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Care Model Innovations – Changing The Way Maternity Care Is Provided

February 17th, 2015 by avatar
© Serena O'Dwyer

© Serena O’Dwyer

Amy Romano was the original community manager, editor and writer of Science & Sensibility back when this blog was first established by Lamaze International in 2009.  After a healthy stint in that role, Amy has since moved on to other positions and most recently can be found in the position of Vice President of Health Ecosystems at Maternity Neighborhood, a technology company providing digital tools and apps to maternity health care providers around the world.  Additionally, Amy has been focused on finishing up her MBA at the same time.  (Talk about multitasking!)

While moving on to other things, Amy has not stopped blogging and I have been enjoying her most recent series on care model innovation in maternity care in particular and healthcare in general.  The series started in October of 2014, and Amy just published the seventh post in her ten post series. The entire series is part of Amy’s school work toward receiving her MBA.  That is a great blend of combining her degree program with her work, with her passion and interest.

Amy decided to look at four care models in particular: Nurse-Family Partnership, community-based doulas, midwife-led maternity services, and CenteringPregnancy. In talking with Amy, she shared that one of the things that really struck her is that these evidence-based care models are all very much relationship-based. She is more convinced than ever that trusting relationships are the “secret sauce” of good birth outcomes.

The posts available in the series so far include:

  1. What is care model innovation?
  2. The case for care model innovation in U.S. maternity care
  3. Care models that work: Nurse-Family Partnership
  4. Care models that work: Doulas as community health workers
  5. Care models that work: Midwife-led maternity services
  6. Care models that work: Group Prenatal Care
  7. Early examples of payment innovation in maternity care

And those posts yet to come:

8.  More mature payment reform models: An overview
9.  Driving community-based care through payment reform
10. The data infrastructure required for care model transformation

Particularly helpful are the references and learning resources that Amy includes in each of her posts, where the reader can go for more information and to dig deeper into the programs and research that Amy used to substantiate her research.

Changing the maternity care model currently in place is a critical piece for helping to improve the current status of both maternal morbidity and mortality as well as neonatal morbidity and mortality in the USA, which despite our abundance of resources, still has our world ranking in these categories shamefully at the bottom of the list.

According to Amy:

We’re in the midst of a “perfect storm” right now, with implementation of health care reform and lots of forces changing healthcare to be more patient-centered and integrated with community services. If ever there was a time when midwifery care, doulas, physiologic birth practices, etc., were going to take hold, that time is now.

As I have been reading Amy’s series, I have been struck by how some of her posts have reinforced the Lamaze Six Healthy Birth Practices themes, in particular #3 – Bring a friend, loved one or doula for continuous support, and #4 – Avoid interventions that are not medically necessary.

I asked Amy to share what her thoughts on what the role of the childbirth educator was in this time of transition.  Her response:

I think childbirth educators have lots of opportunities in the new healthcare landscape, but it will require a shift in thinking for some. New payment models will reward team-based care and CBEs have an important potential role as valued members of these teams, helping to implement shared decision making, help with care navigation/coordination, and extending educational offerings to postpartum/parenting, special conditions (e.g. gestational diabetes), etc. 

Amy Romano

Amy Romano

We need innovative ideas, forward thinking, and the ability to examine what we are currently doing with a critical eye, if we are to design and implement maternity care programs that improve outcomes and utilize resources more effectively to help mothers and babies.  As Amy highlights, there are existing programs that have shown great results and deserve the opportunity to be implemented on a wider scale.

Take some time to read the seven posts and come back to the Maternity Neighborhood blog to catch the final three when they become available.  Share your thoughts about what Amy is discussing as she rolls out the entire series.  And, consider what your role will be in the changing landscape of care that women receive during their childbearing year.

Babies, Childbirth Education, Doula Care, Healthcare Reform, Healthy Birth Practices, Maternal Mortality, Maternal Quality Improvement, Maternity Care, Midwifery, New Research, Newborns, Research , , , , , , ,

New Lamaze Infographic on Labor Support and Doulas!

