Posts Tagged ‘guest post’

Series: Supporting Women When a VBAC Doesn’t Happen – Part One: A Unique Grief

November 5th, 2015 by avatar

By Pamela Vireday 

“Although the world is full of suffering, it is also full of the overcoming of it.”  –Helen Keller

CBAC part 1I am delighted to share with you a three part series that begins today, written by Pamela Vireday, who is an occasional contributor to Science & Sensibility.  In this series, Pamela examines the topic of women who experience a Cesarean Birth after a Cesarean. This is when families are planning for a vaginal birth after a prior cesarean, but the birth does not go as planned.  The experiences of women who have a CBAC are often negated and their emotional and physical well-being given short-shrift by both professionals and their social community of friends and family.  The research on this topic is slim and begs for exploration by qualified investigators.  Today, Pamela discusses the unique grief that CBAC women may experience.  Part two will examine the limited research available and part three will provide information on how to support CBAC women in the absence of published research.  We will also conclude the series with a useful resource list to share with the families you may work with  who find themselves in this situation.  You can also read a companion piece of Pamela’s own personal story, “Cesarean Birth after Cesarean, 18 Years Later” on her own website.- Sharon Muza, Community Manager, Science & Sensibility.

It is a hard truth that not all women who want a VBAC will have one.

In a typical high-intervention hospital setting, about 60-80% of women who attempt a VBAC will have one. (Grobman 2010) That’s a terrific, strong reason to support VBACs.

The underappreciated flip side of this statistic, however, is that about 20-40% of women who attempt a VBAC will have another cesarean instead, often after a long, hard labor. Yet little attention has been paid to these women and their families. How do they feel about their experience? How is their emotional journey different than after a primary cesarean or an elective repeat cesarean? What do these women need to integrate this experience into their lives?

Anecdotally, many women report that they did not feel supported after a VBAC attempt  (referred to as TOLAC – Trial of Labor after Cesarean) that ended in another cesarean. Some even felt judged or deserted by their care providers and friends. Research shows that the physical recovery is often harder, too. Yet little attention has been paid in the research to the needs of these women, and few resources exist that directly address their experiences.

Where is the support for women who have an undesired, unplanned second cesarean? Where is the acknowledgement of all the work they put in towards a VBAC, the hours of labor, the pain, the worry? Does all that preparation and work not count if one does not end up with a VBAC?

How can we in the birth field better support the women who do not have a VBAC? How can we help all mothers feel supported, regardless of outcome?


The first thing that we can do is to be mindful of our terminology.

Obstetric research typically uses the terms “Failed VBAC” or “Failed Trial of Labor After Cesarean” (Failed TOLAC). Many women feel that this terminology is judgmental and insensitive, adding to their emotional wounds at a time when they feel most vulnerable. Women who did not get a VBAC are not failures. The reality of birth is much grayer than a black-or-white, success-or-failure binary equation.

The term, “trial of labor cesarean,” is a better alternative than “failed VBAC.” However, it is cumbersome and perpetuates the mentality of being “on trial.”

Members of the International Cesarean Awareness Network (ICAN) created the more-neutral term “Cesarean Birth After Cesarean” (CBAC) as an alternative. It helps distinguish between a repeat cesarean that was gladly chosen and one that occurred when a mother planned and worked for a VBAC but didn’t get one.

Most of the time, CBAC refers to a woman who labored and then had a repeat cesarean. However, sometimes CBAC can also refer to an unwanted repeat cesarean performed before labor for legitimate medical reasons, because the mother was coerced or scared into a repeat cesarean, or because she was unable to find a supportive provider. The point is that an undesired cesarean is going to have a different emotional resonance than one which was wanted.

Some women prefer “CSAC” (Cesarean Surgery After Cesarean). We will use “CBAC” here because its meaning is intuitive and it is a logical companion term to “VBAC” but women should choose the term that feels right for their experience.

Women’s Stories

Women who have had CBACs often report that they did not receive adequate emotional support from birth professionals, friends, or family after the birth.

