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New Report Provides Information on America’s Children, Including Key Birth Indicators

July 16th, 2015 by avatar

flickr photo by [derekmswanson] http://flickr.com/photos/derekmswanson/4875902007 shared under a Creative Commons (BY) license

flickr photo by [derekmswanson] http://flickr.com/photos/derekmswanson/4875902007 shared under a Creative Commons (BY) license

The just released report – America’s Children: Key National Indicators of Well-Being, 2015 is a collaboration between 23 different Federal agencies, all participating in the Federal Interagency Forum on Child and Family Statistics, which was chartered in 1997 with a mission to collect and document enhanced data on children and youth in the United States, improve the publication and dissemination of information to interested community members along with the general public and capture more accurate and extensive data on children at the Federal, state and local levels.

This extensive report is prepared from the most reliable Federal statistics and research and represents large segments of the population, examining 41 key indicators that represent important aspects of the lives of children. It is designed to be easily understood by the general public.  This is the 17th report in the series.  The key indicators found in the report can be divided into seven domains: family and social environment, economic circumstances, health care, physical environment and safety, behavior, education, and health.  America’s Children: Key National Indicators of Well-Being, 2015 is an exhaustive but fascinating report that makes for interesting reading.

I have pulled out some of the updated statistics and interesting facts as it relates to pregnancy, birth and newborns.

  • The United States had 73.6 million children in 2014 and this number is expected to increase to 76.3 million in 2030. While the number of children living in the United States has grown, the ratio of children to adults has decreased.
  • The continued growth of racial and ethnic diversity will be more an more apparent in the population of children in the USA. In 2020, less than half of all children are projected to be White, non-Hispanic and by 2050, 39 percent are projected to be White, Non-Hispanic and 32 percent of the children will be Hispanic.
  • In 2013, there were 44 births for every 1,000 unmarried women ages 15–44, down from 45 per 1,000 in 2012. The birth rate in 2013 was highest for women in the 25-29 age group (67 per 1,000), followed by the rate for women ages 20–24 (63 per 1,000). The percentage of births to unmarried women among all births decreased from 41.0 percent in 2009 to 40.6 percent in 2013.
  • The adolescent birth rate was 12 per 1,000 adolescents ages 15–17 in 2013, which was a record low for the country.
  • The percentage of infants born preterm declined to 11.4 percent in 2013; it was the seventh straight year the percentage declined.  In 2013, as in earlier years, Black, non-Hispanic women were more likely to have a preterm birth (16.3 percent) than were White, non-Hispanic (10.2 percent) and Hispanic (11.3 percent) women.
  • The percentage of infants born with low birthweight was 8.0 in 2013.  Low birth weight is defined as less than 2,500 grams, or 5 lbs. 8 oz. Black, non-Hispanic women were the most likely to have a low birthweight infant in 2013 (13.1 percent, compared with 7.0 percent for White, non-Hispanic, 7.5 percent for American Indian or Alaska Native, 8.3 percent for Asian or Pacific Islander, and 7.1 percent for Hispanic mothers).
  • The infant mortality rate of 6 deaths per 1,000 live births in 2012 was unchanged from 2011. The mortality rates of Black, non-Hispanic and American Indian or Alaska Native infants have been consistently higher than the rates of other racial and ethnic groups. The Black, non-Hispanic infant mortality rate in 2012 was 11.2 infant deaths per 1,000 live births and the American Indian or Alaska Native rate was 8.4 per 1,000 live births; both rates were higher than the rates among White, non-Hispanic (5.0 per 1,000 live births), Hispanic (5.1 per 1,000 live births), and Asian or Pacific Islander (4.1 per 1,000 live births) infants.

When you read these facts and look at the other fascinating information included in the report – what comes to mind for you?  Do you see opportunities for providing services beyond what you already provide?  Might there be a need for education, information and resources designed to serve another demographic than the current populations you serve?  Could you help improve outcomes (prematurity, low birth weight, teen pregnancy) by adding classes, providing additional information or making your current classes accessible to a more diverse population?  Let us know in the comments section after you have a chance to poke around the information available in the recently released report –  America’s Children: Key National Indicators of Well-Being, 2015.  For more general information, including supplemental reports and an overall summary, check out the ChildStats.gov website.

