24h-payday

Archive

Posts Tagged ‘Pamela Vireday’

Six Birth Blogs Every Childbirth Educator Should Be Reading

September 17th, 2013 by avatar

Today on Science & Sensibility, I wanted to share with readers some of my favorite birth related blogs, after Science & Sensibility of course! I subscribe to over 400 blogs, on a variety of topics, not just birth. I hope that someone has a larger blog list then I do, otherwise I will start to worry about how this might be an obsession.

I really enjoy reading what experts in the field of maternal and infant health have to say on their blogs and frequently find myself sharing information in my classes and with the families that I work with as well as with other professionals. I appreciate the effort, the research, the time and the energy that goes into making my favorite blogs so rich and useful for me, and so relevant to the work I do as an LCCE. 

Here are six of my favorite blogs, in no particular order:

1. Spinning Babies Blog

Midwife Gail Tully has long been well known for her website, Spinning Babies and her blog is an added bonus!  Gail frequently answers questions from readers, describes some new research she came across or shares a new technique to help babies move easier through the pelvis.  Here you can frequently find a video snippet you can use in your childbirth class, a book review or an inspiring birth story usually related to babies who chose to do things their way, as they work to be born.  

2. Evidence Based Birth

This blog burst onto the scene in mid-2012, and has been a fantastic resource ever since.  Rebecca Dekker, PhD, RN, APRN is an assistant professor of nursing at a research university in the U.S. She teaches pathophysiology and pharmacology, but has a strong personal interest in birth, and hence the blog was created.  The mission of Evidence Based Birth is to “promote evidence-based practice during childbirth by providing research evidence directly to women and families.”  Rebecca takes a look at the big issues (failure to progress, big babies, low AFI, for example) that face women during their pregnancy and birth, and does a thorough job of evaluating all the research and explaining it in a logical, easy to understand post.  Rebecca sums up her posts with recommendations based on the evidence and gives readers the bottom line and take-away.  Additionally, there are “printables” that are concise versions of some of her blog posts that families can print out and take to appointments with their healthcare providers in order to help facilitate discussions about best practice.

3.  VBAC Facts

Jennifer Kamel has created a plethora of useful information on vaginal birth after cesarean (VBAC) facts and statistics.  She founded her blog after doing a huge amount of research on the benefits and risks of VBAC, after her first birth ended in a Cesarean and she prepared for her second.   The amount of information, statistics, research summaries and discussion found on her blog is amazing.  Jen is a “numbers gal” and does a great job of explaining risks and numbers in an easy to understand presentation.  I frequently find myself going to her blog when I want to know the risk of placental complications after a cesarean or to better understand some of the new research and policy statements from ACOG and other professional organizations.  When 1 in 3 women in the US will give birth by Cesarean, it is good to have a resource such as VBACFacts.com to go to that can help me understand and explain options to families birthing after a cesarean.

4. The Well-Rounded Mama

Pamela Vireday has written “The Well-Rounded Mama” blog since 2008 and it has been a valuable resource for women of all sizes, when they are looking for answers and facts about options for birth.  The mission of the blog is “to provide general information about pregnancy, birth, and breastfeeding, to discuss how to improve care for women of size, to raise awareness about the impact of weight stigma and discrimination on people of size, and to promote health by focusing on positive habits instead of numbers on a scale.” Pamela does an awesome job of gathering, explaining and summarizing research, particularly related to women of size, but in all honestly, extremely relevant to all birthing women.  I appreciate her plus size photo galleries of pregnant and breastfeeding women of size. If you might be a  woman who is larger than many of the models in today’s pregnancy magazines, seeing the gallery of women who look beautiful pregnant and breastfeeding, with a wide range of body shapes, can be comforting.  In addition to providing evidence based information,  Pamela answers some of the questions that plus sized mothers might have, but are hesitant to ask their healthcare provider, such as concerns about about whether fetal movement will be noticeable if they are larger sized.  A great blog, with relevant articles for all women!

