Thursday, June 26, 2008

Canada is getting it right!

I am out the door to a seminar in Chicago, but this is so exciting. Read what the Society of Obstetricians and Gynecologists of Canada are saying about their rising Cesarean Rate and how it needs to come down! SOGC

Three cheers!!

Thursday, June 19, 2008

GBB instead of EDD or EDC!


An observant doula posted on a list-serv I am on, that it seems that current maternity care has shifted from using EDC (Estimated Date of Confinement: how is that for an old term!) or EDD (Estimated Due Date/Expected Date of Delivery/and even more terms when you google it!) to a GBB (GIVE BIRTH BY). The induction rate is skyrocketing while improved outcomes are not.

When I am teaching I like to have people in the class do mini-presentations on different interventions. I provide a packet of reliable, evidenced based information and am always on the lookout for new brochures/studies to add to the portfolio. I found it interesting today when I printed out the patient information brochure from ACOG (American College of Obstetricians and Gynecologists). It says:
Following are examples of conditions that may be a reason for inducing labor:
Your pregnancy is postterm (more than 42 weeks).
You have high blood pressure caused by your pregnancy.
You have health problems that could harm you or your baby.
You have an infection in the uterus (chorio-amnionitis).
You have abruptio placenta (the placenta has begun to separate from the inner wall of the uterus before the baby is born).
You have premature rupture of membranes (your water has broken


Postterm = more than 42 weeks! When was the last time someone in your class wasn't labeled POSTTERM until after 42 completed weeks? To see the brochure, go to ACOG
Needless to say, the brochure is going in the folder as a resource. Obviously having something from ACOG might be helpful when a woman is advocating not to be induced. (Please note that large baby is NOT on the list!) So I would love the trend to swing away from GBB (give birth by) and the focus on a specific day, to a more general target like a DUE MONTH.....or if we have to have a GBB, move it to the first day after 42 completed weeks!

Wednesday, June 18, 2008

Great resource for parents


This is a great booklet that Nova Scotia Department of Health Promotion has developed that I think is an asset for childbirth educators. If you are following my recommendation and sending out email messages after each class, this could easily be an attachment when you cover babies!

Nova Scotia Loving care

Sunday, June 15, 2008

Congrats to BF advocates in WA (and Alaska, Montanta and Oregon)

The figures are out - these four states have reached all five of the Healthy People 2010 objectives! (interesting geographic trend when you think of it Alaska, Washington, Oregon, Montana)

The revised Healthy People 2010 breastfeeding targets using CDC
National Immunization Survey data, are as follows:

Objective 16-19

Increase the proportion of mothers who breastfeed their
infants:

* in the early postpartum period to: 75%
* at 6 months to: 50%
* at 12 months to: 25%
* exclusively for 3 months to: 40%
* exclusively for 6 months to: 17%


So what are hospitals in other states doing that stops them from reaching those goals?

65% of facilities advised women to limit the duration of suckling at each breastfeeding, and 45% reported giving pacifiers to more than half of all healthy, full-term breastfed infants, practices that are not supportive of breastfeeding (7).

The lowest score (40) was for breastfeeding support after discharge. For this subscale, 70% of facilities reported providing discharge packs containing infant formula samples to breastfeeding mothers, a practice not supportive of breastfeeding (8). Although 95% of facilities reported providing a telephone number for mothers to call for breastfeeding consultation after leaving the birth facility, 56% of facilities reported initiating follow-up calls to mothers. Facility-based postpartum follow-up visits were offered by 42% of facilities, and postpartum home visits were reported by 22% of facilities.

For newborn feeding, 24% of facilities reported giving supplements (and not breast milk exclusively) as a general practice with more than half of all healthy, full-term breastfeeding newborns, a practice that is not supportive of breastfeeding (7,10). When asked whether healthy, full-term breastfed infants who receive supplements are given glucose water or water, 30% of facilities reported giving feedings of glucose water and 15% reported giving water, practices that are not supportive of breastfeeding. In addition, 17% of facilities reported they gave something other than breast milk as a first feeding to more than half the healthy, full-term, breastfeeding newborns born in uncomplicated cesarean births.


To read more CDC

Tuesday, June 10, 2008

Fear, fear, fear

A new study is out: Medscape article on Epidural

I just skimmed it and this was an interesting paragraph:
Of the women who delivered with epidural anesthesia, 76.5% chose to do so out of a desire for a pain-free delivery, 66.7% of them were afraid of the labor process, and 25.5% had previously had a negative delivery experience. In addition, 35.3% chose epidural analgesia based on the positive experiences of their friends, 29.4% wanted to have a normal delivery, and 31.4% wanted to be the first to see their baby

I think I had better read the rest.....but we really have to work harder at lowering women's fears!

Public comment time!

The National Quality Forum on the Obstetric and Neonatal Measures has released what they feel are important things to measure and want public review and comment. It's important for you to comment before June 11.

