In Search of a Common Agenda for Planned Home Birth in America

Leading maternity provider organizations in North America have been in conflict about birth at home and birth centers, debating issues related to safety, access, the value of obstetric intervention, and patient autonomy. In today’s environment, childbirth educators and doulas are often required to explain to parents why physiological birth and evidence-based, low-technology methods of labor and birth care are not available in every setting, and why maternity providers disagree about birth place. There are very few regions in the United States where home birth providers are integrated into interprofessional provider networks that allow for seamless care across birth settings. In October 2011, multidisciplinary leaders met at a Home Birth Consensus Summit in Warrenton, Virginia, to discuss the status of home birth within the greater context of maternity care in the United States. This article describes the intent and outcomes of the summit. Four of the nine consensus statements developed at the summit are of particular interest and importance to mothers and families and, hence, to childbirth educators and advocates. Consumers, educators, and birth advocates are encouraged to widen the circle, identify communications experts, lead individual projects, or serve as advisors.     

Teaching in a patient-centered medical home

Teaching Lamaze International classes in a patient-centered medical home allows the childbirth educator the best environment for giving evidence-based information and empowering parents to give birth their way. Patient-centered medical home facilities and providers practice evidence-based care and adhere to the principles of family-centered maternity care. In patient-centered medical homes, women can expect to give birth using the Lamaze Healthy Birth Practices and to fully participate in their care with appropriate interventions and the right to informed consent and informed refusal.     

Continuing Education Module: Persuasion: The Key to Changing Women's Ideas About Birth

Although standard maternity care is not evidence-based and, in many cases, increases risks for mothers and babies, few women make birth decisions that reflect this knowledge. This column discusses persuasion as a way to change women''s ideas about safe, healthy birth. The relationship between persuasion and choice is discussed, and the differences between presenting information and persuading women that natural birth is the safest and healthiest way to give birth are explored.     

The power of numbers: transforming birth through collaborations

Collaborative efforts and coalitions have replaced exclusivity as birth organizations and individuals unite to humanize birth and provide women with transparency of information about maternity care providers and facilities and about access to the midwifery model of care. The Coalition for Improving Maternity Services and the upcoming 2010 "Mega Conference" to jointly celebrate the 50th anniversaries of Lamaze International and the International Childbirth Education Association serve as excellent examples of collaborative efforts to support natural, safe, and healthy birth practices as well as women's choices in childbirth. Childbirth educators are encouraged to learn from and support national coalitions devoted to improving maternity care and to use local resources to develop their own collaborative efforts on behalf of childbearing families.     

Innovation in Practice: Preparing Doulas to Support Cesarean Births

Despite growing initiatives to support patient-centered labor and birth care, implementation of this care in the operating room is still limited. Doulas can be utilized in the operating room to facilitate evidence-based practices such as skin-to-skin contact for patients and newborns during cesarean birth. This article evaluates a curriculum and training method that was developed to educate doulas to provide safe and effective care during the cesarean birth experience. This intervention was found to be effective at improving doulas'' self-perceived confidence in skills essential to support cesarean births and may serve as a model for other institutions to address barriers to the implementation of patient-centered evidence-based care in the operating room.     

Listening to Mothers II as a Catalyst

The Listening to Mothers II report is not only a document; it is a tool that is accessible to childbirth educators. By becoming familiar with its contents, educators can use the information to help expectant parents think about options available to them and inspire them to use evidence-based information as they make choices for the birth of their child.     

Healthy Birth Practice #6: Keep Mother and Baby Together— It’s Best for Mother,Baby, and Breastfeeding

Mothers and babies have a physiologic need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and babies together is a safe and healthy birth practice. Evidence supports immediate, uninterrupted skin-to-skin care after vaginal birth and during and after cesarean surgery for all stable mothers and babies, regardless of feeding preference. Unlimited opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding,” published in The Journal of Perinatal Education, 16(3), 2007.     

Position paper: promoting, supporting, and protecting normal birth

This updated position paper contrasts medical management of labor and birth with the normal physiology of birth and describes the care practices that support and facilitate the normal process. Lamaze International urges care providers to adopt these care practices as the standard of care, unless evidence-based medical reasons dictate otherwise. The roles of Lamaze-certified childbirth educators and the Lamaze Institute for Normal Birth in protecting, preserving, and promoting normal birth are described.     

How I teach evidence-based epidural information in a hospital and keep my job

A childbirth educator reveals her dilemma in teaching evidence-based practice in today's high-tech birth climate. She focuses on strategies to use when sharing epidural information with expectant parents.     

Continuing education module-lamaze parents magazine: more than a giveaway

The Lamaze Parents magazine is an annual publication produced by Lamaze International to inform parents and childbirth educators on issues related to healthy birth preparation, normal birth, and parenting. The author of this column introduces teaching strategies for childbirth educators and doulas to use in tandem with the magazine's content in order to enhance their efforts in sharing current, evidence-based information with expectant parents.     

