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Webinar – “Childbirth Class for Students Who Want An Epidural” – Today! Register Now.

June 25th, 2015 by avatar
Photo by Patti Ramos Photography

Photo by Patti Ramos Photography

Robin Weiss, PhD, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE, President of Lamaze International, has an absolutely great webinar scheduled for later today that you definitely don’t want to miss. This 60 minute live webinar, titled “Childbirth Class for Students Who Want an Epidural” will be valuable for both new educators and experienced educators alike at 1 PM EST.

When families enroll in Lamaze classes, some people may be planning to birth without pain medications while others may already have made a different decision and are intending to get an epidural.  Then of course, there are those people who prefer to “see how it goes” and make a decision at during labor.

As a childbirth educator, we won’t necessarily know who falls into which category, and honestly, it simply doesn’t matter.  Our role is to present information that is unbiased, based on evidence and best practice and helps families to make the best decision for themselves. Everyone who takes a childbirth class needs to receive quality information and deserves to have the facts presented in a nonjudgmental manner.

Teaching about epidurals in a Lamaze class allows families to gain knowledge in a safe and welcoming environment.  Whether this topic is covered extensively during your regular classes (which it should be) or you decide to offer a module for those who are positive they want medication, families should have the opportunity to learn what they need to know.

Robin Weiss is the perfect facilitator to lead us through this potentially tricky topic. She has been a childbirth educator, author and trainer of Lamaze educators for many years. She recently completed her Ph.D in Maternal Infant Health at the University of Louisville in KY.

This will be a great check-in to help you evaluate how you are presenting this topic to your students, give you some new ideas and perspective for approaching the subject and possibly even provide the impetus to offer a specialized class.

© Robin Elise Weiss

© Robin Elise Weiss

If you participate in this webinar, you have the option of receiving contact hours for a small additional fee upon completion of a post-webinar evaluation.

Won’t you consider registering now for this webinar that happens today, at 1 PM EST.  After you participate in the webinar, I invite you to come back and share your thoughts, ideas and any learning moments that you have taken away on this topic.

 

Childbirth Education, Epidural Analgesia, Medical Interventions, Webinars , , , , ,

Congratulations to Cara Terreri and Lamaze Parent Blog – Giving Birth With Confidence

June 23rd, 2015 by avatar

Congratulations Giving Birth withWhile Science & Sensibility is geared primarily for birth professionals and health care providers, Lamaze International also has a long running blog that is written by Cara Terreri, specifically with the expectant family in mind.  Giving Birth with Confidence (GBWC) offers families a wonderful mix of posts that highlight current best practice and evidence based information, fun and lighthearted topics for the pregnant and parenting crowd, and regular pregnancy week by week features that showcase development and concerns as a people move through their pregnancies.  One of my favorite topics on the GBWC blog is the “Great Expectations” series which follows a pregnant person through their pregnancy and birth, with regular posts documenting the progress, emotions and circumstances that are arising for the featured family.

I am not the only one that thinks that the Giving Birth with Confidence Blog is the bomb!  Healthline recently named Giving Birth with Confidence one of the top pregnancy blogs for 2015.  Cara Terreri has been writing the GBWC blog since its inception, and the honor is well deserved.  You may recall Cara from some posts she has done on this blog, as we followed her on her path to becoming a Lamaze Certified Childbirth Educator.  She has also been a guest blogger here on other topics.

I asked Cara some questions about her experience as writer and community manager for the Giving Birth with Confidence Blog and share her answers with you here now.

Sharon Muza: What do you hope that parents take away from reading the Giving Birth with Confidence blog?

Cara Terreri: I hope that parents  take away from GBWC that birth is a normal part of life, not an illness or fearful event, and in fact, that it can be an exhilarating, amazing, and beautiful experience. I also hope they take away practical information to help prepare for and shape their experience.

SM: What are some of the challenges that you see when writing a blog geared for parents in the childbearing year?

CT: I can identify two challenges — giving topics the detail they deserve without overwhelming parents with information. That’s a challenge childbirth educators often face in classes, too. The other is presenting information in a non-biased, non-judgmental way. It can be easy for my opinion to creep in when I should be presenting “just the facts, ma’am.”