“When it comes to support, I had tons when PLANNING the VBAC but once it turned into a CBAC? Everyone disappeared. No one was willing to talk to me about it. No one really had information to GIVE me about a ‘failed VBAC.’ “Sarah Vincent

“I remember after my failed [VBAC] attempt how much I needed to share my story, talk about my disappointment and sadness, and process what went wrong. But it seemed as though nobody wanted to hear it. It was almost as if my CBAC might be contagious so I should refrain from talking much about it.” Teresa Stire

Personally, I had a CBAC after 5 hours pushing with no progress. My doula made me feel like I had given up too soon. She left soon after the cesarean and I never saw or heard from her again, despite the fact that she was supposed to do a postpartum visit. Her abandonment spoke volumes. Sadly, her judgment was only the first of many from the birth world.

CBAC mothers often feel their decisions are second-guessed like this. Well-meaning people will go through a CBAC mother’s birth story, looking for “wrong” decisions that caused the CBAC. Sometimes CBAC stories are used as cautionary tales to other hopeful VBAC mothers. Even when there are things a CBAC mother might have changed about her decisions, being held up as an example of “what not to do” is incredibly hurtful.

Furthermore, the grief around a CBAC is different in some ways than that around a primary cesarean; women tend to feel more “broken” after a CBAC, as if their bodies had truly failed them, and many feel isolated and unsupported. Yet the birth community treats CBACs as if they are no different from primary cesareans. CBAC mothers have shared:

“I personally felt screwed by careproviders after my 1st CS, but after my 2nd I felt screwed by my body― I truly was broken.” Elaine Mills

“The isolation of CBAC is another aspect that may be relatively unknown. I felt very isolated ― from vaginal birth moms, from Elective Repeat Cesarean moms (ERCS) moms, and very much from VBAC moms. This has been very toxic for me.”   Rebecca H.

“Validating the…compounding nature of that loss (as opposed to a primary c/s) ― the nail in the coffin feeling ─ is so important.” Caroline Kelley

A CBAC is not experienced in the same way as a primary cesarean or an elective repeat cesarean. The grief resonates differently, even if the CBAC was prudent or necessary. Yet seldom is the unique nature of this loss acknowledged. How can we, as birth professionals, recognize these differences and support these women through this emotional journey? More on this in the Part Two of the series on Tuesday.


Grobman, W. A. (2010, August). Rates and prediction of successful vaginal birth after cesarean. In Seminars in perinatology (Vol. 34, No. 4, pp. 244-248). WB Saunders.

About Pamela Vireday

Painting by Mary Cassatt, 1844-1926. (public domain) Image from Wikimedia Commons.

Pamela Vireday is a childbirth educator, writer, woman of size, and mother to four children. She has been collecting the stories of women of size and writing about childbirth research for 20 years. She writes at www.wellroundedmama.blogspot.com and www.plus-size-pregnancy.org.


Cesarean Birth, Childbirth Education, Guest Posts, Series: Supporting Women When a VBAC Doesn't Happen, Vaginal Birth After Cesarean (VBAC) , , , , , , , , , , ,

Series: Brilliant Activities for Birth Educators: Trick or Treat – Halloween Spoils Make Great Teaching Aids

October 29th, 2015 by avatar

By Stacie Bingham, LCCE, CD(DONA)

pelvis title BABEOctober’s Brilliant Activities for Birth Educators honors the Halloween holiday as educator Stacie Bingham takes us down the Halloween aisle for items you can use to make props for teaching families about baby’s movement through the pelvis.  Stacie is a creative educator who is always coming up with new ways to introduce families to concepts that help them to have safe and healthy births.  I would also like to take a moment to congratulate Stacie on passing the recent Lamaze exam and earning the credentials Lamaze Certified Childbirth Educator.  Way to go Stacie!  Enjoy this month’s Brilliant Activities for Birth Educators post and consider checking out past posts as well for other great ideas.  Happy Halloween! – Sharon Muza, Community Manager, Science & Sensibility

