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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 , , ,

Book Review: “A Breastfeeding-Friendly Approach to Postpartum Depression: A Resource Guide for Health Care Providers”

May 28th, 2015 by avatar

By Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM

monograph cover_tn_kenKathleen Kendall-Tackett, Ph.D, author, IBCLC, researcher, internationally acclaimed speaker and occasional contributor to our blog, has written a new book – “A Breastfeeding-Friendly Approach to Postpartum Depression: A Resource Guide for Health Care Providers,” that tries to lay to rest the myth that receiving help for a postpartum mood disorder and breastfeeding are not compatible.  I asked Cynthia Good Mojab to share her expert review of the book to commemorate the end of Perinatal Mood Disorders Awareness Month.  Cynthia is the perfect person for this task as she wears the hat of both a lactation consultant and a clinical counselor.  As birth professionals who work with families throughout the childbearing year, we have a sincere responsibility to provide information and screening resources so that families can be evaluated and directed to receive help that continues to support the breastfeeding dyad if breastfeeding is the parent’s desire.  Read Cynthia’s review and consider what you can do to increase awareness of perinatal mood disorders and offer your clients and students the best evidence based information available about how treatment options and breastfeeding are not mutually exclusive. – Sharon Muza, Community Manager, Science & Sensibility

Globally, the prevalence of postpartum depression is as high as 82.1% when measured using self-report questionnaires and as high as 26.3% when measured using structured clinical interviews (Norhayati, Nik Hazlina, Asrenee, & Wan Emilin, 2014). These high rates mean that a significant proportion of families navigate breastfeeding in the context of postpartum depression.

As a perinatal mental health care provider and an IBCLC, I am frequently contacted by parents who found me after having been unable to access breastfeeding-compatible mental health care for postpartum depression (Good Mojab, 2014). They report feeling as though they are caught between a rock and a hard place: they’ve been diagnosed with postpartum depression and have been told by their primary care provider and/or their mental health care provider that they must wean in order to treat their depression. Sometimes they are even told that breastfeeding is causing their depression. Not only is that not true, but the relationship between infant feeding and postpartum depression is actually quite complex (Nonacs, 2014). While breastfeeding problems increase the risk of postpartum depression, breastfeeding itself is protective (Kendall-Tacket, n.d.). And research shows that infant-feeding intentions matter: breastfeeding mothers who are unable to accomplish their breastfeeding goals are two-and-a-half times more likely to develop postpartum depression (Borra et al., 2015). These research findings match what I see in my private practice: the partial or complete loss of a parent’s desired experience of breastfeeding can precipitate deep grief and worsen or precede the onset of postpartum depression.

Fortunately, there are many breastfeeding-compatible treatments for postpartum depression which health care providers and mental health care providers can use to effectively treat the vast majority of their clients. Dr. Kathleen Kendall-Tackett’s new book, “A Breastfeeding-Friendly Approach to Postpartum Depression: A Resource Guide for Health Care Providers,” presents an up-to-date overview of the related research in an outline format that is quick and easy to read. She presents a compelling case for ensuring that families coping with breastfeeding problems receive additional lactation support and that breastfeeding parents coping with postpartum depression have access to treatment that is compatible with the continuation of breastfeeding.

In the first chapter, Kendall-Tackett introduces the rationale for screening for, referring for, and treating postpartum depression: postpartum depression is common in new parents and untreated postpartum depression has significant, immediate, and long-term negative consequences for both parent and child. She then presents research showing that breastfeeding does not cause depression (as some health care providers falsely believe); rather, breastfeeding serves to protect the dyad from the deleterious consequences of postpartum depression via its dampening of the stress response and via its facilitation of ongoing engagement between parent and baby. (When we shift our culturally based reference frame in recognition that breastfeeding is the biological norm for humans, we can see that this research also shows that formula feeding increases the risk of deleterious consequences from postpartum depression through increasing the stress response and potentially lessening ongoing engagement between parent and baby.) The substantial evidence base for why the effective treatment of postpartum depression is so critical—briefly introduced in chapter 1—is presented in more detail in chapter 3. Psychological disorders that often co-occur with postpartum depression, such as posttraumatic stress disorder, bipolar disorder, eating disorders, and obsessive-compulsive disorder, are then described. Chapter 5 reviews the complex causes of postpartum depression, including inflammation, fatigue and sleep disturbance, pain, traumatic birth experiences, infant characteristics such as illness and prematurity, and maternal characteristics, life history, psychiatric history, and social context.baby breastfeeding

