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Top Ten Reasons to Become a Member and Join Lamaze International Now!

January 3rd, 2013 by avatar

Did you know that Lamaze International membership runs with the calendar year?  Did you remember to renew your membership at the end of 2012, or did it get lost in the hustle and bustle of the holidays, along with your normal everyday juggle of work, family and self-care?  Have you considered becoming a Lamaze International member but never followed through or were unsure of how it benefits you?  I would like to take a few minutes to share my “Top 10 List” of why it is simply wonderful to be a Lamaze International member, and how I benefit financially and professionally from my membership every day.

1. Supporting the Lamaze International Mission

The mission of Lamaze International is to promote, support and protect natural, safe and healthy birth through education and advocacy through the dedicated efforts of professional childbirth educators, providers and parents.

I am a childbirth professional, working with birthing families, new doulas and new childbirth educators.  I find that Lamaze’s mission aligns so well with my own, and how I create my classes and work with families and birth professionals.  I am proud to say that I am a member of Lamaze and an LCCE.  I think that many of today’s families and birth professionals can also respect and relate to Lamaze’s mission and find that their values are in sync with what Lamaze offers to the maternity world.  Your membership dollars, combined with other members’ financial support help Lamaze to fulfill this very important mission.

2. Journal of Perinatal Education

The Journal of Perinatal Education (JPE) is a quarterly journal mailed to the home of all Lamaze members and is  filled with relevant, current research that can change the way you teach or practice.  The JPE offers you insights into current maternity trends, access to in-depth articles and the opportunity to learn from international experts.  The JPE is read by childbirth educators, doulas, midwives, RNs, Doctors, Lactation Counselors and other professionals. Additionally, as a Lamaze member, you have access to back issues of the JPE online.

3. FedEx Office Discounts

Being a member of Lamaze International allows you to receive a FedEx Office (Kinko’s) discount that has the opportunity to provide you with significant savings.  All of the discounted services that you can receive at the FedEx Office store along with online discounts have the potential to save you more money than your membership costs.  I am amazed at the level of savings on some of the products and services I use for my business printing and shipping needs.

4. Reduced Fees for Lamaze Products and Events

As a member of Lamaze, you receive member discounts when you register for the annual conference, continuing education contact hours, purchase the Study Guide and other Lamaze materials in the Online Education Store, certification materials and test fees for your LCCE or when you recertify for your LCCE.

5. Birth: Issues in Perinatal Care Journal Discounts

Birth is published quarterly and Lamaze members receive a 50% discount on both the hard copy journal and the online journal. Birth: Issues in Perinatal Care is a multidisciplinary, refereed journal devoted to issues and practices in the care of childbearing women, infants, and families. It is written by and for professionals in maternal and neonatal health, nurses, midwives, physicians, public health workers, doulas, psychologists, social scientists, childbirth educators, lactation counselors, epidemiologists, and other health caregivers and policymakers in perinatal care.

6. Your Lamaze Classes Listed on Lamaze Website

If you are a Lamaze Certified Childbirth Educator and a current Lamaze member, your childbirth classes can be listed on the Lamaze International website for parents, in the “Find a Lamaze Childbirth Class” section so that those families looking for a childbirth class can locate your offerings. Increase your class enrollment with this members only benefit.

7. Full Cochrane Library Access

Lamaze International members have full access to the Cochrane Library, a collection of databases containing independent evidence to inform healthcare decision-making.  The Cochrane Library is considered the gold standard of evidence based information and if you are looking for the most up-to-date research on topics relevant to obstetrics and maternity care, breastfeeding and newborn issues, this is the ideal place to find the information you are looking for.

8. Lamaze Forums and Community

As a Lamaze International member, you have member access to our professional forums, on-line communities and discussion groups, where you can share teaching ideas, learn how your peers feel and respond to different topics of interest and collaborate with professionals around the world, from the comfort of your own home or office.

9. Members Only Teaching Resources

When you join Lamaze International, you are provided access to teaching handouts and resources to share with your students, and a variety of class-enriching resources to make your course more relevant, useful and informative to the families that you are working with.