December 23rd, 2014 by avatar

Lamaze International has been periodically releasing a comprehensive series of infographics designed to help consumers understand maternal infant best practices.  These easy to read, evidence based infographics can help families to know the facts and supports the “Push for Your Baby” campaign that can help improve birth outcomes.

doula info 1

The newest infographic covering the topic of labor support helps families to understand that building a great support team, including adding a professional doula, can reduce the risk of unwanted interventions and non-medically needed cesareans.  “Who Says Three’s A Crowd”  lets families know that while health care providers can offer emotional support and physiological comfort measures, their responsibilities and patient load may prevent them from offering the continuous support that has been shown to reduce cesareans, need for pitocin, epidurals and improve satisfaction with the birth experience.

Lamaze International’s Healthy Birth Practice #3 “Bring a loved one, friend or doula for continuous support” goes into further detail about the benefits of having good labor support, and includes a short but informative video that supports the third birth practice.  The labor support infographic is a very simple and attractive learning tool that educators can use to teach from or make available in handouts or on the classroom wall for passive learning.

doula info 2

Available infographics include:

Lamaze International provides links to specific infographics for viewing online and makes them available in downloadable “pdf” or “jpeg” formats. Check out the Lamaze International Professionals website here, specifically the infographics page, to see all the infographics.  Parents can find them at the “Push for Your Baby” website.

Have you checked out the infographics?  Have you shared them with your students and clients?  Which one is your favorite?  How do you use them for teaching?  We’d love to hear from you!

Childbirth Education, Doula Care, Evidence Based Medicine, Healthy Birth Practices, Lamaze International , , , , , ,

Non-Drug Pain Coping Strategies Improve Outcomes

July 17th, 2014 by avatar

 Today, contributor Henci Goer reviews a recently published study in the journal Birth, that compared the outcomes of births in women who received non pharmacological pain management techniques with women who received the “usual care” treatment.  The researchers found that maternal and infant outcomes were improved.  Take a moment to read Henci’s review to get a glimpse at the results and her analysis.- Sharon Muza, Science & Sensibility Community Manager

© Patti Ramos Photography

© Patti Ramos Photography

In 2012,  the Cochrane Database published an overview of systematic reviews of forms of pain management that summarized the results of the Cochrane database’s suite of systematic reviews of randomized controlled trials (RCTs) of various pain management techniques. Reviewers reached the rather anemic conclusion that epidurals did best at relieving pain—no surprise there—but increased need for medical intervention—no surprise there either—while non-drug modalities (hypnosis, immersion in warm water, relaxation techniques, acupressure/acupuncture, hands on techniques such as massage or reflexology, and TENS) did equally well or better than their comparison groups (“standard care,” a placebo, or a different specific treatment) at relieving pain, at satisfaction with pain relief, or both, and they had no adverse effects (Jones 2012). Insofar as it went, this finding was helpful for advocating for use of non-drug strategies, but it didn’t go very far.

Fast forward two years, and we have a new, much more robust review: Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis. Its ingenious authors grouped trials of non-drug pain relief modalities according to mechanism of action, which increased the statistical power to determine their effects and avoided inappropriately pooling data from dissimilar studies in meta-analyses (Chaillet 2014). The three mechanisms were Gate Control Theory, which applies nonpainful stimuli to partially block pain transmission; Diffuse Noxious Inhibitory Control, which administers a painful stimulus elsewhere on the body, thereby blocking pain transmission from the uterine contraction and promoting endorphin release in the spinal cord and brain; and Central Nervous System Control, which affects perception and emotions and also releases endorphins within the brain.

Overall, 57 RCTs comparing non-drug strategies with usual care met eligibility criteria: 21 Gate Control (light massage, warm water immersion, positions/ambulation, birth ball, warm packs), 10 Diffuse Noxious Inhibitory Control (sterile water injections, acupressure, acupuncture, high intensity TENS), and 26 Central Nervous System Control (antenatal education, continuous support, attention deviation techniques, aromatherapy). Eleven of the Central Nervous System Control trials specifically added at least one other strategy to continuous support. More about the effect of that in a moment.

