Friday, July 29, 2011

Weekend Movie: A Walk to Beautiful

A powerful story of healing and hope for women in Ethiopia devastated by childbirth injuries, A Walk to Beautiful portrays the loneliness and shame that thousands of Ethiopian women experience because of obstetric fistula. The story ends in a productive new life and hope for the future in this award-winning film.



Sunday, July 24, 2011

Native American Breastfeeding Promo Video

This beautiful video, which I found via Motherwear Breastfeeding Blog, is a video from the Native Breastfeeding Council.  


Its so awesome that the interviewees discuss the importance of breastfeeding not only for health but also for the special relationship between mother and baby, and for keeping with native traditions. 


There are some lovely clips of Native American women breastfeeding, too. 





Also covered in the video are the high prevalence of diabetes among Native Americans, and pumping and nursing when you have to go back to work. Moms share their breastfeeding experiences and opinions. 



Thursday, July 21, 2011

Home Births and the Public Health Response Webinar



Home Births and the Public Health Response: Promoting Informed Choices and Healthy Outcomes
This seminar took place Wednesday, July 20, 2011 from the John Hopkins Bloomgberg School of Public Health in Maryland and was broadcast live online. These are my notes from the webinar, along with some of Dr. Declerq's slides. 


Eugene Declerq, PhD Assistant Dean, Doctoral Education Professor, Community Health Sciences
Boston University School of Public Health



We're talking very small numbers
Historical Context:
  • As the number of hospital beds increased, out of hospital birth decreased. 
  • Supreme Court determines that even though midwife's (Porn) birth outcomes were as god or better than local doctors, they could not separate midwifery from medicine, so she was charged with practicing medicine without a license. 
  • Nurse midwifery came about so midwives could work unders direct supervision of doctors
  • Netherlands remain the only industrialized country with a sig. portion of births at home, now at 26% of all births are at home. 
  • Trend in England and Wales - only industrialized country other than US showing a sig. increase in home birth. 
  • U.S. post 1989 - Decrease in out of hospital birth but a jump at around 2008... but very small numbers. 
  • 2003 live birth certificate asked "planning status" of home birth. 83% of home births in 2006 are planned home births. 



Present Day
  • Planned home births in the U.S. are white/non-hispanic. Small numbers of other ethnic/racial groups. The increases have occurred almost completely in white/non-hispanic mothers. 
  • Overwhelmingly married, usually over 30, full gestation. More likely to be in rural areas, well-educated, nonsmokers. 75% of cases tend to be mothers who have given birth before. The people having home birth in the U.S. are a selective group.
  •  The primary group attending home births (planned or unplanned) are Certified Professional Midwives. CNM's have dropped off, esp. because of legal constraints (also physicians).
  • Gestational age distribution - the average in the U.S. is 39th week. The planned home birth distribution shows the classic distribution with the peak at 40 weeks. 
  • Significant increases have occurred in California, MD, Vermont, Ohio, Kentucky, VA, NC, 
"Other" could actually be attended by an "illegal" midwife but signed off on by a father, for example.

So many inferences can be made from this slide
Maryland
  • Home birth rates jumped in 1994 but declined until 1999, until a slow general increase. 
  • Not all planned home births end up at home. The transfer rate for home births is roughly 15%. 
  • Much higher proportion of black/non-hispanic home births in MD than in the rest of the US, but could be unplanned home births. 



Mairi Breen Rothman, CNM, MSN Certified Nurse Midwife
Metro Area Midwives and Allied Services

