Author Archive

Black Breastfeeding Week – “Lift Every Baby” Supports Breastfeeding Black Families

August 27th, 2015 by avatar

BBW-Logo-AugustDates-300x162August 1-7th was World Breastfeeding Week, and the entire month of August was National Breastfeeding Awareness Month.  Science & Sensibility shared information and resources in two posts; Breastfeeding and Work – Let’s Make It Work! Join Science & Sensibility in Celebrating World Breastfeeding Week and Happy World Breastfeeding Week! The Celebration Continues with More Free Resources, along with a “Brilliant Activities for Birth Educators: Nine Ideas for Using Knit Breasts in Breastfeeding Classes” post for those who teach expectant families.

This week we want to recognize and honor Black Breastfeeding Week (August 25-31, 2015) and share information about the “Lift Every Baby” awareness campaign that is the theme of this year’s program.  Black Breastfeeding Week is designed to raise awareness and provide support in black communities.  Both the initiation rate and the duration rate of breastfeeding in black families has been lower than the rates in white families for more than four decades. Low birth weight, preterm deliveries and maternal complications such as preeclampsia are all higher in black women and the black infant mortality rate is more than twice that of white babies.  Breastfeeding and the important benefits it provides can help all babies, but for the most vulnerable and the sickest, breastmilk is a critical component that can mean the difference between life and death.

black breastfeeding mother babyBlack Breastfeeding Week was established three years ago by three women, Kimberly Seals Allers, Kiddada Green and Anaya Sangodele-Ayoka, all leaders in the field of maternal child health, with a focus on families of color.  In the past three years, attention, discussion and events focused on supporting Black Breastfeeding Week have only grown as people of all colors recognize the health disparities that exist right here in the United States, between white families and black families that have lifelong impacts, simply due to the color of one’s skin.

Kimberly Seals Allers wrote an excellent commentary on why there is a need for Black Breastfeeding Week.

There are many activities around the country to support Black Breastfeeding Week.  A full event list can be found here.  On August 29 at 3 PM EST the first nationally coordinated “Lift Up” will be held in various cities across the United States.  Black families will join together at different meeting points across the country to “Lift Up” their babies, regardless of their size or age, to recognize the importance of community support for children.

There will also be the first ever Twitter chat (#LifeEveryBaby) in honor of Black Breastfeeding Week, scheduled for tonight, August 27th at 9 PM EST that you are invited to participate in.

Cara Terreri, from Lamaze International’s blog for parents, Giving Birth With Confidence, has compiled a list of  black breastfeeding resources that you should be aware of:

Black Breastfeeding Week website & Facebook page

It’s Only Natural,” – CDC & Office of Women’s Health breastfeeding guide for African American families

Normalize Breastfeeding

Black Women Do Breastfeed website & Facebook page

Mocha Manual

Your Guide to Breastfeeding for African American Women

You can also find more information and resources on the Black Breastfeeding Week Resources and Toolkit page.

Additionally, I would like to refer you to two previous posts in our “Welcoming All Families” series, written by Lamaze educator and lactation consultant Tamara Hawkins, discussing welcoming families of color to your classes.  Working with Women of Color and Working with Women of Color – Educator Information can help educators create and provide applicable classes and information to the families of color joining their classes.

Black Breastfeeding Week is an important event that can help create awareness for the importance of culturally relevant and accessible breastfeeding support and information for black families.  Childbirth educators and other birth professionals should be ready to provide resources that can help close the gap to the families they work with.  Are you participating in any Black Breastfeeding Week events?  Let us know in the comments section and please, let us all join together to “Lift Every Baby.”