Now for the results…

Compared with Gate Control-based strategies, usual care was associated with increased use of epidurals (6 trials, 3369 women, odds ratio: 1.22), higher labor pain scores (3 trials, 278 women, mean difference 1 on a scoring range of 0-10), and more use of oxytocin (10 trials, 2672 women, odds ratio: 1.25). Usual care also increased likelihood of cesarean in studies of walking (3 trials, 1463 women, odds ratio: 1.64).

Compared with Diffuse Noxious Inhibitory Control strategies, usual care was associated with increased use of epidurals (6 trials, 920 women, odds ratio: 1.62), higher labor pain scores (1 trial, 142 women, mean difference 10 on a scoring range of 0-100), and decreased maternal satisfaction as measured in individual trials by feeling safe, relaxed, in control, and perception of experience.

We hit the jackpot with Central Nervous System Control strategies (probably because female labor support, which has numerous studies and strong evidence supporting it, dominate this category [19 labor support, 6 antenatal education, 1 aromatherapy]). As before, usual care is associated with more epidurals (11 trials, 11,957 women, odds ratio: 1.13), more use of oxytocin (19 trials, 14,293 women, odds ratio: 1.20), and decreased maternal satisfaction as measured in individual trials by perception of experience and anxiety. In addition, however, usual care is associated with increased likelihood of cesarean delivery (27 trials, 23,860 women, odds ratio: 1.60), instrumental delivery (21 trials, 15,591 women, odds ratio: 1.21), longer labor duration (13 trials, 4276 women, 30 min), and neonatal resuscitation (3 trials, 7069 women, odds ratio: 1.11).

© Breathtaking Photography http://flic.kr/p/3255VD

© Breathtaking Photography http://flic.kr/p/3255VD

The big winner, though, was continuous support combined with at least one other strategy. Usual care in these 11 trials was even more disadvantageous than in central nervous system trials overall with respect to cesareans (11 trials, 10,338 women): odds ratio 2.17 versus 1.6 for all central nervous system trials, and instrumental delivery (6 trials, 2281 women): odds ratio 1.78 versus 1.21 for all central nervous system trials.

The strength of the data is impressive. Altogether, Chaillet et al. report on 97 outcomes, of which 44 differences favoring non-drug strategies achieve statistical significance, meaning the difference is unlikely to be due to chance, while not one statistically significant difference favors usual care. And there’s still more: benefits of non-drug strategies are probably greater than they appear because on the one hand, “usual care” could include non-drug strategies for coping with labor pain and on the other, many institutions have policies and practices that make it difficult to cope using non-drug strategies alone, strongly encourage epidural use, or both.

The reviewers conclude that their findings showed that:

Nonpharmacologic approaches can contribute to reducing medical interventions, and thus represent an important part of intrapartum care, if not used routinely as the first method for pain relief…however, in some situations, nonpharmacologic approaches may become insufficient…the use of pharmacologic approaches could then be beneficial to reduce pain intensity to prevent suffering and help women cope with labor pain…birth settings and hospital policies . . . should facilitate a supportive birthing environment and should make readily available a broad spectrum of nonpharmacologic and pharmacologic pain relief approaches. (p. 133)

No one could argue with that, but a persuasive argument alone is unlikely to carry the day given the entrenched systemic barriers in many hospitals. States an anesthesiologist: “While there may be problems with high epidural usage, in the presence of our nursing shortages and economic or business considerations, having a woman in bed, attached to an intravenous line and continuous electronic fetal monitor and in receipt of an epidural may be the only realistic way to go” (quoted in Leeman 2003). The Cochrane reviewers concur, writing that using non-drug strategies is “more realistic” (p. 4) outside of the typical hospital environs.

So long as this remains the case, attempts to introduce non-drug options are likely to make little headway. As Lamaze International’s own Judith Lothian trenchantly observes:

If we put women in hospitals with restrictive policies—they’re hooked up to everything, they’re expected to be in bed—of course they’re going to go for the epidural because they’re unable to work through their pain. . . . I go wild with nurses and childbirth educators who say, . . . “[Women] just want to come in and have their epidural.” I say, “And even if they don’t . . ., they come to your hospital, and they have no choice. . . . They can’t manage their pain because you won’t let them.” (quoted in Block 2007, p. 175)

Success at integrating non-drug strategies will almost certainly depend on addressing underlying factors that maintain the status quo. Can it be done? You tell us. Does your hospital take a multifaceted approach to coping with labor pain? If so, how was it implemented and how is it sustained?