I am crafty and cheap frugal; finding alternatives to traditional (costly!) childbirth education supplies is one of my favorite pastimes. I wander thrift stores, clearance aisles, even the market where I buy groceries, always thinking: what could I do with this? It has enabled me to build up a collection of props to support my classes at very little cost, while also giving me more wiggle room in my budget for items that must be purchased, such as media and print resources.

skeletonMake your own mini pelvis, placenta, umbilical cord and amniotic sac

Last October, I had the idea of creating a miniature baby/pelvis model from a Halloween skeleton. I made a trip to my local superstore and purchased a skeleton, and then my labor began. I had a tiny baby doll, I believe it is a Barbie baby from sometime in the past 20 years (it was my little sister’s, swiped acquired by me on a visit to my mom’s house). I started digging around my house to see what else would work. My supply list ended up as follows:

  • Skeleton (I used a 10 inch one in this example)
  • Doll that fits through skeleton’s pelvis
  • Embroidery floss, blue and red
  • 1 Orthodontic rubber band
  • Needle and thread
  • Reddish fabric for placenta
  • Plastic baggy (amniotic sac)
  • Washi tape
  • Tiny baby sock (uterus)

How to assemble the pelvis

I started by separating the pelvis from the torso with scissors. I boiled some water on the stove and submerged the pelvis in while holding on to the legs. Every so often I would pull it out and work to widen the pelvis. I used scissors, although other tools would work as well. After repeating this a few times, re-submerging and working again, the pelvis shape was to my liking. Then I used a utility knife to further excise the remaining segments of the spine.

Stacie BABE3How to assemble the umbilical cord and placenta

For the umbilical cord, I used three strands of embroidery floss, which I braided together. To make the placenta, I took two small squares of fabric (leftover from a quilting project), and cut a circle shape. I turned the fabric prints to face each other, and then I began to sew. I left a small opening so I could turn the fabric right-side out (I found a straw handy to help poke out all the places I couldn’t reach with my fingers), and then I closed the hole with a couple of small stitches. At this point, I took the “cord” and threaded it through the needle (did I mention I used a very large needle?). Carefully inserting the needle through the side of the placenta between stitches, so it would disappear into the placenta, I poked the needle out through the middle of one layer of the placenta, anchoring it into place and allowing the cord to attach from that spot. I wasn’t sure how I would link the baby to the cord, which is where the orthodontic band came into place. It is clear and fit snugly around the baby’s belly. Since there was a tiny knot in the end of the cord, I simply tucked it under the band.

Stacie BABE2How to assemble the amniotic sac

For the amniotic sac, I turned to a clear plastic baggy. I cut it into a u-shape and used Washi tape to seal the edges. It is a bit disconcerting to see a baby in a plastic bag, and there are so many other things you could use – one item that comes to mind is an organza bag you might get candies or favors in at a wedding or shower. The final touch was, using one of my baby’s socks for the uterus, and, voila!

How I use it

I love the idea of table-top props, those designed to be used as you sit across the kitchen table from a couple during a private class. The tiny pelvis and baby fits easily into my bag with the curriculum, handouts, and other supplies I may need, saving me from dragging my big set along.  If you are talented enough, consider making many sets of them, and providing each family a set to use in your group classes.

What the families say

Families enjoy getting to manipulate the baby through the pelvis as you take them through the class content. Often parents are delighted to see such a small little baby and pelvis, and they want to touch and try, passing the baby through the bones. The benefit of seeing and navigating the baby through the pelvis with these teaching aides supports two of the Lamaze International Healthy Birth Practices, #2: “Walk, move around and change positions throughout labor”  and #5 “Avoid giving birth on your back and follow your body’s urges to push.” For some parents, this is the first time this idea has been not only explained, but more importantly, demonstrated.  The little kit is always well received.


I am sure this design could be improved upon, and I would love to hear your ideas! It took me less than an hour and about $5 to complete this project — I was only limited by my imagination and what was lying around my house (as a personal challenge). This Halloween season, I also purchased three boxes in the shape of (haunted) houses that nest inside each other, and a candy mold of tiny brains. I recovered the houses with scrapbook paper and am creating an activity about making hospital birth more like home, and the candy molds will be tiny soap-reminders for families to use their “BRAIN”s when making birth choices. (Benefits, Risks, Alternatives, Intuition and Not Now.) With Halloween fast approaching, get out there and see what you can find in the seasonal sale bins to make your classes interesting and exciting, and keep your supply budget down.  Remember, making your own supplies doesn’t have to be scary!  It can be economical and a lot of fun.