Babies, Childbirth Education, Newborns, Research , , ,

Access Safe Sleep Photos for Your Use – Help Families Reduce Unsafe Sleep Environments

July 9th, 2015 by avatar

 Lamaze Certified Childbirth Educators and other professionals that work with expectant and new families often share information and resources on the topic of newborn and infant sleep.  This subject always elicits lots of questions and discussion in my childbirth classes from the families.  I always make sure to provide resources that clearly demonstrate what constitutes a safe sleep environment, some helpful strategies on getting “enough” sleep with a newborn and how families can reduce the risk of SUID/SID for their infant.

Lamaze International President Robin Elise Weiss, Ph.D recently participated in a Federal SUID/SID Workgroup forum and one of the outcomes of this forum was a Safe Infant Sleep Photo Repository.  This collection of images reinforces the American Academy of Pediatrics safe sleep recommendations.  All of the images are in the public domain, which means that you are free to use them for your blog posts, teaching presentations, classroom posters, websites and other needs as you like.  There are plans to increase the diversity of families represented in the images in the near future, to include Native Americans and Native Alaskans.

First Candle’s Safe Sleep Image Guidelines is a useful resource if you are a photographer who takes your own images or you are looking to better understand what type of safe sleep image to use in your work with families.  Additionally, if you see images in the media (magazines, websites, commercials, marketing materials, ads, etc.) that are using unsafe sleep images, you can contact First Candle and let them know, so they can contact the appropriate organization and have them replaced with images showing safe sleep environments.

Some of my favorite safe sleep resources include:

Take a moment to review your teaching materials and resources on the topic of safe sleep for new families.  Make sure your images model safe sleep practices. Check out the images in the Safe Sleep Image Repository and use them as you like in your classroom, your practice and as you work with families.  What families learn from you about safe sleep can help to reduce the tragic death of an infant as a result of being placed in an unsafe sleep environment.  How do you talk about safe sleep to your clients and students?  Share your favorite resources and teaching ideas on the topic of safe sleep in the comments section below.  Would you consider using some of the images available in the Safe Sleep Image Repository?  Let us know.

 

 

 

Childbirth Education, Newborns , , , , , , , ,

Book Review: “A Breastfeeding-Friendly Approach to Postpartum Depression: A Resource Guide for Health Care Providers”

May 28th, 2015 by avatar

By Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM

monograph cover_tn_kenKathleen Kendall-Tackett, Ph.D, author, IBCLC, researcher, internationally acclaimed speaker and occasional contributor to our blog, has written a new book – “A Breastfeeding-Friendly Approach to Postpartum Depression: A Resource Guide for Health Care Providers,” that tries to lay to rest the myth that receiving help for a postpartum mood disorder and breastfeeding are not compatible.  I asked Cynthia Good Mojab to share her expert review of the book to commemorate the end of Perinatal Mood Disorders Awareness Month.  Cynthia is the perfect person for this task as she wears the hat of both a lactation consultant and a clinical counselor.  As birth professionals who work with families throughout the childbearing year, we have a sincere responsibility to provide information and screening resources so that families can be evaluated and directed to receive help that continues to support the breastfeeding dyad if breastfeeding is the parent’s desire.  Read Cynthia’s review and consider what you can do to increase awareness of perinatal mood disorders and offer your clients and students the best evidence based information available about how treatment options and breastfeeding are not mutually exclusive. – Sharon Muza, Community Manager, Science & Sensibility

Globally, the prevalence of postpartum depression is as high as 82.1% when measured using self-report questionnaires and as high as 26.3% when measured using structured clinical interviews (Norhayati, Nik Hazlina, Asrenee, & Wan Emilin, 2014). These high rates mean that a significant proportion of families navigate breastfeeding in the context of postpartum depression.

As a perinatal mental health care provider and an IBCLC, I am frequently contacted by parents who found me after having been unable to access breastfeeding-compatible mental health care for postpartum depression (Good Mojab, 2014). They report feeling as though they are caught between a rock and a hard place: they’ve been diagnosed with postpartum depression and have been told by their primary care provider and/or their mental health care provider that they must wean in order to treat their depression. Sometimes they are even told that breastfeeding is causing their depression. Not only is that not true, but the relationship between infant feeding and postpartum depression is actually quite complex (Nonacs, 2014). While breastfeeding problems increase the risk of postpartum depression, breastfeeding itself is protective (Kendall-Tacket, n.d.). And research shows that infant-feeding intentions matter: breastfeeding mothers who are unable to accomplish their breastfeeding goals are two-and-a-half times more likely to develop postpartum depression (Borra et al., 2015). These research findings match what I see in my private practice: the partial or complete loss of a parent’s desired experience of breastfeeding can precipitate deep grief and worsen or precede the onset of postpartum depression.

