24h-payday

Archive

Archive for the ‘Guest Posts’ Category

Series: Welcoming All Families – Supporting the Orthodox Jewish Family

July 28th, 2015 by avatar

Today on Science & Sensibility, we continue with our occasional series: Welcoming All Families by examining how an educator might make their class inviting for the Orthodox Jewish family who attends. There are rich traditions and customs that are unique to observant Jewish families and a knowledgeable educator can help families to prepare for birth and navigate the protocols of  the birth location feeling ready and confident that their practices will be respected and accommodated. Check out the entire series and learn how your childbirth class can be a place where all kinds of families feel respected, accepted and comfortable. – Sharon Muza, Science & Sensibility Community Manager.

By Jodilyn Owen, CPM, LM

By Adam Jones [CC BY-SA 2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons

By Adam Jones [CC BY-SA 2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons

As educators, our first jobs are to meet families where they are at and work with them in that place. As educators who have the responsibility to prepare families to navigate a complex healthcare system, we have a mighty task. The layers of birth preparation are unique for each family we will encounter. Establishing a baseline of knowledge about cultural and religious or spiritual backgrounds and practices will allow us to educate in a much more complete way.

The term “Orthodox Jewish” encompasses a great variety of practices and beliefs, so the most important take-away message here is that like all things related to the intersection of culture, religion, and birth, we must remain open to learning as we go, from the family, what their unique practices are. The basic premise that Orthodox Jewish families live by is that G-d exists, that the Torah (also known as the “Old Testament”) is true, and that G-d gave it as His instructions for living and navigating life. The families you work with accept these ideas and therefore live lives that are, for them, enriched by fulfilling what they see as G-d’s will by keeping the laws of the Torah and the Rabbis who mold and shape those laws in every generation and community around the world.

There has been a lot of buzz lately about hospitals that serve large populations of Orthodox families having extraordinarily low cesarean rates. This is being attributed to the tendency for large families in this community and the sense of importance around avoiding operative deliveries for the safety and health of future deliveries. Cesarean birth typically requires longer recuperation times which is very hard on a family with several children. Discussion in class around laboring at home until mom is in established active labor becomes critical to the process she will experience. This is in line with the efforts to reduce primary cesarean rates and an important part of the new ACOG guidelines .

While the theme of this article definitely revolves around variation in religious practices amongst Orthodox families, there are some commonalities you may encounter that are worth exploring. Perhaps the greatest gift as an educator you can give to your students is to illuminate the way that their behavior may be perceived so they do not have unnecessarily difficult interactions with the staff. These families have been navigating the world until this point and they likely have the tools they need to be who they are in new settings. Even so, you may help them clarify ways to mitigate the common pitfalls in the system so that they can proactively and effectively engage providers.

Let’s explore some key areas of interest. A bit of a disclaimer: As a licensed midwife practicing out of hospital, I have a lot of time to get to know my clients, their religious and cultural preferences and needs, and how I can best support them. I hope most out of hospital practices are similar. Therefore I refer here consistently to challenges that come up in the hospital. Jewish women have a long and beautiful history of being tended to by midwives, but in today’s society, most will seek care from an OB and choose to birth in a hospital.

Jewish Law

Many families observe a variety of Jewish laws that affect how they behave during the labor, birth, and postpartum times. This includes things such as saying blessings over the food and liquid that they drink, praying at prescribed times during the day, and even saying a brief prayer after using the bathroom to thank G-d for their body working the way it was designed to work.

  • In the hospital

If a person is praying they will not interrupt their prayers to answer questions or engage in any discussion. You can remind families that letting their nurse know that they are going to be unavailable for a short time will help avoid the nurse assuming that they are difficult to communicate with. They will need access to Kosher food—most families will bring their own if the hospital or birth center does not have any. Call around to find out which hospitals offer Kosher menus so that you can inform families during your class.

Consulting with the Rabbi

While there are dozens of laws that govern everyday life for Jewish families, they will all turn to their Rabbi for help with making decisions when it is unclear to them either how to apply the laws to their current situation or for guidance as they navigate life’s greater challenges. Mothers may want to talk with their Rabbi about the Jewish laws related to childbirth or decision points that come up during the pregnancy, birth, or postpartum time. This is not a sign of weakness or submission—it is a source of strength and guidance and a deeply valued relationship within the family and community structure. Most often the Rabbi will help a family work out ways to approach and solve problems, helping to build life skills within the context of Jewish law and philosophy. There is a lot of sensitivity to a family’s capacity at any given time, and their Rabbi may offer advice that varies from family to family. Thusly you may hear of a custom or law being observed in a several different ways—this is normal within the Jewish community.

  • In the Hospital

A woman may defer decision making until she and her husband evaluate which path to take in order to best meet the structure of Jewish law. This is not an act of defiance against authorities but can be taken that way. Teach skills that build capacity for creating space to talk over options alone.

The Yearly Calendar

Jewish families live very rich community and family lives that occur in conjunction with the Sabbath (often referred to as Shabbat or Shabbos), holidays and fast days. There are a total of 25 holidays and fast days, each with their own purpose and rituals that families will observe even during labor and birth. Fasting can be a health issue during early and mid-pregnancy. Women should be advised to talk with their doctor and their Rabbi before fasting. A retrospective study of 725 births found that fasting for 25 hours is an independent risk factor for preterm birth.

