Archive for the ‘Newborns’ Category

Series: Brilliant Activities for Birth Educators – Events of Late Pregnancy and Premature Birth

November 19th, 2015 by avatar

PlaybillNovember is Prematurity Awareness Month and November 17th was World Prematurity Awareness Day. This month’s Brilliant Activities for Birth Educators post is about preventing prematurity, the events of late pregnancy and the importance of waiting for labor to begin on its own. As they do every year, the March of Dimes leads the way in recognizing the importance of preventing premature births. They have provided information and resources to bring this important problem to light.  The number one cause of death of young children worldwide is complications from being born too early, with estimates of 1.1 million deaths directly linked to being born too early.   In the United States, one in ten babies are born premature.  If you live in the USA, you can check out how your state has performed on the prematurity report card.  On the international level, you can find out how your country ranks here.  In the US, we also know that premature births and low birth weight babies are more likely to occur in families of color.

I cover premature birth in my childbirth classes in many ways, including recognizing the signs of premature labor, and facilitating a discussion around the Lamaze Healthy Birth Practice “Let Labor Begin On Its Own” as induction before a baby is ready and has started labor can unintentionally result in a premature birth if the gestational age is estimated incorrectly or even if the baby was not ready and needed some more time in utero.  Not every baby is ready to be born at the same time.

My favorite activity to do in class on this topic leaves families really understanding the benefits of letting baby start labor when they are ready (in the absence of medical complications).  In small groups – the families prepare and present a short skit on the events of late pregnancy.

When this is activity is done in class

I cover this information on week two of a seven week series, at the beginning of class.  The families are just beginning to gel and we have done quite a bit of interactive learning the week before, on class one, but this is definitely a leap of faith on their part to be doing such a “daring” activity at the start of the second class.  They have only been with me and their classmates for one 2.5 hour session.  I am asking a lot of them, but they always rise to the challenge.

© Penny Simkin

© Penny Simkin

How I introduce the topic and set up the activity

I hand out Penny Simkin’s “Events of Late Pregnancy” information sheet that is available for purchase as a tear pad from PennySimkin.com. I discuss how both pregnant person and baby are getting ready for birth in the last weeks of a pregnancy.  Many different processes are happening and systems are moving forward to have everything culminate and coordinate in the labor and birth.  Each and every process is critical to a healthy baby and a body that is ready for labor.  I divide the class into four groups and assign each group to be either a Pregnant Person, Uterus, Fetus, or the Placenta/Membranes.  I ask them to collaborate together and prepare a skit, activity, active presentation, interpretive dance, charade etc., that shares information on the changes their assigned role undergoes during the last weeks of pregnancy and through labor.  I give them around five minutes to prepare and offer to provide any props that they might need from my teaching supplies.  They gather their groups, take their tear sheet and head to four corners of the classroom to get to work.

The results of their creativity

After the small group work is completed, we gather back as a class and get ready for the “show.”  In turn, each group (and their chosen props) heads to the front of the room to do their presentation.  Everyone follows along with their info sheet.  The results are outstanding and usually quite comically.

Some of the most memorable presentations have included a newscaster holding a microphone and interviewing the fetus at different gestational ages.

Newscaster: “Hello 34 week old fetus, can you tell me what you are working on now?”

Fetus: “Well, this week, I am taking on iron and my mother’s antibodies. I need the iron to help me through my first six months and the antibodies protect me until I can make my own. ”


© Anne Geddes and March of Dimes

Other groups have created a giant pelvis with their bodies and had a “baby” assume the birth position and move through.  I recall a group ripped up red paper into confetti, and released it from up high to represent bloody show.  Just this week, one group did a hip hop dance and chanted along with the different events.  “Antibodies” have leapt through “placentas,” and fake breasts have leaked colostrum.  Giant uteri have contracted and pushed babies out.  One week, uncoordinated contractions representing Braxton-Hicks contractions “squeezed” out of sync and then got “organized” and worked in unison to represent labor contractions getting longer, stronger and closer together, flexing and squeezing like a well fabricated machine. I am continually amazed at the creativity and ingenuity of the results.  Everyone laughs and best of all, the events are memorable and easy to recall.


