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“Pathway to a Healthy Birth” – Using Consumer Materials from Hormonal Physiology of Childbearing Report in Your Classes.

January 22nd, 2015 by avatar

Screen Shot 2015-01-21 at 6.01.46 PMLast week, Dr. Sarah Buckley in coordination with Childbirth Connection released a new research report, “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies and Maternity Care.”  This massive tome gathers in one place, all the current information available on the role of various hormones on pregnancy, labor, birth, breastfeeding and postpartum and provides information on what happens to the processes when interventions are introduced.  Well known childbirth educator Penny Simkin reviewed the report on Science & Sensibility on January 13th and then Michele Ondeck followed up with an exclusive Science & Sensibility interview with Sarah Buckley later in the week.

I think that everyone will acknowledge that this report is a remarkable and valuable piece of work, but at over 400 pages if you take into account all accompanying documents and with a bibliography consisting of over 1100 sources, the typical pregnant woman is hardly going to be keeping a copy on their bedside table for some light reading before drifting off to sleep.  Today on Science & Sensibility, I would like to highlight the resources and tools that Childbirth Connection has thoughtfully provided that are geared specifically for the consumer.  Childbirth educators, doulas and health care providers can access and share these materials with their students, clients and patients.

Pathway to a Healthy Birth – How to Help Your Hormones to Do Their Wonderful Work – consumer booklet

This 17 page colorful consumer booklet is written in easy to comprehend language and illustrated with attractive photographs that show a diverse collection of families.  Families are introduced to the hormones of birth and postpartum; oxytocin, beta-endorphins, catecholamines and endorphins.  Each hormone has a brief description and a short explanation about the role it plays in childbearing.

Families are told that events can interfere with the intended actions of the childbearing hormones.  Birthing women are encourage to think about how activities around them during their labor and birth may interfere with hormones and prevent the hormones from working effectively.

Women learn that hormones prepare her body for an efficient labor and birth.  The booklet addresses how women’s bodies are prepared by some hormones to handle the pain and stress that may accompany labor. They also find out that the hormones help prepare their babies for the newborn transition.  Infant attachment and maternal behaviors are also supported by the role of the hormones.

Follow Angela’s Birth Story

Families are introduced to “Angela” and read about her labor and birth story.  The story shows how the hormones allow the labor and birth to unfold in support of the normal processes and how small things can have a big impact and disrupt the process.  For example, The transition from home to hospital reduces the intensity and frequency of Angela’s contractions as a result of interference with the normal hormonal process.  The story is filled with lots of strategies to encourage and allow the hormonal effects as they are intended to occur.

It is easy to see from Angela’s story, that while labor and birth are hard and do involve pain, with the right support and environment, along with best practices that endorse physiological birth, Angela is able let her body do the work it is designed to do, and have a birth that is very satisfying to her.

“What’s Happening”

Accompanying the story is an easy to read guide that demonstrates exactly what the hormones of childbearing are doing at each particular point in Angela’s story.  Explanations of the role of each hormone as things unfold help families to understand how what happens in their own birth can affect their own birth story and outcome.

What Can You Do

The next portion of the brochure offers steps that families can take to help them identify providers and facilities that support physiologic birth.  Lists of questions to ask, tips for making a hospital room comfortable and private, interview questions for their doctor or midwife, how to pick a childbirth class, find a doula, how to determine if medical procedures are necessary and explore less interventive alternatives and more are all there in an easy to digest format. Included are valuable links in the final section that makes the booklet resource rich.  There are many web links to get more information about all the topics covered above.  This makes the booklet an ideal handout for a childbirth class, doula consultation or meet and greet with potential health care providers.

Infographic

Screen Shot 2015-01-21 at 6.03.49 PMThere is a consumer infographic that can be printed in a size suitable for hanging in a classroom or office, or provided in a smaller format that makes a great accompaniment to the above booklet.  The infographic identifies things that can keep a woman on the “pathway” to a physiological birth and what can steer her away from the pathway.  There is a lot of similarity between the points made in this infographic and the Lamaze Six Healthy Birth Practices.

One teaching idea

After discussing the role of hormones in labor and sharing the infographic as a visual aid, I can easily see how an educator can play a game with her class – making and distributing cards to class members with scenarios on them, and asking families to share if those scenarios and activities are making it easier for the mother to stay on the physiological pathway or what steers her further away and having the students identify which hormones are affected.

We have a responsibility as childbirth educators to share the important role the hormones of childbearing play in supporting healthy mothers, healthy births and healthy babies.  Using the Pathway to a Healthy Birth consumer booklet and accompanying infographic as part of your teaching materials provides a simple to understand but effective tool for conveying this information to the families you interact with.

How do you see yourself using these consumer products in your childbirth classes?  With your doula clients?  Please share your ideas for teaching, discussing and using this material and covering these topics with the families you work with.  I would love to hear your thoughts.

