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Advocacy: Lamaze International Leaders on Capitol Hill

April 7th, 2015 by avatar

By John Richardson, Director, Government Relations, Lamaze International

I am proud of being both a member of Lamaze International and a Lamaze Certified Childbirth Educator for many reasons.  Today’s post by John Richardson, Lamaze International’s Director of Government Relations is just one reason why I am happy to pay my membership dues and be a part of the Lamaze organization.  Lamaze is actively working in both the private sector and with public/governmental leaders to help every family to have access to the resources to have a safe and healthy birth.  Today on the blog, we share about how our Board of Directors met with Congressmen and Congresswomen to share the importance of an evidence based childbirth education class being available to all families.  My certifying organization works hard for me and the families I teach every day.  – Sharon Muza, Science & Sensibility Community Manager.

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Lamaze BoD on Capitol Hill, 2015

Advocacy is a foundational element of the Lamaze International mission to advance safe and healthy pregnancy, birth and early parenting through evidence-based education and advocacy. Assisting women and their families to make informed decisions for childbearing and acting as an advocate to promote, support, and protect safe and healthy birth are two core competencies of a Lamaze Certified Childbirth Educator.

Advocacy comes in many different forms. The new Lamaze Strategic Framework specifically calls for taking advocacy efforts to the next level, focusing on government and legislative advocacy — leveraging strategic partnerships to advocate for perinatal/childbirth education coverage under the Affordable Care Act (ACA) and partnering with insurance companies, including the Centers for Medicaid and Medicare Services (CMS), to become part of the “bundled care” system. (Bundled care payment programs refer to the concept of grouping together the multiple services associated with a certain health “episode” versus the current fee for service system where each service associated with a condition is charged separately, and is one of the ACA’s many attempts to incentivize health care providers to be more cost efficient.)

BoD President Robin Elise Weiss and BOD Christine Morton

BoD President Robin Elise Weiss and BOD Christine Morton

Over the years, Lamaze has been involved in a variety of coalition and advocacy efforts related to improving access to high-quality maternity care that includes evidence based childbirth education by qualified educators and the promotion of breastfeeding within the health care industry. These efforts will continue with Lamaze taking its message directly to Capitol Hill to have a stronger voice with federal policymakers on behalf of the organization, its members, and the women and families that Lamaze serves. We want to let Congress know that Lamaze International provides gold standard childbirth education which can play an important role in promoting healthier outcomes for mother and baby and reducing healthcare costs and burdens on the healthcare system.

What does advocacy look like?

Advocacy campaigns at the federal level in the United States are typically a set of actions targeted to create support for a specific policy or proposal. The goals of an advocacy campaign may include drafting and passing a new law, drafting and passing amendments to existing laws, commenting on regulation, or influencing public perception and awareness of a particular issue.

Why is advocacy important for Lamaze?

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Board member Alice Turner

The delivery of health care is one of the most regulated industries in the United States. State and federal regulations often define whether services are covered by insurance, which practitioners are allowed to deliver services, the manner in which services are delivered, and how much individual practitioners and health care organizations are reimbursed. Naturally, there are a lot of people and organizations invested in steering and influencing these policies. There are literally thousands of issues and groups vying for policymakers’ attention. For Lamaze, it is critical to engage directly in advocacy activities so that policymakers become aware of the issues that are important to our organization and make them priorities.

There have been several recent successful advocacy initiatives to improve care for pregnant and postpartum women. For example, Lamaze has worked in collaboration with other organizations and lawmakers to improve breastfeeding services under the Affordable Care Act. As a result, there are several benefits now available to women who receive coverage through the Health Insurance Marketplaces (exchanges) and private non-grandfathered plans. Benefits such as lactation support and counseling by trained professionals are now covered without co-pay or co-insurance. Breast pumps are also covered at no charge and most employers must provide access to clean and private locations to pump for women who are hourly employees.

These victories are impressive and it is important to note that they did not occur in a vacuum. Advocates flooded the halls of Congress for years to ensure that policymakers appreciated the importance of breastfeeding. A key component of the success of these advocacy efforts was that they were based on research, focused on higher quality health outcomes, and provided fiscal benefits to the health care system and the federal government.

The Lamaze Board of Directors’ “Hill Day”

cbe graphicBearing all this in mind and in conjunction with their in-person meeting in Washington, DC, members of the Lamaze Board of Directors took to Capitol Hill on March 19, 2015 to meet with their Representatives and Senators about the excellent childbirth education that Lamaze provides and its potential to reduce costs and improve outcomes. The members of the Board met with a total of 23 Congressional offices, the majority of whom sit on committees with jurisdiction over health policy.

Our advocacy efforts on Capitol Hill centered on the following core messages:

  1. Promoting greater utilization of evidence-based childbirth education is a critical element in closing quality outcomes gaps and reducing unnecessary costs. In the face of high rates of cesarean sections, early inductions, and maternal/infant mortality, there is an increasing imperative for women to be informed and in charge of their maternity care to improve birth outcomes.

Maternal or neonatal hospital stays make up the greatest proportion of hospitalizations among infants, younger adults and patients covered by private insurance and Medicaid, which is why improvements in care are a major opportunity to reduce overall healthcare spending. Increasing quality outcomes by reducing the rates of unnecessary interventions, such as early induction of labor and cesarean section, are critical to reduce healthcare spending, particularly with Medicaid.

