Archive for the ‘New Research’ Category

Lamaze Parent Satisfaction Survey Will Benefit Families – Educators Play a Key Role in Increasing Response Rate

November 3rd, 2015 by avatar

VoteSurveyParticipation at in-person childbirth education classes has been on the decline in past years.  There has not been much research on the benefits of taking a childbirth class, and with the plethora of information available online, it is no surprise that enrollment may very well be on the decline.  At the same time, cesarean rates and obstetrical interventions have overall been increasing.  Maternal and neonatal morbidity and mortality rates have not been improving either.

In the 2013 Listening to Mothers  (LtM) III report, 59% of all first time mothers took childbirth classes, compared with 70% in the 2002 LtM I report.  In 2013, 17% of experienced mothers took classes, down from 19% in 2002 (Declercq, 2013, Declercq 2002).

Lamaze International, with its diverse and experienced team of Lamaze Certified Childbirth Educators, is in a unique position to collect data on the experiences of parents who take Lamaze childbirth classes and utilize Lamaze International resources.  The Lamaze staff and Board of Directors have developed and initiated a Parent Satisfaction Survey that can be filled out by families who have completed a Lamaze class.  The survey is meant to be completed after the birth of their baby, so that the information can be used to determine how their Lamaze class impacted their actual choices and experience.

The information being collected in this Parent Satisfaction Survey can play a key role in helping to:

Understand the impact of Lamaze classes

Data collected through these surveys can be used to understand the impact of Lamaze classes on families and birth outcomes and guide further research on this topic. Exploring this area of research can help Lamaze and other organizations to access funding to further develop and continue studying this important topic

Lobby for improved access

Information gained through these post-birth surveys  can be used to educate lawmakers on the outcomes of births when families participated in birth classes and encourage legislators to offer reimbursement and increased access for childbirth education classes across all socioeconomic and ethnic categories. Lamaze International plans to repeat their “Hill Day” campaign and lobby Congressmen/women in early spring of 2016 by visiting them in their D.C. offices and sharing information about maternal infant health and outcomes experienced by parents and infants during the childbearing year.

Improve information and educational materials

The results of the survey can help Lamaze International to be sure their message is on target and their educational materials are effective in sharing information on best practices, evidence based care and informed consent and refusal.  Lamaze can continue to develop curriculum and services that help families to “Push for Their Baby” during pregnancy, birth and postpartum.

Help LCCEs to deliver education

Every childbirth educator’s goal is to communicate important information to expectant families through engaging and effective activities.  Aggregated survey information can help Lamaze International provide information and direction to all the LCCEs so that they can assess how they can continue to provide valuable and useful information to the families participating in their Lamaze classes.

Share the message with other stakeholders

Information gleaned from the survey will be shared with policymakers and key third-party organization stakeholders at upcoming roundtables that Lamaze representatives facilitate in and host.  It is important for health care providers, hospital administrators and maternal infant health organizations to recognize how effective Lamaze childbirth classes can be be in creating a safe and healthy birth for participating families.

Linda Harmon, Lamaze International’s Executive Director took a moment recently to answer some questions about the Parent Satisfaction Survey.

Sharon Muza:  There is not a lot of research available on the effectiveness of childbirth/Lamaze classes.  Do you feel this information could be used as the basis of that research?

 Linda Harmon: Lamaze has commissioned a White Paper which will present the evidence related to childbirth interventions overuse in the US hospital system, and the effects they can have on childbirth outcomes, and present the argument that evidence-based prenatal education is a critical avenue for women when making childbirth care decisions.  The parent satisfaction survey will support this research by providing data from the parents who have used Lamaze resources.

SM: How could the information gained from this survey be used to further reimbursement for families who take childbirth classes?

LH: Data gained from the Lamaze Parent Satisfaction Survey will be used to provide important insights about the impact of Lamaze childbirth education on the experiences and outcomes of pregnant women and their babies. These insights will provide valuable information to support discussions with healthcare insurers, hospitals and other strategic partners to advance Lamaze education.  Preliminary data from the Lamaze national parent satisfaction survey shows that women engaged with Lamaze have a cesarean rate of 20%. That’s about 13% less than the national cesarean rate of 33%.  If a 13% reduction in cesarean could be translated across the U.S., the potential cost savings would be nearly $4.7 billion annually.