Fortunately, there are many breastfeeding-compatible treatments for postpartum depression which health care providers and mental health care providers can use to effectively treat the vast majority of their clients. Dr. Kathleen Kendall-Tackett’s new book, “A Breastfeeding-Friendly Approach to Postpartum Depression: A Resource Guide for Health Care Providers,” presents an up-to-date overview of the related research in an outline format that is quick and easy to read. She presents a compelling case for ensuring that families coping with breastfeeding problems receive additional lactation support and that breastfeeding parents coping with postpartum depression have access to treatment that is compatible with the continuation of breastfeeding.

In the first chapter, Kendall-Tackett introduces the rationale for screening for, referring for, and treating postpartum depression: postpartum depression is common in new parents and untreated postpartum depression has significant, immediate, and long-term negative consequences for both parent and child. She then presents research showing that breastfeeding does not cause depression (as some health care providers falsely believe); rather, breastfeeding serves to protect the dyad from the deleterious consequences of postpartum depression via its dampening of the stress response and via its facilitation of ongoing engagement between parent and baby. (When we shift our culturally based reference frame in recognition that breastfeeding is the biological norm for humans, we can see that this research also shows that formula feeding increases the risk of deleterious consequences from postpartum depression through increasing the stress response and potentially lessening ongoing engagement between parent and baby.) The substantial evidence base for why the effective treatment of postpartum depression is so critical—briefly introduced in chapter 1—is presented in more detail in chapter 3. Psychological disorders that often co-occur with postpartum depression, such as posttraumatic stress disorder, bipolar disorder, eating disorders, and obsessive-compulsive disorder, are then described. Chapter 5 reviews the complex causes of postpartum depression, including inflammation, fatigue and sleep disturbance, pain, traumatic birth experiences, infant characteristics such as illness and prematurity, and maternal characteristics, life history, psychiatric history, and social context.baby breastfeeding

Chapter 6 emphasizes the importance of screening for postpartum depression. Kendall-Tackett wisely advocates that validated screening tools be used (rather than relying merely on casual observation) and that screening occur in a variety of care settings—prenatal, hospital, home, and pediatric office visits. The recommendation for prenatal screening is very important. Depression during pregnancy is common (11% to 23% of pregnant women experience depression), is a risk factor for adverse reproductive outcomes such as preterm delivery, and is among the strongest predictors of postpartum depression (Gaynes, et al., 2005; Yonkers, et al., 2009; Norhayati, Nik Hazlina, Asrenee, & Wan Emilin, 2014). Kendall-Tackett describes three reliable screening tools—two of which (the Patient Health Questionnaire-2 and the Edinburgh Postnatal Depression Scale) are in the public domain. This excellent chapter would be improved further with information about how to implement perinatal mental health screening in various settings, including the need to build a breastfeeding-friendly referral network prior to initiating screening and the need to develop or obtain materials (e.g., brochures, handouts, posters, resource lists, referral lists) that provide anticipatory guidance and help parents more easily access information, support, and treatment for postpartum depression (Good Mojab, 2015).

In chapter 7, Kendall-Tackett presents the development of a breastfeeding-friendly treatment plan as being grounded in the facilitation of informed decision making—something perinatal care providers are ethically obligated to do. Informed decision making requires that parents be offered evidence-based information that will allow them to weigh the risks and benefits of a variety of treatment options. This final chapter presents such information in the form of a succinct review of the available research on treatments that have been shown to be effective in treating depression, including: 1) “alternative” treatments (i.e., long-chain omega-3 fatty acids, exercise, S-Adenosyl-L-Methionine, and bright light therapy), 2) psychotherapeutic treatments (i.e., cognitive behavioral therapy and interpersonal therapy), 3) herbal medications (i.e., St. John’s Wort); and 4) anti-depressant medications. The reader is referred to the Infant Risk Center for up-to-date information about the use of particular anti-depressant medications during breastfeeding. Additionally, Medications and Mothers’ Milk: A Manual of Lactational Pharmacology is listed among the references. The LactMed app, though not mentioned in the book, is another useful resource for facilitating informed decision making regarding the use of drugs and supplements during breastfeeding.

