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Posts tagged ‘Childbirth’

*Promote NORMAL Birth and Breastfeeding* & more New Year’s Resolution Ideas for all my Co-Workers… Any Ideas?

I am continually working (baby steps- a little bit at a time) on improving what we do to care for the moms and babies in my little neck of the woods. Sometimes it feels exciting, positive and helpful….. but other times frustrating or futile.

Since I have been recently consumed with my newest career as a NICU nurse, I have seen some of my earlier successes of positive changes (on the mother baby unit and L&D)…. slowly. turn. back. to previous bad practices ….. I come over to the units and I see so many of the older traditional care models in place again which we had worked hard to place in a vault! You get new doctors, new nurses, new anesthesiologists etc… and they don’t give a crap about any guidelines or protocols for a natural process! However if the CDC changes their Hepatitis B, HIV or  GBS protocols… they are all over it….  In. A. Heartbeat.

Why is it so hard for these professionals to relinquish control over all aspects of the birth process? Why can’t they look at any of that research? Why aren’t any of the recommendations for encouraging VBAC, discouraging scheduled CS’s without a TOL or keeping mother and baby together while delaying routine procedures taken as seriously?? Why?

I think I know why…I do.  But that isn’t really what I wanted to talk about today.

I want to provide some encouraging – positive – inspirational ideas for my fellow nurses, practitioner or heathcare provider to do what is best for each mother and baby in their car. Even if you all pick just one… it can make a difference. So don’t feel overwhelmed. Just try to add at least one of these to YOUR daily practice.  These suggestions are meant for situations without complications requiring urgent intervention of some kind.

Readers: Please ADD more in comments if you have them!

  • Promote and Preserve NORMAL Physiologic Birth……  Try NOT to interfere. Please really find out what that means if you don’t know. Seriously. (sorry but please… my friends… it’s not about hurrying it up or getting it over with and closing out the chart!)
  • Spend time each month reviewing Evidence-Based practice recommendations and changes with regards to Birth and Breastfeeding. You’ll learn something!
  • SKIN TO SKIN…if you do nothing else… make THIS your project for EVERY mother/baby in your care. If you do this for them– nature can have a chance. Get them S2S at birth and several times each day to help with breastfeeding! (this one is my favorite!)
  • Yes… Skin to Skin can be done in the O.R. Teach your fellow co-workers when just DO it!! Come on TRY IT!
  • Keep a mother’s wishes at the forefront of your plan of care. Her birth plan is very important to her! Advocate for her and empower her. This is her birth, not yours.
  • Advocate and Empower your patient to make truly informed decisions about her care. If she doesn’t have the right information to make a real INFORMED decision, please help her get the information or provide it for her!
  • Embrace the idea and recommend Doulas to your patients. Keep a list of local doulas available and provide them at prenatal visits or out-pt testing.
  • Question the doctor/midwife when an induction and or Cesarean is scheduled. Just ask why and discuss… Bring up points you’ve learned in your reading and find out the practitioners reasons for inducing. There is a way to discuss without challenging. Sometimes –> everyone learns from such a discussion. Perhaps the practitioner will realize his reasons for some cases may not be appropriate.. who knows?
  • Breastfeeding and Formula feeding are not equal choices and remember it is inappropriate to indicate to a mother directly or indirectly that they are equal. She deserves correct information before making an informed choice. Utilize teachable moments to discuss the superiority of Human breast milk as the food for human infants. Show her where she can get more information before making a decision. Honor her decisions once she has made them.
  • Keep the baby with the mother until the FIRST Breastfeed has taken place. Please delay all your routine procedures and help the mother (if needed) to start breastfeeding! This is recommended by ALL the experts.
  • Keep the baby with the mother AT ALL TIMES. Almost everything we do can be done at the mother’s bedside. Think about it.
  • Keep the baby with the mother AT ALL TIMES means at night too. Separating mother and baby so “Mom can rest” had been shown to be a barrier to successful breastfeeding. Encourage frequent feedings based on feeding cues.
  • Teach and empower the mother. Include how to recognize feeding cues, signs of an effective feeding with appropriate latch, and how to recognize an overall good feeding pattern.
  • Support the mother, support the mother, support the mother.

