Archive for the ‘Guest Posts’ 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 , , , , ,

Sharon Muza – Community Manager for Science & Sensibility Receives Lamaze International Media Award

September 24th, 2015 by avatar

By Cara Terreri, CD(DONA), LCCE

cara and sharon lamaze media award

Sharon Muza & Cara Terreri receive Lamaze International 2015 Media Award

One of the highlights of the recent Lamaze International/ICEA 2015 Joint Conference in Las Vegas, was being awarded the Lamaze International Media Award for 2015.  The purpose of the Lamaze International Media Award is for Lamaze International to honor individuals or organizations that present normal, physiologic birth and/or Lamaze International in a positive light in the mass media. It is given to a blogger or journalist who has worked hard to provide both consumers and professionals with accurate information on current best practice.  Both Cara Terreri, the Community Manager of Giving Birth With Confidence, Lamaze International’s consumer blog, and I were 2015 recipients.  Cara and I interviewed each other for both blogs this week so we could share the news.  Today, you find Cara’s interview of me, and tomorrow on GBWC- I interview Cara. Check out both blogs and learn a bit more about the Community Managers behind the two Lamaze International blogs – including some fun facts. – Sharon Muza Community Manager, Science & Sensibility

Cara Terreri: How long have you been the Community Manager for Science & Sensibility?

Sharon Muza: I have been the Community Manager with Science & Sensibility since May, 2012, and have written or edited more than 200 posts for the blog. Yowza!

CT: What else do you do professionally in addition to this position?

SM: A lot! I hold many birth related jobs in Seattle, WA and sometimes it is hard to keep track! I am an independent childbirth educator and I teach some specialized classes that I developed like “VBAC YOUR Way,” “Labor YOUR Way” and “Cesarean YOUR Way” along with a lot of private classes. I am a certified birth doula, and also a birth doula trainer for the Simkin Center, Bastyr University, which offers a DONA Approved workshop. I teach a seven week out of hospital birth series for the fabulous Penny Simkin, as part of her teaching team. I am a consulting instructor for Parent Trust for Washington Children’s childbirth education group – Great Starts, where we have over 30 childbirth educators working. I am a trainer for Passion for Birth, a Lamaze approved program that trains childbirth educators. I rent birth tubs, sell rebozos and TENS units and conduct advanced doula trainings on a variety of topics both locally and on the road. I offer editing and copywriting services, typically for other birth related businesses. I also present at both local and international conferences and sometimes do a bit of writing for other online publications. In between all that, I work on a variety of smaller projects that come and go. I am really a serious multi-tasker when it comes to my employment. A true freelancer. You can learn more about me at SharonMuza.com

CT: How did you feel when you learned that you had received the Lamaze International 2015 Media Award?

SM: Robin Elise Weiss, President of Lamaze International, called to tell me initially, and I was stunned speechless, which doesn’t often happen. I was honored and amazed and feel very, very grateful for the recognition. It makes all the hard work feel very worthwhile. I am still smiling and beaming with pride.

CT: What do you enjoy about writing and managing the blog?

SM: Writing and managing the blog means that I have to work hard at staying current with new research as it comes out, which truly helps me to know what best practices are, and I believe makes me a better educator and doula. I also get to work with fabulous writers and researchers who are guest bloggers and regular contributors, and that collaboration is very enjoyable. I very much enjoy other contributions I get to make to the Lamaze International organization, including developing and contributing to some of the online classes, participating in the Lamaze Institute for Safe & Healthy Birth projects and providing feedback on other ongoing projects.

CT: What are some of the challenges of this position?

SM: I think one of the biggest challenges as Community Manager for Science & Sensibility is that no sooner do I finish one blog post then I am focused on the next one and the next one and so on.  It is challenging to keep up with the editorial calendar. Also, I find it challenging to really dig deep into the research and understand the studies, which can be thick with facts, assumptions and statistics.  And deadlines.  Always deadlines.

CT: Where do you get inspiration for post topics?

SM: I do a lot of reading, I subscribe to over 400 blogs and news feeds (I cried when Google Reader went away a few years ago) and I have a ton of Google alerts set up for a variety of different topics. I also receive ideas and suggestions from researchers and contributors. Readers of the blog often email me with suggestions as well. Sometimes there is a topic that I want to learn more about, so I either research and write a post or contact an expert in that subject matter to ask them to share their expertise.

CT: Do you have a top post or two that you are really proud of or is a particular favorite? Why?