The Sabbath is well known as a day of rest. In Orthodox families it is a time to gather with family and friends and enjoy community. Many families avoid the use of electronics including phones, cars, and elevator buttons. This is something to keep in mind when scheduling your classes—Orthodox families will be preparing for Shabbat on Friday and observing it from sunset on Friday through sundown on Saturday night. Sunday and weekday schedules will accommodate this population well.

  • In the Hospital

This is a great time to talk about the role of a doula. It helps to have an advocate who can bridge the gap between the family and the hospital technology and normal protocols. Women will not sign papers, adjust the bed, or use the call button on Shabbat. Holiday laws are similar to Shabbat laws and families will need help facilitating their entry and stay in the hospital. Most hospitals in locations where there are large Jewish populations are prepared to work with observant families.

Modesty

Women will observe the laws of modesty in varying degrees depending on community customs and personal choice. Most women will wear clothing that covers their arms down to their elbows and skirts that are just below the knee or longer. Because it is normal for them to wear clothing that covers their body, hospital gowns that are short sleeved or short in length can leave a woman feeling vulnerable. Offer education for families on talking with the hospital staff about wearing their own clothing. Advise families that it is normal for Jewish women to wear a skirt of their choosing and to simply lift it up at the time of birth. Many women throw away the skirt after the birth but a half bottle of hydrogen peroxide with their normal laundry soap will remove any staining.

Many Jewish women cover their hair. You may see a hat, a handkerchief or scarf, or a wig used. Some women cover their hair throughout the birth process. Birth is unpredictable and for many women regardless of religion or culture, having clothing touch their bodies during the heat of labor becomes unbearable. Having attended dozens of births with Orthodox women, I can confidently say that it is normal for many women to forego their usual levels of modesty during transition and birth, while others maintain their norm. They can ask their doula or hospital staff for help covering up again when they are ready. They should also be made aware that they can always ask for a bed sheet if they want something light to wrap up in.

  • In the Hospital

Many women prefer to wear their own clothes during labor and birth. If the hospital insists on a gown, let women know that they can wear one gown with the opening in the back and another with the opening in the front over it. Women can wear their head covering if they wish to during the entire labor and birth. They need to tell their provider to let the father know when an exam will be done that exposes the mother’s body in case she prefers him to leave the room. Some fathers leave the room for the actual birth and come back in after the mom is sutured and in bed. Others sit on a chair or stand by their wife’s side at the head of the bed and they can be reminded that encouraging and loving words are always welcome during this time!

Touching and Passing

There are Jewish laws that govern physical separation between man and wife, and revolve around the woman’s cycle or evidence of uterine bleeding, including childbirth. Again, every family has unique customs they have built up that work for them. This may involve the couple not touching at all. Many couples report a high level of marital satisfaction having this separation each month, they come back to each other with renewed energy for connection and have space to develop their relationship outside the realm of physical intimacy. This is one of the most misunderstood set of laws in Jewish life—many looking from the outside project ideas of shaming or submission, inferiority or inequality in the relationship onto what they see. In fact Jewish women hold, by contract, much of the power of the relationship. A Jewish marriage contract is a standardized document that charges the wife with control of the home, purchases, and mandates the husband provide her sexual satisfaction, fidelity, support for the household expenses and any children, gifts on holidays, the highest standard of living he can supply, and alimony. This is a living functional legal document that is signed by witnesses at the time of marriage and given to the bride at the wedding for her safekeeping. Women are held in high regard in the majority of Orthodox communities and this carries into the privacy of their home. The time of physical separation may include the direct passing of items to each other. If one is passing the salt, they will set it down on the table before the other picks it up. If they are keeping these laws during labor, birth, and the postpartum time there are a number of areas this would affect.

  • In the Hospital

This is another great point to recommend a doula! The father may be emotionally and verbally supportive during the birth or they may have decided together that they prefer he read prayers. He may want to leave the room or go to a corner where he will not see the actual birth of his baby in an effort to keep the laws in accordance with his tradition. There is a huge variety in the ways that couples observe the laws relating to touch during labor, birth, and the immediate postpartum time. It can affect everything from passing the mom a cup of juice or a snack, providing physical support such as holding her head or hand while pushing, and even passing the newborn baby to be held by the other parent. Educate families on how normal it is for a nurse to ask a partner to pass something to the mom or to support her leg or neck during pushing. Nursing staff may see the father’s lack of touch as unsupportive and even neglectful if they do not understand what they are seeing. They may send a report to the hospital social worker asking for an evaluation that is inappropriate and unnecessary. Preparing families to talk openly with their nurse about their religious practices is of prime importance in the education of Orthodox families.

