I'm back from another Lamaze conference. This year seemed to be "all about the baby." Almost every presentation I attended (and the talk I gave) was about breastfeeding, skin-to-skin, or other post-birth baby care. Last year Linda Smith, in her plenary address, urged us: "If you want to change birth practices, get on the breastfeeding bandwagon." It seems like people have taken her advice seriously!
Thursday's plenary session was about elective late pre-term and early term inductions (before 39 weeks). The presenter, Dr. Rebecca Ewing, showed the video RISK: Consequences of a Near Term Birth, aimed at discouraging parents from choosing inductions before 39 weeks because of the risks involved. I have some serious concerns that the movie will just foster more fear and guilt in parents, rather than motivating them to avoid an early induction. It told the story of two mothers who had late preterm/early term births at 36 and 37 weeks and whose babies had serious complications from being born early. But these mothers went into labor spontaneously. The film really should have featured women who had elective near term inductions, not spontaneous preterm births!
Friday's first plenary session was by Debra Pascali-Bonaro. She heads the International MotherBaby Childbirth Organization and has helped implement Mother-Friendly birth practices in hospitals and birth centers across the world. Her presentation "IMBCI: What Does an Optimal MotherBaby Model Look, Feel and Smell Like?" showed IMBCI hospitals from high, medium, and low-resource countries. It is amazing what these hospitals have been able to do, even with extremely high patient volumes and very little money.
I spoke during the first breakout session about "A Proactive Approach to Breastfeeding." I had an aha! moment while preparing my presentation and realized that learning how to breastfeed (in our culture) is like learning a foreign language. Sure, breastfeeding is natural and instinctual and almost all women can breastfeed successfully--but only in a culture where breastfeeding is still the "native tongue." But we don't live in that cultural context any more. We are fluent in bottle-feeding, not breastfeeding. So we have to learn (re-learn) the language of breastfeeding--how to hold a breastfed baby, what a good latch looks and feels like, how often and how long to feed the baby, how to know when a baby is hungry or is satiated. These are all things that women who are breastfeeding natives might not even be able to articulate; they would just know through observing it everywhere, day in and day out.
Next, I attended Ann Grauer's presentation "Seeing is Believing: Building Breastfeeding Confidence from the Start." Fantastic. So fantastic that I am dying to have her write a guest post and explain how breastfeeding really can be so easy to learn and to teach.
The last session on Friday was a research updated on labor management, fetal well-being, and induction of labor. Liz DeMaere, who used to work as a L&D nurse in Canada and now works for Salus Global Corporation implementing safety & quality measures, explained the newest research based on the SOGC's MORE OB program. Did you know that the ACOG has approved MORE OB? That means that (in theory, if not in reality) all low-risk laboring women should received intermittent auscultation as the standard of care, that primips should not be admitted until they are at least 3-4 cms dilated and having regular contractions (no admits at 1 cm and no effacement!), and that induction of labor should occur unless the reasons are "convincing, compelling, consented, and documented"?
On Saturday morning, I watched the new film The Magical Hour: Holding Your Baby Skin-to-Skin in the First Hour After Birth. Dr. Kajsa Brimdyr (love her name! pronounced "KAI-suh"), who produced the film, led a discussion after the film. This is a companion film to Skin to Skin in the First Hour after Birth: Practical Advice for Staff after Vaginal and Cesarean Birth, which I reviewed last year. So many parents and childibrht educators were using the practical advice film (which was aimed towards care providers and more technical and pragmatic) that Dr. Brimdyr decided to produce a more parent-oriented version. It's fantastic and at less than $40, an amazing value.
Following the film showing, I attended "Listening to Newborns: What Babies Have to Say About Transitions to Life" by Linda Jablonski. It was a research update about bulb suctioning, cord clamping, skin-to-skin contact immediately after birth, and self-attachment. She works at Baystate Franklin Medical Center and helped implement the practices supported by the latest research (no routine bulb suctioning, even after cesarean section; delayed cord clamping, at least 3 mins and/or when cord ceases pulsing; immediate S2S; and self-attachment, rather than actively helping the baby latch on). Her hospital, located in western MA, has a fantastic track record with the lowest cesarean rate in the state (21%) and a VBAC rate of 42% (80% successful). Her hospital really tries to be on the front line of offering innovations. They were the first hospital in the state to offer waterbirth and PCEA (patient-controlled epidural anesthesia). I came away with a thorough bibilography of the latest evidence base for these four practices.
Next, I went to three brief research presentations about chiropractic care in pregnancy (definitely underwhelmed by the quality of both the evidence and of the presentation), about prenatal care in home birth, and about the relationship between epidural anesthesia and childbirth outcome.
I was so tired by this point that I skipped the last session of the day and had a relaxing dinner & evening at home with Inga.
Sunday had one last set of breakout sessions. I attended "Whys and Hows of Supporting Newborns: 9 Stages During Skin-to-Skin" by Jeannette Crenshaw and Kajsa Brimdyr. I told you that it was all about the babies this year!
The last plenary session had nothing to do with childbirth. Instead, it featured a motivational speaker trying to get us to "Fire Up Your Life!". I'm just not into motivational speakers. I really want to hear about pregnancy, birth, or breastfeeding at a Lamaze conference, not how to set goals or find balance in your life.
The journey home was long. I spent 8 hours in the DFW airport (I hoped to go standby on an earlier flight, but no luck). I graded papers and kept Inga amused and somehow we survived. We got home at 1:30 am; Eric had to wake up the kids and drive everyone to the airport to pick me up, so we were all pretty tired the next day.
Inga was the star of the show at the Lamaze conference. She was a total angel and stayed happy and quiet the entire four days of the conference. She loved all of the attention! In fact if people aren't paying attention to her, she will practically yell at them to catch their eye, then smile and preen once they look over.