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American Obstetrician Takes Rational Position on Home Birth

June 16th, 2015 by avatar

Neel Shah, Harvard Medical School assistant professor and practicing obstetrician, commenting in the New England Journal of Medicine Perspectives section –  “A NICE Delivery – The Cross-Atlantic Divide over Treatment Intensity in Childbirth“, agrees with new United Kingdom National Institute for Health and Care Excellence (NICE) guidelines concluding that healthy, low-risk women are better off at home or in a midwife-led unit than in a hospital under the supervision of an obstetrician. Citing a table comparing outcomes in low-risk multiparous women from the Birthplace in England data, Shah writes:

The safety argument against physician-led hospital birth is simple and compelling: obstetricians, who are trained to use scalpels and are surrounded by operating rooms, are much more likely than midwives to pick up those scalpels and use them. For women giving birth, the many interventions that have become commonplace during childbirth are unpleasant and may lead to complications . . . .

He quite reasonably adds the caveat that the guidelines apply to low-risk women only and that even these women may develop labor complications without warning, but then, responsible home birth advocates acknowledge those same two points. That being said, I can’t resist adding a couple of caveats of my own.

© Families Upon ThamesFirst, one reason why women with risk factors plan home birth, women with prior cesareans being a common example, is that doctors and hospitals deny them the possibility of vaginal birth (Declercq 2013). With their only hospital alternative being unwanted and unneeded cesarean surgery, planned home birth becomes their least, worst option. This dilemma puts their choice squarely in the lap of the medical system. Another reason is that some women have been so emotionally traumatized by their treatment during a previous birth that they reject planned hospital birth and refuse intrapartum transfer even when this may be the safer option (Boucher 2009; Symon 2010). Again, the failure and its remedy lie with the system, not the woman.

Second, if the hospital lacks 24/7 obstetric, anesthesia, and pediatric coverage and at least a Level 2 nursery, which many do, then a woman is probably no better off in the hospital in an emergency than she would be at home or at a freestanding birth center. Furthermore, most urgent situations—a baby who doesn’t breathe, excessive bleeding, even umbilical cord prolapse—can be managed or stabilized by a properly trained and equipped home birth attendant. In fact, what would be done in the hospital is no different from what would be done at home: neonatal resuscitation, oxygen, medications to stop bleeding, maternal knee-chest position and manually holding the fetal head off the cord until cesarean.

Finally, with admirable frankness, Shah notes that unlike the U.K., and to the detriment of safety, “[A]ccess to obstetric care that is coordinated among homes, birthing centers, and hospitals is both unreliable and uncommon.” And while he doesn’t cast any blame, once more, the fault lies with the system. (Just as an FYI, a model guideline for transfer of care developed by a workgroup that included all stakeholders is publically available.)

Shah concludes: “The majority of women with straightforward pregnancies may truly be better off in the United Kingdom.” True that, but it doesn’t have to be that way. Dialing back the overuse of medical intervention and cesarean surgery; respecting the woman’s right to give informed consent and refusal; implementing a culture of care that is kind, compassionate, and respects a woman’s dignity; and ensuring that out-of-hospital birth attendants can consult, collaborate, and transfer care appropriately would have two benefits: it would reduce the number of women refusing hospital birth while minimizing the chance of adverse outcomes in those who continue to prefer to birth at home or in a freestanding birth center. Nonetheless, despite the generally positive responses accompanying Shah’s commentary, rather than inspiring a wave of reform, I would lay odds that the more common reaction to Shah’s piece within the medical community will be to shoot the messenger.

References

Boucher, D., Bennett, C., McFarlin, B., & Freeze, R. (2009). Staying home to give birth: why women in the United States choose home birth. J Midwifery Womens Health, 54(2), 119-126.

Declercq, E., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, Ariel. (2013). Listening to Mothers III. Pregnancy and Birth. New York: Childbirth Connection.

Symon, A., Winter, C., Donnan, P. T., & Kirkham, M. (2010). Examining autonomy’s boundaries: a follow-up review of perinatal mortality cases in UK independent midwifery. Birth, 37(4), 280-287.

