Wouldn't it be wonderful if there was a show on TV that gave women evidence-based information about the risks and benefits of various pregnancy and birth options and empowered them to make informed decisions about their care?
Oprah is currently searching for contestants for her "Your Own Show" reality series, which will be a competition to win their show idea a spot on Oprah's new network. Kerry Tuschhoff, founder and president of Hypnobabies, submitted her audition video to the contest, but the video must makes it into the top 5 most voted-for videos for her to be considered for the realityshow. Please watch her video and vote for her show idea, Every Mother, Every Baby. If you don't mind registering for the site, comments on the video would also be helpful so that everyone can know why you support the idea. Voting lasts until July 3rd!
The more votes the audition video gets, the more attention this issue will gather, so please pass the link on!
Wednesday, June 30, 2010
Sunday, June 27, 2010
How Midwifery Care Can Reduce Racial Disparities In Birth Outcomes
At the request of Courtroom Mama posting at The Unnecessarean, I watched the documentary Crisis in the Crib: Saving Our Nations Babies. I think the film does a great job of raising awareness on the issue of racial disparities in birth outcomes and infant mortality in the United States. It really got me thinking about what factors contribute to this disparity. I think it is a very complex problem, and it can be difficult to pinpoint all of the causes. Poor nutrition, lack of exercise, and lack of access to care are all factors, but they don't explain why there is still a disparity for babies of college educated black women. The film suggests higher stress levels and the lack of presence of a supportive partner as possible additional factors that could influence middle class populations. There are also some life-course factors.
As I was considering these factors and trying to decide what to write this blog post about, I remembered this video from last year's The Big Push for Midwives Issue Briefing for members of Congress showing Jennie Joseph, LM, CPM talking about her birth center, The Birth Place, in Orlando, Florida.
As I was considering these factors and trying to decide what to write this blog post about, I remembered this video from last year's The Big Push for Midwives Issue Briefing for members of Congress showing Jennie Joseph, LM, CPM talking about her birth center, The Birth Place, in Orlando, Florida.
It's pretty clear that The Birth Place has drastically fewer racial disparities than her area's average. She attributes the difference to their care being more accessible to the uninsured, but I think that is only part of the story. I believe that the obstetric model of care, which is the norm in the U.S., is failing black women. Here are some components of the midwifery model that I believe may better meet their needs:
- Focus on Preventing Complications with Healthy Lifestyle - While obstetric practices generally focus mostly on screening for pathology, midwifery care includes extensive counseling on nutrition and exercise during pregnancy. This approach integrates prevention of problems.
- Individualized Care - Midwives strive to make their care specific to the needs of individual women instead of providing one-size-fits-all care that may be more suited to one race than another.
- Holistic Treatment - Midwifery care treats the whole woman, not just her body. Prenatal care that is only a medical check up is a missed opportunity to resolve other issues that could contribute to disparities, including social and emotional stresses in the woman's life.
- Longer Prenatal Visits - The average length of a midwife visit is significantly longer than one with a physician. This allows more time to focus on these issues and develop a trusting caregiver/client relationship.
- Relaxation Practice - Birth centers do not offer epidurals, so midwives at a birth center would encourage women to prepare for a natural birth. In fact, State of Florida Law requires that birth centers counsel their clients to receive appropriate childbirth education. This preparation usually involves relaxation practice, which can be helpful for dealing with stress.
- Empowering Education - Midwifery supports women in being educated and involved in decisions about their care instead of letting the birth professional make most of the choices for them. This can help them learn to take responsibility for themselves and their babies, both during and after the childbearing cycle.
Thursday, June 24, 2010
A Natural Third Stage?
The idea of active management of the third stage has never sat right with me. Even before I developed my interest in natural childbirth. When I was pregnant with my daughter, I was taking one of the hospital classes I talk about that are not so great. The nurse who was teaching the class told us that after our babies were born, we would be getting pitocin in our IVs to help the placenta come out and help the uterus clamp down to put pressure on the placenta site to prevent too much bleeding. I asked if you can decline it and she acted like that would be a stupid thing to do, because why would you want to risk bleeding too much and before we had it a lot of women died from hemorrhage.