NQF comment In the left side bar, click on: Comment on National Voluntary Consensus Standards for Perinatal Care OR View Submitted Comment

So what is this all about? From the NQF website:

Pregnancy and childbirth is the second most common reason for hospital admission. Morbidity and mortality associated with pregnancy and childbirth is substantial and, evidence suggests, is largely preventable through the delivery of high quality perinatal care and adherence to evidence-based guidelines. To date, however, NQF has endorsed very few consensus standards that assess the quality of care for mothers and babies. The purpose of this project is to achieve voluntary consensus on a set of performance measures that can be used to assess the quality of perinatal care in the United States. In March and April 2008, the Perinatal Care Steering Committee reviewed 33 candidate performance standards and recommends 18 for NQF endorsement.

Childbirth Connection has identified concerns about five of the measures recommended for endorsement. So if you are thinking about commenting (come on, be active!) Read here: NQF Comment. Read background about what all this means and Childbirth Connection's letter and draft report here: childbirthconnection.org The five concerns are:
1) the percentage of C-sections among low-risk women giving birth for the first time;
(2) the percentage of elective deliveries prior to 39 completed weeks' gestation;
(3) hospital support of breastfeeding;
(4) rate of episiotomy; and
(5) the percentage of infants screened for jaundice prior to hospital discharge.

One Million Mothers Helping to Raise One Million Dollars—One Dollar at a Time



Mothering Magazine has put an appeal out: If one thousand mothers donate one dollar and then each passes this story to all the mothers she knows, and these mothers donate one dollar, and pass this effort to all the mothers they know, we will reach a million mothers, raise a million dollars, and have built a birth clinic one mother at a time.

Learn how to donate

Learn about Robin Lim and her Birth Center in Bali
More info

Sunday, June 08, 2008

Time to wear your pearls!


Edwina Froelich, one of the founders of La Leche League International died this morning. On one of the lists I am on, it was suggested that we all wear our pearls this week in honor of her. As a retired LLL leader, I think I will wear mine!
The idea about wearing pearls comes from the book "The Revolutionaries Wore Pearls" the story of the beginnings of La Leache League in the mid 1950's when ladies did not go out without their pearls and hats.

To learn more about her life and to consider making a donation in her memory, go to LLLI

World Breastfeeding Week



World Breastfeeding Week is celebrated in most areas of the world in August. The theme this year obviously relates to the Olympics. I enjoyed going to the WBW website - they had a video You Tube contest and the winners are there. They are even having a Virtual Torch Run based on pledges of support. What can happen on the web is truly amazing! World Breastfeeding Week

Saturday, June 07, 2008

momScore

I somehow missed writing about this - but there is a new service that ranks states according to the following:
* Access to prenatal care
* Maternal mortality
* Risk of pregnancy complications
* Availability of child care services
* Infant mortality
* Air quality
* Violent crime rate
* Health insurance rate
* Affordability of children's health insurance
* Family paid leave policy

To see where your state ranked, check out momScore

Looks like we should move to Vermont?? There is a great Lamaze educator/belly dance/ breastfeeding advocate there - Dawn Kersula...
or maybe we should just try to improve where we live!
(and hopefully she won't mind I "borrowed" her picture from her public Facebook page!)

Thursday, June 05, 2008

Time to celebrate!

Today the Lamaze certification exam results were posted and my inbox has been overflowing with celebratory exclamations of "I passed"... needless to say, I thought they would. I am so proud!

And I thought I should finish my re-spin on the last three Lamaze care practices that support normal birth - from "features" to "benefits"...hopefully it will motivate you to look at your materials - are you describing features or benefits. Benefits are much more motivational! Read marketing materials - see what hits you to think about taking action - I bet it's the benefits!

No routine interventions: Be reassured you are getting individualized care based on your body, your baby and your birth!
Non-supine positions for birth: Feel efficient and strong while you push for a shorter period of time!
No separation of mother and baby after birth: Snuggle with your baby as you get breastfeeding off to an easier start!

Monday, June 02, 2008

Marketing benefits...not features!


As I am getting more and more concerned about the price of travel (and added fees for all the luggage I haul) I find that I am looking at marketing with a whole new light! And while I was looking through the piles of files, Molly Gordon's (authentic promotion) wise words surfaced. It was an old worksheet that was titled "It's About Them: Talk about the Benefits, not the Features" For a long time in seminars I have been talking about WIIFM for childbirth classes - What's In It For Me (participant.) And we need to make sure our marketing materials as childbirth educators focus on the benefits (WIIFM) not the features (ie not the topic list but what they will have at the end of the class series.)

Interestingly, the worksheet had the Lamaze Care Practices for Normal Birth on one side of the table listed as features with space on the other side to re-write them as benefits.

So currently Lamaze is promoting:
Labor Begins on Its Own....as educators we need to focus on the benefit which could be written as Be confident your baby is ready to be born while making labor easier.
Care practice: Freedom of Movement throughout labor. Refocus on the benefit: Shorten your labor and feel in control.
Care Practice: Continuous labor support vs Feel continuously supported.

Now it's your turn to see how you would focus on the benefits for the other three: No routine interventions, non-supine positions for birth and no separation of mother and baby after birth. I'll post my versions later!



Molly has a ton of great resources on her website and I would encourage you to sign up for her ezine! And I am working through her book and gaining a lot! E-zine