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Report Finds Widespread Global Mistreatment of Women during Childbirth

July 2nd, 2015 by avatar
© Pawan Kumar

© Pawan Kumar

The journal PLOS Medicine published a research review yesterday, “The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Method Systematic Review” (Bohren, et al, 2015).  Reading this report was both disturbing and extremely sad to me. Respectful care is a part of the United Nations Millennium Development Goal Target 5A: Improve Maternal Health. – which set a goal of reducing the maternal mortality ratio (the number of deaths among women caused by pregnancy- or childbirth-related complications (maternal deaths) per 100,000 live births) by 75% from 1990 to 2015.  The target rate had been 95 pregnancy or childbirth related deaths per 100,000 women but the current rate is sitting at 210/100,000, which is just a 45% drop.  99% of all maternal deaths occur in low-income and middle-income countries, where resources are limited and access to safe, acceptable, good quality sexual and reproductive health care, including maternity care, is not available to many women during their childbearing year. The most common cause of these maternal deaths are postpartum hemorrhage, postpartum infection, obstructed labors and blood pressure issues – all conditions considered very preventable or treatable with access to quality care and trained birth attendants.

Analysis of reports examined in this paper indicate that “many women globally experience poor treatment during childbirth, including abusive, neglectful, or disrespectful care.” This treatment can further complicate the situation downstream, by creating a disincentive for women to seek care from these facilities and providers in future pregnancies.

The reports and studies that were reviewed to create this report obtained their information from direct observation, interviews with women under care,  and were self-reported by the mothers.  Follow-up surveys were also conducted.

From the qualitative research, investigators were able to classify the mistreatment  into seven categories:

  1. physical abuse
  2. sexual abuse
  3. verbal abuse
  4. stigma and discrimination
  5. failure to meet professional standards of care
  6. poor rapport between women and providers
  7. health system conditions and constraints

The quantitative research revealed two themes: sexual abuse and the performance of unconsented surgical operations.

World Bank Photo Collection http://flickr.com/photos/worldbank/7556637184 shared under a Creative Commons (BY-NC-ND) license

It is no surprise that women’s experiences were negatively impacted by the mistreatment they received during their maternity care treatment period.  Some of the treatment was one on one – from the care provider to the mother, while other inappropriate treatment was on a facility level.

Investigation of the treatment of women during pregnancy and childbirth was conducted because it is known that care by a qualified attendant can significantly impact maternal mortality, but if women are disinclined to seek out appropriate care due to a fear of mistreatment, help is not available or utilized and mortality rates rise.  Removing this obstacle is key to reducing maternal deaths.

Prior experiences and perceptions of mistreatment, low expectations of the care provided at facilities, and poor reputations of facilities in the community have eroded many women’s trust in the health system and have impacted their decision to deliver in health facilities in the future, particularly in low- and middle-income countries Some women may consider childbirth in facilities as a last resort, prioritizing the culturally appropriate and supportive care received from traditional providers in their homes over medical intervention. These women may desire home births where they can deliver in a preferred position, are able to cry out without fear of punishment, receive no surgical intervention, and are not physically restrained. – Bohren, et al.

Women who are mistreated during childbirth obviously reflects a quality of care issue, but also a larger scale- a fundamental human rights issue.  International standards are clear that this is not acceptable.  The researchers encourage the use of their finding to assist in the development of measurement tools that can be used to inform policies, standards and improvement programs.

We must seek to find a process by which women and health care providers engage to promote and protect women’s participation in safe and positive childbirth experiences. A woman’s autonomy and dignity during childbirth must be respected, and her health care providers should promote positive birth experiences through respectful, dignified, supportive care, as well as by ensuring high-quality clinical care. – Bohren, et al.

I encourage you to read the study for a thorough review of the research findings.  The information is difficult to fully take in. Additionally, a companion paper  – “Mistreatment of Women in Childbith: Time for Action on this Important Dimension of Violence against Women” provides further information.  The New York Times covered this topic in their June 30th Health Section. The World Health Organization also covered this report and has a statement on this issue, endorsed by over 80 organizations, including Lamaze International.  The WHO also has a list of videos on the topic of abuse and mistreatment of women during pregnancy and childbirth that can be found here.