For some more ideas.. I have numerous previous posts about breastfeeding education, support and sited references such as the Coalition for Improving Maternity Services Ten Steps for example and other important issues.

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Skin to Skin Minutes After C/S in the OR… Speaking Up and Making it Happen

Beautiful Skin to Skin after birth (iStock Photos)

Submitted for the Healthy Birth Blog Carnival #6: MotherBaby Edition


Skin to Skin immediately after birth is an extremely important part of the continuum of the nurturing of pregnancy, the process of birth and the transition of nurturing from inside mom to outside mom. This is the natural habitat where baby should transition and begin his own regulations of breathing, heart rate, temperature etc… This is recognized by the AAP in their changes to the Neonatal Resuscitation Algorithm back in 2000. The recommendation was to keep baby with mom and provide all initial evaluations and steps with baby on moms chest for all healthy babies!  We all know that babies have an inborn innate ability to self attach and nurse right after birth. These recommendations are not just for vaginal births. Kathy Petersen has a beautiful description of the importance of STS after a Cesarean birth on her Woman to Woman Childbirth Education blog in her 5/30/10 post Skin-to-Skin in the O.R. after a C-section.

As soon as I heard about the last edition of Science and Sensibility’s Healthy Birth Blog Carnival with a theme about “keeping moms and babies together after birth”, I wanted to write about my tiny little efforts, struggles and some successes in providing moms and babies with an environment that supports and protects their need to stay together. My recent role in the protection of such an environment and subsequent privilege of watching a baby self attach in the OR 15 min after a C/S birth has re-energized my efforts to get more mother’s and nurses to speak up and make this a standard for healthy babies!

Then….. I saw a link on Laura Keegan’s Facebook fan page for her book Breastfeeding with Comfort and Joy to an awesome video and a beautiful photo posted by the author of Cesarean Parents Blog about her birth. I had heard of Laura’s search for images of STS after C/S and asking for mother’s experiences. Amy Romano from Science and Sensibility alerted Laura of the photo: Kathy blogged about STS after C/S and I was working on this post! Such uncanny timing! I am just in awe of this marvelous networking community! Head over to Laura’s facebook link and share your experience for her info gathering. Here is the fabulous video they are all talking about “Breast is Best” from Norway:

Why is it so hard for the doctors and nurses to get on board? Most of them understand the word “bonding”.  But what many don’t realize is that it took a long time for the actual concept to take hold, to allow “time” for bonding to occur.  It sounds silly but many times if the baby and mother are still together after 2 hours…the nurses call that “extended bonding”.  I have been doing this for over 35 years now and the changes from the 70’s to now are fascinating and frustrating at the same time. To understand the process of change, we have to sometimes remember where we’ve been. I wrote about Medical Science vs Natural Childbirth a year ago because I feel history IS important to help us move forward. Often it is about control… but many times nurses and doctors are simply task oriented/focused and not patient centered. They want to complete all their procedures and charting and move on to the next task. I understand this, there is always a lot to do and document. I work there too! The environment provided to us, the health-care workers, is one in which regulations are abundant and staffing is not always optimal. Flexibility is needed. I know there is a way. This culture just has to change. And it happens in small little doses.

SO–> Skin to Skin immediately after a C/S? I have been told by coworkers, doctors and anesthesia:

“It’s impossible, “

“It can’t be done”

“There’s not enough room”

“This patient (the mom) is in the middle of major surgery!”

“The baby needs to be under the warmer, it’s too cold in the OR.”