Babies, Breastfeeding, Childbirth Education, Healthy Birth Practices, Infant Attachment, Medical Interventions, Newborns, Research, Transforming Maternity Care , , , , , ,

An Interview with Sarah Buckley: Discussing Her New Report – “Hormonal Physiology of Childbearing”

January 15th, 2015 by avatar

By Michele Ondeck,RN, MEd, IBCLC, LCCE

© Sarah Buckley

© Sarah Buckley

Sarah Buckley is a family doctor, mother of four, and author of the bestselling book Gentle Birth, Gentle Mothering. She has been writing and lecturing about the hormones of birth, among other topics, since 2001. Mothering Magazine published her article “Ecstatic Birth, Nature’s Hormonal Blueprint of Labor” in 2002.  She lives with her family near Brisbane, Australia.  On Tuesday, January 13th, 2015, Dr, Buckley released a comprehensive report entitled “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care” in cooperation with Childbirth Connection.  Two days ago, Penny Simkin reviewed the report and shared valuable information on how birth professionals will be able to use this report in their classes or practices.  Today, Lamaze International Past President, Michele Ondeck, shares her recent interview with Dr. Buckley.  In this interview, they discuss Sarah’s thoughts on what this report means for both families and professionals. Sarah speaks to how it we are just beginning to recognize the downstream effects of disturbing the normal hormonal process that occurs during labor, birth and postpartum and what this disturbance might mean for future generations. – Sharon Muza, Community Manager, Science & Sensibility.

Michele Ondeck: Sarah, thank you for the in-depth review of the hormones of labor in the Hormonal Physiology of Childbearing (HPOC) report. I am thankful for the support you received for this project from the Childbirth Connection programs with the National Partnership for Women & Families. As a board member of Lamaze International, I am proud that we were able to also provide some support to make this report possible. How are you celebrating the report’s release?

Sarah Buckley: Finishing the report has been a big milestone, not just for me but also for my family who have been very involved and supportive. We’ll be celebrating with champagne and, as its summer down here, with an Aussie barbeque.

MO: Sarah, I have been sharing orchestration of the hormones of birth: oxytocin, beta endorphins, epinephrine and nor-epinephrine and prolactin from Ecstatic Birth with parents and professionals since its publication. You have expanded, clarified, and synthesized that basic information in your report. I know that you have been working on this report since 2011. What was your inspiration to keep at it? How did you find time to review more than 1,100 publications?

SB: Yes, it’s been a long gestation! What has kept me engaged is the practical relevance of the material for mothers, babies, fathers, and families, and my own lived experiences. For me, its much more than an academic body of knowledge, it’s a paradigm that recognizes the superb design of our female bodies, and describes the smoothest, safest, easiest, and most pleasurable path to parenting. I am also lucky to receive much support and positive feedback about this material, both from maternity care providers, who gain a scientific understanding of what they are seeing every day in the birth room, and from women themselves, who realize that there are positive ways to support their hormones and increase safety, ease, and pleasure for themselves and their babies.

Screen Shot 2015-01-13 at 6.38.16 PMMO: Now with the publication of the Hormonal Physiology of Childbearing, there is the potential to educate so many more professionals in the maternity and newborn care community. How does the timing of the report fit with the changes that you see happening today that can influence professionals?

SB: I have been writing and lecturing about the hormonal physiology for more than 10 years and I have seen a significant shift in receptiveness to this perspective, especially in the last 2 to 3 years. I think we are maturing as birth professionals and beginning to think more widely about the perinatal period. The microbiome paradigm, for example, which looks at the effects of birth on the transfer of healthy bacteria from mother to newborn, is giving us solid evidence that what happens at birth can have long-term consequences.

It is also a very exciting time to launch the report because this material is very much aligned with other initiatives, including ACNM’s Physiologic Birth Initiative and the ACOG/SMFM Safe Prevention of the Primary Cesarean Delivery statement. It’s also a pleasure to me that the Hormonal Physiology of Childbearing supports and extends other current models including the Lamaze Healthy Birth Practices.

MO: You refer to the growing recognition of the significance of the Developmental Origins of Health and Disease (DOHaD) in the report. Midwives, childbirth educators and doulas among others have long discussed the unintended consequences of interventions in childbirth. Now with more recognition of the importance of the perinatal period as a sensitive period that potentially affects long term health, how do you simply explain this fascinating concept and others like epigenetic programming for childbearing families?

SB: The perspective of Hormonal Physiology is very much aligned with these big-picture models including DOHaD, epigenetics, and Lifecourse Health Development, which is a multi-system model looking at the potential for early events to change the trajectory of long-term health and development.

Epigenetics refers to the biochemical processes that switch genes on or off, which helps organisms to adapt to their environment and circumstances. We know that epigenetic changes give critical adaptations (“programming”) in early life that increase the chance of survival in the environment they have come into.

In relation to DOHaD, it is now scientifically established, and widely accepted — e.g., you read this research in the media and online — that the baby’s exposures in the womb can have long-term health effects. We also know from animal studies (with a growing interest in human research also) that early life events can have long-term programming effects, and we have even identified the associated epigenetic changes in some animal studies.

What the HPOC perspective adds to these models is the possibility that these long-term programming effects may occur not only before and after birth but also during birth, and it provides possible mechanisms for such effects. In other words, changing the hormonal experiences around the time of birth could have far-reaching effects.