In the Community

Birth is a celebrated, treasured, and well supported community event. The family will very likely receive dinner every day for 2-4 weeks postpartum from community members and help with managing and care of older children and the home. There are many traditions involved in the welcoming of a baby over the first month of life. These may include a postpartum baby shower, because many Jewish families do not believe in purchasing items for the baby until after the baby has arrived. This tradition is rooted for some in a kind of superstition that arose in Eastern Europe and for others it is a matter of family tradition though they don’t necessarily share the feelings of superstition. Most families will circumcise their baby boy on the 8th day of life. This is a custom that celebrates the unique and individual relationship the boy has with G-d. Orthodox Jewish families will not need resources from you regarding where or how to contact professionals for newborn rituals, they will get that information from their synagogue.

  • In Class

Community standards and norms can be covered in class by contextualizing information based on the ideas that families will have strong customs and an interest in learning, gathering information, and talking things over with their trusted Rabbi. Education for families can point towards the need to balance community events with rest and healing and it might be a nice addition to class to get into the physical and emotional needs of the postpartum mother in some details. They are coming from a community where mothering is a valued and well promoted event in a woman’s life. For women who don’t feel happy or struggle with depression or anxiety, it can be very isolating. Be sure to share resources for mental health and hormonal support. Acupuncture is excellent for balancing hormones and a qualified practitioner can provide significant relief within 2-4 visits.   Pharmacological treatment provides help for those who prefer that route or don’t find relief from acupuncture. It is important to stress the normalcy of these mood disorders and the causes behind them.

For mothers with several small children, pelvic health must be discussed. One can look to the practices of other cultures for supporting the body as it transitions back into a non-pregnant state.

It is important to tell families that they need to either have a car seat with them when they go to the hospital or have a friend or family member go get one after the birth so that they can bring baby home if they are having a hospital birth. You might consider making a short list of items needed for a layette and encourage them to have those items picked up for them as well. If you are presenting current research on the effects of circumcision, do so without bias or judgment. Present the evidence and offer opportunities for questions just as you would for any other topic. These families will make their decision on their own and you have the opportunity to help them make that from an informed place—not a place of fear.

Conclusion

In conclusion, serving Orthodox families is about awareness for a culture that wraps its life around the yearly cycle of communal gathering and creates space to connect in time-honored ways within the family. While there is no one prescription for teaching childbirth classes to an Orthodox Jewish family, the approach of open-mindedness, cultural awareness and sensitivity, and leaving room for class participants to ask questions and share their ideas, ideals, and fears will always be just right.

Have you had Orthodox Jewish families in your childbirth classes?  What have you done to make them feel welcome.  Do you have any tips to share with other educators?  Let us know in the comments section below. – SM

About Jodilyn Owen

owen head shotJodilyn Owen, LM, CPM is co-author of The Essential Homebirth Guidea guide for families planning or considering a homebirth.  She is a practicing midwife at Essential Birth & Family Center in Seattle, WA and is a wife and mother.  Jodilyn is passionate about bringing babies into the arms of healthy mothers. Jodilyn’s newest venture is the Rainer Valley Community Clinic – a midwifery-led clinic in South Seattle, WA. The clinic serves an area that is a Federally Designated Medically Underserved Community. Rainier Valley Community Clinic is sponsored by the South Seattle Women’s Health Foundation, which is dedicated to creating spaces for high quality, individualized perinatal care and increasing capacity within the community for jobs in the healthcare industry for local women, especially those of color and immigrant women.  She enjoys hiking, camping, boxing, and watching her kids on the basketball court.  Jodilyn welcomes your comments and questions and can be reached through her website

Childbirth Education, Guest Posts, Maternity Care, Series: Welcoming All Families , , , ,

Elective Induction at 40 Weeks? “Decision-Based Evidence Making” Strikes Again

July 14th, 2015 by avatar

Today on Science & Sensibility, contributor Henci Goer takes a look at a systematic review released in spring that examined the impact of elective inductions on the cesarean rate.  Sound analysis or a house of cards?  Looking closer at the studies reviewed provides insight into how the conclusions reached by the investigators might need to be examined more closely.  Henci does that in this review.  Have you read this new systematic review?  Did you come to the same conclusions?  I invite you to share your thoughts in our comments section below. – Sharon Muza, Community Manager, Science & Sensibility.

flickr photo by catharticflux http://flickr.com/photos/catharticflux/2710057340  CC licensed.

flickr photo by catharticflux http://flickr.com/photos/catharticflux/2710057340 CC licensed.

Yet another systematic review has surfaced “Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials”  in which reviewers claim that electively inducing healthy women, this time at 40, not 41 weeks, offers benefits and doesn’t increase the cesarean surgery rate (Saccone 2015).

Let’s take a closer look.

Reviewers included five trials: three of them conducted in the 1970s (Cole 1975; Martin 1978; Tylleskar 1979), the fourth published in 2005 (Nielsen 2005), and the fifth in 2014 (Miller 2014). Already we have a problem. Induction management in the 1970s is sufficiently different from management today that results are unlikely to apply to contemporary care, but let’s get down to specifics. Two of the 1970s trials were deemed inadequate for inclusion in the Cochrane review of elective induction (Gulmezoglu 2012), and Miller 2014 is published only as an abstract. Quality systematic reviews exclude abstracts because they don’t provide enough information to evaluate the study. For these reasons, these three trials should be taken off the table..

