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Portrait of a Grant Funded Community Doula Program

April 6th, 2012 by avatar

A guest posting by Jill Wodnick, MA

Hudson Perinatal Community Doula Valerie Inzinna explains,

Istock/SuriyaPhoto

“I first met Tina (not her real name) in January. She was nervous, scared and very much alone. We took Lamaze childbirth education classes together at a federally funded health center; we toured her birthing hospital and discussed everything from car seats and slings to timing contractions. My back-up doula Alison Chiappetta and I were impressed from the beginning with Tina’s inner strength, her intelligence and her commitment to breastfeeding her expectant baby, Rose.   Our doula  time together was more than just educational; it was emotionally intimate.  As Tina shared her very real fears and concerns with us, she became more confident in her abilities to not only birth, but parent. At our last meeting together before she gave birth, for the very first time Tina said, ‘I can do this,’ as she caressed her belly with her hands. We agreed!”

The state of New Jersey is an interesting and complex microcosm of birth and breastfeeding for American women. Some counties are extraordinarily wealthy, while others have some of the highest poverty rates in the nation. From the highest cesarean birth rates (44%-51% c-section rates in Hudson County hospitals) to growing homebirth rates, but with no free-standing birth centers, the state with the highest density of people presents many challenges to the Lamaze evidence based care practices for birth and breastfeeding. Tina’s story dramatizes the tremendous power of the community doula model as well as the tremendous difficulties of implementing it effectively.

Tina is a 20 year old woman enrolled in a local community college and living in Jersey City. Her prenatal medical care was supported through a Medicaid managed plan at an FQHC (federally qualified health center); WIC services; and community doula care and childbirth education delivered through HPC (Hudson Perinatal Consortium). This alphabet soup of public health programs would be much more difficult for expectant moms like Tina to navigate without what HPC Community Doulas do: engage, inspire and support their clients.

Founded in the summer of 2010 through an Access to Prenatal Care grant from the New Jersey Department of Health & Senior Services, the Hudson Perinatal Consortium’s Community Doula Program offers relationship-based intervention to low-income expectant women. Our clients, who receive free doula care with home visits and breastfeeding support, are enrolled in Medicaid, in WIC, or are without insurance. Our comprehensive doula training and education is free for women wanting to be doulas through Merck’s NJ Neighbor of Choice Award. Our doulas get cross trained in many public health topics, among which are the Lamaze Care Practices for a Safe & Healthy Birth. With a 20 hour a week commitment for training, the women entering our fellowship see first-hand how poverty impacts pregnancy and parenting.

HPC Doula Mary Szubiak summarized research on doula care as part of her training with us.  In her summary, she states that “doulas offer value as they work toward providing more positive obstetric outcomes in an attempt to reduce birth disparity among women. Research has shown that black non-Hispanic mothers experience much higher rates of preterm labor, low birth weight, and fetal and maternal mortality (Martin et al. 2006). By providing doula services, we work with many other community health partners to reduce this disparity.  A national survey highlighted that the women with the least amount of resources are most likely to benefit from doula care and are least likely to receive it (Lantz, et al., 2005). Furthermore, a focused study in Northern California involving low-income participants concluded that doula care was associated with timely onset of lactogenesis and higher breastfeeding prevalence at 6 weeks postpartum (Nommsen-Rivers et al 2009).”

Just a few days ago, Tina gave birth to Rose, who looks exactly like her mother. It was a natural birth with directed pushing in the supine position after which the baby was routinely separated but then returned to breastfeed.

Unfortunately, some of the most important care practices for safe and healthy birth, like freedom of movement, and non-separation of mother and baby, are not supported by the system mothers like Tina typically birth in.

HPC Doula Alison explained, “When Valerie and I left Tina and baby Rose, we were thrilled to know that she was committed to exclusive breastfeeding. After her discharge from the hospital, I checked in with Tina by phone to see how things were going. As she was settling into her new role as Rose’s mother, she informed me that Rose had been given formula at the hospital on the day following her birth since Tina was told by the nurse that she ‘did not have any milk in her breasts and Rose was nursing constantly because she was hungry.’ Since they have returned home, Tina has not had success inviting Rose to latch on her breast and has resorted to pumping and offering expressed breastmilk in a bottle. I am amazed at Tina’s commitment to feeding her daughter breastmilk, but am also saddened by the misinformation received at the hospital which has had a huge impact on her ability to breastfeed naturally.  I found it so frustrating that all the information Tina had heard and digested during her pregnancy had been undermined by what she was told during her hospital stay and it seems that it has had a profound impact on her breastfeeding relationship.”