After each group has a chance to present their section, we debrief and discuss any questions.  We bring things full circle by talking about what the impact might be for a premature birth or a birth that occurs before the baby or parent’s body is ready.  Everyone is clear that the process of birth and the transition that baby needs to make works best when baby chooses their birth day.  We admire everyone’s creativity and laugh about the mad skills that the class has!  As the series continues, I can refer back to these skits and remind them of the important steps as they come up again in class.  I am amazed that they have great recall of the progression.

What the families say about the activity

After we have finished, the feedback I receive on this activity is great!  Despite their initial hesitancy to get so far out of their comfort zone, families really remember the events, recognize how important the changes are that occur in the pregnant parent, the uterus, the baby and the placenta and membranes. They can clearly articulate why it is important to reduce the chance of a premature baby and wait for labor to start on its own.  The unique presentations really make things memorable and the families report back to me weeks later, or even at the class reunion after birth, how they often thought of this activity and it helped them to have patience to wait for baby to come.  They knew good (and important) things were happening in the last few weeks that would make for a healthy birth and baby.

How do you teach about preventing premature birth and the importance of waiting until baby starts labor?  What interactive teaching ideas do you use?  Do you think that you might try something like this in your childbirth classes?  How might you modify it.  Share your thoughts in the comments below.  I would love to hear from you.

Babies, Childbirth Education, Healthy Birth Practices, Lamaze International, Newborns, Pre-term Birth, Series: Brilliant Activities for Birth Educators , , , , ,

Breast Pump Recycling Programs – Good for Families, Good for the Earth!

October 20th, 2015 by avatar

By Cara Terreri, CD(DONA), LCCE

Breast Pump Recycling (1)If you are a childbirth educator, doula, lactation consultant, midwife or doctor who works with expectant families, one of the topics you may be discussing with them as their birth day draws near is the acquisition of a breast pump. You may make suggestions on which pump will best suit their needs, let them know that breast pumps are considered durable medical equipment under the Affordable Care Act and are provided at no charge to them, and even provide instruction on how and when to use it, along with information on breast milk storage.  Do you realize that you can also provide information on what to do with that breast pump when it is no longer needed in the family?  There are several programs that offer breast pump recycling programs and families and the environment will benefit if they were utilized more.  Cara Terreri, Community Manager for Lamaze International’s Giving Birth With Confidence blog shares information that you can pass on to parents, helping them to keep breast pumps out of the landfills and support recycling efforts. – Sharon Muza, Community Manager, Science & Sensibility

Breast pumps are an expensive — and important — piece of equipment for many breastfeeding parents. But what happens when families aree done with their breast pump — like not going to have more children done? Do they sell it? Donate it? Recycle it? Trash it? Let’s take a look at the options.

Selling A Used Breast Pump

Families may have spent significant money on their high quality double electric pump — it would be nice to see some of that money back in their pocket! Be aware that many breast pumps are designed as “single use” pumps, which means that they are not created to be safely used by another person. The reason is, these pumps use what is known as an “open system,” which means that there is not a barrier to stop milk (even tiny particles) or moisture from traveling up into the pump’s motor. There is no way to fully clean or sterilize these kinds of pumps — even if the pump’s new owner purchases new tubing and plastic parts. The good news is that many, many breast pump brands sell pumps with closed systems. That said, even a closed system pump can be problematic when passing along to someone else. The motor can be weak, which affects the pump’s ability to operate as it should, causing less suction. A weak pump can impact a breastfeeding parent’s milk supply! If a parent does consider selling their pump, be sure to let the new user know that it’s used and for how long. Many lactation consultants will test a pump’s suction for free, which is something that can be done before selling.

Donating A Used Breast Pump

When considering donating  used breast pump, all of the information above applies. Families can donate a used pump directly to another family, or seek out an organization that will give it to a parent in need. Be forewarned, however, that many non-profit organizations will not be able to accept a used pump due to liability and health concerns, even if it is a closed system pump. A parent’s best bet is to connect with other families in their community, or perhaps a charity or community organization, to find a family in need.

Recycling A Used Breast Pump

Good news! There are now two pump manufacturers who offer recycling. Medela developed the Medela Recycles program, which allows families to ship their electric Medela pump for free back to the company, where they will then break down the pump and recycle all components appropriately. With each recycled pump Medela receives, they support the donation of new hospital-grade, multi-use breastpumps and supplies to Ronald McDonald House Charities® (RMHC®). This helps provide parents with high quality pumps hospital during their stay at a Ronald McDonald House, which helps ease the transition for families caring for a baby in the NICU. The recycled pumps are not re-used or re-sold in any way.