That leaves us with the other two. Nielsen 2005 states in the title “Comparison of elective induction of labor with favorable Bishop scores versus expectant management: a randomized clinical trial” that it is confined to women with favorable Bishop scores. Anyone familiar with elective induction research should know that inducing when the cervix is ready to go won’t increase the cesarean rate compared with spontaneous onset, but inducing with an unripe cervix is a different story even when using cervical ripening agents (Dunne 2009; Jonsson 2013; Le Ray 2007; Macer 1992; Prysak 1998; Thorsell 2011; Vahratian 2005). As you move the induction date earlier and earlier, more and more women will have an unfavorable cervix, so including a trial limited to women with a ripe one will tilt the playing field in favor of induction. Furthermore, half the participants were multiparous women (113/226). Women with prior vaginal births will go on having vaginal births pretty much no matter what you do to them, which raises another point: inducing earlier means a higher percentage of the inductees will be first-time mothers because first time mothers tend to run longer pregnancies (Mittendorf 1990). Nulliparous women are much more vulnerable to anything that pushes them in the direction of a cesarean. That’s not all: The authors tell us that their hospital has a 7% cesarean rate for dystocia in women at term. If a hospital has a cesarean rate much higher than that—and many do—then results can’t be generalized to it, although, frankly, if the doctors are performing cesareans left and right, induction or spontaneous onset may not make much difference. In short, Nielsen (2005) doesn’t make a compelling argument for 40-week elective induction.

flickr photo by Selbe <3 http://flickr.com/photos/stacylynn/11944718954 shared under a Creative Commons (BY-NC-ND) license

flickr photo by Selbe < http://flickr.com/photos/stacylynn/11944718954 shared under a Creative Commons (BY-NC-ND) license

This brings us to the last trial, Cole (1975). Investigators allocated healthy women either to induction at 40 weeks (111 women) or 41 weeks (117 women). As with Nielsen, half the women had prior vaginal births. Despite being healthy, 22 women were induced for “obstetric complications” (undefined) in the 41-week induction group before reaching 41 weeks. If their doctors induced labor because they had concerns, then this would likely put the women at heightened risk for cesarean. Another 32 women were induced for exceeding 41 weeks. This means that overall, nearly half (46%) of the comparison group didn’t begin labor spontaneously, which would mask any association between induction and cesarean. Leaving the induction vs. spontaneous onset issue aside, the U.S. cesarean rate in the early 1970s was around 5%, which means it was a rare woman who would have one regardless of circumstances. Again, not exactly a strong case for inducing at 40 weeks.

What about the benefits? The best reviewers can come up with are a clinically meaningless reduction in mean blood loss (-58 ml); a lower rate of meconium-stained amniotic fluid (4% vs. 14%), not, mind you, a reduction in meconium aspiration, and therefore clinically meaningless as well; and an equally meaningless reduction in mean birth weight of -136 g (5 oz). If they had found something more impressive, surely they would have reported it.

Really? This merited a pre-publication media blast? Because it amounts to a textbook example of “garbage in, garbage out.” I can see only three possibilities to explain it: either 1) the authors and peer reviewers at the American Journal of Obstetrics and Gynecology (AJOG) don’t know as much as they should about what constitutes a quality systematic review, 2) they are so steeped in medical model thinking—“How early can we get the baby out of that treacherous maternal environment?”—that their judgment is compromised, or 3) we have a “pay no attention to what’s behind the curtain” effort to promote elective induction. I don’t know which is the more troubling, but if it’s the last one, the sad thing is that because it’s got the magic words “systematic review,” “meta-analysis,” and “randomized controlled trials” in the title, it’s likely to succeed.

References

Cole, R. A., Howie, P. W., & Macnaughton, M. C. (1975). Elective induction of labour. A randomised prospective trial. Lancet, 1(7910), 767-770.

Dunne, C., Da Silva, O., Schmidt, G., & Natale, R. (2009). Outcomes of elective labour induction and elective caesarean section in low-risk pregnancies between 37 and 41 weeks’ gestation. J Obstet Gynaecol Can, 31(12), 1124-1130.

Gulmezoglu, A. M., Crowther, C. A., Middleton, P., & Heatley, E. (2012). Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev, 6, CD004945.

Jonsson, M., Cnattingius, S., & Wikstrom, A. K. (2013). Elective induction of labor and the risk of cesarean section in low-risk parous women: a cohort study. Acta Obstet Gynecol Scand, 92(2), 198-203. doi: 10.1111/aogs.12043

Le Ray, C., Carayol, M., Breart, G., & Goffinet, F. (2007). Elective induction of labor: failure to follow guidelines and risk of cesarean delivery. Acta Obstet Gynecol Scand, 86(6), 657-665.

Macer, J. A., Macer, C. L., & Chan, L. S. (1992). Elective induction versus spontaneous labor: a retrospective study of complications and outcome. Am J Obstet Gynecol, 166(6 Pt 1), 1690-1696; discussion 1696-1697.

Martin, D. H., Thompson, W., Pinkerton, J. H., & Watson, J. D. (1978). A randomized controlled trial of selective planned delivery. Br J Obstet Gynaecol, 85(2), 109-113.