Chapter 6 emphasizes the importance of screening for postpartum depression. Kendall-Tackett wisely advocates that validated screening tools be used (rather than relying merely on casual observation) and that screening occur in a variety of care settings—prenatal, hospital, home, and pediatric office visits. The recommendation for prenatal screening is very important. Depression during pregnancy is common (11% to 23% of pregnant women experience depression), is a risk factor for adverse reproductive outcomes such as preterm delivery, and is among the strongest predictors of postpartum depression (Gaynes, et al., 2005; Yonkers, et al., 2009; Norhayati, Nik Hazlina, Asrenee, & Wan Emilin, 2014). Kendall-Tackett describes three reliable screening tools—two of which (the Patient Health Questionnaire-2 and the Edinburgh Postnatal Depression Scale) are in the public domain. This excellent chapter would be improved further with information about how to implement perinatal mental health screening in various settings, including the need to build a breastfeeding-friendly referral network prior to initiating screening and the need to develop or obtain materials (e.g., brochures, handouts, posters, resource lists, referral lists) that provide anticipatory guidance and help parents more easily access information, support, and treatment for postpartum depression (Good Mojab, 2015).

In chapter 7, Kendall-Tackett presents the development of a breastfeeding-friendly treatment plan as being grounded in the facilitation of informed decision making—something perinatal care providers are ethically obligated to do. Informed decision making requires that parents be offered evidence-based information that will allow them to weigh the risks and benefits of a variety of treatment options. This final chapter presents such information in the form of a succinct review of the available research on treatments that have been shown to be effective in treating depression, including: 1) “alternative” treatments (i.e., long-chain omega-3 fatty acids, exercise, S-Adenosyl-L-Methionine, and bright light therapy), 2) psychotherapeutic treatments (i.e., cognitive behavioral therapy and interpersonal therapy), 3) herbal medications (i.e., St. John’s Wort); and 4) anti-depressant medications. The reader is referred to the Infant Risk Center for up-to-date information about the use of particular anti-depressant medications during breastfeeding. Additionally, Medications and Mothers’ Milk: A Manual of Lactational Pharmacology is listed among the references. The LactMed app, though not mentioned in the book, is another useful resource for facilitating informed decision making regarding the use of drugs and supplements during breastfeeding.

The appendices are helpful for readers who have not yet begun to screen for perinatal depression and are looking for appropriate screening tools. Included are the Postpartum Depression Predictors Inventory—which can be used to identify risk factors for postpartum depression—and the Edinburgh Postnatal Depression Scale—which is well-validated as a screening tool for perinatal depression in mothers, in many cultures and languages, and in fathers. (A gender/prenatal/postpartum inclusive version of the EPDS is available here.) Because postpartum depression often includes symptoms of anxiety and/or co-occurs with an anxiety disorder, the appendices would have been improved by including the well-validated Generalized Anxiety Disorder 7-item (GAD-7) Scale, which is also in the public domain.

Scattered throughout the book are links to video clips that provide information on topics such as how breastfeeding protects maternal mental health and how breastfeeding ameliorates the negative effects of sexual assault. Readers with an auditory learning style will especially appreciate this access to online interviews and mini-presentations. Unfortunately, the dark gray links on a light gray background can sometimes be hard to read, leaving the reader to wonder “is that character a capital I, a lowercase L, or a numeric 1?” But, the video resources are worth the trial and error needed to open a couple of the links. Those with access to a smartphone with a QR code reader or barcode scanner can simply scan the code for each video clip to open the links, which greatly simplifies the process.