Hygeia, who promotes “No Pumps in Dumps™,” also offers a pump recycling program. Depending on the pump’s age and model, Hygeia may refurbish the pump and provide it to a mom in need (or work with an agency to do so), or if a pump can’t be refurbished, they will recycle it appropriately. Hygeia also recycles pump parts replaced when servicing customers’ pumps. Hygeia’s pumps are a closed system designed to be used by multiple families when each breastfeeding parent has their own “Personal Accessory Kit.”

If a family owns a pump made by one of the many other manufacturers, families should contact them directly to find out if they offer a way to recycle their pump. If not, recycle the pump’s plastic pieces appropriately and then take the electronic components to a facility or business that recycles electronics.   Often communities and municipalities hold recycling events where community members and drop off electronics to be recycled for free.  Families should monitor local news sources for upcoming recycling opportunities.

Throwing Away A Used Breast Pump

With the many safe and eco-friendly options available for getting rid of used breast pump, families don’t have to throw it away! And really, they shouldn’t — with the amount of garbage in our landfills, trashing a recyclable breast pump is not a good option.

Babies, Breastfeeding, Childbirth Education, Guest Posts, Newborns , , , , , , ,

Honoring Henry Dean: A Mother Shares Her Journey after the Stillbirth of Her Son

October 15th, 2015 by avatar

henrydeanOctober is Pregnancy and Infant Loss Awareness Month.  Today, October 15th, is also a special day of remembrance.  As a childbirth educator and a doula, I have worked with several families over the years who have experienced losses while taking a childbirth class with me, after the class ended or while they were my doula clients. I have had the honor of attending clients as they birthed their baby, born still.  I have also supported client and student families who lost their child several years after the birth.  You never know when such a tragedy might hit.  I asked my recent student, Rachel to share her experience, still very fresh, of the still birth of her son Henry Dean, on June 17th , 2015, shortly after she and her husband finished a seven week childbirth class series with me and several other families. I am grateful and honored that she was willing to share such a personal journey with me and all of you.

Sharon Muza: You recently gave birth to a son who was born still. Can you share the events leading up to the birth of Henry?

Rachel: I had a wonderfully boring pregnancy. All tests came back with good numbers, my blood pressure was always good, I never had any protein in my urine, we had a good anatomy scan, Henry’s heartbeat was always in range…everything seemed right on track.

At my 37th week checkup, once again everything checked out fine. The very next day, I had a busy day at work and by the time I got home, I realized I hadn’t felt him move much that day. I did all of the tricks and still couldn’t get any movement, so we went to the hospital that evening to calm our fears. The nurse must have hunted for a heartbeat for 20 minutes. I had a horrible sinking feeling. I knew something was very wrong, and I could read it on her face. The doctor came in with the ultrasound and announced, sadly, that there was no heartbeat.

The sound that I made at that moment was pure anguish. Never had I felt that things were so very wrong in all my life. I just couldn’t believe it was true. He was absolutely fine the night before, as far as I knew. And it didn’t make sense that he could have possibly died just as we were planning his arrival into the world. They gave us the choice of a vaginal birth or cesarean and they ushered us into another room to begin induction. That night, my husband and I slept horribly as we held hands and cried. My mom and sister arrived the next morning. When I had dilated to 3cm from the prostaglandin, they started me on a Pitocin drip. I opted for an epidural before I even started feeling bad labor pain. I knew I couldn’t handle the physical torment on top of my emotional state.

This is the laundry I hung out less than a week before we lost Henry. I had packed my hospital bag and there was little left on my "to do" list.

This is the laundry I hung out less than a week before we lost Henry. I had packed my hospital bag and there was little left on my “to do” list.

If there was any mercy at all during this impossible situation, it’s that I had a relatively fast labor, especially for a first time mom. In less than 2 hours, I went from 3cm to complete. I only pushed for an hour and a half, staring in my husband’s eyes and breathing in rhythm to his counting. Once he was born, my son was placed on my chest, as I had requested, and I sobbed as my mom and sister gave me and him kisses and said their goodbyes. Les and I were alone with our son for a little while before the nurse offered to bathe him. I realized I hadn’t really been able to look at his little sweet face. I was clutching him so tightly to my chest, I didn’t want to let him go and I didn’t want to see that he really was dead.