The appendices are helpful for readers who have not yet begun to screen for perinatal depression and are looking for appropriate screening tools. Included are the Postpartum Depression Predictors Inventory—which can be used to identify risk factors for postpartum depression—and the Edinburgh Postnatal Depression Scale—which is well-validated as a screening tool for perinatal depression in mothers, in many cultures and languages, and in fathers. (A gender/prenatal/postpartum inclusive version of the EPDS is available here.) Because postpartum depression often includes symptoms of anxiety and/or co-occurs with an anxiety disorder, the appendices would have been improved by including the well-validated Generalized Anxiety Disorder 7-item (GAD-7) Scale, which is also in the public domain.

Scattered throughout the book are links to video clips that provide information on topics such as how breastfeeding protects maternal mental health and how breastfeeding ameliorates the negative effects of sexual assault. Readers with an auditory learning style will especially appreciate this access to online interviews and mini-presentations. Unfortunately, the dark gray links on a light gray background can sometimes be hard to read, leaving the reader to wonder “is that character a capital I, a lowercase L, or a numeric 1?” But, the video resources are worth the trial and error needed to open a couple of the links. Those with access to a smartphone with a QR code reader or barcode scanner can simply scan the code for each video clip to open the links, which greatly simplifies the process.

While the title of the book, “A Breastfeeding-Friendly Approach to Postpartum Depression,” is gender neutral, readers should know that the book is focused on cisgender mothers and uses cisnormative language. Certainly, there is a dearth of research on transgender and gender non-conforming parents which makes it difficult to write an evidence-based book addressing their needs in the context of breastfeeding/chestfeeding and postpartum depression. Nonetheless, we can infer that the high rate of clinical depression (44.1%) among transgender individuals means that transgender parents are at high risk for postpartum depression. And, the fact that transgender individuals experience “gender insensitivity, displays of discomfort, denied services, substandard care, verbal abuse, and forced care” in health care settings (Bockting, et al., 2013) means that transgender parents are also at high risk of being unable to access effective mental health care, much less breastfeeding/chestfeeding-compatible mental health care. Perinatal care providers need to be aware of these higher risks and learn how to bring their services into compliance with the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (Bockting, et al., 2011). The lactation-friendly treatment options for postpartum depression that are reviewed in the book are likely to also be effective for transgender and gender non-conforming parents who breastfeed, chestfeed, or feed their expressed milk to their babies. The effective treatment of breastfeeding/chestfeeding parents with postpartum depression will also need to include responding to whether and how they are experiencing gender dysphoria during lactation.

Although written for health care providers, “A Breastfeeding-Friendly Approach to Postpartum Depression” will also be useful for childbirth educators, doulas, lay supporters, lactation specialists, and perinatal mental health care providers as they strive to do their part to offer families evidence-based anticipatory guidance about postpartum depression and its treatment options, advocate for more lactation support for families coping with breastfeeding difficulties, screen for postpartum depression, refer to and effectively collaborate with other breastfeeding-friendly perinatal care providers, and provide services that avoid iatrogenically increasing the risk of negative health, developmental, and mental health consequences for parents and babies through the unnecessary undermining of breastfeeding. The more widely Dr. Kendall-Tackett’s powerful little book is read and applied in practice, the more breastfeeding families will have access to breastfeeding-compatible treatment that truly meets their needs in the context of postpartum depression.

References

Bockting, W., Miner, M., Swinburne, R., Hamilton, A., and Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health, 103:943–951. Accessed: May 23, 2015. Url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698807/pdf/AJPH.2013.301241.pdf

Borra, C., Iacovou, M., and Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intentions. Maternal and Child Health Journal, 19:897–907. Url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353856/pdf/10995_2014_Article_1591.pdf

Coleman, E., Bockting, W., Botzer, M., et al. (2011). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13:165–232. Accessed May 23, 2015. Url: http://www.wpath.org/uploaded_files/140/files/IJT%20soc,%20v7.pdf

Gaynes, B., Gavin, N., Meltzer-Brody, S., Lohr, K., Swinson, T., Gartlehner, G., Brody, S., Miller, W., et al. (2005). Perinatal depression: Prevalence, screening accuracy and screening outcomes;Evid Rep Technol Assess (Summ). 119:1–8.

