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Working to Improve Perinatal Depression Rates – An Interview with Researcher Nany Byatt, DO

September 1st, 2015 by avatar

By Walker Karraa, PhD.

sad mother and baby dropboxPerinatal and/or postpartum depression affects more than 15% off all women during pregnancy or after birth.  Many women are not diagnosed and therefore are not referred on to specialists who can help them with appropriate treatment. Last month, the Centers for Disease Control (CDC) announced an inaugural grant of 2.5 million dollars to University of Massachusetts Medical School researchers for the purpose of exploring the feasibility and effectiveness of obstetricians diagnosing and treating women suffering from perinatal or postpartum depression within their current obstetrical practice.  The ability of obstetricians to identify and treat affected women may help to close the gap that exists in women receiving treatment, and ensure adequate care is available and provide the ability to monitor how the women respond to treatment.  Creating a network of resources and providing OB access to psychiatric specialists for consultations can result in more women receiving more effective treatment faster from the provider they are already seeing.  Dr. Walker Karraa, perinatal mental health expert interviewed on of the co-investigators, Dr. Nancy Byatt about this research grant and what it might mean for women suffering from perinatal depression. – Sharon Muza, Community Manager, Science & Sensibility.

Walker Karraa, PhD: How is this grant first of its kind?

Nancy Byatt, DO: This is the first time the Centers for Disease Control put forth a request for applications for the Evaluation of a Stepped Care Approach for Perinatal Depression Treatment in Obstetrics and Gynecology Clinics.

WK: How long have you and your colleagues been working on this grant?

NB: Our team began working on understanding how depression could be addressed in obstetric settings in 2010. Driven by our commitment to helping women get treatment by leveraging the obstetrical care setting, we were awarded two institutionally funded grants to conduct three formative research studies with obstetric providers and staff, postpartum patients and pregnant women.

Jeroan Allison, MD, Nancy Byatt, DO, and Tiffany Moore Simas, MD.

Investigators Jeroan Allison, MD, Nancy Byatt, DO, and Tiffany Moore Simas, MD.

Our preliminary studies evaluated the perspectives of obstetric providers and postpartum women, about ways to improve depression treatment in the obstetric setting. We found that barriers occurring at the patient, provider, and systems-level prevent perinatal women and obstetric providers from addressing depression. Our preliminary data led us to hypothesize that transforming obstetrical practice to include depression treatment would enhance women’s access to and engagement in treatment and thereby improve depression outcomes.

WK: Tell us about the pilot study and how it revealed the gaps in treatment. What are the gaps identified? Why do you feel these gaps exist?

In our formative studies, and literature reviews, we identified a number of patient, provider, and systems-level barriers and facilitators to the treatment of perinatal depression and reviewed clinical, programmatic, and systems-level interventions. Provider and systems-level barriers include: (1) lack of obstetric provider training in technical aspects of depression care and communication skills; (2) absence of standardized processes and procedures for stepped depression care; (3) lack of mental health providers willing to treat pregnant women; (4) lack of referral networks; and, (5) inadequate capacity for follow-up and care coordination. These are exacerbated by patient-level barriers. Perinatal women report they fear stigma, losing parental rights, and being judged as an unfit mother. Many women perceive obstetric providers and staff as unsupportive, unavailable, and inadequately trained in depression.  We have built the RAPPID program to address these critical barriers at the provider, patient, and system level.

WK: If readers wanted to learn more about your work and/or the gaps in treatment, what literature would you recommend?

NB: We have several peer-reviewed articles that summarize our work. (see the reference section below.)

WK: What was your original vision for MCPAP?

NB: We aimed to translate the successful Massachusetts Child Psychiatry Access Project (MCPAP) to address perinatal depression. MCPAP has transformed the delivery of child mental health services in Massachusetts by making immediate psychiatric consultation available to pediatricians, to address depression in obstetric settings.   Our vision was that expanding MCPAP to create MCPAP for Moms, a new program that could provide obstetric, psychiatric, primary care and pediatric providers with access to care coordination and psychiatric telephone consultation to help them address perinatal depression. We aimed to create a population-based program that would help the entire state of Massachusetts address depression by building capacity of the frontline providers who are serving pregnant and postpartum women in their medical setting.