Finally, I handed him over to a nurse and she cleaned me and then him. I was tethered to the bed because of all the IV and monitors. I hated it. I wanted to be able to get up and walk over to where he was at, but I couldn’t. She put some clothes and a hand knit hat from the NICU on him, swaddled him, and handed him back to me. He was so beautiful. He was perfect. We spent several hours holding him, talking to him and kissing him. I remember whispering over and over, “I’m so sorry baby. I didn’t know. I’m so sorry. I love you so much. So much.”

Now I Lay Me Down To Sleep” sent a photographer and he took some photos of our sweet Henry. They are still my most precious keepsakes, even more than his ashes or his little hat or his feet and handprints. Those photos are the world to me. Soon after the photos, we said our last goodbyes. Leaving the hospital with no baby was  the worst. I felt so empty. And so stunned. It was like a nightmare I couldn’t wake up from. I was in that state for several weeks.

SM: During your pregnancy, and while attending childbirth classes, did you ever think that something so tragic and shattering could happen to you?

R: Absolutely not. I heard stories sometimes and of course I had pity for those people, but I never ever considered it could happen to me. It’s not something a pregnant woman really allows herself to think about, if she can help it. I remember in class, one of the couples asked about adding some “in case of death” contingency plan to their birth plan and Les and I looked at each other like “Why are we talking about this? What are we going to do if our baby dies?? We will crawl into a hole and die ourselves, that’s what!”


Remembrance handmade and gifted to us by childbirth classmate Elizabeth Dewar

SM: Did I cover anything during your seven weeks of childbirth classes that helped you during the birth of your child, or in the days and weeks after?

R: I think the exercise when we held our hands in ice water helped me realize my pain management style, which ended up being the same for my delivery. I wasn’t noisy. I just wanted to stare in my husband’s eyes and breathe controlled, rhythmic breaths. That’s exactly what I did during labor and pushing. As for the days and weeks after, I was not on any normal plan. I needed to be up and about much more than the average mom who recently gave birth. I needed to be outdoors and around people.

SM: After Henry’s birth, how did you consider next steps in regards to letting your friends from childbirth class know what had happened? Did you feel it was important for them to hear? Were you worried about the impact this news might have on them?

R: I really questioned how and when to tell them. I wasn’t sure if I should convey my story when not everyone had birthed their babies by that time. I didn’t want to panic anyone, but I had a strange dilemma: I wanted to shield myself from any “hey you must be set to pop!” messages from my friends and family, so I felt compelled to share my sad news on Facebook. Since most of the class was also friends with me on Facebook, I knew they would see a post. So I decided it was more important for the timeline to be dictated by my needs, and what I needed was to share with my friends and family. I made two posts. One for my general Facebook and one for the birth class, which included a bit more detail about my birth. For some reason, writing out some of the labor details felt necessary to keep it in context of the other birth stories. It seems strange, looking back. But I don’t know that there is any clear path forward when you are in that mental state.

SM: What type of response did you receive from your classmates when they became aware of the situation?

R: They were amazing. They showered us with support and words of comfort. Many of them chose to sign up to bring meals to us and a few have reached out and followed up even recently. Just today, we received a wonderful gift of handmade memorial artwork from one of the couples. It truly made my day.

SM: Have you remained connected to anyone from the class? Did you continue to stay in the online FB group? As others announced their births, how did you protect yourself while being in such an emotional place?

R: Yes, I am still in touch with some of them. I am planning to stay on the FB group, I think because I want to see the babies grow up.  It might be difficult but nothing about this is easy. I had mixed emotions seeing their birth announcements. In some ways, I had a wave of relief every time another healthy baby was born. In other ways, it was such a horrible reminder of what we lost. Frankly, I did a bad job protecting myself. I convinced myself that I needed to scroll through Facebook every day and see photos of all those newborns to desensitize myself. “It’s life! Get used to it! Better to sob over babies in the comfort of your own home than out in public!” I only recently gave up on keeping up. I found online support groups that take more of my time these days.

