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Series: On the Independent Track to Becoming a Lamaze Trainer – The Curriculum Gets Written (Almost)!

July 7th, 2015 by avatar

By Jessica English, LCCE, FACCE, CD/BDT(DONA)

Late last year, LCCE Jessica English began the path to become an independent trainer with Lamaze International, as part of the just opened “Independent Track”  trainer program.  This new program helps qualified individuals become Lamaze trainers – able to offer Lamaze childbirth educator trainings which is one step on the path for LCCE certification.  She’s agreed to share her trainer journey with us in a series of blog posts; “On the Independent Track to Becoming a Lamaze Trainer”, offering insights at key milestones in the process.  You can read the first part of Jessica’s journey here.  Today, Jessica updates readers on her progress as she tackles the curriculum. If you are interested in becoming a trainer of Lamaze Childbirth Educators, you can find information on applying for the November 2015 Independent Track Program on the website now, and applications are due August 31, 2015.   –  Sharon Muza, Science & Sensibility Community Manager.

JEnglish retreat 1I am so ready to start training childbirth educators!

Unfortunately, my curriculum is not so ready. But I’m getting there — and building lots of empathy for the process my future students will be going through as well.

After finishing my trainer workshop in November, I spent some time processing everything I’d learned. I felt excited about becoming a Lamaze trainer, but I wasn’t ready to jump into writing my curriculum. This is a pretty typical pattern for me, so I was patient with what I know to be a healthy process for myself. I think and process and mull… And then when I’m ready I leap.

As winter turned to spring in the U.S., I watched a few of my classmates finish their curricula and start promoting their trainings. Awesome! Birth workers I had connections with from around the country started asking me when I’d be teaching my first workshop. Wonderful! I started a list of future Lamaze educators so I can update them when I am fully approved to train. I started to feel ready to leap, but the days, weeks and months flew by without much of a dent in my curriculum. I run a busy doula agency and I’m a birth doula trainer and business coach. Not to mention teaching my own childbirth classes and taking care of my own doula clients! And did I mention that I organize a major baby and family expo each February? The phone was always ringing, the email never stopped, meetings dotted each day. I’d jot down ideas or bookmark a resource that I wanted to use with my students. I tried reserving an hour a day to work on the curriculum, but it was challenging to really hold that time sacred. I also found it hard to clear out other distractions. It felt like just as I’d really dig in to a topic, time was up and I needed to move on to another (wildly different) task.

english independent - jpgYears ago in my corporate life, I learned the Eisenhower Decision Matrix for categorizing tasks (popularized by Stephen Covey). I sometimes use this matrix with my business coaching clients. Tasks are divided into categories of urgent, important, both or neither. Using this tool, I could see that I was stuck mostly in the urgent column, but not getting to the Lamaze trainer curriculum because although it was extremely important, it was in no way urgent. It was time to prioritize the important.

I checked in with a couple of folks in my brain trust, sharing my frustration about finding the time to write. (I’ll bet you have a brain trust too! This is my inner circle of trusted advisors that I turn to for support. Some of them are paid, others are mentors or friends with whom I’ve developed a circle of reciprocity — “you help me engineer my life, I’ll help you figure out yours too.”)

My business advisor suggested a retreat.  I talked with another brain trustee, looking for ideas on an affordable retreat. She mentioned Gilchrist, a local retreat center where I could rent a simple cabin and spend a couple of days in the woods. Yes! Perfect! My brain trust had come through for me again.

I reserved three days and two nights in the woods, packed up my food, teaching supplies and laptop. My goal was to leave the retreat center with a fully written curriculum ready to submit to Lamaze International for review. Gilchrist is a 45-minute drive from my home, so I tried to use the drive time to clear out all of the “urgent” from my system. The cabin and the grounds were beautiful. There was no wifi in my cabin and even phone service is spotty, which made it easier to focus in on the curriculum. Each day I walked the trails, cooked, wrote and meditated on everything new childbirth educators would need to make a real difference for families.

