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ACOG & SMFM Standardize Levels of Maternal Care to Improve Maternal Morbidity & Mortality

February 5th, 2015 by avatar

obThe American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine released their second joint consensus statement on January 22nd, 2015. This consensus statement, Levels of Maternal Care is published in the February 2015 issue of Obstetrics and Gynecology (Green Journal).

What are the objectives of this statement?

The objectives of the statement, Levels of Maternal Care, is fourfold:

  1. To introduce uniform designations for levels of maternal care that are complementary but distinct from levels of neonatal care and that address maternal health needs, thereby reducing maternal morbidity and mortality in the United States
  2. To develop standardized definitions and nomenclature for facilities that provide each level of maternal care
  3. To provide consistent guidelines according to level of maternal care for use in quality improvement and health promotion
  4. To foster the development and equitable geographic distribution of full-service maternal care facilities and systems that promote proactive integration of risk-appropriate antepartum, intrapartum, and postpartum services

With a system in place that defines the levels of care, it will be clear when a transfer of care is deemed necessary to a facility that is better able to provide risk appropriate care to those women who need a higher level of maternity care.  This will improve maternal outcomes and reduce maternal morbidity and mortality.

Our goal for these consensus recommendations is to create a system for maternal care that complements and supplements the current neonatal framework in order to reduce maternal morbidity and mortality across the country. – Sarah J. Kilpatrick, MD/PhD, Lead Author

The USA ranks 60th in maternal mortality worldwide (Kassebaum NJ, 2014) and while some states  have established programs for a striated system of maternity care separate from the needs of the newborn, designations of what level of maternal care center will best serve the mother is not consistent and and creates confusion with a lack of uniform terms and definitions. Data supports better outcomes for mothers when certain maternal complications are handled in a facility deemed most appropriate for that condition.

Many years ago, thanks to the efforts of the March of Dimes, a similar system of levels of neonatal care was designated for the newborn, with each level having clear definitions of the type of services they were best able to provide, how they should be staffed and when a baby was to be transferred to a higher level facility based on newborn health conditions.  This newborn level of care system improved outcomes for babies in the USA, as they were assigned to a location that could best meet their medical needs. The levels of maternal care compliment the levels of care for the neonate, but should be viewed independently from the neonatal designations.

What are the levels of maternal care?

The statement defines five levels of care – Birth Center, Level I (Basic Care), Level II (Specialty Care), Level III (Subspecialty Care) and Level IV (Regional Perinatal Health Care Centers).

For each level, there is a definition, a list of capabilities that each facility should have, the types of health care providers that are assumed to be competent to work there and examples of appropriate patients.

Each level requires meeting the capabilities of the previous level(s) plus the ability to serve even more complicated situations until you reach Level IV, suitable for the most complicated, high populations.

The risk appropriate patient deemed suitable for each level takes into account the skills and training of the midwives or doctors who staff that facility and the ability of those individuals to initiate appropriate emergency skills and response times for the patient.  As a woman becomes less and less “low risk”, she will need to have her care transferred to the appropriate level.  This transfer may occur prenatally, intrapartum or during the postpartum period.

Recognition of the out of hospital midwife and the birth center

The consensus statement recognizes the credentials of the Certified Midwife (CM), the Certified Professional Midwife (CPM) and the Licensed Midwife (LM) as appropriate health care providers, along with Certified Nurse Midwives, OBs and Family Practice doctors, for low risk women in out of hospital facilities where those individuals are legally recognized as able to practice.  The low risk woman is defined as low-risk women one with an uncomplicated singleton term pregnancy with a vertex presentation who is expected to have an uncomplicated birth.

The statement also officially recognizes the freestanding birth center as an appropriate place to give birth for low risk women, along with supporting the collaboration of birth center midwives with the health care providers at higher level maternal care facilities.

Clear capabilities and requirements

The statement also outlines the type of staffing requirements to be available for services, consultation, or emergency procedures at each type of facility.

The consensus statement acknowledges that the appropriate level of  care for the baby may not align with the appropriate level of care for the mother.  Care guidelines that have been long established and well determined for the newborn should also be followed.