It just didn't seem right to me. I didn't like the idea of having a medication to prevent a complication that only might happen. This was part of my reasoning behind changing providers and hospitals. My CNMs told me that with an unmedicated birth, third stage pitocin is often unnecessary, so my birth plan said I didn't want it unless I started to hemorrhage. I ended up being induced with pitocin for that birth anyway, so it didn't matter.
When I moved to a new area while 3 months pregnant with my son, I called the hospital where I was planning on birthing for a recommendation for a provider who would be supportive of natural birth (they recommended Dr. I., who was awesome) and the nurse and I talked about the policies. She said that if I really didn't want an IV, they could do the postpartum pitocin as an IM injection instead and told me that in her 10 years as a nurse, she had never seen a woman not get pitocin after giving birth. When I met with Dr. I., I talked to her about this, and she brought up that breastfeeding really should work just as well as pitocin. She said she would support trying breastfeeding first.
So, then, I had an unmedicated birth, but they had to take my baby to the warmer to give him oxygen. Dr. I. waited until the placenta was out to see how much I bled, but it was too much, so I got both pitocin and methergine--I think it is possible that doing it later is why I needed both.
I wondered if perhaps I'm just a "bleeder" and will need pitocin for all of my births. I don't have a problem with it if it is actually necessary. Then Gloira Lemay shared with me an Australian article called Optimising psychophysiology in third stage of labour: theory applied to practice. I read the full article (link is to the abstract). I believe these authors are on to something, and I would love to see more research on this topic. You can read an interview with one of the article's authors at the Science and Sensibility blog.
The basic idea is that studies of "active management" and "expectant management" haven't really studied truly physiological third stages. The authors theorize that in order to produce the oxytocin surge necessary to help her uterus contract sufficiently to avoid hemorrhage, the mother needs to focus on her baby, holding him skin to skin, in a calm environment with little distraction. This is certainly different than how my 3rd stage was with my son, and I think it is likely pretty rare in a hospital setting.
In natural childbirth education, and especially with hypnosis, we try to help women produce the right natural chemicals in their bodies to promote smooth (and even comfortable) birthing in the first and second stages (though the second seems to be more difficult for some of us). There is scientific evidence that the mind and body are connected and our thoughts and feelings have direct effects in our bodies (the research of Dr. Candace Pert on neuropeptides is one example). We strive for a relaxed, comfortable state of mind to promote oxytocin and endorphins in the first two stages--it makes sense that the same sort of mental state would be necessary for a natural third stage. Third stage is still part of birth, and it's important for both women and their caregivers to recognize this.
The belief of the L&D nurses I have spoken with seems to be that an unmedicated third stage with a small amount of bleeding would be an exception. It seems to me that under the right conditions, a gentle, hands-off approach could make postpartum hemorrhage the exception rather than the rule. According to Gloria Lemay, it works.
In order to accomplish a natural third stage, separation of mother and baby must be avoided whenever possible. This is easy if you don't cut the cord right away. Check out Navelgazing Midwife's recent post on the gross practice of using shoestrings to clamp the cord in unplanned out-out-of-hospital births. And for more on keeping mother and baby together, check out the recently posted Healthy Birth Blog Carnival #6: MotherBaby Edition
be sure to check out my new follow up to this post: Physiological Third Stage, without the "as long as"
It just didn't seem right to me. I didn't like the idea of having a medication to prevent a complication that only might happen. This was part of my reasoning behind changing providers and hospitals. My CNMs told me that with an unmedicated birth, third stage pitocin is often unnecessary, so my birth plan said I didn't want it unless I started to hemorrhage. I ended up being induced with pitocin for that birth anyway, so it didn't matter.
When I moved to a new area while 3 months pregnant with my son, I called the hospital where I was planning on birthing for a recommendation for a provider who would be supportive of natural birth (they recommended Dr. I., who was awesome) and the nurse and I talked about the policies. She said that if I really didn't want an IV, they could do the postpartum pitocin as an IM injection instead and told me that in her 10 years as a nurse, she had never seen a woman not get pitocin after giving birth. When I met with Dr. I., I talked to her about this, and she brought up that breastfeeding really should work just as well as pitocin. She said she would support trying breastfeeding first.