  1. The ACA has provided an opportunity for millions of uninsured Americans to access health care coverage through the creation of the exchanges. For those that do not enroll in a plan during the “open” enrollment period, there are qualifying “life events” that trigger special enrollment periods. One of those life events is when a woman gives birth. After the birth, the mother can sign herself and her infant up for coverage.

Lamaze believes, along with many others, that pregnancy, rather than birth, should be the life event that triggers the special enrollment period. Recently, 37 Senators and 55 Representatives sent a letter to U.S. Health & Human Services Secretary Sylvia Mathews Burwell  requesting this change. It appears Secretary Burwell can make this change administratively, as it does not require an act of Congress. Lamaze will join a chorus of other organizations that are making this request directly to the Secretary. Lamaze will also emphasize the importance of ensuring that ACA and state Medicaid plans include childbirth education as a covered service under maternity care benefits.

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Hill Day meetings

While meeting and communicating with legislators and staff on Capitol Hill may seem intimidating, it is actually very easy. Legislators are elected (and re-elected) by their constituents (you) so they have an obligation to listen to their constituents (you). That is a very important dynamic to remember. They are naturally inclined to help address the issues raised by their constituents.

However, advocates should always be well-prepared, a task that proved to be almost second nature for the Lamaze Board members as they met with Congressional offices. As experts in the field and natural educators, Lamaze leadership did a fantastic job representing the views of childbirth educators and establishing a rapport with the officials and staffers they met – the most important accomplishment of any first meeting on Capitol Hill.

Check out all the pictures of our Board of Directors on the “Hill” last month here.

Getting Involved

If you want to get involved and contact or meet with Congressional offices in your state, the most important action is to convey who you are, what you do, how you do it, and why it is important. Then, continue a dialogue of how specific policies might be improved for safer, higher quality, lower cost birth outcomes. In preparation for the first Lamaze “Hill Day,” several key documents were developed, including a policy paper and supporting documents to convey Lamaze’s core message in meetings with Congressional offices. By following this link, you can access and use these documents for advocacy efforts with your state’s representatives and in your local communities with insurers, health care providers, and hospitals.

Providing Lamaze’s unique perspective on the state and national level is extremely important and we can only be successful with the help of our members and supporters. In the coming months, we will provide a webinar on how to become an effective advocate and what Lamaze is doing to have an impact on access to high-quality childbirth education. Stay tuned!  If you are already an advocate in your community, on the county or state level or even nationally, share what you are doing to help families receive good care and improve outcomes in our comments section.

About John Richardson

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© John Richardson

John Richardson joined SmithBucklin, Lamaze International’s management company, in 2001 as Director of Government Relations, Healthcare Practice Group. He guides the policy efforts of healthcare organizations whose members include healthcare administrators; allied health professionals; physicians and hospitals. His experience provides his clients with a deep understanding of policy and politics and their effects on the healthcare system.

John lobbies Congress and government agencies at the federal level and also develops strategy for state lobbying efforts. He also has experience pursuing client objectives such as the development of practice guidelines, CPT codes, evidence based research, and technologies that promote efficiencies within healthcare administration.

Prior to joining SmithBucklin, John served as an Associate to the House Committee on Appropriations for a former member of the committee. Preceding his work of 5 years on the Hill, John acquired extensive political and grassroots experience working as a campaign aide to congressional and presidential campaigns.

A New Hampshire native, he graduated with a B.A. in Political Science from Roger Williams University in Bristol, R.I, and currently resides in Bowie, MD with his wife Kristin and sons Garrett and Holden.

 

Childbirth Education, Evidence Based Medicine, Guest Posts, Healthcare Reform, Healthy Birth Practices, Lamaze International, Lamaze News, Maternal Quality Improvement, Push for Your Baby, Research for Advocacy , , , , , ,

Too Bad We Can’t Just “Ban” Accreta – The Downstream Consequences of VBAC Bans

April 2nd, 2015 by avatar

April is Cesarean Awareness Month (CAM), and throughout the month, Science & Sensibility will be covering issues that are directly related to the number of cesareans (1,284,339 in 2013) performed every year in the United States.  To start our CAM series off, Jen Kamel, founder of VBACFacts.com, shares important information about placenta accreta.  Tomorrow, April 3rd, is the Hope for Accreta Awareness National Blood Drive, as part of the 30 Day Hope for Accreta Challenge sponsored by the Hope for Accreta nonprofit that provides consumer information and offers support to families affected by placenta accreta. – Sharon Muza, Community Manager, Science & Sensibility

cam lamaze 2015Even though the American College of Obstetricians and Gynecologists (ACOG) and the National Institutes of Health (NIH) have described vaginal birth after cesarean (VBAC) as a safe, reasonable, and appropriate option for most women, VBAC bans (hospital or practice wide mandates that requires repeat cesareans for all women with a prior cesarean) remain in force in almost half of American hospitals. It’s true that scheduled repeat cesareans almost always successfully circumvent the most publicized risk of VBAC (uterine rupture) by virtually eliminating its incidence and for this reason, many people celebrate and credit the repeat cesarean section for resulting in a good outcome for mother and baby. But what most people do not consider is that VBAC bans translate into mandatory repeat cesareans, and those surgeries expose women and babies to a condition far more life-threatening and difficult to treat than uterine rupture: placenta accreta.