For complete instructions with pictures, and more DIYs for CBEs, visit me at www.staciebingham.com.

About Stacie Bingham

© Stacie Bingham

© Stacie Bingham

Stacie Bingham, LCCE, CD(DONA), embraces the lighter side of the often weighty subject of birth. Her style feels more like a comedy-show experience than a traditional class. She has been a La Leche League Leader for 13 year, attended 150 births as a doula, and logged 1000 hours as a childbirth educator. An experienced writer and editor, she was a columnist for the Journal of Perinatal Education’s media reviews, has been published in LLLI’s New Beginnings and DONA International’s International Doula, and keeps up with her blog (where she frequently shares her teaching ideas).

She is the current Chair for Visalia Birth Network, and a founding member of Chico Doula Circle, and Advocates for Tongue Tie Education. Stacie has presented at conferences on the topic of tongue tie, as her 4th baby came with strings attached. Stacie and her four sons, husband, and two dogs reside in California’s Central Valley. For more information or teaching tips, visit her at staciebingham.com.

Childbirth Education, Guest Posts, Healthy Birth Practices, Lamaze International, Series: Brilliant Activities for Birth Educators , , , , , , , ,

Breast Pump Recycling Programs – Good for Families, Good for the Earth!

October 20th, 2015 by avatar

By Cara Terreri, CD(DONA), LCCE

Breast Pump Recycling (1)If you are a childbirth educator, doula, lactation consultant, midwife or doctor who works with expectant families, one of the topics you may be discussing with them as their birth day draws near is the acquisition of a breast pump. You may make suggestions on which pump will best suit their needs, let them know that breast pumps are considered durable medical equipment under the Affordable Care Act and are provided at no charge to them, and even provide instruction on how and when to use it, along with information on breast milk storage.  Do you realize that you can also provide information on what to do with that breast pump when it is no longer needed in the family?  There are several programs that offer breast pump recycling programs and families and the environment will benefit if they were utilized more.  Cara Terreri, Community Manager for Lamaze International’s Giving Birth With Confidence blog shares information that you can pass on to parents, helping them to keep breast pumps out of the landfills and support recycling efforts. – Sharon Muza, Community Manager, Science & Sensibility

Breast pumps are an expensive — and important — piece of equipment for many breastfeeding parents. But what happens when families aree done with their breast pump — like not going to have more children done? Do they sell it? Donate it? Recycle it? Trash it? Let’s take a look at the options.

Selling A Used Breast Pump

Families may have spent significant money on their high quality double electric pump — it would be nice to see some of that money back in their pocket! Be aware that many breast pumps are designed as “single use” pumps, which means that they are not created to be safely used by another person. The reason is, these pumps use what is known as an “open system,” which means that there is not a barrier to stop milk (even tiny particles) or moisture from traveling up into the pump’s motor. There is no way to fully clean or sterilize these kinds of pumps — even if the pump’s new owner purchases new tubing and plastic parts. The good news is that many, many breast pump brands sell pumps with closed systems. That said, even a closed system pump can be problematic when passing along to someone else. The motor can be weak, which affects the pump’s ability to operate as it should, causing less suction. A weak pump can impact a breastfeeding parent’s milk supply! If a parent does consider selling their pump, be sure to let the new user know that it’s used and for how long. Many lactation consultants will test a pump’s suction for free, which is something that can be done before selling.

Donating A Used Breast Pump

When considering donating  used breast pump, all of the information above applies. Families can donate a used pump directly to another family, or seek out an organization that will give it to a parent in need. Be forewarned, however, that many non-profit organizations will not be able to accept a used pump due to liability and health concerns, even if it is a closed system pump. A parent’s best bet is to connect with other families in their community, or perhaps a charity or community organization, to find a family in need.