Babies, Breastfeeding, Childbirth Education, Infant Attachment, Newborns, Push for Your Baby , , , , ,

Meet William Camann, MD – Lamaze/ICEA Conference Plenary Speaker

August 25th, 2015 by avatar
William Camann, MD

William Camann, MD

With the Lamaze/ICEA Joint Conference a little more than three weeks away, final details are well underway to make sure this joint conference offers something for everyone who attends.  And if for some reason, you are unable to join the conference in person, there is a Virtual Conference option for some of the sessions.  Today on Science & Sensibility, we meet Dr. William Camann, Director of Obstetric Anesthesia, Brigham and Women’s Hospital, author and researcher.  Learn more about Dr. Camann and hear some of his thoughts today on the blog.  Then plan on attending Dr. Camann’s plenary session – “What Does the Informed Childbirth Educator Need to Know About Labor Pain Relief in 2015?” at the Lamaze/ICEA 2015 Joint Conference in Las Vegas, NV next month.

Sharon Muza: What is the role of the childbirth educator in helping families to understand their childbirth pain relief options as they prepare for labor?

William Camann, MD: One of the things I often say is that “the most predictable thing about labor is that it is unpredictable”. The childbirth educator plays a critical role in properly preparing women and their partners for labor and birth. But the educator is also up against the reality of our electronic age. Much information is available online, and many women utilize these electronic resources as an adjunct to, or even in place of, traditional classes. Openness to all options, realization that things may change as labor begins and progresses, and an understanding of why some common medical procedures and interventions are done, is critical.

The educator needs to be realistic and unbiased and not try to place their own thoughts/feelings/agendas onto the woman and her partner. Just as the woman and her partner need to go into labor with an open mind, likewise those who teach childbirth education must approach the task with all options open. It can indeed be a very tricky interaction. Some do it better than others. Another important thing is for the educator to be aware of particular practices at local hospitals. Not all hospitals do things exactly the same way. Being aware of local practice patterns and preferences can assist with proper preparation of the women for what they can expect. Hopefully conferences like this one will assist with sharing of valuable ideas for all of us to make ourselves better educators.

SM: What are some of the common misconceptions that parents and/or childbirth educators have about epidurals?

WC: Many parents have heard that epidurals:

  1. don’t work
  2. are dangerous, to both mother and baby
  3.  cause back pain
  4. cause headaches
  5. contribute to unnecessary cesarean deliveries
  6. make it impossible to push the baby out
  7. you have to be a certain number of centimeters dilated to get an epidural and if labor has progressed very far, it may be “too late” to get an epidural
  8. are not needed in most labors
  9. can result in paralysis

All of these concepts need to be discussed in proper context. There is very comprehensive research behind each of these concepts, but it is complex, and sometimes conflicting and confusing. This is where a good, insightful, informed and realistic childbirth educator can be so helpful.

A related misconception is that some, perhaps many, women feel that they do not need to attend childbirth classes if they are planning to have an epidural. Not true!

easy labor book cover camannSM: How have labor pain relief options changed in the past 10 years? What is new and exciting?

WC: The most significant changes have been with regard to the technology and medications used in epidurals. “Low-dose” epidurals with ability to maintain movement, and “patient-controlled” epidurals which give a large degree of control back to the patient, are now very commonly used in most labor units. Small changes in needle and catheter design, and drug delivery systems, have made these techniques more effective, with even lower doses of medications, resulting in fewer side effects. Likewise, technological advances allow for increased flexibility and comfort in how the actual epidural is inserted. Overall, these changes have made the use of epidural anesthesia a much more user-friendly technique, and a technique that can really facilitate a good, safe, satisfying birthing experience.

SM: As an obstetrical anesthesiologist, how has your role as a valuable member of the birth team changed over the years?

WC: There has been increasing awareness, among both anesthesiologists and others also (nurses, obstetricians, midwives, doulas, childbirth educators) that anesthesiologists are a critical part of the entire birth team. We can provide much more than just administering anesthesia. We are often sought after for advice on appropriate pain management choices, particularly in mothers with various comorbidities and other complex medical conditions. We are more often being asked to participate in prenatal education classes. We are very welcoming to learning about alternative methods of pain relief, and how this may fit into the overall paradigm of care during labor. As more and more mothers with complex medical conditions become pregnant, our role as anesthesiologists has expanded to include significant consultations with obstetricians and other medical colleagues to assist with ensuring a safe pregnancy and birth.

