America Scores a “D” on the Premature Birth Report Card
November 17, 2009
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Our Cesarean Section Rates still Below the National Average
October 28, 2009
I had checked out a post by Jill from Unnecesarean reviewing ICAN’s Press release on the rising Cesarean Rate and how mom’s really don’t realize or recognize how they can reduce their risk for a surgical delivery. It is very good informative post. It’s just totally shameful and pathetic that one third of our nation’s babies are brought in to this world with a surgical delivery! I’ve been present for thousands of births. I remember when the doctors were under pressure to keep their C/S rates down under 20%!! They had to go under peer review when they hit individual rates over 16%. Those days are over.
I have seen many different changes in the field of obstetrics, I am embarrassed that our national rates are now this high! I don’t feel that this is an advancement in maternal fetal obstetrical care. It feels like such a cop out most of the time when you are there in the trenches experiencing the “call” for a C/S time after time for “failure to progress”; “failure to descend”; “arrest of dilitation” etc…etc..
I came across the perinatal statistics and thought I’d share.
Here are our Actual Cesarean Section Rates so far this year January thru September
for nearly 750 births:
- Total C-Section Rate = 25.8% (monthly range 16.9% to 34.4%)
- Primary C-Section Rate = 16.4% (monthly range 12.5% to 23.6%)
- Primary Rate in labor = 13.4% (monthly range 8.9% to 20.0%)
Our average is about a quarter of the births falling below the national average of a third… for now. Can we keep this up?? I hope so. I really hope so. I hope we can even lower it! With a NICU coming in and sicker patients to go along with that… I am hopeful to just keep it where it is. I will do my best to help educate women, co-workers and the doctors I work with.
Funny Breastfeeding Cartoons for Wordless Wednesday
October 21, 2009
More Breastfeeding Cartoons by Neil
for Wordless Wednesday!
These cartoons were purchased nearly 20 years ago for slide presentations and breastfeeding education.
We Deliver? How about we make it a better delivery?
October 20, 2009
permission from CartoonStock
Our Maternity Services
Need Help!
The Maternal Child care delivery system in this country as a whole needs vast improvement. All of these 10 steps as well as the 10 steps to ensure optimal successful breastfeeding are very important.
These items are sadly grossly misconstrued or ignored by many facilities offering maternity services in this country. I have been having the same discussions and occasional arguments with co-workers lately on this battle of the newborn baby staying in the moms room overnight!!! I know~ it is a no brainer to those of you who read, research and understand. Many of my co-workers still defend their philosophy that the baby needs to come into the nursery at night so the mom can sleep!! Many argue with me about labor positions and inductions!! AARRGGHH! I won’t get into our details right now…….
What I have here for you today is NOT new info but I recently reviewed it again as I was searching for evidence to back my discussions with staff. If you haven’t placed this information in your workplace to nudge some resistant peers, I urge you to do so!
This document : THE COALITION FOR IMPROVING MATERNITY SERVICES:
EVIDENCE BASIS FOR THE TEN STEPS OF MOTHER-FRIENDLY CARE can show you research studies or data which support the ten steps below.
The 10 steps for Mother-Friendly Care from CIMS {Coalition for Improving Maternity Services} taken from their website…..are:
Ten Steps of the Mother-Friendly Childbirth Initiative
For Mother-Friendly Hospitals, Birth Centers,* and Home Birth ServicesTo receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care.
A mother-friendly hospital, birth center, or home birth service:
- Offers all birthing mothers:
- Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
- Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
- Access to professional midwifery care.
- Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
- Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
- Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
- Has clearly defined policies and procedures for:
- collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
- linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
- Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
- shaving;
- enemas;
- IVs (intravenous drip);
- withholding nourishment or water;
- early rupture of membranes*;
- electronic fetal monitoring;
- Has an induction* rate of 10% or less;†
- Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
- Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
- Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
other interventions are limited as follows:
- Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
- Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
- Discourages non-religious circumcision of the newborn.
- Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
- Have a written breastfeeding policy that is routinely communicated to all health care staff;
- Train all health care staff in skills necessary to implement this policy;
- Inform all pregnant women about the benefits and management of breastfeeding;
- Help mothers initiate breastfeeding within a half-hour of birth;
- Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
- Give newborn infants no food or drink other than breast milk unless medically indicated;
- Practice rooming in: allow mothers and infants to remain together 24 hours a day;
- Encourage breastfeeding on demand;
- Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics
† This criterion is presently under review.
I endorse these steps. You can visit their website to also endorse.
Kathy from Woman to Woman Childbirth Education wrote about the CIMS press release on the Need for Transparency regarding the rising C/S rates. Excellent information is discussed here by the CIMS and I enjoyed the discussion between Kathy and RealityRounds.
I also would urge you all to visit and give information to The Birth Survey.
How is your birth place measuring up to these initiatives?
Let’s all continue to make this a better world
in which to give birth!!
**ROAR** on Breastfeeding Guilt
October 16, 2009
(Image found at Google Images)
**ROAR**
The Mommy Wars over feeding babies continue..I guess it won’t ever be truly over. I’ve been following a discussion over at NursingBirth on “Why Educating Our patients is a Professional Responsibility and Not about Guilt.”
I thank her for quoting me and including thoughts I wrote on what I have learned over the years talking to, educating and helping mothers.
I have re-posted this earlier segment “Breastfeeding, Bottle-feeding and Somewhere In-between… Why the Guilt?” This post is about what I have learned speaking from a professional point of view. As a professional, it is inappropriate for any of us to imply directly or indirectly to any mother trying to make feeding choices that breastfeeding and formula feeding are equal. They are not. Human milk is the superior species-specific food for Human infants. The recommended feeding hierarchy from the experts (AAP,CDC, WHO) is Breastfeeding, expressed mother’s milk, expressed donor milk then properly prepared infant formula. That’s why NursingBirth’s post is so important to understand. Reading the comments……
There are STILL moms out there confusing the issue.
All or most of this discussion is NOT directed at any mother who tried to breastfeed under any circumstance and wasn’t able to at all or wasn’t able to fulfill her individual goals. I applaud all your efforts for trying to give your baby the best food you could. I am so sorry that you experienced the difficulties you have. Your situation is not what this discussion is about. I think it’s very possible that advocates and some professionals lack sufficient skills to help you deal with the loss of a breastfeeding relationship. If breastfeeding is important to you then you would truly go through a grieving process and guilt would most likely come into play somewhere along the line. We do that to ourselves a lot as women anyway. I did personally experience that guilt. I had wanted to breastfeed my last baby for a full year and was unable to because of personal health problems. I had a lot of guilt. This discussion is NOT about these situations. Let’s stop making it about that. Please!
This mommy war guilt discussion as I see it is one where a mother who chooses to formula feed defends her choice and lays claim that those who are promoting or advocating breastfeeding make her feel guilty.
Guilt comes from within an individual if they feel they haven’t done what they “should” or wanted to. Guilt is a very strong emotion. NursingBirth has a great description of guilt as does The Feminist Breeder in “Mommy Guilt- Its all about Perspective.” It would be a good idea for guilt-ridden moms to read these articles. Those professionals or advocates who I have mentioned here or in my re-post are trying to do a good job of making sure people have the information to make educated decisions about health care issues. Any professional who intentionally tries to make a mother feel guilty isn’t being very professional. If there is an advocate out there continually finding moms feeling guilty, perhaps you should change how you deliver the message. I said in this earlier post about how one single word can make a difference:
“She needs to be comfortable and confident with her decision. Perhaps her guilt comes from how one single little word or sentence was said, even if what was said is accurate and true. Perhaps her guilt is coming from her own internal struggles. I don’t know. She needs to come to terms with that herself, and not punish herself and or publicly criticize the advocates saying they are causing the guilt. Although there are some very zealous advocates out there, I feel in my heart they are not trying to make any individual mother feel guilty. I read a comment from a mom somewhere that said something like… “perhaps if moms knew it wasn’t all or nothing, maybe more would try breastfeeding.” My first thought was..why do they even think that..are there really mom’s who feel it has to be all or nothing? Is this causing the guilt because they don’t think they can breastfeed exclusively for the first 6 months as the experts recommend??”