About Henci Goer

© Henci Goer

Henci Goer, award-winning medical writer and internationally known speaker, is the author of The Thinking Woman’s Guide to a Better Birth and Optimal Care in Childbirth: The Case for a Physiologic Approach She is the winner of the American College of Nurse-Midwives “Best Book of the Year” award. An independent scholar, she is an acknowledged expert on evidence-based maternity care.

Evidence Based Medicine, Guest Posts, Home Birth, Maternal Quality Improvement, Maternity Care, Medical Interventions, Midwifery , , , , , ,

Customizing Your Lamaze International Directory Profile – A Quick and Easy How To Guide

June 11th, 2015 by avatar

jim croceOn Monday, I shared the news that Lamaze International has just released a new mobile app “Pregnancy to Parenting” that families can download from the Google Play or Apple App store for their smart phones. With this app, they can receive valuable tips and tools, and useful evidence based information that will take them from pregnancy, through labor and birth, and well into the first weeks of parenting. Families can also search for a local Lamaze class in order to receive the gold standard in childbirth education. You can get all the details on the mobile app by reviewing the blog post “Lamaze International Launches Free Pregnancy to Parenting Mobile App to Support Families” and then clicking over to the mobile app information page on our website where you can find a mobile app resource kit for your use.

As more and more families continue to download and access the app, Lamaze Certified Childbirth Educators can expect that more families will utilize the “find a local class” feature and contact you to register for your Lamaze childbirth program.  You will want to be sure that your profile information is current and up to date on the Lamaze International website.

When you set up your profile, there is some information that is required and other information that is optional.  Additionally, you can set the parameters for the information that parents see when searching the Lamaze directory.  The more information that you complete, the more information will display in your directory listing.  Today on Science & Sensibility, I will walk you through the steps on how to control what is listed and visible in the “find a local class” feature and the overall directory.

Modifying your Lamaze International directory profile

1. Log in to your lamazeinternational.org account by using this link.

2. Select edit profile on the right.

3. Please note that the following profile fields are optional:

  • Designations
  • Job Title
  • Company
  • Personal Website
  • Fax
  • Languages you teach

A full profile in the directory will look like this:

directory 1 4. If you fill out the Languages you teach and add a picture to your profile, they will appear when hovering over the “i” (information) box.

directory 2

5. You can add your picture by clicking on the ‘My Picture’ link on the right side bar of your profile page, and uploading an image.

directory 3

6. When editing your profile, you can also use the following checkboxes to control certain aspects of your directory listing:

  • You can exclude yourself from the directory entirely by checking either the ‘Exclude from LCCE Directory’ or ‘Not Currently Teaching’ checkboxes.
  • You can hide your street address from the directory by checking the ‘Hide Street Address from LCCE Directory’ checkbox.

directory 4

Here is an example of a directory listing with the street address “hidden.”

directory 5

Consider how you would like your profile to appear in the Lamaze Directory and in the “find a local class” feature on the parents’ Lamaze.org website, the professional LamazeInternational.org website or in the “Pregnancy to Parenting” mobile app.  Go ahead and make any changes using the directions above and save by selecting “hit ok” at the bottom left of the webpage.  When the database is refreshed, your information should appear as you have selected.  Check it out for yourself.  Should you have any questions about these instructions or need additional information, please do not hesitate to email info@lamaze.org with “directory assistance” in the subject line and your email will be directed to a staff member who will be happy to help.  Alternately, you can contact the Lamaze office by phone at 202-367-1128 or Toll-free: 800-368-4404.

With the new mobile app roll-out, now is a great time to verify that your directory information is:

  • current,
  • accurate, and
  • as you wish it to appear

Go ahead and take a few minutes to take care of this small detail and you will be helping families to be able to find and contact you for your Lamaze class offerings.