Really? Seriously? Watch Me………

I have actually been working on this issue for the past few years…… Ever since I began staff education for World Breastfeeding Week 2007′s theme “Breastfeeding: The first hour — Welcome Baby Softly”. The focus from ILCA was: ‘Establishing a welcoming environment that keeps mothers and babies together.’ It was then that I gently tried to introduce the concepts for C-Sections as well as all vaginal births. I was getting a lot of positive response for vaginal births…not so for C/S.

Anesthesia is our biggest barrier. The chest area of the mother seems to belong to them somehow. The arms too.. I always politely ask the doctor for permission to have at least one arm released so she can touch her baby. (they are secured on armboards to her sides.) Really the OB’s didn’t mind what was happening outside of their draped domain. The Pediatrician is the next barrier because they want to finish a complete exam…. in the nursery…. before they returned to the office or whatever.  So I started with the Peds… hoping they would stop expecting the baby to be quickly removed from the OR. I started with just simple requests for prolonged “bonding”… because they all get that. “Look how well this baby is transitioning.. so alert and PINK! ” “I’ll write all the measurements in your exam note…. I’m fine… I know you’re busy….” I’d say.   Sometimes mom and baby got to stay together. Soon, for some of the doc’s, the expectation of baby leaving mom was gone. They got tired of waiting around and would leave. More moms and babies got to stay together…even if it was dad doing the holding. My co-workers were not always so understanding because of the work flow on the unit. It would work best when the birth happened any time other than first thing in the morning when it’s busy everywhere. Isn’t that sad? Sitting here writing this I’m thinking of ways to work on that….. another time…..

Anesthesiologists or Nurse Anesthetists are all different. There are some wonderful ones who are releasing both arms and pushing things out of the way for the baby and others who are constantly telling moms they are “under” anesthesia and can’t hold the baby, or they have given meds to mom right after baby is born so mom is now groggy. I talk to each of them respectfully and differently depending on their own approach. I have discussed my plans for STS if baby stable ahead of time. I have discussed how it is up to us to provide this protected environment for moms etc…  I have used the patient satisfaction discussion, the scientific evidence discussion, the patient centered care discussion, and the increased patient numbers due to higher satisfaction talk.  I have let them know that when a mother requests that–> we must do everything possible to help her experience this.

Slowly, over the last few months, I was able to facilitate some babies really getting skin to skin in the OR for short periods before going to the nursery. There were a variety of factors for why it wasn’t very long each time but at least it was happening!! It’s not a standard of care yet and I’m the only one working on it but others are getting interested… Communication has been very important to create the environment and reduce barriers. We still have a long road ahead. But we did pave a path for this mom….

She came in with an unknown double footling breech presentation in active labor and the doctors wanted to do a C/S right away. She was really upset and had a beautiful birth plan that was already getting discarded. “STS until first breastfeed accomplished” was on her plan and I was determined to help her with that! Things were happening fast. The anesthesiologist wasn’t my best STS supporter.. “oh well” I thought, “I’ll do what I can to help.” The baby was crying and pink when born and without thinking about it, the doctor, nurses and myself had him on the baby unit drying him. Mom went panicky! “Give him to me, give him to me! He has to be ON me! You just took him OUT of me, now he HAS TO BE ON ME!”  She was literally trying to sit up. Anesthesia was drawing up meds for her (that was his answer).  I said “OK here he comes!”. So I didn’t ask anyone’s permission this time….. just held that naked baby in one hand, snapped open her gown with the other and helped him move in. I asked for a warm blanket and looked up to see the other nurse and doctor staring at me. I said “Seriously… she’s exactly right, he does belong ON her!” Anesthesia saw the immediate transformation of his frantic patient to one with calm maternal bliss, admiration and cooing. He was then helpful to let her other hand out. This little boy stayed with mom, breastfed before he was 15 min old and went to the PACU with mom. She was so incredibly happy. I never got to see her after that since it was near the end of my shift and I wasn’t on shift the next few days. I saw that she exclusively breastfed in the hospital and without complication went home on day 3. At least part of her birth experience went according to plan!