None of this changes the facts. Like it or not, breastfeeding is and will continue to be a major Public health Issue to the point of a public health crisis! As professionals and advocates, our work is not finished. I think sometimes that those speaking out against advocates get in the way of facts and put their personal opinions or views out in front and totally distort the issue. I read on someones blog this week (TFB) a great quote by Daniel P. Moynihan: “You are entitled to your own opinion, but not your own facts.” and I loved it!
According to this article from the American Journal of Public Health:
“Today’s medical community recognizes what their
predecessors knew a century ago—that the
American propensity to shun human milk is
a public health problem and should
be exposed as such.”
I am still going to promote breastfeeding. I am still going to provide appropriate factual information to the mothers in my care and support whatever feeding decision they make. I will never be pushy. I will gently encourage those on the fence to give breastfeeding a try. I always support the mother.
But more people need to talk about the importance of breastfeeding.
Because it is
Important.
Don’t be guilty
Stop it
*ROAR*
Repost~ The Guilt trip~ Breastfeeding, Bottle-Feeding and…. Somewhere In-between…. Why the Guilt?
October 16, 2009
There has been so much discussion circulating in the blogosphere right now about breastfeeding. I thought I’d add my 2 cents because….I have an opinion and….. I have just a little experience in this field both in study (2 year Lactation course, IBCLC for 10 years, current CLC) and in practice (35 years).
I thought I knew so much in 1988 after nursing 3 babies and assisting others for nearly 15 years. I actually thought I could just take the IBLCE exam based on my experience!
I was so ignorant and naïve!
I started to talk to some IBCLC’s and my eyes were opened wide to the real world. Up to that point, at that time, (I sadly and guiltily admit) I had no idea about the volume of study and research in the field of lactation. I had NO idea just how wrong we were doing things at my hospital.
I launched into a lactation course, soaking up all I could, 3 years of study preparing for certification. I set out to change the world… at least my world. I wrote big proposals for the hospital. I applied for grants to fund a lactation program. I developed education competencies for the staff. I started breastfeeding classes. I thought everybody shared my passion, that they too would want to learn …. because I was right!!
Instead I was the target of all the boob jokes you could think of and I had almost no support. My ideas were rejected left and right.
Long story short…it took me a long time to come to terms with accepting small changes, taking baby steps…..continuing to do the best job I could with each mother-baby couple and to keep a positive outlook. I needed to remain realistic about how much I could actually accomplish one step at a time. Slowly I began to have people under my wing trying to learn. Yeah!
I learned a lot about how to approach physicians, co-workers, managers and most of all …. mothers.
I am not an expert in journalism or critical analysis so this is my opinion of what is going on right now.
There have been some irresponsible journalists, those who have a bigger platform than most of us, writing negatively about something they have not studied or truly researched. They are expressing their opinion and including an emotional component which has, in my opinion, gotten the reaction they hoped for from breastfeeding advocates as well as those who concur with the authors. More hits, more readers. I feel they have twisted the facts to benefit or support a point they want to make. I read some of them.. other’s I really just scanned then brushed off so I don’t know everything that’s been said. On the positive side, these articles possibly give us a larger platform to provide correct information to a larger public in reply.
I read a lot of blogs and I really respect and admire all the research that many breastfeeding advocates put into their fabulous posts. These are educated women who are trying to provide current accurate information! (@phdinparenting, @bfmom, @MommyNews , @JakeAryehMarcus, @blacktating ,@AmberStrocel, and so many more). I applaud their passion and breastfeeding advocacy. They are doing a very important job. Breastfeeding IS very important and deserves advocacy, protection and support! There are still large scores of women out there making choices with only tiny bits of information, who really do not know the important benefits of breastfeeding. It is because of this, and because we still haven’t met the US Dept HHS Healthy People Goals for 2010, that breastfeeding advocacy needs to continue. I have been there, advocating in a time where I faced great adversity and a lot of negativity. I am bothered that it still exists…and exists now in so many new ways.