Resources

Block, Jennifer. (2007). Pushed: The Painful Truth About Childbirth and Modern Maternity Care. Cambridge, MA: Da Capo Press.

Chaillet, N., Belaid, L., Crochetiere, C., Roy, L., Gagne, G. P., Moutquin, J. M., . . . Bonapace, J. (2014). Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis. Birth, 41(2), 122-137. doi: 10.1111/birt.12103 http://www.ncbi.nlm.nih.gov/pubmed/24761801

Jones, L., Othman, M., Dowswell, T., Alfirevic, Z., Gates, S., Newburn, M., . . . Neilson, J. P. (2012). Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev, 3, CD009234. doi: 10.1002/14651858.CD009234.pub2 http://www.ncbi.nlm.nih.gov/pubmed/2241934

Leeman, L., Fontaine, P., King, V., Klein, M. C., & Ratcliffe, S. (2003). Management of labor pain: promoting patient choice. Am Fam Physician, 68(6), 1023, 1026, 1033 passim. http://www.ncbi.nlm.nih.gov/pubmed/14524393?dopt=Citation

About Henci Goer

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 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.  

Childbirth Education, Doula Care, Epidural Analgesia, Guest Posts, Maternity Care, Medical Interventions, Newborns, Research , , , , ,

Insta-gram or Insta-gasp? The Ethics of Sharing on Social Media for Birth Professionals

October 24th, 2013 by avatar

Attorney and Lactation Consultant Liz Brooks, President of the International Lactation Consultant Association, takes a look at the issues that childbirth professionals might want to consider before sharing information on a social media platform like Facebook, Twitter, Instagram, Pinterest or others.  Do you follow the HIPAA guidelines, even if you are not bound to do so?  What has been your experience?  Please share your thoughts and experiences in our comments section. – Sharon Muza, Science & Sensibility Community Manager.

By Liz Brooks, JD IBCLC FILCA

Is it ever ethical for a healthcare provider (HCP) to post a photograph or video of a patient on a website or Facebook page? My first reaction is “Heck No!,” but the question deserves a deeper look, especially since social media platforms serve as a predominant means of communication, marketing and information-sharing. It is the way we can speak to today’s mothers, and it is the way they insist on reaching us. 

Privacy and confidentiality are hallmarks of the traditional healthcare professions. I am an International Board Certified Lactation Consultant (IBCLC), and right there, in my ethical code (called the IBLCE Code of Professional Conduct for IBCLCs, or CPC), it says at Principle 3 “Preserve the confidentiality of clients.” Further, I am required under the CPC (a mandatory practice-guiding document) to “Refrain from photographing, recording or taping (audio or video) a mother or her child for any purpose unless the mother has given advance written consent on her behalf and that of her child.” 2011 IBLCE CPC, 3.2. Translation: If I want to take a picture of a mother for any reason at all (to document healing of a damaged nipple, perhaps), even if I drop it into a patient folder only I will ever see, and which I lock away in a file cabinet, I had better get the mother’s written consent first. 

But what about a doula or childbirth educator? Are doulas or educators considered “healthcare providers” in the way a doctor, nurse, midwife or IBCLC would be? Or are they removed from the rules in healthcare?

The Childbirth and Postpartum Professional Association (CAPPA) describes the doula as an important informational and emotional link between the pregnant/laboring woman and her healthcare providers … a part of the birth team. DONA International, another doula organization, describes the role as “a knowledgeable, experienced companion who stays with [the mother] through labor, birth and beyond.”