If she hadn’t have been so vocal about what she wanted, so adamant… she would not have experienced what she did.

SPEAK UP AMERICA…. MAKE IT HAPPEN

Want to see more? This stunning video of a baby skin to skin then breastfeeding at birth in the operating room via @MothersUtopia @Laura_Keegan. What were your experiences? Please don’t forget to head on over to Breastfeeding with Comfort and Joy on FB to comment on your experience or opinion about this important topic!! Calling for women to share their experiences with skin to skin here, to help give a voice to the real need to make skin to skin in the OR routine practice in all ORs.






NIH Conference on VBAC’S ~ Continuing to Spread the Word

Spreading the word from the NIH VBAC conference….It’s now coming thru via AWHONN Vitals!!!

This is at least a month old news to most birth junkies but….. but I find it encouraging that the news is coming thru from AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses). There are many many nurses and birth professionals out there that haven’t even heard about this conference. I know the big AWHONN convention is coming up in Nashville June 12th, and possibly this topic will be presented somewhere although late to get on agenda. Sometimes the nurses can help educate the docs…… ya think?

One topic on the Nashville Agenda is:

“SOLUTIONS FOR SURVIVAL: Working where Birth is NOT Considered NORMAL”

Boy~ would I love to go to that presentation!!!!!

From the recent AWHONN newsletter~

“Panel Urges New Look at Caesarean Guidelines”
The New York Times, Denise Grady
A government panel recently took steps that will increase women’s ability to find doctors and hospitals that will let them attempt a normal birth after a previous caesarean section. The recommendations came from a panel at a National Institutes of Health (NIH) conference convened to assess why the rate of vaginal birth after Caesarean section (VBAC) has gone from 28.3% in 1996 to less than 10% today. The repeat surgeries are contributing to the growing rates of C-sections in the U.S., which today account for nearly a third of all deliveries. Repeat C-sections were previously deemed safer due to concerns that the uterine scar would rupture, putting both the mother and the baby at significant risk. According to the chairman of the NIH conference, “We found the use of VBAC is certainly a safe alternative for the majority of women who’ve had one prior” C-section, as long as the incision was horizontal and low on the uterus. Approximately 70% of women who have had C-sections are good candidates for attempting a normal birth, and 60% to 80% of those who try succeed. The government panel urged the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists to “reassess” their guidelines, which have rendered many clinicians and hospitals unwilling to allow VBACs. The groups’ current guidelines require that surgical and anesthesia teams be “immediately available” during labor if a women has had a prior C-section. Some institutions were unable to comply, and thus banned VBACs altogether.
Link to Article

NBC’s “The Office” sends Positive Message to America for Birth and Breastfeeding

I haven’t ever sat through a whole episode of The Office….    maybe that’s why I didn’t ever really like it.  Perhaps I just didn’t “get” it!  This is a smart and funny show. Last night, they had a large viewing audience and great forum to send a positive message to America. They delivered… in a big way! This was a planned hospital birth so I am mentioning what I thought was positive about the reality of how this was portrayed.

Here’s what I liked:

  • Insurance issues … very real for some and guides some of parents decisions
  • Calm approach to early labor …no need to rush to the hospital with first contraction
  • Could be that she just wants another night in hospital but still comes off as a calm early labor
  • Many people in the Office were crazy & nervous except the mom –Pam
  • Pam feasts and enjoys the food while contracting..nobody said you better not eat!
  • I don’t think ever I heard epidural or C-Section mentioned!! (YAY)
  • Dwight decides he wants a baby and makes a contract including the “baby will be breastfed for the first 6 months” after-which he plans to feed some weird stuff but HEY… at least he indicated exclusive breastfeeding to start…right?
  • Pam still doesn’t want to go to hospital when her water broke
  • She showed a real but pretty brief fear of really “doing this” and becoming a parent
  • She didn’t have her ipod w/ birth music.. but this showed she was really planning and preparing for her birth
  • Pushed her baby out! YAY
  • I don’t think I EVER heard epidural or C-Section mentioned!! (I know I already said that but still— 🙂  No talk of interventions!)
  • Breastfeeding was the NORM in this episode! I did not SEE a bottle even though it was mentioned. The roommate was ALSO breastfeeding!
  • Trouble latching in the beginning is a common situation… It didn’t stop Pam
  • THE NURSE! Oh. My. God.!!! What a TRUE portrayal of the inept ignorant rude comments made by the nursing staff at many many hospitals!! (even mine.. but I’m working on that) Good for Pam to question her and stick her plan.
  • A male Lactation Consultant!
  • The fact that they used a Lactation Consultant…. YAY!
  • Great support from new dad Jim… even though it was funny how his facial expressions were not supportive of a male lactation consultant! (did we see the birth attendant? don’t remember)
  • They reach over in the middle of night and grab the wrong baby to breastfeed… I’m sorry—> that was really funny, I hope it didn’t offend any one. It’s not like a nurse gave Pam the wrong baby……
  • They have common new parent issues ie diapering, car seat, not feeling ready to go home etc…
  • Breastfeeding works out at the end of the show and Pam looks incredibly peaceful and happy… 🙂

The funky cover –> hey..it worked for her so really–who cares..?? I didn’t feel like that was a big part of the overall message IMHO.

My rating : Big A+

After the show– I find out via twitter that I actually know the writer and supervising producer! So cool!

(I work with his father who is an excellent Pro-Breastfeeding Pediatrician!)

😎 Psych 😎

What did you think?? The episode is called “The Delivery”. If you haven’t seen it, you can catch it online here.

For Expectant Families… your “Due Date”…

Hi everyone! Happy New Year!

I have been very very busy over these past months and I’ve spent very little time on the computer….. many of you have had the same situation. Thanks to all of you who keep checking my blog anyway!

I’m here now to talk about one of my big concerns.

Your due date…

Every single year around the holidays, we have a surge of elective, social induction requests.  Here are some comments we occasionally may hear each year around this time on an L&D unit:

“Please, please induce me so I can have the baby and be home for Christmas…please!”

“I’m only 2 1/2 weeks from my due date anyway so I’m ready…”

“I can’t have this baby on Christmas day..I just can’t…you HAVE to help me!!”

“I’m so tired of being pregnant and I have so much to do…can’t you do SOMETHING and make me have this baby today??” (37weeks)

“I really really need another tax deduction this year… ” (heard quite often!)

“Please do something so this baby is born by the end of December…I’ll even have a C/S if you want.”

“Can you induce me while my family is all here?? Please??”

Young pregnant women~ Please don’t do something crazy for a special delivery date.

Please!

Please educate yourself about the risks of induction and the risks of late preterm births.

PATIENCE

“A little patience now adds up to long-term health benefits for your new baby.”

I have received this following information from the Mother-Friendly childbirth community.

I felt it was well worth sharing……..

This is an excerpt from a newsletter from the CIMS ~ Coalition for Improving Maternity Services.

Please read, check out their website link above and the other resources listed below the letter.

Thanks so much!

“For Expectant Families

What you need to know about your due date and late preterm birth

A little patience now adds up to long-term health benefits for your new baby.

You’re not alone if you’re secretly (or openly!) hoping that your baby will get here sooner rather than later.  But when it comes to your due date, it’s important to understand what it represents, what it does not represent, and the potentially serious consequences of agreeing to an induction or c-section before your baby is ready to be born.

