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Report Finds Widespread Global Mistreatment of Women during Childbirth

July 2nd, 2015 by avatar
© Pawan Kumar

© Pawan Kumar

The journal PLOS Medicine published a research review yesterday, “The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Method Systematic Review” (Bohren, et al, 2015).  Reading this report was both disturbing and extremely sad to me. Respectful care is a part of the United Nations Millennium Development Goal Target 5A: Improve Maternal Health. – which set a goal of reducing the maternal mortality ratio (the number of deaths among women caused by pregnancy- or childbirth-related complications (maternal deaths) per 100,000 live births) by 75% from 1990 to 2015.  The target rate had been 95 pregnancy or childbirth related deaths per 100,000 women but the current rate is sitting at 210/100,000, which is just a 45% drop.  99% of all maternal deaths occur in low-income and middle-income countries, where resources are limited and access to safe, acceptable, good quality sexual and reproductive health care, including maternity care, is not available to many women during their childbearing year. The most common cause of these maternal deaths are postpartum hemorrhage, postpartum infection, obstructed labors and blood pressure issues – all conditions considered very preventable or treatable with access to quality care and trained birth attendants.

Analysis of reports examined in this paper indicate that “many women globally experience poor treatment during childbirth, including abusive, neglectful, or disrespectful care.” This treatment can further complicate the situation downstream, by creating a disincentive for women to seek care from these facilities and providers in future pregnancies.

The reports and studies that were reviewed to create this report obtained their information from direct observation, interviews with women under care,  and were self-reported by the mothers.  Follow-up surveys were also conducted.

From the qualitative research, investigators were able to classify the mistreatment  into seven categories:

  1. physical abuse
  2. sexual abuse
  3. verbal abuse
  4. stigma and discrimination
  5. failure to meet professional standards of care
  6. poor rapport between women and providers
  7. health system conditions and constraints

The quantitative research revealed two themes: sexual abuse and the performance of unconsented surgical operations.

World Bank Photo Collection http://flickr.com/photos/worldbank/7556637184 shared under a Creative Commons (BY-NC-ND) license

It is no surprise that women’s experiences were negatively impacted by the mistreatment they received during their maternity care treatment period.  Some of the treatment was one on one – from the care provider to the mother, while other inappropriate treatment was on a facility level.

Investigation of the treatment of women during pregnancy and childbirth was conducted because it is known that care by a qualified attendant can significantly impact maternal mortality, but if women are disinclined to seek out appropriate care due to a fear of mistreatment, help is not available or utilized and mortality rates rise.  Removing this obstacle is key to reducing maternal deaths.

Prior experiences and perceptions of mistreatment, low expectations of the care provided at facilities, and poor reputations of facilities in the community have eroded many women’s trust in the health system and have impacted their decision to deliver in health facilities in the future, particularly in low- and middle-income countries Some women may consider childbirth in facilities as a last resort, prioritizing the culturally appropriate and supportive care received from traditional providers in their homes over medical intervention. These women may desire home births where they can deliver in a preferred position, are able to cry out without fear of punishment, receive no surgical intervention, and are not physically restrained. – Bohren, et al.

Women who are mistreated during childbirth obviously reflects a quality of care issue, but also a larger scale- a fundamental human rights issue.  International standards are clear that this is not acceptable.  The researchers encourage the use of their finding to assist in the development of measurement tools that can be used to inform policies, standards and improvement programs.

We must seek to find a process by which women and health care providers engage to promote and protect women’s participation in safe and positive childbirth experiences. A woman’s autonomy and dignity during childbirth must be respected, and her health care providers should promote positive birth experiences through respectful, dignified, supportive care, as well as by ensuring high-quality clinical care. – Bohren, et al.

I encourage you to read the study for a thorough review of the research findings.  The information is difficult to fully take in. Additionally, a companion paper  – “Mistreatment of Women in Childbith: Time for Action on this Important Dimension of Violence against Women” provides further information.  The New York Times covered this topic in their June 30th Health Section. The World Health Organization also covered this report and has a statement on this issue, endorsed by over 80 organizations, including Lamaze International.  The WHO also has a list of videos on the topic of abuse and mistreatment of women during pregnancy and childbirth that can be found here.