While the title of the book, “A Breastfeeding-Friendly Approach to Postpartum Depression,” is gender neutral, readers should know that the book is focused on cisgender mothers and uses cisnormative language. Certainly, there is a dearth of research on transgender and gender non-conforming parents which makes it difficult to write an evidence-based book addressing their needs in the context of breastfeeding/chestfeeding and postpartum depression. Nonetheless, we can infer that the high rate of clinical depression (44.1%) among transgender individuals means that transgender parents are at high risk for postpartum depression. And, the fact that transgender individuals experience “gender insensitivity, displays of discomfort, denied services, substandard care, verbal abuse, and forced care” in health care settings (Bockting, et al., 2013) means that transgender parents are also at high risk of being unable to access effective mental health care, much less breastfeeding/chestfeeding-compatible mental health care. Perinatal care providers need to be aware of these higher risks and learn how to bring their services into compliance with the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (Bockting, et al., 2011). The lactation-friendly treatment options for postpartum depression that are reviewed in the book are likely to also be effective for transgender and gender non-conforming parents who breastfeed, chestfeed, or feed their expressed milk to their babies. The effective treatment of breastfeeding/chestfeeding parents with postpartum depression will also need to include responding to whether and how they are experiencing gender dysphoria during lactation.

Although written for health care providers, “A Breastfeeding-Friendly Approach to Postpartum Depression” will also be useful for childbirth educators, doulas, lay supporters, lactation specialists, and perinatal mental health care providers as they strive to do their part to offer families evidence-based anticipatory guidance about postpartum depression and its treatment options, advocate for more lactation support for families coping with breastfeeding difficulties, screen for postpartum depression, refer to and effectively collaborate with other breastfeeding-friendly perinatal care providers, and provide services that avoid iatrogenically increasing the risk of negative health, developmental, and mental health consequences for parents and babies through the unnecessary undermining of breastfeeding. The more widely Dr. Kendall-Tackett’s powerful little book is read and applied in practice, the more breastfeeding families will have access to breastfeeding-compatible treatment that truly meets their needs in the context of postpartum depression.

References

Bockting, W., Miner, M., Swinburne, R., Hamilton, A., and Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health, 103:943–951. Accessed: May 23, 2015. Url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698807/pdf/AJPH.2013.301241.pdf

Borra, C., Iacovou, M., and Sevilla, A. (2015). New evidence on breastfeeding and postpartum depression: The importance of understanding women’s intentions. Maternal and Child Health Journal, 19:897–907. Url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353856/pdf/10995_2014_Article_1591.pdf

Coleman, E., Bockting, W., Botzer, M., et al. (2011). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13:165–232. Accessed May 23, 2015. Url: http://www.wpath.org/uploaded_files/140/files/IJT%20soc,%20v7.pdf

Gaynes, B., Gavin, N., Meltzer-Brody, S., Lohr, K., Swinson, T., Gartlehner, G., Brody, S., Miller, W., et al. (2005). Perinatal depression: Prevalence, screening accuracy and screening outcomes;Evid Rep Technol Assess (Summ). 119:1–8.

Good Mojab, C. (2014). Mental Health Care for Postpartum Depression During Breastfeeding. Lynnwood, WA: LifeCircle Counseling and Consulting, LLC. Accessed May 23, 2015. Url: http://lifecirclecc.com/yahoo_site_admin/assets/docs/MentalHealthCarePPDBfd2014.pdf

Good Mojab, C. (2015). The Basics of Perinatal Screening. Accessed May 23, 2015. Url: http://www.lifecirclecc.com/professionals/perinatal_screening

Hale, T. and Rowe, H. (2014). Medications and Mothers’ Milk: A Manual of Lactational Pharmacology. Amarillo, TX: Hale Publishing.

Kendall-Tackett, K. (n.d). Why Breastfeeding and Omega-3s Help Prevent Depression in Pregnant and Postpartum Women. Accessed May 23, 2015. Url: http://www.uppitysciencechick.com/why_bfand_omega_3s.pdf

Kosenko, K., Rintamaki, L., Raney, S., and Maness, K. (2013). Transgender patient perceptions of stigma in health care contexts. Med Care, 51(9):819-22.