References

Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. (2015) The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med 12(6): e1001847. doi:10.1371/journal.pmed.1001847

Jewkes R, Penn-Kekana L (2015) Mistreatment of Women in Childbirth: Time for Action on This Important Dimension of Violence against Women. PLoS Med 12(6): e1001849. doi:10.1371/journal.pmed.1001849

Do No Harm, Maternal Mortality, Maternal Mortality Rate, Maternal Quality Improvement, Maternity Care, New Research, News about Pregnancy, Research , , , , , ,

Lamaze International Launches Free Pregnancy to Parenting Mobile App to Support Families

June 8th, 2015 by avatar

Free new app!Lamaze International is delighted to announce the launch of their new “Pregnancy to Parenting” mobile app for families.  This just released app is meant to be a comprehensive evidence based resource for people to use during the childbearing year and is free to anyone who downloads it.  In addition to sharing customized information about their pregnancies, the app also provides tips and information for labor and birth and then continues to support families after birth as they feed and care for their new baby.  85% of millennials are heavily reliant on their smartphones for both information as well as entertainment throughout the day.  Lamaze International, well-recognized as the leader in childbirth education, meets today’s parents where they are at (on their smart phones) with this well designed, well thought-out app that takes families from conception all the way into their first weeks and months of parenting!

After downloading the app from either the Apple App store or from Google Play, parents can get weekly information about their pregnancy, updates on what baby development looks like that week and even access fun lighthearted facts that are entertaining as well as interesting. Daily tips, relevant articles, and Q&As are also included.

The “Pregnancy to Parenting” app lets pregnant families find a Lamaze class near them (make sure your information is up to date in your membership profile!  We will discuss how to access and update your profile in a post here on Thursday), maintain a calendar that tracks their CBE classes, doctor or midwife appointments, and even create a pregnancy journal with notes, videos and pictures.LI_MobileAppScreenshots5

As labor begins, there is a handy contraction timer and parents can access evidence based information about what to expect during labor and birth as well as useful tips, for example – information on the importance of moving around and changing positions as labor continues to progress.

After birth, parents can use the useful breastfeeding and diaper tracker as they head into the wonderful but exhausting first days and weeks with their newborn.  There is also information on postpartum mood and anxiety disorders, what to look for and how to get help.

The content in the “Pregnancy to Parenting” mobile app was prepared and approved by Lamaze Certified Childbirth Educators just like you, and delivered in a thorough and easy to navigate app that looks great and functions well on today’s mobile devices.

As the “Pregnancy to Parenting” mobile app gets introduced to expectant and new parents, Lamaze International is offering educators and other birth professionals an opportunity to participate in a 60 minute webinar: Utilizing the New Lamaze Mobile App – Pregnancy to Parenting, facilitated by former Lamaze President Michelle Deck, RN, MEd, BSN, LCCE, FACCE on Tuesday, June 9th at 1:00 PM EDT.  The purpose of this webinar is to share information with childbirth educators on the app’s content and functionality as well as suggest how educators can introduce the mobile app to families and incorporate the app in their classrooms.  You can register now for this informative session.

LI_MobileAppScreenshots3Lamaze International has prepared an educator resource kit to help you spread the word about the new “Pregnancy to Parenting” mobile app that includes flyers for your classroom and workplace, a friendly email that you can use to introduce the app to your students and community and even PowerPoint slides that can be integrated into your classroom curriculum.  Learn more about the mobile app and these resources here on the resource kit page of the Lamaze International website.

Lamaze International wants to offer the families you work with (and all families) access to additional information that supports what they are already learning in their Lamaze class.  Having access to resources that provide evidence based information in a format that today’s families are used to accessing helps families to have a safe and healthy birth and make decisions that support healthy mothers, healthy babies and healthy families.  Making it easy for families to find a Lamaze class in their area, when they have not yet signed up for childbirth classes, helps educators to reach more families and benefits educators by directing those families right to you! The new “Pregnancy to Parenting” mobile app is a great tool for families and educators a like.  Head over to the app store of your choice and download the app, so you can become familiar with it and will be ready to share with the families that you work with.  See you in the webinar!

Babies, Breastfeeding, Childbirth Education, Lamaze International, Lamaze News, News about Pregnancy, Pregnancy to Parenting Mobile App , , , ,

Online Course- “Labor Pain Management: Techniques for Comfort & Coping” Goes Live

February 24th, 2015 by avatar

online course adLamaze International is very pleased to announce the release of their fourth and newest online Lamaze childbirth education course for expectant families.  This newest offering, “Labor Pain Management: Techniques for Comfort and Coping” provides families with coping skills for all the stages and phases of labor, from early labor right through pushing and birth.  All of the Lamaze International online courses are interactive, filled with great photographs and graphics, and based on the most current evidence.  You can read more about the previous courses that were released in this post from November, 2014.  Our first online course: Safe and Healthy Birth: Six Simple Steps was released in early 2014 when Lamaze unveiled the Online Parent Learning Center.

