Archive for the ‘Babies’ Category

Interview with Alice Callahan about Science of Mom: A Research-Based Guide to Your Baby’s First Year.

October 6th, 2015 by avatar

In an earlier post on Science and Sensibility, regular contributor Anne Estes, PhD reviewed Science of Mom: A Research-Based Guide to Your Baby’s First Year, a new evidence-based book focused on answering questions on health, sleeping, and feeding for an infant’s first year. The book grew out of author Dr. Alice Callahan’s blog, Science of Mom, that she began writing as a new mother. Dr. Callahan took some time out of her busy schedule to talk with Anne about her new book and how it might be helpful for childbirth educators and new parents.  Readers will also want to pop over to Anne’s blog – Mostly Microbes, to listen to a podcast of  a more detailed interview with Dr. Callahan, the author of The Science of Mom. We’d also like to congratulate Amy Lavelle for being randomly chosen from the commenters on the original post. Amy wins herself a free copy of the book.  We hope that she will enjoy reading it.  – Sharon Muza, Community Manager, Science & Sensibility.

Science of Mom Cover HiDefAnne Estes: What do you see as the role of this book for childbirth educators and other birth professionals?

Alice Callahan: First, my book gives a really in-depth look at several newborn medical procedures, including timing of cord clamping, the vitamin K shot, and eye prophylaxis, plus shorter sections on newborn screening, the hepatitis B vaccine, and the newborn bath. Childbirth educators will take away a clear understanding of the evidence behind these procedures, and they can pass that knowledge onto students and clients. Second, and just as useful, those in-depth sections serve as excellent case studies for how to look at scientific evidence. My hope is that this background will give readers the tools needed to evaluate scientific evidence on their own as they encounter new questions – and I’m sure birth professionals are constantly faced with new questions!

AE: Why should childbirth educators suggest your book as a resource for interested parents?

AC: New parents are often taken off guard by the number of questions they have about childbirth and caring for a new baby. In online forums and playground conversations, they’re suddenly thrown into discussions of what is best for babies, and they find themselves trying to sort through lots of conflicting opinions and misinformation, trying to make the best choices for their own babies. It’s tremendously valuable and empowering to be able to understand how science can inform these decisions and how to find evidence-based resources. My book not only gives parents evidence-based information on infant health, feeding, sleep, and vaccines, but it also illustrates for parents how to find it themselves.

AE: What message from your book is most important for childbirth educators to share with their students?

AC: Seek evidence to inform your decisions. Be very skeptical of everything you read on the Internet, and make sure you’re getting your information from an accurate source. There’s so much misinformation out there that can be very misleading and even dangerous for parents and their babies. Don’t assume that something more natural or involving less intervention is always better. That isn’t always the case. Instead, look for objective evidence of risks and benefits, and make an informed choice.

AE: How did you choose the topics for your book? Was it difficult to decide what to leave out?

AC: I tried to choose topics that I think are some of the most common causes of confusion and anxiety for parents, based on questions that I get on my blog or that I see in online parenting forums. To be honest, my original proposal for this book included several more topics, but as I fleshed out chapters, I realized that it was more interesting to look at several topics in a really in-depth way rather than skim the surface on lots of different topics. But honestly, if I’d been able to devote another year or two to it, it could easily have been twice as long, because there are just so many great questions that parents have about the first year of life. I would have liked to cover topics like emerging research on the microbiome and concerns about chemical exposures, for example, but I may have to save those for another book!

AE: What do you feel is the most controversial topic in your book? 

AC: The safety of bedsharing is probably the most controversial topic in the book. Sleep practices are just so personal, and many parents really value bedsharing with their babies for cultural, emotional, or practical reasons. This is an area where you’ll find very conflicting advice, and everyone cites scientific studies to back their stance. In the book, I do my best to look honestly at the evidence for and against bedsharing safety. I explain that multiple studies do show risk of bedsharing in certain circumstances, especially with babies in the first few months of life, but I acknowledge the limitations of those same studies. And I also point out that individual factors, such as ease of breastfeeding or alternatives to bedsharing (including the risks of falling asleep with your baby on a couch or trying to drive a car while severely sleep deprived, for example) might make careful bedsharing a reasonable choice. I think we need to share all of this information with parents and discuss how to set up a bed to make bedsharing as safe as possible if that is the choice.

AE: Could you describe how you determine which findings from the scientific literature are best for answering a parenting question?

AC: In the book, I give a rough guide to types of study designs and explain which ones are most likely to give us strong evidence that is relevant to parenting decisions. Systematic reviews and meta-analyses are usually most useful, because they combine the results of multiple studies so are more likely to give us a big picture consensus about a question. (This assumes that the authors selected high quality studies for the review, so you have to be a little careful here.) Looking at single studies, randomized controlled trials are the best quality, whereas observational studies are usually limited by confounding factors and can only show correlations, not causation. Studies conducted in animal models or cell culture are an important step in scientific research, but we really want to see follow-up in human studies before we change our lives over the results. As you look at studies, you also want to pay attention to how many people were included in the study and whether or not the population is similar to your own. Evaluating scientific evidence takes some practice, and I go into lots more detail in the book.

AE: I was shocked to read that immediate cord clamping and cutting and stomach sleeping were practices changed in the mid-1900s without any evidence. Could you talk about how one of those practices began, the implications, and what it took (or will take in the case of umbilical cord clamping) for the original practices to be put back into place?

AC: It’s surprisingly difficult to pin down exactly when the shift to immediate cord clamping occurred, but it probably happened in the early to mid-1900s. Before this, it was likely standard practice to wait a few minutes or until the cord stopped pulsing before clamping it. The shift to immediate cord clamping seemed to coincide with the movement of birth from the purview of midwives in homes to obstetricians in hospitals. Immediate cord clamping was also part of the practice of active management of the third stage of labor, which was introduced in the 1960s. However, there was no evidence then that immediate cord clamping was beneficial to either mom or baby, and studies show that delayed cord clamping does not increase the mom’s risk of postpartum hemorrhage (which was a belief for a while).