References

Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. (2015) The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med 12(6): e1001847. doi:10.1371/journal.pmed.1001847

Jewkes R, Penn-Kekana L (2015) Mistreatment of Women in Childbirth: Time for Action on This Important Dimension of Violence against Women. PLoS Med 12(6): e1001849. doi:10.1371/journal.pmed.1001849

Do No Harm, Maternal Mortality, Maternal Mortality Rate, Maternal Quality Improvement, Maternity Care, New Research, News about Pregnancy, Research , , , , , ,

Webinar – “Childbirth Class for Students Who Want An Epidural” – Today! Register Now.

June 25th, 2015 by avatar
Photo by Patti Ramos Photography

Photo by Patti Ramos Photography

Robin Weiss, PhD, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE, President of Lamaze International, has an absolutely great webinar scheduled for later today that you definitely don’t want to miss. This 60 minute live webinar, titled “Childbirth Class for Students Who Want an Epidural” will be valuable for both new educators and experienced educators alike at 1 PM EST.

When families enroll in Lamaze classes, some people may be planning to birth without pain medications while others may already have made a different decision and are intending to get an epidural.  Then of course, there are those people who prefer to “see how it goes” and make a decision at during labor.

As a childbirth educator, we won’t necessarily know who falls into which category, and honestly, it simply doesn’t matter.  Our role is to present information that is unbiased, based on evidence and best practice and helps families to make the best decision for themselves. Everyone who takes a childbirth class needs to receive quality information and deserves to have the facts presented in a nonjudgmental manner.

Teaching about epidurals in a Lamaze class allows families to gain knowledge in a safe and welcoming environment.  Whether this topic is covered extensively during your regular classes (which it should be) or you decide to offer a module for those who are positive they want medication, families should have the opportunity to learn what they need to know.

Robin Weiss is the perfect facilitator to lead us through this potentially tricky topic. She has been a childbirth educator, author and trainer of Lamaze educators for many years. She recently completed her Ph.D in Maternal Infant Health at the University of Louisville in KY.

This will be a great check-in to help you evaluate how you are presenting this topic to your students, give you some new ideas and perspective for approaching the subject and possibly even provide the impetus to offer a specialized class.

© Robin Elise Weiss

© Robin Elise Weiss

If you participate in this webinar, you have the option of receiving contact hours for a small additional fee upon completion of a post-webinar evaluation.

Won’t you consider registering now for this webinar that happens today, at 1 PM EST.  After you participate in the webinar, I invite you to come back and share your thoughts, ideas and any learning moments that you have taken away on this topic.

 

Childbirth Education, Epidural Analgesia, Medical Interventions, Webinars , , , , ,

Congratulations to Cara Terreri and Lamaze Parent Blog – Giving Birth With Confidence

June 23rd, 2015 by avatar

Congratulations Giving Birth withWhile Science & Sensibility is geared primarily for birth professionals and health care providers, Lamaze International also has a long running blog that is written by Cara Terreri, specifically with the expectant family in mind.  Giving Birth with Confidence (GBWC) offers families a wonderful mix of posts that highlight current best practice and evidence based information, fun and lighthearted topics for the pregnant and parenting crowd, and regular pregnancy week by week features that showcase development and concerns as a people move through their pregnancies.  One of my favorite topics on the GBWC blog is the “Great Expectations” series which follows a pregnant person through their pregnancy and birth, with regular posts documenting the progress, emotions and circumstances that are arising for the featured family.

I am not the only one that thinks that the Giving Birth with Confidence Blog is the bomb!  Healthline recently named Giving Birth with Confidence one of the top pregnancy blogs for 2015.  Cara Terreri has been writing the GBWC blog since its inception, and the honor is well deserved.  You may recall Cara from some posts she has done on this blog, as we followed her on her path to becoming a Lamaze Certified Childbirth Educator.  She has also been a guest blogger here on other topics.

I asked Cara some questions about her experience as writer and community manager for the Giving Birth with Confidence Blog and share her answers with you here now.

Sharon Muza: What do you hope that parents take away from reading the Giving Birth with Confidence blog?

Cara Terreri: I hope that parents  take away from GBWC that birth is a normal part of life, not an illness or fearful event, and in fact, that it can be an exhilarating, amazing, and beautiful experience. I also hope they take away practical information to help prepare for and shape their experience.

SM: What are some of the challenges that you see when writing a blog geared for parents in the childbearing year?

CT: I can identify two challenges — giving topics the detail they deserve without overwhelming parents with information. That’s a challenge childbirth educators often face in classes, too. The other is presenting information in a non-biased, non-judgmental way. It can be easy for my opinion to creep in when I should be presenting “just the facts, ma’am.”