This is what else we learn from CAPPA and DONA International: It is clear that privacy of the mother is paramount. Any person who is certified through CAPPA is expected to follow a Code of Conduct that is quite plain in its requirement to protect privacy: “CAPPA certified professionals will not divulge confidential information received in a professional capacity from their clients, nor compromise clients’ confidentiality either directly or through the use of internet media such as Facebook or blogs.” (Page 1, Bullet 4, CAPPA Code of Conduct.) The Code of Ethics from DONA International echoes this requirement: “Confidentiality and Privacy. The doula should respect the privacy of clients and hold in confidence all information obtained in the course of professional service.” (DONA Int’l Code of Ethics Birth Doula, 2008.)

Childbirth educators are held to a similar standard. Lamaze International, which offers an international certification for those who are working with pregnant women and their families, has a Code of Ethics for its Certified Childbirth Educators. That Code indicates “Childbirth educators should respect clients’ right to privacy. Childbirth educators should not solicit private information from clients unless it is essential to providing services. Once a client shares private information with the childbirth educator standards of confidentiality apply.” (Standard 1.07, 2006 Code of Ethics, Lamaze International.)

So it seems that healthcare providers, childbirth educators and doulas alike should NOT be posting pictures of their clients/patients on the Internet. So why are we seeing so many of them?

Because if the mother agrees to have her picture or personal information shared, her informed consent changes everything. The notion of protecting privacy is that the patient or client ought to be in control of whatever information gets shared with the outside world. Anyone who has attended a conference, and benefited from education that included clinical photographs, knows that some clients/patients are willing to allow their images to be seen by others. They may require conditions of use (i.e. do not show the face), but they willingly agree.

“So all I have to do is just ask the mother?” you wonder. Well … not so fast. Some other considerations may (dare I say it?) cloud the picture:

  1. Some healthcare providers, hospitals or birth facilities may have rules of their own affecting whether or not images may be taken, by you or even the family. You will need understandings and consent up front, often signed on forms as proof, before you can whip out the smart phone. 
  2. If the doula or childbirth educator has a professional, business relationship with other healthcare providers, or healthcare facilities, she may well be considered a “business associate” for purposes of the privacy-protecting sections of the Health Insurance Portability and Accountability Act (HIPAA), and its first cousin in enforcement, the Health Information Technology for Economic and Clinical Health Act (HITECH). Under HIPAA/HITECH “business associates” who have ANY kind of access to patient information (like: name and address) are held to the same standard for privacy as the healthcare provider. And if there are breaches of privacy, both the business associate AND the HCP are held liable. Enforcement actions recently have included actions against small practices, including the levying of some hefty fines. The person working with the family, who has a professional relationship with a covered entity under HIPAA, should be certain that her own business associate agreement is up-to-date and signed. It is important that she respect the requirements set by her (probably skittish) business partner, before she seeks the mother’s consent.
  3. Make sure you and the mother are very clear in your understanding of what her “consent” really means. Many a mother has been disappointed that her great and wonderful news announcing her baby came from someone else first … even if the plan all along was to have everyone share the great news once mom revealed it.

Discuss all the possibilities with the patient/client. Who can publicly discuss the pregnancy/birth/sonogram? Who can take and post pictures? What and who can be included in the pictures (faces, body parts, location-identifying background all matter). Who can text? Who can tweet? Is a link back to a website or Facebook page by the mother required? When can all of this take place?

As a savvy advocate for the mother, you may want to suggest that she have these same discussions with her own circle of family and friends. While they will not be held to the legal and ethical standards required of a doula or HCP, the disappointment will be no less acute for the mother if the glorious news of her pregnancy or birth is spilled by a friend, first. 

As doulas, childbirth educators, IBCLCs and HCPs who work in maternal-child health, we are privileged to be willingly called into the intensely personal and life-changing events that pregnancy, birth and early parenting represent. Our need to respect the wishes, dignity and privacy of the family are not diminished because modern technology makes news-sharing so easy.

About Liz Brooks

Liz Brooks, JD, IBCLC, FILCA, is a lawyer (since 1983) and earned her International Board Certified Lactation Consultant credential in 1997 after several years as a lay breastfeeding counselor.  Before she left the practice of law, Liz worked as a criminal prosecutor, a lobbyist and a litigator, with a focus on ethics and administrative law.  That expertise followed her to lactation:  She wrote the 2013 book, “Legal and Ethical Issues for the IBCLC,” and was lead author for one ethics chapter in each of three other books.