I felt connected and focused. It’s always easier for me to tackle big tasks in one large chunk than to piecemeal it, and the retreat was just what I needed. As I think ahead to helping new educators find time to finish their curricula and plan for their classes, I’ll offer the options of reserving small chunks of time over a long period (this works well for some people, even though it’s not a great match for my personal style) or maybe booking their very own Lamaze retreat.JEnglish retreat 2

Unfortunately, I didn’t quite reach my goal to finish the trainer curriculum on retreat. I’m close, though. Another full day of writing should be enough to wrap up what I need to submit to Lamaze International’s lead nurse planner, Susan Givens. An interesting sidelight of the trainer process is that I’m getting laser focused on my own childbirth classes. What are the strongest pieces of my curriculum? Where are the weak links? If I’m training new educators, I want to be sure I’m modeling the best teaching techniques in my own classes. So tucked into the calendar this summer, I have another full day reserved for finishing my trainer curriculum, and also a full day to re-examine and revitalize a few topic areas in my own eight-week Lamaze series.

I’m still puzzling through a few technical issues with the curriculum. I’m working toward enough structure that I can make sure attendees get everything they need, but also some flexibility to let them take the reins at times. I want to model the same innovative teaching techniques I hope they will use in their own classes. I’m grateful for my experience not only as a childbirth educator for the past decade but also as an approved birth doula trainer for DONA International. I have a great sense of both the research and the reality of adult learning. Also on the docket: figuring out how my business curriculum will be incorporated into my Lamaze workshop. Should it be part of the core training, or an extra day or half day that new educators can opt into if they’re planning to teach independently? Business building is a big part of my focus in the birth world, so this piece of the curriculum is really important to me! Some of this will come clear as I finish writing, but experience also tells me that things will shift and adjust as I start to train and get a sense for what works best in action.

To use a birth analogy (because Lamaze educators can turn everything into a birth analogy!), my trainer curriculum feels like it’s in transition. Intense. A little overwhelming. But transition! What a fantastic place to be! Almost there. Keep going. Almost there.

About Jessica English

jenglish-headshot-2015-2Jessica English, LCCE, FACCE, CD/BDT(DONA), is the founder of Heart | Soul | Business. A former marketing and PR executive, she owns Birth Kalamazoo, a thriving doula and childbirth education agency in Southwest Michigan. Jessica trains birth doulas and (soon!) Lamaze childbirth educators, as well as offering heart-centered business-building workshops for all birth professionals.

Childbirth Education, Guest Posts, Lamaze International, Lamaze News, Series: On the Independent Track to Becoming a Lamaze Trainer , , , , ,

BABE Series: “Should I Stay or Should I Go Now?” or When To Go To The Hospital or Birth Center

June 30th, 2015 by avatar

Today I am sharing our Brilliant Activities for Birth Educators (“BABE”) idea for June!  “Should I Stay or Should I Go Now?”- submitted by Lamaze Certified Childbirth Educator Mindy Cockeram. The BABE series contain fun and interesting ideas that childbirth educators can use in their Lamaze classes to make them engaging and memorable for the families in attendance.  Today’s idea covers when families in labor should move to the birth location. Do you have a fun teaching idea that you would like to share in a future BABE article.  Please pop me an email and we can connect. – Sharon Muza, Community Manager, Science & Sensibility.

By Mindy Cockeram, LCCE

© Mindy Cockeram

© Mindy Cockeram

Introduction

The topic of ‘when to go’ to the hospital or birth location, when a woman is in labor is one subject I’m sure most childbirth educators discuss early on in the childbirth class series, – possibly even on the first night – because it is one of the most perplexing and often worrying topics on which families want clarification. I find that most people have received many different pieces of advice about ‘when to go’ from a whole host of friends, family and care providers.