Immediate cord clamping is an example of an intervention put into place because it was convenient, not because it was evidence-based. We now have good evidence that delayed cord clamping is beneficial to infants, especially those born preterm. For term infants, the biggest benefit is a boost in iron stores that can prevent iron deficiency later in infancy. There is some evidence that the risk of jaundice is increased, but as I discuss in the book, this is controversial. We’re seeing some obstetricians making delayed cord clamping their standard of care, but practice is really mixed in the U.S. At this time, ACOG recommends a delay of 30-60 seconds for preterm infants, but they refrain from making any recommendation for term infants, citing insufficient evidence. I actually appreciate that they’re careful to ensure there is adequate evidence before changing practice, but I do think we have enough evidence now that we should really be going back to delayed cord clamping whenever possible. I think that with a little more time and a few more studies, delayed cord clamping will again become standard practice, especially with doctors in the U.K. testing a resuscitation trolley that allows the cord to remain attached even if the infant requires resuscitation.

AE: What did you do to feel prepared for your labor and birth, and first weeks of parenting? Did you choose to take a childbirth class?  Do you feel it helped you feel prepared and confident?

AC: Before the birth of my first child, I took a childbirth class through a local hospital. It was very helpful in terms of knowing generally what to expect with labor and learning some ways to cope with discomfort. To prepare for the birth of my second baby four years later, my husband and I both read The Birth Partner by Penny Simkin. I liked that it was evidence based and a straight-forward source of information, and my husband put Simkin’s suggestions into action to truly be a great birth partner.

One of the most important aspects of birth preparation for me was developing a trusting and respectful relationship with my healthcare providers. My babies were delivered by two different OBs, and both were wonderful at communicating options to me as things progressed. Based on our discussions throughout pregnancy, I knew that I could trust them to be evidence based in their practice, and that helped me relax in labor and focus on my job of giving birth.

How did I prepare for the first few weeks of caring for a newborn? I did what women have been doing throughout the history of our species – I invited my mom to come and help! She was a wonderful help after the birth of both of my babies, and I felt lucky to have her.


AE: What future topics are you looking forward to writing about next?

AC: Readers of my blog keep me well-supplied with questions about parenting, and I have a huge list of topics that I’d like to tackle. One of my favorite areas of focus is nutrition, as that is the field of my PhD training, so I’d like to develop more information about infant nutrition on my blog.

While I was researching and writing my book, I had three miscarriages. That brought up lots of questions for me about miscarriage and infertility, but I didn’t have time to write much about these topics because I was working so hard on The Science of Mom. I’d like to write more about them now. I think there is a real need for compassionate and evidence-based writing about these tough topics.

About Anne M. Estes, PhD

AnneMEstes_headshot 2015Anne M. Estes, PhD is a postdoctoral fellow at the Institute for Genome Sciences in Baltimore, MD. She is interested in how microbes and their host organisms work together throughout host development. Anne blogs about the importance of microbes, especially during pregnancy, birth, first foods, and early childhood at Mostly Microbes.

Babies, Book Reviews, Childbirth Education, Evidence Based Medicine, Guest Posts, Newborns , , , , , ,

The Top Ten Safety Messages to Share with New Parents – September is Baby Safety Month!

September 28th, 2015 by avatar

By Jenny Burris Harvey, BA, CPST

JPMA-BabySafetyMonthLogo-OLSeptember is Baby Safety Month, and before the month entirely slips away, I wanted to acknowledge this and share some resources with childbirth educators that they can use in their classes.  I asked colleague Jenny Burris Harvey, BA, CPST, a skilled safety educator in Seattle, WA to share the top ten safety messages that birth professionals and others can make sure parents hear or receive information on during their prenatal classes.  While I acknowledge that there already is so much we want to cover during our classes, I urge educators to consider how they can pass this important information on to families.  If there is absolutely no time to mention these topics in class, consider putting out an information sheet with important resources and links that you provide to the families you work with.  It could save a life. – Sharon Muza, Community Manager, Science & Sensibility

Childbirth educators often find themselves in the awkward position of having a wealth of information to share with expectant families but not enough time to share it all. As you pick and choose what to spend your time on, consider that your class may be the only class that these families take in preparation for parenthood. While the bulk of what you teach will be about pregnancy, birth, and postpartum, you may have the opportunity to incorporate some key messages about keeping those new babies safe, as well.

© Jenny Burris Harvey

Beds are not a safe place to leave baby, especially with pets. © Jenny Burris Harvey

There’s never a safe time to leave a baby in an unsafe place. Most parents and caregivers assume that they’ll have at least a few months before they have to worry about having a safe place to contain their baby. They don’t expect that a new baby could roll off a couch, sit up and fall from a bouncy seat, or pull loose car seat straps around their neck. They don’t think about the cat jumping up on the bed being enough weight to knock the baby off or how deadly it can be to leave baby alone in the car for even a moment.

This simple message can be used in many contexts and easily incorporated into newborn care classes. It applies to holding baby, putting baby to sleep, wearing baby in a carrier, bathing baby, putting baby in a car seat, or even the logistics of getting dressed, going shopping, or any other aspect of daily life.

Here are a few other messages that, in my years of teaching, I have found to be the most valuable for new and expectant parents to hear from someone they trust.

