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Book Review: The Science of Mom: A Research-Based Guide to Your Baby’s First Year

September 3rd, 2015 by avatar

By Anne M. Estes, PhD

Today on Science & Sensibility, Anne M. Estes, PhD reviews a new book – The Science of Mom: A Research-Based Guide to Your Baby’s First Year.  Lamaze International and Science & Sensibility are all about providing families and professionals with evidence based information that can help inform decision making.  Seems like this book might fit in nicely with the philosophy that Lamaze has held for decades.  Regular contributor Anne M. Estes, PhD shares her review on this new book and lets us know if it might be something to add to our resource list for new parents.  See the end of the review to learn how you can enter to be chosen for a free copy of this book courtesy of the author, Alice Callahan. – Sharon Muza, Community Manager, Science & Sensibility. 

Science of Mom Cover HiDefMitchell Kapor once said, “Getting information off the Internet is like drinking from a fire hydrant.” New parents and child care professionals are certainly easily drenched by all the information that can be acquired on the internet from a variety of sources. As newly minted scientist-mom seven years ago, I was frustrated at the number of opinion and experienced-based baby books that lacked scientific support. The Science of Mom: A Research-Based Guide to Your Baby’s First Year, now fills that gap. Alice Callahan, a PhD in nutritional biology and mom of two, systematically examines common questions and concerns about infant care from a scientific perspective. In each chapter, she discusses the historical practice of the question, recommendations of different organizations, the current research, and the risks and benefits of a practice. Dr. Callahan does an excellent job presenting the strengths and limitations of particular studies and the logic behind different recommendations. Although The Science of Mom is science-focused, it is well-written and easy to read. The style of the book is personal and conversational. Personal experiences are intermingled with the science to illustrate her points well. A list of both the references used for each chapter and recommended books and websites are also given to help parents identify credible resources instead of getting lost in the fog of Internet “experts”.

Potential readers

For childbirth professionals and parents or parents-to-be interested in evidence-based practices for birth and an infant’s first year, The Science of Mom is a new and invaluable resource. Questions covered include: When is the right time to cut the umbilical cord? Which newborn treatments are necessary? How do newborns experience and explore their world? What are the differences between breastmilk and formula feeding? Where and how can babies sleep safely? What is the evidence for vaccinations? When and what kinds of solid food are best for babies?

Importance of evidence based decisions

Perhaps it’s also my bias as a scientist, but I greatly enjoyed reading such an insightful description of the process of science, the importance of scientific consensus, differences in quality across studies, and how scientific data can assist families in making informed decisions. Though readers of an evidence based blog like Science and Sensibility may already understand these points, the introduction could be helpful when introducing the rationale behind evidence based practices during child birth classes. It also serves as a guide for anyone who wants to research their own questions in the scientific literature.

I was particularly surprised to read about two instances where changes to medical practices in the early to mid 1900s had occurred without any evidence based support. One example was timing of cutting the umbilical cord. The author speculates that perhaps due to efficiency or convenience, the umbilical cord began to be cut before all the blood was pumped into the newborn. This practice is now being reconsidered due to the increased iron stores in the first 6 months of life of infants when cord clamping is delayed. Such an example certainly reinforces the importance of having evidence of benefit before new procedures are introduced or changes are made in traditional birth procedures.

Filling a gap in the bookshelf

In science and medicine there are no borders and no “right” answers. The Science of Mom is the same. Throughout the book, the author explores how a variety of countries and cultures deal with issues from giving Vitamin K to newborns (oral vs injected) to sleep practices (bed/room sharing vs separate sleeping arrangements). Different personal health conditions and prevalence of disease differ across the globe, making the need for some newborn treatments, such as eye prophylaxis, less clear. Dr. Callahan provides the data and information for people to make informed choices for their own family’s practices and situations. I found the honest, open, and nonjudgmental tone throughout the book refreshing.