SM: There has never been more online information available to parents – what distinguishes GBWC from other online resources?

CT: Evidence based information, first and foremost. Followed by a tendency to address important issues and choices women face, not just what’s “hot” or “trendy.”

SM: What have been some of your favorite posts of all time?  What about the favorite posts of the readers?

CT: My favorite posts come from the expectant moms who participate in our Great Expectations series, an every-other-week chronicle of their pregnancy. Often, the posts just contain thoughts and reflections of pregnancy, motherhood, and birth, which is just perfect. Our readers, interesting enough, tend to click through most to our post about Lamaze breathing, which provides clarity on how Lamaze teaches breathing as a coping mechanism in labor. Families might come to us to learn about breathing, but they leave with so much more!

SM: Why should childbirth educators and other birth professionals share this blog with the families that they work with and encourage them to become regular readers?

CT: Birth professionals and CBEs can trust the content, when they recommend it to the families they work with. It supports and mirrors what is taught in a Lamaze class. Our content is also easy to read and understand.

I hope that you will share this blog with the families you teach or work with, so that they can receive the information and community that GBWC offers to readers.  If you have suggestions for future post topics, would like to be a guest blogger or have some helpful feedback, please contact Cara directly.

cara headshotI would like to invite all of you to join me in congratulating my friend and colleague Cara Terreri and the Giving Birth with Confidence blog on a job well done!  I know that many families are better prepared and better informed as a result of the exceptional information that is shared on the blog.  Make sure that the families that you work with are aware of this valuable resource.  This recognition is well-deserved and I am delighted that you have received it.  I look forward to more posts on the topics that are important to families everywhere.

Awards, Babies, Giving Birth with Confidence, Lamaze International, Lamaze News , , ,

Customizing Your Lamaze International Directory Profile – A Quick and Easy How To Guide

June 11th, 2015 by avatar

jim croceOn Monday, I shared the news that Lamaze International has just released a new mobile app “Pregnancy to Parenting” that families can download from the Google Play or Apple App store for their smart phones. With this app, they can receive valuable tips and tools, and useful evidence based information that will take them from pregnancy, through labor and birth, and well into the first weeks of parenting. Families can also search for a local Lamaze class in order to receive the gold standard in childbirth education. You can get all the details on the mobile app by reviewing the blog post “Lamaze International Launches Free Pregnancy to Parenting Mobile App to Support Families” and then clicking over to the mobile app information page on our website where you can find a mobile app resource kit for your use.

As more and more families continue to download and access the app, Lamaze Certified Childbirth Educators can expect that more families will utilize the “find a local class” feature and contact you to register for your Lamaze childbirth program.  You will want to be sure that your profile information is current and up to date on the Lamaze International website.

When you set up your profile, there is some information that is required and other information that is optional.  Additionally, you can set the parameters for the information that parents see when searching the Lamaze directory.  The more information that you complete, the more information will display in your directory listing.  Today on Science & Sensibility, I will walk you through the steps on how to control what is listed and visible in the “find a local class” feature and the overall directory.

Modifying your Lamaze International directory profile

1. Log in to your lamazeinternational.org account by using this link.

2. Select edit profile on the right.

3. Please note that the following profile fields are optional:

  • Designations
  • Job Title
  • Company
  • Personal Website
  • Fax
  • Languages you teach

A full profile in the directory will look like this:

directory 1 4. If you fill out the Languages you teach and add a picture to your profile, they will appear when hovering over the “i” (information) box.

directory 2

5. You can add your picture by clicking on the ‘My Picture’ link on the right side bar of your profile page, and uploading an image.

directory 3

6. When editing your profile, you can also use the following checkboxes to control certain aspects of your directory listing:

  • You can exclude yourself from the directory entirely by checking either the ‘Exclude from LCCE Directory’ or ‘Not Currently Teaching’ checkboxes.
  • You can hide your street address from the directory by checking the ‘Hide Street Address from LCCE Directory’ checkbox.

directory 4

Here is an example of a directory listing with the street address “hidden.”

directory 5

Consider how you would like your profile to appear in the Lamaze Directory and in the “find a local class” feature on the parents’ Lamaze.org website, the professional LamazeInternational.org website or in the “Pregnancy to Parenting” mobile app.  Go ahead and make any changes using the directions above and save by selecting “hit ok” at the bottom left of the webpage.  When the database is refreshed, your information should appear as you have selected.  Check it out for yourself.  Should you have any questions about these instructions or need additional information, please do not hesitate to email info@lamaze.org with “directory assistance” in the subject line and your email will be directed to a staff member who will be happy to help.  Alternately, you can contact the Lamaze office by phone at 202-367-1128 or Toll-free: 800-368-4404.

