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A Tale of Two Births – Comparing Hospitals to Hospitals

December 9th, 2014 by avatar

By Christine H. Morton, PhD

Today, Christine H. Morton, PhD, takes a moment to highlight a just released infographic and report by the California Healthcare Foundation that clearly shows the significance of birthing in a hospital that is “low performing.”  This is a great follow up post to “Practice Variation in Cesarean Rates: Not Due to Maternal Complications” that Pam Vireday wrote about last month. Where women choose to birth really matters and their choice has the potential to have profound impact on their birth outcomes.   – Sharon Muza, Science & Sensibility Community Manager.

An Internet search of “A Tale of Two Births” brings up several blog posts about disparities in experience and outcomes between one person’s hospital and subsequent birth center or home births. Sometimes the disparity is explained away by the fact that for many women, their second labor and birth is shorter and easier than their first. Or debate rages about the statistics on home birth or certified professional midwifery. Now we have a NEW Tale of Two Births to add to the mix. However, this one compares the experiences of two women, who are alike in every respect but one – the hospital where they give birth.

Screen Shot 2014-12-08 at 5.15.04 PM

 

The California HealthCare Foundation has created an infographic drawn from data reported on California’s healthcare public reporting website, CalQualityCare.org. In this infographic, we meet two women, Sara, and Maya who are identical in every respect – both are the same age, race, and having their first baby, which is head down, at term. However, Sara plans to have her baby at a “high-performing” hospital while Maya will give birth at a “low-performing” hospital. “High performing” is defined as three or more Superior or Above Average scores and no Average, Below Average, or Poor scores on the four maternity measures. “Low performing” is defined as three or more Below Average or Poor scores on the four maternity measures.

Based on the data from those hospitals, the infographic compares the likelihood of each woman experiencing four events: low-risk C-section, episiotomy, exclusive breastmilk before discharge, and VBAC (vaginal birth after C-section) rates (the latter one of course requires us to imagine that Sara and Maya had a prior C-section).

First-time mom Sara has a 19% chance of a C-section at her high-performing hospital, while Maya faces a 56% chance of having a C-section at her low-performing hospital. These percentages reflect the weighted average of all high- and low- performing hospitals.

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The readers of this blog will no doubt be familiar with these quality metrics and their trends over time. Two of these metrics (low risk C-section and exclusive breastmilk on discharge) are part of the Joint Commission’s Perinatal Care Measure Set. The other two – episiotomy and VBAC are important outcomes of interest to maternity care advocates and, of course, expectant mothers.

Hospitals with >1100 births annually have been required to report the five measures in the Joint Commission’s Perinatal Care Measure Set since January 2014, and these metrics will be publicly reported as of January 2015.

Childbirth educators can help expectant parents find their state’s quality measures and use this information in selecting a hospital for birth. In the event that changing providers or hospitals is not a viable option, childbirth educators can teach pregnant women what they can do to increase their chances of optimal birth outcomes by sharing the Six Healthy Practices with all students, but especially those giving birth in hospitals that are “low-performing.”

You can download the infographic in English and en Español tambien!

About Christine H. Morton

christine morton headshotChristine H. Morton, PhD, is a medical sociologist. Her research and publications focus on women’s reproductive experiences, maternity care advocacy and maternal quality improvement. She is the founder of an online listserv for social scientists studying reproduction, ReproNetwork.org.  Since 2008, she has been at California Maternal Quality Care Collaborative at Stanford University, an organization working to improve maternal quality care and eliminate preventable maternal death and injury and associated racial disparities. She is the author, with Elayne Clift, of Birth Ambassadors: Doulas and the Re-emergence of Woman Supported Childbirth in the United States.  In October 2013, she was elected to the Lamaze International Board of Directors.  She lives in the San Francisco Bay Area with her husband, their two school age children and their two dogs.  She can be reached via her website.