In fact, we would expect very significant epigenetic effects at this time, as part of the enormous shifts involved with adapting to life outside the womb and, for the mother, optimally adapting her to the essential tasks of nurturing and nourishing her young. We have substantial animal research showing long-term effects from perinatal hormone exposures, including exposure to high doses of synthetic oxytocin.

MO: When you were doing this in-depth research on the hormones of labor. What finding(s) were most meaningful to you as a mother?

SB: As we describe in the report, this is a “consistent and coherent mosaic coming into view,” so we don’t have all the gaps filled in. However, what strikes me as a mother, and in relation to my own experiences of birth and mothering, is evidence that the hormonal processes of labor and birth, including mother-newborn contact in the first hour after birth, might switch on maternal reward systems in the brain at this powerful time, so that the new mother finds her offspring rewarding into the future. This is a critical mechanism for species survival, and ensures that mammalian mothers give the dedicated care that their newborns need- without going to a prenatal class! And after birth, these systems are reinforced for the mother by rewarding hormones including oxytocin and beta-endorphins released with breastfeeding and also with close infant contact.

© Sarah Buckley

© Sarah Buckley

I wonder if some of the problems we have with parenting in our culture, that it seems like hard work, that we can find caring for our young children boring, are because we can miss all of these sources of rewarding hormones.

MO: The forward to the report was written by leaders in medicine, midwifery, nursing, obstetrics, and pediatrics urging maternity care to support physiologic birth in order to uphold the Precautionary Principle of “do no harm.” What do you want to say to us on where to start in changing the current environment?

SB: I think one of the most powerful things we can do is to share the information in this report, including the knowledge gaps, with professionals and with expectant parents, so that we can shift our cultural understanding towards appreciating how superbly designed women’s bodies are for childbearing, how these hormonal systems can be disrupted, and that we actually don’t know the long-term effects for our children, so we should be applying precaution.

I especially want to reach high-technology settings, so that we can begin to recognize the gap between physiology and current practice and work to bridge it. In situations where interventions are genuinely needed, I want care providers to be asking “How can we safely add more hormonal physiology?” and take actions. This could be as simple as supporting skin-to-skin after cesarean, or promoting doula care for women with pregnancy complications.

I also want this report to get the attention of policy makers and funders. Physiologic childbearing is a low-technology approach that is generally inexpensive compared to our current high-technology models of care. The hormonal physiology perspective also suggests significant longer-term and public health benefits, for example through support for breastfeeding. This could give even greater benefits and cost-effectiveness in the longer-term, making it an excellent investment of health-care funds

About Michele Ondeck

michele ondeck head shot 2015Michele Ondeck,RN, MEd, IBCLC, LCCE serves the Lamaze International Board of Directors as its immediate past president. She was employed by Magee-Womens Hospital of University of Pittsburgh Medical Center for more than thirty years in a number of positions including education and research in the pursuit of improving women’s health and maternity care. She is the mother and grandmother of four. Currently, she is a director of a Lamaze International Accredited Childbirth Educator Program and self-employed as a perinatal education consultant.

 

 

 

 

 

 

 

Babies, Childbirth Education, Guest Posts, Healthy Birth Practices, Infant Attachment, Medical Interventions, Newborns , , , , , ,

Sarah Buckley’s “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care” – A Review for Birth Educators and Doulas

January 13th, 2015 by avatar

by Penny Simkin, PT, CD(DONA)

Today, a long awaited report written by Dr. Sarah Buckley, “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care” is being released by Childbirth Connection. In this valuable report, Dr. Buckley gathers the most current research and provides the definitive guide for the role of hormones in normal, natural birth.  Esteemed childbirth educator, doula and author/filmmaker Penny Simkin has reviewed Dr. Buckley’s latest offering and shares today on Science & Sensibility how childbirth educators, doulas and other birth professionals can use this information to inform parents on how best to support the physiological process of childbirth.  In coordination with this research report, Dr. Buckley and Childbirth Connection are releasing a consumer booklet geared for families and consumers as well as other material, including infographics in support of this report.  On Thursday, Lamaze International Past President Michele Ondeck will share her interview with Dr. Buckley. In that interview,  S&S readers can get the full story directly from Dr. Buckley, on just what it took to create this remarkable tome. – Sharon Muza, Community Manager, Science & Sensibility.

© Childbirth Connection

© Childbirth Connection

Introduction

For many of us who work in the maternity field, Sarah Buckley’s fine work is well-known. Her book, “Gentle Birth, Gentle Mothering” (Buckley, 2009) has provided scholarly and enlightening guidance on natural childbirth and early parenting for many years. Her 16 page paper, “Ecstatic Birth,” (Buckley, 2010) guides educators and doula trainers, who rely heavily on her explanations of hormonal physiology in childbearing, for teaching about labor physiology and psychology and the impact of care practices.

