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New Year’s Resolutions

January 17th, 2011 by Debby

Ok, I realize that I am a little late. That is one of my problems. I get caught up in everyday activities and don’t take time to do some of the things that I want to do and know that I should do. For instance, reading my childbirth education journals. My new copy of the Journal of Perinatal Education arrived in the mail last week.  I sat down and “let” myself take the time to read it. I was reminded of how valuable it is to take advantage of this excellent resource. Each issue features a birth story and “Naomi’s Birth,” written by a nurse, is wonderful. Kathleen Kendall-Tacket’s guest editorial on the relationship between postpartum depression and breastfeeding is thought-provoking and has important implications for childbirth educators. In other articles, practitioners share strategies for increasing teaching about postpartum depression in the hospital and for increasing breastfeeding rates. There is more, including Amy Romano’s always excellent column; in this issue, on the importance of data.

On a roll, I went online and also read the latest edition of the ICEA Journal, The International Journal of Childbirth Education. I loved Kim James’s article on teaching what is possible versus what is probable . (Are you a “Dorothy,” a “Paula,” or a “Sarah?”) Nancy Mohrbacher helps us to look critically at swaddling and Robin Weiss provides valuable advice for setting up a Website. There is more, including another wonderful birth story and a book review of the new edition of Pregnancy, Childbirth, and The Newborn.

So I promptly made sure that both my memberships are current and resolved for 2011 to read the journals as they come out, not just when I’m researching a specific topic. I hope that you too are part of an international childbirth education organization such as Lamaze International and/or ICEA and that you too will resolve to take the time to read their journals and newsletters as they come out.

Patience Please!

December 7th, 2010 by Debby

How many times has a student in your childbirth class reported that she had a cesarean delivery because, at 5 cm of  dilation, labor stalled for 2 or 3 or even 4 hours? This could become a thing of the past if healthcare providers heed the advice of researchers from the NIH-supported Consortium on Safe Labor.

In a study published in the December edition of Obstetrics and Gynecology, researchers from the Consortium on Safe Labor found that normal labor may take more than 6 hours to progress from 4 cm to 5 cm and more than 3 hours to progress from 5 to 6 cm of dilation.

The Consortium for Safe Labor is a multicenter retrospective study that abstracted detailed labor and delivery information from electronic medical records in 19 hospitals across the United States. For this study, a total of 62,415 pregnant women were selected who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome. The study included both nulliparous and multiparous women; approximately half the women received oxytocin for labor augmentation; and about 80% received epidural analgesia. The majority of the women had a spontaneous vaginal birth. Surprisingly, researchers found that labor progress before 6 cm was similar for both nulliparous and multiparous women; only after 6 cm did labor progress faster for multiparous women.

Importantly, the researchers recommended that for our contemporary population, 6 cm rather than 4 cm may be a more appropriate landmark for the start of active labor. For both nulliparous and multiparous women, labor progressed at a much faster pace after 6 cm. The authors called for healthcare providers to allow labor to continue for a longer period before 6 cm in order to reduce intrapartum and subsequent repeat cesarean surgeries.

This study confirmed several earlier studies that also indicated that normal labor may take much longer than previously thought.

Important information for childbirth educators to know and to pass along to their students!

(Regarding patience: Thank you to our blog readers who have continued to check The Family Way blog over the last two months. Moving is hard work and very time-consuming! We plan to resume more frequent blog posts.)

A Baby’s 9 Instinctive Stages

October 14th, 2010 by Debby

There has been quite a gap since I last posted a blog. My husband and I found out about six weeks ago that we will be moving to Houston because of changes in his job responsibilities. My son, daughter-in-law, and two-year old grandson live there so we are delighted. But finding a new place to live, getting the house we’ve lived in for 20 years ready to sell, and getting ready to present at the recent Lamaze-ICEA MegaConference in Milwaukee left no time for blogging. But now we have a contract on a townhouse in Houston, our house is on the market, and the MegaConference is but a wonderful memory.

One of the topics that I discussed during my MegaConference presentation was a baby’s nine instinctive stages while skin-to-skin during the first hours after birth. Ann-Marie Widstrom, a Swedish researcher on skin-to-skin contact between mother and baby, described the nine stages that occur in the first hour or two after birth when a baby is placed immediately skin-to-skin with his mother. She (and many other breastfeeding experts) believe that if a baby is put skin-to-skin on the mother’s chest immediately after birth, without a delay for routine procedures, and left there undisturbed as he or she goes through the nine developmental stages at his or her pace, that the likelihood of breastfeeding success is greatly enhanced. I have a dear friend, Jeannette Crenshaw, who is doing her doctoral project on the impact of immediate, uninterrupted skin-to-skin contact on rates of exclusive breast milk feeding at hospital discharge. (Note: Exclusive breast milk feeding at hospital discharge is one of the new Joint Commission perinatal quality measures that went into effect on April 1st, 2010.)