So, then, I had an unmedicated birth, but they had to take my baby to the warmer to give him oxygen. Dr. I. waited until the placenta was out to see how much I bled, but it was too much, so I got both pitocin and methergine--I think it is possible that doing it later is why I needed both.
I wondered if perhaps I'm just a "bleeder" and will need pitocin for all of my births. I don't have a problem with it if it is actually necessary. Then Gloira Lemay shared with me an Australian article called Optimising psychophysiology in third stage of labour: theory applied to practice. I read the full article (link is to the abstract). I believe these authors are on to something, and I would love to see more research on this topic. You can read an interview with one of the article's authors at the Science and Sensibility blog.
The basic idea is that studies of "active management" and "expectant management" haven't really studied truly physiological third stages. The authors theorize that in order to produce the oxytocin surge necessary to help her uterus contract sufficiently to avoid hemorrhage, the mother needs to focus on her baby, holding him skin to skin, in a calm environment with little distraction. This is certainly different than how my 3rd stage was with my son, and I think it is likely pretty rare in a hospital setting.
In natural childbirth education, and especially with hypnosis, we try to help women produce the right natural chemicals in their bodies to promote smooth (and even comfortable) birthing in the first and second stages (though the second seems to be more difficult for some of us). There is scientific evidence that the mind and body are connected and our thoughts and feelings have direct effects in our bodies (the research of Dr. Candace Pert on neuropeptides is one example). We strive for a relaxed, comfortable state of mind to promote oxytocin and endorphins in the first two stages--it makes sense that the same sort of mental state would be necessary for a natural third stage. Third stage is still part of birth, and it's important for both women and their caregivers to recognize this.
The belief of the L&D nurses I have spoken with seems to be that an unmedicated third stage with a small amount of bleeding would be an exception. It seems to me that under the right conditions, a gentle, hands-off approach could make postpartum hemorrhage the exception rather than the rule. According to Gloria Lemay, it works.
In order to accomplish a natural third stage, separation of mother and baby must be avoided whenever possible. This is easy if you don't cut the cord right away. Check out Navelgazing Midwife's recent post on the gross practice of using shoestrings to clamp the cord in unplanned out-out-of-hospital births. And for more on keeping mother and baby together, check out the recently posted Healthy Birth Blog Carnival #6: MotherBaby Edition
be sure to check out my new follow up to this post: Physiological Third Stage, without the "as long as"
Sunday, June 20, 2010
Learned Helplessness Part II
As I was searching the net for info for my first Learned Helplessness post, I came across an article on a Buddhism site by Buddhist teacher Ken McLeod that talks about learned helplessness in systems run amok.
McLeod next explains how learned helplessness perpetuates patterns of abuse within systems (such as boyfriend/girlfriend relationships or families).
McLeod's article says that the only way to overcome learned helplessness as passivity to a system is to sever all ties with the system.
Learned helplessness results from being trained to be locked into a system. The system may be a family, a community, a culture, a tradition, a profession or an institution.He explains that systems sometimes distort their original purposes, but people are still expected to function in the system, because the system itself has power.
Initially, a system develops for a specific purpose. But as a system evolves, it increasingly tends to organize around beliefs, perspectives, activities and taboos that serve the continuation of the system. Awareness of the original purpose fades and the system starts to function automatically. It calcifies. The beliefs, perspectives, activities and taboos shift in subtle (and sometimes not so subtle) ways, to ensure continuation. And those beliefs, perspectives, activities and taboos are trained into the people that comprise the system.