Babies, Cesarean Birth, Childbirth Education, Do No Harm, Evidence Based Medicine, Guest Posts, Healthy Birth Practices, Maternal Quality Improvement, Maternity Care, Medical Interventions, New Research, Newborns, Push for Your Baby , , , , , ,

Prematurity Awareness Month – Test Your Knowledge on Our Quiz

November 25th, 2014 by avatar

Prematurity Awareness Month 2014As November comes to a close, you may have read or seen many articles on the topic of premature babies.  November is Prematurity Awareness Month, recognized in the United States and around the world.  Prematurity affects 15 million babies a year globally and the downstream health consequences to the babies are significant.  There is also a huge burden in terms of health care dollars that are required to treat the baby after birth and then potentially for many years beyond that.

In 2013, the national preterm birth rate fell to its lowest rate in 17 years.  This decrease helped us to meet the 2020 Healthy People Goals 7 years early, which is something to celebrate.  But overall, our prematurity rate is still nothing to be admired, as the United States has one of the highest rates amongst developed nations.

As childbirth educators, we are in a unique position to share information with families, including signs of preterm labor, risk factors and warning signs.  Having conversations in your classes can help families to recognize when something may not  be normal and encourages them to contact their doctor or midwife if they suspect they may be experiencing some of the signs of a potential preterm birth.  While no family wants to think that this might happen to them, bringing up the topic can help them to seek out help sooner.

Science & Sensibility has put together some resources that you can share with the families that you work with.  We also invite you to take the Prematurity Awareness Month Challenge Quiz, and test your knowledge on some basic facts about preterm birth.  See how well you do and compare your results with others also taking the quiz.

Resources to share

Go the Full 40 – AWHONN’s prematurity prevention campaign, including 40 reasons to go the full 40.

Healthy Babies are Worth the Wait – March of Dimes

Healthy People 2020 – Maternal, Infant & Child Health

March of Dimes Prematurity Report Card – Find your state’s grade

Centers for Disease Control and Prevention – Prematurity Awareness

March of Dimes Videos on Prematurity Awareness

Signs of Preterm Labor – March of Dimes Video

Preterm Labor Assessment Tool Kit for Health Professionals – March of Dimes.

How do you cover the topic of preterm labor in your classes?  What activities do you do?  What videos do you like to show?  Please share with others how you do your part to inform parents about this important topic and help to reduce prematurity in the families you work with.  Let us know in the comments section below.

 

Babies, Childbirth Education, Maternal Quality Improvement, Maternity Care, Newborns, Pain Management, Pre-term Birth , , , ,

Series: Welcoming All Families: Supporting the Native American Family

November 18th, 2014 by avatar

By Melissa Harley, CD/BDT(DONA), LCCE

November is Native American Heritage Month and LCCE Melissa Harley shares some interesting facts about the rich culture included in some of the varied childbearing year traditions observed by some of the U.S. tribes.  There are many different tribal nations, and each one has their own ceremonies and practices around pregnancy and birth.  Beautiful and fascinating stories that are each unique in their own right.  This post is part of Science & Sensibility’s “Welcoming All Families” series, which shares information on how your childbirth class can be inclusive and welcoming to all. – Sharon Muza, Community Manager, Science & Sensibility.

© Bob Zellar http://bit.ly/1EVALCk

© Bob Zellar http://bit.ly/1EVALCk

As childbirth educators of today, we must strive to have a connection to childbirth of yesterday.   As educators, we should continually be looking for ways to be welcoming of all cultures, customs, and traditions in the classroom setting and when working individually with students.  In order to achieve these goals, it is helpful to better understand how such traditions played out in years gone by.  So often, we look at birth from a very telescopic lens of the past (singling out one or two cultures) rather than looking at history from a more wide panoramic view point.  As we strive to embrace cultural diversity, we should continue to explore populations that are perhaps a little less known.    Have you considered the culture of Native Americans in childbirth and how the past compares to childbirth in our society now? According to the Centers for Disease Control and Prevention (CDC), currently, there are roughly 5.2 million American Indians and Alaska natives spread throughout 565 federally recognized tribes in the US. (CDC, 2013)  Let’s take a look at some of the commonalities that we have with our Native American ancestors and learn a little together about being welcoming, helpful, and inclusive of Native Americans in our classes today!