10. Supporting Lamaze Improves Maternity Care Worldwide

LCCEs attend the DONA Conference
Photo Credit HeatherGail Lovejoy

When you purchase a Lamaze membership, Lamaze International can pool your dollars with other members’ dollars and use some of this income to support other organizations that are leading the way in changing maternity care around the world for the better.  Lamaze International supports and collaborates with the Coalition for Improving Maternity Services (CIMS) and others.  Additionally, Lamaze can send personnel to international conferences to represent Lamaze International, create networking opportunities for all of us, collaborate with other maternity leaders and further work to fulfill the mission of Lamaze International and improve birth for women everywhere.

Where else can a membership that costs only $115 ( or less, depending on your country of residence) produce such tangible benefits and savings for you and combine with other membership funds to improve maternity care world-wide?  I am proud and excited to renew my Lamaze International membership every year and invite you to renew yours, if you haven’t already.  If you are not a member of Lamaze, then now is the time to join, so that you can reap the professional benefits for the full calendar year.  For a full list of member benefits , please see the member benefits page on the website. Don’t hesitate, join or renew now!

Can you share how being a Lamaze International member has benefited you? Why are YOU a Lamaze member?  Tell us what it means to you in the comments section.

Journal of Perinatal Education, Lamaze International, Maternal Quality Improvement, Maternity Care, Push for Your Baby , , , , , , , , ,

“Should We Private Bank Our Baby’s Cord Blood?” Information That Can Help You Answer That Question

September 21st, 2012 by avatar

www.flickr.com/photos/lovemybunnies/4740682244/

I was recently asked my thoughts on private cord blood banking by a couple expecting their first child.  This was something that they were considering and wanted to know what information was out there.  I had read various articles and commentaries on private cord blood banking in recent years, but I viewed this as an opportunity to refresh my knowledge before I provided an answer to them.  I wanted to share this information with Science & Sensibility readers, so that you may use it with your classes, clients and patients as well, if you wish.

Kimmelin Hull wrote a very comprehensive post on Science and Sensibility in April, 2011, discussing “Should we, or should we not retrieve Umbilical Cord blood at all?” along with providing information on delayed cord clamping current research, and referring readers to a fantastic Journal of Perinatal Education article, Umbilical Cord Blood: Information for Childbirth Educators, written by Renece Waller-Wise, MSN, CNS, CLC, CNL, LCCE.  Kimmelin Hull’s post and Renece Waller-Wise’s JPE article were great places for me to start my exploration to be able to answer this couple.

Today’s post is not about the benefits and/or risks of delayed cord clamping.  Information on that topic has been provided previously on this site.  What I was really looking for was more information on the likelihood that private banked cord blood might be used for that child or other relatives in the future.

Research indicates that pregnant women frequently do not have adequate information to make an informed decision about cord blood banking. (Fox, et al, 2007).   Additionally, the information sources for childbirth birth educators are frequently the private blood banks or their designated representatives, adding in the potential for bias. (Cord Blood Registry, 2009; Wolf, 1998, 1999) Interestingly, in the state of Washington, where I live, the state requires practitioners to provide information on cord blood donation and banking. (but not on delayed clamping.)

Revised Code of Washington (RCW) 70.54.220  All persons licensed or certified by the state of Washington to provide prenatal care or to practice medicine shall provide information to all pregnant women in their care regarding:

(1) The use and availability of prenatal tests; and

(2) Using objective and standardized information: (a) The differences between and potential benefits and risks involved in public and private cord blood banking that is sufficient to allow a pregnant woman to make an informed decision before her third trimester of pregnancy on whether to participate in a private or public cord blood banking program; and (b) the opportunity to donate, to a public cord blood bank, blood and tissue extracted from the placenta and umbilical cord following delivery of a newborn child.

Nationwide, 26 states have legislation on providing cord blood information. This legislation is intended to guide health care providers and inform parents about their options concerning donation and banking.  You can access this information on a state by state basis here. In Washington, exactly what information should be provided is not spelled out.

Stem cells are available from a variety of sources, but umbilical cord stem cells are the easiest to collect, collection is painless, and according to studies can be done before or after the placenta is delivered. (Gonzalez-Ryan, VanSyckle, Coyne, & Glover, 2000; Percer, 2009). The stem cells are quickly available to be used. But, according to one study, approximately 50% of all cord blood collection samples contain an insufficient volume of blood.  (Drew, 2005).