Miller, N., Cypher, R., Pates, J., & Nielsen, P. E. (2014). Elective induction of nulliparous labor at 39 weeks of gestation: a randomized clinical trial. Obstet Gynecol,132(Suppl 1):72S.

Mittendorf, R., Williams, M. A., Berkey, C. S., & Cotter, P. F. (1990). The length of uncomplicated human gestation. Obstet Gynecol, 75(6), 929-932.

Nielsen, P. E., Howard, B. C., Hill, C. C., Larson, P. L., Holland, R. H., & Smith, P. N. (2005). Comparison of elective induction of labor with favorable Bishop scores versus expectant management: a randomized clinical trial. J Matern Fetal Neontal Med, 18:59-64.

Prysak, M., & Castronova, F. C. (1998). Elective induction versus spontaneous labor: a case-control analysis of safety and efficacy. Obstet Gynecol, 92(1), 47-52.

Saccone, G., & Berghella, V. (2015). Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials. American journal of obstetrics and gynecology.

Thorsell, M., Lyrenas, S., Andolf, E., & Kaijser, M. (2011). Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women. Acta Obstet Gynecol Scand, 90(10), 1094-1099. doi: 10.1111/j.1600-0412.2011.01213.x

Tylleskar, J., Finnstrom, O., Leijon, I, et al. (1979). Spontaneous labor and elective induction – a prospective randomized study. Effects on mother and fetus. Acta Obstet Gynaecol Scand, 58:513-518.

Vahratian, A., Zhang, J., Troendle, J. F., Sciscione, A. C., & Hoffman, M. K. (2005). Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstet Gynecol, 105(4), 698-704.out

About Henci Goer

Henci Goer

Henci Goer, award-winning medical writer and internationally known speaker, is the author of The Thinking Woman’s Guide to a Better Birth and Optimal Care in Childbirth: The Case for a Physiologic Approach She is the winner of the American College of Nurse-Midwives “Best Book of the Year” award. An independent scholar, she is an acknowledged expert on evidence-based maternity care.

 

ACOG, Cesarean Birth, Childbirth Education, Do No Harm, Evidence Based Medicine, Guest Posts, Medical Interventions, New Research, Research , , , , , ,

Series: On the Independent Track to Becoming a Lamaze Trainer – The Curriculum Gets Written (Almost)!

July 7th, 2015 by avatar

By Jessica English, LCCE, FACCE, CD/BDT(DONA)

Late last year, LCCE Jessica English began the path to become an independent trainer with Lamaze International, as part of the just opened “Independent Track”  trainer program.  This new program helps qualified individuals become Lamaze trainers – able to offer Lamaze childbirth educator trainings which is one step on the path for LCCE certification.  She’s agreed to share her trainer journey with us in a series of blog posts; “On the Independent Track to Becoming a Lamaze Trainer”, offering insights at key milestones in the process.  You can read the first part of Jessica’s journey here.  Today, Jessica updates readers on her progress as she tackles the curriculum. If you are interested in becoming a trainer of Lamaze Childbirth Educators, you can find information on applying for the November 2015 Independent Track Program on the website now, and applications are due August 31, 2015.   –  Sharon Muza, Science & Sensibility Community Manager.

JEnglish retreat 1I am so ready to start training childbirth educators!

Unfortunately, my curriculum is not so ready. But I’m getting there — and building lots of empathy for the process my future students will be going through as well.

After finishing my trainer workshop in November, I spent some time processing everything I’d learned. I felt excited about becoming a Lamaze trainer, but I wasn’t ready to jump into writing my curriculum. This is a pretty typical pattern for me, so I was patient with what I know to be a healthy process for myself. I think and process and mull… And then when I’m ready I leap.

As winter turned to spring in the U.S., I watched a few of my classmates finish their curricula and start promoting their trainings. Awesome! Birth workers I had connections with from around the country started asking me when I’d be teaching my first workshop. Wonderful! I started a list of future Lamaze educators so I can update them when I am fully approved to train. I started to feel ready to leap, but the days, weeks and months flew by without much of a dent in my curriculum. I run a busy doula agency and I’m a birth doula trainer and business coach. Not to mention teaching my own childbirth classes and taking care of my own doula clients! And did I mention that I organize a major baby and family expo each February? The phone was always ringing, the email never stopped, meetings dotted each day. I’d jot down ideas or bookmark a resource that I wanted to use with my students. I tried reserving an hour a day to work on the curriculum, but it was challenging to really hold that time sacred. I also found it hard to clear out other distractions. It felt like just as I’d really dig in to a topic, time was up and I needed to move on to another (wildly different) task.

english independent - jpgYears ago in my corporate life, I learned the Eisenhower Decision Matrix for categorizing tasks (popularized by Stephen Covey). I sometimes use this matrix with my business coaching clients. Tasks are divided into categories of urgent, important, both or neither. Using this tool, I could see that I was stuck mostly in the urgent column, but not getting to the Lamaze trainer curriculum because although it was extremely important, it was in no way urgent. It was time to prioritize the important.

I checked in with a couple of folks in my brain trust, sharing my frustration about finding the time to write. (I’ll bet you have a brain trust too! This is my inner circle of trusted advisors that I turn to for support. Some of them are paid, others are mentors or friends with whom I’ve developed a circle of reciprocity — “you help me engineer my life, I’ll help you figure out yours too.”)