Photo Credit: http://fetalsono.com/teachfiles/PlacAcc.lasso

Photo Credit: http://fetalsono.com/teachfiles/PlacAcc.lasso

Placenta accreta occurs when a placenta abnormally attaches to (accreta), in (increta), or through (percreta) the uterine wall. No one knows exactly why some women develop accreta other than there is some abnormality in the area where the fertilized egg implants (Heller, 2013). Anyone who has had a prior surgery on her uterus is at a substantially increased risk of accreta and, as it happens, cesarean section is the most common surgery in the United States (Guise, 2010). In fact, the rate of accreta has grown along with the rate of cesarean surgery: from 1 in 4,027 pregnancies in the 1970s, to 1 in 2,510 pregnancies in the 1980s, to 1 in 533 from 1982-2002 (American College of Obstetricians and Gynecologists [ACOG], 2012). That rate escalates to 1 in 323 among women with a prior uterine surgery and the risk rises at a statistically significant rate with each additional cesarean section (Silver, Landon, Rouse, & Leveno, 2006).

Up to seven percent of women with accreta will die from it (ACOG, 2012). After the baby is born, the placenta does not detach normally, causing bleeding, which can’t be stopped before the doctors are able to either surgically remove the placenta or perform an emergency cesarean hysterectomy. Babies die from accreta due to the very high rate of preterm delivery associated with accreta. In fact, 43% of accreta babies weigh less than 5.5 lbs (2,500 gm.) upon delivery (Eshkoli, Weintraub, Sergienko, & Sheiner, 2013). Accreta is not a routine complication. Accreta is serious.

As Silver (2006) points out, the risk of accreta after two cesareans (0.57%) is greater than the risk of uterine rupture after one prior low transverse cesarean during a non-induced/augmented planned VBAC (0.4%) (Landon, Hauth, & Leveno, 2004). In other words, women are literally exchanging the risk of uterine rupture in a current pregnancy for the more serious risk of accreta in future pregnancies. This poses a striking public health issue when you combine what the CDC (2012) has reported for numbers of unintended pregnancies–49%–and the lack of access to vaginal birth after cesarean: over half a million repeat cesareans every year, resulting in higher rates of accreta.

Yet due to the nonmedical factors that inhibit access to VBAC and influence how the risks and benefits of post-cesarean birth options are communicated to the public, women are rarely informed of these risks in a transparent and straightforward way. Additionally, it can be very difficult for the woman to obtain social support when confusion and fear about giving birth after cesarean remains the norm.

Given all this, providers are ethically obligated to inform patients of the future implications of their current mode of delivery. However, it can be especially difficult for providers working within the political climate of a hospital where VBAC is banned to frankly inform their patients of this reality. How can providers clearly explain to women the risks and benefits of their options, with VBAC as a viable option, when they do not offer that option at the facility? Such a situation could even result in professional ramifications for the provider, like revocation of hospital privileges. Additionally, some providers do not offer VBAC, “not because of an explicit hospital policy against it, but because [they] were unwilling to stay in the hospital with a woman attempting [a planned VBAC]” (Barger, Dunn, Bearman, DeLain, & Gates, 2013).

It is for this reason that some argue that VBAC bans create a conflict of interest among providers (ACOG, 2011; Charles, 2012). On one hand, they are bound by ethical obligations to the patient’s well-being, respect for patient autonomy, and support of an informed decision-making process. But these obligations are threatened by financial and professional ties to the hospital.

ACOG stresses throughout their guidelines and committee opinions that informed consent and patient autonomy are paramount (ACOG, 2011). They share how obstetrics should be moving from a paternalistic system to a more collaborative model (ACOG, 2013). They acknowledge that women should be allowed to accept increased levels of risk (ACOG, 2010). They assert how there is no “right” or “wrong” answer, only what is right or wrong for a specific woman (ACOG, 2010). And they are clear that restrictive VBAC policies cannot be used to force women to have a repeat cesarean or to deny a woman care during active labor (ACOG, 2010).

Yet, with 48% of women interested in the option of VBAC, 46% of them cannot find a provider or facility to attend their VBAC (Declercq, Sakala, Corry, Applebaum, & Herrlick, 2013). Only 10% of U.S. women have a vaginal birth after cesarean, as opposed to another cesarean (National Center for Health Statistics, 2013). Barriers to VBAC remain firm.

Those barriers often include one-sided counseling to women of the risk of uterine rupture in a VBAC. Rarely are they told of the complication rates of accreta, which are higher across several measures. This is true when we look at maternal mortality (7% vs. 0%) (ACOG, 2012; Guise, et al., 2010), blood transfusion (54% vs. 12%) (Eshkoli, Weintraub, Sergienko, & Sheiner, 2013; Barger, et al., 2012), cesarean hysterectomy (20-70% vs. 6%) (Eshkoli, Weintraub, Sergienko, & Sheiner, 2013; Barger, et al., 2012), and maternal ventilation (14% vs. 3%) (Eshkoli, Weintraub, Sergienko, & Sheiner, 2013; Barger, et al., 2012). Further, 5.8% of accreta babies will die within the first week of life (Eshkoli, Weintraub, Sergienko, & Sheiner, 2013) in comparison to 2.8 – 6.2% of uterine rupture babies (Guise, et al., 2010).