1. Learn how to use the child’s car seat correctly.

Three out of four car seats are used incorrectly, meaning they would likely not be able to protect the child in a sudden stop or crash. A properly used car seat reduces an infant’s risk of injury or death by 71 percent. It’s not that car seat use is rocket science, it’s that it’s a big, often complicated puzzle. Parents should start by reading their car seat manual and their vehicle manual. Dr. Alisa Baer (The Car Seat Lady) has great tips on how to properly put a newborn in a car seat and safely keeping baby warm in cold weather. Urge parents to practice getting the harness straps nice and snug and the chest clip up to armpit level. Finally, emphasize the value of having their car seat checked by a certified child passenger safety technician (CPST). Make note of local resources in your area or have them go to Seatcheck.org to find a fitting station near them. Consider an educational handout, such as This is the Way the Baby Rides, but be sure to keep it current.

© Jenny Burris Harvey

Proper harness use on a newborn © Jenny Burris Harvey

Note: Please do not send families to any fire station, police station, or hospital without confirming that they do have a CPST who provides seat checks. If you want to learn more about child passenger safety, contact your local Safe Kids Coalition to find out about the CPS awareness classes or technician trainings nearest you.

2.  Keep the child rear facing as long as possible, at least two to three years.

The safest way to ride in a vehicle is rear facing. Rear facing children are 75 percent less likely to suffer head, neck, or spinal cord injuries in a crash. Experts agree that keeping a child rear facing until they outgrow the height or weight maximum for the rear-facing mode of their convertible car seat is the safest for the child. A study from the American Academy of Pediatrics found that children are five times safer staying rear facing until age two than turning around at age one. The National Highway Traffic Safety Administration recommends staying rear facing until at least age three. What everyone agrees on is to find a car seat that allows a child to stay rear facing as long as possible.

3. Learn about sleep safety.

To protect against sudden unexpected infant deaths (SUIDs), such as sudden infant death syndrome (SIDS) and accidental suffocation, it is recommended that baby:

  • Be put down on his back for sleep, every time he sleeps.
  • Sleep in his own crib or safety-approved sleep area in the same room as the parents.
  • Is breastfed.
  • Does not get overheated by clothing, sleepers, hats, or heaters.
  • Uses a dry pacifier as he falls asleep.
  • Has nothing else in the sleep area with him, including blankets, pillows, toys, or sleep positioners.

Safe sleep can be difficult to remain objective about for some childbirth educators. Always offer evidence-based best practice guidelines first, then offer some help on practical trouble shooting if things don’t end up working that way. Co-sleeping or bed-sharing is a controversial issue that can get heated pretty quickly. It’s important to acknowledge the risks involved, as well as the likelihood that parents might find themselves resorting to it at some point just to get some sleep. Offer resources on how they can learn more about how to share a bed with their baby as safely as possible. James McKenna and La Leche League offer well-researched and easy-to-read information on the topic.

Note: There are a number of great safe sleep guides for parents and caregivers, such as those from the American Academy of Pediatrics. Be sure you have the most current information on safe sleep, too. Sign up for updates from the Safe to Sleep campaign, the Infant Sleep Information Source, and watch for webinars and other professional training updates on safe sleep.

4.  Baby gadgets and gizmos cannot do a parent’s job for them.

There are many baby products that claim to keep a baby safe for parents, from heating bottles to the perfect temperature to protecting them from SIDS. While these products may be tempting, it’s important to know that most of them are not regulated and often offer a very false sense of security. Some products may make parents’ jobs a little quicker or easier, but they cannot keep a child safe for them. Baby monitor cords have strangled babies in their crib, many “safe sleep” products have been recalled due to injury or death, and aftermarket car seat accessories can jeopardize baby’s airway or their safety in a crash. Emphasize the importance of thinking through possible risks before using an unregulated product for a baby. Remind parents that nothing should replace supervision and following best practice guidelines for keeping their baby safe.

5. Falls are the leading cause of unintentional injury in the first two years of life, and most of these falls occur when the child is dropped by a caregiver.

Dropping the baby is a big fear for a lot of new parents. While we want to offer reassurance, we also need to acknowledge the validity of this fear and offer some tips for reducing the likelihood of it happening. Carrying only baby, having a good hold on the head and a hip, removing trip or fall hazards around the home, and keeping a little light on throughout the house at night are some of my favorite tips for helping parents not drop their little ones.

Babywearing is a great tool for caring for a baby who wants to be held while still giving parents some freedom to do other things. There are many different kinds of carriers, and they all have different rules and instructions. Families should make sure their carrier is safe for use with newborns and that they are able to use it correctly. Baby carrier manufacturers often provide tips and videos on proper use and Babywearing International has information online and local chapters where people can get hands-on help.

Learn more about reducing fall hazards around the home. Mounting walk-through baby gates at the top and bottom of stairs, using safety straps on baby products, using window guards, bolting furniture to walls, moving the crib mattress down before baby can sit up, and never leaving baby alone on a raised surface will all reduce the likelihood of a serious fall.

6.  It’s really, really stressful when a baby cries. Have a plan.

The average baby cries between one and five hours per day. Most crying is a late cue to let parents know that baby had a need that wasn’t met in time. If the need is met, she’ll stop crying. However, some crying will not stop, no matter how parents try to soothe their baby. This inconsolable crying often seems very severe, as if the baby is in pain. Caregivers often feel as though something is very wrong, either with their baby who won’t stop crying or with themselves because they can’t make it stop.

The Period of P.U.R.P.L.E. Crying offers information about inconsolable crying, including reassurance that, unless there are other symptoms or indicators, there is nothing wrong with the parents or their baby. Of particular note to new parents may be the findings that:

  • Inconsolable crying peaks around two months old.
  • Most babies have a regular fussy time, typically in the evenings.
  • Baby’s nervous system isn’t fully developed, which means she can’t fully control when she stops crying.

It is critical to address how difficult this is to cope with, even for loving caregivers, because it is the leading cause of abusive head trauma (Shaken Baby Syndrome). Shaken Baby Syndrome happens when the baby’s head is shaken front-to-back with enough force, even just for a moment, to cause permanent damage to the baby’s brain. Parents and other caregivers should have a plan for what to do when baby won’t stop crying. Getting support from their family and their community can help during this hard time. Having the phone number for the Fussy Baby Network or crisis hotline within easy reach at all times is also a good idea.