Private cord blood banking is often marketed as “biological insurance” for potential problems with that child in the future. “Autologous transplant” is where the cord blood is given back to the child it was taken from.  The chance that a child will need its own cord blood is extremely small; a 1:400 to a 1:200,000 chance over the child’s lifetime (Sullivan, 2008). In the case of some illnesses, it would be unwise to transfer the same cord blood cells as they are considered “contaminated” with the very disease that is hoping to be cured.

There is not a lot of research on the period of time that a collected cord blood sample would be viable after storage, and no research on viability over the course of the average human lifespan.

Private cord blood banking is not without significant expense and cost.  Collection and initial processing can run approximately $3000, and then there is an annual fee that can run several hundred dollars for storage each year after that.

Private cord banking services are not regulated, either on the federal level or by the state, so without oversight, regulations and a quality assurance program managed by a third party, consumers may find themselves dealing with programs that could not be financially viable over the long term or may not be handling or storing stem cell products appropriately.

What do various organizations say about private cord blood banking?

 American Congress of Obstetricians and Gynecologists (ACOG)

ACOG has a statement on Umbilical Cord Blood Banking and in their recommendations and conclusions they state:

  • If a patient requests information on umbilical cord banking, balanced and accurate information regarding the advantages and disadvantages of public versus private umbilical cord blood banking should be provided. The remote chance of an autologous unit being used for a child or a family member (approximately 1 in 2,700 individuals) should be disclosed.
  • Discussion may include information regarding maternal infectious disease and genetic testing, the ultimate outcome of use of poor quality units of umbilical cord blood, and a disclosure that demographic data will be maintained on the patient.
  • Some states have passed legislation requiring physicians to inform their patients about umbilical cord blood banking options. Clinicians should consult their state medical associations for more information regarding state laws.
  • Directed donation of umbilical cord blood should be considered when there is a specific diagnosis of a disease known to be treatable by hematopoietic transplant for an immediate family member.
  • Obstetric providers are not obligated to obtain consent for private umbilical cord blood banking.
  • The collection should not alter routine practice for the timing of umbilical cord clamping.
  • Physicians or other professionals who recruit pregnant women and their families for for-profit umbilical cord blood banking should disclose any financial interests or other potential conflicts of interest.

American Academy of Pediatrics

The American Academy of Pediatrics also has a policy statement out on cord blood banking.  Their recommendations are similiar to ACOG.

  • Cord blood donation should be discouraged when cord blood stored in a bank is to be directed for later personal or family use, because most conditions that might be helped by cord blood stem cells already exist in the infant’s cord blood (ie, premalignant changes in stem cells). Physicians should be aware of the unsubstantiated claims of private cord blood banks made to future parents that promise to insure infants or family members against serious illnesses in the future by use of the stem cells contained in cord blood. Although not standard of care, directed cord blood banking should be encouraged when there is knowledge of a full sibling in the family with a medical condition (malignant or genetic) that could potentially benefit from cord blood transplantation.
  • Cord blood donation should be encouraged when the cord blood is stored in a bank for public use. Parents should recognize that genetic (eg, chromosomal abnormalities) and infectious disease testing is performed on the cord blood and that if abnormalities are identified, they will be notified. Parents should also be informed that the cord blood banked in a public program may not be accessible for future private use.
  • Because there are no scientific data at the present time to support autologous cord blood banking and given the difficulty of making an accurate estimate of the need for autologous transplantation and the ready availability of allogeneic transplantation, private storage of cord blood as “biological insurance” should be discouraged. Cord blood banks should comply with national accreditation standards developed by the Foundation for the Accreditation of Cellular Therapy (FACT), the US Food and Drug Administration (FDA), the Federal Trade Commission, and similar state agencies.
Online Resources on Cord Blood Banking to Share with FamiliesParents Guide to Cord Blood Foundation

American College of Nurse–Midwives—“Cord Blood Banking—What It’s All About” (from 2008 Journal of Midwifery & Women’s Health53[2], 161–162)

National Marrow Donor Program—“Cord Blood Donation: Frequently Asked Questions”

compiled by Renece Waller-Wise

I will provide this information to the family who asked me.  I will encourage them to talk to their doctor or midwife, and determine if it is appropriate for them to consult with a genetic counselor, to address family history and other information that may make it more likely for this child or another family member to need collected cord blood.