  • Birth center births are like having a home birth at someone else's house. There is nothing there that a midwife wouldn't have at your home. They both involve trained midwives who know how to use medications, IV fluids, oxygen, resuscitation, acute care period, etc. 
  • In a home birth you have no institutional bacteria, and it doesn't require a nervous woman and partner to get in a car and drive somewhere and then leave in a few days.
  • The safety of home birth has been established again and again (Olsen 1977, Johnson & Daviss 2005, Leslie and Romano, Janssen Saxell et al 2009), in North American and abroad. 
  • Wax et al, recent meta analysis AJOG - deeply flawed inclusion data 
    • included pre-term infants in hospital; includes data from birth certificates that do not differentiate between planned and unplanned home births; did not consider culture, geography, health care systems impact)
  • Why women choose home birth (Boucher-Bennett et al 2009)
    • Number one reason: SAFETY
    • Avoidance of unnecessary medical interventions
    • Previous negative hospital experience
    • More control
    • Comfortable, familiar environment
  • Home birth patients feel they are not listened to and respected in the hospital
  • Public Health: more women are choosing midwives, so how can we make this option safe.
  • Ideal scenario is that everyone who is qualified to attend births is licensed, operating within the system, has access to the model of care she chooses, we have enough midwives and no unattended home births, streamlined way to do hospital transfers, midwives can collaborate or consult with physicians, and that Medicaid covers all services. 
  • Bottom line: Birth is about Women. The discussion is about the Sovereignty of Women.
    • Frequently we hear "Should women be allowed...?" Have you ever heard "Should men be allowed...?"
    • "If we take good care of the mothers, the mothers will take care of the babies" - Kitty Ernst

Notes from the Q&A Discussion:

We can't have randomized trials of birth, so they are typically retrospective and women are matched. Frequent limitation: can't distinguish planned home birth and which home births become hospital births. 
Studies frequently find that low-risk pregnancy/births are comparable at home and in the hospital.
One study found that matched women being cared for by midwives prenatally other than physician care had a 19% lower infant mortality rate and 33% lower low-birth weight rate. Midwifery care is designed to optimize women's self-care during pregnancy.

Midwives are extremely selective at picking women to attend at birth at home because they don't want anything to go wrong at home. Age is generally no issue. 

Problem with Medicaid - payment doesn't cover everything. Midwives get a very low payment that doesn't cover all over-head. 

The Healthcare Reform Act has this impact on pregnant women - will cover all pregnant women who are not covered. Also, pay for certified professional midwives but only in a birth center. CNMs will be paid by medicaid at 100% of the physician fee schedule. 

Low risk moms in any setting - 97% of babies are fine. What's important is to have emergency pathways to deal with babies that need help. The best thing to do for women choosing home births is to have those systems in place, so that women can access the medical system without being punished. 

The British system is instructive - give people a real option to have home birth - they are at about 3%. The U.S. has a more antagonistic view of home birth so we might at some point get up to 1.5%. Probably no huge shift in the future. But maybe there will be a much more activist maternity movement in the U.S.

Quiet revolution - women are quietly examining their options, looking at research, making a choice. More and more true as time goes on. 

Physician-attended home births data - who are these physicians? Could be a physician sign-off at a home birth transfer or an unplanned home birth on birth certificates. Highly unlikely that physicians are at home with mother while she is laboring, attending the delivery, cleaning up, and leaving. 


From a historical perspective, CNMs and CPMs have has some divisions and competition. These days there is an attempt by the ACNM and MANA to work together. 



____________
The presenters' slideshows are posted under "Documents" here 
There will be a link online at the Johns Hopkins Bloomberg School of Public Health archiving this webcast for future viewing.
Learn more about Eugene Declerq's work (and what he looks like) in his video Birth by the Numbers



Wednesday, July 20, 2011

A Breastfeeding and Culture Moment

I was watching a video on the growing population of elderly worldwide and a comparison of how the elderly are cared for in different countries, when I heard this quote by a young Tunisian man:

"Mothers milk creates an affection between mother and son, and by the grace of god all our mothers have breastfed us. That contact with the breast strengthens the affection." 

In a video completely unrelated to breastfeeding, an interesting perspective on breast milk is presented. Let that be a lesson - if you want your sons to care for you in your old age, breastfeed them! :)


Note: The video was made in 2000, and the rate of breastfeeding has decreased in Tunisia in recent years.