My business advisor suggested a retreat.  I talked with another brain trustee, looking for ideas on an affordable retreat. She mentioned Gilchrist, a local retreat center where I could rent a simple cabin and spend a couple of days in the woods. Yes! Perfect! My brain trust had come through for me again.

I reserved three days and two nights in the woods, packed up my food, teaching supplies and laptop. My goal was to leave the retreat center with a fully written curriculum ready to submit to Lamaze International for review. Gilchrist is a 45-minute drive from my home, so I tried to use the drive time to clear out all of the “urgent” from my system. The cabin and the grounds were beautiful. There was no wifi in my cabin and even phone service is spotty, which made it easier to focus in on the curriculum. Each day I walked the trails, cooked, wrote and meditated on everything new childbirth educators would need to make a real difference for families.

I felt connected and focused. It’s always easier for me to tackle big tasks in one large chunk than to piecemeal it, and the retreat was just what I needed. As I think ahead to helping new educators find time to finish their curricula and plan for their classes, I’ll offer the options of reserving small chunks of time over a long period (this works well for some people, even though it’s not a great match for my personal style) or maybe booking their very own Lamaze retreat.JEnglish retreat 2

Unfortunately, I didn’t quite reach my goal to finish the trainer curriculum on retreat. I’m close, though. Another full day of writing should be enough to wrap up what I need to submit to Lamaze International’s lead nurse planner, Susan Givens. An interesting sidelight of the trainer process is that I’m getting laser focused on my own childbirth classes. What are the strongest pieces of my curriculum? Where are the weak links? If I’m training new educators, I want to be sure I’m modeling the best teaching techniques in my own classes. So tucked into the calendar this summer, I have another full day reserved for finishing my trainer curriculum, and also a full day to re-examine and revitalize a few topic areas in my own eight-week Lamaze series.

I’m still puzzling through a few technical issues with the curriculum. I’m working toward enough structure that I can make sure attendees get everything they need, but also some flexibility to let them take the reins at times. I want to model the same innovative teaching techniques I hope they will use in their own classes. I’m grateful for my experience not only as a childbirth educator for the past decade but also as an approved birth doula trainer for DONA International. I have a great sense of both the research and the reality of adult learning. Also on the docket: figuring out how my business curriculum will be incorporated into my Lamaze workshop. Should it be part of the core training, or an extra day or half day that new educators can opt into if they’re planning to teach independently? Business building is a big part of my focus in the birth world, so this piece of the curriculum is really important to me! Some of this will come clear as I finish writing, but experience also tells me that things will shift and adjust as I start to train and get a sense for what works best in action.

To use a birth analogy (because Lamaze educators can turn everything into a birth analogy!), my trainer curriculum feels like it’s in transition. Intense. A little overwhelming. But transition! What a fantastic place to be! Almost there. Keep going. Almost there.

About Jessica English

jenglish-headshot-2015-2Jessica English, LCCE, FACCE, CD/BDT(DONA), is the founder of Heart | Soul | Business. A former marketing and PR executive, she owns Birth Kalamazoo, a thriving doula and childbirth education agency in Southwest Michigan. Jessica trains birth doulas and (soon!) Lamaze childbirth educators, as well as offering heart-centered business-building workshops for all birth professionals.

Childbirth Education, Guest Posts, Lamaze International, Lamaze News, Series: On the Independent Track to Becoming a Lamaze Trainer , , , , ,

BABE Series: “Should I Stay or Should I Go Now?” or When To Go To The Hospital or Birth Center

June 30th, 2015 by avatar

Today I am sharing our Brilliant Activities for Birth Educators (“BABE”) idea for June!  “Should I Stay or Should I Go Now?”- submitted by Lamaze Certified Childbirth Educator Mindy Cockeram. The BABE series contain fun and interesting ideas that childbirth educators can use in their Lamaze classes to make them engaging and memorable for the families in attendance.  Today’s idea covers when families in labor should move to the birth location. Do you have a fun teaching idea that you would like to share in a future BABE article.  Please pop me an email and we can connect. – Sharon Muza, Community Manager, Science & Sensibility.

By Mindy Cockeram, LCCE

© Mindy Cockeram

© Mindy Cockeram

Introduction

The topic of ‘when to go’ to the hospital or birth location, when a woman is in labor is one subject I’m sure most childbirth educators discuss early on in the childbirth class series, – possibly even on the first night – because it is one of the most perplexing and often worrying topics on which families want clarification. I find that most people have received many different pieces of advice about ‘when to go’ from a whole host of friends, family and care providers.

When we start discussing contraction timing, I suggest families use the ‘3 in 10’ guideline (3 contractions in ten minutes OR five minutes apart for a whole hour). But of course active, well-established contractions are not the only reason to turn up at Labor & Delivery and so we use this deck of cards to introduce different situations and their possible ramifications.

How It’s Used

To add some humor into the activity, I call the decision of when to go to the hospital ‘The Clash Moment’ – from the song ‘Should I Stay or Should I Go’ sung by the great British rock band The Clash. In my opinion, this song was written for the laboring couple. The lyrics ring out:

“Should I stay or should I go now?
If I stay there will be trouble.
If I go there will be double?
So come on and let me know,
Should I stay or should I go?”