Accreta results in higher rates of mortality and morbidity because it requires a complex response which most hospitals are not equipped to provide. A 2012 study advises, “Treatment of placenta accreta is best accomplished in centers that have the expertise to handle the management, which involves multiple disciplines, including blood bank, interventional radiology, anesthesia, and surgical expertise, gynecologic oncology, urology, or obstetric subspecialty expertise” (Heller, 2013).

It ís worth noting that uterine rupture does not require this level of response in order to generate a good outcome. As Aaron Caughey, OB-GYN and Chairman of the Department of Obstetrics and Gynecology at Oregon Health & Science University in Portland explains, “From an obstetrician standpoint, there are no particular special skills to managing a VBAC. Even in an emergency situation, we all have the surgical skills to deal with it” (Reddy, 2014).

Because some hospitals are not equipped to manage an accreta, some women who are diagnosed prenatally find themselves traveling hundreds of miles away from their family in order to deliver with accreta specialists.

At 19 weeks pregnant, Dawn was diagnosed with percreta, the most severe form of accreta where the placenta goes through the uterine wall and attaches to other structures in the abdominal cavity. She had nine prior pregnancies. Dawn was among the 93% of women who were never informed of the risks of accreta when she was pregnant after her first, second, or third cesarean (Kamel, 2014). All she heard were the dangers of VBAC. Thus, she had three cesareans.

Mother after cesarean hysterectomy in ICU. © Dawn Johnson-Baranski

When she got pregnant again, she heard the word accreta for the first time upon her diagnosis as is the case in 59% of women diagnosed with accreta (Kamel, 2014). Dawn ultimately traveled from her home in rural Virginia to Houston, Texas, at 27 weeks pregnant, to the Fox-Texas Children’s Pavilion for Women, an accreta specialty center. Due to complications related to her precreta, her son was delivered by cesarean hysterectomy at 33 weeks. Her son spent 19 days in the NICU before they could return back home to Virginia (personal communication, March 30, 2014).

It’s because accreta is so dangerous, complex to treat, and unknown to the general public, that professionals and researchers are sounding the alarm about the risk exchange that happens when repeat cesarean is chosen (or forced) over VBAC. As Dr. Elliot Main, Medical Director of the California Maternal Quality Care Collaborative, cautions, “In California, we are seeing a lot of hysterectomies, accretas, and significant blood loss due to multiple prior cesareans. Probably the biggest risk of the first cesarean is the repeat cesarean” (Main, 2013). (The state of California has a 9% VBAC rate, just a point below the national rate) (State of California Office of Statewide Health Planning and Development, 2013). A 2009 study from the Netherlands advises, “Ultimately, the best prevention [of uterine rupture] is primary prevention, i.e. reducing the primary caesarean delivery rate. The obstetrician who decides to perform a caesarean has a joint responsibility for the late consequences of that decision, including uterine rupture” (Zwart, et al., 2009). And a 2012 study warns, “Because cesarean delivery now accounts for about one-third of all deliveries in the United States, rates of abnormal placentation and subsequent hysterectomy will likely continue to rise” (Bateman, Mhyre, Callaghan, & Kuklina, 2012). By reducing the primary cesarean rate and increasing access to VBAC, we could also reduce the incidence of accreta, cesarean hysterectomy, and hemorrhage.

Following multiple uterine rupture lawsuits in the 1990s, some hospitals crafted their restrictive VBAC policies around litigation fears. However, the concern over lawsuits resulting from “VBAC gone wrong” may soon be overshadowed by the worry of being sued when women or babies die from accreta, after failing to adequately respond to this dangerous condition and/or denying access to VBAC (Associated Press, 2013; Children to sue hospital over death of mother, n.d.). This will certainly become the case as the public becomes more aware of the connection between VBAC bans, cesareans, and accreta.

It could also become a public relations nightmare as Americans begin to realize that litigation fears–not patient safety, drive hospital policy. This becomes more likely as more women are diagnosed with accreta.

As mothers are the ones who carry the risk of either uterine rupture or accreta, shouldn’t they be the ones deciding which set of risks are tolerable to them? As ACOG (2010) says, “the ultimate decision to undergo [planned VBAC] or a repeat cesarean delivery should be made by the patient in consultation with her health care provider” –  not by hospital administrators, malpractice insurance companies, or providers who simply don’t want to deal with VBAC.

As Dr. Howard Minkoff (2010) shared at the 2010 NIH VBAC Conference, “We should be starting with a sense of what’s the best interest of the mother. Unfortunately, the decision here is not always who are better equipped, it’s more like who are willing. There are a lot of hospitals that are quite capable of providing VBACs but exercise an option not to do it particularly if there’s someone nearby that will take that on for them.”

Hospitals around the country, and particularly those that are located in areas where VBAC bans mean that all women have repeat cesareans, are seeing and will continue to see increasing numbers of accreta. They have no choice but to manage it – which can be especially problematic for smaller facilities in rural areas that don’t offer the sophisticated response accreta requires.

But motivation remains the driving factor in hospital VBAC policy even in rural hospitals. Take the five small community hospitals in New Mexico that serve the Navajo Nation. As Dr. Jean Howe (2010), their Chief Clinical Consultant for Obstetrics, shared at the 2010 NIH Conference, these rural facilities collectively deliver 3,000 babies each year and maintain a 15% cesarean rate and a 38% VBAC rate. Numbers like that just don’t happen. They are the result of motivated administrators, providers, and patients who want VBAC to be an option at their facility.