SM: There has never been more online information available to parents – what distinguishes GBWC from other online resources?

CT: Evidence based information, first and foremost. Followed by a tendency to address important issues and choices women face, not just what’s “hot” or “trendy.”

SM: What have been some of your favorite posts of all time?  What about the favorite posts of the readers?

CT: My favorite posts come from the expectant moms who participate in our Great Expectations series, an every-other-week chronicle of their pregnancy. Often, the posts just contain thoughts and reflections of pregnancy, motherhood, and birth, which is just perfect. Our readers, interesting enough, tend to click through most to our post about Lamaze breathing, which provides clarity on how Lamaze teaches breathing as a coping mechanism in labor. Families might come to us to learn about breathing, but they leave with so much more!

SM: Why should childbirth educators and other birth professionals share this blog with the families that they work with and encourage them to become regular readers?

CT: Birth professionals and CBEs can trust the content, when they recommend it to the families they work with. It supports and mirrors what is taught in a Lamaze class. Our content is also easy to read and understand.

I hope that you will share this blog with the families you teach or work with, so that they can receive the information and community that GBWC offers to readers.  If you have suggestions for future post topics, would like to be a guest blogger or have some helpful feedback, please contact Cara directly.

cara headshotI would like to invite all of you to join me in congratulating my friend and colleague Cara Terreri and the Giving Birth with Confidence blog on a job well done!  I know that many families are better prepared and better informed as a result of the exceptional information that is shared on the blog.  Make sure that the families that you work with are aware of this valuable resource.  This recognition is well-deserved and I am delighted that you have received it.  I look forward to more posts on the topics that are important to families everywhere.

Awards, Babies, Giving Birth with Confidence, Lamaze International, Lamaze News , , ,

Looking Back in Time: What Women’s Bodies are Telling Us about Modern Maternity Care

June 18th, 2015 by avatar

By Christina Gebel, MPH, LCCE, Birth Doula

Christina Gebel, MPH, LCCE, Doula writes a reflective post examining current birthing conditions to see how today’s practices might be interfering with the the normal hormonal physiology and consequently impacting women’s ability to give birth.  Times have certainly changed and birth has moved from the home to the hospital.  A slow but steady increase in out of hospital births is examined and Christina asks us to consider why women are increasingly choosing to birth outside the hospital – and what do hormones have to do with it? – Sharon Muza, Science & Sensibility Community Manager

“Pregnancy is not a disease, but a beautiful office of nature.” These are the words of Victoria Woodhull, the first female candidate for President of the United States in 1872.

Lajja_gauri ancient birth art

© “Lajja gauri

The world in which pregnant women find themselves today looks a lot different than the time of Woodhull’s campaign run. For instance, hospitals didn’t become the mainstream setting for labor and delivery until the 1930s and 40s. While modern medicine has undoubtedly helped millions of women who may have otherwise died in childbirth, mothers and birth advocates across the nation are beginning to ask if we are paying a price for today’s standard maternity care. With increasing protocols and interventions, pregnancy is viewed less like the office of nature Woodhull spoke of and more like a pathological condition.

The Hormonal Physiology of Childbearing, a recent report by Sarah Buckley, systematically reviews existing research about the impact that common maternity practices may have on innate hormonal physiology in women and fetuses/newborns. The report finds strong evidence to suggest that our maternity care interventions may disturb these processes, reduce their benefits, or even create new challenges. To find out more, read an interview that Science & Sensibility did with Dr. Buckley when her groundbreaking report was released.

Let’s examine something as simple as the environment that a woman gives birth in. In prehistoric times, laboring women faced immediate threats and dangers. They possessed the typical mammalian “fight-or-flight” reaction to these stressors. The hormones epinephrine and norepinephrine caused blood to be diverted away from the baby and uterus to the heart, lungs, and muscles of the mother so that she could flee. This elevation in stress hormones also stalled labor, to give the mother more time to escape. Essentially, she told her body ‘this place is not safe,’ and her body responded appropriately by stopping the labor to protect the mother and her child during a very vulnerable time.

