usual care was associated with increased use of epidurals (6 trials, 920 women, odds ratio: 1.62), higher labor pain scores (1 trial, 142 women, mean difference 10 on a scoring range of 0-100), and decreased maternal satisfaction as measured in individual trials by feeling safe, relaxed, in control, and perception of experience.

We hit the jackpot with Central Nervous System Control strategies (probably because female labor support, which has numerous studies and strong evidence supporting it, dominate this category [19 labor support, 6 antenatal education, 1 aromatherapy]). As before, usual care is associated with more epidurals (11 trials, 11,957 women, odds ratio: 1.13), more use of oxytocin (19 trials, 14,293 women, odds ratio: 1.20), and decreased maternal satisfaction as measured in individual trials by perception of experience and anxiety. In addition, however, usual care is associated with increased likelihood of cesarean delivery (27 trials, 23,860 women, odds ratio: 1.60), instrumental delivery (21 trials, 15,591 women, odds ratio: 1.21), longer labor duration (13 trials, 4276 women, 30 min), and neonatal resuscitation (3 trials, 7069 women, odds ratio: 1.11).

© Breathtaking Photography http://flic.kr/p/3255VD

© Breathtaking Photography http://flic.kr/p/3255VD

The big winner, though, was continuous support combined with at least one other strategy. Usual care in these 11 trials was even more disadvantageous than in central nervous system trials overall with respect to cesareans (11 trials, 10,338 women): odds ratio 2.17 versus 1.6 for all central nervous system trials, and instrumental delivery (6 trials, 2281 women): odds ratio 1.78 versus 1.21 for all central nervous system trials.

The strength of the data is impressive. Altogether, Chaillet et al. report on 97 outcomes, of which 44 differences favoring non-drug strategies achieve statistical significance, meaning the difference is unlikely to be due to chance, while not one statistically significant difference favors usual care. And there’s still more: benefits of non-drug strategies are probably greater than they appear because on the one hand, “usual care” could include non-drug strategies for coping with labor pain and on the other, many institutions have policies and practices that make it difficult to cope using non-drug strategies alone, strongly encourage epidural use, or both.

The reviewers conclude that their findings showed that:

Nonpharmacologic approaches can contribute to reducing medical interventions, and thus represent an important part of intrapartum care, if not used routinely as the first method for pain relief…however, in some situations, nonpharmacologic approaches may become insufficient…the use of pharmacologic approaches could then be beneficial to reduce pain intensity to prevent suffering and help women cope with labor pain…birth settings and hospital policies . . . should facilitate a supportive birthing environment and should make readily available a broad spectrum of nonpharmacologic and pharmacologic pain relief approaches. (p. 133)

No one could argue with that, but a persuasive argument alone is unlikely to carry the day given the entrenched systemic barriers in many hospitals. States an anesthesiologist: “While there may be problems with high epidural usage, in the presence of our nursing shortages and economic or business considerations, having a woman in bed, attached to an intravenous line and continuous electronic fetal monitor and in receipt of an epidural may be the only realistic way to go” (quoted in Leeman 2003). The Cochrane reviewers concur, writing that using non-drug strategies is “more realistic” (p. 4) outside of the typical hospital environs.

So long as this remains the case, attempts to introduce non-drug options are likely to make little headway. As Lamaze International’s own Judith Lothian trenchantly observes:

If we put women in hospitals with restrictive policies—they’re hooked up to everything, they’re expected to be in bed—of course they’re going to go for the epidural because they’re unable to work through their pain. . . . I go wild with nurses and childbirth educators who say, . . . “[Women] just want to come in and have their epidural.” I say, “And even if they don’t . . ., they come to your hospital, and they have no choice. . . . They can’t manage their pain because you won’t let them.” (quoted in Block 2007, p. 175)

Success at integrating non-drug strategies will almost certainly depend on addressing underlying factors that maintain the status quo. Can it be done? You tell us. Does your hospital take a multifaceted approach to coping with labor pain? If so, how was it implemented and how is it sustained?

Resources

Block, Jennifer. (2007). Pushed: The Painful Truth About Childbirth and Modern Maternity Care. Cambridge, MA: Da Capo Press.