The bottom line is, VBAC bans simply delay risk. The sooner hospital administrators and the American public realize this, the sooner we can mobilize–reducing future risks of accreta by making VBAC a viable option in more hospitals. It is one thing for a woman to knowingly plan a repeat cesarean understanding this risk. That is her choice as both VBAC and repeat cesarean come with risk. However, it is unconscionable when a woman is not presented with her options and she develops accreta in a subsequent pregnancy.

As the American public becomes more aware of the serious risks associated with repeat cesarean, will more providers and facilities be sued as a result of accreta-related complications and death? Will it have to come to fear of litigation, again, in order for hospitals to throw aside their current VBAC bans, listen to what the NIH, ACOG, and the medical research has to say; to create an environment that is supportive of VBAC, respect a mother’s right to make her own medical decisions, and prepare accreta-response protocols?

Women are entitled to understand what that first cesarean means in terms of their future birth options and their long term health. Consumers and providers should work with hospital administration to reverse VBAC bans, review current VBAC policies to insure they are aligned with national guidelines and evidence, and improve response times for obstetrical emergencies through team training and drills (Cornthwaite, Edwards, & Siassakos, 2013). Providers should have frank conversations with patients about the immediate and long-term risks and benefits of their options within the context of intended family size, acknowledging that sometimes the stork delivers when you’re not expecting it. This is about administrators, providers, professionals, and consumers working together for better processes and healthier outcomes. Let’s get to work.

References

American College of Obstetricians and Gynecologists. (2010, August). Practice Bulletin No. 115: Vaginal Birth After Previous Cesarean Delivery. Obstetrics & Gynecology, 116(2), 450-463. Retrieved from http://dhmh.maryland.gov/midwives/Documents/ACOG%20VBAC.pdf

American College of Obstetricians and Gynecologists. (2011). Code of Professional Ethics. Retrieved May 16, 2013, from ACOG: http://www.acog.org/About_ACOG/~/media/Departments/National%20Officer%20Nominations%20Process/ACOGcode.pdf

American College of Obstetricians and Gynecologists. (2012, July). ACOG Committee Opinion No. 529: Placenta accreta. Obstetrics & Gynecology, 201-11. Retrieved from http://www.acog.org/Resources%20And%20Publications/Committee%20Opinions/Committee%20on%20Obstetric%20Practice/Placenta%20Accreta.aspx

American College of Obstetricians and Gynecologists. (2013). Elective surgery and patient choice. Committee Opinion No. 578. Obstetrics & Gynecology, 122, 1134-8. Retrieved from http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Ethics/Elective_Surgery_and_Patient_Choice

Associated Press. (2013, Nov 25). $15 million awarded in Illinois childbirth death lawsuit. Retrieved from Insurance Journal: http://www.insurancejournal.com/news/midwest/2013/11/25/312169.htm

Barger, M. K., Dunn, T. J., Bearman, S., DeLain, M., & Gates, E. (2013). A survey of access to trial of labor in California hospitals in 2012. BMC Pregnancy and Childbirth. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636061/pdf/1471-2393-13-83.pdf

Barger, M. K., Nannini, A., Weiss, J., Declercq, E. R., Stubblefield, P., Werler, M., & Ringer, S. (2012, November). Severe maternal and perinatal outcomes from uterine rupture among women at term with a trial of labor. Journal of Perinatology, 32, 837-843. Retrieved from http://www.nature.com/jp/journal/v32/n11/full/jp20122a.html

Bateman, M. T., Mhyre, J. M., Callaghan, W. M., & Kuklina, E. V. (2012). Peripartum hysterectomy in the United States: nationwide 14 year experience. American Journal of Obstetrics & Gynecology, 206(63), e1-8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21982025

Charles, S. (2012, Jul-Aug). The Ethics of Vaginal Birth After Cesarean. The Hastings Center Report, 42(4), 24-27. Retrieved from Medscape: http://onlinelibrary.wiley.com/doi/10.1002/hast.52/abstract

Cornthwaite, K., Edwards, S., & Siassakos, D. (2013). Reducing risk in maternity by optimising teamwork and leadership: an evidence-based approach to save mothers and babies. Best Practice & Research Clinical Obstetrics and Gynaecology, 27, 571-581. Retrieved from http://www.bestpracticeobgyn.com/article/S1521-6934(13)00051-5/abstract

Declercq, E. R., Sakala, C., Corry, M. P., Applebaum, S., & Herrlick, A. (2013). Listening to Mothers III: Pregnancy and Birth. New York: Childbirth Connection. Retrieved from http://www.childbirthconnection.org/article.asp?ck=10450

Eshkoli, T., Weintraub, A., Sergienko, R., & Sheiner, E. (2013). Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. American Journal of Obstetrics & Gynecology, 208, 219.e1-7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23313722

Guise, J.-M., Eden, K., Emeis, C., Denman, M., Marshall, N., Fu, R., . . . McDonagh, M. (2010). Vaginal Birth After Cesarean: New Insights. Rockville (MD): Agency for Healthcare Research and Quality (US). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK44571/

Hale, B. (n.d.). Children to sue hospital over death of mother. Retrieved from Daily Mail: http://www.dailymail.co.uk/health/article-129801/Children-sue-hospital-death-mother.html

Heller, D. S. (2013). Placenta accreta and percreta. Surgical Pathology, 6, 181-197. Retrieved from http://www.surgpath.theclinics.com/article/S1875-9181(12)00183-3/abstract

Howe, J. (2010). National Institutes of Health VBAC Conference, Day 2, #04: Public Comments. 14:45-17:08. Retrieved from Vimeo: http://vimeo.com/10898005

Kamel, J. (2014, Dec 14). Online poll of 227 women with prior cesareans.