I shuffle the “Clash Deck” and then hand the deck to a partner. The partner then takes the top card off the deck and reads it out. I shout out to the class ‘Stay or Go?’ and they decide and answer back. Often the reactions are mixed, so I usually facilitate a discussion if necessary and introduce the evidence based arguments. If the situation on the card would send the pregnant person to the hospital, the deck is handed over to the next family. If the situation on the card is not a reason to go, the same family draws the next card. Often a family will draw a card signaling early labor, then draw the loss of the mucus plug (‘showtime’), then ‘feel shaky’ before finally drawing ‘want to push now’. It’s fun watching the pregnant person’s face and the partner’s reaction as they read the next card if they are ‘still at home’.

Depending on the number of cards in your deck, the activity normally takes about 20-30 minutes to do well.

Takeaways

It is interesting to see how often the partners disagree with the pregnant people about whether to stay or go. The statements that usually create the most conversation are ‘Gush of water’ (termPROM), ‘Feel something small protruding inside’ (rare cord prolapse), ‘Instinct says it’s time’ and ‘Backache comes and goes’ (possible posterior labor).

clash babe 2

© Mindy Cockeram

I always present the evidence for staying at home with term PROM vs going in and the difference between guidelines for PROM in the USA (baby out within 24 hrs from PROM) vs the UK (if PROM within 24, baby out within 48) where I trained. PROM usually also leads into a light discussion on warding off Group B Strep and other bacteria by evening out the ‘bad’ bacteria with the ‘good’ bacteria (lactobacillus).

In the first class I also show a hypnobirth video clip and the pregnant person is totally silent. When a family reads out ‘ouch with a contraction’ and all yell ‘stay’, I remind them that the hypnobirthing person we watched never once murmured ‘ouch’ and a baby popped out. Then we discuss how people will have different ‘ouch tolerances’ based on their length of labor and the position in which the baby is in. So eventually they realize they should time the ‘ouch’ instead of trying to guess dilation based on the sounds that are being made.

Modifications

You can add any situation or symptom to a card that you like. I’m in California and am thinking of adding ‘Feel an earthquake’ to my “Clash Deck” to see what they think. I also want to add some pre-eclampsia symptoms like ‘have a persistent headache with flashing aura’ while Pre-Eclampsia Month is still fresh in my mind.

Creating Your Own

It is really simple to make the card deck. Just type or write out situations or symptoms like I have and attach each one to each card from an old deck. Then laminate the cards between two sheets of plastic laminate, cool and trim with scissors.   Leave a bit of a plastic edge when you trim them otherwise they might peel if cut too close to the card. I’ve been using the same deck for almost ten years and they’ve held up very well.

The class seems to love this activity and I hope you do to. Let me know if you have any questions or feedback on its use in your classes.

Note/Disclaimer: The use of the acronym “BABE” (Brilliant Activities for Birth Educators) is not affiliated with, aligned with or associated with any particular childbirth program or organization.

About Mindy Cockeram

Mindy Cockeram head shotMindy Cockeram is a recently recertified Lamaze Educator working with a large hospital chain in Southern California where she’s been teaching for four years. She trained initially through the UK’s National Childbirth Trust in Wimbledon, England in 2006 after a career in the financial markets industry in London. She graduated from Villanova University in 1986 with a bachelor’s degree in Communications and a minor in Business Studies. Currently working on a book, she resides in Redlands, California with her British husband and two children.

Childbirth Education, Guest Posts, Series: BABE - Brilliant Activities for Birth Educators , , , ,

Looking Back in Time: What Women’s Bodies are Telling Us about Modern Maternity Care

June 18th, 2015 by avatar

By Christina Gebel, MPH, LCCE, Birth Doula

Christina Gebel, MPH, LCCE, Doula writes a reflective post examining current birthing conditions to see how today’s practices might be interfering with the the normal hormonal physiology and consequently impacting women’s ability to give birth.  Times have certainly changed and birth has moved from the home to the hospital.  A slow but steady increase in out of hospital births is examined and Christina asks us to consider why women are increasingly choosing to birth outside the hospital – and what do hormones have to do with it? – Sharon Muza, Science & Sensibility Community Manager

“Pregnancy is not a disease, but a beautiful office of nature.” These are the words of Victoria Woodhull, the first female candidate for President of the United States in 1872.

Lajja_gauri ancient birth art

© “Lajja gauri

The world in which pregnant women find themselves today looks a lot different than the time of Woodhull’s campaign run. For instance, hospitals didn’t become the mainstream setting for labor and delivery until the 1930s and 40s. While modern medicine has undoubtedly helped millions of women who may have otherwise died in childbirth, mothers and birth advocates across the nation are beginning to ask if we are paying a price for today’s standard maternity care. With increasing protocols and interventions, pregnancy is viewed less like the office of nature Woodhull spoke of and more like a pathological condition.