Childbirth Education, Lamaze International , , , ,

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

June 8th, 2015 by avatar

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

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

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

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

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

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

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

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

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

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

Applying the Health Belief Model in Your Role as a Birth Professional

June 4th, 2015 by avatar

HealthBeliefModelPart2Last Tuesday, in part one of this two part post series, Andrea Lythgoe explained the Health Belief Model in her blog post Understanding the Health Belief Model.  Andrea discussed the different components that make up this model.  As we learned, perception is key and there are several different ways that a family’s perception of their circumstances can influence their decision making.  Today on Science & Sensibility, Andrea discusses how the childbirth educator or other birth professional can use this knowledge about the Health Belief Model to structure conversations and activities that assist families in making important decisions about their maternity care. – Sharon Muza, Science & Sensibility Community Manager

So how does this Health Belief Model come into play with childbirth education? It is important to remember that as childbirth educators, our role is not to be manipulative and push families towards certain goals.  Our responsibility is to present evidence based information so that families can make decisions that feel right for them.Here are some approaches we can use that make use of this model when fostering decision making skills in the families that attend our classes:

Perceived Benefits

Childbirth educators can provide families with information about the benefits and risks of the choices they are considering, and introduce other options they might not have considered. For example, I frequently have families in my classes who are unhappy with their care provider. I can help the family understand the benefits of more clearly communicating their birth preferences with their care provider to make sure that the HCP is on board. I can point out that they may find switching to a different care provider or birth place potentially more compatible with their own preferences, and give them tools to explore, evaluate, and choose the option that feels right to them.

Perceived Barriers

Childbirth educators can carefully listen for and identify the barriers that families perceive exist. You may be able to correct misinformation that a family believes prevents them from making a change they wanted to make. Be a MythBuster! Proactively address and correct myths that might be perceived barriers for your students and clients.ApplyingHBM2

Perceived Seriousness

Childbirth educators can help families to recognize, investigate and  accurately understand the risks of choices they may encounter.  We can give them tools to discuss and understand the “culture of risk” so that they have an idea of the severity of potential interventions and side effects. This goes both ways, as we need to be careful to be honest and realistic about the information we present. Always provide evidence based information and steer clear of exaggeration, minimization and scare tactics.

Perceived Susceptibility

Susceptibility is the hardest one to address. As I mentioned in my earlier blog post, once a person has experienced a loss or complication – in themselves or a loved one – there is a loss of innocence, and it is difficult to get past the previous experience. They don’t need to be “talked out” of feeling susceptible, but childbirth educators can often help families navigate the fear they may feel. Validation of their fears, suggestions for coping with fears, and potentially referring to counseling are ways to assist families who may be paralyzed by fear. It is important to be aware of how your own experiences affect your approach to providing unbiased information to your students and clients.

Self-efficacy

Childbirth educators can do wonders for helping class members build their self-efficacy. One simple activity that I have found builds self-efficacy is to ask pregnant people to list two times in their life when they have achieved something that did not come easily, and two times they saw their partner do the same. They then share their lists with each other or even with the class. I ask them to describe to each other or write down the personal traits that helped them accomplish this difficult task.CaregiversMotto

Another way to build self-efficacy in your classes is to provide lots of opportunity for families to practice the skills and coping tools they may find helpful in labor, multiple times during their childbirth class, in a variety of situations. This repetition helps to build confidence in their ability to remember and use the techniques when they are in labor. You can build on techniques you’ve previously taught. If you taught a slow deep breathing technique last week, encourage pregnant people to practice it during later parts of their class when you teach massage or positions.

Cues to Action

As childbirth educators, we may be able to provide some cues to action. Giving families the assignment to prepare a birth plan before your next class can be one such cue to action. You can also help partners to learn to provide these cues to action as well. Reminders in labor to ask for time to make decisions can be a cue to review all their options and use the “BRAIN” tool to make decisions. As a childbirth educator, it is key to remember that you cannot force them take action, you can only provide the pregnant person and their partner with cues they can choose to act on – or not.

Summary

Having a good understanding of the perceptions and factors influencing families’ decision making can help us as childbirth educators and birth professionals to create effective classroom activities.  We can also use this information to improve communication and personal interactions with the families we work with. When childbirth educators can provide their students with tools for making the decisions that are best for them, families can move confidently through any decisions that they may face throughout the childbearing year and beyond.