WK: Can you explain how the RAPPID program will be compared to the MCPAP program?

NB: To build on and address the limitations of MCPAP for Moms, we developed and pilot tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program to create a more comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to the immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers via MCPAP for Moms; (2) clinic-specific implementation of stepped care, including training support and toolkits; and, (3) proactive treatment engagement, patient monitoring, and stepped treatment response to depression screening/assessment. RAPPID was developed using formative data and feedback from key stakeholders.

We will compare two active interventions, enhanced usual care (access to MCPAP for Moms) vs. RAPPID in a cluster randomized controlled trial (RCT) in which we will randomize 12 Ob/Gyn clinics with diverse patient populations to either RAPPID or enhanced usual care.

WK: How is stepped care different than collaborative care?

NB: Stepped care models involve initial determination of treatment based on illness severity and intensification of care (such as stepwise increases in dose of antidepressant medication) for those with persistent illness.

WK: What has inspired your work in this field?

NB: I have been moved by women’s stories and how hard it was for them to access the care that they needed and deserved. In the beginning of my career I was seeing this time and time again.

I am inspired by the women I serve. I have worked with countless pregnant and postpartum women. Perinatal women initially or in a prior pregnancy were not able to access the care they needed and deserved. This led me to want to make an impact beyond patient care and I envisioned a program would help pregnant and postpartum women access treatment for their depression.

WK: What are the most critical issues in perinatal mental health today?

NB: Despite having evidence based treatments available, depression is not detected among many pregnant and postpartum women and even if it is detected, many women will not be able to access treatment. Depression during pregnancy is twice as common as diabetes and it needs to be a routine part of obstetric care just as diabetes is a routine part of obstetric care.

References

  1. Byatt N, Levin L, Ziedonis D, Moore Simas T, Allison J. To What Extent Does Screening and Referral Improve Depression Outcomes and Mental Health Care Utilization Among Perinatal Women? Obstetrics and Gynecology. In Press.
  1. Byatt N, Rui X, Dinh K, Waring EM. Trends in Mental Health Care Use in Relation to Depressive Symptoms Among Pregnant Women. Archives of Women’s Mental Health. 2015 Apr 7. Epub ahead of print.
  1. Weinreb L, Byatt N, Moore Simas TA, Tenner K and Savageau JA. What happens to mental health treatment during pregnancy? Women’s experience with prescribing providers. Psychiatr Q. 2014;85:349-355.
  1. Byatt N, Biebel K, Friedman L, Debordes-Jackson G, Pbert L, Ziedonis D. Patient’s Views on Depression Care in Obstetric Settings: How Do They Compare to the Views of Perinatal Health Care Professionals? General Hospital Psychiatry. 2013;35(6):598.
  1. Byatt N, Biebel K, Debordes-Jackson G, Lundquist R, Moore Simas T, Weinreb L, Ziedonis D. Community Mental Health Provider Reluctance to Provide Pharmacotherapy May Be a Barrier to Addressing Perinatal Depression: A Preliminary Study. Psychiatric Quarterly. 2013;84(2):169-174.
  1. Byatt N, Moore Simas T, Lundquist R, Johnson J, Ziedonis D. Strategies for Improving Perinatal Depression Treatment in North American Outpatient Obstetric Settings. Journal of Psychosomatic Obstetrics & Gynecology. 2012;33(4):143-61.
  2. Byatt N, Biebel K, Lundquist R, Moore Simas T, Debordes-Jackson G, Ziedonis D. Patient, Provider and System-level Barriers and Facilitators to Addressing Perinatal Depression. Journal of Reproductive and Infant Psychology. 2012;30(5):436-439.
  3. Byatt N, Moore Simas T, Lundquist R, Johnson J, Ziedonis D. Strategies for Improving Perinatal Depression Treatment in North American Outpatient Obstetric Settings. Journal of Psychosomatic Obstetrics & Gynecology. 2012;33(4):143-61.

About Nancy Byatt, D.O., M.S., M.B.A., F.A.P.M.