Native Americans and Pregnancy

Although there are some differing opinions regarding historical pregnancy and birthing traditions of Native Americans, according to historian Ellen Holmes Pearson, PhD, Native Americans were known to take exceptional care of themselves during pregnancy.  Similar to today, maintaining good health throughout pregnancy often led to an uncomplicated labor and birth.  Much regard was taken to ensure that a Native American mother’s health needs were met in a way that would support the nutritional and physical needs of both mom and baby.  From the website teachinghistory.org, Dr. Pearson states   “During their pregnancies, women restricted their activities and took special care with their diet and behavior to protect the baby. The Cherokees, for example, believed that certain foods affected the fetus. Pregnant women avoided foods that they believed would harm the baby or cause unwanted physical characteristics. For example, they believed that eating raccoon or pheasant would make the baby sickly, or could cause death; consuming speckled trout could cause birthmarks; and eating black walnuts could give the baby a big nose. They thought that wearing neckerchiefs while pregnant caused umbilical strangulation, and lingering in doorways slowed delivery. Expectant mothers and fathers participated in rituals to guarantee a safe delivery, such as daily washing of hands and feet and employing medicine men to perform rites that would make deliveries easier.”

In addition to caring for the body in pregnancy, it was extremely important for Native Americans to care for their mind and spirit.   In the Navajo communities, pregnancy and childbirth were approached as a spiritual event.  Much time and effort was spent making sure that the mother had a positive pregnancy.  Ceremonies in the Navajo community in general were very important.  Some ceremonies could last for days and days.  It was only natural that the tribes would hold Blessing Ways for expectant mothers.   Unlike many other Navajo ceremonies, the Blessing Way was not held to cure a sickness, but rather to invoke positive blessings and avert misfortune. Contrary to current use of the Blessing Way, the traditional Navajo tribes used the Blessing Way for more than just pregnancy and birth.  The ceremony was also used for blessing of the home, and also to enhance good fortune through the kinaalda (girl’s puberty rites).  Native Americans today that wish to connect with their heritage during the childbearing time often do so by being very careful about their spiritual surroundings.  It is quite important for mothers to keep their thoughts positive, and to maintain a climate of peace with those around them.  It is also suggested that mothers should avoid arguing with others during pregnancy, or to allow bad thoughts to enter their minds.

Native Americans and Birth

Native Americans were known to give birth in a simple way, with only other women in attendance as men were never allowed to see a woman give birth.   In general, Indian women likely gave birth without much assistance at all.  A midwife would at times attend the birth, along with other female family members from the tribe.  In very simplistic style, the baby would be birthed directly onto the leaves below the mother who used upright posturing for birth.   The baby would be welcomed by the earth, rather than by man’s hands.

To hasten labor and reduce pain during the birth, tribes sometimes utilized herbal remedies.   Cherokees made a tea with Partridgeberry and started consuming it several weeks before the birth.  They were also known to use Blue Cohosh to promote rapid delivery and to speed delivery of the placenta. To relieve pain, the Cherokees turned to wild black cherry tea made with the inner bark from the tree. The Koasati tribes made a tea of the roots from the plant of cotton that reduced pain for birthing women.

In some tribes, rituals to “scare” the baby out were utilized.  An elder female would often yell “Listen! You little man, get up now at once. There comes an old woman. The horrible [old thing] is coming, only a little way off. Listen! Quick! Get your bed and let us run away. Yu.”

Another common tradition in birth was the use of the rope or Sash Belt thrown over tree limbs for the mother to hold.  The traditional Navajo sash belt is made of intricate-colored sheep wool that is woven upon a wooden loom.  Some hospitals today near Indian reservations have a Sash Belt installed in the ceiling for mothers to use.

Connecting the Past and the Present

While the mothers of today might not fear that eating speckled trout will cause birthmarks, most do still have concerns  and want to take steps to ensure a healthy baby.  We see mothers avoiding large amounts of caffeine and high mercury fishes. While we don’t often see our students choosing to give birth without much assistance onto the leaves of the trees, many do still choose upright posturing.  We also see a desire at times to hasten the labor, and some mothers turn to herbal or medicinal means to help that happen.   As childbirth educators, we can at times be of comfort to our students as they prepare for the healthiest birth possible. We can connect the past with the present, allowing parent’s space to explore the traditions within their cultures while also honoring current evidence and research based maternity care.  As I say in my classes, while pointing students to the evidence associated with Healthy Birth Practice #5, those mamas from long ago knew something intuitive: that using upright positions for labor and birth made a difference!