Lamaze International expanding into online childbirth education

The Lamaze International Strategic Framework 2014-2017 that resulted from in-depth strategic planning meetings held in 2014 with the Board of Directors and Lamaze management resulted in many forward thinking, comprehensive and courageous goals, including plans to “innovate education and expand to the childbearing years” by:

  • reaching more women earlier and more frequently throughout childbearing years,
  • expanding delivery methods for online education (e.g., virtual classes, Facetime consults, and mobile apps), and
  • developing a strategy to broaden outreach at the electronic level and cultivate moms ‘up’ the ladder for more personalized services and training.

Labor Pain Management: Techniques for Comfort and Coping

The course description lets families know that “labor and birth require a lot of physical and mental preparation. As you get ready for your upcoming birth, you will want to have a variety of comfort measures and coping techniques in your labor toolbox so that you and your support team can be as prepared as possible. Learning helpful labor positions and strategies to promote labor progress will allow your body to work with your baby toward a safe and healthy birth. Lamaze International has created this class to provide you with the information and skills you will need to minimize discomfort and labor confidently.”

The voice over sections with the birth story were particularly helpful in making me feel like others have gone through this – so I can too.” – online course participant.

The class objectives

After completing this class learners will be able to:

  • Use learned relaxation skills suitable for early labor
  • Practice a variety of comfort techniques that minimize active labor discomfort
  • Understand back labor and how to cope with back pain while encouraging baby to turn
  • Plan for transition with effective labor strategies
  • Learn the top positions for pushing that open the pelvis and shorten the pushing time

Practice makes perfect

Interactive activities invite parents to practice coping activities, breathing skills and different positions alone and with a partner to see what might work for them in labor.  They can also follow along with a birth story from start to finish, woven throughout the course, to see how a new family applied the skills covered in the course at their own birth.  Families are encouraged to stop and practice newly learned techniques and note what they think will work well for them in labor.  The sections of the course detail what is happening physiologically during each phase and offers suggestions for emotional and physical  coping and comfort techniques that might be helpful.  Families are introduced to positions and activities to practice as they near the end of their pregnancies, so they are familiar with them prior to labor beginning.  The course builds confidence in the pregnant person that they will have many helpful techniques to try, and demonstrates the important role of the birth partner and other support people who will be in attendance.  There is also information about how to continue to promote labor progress should a woman choose to have an epidural.

I loved how easy the online format was, and I completed the entire class with my husband, who learned a lot about his role in birth supporting me. – online course participant.

This self-paced class is accessible on both desktop and mobile devices, and discussion forums built into the course encourage community building and online engagement with other families.

Class participants are able to repeat the course material as often as they wish and fun quizzes spaced throughout reinforce their learning.  At the end of the course, families are provided with the benefits of taking an in-person online class, and directed to the “Find a Lamaze Class” section of the parent website to locate a class in their area.

Online courses still to come in 2015 include Parenting Together: Starting Off Strong and Prepared for Pregnancy: Start Off Right, which are still in development.  Existing classes that are available now are:

  • Labor Pain Management: Techniques for Comfort and Coping
  • VBAC: Informed and Ready
  • Breastfeeding Basics: From Birth to Back to Work
  • Safe and Healthy Birth: Six Simple Steps

To learn more about this newest addition to the Lamaze International online course catalogue, preview the courses and persuse all the offerings, please visit the online course catalog.

Childbirth Education, Lamaze International, News about Pregnancy , , , ,

You’re Invited to Lamaze International’s Next Twitter Chat: Prenatal Fitness

August 19th, 2014 by avatar
perinatal fitness

CC http://flickr.com/photos/cumidanciki/7807501656

Won’t you consider joining Lamaze International’s President Elect, Robin Elise Weiss, as she hosts our next Twitter Chat on Thursday, August 21, 2014 at 9:00-10:00 PM EST.  The topic to be discussed is prenatal fitness and you can find the party at #LamazeChat.  You will want to put this event on your own calendar as well as share with your clients and students via social media, so everyone can benefit from the fast moving discussion that will no doubt be filled with facts and information that everyone can use.

Perinatal Fitness expert Catherine Cram, M.S.,  owner of Comprehensive Fitness Consulting shares some tips that will be discussed further during the Twitter chat. Childbirth educators may find it useful to share this information when discussing fitness and exercises in your childbirth classes.

• The key to getting the greatest benefits with prenatal exercise for both mom and baby are to continue to workout to the end of the pregnancy.

• Research has shown that women who continue to exercise throughout pregnancy gain less weight, have reduced complications during labor and delivery and return to pre-pregnancy weight faster than those that don’t exercise.

Tips for sticking with exercise during all trimesters:

• Try to include several types of exercise, from walking to swimming or biking and mix it up so mothers don’t overwork muscles and joints.