Callahan author photo

Author Alice Callahan and her newborn © Alice Callahan

What a scientist-mom adds to the conversation

Each profession trains people to strengthen different skill sets. Training in the life sciences, especially at the PhD level, encourages a person to gather resources, sort through different quality data, synthesize data, and reach a conclusion based on that data for a given situation. Add to that training first-hand experience with raising two kids – knowledge of what it’s like to be in the parenting trenches, experience the “mommy wars”, and feel the exhaustion and yet love and concern of being a parent – and you’ve got a winning combination. The author is not a medical professional and most likely has only attended the births of her own two kids. However, in Science of Mom, Alice Callahan, PhD combines the critical eye of a scientist with the heart of a mother to create a helpful resource for all people interested in evidence based infant care and parenting.

What is missing?

What The Science of Mom does not do in general is to give you prescriptives for answering many of the parenting questions she poses. Data are still being collected and debated for many birth and parenting questions. There simply may not be one “right” way. In these cases, the scientific data are presented, the pros and cons of the different perspectives are addressed, then Dr. Callahan recommends following your baby’s lead and doing what feels best for your own family. After all, parenting is an art as well as a science.

In situations where scientists have reached a consensus, such as with the benefits of vaccines or back sleeping for infants, the author provides insight into how and why that consensus was reached by the scientific community. In such cases, Dr. Callahan provides additional information such as the role of each ingredient in the vitamin K shot in order to provide additional comfort to worried parents.

The Science of Mom is an excellent new addition to the bookshelves of any birth professional or parent who is interested in evidence-based parenting practices. Although the copy of The Science of Mom that I reviewed was complementary, I have given copies to several scientist-mom friends with newborns who also enjoy the nonjudgmental and objective tone of the book. For those wanting to read more of Dr. Callahan’s excellent commentary on the science of parenting, you can find her writing at the blog, The Science of Mom.

Enter to win your own copy of The Science of Mom

Have you had a chance to read this book?  What did you think of it?  Does this sound like a book that you would like to read?  Would you consider adding it to your resource list?  Share your thoughts about the book, how necessary or needed a book such as this might be, or other favorite resources for families to get evidence based information in understandable and easy to digest formats in the comments section below and include your email address.  All comments will be entered in a drawing for your own copy of the book.  The winner will be announced next month when Anne Estes interviews Dr. Callahan about her book. – SM

About Anne Estes

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, Breastfeeding, Childbirth Education, Evidence Based Medicine, Guest Posts, New Research, Newborns, Parenting an Infant , , , , , , , ,

Working to Improve Perinatal Depression Rates – An Interview with Researcher Nancy Byatt, DO

September 1st, 2015 by avatar

By Walker Karraa, PhD.

sad mother and baby dropboxPerinatal and/or postpartum depression affects more than 15% off all women during pregnancy or after birth.  Many women are not diagnosed and therefore are not referred on to specialists who can help them with appropriate treatment. Last month, the Centers for Disease Control (CDC) announced an inaugural grant of 2.5 million dollars to University of Massachusetts Medical School researchers for the purpose of exploring the feasibility and effectiveness of obstetricians diagnosing and treating women suffering from perinatal or postpartum depression within their current obstetrical practice.  The ability of obstetricians to identify and treat affected women may help to close the gap that exists in women receiving treatment, and ensure adequate care is available and provide the ability to monitor how the women respond to treatment.  Creating a network of resources and providing OB access to psychiatric specialists for consultations can result in more women receiving more effective treatment faster from the provider they are already seeing.  Dr. Walker Karraa, perinatal mental health expert interviewed on of the co-investigators, Dr. Nancy Byatt about this research grant and what it might mean for women suffering from perinatal depression. – Sharon Muza, Community Manager, Science & Sensibility.

Walker Karraa, PhD: How is this grant first of its kind?

Nancy Byatt, DO: This is the first time the Centers for Disease Control put forth a request for applications for the Evaluation of a Stepped Care Approach for Perinatal Depression Treatment in Obstetrics and Gynecology Clinics.