I would also provide information on the timing of umbilical cord clamping and suggest they discuss with knowledgable providers and the potential bank, the likelihood of an adequate collection when cord clamping is delayed.

After receiving this information from a variety of sources, I trust the parents will be able to make a decision that feels appropriate to them and I will feel that I have provided evidenced based sources that they found useful in their decision-making process.

How do you answer the question “Should we private bank our baby’s cord blood?” What do you say?  What have been your favorite resources on this topic?  Please share information that you feel we can all benefit from.  I welcome your discussion.

References

American Academy of Pediatrics:Policy Statement: Cord blood banking for potential future transplantation.  PEDIATRICS Vol. 119 No. 1 January 1, 2007 pp. 165 -170 (doi: 10.1542/peds.2006-2901)

American Congress of Obstetricians and Gynecologists. (2008) Umbilical Cord Blood Banking. ACOG Committee Opinion No. 399. Obstet Gynecol 2008;111:475–7.

Cord Blood Registry. (2009). Cord blood spotlight: Childbirth educator’s guide, 1(2), 1–4.

Drew, D. (2005). Umbilical cord blood banking: A rich source of stem cells for transplant. Advance for Nurse Practitioners, 13(Suppl. 4), S2–S7.

Fox, N. S., Stevens, C., Cuibotariu, R., Rubinstein, P., McCullough, L. B., & Chervenak, F. A. (2007). Umbilical cord blood collection: Do patients really understand? Journal of Perinatal Medicine, 35, 314–321.

Gonzalez-Ryan, L., VanSyckle, K., Coyne, K. D., & Glover, N. (2000). Umbilical cord blood banking: Procedural and ethical concerns for this new birth option. Pediatric Nursing, 26(1), 105–110.

Percer, B. (2009). Umbilical cord blood banking: Helping parents make informed choices. Nursing for Women’s Health, 13(3), 216–223

Sullivan, M. J. (2008). Banking on cord blood stem cells. Nature Reviews Cancer, 8, 554–563

Waller-Wise, Renece. (2011) Umbilical cord blood: information for childbirth educators. Journal of Perinatal Education, 20(1), 54–60, doi: 10.1891/1058-1243.20.1.54

Washington State Legislature, Revised Code of Washington 70.54.220 Practitioners to provide information on prenatal testing and cord blood banking. http://apps.leg.wa.gov/rcw/default.aspx?cite=70.54.220  Accessed September 21, 2012.

Wolf, S. (1998). Cord blood banking: A promising new technology. Neonatal Network, 17(4), 5–6.Wolf, S. (1999). Storing lifeblood: Cord blood stem cell banking. American Journal of Nursing, 99(8), 60–68.

 

Babies, Childbirth Education, Delayed Cord Clamping, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, informed Consent, Journal of Perinatal Education, Newborns, Research, Third Stage, Uncategorized , , , , , , , , , ,

Journal of Perinatal Education 20.1 Feature Article: Umbilical Cord Blood: Information for Childbirth Educators

April 11th, 2011 by avatar

The Spring 2011 issue of the Journal of Perinatal Education (JPE 20.1) has already landed in your mailbox and is now available on-line. As always, it is chock-full of illuminating and informing articles about perinatal health care issues.  Considering our recent re-post of Dr. Nicholas Fogelson’s Grand Rounds lecture on delayed umbilical cord (UC) cutting and clamping, the continuing education module contained in this issue of the JPE caught my attention: Umbilical Cord Blood: Information for Childbirth Educators by Renece Waller-Wise, MSN, CNS, CLC, CNL, LCCE.

As options for UC collection and banking/donation are increasing, questions about efficacy and indications grow.  Waller-Wise does a tremendous job in her article providing not only the background on stem cell research (dating back to the 1950s) and transplant and collection (1980s and 1990s, respectively) but she reviews the illnesses that are currently amenable to treatment with umbilical cord blood stem cell transplantation along with the advantages and disadvantages of employing this treatment modality.