Landon, M. B., Hauth, J. C., & Leveno, K. J. (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. The New England Journal of Medicine, 351, 2581-2589. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa040405

Main, E. (2013). HQI Regional Quality Leader Network December Meeting. San Diego.

Minkoff, H. (2010). National Institutes of Health VBAC Conference, Day 2, #04: Public Comments. 11:16. Retrieved from Vimeo: http://vimeo.com/10898005

National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health. (2012, Apr 4). Unintended Pregnancy Prevention. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/index.htm

National Center for Health Statistics. (2013). User Guide to the 2012 Natality Public Use File. Hyattsville, Maryland: National Center for Health Statistics. Retrieved from ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/natality/UserGuide2012.pdf

Reddy, S. (2014, Dec 8). A type of childbirth some women will fight for. Retrieved from Wall Street Journal: http://www.wsj.com/articles/a-type-of-childbirth-some-women-will-fight-for-1418081344

Silver, R. M., Landon, M. B., Rouse, D. J., & Leveno, K. J. (2006). Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries. Obstetrics & Gynecology, 107(6), pp. 1226-1232. Retrieved from http://journals.lww.com/greenjournal/fulltext/2006/06000/maternal_morbidity_associated_with_multiple_repeat.4.aspx

State of California Office of Statewide Health Planning and Development. (2013, December 17). Utilization Rates for Selected Medical Procedures in California Hospitals, 2012. Retrieved from http://www.oshpd.ca.gov/HID/Products/PatDischargeData/ResearchReports/Hospipqualind/vol-util_indicatorsrpt/

Zwart, J. J., Richters, J. M., Ory, F., de Vries, J., Bloemenkamp, K., & van Roosmalen, J. (2009, July). Uterine rupture in the Netherlands: a nationwide population-based cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 116(8), pp. 1069-1080. Retrieved January 15, 2012, from http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02136.x/full

About Jen Kamel

Jen kamel head shot 2015Jen Kamel is a consumer advocate and a leading national speaker on the medical facts and political, historical climate surrounding vaginal birth after cesarean.  She is the founder of VBACFacts.com and has brought her workshop “The Truth about VBAC: Politics, History and Stats” to over 900 people around the country, giving accurate, current information about post-cesarean birth options directly to families, practitioners, and professionals.

Cesarean Birth, Childbirth Education, Evidence Based Medicine, Guest Posts, Maternal Mortality, Maternal Quality Improvement, Pregnancy Complications, Vaginal Birth After Cesarean (VBAC) , , , , , , ,

Using Pinterest for your Childbirth Classes

March 31st, 2015 by avatar

By Robin Elise Weiss, PhDc, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE

Today on Science & Sensibility, social media expert and Lamaze International President Robin Elise Weiss shares how she uses the popular social media platform Pinterest with her childbirth education classes and offers suggestions on how you can use it as well with great results. – Sharon Muza, Science & Sensibility Community Manager.

You Can Use PinterestPinterest is the hottest new social media format and it can be a great addition to your childbirth classes. Pinterest is like a virtual cork board, where you add “pins” (links) to content that you see and like. You can categorize them however you wish, though most people usually have multiple boards on which to pin.

A Pinterest account is free of charge. You can register at http://pinterest.com.

It is a very simple format and once you start pinning it is usually quickly learned. You can have multiple boards. The boards can be public or private. You can pin alone or invite others to pin on your boards.

Here are a few ways that you can use Pinterest to extend or supplement your childbirth classes:

1.     Have a Board for Anyone Interested in That Topic (Level: Beginner)

This simply requires that you are a member of Pinterest and have a board that has at least one pin on it. Examples of board topics might be as broad as pregnancy or as focused as pain relief in labor. As you see content on Pinterest, you simply add more pins to the board.

Each board has an individual URL, therefore you can send that specific URL to everyone in class, simply as extra reading material or interesting things that you find. If you are using Pinterest as something that is business only, you might just show them your main URL and let them chose to follow a specific board or all of your boards.

A specific board link

A broad board link

2.     Have a Board for Each Series (Level: Intermediate)

If you have already gotten the hang of Pinterest and are ready for the next level, you might want to consider doing a private board that is for each series. You would start a board, and set its privacy setting to private. Then send out invitations to everyone in class. You can choose whether to allow them to pin or not. I personally enjoy letting my students pin.

Screenshot 2015-03-30 20.15.58Letting the students pin can show you where they are looking for pregnancy and birth interest, but it can also help you find new things online. Another educator that I spoke with said that she was worried about letting the students pin to the boards, in case it was not an appropriate link. Another wonderful feature is the comments section. You or students, can post to each pin. So you can handle it the same way that you might handle a student in class who just presented misinformation as fact.