WK: How long have you and your colleagues been working on this grant?

NB: Our team began working on understanding how depression could be addressed in obstetric settings in 2010. Driven by our commitment to helping women get treatment by leveraging the obstetrical care setting, we were awarded two institutionally funded grants to conduct three formative research studies with obstetric providers and staff, postpartum patients and pregnant women.

Jeroan Allison, MD, Nancy Byatt, DO, and Tiffany Moore Simas, MD.

Investigators Jeroan Allison, MD, Nancy Byatt, DO, and Tiffany Moore Simas, MD.

Our preliminary studies evaluated the perspectives of obstetric providers and postpartum women, about ways to improve depression treatment in the obstetric setting. We found that barriers occurring at the patient, provider, and systems-level prevent perinatal women and obstetric providers from addressing depression. Our preliminary data led us to hypothesize that transforming obstetrical practice to include depression treatment would enhance women’s access to and engagement in treatment and thereby improve depression outcomes.

WK: Tell us about the pilot study and how it revealed the gaps in treatment. What are the gaps identified? Why do you feel these gaps exist?

In our formative studies, and literature reviews, we identified a number of patient, provider, and systems-level barriers and facilitators to the treatment of perinatal depression and reviewed clinical, programmatic, and systems-level interventions. Provider and systems-level barriers include: (1) lack of obstetric provider training in technical aspects of depression care and communication skills; (2) absence of standardized processes and procedures for stepped depression care; (3) lack of mental health providers willing to treat pregnant women; (4) lack of referral networks; and, (5) inadequate capacity for follow-up and care coordination. These are exacerbated by patient-level barriers. Perinatal women report they fear stigma, losing parental rights, and being judged as an unfit mother. Many women perceive obstetric providers and staff as unsupportive, unavailable, and inadequately trained in depression.  We have built the RAPPID program to address these critical barriers at the provider, patient, and system level.

WK: If readers wanted to learn more about your work and/or the gaps in treatment, what literature would you recommend?

NB: We have several peer-reviewed articles that summarize our work. (see the reference section below.)

WK: What was your original vision for MCPAP?

NB: We aimed to translate the successful Massachusetts Child Psychiatry Access Project (MCPAP) to address perinatal depression. MCPAP has transformed the delivery of child mental health services in Massachusetts by making immediate psychiatric consultation available to pediatricians, to address depression in obstetric settings.   Our vision was that expanding MCPAP to create MCPAP for Moms, a new program that could provide obstetric, psychiatric, primary care and pediatric providers with access to care coordination and psychiatric telephone consultation to help them address perinatal depression. We aimed to create a population-based program that would help the entire state of Massachusetts address depression by building capacity of the frontline providers who are serving pregnant and postpartum women in their medical setting.

WK: Can you explain how the RAPPID program will be compared to the MCPAP program?

NB: To build on and address the limitations of MCPAP for Moms, we developed and pilot tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program to create a more comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to the immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers via MCPAP for Moms; (2) clinic-specific implementation of stepped care, including training support and toolkits; and, (3) proactive treatment engagement, patient monitoring, and stepped treatment response to depression screening/assessment. RAPPID was developed using formative data and feedback from key stakeholders.

We will compare two active interventions, enhanced usual care (access to MCPAP for Moms) vs. RAPPID in a cluster randomized controlled trial (RCT) in which we will randomize 12 Ob/Gyn clinics with diverse patient populations to either RAPPID or enhanced usual care.

WK: How is stepped care different than collaborative care?

NB: Stepped care models involve initial determination of treatment based on illness severity and intensification of care (such as stepwise increases in dose of antidepressant medication) for those with persistent illness.

WK: What has inspired your work in this field?

NB: I have been moved by women’s stories and how hard it was for them to access the care that they needed and deserved. In the beginning of my career I was seeing this time and time again.