My role as the HPC Community Doula Fellowship Coordinator blends my passion for social justice beginning with birth and breastfeeding with the clarity that the safe and healthy birth practices I teach are evidence-based thanks to Lamaze International.  I encourage all Lamaze International members to learn about community health programs.  Nationally, 44% of pregnant women birth through Medicaid.  By making an impact in public health programs like Medicaid through the research and resources of Lamaze, we can truly change the culture of birth and breastfeeding for all families.

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Jill Wodnick, M.A., is a Lamaze & Birthing From Within trained childbirth educator; an advanced doula trainer; a prenatal yoga instructor and a mom of 3 boys.  She runs the Hudson Perinatal Consortium’s CommunityDoulaFellowship.  Please visit www.HPCDoulas.com or www.Hudsonperinatal.org

Lantz PM, Kane Low L; Varkey S, Watson R. L. (2005). Doulas as childbirth paraprofessionals: Results from a National Survey. Women’s Health Issues. 2005: 15: 109-116.

Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, and Kirmeyer S. (2006). Births final data for 2004. National Vital Statistics Reports 55(1). Hyattsville, MD: National Center for Health Statistics.www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07.pdf

Mastergeorge AM, Hansen RL, Cullum AS, Dewey KG. (2009). Doula care, early breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low-income primiparae. Journal of Obstetrics Gynecology Neonatal Nursing. Mar-Apr;38(2):157-73.

Nommsen-Rivers LA, Mastergeorge AM, Hansen RL, Cullum AS, Dewey KG. (2009). Doula care, early breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low-income primiparae. Obstetrics Gynecology Neonatal Nursing. 2009 Mar-Apr;38(2):157-73.

Babies, Baby Friendly Initiative, Childbirth Education, Doula Care, Guest Posts, Healthy Birth Practices , , , ,

The 6th Healthy Birth Blog Carnival: MotherBaby Edition…

June 19th, 2010 by avatar

…is up! Go check it out at Giving Birth with Confidence. What a PHENOMENAL collection of contributions about the moments, hours, and days after birth. Each of our Blog Carnivals has vastly surpassed my own expectations. I hope you’ll agree.

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No more excuses: video trains hospital staff in the whys and hows of skin-to-skin after birth

June 13th, 2010 by avatar

[Editor’s note: This is a guest post from former Lamaze International President, Jeannette Crenshaw. When Jeannette told me about the video she reviews in this post, I knew I wanted to highlight it as part of the Sixth Healthy Birth Blog Carnival.

I recall  one birth I attended as a midwife, I had to negotiate with the nurse about how long we would “let” the mother and baby remain in skin-to-skin contact after birth. Her reason for wanting to disrupt skin-to-skin time? “I have to put the baby in the computer.” Her job (completing birth documentation) was interfering with her job (safeguarding the health and wellbeing of the mother and baby).

Hospital routines are the #1 reason mothers and babies are denied skin-to-skin contact after birth. Changing this  harmful practice is possible, but it takes a commitment to quality and systems improvement.  Now that the Joint Commission is measuring hospital perinatal quality by the proportion of babies exclusively breastfed at discharge,  hospitals need concrete tools to retrain staff and change delivery room culture. Hospitals: it seems like this video may be $39.00 well spent. – AMR]

Skin to Skin in the First Hour After Birth:
Practical Advice for Staff After Vaginal and Cesarean Birth (DVD)

Executive producer and videographer: Kajsa Brimdyr, PhD, CLC; executive and content producers: Kristin Svensson, RN, PhD (cand.) and Ann-Marie Widström, PhD, RN, MTD.
$39.00 at Healthy Children

scan0004A new DVD from Healthy Children Project should be mandatory viewing for every labor and delivery nurse and birth attendant. It will help maternity health professionals in hospital settings to implement the best practice of uninterrupted skin to skin care beginning immediately after birth until after the first feeding. This is a “how to” DVD, with the practical advice health professionals need to provide clinical care to mothers and babies who are skin to skin immediately after a vaginal or cesarean birth.

The 40 minute DVD, set to original music by J. Hagenbuckle, has 3 content sections, and a section with a complete list of references. The first section describes the short and long term benefits of skin to skin care for newborns and mothers. It shows the 9 stages healthy newborns experience while skin to skin during the first hour after birth—from the birth cry (stage 1), through suckling (stage 8), and sleep (stage 9). The narrator emphasizes the individual way each baby moves through the 9 stages.