SM: Personally, I really love the “Welcoming All Families” series that I started in 2012 that explores how educators and other birth professionals can make their classrooms, practices, and services a welcome place for a variety of diverse clientele. I look forward to that occasional series continuing in the future. My new favorite is the 2015 series I started, “Brilliant Activities for Birth Educators” where each month I, along with other educators, share interesting and engaging activities that educators can use in their classrooms when working with families. My heart is in teaching and that series really excites me. I have tried several of the ideas written by others and they have been a big hit with the families I work with.

CT: What’s the most visited/read post on the blog?

SM: Last time I checked, it was a blog post written by Mindy Cockeram, LCCE – “The Red/Purple Line: An Alternative Method for Assessing Cervical Dilation Using Visual Cues” first posted in 2012.  I wouldn’t have expected this, but this post has had the most visitors of all the posts ever published on the blog.

CT: What do you hope the readers of the blog take away from your posts?

SM: My hope is that readers of the blog will be able to learn about and understand just a small portion of the research that is constantly being published and has the potential to affect maternal-infant health. I hope that readers will find information that they can synthesize and share with the families they work with in a helpful way. I also hope that readers enjoy the blog, find it useful and continue to read it.

cara sharon robin lamaze media award 2015CT: What are some of your favorite blogs that you enjoy reading yourself?

SM: This is a hard question to answer, as I really read a lot of blogs.  I have several food/cooking blogs that I enjoy, and I also am very interested in zero waste living (reducing garbage, recycling, upcycling and repurposing) so I read several blogs related to that.  Then a whole host of maternal infant health blogs.  Some blogs on being a better educator and teacher. But mostly hundreds of blogs on the childbearing year written by consumers and professionals.

CT: What is the last book you read of a professional nature?

SM: The most recent book I read of a professional nature was “The Science of Mom” in order to edit a recent book review on Science & Sensibility by contributor Ann Estes.  For fun, I am reading one of Mindy Kaling’s books and have a graphic novel about Julia Child on hold at the library for me.  I am a big library user – both “real” books and electronic books I can check out for the Kindle.

CT: What are some exciting plans for the blog in the future?

SM: I would love to add some more contributors to the line up on the blog – are you interested in writing for Science & Sensibility? Let me know! I have a few other ideas up my sleeve; readers will have to stay tuned to see what turns up!

CT: What is something unusual or fun about you that readers don’t know?

SM: I love good coffee – as soon as my feet hit the ground in the morning! People who know me understand it is best to wait to talk to me until I have started my one (and only one) very strong, large cup that I drink each day. I love to laugh, I am a wee bit sarcastic (which is not always appreciated), and am normally change adverse. I love routine! I have a degree in Biology with a concentration in Fisheries, and have been about 1600 feet down to the bottom of the ocean in a two man submersible. It is very dark down there!  When I was growing up I wanted to be a pilot/lawyer/marine mammalogist – all together.

2015 Conference, 2015 Lamaze & ICEA Joint Conference, Awards, Childbirth Education, Giving Birth with Confidence, Guest Posts, Lamaze International, Lamaze News , , , , , ,

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) , , , , , , , , , , ,

Book Review: The Science of Mom: A Research-Based Guide to Your Baby’s First Year

September 3rd, 2015 by avatar

By Anne M. Estes, PhD

Today on Science & Sensibility, Anne M. Estes, PhD reviews a new book – The Science of Mom: A Research-Based Guide to Your Baby’s First Year.  Lamaze International and Science & Sensibility are all about providing families and professionals with evidence based information that can help inform decision making.  Seems like this book might fit in nicely with the philosophy that Lamaze has held for decades.  Regular contributor Anne M. Estes, PhD shares her review on this new book and lets us know if it might be something to add to our resource list for new parents.  See the end of the review to learn how you can enter to be chosen for a free copy of this book courtesy of the author,  Alice Callahan. – Sharon Muza, Community Manager, Science & Sensibility. 

Science of Mom Cover HiDefMitchell Kapor once said, “Getting information off the Internet is like drinking from a fire hydrant.” New parents and child care professionals are certainly easily drenched by all the information that can be acquired on the internet from a variety of sources. As newly minted scientist-mom seven years ago, I was frustrated at the number of opinion and experienced-based baby books that lacked scientific support. The Science of Mom: A Research-Based Guide to Your Baby’s First Year, now fills that gap. Alice Callahan, a PhD in nutritional biology and mom of two, systematically examines common questions and concerns about infant care from a scientific perspective. In each chapter, she discusses the historical practice of the question, recommendations of different organizations, the current research, and the risks and benefits of a practice. Dr. Callahan does an excellent job presenting the strengths and limitations of particular studies and the logic behind different recommendations. Although The Science of Mom is science-focused, it is well-written and easy to read. The style of the book is personal and conversational. Personal experiences are intermingled with the science to illustrate her points well. A list of both the references used for each chapter and recommended books and websites are also given to help parents identify credible resources instead of getting lost in the fog of Internet “experts”.