SM: What community and online resources did you find most valuable after you lost your son that should be included in every childbirth class?

R: We met some very good friends from our local support group, “Parent Support of Puget Sound.” I like reading “Still Standing” magazine and “A Glow in the Woods.” And there are other blogs I read, including “Scribbles and Crumbs” and “Pregnancy After Loss Support” to keep some hope for the future. I am extremely active in a reddit group called ttcafterloss and they have been amazingly supportive. It’s a small online community and you really get to know each other. Really, I don’t know if it’s appropriate to distribute a list of these resources to every class. I think doulas and childbirth educators could maintain their own lists and then let everyone know ahead of time that they have a good current list if it’s ever needed.

SM: What would you like to tell other childbirth educators and birth professionals about your experience that could help them to help others who find themselves in a similar situation?

R: During this type of birth, the parents cannot think straight or make all the right choices. Nurses are asking you whether you want an autopsy and to which funeral home they should send your baby’s body. These are not normal questions, and they are impossible to answer. Meanwhile, you are trying to determine what to do with the last hours with your baby as your world is crumbling around you. I would like childbirth educators and birth professionals to have their own list of “default” decisions. Most people who don’t have an autopsy seem to regret it, for instance (we did have one). People who refuse photos are also likely going to regret it later. Somehow, please find a way to gently usher these poor parents toward the choice that they will regret the least. Don’t be pushy, of course, but don’t assume each half-brained decision is set in stone. They are not themselves. Tell them a friend of yours whose son was stillborn (me) only got a few photos because it was uncomfortable to watch the photographer…she didn’t get any of her holding her son and it is her biggest regret about that day. Comfort and words of support are great, but sound and practical advocacy is downright necessary. Also, be sure they know what to do when their milk comes in. It is agony on so many levels, and some people in my support group were not even warned that it would happen!

rachel henry

18 weeks pregnant and blissfully ignorant.

SM: What else would you like others to know about your experience? What has been helpful and given you strength to move forward in the face of such a significant loss?

R: My greatest fear is that people around me will forget Henry or expect me at some point to have moved on. In reality, Henry will always be my first child, and I will never ever “move on” or “get over” him. When people ask me about him or say his name, it means the world to me. Even if it makes me cry, it is the greatest gift to know that others haven’t forgotten and they miss him too. I’m still very fresh in my grief, but I worry that as the years go by, my husband and I will be grieving alone.

What has been helpful and given me strength is finding ways to connect and feel close to Henry, and finding ways to create a meaningful legacy for him. Being outside is always very helpful. Just looking at the trees sway in the wind or watching waves on the beach makes me feel close to him. And I truly believe I am a better person because of him. My love for him didn’t go anywhere. I have more love and compassion and empathy, and I want to spread more “good” into the world to try to make up for what we all lost. I want to live life more fully, since he never got the chance. I want his birthday to prompt “Random Acts of Kindness,” and I want his due date to be a “Day of Hope.” Finding these ways to share him with my friends and family has helped me heal.

For some reason, metaphors became quite helpful as I tried to make sense of things. One of the first examples is a quote by Beau Taplin that was shared by my sister in the first or second week after we lost Henry: “Listen to me, your body is not a temple. Temples can be destroyed and desecrated. Your body is a forest—thick canopies of maple trees and sweet scented wildflowers sprouting in the underwood. You will grow back, over and over, no matter how badly you are devastated.” I read and thought about that quote a lot. The idea that I was alive and resilient, even if I didn’t feel like I was either of those things, gave me hope. All summer long, there were wildfires in the area. I started feeling like Henry’s death was a wildfire in my life. I was just a sad and destroyed version of my former self. Then I thought more about it and realized how important wildfires are, and how they are vital to healthy forests.  There are also things that can only grow after a wildfire. In the same way that I was open to the world in a new way. And I can actively choose what to plant and what to leave behind. It was empowering and important, and it helped me put a positive light on the absolute worst reality. I also felt the metaphor of a tunnel. I felt like I was in a pitch black tunnel, but there was as tiny glowing light at the end that represented hope, love, support, compassion – the potential beauty of life. I could turn my back and feel alone in the dark whenever I needed to (and sometimes, you really do need to), but I knew that light was there and I could focus on it when I needed it.