Her newest publication, “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care,” (Buckley, 2015) is a gift to us all. It represents a massive scholarly effort, a review of all the related scientific literature on the topic. With 1141 references, most of which were published in recent years, Dr. Buckley’s overview provides the transparency to allow readers to trace her statements to the evidence on which they are based. She exercises caution in drawing concrete conclusions when the evidence is insufficient; she presents such information as theory (rather than fact), and points out when more research is necessary for concrete conclusions. The “theory” that undisturbed birth is safest and healthiest for most mothers and babies most of the time is impressively supported by her exhaustive review, as stated in the conclusion (Buckley, 2015):

“According to the evidence summarized in this report, the innate hormonal physiology of mothers and babies – when promoted, supported, and protected – has significant benefits for both during the critical transitions of labor, birth, and the early postpartum and newborn periods, likely extending into the future by optimizing breastfeeding and attachment. While beneficial in selected circumstances, maternity care interventions may disrupt these beneficial processes. Because of the possibility of enduring effects, including via epigenetics, the Precautionary Principle suggests caution in deviating from these healthy physiologic processes in childbearing.”

The Precautionary Principle, to which she refers, has been stated as follows:

“When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context the proponent of an activity, rather than the public, should bear the burden of proof. . . . It (the activity) must also involve an examination of the full range of alternatives, including no action.” (Science and Environmental Health Network, 1998).

In other words, when applied to maternity care, The Precautionary Principle states that when a practice, action, or policy may raise threats of harm to mother, baby, or family, the burden of proof that it will result in more good than harm falls on those who wish to adopt it – the policy maker, caregiver, or administrator, not on the pregnant person.

© Sarah Buckley

© Sarah Buckley

What’s new in this document and how might you use it and apply it in your classroom or practice?

This document represents the “State of the Science” regarding hormonal physiology of childbirth (HPOC). It should be the starting point for consideration of proposed changes in maternity care management and education. The question, “How might this policy, practice, or new information impact the HPOC and subsequent outcomes for mother and/or baby?” should be asked and answered about both existing and proposed interventions.

Sarah Buckley has asked and answered this question, and reveals the unintended consequences of numerous widespread practices, including scheduled birth – induced labor or planned cesarean; disturbance and excessive stress during labor; synthetic oxytocin (Pitocin); opioids and epidural analgesia for labor pain; early separation of mother from infant or wrapping the infant in a blanket to be held (i.e., no skin-to-skin contact); breastmilk substitutes, and many more. All of these practices cause more harm than good, except in unusual or abnormal circumstances.

One of the greatest contributions of this book is showing that hormonal physiology is affected by virtually every intervention –major and minor — and understanding this is the key to appropriate maternity care. The topic is complex and not nearly fully understood, but Sarah Buckley has pulled together just about everything that is now known on this topic. If you’re a maternity care practitioner or student, who wants to approach the care you give from a physiological perspective, or want information on the impact of common interventions on the physiological process, it’s all here. If you’re a researcher interested in studying some aspect of HPOC, your literature search has already been done for you and you can discover the many areas that have been insufficiently studied and plan where to go from there.

If you’re a childbirth educator seeking to give accurate information to expectant parents about how normal childbirth unfolds and how it can be altered (for better or worse) with common procedures and medications, you can learn it here. If you’re a doula who wants to understand how your presence and actions may contribute to normalcy, you can learn it here. If you’re an expectant parent who wants to make choices that maintain or improve the pregnant person and infant’s well-being, you can learn it here or access the consumer guide.

Organization of the Chapters

This book, with its numerous references, sheer number of pages, level of detail and broad scope, may seem daunting at first. However, if you take some time to familiarize yourself with the layout of the book before plunging in, you will find that the material in each chapter is arranged so that readers can explore each topic at varying levels of detail.

The book begins with a very helpful 10 page executive summary of the contents. There are then two chapters introducing concepts relevant to HPOC, and on the physiologic vs. scheduled onset of birth (induction and planned cesarean birth). The 7 chapters are organized with topics and subtopics. The first paragraph beneath the headings for each topic or sub-topic briefly and clearly summarizes the information in that section in italics, so that you can skim each topic by reading only the italicized summary. If you wish to investigate some subtopics more deeply, you can read everything included on those topics. Each chapter also ends with a summary of the entire chapter. Chapters 3, 4, 5, and 6 (Chapter 3 — “Oxytocin;” 4 —“Beta-Endorphins;” 5 —“Epinephrine-Norepinephrine and Related Stress Hormones;” ; and 6 —“Prolactin”) follow the same outline of topics and subtopics.

Using Chapter 6 (“Prolactin”) as an example, here is the outline:

  • 6.1 Normal physiology of prolactin
    • 6.1.1 Introduction: Prolactin
    • 6.1.2 Prolactin in pregnancy
    • 6.1.3 Prolactin in labor and birth
    • 6.1.4 Prolactin after birth
  • 6.2 Maternity care practices that may impact the physiology of prolactin
    • 6.2.1 Possible impacts of maternity care provider and birth environment on prolactin
    • 6.2.2 Prostaglandins for cervical ripening and labor induction: possible impacts on prolactin
    • 6.2.3 Synthetic Oxytocin in labor for induction, augmentation, and postpartum care: possible impacts on prolactin
    • 6.2.4 Opioid analgesic drugs: possible impacts on physiology of prolactin
    • 6.2.5 Epidural analgesia: possible impacts on physiology of prolactin
    • 6.2.6 Cesarean section: possible impacts on physiology of prolactin
    • 6.2.7 Early separation of healthy mothers and newborns: possible impact on physiology of prolactin
  • 6.3 Summary of all findings on prolactin

For childbirth educators: how might we use this information to benefit our students?