© Nancy Byatt

© Nancy Byatt

Nancy Byatt, D.O., M.S., M.B.A., F.A.P.M is a psychiatrist focused on improving health care systems to promote maternal mental health. Dr. Byatt is an Assistant Professor at UMass Medical School in the Departments of Psychiatry and Obstetrics and Gynecology. Byatt is a psychosomatic medicine psychiatrist with subspecialty expertise in perinatal mental health. She provides expert psychiatric consultation to obstetric, psychiatric, primary care and pediatric providers serving pregnant and postpartum women. She is the Founding and Statewide Medical Director of the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms). MCPAP for Moms addresses perinatal depression across Massachusetts by providing mental health consultation and care coordination for medical providers serving pregnant and postpartum women.

Byatt’s research focuses on developing innovative ways to improve the implementation and adoption of evidence-based depression treatment for pregnant and postpartum women. She has a Career Development Award that funds her research to help women access and engage in perinatal depression treatment in obstetric settings. She has also received federal funding from the Center for Disease Control to test an intensive, low-cost program that aims to ensure that pregnant and postpartum women with depression receive optimal treatment. Her academic achievements have led to numerous peer-reviewed publications and national awards.

 

Babies, Depression, Guest Posts, Infant Attachment, Maternity Care, New Research, Newborns, Perinatal Mood Disorders, Postpartum Depression, Research , , , , , , ,

Black Breastfeeding Week – “Lift Every Baby” Supports Breastfeeding Black Families

August 27th, 2015 by avatar

BBW-Logo-AugustDates-300x162August 1-7th was World Breastfeeding Week, and the entire month of August was National Breastfeeding Awareness Month.  Science & Sensibility shared information and resources in two posts; Breastfeeding and Work – Let’s Make It Work! Join Science & Sensibility in Celebrating World Breastfeeding Week and Happy World Breastfeeding Week! The Celebration Continues with More Free Resources, along with a “Brilliant Activities for Birth Educators: Nine Ideas for Using Knit Breasts in Breastfeeding Classes” post for those who teach expectant families.

This week we want to recognize and honor Black Breastfeeding Week (August 25-31, 2015) and share information about the “Lift Every Baby” awareness campaign that is the theme of this year’s program.  Black Breastfeeding Week is designed to raise awareness and provide support in black communities.  Both the initiation rate and the duration rate of breastfeeding in black families has been lower than the rates in white families for more than four decades. Low birth weight, preterm deliveries and maternal complications such as preeclampsia are all higher in black women and the black infant mortality rate is more than twice that of white babies.  Breastfeeding and the important benefits it provides can help all babies, but for the most vulnerable and the sickest, breastmilk is a critical component that can mean the difference between life and death.

black breastfeeding mother babyBlack Breastfeeding Week was established three years ago by three women, Kimberly Seals Allers, Kiddada Green and Anaya Sangodele-Ayoka, all leaders in the field of maternal child health, with a focus on families of color.  In the past three years, attention, discussion and events focused on supporting Black Breastfeeding Week have only grown as people of all colors recognize the health disparities that exist right here in the United States, between white families and black families that have lifelong impacts, simply due to the color of one’s skin.

Kimberly Seals Allers wrote an excellent commentary on why there is a need for Black Breastfeeding Week.

There are many activities around the country to support Black Breastfeeding Week.  A full event list can be found here.  On August 29 at 3 PM EST the first nationally coordinated “Lift Up” will be held in various cities across the United States.  Black families will join together at different meeting points across the country to “Lift Up” their babies, regardless of their size or age, to recognize the importance of community support for children.

There will also be the first ever Twitter chat (#LifeEveryBaby) in honor of Black Breastfeeding Week, scheduled for tonight, August 27th at 9 PM EST that you are invited to participate in.

Cara Terreri, from Lamaze International’s blog for parents, Giving Birth With Confidence, has compiled a list of  black breastfeeding resources that you should be aware of:

Black Breastfeeding Week website & Facebook page

It’s Only Natural,” – CDC & Office of Women’s Health breastfeeding guide for African American families

Normalize Breastfeeding

Black Women Do Breastfeed website & Facebook page

Mocha Manual

Your Guide to Breastfeeding for African American Women

You can also find more information and resources on the Black Breastfeeding Week Resources and Toolkit page.