7.  Don’t try to fix a problem before it’s there.

Parents have access to so many baby products, baby care blogs and books, and parenting advice, it can be really easy to buy into the idea that they need to prevent common problems parents face before they start. “Oh, you have to get one of these baby seats because it’s the only way my baby would sleep for the first three months!” can sound pretty convincing to a parent who is anxious about not getting enough sleep. Seeing a rear-view mirror that allows a parent to see baby while he’s in his car seat could make a parent think that it would be dangerous to not be able to see him.

Many parents choose to do things that are potentially unsafe for their baby, based on purely good intentions, without having tried it the safest way first. Start with what is known to be the safest for the baby. If, after a good effort, that doesn’t work, then think about what the next safest option to try is. Be sure to consider the risks before trying alternatives.

bsm-hiddenhazards-infographic8.  Give the home a safety makeover.

Start with the basics. A home should be a safe place for the child to explore and learn about navigating the world around them. It should also be a place where parents don’t have to constantly worry about the baby’s safety.

Burns & Fires:

  • Scalds are the leading cause of burns in infants. Turn the water heater down to 120 F, use the back burners, and don’t eat, drink, or prepare hot things while holding a baby.
  • Have working smoke alarms, carbon monoxide detectors, and fire extinguishers on every level of the home and outside each sleep area. Have a fire escape plan that includes a safe way to get out from the upstairs with baby.


  • Program Poison Control 1-800-222-1222 into cell phones and call right away if there is a possibility that a child has been poisoned.
  • Include cosmetics and personal care items during child proofing, as they’re the leading cause of poisonings in young children.


  • It takes as little as 2 inches of liquid for a child to drown.
  • Most infants drown in the bathtub. Always have one hand on the baby in the tub.


  • Have first aid kits, with infant supplies, in the home, car, and diaper bag.
  • Have a plan and supplies for emergencies or disasters, including supplies for baby.

Anything with potential to cause life-threatening injuries must be child-proofed. Guns, knives, poisons, pools, staircases, and other immediate threats must be locked and inaccessible. Things that could potentially harm a child are more of a grey area where caregivers must weigh the risk versus the inconvenience of child-proofing and decide what their comfortable level of risk is.

9.  Learn CPR and Choking Rescue.

It is very unlikely that a baby will need Cardiopulmonary Resuscitation (CPR). However, if he does, it’s critical that parents know what to do. Choking is a common emergency in infants and young children, so it’s also important that parents are confident in performing choking rescue. Guidelines change every few years, encourage families to keep their skills current. The American Heart Association and American Red Cross offer CPR and choking rescue classes in hospitals and communities all across the U.S.

10.  Slow down.

We live in a culture of multitasking. Being stressed, distracted, or in a hurry greatly increases the risk of injury for the children we care for. From baby choking because a baby is being fed too fast, to dropping baby while trying to carry too many things at once, to forgetting baby in the back seat of the car while parents are busy talking on the phone, it’s dangerous to do too much at once. Slow down. Encourage parents to shift their priorities and give themselves some slack for a while. Get support when needed. A healthy, engaged parent is one of the best safety nets for a child.

While the topics may be very different than what you usually cover, the big concepts are very similar. Encourage families to educate themselves and get support so they can make informed decisions about their child’s safety from the very start.

What safety information do you like to share with the parents you work with?  What are your favorite resources for helping parents to learn how to keep babies safe?  Share your thoughts, ideas and resources in the comments section below. – SM


Decina, L.E., Lococo, K.H., & Block, A.W. (2005) Misuse of child restraints: results of a workshop to review field data results. Traffic Safety Facts: Research Note. Retrieved from http://www.nhtsa.gov/people/injury/research/tsf_misusechildretraints/images/809851.pdf

Durbin, D. & COMMITTEE ON INJURY, VIOLENCE, AND POISON PREVENTION (2011). Technical report – child passenger safety. Pediatrics peds.2011-0215. doi:10.1542/peds.2011-0215

Henary, B., Sherwood, C.P., Crandall, J.R., Kent, R.W., Vaca, F.E., Arbogast, K.B., & Bull, M.J. (2007). Car safety seats for children: rear facing for best protection. Injury Prevention, 13:6 398-402. doi:10.1136/ip.2006.015115

NEISS All Injury Program operated by the Consumer Product Safety Commission (CPSC). 10 leading causes of nonfatal injury, United States, 2003-2013, all races, both sexes, disposition: all cases. National Center for Injury Prevention and Control, CDC. Retrieved from WISQARS http://www.cdc.gov/injury/wisqars/nonfatal.html

About Jenny Burris Harvey

jenny burris harvey head shot 2015Jenny Burris Harvey, BA, CPST, is an educator, writer, and mom with a background in injury prevention health promotion, human development, and family support who specializes in infant injury prevention and child passenger safety. She has been supporting and educating families and professionals around child health and safety for many years, but found her passion in empowering new and expectant parents to keep their babies safe. With over ten years in the child passenger safety field, Jenny has worked and volunteered on a local, national, and federal level to educate families and professionals on proper car seat use. She also worked with Safe Ride News to create a continuing medical education module for pediatric healthcare providers. Jenny currently oversees and teaches Babysafe classes for Great Starts Birth and Family Education program at Parent Trust for Washington Children and is the co-author of the 5th edition of Baby & Me, a low-reading level book on pregnancy and newborn care.