I especially appreciate that Dr. Buckley begins every section with a description of the relevant physiology. In order to be truly effective, we educators should do the same in our classes, to ensure that our students understand how and when their care is consistent with physiological childbearing and when (and why) it is not. “’Physiological childbearing’ refers to childbearing conforming to healthy biological processes,” (Buckley, 2015, page 11) as opposed to what many might refer to as “medicalized childbearing,” in which the physiologic process is altered or replaced with interventions and medications.

© Childbirth Connection

© Childbirth Connection

Childbirth education should be designed to allay the pregnant person’s anxiety, not by avoiding mention of potentially troubling labor situations, or minimizing concerns mentioned by the students, but rather by giving realistic portrayals of birth, encouraging expression of feelings, and dealing with them by informing, reframing, desensitizing, and strategizing ways to handle troubling situations. Following is an example of how an educator might include hormonal physiology of childbearing to teach about one critical topic – Physiologic Onset of Labor, which is Lamaze International’s First Healthy Birth Practice.

Let labor begin on its own: How to teach from the standpoint of HPOC

Chapter 2 in HPOC , “Physiologic Onset of Labor and Scheduled Birth,” details the ‘highly complex orchestrated events that lead to full readiness for labor, birth and the critical postpartum transitions of mother and baby.” (Buckley, 2015). As educators, we should try to convey this information, in simplified form, to help our students appreciate the beauty and connectedness of the whole mother-baby dyad. They need to understand the consequences of interrupting the chain of events that usually result in optimal timing of birth. Most parents (and many caregivers as well) have no idea that the fetus determines the onset of labor. Nor do they know that fetal readiness for labor (including protection against hypoxia and readiness for newborn transitions after birth) is coordinated with preparation of the mother’s body for labor, breastfeeding and mother-infant attachment. Once students have some grasp of these processes, they appreciate and want to protect them from interruption or replacement by medical means. As we know, most inductions and many planned cesareans are done without medical reason (ACOG, 2014). Out of ignorance and/or misinformation from their caregivers, parents often agree or even ask for these procedures.

While many educators know and teach about the risks and benefits of induction and planned cesarean, they often don’t convey the physiology on which the benefits and risks are based. It’s all here in HPOC, and this information may inspire parents to question, seek alternatives or decline these procedures.

Over the years, I have wrestled with the challenge of conveying this information fairly simply and concisely, and now, with the help of Katie Rohs, developed a new animated PowerPoint slide, “The Events of Late Pregnancy” (Simkin, 2013) that I use in class. You may access this animated slide and accompanying discussion points/teacher guide here.© Penny Simkin

© Penny Simkin

This is just one example of how we may shift our focus as teachers to incorporate basic hormonal physiology as a starting point. Dr. Buckley gives us a solid understanding of what is known about the key role the endocrine system plays in orchestrating the whole childbearing process, and why we shouldn’t disrupt this elegant process without clear medical reasons. If we teachers and other birth workers incorporate this information in our practices and in our teaching, outcomes will improve.

“Hormonal Physiology of Childbearing” is surely the most extensive search ever done on this topic, and is a solid guide to learning this crucial information. Encyclopedic in its scope, and multi-layered in its depth, this book will be most useful as a reference text, rather than a book to read straight through. It is pretty dense reading, but when you have a question relating to reproductive physiology or the effects of interventions, you can search for well-explained answers. The evidence-based conclusions that Sarah Buckley has synthesized from an abundance of research (1141 references!) are authoritative and must be made accessible. This is truly “State of the Science” on Hormonal Physiology of Childbearing.

Conclusion

Typical maternity care today has departed so far from physiology that in many cases it causes more harm than good, as borne out by Dr. Buckley’s discussions throughout the book of the impact (i.e., unintended consequences) of common maternity care practices on hormonal physiology and mother-baby outcomes. Our job is to inform expectant parents of these things and help them translate information into preparedness and confident participation in their care. If we do our job well, our students will want to support, protect, and participate in the physiological process, which has yet to be improved upon. Parents and their babies will benefit! Our thanks should go out to Sarah Buckley and to Childbirth Connection for bringing this gift to us.

In conclusion, Sarah Buckley’s “Hormonal Physiology of Childbearing” is an impressive exploration of the major hormonal influences underlying all aspects of the labor and birth process. As we understand and incorporate the knowledge included in the book, the birth process will become safer, with effects lasting over the life span.

References 

American College of Obstetricians and Gynecologists and Society of Maternal-Fetal Medicine, 2014. Safe Prevention of the Primary Cesarean Delivery. Obstetric Care Consensus Number 1. Obstet Gynecol ;123:693–711.

Buckley S. Ecstatic Birth. Nature’s Hormonal Blueprint for Labor. 2010. www.sarahbuckley.com

Buckley S. 2009, Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, Berkeley

Buckley S. 2015. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies and Maternity Care. Childbirth Connection, New York

Science & Environmental Health Network. 1998. Wingspread Conference on the Precautionary Principle. Accessed Jan. 8, 2015, https://www.google.com/search?q=The+Precautionary+Principle&ie=utf-8&oe=utf-8.