Recycling A Used Breast Pump

Good news! There are now two pump manufacturers who offer recycling. Medela developed the Medela Recycles program, which allows families to ship their electric Medela pump for free back to the company, where they will then break down the pump and recycle all components appropriately. With each recycled pump Medela receives, they support the donation of new hospital-grade, multi-use breastpumps and supplies to Ronald McDonald House Charities® (RMHC®). This helps provide parents with high quality pumps hospital during their stay at a Ronald McDonald House, which helps ease the transition for families caring for a baby in the NICU. The recycled pumps are not re-used or re-sold in any way.

Hygeia, who promotes “No Pumps in Dumps™,” also offers a pump recycling program. Depending on the pump’s age and model, Hygeia may refurbish the pump and provide it to a mom in need (or work with an agency to do so), or if a pump can’t be refurbished, they will recycle it appropriately. Hygeia also recycles pump parts replaced when servicing customers’ pumps. Hygeia’s pumps are a closed system designed to be used by multiple families when each breastfeeding parent has their own “Personal Accessory Kit.”

If a family owns a pump made by one of the many other manufacturers, families should contact them directly to find out if they offer a way to recycle their pump. If not, recycle the pump’s plastic pieces appropriately and then take the electronic components to a facility or business that recycles electronics.   Often communities and municipalities hold recycling events where community members and drop off electronics to be recycled for free.  Families should monitor local news sources for upcoming recycling opportunities.

Throwing Away A Used Breast Pump

With the many safe and eco-friendly options available for getting rid of used breast pump, families don’t have to throw it away! And really, they shouldn’t — with the amount of garbage in our landfills, trashing a recyclable breast pump is not a good option.

Babies, Breastfeeding, Childbirth Education, Guest Posts, Newborns , , , , , , ,

Series: Building Your Birth Business: Blog for a Business Boost!

October 8th, 2015 by avatar

BloggingForBusinessMaintaining a blog as part of your website is an excellent way to keep your website content fresh, share useful information with clients (and potential clients!), and increase and maintain an excellent ranking in the search engines that crawl the web.  In simplistic terms, a good SEO ranking means your website comes up at or near the top when people are looking for the services you (and your competitors) provide.  Today, contributor Andrea Lythgoe, LCCE, shares how she easily keeps her website updated with new material by curating a weekly blog and also writing new content as well.  The benefits to her business are measurable and really help!  You can do it too!  Andrea shares some quick and easy ideas for adding a blog to your business website and giving your business a boost! – Sharon Muza, Community Manager, Science & Sensibility

Many birth professionals want their website to rank well in search engines so they can be found by potential clients and students. When it comes to staying at the top of the search results, it is important to keep your site current. Essentially, the search engines assume that “If you’re not updated, you are outdated” and a site that doesn’t change hurts you in the rankings. The easiest way to keep your website current and fresh is to keep an updated blog on your site. The “on your site” part is important. For best SEO, your blog should be integrated into your web site, not a separate blog hosted elsewhere.  Blogging on a different platform like Blogspot or WordPress.com is easy, but separating it from your main site does not give you the benefit of a blog that is an integral part of your site.

I find that having a blog also gives people a reason to come back and visit my site often or subscribe to receive my posts regularly, and this keeps me in their minds throughout their pregnancy. It helps me share my thoughts and personality in a way that connects with potential clients. My work can be shared in other venues and amplifies my voice and gets my information out in front of more potential students.

The hardest part of blogging by far is coming up with ideas. Over the years, I’ve gotten better at coming up with ideas and I can find inspiration in many places. Here are some examples of when the blogging muse has spoken to me:

Occasionally I write an article because I am annoyed or angry about something. In these cases, I write it and save it in draft form, waiting at least a week before I look at it again. Often I find that I need to tone those types of articles down before publishing, but those posts tend to be the ones that resonate well with my readers. I find it best to write articles when I am feeling inspired and motivated. But because I’m not always inspired to write full articles, the bulk of my blogging is a weekly feature I call the “Wednesday Wrap Up”.