Additionally, I would like to refer you to two previous posts in our “Welcoming All Families” series, written by Lamaze educator and lactation consultant Tamara Hawkins, discussing welcoming families of color to your classes.  Working with Women of Color and Working with Women of Color – Educator Information can help educators create and provide applicable classes and information to the families of color joining their classes.

Black Breastfeeding Week is an important event that can help create awareness for the importance of culturally relevant and accessible breastfeeding support and information for black families.  Childbirth educators and other birth professionals should be ready to provide resources that can help close the gap to the families they work with.  Are you participating in any Black Breastfeeding Week events?  Let us know in the comments section and please, let us all join together to “Lift Every Baby.”

 

Babies, Breastfeeding, Childbirth Education, Infant Attachment, Newborns, Push for Your Baby , , , , ,

Breastfeeding and Work- Let’s Make It Work! Join Science & Sensibility in Celebrating World Breastfeeding Week

August 4th, 2015 by avatar

wbw2015-logo-purpleAugust 1-7th, 2015 is World Breastfeeding Week and is coordinated by the World Alliance for Breastfeeding Action (WABA).  WABA is a global network of individuals & organizations concerned with the protection, promotion & support of breastfeeding worldwide.  World Breastfeeding Week is traditionally celebrated annually the first week of August and this year’s theme – “Breastfeeding and Work- Let’s Make It Work!

As childbirth educators and birth professionals, we are working with expectant families in the weeks and months leading up to birth, and then often in the early weeks of parenting.  During that time, returning to work is often a distant thought, as families struggle to navigate the labor and birth experience and transition to life with a new baby.  Most of the breastfeeding topics we cover in class and one-on-one with families are of the need to know variety that helps them get breastfeeding off to a good start.  If there is even enough time to touch on returning to work as a breastfeeding parent, it is brief and quick due to time limitations and current concerns.

The reality is that most breastfeeding parents return to work.  This return to formal or informal work may occur earlier than parents would have liked due to financial concerns, lack of paid (or unpaid leave) from employers, professional pressures and expectations, as well as family and society demands.  The struggle to maintain an adequate supply of expressed breastmilk and to continue to breastfeed is real and affects many, many families worldwide.  Issues include an unsupportive workplace, insufficient time  and an inadequate or inappropriate place to express milk that can be bottle fed to their child, and an unwelcome environment to be able to nurse their child, if the child can be brought to the workplace.

Childbirth educators may not have time in our routine breastfeeding class to address many of the issues and concerns that these families face when they return to work.  The typical breastfeeding class is geared for the initial days and weeks with a newborn.  Educators can provide take home resources in the form of handouts and useful links that can help families to navigate returning to work successfully, minimizing impact on the breastfeeding dyad.

wbw2015-obj

Additionally, you might consider preparing a stand-alone class that runs a couple of hours geared specifically for the parent who is returning to work  and hoping to continue to breastfeed.  This might be offered for families to attend while still pregnant or after their baby arrives and they are facing the fact that they are going to be returning to work sooner rather than later.  Do you currently already teach such a class in your community?  How do you market it?  How is it received?  Can you share some of your objectives and favorite resources for the Return to Work class that you teach in our comments section below?

© Helen Regina - Policial WABA 2015

© Helen Regina – Policial WABA 2015

Continuing to breastfeed after returning to work benefits businesses as well as mothers, babies and families by providing a three to one Return on Investment (ROI) through lower health care costs, lower employee absenteeism rates due to babies that are healthier, requiring less sick leave, lower turnover rates, and higher employee productivity and loyalty.

Here is some useful information and resources that I have gathered in one location that you may want to share with your students and families, in order to help them make a smooth transition when they return to work as a breastfeeding family.

Many of these websites also provide information in Spanish and other languages as well.