Chaillet, N., Belaid, L., Crochetiere, C., Roy, L., Gagne, G. P., Moutquin, J. M., . . . Bonapace, J. (2014). Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis. Birth, 41(2), 122-137. doi: 10.1111/birt.12103 http://www.ncbi.nlm.nih.gov/pubmed/24761801

Jones, L., Othman, M., Dowswell, T., Alfirevic, Z., Gates, S., Newburn, M., . . . Neilson, J. P. (2012). Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev, 3, CD009234. doi: 10.1002/14651858.CD009234.pub2 http://www.ncbi.nlm.nih.gov/pubmed/2241934

Leeman, L., Fontaine, P., King, V., Klein, M. C., & Ratcliffe, S. (2003). Management of labor pain: promoting patient choice. Am Fam Physician, 68(6), 1023, 1026, 1033 passim. http://www.ncbi.nlm.nih.gov/pubmed/14524393?dopt=Citation

About Henci Goer

Henci Goer

Henci Goer

Henci Goer, award-winning medical writer and internationally known speaker, is the author of The Thinking Woman’s Guide to a Better Birth and Optimal Care in Childbirth: The Case for a Physiologic Approach winner of the American College of Nurse-Midwives “Best Book of the Year” award.An independent scholar, she is an acknowledged expert on evidence-based maternity care.  

Childbirth Education, Doula Care, Epidural Analgesia, Guest Posts, Maternity Care, Medical Interventions, Newborns, Research , , , , ,

A Celebration of Midwifery – Supporting Safe, Healthy Birth!

July 1st, 2014 by avatar

In June, midwives were making news all around the world in person and in print.   Maternity care researcher Judith Lothian presented at the International Congress of Midwives conference in Prague, an enormous international gathering of thousands of midwives from all the corners of the globe that occurs every three years. Dr. Lothian shares her impressions of the Congress gathering today.  Additionally, the journal, The Lancet released its Series on Midwifery, long awaited and recognizing that if normal, safe birth is to be supported, midwifery care is the key to achieving that goal.  Dr Lothian summarizes this important series and shares what it means for women and their babies. – Sharon Muza, Community Manager, Science & Sensibility

@ Barbara Harper

@ Barbara Harper

In the US, where midwives attend around 10% of births and around 1% of women have planned out of hospital births, most women and many health care providers know little, if anything, about midwifery. Several decades ago, I began to write about midwifery and out of hospital birth as a way of promoting, protecting and supporting normal birth.  More recently, I’ve done research on women’s and midwives’ experiences of home birth. I’ve also spent a great deal of time with midwives, with my daughters during the births of my grandchildren, at two historic Home Birth Summits, at Normal Birth conferences and, in the last 2 years working with the American College of Nurse Midwives on their Normal Birth Initiative. I count many midwives among my most respected and cherished friends.

I’ve wanted to spread the good news about midwifery and women and babies for a very long time, but the last month has me wanting to ring bells, light candles, and shout from the rooftops to celebrate the tremendous accomplishments of midwives and midwifery, the courage of midwives, and the commitment of midwifery to women and children here in the United States and across the globe.

In early June I attended the International Congress of Midwives in Prague. Thirty eight hundred midwives (and a smaller group of nurses, sociologists, epidemiologists, birth advocates and researchers) came together as they do every three years to share what they know, learn what they don’t know, and recommit themselves to women and babies around the world.  Midwives from 85 countries, most often in the traditional dress of their country, paraded into the opening ceremony. The video and pictures from this event can’t begin to capture what it was like to be there, but it does give you a taste of the excitement and the pride.  It was truly amazing.

ICM.Frances_open

@ Barbara Harper

The number of sessions was mind boggling. In each time slot there were multiple sessions on normal birth. It was difficult to choose and impossible to get to even a small percentage of what was offered. I am sharing some of the standouts for me.

Lisa Kane Low, from the University of Michigan, and a champion of midwifery and evidence based maternity care, was a plenary speaker. Her talk on access to care highlighted the importance of meeting women where they are and putting their needs, not ours, first. Toyin Saraki is the newly appointed ICM Global Goodwill Ambassador. The former First Lady of Nigeria, she is the founder and director of the Wellbeing Foundation Africa. The work of the foundation has reduced maternal mortality in Nigeria by 20%.

Ms. Saraki shared a Nigerian saying with us: If you want to go fast, go alone. If you want to go far, go together.  I can’t stop thinking about that, and its implications for our work.  Cecily Begley, the Chair of Nursing and Midwifery at Trinity College Dublin, participated in a plenary panel, Education: The Bridge to Midwifery and Women’s Autonomy. Professor Begley talked about “communities of change” and she described education and research as necessary in crossing the bridge to change. Ray DeVries and Saras Vedam participated in a symposium on ethics related to birth place. Both Ray and Saras contributed to the Journal of Clinical Ethics Fall 2013 special issue on place of birth. The audience participation was lively.