Liz is on the ILCA Board of Directors (President 2012-2014).  She was designated Fellow of the International Lactation Consultant Association (FILCA) in 2008. She currently is the United States Lactation Consultant Association Alternate to the United States Breastfeeding Committee and is an Elected Representative on their Board of Directors (2012-14).  Liz can be reached through her website.

 

 

Babies, Breastfeeding, Childbirth Education, Guest Posts, informed Consent, Legal Issues , , , , , , , , , , , , , , , ,

Celebrate Fathers; Birth Professionals Play A Critical Role

June 13th, 2013 by avatar

With Father’s Day being celebrated this Sunday, Certified Doula David Goldman shares his experiences as both a birth doula and expecting father, as he ponders the role birth professionals and health care providers have in welcoming or marginalizing the partner during pregnancy, birth and early parenting.  The role of men at births has been questioned, mocked and celebrated over the years.  Read and hear how David has been able to experience it from both sides. – Sharon Muza, Community Manager

___________________

© Patti Ramos Photography

My head was spinning with joy, fear and uncertainty as I walked into the birth room for the first time as a doula. I squatted to the side as I acclimated to the calm energy and slowly made my way toward the laboring mother. A nurse walked in and with unexpected excitement shook my hand and smiled deep into my eyes as she walked passed me. My doula mentor stepped in to explain that I was not the dad but was the doula. I laughed to myself, having once again forgotten the rarity of men, especially those in non-medical roles, in the birth room. Since then, I carry a shirt in my birth bag that reads, “Nope, I’m not the Daddy, I’m the Doula” to avoid the confusion and the awkward and misplaced, but well intentioned congratulations. I also wear the shirt because once the staff knows I’m a birth professional, I’m often accepted as part of the ‘real team’ rather than just a ‘bystander’ who might get in the way and needs to be looked out for.

As we are likely well aware, the history of childbirth in North America has included discrimination, sexism, misogyny and other forms of oppression against women. Birth communities have become a source of strength and have collectively fought and won major battles including public breastfeeding, rights to options and evidence-based care in childbirth and so much more. But as with all forms of oppression and marginalization, we can’t bring one person up by bringing another down.  As one of a very small handful of certified male birth doulas  in North America and a birth professional who has completed a Lamaze International approved childbirth educator workshop on the path to obtaining LCCE status, I feel honored to work among thousands of strong women who are pushing the boundaries every day to make childbirth and parenting less traumatic and more empowering for all birthing women.

As a birth professional, I have worked with many amazing dads who glowed at least as bright as their pregnant partners. At most of the births that I have attended, the tears coming from the eyes of men overwhelmed with joy and relief at the birth of their baby have been just as wet as those of the mothers. I am not trying to equate the experiences of becoming a father with becoming a mother.  However, I do hope to shed light on how birth professionals’ communication with fathers can influence the pregnancy and childbirth experience not just for fathers but also for mothers and babies. Like many birth professionals, I have worked hard to support the whole “client family” and honor the role of each person involved. However, now that I find myself in the role of the client family for the first time, I am quite surprised by my experience.

The presence of a father, birth partner or family member can help to improve women’s birth experience by providing emotional support and reassurance during labour and delivery. While unexpected emergencies may arise, for many couples, birth can be a very positive experience.  Royal College of Obstetricians and Gynecologists

Currently, my partner and I are halfway through a pregnancy and, as you can imagine, I now have the opportunity to see things from a whole new perspective. As a birth professional who has taken many courses, attended conferences, read piles of books, shared dialogue via various internet forums and participated as an active and founding member of the local birth professional group in my community, I feel relatively empowered and knowledgeable on the topic of pregnancy, labor, birth and postpartum.

