Monday, January 31, 2011

Breastfeeding Comics on Baby Blues

I just found out via Motherwear Breastfeeding Blog about these adorable comics from the Baby Blues comic strip featuring breastfeeding either prominently or in the background of a lot of their comics. I love them!

(click to enlarge)

Be sure to check out the collection that they put together at Baby Blues, and the newest one here.

The Motherwear blog post includes a couple that the Baby Blues compilation does not, so be sure to click over there if you'd like to see more!

Thursday, January 27, 2011

Link Roundup!

My apologies for the formatting issues with this post...

1. Ever think about how birth is done in other countries? Here is more from Rixa at Stand and Deliver: Birth Around the World series

Highlights Mother Health International, a non-profit organization dedicated to improving maternal and child health in Haiti.

Story of a VBAC in Tajikistan witnessed by a doula and student.

From Azerbaijan to the U.S., here are two different birth stories.

2. U.S. Surgeon General's Call to Action: Breastfeeding- BIG NEWS!

On Jan. 20, 2011 the Surgeon General Regina M. Benjamin issued a “Call to Action to Support Breastfeeding,” outlining steps that can be taken to remove some of the obstacles faced by women who want to breastfeed their babies.

Dr. Benjamin’s “Call to Action” identifies ways that families, communities, employers and health care professionals can improve breastfeeding rates and increase support for breastfeeding:
  • Communities should expand and improve programs that provide mother-to-mother support and peer counseling. 
  • Health care systems should ensure that maternity care practices provide education and counseling on breastfeeding.  Hospitals should become more “baby-friendly,” by taking steps like those recommended by the UNICEF/WHO’s Baby-Friendly Hospital Initiative.
  • Clinicians should ensure that they are trained to properly care for breastfeeding mothers and babies.  They should promote breastfeeding to their pregnant patients and make sure that mothers receive the best advice on how to breastfeed.
  • Employers should work toward establishing paid maternity leave and high-quality lactation support programs.  Employers should expand the use of programs that allow nursing mothers to have their babies close by so they can feed them during the day.  They should also provide women with break time and private space to express breast milk.
  • Families should give mothers the support and encouragement they need to breastfeed.
Read the Surgeon General’s Press Release  Click here 
Read/print the Fact Sheet
Download the entire Surgeon General’s Report

from Jan 10-15th, which was fantastic (though truthfully I'm still going back to catch up on them all).
Definitely don't miss this one, where Dr Dorn describes obstetrics as having its own rituals, which is exactly what Robbie Davis-Floyd writes about! (Science and Sensibility even re-posted):
OB-GYN Henry Dorn examines the role of technology and public opinion of modern obstetrics.
"The obstetrical community must fit that model, insisting on specific rituals of care, even in the absence of absolute evidence of their efficacy, in order to gain a sense of control and mastery of the birthing process. The fetal heart rate tracing is poured over like tea leaves or cast bones, and the doctor becomes the shaman." 
Here is a full list of all rest of the Posts:
Sociologist Louise Marie Roth shares her research, which challenges the claim that the number of obstetric malpractice lawsuits has caused the rise in the cesarean rate in the United States.
Courtroom Mama, a contributor to The Unnecesarean, offers an introduction to medical malpractice for the non-attorney.
An anonymous OB-GYN describes the lawsuit that changed everything.
Lee Tilson, who has litigated medical malpractice cases for decades and was drafted into the patient safety movement by medical errors that adversely affected two family members, shares his views on cesarean sections.
Sociologist Barbara Katz-Rothman looks critically at malpractice insurance, pregnancy, risk and the U.S. health care system.
National Advocates for Pregnant Women ask whether recent debates about so-called “personhood” measures—ones that would legally separate eggs, embryos and fetuses from the pregnant women who carry, nurture, and sustain them—raise the question of whether “defensive medicine” provides a reasonable justification for forcing pregnant women to undergo cesarean surgery or for locking them up if they refuse.
Emjaybee, a contributor to The Unnecesarean, gets real about her experience with defensive medicine in maternity care from the perspective of a patient.
Non-partisan, consumer advocacy organization Texas Watch analyzes the effects of Proposition 12.
President of the International Cesarean Awareness Network (ICAN) Desirre Andrews reflects on the organization’s concern for the effects of a defensive practice style.
ANaturalAdvocate, a contributor to The Unnecesarean and almost-lawyer, tells how her son’s iatrogenic prematurity stemming from an induction at 37 weeks for suspected macrosomia affected her and her choices for future births.
Amy Tuteur, MD, proposes that while defensive medicine appears to be about protecting doctors from liability, it’s really about protecting patients from any and all risk.
Two well-known patient advocates, Trisha Torrey and Dave deBronkart, share their thoughts on how to defend oneself from defensive medicine.
Jill Arnold and Henry Dorn, MD, explore how to build trust in the patient-provider relationship in the final post of the Defending Ourselves against Defensive Medicine series.

