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April is Cesarean Awareness Month – Resources and a Test Your Knowledge Quiz

April 10th, 2014 by avatar

fb profile cam 2014April is Cesarean Awareness Month, an event meant to direct the American public’s attention to the United States’ high cesarean rate. 32.8% of all birthing women gave birth by cesarean in 2012. A cesarean delivery can be a life-saving procedure when used appropriately, but it takes one’s breath away when you consider that one third of all women birthing underwent major abdominal surgery in order to birth their babies.

Professionals that work with women during the childbearing year can be a great resource for women, pointing them to evidence based information, support groups and organizations that offer non-biased information to help women lower their risk of cesarean surgery, receive support after a cesarean and work towards a trial of labor after a cesarean (TOLAC) and achieve a vaginal birth after a cesarean (VBAC) for subsequent births if appropriate.

Here are my top suggestions for websites and resources every birth professional should have on their short list to share with students and clients when it comes to cesarean awareness.

1. International Cesarean Awareness Network – an international organization with almost 200 volunteer led chapters, (most in the USA) offering peer to peer support for cesarean recovery and VBAC information by way of a website, e-newsletters, webinars, online forums, Facebook groups and monthly meetings in the community.

2. VBACFacts.com – Led by birth advocate Jen Kamel, this website is big on research and helps consumers and professionals alike understand the evidence and risks and benefits of both repeat cesareans and vaginal birth after cesarean, including vaginal birth after multiple cesareans.

3. Lamaze International’s “Push for Your Baby” – is a great resource for families to learn about the Six Healthy Care Practices, what evidence based care looks like and how to work with your health care provider to advocate for a safe and healthy birth. Also Lamaze has an wonderful infographic that can be shared online or printed.

4. Spinning Babies – Midwife Gail Tully really knows her stuff when it comes to helping babies navigate the pelvis during labor and birth. Many cesareans are conducted for “failure to progress” or “cephalopelvic disproportion” when really it is a case of a malpositioned baby who needed to be in a different position. This website is a wealth of information on what women can do to help their babies into the ideal position to be born, prenatally and during labor. It includes valuable information about helping a breech baby turn vertex. This is important, because finding a health care provider who will support vaginal breech birth is like finding a needle in a haystack.

© Patti Ramos Photography

© Patti Ramos Photography

5. Childbirth Connection – This website is a virtual goldmine of evidence based information about cesareans and VBACs including a valuable guide “What Every Pregnant Woman Needs to Know about Cesareans.” There are questions to ask a care provider and includes information on informed consent and informed refusal.

6. Cesareanrates.com is a great website run by Jill Arnold for those who love the numbers. Find out the cesarean rates of hospitals in your area. All the states are represented and families can use the information when searching out a provider and choosing a facility. Jill’s resource page on this site is full of useful information as well.

7. Safe Prevention of the Primary Cesarean –  The American Congress of Obstetricians and Gynecologists along with the Society for Maternal Fetal Medicine recently published a groundbreaking document aimed at reducing the first cesarean. While fairly heavy reading, there is so much good information in this committee opinion that I believe every birth professional should at least take a peek. You may be pleasantly surprised.

Test your knowledge of the facts around cesareans and VBACs with this informative quiz:

As a birth professional, you can be a great resource for all your clients, helping them to prevent their first cesarean, providing support if they do birth by cesarean and assisting them on the journey to VBAC by pointing them to these valuable resources. You can make every day “Cesarean Awareness Day” for the families you work with, doing your part to help the pendulum to swing in the other direction, resulting in a reduction in our national cesarean rates and improving outcomes for mothers and babies. What are your favorite resources on the topic of cesareans and VBACs? Share with us in the comments section.
Images

  1. Patti Ramos
  2. creative commons licensed ( BY-NC ) flickr photo shared by Neal Gillis
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  5. creative commons licensed ( BY-NC-SA ) flickr photo shared by mikeandanna
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Series: Journey Towards LCCE Certification – Update: Preparing for the Exam