Nonacs, R. (2014). Breastfeeding and Postpartum Depression: Further Insights Into a Complicated Relationship. Massachusetts General Hospital Center for Women’s Mental Health. Accessed: May 23, 2015. Url: http://womensmentalhealth.org/posts/breastfeeding-postpartum-depression-insights-complicated-relationship/

Norhayati, M., Nik Hazlina, N., Asrenee, A., & Wan Emilin, W. (2014). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, 175C, 34-52.

Yonkers, K. Wisner, K., Stewart, D. Oberlander, T., Dell, D., Stotland, N., Ramin, S., et al. (2009). The management of depression during pregnancy: A report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol. 114(3):703–713. Accessed: May 28, 2015. Url: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094693/pdf/nihms293837.pdf 

About Cynthia Good Mojab

cynthia good mojab headshot 2015Cynthia Good Mojab, MS Clinical Psychology, is a Clinical Counselor, International Board Certified Lactation Consultant, author, award-winning researcher, and internationally recognized speaker. She is the Director of LifeCircle Counseling and Consulting, LLC where she specializes in providing perinatal mental health care, including breastfeeding-compatible treatment for postpartum depression. Cynthia is Certified in Acute Traumatic Stress Management and is a member of the American Academy of Experts in Traumatic Stress and the National Center for Crisis Management. Her areas of focus include perinatal loss, grief, depression, anxiety, and trauma; lactational psychology; cultural competence; and social justice. She has authored, contributed to, and provided editorial review of numerous publications. Cynthia can be reached through her website.

 

Babies, Book Reviews, Breastfeeding, Childbirth Education, Evidence Based Medicine, Guest Posts, Maternal Mental Health, New Research, Newborns, Perinatal Mood Disorders, Postpartum Depression, Uncategorized , , , , , , , ,

BABE Series: Postpartum Survival Kit – Helping Families Be Ready for Life with a Newborn

May 26th, 2015 by avatar

By Cara Terreri, LCCE

PSK BABEMay’s Brilliant Activities for Birth Educators (BABE) idea is all about the postpartum period.  Lots of families don’t realize that good childbirth classes not only prepare families for the labor and birth but can be a wealth of information about the first weeks with a new baby.  Today on Science & Sensibility, Cara Terreri, LCCE shares her classroom activity to help families get ready for what happens after the birth – when they bring that new little one home. – Sharon Muza, Science & Sensibility Community Manager 

Introduction

The postpartum period is an important component of childbirth education. As we know, preparation for the birth of a child isn’t enough. And unfortunately in our culture, postpartum needs aren’t given a lot of attention, which means that parents often feel unprepared, confused, and frustrated during the early days and weeks after baby comes home.

For my childbirth classes, I developed a fun and interactive activity to introduce and discuss the many topics related to postpartum. The exercise can be a stand-alone activity (in a refresher childbirth class) or used as an opener to more in-depth activities and lessons on postpartum in an entire series. My inspiration for creating the “Postpartum Survival Kit” was the wonderfully humorous “Postpartum Robe,” a trademark teaching tool from Teri Shilling, MS, CD(DONA), IBCLC, LCCE, Passion for Birth founder and Lamaze educator, as well as Lamaze Childbirth Educator Seminar trainer.

The Postpartum Survival Kit (PSK) consists of a large plastic container with lid (mine also includes a handle, which helps for easy transport), and includes 23 items representing different issues or experiences a family may encounter during the postpartum period. The items represent everything from the physical recovery after birth (peri bottle, thick menstrual pad, and hemorrhoid cream) to emotional issues, like the importance of finding “me time” and postpartum mood disorders.

How It’s Used

In my classes, after introducing the topic of the postpartum period, I bring out the PSK, pass it around, and instruct families to take out 2-3 items (depending on the number of students in class). I then introduce the PSK and talk about how the different items represent typical encounters and issues during the postpartum. We then go around the room and each couple is asked to share the items they pulled and offer an explanation of their significance. Some items are more obvious, like the sleep mask for the importance of getting sleep when you can; some elicit giggles and awkward moments, like the KY jelly which represents the possible need for vaginal lubrication during intercourse if the parent is breastfeeding; and some items are confusing, like the mini manicure kit (taking “me time”) and the red golf ball (size of postpartum clots, what’s normal and what’s not).

photo 2When students share their items, I jump in when they (or the other students) cannot accurately describe the item’s meaning. I also open the floor for discussion with open-ended questions like “How would you cope?” and “What kind of support would you need if this should happen to you?” and “Who could you call on for help?” Depending on the size of your class, this exercise can take up a good amount of time, so be sure to plan appropriately and be prepared to reel in side discussions should it get off course.