Health Services for Native Americans Today

If you live and work near an Indian reservation, you may be familiar with Indian Health Service (IHS).   IHS was established in 1955 with a goal to raise the health status to the highest possible level for Native Americans registered in a federally recognized tribe.   As childbirth educators, some of our students may seek medical attention at one of the nation’s 33 IHS hospitals or 59 IHS health centers.   Dr. Michael Trujillo, past director of IHS states in regard to IHS, “The values of human dignity, honesty, compassion, coupled with shared values of many different tribes and cultures, that have come to be spoken of as “Indian values, of listening, mutual respect, dignity, and harmony must always be at the forefront of what we do and how we do it. We must be professional in all our actions.”

This year, in accordance with the Affordable Care Act, the Indian Health Care Improvement Act was permanently reauthorized.  This provision in the current law will increase access of quality health care to Native Americans near IHS facilities as well as those who do not live near an IHS facility.  The ACA includes some very specific benefits that will impact American Indians and Alaskan Natives.  Tribes across the country are encouraging members to become familiar with the new laws, and to evaluate how the provisions can increase access and affordability to quality healthcare for their members.

Connecting our Native American clientele with quality prenatal care is extremely important.   Consider the following statistics from the CDC:

  • American Indian/Alaska Natives have 1.6 times the infant mortality rate as non-Hispanic whites.
  • American Indian/Alaska Native babies are 2.2 times as likely as non-Hispanic white babies to die from sudden infant death syndrome (SIDS).
  • American Indian/Alaska Native infants were 2.5 times as likely as non-Hispanic white infants to have mothers who began prenatal care in the 3rd trimester or not receive prenatal care at all.

What’s a Childbirth Educator to Do?

As we strive to better serve the mothers of today, first and foremost, we should recognize the importance of the history that First Nations people bring to birth.   Many Native Americans today still practice customs and traditions from years gone by.  If you currently service a population that includes American Indians and Alaskan Natives, then you may already be aware of the customs in your area.

© Ursula Knoki-Wilson

© Ursula Knoki-Wilson

To help Native Americans feel welcomed in class, ensure that visuals of contemporary Native Americans are included in your curriculum.   You might also offer a segment in your comfort measures class that specifically addresses the customs from that population.  In general, keeping language inclusive of a variety of cultures can also lead to a sense of acknowledgement and acceptance. Simply recognizing that you are aware of different cultural traditions in class can lead to parents feeling more comfortable, thus opening a door for sharing and further education.

Regardless of your target clientele, it would be helpful for a childbirth educator to become familiar with the many different traditions surrounding childbirth in the cultures around us.  A quick internet search can lead to a wealth of information that might be helpful in class.  As with any tradition or culture that you are not familiar with, education is power!  If you are on or near a reservation, perhaps reaching out to the IHS facility nearby might be an option.  Some facilities have staff members that hold workshops and courses to help the people within their tribes stay connected with tradition. In addition, it might be helpful to inform area IHS facilities that there is a childbirth educator nearby who is sensitive to the mental, physical and spiritual needs of the tribe members. It would also be advisable for childbirth educators to become aware of the provisions in the ACA for American Indians, as to be prepared with resources, if you are asked any questions in regard to healthcare for American Indians.   As childbirth educators, we are in a unique position to encourage our clients to seek quality prenatal care.  Working together with the families in our classes, we can positively impact the infant mortality rates among these populations by educating the families about safe and healthy birth practices and the options available to them.