5. Midwife Thinking

This blog is written by Rachel Reed, an Australian PhD midwife, who enjoys taking a look at the research and sharing her thoughts on how well the research is applied to application.  I enjoy reading her blog for that reason, and often find myself amazed that she chooses to write about the very topics that I wonder about and want to learn more on.  Rachel’s aim is to “stimulate thinking and share knowledge, evidence and views on birth and midwifery. ”  I also appreciate her “Down Under” perspective and celebrating the commonalities of birth across the many miles.  Rachel is not afraid to agree when the science backs up the “less popular” treatment and care amongst childbirth advocates, allowing the evidence to speak for itself and carefully explaining why.   Rachel does a great job of normalizing many of the topics that bog women down during labor and birth, such as the “anterior cervical lip” or “early labor and mixed messages.”  I like to share Rachel’s posts with families who are experiencing the very situation she is writing about.

6. ACOG President’s Blog

Every week, the current president of the American Congress of Obstetricians and Gynecologists (ACOG) writes a blog post on a matter of importance to women.  Not all the posts are on birth related topics, but I find it very interesting to see what Dr. Jeanne A. Conry, M.D. PhD shares with readers.  While some of her blogs are directed at her fellow physicians, many of the posts highlight information and resources directly related to women’s health, especially during the reproductive years.  I enjoy learning more about what Dr. Conry feels is important, and especially what messages and information she is directing to her colleagues. I appreciate her middle of the road approach and look forward to a new post every week.

I hope that you might consider following some of the blogs I mentioned here, if you are not already doing so.  I would also love if you shared your favorite blogs with myself and our Science & Sensibility readers.  I always have room for more good birth related blogs in my blog reader!  What blogs do you read?

ACOG, Authoritative Knowledge, Breastfeeding, Cesarean Birth, Childbirth Education, Continuing Education, Evidence Based Medicine, Maternity Care, Midwifery, Research, Science & Sensibility , , , , , , , , , , , , , ,

Welcoming All Families Series: Welcoming Women of Size & Promoting Optimal Birth Outcomes

November 8th, 2012 by avatar

Continuing along in our occasional series on “Welcoming All Families” to our childbirth classes, this two part guest post is written by Pam Vireday,  creator of the Well-Rounded Mama blog.  Today, Pam shares how to promote optimum outcomes at the births of plus sized mothers. Click here to read the first post in the series, where Pam shared how to create childbirth education classes with women of size in mind. – Sharon Muza, S&S Community Manager

______________________

In part one of the series,  we discussed how birth professionals can make women of size feel more welcome by creating a size-friendly space, by addressing special needs, by finding size-positive images and birth stories, and by addressing potential risks in a proactive, non-judgmental way.  Today, in part two, let’s discuss ways to promote optimal outcome in women of size.

Nutrition and Exercise

photo courtesy of Pamela Vireday

Many women of size find they feel better and have more stable blood sugar when they combine carbohydrates with protein instead of consuming carbohydrates by themselves. Modestly limiting carbohydrates at meals, eating smaller and more frequent meals, and using whole grains instead of refined carbs may also help promote euglycemia.

An even more powerful tool for optimizing blood sugar is exercise. Intensity of exercise is far less important than regularity of exercise, with daily exercise being optimal. Many women of size find walking, swimming, prenatal yoga, and water aerobics particularly friendly to larger bodies.

Nutrition Diaries

One of the most trying things for some fat women is the pregnancy nutrition diary. If used, these must be done with care.

After years of having every bite nit-picked, pregnancy food diaries can be very triggering for women with long histories of dieting or eating disorders. In addition, many providers don’t believe women of size no matter what they say. As one mom shared, “[My midwife] refused to believe what I recorded. She flat-out accused me of lying, telling me that I ‘must be living on ice cream and donuts.’”  This can be very disillusioning.

If you decide to use food diaries, question your assumptions about what fat women “must” be eating.  Some people eat normally and are still fat, while some thin women have terrible habits and yet are thin. Leave out assumptions, scolding, and lecturing, and find a way to neutrally help women analyze their own intake and gently adjust if needed.

Prenatal Weight Gain

Current weight gain recommendations from the Institute of Medicine are 11-20 lbs. for obese women, and 15-25 lbs. for overweight women.  However, many care providers these days are strongly pressuring obese women to diet to restrict weight gain, or even to deliberately lose weight during pregnancy.