Simkin P. 2013, Events of Late Pregnancy. Childbirth Education Handout and Slide Penny Simkin, Inc. Seattle. https://www.pennysimkin.com/events-powerpoint

About Penny Simkin

penny_simkinPenny Simkin is a physical therapist who has specialized in childbirth education and labor support since 1968. She estimates she has prepared over 13,000 women, couples and siblings for childbirth, and has assisted hundreds of women or couples through childbirth as a doula. She has produced several birth-related films and is the author of many books and articles on birth for both parents and professionals. Her books include The Labor Progress Handbook (2011), with Ruth Ancheta, The Birth Partner (2013), and When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse of Childbearing Women (2004), with Phyllis Klaus. Penny and her husband have four adult children and eight grandchildren. Penny can be reached through her website.

 

Babies, Breastfeeding, Cesarean Birth, Childbirth Education, Guest Posts, Healthy Birth Practices, Infant Attachment, Maternity Care, Medical Interventions, New Research, Newborns, Uncategorized , , , , ,

New Series: “BABE”- Brilliant Activities for Birth Educators! “Got Oxytocin?”

January 9th, 2015 by avatar

By Kyndal May, MFA, LMP, CD(DONA), BDT(DONA), LCCE

Today on Science & Sensibility, we start a new series on teaching ideas and techniques for you to use in your birth classes. The BABE series (Brilliant Activities for Birth Educators) will bring you exciting and innovative methods to teach the topics normally covered in a Lamaze CBE series. We will be highlighting a variety of childbirth educators as they share some of their favorite activities from their classes.  Today, we welcome Kyndal May, a childbirth educator in Boise, ID, as she shares how she covers the hormones of birth, and the role of oxytocin.  Do you have a creative method of teaching a CB topic?  Let me know via email, and we can connect about sharing in a future BABE blog post!  Everyone loves to learn new ideas and refresh their class activities.  I would love to hear from you.- Sharon Muza, Community Manager, Science & Sensibility.

© Kyndal May

© Kyndal May

This past September, I was among many doulas and childbirth educators lucky to attend Sarah Buckley’s session on The Hormonal Physiology of Childbearing at the Lamaze International/DONA International Confluence in Kansas City, MO. Following Dr. Buckley’s U.S. tour of her Undisturbing Birth Workshops, I suspect many childbirth educators may be revisiting the way we approach and explore the topic of the hormones of labor in our classes.  After viewing her DVD, Undisturbed Birth: the Science and the Wisdom, I am currently working to adapt both my childbirth classes and my birth doula workshops to incorporate this information in a new way.

While I play with what that will look like and how best to make that learning both powerful and playful, I’ll share how I have long taught about the hormones of labor –with a focus on oxytocin and a few activities (both past and present) that make it meaningful and fun.

Like everything in my classes, both content and my facilitation style is constantly changing based on what I am reading at the time, what I am witnessing in births, and the dynamics of the group. My students’ interactions and participation bring so much to the experience that they unknowingly contribute (often month to month) to what stays and what gets tossed.

I doubt that I am that different from other passionate childbirth educators who tend to see life through a “birth lens” if you will, meaning that very often, what I see, hear, and experience goes through the “how does this relate to birth?” or “could I tweak this to be a teaching tool?” filter in my brain. So, in 2009, when I saw t-shirts with messages like “I love my midwife” and “My midwife helped me out,” I immediately starting thinking of a t-shirt message I could use in my class and quickly put in a custom order for my “Got Oxytocin?” t-shirt.

© Kyndal May

© Kyndal May

I wore this t-shirt under another shirt through the first half of class one but I wait to show it to the class until we have explored the role of oxytocin in relation to birth. For example, oxytocin as a smooth muscle contractor – the perfect lead-in to discovering the unique structure of the myometrial musculature and watching as moms and their partners come to appreciate the uterine muscle and its work in labor in a new and meaningful way; oxytocin as ejection reflex initiator – the perfect lead-in to discussing oxytocin’s role both in the second stage and in orgasm and watching the connections made by each couple as they realize the essential environmental commonalities between the two and the need for a safe, private space for both.

At this point, orgasm becomes the perfect lead-in for understanding the role of beta-endorphins — as pain-suppressant and pleasure/transcendence producer — through a brief lesson on the etymology of the word (sometimes using smart phones).

Endorphin

With a consensus regarding the pleasure of orgasm and the pulsating rhythm of labor, everyone would very much like to know how to avoid inhibiting that process. So, epinephrine and norepinephrine become the perfect lead-in to receptors and …a short detour actually, to the brain, where we acknowledge the differences between a “typical male” and “typical female” brain through the perspective of the adolescent brain, in particular. Here, we compare the fight or flight response to ‘tending and befriending’ and what that can look like in different settings.

Throughout this process, we pause so that each couple can answer a few questions together and privately identify their own unique styles of co-creating an oxytocin-rich environment in their day-to-day living and connect it to their mutual vision of a safe birthing space.