Consensus statement receives strong support

The consensus statement has been reviewed and endorsed by:

American Association of Birth Centers

American College of Nurse-Midwives

Association of Women’s Health, Obstetric and Neonatal Nurses

Commission for the Accreditation of Birth Centers

The American Academy of Pediatrics leadership, the American Society of Anesthesiologists leadership, and the Society for Obstetric Anesthesia and Perinatology leadership have reviewed the opinion and have given their support as well.

Additionally, the Midwives Alliance of North America was pleased to see this consensus statement and read how the role of out of hospital midwives was addressed.

MANA applauds ACOG’s identification of the need for birthing women to have a wide range of birthing options, from out of hospital settings for low-risk women to regional perinatal centers for families experiencing the most complicated pregnancies. As ACOG states, a wide variety of providers can meet the needs of low-risk women, including Certified Professional Midwives, Certified Nurse Midwives, Certified Midwives, and Licensed Midwives. We strongly concur with the need for collaborative relationships between midwives and obstetricians. Treesa McLean, LM, CPM, MANA Director of Public Affairs

What does this mean for the childbirth educator?

I encourage all birth professionals to read the consensus statement (it is easy to read) to understand the specifics of each level of maternal care.  As we teach classes, we can discuss with our families that there may be circumstances during their pregnancy or labor that require their care to be changed or transferred to a facility that offers the level of maternal care appropriate for their condition. Some of us already work in hospitals that are Level IV while others of us might teach elsewhere. We can help families to understand why a transfer might be necessary, and how to ask for and receive the information they need to fully understand the reason for a transfer of care and what all their options might be.  Families that are prepared, even for the events that they hoped to avoid, can feel better about how their labor and birth unfold.

Thank you ACOG and SMFM for working hard to clarify and bring about uniform standards that can be applied across the country that will improve the outcomes for mothers giving birth in the USA.

Photo source: creative commons licensed (BY-NC-SA) flickr photo by Paul Gillin

References

Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 [published erratum appears in Lancet 2014;384:956]. Lancet 2014;384:980–1004. [PubMed]

Levels of maternal care. Obstetric Care Consensus No. 2. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125:502–15.

American Academy of Pediatrics, Childbirth Education, Evidence Based Medicine, Maternal Mortality, Maternal Quality Improvement, Maternity Care, Medical Interventions, Midwifery, New Research, Practice Guidelines, Pregnancy Complications , , , , ,

You Are Invited to Participate in an Online Learning Opportunity: Patient, Staff, and Family Support Following a Severe Maternal Event

October 10th, 2014 by avatar

council women safety

Past posts on Science & Sensibility – CDC & ACOG Convene Meeting on Maternal Mortality & Maternal Safety in Chicago and U.S. Maternal Mortality Ratio is Dismal, But Changes Underway, and You are Invited to Participate have shared information on the National Partnership for Maternal Safety, a multidisciplinary initiative focused on reducing the rates of maternal morbidity and mortality in the United States.  This partnership falls under the umbrella of The Council on Patient Safety in Women’s Health Care. This unique consortium of organizations across the spectrum of women’s health has come together to promote safe health care for every woman, at every birthing facility in the U.S. through implementation of safety bundles for common obstetric emergencies (hemorrhage, preeclampsia/hypertension and venous thromboembolism) as well as supplemental bundles on Maternal Early Warning Criteria, Facility Review after a Severe Maternal Event, and Patient/Family and Staff Support after a Severe Maternal Event.

The public Safety Action Series has introduced topics including an overview of the Partnership, efforts underway to define and measure Severe Maternal Morbidity, identify and implement Maternal Early Warning Criteria, Quantification of Blood Loss, and the outlines of the OB Hemorrhage Patient Safety Bundle. These slide sets and audio recordings have been archived and are available to the public.

christine morton headshotThe next event will be Tuesday, October 14 at 12:30 pm EST, with presenters Cynthia Chazotte, MD, FACOG, and Christine Morton, PhD, on Patient, Staff, and Family Support Following a Severe Maternal Event, and you can register for the event here. Registering for any event puts you on a list to be informed of upcoming events and future activities of the Partnership. Childbirth educators and other birth professionals may have students and clients who experience a serious medical event during labor and birth.  Having resources for families and for yourself is absolutely critical.  This information will be covered during the online event.

Christine Morton is a board member on the Lamaze international Board of Directors.   We are lucky to have such an active and knowledgeable professional to serve and support the Lamaze mission and values. Please share this information and get involved.