Babies, Childbirth Education, Guest Posts, Newborns, Parenting an Infant , , , , ,

Planned Home VBAC in the United States, 2004–2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making – Interview with Study Author Melissa Cheyney, PhD, CPM, LDM

September 15th, 2015 by avatar


“Planned Home VBAC in the United States, 2004–2009: Outcomes, Maternity Care Practices, and Implications for Shared Decision Making” came out on August 26th as an e-pub ahead of print in the journal Birth: Issues in Perinatal Care. It provides a much-needed analysis of VBACs in the home setting in the United States. To help the birth professional community better communicate the findings with students, clients and others considering home birth after cesarean (HBAC), Jeanette McCulloch of BirthSwell interviewed Melissa “Missy” Cheyney, PhD, CPM, LDM, one of the paper’s authors. The abstract of the paper, lead-authored by Kim Cox, CNM, PhD and co-authored by Marit Bovbjerg PhD, MS and Lawrence M. Leeman MD, MPH, can be found in an online-only version here. Additional insights specifically for midwives can be found at the MANA blog. – Sharon Muza, Community Manager, Science & Sensibility

Jeanette McCulloch: Tell me about the new study looking at outcomes for families planning a trial of labor after cesarean (TOLAC) at home.

Melissa Cheyney: This study is significant because it is the largest study to date on outcomes for women and babies who attempt a TOLAC at home in the United States. We were able to create two subsamples from the MANA Stats 2.0 data set: 12,092 multiparous women without a prior cesarean and 1,052 women with a prior cesarean. This enabled us to compare outcomes for women who went into labor intending to deliver at home and had a previously scarred uterus with those who did not. Our goal was to provide whatever information we could (given our sample size) about the potential risks and benefits of attempting a VBAC at home.

JMc: The actual number of people who are planning TOLACs is relatively small. Why did you think this research was important?

MC: We know that as long as the primary cesarean section rate in the US remains above 20% (it’s currently 21.5%), and as long as many women continue to desire more than one baby, families will be faced with important decisions about what to do in subsequent deliveries. Because there are well-known risks to repeat cesareans as well as to a trial of labor after cesarean, we wanted to make sure that we could provide women who are considering a VBAC (and especially a VBAC outside of the hospital) with as much information as possible to support shared decision making.

JMc: What were the top findings of the study?

MC: First off, we found relatively high success rates. Overall, women with a prior cesarean had a VBAC success rate of 87%. Most of these were HBACs. While some women who who transferred to the hospital during labor went on to have a VBAC in the hospital, most had cesareans for “failure to progress.” Women who had also had a previous vaginal birth had a success rate of 90.2%, and those who had a previous VBAC had an even higher rate of success at 95.6%. These rates are among the highest reported in the literature across places of delivery and provider types.

We also found that women who had a previous cesarean were more likely to need to transfer care to the hospital in the intrapartum period than were women without a previous cesarean. So the transfer rate for women who were attempting a VBAC at home was 21.7% compared to 8.5% for multiparous women who did not have a previously scarred uterus.

We also found that, for those women who transferred, the most common reason that they transferred was a slow, non-progressive labor and not a uterine rupture or anything emergent. We also were able to calculate a combined intrapartum and neonatal mortality rate in the group that had a prior cesarean, and that was 4.75 out of 1000 compared with a rate of 1.24 out of 1000 in multiparous women without a history of cesarean. This is a highly statistically significant difference, and means that we know there is some elevated risk for women who’ve had a prior cesarean relative to a woman who’s already had a baby and who has no scarring of the uterus.

JMc: You had some interesting findings that suggest that not all TOLACs have the same outcomes. Tell us about that.

MC: We also performed some sub-group analyses where we compared women who were having a trial of labor after cesarean with other groups. We compared them to first-time mothers and to women who had a previous vaginal birth and a cesarean and were now attempting a VBAC after a cesarean. We were able to get pretty nuanced findings about relative risk within the TOLAC group.

In other words, we found that there is variation in risk within the TOLAC subsamples. So, just to say that VBAC is dangerous or that TOLAC at home has a high success rate doesn’t really give the full picture. You can break down this group, look at it much more closely, and get a better sense of how to talk with clients about the risks of TOLAC at home under their specific circumstances. Just as success rates vary by obstetric history, so do risks associated with VBAC. Our study is certainly the first study to do that for a large sample of planned HBACs

JMc: What advice do you give to families that may be considering HBAC in your practice?



MC: I say that it’s important to look at success rates, but that it is also important to think about the likelihood of an intrapartum transfer, distance from the hospital, and a variety of other factors that are unique to each person. I actually think that looking at the cases that did not have good outcomes can be very informative. They help us to see who might be a reasonable candidate for an HBAC and who might not be. For example, in our dataset there were five deaths overall—three during labor or in what we call the intrapartum period, one that was early neonatal (or the first 7 days of life), and one that was late neonatal (out to 28 days after birth). Those all occurred in the TOLAC group, yielding death rates of 2.85 for intrapartum, .95 for early neonatal, and .95 for late neonatal. So for the combined intrapartum and neonatal mortality rate, the total is 4.75 out of 1000.

When we look at these cases more closely, we see that two of the cases were very likely uterine ruptures, based on the heart tone patterns that the midwife was able to distinguish at home. The three other ones were deaths that were totally unrelated to the TOLAC status of the mother. One involved known risk factors related to giving birth to a twin, the second one was a surprise breech with an entrapped head, and the third one was a cord prolapse. So three of the five deaths likely had nothing to do with the fact that the mother had had a previous cesarean.

JMc: It’s surprising to see mothers with this kind of risk profile delivering at home. Can you help us understand why you think a mother, for instance, one that is attempting a twin VBAC birth at home, might choose that?

MC: In these kinds of cases, you have to ask this: if you have someone who has a cesarean for her first birth and she gets pregnant subsequently, what happens to her if she has twins in her second pregnancy? Who is going to offer her a TOLAC? What if she happens to be breech at term in the pregnancy following an unplanned and often unwanted cesarean? These women, who have a compounding of risk, have no chance, very likely, of finding a provider in the hospital who’s going to support these births. So, it might seem odd that out of only 1000 VBACs, you’d have this scenario. But it does make sense, if you think about the fact that these women might be the most likely to be excluded from a trial of labor in the hospital. This actually kind of fits with something else we found.