I’m surprised, however, by how marginalized I feel being the partner in the pregnancy and that I feel less and less central in the birth of our baby as we include and add professionals to our team. Providers make little eye contact with me and ask for decisions almost exclusively from my partner. People frequently ask where she will be birthing and whom she has chosen to attend. I’m finding that images in advertising and instructional materials with partners in primary support roles are not as common as those with birth professionals at the center. Many online birth communities are specific to “Mommas” and a large group that had once made an exception (not at my request) to include me as a birth professional recently removed me from the group now that I am a “Dad-to-be” reducing my access to the very support that I had previously offered to many new families. Overall, while we often intend to honor the role of partners, I’m seeing that we are missing the mark throughout the field.

If a well-trained and experienced birth doula and an active part of the local birthing community is feeling disempowered, how must partners who are brand new to birth feel? After all, we may hold knowledge and experience but as we have all seen, a sweet smile or a kiss from a partner can be an amazingly effective medicine for a birthing mother. We already know that the experience of women and babies is improved by continuous care during childbirth. (Hodnet, 2012). What can we do as birth professionals to better support partners in being fully present and connected?

One of the most significant things that birth professionals and health care providers can do is to welcome partners with mutual respect and honoring their challenging and important roles.  By doing so, we can likely improve the experience overall and help foster attachment between the parents and with the partner and the baby even before the birth. The bonds, attachment and successes fostered in childbirth are likely to be a great springboard into future parenting experiences.

In order to improve the likelihood that partners will feel central in the birth team, we as birth professionals must include them from the beginning. We can frequently make eye contact, ask for their opinions and check in to see how they are feeling about decisions. In our prenatal discussions, we can help partners address any barriers they may feel to fully supporting the birth. We can create communities that include partners to seek advice, support and dialogue. Just as we reassure birthing women throughout the process, we might provide acknowledgement for the hard work and endurance of partners. Discussions that promote collaborative dialogue between partners can be encouraged when decisions are needed. Childbirth educators can offer suggestions on how to ask care providers to include the partner more substantially and role-play scenarios with couples in class.

© Patti Ramos Photography

Birth professionals should stop applying the standard stereotypes that have been around for ages, and are continually propagated through the media, assuming fathers are bumbling fools who are being dragged to childbirth classes,  panic at the first contraction, don’t know their way around a newborn, just might “pass out” at the birth and who are easily excited and unable to contribute anything positive to the experience.  This is just not the truth.  Today’s father is often researching right along with the mother for best practices, exploring choices and celebrating each milestone in the pregnancy.  During labor and birth, many fathers want to be the main support and fully share the experience with their partners.

We want the professionals we have chosen to participate with us on this journey to recognize the unique roles and needs that each parent has.  Their very actions and choice of words can help fathers to feel more involved and respected or can marginalize the father to a spot on the edge of the process.  Welcome us as an equal player, celebrate what we bring to the table, share resources and information sources that are specific to our needs as fathers and partners in creating this life.  Have office and classroom spaces filled with diverse images celebrating the amazing role that we are honored to play as partners. Use posters, films and activities that highlight and honor the special place we hold.  Allow us to grow into the role of father, feeling secure, supported and respected by the professionals who are helping us to birth our baby.

As childbirth educators, do you often make light of the lack of information and experience that fathers bring to the birth experience.  Do you make assumptions about the dads in your classes?  Have you perpetuated any of the longstanding stereotypes by the media you use, activities you conduct or your choice of words?  Can you share what you are doing in your class to be as inclusive as possible and to help the couple to moving into parenting by setting them up for a labor and birth filled with connection and support?  Let us know in the comments. – Sharon Muza

References

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub4. 

About David Goldman, MAEd, CD(DONA, PALS)

David P. Goldman, MAEd. CD(DONA, PALS), was trained as a birth doula six years ago at the Simkin Center, Bastyr University and has become one of the very few male certified birth doulas in North America. He has been an educator working with students of all ages for over fifteen years and has completed a Lamaze International approved childbirth educator workshop on the path to obtaining LCCE status. David works with the WISE Birth Doula Collective in Bellingham, WA as well as Open Arms Perinatal Services in Seattle, WA. David can be reached at douladavid@gmail.com

Babies, Childbirth Education, Guest Posts, Infant Attachment, Maternity Care, Newborns, Parenting an Infant, Series: Welcoming All Families, Uncategorized , , , , , , , ,

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