March 11th, 2014 by avatar

By Cara Terreri, BA, Community Manager for Lamaze International’s Giving Birth With Confidence blog

Many of you may be busy preparing to sit for the exam that, will, upon passing, bestow the credentials; Lamaze Certified Childbirth Educator (LCCE) after your name.  The exam will be held during the 23-25th of April, 2014.  For some of you, this has been a long time coming and you have been working steadily working towards your goal.  For others, it has been a whirlwind of workshops and prep and observed teaching.  Regardless, now the exam date is nearing.  We have been following Cara Terreri, the community manager for Lamaze International’s parent blog, Giving Birth with Confidence, on her journey to become Lamaze certified in a regular series on this blog.  Read all of the posts to get the back story on Cara’s childbirth educator journey. Today, Cara updates us as she is counting down the days to the exam.  If you were considering taking the exam, but thought you missed the deadline, please be aware that the registration deadline has been extended until March 17th!  There is still time for you to register!  Contact the Lamaze International Certification Associate for questions and information about the process or to register for the April exam. -Sharon Muza, Science & Sensibility Community Manager

good luck signAs the April Lamaze Certified Childbirth Educator exam date draws closer, I finding myself knee deep in studying. Of course, this is on top of finishing certification requirements for DONA, serving existing doula clients, teaching private childbirth classes, blog writing and management at Giving Birth with Confidence, and of course, my personal life. But who doesn’t have a full plate these days?

There are times when I question my choice to take on this path at a time when my children are young, my days are full, my patience is worn, and my energy wanes. And then, I wrap up teaching a class to first-time parents, and the dad turns to me and says enthusiastically, “Wow, I feel like I learned so much in a short amount of time – this was awesome!” There’s nothing like instant positive feedback to feel a renewed sense of purpose. I never thought I would enjoy the experience of teaching as much as I actually do – I love helping families build their own path to birth and discover confidence that previously didn’t exist. It is because of this desire that I feel an even stronger imperative to complete my Lamaze certification. It’s important to demonstrate to families that what I teach is evidence based and proven.  This is the foundation of today’s Lamaze.

So here I am, committed to my path, and working to fit it all in. I spend my evenings and mornings huddled over the Lamaze Study Guide, with a notebook at my side, jotting down important items – in particular, anything that is unfamiliar or not yet a solid part of my knowledge bank. The Study Guide has been most helpful in identifying several new (to me) reading materials (as well as many that are familiar, including resources from Science & Sensibility!  It’s designed in such a way that reading resources are either hyperlinked directly from the PDF so you can easily click through to the source, or they are included at the end each module. Each module also contains in-depth review questions to that serve as a quiz on the material just covered.

Perhaps most valuable to my confidence in preparing for the exam is the 20+ hours I’ve spent already teaching couples (not to mention the countless hours I’ve spent preparing and researching my curriculum and setting up my business). I feel confident that a good portion of the exam will be testing information that I know, live, and breathe on a daily basis. Of course, there is always more to learn, but I do feel more prepared than if I had not been teaching.

As this is my last update until after I sit for the exam, I would appreciate any words of encouragement – or better yet, study tips! Thanks for taking interest in my journey and supporting me along the way.

Cara- I wish you good luck on the upcoming exam.  I know you are well prepared and understand the material.  My tip for you is to know that you have done your best to prepare, you are ready, and I hope that you feel confident when you test.  Just like labor and birth – one question/contraction at a time!  To all of you who are also preparing at the same time, I wish you well and much success on this next big step.  I invite readers to share their best tip and well wishes for Cara and all the others registered for the exam,  in our comments section below.- SM

About Cara Terreri

Cara began working with Lamaze two years before she became a mother. Somewhere in the process of poring over marketing copy in a Lamaze brochure and birthing her first child, she became an advocate for childbirth education. Three kids later (and a whole lot more work for Lamaze), Cara is the Site Administrator for Giving Birth with Confidence, the Lamaze blog for and by women and expectant families. Cara continues to have a strong passion for the awesome power and beauty in pregnancy and birth, and for helping women to discover their own power and ability through birth. It is her hope that through the GBWC site, women will have a place to find and offer positive support to other women who are going through the amazing journey to motherhood.