Potential readers

For childbirth professionals and parents or parents-to-be interested in evidence-based practices for birth and an infant’s first year, The Science of Mom is a new and invaluable resource. Questions covered include: When is the right time to cut the umbilical cord? Which newborn treatments are necessary? How do newborns experience and explore their world? What are the differences between breastmilk and formula feeding? Where and how can babies sleep safely? What is the evidence for vaccinations? When and what kinds of solid food are best for babies?

Importance of evidence based decisions

Perhaps it’s also my bias as a scientist, but I greatly enjoyed reading such an insightful description of the process of science, the importance of scientific consensus, differences in quality across studies, and how scientific data can assist families in making informed decisions. Though readers of an evidence based blog like Science and Sensibility may already understand these points, the introduction could be helpful when introducing the rationale behind evidence based practices during child birth classes. It also serves as a guide for anyone who wants to research their own questions in the scientific literature.

I was particularly surprised to read about two instances where changes to medical practices in the early to mid 1900s had occurred without any evidence based support. One example was timing of cutting the umbilical cord. The author speculates that perhaps due to efficiency or convenience, the umbilical cord began to be cut before all the blood was pumped into the newborn. This practice is now being reconsidered due to the increased iron stores in the first 6 months of life of infants when cord clamping is delayed. Such an example certainly reinforces the importance of having evidence of benefit before new procedures are introduced or changes are made in traditional birth procedures.

Filling a gap in the bookshelf

In science and medicine there are no borders and no “right” answers. The Science of Mom is the same. Throughout the book, the author explores how a variety of countries and cultures deal with issues from giving Vitamin K to newborns (oral vs injected) to sleep practices (bed/room sharing vs separate sleeping arrangements). Different personal health conditions and prevalence of disease differ across the globe, making the need for some newborn treatments, such as eye prophylaxis, less clear. Dr. Callahan provides the data and information for people to make informed choices for their own family’s practices and situations. I found the honest, open, and nonjudgmental tone throughout the book refreshing.

Callahan author photo

Author Alice Callahan and her newborn © Alice Callahan

What a scientist-mom adds to the conversation

Each profession trains people to strengthen different skill sets. Training in the life sciences, especially at the PhD level, encourages a person to gather resources, sort through different quality data, synthesize data, and reach a conclusion based on that data for a given situation. Add to that training first-hand experience with raising two kids – knowledge of what it’s like to be in the parenting trenches, experience the “mommy wars”, and feel the exhaustion and yet love and concern of being a parent – and you’ve got a winning combination. The author is not a medical professional and most likely has only attended the births of her own two kids. However, in Science of Mom, Alice Callahan, PhD combines the critical eye of a scientist with the heart of a mother to create a helpful resource for all people interested in evidence based infant care and parenting.

What is missing?

What The Science of Mom does not do in general is to give you prescriptives for answering many of the parenting questions she poses. Data are still being collected and debated for many birth and parenting questions. There simply may not be one “right” way. In these cases, the scientific data are presented, the pros and cons of the different perspectives are addressed, then Dr. Callahan recommends following your baby’s lead and doing what feels best for your own family. After all, parenting is an art as well as a science.

In situations where scientists have reached a consensus, such as with the benefits of vaccines or back sleeping for infants, the author provides insight into how and why that consensus was reached by the scientific community. In such cases, Dr. Callahan provides additional information such as the role of each ingredient in the vitamin K shot in order to provide additional comfort to worried parents.

The Science of Mom is an excellent new addition to the bookshelves of any birth professional or parent who is interested in evidence-based parenting practices. Although the copy of The Science of Mom that I reviewed was complementary, I have given copies to several scientist-mom friends with newborns who also enjoy the nonjudgmental and objective tone of the book. For those wanting to read more of Dr. Callahan’s excellent commentary on the science of parenting, you can find her writing at the blog, The Science of Mom.

Enter to win your own copy of The Science of Mom

Have you had a chance to read this book?  What did you think of it?  Does this sound like a book that you would like to read?  Would you consider adding it to your resource list?  Share your thoughts about the book, how necessary or needed a book such as this might be, or other favorite resources for families to get evidence based information in understandable and easy to digest formats in the comments section below and include your email address.  All comments will be entered in a drawing for your own copy of the book.  The winner will be announced next month when Anne Estes interviews Dr. Callahan about her book. – SM

About Anne Estes

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, Breastfeeding, Childbirth Education, Evidence Based Medicine, Guest Posts, New Research, Newborns, Parenting an Infant , , , , , , , ,

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