The system uses shame and the withdrawal of attention to instill a fear of survival. Simultaneously, the system presents the view that power resides in the system, not the individual. The combination creates a dependence on the system for survival. Gradually, the system is internalized and the person identifies with it -- he sees himself the way the system sees him. His sense of who he is is defined by the system. (We see this tendency very clearly in the professions -- "I'm a doctor, so I do x, y and z" or "I'm an attorney, so I do x, y and z.")"The system" could here refer to a maternity care system, in which physicians are expected to act one way and patients another. The system developed for the purpose of helping mothers and babies, but in some ways, it has shifted its focus to perpetuating itself, by keeping the system functioning and keeping the way it functions the same.
McLeod next explains how learned helplessness perpetuates patterns of abuse within systems (such as boyfriend/girlfriend relationships or families).
Whenever we are subjected to abuse, physical, emotional or spiritual, two patterns form inside us: the victim and the abuser. Our experience of being abused lays the basis for the victim pattern. Our experience of how abuse can be meted out lays the basis for the abuser pattern. Both give rise to learned helplessness, though the learned helplessness manifests differently. In the case of the abuser, learned helplessness might manifest as "Something just took over; I didn't mean to say or do that." In the case of the victim, it might manifest as "I don't know why I put up with it but I can't seem to do anything about it." In both cases, we are expressing passivity with respect to the patterns operating in us. In both cases, we are confessing helplessness.In the functioning of a maternity care "system", the provider is in a position of authority and the patient is subservient. We follow the patterns of behavior that the system expects from us because our brains recognize this as normal. We have been trained to believe that people in authority are there to help us and that we should listen to them. So, even if our own research or personal beliefs tells us otherwise, we may still go along with what our provider says (or even what we believe they think) we should do--agree to have a test done, schedule an induction, have a vaginal exam, push in the bed, whatever--because we are passive in respect to the system. It is not a fear of the care provider per se, but a fear of doing something that doesn't fit in the construct of a system. The system makes us feel powerless to act differently than its pre-determined role for us.
McLeod's article says that the only way to overcome learned helplessness as passivity to a system is to sever all ties with the system.
Thursday, June 17, 2010
Learned Helplessness
In my studies of early childhood education in college, I learned the term learned helplessness. In education, we usually used the term to describe children who constantly ask others for help and say that they "can't" preform tasks on their own.
The term learned helplessness originates from the research of Martin Seligman and Steve Maier at the University of Pennsylvania in 1967. Seligman and Maier used shock harnesses on dogs in three groups. Group 1 was the control group, who wore harnesses but received no shocks. Groups 2 and 3 both received shocks from their collars and both had levers they could push. In group 2, the lever stopped the shock, but in group 3, the lever didn't do anything--those dog's collars were activated by the levers controlled by group 2 dogs. The group 3 dogs stopped trying to push the levers and developed depressive symptoms. Then, the same dogs were put in another situation where they were the dogs could stop the shocks by jumping over a low partition. About two thirds of the dogs from group 3, did not try to escape the shocks. They had learned from the previous experiment that they were powerless against them.
Learned helplessness is used to explain depression in humans. When people come to believe that their actions have no impact on their environments ("no matter how hard I try, I always end up with the same negative result") or they come to see failure as a result of some intrinsic flaw in them ("I couldn't do it because I can never do anything right"), they lose motivation because they believe that they have no power to influence their lives.
I believe that a culture that has an over-reliance on epidural-managed childbirths promotes learned helplessness in women. My doula friend Judi Hull told me that childbirth education that highly promotes epidural use "take[s] ... women's power away from them." She feels that going through the experience of childbirth unmedicated can be self-esteem building for women. Medically controlled childbirth takes away from women not only control of the process of birth, but also power to overcome the obstacle of birth using their own tools. When women feel that they "can't" do childbirth without medical help, what else might they later feel they "can't" do? If women develop a dependency on anesthesiologists to get them through birth, how does this influence their ability to think for and act for themselves as mothers and women?