After the babies have arrived, this board can morph into their support system. You can drop in and post a few links every now and then, but it is a great way for them to stay together and continue learning from each other.

3.     Have a Board for Each Class Within a Series (Level: Expert)

You might also consider using a different board for each class within a series. The benefit of doing this is that Class One info is altogether on one board and the same for every class after that. This can make it easier for parents to find information on a specific topic.

The down side is that you now manage multiple boards for every series. I will say that in addition to the individual class boards that I have done, I also incorporate a board like I described in section two. This is to allow for the social aspects. The parents can pin baby shower and nursery pins, which might not be on my radar, but are important to them. It’s a place for them to share product recommendations, and to talk in the comments. So, I do not see this as an either or option, but rather as an addition to the boards.

Example with conversation

All of this can seem to be really overwhelming. It is important to find a plan that works for you. One thing that I would recommend is to keep a list of links that you like. Do not reinvent the wheel. While you will have to add them, no one will know that you are reusing pins. And example might be an infographic from Lamaze. You want every class you teach to see it and repin it. Your fall series class won’t know that you used the same pins because they are on a different, private board.

You should also devise a schedule for when to pin which pin. So for example, if you’re teaching about epidurals, you might not post about epidurals until just before or just after that class. Ask questions under the links yourself, let the students answer.

There are also ways to use Pinterest to further your business, but that’s another article.  Are you currently using Pinterest as a birth professional?  Do you already use it in your classes?  Share how you use it with clients and students, and any suggestions you might have for the new user.

About Robin Weiss

© Robin Elise Weiss

© Robin Elise Weiss

Robin Elise Weiss,  PhDc, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE, is a childbirth educator in Louisville, KY. She is also the President of Lamaze International. You can find her at pregnancy.about.com and robineliseweiss.com

Childbirth Education, Guest Posts , , , , ,

BABE Series: Ms. Potato Head Does the Stages of Labor – and So Can YOU!

March 26th, 2015 by avatar

 By Stacie Bingham, CD(DONA)

mom & spudFor the March BABE (Brilliant Activities for Birth Educators) series post, childbirth educator Stacie Bingham breaks out a well-known children’s toy and uses it to help class participants to fully understand what they might experience emotionally during labor and birth.  Creative, interactive and very memorable, this activity helps parents connect what they just learned about the stages and phases of labor and prepares them for the normal roller coaster of emotions and activities that may arise during their own labor and birth. I cannot wait to try this myself, I just have to find myself a whole lot of Potato Head toys! – Sharon Muza, Community Manager, Science & Sensibility

 

“A fun, interactive way to incorporate a tactile experience into class instruction. All the moms and support people were laughing and interacting and really applying what we had just learned about.” – class participant

early laborWhen people laugh and confess that they “actually had fun in a childbirth class,” you know something’s gone right. As an educator, this is my goal. If learners let their guards down and enjoy themselves, presented ideas don’t just fly in one ear and out the other — they flow in and settle, like books on a bookshelf, where information can be accessed later.

Looking for an activity to reinforce the stages of labor, and the emotions and physical sensations that go along with each stage,  I came up with an idea involving Potato Heads. Luckily, our family has been amassing a Potato Head collection since 2001. I wanted one Potato for each stage and phase of labor. The bonus was, I found a “Baby Potato,” complete with extended tongue and ready to nurse (where? I am not sure, as breasts aren’t something Potato Heads come with as standard equipment). I carefully selected each Potato’s accessories, to physically or symbolically represent what she might be experiencing. I then disrobed the Potatoes and placed their accessories in their storage area (AKA butt).active labor

In my classes, covering the “Stages of Labor” topic takes about an hour. In a typical two-hour class, this activity fits well for the last 20 minutes or so on the same night. At this point, the class has had a snack break and additional discussion about pertinent topics. As a closing, and a way to recall what was just shared in the first hour, I pass around the Potatoes. Each person or couple takes one, (depending on class size.) They put together their Potatoes, and then we discuss which stage or phase they have, and what they think about the specific wardrobe selection – what it might mean for labor.

Early Labor 

Ms. “Early Labor Potato” is wearing earrings; she has her purse and her nice shoes on. Her eyes are excited, her nose is pink (calm), and her grin tells it all – she is excited labor is finally beginning! She has decided to go shopping to pass the time and pick up some last-minute items. I added the purse as well to think about what baggage she might be carrying around as labor becomes imminent.

Active Labor

transitionMs. “Active Labor Potato” is starting to get her first intense contractions, and with that, the first worries about her ability to cope. Her eyes are wider, showing her uncertainty. She is gritting her teeth, her nose is red, and her sneakers are on – she is working harder, warming up, and moving around.

Transition 

Ms. “Transition Potato” – she’s hot! Her visor, her tongue, and her orange nose show it. I have no idea why we have a hand with that green stuff on it, but I decided it was appropriate! (“Is that vomit in my Potato’s hand?” a mom questioned.) Her wide eyes give an idea of her emotional state, and her bunny slippers further address her need to be comfortable (which is also symbolic of the need to feel safe).

Pushing

second stageMs. “Second Stage” I likened to how pushing can sometimes feel foreign, or alien. She has no shoes, because at this point they would be off her feet (I used a jar lid under her base to keep her upright). I also made her a “pushy” face (while wishing I had a 3D printer!). Her red nose has returned, as this is physical work, and her confidence is increasing as she knows her baby is closer than ever.