Lamaze International President Robin Elise Weiss has created a new “From the President’s Desk” video – “Tips for Breastfeeding Success” that you can share with parents. While not specifically about breastfeeding while working, helping families get off on the right foot with a solid breastfeeding relationship can help parents to feel confident that they are meeting their baby’s nutritional needs right from the start and that can continue once they return to work.  You can also direct families to Lamaze International’s online breastfeeding class, where additional information and resources can be found.  Finally, consider encouraging parents to download our new free Pregnancy to Parenting app which contains evidence based and easily accessible information on many topics includingbreastfeeding as well as useful app features like a breastfeeding and diaper log and additional resources.

How are you celebrating World Breastfeeding Week in your community? Share your activities and ideas in the comments section below and thank you so much for all you do to support breastfeeding with the families you work with.

Babies, Breastfeeding, Childbirth Education, Infant Attachment, Lamaze International, Newborns, Push for Your Baby , , , , , , ,

Remembering Sheila Kitzinger – An Amazing Advocate for Women, Babies and Families

April 13th, 2015 by avatar

“Sheila Kitzinger is a giant upon whose shoulders we will stand on as we continue our important work for women and their babies. She will be sorely missed.” – Judith Lothian

SheilaKitzinger85Birthday_lSheila Kitzinger passed away on April 12th at her home in Oxfordshire, England after a short illness  Ms. Kitzinger was 86 years old. My eldest son, the father of four, forwarded me the BBC announcement. It shouldn’t have been a shock because I had heard she was very ill. But it is. We have lost a birth advocate who “rocked the boat” and taught the rest of us how to do it.

Kitzinger was an anthropologist and childbirth educator. As a childbirth educator, she pushed educators to go beyond just sharing knowledge, beyond just educating women about birth. She believed that we needed to confront the system in which birth takes place, to advocate in powerful ways so that women could give birth without being traumatized physically or emotionally. She wrote more than 25 books, an endless number of articles in scholarly journals, including her wonderful “Letter from Europe” column in Birth, and a steady stream of newspaper and magazine articles and letters to the editors. Her latest book, A Passion for Birth: My Life; Anthropology, Family, and Feminismher memoirs, will be published in the UK in June.

Sheila came to New York City in the 1970s several times. I was a young mother and new childbirth educator who knew nothing about Kitzinger before I heard her speak. Her passion, her knowledge, and her genuine interest in everyone she met inspired and motivated me, really all of us, to meet the challenges (and they were substantial) that we faced back then. I have spent the last 40 years reading literally everything Sheila Kitzinger has written. Many of those books and articles I have read over and over again, always learning something new. I consider Sheila Kitzinger one of my most important mentors, although we only spoke at length on four occasions in all those years.rediscovering birth kitzinger

With a handful of others, Kitzinger turned the world of birth upside down. Although we still have a long way to go, Sheila Kitzinger’s work has made contributions that simply cannot be measured. Kitzinger’s work going back to the 1970s on episiotomy and the value and importance of home birth were the start of what would become prolific contributions. Her books for women on pregnancy and childbirth, breastfeeding, sex and pregnancy, and the sexuality of birth and breastfeeding can’t be beat. Her work on post traumatic birth in the Uk was groundbreaking. Her books on the politics of birth, the culture of birth, becoming a mother, and becoming a grandmother are major contributions to the literature. Rediscovering Birth is a personal favorite. If that book doesn’t inspire women to think differently about birth, I don’t know what can!

sheila kitzinger 2The article that made the biggest difference in my life was “Should Childbirth Educators Rock the Boat?” published in Birth in 1993. At the time I was new to the Board of Directors of Lamaze International (then ASPO Lamaze) and was soon to become President of the organization. Kitzinger wrote powerfully of the need for childbirth educators to not just teach women about birth but to advocate within the system for change, to take strong stands in support of normal physiologic birth, home birth, and humane, empowering childbirth. Her call to action drove my own work within Lamaze. The result was a philosophy of birth that was courageous and groundbreaking and has driven the work of the organization since then. Advocacy is a competency of a Lamaze Certified Childbirth Educator and the mission of the organization clearly identifies the role of advocacy. Lamaze International’s six evidence based Healthy Birth Practices “rock the boat” of the standardized childbirth education class that creates good patients and hospitals that claim to provide safe care to women and babies. When The Official Lamaze Guide: Giving Birth with Confidence was first published in 2005, Sheila reviewed the book. In her review she wrote, “…It’s humane, funny, tender, down-to-earth and joyful. Essential reading for all pregnant women who seek autonomy in childbirth.” I wanted to tell her – “Without your passion and inspiration that book might not have been written.”