Monday, July 18, 2011

Maternal and Child Health Leadership Training

I've got good news to announce! I have been awarded a Maternal and Child Health Leadership Traineeship through my school of public health! These training grants are distributed by the Maternal and Child Health Bureau, part of the federal agency HRSA.


As part of my MCH leadership training I will  be required to attend specialized seminars on various MCH leadership competencies, receive individualized mentoring from both a faculty member and a member of a community organization, and attend research-to-practice seminars.

This is very exciting news for me because it will help me get a foot into the MCH public health community here in my area, get involved in MCH research, and also provide a tuition waiver to help me with my education! The traineeship also provides travel support to conferences and a stipend.

If you are interested in pursuing this same traineeship at your own college of public health, visit the funded projects page on the MCHB website and search for your school!

Sunday, July 17, 2011

Books: The Doula Advantage

The Doula Advantage: Your Complete Guide to Having an Empowered and Positive Birth with the Help of a Professional Childbirth Assistant
by Rachel Gurevich

I just finished reading The Doula Advantage and have found it a great overview of the doula profession.

Rachel Gurevich covers why doulas are needed in our modern society, a great overview of the research on labor doulas, such as on the positive birth experience, the reduced need for pain medication, breastfeeding and bonding, and medical interventions overall. She then describes in detail each role the labor doula plays: Informational, Emotional, Physical, and more.

There is a chapter devoted especially to Dads and Doulas and commonly asked questions, especially by those who are unsure about the interplay between dads and doulas. This chapter even includes the opinions by dads who have hired doulas themselves.

There is also a chapter explaining the facts surround many myths about doulas and epidurals, for example: "Doulas are only interested in supporting women who plan on giving birth without medication," "Doulas push their opinions and philosophies onto their clients," "A doula will make me feel guilty if I 'chicken out' and choose to use medication," and "Women who use medication during childbirth do not need the services of a professional labor support person. There will be nothing for the doula to do." If you are interested in the truth behind these myths, I encourage you to pick up this book!

The book explains the different roles of the doula vs the labor nurse, the doctor, the midwife, as well as birth locations. It also explains the difference between a postpartum doula and a maid, baby nurse, lactation counselor.

Most importantly, the book is a fantastic resource for how to find a doula, how to decide what kind of doula is the right one for you, how to interview a doula, and how to hire one.

The Doula Advantage is full of quotes, testimonials, opinions, and unique experiences of women who have used a Labor Doula, Postpartum Doula, or Antepartum Doula which are extremely helpful for anyone interested in finding a doula.

The most interesting aspects of the book for me, as a labor doula, was the detailed explanation of what exactly a Postpartum doula does and doesn't do, and the information on Antepartum doulas (which are the least known type of doula). I also enjoyed the part on Becoming a Doula, which is full of great information for anyone to know to help understand what goes into training, business, and lifestyle of a doula. Most importantly, Gurevich outlines the Six Traits that all Great Doulas Must Have:
1. Self-motivation
2. A desire for lifelong learning
3. Perceptiveness
4. Passion
5. Flexibility
6. Professionalism

Even if you are a friend of a doula or a doula yourself there is something to learn from this great book!

I would recommend The Doula Advantage book to women, men, mothers, fathers, doctors, midwives, nurses, family members, etc who are:
- New to the concept of a doula,
- Unsure exactly about the role of a doula, postpartum doula or antepartum doula and the benefits the doula provides,
- Looking to hire a doula and get a better idea of how to go about doing so,
- Interested in becoming a doula themselves!

Tuesday, July 12, 2011

Favorite Blogs: Birth Sense

While I'm on the topic, another blog I absolutely adore is Birth Sense!


Her blog is the blog that says everything I wish I could say, but 10x better than I could ever say it. It is written by an anonymous hospital midwife, who shares not only researched articles but also her observations of the hospital birth world. Her posts are fabulous discussion-starters and are very thought-provoking. She also responds to other articles, comments, or reader questions and birth stories. It is a must-read!