This is a dilemma for women of size, because research suggests that very low gain or gestational weight loss may actually increase the risk of small-for-gestational-age or premature babies. Some research suggests differing weight gain recommendations for differing classes of obesity, but studies on limiting weight gain have many design flaws, so providers must tread carefully to balance potential benefits and risks.

Another alternative is to take a Health At Every Size® approach. Good nutrition and regular exercise is promoted, but without the scale as a goal.  The finger-wagging, shaming approach of most dietary intervention is absent, and although particular weight gain goal ranges can be encouraged, good nutrition is put ahead of rigid goals. Many women with a long history of dieting find a Health At Every Size® approach very freeing because it still emphasizes healthy behaviors, but without the scale as judge and jury.

Weight gain among women of size is extremely variable. A lot depends on the woman’s individual circumstances. Differing amounts can be normal as long as you are eating nutritiously.

As one big mom notes:

Talk about weight gain, but explain that every body is different. Some people gain lots and have healthy babies. Some people gain very little or even lose and have healthy babies. Don’t focus on the scale, but on healthy eating and assure people their bodies will then do what they need to do.

Another mom agrees, saying, “Providers can get across the point that excellent nutrition is key to a healthy pregnancy and birth without making mom stress over it.”

Finding a Size-Friendly Caregiver

Finding a size-friendly caregiver is critical to having a positive birth experience. Unfortunately, bias and mistreatment are not uncommon. Some of it is egregious mistreatment, while other examples show a more subtle bias.  In particular, many well-meaning care providers overutilize interventions in the labors of women of size.

Research shows that obese women are induced at much higher rates, experience a higher rate of interventions, and that caregivers have a lower threshold for surgical intervention in their labors. Although it is commonly believed that obesity predisposes to a cesarean, recent research suggests that cesarean rates can vary dramatically within the same weight class, depending on how the labor is managed.  This suggests that labor management and attitudes may be more of a factor in c-section rates than obesity itself.

High-BMI women need to ask careful questions about special protocols they may be pressured into (like early inductions for suspected macrosomia, early amniotomy, internal monitoring, or early epidurals) and how much wiggle room there is for working around these.

 One plus-sized postpartum nurse states bluntly:

As far as labor, the best advice I could give another [plus-sized] mom is to STAY MOBILE!!!!! Staying in bed, getting an epidural too soon, not being able to change positions frequently [equals] dysfunctional labor and c-section.

Other tips for lowering an obese woman’s chances for a cesarean can be found here and here.

Like other women, women of size need information on patient rights, how to advocate for themselves, their right to decline procedures, and information on filing a complaint if needed.  Knowing that they have the right to stand up for themselves and say “no” is a new concept to far too many plus-sized women.

Pay Attention to Fetal Position

There is some research and anecdotal evidence that suggests that women of size have a higher rate of malpositioned babies, and that this may play a role in their increased cesarean rate. Talk with women about fetal position, discuss ways to promote optimal fetal positions, and mention the possibility of chiropractic adjustments for those who are interested.

Since some very heavy women have pendulous bellies which may make it harder for the baby to engage in the pelvis, include some information about the “abdominal lift and tuck” exercise, as well as other positions that can help babies to engage during labor.

Birthing Positions for Women of Size

Encourage women of size to experiment with finding useful laboring and birthing positions that work with their bodies. Remember that like all women, women of size will vary in how athletic and flexible they are. Explore each position without judgment.

Many women of size find the all-fours position or a forward-leaning kneeling position useful. If the woman has an epidural, side-lying can be extremely helpful. Although “soft tissue dystocia” is an unproven concept, if there is any question of pelvic capacity frequent position changes and asymmetric positions like lunging may be helpful.  A birth ball (appropriate for height and weight) can also help relax the perineum, open the pelvis, and allow easier rotation among positions.

Many women of size report loving laboring in water. The buoyancy of the water allows position changes with greater ease, and eases pressure on the knees. The pain-relieving effect of water is another bonus, since epidurals can be harder to place in larger women.

Further information (and pictures) on birthing positions for women of size can be found here and here. Some care providers actively discourage mobility in women of size, so having a supportive caregiver is key. Practice multiple positions beforehand, emphasize the importance of frequent position changes, and promote having a labor support person who can help women utilize position changes more easily.