SM: You do a lot of work and research around offering a family centered cesarean? Do you consider it important for the mother to have a second support person (doula or other support) along with her partner, in the OR for the birth? How can families advocate for their desire to have two support people during a cesarean?

WC: For those who do want a second support person, if properly chosen and truly desired by the woman, then I believe there is value in this. In my personal practice, I am totally fine with a second support person in the operating room, if this is what the family wants. In the overall picture of women having cesareans, it just is not a common request.

SM: Do you see any challenges to presenting informed consent information to a woman in the throes of labor? How do you do this effectively?

Photo by Patti Ramos Photography

Photo by Patti Ramos Photography

WC: YES! This is an extraordinarily difficult and complex time to properly obtain informed consent. In these situations, we try our best. It is not easy. The involvement of a good obstetrician, labor nurse, midwife and doula can be very helpful. Pre-labor education is crucial, to avoid these difficult circumstances. However, pre-labor it is impossible to really know what the pain is like. We have all seen “best laid plans” rapidly change once the reality of labor pains commence. This is why having an open mind and flexibility is so important for women about to embark on labor and birth.

SM: What are you looking forward to most about being a plenary speaker and presenting to the Lamaze/ICEA 2015 conference attendees?

WC: I always enjoy these types of conferences. I feel I become a better anesthesiologist when I interact with and learn from interested colleagues who may share some different perspectives. I also hope that the attendees at the conference will become better educators, doulas, and midwives as a result of what I will share in my lecture and by attending the meeting.

SM: Is there anything else you would like to share with the readers of Science & Sensibility and attendees at the upcoming conference?

WC: We are all working together to ensure a safe, satisfying birth for mom, partner and baby. Thank you for the opportunity to participate in this conference.



2015 Conference, 2015 Lamaze & ICEA Joint Conference, Childbirth Education, Conference Schedule, Epidural Analgesia , , , , ,

Series: Brilliant Activities for Birth Educators – Nine Ideas for Using Knit Breasts in Breastfeeding Classes

August 20th, 2015 by avatar

babe breastfeedingAugust is National Breastfeeding Awareness Month (and August 1-7 was World Breastfeeding Week) and Science & Sensibility covered the WBW theme “Breastfeeding and Work: Let’s Make It Work!” in a post earlier this month.  August’s Brilliant Activities for Birth Educators will continue to increase the awareness about breastfeeding and breastfeeding education.  I would like to talk about how I and the families in my class use a set of  wonderful knitted breasts when I cover breastfeeding topics in my childbirth class.  You can find all the Brilliant Activities for Birth Educator posts here.

I currently teach a seven week series and cover the majority of  the breastfeeding topics on the last week.  The entire series is rich in information about breastfeeding, skin to skin, safe and healthy birth options, and other choices that support getting breastfeeding off on the best path possible.  Week seven is the nuts and bolts of breastfeeding, covering topics like latch, how the breasts make milk, positions for breastfeeding, is your newborn getting enough milk and common problems that new families experience as well as other information.

For the breastfeeding class, I use these wonderful handknitted breasts that I purchased from a talented colleague here in Seattle.  You can find similar patterns to make your own in the links below.  Each breast is unique in skin tone, nipple and areola size, overall size and weight.  Every family receives one breast and one baby. (I use these Ikea dolls, for their affordability, size and softness.)  Using these knitted breasts and dolls allows the families to experience common breastfeeding situations in a comfortable and humorous way, while gaining experience positioning themselves and their babies for comfortable and supportive breastfeeding.