SM: Lamaze International is an international leader in childbirth education and offers a great curriculum filled with best practice and evidence based information.  Have initial survey responses indicated that our classes have been a useful component for families welcoming a child?

LH: The preliminary data is very positive, but we need substantially more parent survey responses to  validate general trends. In the initial review of survey findings in March 2015,  we compared what women told us in the Lamaze survey with what women reported in the highly-respected national survey Listening to Mothers III: Pregnancy and Birth.  Early survey responses show that 94% of women taking Lamaze classes say that education provided by Lamaze improved their childbirth experience and 91% feel well informed about decisions in labor and birth.

You Can Help Advocate for Childbirth Education

Lamaze Certified Childbirth Educators play a key role in getting the word out to the families who participate in their classes.  Through information received from you, families can be directed to the survey and asked to participate.  During the online survey, participants are asked a handful of simple questions that seek to learn if childbirth education improved their birth experience.

Lamaze has put together many resources for LCCE educators to help you understand the importance of this survey.  These resources include:

  • An FAQ to help you become familiar with the survey and encourage you to participate.
  • How to introduce the survey in class – We have created sample messages and instructions for  encouraging your students to sign up for the survey
  • Promote the survey – We have developed a sample email you can send your class, introducing them to the survey, as well as sample Facebook, Twitter and blog posts.

Every family that participates in the survey will receive a coupon for a discount on a Lamaze toy.

Win a 2016 Lamaze International conference registration

If you encourage participation, you will be entered to win a complimentary Lamaze International 2016 Annual Conference registration. If your name is referenced as their childbirth educator in the survey, you will be entered in the drawing—and the more your name is referenced, the more entries you will have!  This is a real bonus reason to share the survey with parents, even beyond the benefits to research and programs. 

 Are you already encouraging your families to take the Parent Satisfaction Survey?  Share your experiences in the comments section.  If you have not yet begun to communicate information to your families about the survey, I hope that you will reconsider as you recognize the importance of your role in collecting this valuable data.


Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, A. (2013). Listening to Mothers III: Pregnancy and Birth; Report of the Third National US Survey of Women’s Childbearing Experiences. New York, NY: Childbirth Connection.

Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Risher, P. (2002). Listening to mothers: Report of the first national US survey of women’s childbearing experiences. New York.

Babies, Cesarean Birth, Childbirth Education, Lamaze International, Lamaze News, New Research , , , , , ,

The Numbers Are In – Good News on Key Birth Statistics, But Work Still to Be Done

October 13th, 2015 by avatar

the numbers are inLast week, the National Center for Health Statistics (NCHS), part of the Centers for Disease Control (CDC) released 2014 information from the National Vital Statistics System, which works collaboratively with the NCHS.  This information comes from birth certificates and captures all births that have occurred in the United States during the reporting period.

There was definitely some good news amongst the mammoth report. Here are some highlights:

General Fertility Rate

The general fertility rate (GFR- number of births/1,000 women) increased to 62.9 per 1,000 women between the ages of 15 to 44..  This increase is the first increase since 2007.  Birth rates often decrease during periods of national financial instability.  Possibly, people are feeling more positive about the economy and their own financial security. While the increase from 2013 to 2014  was only 1%, things may be turning around as it has been an eight year streak of consecutive decreases.  it should be noted that non-Hispanic white women and Asian Pacific Islanders both had an increase in the GFR, the rate remained unchanged for non-Hispanic black women.  The fertility rates of Hispanic and American Indian or Alaskan Native women both hit historic lows.

Teen Birth Rates

The birth rates amongst teens aged 15-19 declined to historic lows for all teens as well as for each race and Hispanic origin group.  The birth rate for teens aged 15-19 dropped 9% from 2013 to 2014.   It was 24.2 per 1,000 females aged 15-19.  Comparing the 2014 rate to 2007, the rate has dropped 42%!