And that should keep you busy through the weekend ;]

Tuesday, January 25, 2011

Saturday, January 22, 2011

Weekend Movie: Newborn Birth Injuries

I apologize for going from an uplifting post about birth success stories right into one about birth injuries.

This is a very sad weekend movie, but I hope you watch the video and learn about the cause and prevention of brachial plexus birth injuries.

A brachial plexus birth injury is caused by the person who is attending the birth, aka iagtrogenic. 

"You would stop every brachial plexus birth injury if doctors would stop pulling heads."

"To reduce the risk of trauma and injury to your baby, GET OFF YOUR BACK!"

To read more about why current literature supports the fact that non-supine positions are more favorable when compared to the dorsal lithotomy position, read this piece from Science and Sensibility.

Tuesday, January 18, 2011

Success Stories from the Field

Birth activists spend a lot of time trying to educate and make change in the birth world. We talk a lot about negative practices and negative experiences to avoid. Bad doctors, bad nurses, horror stories, things to avoid, the cons of every medical procedure, the safety of home vs hospital birth, etc. But every now and then we like to celebrate the success stories - the births that we read about or see that are truly wonderful for the new mom and baby, and for us as birth professionals. They give us hope for the future of maternity care.

I was pretty lucky as a fledgling doula. Two of the first three births I attended when I first became a doula were successful in implementing all 6 of the Lamaze Health Birth Practices. You can actually check these off in the success story I'd like to share.  

I got a call in the middle of the night from my client, "We think its time! My wife would like to go to the hospital. Will you meet us at there?" 

My client had been having contractions all day, after not having any Braxton-Hicks or "practice" contractions at all leading up to her due date. We were pretty sure that it was early labor, and I had encouraged her to relax at home all day.(Healthy Birth Practice 1: Let labor begin on its own!)

When I arrived at the hospital she had been checked and she wasn't dilated enough to be considered in active labor yet. She was allowed to roam the halls on the Labor and Delivery floor, walking to get her contractions to progress and stopping to breathe through each one. (Healthy Birth Practice 2: Walk, move around and change positions throughout labor!)

Her husband and I (Healthy Birth Practice 3: Bring a loved one, friend or doula for continuous support) discussed options with her: staying in the hospital and having to follow the "one centimeter per hour" rule or else be augmented, or going to her nearby home to relax and labor in her own environment. She decided to avoid the possibility of unwanted interventions and head home (Healthy Birth Practice 4: Avoid interventions that are not medically necessary!)

When we arrived at her home we all tried to lay down and relax. Ten minutes after I laid down to rest in the living room, my client's water broke! After that her contractions were coming on stronger and she began to labor on the floor in her hallway. She was standing and swaying, on all fours and vocalizing, sitting on the toilet, you name it! (Again, Healthy Birth Practice 2: Walk, move around and change positions throughout labor!). She was in her zone and doing wonderfully.

When I could tell she was getting ready to push we got her clothed and into the car to head back to the hospital. Once in the labor and delivery room she crawled up onto the bed on all fours, following her instinct and her urges to push on her own. She changed positions to a squat, leaning against the back of the raised bed, so that she would be able to catch her own baby. (Healthy Birth Practice 5: Avoid giving birth on your back and follow your body's urges to push!)

This is my favorite part of the story, and my favorite part of any birth so far...
While the baby's head was crowning, she reached down and felt his head, and she looked up with a face full of wonderment and said, "His head is coming out and then going back in a little!" She was so calm and intrigued, fully experiencing the birth of her first child. Then she pushed out her baby and pulled him up onto her stomach, all the while calm and grinning like mad!