Nine Breastfeeding Teaching Ideas Using a Knitted Breast

1. Having different size breasts with different size nipples and areolas gives me an opportunity to share that breastfeeding can be successful no matter the size of a person’s breast tissue or breast anatomy.  Large and small breasts can both feed a baby quite satisfactorily.  My collection is quite varied.

2. When a person uses their finger to press in on the tissue around the baby’s nose in order to “make space for air”during breastfeeding, it can change the angle of the nipple in the baby’s mouth and create unnecessary discomfort.

3. Supporting the breast with the “c-hold” and placing the fingers well back from the areola will help the baby to have a deeper latch and pull more breast tissue into their mouth.

4. Shaping and supporting the breast “like a hamburger” so the baby can get a good latch can reduce nipple pain and help the baby to transfer milk.

5. The five most common positions to breastfeed – laidback breastfeeding, cross cradle, cradle, football and side lying can feel awkward, but with practice will become second nature.  Everyone gets to try them using their “breast” and “baby”.  They can practice holding and positioning the knitted breast in the best way for each position.

6. Placing lots of pillows for proper support for the dyad can help keep breastfeeding comfortable.

7. A baby can nurse “around the clock” on the breast, with sometimes subtle position changes that allows the baby to stimulate and remove milk from all parts of the breast.

8. There is a small bead sewn into each of these weighted knitted breasts.  I can ask the families to find the little pea sized lump and can discuss how this might be a sign of a clogged duct, and how to resolve it.

9. Hand expressing milk if parents are separated from their baby after birth, can help with overall supply and volume while supplying valuable colostrum for their baby.  They can also use this skill to increase supply, or if they are experiencing engorgement.  Learning this skill on the knitted breast in class is great.

Open Mouthed Ikea Doll

If you are extra creative, there is a great “hack” that can be done to the Ikea doll to make the mouth open and include a tongue, (which can even be “tongue-tied”) to make the knitted breast/doll demo even more realistic.  Find this clever idea created by Tova Ovits, CLC here on Galactablog.

Bonus Diaper

© Sharon Muza

© Sharon Muza

I also use a knitted diaper that shows how a newborn baby’s stool changes over time from dark meconium to mustardy breastfed baby stool. A great visual aid and always gets lots of comments from families.  Thanks Betsy Hoffmeister, IBCLC,  for making me such a great tool to use in my Lamaze classes.

Family Reactions

At first, families may feel a little awkward handling the knitted breast, and may laugh if it is particularly large or small, or as an unusually large nipple.  But over the course of the night, they become comfortable in handing the breast, confident in finger placement and are eager to try different positions and experiment with their own additional suggestions for comfortable and useful techniques.  We all have fun, they leave class excited and ready to get breastfeeding off to a good start and knowledgeable in some of the basics to help them do so.

Knitted Breast Patterns

LCGB Knitted Breast Pattern

Breastfeeding Network Pattern

What interesting techniques and tools do you use to help your families during your breastfeeding instruction?  Share your ideas and resources in our comments section below.

Babies, Breastfeeding, Childbirth Education, Series: Brilliant Activities for Birth Educators , , , , ,

The PregSense Monitor: A useful new tool or fear-based marketing

August 18th, 2015 by avatar

By Deena Blumenfeld, ERYT, RPYT, LCCE 

pregsensePart of a parent’s job description is to worry about their children. In doing so, parents can help the child maintain their physical health and their emotional wellbeing. However, when the line is crossed into fear based parenting; they may become overprotective to the point of stifling a child’s natural curiosity and the need to learn by making mistakes. They are then at risk of becoming “helicopter parents”.

This is an issue of control. When parents take full control, of their child’s overall well being, they feel that they are protecting them from all the negative aspects of the world. This is a fallacy.

Advertisers and marketers play into this fear and the need for control, that feeds into the parents’ feelings of limited or lack of control. Companies create and market products that provide the impression of safety and security. These products provide a false sense of control for parents, which furthers the illusion that they are doing something “good” or “right” as they “protect” their baby.