When we start discussing contraction timing, I suggest families use the ‘3 in 10’ guideline (3 contractions in ten minutes OR five minutes apart for a whole hour). But of course active, well-established contractions are not the only reason to turn up at Labor & Delivery and so we use this deck of cards to introduce different situations and their possible ramifications.

How It’s Used

To add some humor into the activity, I call the decision of when to go to the hospital ‘The Clash Moment’ – from the song ‘Should I Stay or Should I Go’ sung by the great British rock band The Clash. In my opinion, this song was written for the laboring couple. The lyrics ring out:

“Should I stay or should I go now?
If I stay there will be trouble.
If I go there will be double?
So come on and let me know,
Should I stay or should I go?”

I shuffle the “Clash Deck” and then hand the deck to a partner. The partner then takes the top card off the deck and reads it out. I shout out to the class ‘Stay or Go?’ and they decide and answer back. Often the reactions are mixed, so I usually facilitate a discussion if necessary and introduce the evidence based arguments. If the situation on the card would send the pregnant person to the hospital, the deck is handed over to the next family. If the situation on the card is not a reason to go, the same family draws the next card. Often a family will draw a card signaling early labor, then draw the loss of the mucus plug (‘showtime’), then ‘feel shaky’ before finally drawing ‘want to push now’. It’s fun watching the pregnant person’s face and the partner’s reaction as they read the next card if they are ‘still at home’.

Depending on the number of cards in your deck, the activity normally takes about 20-30 minutes to do well.

Takeaways

It is interesting to see how often the partners disagree with the pregnant people about whether to stay or go. The statements that usually create the most conversation are ‘Gush of water’ (termPROM), ‘Feel something small protruding inside’ (rare cord prolapse), ‘Instinct says it’s time’ and ‘Backache comes and goes’ (possible posterior labor).

clash babe 2

© Mindy Cockeram

I always present the evidence for staying at home with term PROM vs going in and the difference between guidelines for PROM in the USA (baby out within 24 hrs from PROM) vs the UK (if PROM within 24, baby out within 48) where I trained. PROM usually also leads into a light discussion on warding off Group B Strep and other bacteria by evening out the ‘bad’ bacteria with the ‘good’ bacteria (lactobacillus).

In the first class I also show a hypnobirth video clip and the pregnant person is totally silent. When a family reads out ‘ouch with a contraction’ and all yell ‘stay’, I remind them that the hypnobirthing person we watched never once murmured ‘ouch’ and a baby popped out. Then we discuss how people will have different ‘ouch tolerances’ based on their length of labor and the position in which the baby is in. So eventually they realize they should time the ‘ouch’ instead of trying to guess dilation based on the sounds that are being made.

Modifications

You can add any situation or symptom to a card that you like. I’m in California and am thinking of adding ‘Feel an earthquake’ to my “Clash Deck” to see what they think. I also want to add some pre-eclampsia symptoms like ‘have a persistent headache with flashing aura’ while Pre-Eclampsia Month is still fresh in my mind.

Creating Your Own

It is really simple to make the card deck. Just type or write out situations or symptoms like I have and attach each one to each card from an old deck. Then laminate the cards between two sheets of plastic laminate, cool and trim with scissors.   Leave a bit of a plastic edge when you trim them otherwise they might peel if cut too close to the card. I’ve been using the same deck for almost ten years and they’ve held up very well.

The class seems to love this activity and I hope you do to. Let me know if you have any questions or feedback on its use in your classes.

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 Mindy Cockeram

Mindy Cockeram head shotMindy Cockeram is a recently recertified Lamaze Educator working with a large hospital chain in Southern California where she’s been teaching for four years. She trained initially through the UK’s National Childbirth Trust in Wimbledon, England in 2006 after a career in the financial markets industry in London. She graduated from Villanova University in 1986 with a bachelor’s degree in Communications and a minor in Business Studies. Currently working on a book, she resides in Redlands, California with her British husband and two children.