Some recent excellent posts on Birth Sense:

Patient Apathy or Provider Apathy?
Does it scare you that an entire generation of young obstetricians view c-section as safer than vaginal delivery? That they view epidural use as part of a normal, routine labor? That the only unmedicated, physiologic labors they may have ever seen were accidental ones, where the woman delivered too quickly for intervention?
I propose that the widespread acceptance of these attitudes is trickling down to women. Obstetricians don’t often talk about choices in childbirth, because as far as they have ever seen, childbirth is not a choice; it is a set of routines and procedures that everyone follows...
Does your provider voluntarily bring up choices with you? For example, do you hear, “It’s time for your ______ test. . .” or do you hear, “I’d like to discuss with you a test we offer to women at this stage of pregnancy. It is called _______, and the reason we offer this test is because (present evidence in favor of the test). Some women prefer not to have this test done. Some of the concerns I am aware of about this test are (present evidence against the routine use of the test, if any). Some alternatives to having this test done now would be (present alternatives, even if you don’t agree with them). What questions do you have for me, and how do you feel about having this test done?”


The #1 Reason To Choose A Midwife
Many of the incidents in the case studies related in the cited report involved situations which very likely would have been avoided had the health care provider been present with the woman throughout labor.  Midwifery care  ideally provides this continuity of care throughout labor....
Continuous labor support, continuous care by the decision-maker, is the number one reason to choose a midwife for your next birth.


and a follow-up post with some chilling stories: Do the “decision makers” listen?
Having been a labor nurse myself for 15 years before becoming a nurse midwife, I am well aware of the challenges facing nurses, especially when they care for a patient who is experiencing complications and cannot get the care provider to respond appropriately to their concerns. ..
Decision makers do not always listen.  Nurses may communicate most excellently, and still be unable to secure good care for their patients.

I encourage you to follow Birth Sense! And on facebook!

Monday, July 11, 2011

Favorite Blogs: Science & Sensibility

I'm going to make a big plug for Science and Sensibility, "A Research Blog About Health Pregnancy, Birth and Beyond" from Lamaze International. 


I LOVE this blog! I've been reading it since the time I started my own blog, and it is absolutely fantastic.  The contributors are wonderful, bringing in birth-related research from the entire spectrum of parturition-related topics. I love that everything is very carefully researched and thought-out, providing all sides of the argument, with references. 

The blog contributors have different areas of expertise, and the topics cover understanding research, systematic reviews, conferences, becoming a critical reader, and so on. They frequently invite guest bloggers to add to the diverse topics of the blog. 



Some state Departments of Health, as that in Ohio, have got it right, and officially recommend skin-to-skin. That state prints and distributes cards for its WIC program that read, in part:  “Hold me, Mom. Babies who are held skin-to-skin on their mother‘s chest right after birth are happier and less likely to cry, are more likely to latch on and [sic] breastfeeding well, have better heart rates, have better temperatures than under a warmer, have better blood sugars, burn less [sic]  calories than under a warmer. So, be sure to tell your doctor and the hospital nurses that you want to hold your baby for at least the first hour after the birth, skin-to-skin (baby naked, not wrapped in a blanket). That‘s the best way to introduce your baby to the world”4

How can we account for the fact that a mother is advised by a government agency to “be sure” to tell her doc and staff to give her best-evidence care? Even for this well-documented and uncomplicated course of action, we cannot count on our caregivers to act reliably in the interests of mother and baby.  Again, a Healthy Birth Practice can be read as a subtle warning: Do not let them take your baby from you for the first hour!


Why must women spend precious energy and focus during labor to advocate for best-evidence care for themselves when that kind of care should just be expectations met?  Period.

Here, here!

Why should women have to defend themselves, hire doulas to advocate for their desires, fear the hospital experience so much that some switch to home birth? The U.S. maternity care system could be so much better if doctors, nurses, hospitals, insurance companies, etc all recognized and practiced evidence-based procedures, true informed consent, and respect for the choices of the mother. Instead, they practice defensive medicine and women must bring in reinforcements (in the form of people, scientific studies, etc)!  