While the use of umbilical cord blood stem cells to treat previously identified familial illness in a first degree relative provides a primary indication for collection and banking, the procedure and storage is costly, the cells have a definitive shelf life and success of transplant is not necessarily guaranteed (see Waller-Wise’s article for details).  And the chance of using these stem cells for treatment at all?  At best, the likelihood is estimated to be 1 /2,700.[1]

Beyond whether or not cord blood banking is a reasonable “insurance policy” to invest in, another debate is ensuing which heightens the gravity of the following questions: “Should we, or should we not retrieve UC blood at all?  And if so, should the commonly accepted practices surrounding cord blood collection be altered?”

In Dr. Fogelson’s Grand Rounds videos, his message is clear: immediate clamping and cutting of the umbilical cord deprives the newborn of nearly 20mL/kg of her potential blood volume.  As Fogelson describes it, “…by clamping the umbilical cord [early] you phlebotomize the baby of 40% of its blood volume.”  Dr. Fogelson goes on to explain the various suspected and documented morbidities associated with newborns who have been deprived of this extra (read: nature-intended) blood volume.

Renowned family practice and obstetrics physician, Dr. Sarah Buckley, echoes these concerns in her seminal book, Gentle Birth, Gentle Mothering:  A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Dr. Buckley expands upon the risks of early umbilical cord cutting and clamping this way:

“Active management [of the Third Stage] also creates specific difficulties for mother and baby. In particular, active management can lead to the deprivation of one third,
on average, of a newborn’s expected blood volume. When active
management is used, this extra blood, intended to perfuse the newly
functioning lungs and other vital organs, is discarded along with the placenta.
Possible consequences include breathing difficulties and anemia,
especially in vulnerable babies; long-term effects on brain development
are also very plausible.”[2]

 

But how much of this placental blood is the newborn really deprived of during UC blood collection?

Depending on the system used (needle + syringe extraction vs. needle + dependent bag collection) along with provider skill/preference, cord blood collection requires between 40-200mL of blood such that an adequate volume of stem cells might be retrieved, processed, and made available for transplant.  This volume, incidentally, is on par with the amount of blood a newborn can receive via placental transfusion when the cord is left patent for at least three minutes after birth.  (See Dr. Buckley’s and Dr. Fogelson’s works, referenced above.)  Because of this, common practice is to immediately clamp the umbilical cord following the baby’s birth and initiate cord blood collection moments later—capturing every drop of blood possible into the collection device.

The question, then, becomes:  does the benefit of potentially successful treatment of current familial illness, or future autologous UC blood stem cell transplantation, outweigh the risk of significant newborn phlebotomization?

Before jumping into this debate, my heart tells me there is a third option.

Google “cord blood withdrawal without clamping” and you will find message board and blog site discussions like this one where anecdotal evidence is beginning to emerge and become the subject of hot debate:  it just might be possible to delay clamping & cutting the umbilical cord and collect a cord blood sample that satisfies requirements for banking/transplantation purposes. Make no mistake:  I am not presenting these discussions as science, evidence or infallible support for creating a new Third Stage practice.  I am simply relaying what some maternity care providers have begun doing on their own.  (Isn’t that how medical advances have developed in the past?  Someone tries something new and, low and behold it works…leading to the adoption of the new practice by others?)

The catch, of course, if how much UC blood can be collected after delayed clamping, and whether collection can take place before clotting sets in within the cord/placenta.  One maternity care provider respondent on the Mothering.com message board offered a depiction of how she goes about collecting cord blood after placental delivery:

“The bag is about 500mL, I can usually get about 1/3 of a bag, so a bit more than 150mL, even after the placenta is born.  I usually put the placenta on a counter top, with the bag resting on the floor, start low by the clamp and move up the cord, and use all those juicy veins on the fetal side of the placenta. If you elevate the placenta with the cord hanging, quite a bit will flow into the cord. Obviously, you’re not going to get a full 500mL if you wait for the birth of the placenta, but you can get a decent amount with a little patience and multiple sticks. And you don’t want to wait too long after the birth of the placenta, or the blood coagulates, so someone else should be watching mama and baby while the other does the collection.”

 

If the practice described above is truly reproducible, it would suggest that there is plenty of cord blood available (and perhaps more than what has been previously assessed).