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

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

June 4th, 2015 by avatar

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

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

Perceived Benefits

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

Perceived Barriers

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

Perceived Seriousness

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

Perceived Susceptibility

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

Self-efficacy

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

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

Cues to Action

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

Summary

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

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

 “A person  has a very good reason for…

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

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

About Andrea Lythgoe

Andrea Lythgoe

Andrea Lythgoe

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

 

 

 

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

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 , , , , , , , ,

New Research: Majority of Preeclampsia-Related Maternal Deaths Deemed Preventable

May 12th, 2015 by avatar

By Eleni Z. Tsigas

Preeclampsia Awareness Month 2015May is Preeclampsia Awareness Month and the journal Obstetrics and Gynecology highlighted some new research published by doctors and researchers at the California Maternal Quality Care Collaborative that demonstrated that the majority of preeclampsia-related deaths could have been prevented.  This is significant because preeclampsia is one of the top perinatal causes of death. Today on Science & Sensibility, Preeclampsia Foundation Executive Director Eleni Z. Tsigas provides an update on this new research and important facts that birth professionals should know.  As childbirth educators, along with teaching families about normal labor and birth, we have an obligation to share information about warning signs and potential complications.  While not as much “fun” as teaching how to cope with a contraction, it is equally important.  Have you checked out the information available at the Preeclampsia Foundation‘s website?  There is a great short video, class tear sheets and even information en español.  How do you teach about preeclampsia to the families that you work with?  Let us know in the comments section. – Sharon Muza, Science & Sensibility Community Manager

Research published in the April 2015 issue of Obstetrics & Gynecology shows that 60 percent of preeclampsia-related maternal deaths were deemed preventable. This large study – Pregnancy-Related Mortality in California: Causes, Characteristics, and Improvement Opportunities – analyzed U.S. pregnancy-related mortality administrative reports and medical records for each maternal death to identify the causes and contributing factors, and improve public health and clinical practices.

Over the last 20 years, a previous decline in maternal deaths has reversed and is cause for concern. The 2009 U.S. pregnancy-related mortality rate was 17.8 deaths per 100,000 live births, up from 7.7 per 100,000 in 1997 and above that of other high-resource countries.

One of every eight U.S. births occurs in California, resulting in more than 500,000 annual deliveries with extensive racial and ethnic diversity. With California’s large population-based sample, this study provides a unique opportunity to compare major causes of pregnancy-related mortality and identify improvement opportunities.

Preeclampsia-related maternal death deemed most preventable

Among the 207 pregnancy-related deaths from 2002 to 2005 studied in California, preeclampsia or eclampsia were identified as one of the five leading causes. The others were cardiovascular disease, hemorrhage, venous thromboembolism, and amniotic fluid embolism.

Of the five leading causes of death, preeclampsia was deemed one of the most preventable – preeclampsia-related deaths had a good-to-strong chance of preventability, estimated at 60%.

Healthcare provider factors were the most common type of contributor, especially delayed response to clinical warning signs followed by ineffective care.

Patients play important role in preventing preeclampsia-related deaths 

The leading patient factors among preeclampsia deaths were delays in seeking care (42%), presumed lack of knowledge regarding the severity of a symptom or condition (39%), and underlying medical condition (39%).

Preeclampsia deaths were most common among foreign-born Hispanic and African American women and associated with early gestational age, consistent with studies demonstrating the increased severity of early-onset preeclampsia.

These findings illustrate the need for public health interventions aimed at helping all women understand and recognize their risks and attain optimal pre-pregnancy health and weight.

It’s worth noting that since the study period, patient awareness has improved, led by several Preeclampsia Foundation education initiatives – currently preeclampsia awareness among pregnant women is 83%, according to a survey conducted last year by BabyCenter®.

The findings also underscore the need for focused approaches to improve care such as hospital-based safety bundles as well as comprehensive programs for patient education, communication, and teamwork development. Read the full report here.