 

 

Childbirth Education, Guest Posts, Lamaze International, Series: Journey to LCCE Certification , , , , , , , ,

Book Review: “Lamaze: An International History” – Breath Control: The Rise and Decline of Psychoprophylaxis

March 7th, 2014 by avatar

Lamaze: An International History is  newly published book by Paula A. Michaels that takes a look at the historical concept of pain-free childbirth through breath control and other relaxation techniques.  Regular contributor, Deena Blumenfeld reviews this book and shares her thoughts on how accurate the book is, what the book does well and where the book falls short.  Read Deena’s review and if you also have read this perspective on the history of Lamaze, please share your thoughts in our comment section. – Sharon Muza, Science & Sensibility Community Manager.

lamaze history book cover

When we look back at the past, we often see it through the filter of our modern sensibilities, values and sociopolitical beliefs. However, the past is best understood within the context of the social, political and ethical values of the time period. “Lamaze, An International History” by Paula A. Michaels should be read and understood within its appropriate historical context.

 Most of us know the Cliff’s Notes version of the origins and history of Lamaze. What we may not know are the details of the development of psychoprophylaxis and its journey from Russia to France and then to the United States. We may also not know of its decline in use and the reasons behind the decline.

Psychoprophylaxis is the technique developed by Dr. Vel’vovskii, a psychologist, and his colleagues, in the 1920s. The technique included multiple weeks of childbirth education classes taught by the woman’s physician, patterned breathing (“hee, hee, hoo, hoo”) and relaxation techniques. This was a training method designed to help women have painless childbirth. The belief was that fear caused pain and through education and training, fear could be eliminated. This follows directly from the belief that women’s gynecological health issues were all in their heads. Victorian physicians espoused this idea and the emerging field of psychology latched on to it and perpetuated it.

Michaels seeks to elucidate the social, economic and political influences behind psychoprophylaxis and its relative importance with regards to women’s expectations for childbirth; the prevailing opinions on pain during labor; roles of the father and the doctor during birth and the overall social implications regarding feminism and paternalism. She explores not only psychoprophylaxis, but its creators, its rise in popularity and its decline in use. Michaels looks at the medical environment of the day, as well as the social, economic and political influences on women and childbirth at the time (1930s – 1980.)

Only in the final chapter does Michaels address the Lamaze of today. She alludes to the Six Healthy Birth Practices and modern teachings. She appropriately refers to modern Lamaze as more of a “philosophy” rather than a “method.”

Being that her intention is to address the origins of Lamaze, more specifically psychoprophylaxis, there is little need for her to discuss how classes are taught currently or about present day birthing culture. The reader should not impress the image of historical childbirth class, or the childbirth class of another culture, onto current day classes. Michaels does say that:

“The international history of psychoprophylaxis speaks to how we arrived at today’s status quo, but perhaps more significantly it also reminds us that the values and meanings that we attribute to certain obstetric interventions, like the use of anesthesia, are not constant, but provisional. Practices are historical products of specific technological, economic, social and political conditions. What constituted a desirable birth experience changed with the times, as issues of safety, dignity, control and power each came to be reconfigured under both national and international influence.”

There was a review of this book published on The New Republic recently. The review fell into this trap of imposing historical Lamaze and the practice of psychoprophylaxis onto modern Lamaze, thus presenting a false impression of the purpose and intention of current Lamaze childbirth classes and broader Lamaze International organizational work to improve maternity care for all women. It also misrepresented the intention of the book which is, as best I can tell, an historical perspective, set in the context of the prevailing beliefs at the time with regards to women’s place in society, proper behavior and issues of power and control.

Power and Control

The proponents of early childbirth education, including Dick-Read, Vel’vovskii (creator of psychoprophylaxis), Lamaze, Bradley and others sought to help women control their pain through education, managing expectations, breath control, and relaxation including very specific techniques for pain management. Their initial intentions fell within the scope of prevalent societal beliefs surrounding women’s role in society, religious beliefs, proper behavior, and origins of pain, patriarchy and the political climate of their respective countries.