Takeaways

Parents in my classes really enjoy this exercise. I get a lot of laughs, bewildered looks, and “lightbulb” moments. It’s always interesting to see how often the non-birth parent accurately describe the significance of items in this exercise – there have been many moments where the pregnant person is stumped, but the partner knows. In these instances, the exercise provides reassurance to both parents that the knowledge on what to expect during postpartum is intuitive. Additionally, I have found that this tangible exercise helps reinforce learning and memory when we talk more in depth about postpartum issues later in the class.

Modifications

The PSK exercise can be modified in several ways. I’ve used it in coordination with a worksheet, which could also be turned into a competition between families. If using in a private class, you can have each family member take turns with each new item. You could also use the exercise as an interactive teach-back. Ask each family to take out 2-3 items, learn about their significance (offer assistance if they are completely stumped), and then return to the next class and teach the other students.

The PSK also could be replicated for use in teaching the stages of labor and breastfeeding. Create a similar, smaller kit for each stage of labor and/or breastfeeding and begin the segment with the kit. For example, a Transition Kit may include a focal point, washcloth, water bottle, and mini bullhorn (to signify the “take charge” routine). 

Contents & Creating Your Own

The fun part about creating a PSK is making it uniquely your own! Some of the items will naturally be the same (lochia pad, hospital underwear, peri bottle, breastfeeding pads, for example), but others are limited only by your creativity! Consider the ways in which you can demonstrate postpartum mood disorders, changing emotions, dividing up hours in the day, eating nutritious food, sleep, etc. Items included in my Postpartum Survival Kit are:

  • Water bottle – keeping hydrated
  • Hospital underwear and pad – postpartum bleeding
  • Peri bottle, Dermaplast, and ice pack – perineal healing
  • Elastic abdominal brace – cesarean healing and core strengthening
  • Plate with balanced meal – postpartum nutrition
  • Ibuprofen – normal aches and pains
  • Hemorrhoid cream – a not uncommon postpartum issue
  • Stool softener – this is an important concern for many!
  • KY Jelly – lubrication issues
  • Condoms – postpartum fertility/birth control
  • Eye mask – getting sleep
  • Small red balloon paired with giant red balloon – involution, postpartum tummy
  • Hand mirror with puzzled/confused face – postpartum mood disorders (“I don’t recognize myself”)
  • Laminated speech bubble with “helpful” advice – dealing with influx of family/friend advice
  • Cloth breastfeeding pads – leaking nipples
  • Stuffed heart toy with wide open arms – finding and accepting support
  • Do not disturb door hanger – limiting visitors is ok; family time is important
  • Small baby doll with a heart and question mark on her tummy – conflicting emotions a baby often brings
  • Encouragement flags – encourage and praise your partner
  • Manicure kit – making time for yourself
  • Pill box modified to read “house, partner, work, baby care, errands, etc.” and filled with 24 beads, divvied up into the different compartments – how will you divide your time

 What else might you add to your customized Postpartum Survival Kit? There are many ways to teach about adapting to and surviving the postpartum weeks.  How do you teach about the postpartum period in your childbirth classes?  What activities have you found effective?  Share with all of us in the comments section.  If you have a “BABE”  to share in future posts – please contact me and let’s talk. – SM

Note/Disclaimer: The use of the acronym “BABE” (Brilliant Activities for Birth Educators) is not affiliated with, aligned with or associated with any particular childbirth program or organization.

About Cara Terreri, LCCE

© Cara Terreri

© Cara Terreri

Cara is a Lamaze Certified Childbirth Educator, doula, and site administrator for the Lamaze parent blog, Giving Birth with Confidence. She teaches and works in Myrtle Beach, SC, where she lives with her husband and three children. You can learn more about Cara at Simple Support Birth.