“The potatoes were perfect to play with and keep everyone in class alive and moving. It held our interest and was still a teaching exercise.” – class participant

Third Stage

Ms. “Third Stage” has blissed-out eyes (which I drew and taped on) – she finally birthed her little spud! Her mouth shows joy, and her nose has returned to its calm pink color. Still no shoes – who needs ‘em? A few minutes and a little push for the placenta, and now it’s on to enjoying her newborn!third stage

The feedback from this activity is always amazing. It may seem silly and juvenile – I mean birth is serious business, right? But parents appreciate outside-the-box learning opportunities. As adults, there aren’t many times in training or instruction when we veer from left-brain directed thinking – and there’s too much PowerPoint out there in many classes. Manipulating the pieces while talking and laughing, anchors and connects information through touch as well as sight. Playing with these Potatoes allows creativity to spark. As educators, make the effort to offer alternative, unconventional ways to share information – and I promise, your class won’t forget it.

About Stacie Bingham

© Stacie Bingham

© Stacie Bingham

Stacie Bingham, CD(DONA), is a Lamaze-trained educator who embraces the lighter side of the often weighty subject of birth. Her style feels more like a comedy-show experience than a traditional class. She has been a La Leche League Leader for 13 year, attended 150 births as a doula, and logged 1000 hours as a childbirth educator. An experienced writer and editor, she was a columnist for the Journal of Perinatal Education’s media reviews, has been published in LLLI’s New Beginnings and DONA International’s International Doula, and keeps up with her blog (where she frequently shares her teaching ideas).

She is the current Chair for Visalia Birth Network, and a founding member of Chico Doula Circle, and Advocates for Tongue Tie Education. Stacie has presented at conferences on the topic of tongue tie, as her 4th baby came with strings attached. Stacie and her four sons, husband, and (male) dog reside in California’s Central Valley. For more information or teaching tips, visit her at staciebingham.com.

Childbirth Education, Guest Posts, Series: BABE - Brilliant Activities for Birth Educators , , , , ,

New Webinar for Birth Pros: “Making It Work! – Breastfeeding Tips for the Working Mom”

March 24th, 2015 by avatar
breastfeeding working mother

flickr.com/photos/jennysbradford/4356862824

I often share in childbirth classes that breastfeeding can be the next big challenge after birth.  As a childbirth educator, I weave breastfeeding information throughout my class series. By the time the “breastfeeding” part of the class happens towards the end of the series, the families are eager and ready to learn how to be as prepared as possible to feed their baby, without actually having baby there yet to “practice” with.

I provide additional follow up resources for the families as well, including where to get help locally with breastfeeding issues, what current best practice says on a variety of breastfeeding topics and useful videos like effective hand expression.  Returning to work and breastfeeding is one topic that I feel is important to cover, but often gets short shrift due to lack of time. Families don’t even have their babies in their arms yet, and the “return to work” point still seems very far off, and I have a lot of information to share in a short class time. In some areas, there are specific classes that families can attend that specialize in the “breastfeeding for the working parent” topic, but not many families can locate or take advantage of this type of class.

I would love to be able to support my families long after their childbirth education class is over with information they can use and apply for the working/breastfeeding parent, and that is why I am planning on attending Lamaze International’s free (non-Lamaze members $20) 60 minute webinar “Making It Work! Breastfeeding Tips for the Working Mom” offered on March 26th at 1:00 PM EST.

It is well documented that exclusive breastfeeding rates drop significantly when women return to work or school.  There are many barriers to overcome and prenatal information and support can help families to prepare for the time when babies are being cared for by others and still being breastfed.  This online webinar is appropriate for doulas, childbirth educators, lactation consultants, nursing staff, physicians and midwives.

The webinar is being presented by Patty Nilsen, RN, BSN, BA, IBCLC, ANLC.  Patty is an Outpatient Lactation Consultant for Mount Carmel East, West & St. Ann’s Hospitals in Columbus, Ohio, where she provides daily private outpatient lactation consultation for women experiencing challenges and in need of encouragement with breastfeeding, leads weekly breastfeeding support groups, and answers over 300 breastfeeding helpline calls per month.  Patty has learned many innovative tips for returning to work and breastfeeding from the thousands of mothers she has worked with over the years and is eager to share them in this webinar.

© womenshealth.gov

© womenshealth.gov

The webinar is open to all, and Lamaze International members are able to attend at no cost.  Non-members will pay $20 at registration to participate.  Additionally, this workshop has been approved for continuing nursing education hours which  are accepted by DONA, Lamaze, ICEA and other birth professional organizations. The cost for receiving continuing education hours for Lamaze members is $35 and for non-members is $55, (which includes the cost of the webinar). As mentioned above, Lamaze members attend for free, if they are not enrolled for the contact hours.  Contact hours are awarded after completing the webinar and a post-webinar evaluation. CERPS are pending.

You can register for the webinar (select contact hours or no-contact hours) at this link – and then prepare to join on Thursday at 1:oo PM EST.  After the webinar, come back and share your top takeaways and how you are going to use this information to support families in your area with other Science & Sensibility readers.

Babies, Breastfeeding, Childbirth Education, Lamaze International, Webinars , , , , , , ,