Maternal health improvement initiatives underway 

As these Pregnancy-Related Mortality research findings are announced, several states have already moved forward with maternal health improvement initiatives. Recently the California Maternal Quality Care Collaborative (CMQCC), Hospital Corporation of America, and the American College of Obstetricians and Gynecologists released guidelines and quality improvement toolkits with standardized approaches to recognize and treat severe hypertension, and to increase awareness of atypical clinical presentations and patient education.

CMQCC’s Preeclampsia Toolkit incorporated the Preeclampsia Foundation’s Illustrated Symptoms Tear Pad that effectively informs women who are pregnant or recently gave birth about preeclampsia, which can strike up to six weeks after delivery. Developed by the Preeclampsia Foundation and researchers at Northwestern University Feinberg School of Medicine, the tear pad uses illustrations to describe the symptoms of preeclampsia so they are easily understandable, especially for those with poor health literacy. This toolkit is freely available online and has been downloaded by over 5,100 persons in the United States and more than 60 other countries. It is also being implemented in more than 150 California hospitals as part of the California Partnership for Maternal Safety.

In the year since implementing a Severe Maternal Morbidity Pre- and Post-Toolkit, CMQCC has noted a 34% reduction in maternal adverse outcomes. After implementing Pre- and Post-Hypertension Bundles, the rate of eclampsia has decreased by 31%.

New York joins California in distributing the tear pad throughout the state – as part of a statewide Maternal Preeclampsia Initiative, the New York State Perinatal Quality Collaborative, an initiative of the New York State Department of Health and the New York State Partnership for Patients – has adopted this patient education tool, making it available to all New York birthing facilities.

The Preeclampsia Foundation is proud to play a role in reversing the rate of maternal mortality and severe morbidity; it’s a team effort that requires the combined efforts of public health, clinical and hospital leaders and their institutions, and professional and consumer organizations.

References

Main, E. K., McCain, C. L., Morton, C. H., Holtby, S., & Lawton, E. S. (2015). Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstetrics & Gynecology, 125(4), 938-947.

About Eleni Z. Tsigas

G8FK7644Eleni Z. Tsigas is the Executive Director of the Preeclampsia Foundation. Prior to this position, she served in a variety of volunteer capacities for the organization, including six years on the Board of Directors, two as its chairman. Working with dedicated volunteers, board members and professional staff, Eleni has helped lead the Foundation to its current position as a sustainable, mission-driven, results-oriented organization.

As a preeclampsia survivor herself, Eleni is a relentless champion for the improvement of patient and provider education and practices, for the catalytic role that patients can have to advance the science and status of maternal-infant health, and for the progress that can be realized by building global partnerships to improve patient outcomes.

She has served as a technical advisor to the World Health Organization (WHO) and participated in the Hypertension in Pregnancy Task Force created by the American College of Obstetricians and Gynecologists to develop the national guidelines introduced in 2013, as well as a similar task force for the California Maternal Quality Care Collaborative (CMQCC). Eleni also serves on the National Partnership for Maternal Safety initiative, the Patient Advisory Board of IMPROvED (IMproved PRegnancy Outcomes via Early Detection), Ireland, and the Technical Advisory Group and Knowledge Translation Committee for PRE-EMPT (funded by the Bill & Melinda Gates Foundation). Eleni is frequently engaged as an expert representing the consumer perspective on preeclampsia at national and international meetings, and has been honored to deliver keynote addresses for several professional healthcare providers’ societies.

Eleni has collaborated in numerous research studies, has authored invited chapters and papers in peer-reviewed journals, and is the Principal Investigator for The Preeclampsia Registry.

A veteran of public relations, she has secured media coverage about preeclampsia in national consumer magazines, as well as newspapers, radio and online. Eleni previously spent 8 years executing and managing strategic communications and public relations for technology and biotech companies with Waggener Edstrom Worldwide and for 6 years prior in the television industry.

She is married, and has had two of her three pregnancies seriously impacted by preeclampsia. 

 

Childbirth Education, Guest Posts, Maternal Quality Improvement, Maternity Care, Pre-eclampsia, Research , , , ,

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