© Barbara Harper

© Barbara Harper

The ethical issues related to pushing women to unassisted births when there is no real choice related to planned, assisted out of hospital birth and the ethical issues of hospitals and providers stonewalling efforts to make transfer seamless, safe, and without recrimination were discussed. Dr. Marianne Nieuwenhuijze from the Netherlands, presented her excellent work on shared decision making. Tanya Tanner from ACNMEllie Daniels from National Association of Certified Professional Midwives, and I presented the collaborative work of ACNM, MANA and NACPM developing a consensus statement on normal, physiologic birth, and more specifically, our work developing a consumer statement based on the consensus statement, Normal, Healthy Childbirth for Women and Families: What You Need to Know.

It was wonderful meeting midwives from Australia, Canada, Ghana, the UK, and Ireland. The challenges are not exactly the same as ours in the US, but we are all fighting uphill battles in support of normal birth.

On the heels of the ICM, The Lancet launched its eagerly awaited Lancet Series on Midwifery.  In Ireland for the summer, I was glued to my computer savoring every moment of the launch online on June 23.    The lead author of each of the four major papers provided a summary and there were comments from a wide array of noted scholars, researchers, practitioners and policy makers from around the world. There were many familiar faces from the International Congress of Midwives. Toyin Saraki gave a stirring speech applauding midwifery, noting that midwifery is not a job, but a passion, a vocation.  Holly Kennedy, who co-authored a paper, and is working on a follow up paper, brought congratulations from the ACNM.

Why did the Lancet do a series on midwifery? Richard Horton, who was involved in the project from the beginning , has this to say in his commentary, The Power of Midwifery:

“Midwifery is commonly misunderstood. The Series of four papers and five Comments we publish today sets out to correct that misunderstanding. One important conclusion is that application of the evidence presented in this Series could avert more than 80% of maternal and newborn deaths including stillbirths. Midwifery therefore has a pivotal, yet widely neglected, part to play in accelerating progress to end preventable mortality of women and children”.  Horton and Astudillo  go on to note that the work is based on a set of values and philosophy that are distinctive. “These values include respect, communication, community knowledge and understanding, and care tailored to a woman’s circumstances and needs. The philosophy is equally important—to optimise the normal biological, psychological, social, and cultural processes of childbirth, reducing the use of interventions to a minimum. “

The four papers include

  • Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care by Mary J Renfrew, Alison McFadden, Maria Helena Bastos, James Campbell, Andrew Amos Channon, Ngai Fen Cheung, Deborah Rachel Audebert Delage Silva, Soo Downe, Holly Powell Kennedy, Address Malata, Felicia McCormick, Laura Wick, Eugene Declercq
  • The projected effect of scaling up midwifery by Caroline S E Homer, Ingrid K Friberg, Marcos Augusto Bastos Dias, Petra ten Hoope-Bender, Jane Sandall, Anna Maria Speciale, Linda A Bartlett
  • Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality by Wim Van Lerberghe, Zoe Matthews, Endang Achadi, Chiara Ancona, James Campbell, Amos Channon, Luc de Bernis, Vincent De Brouwere, Vincent Fauveau, Helga Fogstad, Marge Koblinsky, Jerker Liljestrand, Abdelhay Mechbal, Susan F Murray, Tung Rathavay, Helen Rehr, Fabienne Richard, Petra ten Hoope-Bender, Sabera Turkmani
  • Improvement of maternal and newborn health through midwifery by Petra ten Hoope-Bender, Luc de Bernis, James Campbell, Soo Downe, Vincent Fauveau, Helga Fogstad, Caroline S E Homer, Holly Powell Kennedy, Zoe Matthews, Alison McFadden, Mary J Renfrew, Wim Van Lerberghe

The Lancet Series on Midwifery makes a major contribution to the literature bringing together the evidence basis for midwifery, its outcomes, and how to affect policy. We need to translate that evidence into action, into the education of the women we teach, and into our advocacy efforts on behalf of safe, healthy birth.

The Lancet Series on  Midwifery can be accessed at through this link. The series includes an executive summary, commentaries, and the four major papers. You need to register on the Lancet site but everything can be accessed for free.

The time has come to recognize and celebrate the incredible work that midwives do. In the US, it is time for women to know about midwifery, and to see the connection of midwifery and normal, physiologic birth.  It is time for childbirth educators to encourage women to choose midwifery care, and time to collaborate with midwives both in our communities and on organizational and governmental levels.  If we want to promote safe, healthy, normal physiologic birth, we need to promote and support midwifery. Healthy low risk women need to know that if they want the safest, healthiest birth for themselves and their babies that they need to find a midwife.