The Hormonal Physiology of Childbearing, a recent report by Sarah Buckley, systematically reviews existing research about the impact that common maternity practices may have on innate hormonal physiology in women and fetuses/newborns. The report finds strong evidence to suggest that our maternity care interventions may disturb these processes, reduce their benefits, or even create new challenges. To find out more, read an interview that Science & Sensibility did with Dr. Buckley when her groundbreaking report was released.

Let’s examine something as simple as the environment that a woman gives birth in. In prehistoric times, laboring women faced immediate threats and dangers. They possessed the typical mammalian “fight-or-flight” reaction to these stressors. The hormones epinephrine and norepinephrine caused blood to be diverted away from the baby and uterus to the heart, lungs, and muscles of the mother so that she could flee. This elevation in stress hormones also stalled labor, to give the mother more time to escape. Essentially, she told her body ‘this place is not safe,’ and her body responded appropriately by stopping the labor to protect the mother and her child during a very vulnerable time.

Today, mothers are not fleeing wild animals but rather giving birth in hospitals, the setting for nearly 99% of today’s births, where this innate response may cause their labor to stall. The sometimes frenetic environment or numerous brief encounters with unfamiliar faces may trigger a sense of unease and, consequently, the fight-or-flight response, stalling the mother’s labor. Prolonged labor in a hospital invariably leads to concern and a need to intervene, often by the administration of Pitocin, synthetic oxytocin, to facilitate regular contractions. Arrested labor could lead to further interventions up to and including a cesarean section. The fight-or-flight response may be further reinforced by these interventions, as they potentially come one after the other, in what is often referred to as the “cascade of interventions.”

This is just one example of how a woman’s body’s natural physiology can go from purposeful to working against the labor, the mother and the baby. Epinephrine and norepinephrine are both necessary in labor and delivery. In fact, at appropriate levels, these hormones support vital processes protecting the infant from hypoxia and facilitating neonatal transitions such as optimal breathing, temperature, and glucose regulation, all markers for a healthy infant at birth.

Recent data show that mothers themselves may already think what the Hormonal Physiology of Childbearing report suggests. The series of Listening to Mothers (LtM) studies, a nationally-representative survey of childbearing women, shows a shift in mothers’ attitudes towards normal physiologic birth: In 2012, 58% of mothers agreed somewhat or strongly that giving birth is a process that should not be interfered with unless medically necessary, up from 45% in 2000. According to 2013 national birth data, out-of-hospital (home and birth center) births have increased 55% since 2004, but the overall percentage is still only 1.35% of all births nationwide. While low, this shows that a small core of mothers are voting with their feet and choosing to give birth out of the hospital. Though their choice may seem extreme, they’re not alone. In the LtM data, which only surveys women who have given birth in a US hospital, 29% of mothers said they would definitely want or would consider giving birth at home for a future birth, and 64% said the same of a birth center. All this raises the question: What’s happening in a hospital that is leading mothers to consider other settings for their next birth?

One answer to upholding women’s preferences, autonomy, and the value of normal physiologic birth is a mother’s involvement in shared decision making with her provider, along with increasing access to models of care that support innate physiologic childbearing, like midwives in birth centers. Increasing access to these options may present a challenge, as demand seems to outweigh availability.

Leslie Ludka (MSN, CNM) has been the Director of the Cambridge Health Alliance Birth Center (Cambridge, Mass.) as well as the Director of Midwifery since 2008. Like other birth centers, the center has seen a steady increase in demand each year, with patients coming from all over New England. Ludka sees many barriers to having more birth centers available including finances (the reimbursement for birth not being comparable to an in-hospital birth), “vacuums in institutional comprehension” of the advantages of the birth center model for low-risk women, and the rigorous process to be nationally certified by the Commission for the Accreditation of Birth Centers (CABC), requiring “a great commitment and a lot of support by all involved.” In order to overcome these barriers, Ludka suggests marketing the safety of birth centers to the general public, sharing outcome statistics for women and infants cared for in birth centers, and educating insurers and providers about the overall benefits and financial savings of midwifery and the birth center model. With supportive policy and better understanding on the part of insurers, the public, and healthcare institutions, models like the birth center could become more plentiful, more easily meeting the demand.

Women’s bodies are sending subtle messages that our current healthcare system is, at times, not serving their needs. It’s time to respond to these messages, beginning by viewing childbirth foundationally as a life event and not first as pathology, and adapting our models of care to speak to this viewpoint. If we fail to do so, we run the risk of creating excess risk for women and newborns.

It’s been 143 years since Woodhull ran for president. We’ve made progress in getting much closer to seeing our first woman president, but with childbirth, perhaps our progress now starts with looking back in time.

About Christina Gebel

© Christina Gebel

© Christina Gebel

Christina Gebel holds a Master of Public Health in Maternal and Child Health from the Boston University School of Public Health. She is a birth doula and Certified Lamaze Childbirth Educator as well as a freelance writer, editor, and photographer. She currently resides in Boston working in public health research. You can follow her on Twitter: @ChristinaGebel and contact her through her website duallovedoula.com

Childbirth Education, Guest Posts, Home Birth, Maternity Care, Medical Interventions, Midwifery , , , ,

cheap oakleys fake oakleys cheap jerseys cheap nfl jerseys wholesale jerseys wholesale nfl jerseys