The husband had tears streaming down his face, and the new mother was immensely pleased with herself. Mama and baby stayed together, skin-to-skin, and began to initiate breastfeeding, for the whole first hour. (Healthy Birth Practice 6: Keep mother and baby together - It's best for mother, baby and breastfeeding)

This post is part of a blog carnival hosted by Science and Sensibility on success stories in implementing the evidence-based Lamaze Healthy Birth Practices. The Blog Carnival Round-Up will appear on on January 28th, 2011.

Health Disparities in Preterm Births

The Centers for Disease Control and Prevention (CDC) has issued the CDC Health Disparities and Inequalities Report — United States, 2011, which is the first in a series of regular reports that focus on selected topics that are important to CDC’s efforts to eliminate disparities.

I think the CDC's key findings on preterm birth disparities are worth bringing to your attention, so I am sharing the findings here.  The text below comes from the CDC's Health Disparities in Preterm Births Factsheet (pdf) 

Released as an MMWR Supplement, the report contains 22 topical essays that address disparities in health-care access, exposure to environmental hazards, mortality, morbidity, behavioral risk factors, and social determinants of selected health problems at the national level. The report provides an analysis of the recent trends and ongoing variations in health disparities and inequalities in selected social and health indicators. The data highlight the considerable and persistent gaps between the healthiest people and the least healthy. By documenting these gaps, CDC hopes to spur further action and attention to these issues at the federal, state and local levels.

Key Findings in Preterm Births Disparities
• Approximately one of every five infants born to non-Hispanic black mothers in 2007 was born preterm, compared with one of every eight to nine infants born to non-Hispanic white and Hispanic women.
• The 2007 preterm birth rate for non-Hispanic black infants was 59% higher than the rate for non-Hispanic white infants and 49% higher than the rate for Hispanic infants.

What Can Be Done
Understanding of the causes for these wide disparities in preterm risk is limited. Reported causes include differences in socioeconomic status, prenatal care, maternal risk behaviors, infection, nutrition, stress, and genetics. Multidisciplinary research into the factors influencing preterm birth is needed for developing effective intervention strategies.
CDC will accelerate its efforts to eliminate health disparities with a focus on surveillance, analysis, and reporting of disparities and the identification and application of evidence-based strategies to achieve health equity.
CDC and its partners can use the findings in this periodic report to raise awareness and understanding of groups that experience the greatest health disparities. The findings also can help motivate increased efforts to intervene at the state, tribal, and local levels to address health disparities and inequalities.

Further information on the Health Disparities Report can be found here.


Monday, January 17, 2011

Breastfeeding PSA's Worldwide

(My apologies for the light posting as of late, I'm getting back into the swing of things with new graduate classes this semester)

In case you haven't seen these, I really want to encourage you to watch - these are so interesting and awesome!

[Edit: I've found the US ones again!]

From Peaceful Parenting, here are some Breastfeeding Public Service Announcements from around the world.

from Puerto Rico:

from the United Nations:

from Canada:

from the US:

the US ones are odd...

and another from the US:

from Australia:

another from Australia:

whoa, that baby has a serious Australian accent haha

from Bulgaria:

not sure if is this really a PSA

And here is another one I found, from Spain, I'm pretty sure:

Thursday, January 6, 2011

Race and Birth Weight Redux

A few months ago I posted an interesting excerpt on Racism and Birth Weight and I here I am going to bring up the topic again.

Jill of the Unnecesarean created a wonderful slide show full of graphs and charts on Racial and Ethnic Disparities in Infant Mortality and all the possible causes. I will be referring you to her slides throughout this post, where you can see a visual representation of the disparity in numbers.

African American infants are more than two times more likely to die during the first year of life than white infants (See Slide 1).

Preterm deliveries and low birth weight are the second leading cause of infant mortality in the United States. Low birth weight is defined as less than 2500 grams, and very low birth weight is defined as less tan 1500 grams. Among African Americans, it is the first leading cause. In fact, African American women are two to three times more likely than white women to deliver preterm, and their babies are three times as likely as white babies to die from prematurity/low birth weight. (See Slide 2)

For the past twenty years, workers and experts in the birth world have been fighting to bring these numbers down. There has been some success, with the overall number of preterm births reduced. However, this gain has been coupled with a widening black-white gap in infant mortality, with whites exhibiting a decline in preterm births at a much greater rate than blacks (CDC).