Summary

Although women of size are more at risk for certain complications, remember that women of all sizes can experience complications. All women benefit from the same basic advice for excellent nutrition, regular exercise, reasonable weight gain, choosing good providers, attention to fetal position, and use of flexible birthing positions. Emphasize proactive health behavior across the board.

What has been your experience in helping prepare women of size for birth?  How have the women you might have had in your classes or practice found the experience of pregnancy and birth as a large sized woman?  Do you have suggestions to add about your observations and favorite resources? Please share with our community.- SM

Plus-Sized Resources

Finding Size-Friendly Care

http://www.cat-and-dragon.com/stef/Fat/ffp.html – size-friendly providers of all types
http://plussizebirth.com/plussizedoulaconnections – size-friendly doulas
http://plussizebirth.com/midwife-ob-gyn-connections – size-friendly midwives and OBs
http://www.aafp.org/afp/2002/0101/p81.html – guidelines from the American Academy of Family Practitioners for improving care for obese patients
www.amplestuff.com – catalogue with products sized for larger people, such as larger blood pressure cuffs, scales that go to higher weights, larger exam gowns, etc.

General Size Acceptance and Health At Every Size® Resources

http://www.jonrobison.net/Health_Every_Size.pdf – pamphlet on Health At Every Size®
http://healthateverysizeblog.org/ – blog about Health At Every Size® issues
www.sizediversityandhealth.org – Association for Size Diversity and Health
www.cswd.org – Council on Size and Weight Discrimination
http://www.lindabacon.org/HAESbook/excerpts.html – info on Health At Every Size®
http://danceswithfat.wordpress.com/blog/ – size acceptance and Health At Every Size®
http://www.healthyweight.net/cntrovsy.htm – Healthy Weight Network
www.naafa.org – National Association to Advance Fat Acceptance
http://www.cat-and-dragon.com/stef/Fat/ffp2.html – tips on obtaining good health care
http://www.fwhc.org/health/fatfem.htm – Large Women’s Healthcare Experiences

Books on Health At Every Size®

• Bacon, Linda. Health at Every Size: The Surprising Truth About Your Weight. BenBella Books, 2010.
• Campos, Paul. The Obesity Myth: Why America’s Obsession With Weight is Hazardous To Your Health, Gotham Books, 2004.

 About Pamela Vireday

Painting by Mary Cassatt, 1844-1926. (public domain) Wikimedia Commons.

Pamela Vireday is a childbirth educator, writer, woman of size, and mother to four children. She has been collecting the stories of women of size and writing about childbirth research for 17 years. She writes at www.wellroundedmama.blogspot.com and www.plus-size-pregnancy.org.

 

Cesarean Birth, Childbirth Education, Evidence Based Medicine, Guest Posts, informed Consent, Maternal Obesity, Series: Welcoming All Families, Uncategorized , , , , , ,

Welcoming All Families Series: Welcoming Women of Size In Your Birth Classes

November 6th, 2012 by avatar

Continuing along in our occasional series on “Welcoming All Families” to our childbirth classes, this two part guest post is written by Pam Vireday,  creator of the Well-Rounded Mama blog.  Are your childbirth classes friendly to women of size?  What special accomodations and resources do larger-sized mothers-to-be need if any? In today’s post, Pam discusses a check list of items that you might consider when teaching childbirth classes and on Thursday, Pam shares how to promote in your classes optimum outcomes at the births of these mothers.- Sharon Muza, S&S Community Manager

______________________

MatthiasKabel GFDL www.gnu.org/copyleft/fdl.html Wikimedia Commons

Although the exact numbers vary according to the source used, it is no secret that many women of childbearing age are “overweight” or “obese”* by government standards.  This means that, sooner or later, most doulas, childbirth educators and health care providers will have women of size as clients or patients.

Many birth professionals are unsure of how to address the unique needs of this group. At a time when the media messages around obesity and pregnancy are almost uniformly negative and scare-mongering, it is important that birth professionals create a place for women of size to discuss their unique concerns without judgment.