Ultimately, it is important to keep our space open for all cultures and honor the individual traditions of the parents that attend our classes.  By becoming more educated and sensitive to the cultures around us we can better serve our clientele as a whole.  And for our Native American students, I’ll leave you with this blessing:

Earth’s Prayer
From the heart of earth, by means of yellow pollen blessing is extended.
From the heart of Sky, by means of blue pollen blessing is extended.
On top of pollen floor may I there in blessing give birth!
On top of a floor of fabrics may I there in blessing give birth!
As collected water flows ahead of it [the child], whereby blessing moves along ahead of it, may I there in blessing give birth!
Thereby without hesitating, thereby with its mind straightened, hereby with its travel means straightened , thereby without its sting, may I there in blessing give birth!S.D. Gill, Sacred Words

Note: to read more information about the images of the cradleboard welcoming home two generations of families, please follow this link to the Turtle Track organization for the full story. – SM

References

American Indian & Alaska Native Populations. (2013, July 2). Retrieved November 15, 2014, from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html

Blessingway (Navajo ritual). (n.d.). Retrieved November 15, 2014, from http://www.britannica.com/EBchecked/topic/69323/Blessingway

Holmes Pearson, E. (n.d.). Teaching History.org, home of the National History Education Clearinghouse. Retrieved November 15, 2014, from http://teachinghistory.org/history-content/ask-a-historian/24097

Infant Mortality and American Indians/Alaska Natives. (2013, September 17). Retrieved November 15, 2014, from http://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=38

Knoki-Wilson, U.M. (2008). Keeping the sacred in childbirth practices: Integrating Navajo cultural aspects into obstetric care. [PowerPoint slides].  Retrieved from Naho.ca website http://www.naho.ca/documents/naho/english/IG_Presentations2008/009KnokiWilsonUrsula.pdf

About Melissa Harley

melissa harley head shotMelissa Harley, CD/BDT(DONA), LCCE has worked with birthing women since bearing witness to the vaginal birth of her twin nieces in early 2002. She is a Native American registered in the  Cherokee Nation Tribe (OK) and the owner of Capital City Doula Services in Tallahassee, Florida.   Melissa holds certifications as a Lamaze Certified Childbirth Educator, DONA International Certified Doula and an Approved Birth Doula Trainer(DONA). She currently holds leadership positions with DONA International as a Florida state representative, and she sits on both the DONA International Education and Certification Committees.Melissa is a contributor to several birthing publications including the Journal for Perinatal Education (JPE), the Bearing Witness Series: Childbirth Stories Told By Doulas, and the sequel book Joyful Birth: More Childbirth Stories Told By Doulas.Married for 16 years and the homeschool mother of two teenagers, Melissa, values education and a life-long pursuit of learning. Her teaching style is comfortable, fun, and interactive, with an emphasis on leading the learner to have their own “light bulb” moments. As a childbirth educator and doula, Melissa most enjoys watching women become empowered to listen to their inner voice and acknowledge their own strength to birth.  Mentorship and education are both her passions, and Melissa is dedicated to fulfilling those passions by actively facilitating childbirth education classes as well as training and mentoring new doulas regularly.  Melissa can be reached at Melissa@capitalcitydoulaservices.com

Babies, Childbirth Education, Newborns, Series: Welcoming All Families , , , , ,

October is SIDS Awareness Month – Educators Can Share Information to Help Families Reduce Risk!

October 28th, 2014 by avatar

Safe to Sleep®SIDS PreventionOctober has been designated as a time to observe some solemn occasions that may affect families during pregnancy, birth and postpartum.  This month, Science & Sensibility has previously covered Pregnancy and Infant Loss Awareness Month in two previous posts here and here.  Today I would like to recognize that October is also SIDS Awareness Month.

As childbirth educators, part of our curriculum for expecting parents includes discussing SIDS, providing an explanation of what it is (and what it isn’t)  and how to reduce the risk of a SIDS death.

What is SIDS?

Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted that includes a complete autopsy, examination of the death scene, and a review of the medical history. SIDS is the leading cause of death for infants aged 1 to 12 months in the United States.  About 2000 infants die every year in the USA from SIDS. African American and American Indian/Alaskan Native babies are twice as likely to die of SIDS as white babies.

Most SIDS deaths occur in babies between 1 month and 4 months of age, and the majority (90%) of SIDS deaths occur before a baby reaches 6 months of age. However SIDS deaths can occur anytime during a baby’s first year. Slightly more boys die of SIDS than girls.

Since the USA introduced the Safe to Sleep® campaign (formerly known as the Back to Sleep Campaign) in 1994, the number of infants dying of SIDS has dropped by 50%.