Anyway, I encourage you to subscribe to Science and Sensibility if you have an interest in childbirth-related research! I have especially loved their articles because it keeps me up-to-date on evidence-based practices and research to back up my answers to the questions that my doula clients have!





Thursday, July 7, 2011

Breastfeeding Doll!

What a cute way to teach about breastfeeding!

The doll is called Bebé Glotón, which in my best Spanish means Gluttonous Baby... But maybe it has a different meaning for the toymakers in Spain? In English it is called "The Breast Milk Baby."


"the first breastfeeding doll"
"Takes the breast! A doll without a baby bottle"


This breastfeeding doll makes sucking noises as it nurses (just by bringing the doll closer to the nursing vest that the child wears).  It even cries, hiccups and burps! 

See the demonstration:


If you go to the Bebe Gloton website, there is a nice video on the home page that is similar to the one here, and it shows that they have male, female, white, black and asian versions of the doll for sale. There is also an English version of the website!

Not that you need a baby doll specifically for breastfeeding in order to mimic breastfeeding with a doll... but its still really great for children to imitate life! 


Created by the Spanish toymaker Berjuan, the doll created some controversy when it was first introduced last year. Some critics felt it was inappropriate to teach young girls how to nurse — as if it would encourage early pregnancy! Even some breastfeeding “lactivists” felt it was unnecessary.
What are your thoughts? Would you buy a breastfeeding doll?

I don't think its inappropriate or unnecessary to have a breastfeeding doll. A young child who sees their mother breastfeed a new baby will imitate the action, with or without a doll specifically designated for such a task. Growing up I had a doll that you could "feed" and then it would "pee." Was this doll "necessary"? No, but it was fun to pretend to feed my baby doll. So, breastfeeding is just another way to do it!

Did pretend bottle or spoon feeding my baby doll make me want to become pregnant? I'm pretty sure I had grown out of the baby doll phase by the time I was old enough to even want to touch a boy. Was it something I "needed" to practice? No, it was just a game! Just like playing school or pretending to cook in a play kitchen. If this doll helps emphasize the breastfeeding norm as an added bonus to child's play -  AWESOME!


THEN, the Spanish toymaker takes it one step further, with the breast pump for the young girl to practice "filling a bottle" with, then handing it to her male playmate, who can now join in and feed the baby, too!




The toymaker says:
Enseñar a los niños la importancia de la leche materna es la principal misión de bebé glotón, por eso lanzamos al mercado "el sacaleches" una forma de seguir alimentando a tu bebé con leche materna y poder así de conciliar la vida laboral social y familiar. El lanzamiento del sacaleches de bebé glotón supone una gran novedad en la forma de educar a nuestros hijos.
Translation:
To teach children the importance of breast milk is the main mission of bebe gloton, for this reason we introduce to the market "the breast pump" a way to continue feeding your baby with breast milk and to be able to combine work life, social life and family life. The launch of the breast pump for baby gloton assumes a great innovation of education for our children.

The breast pump I do feel a little weird about... Maybe because of the controversial nature of breast pumps, or the fact that the child is now interacting with a piece of plastic on her non-breast instead of the baby doll... I can't really explain it.

Anyone else? 

Tuesday, July 5, 2011

Maternal Wisdom: A doula birth story

In response to my call for birth stories featuring doulas, Avital of Mamafesto shared this beautiful story about her birth and her wonderful doula, Chana Luba. Enjoy!

If you have a doula birth story that you'd love to share, either about how indispensable your doula was or a doula birth from your own perspective, please feel free to send it my way - I would love to feature it! 

Avital, a couple days postpartum, with Chana Luba


I was five months pregnant when we moved. We knew in our hearts that we had moved for all the right reasons, but it still felt so terrifying. We were moving further away from our family and friends, and knew less than a handful of people in our new town. My husband's work had him away for long days and sometimes nights, and while I wasn't working, I was finishing up my thesis project for my master's degree. I spent most of my days working diligently on my thesis while taking occasional walks into town as my belly expanded. I visited coffee shops and art galleries, book stores and boutiques, but still felt a lack of community.