Servant Leadership in Sport for Development and Peace: A Way Forward

The field of sport for development and peace (SDP) has been growing exponentially, with many organizations and academics embracing the possible contribution that sport can make to development. To date, leadership in sport for development and peace has not been conceptualized. Perhaps due to the missions of sport for development and peace organizations, many of which focus on helping marginalized individuals, the leadership style needed to effectively guide a sport for development and peace organization may be different than that which is needed to lead other types of sport organizations. In this article, we advance that servant leadership, which is predicated on follower care and development, can be a highly effective leadership style in sport for development and peace. Through a series of propositions, we opine that servant leaders in sport for development and peace will empower followers, lead to more sustainable and effective organizations and participant outcomes, facilitate psychological needs satisfaction, and diffuse issues of power and control. Future research directions stimulated by the propositions are also discussed.     

Many women and providers are unprepared for an evidence-based, educated conversation about birth

Findings from recent Canadian studies on the knowledge and beliefs about birth practices among first-time pregnant women and among obstetricians and other birth providers indicate that many women are inadequately informed and many providers deliver non-evidence-based maternity care. Consequently, informed decision making is problematic for pregnant women and their providers. New strategies are needed to inform pregnant women about key procedures and approaches that might be used in birth so they can have an educated, shared discussion with their provider and successfully advocate for their preferred birth experience. In addition, providers can be encouraged to supplement their knowledge with current, evidence-based maternity care practices. To avoid a lack of informed decision making and to ensure that natural, safe, and healthy birth practices are based on current evidence, pregnant women and providers must work together to inform themselves and to add childbirth to the women's health agenda.     

Implementation and evaluation of linked parenting models in a large urban child welfare system

During the past decade, there have been increased efforts to implement evidence-based practices into child welfare systems to improve outcomes for children in foster care and their families. In this paper, the implementation and evaluation of a policy-driven large system-initiated reform is described. Over 250 caseworkers and supervisors were trained and supported to implement two evidence-based parent focused interventions in five private agencies serving over 2,000 children and families. At the request of child welfare system leaders, a third intervention was developed and implemented to train the social work workforce to use evidence-based principles in everyday interactions with caregivers (including foster, relative, adoptive, and biological parents). In this paper, we describe the policy context and the targeted outcomes of the reform. We discuss the theory of the interventions and the logistics of how they were linked to create consistency and synergy. Training and ongoing consultation strategies used are described as are some of the barriers and opportunities that arose during the implementation. The strategy for creating a path to sustainability is also discussed. The reform effort was evaluated using both qualitative and quantitative methods; the evaluation design, research questions and preliminary results are provided.     

After a Cesarean…What's a Birth Professional to Do?

The discrepancy between the evidence supporting vaginal birth after cesarean and actual medical practice illuminates the larger issues of evidence-based care versus current obstetrical practice. Although the reasons for the disconnect between what we know to be healthy birth practices and what women actually experience are multiple and complex, a commitment to providing accurate education, truly client-centered support, and active patient advocacy will give women the ability to insist on best practice care for themselves and their babies. The International Cesarean Awareness Network believes that all childbirth professionals and advocates share a responsibility to promote change and must work together to be effective.     

ASSESSING THEINFORMATION NEEDS OF STAFF IN TWO LONG-TERM CARE ORGANIZATIONS

As alternate care levels are transferred from hospital to community settings, health care workers in long term care are caring for individuals where conditions are more medically complex. In response to this situation decision makers in long term care are pursuing the goal of practice based on the best evidence. Identifying the information needs of health care workers in this environment represents the first step towards cultivating a best practice culture in long term care. The purpose of this study was to identify what information resources staff need to improve clinical and managerial decision making. The perceptions of health care workers at two long term care organizations were investigated through quantitative and qualitative methods, using a questionnaire and focus groups. In each of the settings there were gaps in the availability of resources and perceived needs for education. The findings from both settings revealed the need for more information resources to assist staff to improve individual care of residents and develop better approaches to health problems.     

The truly disadvantaged? Midlife outcome dynamics of individuals with experiences of out-of-home care

Little is known about developmental outcomes in midlife of persons who were placed in out-of-home care (OHC) in childhood. Utilizing longitudinal Swedish data from a cohort of more than 14,000 individuals who we can follow from birth (1953) to the age of 55 (2008), this study examines midlife trajectories of social, economic, and health-related disadvantages with a specific focus on the complexity, timing, and duration of disadvantage in individuals with and without childhood experience of OHC. Roughly half of the OHC alumni did not have disadvantaged outcomes in midlife. However, experience of OHC was associated with a two-fold risk for various forms of permanent disadvantage, net of confounding factors. Implications for research, policy, and practice are discussed.     

Exploring the Group Prenatal Care Model: A Critical Review of the Literature

Few studies have compared perinatal outcomes between individual prenatal care and group prenatal care. A critical review of research articles that were published between 1998 and 2009 and involved participants of individual and group prenatal care was conducted. Two middle range theories, Pender’s health promotion model and Swanson’s theory of caring, were blended to enhance conceptualization of the relationship between pregnant women and the group prenatal care model. Among the 17 research studies that met inclusion criteria for this critical review, five examined gestational age and birth weight with researchers reporting longer gestations and higher birth weights in infants born to mothers participating in group prenatal care, especially in the preterm birth population. Current evidence demonstrates that nurse educators and leaders should promote group prenatal care as a potential method of improving perinatal outcomes within the pregnant population.