Terminology*

Research shows that many larger people find the terms “obese” and “overweight” stigmatizing. Although size-acceptance activists prefer the word “fat,” some people cannot hear this term neutrally, and euphemisms like “fluffy” can feel patronizing.

Birth professionals are encouraged to notice and adopt the terminology used by clients for themselves. Until then, use more neutral terms like “plus-sized” or “women of size.” (Further discussion of the relative merits of various terms can be found here.)

Create a Safe Space

Most larger women have been negatively judged by others for their weight, and the disapproval is never stronger than when they consider pregnancy. Women of size need a non-judgmental space where they can feel free to discuss their concerns for pregnancy without being shamed, lectured to, or made to feel like “bad mothers.”

Your job as a birth professional is to create this safe place. Examine your own biases about weight, eating, and health.  Question your assumptions and engage with each woman as an individual. Utilize reflective listening, assist them in researching special issues, and neutrally explore proactive behaviors that might help address their concerns.

Make Sure Facilities Are Size-Friendly

Ask yourself ─ are your facilities friendly to larger bodies?  Do you have armless chairs? Seating that is easy to get up from?  Restrooms that accommodate larger people?  Comfortable facilities set the tone for a space that is welcoming to all sizes.

Remember that getting up and down from the floor can be difficult for many women in pregnancy, not just heavier women.  Have a few low stools around that women can use to help boost themselves up.  Also be sure your birth balls are appropriate for heavier women; a little higher and a little more heavy-duty balls can be helpful.

Address Special Equipment Needs

The correct blood pressure cuff size is vital for larger people.  A too-small cuff can artificially inflate blood pressure readings and result in unnecessary intervention.

According to guidelines from the American Heart Association, people with upper arm circumferences above about 13.4 inches (34 cm) need a “large adult” cuff, while those with a circumference above about 17.3 inches (44 cm) need a “thigh” cuff.  If in doubt, measure the client’s arm and cross-check it against the reference range printed on the BP cuff.

Some care providers resist using larger cuffs, so women or their support people may need to be quite assertive about utilizing the correct cuff size.

Discuss Breastfeeding When Well-Endowed

Some high-BMI women are quite well-endowed. This can present special challenges in breastfeeding, yet many women receive no information on how to meet these challenges. Cover a variety of nursing positions and techniques, including the football hold, which may be more useful for well-endowed women.

Have Additional Resources Available for Women of Size

A consistent problem for women of size is the difficulty in finding resources for their specific needs. For example, finding maternity clothes or a nursing bra in a larger size can be a major problem. Many women appreciate having a list of companies that specialize in plus-size maternity products.

Address Potential Risks and Complications

While the possibility of complications must be acknowledged, remind women that having a risk factor for a complication does not inevitably mean developing that complication. An individual’s outcome cannot be predicted by risk factors alone. Treat women of size like any other pregnant woman by expecting normalcy as much as possible.

Share websites that examine weight-related research with a neutral, critical eye, which acknowledge that complications are possible and promote proactive prevention, but which also point out that larger women can and do have normal, healthy pregnancies and births.

Find Positive Images and Stories of Women of Size

photo courtesy of Diaz Family

Media images of heavy people in our society are highly stigmatizing.  Most pictures of fat people are headless (dehumanizing them), unflattering (focusing on bellies or behinds in tight clothes), or reinforce stereotypical behavior (eating junk food or being sedentary).

Media discussions of pregnancy and obesity focus only on the risks for complications, tell apocryphal stories of worst possible outcomes as if they are commonplace, or compare fat pregnancy to child abuse.

Books that focus on obesity and pregnancy pay lip service to being size-friendly, but contain a preponderance of negative stories, highly-interventive births, and scare tactics about complications.  As one doula reviewer on Amazon wrote, “More time was spent telling me how much more likely I am to have a cesarean than to tell me how I can best avoid one.”

It’s very important to counteract these negative messages and images with positive ones.  Direct your client to websites which have plenty of positive images of women of size pregnant, giving birth, and breastfeeding (see list below).  Connect them with a community of like-minded women if they are interested.

Respect Patient Autonomy

Different people will look at the same information with differing values and make varying choices.  The same is true for women of size.  Some will respond to information about obesity-related risks by choosing a more-interventive childbirth model, and some will respond by choosing a less-interventive model.  Neither choice is right or wrong. Respect each person’s right to choose for themselves.