The second section shows how to provide care for mothers and babies while they are skin to skin, after a vaginal, and the third, after a cesarean birth. Both sections begin with health professionals teaching pregnant women about immediate skin to skin care prenatally, and on admission to the hospital—which “sets the stage” for immediate skin to skin contact as a normal part of the birth process. After the vaginal birth, the clinician immediately places the baby on mom’s abdomen. After the cesarean birth, the nurse immediately places the baby on mom’s chest, above the sterile field and drapes, as the doctor continues the surgery and the anesthesiologist monitors the mother. The baby’s father is at mom’s side in both segments. Nurses remove birth fluids as they dry the baby—delicately addressing the common concern that babies should first be “cleaned up” at a warmer. Nurses remove wet blankets, place the baby skin to skin, and cover mom and her baby with warmed blankets. Both sections show competent nurses assessing the newborn, providing care, and supporting the mother and baby as the baby moves through the 9 stages of skin to skin.

I strongly recommend this DVD (only $39.00) for staff in any maternity setting. Childbirth educators will find the first section of the DVD a great addition to their prenatal childbirth and breastfeeding classes (although Breastfeeding—A Baby’s Choice, 2007, may be a better choice). Staff who are working to help their hospitals achieve Baby-Friendly designation will find this DVD useful for training. The narrator uses, for the most part, simple and non-clinical language and the video of mothers and babies will quickly engage the viewer. The DVD’s producers met their objective: “to assist staff in providing behaviorally appropriate, individualized, baby adapted care for the full term newborn using the best practice of skin to skin contact in the first hour after birth”.

Reference:

Healthy Children Project. (Producer). (2007). Breastfeeding—A Baby’s Choice [DVD]. Available from http://www.healthychildren.cc/

Jeannette Crenshaw, MSN, RN, NEA-BC, IBCLC, LCCE, FACCE is a member of the graduate faculty at the University of Texas at Arlington College of Nursing and a family educator at Texas Health Presbyterian Hospital Dallas. She represents Lamaze on the United States Breastfeeding Committee (USBC) and coordinates the Lamaze Breastfeeding Support Specialist Program. She has published articles and presented nationally and internationally on a variety of topics, including evidence based maternity care.

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Are maternity units too noisy?

June 11th, 2010 by avatar

alarmbell

According to a recent article in the Boston Globe, hospital noise has become problematic and researchers, along with some hospital administrators, are starting to listen.

From The Boston Globe article:

In 2005, a team of researchers at Johns Hopkins University led by the engineers Ilene Busch-Vishniac (now the provost at McMaster University) and James West looked at the best available historical data and found that, since 1960, the average daytime noise level in hospitals had doubled. At night, it was four times louder.

So what’s the buzz all about? The numerous studies cited in this article repeatedly point to concerns and, in many cases, concrete evidence that hospitalized patients tend to fare much worse as decibel levels rise. Vitals signs (blood pressure, heart and breathing rates and body temperatures) are less stable. Perceived pain and therefore request for pain medication is higher. Newborns in intensive care nurseries stay longer and can potentially suffer hearing damage. Surgical patients take longer to heal.

For me, this suggests the obvious question about mothers who are supposedly resting up from childbirth—particularly the ~30% of US women who are recovering from cesarean section deliveries—and what type of true “recovery” they are garnering during their 48 – 72 hour stays.

Some cultures around the world take the postpartum recovery of a woman so seriously, they expect mom to do nothing but remain at home, sleeping, eating and nursing her baby for upwards of forty days. In the United States, our hustle and bustle, noise-filled culture accompanies a woman’s postpartum experience.

Typical doctor’s orders on a maternity ward dictate a woman’s nurse(s) to visit her room no less than once every four hours to perform basic nursing duties—and assuming baby is rooming in with mom, there is often times a completely separate schedule of nursing visits for the newborn. But, following each of my three hospital birth experiences, I seem to recall the door to my room swinging open and shut many more than six times in a twenty-four hour period. Between doctors performing medical rounds, someone from the nutrition department collecting food orders, lactation specialists making their daily visits, hospital photographers stopping in for a quick snapshot of each bundle of joy and occasional hospital volunteer drop-ins, there’s actually very little time for a woman to rest following the birth of her baby.