About Judith Lothian

@ Judith Lothian

@ Judith Lothian

Judith Lothian, PhD, RN, LCCE, FACCE is a nurse and childbirth educator. She is an Associate Professor at the College of Nursing, Seton Hall University and the current Chairperson of the Lamaze Certification Council Governing Body. Judith is also the Associate Editor of the Journal of Perinatal Education and writes a regular column for the journal. Judith is the co-author of The Official Lamaze Guide: Giving Birth with Confidence. Her research focus is planned home birth and her most recent publication is Being Safe: Making the Decision to Have a Planned Home Birth in the US published in the Journal of Clinical Ethics (Fall 2013).

Evidence Based Medicine, Guest Posts, Home Birth, Maternal Quality Improvement, Maternity Care, Midwifery , , , , , , ,

5 Business Practices of Successful Childbirth Educators

June 26th, 2014 by avatar

by Robin Elise Weiss, PhDc, MPH, LCCE, FACCE

Robin Weiss, childbirth educator and president-elect of Lamaze International shares some very smart business tips for being a successful childbirth educator, regardless of whether you work for a large hospital system or teach independent classes. Check out her advice below and share your own suggestions in our comments section. – Sharon Muza, Community Manager for Science & Sensibility

Being in childbirth education is an amazing profession. As a childbirth educator, we are privileged to be with families as they learn and prepare for one of the most exciting journeys of their lives, that of giving birth. Many childbirth educators began this path as a calling, and have had to stumble through the business aspects. It can be difficult to separate the calling from the business.

The good news is that there are five things that you can do that will greatly improve your business acumen and help you become successful in all facets of your profession.

1) Get educated

A formal education in childbirth prepares you to teach and for your certification examinations. However, other than quick mentions of finding clients and paperwork, there is often little information given towards having a business and running it well. There are many questions that you might have from settling on a business name, incorporating, taxes, license fees, or office space. These are questions that have widely varying answers, but that are very specific to where you live and how you practice. Finding a local resource for education is an imperative. Many groups that are willing to help small business owners, like SCORE. They offer free classes and counseling to help you get started.

2) Have back up

Back up in this case refers to your certifying organization. Having an international organization behind you will open many doors. While a hospital of doctor’s office may not know you, the name of an organization such as Lamaze International is well known. The people that you are applying to work with know of the high standards that Lamaze International sets forward in their educators.
There are also special benefits to being a member of a professional organization. This can include referrals for clients in your area, continuing education, conferences, and other things of professional interest. In addition to these benefits, there is also the satisfaction of being with like-minded people.

3) Give Referrals

Referrals may seem like something that does not fit in this list. But following the old adage of it being better to give than to receive is only partially true. I would amend it to be that when you give, you also receive. Keep a local resource list handy and feel free to give it away to anyone who would like it. Also be quick with personal referrals for those with complementary business practices. Think about lactation consultants, doulas, midwives, and doctors in your area. Be sure to ask the person to whom you give the referral to say that you sent them. This shows others in the area that you appreciate their services. Consider asking for their cards to pass out when asked for referrals.

4) Be present

Attend all of the local functions that you are invited to attend or that you can apply to attend. This can include baby fairs thrown by hospitals, guest speaking for various groups from nursing education to mothers’ groups. Being seen in public and having lots of people get to know you is beneficial. It has two benefits, 1) to get to know others in the community and to give back, and 2) to let people know about your services.

5) Be prepared

You should always be prepared with at least two things: your business cards and your elevator speech. Multiple business cards is a no brainer. Don’t be so thrilled with your cards that you are afraid to give them out. (I did this when I first started!) Give them out like candy. Need to give another mom your number for a play date? The back of your card works as a great white space!
Your elevator speech is a 1-2 minute long summary of what you do. Be prepared so that the next time someone asks you what you do for a living, you can quickly and confidently tell them. You can practice this after writing it out at home if that helps you. Some childbirth educators say that they’ve even made a video to watch themselves give this mini-speech to help make it more natural.

In the end, do not let the business side of your calling be a barrier. There are ways to build this side of your skill set and to be both a great childbirth educator and a great businessperson, with just a few steps.

About Robin Weiss

robin weiss head shotRobin Elise Weiss is a childbirth educator in Louisville, KY. She is also the President-Elect of Lamaze International. You can find her at pregnancy.about.com and robineliseweiss.com

Childbirth Education, Continuing Education, Guest Posts, Lamaze International , , ,