Sound complex? It is – as complex as the interactions of these hormones, but just as rewarding and very fun. At this point, we take a break and when we come back together, I am sporting my “got oxytocin?” t-shirt for all the class to see.

As we turn our attention to how oxytocin and its partnering hormones set up both mother and baby for a thriving start together in the postpartum period, I pass out plain, white baby t-shirts to each couple. I invite them to take them home and design their own “Got Oxytocin?” baby t-shirt. I ask them to create it as if the baby was asking the question of everyone who comes into the birthing space.

© Kyndal May

© Kyndal May

My intention is to have them continue to think about oxytocin’s value in labor; to remember how it interacts with and is inhibited by the other hormones and how they might best co-create a space that supports the free-flow of the hormone. And most of all, because their canvas is the baby t-shirt, they are mindful how it benefits not only the mother but also the baby.

Each time I have used this activity, the response has been very positive. The first time, it was met with surprising enthusiasm and every couple chose to participate. Two weeks later, they returned with their amazingly creative t-shirts using everything from paint, to iron-on transfers, crochet to tie-die. One couple even reconstructed their t-shirt into a bowling shirt complete with buttons, color panels, collar and nametag. It was clear all of them not only enjoyed the activity, they enjoyed doing it together as a couple. A few commented that the activity provoked them to imagine their baby’s personality.

At least one couple took their baby t-shirt to their birth as a reminder to everyone who entered to support their efforts to create a safe and private birth space. Many couples commented how meaningful it was to them to have the t-shirt as a memento from the class in their baby book.

It has been a while since I have done this kind of an activity in class, but a new idea came to me last year. As we approached the holiday season, it seemed the perfect time of year to try it out.

© Kyndal May

© Kyndal May

At the end of class one, I handed each couple 2 clear plastic tree ornaments – one round and one in the shape of a heart. These ornaments can be opened and filled with paint, confetti or, in the case of the photo here, a piece of paper with some writing on it. I asked each couple to think of some way they might represent oxytocin or what oxytocin means to them and put it into the ornament. The objective is to work together to identify what is especially oxytocin producing for them. Once they do that, they’ll find a creative way to represent it and put it in the ornament that will then become their personal “mistletoe”.

They are invited to hang their “oxytocin ornament” and each time they walk under it, it will remind them to stop and spend a little time in an embrace — which we know, if they will hold for 10 seconds or more and do it 8 times a day, is a wonderful way to increase their own oxytocin levels.

Ornament music

© Kyndal May

This first group brought their oxytocin ornaments back and I had just a moment to photograph just a couple at the break. The first one is filled with berries that represent gooseberries for the couple who met a health store called “Gooseberries.”
Another couple filled theirs with sheet music as each of them is very musical and plan to use music as a comfort measure in their birth. One couple filled their ornament with small birthday candles to represent candlelit moments and another filled theirs with layers of colored cake decorations – each color representing something about their relationship. Overall, the project was met with positive interest and one couple said they enjoyed it so much they found themselves giggling through the process which became a very playful experience them.

Early in my teaching career one of the moms in class brought a gift to give everyone at the closing class of the session.   She told us all, “The way Kyndal talked about oxytocin, I just felt it was a ‘wonder-product’. It can contract the uterus and bring milk down, it can bond people to each other and more…maybe even get stains out of the carpet. So, I thought everyone should have their own bottle of oxytocin.” She passed out massage oil in tiny bottles with a label claiming the contents to be “oxytocin” and thus began an long tradition of sending each couple home with their own personal bottle of “oxytocin”.

I have since shifted my parting gifts but I revisit that one now and again as it was a long-running favorite. You can see more of the “Got Oxytocin” baby t-shirts by visiting my site.

Maybe you would like to incorporate some of the ideas listed here in your childbirth classes as you cover the hormones of labor.  If you do, please consider coming back to Science & Sensibility and sharing how it goes.  We’d love to hear from you. – SM

About Kyndal May 

© Kyndal May

© Kyndal May

Kyndal May, MFA, LMP, CD(DONA), BDT(DONA), LCCE, is a storyteller and facilitator; a confidence and commUnity builder for expectant parents, doulas and childbirth educators. She has been an active, private practice childbirth professional since 1995. Teaching her own curriculum, first in Seattle, WA and now in Boise, ID, she has well over 2000 hours of teaching experience and has attended nearly 300 births. A Licensed Massage Practitioner, she incorporates her background in bodywork and movement into her classes to facilitate awareness and help her students discover their own way to labor and birth. She refers to her Confident Birthing Childbirth Class as an ‘informed choice’ class and her unique education platform is used by educators in the United States and abroad.

She is a Lamaze Certified Childbirth Educator, a DONA Certified Birth Doula and Birth Doula Trainer offering advanced doula trainings in loss and communication. She serves as the consumer member of the Idaho State Board of Midwifery and on the DONA International Board of Directors as the Western Pacific US Regional Director.