There are a number of other bits of wisdom from Kitzinger that I often quote. They have made a difference to me and, I suspect, to everyone who knows Sheila’s work.

  • What breastfeeding mothers need most is a healthy dose of confidence
  • Home birth should be a safe, accessible option for women
  • Touch in childbirth has changed from warm, human touch to the disconnected touch of intravenous, fetal monitors, blood pressure cuffs
  • Women know how to give birth
  • The clock is perhaps the most destructive piece of modern technology

Kitzinger gave me a healthy dose of confidence in myself and in the importance of what we do in small and big ways as we go about the work of changing the world of birth. She convinced me that talking about birth and writing about birth, even if only to the choir, makes a difference. We know we’re not alone and we become more passionate and more committed. We develop the courage to “rock the boat”.

Sheila Kitzinger is a giant upon whose shoulders we will stand on as we continue our important work for women and their babies. She will be sorely missed. May she rest in peace. Our deepest sympathies go out to her family and friends.

Do you have a memory or story to share about Sheila Kitzinger?  How has she or her work impacted you personally or professionally?  Share your stories in our comments section. – SM

About Judith Lothian

@ Judith Lothian

@ Judith Lothian

Judith Lothian, PhD, RN, LCCE, FACCE is a nurse and childbirth educator. She is an Associate Professor at the College of Nursing, Seton Hall University and the current Chairperson of the Lamaze Certification Council Governing Body. Judith is also the Associate Editor of the Journal of Perinatal Education and writes a regular column for the journal. Judith is the co-author of The Official Lamaze Guide: Giving Birth with Confidence. Her research focus is planned home birth and her most recent publication is Being Safe: Making the Decision to Have a Planned Home Birth in the US published in the Journal of Clinical Ethics (Fall 2013).

Babies, Breastfeeding, Childbirth Education, Guest Posts, Healthy Birth Practices, Home Birth, Infant Attachment, Lamaze International, Maternity Care, Midwifery, Newborns , , , ,

Because… A Poem Honoring Cesarean Awareness Month

April 9th, 2015 by avatar

CAM 2015 GBWCGiving Birth with Confidence is the sister blog to Science & Sensibility, Lamaze International and is geared for parents and new families.  Cara Terreri, ( you may remember Cara, we followed her journey to becoming an LCCE) has been the Community Manager there since the blog was first established in 2008.  I always point the families in my classes to Giving Birth with Confidence because I know that they will find evidence based information along with great inspiration to push for a safe and healthy birth.

Cara recently wrote and published a poem on Giving Birth With Confidence to commemorate Cesarean Awareness Month (April), and it really spoke to me.  Since April is also National Poetry Month, I wanted to share her poem with you, in hopes that you might pass on and share with the families you work with.  Because 1 in 3 is too many.

Because…

1 in 3 is too many

Recovery is hard

My birth was still a birth

I want to have a VBAC

My scar still hurts

I was separated from my baby

My doula supported me in the OR

I didn’t have a choice

I got to experience skin to skin with my baby right away

I made the choice this time

I wish I would have known

I feel cheated

My doctor never told me this could happen

It’s going to be OK

My sister said this was easier anyway

My midwife made the right decision to transfer to the hospital

Friends told me at least I had a healthy baby

I have postpartum depression

It was the best decision for my birth

My husband has scars too

I’m embarrassed

My doula wasn’t allowed back into the OR

I failed the one thing I’m supposed to be able to do as a woman

My mom had one too; I guess it was meant to happen

I know my doctor helped me make the best decision

I want more for my daughter

I am a source of courage and support for others who have gone before me and those who will go after me

I did the best that I could with the knowledge I had at the time

I’m doing better now

My baby is beautiful

My body is strong

I am resilient

My birth matters

By Cara Terreri

cara headshot

 

Cesarean Birth, Childbirth Education, Depression, Giving Birth with Confidence, Guest Posts, Infant Attachment, Newborns , , , , , ,

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