Wednesday, September 21, 2011

Lamaze Conference, Fort Worth TX

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.


  1. That is so true that we are not a breastfeeding culture. Last summer I was visiting my sister and one of my friends from college came by to visit. We were getting ready to go out, so I picked up my six month old and nursed him before we left. And my friend was SO surprised that I breastfeed in front of her! This is a girl I had lived with for 2 years in college and we were in a private home! It startled me how surprised she was, but that really is the culture we live in.

  2. I just wrote about this on my blog and said I was terrified about breastfeeding because I had NEVER seen a baby breastfeed except from a far distance and usually covered.

  3. Yes! I'd love to hear more about Ann Grauer's presentation. I find it really interesting that in my experience, men seem to be more comfortable with seeing me breastfeed my daughters than women. I tend to get more eye contact when talking to men while breastfeeding, whereas a lot of women seem to give me a "oh, I'll give you some privacy" look.

  4. Lovely meeting you and Inga at the conference! She's a total sweetie and kept making eyes at me in Ann Grauer's session.

    I will say that Ann simplified BF beautifully. I've typed up a one-page, bullet point hand out for my students, based on her presentation.

    And you are right - monkey see, monkey do. If moms don't see breastfeeding they don't do it. I heard that a lot when I taught classes at a women's center for teens and underprivileged moms. Very few in that demographic knew anyone who BF. These are the groups with the lowest BF rates...

    On the movie RISK: I do wonder if it was geared towards the care provider market rather than the parent market. You can't go in and tell an OB "shame on you for inducing early" but you can show direct consequences of early birth and use that to sway opinion. So, I see this film as a tool for providers, not parents. There's enough mama guilt as it is, we don't need to foster anymore.

    Oh, and yep. I'm with you on the "motivational speaker"... :-P

  5. I love your comparison of learning to breastfeeding = learning a new language. So true.
    A quick correction Baystate Franklin Med Center is in Western Massachusetts.

  6. I agree with you about the video RISK. I don't think using spontaneous early term births is a good example for not electing to be induced before 40 weeks. My other thought is, why aren't folks working on (or maybe they are I just haven't heard much about it) repeat c-sections at or "near" term? I have heard many women are encouraged by their doctors to schedule c-sections at 39 or even 38 weeks. My sister in law is scheduled for a c-section for her third child at 39 weeks. I am worried for her and the baby. Do you know of any good resources that I can provide to her?

  7. Oops, thanks for catching that! I fixed it.

    Honestly, if she's already going with a scheduled ERCS, you're not going to be able to change her mind. With the recent push not to do elective deliveries before 39 weeks, it also means a virtual go-ahead once you hit 39 weeks (even though it's not intended that way). The first thing is to ask her if she needs anything: information, support, whatever. And just meet her on her terms.

  8. I agree that the breastfeeding culture is not prevalent in North America, compared to bottle feeding paraphanalia. Although I was surprised at Babies R Us to see a big Medela display right inside the front doors. However, if aproximately 75% of newborns are breastfed, then isn't it considered the 'standard'/normal/most common way to feed a baby? I do agree that number needs to stay higher than it does as the first year marches on. I keep reading about people who don't know anyone that breastfeeds, but then how do we get stats that show breastfeeding IS the norm, at least for newborns?
    (I'm coming at this from an armchair lactivist position, nothing scholarly or anything!)

  9. Rixa, I was very interested to read about the MORE OB program, and immediately took a look at the website. Can you point me at the place where they talk about a choice of intermittent auscultation over EFM? I can't find anything about it. Thanks!

  10. @TracyKM: those 75% stats are initiated breastfeeding rates, so right after the baby is born. The numbers fall dramatically after the first week, and again by six weeks. Only about 13% of women are exclusively breastfeeding at 6 months. The numbers also very greatly by region, so depending on which state a person lives in, they will have more or less exposure to breastfeeding.

  11. Hi Rixa,
    Thank you for this great account of the Lamaze conference! I'd be interested in your thoughts on chiropractic care in pregnancy. This is something I know little about and as you stated you were "underwhelmed" by the evidence presented, I,d love to hear more about it.

  12. Rixa,
    I am curious about the Bulb Suctioning and the reasons not to do it after birth. My midwife did not suction my son but I had never heard of that before and I can't find any information on it. Just curious!


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