Childbirth Education, Lamaze International, Maternal Mortality, Maternal Quality Improvement, Maternity Care, Pregnancy Complications , , , ,

CDC & ACOG Convene Meeting on Maternal Mortality & Maternal Safety in Chicago

May 23rd, 2014 by avatar
creative commons licensed (BY-NC-SA) flickr photo by Insight Imaging: John A Ryan Photography: http://flickr.com/photos/insightimaging/3709268648

creative commons licensed (BY-NC-SA) flickr photo by Insight Imaging: John A Ryan Photography: http://flickr.com/photos/insightimaging/3709268648

Earlier this week, I shared information on the Safety Action Series kickoff that all were invited to participate in, by the National Partnership for Maternal Safety – focused on reducing the maternal mortality ratio and morbidity ratio for mothers birthing in the U.S.  This partnership is part of the Council on Patient Safety in Women’s Health Care.  Last month Christine Morton, PhD and Robin Weiss, MPH attended a meeting as board members of Lamaze International.  Christine shares meeting notes and topics that were discussed and what maternity professionals, including childbirth educators,  can do to help. – Sharon Muza, Science & Sensibility Community Manager.

Disclosure:  Christine is a member of the Patient/Family Support Workgroup of the National Partnership for Maternal Safety, and a current board member of Lamaze International. 

Since 1986, the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) convened interested persons in public health, obstetrics and maternity care to discuss and share information about maternal mortality, including methodologies for pregnancy mortality surveillance at state and national levels, and opportunities to reduce preventable maternal deaths.   Recently, under leadership of Dr. Elliott Main, medical director of California Maternal Quality Care Collaborative (CMQCC), and drawing from the recent experience of California in maternal quality improvement and work by other organizations and collaboratives, the focus of the interest group has shifted from surveillance to quality improvement.  The meeting has evolved from the early years when 12-20 persons sat around tables to discuss the issue, to this year’s meeting which had over 180 persons registered.  Clearly the time has come for a coalition around improving maternity outcomes in the U.S.

The National Partnership for Maternal Safety was proposed in 2013 in New Orleans, and the goal of the April 27, 2014 meeting in Chicago was to formally launch the initiative and report on the progress of each work group. The goal of the National Partnership for Maternal Safety is for every birthing facility in the United States to have the three designated core Patient Safety Bundles (Hemorrhage; Venous Thromboembolus Prevention; and Preeclampsia) implemented within their facility within three years. The bundles will be rolled out consecutively, beginning with obstetric hemorrhage and advancing to the other areas. To support this national effort, publications are underway in peer-reviewed journals. The first article, as an editorial call to action, appears in the October 2013 issue of Obstetrics & Gynecology, the official publication of the American College of Obstetricians and Gynecologists.

Highlights from this year’s meeting included two presentations from CDC researchers William Callaghan, MD, MPH and Andreea Creanga, MD, PhD, on work being done to better identify cases of severe maternal morbidity (SMM) and drivers of racial/ethnic disparities.  One of the goals of creating a working definition of SMM is to help facilities track and review cases in order to identify systems issues and address them through quality improvement efforts.

Next, representatives from selected work groups (Hemorrhage; Venous Thromboembolus Prevention; Patient/Family Support) shared their updates.    It has become very clear from ongoing work within large hospital systems, state-based quality collaboratives and other countries such as the UK, that standardized protocols for recognition and response to preventable causes of mortality and morbidity are effective.  Unfortunately, there is no national requirement for all birthing facilities (hospitals and birth centers) to have updated policies and protocols on these preventable causes of maternal complications.

The good news is that there is a groundswell of support for a coordinated effort to realize the goals of the Initiative.  From state quality collaboratives in California, New York, Ohio and Florida to Hospital Engagement Networks, there are many hospitals already implementing some maternal quality improvement toolkits.  The Joint Commission plays a key role in helping hospitals work on patient safety issues and identified maternal mortality as a sentinel event in 2010 and is now proposing that any intrapartum (related to the birth process) maternal death or severe maternal morbidity should be reviewed.  As the nation’s largest accreditation body for hospitals, the Joint Commission is in a position to provide oversight as well as guidance to hospitals as they develop system-level reviews of these outcomes.