I am inspired by the women I serve. I have worked with countless pregnant and postpartum women. Perinatal women initially or in a prior pregnancy were not able to access the care they needed and deserved. This led me to want to make an impact beyond patient care and I envisioned a program would help pregnant and postpartum women access treatment for their depression.

WK: What are the most critical issues in perinatal mental health today?

NB: Despite having evidence based treatments available, depression is not detected among many pregnant and postpartum women and even if it is detected, many women will not be able to access treatment. Depression during pregnancy is twice as common as diabetes and it needs to be a routine part of obstetric care just as diabetes is a routine part of obstetric care.

References

  1. Byatt N, Levin L, Ziedonis D, Moore Simas T, Allison J. To What Extent Does Screening and Referral Improve Depression Outcomes and Mental Health Care Utilization Among Perinatal Women? Obstetrics and Gynecology. In Press.
  1. Byatt N, Rui X, Dinh K, Waring EM. Trends in Mental Health Care Use in Relation to Depressive Symptoms Among Pregnant Women. Archives of Women’s Mental Health. 2015 Apr 7. Epub ahead of print.
  1. Weinreb L, Byatt N, Moore Simas TA, Tenner K and Savageau JA. What happens to mental health treatment during pregnancy? Women’s experience with prescribing providers. Psychiatr Q. 2014;85:349-355.
  1. Byatt N, Biebel K, Friedman L, Debordes-Jackson G, Pbert L, Ziedonis D. Patient’s Views on Depression Care in Obstetric Settings: How Do They Compare to the Views of Perinatal Health Care Professionals? General Hospital Psychiatry. 2013;35(6):598.
  1. Byatt N, Biebel K, Debordes-Jackson G, Lundquist R, Moore Simas T, Weinreb L, Ziedonis D. Community Mental Health Provider Reluctance to Provide Pharmacotherapy May Be a Barrier to Addressing Perinatal Depression: A Preliminary Study. Psychiatric Quarterly. 2013;84(2):169-174.
  1. Byatt N, Moore Simas T, Lundquist R, Johnson J, Ziedonis D. Strategies for Improving Perinatal Depression Treatment in North American Outpatient Obstetric Settings. Journal of Psychosomatic Obstetrics & Gynecology. 2012;33(4):143-61.
  2. Byatt N, Biebel K, Lundquist R, Moore Simas T, Debordes-Jackson G, Ziedonis D. Patient, Provider and System-level Barriers and Facilitators to Addressing Perinatal Depression. Journal of Reproductive and Infant Psychology. 2012;30(5):436-439.
  3. Byatt N, Moore Simas T, Lundquist R, Johnson J, Ziedonis D. Strategies for Improving Perinatal Depression Treatment in North American Outpatient Obstetric Settings. Journal of Psychosomatic Obstetrics & Gynecology. 2012;33(4):143-61.

About Nancy Byatt, D.O., M.S., M.B.A., F.A.P.M.

© Nancy Byatt

© Nancy Byatt

Nancy Byatt, D.O., M.S., M.B.A., F.A.P.M is a psychiatrist focused on improving health care systems to promote maternal mental health. Dr. Byatt is an Assistant Professor at UMass Medical School in the Departments of Psychiatry and Obstetrics and Gynecology. Byatt is a psychosomatic medicine psychiatrist with subspecialty expertise in perinatal mental health. She provides expert psychiatric consultation to obstetric, psychiatric, primary care and pediatric providers serving pregnant and postpartum women. She is the Founding and Statewide Medical Director of the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms). MCPAP for Moms addresses perinatal depression across Massachusetts by providing mental health consultation and care coordination for medical providers serving pregnant and postpartum women.

Byatt’s research focuses on developing innovative ways to improve the implementation and adoption of evidence-based depression treatment for pregnant and postpartum women. She has a Career Development Award that funds her research to help women access and engage in perinatal depression treatment in obstetric settings. She has also received federal funding from the Center for Disease Control to test an intensive, low-cost program that aims to ensure that pregnant and postpartum women with depression receive optimal treatment. Her academic achievements have led to numerous peer-reviewed publications and national awards.