I use this weekly feature to curate content – I’m reading lots of blogs, following birthy people on Pinterest, and have some useful Google Alerts that help me find and read articles anyway, so I started sharing some of the most interesting finds with my readers. I make sure that I am using links, not reposting full articles. Reposting articles is an ethical no-no, plus you can share more if you use a collection of links.

With each link, I add a little commentary. Just a sentence or two – adding some original words or thoughts  instead of just a list of links helps add the original updated content that the search engines are looking for and reward. Having that weekly deadline helps me to make sure that my website has new content added regularly. . I aim for the weekly update plus two other articles each month. Some months I meet that, some months all I do is the weekly update. The weekly feature keeps me at the top of the search engine lists even when I don’t feel inspired.

Whenever I post a Wednesday Wrap Up, I immediately start a draft of the new one. Any time I see a good article in my blog reader, my Pinterest feed, or shared to Facebook or Twitter, I add it to the draft. I try to add my commentary at the time I read the article, but sometimes I get lazy and just have a list of links to work from on Tuesday evening. I aim to have five to ten links to share each week. If I get ten links and it isn’t Wednesday yet, I go ahead and schedule that post to run on Wednesday and start a new draft for the next Wednesday. At times I’ve been two or three weeks ahead, and at times I’m scrambling on Tuesday evening (or even Wednesday morning!) to find links to fill it. When I first started out, I shared a video each week as well, but I found that it took too much time to find and choose the links, and if not a public video, I needed to  get permission to embed the video. Therefore,  I recently simplified and now just share links.


When blogging, ALWAYS include an image or graphic with each post. Pinterest is a huge way of reaching women of childbearing age on social media, and without a photo or graphic, your blogging won’t be “pinnable” and cannot be shared. Make sure you stay on the right side of copyright law and make your own or use others with permission.

Articles you write don’t have to be long, just long enough to make the point clearly. If you have a longer post, consider breaking it up into a series. Expert opinions vary, and the trend seems to be towards longer posts, but most sources say the ideal length for a blog post is between 500-1000 words. Use as few words as possible to make your point and don’t pad a post to make it longer than necessary.

Find your voice – you can be casual or professional, but stick with it and be consistent. I choose to be very casual on my web site. I want to come across as someone they can sit down and have a nice visit with. I do not want to come off sounding distantly professional. The choice is yours; either approach can work well, just be very aware, conscious and consistent in using your voice.

Pay attention to proper spelling and grammar. Because I use a more casual voice on my blog, I will sometimes use words like “kinda” but I try hard to not have any spelling errors and to use apostrophes incorrectly, etc.

Blogging can be a rewarding way to keep yourself relevant and to increase your rankings in the search engines. It is a valuable tool that you can use to build your business and reach your target market. Start today by sitting down and brainstorming a list of topics. If you are inspired by this article and start blogging (or recommit to that blog that you have been neglecting) please post a link to your new post in the comments below!

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 websiteUnderstandingResearch.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, Series: Building Your Birth Business , , , , , ,

Interview with Alice Callahan about Science of Mom: A Research-Based Guide to Your Baby’s First Year.

October 6th, 2015 by avatar

In an earlier post on Science and Sensibility, regular contributor Anne Estes, PhD reviewed Science of Mom: A Research-Based Guide to Your Baby’s First Year, a new evidence-based book focused on answering questions on health, sleeping, and feeding for an infant’s first year. The book grew out of author Dr. Alice Callahan’s blog, Science of Mom, that she began writing as a new mother. Dr. Callahan took some time out of her busy schedule to talk with Anne about her new book and how it might be helpful for childbirth educators and new parents.  Readers will also want to pop over to Anne’s blog – Mostly Microbes, to listen to a podcast of  a more detailed interview with Dr. Callahan, the author of The Science of Mom. We’d also like to congratulate Amy Lavelle for being randomly chosen from the commenters on the original post. Amy wins herself a free copy of the book.  We hope that she will enjoy reading it.  – Sharon Muza, Community Manager, Science & Sensibility.