More states are being supported by federal and nonprofit agencies to develop and conduct maternal mortality reviews, and the role of Title V, the only federal program that focuses solely on improving the health of mothers and children, is critical.  Title V is administered by each state to support programs enhancing the well being of mothers and their children.

The last topics of the day were how to address the most common cause of maternal mortality – cardiovascular disease in pregnancy – but not as preventable as the three causes featured in the Initiative.

Suggested topics for future meetings including looking at maternal mortalities due to suicide, helping states with small populations aggregate their data, and addressing the issue of prescription (and other) drug abuse among pregnant women.  Eleni Tsigas from the Preeclampsia Foundation stressed the importance of including women’s perspectives and the emotional, social and ongoing physical sequelae of living after a severely complicated childbirth experience.

How is this information relevant for childbirth educators, doulas and other maternity professionals?  First, the rising rates of maternal mortality and morbidity are in the news.  While deaths are rare, severe complications are more common.  CBEs and doulas can reassure pregnant women in their classes that the likelihood of a severe morbidity is low, and can provide resources to share with women and help them learn which hospitals in their communities have begun the work of maternal quality improvement.  CBEs can share this information with key nursing and medical leaders at hospitals where they teach, and offer to help with the Quality Improvment (QI) efforts.

Childbirth educators and others can help ensure the focus not become too one sided – while it is important for every hospital to be ready for typical obstetric emergencies, it is also important for every hospital to be prepared to support women through normal physiologic birth by trained staff and supportive physicians. AWHONN launched its campaign, “Go the full 40” in January 2012 to help everyone remember that while we don’t want to ELECTIVELY deliver babies prior to 39 completed weeks gestation, we also want to support labor starting on its own.  And most recently, ACNM unveiled its BirthTOOLs site, which includes resources, tools and improvement stories on supporting physiologic, vaginal births.  CBEs and doulas can be strong advocates in supporting facility and maternity clinician preparedness for the ‘worst case’ and ‘best case’ scenarios in childbirth.

For more info about National Partnership for Maternal Safety or the CDC/ACOG Maternal Mortality Interest Group, please contact:  Jeanne Mahoney, jmahoney@acog.org

Past and future webinars about the initiative are available to the public here: http://www.safehealthcareforeverywoman.org/safety-action-series.html

Archived presentations from past CDC/ACOG maternal mortality interest group meetings

2014:  http://bit.ly/1sXkaGw

2012: http://bit.ly/1pfay9S

 

Childbirth Education, Guest Posts, Lamaze International, Maternal Mortality, Maternal Mortality Rate, Maternal Quality Improvement, Pregnancy Complications, Uncategorized , , , , ,

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 , , , ,

Now I Lay Me Down To Sleep Photography; Honoring the Babies Whose Stay Was Too Short

October 15th, 2013 by avatar

© Vicki Zoller

October 15 is National Pregnancy and Infant Loss Remembrance Day. If you are a professional who works with expecting families, you no doubt will at some point have a family who suffers a loss during their pregnancy, a stillbirth or the death of their newborn in the days and weeks after birth.  I wanted to share with Science & Sensibility readers a wonderful organization dedicated to honoring the loss or short life of a baby. Now I Lay Me Down To Sleep is a non-profit organization of photographers dedicated to capturing the images of a beautiful baby taken too  soon from the families who loved them.  I had the opportunity to interview a longtime photographer, Vicki Zoller with the program for today’s post in honor of this special day.  On Thursday, we will meet a family who lost a child and had their story documented by Vicki through the NILMDTS program.

_______________________

Sharon Muza:  How did you become involved in NILMDTS?

Vicki Zoller: 
I heard about the organization through another photographer. I haven’t experienced a loss but felt the draw of this work as a photographer. Being able to capture that moment in time, that private, painful moment in time and hold it captured forever for the family was the draw for me.  I have been involved in NILMDTS since 2008.

 SM:  What kind of photographer makes a great NILMDTS photographer?