 

Babies, Depression, Guest Posts, Infant Attachment, Maternity Care, New Research, Newborns, Perinatal Mood Disorders, Postpartum Depression, Research , , , , , , ,

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

August 18th, 2015 by avatar

By Deena Blumenfeld, ERYT, RPYT, LCCE 

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

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

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

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

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

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

Nuvo Group claims

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

References:

 Nuvo Group’s website

Reuters, “Wearable device provides continuous fetal monitoring”

Dekker, Rebecca, Evidence Based Fetal Monitoring, 2012

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

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

FDA, Ultrasound Imaging

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

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

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

 

 

 

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

Series: Building Your Birth Business – Using Facebook Ads to Advertise Your Birth Business

August 11th, 2015 by avatar

By Janelle Durham, MSW, LCCE

Building Your Birth Business- Using FacebookToday we have another post in the Building Your Birth Business series.  You may be interested in growing your own independent childbirth education or birth related business.  Maybe you already have such a business already established but are looking to take it to the next level. Even if you work for a hospital or organization, this information is useful as well, if they are looking to expand their reach.  Today’s post by author and educator Janelle Durham, MSW, LCCE, helps you to understand Facebook Ads and how to customize them.  Targeted to your specific audience, Facebook Ads can increase traffic to your website or Facebook page where families can learn more about your services. You can find all the posts in this series here– Sharon Muza,  Science & Sensibility Community Manager

Facebook ads let you write an ad that appears on someone’s Facebook feed. So, as they’re scrolling through for news of their friend’s adventures, they see your ad. This is a good way to raise awareness of your services. For $10, you can put your ad in front of about 800 people, and about 15 of them will click through to learn more. But, the best part is that you can target these ads to very specific demographics, like expectant parents who live in Monroe, Washington. You don’t waste money showing it to anyone who doesn’t fit that description. (Unlike that newspaper ad, which is mostly read by retirees.)

Note, this type of ad raises awareness of your business. I can’t guarantee it will get you clients and students! When someone was reading Facebook, they weren’t necessarily looking for a doula or a childbirth class, so they may not immediately click through and call you up. But, you have increased the chance they’ll do that in the future. It’s worth $10.

Here’s How to Create a Facebook Ad

First, if you don’t already have a Facebook page, create one here. (Here are some tips on pages for businesses.)

Then, log on to your page

Click on Create ad (it probably displays on your left sidebar under the heading “pages” or it might appear on the top right corner of your page)

It will ask you what kinds of results you want to get: choose ‘clicks to website’. Paste in the website address. (Make sure you choose the specific page you’ll want them to land on on YOUR website.)

Defining Your Audience

durham fb audience-definition

There’s lots of variables you can adjust here. Each changes the potential total audience for the ad – the total number of Facebook users who fit the description you’ve chosen.

Keep an eye on the little “audience definition” meter on the right hand side, and also, at the bottom of that column, it will tell you “potential reach” of your ad. Make choices, and see what gets you to the number you want… it usually takes a little experimentation to get it just right. I have found that if I spend $10 on an ad, it’s typically going to be displayed to about 800 – 1200 people, so I’m looking to narrow my demographics down to a total potential audience in the range of 2000 – 4000 people who are the closest possible match I can get to who I’m looking for. I won’t reach them all, but I’ll reach a good percentage of them. This gives me the best bang for my buck. If you had a bigger budget, you would want higher numbers for potential audience.