What SIDS is not

  • SIDS is not suffocation nor is it caused by suffocation
  • Vaccines and immunizations do not cause SIDS
  • SIDS is not a result of choking or vomiting
  • SIDS is not caused by neglect or child abuse
  • SIDS is not contagious
  • SIDS is not caused by strangulation

What causes SIDS?

While the cause of SIDS is not known, there is more and more evidence that infants who die from SIDS have brain abnormalities that interfere with how the brain communicates with the parts of the nervous system that control breathing, heart rate, blood pressure, waking from sleep, temperature and other things.  More information on what researchers are finding as they work to identify the cause of SIDS can be found here.

What are the risk factors for SIDS?

There are several risk factors that put babies at higher risk of SIDS.  Childbirth educators should be providing this information to families during class. These risk factors include:

  • Being put to sleep on their stomachs
  • Being put to sleep on couches, chairs, or other soft surfaces or under soft coverings
  • Being too hot during sleep
  • Being put to sleep on or under soft or loose bedding
  • Being exposed to smoke in utero, or second hand cigarette smoke in the home or car, or the second hand smoke of care-givers or family.
  • Sleeping in an adult bed with parents, other children or pets especially if:
    • Bed-sharing with an adult who smokes, recently had alcohol or is tired
    • Sleeping with more than one bed sharer
    • Covered by a blanket or a quilt
    • Younger than 14 weeks of age

NOTE: If families in your classes are going to be bed-sharing with their infants, (which sometimes is the reality for new parents getting accustomed to life with baby) it is important for you to provide information about what safe bed sharing looks like.  I recommend “Sharing Sleep with Your Baby” by Robin Elise Weiss for resources to share on this topic.

What reduces the risks of SIDS?

New parents can do many things to reduce the risk of their infant dying from SIDS.  You can share this information with your classes.   These risk reductions include:

  • Always place a baby to sleep on his/her back
  • Have the baby sleep on a firm sleep surface (Not a carseat, bouncy seat or swing as your baby’s normal sleep spot.)
  • No crib bumpers, toys, soft objects, or sleep positioning products (even if they claim to reduce the risk of SIDS) in the baby’s sleep space
  • Breastfeed the baby
  • Room sharing with the baby
  • Have regular prenatal care during pregnancy
  • Mothers who refrain from smoking, drinking alcohol or using illicit drugs during pregnancy and after the baby is born
  • Do not allow second hand smoke around the baby or have caregivers or family members who smoke around the baby
  • Once breastfeeding and milk supply is firmly established and baby is gaining weight appropriately, offer a pacifier (not on a string) when baby goes down for their last sleep.
  • Do not overdress the baby for bed or overheat the room
  • Maintain all the healthy baby checkups and vaccines as recommended by the baby’s health care provider
  • Do not use home breathing monitors or heart monitors that claim to reduce the risk of SIDS.

Talking about difficult topics in a childbirth class can be hard for both the eductor and the families.  No one wants to think that the unthinkable might happen to them.  But sharing accurate facts about the risks and how to reduce those risks is an important part of any childbirth curriculum.  How and when do you discuss this topic in your classes?  Do you have a video or handout that you like to share?  Please let us know in the comments section, how you effectively cover SIDS topics in your childbirth classes.

Resources for professionals

Resources for parents and caregivers

 

 

 

 

 

 

 

Babies, Breastfeeding, Childbirth Education, Newborns , , , , ,

The Role of the Childbirth Educator during a Perinatal or Infant Loss

October 14th, 2014 by avatar
Original Painting © Johann Heinrich Füssli

Original Painting © Johann Heinrich Füssli

As we continue to observe Pregnancy and Infant Loss Awareness Month, I would like to discuss a difficult topic that may come up for childbirth educators.  Last week, Robin Elise Weiss shared ways to commemorate the loss of a baby. Today, I would like to talk about when a class member experiences a perinatal loss while taking your class, or after the class is over.  If you work long enough as an educator, eventually this will be an issue that you are going to need to face.