Is is genetics?

No. Birth weight distribution of African-born blacks is more closely related to US-born whites than to US-born blacks (See Slide 4)

Is it lack of prenatal care?

No. African American women are just as likely or more likely to receive prenatal care and yet still have higher rates of infant deaths than White Americans, including whites who receive little to no prenatal care (See Slide 6)

Is it a class issue? What about education level or socio-economic status?

No. See Slide 8

Many epidemiological studies have attempted to explain the difference in terms of factors such as maternal age, education, lifestyle, and socio-economic position. However, the results of these studies show that, at best, these factors can account for only a tiny portion of the difference. Studies show that college-educated black mothers are more likely to deliver low birth weight infants than white college-educated mothers.

Also, women who recently migrated to the United States are more likely to have infants of a higher birth weight than women in the same race/ethnic category born and raised in the United States, despite the majority of the migrant women falling into a lower socioeconomic class. These studies suggest “that growing up as a woman of color in the U.S. is somehow toxic to pregnancy, and imply a social etiology for racial/ethnic disparities in prematurity that is not solely explained by economics or education" (Rich-Edwards).

Its not even about maternal smoking during pregnancy.

African American non-smokers still had higher rates of infant deaths than White American smokers (See Slide 10).

Studies have shown that the common factor among African American women having preterm births and low birth weight babies may be a common, negative experience. Among all socioeconomic levels, African American women who reported experiences of racial discrimination at least three or more times proved to be at more than three times the risk for preterm delivery than women who have never experience racial discrimination (Lock).

Factors that might contribute to the disparity include racial differences in maternal medical conditions, stress, lack of social support, previous preterm delivery, and maternal health experiences that might be unique to black women (Hogan).

It would be beneficial to use a life course perspective to understand the effects of race and racism on birth outcomes. This would mean taking into account a person's biology, economics, psychology, sociology, history, etc (the sum total of a person's experience) in addition to that of their parents and grandparents.

Please enjoy these fascinating videos to help further understand what is going on between race and birth outcomes:

When the Bough Breaks: Kim Anderson's Story

When Atlanta lawyer Kim Anderson was pregnant with her first child, she did everything right: she ate a healthy diet, exercised, and got the best prenatal care. But her baby was born almost three months premature. How could this have happened? Some researchers believe that racism may play a role in unusually high rates of premature birth in the African-American community.

Excerpt from Episode 2 of "UNNATURAL CAUSES: Is Inequality Making Us Sick?", a ground-breaking documentary series that looks at how the social, economic and physical environments in which we are born, live, and work profoundly affect our longevity and health. The series broadcast nationally on PBS in spring 2008

How Racism Impacts Pregnancy Outcomes

UCLA obstetrician and gynecologist Dr. Michael Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions that impact women's health not just when they become pregnant but from childhood, adolescence and into adulthood.

This video is a Web-exclusive supplement to "When the Bough Breaks," Episode 2 of "UNNATURAL CAUSES: Is Inequality Making Us Sick?"

The Unnecesarean - "Racism and Low Birth Weight 101"
Center for Disease Control 2002. "Infant Mortality and Low Birth Weight Among Black and White Infants - United States, 1980—2000” in Morbidity and Mortality Weekly Report 51(27):589-592

Rich-Edwards, J; Nancy Krieger, J Majzoub, Sally Zierler, E Lieberman, M Gillman 2001. "Maternal experiences of racism and violence as predictors of preterm birth: rationale and study design” In: Paediatric and Perinatal Epidemiology. Vol 15:124-135

Lock, M and V. Nguyen 2010. Biomedical technologies in practice. In: An Anthropology of Biomedicine. Pp. 17-31

Hogan VK, Richardson JL, Ferre CD, Durant T, Boisseau M. 2000. A public health framework for addressing black and white disparities in preterm delivery. Journal of American Medicine Women’s Association, Vol. 56:177-80
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