Regions of the US that have low rates of VBAC access in the hospital, the southeast, for example, have a higher percentage of the total births contributed to MANA Stats that are VBACs. When you look on the west coast, in states like Oregon, Washington, and California, where VBACs are more readily available in the hospital, even though there are more contributors and more data coming from the west coast, the total proportion of births that are VBACs is significantly lower in our data set. We take that to mean that when women have the option to try VBAC in the hospital, there is less pressure to attend those women at home. In a state where you have very limited access to hospital VBAC, those midwives are more commonly approached by women who are feeling forced to explore the option of a home birth for a VBAC because they can’t acquire one in their local hospital. That is both concerning and a reminder that even though we often discuss the US maternity care system as less well integrated than, say, the Netherlands, nonetheless, the various models and options for birthing care in this country do impact each other. We should all be working together to make birth safer for all women.

JMc: How do you think these findings should influence families that are considering a trial of labor after cesarean at home? What advice do you have for them?

MC: I think these findings have ramifications for everyone who’s considering a home birth, not just women who are considering a home birth after a cesarean, because one of the most interesting things that we’ve found is that that risk within our sample varies considerably by obstetric history and parity. What I mean by that is that a woman who does not have a previously scarred uterus, and she’s already had a baby vaginally, her risk is incredibly low. It is difficult to find a negative outcome in that group.

The next safest group to be delivering at home is actually women who have had a cesarean, but have also had a vaginal birth. They are less risky than first time mothers as a group. Then the highest risk, along the VBAC status and parity continuum, is a woman who has never had a vaginal birth, but has had a cesarean.

So, the range of risk goes from the lowest risk: a multiparous woman (multip); to a multip with a cesarean and a previous vaginal birth; to a nulliparous woman: and then to a woman who has never had a vaginal birth but has had a previous cesarean. Both deaths from suspected uterine rupture occurred in this later group. Each mother had had only one prior cesarean. That’s a really important thing to keep in mind, and I think that’s where our policy implications lie as well. States that want to restrict all HBACs need to be looking much more closely at the research, especially if some of this work is replicable with larger samples, because there is a nuancing of risk within subgroup. It may not make sense, for example, to allow nulliparous births at home but restrict all VBAC mothers with any prior cesarean history, regardless of the fact that they may have had a previous vaginal birth or a prior VBAC. These women who live within an appropriate distance to a hospital, have well documented placenta positions and adequate time between births may actually be lower risk than a first time mother.

JMc: What advice do you have for policy makers who might be considering HBAC regulations in their state?

MC: Over the course of my career, I’ve seen the data on home and birth center safety, patient selection, ethics, the benefits of normal physiologic birth — so multiple components of midwifery care and birth outside of the hospital — grow so quickly. I recommend setting the scope of practice for midwives in rule (sometimes called regulations or administrative laws) rather than statute. In many states, it is very difficult to get a statute changed, whereas it is often much easier to open your rules or regulations over a period of every few years, for example, to examine new research and make sure that you are writing rules/regulations that support evidence-based practice for midwives. It is an exciting time to be working on some of these questions. Data from registries like MANA Stats and the American Association of Birth Centers’ Perinatal Data Registry should enable us to engage in critical, ongoing quality assurance and quality improvement at national, state and individual practice levels. I think we need to find ways of regulating home birth that stay open, flexible and responsive to the data, to the needs of the families we serve, and to the guidance of medical ethicists who are equipped to help us sort through difficult questions related to choice, individual autonomy and relative risk.

About Melissa Cheyney and Jeanette McCulloch

Melissa Cheyney head shot 2015Melissa Cheyney, PhD CPM LDM is Associate Professor of Clinical Medical Anthropology at Oregon State University (OSU) with additional appointments in Public Health and Women’s Studies. She is also a Certified Professional Midwife in active practice, and the Chair of the Division of Research for the Midwives Alliance of North America where she directs the MANA Statistics Project. She is the author of an ethnography entitled Born at Home (2010, Wadsworth Press) along with several, peer-reviewed articles that examine the cultural beliefs and clinical outcomes associated with midwife-led birth at home. Dr. Cheyney is an award-winning teacher and was recently given Oregon State University’s prestigious Scholarship Impact Award for her work in the International Reproductive Health Laboratory and with the MANA Statistics Project. She is the mother of a daughter born at home on International Day of the Midwife in 2009.

Jeanette McCulloch head shot 2015Jeanette McCulloch, BA, IBCLC has been combining strategic communications and women’s health advocacy for more than 20 years.  Jeanette is a co-founder of BirthSwell, helping birth and breastfeeding organizations, professionals, and advocates use digital tools and social media strategy to improve infant and maternal health. She provides strategic communications consulting for state, national, and international birth and breastfeeding organizations. A board member of Citizens for Midwifery, she is passionate about consumers being actively involved in health care policy.


