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Wednesday, September 24, 2014

Birth by the Numbers Update

Eugene Declerq and the team at Birth by the Numbers have very recently updated their statistics and their video!

Two years ago I posted the video Birth by the Numbers, a fantastic resource for mothers, public health professionals, students, and teachers. If you haven't seen it yet, I highly recommend you check it out.

This brand new updated Birth by the Numbers covers several maternal and infant health indicators, including maternal mortality and neonatal mortality, compared to other countries. This may sound dry, but he makes some jokes to start you off.

Dr. Declerq then covers Cesarean sections, with a great overview of trends in primary cesarean section rates. He even discusses cost savings of reducing these rates.

Are we doing better? Worse? Tune in to find out this answer and more!





I really like this slide:


I also recently saw a graph elsewhere showing the c-section rate rise with the introduction and push of the electronic fetal monitor. And of course, the decrease in the rate during the period in the 90's when Trial of Labor after Cesarean was promoted.


For further information, I highly recommend the Birth by the Numbers website, or any of the sites he references at the end of the video.

Also, if you're into the research on c-sections, here is an article on the variation in cesarean section rates across the country and in each hospital, and some analysis of why:
Cesarean Delivery Rates Vary 10-Fold Among US Hospitals; Reducing Variation May Address Quality, Cost Issues
"We found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals."

Thursday, September 18, 2014

Keeping My Doula Mouth Shut

Recently I feel as if everyone around me is getting pregnant. It started a few years ago and was just a trickle on my facebook page. Now it is more and more frequent, back-to-back newborn photos on my newsfeed, and more immediate, with more people I actually know in person getting pregnant!

And it has become a problem.

Why would this be a problem for a doula and maternal and child health professional?

Well, it is not a problem if it is someone seeking me out for doula services! Then it is great. I can feel free to help them to my fullest extent - send them articles, answer questions, give them advice, etc. They came to me for information and wisdom, and I share it.

The issue occurs is when it is a friend or colleague.

It is very hard to talk to an acquaintance about their pregnancy. Do they want me to give them more information, knowing I'm a doula? Do they want me to keep my mouth shut, as they have not indicated any interest in hiring me? Should I discreetly post things on facebook and hope that they see it?

If I ask the questions I ask doula clients about their pregnancy and birth wishes, if I give advice that has not been solicited, will they pull away? Will they not want to be around me anymore? Will they actually choose something opposite of what I've recommended because I've turned them off? Is it more information than they want to hear (often the case, where most women put all their trust in their OB and rarely take childbirth education)?

It can be so hard to want to tell them how wonderful birth can be! But I know that pregnant women hear a lot of unsolicited advice, and I don't want to be part of the annoying crowd. I want them to know that I am here as an option if they feel comfortable approaching me. I never want to come across too strong (it is like dating)!


If I tell them that the hospital they are going to has the highest intervention and cesarean section rates in town, they will most likely feel judged and angry at me, rather than thinking they should switch providers. I struggle with this with my doula clients, as well.

Do I want my friends and acquaintances to hire me as their doula? Absolutely. I want all my friends to hire me as their doula. I want them to be with someone they feel comfortable talking with, and to receive the benefit of a doula. I would not even be bitter if a colleague hired another doula and not me (I know I'm not the exact perfect fit for every woman!), because I would be glad that they'd have a great source of support and information.

Even though I am approaching the 5th anniversary of my doula training, I still cannot say that I've figured this aspect of being a doula out.

I actually wrote about this 3 years ago in a post called Banned from Baby Showers (inspired by another blogger). In this post I wrote,
I find it difficult not to share everything I've learned with everyone I encounter! I want to shout it all from the rooftops!
But I try to follow the wise advice that I quoted:
I decided a couple of years ago that it was probably more important to have friends than to educate them about why they shouldn't believe everything their OB says.
So for now I wiggle and squirm internally, watching friends post on facebook that they are reaching their due date and "why isn't baby born yet?!" Or listen to people say that their baby is too big. And I can't send them the information that pregnancy is not postterm until 42 weeks (especially in first-time moms), and that suspected macrosomia is not a medical indication for induction. And I feel sad when an acquaintance is induced with a healthy first time pregnancy and ends up with a C-section for failure to progress, as can be expected.

The activist part of me wants to say to everyone that they need to know this, because it will affect every future pregnancy, but I don't want people to shut me out. So I continue to share everything on my Anthro Doula facebook page and my doula services page where those who want to see it, can.

I know some birth professionals who would not cover their mouths - they would still talk to everyone and anyone about what they think. The thing is, I've seen people recoil from them. I don't want to lose potential people to help. Sometimes people ask for help in their own time and we have to let them. Others are more independent. Research has shown that women do not think that there is an issue with modern maternity care. I might talk like there obviously is and turn someone I am trying to help away, thinking I'm crazy.

I won't keep quiet in my professional life. I will still continue to be a birth activist and work towards improved maternity care and better births for all women. But around friends, I have to let them live their lives as they will. Friends who I don't want to unfollow or avoid me will continue to not be hit with unsolicited information or advice. I am here if they need me.


Has anyone else figured this out in their lives? Do you have any advice for birth professionals who struggle with this issue? 



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