Making the rounds of Facebook, and other social media feeds, was this nifty little video about an at-home, wearable baby monitor. It’s called the PregSense Monitor by Nuvo Group. The general consensus from the online community, both mothers and professionals alike, was “Wow! This is amazing! We’ll save so many babies this way!”

My own reaction was a bit different. I’m a skeptic at heart and like all Lamaze educators; I’m a big fan of evidence based products, treatments, procedures and medications. So, I knew I needed to learn more about the PregSense monitor. What’s the evidence behind it? Would it really meet expectations, and save babies and reduce moms’ anxiety?

I attempted to contact Nuvo Group for an interview, but I have not received a response from them at the time of this writing.

Nuvo Group claims

The Israeli tech firm hopes the device will reassure anxious mothers like Michal, in week 32 of her pregnancy, who require monitoring without having to see her doctor.

Claim:  “(The monitor will) allay mothers’ fears by transmitting data about the health of the mother and fetus.”

  • It appears to monitor all of the mother’s vital signs, not unlike a Fitbit or other activity tracker. But how does having the knowledge about your own vital signs and getting additional information about baby’s activities reduce fear?
  • What if the monitor malfunctions? What does that do to a mother’s level of fear?
    • Can one make the assumption that if the monitor isn’t picking up the baby, the mother will become more worried, rather than less. This might lead to increased health care provider visits and further unnecessary medical testing.
  • Could wearing this monitor increase anxiety and potentially cause mothers to be so focused on the monitor it becomes a bit of an obsession?
    • Mothers may become hypervigilant and reliant on the constant stream of “data” available to be reviewed.
  • How would a mother feel if she was unable to wear the monitor one day? Would that increase her fears, even if those fears were unfounded?
    • Removing access, even for a short time could increase worry and interefere with a mother’s ability to continue her daily activities.
  • When there is a constant stream of data it becomes easy to tune out the information. Wouldn’t that defeat the purpose of this device?
    • The information may become white noise and fade into the background, because it’s a nonstop stream.

Claim: Mothers can connect, see and hear the fetus whenever they want, without needing to consult a doctor.

  • Do mothers need a device to help them connect with their babies?
    • This product is trying to create a consumer need that does not exist.
    • Mothers connect with their babies all the time by feeling their movements; talking to them; touching their growing bellies, etc. Would the device reduce this natural mother/fetus interaction? Would a mother be more likely to turn to her smartphone for results from the monitor instead of paying attention to what her baby is actually doing throughout the rhythm of the day.?
  • Using this device would require a health care provider to be monitoring all of these women, all the time. This doesn’t take into account staffing levels or time to complete the task. 24/7 monitoring would be a massive time commitment and responsibility.
  • What about additional liability for the health care provider for not monitoring a woman properly or correctly identifying a problem?
    • We live in a very litigious society. A care provider might be facing a lawsuit if the data from the monitor is not evaluated regularly and an anomaly was missed.
  • Since there are two monitor types – the clinical monitor and the consumer monitor, this raises additional questions. What if the mother is low-risk and healthy, but chooses to wear the consumer model, without a prescription to “reassure” herself that all is well?
    • Would the physician then be required to monitor this mother, if there is no medical need and was not advised by the physician?
    • What is the physician’s liability in this case?