• Break up workouts into two sessions of a shorter duration if fatigue makes it tough to maintain the usual routine.

• The exercise intensity level should stay within a range that feels challenging, but not so hard that a mother is out of breath.  We use what’s called the “talk test” with prenatal exercise, which simply means that a mother should be able to carry on a conversation while exercising, and if she can’t, then she is working too hard.

• As pregnancy progresses it’s as if women are wearing a backpack that gets heavier each week.  Keep this in mind when workouts seem to be getting harder- the workout is a lot tougher even at the same intensity at 30 weeks than at 15 weeks. Modify routines as needed to keep workout level within safe limits.

• Make sure to add some upper body strength training to the workout.  Mothers will need that strength for all the lifting required with baby care.  Keep in mind that all someone needs to do for strength gains is one set of 10-12 repetitions of a weight.  Exercise bands are a great way to do strength training, and they’re inexpensive and easy to use.

• Buddy up with a friend for fitness sessions. Encourage class members to plan exercise sessions together outside of class.  They will be a lot more successful with maintaining a fitness routine when they are partnered or in a fitness group, and it makes the time go a lot faster.

twitter logoTwitter Chats are a fun way to connect with both families and other educators from all over, learn more about the topic, Prenatal Fitness, share resources and enjoy a pleasant discussion.  Robin Weiss is a skilled facilitator who makes every Twitter Chat she hosts a totally enjoyable event. New to participating in a Twitter chat? Check out this article for information on how to participate and get the most out of your experience. Don’t be shy about jumping in.  Your participation will be totally welcomed! See you August 21st at 9PM EST!  Tweet, tweet!

 

 

 

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2014 Preeclampsia Awareness Survey Highlights Need for Education- Educators Play a Key Role

May 13th, 2014 by avatar

May is Preeclampsia Awareness Month and childbirth educators play a key role in informing families about the symptoms of this disease of pregnancy (or postpartum.) Eleni Tsigas, the Executive Director of The Preeclampsia Foundation shares the results of a recent survey quizzing women on their awareness of this potentially deadly disease.  CBEs and others have a responsibility to share information in a calm, factual way duing class so that women are informed but not scared, should this disease present itself during their childbearing year. – Sharon Muza, Community Manager, Science & Sensibility

Preeclampsia_Pledge

As Executive Director of the Preeclampsia Foundation®, the nation’s only patient advocacy organization for preeclampsia and related hypertensive disorders of pregnancy, I’m excited to announce the results of a recent nationwide Preeclampsia Awareness Survey of more than 1,500 expectant and new mothers. These survey findings are driving the Foundation’s strategies associated with National Preeclampsia Awareness Month this month.

The survey, which was conducted by BabyCenter®, shows a high overall awareness of preeclampsia and that it is serious and associated with high blood pressure. There was also near universal knowledge to call a healthcare provider if experiencing symptoms of preeclampsia.

We’re very encouraged by the awareness that’s been raised in recent years, in sharp contrast to our last study six years ago that found very low overall awareness of preeclampsia. But there’s more to do, because this year’s survey also shows low awareness when respondents were asked about specific symptoms associated with preeclampsia.

The more a pregnant woman knows about preeclampsia, the more likely she is to recognize and report symptoms to her doctor or midwife. That improves time to diagnosis and medical evaluation, which saves lives – for both mothers and babies. And that’s why we’re so focused on improving awareness of preeclampsia.

Preeclampsia and other hypertensive disorders of pregnancy remain a leading cause of maternal and infant illness and death. Globally, by conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths every year. In the United States, preeclampsia affects one in every 12 pregnancies, and its incidence has increased by 25 percent during the past two decades.

Key Survey Findings

The recent survey of 1,591 women shows high overall awareness of preeclampsia, its severity and link to high blood pressure, and to immediately report symptoms to their healthcare providers:

  • 83% of respondents had heard of preeclampsia and of those women, 99% knew that it is extremely serious, even life-threatening for mother and baby, very serious, or somewhat serious
  •  88% knew that high blood pressure is a sign of preeclampsia
  • 96% would call their doctor or midwife if they experienced symptoms

Results also show areas that the healthcare community needs to address:

  • Raise awareness of the specific symptoms associated with preeclampsia
    • 78% incorrectly linked preeclampsia to swelling of the feet
    • Only 70% correctly linked preeclampsia to headache and vision changes
    • 3 out of 5 women were not sure about several other symptoms
  • Educate women on when preeclampsia can occur and its long-term impact
    • 44% didn’t know that preeclampsia can occur even after the baby is delivered, up to six weeks postpartum
    • 46% didn’t know that women with preeclampsia are at risk for future health problems
  • Improve access to information, regardless of education or income level
    • Compared to the 83% of respondents in general who had heard of preeclampsia,
      • 51% with some high school education had heard of preeclampsia
      • 37% who earned under $25k a year had heard of preeclampsia