Science of Mom Cover HiDefAnne Estes: What do you see as the role of this book for childbirth educators and other birth professionals?

Alice Callahan: First, my book gives a really in-depth look at several newborn medical procedures, including timing of cord clamping, the vitamin K shot, and eye prophylaxis, plus shorter sections on newborn screening, the hepatitis B vaccine, and the newborn bath. Childbirth educators will take away a clear understanding of the evidence behind these procedures, and they can pass that knowledge onto students and clients. Second, and just as useful, those in-depth sections serve as excellent case studies for how to look at scientific evidence. My hope is that this background will give readers the tools needed to evaluate scientific evidence on their own as they encounter new questions – and I’m sure birth professionals are constantly faced with new questions!

AE: Why should childbirth educators suggest your book as a resource for interested parents?

AC: New parents are often taken off guard by the number of questions they have about childbirth and caring for a new baby. In online forums and playground conversations, they’re suddenly thrown into discussions of what is best for babies, and they find themselves trying to sort through lots of conflicting opinions and misinformation, trying to make the best choices for their own babies. It’s tremendously valuable and empowering to be able to understand how science can inform these decisions and how to find evidence-based resources. My book not only gives parents evidence-based information on infant health, feeding, sleep, and vaccines, but it also illustrates for parents how to find it themselves.

AE: What message from your book is most important for childbirth educators to share with their students?

AC: Seek evidence to inform your decisions. Be very skeptical of everything you read on the Internet, and make sure you’re getting your information from an accurate source. There’s so much misinformation out there that can be very misleading and even dangerous for parents and their babies. Don’t assume that something more natural or involving less intervention is always better. That isn’t always the case. Instead, look for objective evidence of risks and benefits, and make an informed choice.

AE: How did you choose the topics for your book? Was it difficult to decide what to leave out?

AC: I tried to choose topics that I think are some of the most common causes of confusion and anxiety for parents, based on questions that I get on my blog or that I see in online parenting forums. To be honest, my original proposal for this book included several more topics, but as I fleshed out chapters, I realized that it was more interesting to look at several topics in a really in-depth way rather than skim the surface on lots of different topics. But honestly, if I’d been able to devote another year or two to it, it could easily have been twice as long, because there are just so many great questions that parents have about the first year of life. I would have liked to cover topics like emerging research on the microbiome and concerns about chemical exposures, for example, but I may have to save those for another book!

AE: What do you feel is the most controversial topic in your book? 

AC: The safety of bedsharing is probably the most controversial topic in the book. Sleep practices are just so personal, and many parents really value bedsharing with their babies for cultural, emotional, or practical reasons. This is an area where you’ll find very conflicting advice, and everyone cites scientific studies to back their stance. In the book, I do my best to look honestly at the evidence for and against bedsharing safety. I explain that multiple studies do show risk of bedsharing in certain circumstances, especially with babies in the first few months of life, but I acknowledge the limitations of those same studies. And I also point out that individual factors, such as ease of breastfeeding or alternatives to bedsharing (including the risks of falling asleep with your baby on a couch or trying to drive a car while severely sleep deprived, for example) might make careful bedsharing a reasonable choice. I think we need to share all of this information with parents and discuss how to set up a bed to make bedsharing as safe as possible if that is the choice.

AE: Could you describe how you determine which findings from the scientific literature are best for answering a parenting question?

AC: In the book, I give a rough guide to types of study designs and explain which ones are most likely to give us strong evidence that is relevant to parenting decisions. Systematic reviews and meta-analyses are usually most useful, because they combine the results of multiple studies so are more likely to give us a big picture consensus about a question. (This assumes that the authors selected high quality studies for the review, so you have to be a little careful here.) Looking at single studies, randomized controlled trials are the best quality, whereas observational studies are usually limited by confounding factors and can only show correlations, not causation. Studies conducted in animal models or cell culture are an important step in scientific research, but we really want to see follow-up in human studies before we change our lives over the results. As you look at studies, you also want to pay attention to how many people were included in the study and whether or not the population is similar to your own. Evaluating scientific evidence takes some practice, and I go into lots more detail in the book.