Claim: “We will be able to analyze this data to predict about events of pregnancy, like preterm labor, like preeclampsia and more and we will be able to intervene in the right time…”

  • Preterm labor may be able to be detected with continuous monitoring. However, the monitor is only identifying contractions. It’s not looking at vaginal discharge, cervical change, flu-like symptoms or downward pressure from the baby.
  • Would the monitor be able to tell the difference between Braxton-Hicks contractions and early labor?
    • The limited information on Nuvo Group’s website and in their press release does not provide enough information to say for sure.
  • What about those women who experience Braxton-Hicks regularly throughout pregnancy but are not in labor? Would the monitor be helpful or harmful for them in identifying mothers in preterm labor? Would they be in and out of their care provider’s offices more frequently, causing disruption to their daily lives?
  • Preeclampsia cannot be prevented at this time. So, at best, the monitor would let the mother and her care provider know that her blood pressure is high. It would not test for protein in her urine, swelling in her face, headaches, vision changes or any of the other symptoms of preeclampsia, so it’s an incomplete test. Would preeclampsia be missed because mother’s blood pressure is borderline and no other tests were administered.

Claim: Regarding monitoring high risk mothers with continuous monitoring in hospital; the monitor will benefit the health care provider by replacing a bulky machine with one that is lightweight and not connected to the wall.

  • We already have telemetry units for Electronic Fetal Monitoring (EFM), in many hospitals. This device is now redundant and may not integrate with the current software used to monitor the EFM units.
  • How much will this cost a hospital to replace all of their current EFM units by purchasing these PregSense clinical monitors? Is the financial outlay for a new convenience worth the expense?
  • Does the new monitor increase safety for mother and baby in comparison to traditional EFM. Is this alternative truly better for mothers and for doctors in an in-patient setting? Where are the studies that compare the two options? Is the data we get any better? Or are we still subject to human interpretation of the data in identifying the appropriate course of action?

Claim: The PregSense monitor is safer than ultrasounds that can cause tissue damage

nuvo-ritmo-beats-pregsenseAt this point in time there is no evidence and no research, to support monitoring mothers at home during pregnancy. All of the literature refers to full time electronic fetal monitoring (EFM) during labor. Therefore my assumptions are based off of that literature.

Consensus among professional and governmental groups is that, based on the evidence, intermittent auscultation is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM).  (Heelan 2013) These professional groups include ACOG and AWHONN.

The issue with the beneficial claims made by Nuvo Group is they are in opposition to what the research finds for routine continuous EFM. Continuous EFM in low risk mothers provides no benefit for babies and increases the risk of cesarean for mothers. Therefore the whole concept of the PregSense Monitor is based on an erroneous assumption. It is not possible to prevent a problem by monitoring the baby. A problem can only be detected as it is occurring. So, even if a problem is observed while doing at home monitoring, by the time the mother makes it to the hospital it is may be too late to intervene effectively.

There is also the risk of false positive results. The monitor may detect an anomaly that then increases the mother’s fear about her baby’s well being only to be examined to find out that her baby is doing just fine, causing undue stress and panic.

The claims of the manufacturer of this product don’t hold up under current EFM guidelines and are not FDA approved.

Simplifying fetal monitoring for the care provider may not actually be the case when we look at 24/7 monitoring which still needs to be interpreted by a human being and a potentially large financial investment for a hospital that already has an EFM system that is adequate.

The claim that this product is safer than what currently exists with today’s EFM technology and ultrasonography is unsubstantiated. Without proper research, we do not know if it is safer, more harmful or neutral in relation to EFM and ultrasound as they are done today.

Resolving mother’s fears and helping her connect with the baby are at best an assumption regarding the “softer side” of the product’s results. It may be that some women do have greater piece of mind and feel a greater connection with their baby when using the device. Selling a feeling does not provide medical benefit to mother or baby. It is, however, good marketing.

The takeaway for your students is to have them look at all products with a discerning eye. Fear based marketing is insidious and plays to their emotions. They need to be making informed decisions based on accurate and evidence based information, rather than an emotional response to something that hits them in the heart.