One helpful thing was that I created an Instagram account to keep photos of moments and things that remind me of Henry. I collect photos of nature, the many memorials of stones and sticks spelling his name, and other artwork devoted to him. The sweet thing is that other people have started adding their own photos to #hellohenrydean. People also send me photos with stories that I add myself. I recently decided to participate in CarlyMarie’s “Capture Your Grief” photo project for the month of October. It’s a way to honor Henry and share my journey with people, and the support I have received from my daily posts has been amazing.

SM: Many people are compelled to help after a loss like this. What would you recommend to people, if they are searching for a way to support a newly bereaved mother and family?

R: I cannot tell you how many messages I got from people that included the words “please let me know if there is anything I can do for you.” While I understand there is a desire to reach out and help, people should know that those words will almost never solicit an actual meaningful request from parents who just lost their child. Here is a list of the most helpful responses I received from people:

  1. A friend set up a meal train and sent it out to my baby shower list. I then forwarded the link in my announcement email. It was SO helpful to have a place where people could organize themselves. We didn’t cook for nearly two months. You just can’t take care of yourself like normal, so having home cooked meals provided by close friends was a really big help. We were nourished physically and emotionally because we often visited with friends when they dropped by. To follow on my statement above, it was nice to forward the link to anyone who threw out the “let me know if there is anything I can do to help” note.
  2. If there is no meal train but you’d like to help with a meal, be specific with your offer. “I’d love to drop a meal by next week. Let me know if you would prefer breakfast or dinner, if you have any dietary restrictions, if you prefer frozen or hot, and whether you would prefer a visit or for me to leave it on your porch.” And then follow up.
  3. If you have friends or know people who have gone through similar heartbreak, I was desperate to talk to others who have experienced this type of loss but were further along their journey (especially if they had subsequent children). Several people mentioned putting me in touch with friends, but no one ever followed up. Before offering to connect, check with your friend first and then tell the newly bereaved parents that you have a friend who would be willing to talk with them, if they would like. Have the contact info with you, or forward it in an email.
  4. Emailing a list of resources that can be referred back to is definitely helpful. It can include local support groups, websites, blogs, etc.
  5. If you want to send flowers, consider a live plant instead. Something about watching flowers die is depressing.
  6. Offer to come have a cup of tea or coffee with them, and listen to them tell their story. Repeating my story over and over was a big part of my healing.
  7. Going outside was imperative to my healing. Perhaps offer to pick your friend up for a trip to the beach or a pretty park (one that isn’t likely to have babies and children everywhere). It took me some time to realize how important nature is for the healing process. And once my body had healed, I liked going on walks with people.

Thank you Rachel, for sharing your story and the story of your son, Henry Dean. I am very appreciative of your time and thoughtfulness in helping me to share information that may help other birth professionals support families in similar situations.  I want you to know that I will always remember Henry Dean and his story, and his brave and beautiful parents.  I have compiled a list of resources that professionals may find useful.

Science & Sensibility Resources

From our sister blog, Giving Birth With Confidence

2015 Lamaze & ICEA Joint Conference, Babies, Childbirth Education, Newborns, Pregnancy Complications, Trauma work , , , , ,

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

October 13th, 2015 by avatar

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

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

General Fertility Rate

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

Teen Birth Rates

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

Cesarean Rates

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

Preterm Birth Rates

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

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

Leapfrog Group Releases Hospital Cesarean Rates

© Leapfrog Group

© Leapfrog Group

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

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

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

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

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

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

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

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








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



what does it mean when the hospital doesn’t report

transparency acts of mass and NY

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


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

Interview with Alice Callahan about Science of Mom: A Research-Based Guide to Your Baby’s First Year.

October 6th, 2015 by avatar

In an earlier post on Science and Sensibility, regular contributor Anne Estes, PhD reviewed Science of Mom: A Research-Based Guide to Your Baby’s First Year, a new evidence-based book focused on answering questions on health, sleeping, and feeding for an infant’s first year. The book grew out of author Dr. Alice Callahan’s blog, Science of Mom, that she began writing as a new mother. Dr. Callahan took some time out of her busy schedule to talk with Anne about her new book and how it might be helpful for childbirth educators and new parents.  Readers will also want to pop over to Anne’s blog – Mostly Microbes, to listen to a podcast of  a more detailed interview with Dr. Callahan, the author of The Science of Mom. We’d also like to congratulate Amy Lavelle for being randomly chosen from the commenters on the original post. Amy wins herself a free copy of the book.  We hope that she will enjoy reading it.  – Sharon Muza, Community Manager, Science & Sensibility.