 

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

Great Line-up of Plenary Conference Speakers and President’s Desk Updates

May 14th, 2015 by avatar

lamaze icea conf 2015Today on Science & Sensibility – news you can use!  Plenary speakers have been announced for the upcoming conference and Robin Elise Weiss, Lamaze International’s Board President has a new series of informative videos called “From the President’s Desk” that you will want to check out.  Read on for information on both of these topics.

Lamaze/ICEA Joint Conference News

Lamaze International and the International Childbirth Education Association (ICEA) just announced their plenary (general session) speaker line up for the joint Lamaze/ICEA 2015 conference at Planet Hollywood, Las Vegas on September 17-20.  Four speakers will address the entire conference in general sessions and I am very much looking forward to listening to their presentations along with the many concurrent sessions that will be offered over the four days of the conference.

ICEA and Lamaze celebrated their 50th anniversaries together in 2010 in Milwaukee, WI with a well attended “mega-conference” that had great energy and educational offerings and I expect that this conference will be just as big and wonderful.  Bringing together two leaders in childbirth education to hold a joint conference means that all attendees will benefit in numerous ways.

The theme of the Las Vegas conference is “Raising the Stakes for Evidence Based Practices & Education in Childbirth” and I know that educators, doctors, midwives, doulas, L&D nurses, IBCLCs and others will come together and take advantage of this joint conference to network, learn, receive contact hours, and socialize with other professionals.  Maybe, even win a little at the blackjack tables or take in a great show.  Las Vegas is a great venue for this conference, offering a wide variety of locales, activities and nightlife to enjoy outside of conference  hours.

This year’s plenary speakers

camman head shot 2015William Camann, MD
Director of Obstetric Anesthesia, Brigham and Women’s Hospital,  Associate Professor of Anesthesia, Harvard Medical School

Presentation: What does the informed childbirth educator need to know about labor pain relief in 2015?

 

 

combellick head shot 2015Joan Combellick, MSN, MPH,CM
PhD Student, NYU College of Nursing
Midwife, Hudson River Healthcare

Presentation: Watchful Waiting Revisited: Birth Experience and the Neonatal Microbiome

 

 

Joseph head shot 2015Jennie Joseph, LM, CPM
Co-Founder and Executive Director
Commonsense Childbirth School of Midwifery

Presentation:The Perinatal Revolution: Reducing Disparities and Saving Lives through Perinatal Education and Support

 

 

mcallister head shot 2015Elan McAllister
Founder, Choices in Childbirth

Presentation: No Day But Today

 

 

 

 

Concurrent sessions

Watch the website for soon to be released information on concurrent speakers and their topics.  Concurrent sessions will fall into one of four categories:

  • Evidence-Based Teaching and Practice
  • Using Technology and Innovation to Reach Childbearing and Breastfeeding Women
  • New and Emerging Research in the Field of Childbearing and Breastfeeding
  • Challenges of the Maternal Child Professional

Preconference workshops

Additionally, there will be two preconference workshops available for a small additional fee.  These 4 hour workshops allow you to really immerse yourself in the topic and leave with concrete skills applicable to your work with childbearing families.

  • Movement in Birth (AM)
  • Social Media Smarts: Strategic Online Marketing for the Busy Childbirth Professional (PM)

Early bird registration is open until August 1, 2015, so registering now allows you to save money on the conference fees and make your travel and hotel plans now.  Look for interviews with the plenary speakers over the next few months on Science & Sensibility.

 From the President’s Desk

Board President Robin Elise Weiss, Ph.D, has recently made a series of short and useful videos for Lamaze International on several topics.  The video series is called “From the President’s Desk”. Released to date are several on cesareans;

Robin’s newest video discusses the recently released ACOG committee opinion “Clinical Guidelines and Standardization of Practice to Improve Outcomes“. This video helps both birth professionals and consumers to understand how pushing for the best evidence based care can result in both pregnant people and their babies having improved outcomes.  ACOG wants to be able to offer best practice to those receiving care from its members, and consumers can help by sharing their desire to receive care in line with recommended guidelines.