 Nuvo Group’s website

Reuters, “Wearable device provides continuous fetal monitoring”

Dekker, Rebecca, Evidence Based Fetal Monitoring, 2012

Dekker, Rebecca, What is the Evidence for Fetal Monitoring on Admission, 2012

FDA, Avoid Fetal “Keepsake” Images, Heartbeat Monitors, 2014

FDA, Ultrasound Imaging

ACOG Practice Bulletin #106, “Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles,”, July 2009

ACOG press release, ACOG Refines Fetal Heart Rate Monitoring Guidelines, 2009

Lisa Heelan, MSN, FNP-BC, Fetal Monitoring: Creating a Culture of Safety With Informed Choice, J Perinat Educ. 2013 Summer; 22(3): 156–165.




ACOG, Babies, Fetal Monitoring, Guest Posts, Medical Interventions, News about Pregnancy , , , ,

Meet Joan Combellick – Lamaze/ICEA Conference Plenary Speaker

August 13th, 2015 by avatar

The Lamaze International-ICEA 2015 Joint Conference is a little more than a month away and I am excited about all of the learning opportunities and connections that will be happening in Las Vegas.  I remember attending the last Lamaze-ICEA joint conference five years ago and it was very memorable.  Over the next month, I would like to introduce you to the four plenary speakers at the conference. We are lucky to have these experts sharing their wisdom and expertise with us.  Today, we meet Joan Combellick, CM, MSN, MPH.  Joan is a midwife and researcher who is interested in the microbiome and the newborn.  She will be sharing relevant information about this new field of research and how it is related to birth in her plenary session: Watchful Waiting Revisited: Birth Experience and the Neonatal Microbiome.  Meet Joan in this brief interview as she shares some thoughts on her topic.  Join us in Las Vegas to hear the session and learn more about this important new field of research.  To register for the conference and find out more about the Lamaze International – ICEA 2015 Joint Conference visit the conference website.

Sharon Muza: The microbiome and the newborn have been getting lots of attention in the mainstream press in recent months. Parents are coming to class with lots of questions about this topic for their childbirth educator. What do you think are the most common questions expectant families might have on this topic as they prepare to birth?

joan combellick head shotJoan Combellick: I have found it is a topic that is variably known and understood among the women I care for. Many have never heard the term microbiome and think about bacteria primarily as “germs” that we need to rid ourselves of through the use of bactericidal wipes or soap, etc. With these women it is important to start with the concept that bacteria is not always dangerous, rather we actually need and depend on the trillions of bacteria living in all different parts of our bodies. Further, that initial bacterial colonization at birth and in the newborn period is an important developmental process.

 Other women have done extensive reading on the subject. With these women it is important to help ground their knowledge in the current state of the science. For example, the lasting effects of probiotic supplements are not well understood or documented. The relationship between alterations in the newborn microbiome and subsequent disorders, such as asthma and allergies, is an association only, not a causal relationship. The exact characteristics of a “healthy” microbiome for any given person have not yet been clearly defined. These are just a few examples of areas within microbiome research that need further illumination.

SM: How should the childbirth educator respond when parents ask these questions?

JC: I think it is important to reflect this is an emerging science with much more to come. There is a lot of media attention on this topic right now, much of which suggests that the microbiome is the key to all human health. But many answers are still out. Certainly it seems the microbiome may play a role in shaping human health or disease, yet health promotion and disease prevention must also be recognized as a multi-factorial processes.  

SM: What role do childbirth educators play in helping families to understand the role of the microbiome on their newborn?

JC: Childbirth educators are uniquely positioned to engage with women and their families in deep and meaningful ways on microbiome-related issues, as they are with many issues related to pregnancy and birth. This is a new topic for health care providers as well as women receiving care and I suspect it is not very thoroughly discussed during pregnancy, partly due to lack of knowledge on the part of health care providers, but also partly due to lack of time during typical prenatal appointments. Childbirth educators can very effectively open this discussion with women, respond to questions and clarify concerns and practices. They can also support women in a more active pursuit of information and a more robust discussion on this topic with their health care providers.

SM: What changes have you observed in families’ choices and birth preparation plans as their awareness of the importance of their newborn’s microbiome increases?