Babies, Cesarean Birth, Guest Posts, Home Birth, informed Consent, Maternity Care, Midwifery, New Research, Newborns, Research, Vaginal Birth After Cesarean (VBAC) , , , , , , , , , , ,

Meet Jennie Joseph, LM, CPM – Lamaze/ICEA 2015 Conference Plenary Speaker

September 10th, 2015 by avatar
© Jennie Joseph

© Jennie Joseph

Today on Science & Sensibility, we have the opportunity to meet our final Lamaze/ICEA 2015 plenary speaker- Jennie Joseph, LM, CPM.  This British born midwife is the founder and executive director of Florida’s Commonsense Childbirth Inc. whose vision states “We believe that all women deserve a healthy pregnancy, birth and baby!” Jennie is also the creator of the The JJ Way® which has been remarkably effective at reducing disparities and improving outcomes for both women and babies. Jennie owns a birth center in West Orlando, FL. She also operates a midwifery school as well as certifications for a variety of birth professionals  Jennie will be closing the conference with her plenary session: The Perinatal Revolution: Reducing Disparities & Saving Lives Through Perinatal Education. What role do childbirth educators like you play in improving outcomes for families of color?  Today, Jennie speaks a bit about this topic in advance of her presentation at the conference.  I have had the pleasure of hearing Jennie speak several times in recent years, and I know that conference attendees are in for a treat.  For more information about this year’s conference, head to the 2015 Lamaze/ICEA Conference website.

Sharon Muza: What role do childbirth educators play in helping to reduce the disparities that exist in pregnancy, birth and newborn/infant outcomes for women of color?

Jennie Joseph: Today’s educators can play an essential role in reducing disparities simply by educating themselves about what those statistics are, what they represent, who they represent and why. Once an educator understands the extent and the cause of the problem he/she is able to really embrace the need to reach women and families in meaningful and practical ways – ways that will ultimately make an impact on the outcome.

SM: What changes have you observed over time in the perception of the value of childbirth education in the communities you work with?

JJ: I think that in every community in this country there is and has been a movement away from the traditional childbirth classes of the past. Women and their partners are busy and overwhelmed, with a false sense of security engendered by internet searches and with the hope that someone else, or some other entity will take care of everything when the time comes.

SM: Why do you think that many families are not attending childbirth classes in their communities? Is it lack of offerings? Cost? Accessibility? Do new families feel it is irrelevant to their experience?

JJ: When families are disenfranchised in so many other ways there is little value seen, or interest in an additional expense, or reaching for non-existent support, given that time is at a premium and resources are low. The institutionalization of birth inherently leaves one believing that the system is already set in stone, that the options and opportunities for autonomy and independence are not going to be available, and the benefit of doing the required hours of class are not likely to avail much as far as having any say at all. Cost and accessibility may be a factor for low socio-economic communities but more importantly the fact that few independent educators are open to the outreach and innovative thinking that is needed to engage new families, leaves a void which does not appear likely to be filled anytime soon.

SM: What can Lamaze International do to support and encourage people of color to become childbirth educators and be prepared to offer evidence based programs in their communities?

JJ: Childbirth education organizations that recognize and acknowledge the inequities in perinatal health and outcomes, and that are committed to that change, will lead the way in recruiting, training and retaining a diversity of educators. Cultural humility and practical support, not only for the communities themselves, but the providers and the educators that service them typically is what is needed. Supporting from a grass-roots perspective and embracing the dedicated entry-level or non-credentialed perinatal workers and volunteers who are on the ground already will provide a pipeline to further grow the ranks of educators and practitioners able to make a difference.

SM: You have been actively involved in birth work and supporting families for many years. What keeps you from getting discouraged about the slow progress we are making in reducing preterm births, low birth weight babies, maternal complications amongst families of color.

Jennie Joseph with clientJJ: I often feel overwhelmed with the glacial changes that occur and wondered how you continue to make progress and change lives in the face of often discouraging news. I get very discouraged working with families that are disenfranchised in one way or another. I find myself sometimes at my wits end because the agreement that we have in the United States is that we just don’t know the reason why we have such a high prematurity rate and in working in my field and doing the things that I do, the way that I do them, I have been able, as have many others, to not only reduce but all but eradicate prematurity in a population of women who are considered to be at highest risk for prematurity. Low birth weight babies, complications for the mothers, maternal morbidity and mortality is rampant inside African-American communities in particular. So, how I keep from getting totally discouraged is the fact that in seeing the change brought about by applying some very simple and essentially easily applied tenents to how I provide the maternity care that we offer, we have been able to turn the tide. I know that other people are willing and are doing the work the same way. I know that they are seeing the results the same way, so I continue to hope that there will be a turning of the tide that more and more practices and practitioners will embrace these few simple steps and show that they too believe we can stop the scrounge of prematurity and low birth weight in the United States.

SM: What are you looking forward to most about being a plenary speaker and presenting to the Lamaze/ICEA 2015 conference attendees?

JJ: I am very excited about being able to present at Lamaze/ICEA 2015. I am more than thrilled. This is something that has been on my heart for a long time and I am really clear that until we embrace and involve all the perinatal team in the work at hand we will not be successful. I think that childbirth educators have a pivotal role to play in bringing about change and I know there is an openness and a willingness to hear about new and innovative ideas as far as providing that education across the board. This is an awesome opportunity for me and I am very much looking forward to it.


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Meet Elan McAllister – Lamaze/ICEA Conference Plenary Speaker

September 8th, 2015 by avatar

ElanMcAllister head shot-220x220The countdown to the Lamaze/ICEA 2015 Conference in Las Vegas is in single digits and the excitement is building. I recently had an opportunity to interview plenary conference speaker Elan McAllister, founder of Choices in Childbirth, an education and advocacy group for pregnant people and their families.  Elan will be opening the conference with her plenary session “No Day But Today” and I am very excited to hear her presentation as she shares how we all can make a difference in birth outcomes and experiences for parents and babies.  Still time to register if you have the flexibility to join us in Las Vegas.  A joint Lamaze International/ICEA conference means great networking opportunities, plenty of continuing education and two great organizations coming together to collaborate on the things that matter.

Sharon Muza: You have long been involved in theater and then went on to found Choices in Childbirth. Do you see any commonalities between a theater production and a birth? In the way one prepares for both? In what is needed to be “successful” in both?