In my next post, I will share some more ideas about how learned helplessness can develop and how it functions in maternity care systems.
http://www.flyfishingdevon.co.uk/salmon/year2/psy221depression/psy221depression.htm
The term learned helplessness originates from the research of Martin Seligman and Steve Maier at the University of Pennsylvania in 1967. Seligman and Maier used shock harnesses on dogs in three groups. Group 1 was the control group, who wore harnesses but received no shocks. Groups 2 and 3 both received shocks from their collars and both had levers they could push. In group 2, the lever stopped the shock, but in group 3, the lever didn't do anything--those dog's collars were activated by the levers controlled by group 2 dogs. The group 3 dogs stopped trying to push the levers and developed depressive symptoms. Then, the same dogs were put in another situation where they were the dogs could stop the shocks by jumping over a low partition. About two thirds of the dogs from group 3, did not try to escape the shocks. They had learned from the previous experiment that they were powerless against them.
Learned helplessness is used to explain depression in humans. When people come to believe that their actions have no impact on their environments ("no matter how hard I try, I always end up with the same negative result") or they come to see failure as a result of some intrinsic flaw in them ("I couldn't do it because I can never do anything right"), they lose motivation because they believe that they have no power to influence their lives.
I believe that a culture that has an over-reliance on epidural-managed childbirths promotes learned helplessness in women. My doula friend Judi Hull told me that childbirth education that highly promotes epidural use "take[s] ... women's power away from them." She feels that going through the experience of childbirth unmedicated can be self-esteem building for women. Medically controlled childbirth takes away from women not only control of the process of birth, but also power to overcome the obstacle of birth using their own tools. When women feel that they "can't" do childbirth without medical help, what else might they later feel they "can't" do? If women develop a dependency on anesthesiologists to get them through birth, how does this influence their ability to think for and act for themselves as mothers and women?
In my next post, I will share some more ideas about how learned helplessness can develop and how it functions in maternity care systems.
Sources:
http://en.wikipedia.org/wiki/Learned_helplessness
http://www.noogenesis.com/malama/discouragement/helplessness.htmlhttp://www.flyfishingdevon.co.uk/salmon/year2/psy221depression/psy221depression.htm
Tuesday, June 15, 2010
More on Overcomming Fears: The OCD Project
Recently, my husband and I were watching VH1's "The OCD Project," which documents a 21 day treatment camp for people with obsessive-compulsive disorder run by Dr. David Tolin. OCD actually has a lot to do with extreme irrational fear. Much of the therapy in the show involves them facing their fears.
The OCD Project Supertrailer
In the tailor, you see a clip where the patients are writing down their fears about what might happen if they don't do their OCD rituals. On the episode, Dr. Tolin has them read what they wrote into a tape recorder. He then uses these recordings as voice-overs for videos he makes called "fear movies"--images depicting their worst fears. He has them watch these films wearing a heartrate monitor, as increases in heartrate indicate anxiety. The films play twice, and during the first run, all of the patients had increases in heart rate in response to seeing their fears. Their rates stabilized when the film ended and then when it played again, their heartrates remained stable because it became less scary after they had seen it--exposure decreased anxiety.
This exercise reminded me of the Fear Release exercise in Hypnobabies, which involves visualizing watching your fears on a screen. I realized that part of how this exercise works is that by seeing our fears, we become less afraid of them.
The OCD Project Supertrailer
In the tailor, you see a clip where the patients are writing down their fears about what might happen if they don't do their OCD rituals. On the episode, Dr. Tolin has them read what they wrote into a tape recorder. He then uses these recordings as voice-overs for videos he makes called "fear movies"--images depicting their worst fears. He has them watch these films wearing a heartrate monitor, as increases in heartrate indicate anxiety. The films play twice, and during the first run, all of the patients had increases in heart rate in response to seeing their fears. Their rates stabilized when the film ended and then when it played again, their heartrates remained stable because it became less scary after they had seen it--exposure decreased anxiety.
This exercise reminded me of the Fear Release exercise in Hypnobabies, which involves visualizing watching your fears on a screen. I realized that part of how this exercise works is that by seeing our fears, we become less afraid of them.
Monday, June 14, 2010
16-year old doula shares her story
I was very touched by this passionate young woman's journey to becoming a doula. It is very inspiring to read from someone so young who has educated herself about the world of childbirth and understands the risks of medical interventions. She is even already involved by providing information for teen moms and attending births during her summer vacation! What an awesome girl!
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