JC: In my clinical work I have had only one patient who underwent a scheduled cesarean delivery for breech presentation ask for help in exposing her infant to vaginal bacteria. She had already done research on this experimental intervention and carried it out largely on her own. I mostly just helped her navigate the hospital environment while she did so..

I have encountered many women taking pre-, pro-, or syn-biotics, though their goals in taking these supplements is not well defined.

SM: Do you think that hospitals are recognizing and addressing this issue with changes in procedures and protocols that support a healthy microbiome in all the babies born in their facilities?

JC: I believe there is very little discussion about this topic and I have not seen any changes in procedures and protocols at the institutions where I work. I think there is openness on the part of providers to learn more, but I think demand for information from women receiving care may actually lead the way on this.

SM: If families could do one thing prenatally and during labor to help ensure their newborn’s microbiome is the healthiest it could be, what would that one thing be?

JC: Follow a path of normal pregnancy, labor and childbirth to the fullest extent possible. When medications or interventions are suggested, understand why they are medically necessary. Avoid interventions done electively or without medical reason.

SM: How has what you know and have studied about the importance of the newborn’s microbiome changed the way you practice?

skin_to_skinJC: I try to scrutinize all of my own clinical practice more thoroughly in both big and small ways. For example, have I made sure that mother and baby have prolonged skin to skin contact immediately after delivery? Have I educated women to the fullest extent possible about the benefits of breastfeeding and then do I offer the practical support that is needed in the first weeks after delivery when breastfeeding is established? Do I need to prescribe that antibiotic prenatally, or is this a case when watchful waiting is more appropriate? Am I at all times following protocols that prioritize vaginal delivery whenever safe for mother and baby?

SM: It has often been suggested that it takes 17 years to go from “bench to bedside,” when the research can be applied to wide-spread clinical procedures. What do you think can be done by both professionals and consumers to speed this process along as it pertains to the microbiome and the newborn?

JC: As educators and clinicians it is our responsibility to stay up to date on the most current research. But this is often difficult. Professionals and consumers alike can speed this process by opening the discussion, just asking questions and pursuing answers. This can help everyone learn more about the topic and most importantly, insure the most up to date care is given and received. Women should always feel empowered to lead the discussion about this topic with their care providers.

SM: What are you looking forward to most about being a plenary speaker and presenting to the Lamaze/ICEA 2015 conference attendees?

JC: I am both a midwife and a researcher. In my clinical world, I know that it is very difficult to stay up to date on current research. And in my research world, I know that research is all too often not well informed by clinical practice. The two worlds often have a lot of distance between them. This is an exciting conference to me because it is an opportunity to bring research and care together. I hope to clearly present the research I am working on, but I also hope to be better informed about the issues childbirth educators encounter in their work. Childbirth educators often have the best opportunity to know the concerns, knowledge and practices of women and their families. I very much look forward to the sharing of information in all directions.

SM: Is there anything else you would like to share with the readers of Science & Sensibility and attendees at the upcoming conference?

JC: We have observed alterations in newborn bacterial development that are associated with interventions used at or around the time of birth (such as cesarean delivery, antibiotic use, and formula feeding). Further, these alterations have been associated with subsequent health outcomes like obesity, allergy, eczema, asthma, and diabetes. While all of these interventions can be truly life saving when used appropriately, it is also clear that in the US and around the world the use of cesarean delivery, antibiotic treatment and formula feeding is occurring at rates that vastly exceed what is medically necessary. It is important for women to ask for and be told in a way they understand the true medical indication for any and all interventions. It is also important for women to understand that birth is not something that should be scheduled into a busy calendar merely as a matter of convenience. Microbiome research suggests that our normal human birth process, as variable and unpredictable as it may be, is important to promote and protect to the fullest extent possible.




2015 Conference, 2015 Lamaze & ICEA Joint Conference, Babies, Childbirth Education, Lamaze International, New Research, Newborns , , , ,

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