VZ:  I think that a photographer that appreciates what a gift they possess and can share in such a meaningful way is what makes a great NILMDTS photographer. Having a skill, a unique skill that allows you to come into that room and forever record this moment is something that you either ‘get’ as a photographer or you don’t. The photographers that I have worked with, trained and become friends with in this organization have a passion for this. There is chord that resonates in us that tells us, ‘how can I NOT do this’. How often in life do we really get to make this kind of difference? How often do we really get the chance to make something a bit better out of something so horrible. It’s a chance to not just stand on the sidelines and say, ‘Oh how sad’ or to feel powerless. It’s that opportunity to know that you truly are making a difference.

SM: If there is a photographer interested in joining NILMDTS, what are the first steps that they should take?

VZ: They need to go to the main website at Now I Lay Me Down To Sleep and apply to become an affiliate photographer. During the application process an applicant will be asked to submit samples of their professional level work, demonstrating use of natural and auxiliary lighting. If they want to find out more about the organization before they apply they can, at the same website, click on the ‘find a photographer’ link and find someone in their area that might be willing to answer some questions for them.

SM:  Is there special training that a NILMDTS photographer receives before beginning this work.

VZ: NILMDTS photographers are given a training manual after they are accepted. Many larger areas, like here in the Greater Seattle Area, offer training on a fairly regular basis. We also have our new photographers go on a session with a more experienced photographer just to get a feel of where to go, what to say, how to handle the session, etc. But there are many of us, especially those that came into the organization early on, that never had that opportunity to ‘train’ or ‘shadow’ with a photographer. We just went when the hospital called and did what we knew how to do as photographers . . . capture beautifully lit and composed images that the family would have as keepsakes. Not really all that different than what we would try to do for a regular ‘paying’ client. We want to give our NILMDTS families the same quality as we would want to give to anyone.

SM:  How do you record the beauty of these little ones when their bodies may be scarred, or changed due to illness, medical equipment, etc. Do you “celebrate” these things or do you use your skills to portray the babies in a different light?

© Vicki Zoller

VZ: We never change anything that the baby was born with. These are special aspects of a beautiful new baby. So things like cleft lips or special features are kept as is and are indeed celebrated as part of this child. We do retouch images. We retouch blood, mucus, tears in skin, perhaps close the eyes if needed and generally try to create a gently retouched but authentic image of the baby. We may remove tape that held in medical equipment and try to give the family an image that doesn’t have “hospital’ written all over it. We try to pose the babies in gentle and sensitive ways with the parents and without. We tend to keep it simple and clean and truthful in the emotion of the day. We photograph many details, the little feet and hands, the profile, the ears, the swirl of hair on the top of the head. We want the family to have all these details to remember with. Especially when the detail may be a family trait of some kind such as a crocked finger or toes that splay wide . . . just little special things.
All our images are converted to Black and White or Sepia to provide a gentler viewing for the family.

SM: How do you not let the sadness and grief come into your life, when your work taking and processing the pictures is done?

VZ: The beauty of having a camera in front of your face is that is becomes a filter to the events and emotions in the room. That isn’t saying that we don’t feel things while we are there but when you have a job to do, a task to complete, that is where your mind tends to go and that camera is a filter. You are looking at the world through a bit of space that holds only a piece of the room at a time or a piece of the baby at a time. That makes a HUGE difference. We tend to go in to ‘photographer mode’ and that is where we stay during the session. Sometimes processing the images is the harder part. Now you have these images, large and real, on your computer screen and you are looking at them closely to see what you can do to improve them. It tends to come home emotionally for many photographers once they have the images on the computer. 

SM: Can you share a very challenging moment or situation in your work with NILMDTS?

VZ: That’s a tough one but generally the hardest tend to be the full term babies with NO VISIBLE signs of WHY they passed. I’ve been at sessions where mom was fine, baby was fine, all through labor but then at delivery things went south. On one occasion, it was a full term baby boy that came out screaming and crying but once the cord was cut he passed . . . instantly everything changed. I think that for me those kinds of sessions are the toughest. To be so CLOSE to the finish line, to almost have that baby all warm and pink and crying and then to have nothing . . . 
When you see a baby with obvious things wrong or they came too early or the parents have had to make that terribly hard choice to end the pregnancy due to health issues you can almost accept it better. Sort of like, ‘Ah ha! That’s the reason, there it is’. It gives you something to wrap your brain around. 
Not as easy to do with full term losses .  

SM: What would you like birth professionals to share with ALL parents about the NILMDTS program.