Science of Mom Cover HiDefAnne Estes: What do you see as the role of this book for childbirth educators and other birth professionals?

Alice Callahan: First, my book gives a really in-depth look at several newborn medical procedures, including timing of cord clamping, the vitamin K shot, and eye prophylaxis, plus shorter sections on newborn screening, the hepatitis B vaccine, and the newborn bath. Childbirth educators will take away a clear understanding of the evidence behind these procedures, and they can pass that knowledge onto students and clients. Second, and just as useful, those in-depth sections serve as excellent case studies for how to look at scientific evidence. My hope is that this background will give readers the tools needed to evaluate scientific evidence on their own as they encounter new questions – and I’m sure birth professionals are constantly faced with new questions!

AE: Why should childbirth educators suggest your book as a resource for interested parents?

AC: New parents are often taken off guard by the number of questions they have about childbirth and caring for a new baby. In online forums and playground conversations, they’re suddenly thrown into discussions of what is best for babies, and they find themselves trying to sort through lots of conflicting opinions and misinformation, trying to make the best choices for their own babies. It’s tremendously valuable and empowering to be able to understand how science can inform these decisions and how to find evidence-based resources. My book not only gives parents evidence-based information on infant health, feeding, sleep, and vaccines, but it also illustrates for parents how to find it themselves.

AE: What message from your book is most important for childbirth educators to share with their students?

AC: Seek evidence to inform your decisions. Be very skeptical of everything you read on the Internet, and make sure you’re getting your information from an accurate source. There’s so much misinformation out there that can be very misleading and even dangerous for parents and their babies. Don’t assume that something more natural or involving less intervention is always better. That isn’t always the case. Instead, look for objective evidence of risks and benefits, and make an informed choice.

AE: How did you choose the topics for your book? Was it difficult to decide what to leave out?

AC: I tried to choose topics that I think are some of the most common causes of confusion and anxiety for parents, based on questions that I get on my blog or that I see in online parenting forums. To be honest, my original proposal for this book included several more topics, but as I fleshed out chapters, I realized that it was more interesting to look at several topics in a really in-depth way rather than skim the surface on lots of different topics. But honestly, if I’d been able to devote another year or two to it, it could easily have been twice as long, because there are just so many great questions that parents have about the first year of life. I would have liked to cover topics like emerging research on the microbiome and concerns about chemical exposures, for example, but I may have to save those for another book!

AE: What do you feel is the most controversial topic in your book? 

AC: The safety of bedsharing is probably the most controversial topic in the book. Sleep practices are just so personal, and many parents really value bedsharing with their babies for cultural, emotional, or practical reasons. This is an area where you’ll find very conflicting advice, and everyone cites scientific studies to back their stance. In the book, I do my best to look honestly at the evidence for and against bedsharing safety. I explain that multiple studies do show risk of bedsharing in certain circumstances, especially with babies in the first few months of life, but I acknowledge the limitations of those same studies. And I also point out that individual factors, such as ease of breastfeeding or alternatives to bedsharing (including the risks of falling asleep with your baby on a couch or trying to drive a car while severely sleep deprived, for example) might make careful bedsharing a reasonable choice. I think we need to share all of this information with parents and discuss how to set up a bed to make bedsharing as safe as possible if that is the choice.

AE: Could you describe how you determine which findings from the scientific literature are best for answering a parenting question?

AC: In the book, I give a rough guide to types of study designs and explain which ones are most likely to give us strong evidence that is relevant to parenting decisions. Systematic reviews and meta-analyses are usually most useful, because they combine the results of multiple studies so are more likely to give us a big picture consensus about a question. (This assumes that the authors selected high quality studies for the review, so you have to be a little careful here.) Looking at single studies, randomized controlled trials are the best quality, whereas observational studies are usually limited by confounding factors and can only show correlations, not causation. Studies conducted in animal models or cell culture are an important step in scientific research, but we really want to see follow-up in human studies before we change our lives over the results. As you look at studies, you also want to pay attention to how many people were included in the study and whether or not the population is similar to your own. Evaluating scientific evidence takes some practice, and I go into lots more detail in the book.