At the hospital where Jeannette is conducting her project, DVDs illustrating the nine instinctive stages were shown to childbirth education classes, physicians, and nurses. Babies were placed immediately on the mother’s chest after most vaginal and cesarean births. As the mothers and babies were filmed, Jeannette was delighted to hear parents, physicians, and nurses identifying the nine instinctive stages that the babies went through. Staff were surprised to see that cesarean moms who had uninterrupted contact experienced fewer shakes and fewer episodes of hypothermia. She has not yet processed her data, but she is looking forward to exploring the influence of uninterrupted skin-to-skin contact on the rates of exclusive breast milk feeding at hospital discharge.

Here is something that childbirth educators can do to make a real difference! We know how important breastfeeding is to both a baby’s and to a mother’s health and well-being. We also know from the Listening to Mothers’ postpartum survey, New Mothers Speak Out, that too many mothers, especially cesarean mothers, who plan to exclusively breastfeed their babies are not doing so at the time of hospital discharge. If we teach our students about the nine instinctive stages and advocate at our hospitals for immediate, uninterrupted skin-to-skin care until the first feeding is accomplished, we can increase the number of mothers exclusively breastfeeding their babies.

You can read about Ann-Marie Widstrom’s research on the nine instinctive stages in an online article published September 14, 2010 in Acta Paediatrica. In this interesting article, Dr. Widstrom emphasizes the critical importance of not forcing the infant to the breast and of allowing the infant to proceed through the nine stages at his or her own pace. You can order a handout about the nine stages; a DVD, Breastfeeding: Baby’s Choice, for parents about the nine stages; and/or a DVD for staff, Skin to Skin in the First Hour after Birth – Practical Advice for Staff after Vaginal and Cesarean Births, from Health Education Associates, Inc. at www.healthed.cc/. Do what you can to help to increase your hospital’s rate of mothers exclusively breastfeeding at hospital discharge and to promote, protect, and support breastfeeding.

Anybody looking for a house in Plano, Texas?

Looking Back (Fondly)

September 8th, 2010 by Debby

As I look forward to the upcoming Mega Conference in Milwaukee celebrating the 50th anniversaries of both Lamaze International and ICEA, I am also preparing for an unexpected, but happy move to Houston where my son, Brian, and his family live. For the past two days, I have been going through my library of childbirth books. I have been active in the field of childbirth education for over thirty years and clearly I have held on to every book I ever bought!  It doesn’t make sense to move all of them to our new home which will have much less bookshelf space. But how do I give up any of them? So many of the books bring back happy memories of the excitement I felt as I read them and of the passionate discussions I had with other childbirth educators about them. For fun, I decided to create a list of the “Top Ten” books that influenced me as a young childbirth educator. (The books have to be twenty years old.) For those of you who are also “very experienced,” how many of these books do you remember? How would your list compare to mine?

1. Spiritual Midwifery (1977) by Ina May Gaskin

2. The Rights of the Pregnant Parent (1976) by Valmai Elkins – This is easily my most tattered (used often!) book.

3. Immaculate Deception (1975) by Suzanne Arms

4. A Good Birth, A Safe Birth (1992, ok, only 18 years old) by Diana Korte and my dear friend, Roberta Scaer

5. Changing Childbirth (1982) by Diony Young

6. The Complete Book of Pregnancy and Childbirth (1980) and anything else by Sheila Kitzinger

7. Silent Knife (1983) by Nancy Cohen and Lois Estner

8. Birth Without Violence (1975) by Frederick Leboyer

9. Why Natural Childbirth? (1972) by Deborah Tanzer

10. A Child is Born (first edition published almost 40 years ago) by Lennart Nilsson

In another twenty (or thirty!) years, I wonder what books, filmmakers, and bloggers will be mentioned by today’s young childbirth educators as having been most influential in their early years? Birth has certainly changed since I taught my first childbirth class – in some ways for the better and in many ways for the worse. But I am proud to have been a part of the childbirth education movement and look forward to continuing to work with my “sisters” in birth to promote natural, safe, and healthy childbirth.