  • Location. Where it says “Include”, type your city in. It will then offer to do a radius around that city (you’ll see that it says “Carnation+25 miles”). You can adjust that. Next to “+25 miles”, there’s an arrow for a drop-down menu. You can adjust the radius there. You can also exclude things. Like for Carnation, I want everyone in the Snoqualmie Valley to see it (the rural areas north, east, and south of Carnation). But, I know no one from Seattle, Bellevue, Kirkland or Redmond (urban areas) is going to drive to Carnation for a class! Note, when excluding cities, choose “no radius”.

durham fb location

  • Age. You can limit by age group. I’m trying to reach expectant parents, and parents of very young children. While we welcome teen and young adult parents, we have found they don’t usually sign up, so, since my advertising dollar is limited, I target to age 24 and up. On the older side, I set it at 46 or so. (There is an irony in this, since I’m a 48 year old mom of a preschooler…) Note: Ad targeting is NOT about who is welcome or not welcome in our classes!! It’s about focusing our ads on the type of people most likely to be looking for a program like ours.
  • Gender: It’s a stereotype, but likely true, that moms make more decisions about classes than dads do. I do both genders if that gets my audience to the right size, but if I really want to target my ads for best value, I limit to women.
  • Language: I generally leave blank. It will go to anyone in my area, no matter their primary language.
  • More demographics: there’s a LOT of choices here. Some examples: Home >> Household Composition >> Children in Home or Parents >> All Parents >> (0 – 12 months): New Parents or Parents >> Moms >> Stay-at-home moms
    • Note: when you write your ad, think about who you’re going to target. For example, if you’re targeting to “stay at home moms” vs. “parents 0 – 3 years” your ad might be written differently. SAHM might not click on an ad for a preschool if they think of preschools as a 5 day a week thing… so your ad might say something about it being ‘2 mornings a week – great opportunity for a little social interaction for you and your child’.
    • For childbirth classes, I might choose married or partnered. Again, I’m not trying to be biased here… single parents are VERY welcome in the classes, but again, if I have limited ad dollars, I know that partnered moms are more likely to choose to enroll in a class…
  • Interests: You could choose people who are interested in Family and Relationships, and that gets you people who have “liked” pages about Family and Relationships
  • Behaviors. Again, there are lots of things to choose from here. I have tried targeting a preschool ad to Purchase Types >> Baby products and had similar results (click-through rates) to when I targeted at parents of kids 0 – 12 months. Note: use EITHER the “more demographics” section OR “Interests and Behaviors.” If you use both, the ad will only go to people who fit all the descriptions in both sections, and that usually limits your audience too much.

How Much Do You Want to Spend

Now you need to choose your budget. I do the lifetime budget. That refers to the lifetime/lifespan of the ad. I’ve been generally running $10-20 lifetime budget. Then set your start and end dates. I run ads for about 5 days.

durham fb ad budget

Bidding and Pricing

I “optimize for clicks to website” and “get the most website clicks at the best price” and “run ads all the time” and delivery type standard.

Create Your Ad

It asks “How do you want your ad to look.” Although the “multiple images in one ad” is interesting, let’s make it simple now, and choose “a single image”

Then it asks “What creative would you like to use”. Choose “select images”. It will automatically upload some pictures from your website, but if those aren’t the ones you want to use, you can delete them, and upload anything you want. You can choose multiple pictures, and it will randomly choose one whenever it runs an ad, so if you don’t have a single favorite picture, that’s a fine option. You can “crop” the images to make sure they’re displaying the part of the photo you want to display.

durham fb ad ad-design

In the Text and Links section:

  • On Connect Facebook page, make sure it lists the correct page
  • On headline and text, it may have auto-filled the title and description from your webpage. You’ll almost always want to change this for an ad to make them as appealing as possible.
  • Headline: usually this would be the name of your program (25 characters or less)
  • Text: Wants to be a clear, engaging overview of your program, with perhaps an invitation (join us, check us out, be a part, etc.). You’ve only got 90 characters, so make them count.
  • Note: On the mobile ads, all that appears is: name of your Facebook page / text / headline / web address. So, make sure that the text works well in this context as well as on desktop news feed. (Many more people will see your mobile ad than your desktop ad!! 48% of Facebook users access it ONLY on mobile devices; many more use a mixture of mobile and desktop) So, I make sure it includes location, age group – those sorts of key information that tell viewers whether the ad applies to them.
  • Call to Action: Choose one. I like “learn more” or “sign up”
  • Click “show advanced options”, and it will give you a box for news feed link description. You definitely want to use this, as it gives you an opportunity to provide lots more info for those viewing it on a desktop. It’s 200 characters. I use it for a longer summary of the program.
  • Once you’ve done this, make sure you look at the previews for desktop feed, mobile devices, right column display and mobile apps to make sure you’re happy with all versions of the ad.
  • Then place order.