In closing, it is always good to remember the Caregiver’s Motto taught by Penny Simkin:

 “A person  has a very good reason for…

…Feeling this way
…Behaving this way
…Saying these things
…Believing these things…”

How do you help the families that you work with to make decisions?  What activities do you find build self-efficacy and confidence in your classes?  How do you best apply the Health Belief model to your interactions with students and clients? Please share your experiences in the comments section. – SM

About Andrea Lythgoe

Andrea Lythgoe

Andrea Lythgoe

Andrea Lythgoe is a doula, hospital-based Lamaze childbirth educator, birth photographer, and former instructor at the Midwives College of Utah. She is the author of the website UnderstandingResearch.com where she aims to help those just beginning to read research to understand the language of research. Her interest in research started while attending the University of Utah, where she made ends meet by working on a large randomized controlled trial and earned a degree in community health. Andrea served on the Board of Directors for the Utah Doula Association for over 10 years. She lives and practices in the Salt Lake City, Utah area. Andrea can be reached through her website.

 

 

 

Childbirth Education, Guest Posts, Maternity Care , , , ,

Perception is Everything – Understanding the Health Belief Model

June 2nd, 2015 by avatar

HealthBeliefModelPart1Today, regular contributor Andrea Lythgoe explains what the “Health Belief Model” is and how it may influence the decisions that your students and clients make.  As childbirth educators and other birth professionals, we sometimes scratch our head at the choices that some of the families we work with make.  When you examine the Health Belief Model – you can get a better understanding of how those decisions might have been reached.  On Thursday, Andrea will discuss how you can apply this decision making model in your role as a childbirth educator. – Sharon Muza, Community Manager, Science & Sensibility.

Ever wonder why people make the decisions they do about their pregnancy or birth? Why they stick with an health care provider they clearly don’t like? Or why they choose to feed a baby the way they do? Do you, at times, see people make decisions in ways that make no sense to you or are the complete opposite of what you might have decided?

The Health Belief Model was developed over 50 years ago, and it can provide some insight into the way that people make decisions about their health. The Health Belief Model starts with recognizing four factors that can play a role in decision making: perceived benefits, perceived barriers, perceived seriousness, and perceived susceptibility.

Let’s look at each of these factors individually:

Perceived Benefits

This one is pretty easy to understand. This is the “why”. We all know we should eat healthy and exercise, but we don’t always do that. Sometimes it is because we don’t understand or can’t clearly grasp the benefits, or the benefits are not important to us.  Also keep in mind that a benefit that you place a high value on might be of low importance to the families you serve. Remember that this birth is about the benefits the families you work with value, not the benefits you feel are important. For example, you may place a high value on mobility in labor, while a class member may place higher value on pain relief. The family has to feel that the benefits outweigh the costs and inconvenience of the action.

Perceived Barriers

“Perceived barriers” may be keeping people from whatever they “should” do or want to do. Maybe they feel like they can’t improve their diet because of limited money. They might feel that they cannot birth at home because of insurance coverage.  As a childbirth educator, you may – or may not – be able to help families identify the barriers they face and help them navigate around them. You can preach the benefits all you want, but if a perceived barrier is keeping families from making a change they say they want to make, all your efforts to demonstrate the benefits won’t make any difference. Remember that class members will not always feel comfortable disclosing to you the barriers they perceive, and they are not required to disclose them. But specifically asking a family –  “Is there anything you feel is holding you back from changing care providers?” or “What I hear you saying is that you want a home birth but have planned a hospital birth. How did you come to that decision?” may help them – and you – to better understand the barriers they perceive.

© Andrea Lythgoe

© Andrea Lythgoe

Perceived Severity

How much importance people place on the potential or real consequences of an action is “perceived severity.” Do people think it is a “big deal?” With the recent push to avoid inductions, especially before 39 weeks, I am hearing a lot of people state “It can’t be THAT risky for the baby. I know lots of people who were induced at 37 weeks and their babies are just fine!” Another common statement is “I formula fed all my kids and they turned out to be a lawyer and a doctor!”