Head over to Lamaze International’s YouTube Channel to see all the offerings, share the relevant videos with your students and clients and subscribe to the channel so that you don’t miss any of the releases.

2015 Lamaze & ICEA Joint Conference, ACOG, Cesarean Birth, Childbirth Education, Conference Calendar, Conference Schedule, Continuing Education, Lamaze International, Lamaze News , , , , , , , , , , , ,

Celebrate International Day of the Midwife! ACOG Calls for Universal ICM Standards

May 5th, 2015 by avatar

Lamaze and Midwives IDM 2015Lamaze International and Science & Sensibility join with other partners around the world to celebrate International Day of the Midwife.  This global celebration is observed every year on May 5th and was officially recognized by the International Confederation of Midwives in 1992. (Read Judith Lothian’s report from the 2014 ICM Congress here.) This year’s theme is “The World Needs Midwives Today More Than Ever.”

Key midwifery concepts and model of care

Key midwifery concepts as defined by the International Confederation of Midwives describe the unique role that midwives have in providing care to women and families:

  • partnership with women to promote self-care and the health of mothers, infants, and families;
  • respect for human dignity and for women as persons with full human rights;
  • advocacy for women so that their voices are heard and their health care choices are respected;
  • cultural sensitivity, including working with women and health care providers to overcome those cultural practices that harm women and babies;
  • a focus on health promotion and disease prevention that views pregnancy as a normal life event;
  • advocacy for normal physiologic labour and birth to enhance best outcomes for mothers and infants.  (Fullerton, Thompson & Severino, 2011).

ACOG advocates universal standards

http://www.flickr.com/photos/eyeliam/

http://www.flickr.com/photos/eyeliam/

On April 20, 2015, the American College of Obstetricians and Gynecologists (ACOG) endorsed the International Confederation of Midwives education and training standards and suggested that this criteria be adopted as the minimum requirements for midwifery licensure in the United States.  ACOG “advocates for implementation of the ICM standards in every state to assure all women access to safe, qualified, highly skilled providers.” In the same document, ACOG calls for a single midwife credential.  Currently, in the USA there are certified nurse midwives (CNM), Certified Midwives (CM) and Certified Professional Midwives (CPM) and they all have different core competencies and educational requirements.  You can read the entire ACOG statement here.  This document is meant to accompany their Levels of Maternal Care statement that I wrote about in a previous blog post.  Both of these recent statements signify a recognition that families have choices about the type of health care provider they receive their maternity care from and that more and more families every year are choosing midwifery.

Five interesting facts about midwifery

  1. There are approximately 26,000 midwives in the USA.  This number includes Certified Nurse Midwives, Certified Midwives and Certified Professional Midwives.
  2. Midwives practice and catch babies in hospitals, birth centers and in families’ homes.
  3. Midwives who are educated and regulated to international standards can provide 87% of the essential care needed for women and newborns. (UNFPA, 2014)
  4. 11.3% of all babies born in the USA in 2013 were caught by midwives (Martin, Hamilton, Osterman, et al. 2015)
  5. Approximately 0.6% of all midwives in the USA are male. (Pinkerton, Schorn, 2008)

Summary

How are you celebrating International Day of the Midwife in your community and in your classes?  Have you reached out to the midwives in your community and let them know that they are appreciated?  Take a moment to do so and join Lamaze International in thanking midwives for helping families have safe and healthy  births.

References

Fullerton, J. T., Thompson, J. B., & Severino, R. (2011). The International Confederation of Midwives essential competencies for basic midwifery practice. An update study: 2009–2010. Midwifery, 27(4), 399-408.

Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2013. National vital statistics reports; vol 64 no 1. Hyattsville, MD: National Center for Health Statistics. 2015.

Pilkenton, D., & Schorn, M. N. (2008). Midwifery: a career for men in nursing.Men in Nursing Journal, 3(1), 32.

UNFPA. The State of the World’s Midwifery 2014. A Universal Pathway. A Woman’s Right to Health. United Nations Population Fund, New York; 2014

Breastfeeding, Home Birth, Midwifery, Uncategorized , , , , , , , , ,

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