EMc: There are so many similarities! Essentially, both are acts of creation. My role (and its been my honor) in both theater and birth has been to hold space for creation to unfold. Bringing something new into the world, whether a new life or a work of art, challenges us in remarkable ways. It takes tremendous courage to let your self be vulnerable to the creative process and I believe that no one should do it alone. As a producer, I have supported artists and encouraged them to believe in themselves and connect with their voice and vision.   As a doula, I have supported women and encouraged them to own their power in birth.

SM:  I have had the deepest respect for Choices in Childbirth and have so appreciated their invaluable consumer booklets that have been a part of my client and student information packets for many years. Can you share some of the feedback you have gotten from both consumers and professionals regarding their value?

EMc: Thank you so much and I’m thrilled to hear that the Guide to a Healthy Birth has been useful to you! Over the years we’ve distributed thousands of Guides all across the country and have had the most remarkable feedback. Women have told us that it opened a door and encouraged them to think more deeply about their birth choices. Many have referred to it as their birth bible. We worked really hard to create something that would be useful to any woman who picked it up – regardless of her birth choices. We wanted to create something that would be respected by the birth community but that could be embraced by the mainstream. I think we succeeded in that goal and it truly warms the heart to know that something you’ve created has made a difference to people.

choices in childbirth logoSM: Choices in Childbirth has been a leader in maternity care reform and has long been committed to consumer education. The CiC organization along with other maternal-infant health advocates have consistently raised their voices to help improve outcomes for mothers and babies in our country. When you look at all of the programs that CiC has had a hand in, can you share what has made you the most proud? What has been the most challenging?

EMc: Thank you for this opportunity to reflect on the work that CiC has done over the last 12 years and to feel profound gratitude to all of the people who have contributed to CiC’s successes. When you’re in the middle of things, you sometimes lose perspective, so I am grateful for this chance to reflect. In this moment, I’m most proud of the work we did last year to petition the city to reopen the labor and delivery services at North Central Bronx Hospital (NCBH).   For over 30 years, NCBH provided high quality, teamed-based midwifery care to an at risk population in the Bronx. Women who were used to an impersonal, clinic-based health care experience received personalized and continuous care at NCBH with midwives that they were able to build relationship and trust with. While cesarean section rates were skyrocketing all across the city and the nation, NCBH maintained a c-section rate of about 17%, largely due to the fact that 85-90% of births there were attended by midwives. When the services were suddenly closed in 2013, CiC joined a coalition of community organizers that worked together for nearly a year to demand not only that L&D services be returned to the community, but that the midwifery program be returned in tact. Together with local community members and organizations, we were able to make such a compelling argument to the city that they not only reopened the services but invested a million dollars in upgrading the facility!

SM: How do you think childbirth educators can help families to understand the family’s critical role and rights in shared decision-making and informed consent?

EMc: This is such a challenge. We are all faced with the frustrating reality that a huge percent of birthing families are scared about birth and feel most comfortable turning the experience and power over to the “experts.” Negative reinforcement in the form of, say, warning them about the routine overuse of unnecessary medical interventions will typically shut them down further. I have found that the most effective way to encourage families to be more engaged in the decision making process is to inspire them.   Fear of birth is prevalent in our culture and fear shuts us down. The only way to overcome that fear is to awaken families to the deep, essential truth that birth is a sacred, powerful and profoundly important life experience. Be the voice of awe and wonder that inspires them to show up fully and take a higher level of interest and responsibility for this miraculous event in their lives.

Elan McAllister and NCBH Midwives at L&D re-opening

Elan McAllister and NCBH Midwives at L&D re-opening

SM:  If a childbirth educator wanted to spend time (or increase their current level of involvement) in the birth advocacy role – what do you suggest they consider doing on both a local and on a national level? How could they get effectively get involved?

EMc: I love this question and I will be talking a lot about this at the conference. There is both inner and outer work that needs to happen in order for childbirth educators, (and all birth workers) to better engage in birth advocacy work. The inner work consists of two important shifts – 1) Step into the role of Consumer Advocate. Recognize that you are in a critical and powerful position to amplify the voices of the women and families that you are in direct contact with and 2) Become a Bridge Builder. If we’re going to have an impact on the system we must let go of the “us vs. them” victim mentality and start building relationships with decision makers.

The Affordable Care Act offers countless opportunities for us to engage and impact health care reform.   I’ll be talking more at the conference about how to take advantage of this important moment as well as providing examples of work that CiC has been doing over the last couple of years.

SM:  What are the three most important things that families can do to help ensure that their birth experience is both safe and healthy as well as positive?

EMc:  1) Be well informed and in touch with your desires and beliefs so that you can create and communicate a clear vision for your birth.

2) Choose the provider, setting and birth team that will give you the best opportunity to realize the birth that you’ve envisioned.

3) Let go and surrender.   Trust that you have done all that you can, you are stepping into a divine mystery that cannot be controlled and that will unfold exactly as it is meant to.

SM: Can you share a little about how you made the switch from theater producer to tireless advocate for families during their childbearing years? Were you always drawn to birth and birth advocacy and women’s rights? Or was that a “role” you grew into after experiencing specific events in your life?

EMc: I became involved with both theater and birth at around the same time, about 20 years ago. My early career as a professional dancer lead me to theater production right around the time that the young feminist in me picked up a book on midwifery and had her mind blown! I juggled these two passions/ straddled these two worlds for about 15 years before retiring from producing 5 years ago. Though I turned Choices in Childbirth over to new leadership last Fall, I remain devoted to my calling in service of women, babies and families.

SM:  What are you looking forward to most about being a plenary speaker and presenting to the Lamaze/ICEA 2015 conference attendees?

EMc: It’s always a pleasure to speak to a receptive, well informed audience! I look forward to sharing ideas and learning from my peers.

2015 Conference, 2015 Lamaze & ICEA Joint Conference, Babies, Childbirth Education, Lamaze News, Maternal Quality Improvement, Midwifery , , , , ,

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