In 2007, the American Academy of Pediatrics released a statement providing the following guidance as a part of its endorsement of cord blood banking when known familial illnesses treatable by stem cell transplant exist:

“The cord blood stem cell-collection program should not alter routine practice for the timing of umbilical cord clamping.”[3]

 

ACOG’s Committee Opinion paper #399 (Feb ’08), Umbilical Cord Blood Banking offers the same guidance. [1]

If we can all agree that in most cases, delaying the clamping and cutting of the umbilical cord constitutes the best, evidence-based practice, then the above AAP statement ought to apply to cord blood collection after a sufficient amount of time has transpired for placental transfusion to take place.

If you look on the website* of one of the largest cord blood banking companies, you can watch a demonstration of umbilical cord blood collection—complete with instructions on how to collect an adequate volume after the birth of the placenta:

The AAP along with ACOG now advise maternity care providers to counsel interested patients on the risks and benefits of cord blood banking.  Factors such as the likelihood of actually using the stem cells, philanthropic drive to donate stem cells to public cord blood banks and the cost of collection and storage should all be taken into consideration when expectant parents are contemplating this choice.  As should the importance of what that added blood volume can do for the newborn whose body is undoubtedly expecting it.  And I, for one, can’t help but to believe a viable third option exists in which the newborn is granted the lion’s share of the placental transfusion while a small and remaining amount is collected for cord blood banking, when the proper indications are present.

Surely a study can be formed to test this hypothesis.

To learn more about umbilical cord blood collection and storage, go here to read Waller-Wise’s full article (compliments of the Journal of Perinatal Education and Springer Publishing) and don’t forget to take the post test to earn continuing education credits!


[1]Umbilical cord blood banking. ACOG Committee Opinion No. 399.  American College of Obstetrics and Gynecologists. Obstet Gynecol 2008;111:475-7

[2] Gentle Birth, Gentle Mothering : A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices by Sarah J Buckley MD (Celestial Arts, Berkeley CA,2009) p 156; www.sarahbuckley.com

[3] http://aappolicy.aappublications.org/cgi/content/full/pediatrics;119/1/165; Recommendations #7

*Neither Lamaze International nor the editor or contributing writers to Science & Sensibility endorse any particular cord blood bank or registry organization or company.

Posted by:  Kimmelin Hull, PA, LCCE

Delayed Cord Clamping, Evidence Based Medicine, Journal of Perinatal Education, Practice Guidelines, Third Stage , , , , , , , , , , , , , ,

Close Up on Midwifery Care: A New Study Published in the Journal of Perinatal Education

December 14th, 2010 by avatar

The journal article referenced in this post may be accessed here (http://tinyurl.com/2azmhmg) for free, in the event you do not have access to the Journal of Perinatal Education on line—a benefit of Lamaze membership.

Introduction
As a childbirth educator, the Journal of Perinatal Education has been an amazingly helpful tool to me over the years.  Look through my copies of JPE, and you’ll find dog-eared pages, underline marks in varying ink colors, notes in the margins regarding how to implement a certain piece of knowledge into my class curriculum.

The current issue of JPE delivers yet again, and I want to highlight one article in particular, which I found interesting.

Maternity care and childbirth is, at the very heart of things, an intimate business.  And because so many of us have a vested and impassioned interest in how maternity care plays out—no matter what side of the fence we find ourselves on—there have been hundreds of studies completed and published about birth and all things related.

The purpose of this phenomenological study, Midwifery Care:  Reflections of Midwifery Clients, by Mary Ellen Doherty, PhD, RN, CNM, “was to describe the lived experience of midwifery clients throughout the life span.”  Not only did this study collect lived-experience data on women’s impressions of their midwifery care during pregnancy, labor and birth, but before, during and after their childbearing years as well.

There’s a lot to be said for the value of gathering data on care delivered by health professionals from the recipients of that care.

Methods
In-person interviews between Dr. Doherty and self-selected participants from four different New England midwifery practices took place over a three-month period.  The interviews, prompted by the open-ended question, “What has been your experience with midwifery care?” and following brief screening telephone calls, were audiotaped and transcribed verbatim, before grouping responses into broad, and eventually more detailed theme clusters.