Good Mojab, C. (2014). Mental Health Care for Postpartum Depression During Breastfeeding. Lynnwood, WA: LifeCircle Counseling and Consulting, LLC. Accessed May 23, 2015. Url: http://lifecirclecc.com/yahoo_site_admin/assets/docs/MentalHealthCarePPDBfd2014.pdf

Good Mojab, C. (2015). The Basics of Perinatal Screening. Accessed May 23, 2015. Url: http://www.lifecirclecc.com/professionals/perinatal_screening

Hale, T. and Rowe, H. (2014). Medications and Mothers’ Milk: A Manual of Lactational Pharmacology. Amarillo, TX: Hale Publishing.

Kendall-Tackett, K. (n.d). Why Breastfeeding and Omega-3s Help Prevent Depression in Pregnant and Postpartum Women. Accessed May 23, 2015. Url: http://www.uppitysciencechick.com/why_bfand_omega_3s.pdf

Kosenko, K., Rintamaki, L., Raney, S., and Maness, K. (2013). Transgender patient perceptions of stigma in health care contexts. Med Care, 51(9):819-22.

Nonacs, R. (2014). Breastfeeding and Postpartum Depression: Further Insights Into a Complicated Relationship. Massachusetts General Hospital Center for Women’s Mental Health. Accessed: May 23, 2015. Url: http://womensmentalhealth.org/posts/breastfeeding-postpartum-depression-insights-complicated-relationship/

Norhayati, M., Nik Hazlina, N., Asrenee, A., & Wan Emilin, W. (2014). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, 175C, 34-52.

Yonkers, K. Wisner, K., Stewart, D. Oberlander, T., Dell, D., Stotland, N., Ramin, S., et al. (2009). The management of depression during pregnancy: A report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol. 114(3):703–713. Accessed: May 28, 2015. Url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094693/pdf/nihms293837.pdf 

About Cynthia Good Mojab

cynthia good mojab headshot 2015Cynthia Good Mojab, MS Clinical Psychology, is a Clinical Counselor, International Board Certified Lactation Consultant, author, award-winning researcher, and internationally recognized speaker. She is the Director of LifeCircle Counseling and Consulting, LLC where she specializes in providing perinatal mental health care, including breastfeeding-compatible treatment for postpartum depression. Cynthia is Certified in Acute Traumatic Stress Management and is a member of the American Academy of Experts in Traumatic Stress and the National Center for Crisis Management. Her areas of focus include perinatal loss, grief, depression, anxiety, and trauma; lactational psychology; cultural competence; and social justice. She has authored, contributed to, and provided editorial review of numerous publications. Cynthia can be reached through her website.

 

Babies, Book Reviews, Breastfeeding, Childbirth Education, Evidence Based Medicine, Guest Posts, Maternal Mental Health, New Research, Newborns, Perinatal Mood Disorders, Postpartum Depression, Uncategorized , , , , , , , ,

Book Review: Birth Ambassadors; Doulas and the Re-Emergence of Woman-Supported Birth in America.

May 7th, 2015 by avatar

By Kim James, BA, BDT(DONA), CD(PALS), ICCE, LCCE

May is International Doula Month and Lamaze International recognizes the importance of labor support. (Note – there are both birth and postpartum doulas who work with families during the childbearing year. We are grateful for the work that they both do.)  In fact, our third Healthy Birth Practice specifically addresses doulas and support people as an effective component of safe and healthy birth. The American College of Obstetricians and Gynecologists (ACOG) in their 2014 Safe Prevention of the Primary Cesarean Obstetric Care Consensus Statement stated “published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”  Childbirth educators and health care providers have ample opportunity to inform parents about the benefits of a doula when they are meeting with families and patients.  

In mid-2014, sociologist Christine Morton, Ph.D. with Elayne G. Clift, MA, wrote a book, Birth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America examining doulas from both an historical perspective as well as an assessment of the role of the doula in current American society . Kim James, LCCE and certified DONA birth doula, reviews this book and shares her perspective and take-aways with readers of this blog.

This book would make a great read for a book club book for birth professionals, and Kim generously shares some discussion questions at the end of today’s post to facilitate your discussion, should you wish to participate.  Alternately, if you have read the book, please feel free to respond in our comments section. 