VZ: We are free. That is really important for them to know. I think they see our brochures and wonder how much it will cost them.
We are professional. We come in, we act professional, we capture professional quality images, we respect the environment we are in and we respect our families’ privacy and their pain. 

SM: Are there brochures available for placement in childbirth classes, health care provider offices, etc?

VZ: Yes, brochures are available either from our headquarters in Denver or you can get some from your local Area Coordinators or photographers.

 SM:  How does NILMDTS get the word out to birth professionals about the services that are offered to parents?

 

© Vicki Zoller

VZ: Our photographers and our Area Coordinators generally are the ones that get the information out there. I contacted the nursing managers at all our local hospitals when I first started. I built relationships and over time, as they saw the work we did, saw how we interacted with their patients, saw the benefits of what we can give, they began calling us more and more often. It’s a good feeling to be a part of the bereavement groups at the hospitals, to be something that the nurses can offer these families in such a horrible time. There is so little consolation that can be given but the prospect of having some beautiful and thoughtful images of your baby can be of great help in that horrible time.

SM: Who can use the services of NILMDTS?

VZ: All hospitals and birth centers. Also social workers for fetal medicine. Funeral homes as well. Any one that wants to contact us for any reason that might involve this special kind of photography is welcome to call. 

SM: Do you take pictures just of babies or do you also record older children?

VZ: Generally just babies. But if asked we would, if a photographer is ok with it, offer our service for older children. Soulumination (in the Puget Sound, WA area) is another photographer organization that often provides ‘life portraits’ for families of older kids facing a grim prognosis or for children under 18 whose parents are facing a terminal illness. 

SM: How are you received by the staff of the facilities you take pictures in?

VZ: At first it was a bit sketchy. Some nurses thought it was weird, grim, maybe not appropriate. But generally once they see the quality of our work and how it helps the family they become very accepting. We are now very well received at all the major hospitals in the greater Seattle Area.   

SM: What do you tell parents when they are unsure if they want pictures?

VZ: Generally it isn’t us that contacts the parents about our services. The nurses or the social worker will offer the service to the parents. We only come if the parents want us to come. We don’t come just because a nurse wants the photos taken. It is only at the request of the parents. 
Once there, parents might be feeling ambivalent about having images done. It is so surreal isn’t it? Here you are with a baby that has passed and in comes a professional photographer to take portraits!! 
If they tell me they don’t want any photos with the baby I gently remind them that today is raw and painful but there will come a time when the pain has lessened and I don’t want them to have any regrets about not having at least one image of their baby’s hand in their hand. Once I mention that it is just their hands they are more receptive and then sometimes it progresses from hands to a complete family portrait. But we don’t push too hard. As long as they have some photos of their baby, then they will find some peace in that.

 SM: Do you stay connected with families after you have completed your phot session?

VZ: On occasion. It isn’t something that I pursue. If it happens organically, then it’s wonderful. I have been able to see some of my families go on to have other babies, healthy, wonderful babies and I love that!!

SM: Is there anything you would like readers of Science & Sensibility to know?

VZ: If you or anyone you know has ever experienced a loss, please know that there are others out there just like you that are recovering and it’s important to not feel alone, find groups out there that have families going through loss as well. Stay connected to those that will understand what you are feeling.
 NILMDTS is an amazing organization that is always looking for new photographers and community volunteers. If anyone wants more information please contact me or NILMDTS headquarters.

Healthcare professionals are awesome and anyone working in the labor and delivery field knows how fragile the delivery process can be. There is always that moment when you can almost see mom and baby on that razor thin edge between life and death. Having a healthy baby is hard work and those that care for moms during pregnancy and birth are special people! We want to be a part of your bereavement kit but we hate it when you have to make that call. But when you do, please know we will be creating some meaningful images for your families and that we will do that with love and compassion.

Have you had experience with NILMDTS on a personal or professional level?  Do you share this resource with your students, clients and patients so that they are aware of this wonderful organization?   Are you also a photographer who captures these sweet babies? How do you help families experiencing pregnancy and infant loss?  What are your favorite resources.  Please share your thoughts with our readers in the comment section.  And if you know a NILMDTS photographer, thank them on this day, for the heart work that they do.

 

Babies, Childbirth Education, Newborns, Pre-term Birth, Pregnancy Complications, Trauma work, Uncategorized , , , , , , , ,