One of the theme clusters that emerged during the data compilation and analysis phase of the study was Nurse-Midwives as Primary Health-Care Providers Throughout the Life Span.  Many people assume midwives deliver pregnancy-related care only.  And, in my experience, some midwives do choose (or are trained) to only offer perinatal care services—as is typical of Certified Professional and Direct Entry Midwifery training.  But take a look at the curricula offered by all nurse-midwifery programs, and you’ll find several courses on women’s health across the lifespan within each program.  This is, in fact, one of the core competencies as outlined by the American College of Nurse-Midwives.  This element of midwifery care—tending to women from menarche to menopause—seemed to be a recurrent theme in the study participants’ responses, as exemplified by this remark:

“I have been going to the same midwifery practice for about 10 years now…I started with my first pregnancy and never left.  The midwives do my annual exams, pap smear, check my diaphragm to make sure the fit is still good for birth control, and they have even cured a few vaginal infections along the way.”

Along with the theme of midwifery care across the lifespan, other topics that apparently emerged with great frequency were: Decision to Seek Midwifery Care, Working Together in a Therapeutic Alliance, Formulating a Birth Plan and Childbirth Education.  Epitomizing the reason a woman might choose midwifery care, came this statement from one study participant who also happened to be a former pediatric nurse:

“I guess I feel safe with nurses and totally subscribe to the belief that nurse-midwives are experts in normal birth and know when to get help if needed.  I like the fact that they stay with you during labor and don’t just come in at the last minute to catch the baby.”

Doherty goes on to provide many additional quotes from study participants, demonstrating their experiences with midwife-taught childbirth education classes, birth plan formulation and approaching a woman’s health care as a team:

“My midwife coached and supported me.  She always made me feel involved in the decision making and was so positive and encouraging.  She really tuned in to my feelings and behaviors during labor.  There was so much sensitivity.”

Analysis
The twelve participants in Doherty’s study seemed to lack the diversity I would like to have seen:  on average, they were Caucasian, highly educated and married to their baby’s father with a self-proclaimed financial status of “middle class.”  There was some variability in parity (nulliparous through multiparous x 4) and their average age was 34.5 years old.  Lastly, the women included in Doherty’s study all experienced vaginal, non-complicated births following low-risk, singleton pregnancies.  Resultantly, one could argue this subset of participants possessed a commonly biased experience of midwifery care.  For these reasons, I initially found myself questioning the overall generalizability of this study and was compelled to want to know more:  how many of the women who initially responded to brochures they saw/received at their health care provider’s office or the hospital laboratory were actually accepted into the study?  What were the inclusion criteria for this (beyond the stated basic criteria of ability to read, speak and comprehend English)?  What would the response theme clusters (and individual data) look like with a larger number of participants?

Some of these limitations are addressed by Dr. Doherty and countered with the stipulation that she felt data saturation had been sufficiently achieved during the interview process.  She also acknowledged the potential lack of generalizability, but explained this as a common and expected side effect of a phenomenological study.  Likewise, the number of study participants becomes less important than in, say an RCT, because data saturation suggests generalizability, in and of itself.  An enlightening follow-up study then, (as suggested by Dr. Doherty and expanded upon by yours truly) might be to assess and compare lived experiences of more subjects with varying characteristics, as well as across different models of maternity care (provided by different types of midwives, as well as family physicians and OBs), yet using the same interview question:  “What has been your experience with your health care provider?”

Final Thoughts
In re-visiting the themes that arose from the participants’ own depictions of their midwifery care experiences, the process and outcome of their birth experiences was, interestingly enough, not considered a major theme in and of itself.  The experiences associated with midwifery care which seemed to leave a lasting impression on these women revolved around what prompted them to choose midwifery care in the first place, along with the nature and quality of interaction between themselves and their midwives throughout the duration of their care.  Resultantly, this study offers us a categorical glance at the experience a woman might expect to have throughout the spectrum of midwifery care.  Aptly put, one of Dr. Doherty’s concluding remarks suggests,

“It is important for all women to learn about midwifery care, and one of the best ways to accomplish this is for them to listen to the voices of other women as they tell their stories.”

What are we, as maternity care professionals, doing to facilitate this sharing of stories?  Is it our role to connect women with each other and facilitate the oral exchange of lived experiences?  If so, how can we best do this?