AE: I was shocked to read that immediate cord clamping and cutting and stomach sleeping were practices changed in the mid-1900s without any evidence. Could you talk about how one of those practices began, the implications, and what it took (or will take in the case of umbilical cord clamping) for the original practices to be put back into place?

AC: It’s surprisingly difficult to pin down exactly when the shift to immediate cord clamping occurred, but it probably happened in the early to mid-1900s. Before this, it was likely standard practice to wait a few minutes or until the cord stopped pulsing before clamping it. The shift to immediate cord clamping seemed to coincide with the movement of birth from the purview of midwives in homes to obstetricians in hospitals. Immediate cord clamping was also part of the practice of active management of the third stage of labor, which was introduced in the 1960s. However, there was no evidence then that immediate cord clamping was beneficial to either mom or baby, and studies show that delayed cord clamping does not increase the mom’s risk of postpartum hemorrhage (which was a belief for a while).

Immediate cord clamping is an example of an intervention put into place because it was convenient, not because it was evidence-based. We now have good evidence that delayed cord clamping is beneficial to infants, especially those born preterm. For term infants, the biggest benefit is a boost in iron stores that can prevent iron deficiency later in infancy. There is some evidence that the risk of jaundice is increased, but as I discuss in the book, this is controversial. We’re seeing some obstetricians making delayed cord clamping their standard of care, but practice is really mixed in the U.S. At this time, ACOG recommends a delay of 30-60 seconds for preterm infants, but they refrain from making any recommendation for term infants, citing insufficient evidence. I actually appreciate that they’re careful to ensure there is adequate evidence before changing practice, but I do think we have enough evidence now that we should really be going back to delayed cord clamping whenever possible. I think that with a little more time and a few more studies, delayed cord clamping will again become standard practice, especially with doctors in the U.K. testing a resuscitation trolley that allows the cord to remain attached even if the infant requires resuscitation.

AE: What did you do to feel prepared for your labor and birth, and first weeks of parenting? Did you choose to take a childbirth class?  Do you feel it helped you feel prepared and confident?

AC: Before the birth of my first child, I took a childbirth class through a local hospital. It was very helpful in terms of knowing generally what to expect with labor and learning some ways to cope with discomfort. To prepare for the birth of my second baby four years later, my husband and I both read The Birth Partner by Penny Simkin. I liked that it was evidence based and a straight-forward source of information, and my husband put Simkin’s suggestions into action to truly be a great birth partner.

One of the most important aspects of birth preparation for me was developing a trusting and respectful relationship with my healthcare providers. My babies were delivered by two different OBs, and both were wonderful at communicating options to me as things progressed. Based on our discussions throughout pregnancy, I knew that I could trust them to be evidence based in their practice, and that helped me relax in labor and focus on my job of giving birth.

How did I prepare for the first few weeks of caring for a newborn? I did what women have been doing throughout the history of our species – I invited my mom to come and help! She was a wonderful help after the birth of both of my babies, and I felt lucky to have her.


AE: What future topics are you looking forward to writing about next?

AC: Readers of my blog keep me well-supplied with questions about parenting, and I have a huge list of topics that I’d like to tackle. One of my favorite areas of focus is nutrition, as that is the field of my PhD training, so I’d like to develop more information about infant nutrition on my blog.

While I was researching and writing my book, I had three miscarriages. That brought up lots of questions for me about miscarriage and infertility, but I didn’t have time to write much about these topics because I was working so hard on The Science of Mom. I’d like to write more about them now. I think there is a real need for compassionate and evidence-based writing about these tough topics.

About Anne M. Estes, PhD

AnneMEstes_headshot 2015Anne M. Estes, PhD is a postdoctoral fellow at the Institute for Genome Sciences in Baltimore, MD. She is interested in how microbes and their host organisms work together throughout host development. Anne blogs about the importance of microbes, especially during pregnancy, birth, first foods, and early childhood at Mostly Microbes.

Babies, Book Reviews, Childbirth Education, Evidence Based Medicine, Guest Posts, Newborns , , , , , ,

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