Cesarean Rates

The cesarean birth rate was 2014 was 32.2%, down from 32.7% in 2013.  The 2014 cesarean birth rate is down 2% from the high of 32.9 in 2009. Of significance – the cesarean delivery rates for non-Hispanic black, Hispanic and Asian/Pacific Islanders declined for the first time since 1996.  These groups have had 18 consecutive years of increasing cesarean birth rates.  Non-Hispanic white women have consistently had the larger declines.

Preterm Birth Rates

The number of babies born before 37 completed weeks of gestation declined again to 9.57% of all births.  Since 2007, the percentage of preterm babies is down 8% since 2007.  In 2014, non-Hispanic black infants were about 50% more likely to be born preterm than non-Hispanic white, Hispanic, and Asian/Pacific Islander infants.  Many campaigns, such a “Go the Full 40” (AWHONN) and “A Healthy Baby Is Worth the Wait” (March of Dimes) and others by additional organizations have been effective at reducing the number of non-medically necessary inductions before 39 weeks.

If you are interested in all the data – or even accessing the raw data for your own analysis, head over to the NCHS/CDC Vital Statistics website to download the reports or databases of your choice.

Leapfrog Group Releases Hospital Cesarean Rates

© Leapfrog Group

© Leapfrog Group

Additionally, last week, The Leapfrog Group – a nonprofit national watchdog group whose mission is to imporove the safety, quality and affordability of health care by a) supporting informed health care decisions by those who use and pay for health care; and, b) promoting high-value health care through incentives and rewards, released a national cesarean rate by hospital report.  This report, readily available to consumers, includes information on 48 states and Washington DC.  You can read the full press release here.

1122 hospitals voluntarily responded to the 2015 Leapfrog Hospital Survey.  Upon analysis, it was determined tht over 60% of reporting hospitals had excessive rates of cesarean sections.  The Leapfrog Cesarean Report collaborated with Childbirth Connection to help explain the information contained in the report.

The report contains the NTSV cesarean rates for the 1122 hospitals.  NTSV refers to a first time (nulliparous) pregnancy, that is full term (37th week or later) and there is one fetus (singleton) in the vertex (head down) position.  The NTSV cesarean section rate is recognized as being directly associated with quality improvement activities that are being implemented to reduce the number of unnecessary cesareans.

The cesarean section target rate for NTSV population that the Leapfrog Group adopted is 23.9% based on a proposal by the HealthyPeople.gov’s 2020 initiative, which seeks to improve the health and well-being of women, infants, children and families by the year 2020. It is important to realize that this NTSV rate is not the overall cesarean rate, which is much higher as it includes all births, not just those NTSV births.

“This is really about how well we, as doctors, nurses, midwives, and hospitals, support labor. Hospital staff that support labor appropriately and are sensitive to families’ birth plans are shown to have lower C-section rates overall. If we want to improve this rate across the board, then hospitals must hold themselves to this standard to ensure safe short- and long-term outcomes for both mom and baby.” Elliott Main, M.D., chair of Leapfrog’s Maternity Care Expert Panel and medical director of Stanford’s California Maternal Quality Care Collaborative.

Utah had the lowest number of NTSV cesareans at 18.3%.  Kentucky was last with an NTSV cesarean rate of 35.3%.  (Not all states had sufficient hospitals reporting data to calculate their ranking)

Consumers can find out the ranking of hospitals in their state by following this link.  There is also a very helpful section in this report that includes information on how consumers can help navigate their maternity health care options to prevent unnecessary cesarean sections.

As a childbirth educator, will you share this information with the families you work with?  How will you help them to understand the importance of their choice of birth locations?  How can you help families to navigate this situation when they do not have the freedom of choice or do not have an alternative available to them?








Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2014. NCHS data brief, no 216. Hyattsville, MD: National Center for Health Statistics. 2015.



what does it mean when the hospital doesn’t report

transparency acts of mass and NY

and if a firm like leapfrog can’t get them imagine how hard for average consumer


Cesarean Birth, Childbirth Education, New Research, Newborns, Pre-term Birth, Research , , , , , , , , ,

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 , , , , , , , ,

Working to Improve Perinatal Depression Rates – An Interview with Researcher Nancy 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.


  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 , , , , , , ,

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