How to Increase Attendance at Childbirth Classes

August 11th, 2010 by Debby

There can be no doubt that attendance is down at childbirth classes across the country. Prospective parents are relying on the Internet for information about pregnancy and birth and many feel that attending an in-person class will not be worth their time and money. I don’t believe that the Web and online learning can replace the magic that often occurs in high-quality childbirth classes. I am especially concerned about fathers – the likelihood that a pregnant woman and her partner will sit down in front of a computer at the same time so that they can process and discuss what they are learning is not high. Also, human nature is such that we seek out websites that confirm what we are already thinking. A woman who has been convinced by well-meaning friends that the best way to have a baby is by planning an induction and early epidural is not likely to spend a lot of time on a website or in an online class that touts the benefits of natural childbirth. However, in a good childbirth class with plenty of time for thoughtful discussions, this same woman may learn enough from both the instructor and the other parents in the class to open her eyes to all the options available to her. So how can we get her into class?

Here are a few suggestions:

1.  Hit the pavement – with food.

Jeanne and I used to run a community-based childbirth education program. Once a year, we’d visit each physician practice in our area at lunchtime. We’d bring lunch to the practices who referred the most women to us. Lunch was for the support staff as well as the physician. The in-person visit gave us the opportunity to discuss any problems or miscommunications as well as to inform the office about new classes we were offering. If the office nurse enthusiastically recommends your classes to all the pregnant women she sees, attendance at your classes will pick up. (We brought cookies to the other offices.)

2. Consider offering yoga, movement, and/or exercise classes.

Women are into fitness these days. If you schedule classes at times that fit into their busy schedules AND market your classes to health care providers, you will get women into class. We’ve heard about one childbirth educator who offers a “movement” class – a combination of yoga, belly dancing, and prenatal exercise. It sounds like fun. Once you have them in one class, you can often sell them on other classes.

3. Offer a wide variety of classes throughout pregnancy.

Rethink offering only a series of classes during the third trimester. Offer pre-conception classes and early pregnancy classes. Offer single classes on topics such as nutrition, what you need to buy for the baby, prenatal testing, baby-wearing. The possibilities are endless. Signing up for just one class isn’t as intimidating as committing to a series of classes. If the students find one class worthwhile, they may sign up for other classes. Weave information about safe and healthy birth into every class. If you have enough students, try to group students into classes by due dates so that they see familiar faces in their classes. In order to promote safe and healthy birth, you really want to get them into a class or classes that will help them plan for the birth practices that best promote safe and healthy birth. Attending a class like this will lead to a class on comfort measures. Get the point?

4. Supplement your classes with today’s technology.

Have a website with supplementary materials and links to reputable and trustworthy websites. (The Family Way ‘Web-It” feature on our website does this.) Text your students between classes in a series with teasers or questions to think about before the next class.

5. Work hard to make your classes the best they can be.

Don’t get lazy and keep doing the same things. If your classes are fun AND help women and their partners to have safe and healthy births, word will spread!

If you have found strategies that have helped to increase attendance at your classes , or if you have not experienced a drop-off in attendance, please share what you have done. I hope to hear from a lot of you.

In Honor of World Breastfeeding Week

August 3rd, 2010 by Debby

I wanted to write something special to celebrate World Breastfeeding Week. But I really love my post from last year and decided that it is worth repeating (for at least one more year).

In honor of World Breastfeeding Week, I’d like to share one of my favorite personal breastfeeding stories. When my son Ben was a junior in high school, he took speech. One night he locked himself in my office to work on his “persuasive” talk. He wouldn’t tell me the topic. After he left the room, nosy mom that I am, I looked through the trash and pulled out his crumpled drafts. Breastfeeding. My son, who was captain of the defense on his high school football team, gave a speech about why all mothers should breastfeed their babies. It started out, “This year xxx (number) babies will die worldwide because they were not breastfed. This year, in the United States, xxx (number) of babies will die because they were not breastfed.” I don’t think I’ve ever been so proud of him. His speech teacher thought he was kidding when he told her his topic. Probably it’s good that he was a big, burly football player. In high school culture, I don’t know how many boys could get away with extolling the merits of breastfeeding in front of their peers. But no one made fun of Ben.

Wouldn’t it be nice if we lived in a society where breastfeeding is so much a part of normal culture that no one has to make persuasive speeches about it? Where hospitals are all baby-friendly? Where mothers are never asked to leave public places in order to nurse their babies? Where breasts are most appreciated for their ability to nourish and nurture rather than to titillate?

According to the World Health Organization, today we could save 1.3 million children’s lives by teaching women around the world how to breastfeed. This week, I hope that you will join with your co-workers to celebrate World Breastfeeding Week. Take an additional step and visit the website of the U.S. Breastfeeding Committee (or the organization that promotes breastfeeding in your country if you are outside the U.S.) to discover what you can do to promote, protect, and support breastfeeding. It can save lives.