Science & Sensibility and Lamaze International want to thank all the doulas who work tirelessly to support families as they birth their babies and transition to parenthood. Happy International Doula Month. – Sharon Muza, Science & Sensibility Community Manager. 

idm15 lamazeBirth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America, written by Christine Morton, Ph.D. with Elayne G. Clift, MAis a thorough and compelling documentary of the history of doula support, the current dilemmas and issues facing the doula occupation, what drives doulas to pursue this work and how the work of doula support might fit into the future as the United States strains to find better ways of providing quality improvements in maternity care. For doula trainers and doulas looking to pursue this work in a professional manner, Birth Ambassadors is critical, mandatory reading. (For trainers and doulas interested in how to use this book to critically assess your work, please see the discussion questions below this article).

But what about for childbirth educators? What in it for them?

While the history is fascinating, it’s the critical sociological analysis of the current dilemmas and issues facing the doula occupation that childbirth educators’ need to thoroughly understand, especially Lamaze certified childbirth educators.

Lamaze International’s third Healthy Care Practice, ‘Bring a Loved One, Friend or Doula for Continuous Support’, outlines why continuous support is important and how a doula performs their work:

  • Continuous support can help alleviate fear and worry.
  • A doula’s intuitive sense and training mean emotional and physical needs are met with timely, individualized care.
  • Greater emotional and physical comfort may encourage the most efficient and healthy labor progress.

While most childbirth educators are aware of the intended benefits of doula care, not all are aware of the dilemmas doulas face in performing their work and the institutional and cultural issues that prevent doulas from having the greatest beneficial impact. Lamaze certified childbirth educators must have a firm understanding of these dilemmas so as not to ‘over-promise’ what the third Lamaze Healthy Care Practice is intended to deliver.

I want to highlight three dilemmas facing doulas that childbirth educators should be aware of and what they can do to educate parents who want doula-supported birth experiences:

Kim James' well read Birth  Ambassadors

Kim James’ well read Birth Ambassadors

First dilemma

The ecological fallacy of applying aggregate results of research that show doula efficacy to an individual family’s outcome. The cultural and institutional context of most US hospital births limit the doula’s efficacy, often by prohibiting truly continuous support and refusing to recognize a doula’s unique scope of practice. Childbirth educators should lead discussions with parents about what hospitals and which care providers in their areas are most and least supportive of doula care. Childbirth educators are instrumental in helping parents understand the questions they can ask during hospital tours and prenatal visits to find out if their chosen place of birth and attendant understand and support doulas attending families at births.

Second dilemma

The frequent contradiction between a doula’s personal values (often a deep belief in the optimality of the midwifery model of care, natural, drug-free childbirth or specific parenting practices) and her obligation to provide unconditional support for parents’ birth and parenting choices. Childbirth educators must help parents clarify their values around birth and parenting so that parents can find the support people who suit them best. Not every doula will be the best support for every parent.

Third dilemma

No occupation-wide standard for training or certification. The competing tensions within doula organizations between increased professionalization and maintaining low barriers to entry for all people to become doulas remain unresolved. While the majority of doulas are well-trained through recognized, long-standing organizations, some will only have received light, if any, training possibly through correspondence and online courses. Not every doula’s skill set is the same. Not every doula will practice within a scope of practice that is evidence based. Not every doula will pledge to follow a recognized code of ethics backed by an organization with an active grievance policy. Childbirth educators who make referrals to families asking for doulas should always make referrals to doulas who are well-trained, consistently receive excellent feedback from the families they serve and most importantly practice in a manner that is consistent with the evidence based third Lamaze Healthy Care Practice.

As a current Lamaze certified childbirth educator and professionally-working certified doula, I found my own experiences reflected in this book. While at times uncomfortable to confront the dilemmas and issues our occupation faces, Birth Ambassadors is well worth reading for the history and reflections for the future. It will give childbirth educators who are not currently practicing doulas good data on what the real impact of doula support means for the families that hire them.

Book club discussion questions

When Birth Ambassadors was newly released, I hosted a book club-style discussion group with several local doulas to discuss this book’s implications for our current and future work. Here are the big questions that came up for our group representing doulas who were well-established in their practices, those who were just starting out and both certified and non-certified doulas.