Sleep studies tell us that when a person’s sleep is frequently interrupted, they are less likely to slip into non-REM sleep—the mode of rest during which growth and healing is most likely to occur. With overhead pages echoing down the halls, sitcom canned laughter from the neighbors’ too-loud television, and, let’s face it, the sound of multiple babies crying in poorly insulated quarters, it’s no wonder most women leave the hospital more rather than less tired when they entered. (And, if you’ve recently been pregnant, you’ll likely recall how tired you felt by the end of your third trimester.)

But it’s not just the postpartum wing where noise is a problem. The L&D room can be a rather cacophonic place as well. With fetal monitors tapping out the baby’s twice-per-second heart rhythm, constantly spewing out reams of paper, and bing-bonging an alert every time the baby’s heart rate falls outside certain parameters…with patient controlled analgesia pumps pumping and beeping away…with alarms sounding every time an IV line gets kinked or the bag empties…with a infant warming table blaring when it reaches its preset temperature…with labor and delivery nurses, aides, technicians, nursery nurses, midwives, doctors, PAs and possibly residents and interns floating in and out, a hospital birth room can become as busy as the intensive care department.

We know from observing animals that from an instinctual basis, it’s pretty darned hard for childbirth to take place amidst noise and lack of privacy. And, surprise, surprise: human beings are no different. Could the ever-increasing rates of labor augmentations, epidural usage, suction-assisted deliveries, and cesareans for “failure to progress” be explained, in part, by hospital setting noise? Is it possible that with every “unnatural” sound we hear, our bodies shut down just a little more—whether during the process of birth, or during the healing, resting, and mother-baby bonding period that is supposed to occur afterward?

Recently, a dear friend of mine delivered her second baby. Having shared a room with another woman in the postpartum wing, my friend initially spoke favorably of her experience being so close to another puerperal woman. “That’s when I realized how much I needed to be with other women following my birth experience,” she confessed.

But our conversation quickly turned to the idea of a postpartum floor lounge—a place specifically designed for mothers and babies…a spa reception-like setting where women could sit in comfortable rocking chairs and heavenly couches, nurse their babies, share stories, exchange words of advice and encouragement amidst quiet music (or no music at all) and dim lighting, drink from the endless supply of healthy teas, water and juices, and languish in an uninterrupted setting for as long as they desired.

“It wasn’t exactly ideal sharing a [hospital] room with someone else,” she later told me of her two-day postpartum roommate. “I could hear all their conversations and she constantly had the TV on. But still, I learned a lot about myself and my needs following my second baby’s birth.”

In the United States and many, if not most other developed nations, women do not look forward to a 40-day lying in period following childbirth. So, that cultural practice being what it is, perhaps hospitals that are currently looking at their facility-wide noise levels and amelioration plans should also contemplate the overall setting of the labor, delivery and postpartum wing.

This is a guest post by Kimmelin Hull, PA, LCCE. Kimmelin is a Lamaze Certified Childbirth Educator, mother of three, and author of A Dozen Invisible Pieces and Other Confessions of Motherhood. You can visit Kimmelin at her blog site: http://kimmelin.wordpress.com.

Photo by debsilver, used under a Creative Commons license.

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Calling all bloggers! Healthy Birth Blog Carnival #6: Motherbaby edition

May 25th, 2010 by avatar

Keeping birth healthy and safe doesn’t end when the baby is out. Skin-to-skin contact, the beginnings of emotional attachment, the mother’s physical recovery, and the initiation of breastfeeding are the continuum of biological processes that began in pregnancy and labor. We’ve reached number six in our six-part series of Blog Carnivals. And this one is about keeping moms and babies together after birth.

That’s right – this is the last Healthy Birth Blog Carnival! The Carnivals, to me, represent the huge amount of information, support, and woman-to-woman collaboration the internet now offers to support safe and healthy birth. I’ve loved reading all of your stories, hearing diverse perspectives, and working together to generate a new understanding of the type of care that moms and babies deserve. I know I am in for some delightful and insightful reading – and some heartbreaking stories, too.

You can submit anything that relates to the care and support of mothers and babies after birth. Here are some resources from Lamaze International to get you started:

Participation in the Healthy Birth Blog Carnival is easy:

1. If you are a blogger, write a blog post on the Carnival theme. Post it on your blog by Friday, June 11. Make sure the post links back to this blog post, to the Healthy Birth Practice Paper, or to the video above. You may also submit a previously written post, as long as the information is still current.

2. Send an email with a link to your post to amyromano [at] lamaze dot org.

3. If you do not have a blog but would like to participate, you may submit a guest post for consideration by emailing it to me.

4. I will compile and post the Blog Carnival at Lamaze’s brand new web community for women: Giving Birth with Confidence.

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