What results will you get?

It’s really hard for me to predict that. It depends on what market you’re trying to reach, what your product is and so on. I also think that what results I’m getting in August of 2015 may be different in August 2016. I just don’t know how yet. Facebook ads are somewhat new, they’re REALLY easy, really cheap, and get good results. So, a lot of people are using them right now. If that use increases so much that Facebook users get sick of ads, we might see a backlash, and worse results, or Facebook may continue to evolve tools that get even better results. All I can tell you is what I’ve seen with my market, my product, in summer 2014 and 2015.

I’ve been running ads for our program: classes for parents and babies, parents and toddlers, and cooperative preschools. For each audience, I’ve targeted as described in the directions above, with some minor adjustments. For each type of class I spent $10, and had a potential audience from about 2000 – 7000 people. For each of the ads, they’ve been displayed to approximately 800 – 1100 people. The clicks to the website ranged from 8 – 35 per program. Click through rates ranged from 1%. Cost per click ranged from 27 cents to $1.25. So, as an approximation, I figure can get about 15 clicks for $10.

I advertised my blog, More Good Days to a national audience. Married women, age 24 – 44, parents of kids 0 – 3 years old. That’s a potential audience of over a million. I knew I was only going to reach a very small fraction of those. But that was OK… I wanted to reach people all over, under the hope that maybe if someone in Minnesota liked it, she’d tell her friends, and so would someone in New Mexico and so on. I spent $30. Ad displayed to 5200, 79 clicked through. That’s a click-through rate of 1.5%, at a cost-per-click of 38 cents.

I did an ad for our program where instead of setting the goal of what kind of results I wanted to “clicks to website” I chose “Promote your page.” (For some programs, this is a better option than clicks… a click just gets them to look at your website once and take action or not on that day. But if they like your Facebook page, then every time you post something, it appears on their Facebook feed, so you get repeated exposures.) I targeted that ad to expectant parents and parents of kids 0 – 3 in 4 nearby cities. Potential audience of 17,600. I spent $14. Ad displayed to 2443 people (14% of audience). 11 liked the page (my goal), 2 liked the post. That’s a click-through rate of 0.7% and a cost-per-like of $1.20.

I primarily choose ads that are optimized for clicks to website. I find that some of the people who see that ad choose to go to our Facebook page to check us out, and some choose to like the page based on that. In one week of running ads, where our ads were displayed to 11,000 people, we gained 22 likes on our Facebook page as a side effect of those ads.

Setting up your first ad will take you 30 – 45 minutes. It gets faster after that! I can do one in 5 – 10. Try experimenting with one today!

To learn more about online advertising, check out my website at www.janelledurham.com.

Have you had previous experience using Facebook Ads and would like to add some additional information?  Do you think you will give these simple and affordable ad options a try?  Share your experience now or after your first round of ads and let us know how it goes in the comments section below. – SM

About Janelle Durham

Janelle headshotJanelle Durham, MSW, LCCE, has taught childbirth preparation, breastfeeding, and newborn care for 16 years. She trains childbirth educators for the Great Starts program at Parent Trust for Washington Children, and teaches young families through Bellevue College’s Parent Education program. She is a co-author of Pregnancy, Childbirth, and the Newborn and writes blogs/websites on: pregnancy & birth; breastfeeding and newborn care; and parenting toddlers & preschoolers. Contact Janelle at jdurham@parenttrust.org.

Childbirth Education, Guest Posts, Series: Building Your Birth Business , , , , , , ,

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 , , , , ,

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