Sometimes, you may be contacted by the family, with a somber email or phone call, letting you know that they won’t be returning to class. Other times, a family just stops coming, with no explanation, midway through a series.  You are not sure why.  Was it your teaching style?  Did they have their baby early?  Has something happened?  You will also have to consider that this family may have experienced a late term loss.

When a family does not return to class, I always suggest that the childbirth educator reach out to the family via phone or email to politely inquire and determine that all is okay.  Possibly the mother has been placed on bedrest and will need some accommodations or arrangements in order to complete her childbirth education.  Often, you will find out that something has come up and the date and time no longer work, and you breathe a sigh of relief at this information.  You may find out that their baby arrived prematurely, and you have an opportunity to connect them with resources that they may find useful while dealing with a baby in the NICU and adjusting to the new reality of having a baby weeks or months before they thought they would.  It is likely that their baby may require additional resources and have some immediate needs they had not thought about.  And sometimes, unfortunately, you learn that they have lost their baby either in utero or after birth.

If you are a successful childbirth educator, you work hard to build community in your childbirth classes, helping families to connect with each other through engaging activities and interactive learning.  The families start to see each other as resources and comrades in the transition to parenthood.  Connections are made, friendships are developed and a feeling of community is established.  You are faced with the task of sharing with the class that a family will not be returning.  They are missed and class members usually will be inquiring as to their absence.

When you learn of such a loss, I believe you have several responsibilities as a childbirth educator.  First, determine if the family is open to receiving resources that can help them as they deal with the loss of a baby.  These resources may included peer to peer and facilitated support groups in their community, counselors and therapists specializing in perinatal grief and loss, lactation consultants who can help with the transition of not needing to breastfeed, online resources to help them and more.

If there is a public funeral or memorial service, I make every attempt to attend if possible, in order to show my respect.  Sometimes this is not possible or the family has decided to keep the event private. Regardless,  I always try and promptly send a sympathy card to the family, expressing my sadness at the loss of their son or daughter.

I also politely inquire if they would like me to share the news with the rest of the class.  This information needs to be handled very sensitively.  The family may not want the news shared, and their privacy and wishes are my first priority.  But no doubt, someone in the class will soon ask where the missing family has gone.  In my experiences, the family usually has given me permission to share the information with the rest of the class.  This can be a huge challenge – finding a balance of informing the class and not creating fear and worry for them.

In my experience, the best way to share the information is toward the end of class, with just a few minutes to go.  I respect the family’s wishes and only share the information I have been asked to share.  I tell the truth, but I don’t feel the need to go into great detail.  I answer any questions from the class as best I can and stick to the facts, while respecting the family’s wishes.  If allowed, I provide information about a service or how to contact the family.  I acknowledge that this event is hard to hear, and may bring up concerns and fears for the class members. Sometimes families get very upset or cry as they hear the news.  I provide some resources where they can get more information and support, and also suggest they speak to their health care provider about their fears.  I make myself immediately available after class and in the future to listen to their concerns if they feel the need to connect.

Sometimes a family loses a baby after the class has ended, but before a reunion (if you do class reunions, which are very common here in my area.)  If I am made aware of the loss by the family, I follow the steps above, but ask how they would like me to handle sharing with the class.  I provide this information to those in attendance at the reunion, sharing only information as allowed by the family.

If you have class email lists, or Facebook groups for your childbirth classes, be sure to find out what the parents’ wishes are regarding remaining on the list or in the group.  Some families will want to be removed and others will want to stay connected.  When in doubt, I would discreetly remove them from further communication about class activities, baby announcements or planned gatherings.

Losing a baby during pregnancy or after birth is one of the most difficult things a family can experience.  Our society does not do a great job in honoring this type of loss.  The role of the childbirth educator becomes very important when one of your class members has lost a baby.  How you handle this loss, with both the family and with other class members is critical and can impact the experience of all.  As childbirth educators, we are in a unique position to help both the family and our other students when given permission by the grieving family.

Have you had this experience as a childbirth educator?  How have you handled this situation?  Do you have any tips for other educators in case they have a similar experience?  What did you find worked?  What did you do?  Please share your thoughts and suggestions along with any resources in our comments section.

 

 

 

 

Babies, Childbirth Education, Trauma work , , , ,