When I was in labor with my second baby, a nurse told me: “Your baby will DIE if we don’t have you on the monitor all the time!” Luckily, I knew enough to just laugh and ask her exactly what the monitor did that sustained life. This was the nurse’s way of raising the perceived severity in an attempt to get me to stay in bed and stay connected. Sadly, it’s not the only time I have heard this strategy used, and I’ve even heard childbirth educators use a variation of this technique: “If you choose to be induced, your baby will pay the price!” Some people will recognize the hyperbole, but others will only perceive the negative and move into complying solely out of fear, even if that is not what they wanted to do.

Perceived Susceptibility

“Perceived susceptibility” essentially refers to the question “Could this happen to me?” Every person is going to have a different view of what are the chances this could happen to them. Teenagers are pretty notorious for thinking that something won’t happen to them. (There’s a saying that “all teenagers think they are immortal, invincible, and infertile.”) Adults can have a similar attitude, or alternately, they can have an Eeyore-like attitude that “If something bad will happen, surely it will happen to ME.”

Sometimes people’s feelings of being at risk are heightened by past experiences. A person who needed fertility treatments to become pregnant may feel like their pregnancy is high-risk even if all is well. This is another area where fear plays a big role. It can be a tricky thing to try to help someone adjust their perceptions of risk. Past life experiences can also play a role here. I personally am never going to be completely comfortable with a family’s choice not to use antibiotics for GBS, because I lost a niece to GBS over 20 years ago. Your family’s experience, or the experiences of those close to them, may all play a role, as can the personal and clinical experiences of your family’s health care providers.  You could provide statistic after statistic about how rare a birth defect is, and you could explain until you are blue in the face that it is not genetic, but if they or a loved one has experienced a heartbreaking loss, it is natural that they will perceive a greater susceptibility.

Notice the one word connected to all of these factors: PERCEIVED.  Perception is key – and your perception may well be different from the perception of the families you serve.

Cue to Action

After considering these factors, remember that something has to motivate them to put that decision into action. In the Health Belief Model, this is called a “Cue to Action.” For many people, the pregnancy itself triggers them to start eating healthier, exercise, or quit smoking. For others, different experiences may be their “cue to action”. I remember a coworker several years ago who quit smoking cold turkey the first time she felt her baby move, though she had no issues with smoking in pregnancy up until that point.

Self-efficacy

One last factor that can influence decision making is self-efficacy. Self efficacy is how a person feels about their ability to successfully accomplish something. If you have ever heard a pregnant person say “I’d love to do natural childbirth, but I am a wimp. I know I couldn’t do it.”, then you have observed a classic example of low-self efficacy.  Boosting confidence and giving concrete tools to work with can help increase self-efficacy.  This is something that you can help with in your role as a childbirth educator

Summary

Childbirth educators can have an effect on all of these factors in the course of their work with childbearing families. It is important for us to be aware, as we communicate childbirth information, that people often make decisions based on how they feel about the information presented, rather than on the facts themselves. In my next post, I’ll talk about how this model can be applied to childbirth education and even doula work.

Can you think of decisions that your students or clients make that seem to defy logic?  Why do you think they have made those specific choices?  Share your observations and experiences in the comments section of this blog. – SM

Sources:

Green, L.W. & Kreuter, M.W. (1991) Health Promotion Planning: An Educational and Environmental Approach Mayfield Publishing Company, Mountain View, CA

Health Belief Model Definition

About Andrea Lythgoe

Andrea Lythgoe

Andrea Lythgoe is a doula, hospital-based Lamaze childbirth educator, birth photographer, and former instructor at the Midwives College of Utah. She is the author of the website UnderstandingResearch.com where she aims to help those just beginning to read research to understand the language of research. Her interest in research started while attending the University of Utah, where she made ends meet by working on a large randomized controlled trial and earned a degree in community health. Andrea served on the Board of Directors for the Utah Doula Association for over 10 years. She lives and practices in the Salt Lake City, Utah area. Andrea can be reached through her website.

 

 

Childbirth Education, Guest Posts, Maternity Care , , ,

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