I am more disturbed that some mother’s out there are upset. I always try to understand just WHY a mom feels guilty if she chooses to formula feed or do some combination of formula and breastfeeding. I always hope she’s made her choice with good information and that it is her own true choice. Then good for her! I am not to judge. She needs to be comfortable and confident with her decision. Perhaps her guilt comes from how one single little word or sentence was said, even if what was said is accurate and true. Perhaps her guilt is coming from her own internal struggles. I don’t know. She needs to come to terms with that herself, and not punish herself and or publicly criticize the advocates saying they are causing the guilt. Although there are some very zealous advocates out there, I feel in my heart they are not trying to make any individual mother feel guilty. I read a comment from a mom somewhere that said something like… “perhaps if moms knew it wasn’t all or nothing, maybe more would try breastfeeding.” My first thought was..why do they even think that..are there really mom’s who feel it has to be all or nothing? Is this causing the guilt because they don’t think they can breastfeed exclusively for the first 6 months as the experts recommend??
Over the years, I have learned this:
- It is inappropriate for a health care professional to indicate to a mother directly or indirectly that formula feeding and breastfeeding are equal. Human breast milk is the superior food for human infants. Properly prepared infant formula is an acceptable substitute for those who cannot or choose not to breastfeed.
- The first approach is probably the number one factor in gaining a mother’s interest in what you have to say.
- The education process to a mother needs to be in small doses, sensitive to her unique learning abilities, her cultural beliefs and practices and most importantly, her choices and individual breastfeeding goals.
- With that in mind, try to provide her with the information she needs to make her decision.
- Never overestimate a mother’s desire to breastfeed her infant.
- Never underestimate a mother’s desire to breastfeed her infant.
- Listen to the mother; help her define her true desires and goals.
- Many times, the first question she asks may not be what she really wants to ask.
- The mother’s individual breastfeeding goals, how she defines them, how important they are to her and how she relates them to her actual breastfeeding experience all help define how she measures success.
- Support the mother, support the mother, and support the mother.
Here are the top 3 responses to the feeding choice question pertaining to breastfeeding at my facility on admission:
- “Breast and Bottle”
- “I’m going to do both”
- “I’m going to ‘try’ to breastfeed”
To each of these I respond very positively with something like… “Great! Tell me what you’ve learned about breastfeeding.” I will then ask the mom a few questions to somehow find out her true wishes.
Then I say “We will support and honor however you wish to feed your baby. I’d like to give you some information so you can really understand and then tell us what you’d like to do.”
I explain some things, i.e.: how the milk production works, the importance of early feeds etc.. and how formula introduced at that time could interfere with the process of production, the baby’s ability to latch properly and so on… I usually end with..”We usually recommend to focus on breastfeeding for now and then offer bottles later after milk supply is established if that is how you’d still like to manage feeding”. ETC…ETC…. Here’s what I then see:
- There have been so many mom’s who — after a little bit of information decide they would like to focus on breastfeeding. There have been many who totally fell in love with it.
- There have also been many who really didn’t want to breastfeed after one single feeding.
- There are many many still that like to breastfeed and bottle feed in combination right from the start. If they have the right info and understand how things may progress… I still say “Good for you!”
- I have seen many continue that way for months and they are very happy with that.
- I’ve seen many mom’s “partially” ( I don’t like to say it that way) breastfeed and feel very proud. I say “good for you!” They don’t think of it in terms of “exclusive” or “partial”… It’s more like any breast at all…. is breastfeeding vs. no breastfeeding at all.
- There have been many who also never wanted to try until all of a sudden they see milk leaking!
- I’ve worked with mom’s where I can see tremendous improvement in her situation, I think she’s going to keep going…but she decides to totally quit. I simply praise her for all her efforts and help her feel proud of herself.
- I’ve worked with mom’s who have hardly put forth any effort to overcome small obstacles, I think they will probably quit outright… Then..I find out they are the ones exclusively breastfeeding down the road.