Download the Preeclampsia Infographic

Survey Findings Drive Education Campaign

Released in conjunction with Preeclampsia Awareness Month, the survey findings provided the basis of the Foundation’s education campaign launched this month. Its theme – Take the Preeclampsia Pledge: Know the Symptoms. Spread the Word – highlights the importance of early recognition and reporting of symptoms. The campaign features Promise Walks for Preeclampsia™ across the country, social media events, and an easy-to-understand and share video called Preeclampsia: 7 Symptoms Every Pregnant Woman Should Know. (Spanish version)


 Know the Symptoms. Spread the Word.

Early recognition and reporting of symptoms is the key to timely detection and management of preeclampsia. Women who are pregnant or recently delivered should contact their doctor or midwife right away if they experience any of the symptoms listed below, and healthcare providers should be appropriately responsive. While these symptoms don’t necessarily indicate preeclampsia, they are cause for concern and require immediate medical evaluation.

  • Swelling of the hands and face, especially around the eyes (swelling of the feet is more common in late pregnancy and probably not a sign of preeclampsia)
  • Weight gain of more than five pounds in a week
  • Headache that won’t go away, even after taking medication for pain relief
  • Changes in vision like seeing spots or flashing lights; partial or total loss of eyesight
  • Nausea or throwing up, especially suddenly, after mid pregnancy (not the morning sickness that many women experience in early pregnancy)
  • Upper right belly pain, sometimes mistaken for indigestion or the flu
  • Difficulty breathing, gasping, or panting
  • “I just don’t feel right”

It’s also important to know that some women with preeclampsia have NO symptoms. Healthcare providers can only diagnose preeclampsia by monitoring blood pressure and protein in the urine, which is routinely done at prenatal appointments, so keeping all appointments is vital throughout pregnancy and immediately after delivery.

About the Preeclampsia Awareness Survey

The survey was conducted among visitors to the BabyCenter® website from January 17 to January 20, 2014. A total of 1,591 respondents completed the survey; qualified respondents are defined as female U.S. residents, 18 years or older, who are pregnant or have at least one child three years of age or younger.

About the Preeclampsia Foundation

A U.S.-based 501(c)(3) non-profit organization established in 2000, the Preeclampsia Foundation is dedicated to providing patient support and education, raising public awareness, catalyzing research and improving health care practices, envisioning a world where preeclampsia and related hypertensive disorders of pregnancy no longer threaten the lives of mothers and babies. More information can be found at www.preeclampsia.org or by calling toll-free 800.665.9341.

How do you talk about preeclampsia in your childbirth classes?  When do you discuss it?  Are you also sharing that postpartum women can also develop this disease?  Would you consider showing the brief video above highlighting the seven key symptoms.  Let us know how you are discussing this topic in the comments section below. – SM

About Eleni Z. Tsigas 

eleni tsigas head shotEleni Z. Tsigas is the Executive Director of the Preeclampsia Foundation. Prior to this position, she served in a variety of volunteer capacities for the organization, including six years on the Board of Directors, two as its chairman. Working with dedicated volunteers, board members and professional staff, Eleni has helped lead the Foundation to its current position as a sustainable, mission-driven, results-oriented organization.

Eleni is married, and had has two of her three pregnancies seriously impacted by preeclampsia. As a preeclampsia survivor, she is a relentless champion for the improvement of patient and provider education and practices, for the catalytic role that patients can have to advance the science and status of maternal-infant health, and for the progress that can be realized by building global partnerships to improve patient outcomes.

Eleni has served as a technical advisor to the World Health Organization (WHO), is a member of the PRE-EMPT Technical Advisory Group and Knowledge Translation Committee (funded by the Gates Foundation), and participates in the Hypertension in Pregnancy Task Force created by the American College of Obstetricians and Gynecologists (ACOG), as well as a similar task force for the California Maternal Quality Care Collaborative (CMQCC). Eleni is frequently engaged as an expert representing the consumer perspective on preeclampsia at national and international meetings, and as a spokesperson in various public speaking venues. She was honored to deliver The Jim & Midge Breeden Lecture as part of ACOG’s 2012 Annual Clinical Meeting President’s Program.

Childbirth Education, Guest Posts, Maternal Mortality, Maternity Care, News about Pregnancy, Pre-eclampsia, Pregnancy Complications , , , ,

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