Today, mothers are not fleeing wild animals but rather giving birth in hospitals, the setting for nearly 99% of today’s births, where this innate response may cause their labor to stall. The sometimes frenetic environment or numerous brief encounters with unfamiliar faces may trigger a sense of unease and, consequently, the fight-or-flight response, stalling the mother’s labor. Prolonged labor in a hospital invariably leads to concern and a need to intervene, often by the administration of Pitocin, synthetic oxytocin, to facilitate regular contractions. Arrested labor could lead to further interventions up to and including a cesarean section. The fight-or-flight response may be further reinforced by these interventions, as they potentially come one after the other, in what is often referred to as the “cascade of interventions.”

This is just one example of how a woman’s body’s natural physiology can go from purposeful to working against the labor, the mother and the baby. Epinephrine and norepinephrine are both necessary in labor and delivery. In fact, at appropriate levels, these hormones support vital processes protecting the infant from hypoxia and facilitating neonatal transitions such as optimal breathing, temperature, and glucose regulation, all markers for a healthy infant at birth.

Recent data show that mothers themselves may already think what the Hormonal Physiology of Childbearing report suggests. The series of Listening to Mothers (LtM) studies, a nationally-representative survey of childbearing women, shows a shift in mothers’ attitudes towards normal physiologic birth: In 2012, 58% of mothers agreed somewhat or strongly that giving birth is a process that should not be interfered with unless medically necessary, up from 45% in 2000. According to 2013 national birth data, out-of-hospital (home and birth center) births have increased 55% since 2004, but the overall percentage is still only 1.35% of all births nationwide. While low, this shows that a small core of mothers are voting with their feet and choosing to give birth out of the hospital. Though their choice may seem extreme, they’re not alone. In the LtM data, which only surveys women who have given birth in a US hospital, 29% of mothers said they would definitely want or would consider giving birth at home for a future birth, and 64% said the same of a birth center. All this raises the question: What’s happening in a hospital that is leading mothers to consider other settings for their next birth?

One answer to upholding women’s preferences, autonomy, and the value of normal physiologic birth is a mother’s involvement in shared decision making with her provider, along with increasing access to models of care that support innate physiologic childbearing, like midwives in birth centers. Increasing access to these options may present a challenge, as demand seems to outweigh availability.

Leslie Ludka (MSN, CNM) has been the Director of the Cambridge Health Alliance Birth Center (Cambridge, Mass.) as well as the Director of Midwifery since 2008. Like other birth centers, the center has seen a steady increase in demand each year, with patients coming from all over New England. Ludka sees many barriers to having more birth centers available including finances (the reimbursement for birth not being comparable to an in-hospital birth), “vacuums in institutional comprehension” of the advantages of the birth center model for low-risk women, and the rigorous process to be nationally certified by the Commission for the Accreditation of Birth Centers (CABC), requiring “a great commitment and a lot of support by all involved.” In order to overcome these barriers, Ludka suggests marketing the safety of birth centers to the general public, sharing outcome statistics for women and infants cared for in birth centers, and educating insurers and providers about the overall benefits and financial savings of midwifery and the birth center model. With supportive policy and better understanding on the part of insurers, the public, and healthcare institutions, models like the birth center could become more plentiful, more easily meeting the demand.

Women’s bodies are sending subtle messages that our current healthcare system is, at times, not serving their needs. It’s time to respond to these messages, beginning by viewing childbirth foundationally as a life event and not first as pathology, and adapting our models of care to speak to this viewpoint. If we fail to do so, we run the risk of creating excess risk for women and newborns.

It’s been 143 years since Woodhull ran for president. We’ve made progress in getting much closer to seeing our first woman president, but with childbirth, perhaps our progress now starts with looking back in time.

About Christina Gebel

© Christina Gebel

© Christina Gebel

Christina Gebel holds a Master of Public Health in Maternal and Child Health from the Boston University School of Public Health. She is a birth doula and Certified Lamaze Childbirth Educator as well as a freelance writer, editor, and photographer. She currently resides in Boston working in public health research. You can follow her on Twitter: @ChristinaGebel and contact her through her website duallovedoula.com

Childbirth Education, Guest Posts, Home Birth, Maternity Care, Medical Interventions, Midwifery , , , ,

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 , , , ,

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