Kyndal’s photography has been published in The Essential Homebirth Guide, Birth Ambassadors: Doulas and the Re-emergence of Woman Supported Childbirth in the United StatesA frequent speaker at professional conferences, her session, The Doula’s Field Guide to Birth Photography is available online through DONA International’s webinar series. To view more of her birth photography, visit her website at: www.kyndalmay.com

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Remembering Elizabeth Noble and Her Contributions to Maternal Infant Health

January 7th, 2015 by avatar
© Elizabeth Noble

© Elizabeth Noble

Elizabeth Noble, author, presenter, teacher, and advocate for mothers, babies and families, passed away last week after spending time in hospice care.   Elizabeth was a highly respected physical therapist and internationally recognized expert on, and an advocate for, the normal physiology of pregnancy, birth and postpartum. Born and raised in Australia, Elizabeth received degrees in physiotherapy, philosophy and anthropology before she moved to the United States in 1973.  In 1977, Elizabeth founded the Section on Women’s Health for the American Physical Therapy Association.  In 1979, Elizabeth also founded the Maternal and Child Health Center in Cambridge, MA, along with Cambridge Physical Therapy.  She was the director of these organizations until 1990.

Elizabeth Noble authored eight books; Essential Exercises for the Childbearing Year (her most well known), Having Twins and More, Childbirth with Insight, Marie Osmond’s Exercises for Mothers to Be, Marie Osmond’s Exercises for Mothers and Babies, Primal Connections, The Joy of Being a Boy, and Having Your Baby by Donor Insemination.  Many of these books have been translated into several other languages.

Elizabeth created several multimedia productions (videos, DVDs and CDs) that included Inside Experiences, Channel for a New Life, BabyJoyExercises and Activities for Parents and Infants, Essential Exercises for the Childbearing Year and Marie Osmond’s Exercises for Mothers-to-Be and Pelvic Power.

Elizabeth authored  several articles, chapters and forewords and was a member of the editorial board of the International Journal of Pre- and Perinatal Psychology and Medicine, and Primal Renaissance: The Journal of Primal Psychology. A former Director of the Association for Pre- and Perinatal Psychology and Health, she has served on the boards of many organizations such as ICEA, The Toronto Birth Center, Center for Loss in Multiple Pregnancy, and Dancing Through Pregnancy®.

Elizabeth was the creator of “Instructor Training in Prenatal and Postpartum Exercises” a three day course geared for professionals.  She presented this frequently all over the world.

Some of her well known lectures and presentations included:

  • Optimal Health
  • Deskercises
  • Say What You Mean!
  • Pelvic Power: An Evening Public Presentation
  • Pre- and Perinatal Origins of Mental and Physical Health
  • Preventing Professional Burnout: Personal Growth for Maternity Care Providers
  • Hands-on Pelvic Assessment & Treatment
  • Prenatal Preparation
  • Empowerment Challenges for Expectant and New Parents
  • Psychophysical Aspects of Pain in Labor
  • The Pregnancy Playshop:  Weekend Childbirth Intensive for Expectant Parents
  • New Dimensions in Support for Childbearing Year
  • Childbirth Preparation and Unfulfilled Transitions
  • Reproduction and Birth in A Technological World
  • Marching Backward: The Malaise in the Natural Childbirth Movement
  • The Power of Knowing: Psychological Strategies for Expectant Parents and Maternity Care Providers
  • Tapping the Unconscious Mind
  • Inside Experiences: Guided Recall for Birth & Before
  • Reproductive Technology
  • Anonymous Donor Gametes and Genealogical Bewilderment
  • Multiple Pregnancy
  • Fetal Surveillance and the Nocebo Effect: Recommendations for a Normal Pregnancy, Vaginal Birth Optimal Outcome.
  • Pre and Perinatal Loss of a Twin
  • Bonding with Multiples
  • Sharing Space: Twinship Experiences in the Womb

Elizabeth’s dear friend and colleague, Nancy Wainer, CPM, had this to say about Elizabeth Noble:

Liz was quite unique- well-educated, well-read, well-traveled, well-spoken, opinionated (because she was educated!) and feisty. She was extremely articulate and was most dedicated to mothers and babies.

Liz took excellent care of herself – her diet/nutrition was excellent and she exercised regularly. She was mindful.  She had so many things she wanted to accomplish in her lifetime, both professionally and personally. It seems so unfair to those of us who knew her that she was stricken with this dreaded and painful disease, cancer, and that she succumbed this past week. For the past decades, she has been a driving force for mother and babies and and natural living (having had her own home birth in a tub outside on a beautiful day at her’s and Leo’s lovely home in Harwich) and was knowledgeable about so many aspects of birth that made her a true pioneer/trail blazer. She was cut out of a very special mold and her absence will be surely be felt in our circles. Her list of accomplishments are a mile long, and should have been another full mile. Rest in peace, dear Liz… rest in peace.

© Elizabeth Noble

© Elizabeth Noble

The Section of Women’s Health (APTA) recognized Elizabeth by establishing The Elizabeth Noble Award, given yearly to an APTA member in good standing who has provided extraordinary and exemplary service in the field of women’s physical therapy.

Many in the birth world are very familiar with all of Elizabeth Noble’s many contributions to mothers and babies and had the deepest respect for her significant accomplishments.  Her voice and her knowledge cannot be replaced and will certainly be missed.  All of us at Science & Sensibility and Lamaze International offer our condolences to the Noble family.

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