AE: I was shocked to read that immediate cord clamping and cutting and stomach sleeping were practices changed in the mid-1900s without any evidence. Could you talk about how one of those practices began, the implications, and what it took (or will take in the case of umbilical cord clamping) for the original practices to be put back into place?

AC: It’s surprisingly difficult to pin down exactly when the shift to immediate cord clamping occurred, but it probably happened in the early to mid-1900s. Before this, it was likely standard practice to wait a few minutes or until the cord stopped pulsing before clamping it. The shift to immediate cord clamping seemed to coincide with the movement of birth from the purview of midwives in homes to obstetricians in hospitals. Immediate cord clamping was also part of the practice of active management of the third stage of labor, which was introduced in the 1960s. However, there was no evidence then that immediate cord clamping was beneficial to either mom or baby, and studies show that delayed cord clamping does not increase the mom’s risk of postpartum hemorrhage (which was a belief for a while).

Immediate cord clamping is an example of an intervention put into place because it was convenient, not because it was evidence-based. We now have good evidence that delayed cord clamping is beneficial to infants, especially those born preterm. For term infants, the biggest benefit is a boost in iron stores that can prevent iron deficiency later in infancy. There is some evidence that the risk of jaundice is increased, but as I discuss in the book, this is controversial. We’re seeing some obstetricians making delayed cord clamping their standard of care, but practice is really mixed in the U.S. At this time, ACOG recommends a delay of 30-60 seconds for preterm infants, but they refrain from making any recommendation for term infants, citing insufficient evidence. I actually appreciate that they’re careful to ensure there is adequate evidence before changing practice, but I do think we have enough evidence now that we should really be going back to delayed cord clamping whenever possible. I think that with a little more time and a few more studies, delayed cord clamping will again become standard practice, especially with doctors in the U.K. testing a resuscitation trolley that allows the cord to remain attached even if the infant requires resuscitation.

AE: What did you do to feel prepared for your labor and birth, and first weeks of parenting? Did you choose to take a childbirth class?  Do you feel it helped you feel prepared and confident?

AC: Before the birth of my first child, I took a childbirth class through a local hospital. It was very helpful in terms of knowing generally what to expect with labor and learning some ways to cope with discomfort. To prepare for the birth of my second baby four years later, my husband and I both read The Birth Partner by Penny Simkin. I liked that it was evidence based and a straight-forward source of information, and my husband put Simkin’s suggestions into action to truly be a great birth partner.

One of the most important aspects of birth preparation for me was developing a trusting and respectful relationship with my healthcare providers. My babies were delivered by two different OBs, and both were wonderful at communicating options to me as things progressed. Based on our discussions throughout pregnancy, I knew that I could trust them to be evidence based in their practice, and that helped me relax in labor and focus on my job of giving birth.

How did I prepare for the first few weeks of caring for a newborn? I did what women have been doing throughout the history of our species – I invited my mom to come and help! She was a wonderful help after the birth of both of my babies, and I felt lucky to have her.


AE: What future topics are you looking forward to writing about next?

AC: Readers of my blog keep me well-supplied with questions about parenting, and I have a huge list of topics that I’d like to tackle. One of my favorite areas of focus is nutrition, as that is the field of my PhD training, so I’d like to develop more information about infant nutrition on my blog.

While I was researching and writing my book, I had three miscarriages. That brought up lots of questions for me about miscarriage and infertility, but I didn’t have time to write much about these topics because I was working so hard on The Science of Mom. I’d like to write more about them now. I think there is a real need for compassionate and evidence-based writing about these tough topics.

About Anne M. Estes, PhD

AnneMEstes_headshot 2015Anne M. Estes, PhD is a postdoctoral fellow at the Institute for Genome Sciences in Baltimore, MD. She is interested in how microbes and their host organisms work together throughout host development. Anne blogs about the importance of microbes, especially during pregnancy, birth, first foods, and early childhood at Mostly Microbes.

Babies, Book Reviews, Childbirth Education, Evidence Based Medicine, Guest Posts, Newborns , , , , , ,

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