Mayri Sagady Leslie, CNM, MSN, clinical faculty at Yale University School of Nursing, recently penned an insightful post for Lamaze International’s Science and Sensibility blog.  In “Beyond Due Dates: How Late is Too Late,” we’re reminded that, despite widespread belief that EDD stands for ‘due date’, it actually stands for ‘estimated date of delivery’!  Mayri writes, “No matter what you call that date on the calendar, it is nothing more than a formula derived from statistical averages which says that sometime within a range of 4-5 weeks your baby will probably be born.  Smack dab in the middle of that range is one of days on which the labor may start.  Yet when it comes to dates in our life, few take on more significance than this one.”

Appreciating this fact is something of considerable consequence when it comes to the immediate and long-term health of your baby.  There is mounting evidence that only the baby should have the right to choose her/his birthday.  Two recent reports add to this evidence.

The CDC’s National Center for Health Statistics recently reported a 20% increase in the nation’s late preterm (34 to 36 weeks ) birth rate from 1990 to 2006.  The report also cites alarming increases in the number of late preterm births among births for which labor was induced as well as among births that were delivered by c-section.  The report cautions, “…it is becoming increasingly recognized that infants born late preterm are less healthy than infants born later in pregnancy.  Late preterm babies are more likely than term babies to suffer complications at birth such as respiratory distress; to require intensive and prolonged hospitalization; to incur higher medical costs; to die within the first year of life; and to suffer brain injury that can result in long-term neurodevelopment problems.”

March of Dimes 2009For the March of Dimes, prematurity is an extremely important public health issue.  The March of Dimes launched a multimillion dollar, multiyear campaign in 2003 to prevent premature birth and raise awareness of its serious consequences.  Last month, the March of Dimes released its annual Premature Birth Report Card.  Sadly, for the second consecutive year, the U.S. earned only a ‘D’ grade, “demonstrating that more than half a million of our nation’s newborns didn’t get the healthy start they deserved.”

We know you’re anxious to meet your baby.  It’s perfectly understandable too if you’re just plain tired of being pregnant.  We just want to remind you that a little patience now adds up to long-term health benefits for your new baby.

Learn more:

  • Beyond Due Dates: How Late is Too Late” by Mayri Sagady Leslie on Lamaze International’s Science & Sensibility blog.
  • Born a Bit Too Early: Recent Trends in Late Preterm Births” a NCHS Data Brief from the CDC.
  • U.S. Gets A “D” For Preterm Birth Rate” press release from the March of Dimes.”
  • America Scores a “D” on the Premature Birth Report Card

    _

    Hello Everyone

    I haven’t disappeared… I’ve just been too busy outside for computer time!

    This is a copy of a letter I received today trying to

    spread the word

    about Prematurity in this country……

    Today is the release of the second annual Premature Birth Report Card, and I wanted you to hear the news from me: America receives a “D.” As a country, we are failing to give our babies the healthy start they deserve.

    Your state has received its own report card. I’m afraid you’ll agree we have a long way to go. In fact, before the end of this year, more than half a million babies will be born too soon, some very sick.

    It’s Prematurity Awareness Day® — the day when we’re all focused on the terrible toll of premature birth on babies and families. The report card reminds us how urgent the problem is. But with the support of people like you, we can continue to fund lifesaving research and programs.

    If you haven’t already, I hope you’ll visit our Web site and join the fight for preemies.

    Warmly,

    Dr. Jennifer L. Howse

    President

    Our Cesarean Section Rates still Below the National Average

    002I 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.


    We Deliver? How about we make it a better delivery?

    permission from CartoonStock

    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 Services

    To 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:

    1. 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.
    2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. other interventions are limited as follows:

    8. 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.
    9. 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.
    10. Discourages non-religious circumcision of the newborn.
    11. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
      1. Have a written breastfeeding policy that is routinely communicated to all health care staff;
      2. Train all health care staff in skills necessary to implement this policy;
      3. Inform all pregnant women about the benefits and management of breastfeeding;
      4. Help mothers initiate breastfeeding within a half-hour of birth;
      5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
      6. Give newborn infants no food or drink other than breast milk unless medically indicated;
      7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;
      8. Encourage breastfeeding on demand;
      9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
      10. 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!!