The author posits that the Russian doctors used psychoprophylaxis as a method to control women during labor, such that they were calm, quiet and obedient. The technique relied on the doctor, nurse, or later, the woman’s husband, to assist the laboring mother in maintaining the breathing and relaxation such that she remained in a passive state. So we can see, how taken out of proper historical context, this is offensive to modern sensibilities.

When the Lamaze method, psychoprophylaxis, made its transatlantic trip to the United States the intention behind the technique changed. However, this shift was a transition, not an immediate change. It took a decade or so to adapt to the prevailing beliefs regarding women’s autonomy and desire for more control over their bodies. Once the method began to take root, it became more about the feminist movement and women’s empowerment as we moved into the latter 1960s and 1970s.

Final Thoughts on the Book and a Look Forward 

Being that I don’t have a TARDIS to go back in time and observe for myself the successes or failures of psychoprophylaxis; I will have to take into account history’s record and Michael’s analysis thereof.

“Lamaze, an International History” should have been more appropriately titled “Psychoprophylaxis, an International History,” although “Lamaze” is a more well understood title and has the potential to garner more readers. In the book, Michaels paints a paternalistic, often misogynistic, view of how birthing women were treated in mid-century Russia and the rest of the Western world. She describes how psychoprophylaxis, and the proponents of the Lamaze method, strived to reinforce the paternalism and pronatalism of the day, while offering women a non-pharmacological form of pain management during labor, childbirth education and support by bringing husbands into the delivery room.

Psychoprophylaxis and the early days of Lamaze should be viewed in their proper historical context and not through the lens of modern feminism, ethics or social mores. I find Michaels’ book to be an eye-opening perspective regarding a piece of the history of my profession. Her book, however, ends rather abruptly at about 1980, with a small concluding chapter of her own perspective on a more modern Lamaze and what her thoughts are as to what women need or want during birth. I would have liked to have seen her take the history of Lamaze through the 1980s, 1990s and into the 2000s.

There’s been a large paradigm shift in how we as Lamaze educators approach childbirth education since the decline of the use of psychoprophylaxis. The move from being a one method technique to a comprehensive, evidence-based, hands-on, multi-modal form of childbirth education has brought Lamaze effectively into the 21st century to reach mothers and families in the classroom, online and via social media. Our advocacy for women’s health is far reaching, and is not addressed in Michaels’ book. I do not find this to be a flaw in her book as her book is a look into our origins and early history. I do find that I want more from her. I want the rest of the story of Lamaze’s history. I’d love to see her write another 140 pages of well researched analysis of the social, economic and political influences on Lamaze in the past three plus decades.

A peek back into history can often help us determine why we do what we do today and how to make more appropriate changes for the future. My question to you, blog readers: “Where do you see Lamaze in 10 years? 15 years? 20 years? What social, economic and political factors will influence how we are educating and supporting women in the future?

Additional suggested readings

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

Keynote Speakers Announced for 2014 Lamaze/DONA Confluence

February 14th, 2014 by avatar

confluence header

I was excited to hear that the keynote speakers for the Lamaze International/DONA International 2014 Confluence were announced yesterday.  I am very much looking forward to this conference and love the idea of Lamaze and DONA sharing energy, resources and learning opportunities.  I think that both organizations and all the men and women in attendance at the conference will benefit from this joint venture.  The conference takes place on September 18-21, 2014 in Kansas City, MO at the Kansas City Marriot Downtown.

Keynotes for this year’s event include:

Michele Deck, RN, BSN, MEd, LCCE, FACCE

deckAn internationally renowned presenter, author, and educator, Michele Deck is the co-founder, President, and Chief Executive Officer of G.A.M.E.S. and Tool Thyme for Trainers . She has won the prestigious “Excellence in Nursing” award, has been selected as a “Great 100 Nurses in Louisiana” and was elected to Sigma Theta Tau National Nursing Honor Society. In 2000, she received the sought-after Belinda Puetz award and in 2004 was the recipient of the Margaret L. Messore Lectureship award.  I have had the honor of bringing Michele to Seattle for a presentation given to our regional childbirth education conference and she brought down the house!  Her interactive and engaging activities left us all energized and excited.