  • When is your personal bias stronger than your ability to offer unconditional support? (Reference: page 195).
  • Analyze this: “Doulas advocate evidence-based care for physiologic birth, yet are not trained clinically to recognize or treat women when their pregnancies and labors become non-normal”. (Reference: page 37).
  • The original purpose of the first doula organizations was to provide moral support for each other. What do we need from our organizations now? (Reference: page 90)
  • Do we have the training to be professionally non-judgmental? (Reference: page 196).
  • Doula neutrality –When do you abandon it? How do you maintain it? (Reference: page 261).
  • What are the current debates around our standard of practice and code of ethics? (Reference: page 81).
  • Outcome-based care vs emotional companionship: What are you drawn to in this work? (Reference: page 260)
  • Are you comfortable with the “outsider-within” role? Does attract or repel you? (Reference: page 36)

How do you talk about doulas in your childbirth classes?  In your midwifery or obstetrical practice?  Have you read Birth Ambassadors?  What were your big take-aways?  Have you shared Lamaze International’s “Who Says Three’s a Crowd?” infographic with the families you work with?

Note: Christine Morton is a member of Lamaze International’s Board of Directors.

About Kim James 

Kim James HeadshotKim James BA, BDT(DONA), CD(PALS), ICCE, LCCE, is an ICEA and Lamaze certified childbirth educator teaching at Parent Trust for Washington Children/Great Starts where she sits on the Education Committee. She owns and operates www.DoulaMatch.net and is a DONA International and PALS Doulas certified birth doula as well as a DONA-approved birth doula trainer working at the Simkin Center/Bastyr University. Kim also volunteers her time on the Lamaze International membership committee and serves as Washington State DONA SPAR. Her daughters are 9 and 16 years old.  Kim and her family live in Seattle, Washington.

Babies, Book Reviews, Childbirth Education, Doula Care, Guest Posts, Healthy Birth Practices, Lamaze International, Newborns , , , , , ,

BABE Series: Cesarean Section Role Play Helps Prepare Families

April 30th, 2015 by avatar

apron and babyToday, in our monthly series “Brilliant Activities for Birth Educators” (BABE), I would like to share one of the activities that I do in my Lamaze class to help families feel prepared for a cesarean section. Most families in my classes are planning a vaginal birth, but it never hurts to be prepared should plans change.  One in three pregnant people will birth by cesarean in the USA.  April is Cesarean Awareness Month and that is why I am sharing this activity at this time.

Objectives

My objectives for this specific activity are threefold – 1) to share how the procedure is done 2) to offer different options that might be available for the family to request (skin to skin in the OR, delayed newborn procedures, etc., and 3) brainstorm the role of the support person during a cesarean and what kind of support the pregnant person will find comforting and helpful.

This role play is done in the fifth week of a seven week series. We have just covered variations in labor (induction, augmentation, EFM, AROM, pain medications, assisted second stage and more). They have heard about the hard and soft reasons for a cesarean and now I hope that they will understand the procedure and the choices and options they might have at the time.

Supplies for the activity and the setup

  • Cesarean apron
  • surgical masks
  • drape
  • soft baby
  • hair nets
  • scrubs
  • surgical clothing
  • laminated labels for each role
  • optional – IV bag, BP cuff, EKG leads, etc
up close cesarean apron

Up close of four zippers on cesarean apron

My main prop in this activity is a “cesarean apron” handmade by Kris Avery, a fellow LCCE here in Washington State. The apron has breasts, a belly button and some pubic hair painted on it, but what makes it special is a series of zippers that correspond to the different layers of a person’s body that will be cut during the cesarean procedure. Each zipper is sewn into a different layer and opens to reveal the layer underneath. The skin is represented by the apron, and then there is a layer of fat (yellow felt) that zips open, revealing the uterus (red felt). There are no muscles to “open” because as we know, the abdominal muscles are retracted and not cut. Finally, underneath the uterus, is the amniotic sac, represented by a thin white nylon material.

I ask a partner to come with me out of sight of the class and place the cesarean apron on them. All the zippers are closed. I place a soft baby doll (I use the baby from IKEA) underneath the apron with the head positioned right near the inner zipper.  Sometimes I place the baby in the breech position and plan on having the bum be removed first. When the partner is ready, we walk together back into the classroom and I ask them to lay on a table, where I have placed a pillow.