With the new mobile app roll-out, now is a great time to verify that your directory information is:

  • current,
  • accurate, and
  • as you wish it to appear

Go ahead and take a few minutes to take care of this small detail and you will be helping families to be able to find and contact you for your Lamaze class offerings.

Childbirth Education, Lamaze International , , , ,

Lamaze International Launches Free Pregnancy to Parenting Mobile App to Support Families

June 8th, 2015 by avatar

Free new app!Lamaze International is delighted to announce the launch of their new “Pregnancy to Parenting” mobile app for families.  This just released app is meant to be a comprehensive evidence based resource for people to use during the childbearing year and is free to anyone who downloads it.  In addition to sharing customized information about their pregnancies, the app also provides tips and information for labor and birth and then continues to support families after birth as they feed and care for their new baby.  85% of millennials are heavily reliant on their smartphones for both information as well as entertainment throughout the day.  Lamaze International, well-recognized as the leader in childbirth education, meets today’s parents where they are at (on their smart phones) with this well designed, well thought-out app that takes families from conception all the way into their first weeks and months of parenting!

After downloading the app from either the Apple App store or from Google Play, parents can get weekly information about their pregnancy, updates on what baby development looks like that week and even access fun lighthearted facts that are entertaining as well as interesting. Daily tips, relevant articles, and Q&As are also included.

The “Pregnancy to Parenting” app lets pregnant families find a Lamaze class near them (make sure your information is up to date in your membership profile!  We will discuss how to access and update your profile in a post here on Thursday), maintain a calendar that tracks their CBE classes, doctor or midwife appointments, and even create a pregnancy journal with notes, videos and pictures.LI_MobileAppScreenshots5

As labor begins, there is a handy contraction timer and parents can access evidence based information about what to expect during labor and birth as well as useful tips, for example – information on the importance of moving around and changing positions as labor continues to progress.

After birth, parents can use the useful breastfeeding and diaper tracker as they head into the wonderful but exhausting first days and weeks with their newborn.  There is also information on postpartum mood and anxiety disorders, what to look for and how to get help.

The content in the “Pregnancy to Parenting” mobile app was prepared and approved by Lamaze Certified Childbirth Educators just like you, and delivered in a thorough and easy to navigate app that looks great and functions well on today’s mobile devices.

As the “Pregnancy to Parenting” mobile app gets introduced to expectant and new parents, Lamaze International is offering educators and other birth professionals an opportunity to participate in a 60 minute webinar: Utilizing the New Lamaze Mobile App – Pregnancy to Parenting, facilitated by former Lamaze President Michelle Deck, RN, MEd, BSN, LCCE, FACCE on Tuesday, June 9th at 1:00 PM EDT.  The purpose of this webinar is to share information with childbirth educators on the app’s content and functionality as well as suggest how educators can introduce the mobile app to families and incorporate the app in their classrooms.  You can register now for this informative session.

LI_MobileAppScreenshots3Lamaze International has prepared an educator resource kit to help you spread the word about the new “Pregnancy to Parenting” mobile app that includes flyers for your classroom and workplace, a friendly email that you can use to introduce the app to your students and community and even PowerPoint slides that can be integrated into your classroom curriculum.  Learn more about the mobile app and these resources here on the resource kit page of the Lamaze International website.

Lamaze International wants to offer the families you work with (and all families) access to additional information that supports what they are already learning in their Lamaze class.  Having access to resources that provide evidence based information in a format that today’s families are used to accessing helps families to have a safe and healthy birth and make decisions that support healthy mothers, healthy babies and healthy families.  Making it easy for families to find a Lamaze class in their area, when they have not yet signed up for childbirth classes, helps educators to reach more families and benefits educators by directing those families right to you! The new “Pregnancy to Parenting” mobile app is a great tool for families and educators a like.  Head over to the app store of your choice and download the app, so you can become familiar with it and will be ready to share with the families that you work with.  See you in the webinar!

Babies, Breastfeeding, Childbirth Education, Lamaze International, Lamaze News, News about Pregnancy, Pregnancy to Parenting Mobile App , , , ,

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