Having already sadly shelved the notion of a home birth for a variety of reasons, I did my best to immerse myself in the various programs the local hospital offered pregnant mothers. Around my seventh month of pregnancy I started taking a prenatal yoga class, held in the community room of the hospital. It was there that I met my soon-to-be best friend. She was pregnant as well, only a couple of months ahead of me. She had lived in the area for a while, and as we got to know each other, my desire for community started being fulfilled. It was through her that I learned about the work of doulas. She was actually a doula in training at Maternal Wisdom and suggested I call the woman she studied with. 

I took the information home with me and let the idea percolate in my brain for a bit. A person that would help me throughout my labor and birth? Wasn't that what my husband was for? The more I thought about it, the more unsure I was. The concept sounded interesting, but wouldn't the cost be prohibitive? I wanted to talk to my new friend about the idea of a doula more, but she ended up going into labor and was occupied with her newborn daughter. 

In the end, I called up Chana Luba Ertel, the doula behind Maternal Wisdom and it was there that my community continued to solidify. The first time we met, all of my hesitations and concerns seemed to melt away. It was as if Chana Luba could sense what we needed and worked to give us that. After we had made the decision to have her attend our birth, everything seemed to be that much easier. We met frequently and she gave us a few exercises to practice while we were apart. She answered all of my phone calls and emails (some made in non-rational pregnancy induced panic) with grace, humor and kindness. Toward the end of my pregnancy, when I was having prodromal labor for what felt like a week, she helped by visiting me at home, providing me with not only alternative treatments to urge along the pregnancy, but reassurance and strength as well.

The night I went into actual full on labor, I finally relented and called Chana Luba around two in the morning, feeling bad for waking her. She of course only had words of encouragement and reminded me to hydrate, eat a little if I could, and relax. She arrived a few hours later as things began to pick up. From then on, she was the guide to our ship, allowing me to labor as I had hoped for, while allowing my husband his own space as well. When my contractions began getting more painful, she drew me a bath, and then, when my water broke in the bath and the pressure and urge to bear down became too strong, she hustled us along to the hospital.

I was able to stay at home as long as I did because she was there. Despite birthing in a hospital setting, I wanted to labor at home as long as possible and got my wish. Her support continued as we made the short, five minute trip to the hospital. I arrived between shifts and a midwife from my practice didn't see me for another twenty minutes. A nurse began taking vitals and became concerned when she noticed the baby's heart rate had decelerated. At that point, had Chana Luba not been with us, I have no idea what could have happened next. I was mid contraction and not fully present and my husband was concerned for both me and the baby. Chana Luba suggested I change positions, and that immediately helped the baby's heart rate go back up to normal. A little while later she went off to get me some juice and a banana on the sly to help keep my energy levels up. Only a couple of hours later my son was born, and some of those first few pictures we have of him include Chana Luba.

I wouldn't have wanted it any other way. 

She ensured that we stuck as closely to our birth plan as possible and helped us to navigate the unfamiliar. She stepped in and helped us out when we needed it, allowing us to stay the course we were on instead of heading down the slippery slope of intervention, which was my biggest fear with a hospital birth. She already had a relationship with this particular hospital, which made many things easier for us, including allowing me to leave only a few hours later. Her help didn't stop there, however. In the days that followed, she remained in touch, checking up on me and making sure our nursing relationship was going well. She provided me with homeopathic treatments and herbs for a range of things from post-partum hormones to nursing woes. She was also there for me like nobody else eight days post birth when I needed her the most. She truly embodies the name behind her business, Maternal Wisdom.
A former teacher and lifetime learner, Avital Norman Nathman is a play-at-home mama, freelance writer, wife and feminist (and not necessarily in that order). When not gardening, cooking or dancing around the house, you can catch her musing about motherhood and feminism at The Mamafesto.

Thank you, Avital!

(Was your doula worth every penny? Share your story! anthrodoula at gmail dot com)
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