Post by:  Kimmelin Hull, PA, LCCE

Healthy Care Practices, Journal of Perinatal Education, New Research, Research, Uncategorized , , , , , , , , , , ,

Breast Pumps a “Double-Edged Sword”?

June 3rd, 2009 by avatar

Amid a rash of controversial pieces in the mass media about the intersection of breastfeeding, motherhood, and feminism, a new study in the Journal of Perinatal Education reveals an uneasy relationship between professional lactation consultants (LCs) and breast pumps. The piece gives us a fascinating look – from the front-lines of lactation – at the cultural and economic forces that have rendered the breast pump one of the indispensable accessories of new motherhood.

The qualitative pilot study analyzes lactation consultants’ beliefs and experiences related to the increased availability of breast pumps on the practice of breastfeeding. The researcher conducted interviews with lactation consultants about the reasons women use breast pumps, changes in patterns of use over time, mothers’ experiences, and perceived advantages and risks. All 12 interview participants were registered nurses with board certification and at least one year of experience as lactation consultants.

All of the LCs who were interviewed acknowledged a tectonic shift in the role of the breast pump over the past decade or so, a trend that many believed was fueled by aggressive marketing of breast pumps as well as our collective cultural enthusiasm for technology. Once reserved for mothers of premies, women experiencing breastfeeding problems, and those returning to work, breast pumps now feature prominently on baby registries of nearly every mother who plans to nurse, and often get packed right into the birth bag, despite the fact that hospitals themselves make breast pumps available to every new mother. This increased availability of breast pumps in health care settings was troubling to some of the LCs. One of the interview respondents said,

We have pictures in the room behind the bed that you slide up and there is oxygen and [resuscitation] equipment behind them. It’s hidden because it has a subliminal message that we think you might die here. One message [to mothers] is that you need a breast pump and should consider buying one. We didn’t have to fight too hard to get 35 pumps free of charge hauled in there. They’re not philanthropists. They’re just good business people.

The respondents also felt that “technological birth” naturally led to “technological breastfeeding,” both in the sense that technology has been normalized as a part of the processes of childbirth and breastfeeding, and because the overuse of high-tech obstetrical interventions has led to more breastfeeding problems that must be managed with breast pumps. Many LCs also commented that use of breast pumps satisfied women’s desire for control over a process that they did not trust to unfold easily, similar to the perception that labor interventions offer greater control over the unpredictable process of birth.

But perhaps the most interesting theme that emerged from the interviews was that the prevalence of breast pumps has affected the profession of lactation consultation itself. Many of the LCs earned a significant proportion of their income through breast pump rentals and sales, a situation that was widely acknowledged as fraught with ethical problems. In addition, respondents felt that some LCs were overly dependent on breast pumps. “If a mother is having trouble in the hospital, it’s ‘Get her a breast pump’ and not, ‘Let’s work with her more and get her to breastfeed,” said one. In addition, just like the women they provided services to, a few of the LCs lauded the increased “control” of breast feeding afforded by breast pumps as well as the enhanced ability to measure how much the baby was getting, while others were ambivalent or felt that the control was a false promise. Said one of the LCs

“In a way, I wonder if this technology doesn’t help us and has given us an out. We don’t have to give good maternity leave because we are going to give a pump to every mom and give her 15 minutes twice a day to pump her milk.”

This article made me think twice about how I talk about breast pumps with expectant and new mothers. Of course pumps have an important role in the care of premature and sick infants, when women need to temporarily disrupt nursing for medical reasons, and to allow women to go back to work or simply get out of the house in the early months of motherhood. But their routine use, just like any routine intervention, may be doing more harm than good – undermining women’s confidence, unnecessarily complicating the transition to new motherhood, and possibly even leading to early cessation of breastfeeding. The article also made me remember that there is a low-tech alternative to breast pumps that we should be telling to every new mother: hand expression of breast milk. I’ve found myself apart from my own breast pump on enough occasions that I probably owe the fact that I have never had mastitis to my hand expression skills. For readers who don’t know how to do or teach hand expression, here is a great video that teaches one simple technique.

Citation: Buckley, K. M. (2009). A double-edged sword: lactation consultants’ perceptions of the impact of breast pumps on the practice of breastfeeding. The Journal of Perinatal Education, 18(2), 13-22.

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