    Are YOU an Activist? Healthy People 2020 Public Meeting Announcements

    developinghp2020

     

    ARE you an activist?

    Do you want to have input or learn more??

    What do you know about the Healthy People 2010 National Objectives ……. and how the breastfeeding goals haven’t been met?

     

    The PLAN ~ The GOAL:

    (From the Healthy People website:)

    Healthy People 2010 challenges individuals, communities, and professionals, indeed all of us to take specific steps to ensure that good health, as well as long life, are enjoyed by all.

     Healthy People 2010 objectives for breastfeeding in early postpartum period, at 6 months, and 12 months are 75%, 50%, and 25%, respectively. Healthy People 2010 objectives for exclusive breastfeeding through 3 and 6 months of age are 40% and 17%, respectively

     

      So how are we doing???

    From the CDC website regarding Breastfeeding Data:

    Breastfeeding rates have improved since 1999, but fall short of Healthy People 2010 objectives regarding duration and exclusivity. Among children born in 2006, 74% initiated breastfeeding, whereas 43% were breastfeeding at 6 months and 23% at 12 months of age. Approximately 33% of infants born in 2006 were exclusively breastfed through 3 months of age, and 14% were exclusively breastfed for 6 months.

     

    Check the CDC website above for a complete evaluation of how we measure up. I am so happy for thoses states who actually accomplished these objectives! There are some that exceed these goals and others who are really behind. I think because of this, the national picture as a whole is misleading, reflecting an average of a lot of highs and lows. It doesn’t show a true picture for those areas struggling.  I want to learn more to help my area move up towards the goals.

    What can we do to improve and work towards accomplishing these goals ????

     I got this important email letter today and promptly registered to go the meeting in Philadelphia on November 7th.  I want to learn all that I can about what goes into the planning and possibly what more I can do at my local level to help meet the breastfeeding objectives. From the US Lactation Consultant Association:

     

    During October and November the Department of Health and Human Services (DHHS) will conduct public meetings in Kansas City (Kansas), Philadelphia (Pennsylvania), and Seattle (Washington) on draft objectives for Healthy People 2020. The public will have an opportunity to comment on the draft objectives at the public meetings, and on the public comment Web site. The comments received will then be used to revise the objectives appropriately. We hope that you will consider attending if you live near one of these sites. We will coordinate work on this with the US Breastfeeding Committee. This presents a wonderful opportunity to have our voices heard on national policy-making relative to breastfeeding.

    I’m not public speaker, I am interested in policy making for the HP2020.

    I want to go and learn from my well respected colleagues.

    Check it out! Click on the HP 2020 icon at the top of the post!

    A Wonderful Day in the BirthingHood

    What a great fun day in the world of birthing.
    The first words I heard at work today were words that I just love to hear when used in this sequence….

    “Section’s Canceled”

    Hooray!

    Her Cesarean had been scheduled because her baby had been in a transverse lie position…. for weeks.  However–> this smart little genius baby had positioned his little self into a beautiful head down position before arriving at the hospital this morning! Mom was also contracting regularly and was 3 cm dilated. This was her second baby, first exam of the day, so she hung out for a while until it was clear she was continuing to make cervical changes and labor was underway.

    A few others decided it was their time to make an appearance today. One baby boy was a couple weeks early and another a few days over 41 weeks.

    Ever hear that things sometimes happen in 3’s ??

     As luck would have it, 3 young men decided to be born within 15 minutes of each other! All 3 were spontaneous vaginal deliveries. All 3 boys were breastfeeding within that first hour and 1/2 … not bad!

    All the moms were so happy with their birth experiences. All the babies were healthy. The staff worked really well together. Our midwife was awesome! The doctors were fun, funny, thoughtful and kind and made really good patient centered decisions.

    It was just an all around wonderful day in the birthinghood!

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