How I conduct the role play

I invite two class members to come up and hold a drape at chest level, just like it might be positioned in the OR.  I hand out laminated cards to all the other class members. Each card has the role of someone who might be in the OR during a cesarean section – surgeon, baby nurse, anesthesiologist, surgical tech, respiratory therapist, and so on.   I ask the pregnant person who is partnered with my “cesarean person” to play the role of “partner.”  I invite the partner to get into the white “moon suit” that is normally provided to family members during a cesarean.  I hand out hair nets, scrubs, face masks, surgical gowns, to all those who will be in the OR and everyone suits up.  I position all the “actors” in the appropriate spot.  Some go by a pretend “baby warmer” and others stand around the birthing person while others go where they might be in the real operating room. I talk about how hard it is to tell who is in the room and what their role is, when everyone is wearing scrubs/gowns/hats/masks and suggest that they ask people to introduce themselves.  I discuss strategies that the birthing person can use if they are temporarily separated from their support person.  I bring the support person over and seat them at the head of the OR table near the “anesthesiologist” and discuss how they cannot see over the drape for both the patient and the partner. The partner can stand up at the time of birth if they wish, or together they could ask for the drape to be dropped at that moment.  I ask the pregnant person how they are feeling as the surgery is about to begin.FullSizeRender

I walk everyone through the procedure step by step and describe what is happening.  I share what noises they might hear, and what sensations the pregnant person might “feel.”  (Tugging, pressure, pulling, but no pain.)  I try and give a sense of how long it takes for each part of the operation, (prep, incision to baby, closure)  I ask the surgeons to begin to open the zippers, and talk about each layer that they come to.  Finally the surgeons are through the amniotic sac and they reach in and remove the baby’s head through the opening. It is a somewhat tight fit and we discuss how that might benefit the baby.

The baby is delivered, shown to the parents and taken over to the “warmer” where the baby team is waiting.  I encourage partner to go over and see the baby, initiate talking to the baby and start sharing information with the birthing person – what the baby looks like, how s/he is doing, and so on.

cesarean apronWe go on to discuss how the partner can facilitate having the baby brought over to the birthing person ASAP, skin-to-skin, what might need to happen if baby is moved to the special care nursery, and more.  Throughout all of this, the class participants are role-playing through all of the likely activities and people are stepping up to help the family to have a positive experience, within the scope of their assigned role.  The surgeons close (zip up) the different layers and close the outer zipper on the skin.

I am leaving out much of the detail, as I am confident that you can fill in the activities that happen when a person is prepped, taken to the OR, has the cesarean surgery and is then taken to recover.  My hope is to have parents aware of some of the major points of the overall procedure.

Processing the activity

The class members take off the “costumes” and return to their seats.  I feel it is very important to debrief this activity.  It can be overwhelming to some. We debrief further, discussing any observations they had, how they felt as our role play was happening. I ask what are the values that are important to them and their family, if a cesarean should be needed.  A discussion also takes place about what a cesarean recovery plan might look like and how the family’s needs might change if they do not have a vaginal birth.

How is this activity received?

IMG_0116During the activity, class members are usually very engaged and creative in answering questions, acting out their “roles” and brainstorming solutions to the situations I present.  The real magic happens when we debrief.  I can see the wheels turning as families articulate what they will want and need should they have a cesarean birth.  They learn that they have a voice and can share what is important with their medical team.

Time and time again, I receive emails and and notes from class members who ended up having a cesarean. They share how “accurate” our role play was and how it helped them to understand the steps involved with their cesarean.  They were able to speak up in regards to their preferences and felt like their class preparation helped to reduce their stress and anxiety.

Summary

This activity takes time and I often wonder if I should replace it with something much shorter that covers the same topic.  But, I continue to do this role play activity because I see how it really helps families to understand how to play an active role in the birth of their baby, even if it is by cesarean section.

Other resources that I share with the class are the following links:

How might you make a “cesarean apron” that you could use for this activity?  Do you have ideas on how you could modify this activity for your classes?  What other things do you do to help your families to be prepared for a cesarean birth?  I would love to learn how you cover this important topic.  Please share your ideas in the comments section below.

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.

 

Babies, Cesarean Birth, Childbirth Education, Medical Interventions, Newborns, Push for Your Baby, Series: BABE - Brilliant Activities for Birth Educators , , , ,

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