I got a comment from a breastfeeding mom @TheFeministBreeder that I absolutely have to share. She describes her own experience in the full comment and on her new blog post. She comments:
“Yes, I think that’s the most important part – informing a mother of any and ALL benefits/risks to supplementing, and helping them work through the option they choose. But to tell a mother to supplement without explaining that it could undermine her efforts is just plain mean. And too many medpros are doing it. I’m glad there are more nurses like you who will give out the real information to empower a woman to make her own choice. My smart friend always says ‘It’s not really a choice if you don’t have all the information.’ “
For those mom’s really trying to breastfeed and struggling, there’s more than I can say right here to cover that. I’m sorry for your struggles and hope it gets easier for you. It is important to have a skilled competent support person assisting you who listens thoughtfully and helps you get to the root of your problem… and helps you define and realize your goals. If you are experiencing guilt from your struggles or from not being able to fulfill your goals, desires to breastfeed….I think that kind of guilt is different from what I’m trying to discuss here. I am not a an expert on that. It is valuable to get the best help out there that you can as soon as possible.
I’m adding this after reading some comments on other blogs.. When approaching a mom to observe or assist with the latch process…. Permission is a must! I ALWAYS ask the mother if she would like any assistance with the latch or if I may observe how well her baby is latching….. If that answer is yes… The next question is ALWAYS.. May I touch your breast? (if that needs to part of the process). I prefer to help moms by having the mom and BABY do the latch. I try to keep my hands out of it. All nurses and LC’s should practice this. I am sorry for the mom’s who aren’t asked permission to be helped or touched. :(
One of my favorite things I like to say to any breastfeeding mom is:
“Try not to make any final decision when it’s dark outside”.
On another note, regarding some reader comments on various blogs about public breastfeeding, a skimpy bikini or the bathing-suit issue of a favorite sports magazine show more skin in a provocative, sexy way than any mom breastfeeding. Even the movie stars in their gowns with plunging necklines are showing almost the entire breast! Somehow, that is OK. There are volumes of video footage and photos all over the place… even on billboards. It is sad that the public opinion of a baby breastfeeding (the most natural way for him to eat) is something that should be done in private … yet young girls are encouraged by media to bare more and more skin. Of course being discreet while feeding is important, but I can assure you, most girls in a tiny bikini are thinking more about “tacky exhibitionist behavior” than a mother breastfeeding her baby. Why aren’t law-makers focusing on any of that?
More Breastfeeding Cartoons ~ not #BAD09
October 15, 2009
I missed the Wordless Wednesday
I have nothing for the Blog Action Day 09
Instead, I’ll provide a little humor today
More Breastfeeding would help the planet anyway!
More Breastfeeding Cartoons by Neil
Enjoy!
Please Help BOYCOTT this Horrible Book
October 10, 2009
BOYCOTT THIS BOOK
The Petit family
My sister and her husband were friends with this family.
“Please Help Boycott This BookThis is the illegally obtained book written by one the defendants who killed Hayley and Michaela. He illegally met with the author in jail before he was stopped by the DOC and released it prior to the trial in Contempt of the gag order, that has been in place over a year. The book was common knowledge but Donovan, his defense attorney has reacted like a moron as if he had no knowledge of this. Judge Fasano had a hearing yesterday and ignored the entire topic-of course the session was in chambers so it is hard to know exactly what was said-our justice system is far less than transparent. This allows this animal to give his side of the story without cross-examination or forensics and then causes the other side of the defense to whine that they cannot get a fair trial. Amazon The author, Brian McDonald, acts like he did nothing wrong-it was only his job to write a book no matter who it hurts. St. martin Press is the division of McMillan that published the book and it is out at Amazon, Barnes and Noble etc. None of them care that an 11 year old was terrorized, raped and burned alive and that a 17 yr old was beaten and burned alive while a 48 year old mother with MS was strangled while she tried to save her children. They are all the epitome of the American blood lust for money and publicity at all costs. Shame on them. they will get their final rewards in their afterlife of hell. Now 26 months later there is no thought of starting the trial and the judicial system wants me to cheer because this is faster than most trials come to court. Yes I am angry, and suspect I will get angrier, but if you have a minute send an email or call or boycott. Thank you for caring about Jennifer, Hayley, and Michaela.
Bill Petit”
Wordless Wednesday~ Breastfeeding Cartoons
October 7, 2009
Great Breastfeeding Cartoons
by Neil
My personal favorite!
Webinar~ WHO CODE ~ “The Code, Companies, and LC’s”
October 6, 2009
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