Eugene R. Declercq, PhD

Eugene-Declercq2A professor of Community Health Sciences, assistant dean for DrPH Education at the Boston University School of Public Health and professor on the faculty of Obstetrics and Gynecology at the Boston University School of Medicine, Dr. Eugene R. Declercq has served as lead author of national reports on women’s experiences in childbirth. He was a technical advisor to the film documentary, The Business of Being Born, and developed and presented the short film, Birth by the Numbers. He is one of the Principal Investigators for the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART), a NIH funded study of infant and maternal outcomes associated with assisted reproductive technologies.  I have heard Dr. Declercq speak several times and always leave his presentations amazed at the skill he has in presenting data effectively and with humor.  I have great respect for his work and appreciate all he does to promote maternal infant health improvements.  Did you know that Dr. Declercq is a Lamaze Certified Childbirth Educator?

Katharine D. Wenstrom, MD

wenstrom_katharineDirector of the Division of Maternal-Fetal Medicine at Women & Infants Hospital of Rhode Island and director of the Prenatal Diagnosis Centers in Providence, RI, New Bedford, MA and Foxboro, MA. Katharine D. Wenstrom is also professor of obstetrics and gynecology at the Warren Alpert Medical School of Brown University. A geneticist and nationally recognized leader in the field of maternal-fetal medicine, Dr. Wenstrom works to set the standard for the best care of high-risk pregnant women.  What a unique perspective this perinatologist must have.  I look forward to hearing her speak and sharing her views on pregnancy and birth.

Ngozi Tibbs, CD(DONA), LCCE, IBCLC

ngozi tibbsThe founder and owner of Sankofa Childbirth Education and Lactation Services, in Pittsburgh, PA, Ngozi Tibbs holds a Bachelor’s Degree in Maternal Child Health and is a candidate for a Master of Public Health in – 2014. She has served as a doula, childbirth educator and lactation consultant primarily serving at risk communities including: African American, Latino, immigrant and low- income women from more than 10 counties in the United States. She is a Certified Birth Doula through DONA International, a Certified Childbirth Educator (LCCE) through Lamaze International, an International Board Certified Lactation Consultant (IBCLC) and a La Leche League Leader through La Leche League International.  What a powerful combination of talents!  I am confident that Ngozi will share information that will help everyone to better meet the needs of underserved populations who are often lacking in birth services promoting safe and healthy birth.

Penny Simkin, PT

penny_simkinA physical therapist who has specialized in childbirth education and labor support since 1968, Penny Simkin has prepared over 11,000 women, couples and siblings for childbirth. She has produced several birth-related films and is the author of many books and articles on birth for parents and professionals. Currently, she serves on several boards of consultants and on the senior faculty at the Simkin Center for Allied Birth Vocations at Bastyr University, which was named in her honor.  Penny has such wisdom and experience in helping families to have a better birth experience, and her work has had such an impact on birth professionals and families all around the world.  As one of the founding members of DONA International, it is very fitting that she is speaking at this joint conference.

This conference will be very rich in experience and expertise and I am definitely planning on attending. It is also a great way to meet my continuing education requirements.  I am looking forward to hearing who will be presenting concurrent sessions, finding out what preconference sessions are scheduled and making plans to connect with colleagues from all over the world.  Is your calendar marked for this conference?  Registration opens April 15th, 2014!  Register early to take advantage of early bird prices, once it opens.  To learn more about the conference and stay up to date on important information, check back to the conference site regularly.

2014 Confluence, Childbirth Education, Conference Schedule, Confluence 2014, Continuing Education, Lamaze International , , , ,

Lessons from a Snow Field

January 23rd, 2014 by avatar

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

source: flic

source: flic

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

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

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

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

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

source: flickr

source: flickr

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

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

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

About Kimmelin Hull

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

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