 

“All in all I think I just want to be treated the same as anyone else. Give me the information, not opinions, not value judgments. Let me decide what to do with it. Give me all the information, not what you perceive or decide I need. Treat me as thinking adult. Treat me with respect. Don’t belittle me, and do not treat me with kid gloves either.” Lexi Diaz, plus-sized mother of four.

Do you do anything different when women of size attend your classes?  Do you feel like your classes already accomodate any special needs they might bring? Do your visual aids and resource lists include pictures of women of size and resources designed for their needs?  Do you feel that any woman of size attending your class feels welcome or alone?  What have been your experiences with larger sized women taking your classes or being your client or patient.  Let us know your experiences in the comments section and share additional resources if you would like.  Read on Thursday, when Pam shares how CBEs can help women have optimum outcomes at their births.- SM

Plus-Sized Resources

Plus-Sized Pregnancy Information

www.wellroundedmama.blogspot.com
www.plus-size-pregnancy.org
http://www.facebook.com/theamplemother
www.plussizebirth.com
www.facebook.com/plussizemommymemoirs
http://pregnancy.about.com/od/plussizepregnanc/Plus_Size_Pregnancy.htm
http://www.facebook.com/pages/Plus-Maternity-Australia/107067319323331
www.fertilityplus.org
http://community.babycenter.com/groups/a425315/plus_size_and_pregnant

Finding Maternity Clothing in Plus Sizes

Plus-Size Maternity Clothing FAQ – help for finding maternity clothing, nursing clothing, nursing bras, and maternity-related products in plus sizes, both in the U.S. and abroad
http://plus-size-pregnancy.org/BBWBabyCarriers.html – help for finding baby carriers and slings in plus sizes
www.plusmaternity.com.au – resources on plus-sized maternity and nursing clothing in Australia
http://plussizebirth.com/2012/04/babywearing-for-the-plus-size-mom.htm – info on finding baby carriers for plus sizes

Positive Images of Plus-Sized Pregnant Women

*Do not use any of these photos without asking permission first

Plus-Sized Pregnancy Photo Gallery – series of blog posts with many pictures of plus-sized pregnancy and birth
Plus-Sized Pregnancy Breastfeeding Gallery – pictures of women of size breastfeeding
http://plussizebirth.com/gallery- gallery of plus-sized baby bumps, birth pictures, breastfeeding pictures, and babywearing pictures
http://oneyawn.blogspot.com/2012/06/belly-pictures-baby-number-three.html – belly diary of a plus-sized mom, week to week in pregnancy
http://www.facebook.com/theamplemother/photos_stream – plus-sized pregnancy photos
http://birthislife.blogspot.com/2012/08/nursing-portrait-session.html – lovely breastfeeding photos of a woman of size
http://www.yaleruddcenter.org/press/image_gallery.aspx – free for educational purposes with attribution to the Rudd Center for Food Policy and Obesity (no pregnancy images)

Birth Stories of Plus-Sized Women

http://www.plus-size-pregnancy.org/BBWBirthStories/bbwstrindex.html – stories with a wide range of outcomes and experiences
http://www.plus-size-pregnancy.org/BBWBirthStories/bbwvagnlstories.htm – stories of normal vaginal births in women of size
http://www.plus-size-pregnancy.org/BBWBirthStories/bbwspecvagstories.htm – stories of normal vaginal births in women of size despite special circumstances

About Pam Vireday

Painting by Mary Cassatt, 1844-1926. (public domain) Image from Wikimedia Commons.

Pamela Vireday is a childbirth educator, writer, woman of size, and mother to four children. She has been collecting the stories of women of size and writing about childbirth research for 17 years. She writes at www.wellroundedmama.blogspot.com and www.plus-size-pregnancy.org.

 

 

 

Breastfeeding, Cesarean Birth, Childbirth Education, Evidence Based Medicine, Guest Posts, Healthy Birth Practices, Healthy Care Practices, informed Consent, Maternal Obesity, Maternal Quality Improvement, Maternity Care, Series: Welcoming All Families , , , , , , , , ,