Tagged: World Health Organization

Doulas: The Essential Ingredient

‘If a Doula were a drug, it would be unethical not to use it’

Dr John Kennell 1998

DONA International Founder

I believe every mother should have a Doula.I believe that Doulas have the power to enable women to experience their birth in a way they thought was unimaginable.

Birth is, and should be an empowering, life changing event. Something that, no matter how many babies you have, will be magical and unique every time. Women remember their birth experiences for life. I believe it is our role and duty, as birth professionals, to make that memory as special as possible.

A good birth experience is not about how you do it, it’s how you feel about it.

The concept of a birth Doula isn’t something new, it’s just now it has a name. Women have always been surrounded by loving women in childbirth. As recent as a hundred years ago, 90% of births took place at home. Women were surrounded by a sisterhood of mothers, sisters, friends and neighbors. Women were supported emotionally, physically and spiritually. It used to be common for women to have witnessed many births before she was having her first baby. This gave her a greater degree of comfort, knowledge, perspective and experience that benefited her in her own birthing experience.  But times have changed. As birth moved out of the home and in through the shiny doors of the hospital, birth has become a mysterious event. It has become something that takes place behind closed doors. Women are no longer participating in this lesson of life. Birth has become a sterile and separate environment for both mother and baby, and to a large extent, the partner. We have become shielded from this normal life event. Birth has become an event dramatized by technology and interventions, portrayed as a medical emergency waiting to happen on soaps and dramas, and reality tv series, with the true potential of birth being lost along the way.

Since 1970 in the US alone, the cesarean rate has increased from 5.5% to 30% and rising, with no decrease in maternal or infant mortality. This is true in most countries around the world. The World Health Organization (WHO) states ‘there is no justification for cesarean rates to exceed 10-15% in any industrialized country’. Research shows us that continuous support from the Doula reduces the length of labor, reduces rates of intervention and the need for pain medications, therefore lowering the risk for both moms and babies. Research has also shown us the support from a Doula increases a mothers’ satisfaction with her birth. We know that post partum Doulas increase the bonding connection for moms and babies, and help reduce the risk of post partum depression by aiding the transition in to parenthood and providing support and education. It is important to recognize the long lasting powerful effects Doulas can have on women and their families.

‘Psychologically for many women, especially those who have had difficulties in their own childhood, there’s potential for internal re-organization…a feeling of higher self esteem and a greater sense of confidence, feeling good about themselves, and feeling good about the whole experience’. 

Phyllis Klaus, DONA International Founder

‘I think Doulas have shown very, very clearly how essential they are for mothers…Doulas usually have a great drive to help other women, think of their needs and have the spirit to stick with the mother’

Dr John Kennell, DONA International Founder

Having a healthy and positive birth experience is far more than simply the method in which you give birth. A positive birth experience has physiological, emotional, behavioral and psychological benefits, not just for mothers, but to society as a whole.

This is an excellent informative video from DONA (Doulas of North America), explaining the wonderful impact Doulas can have on women, families and society, and the powerful results they can achieve.


The Baby Friendly Way

I think everyone by now is fully aware that I am a big home and natural birth fan. However, as much as I like to talk about it, I am aware that this is not, and should not be for everyone. There are many different reasons (which I won’t get in to now) why some women are not suitable for a home birth, or even a natural vaginal birth, and that’s ok. But one thing I think EVERY women has the potential to do, given the right support, is breastfeed.

It is a rare exception when a woman truly cannot breastfeed for medical or physical reasons. I hear so many stories which sadden me, from women who couldn’t breastfeed for one reason or the other, or didn’t produce enough milk, and I can’t help but wonder, if given the right environment, encouragement, advice and support, would these moms have been more successful? Because if not, how would our species have survived all these generations. What did we do before infant formula was on the market?

We know that a woman’s ability to feel confident and secure in her decision to breastfeed can be challenged along the way by friends, family, media, healthcare providers as well as the health care settings. In fact, despite what you might think, the health care setting has a huge impact on new moms and their feeding choices. Hospitals and maternity units set a powerful example for new moms. It is a known fact that technology driven hospital routines and procedures common on labor and delivery wards, are not conducive to establishing the best start in breastfeeding. We should be doing everything we can to promote breastfeeding no matter what setting a mother chooses to give birth in.

If you are considering having your baby in a hospital or birth center, one thing I would advise you to look in to, is whether or not they are ‘Baby Friendly’.

Baby Friendly?

Isn’t Every Maternity Unit Baby Friendly?

Sadly, this is far from the truth. 20,000 hospitals in 150 countries world-wide have been awarded Baby Friendly status. However, in the US, as of July 2011, only 114 hospitals and birth centers across 23 states have received this prestigious award, with California hosting 18 of these establishments. Some states in the US do not even have one!

I was lucky enough to not only have trained at one of only 3 universities in the UK (at the time) to have received full Baby Friendly Accreditation, but I also worked within a hospital where the Baby Friendly Initiative was facilitated. The maternity and neonatal services I worked in had maintained their Baby Friendly status since 1998. This enabled me as a healthcare provider to provide the best quality of care to support parents, in order for them to make informed choices regarding feeding and caring for their babies.

Click here to read more about how Baby Friendly training increases breastfeeding rates.

What is Baby Friendly?

The Baby Friendly Hospital Initiative is a global program sponsored by UNICEF and the World Health Organization (WHO), which aims to improve the effect of hospital maternity services on a mother’s ability to initiate breastfeeding for their babies. It encourages and recognizes hospitals and birthing centers which implement the ‘Ten Steps to Successful Breastfeeding’ and practice in accordance with the International Code of Marketing of Breastmilk Substitutes. The Baby Friendly Initiative (BFI) works with the health-care system to ensure a high standard of care in relation to infant feeding for pregnant women, mothers and babies. Following the specific ‘Ten Steps’ creates the best possible environment for successful breastfeeding. Baby Friendly establishments aim to give mothers the information, confidence and skills needed to successfully initiate and continue breastfeeding their babies.

A maternity facility can be designated ‘Baby-Friendly’ when it does not accept free or low-cost breastmilk substitutes, feeding bottles or teats, and has implemented the ten specific steps to support successful breastfeeding.

The BFI status is awarded based on strict independent evaluation. Sponsors conduct an ongoing review of the facility and evaluate its commitment to offering an optimal breastfeeding environment. If the establishment is falling short of any of the ‘Ten Steps’, the unit can lose their status.

Baby Friendly USA envisions,

‘an American culture that values the enduring benefits of breastfeeding and human milk for mothers, babies, and society’


Does Baby Friendly Work?

Implementing the Baby Friendly best practice standards is a proven way of increasing breastfeeding rates in terms of breastfeeding initiation, duration, exclusivity and related child health outcomes. By adopting Baby Friendly practices, health professionals can give mothers the support, information and encouragement to continue their chosen method of feeding for as long as they wish.

More Information

Click here to find your nearest Baby Friendly Hospital

Click here (for BFI UK) or here (for BFI USA) to read more about how going Baby Friendly can increase breastfeeding rates.

Too Posh to Push: Something to Consider Before Scheduling Your Birth

‘Actress Elizabeth Hurley had one. So did supermodel Claudia Schiffer. Ex-Spice Girl Victoria Beckham and singer Toni Braxton had two each. TV mom Patricia Heaton had four. They’re so popular among the upper class in Brazil that the only way you won’t get one in Rio de Janeiro, as the joke goes, is if your doctor gets stuck in traffic.’

(Time magazine, 2004)

After reading about the newest arrival to the Beckham household last week, it made me consider the health implications of scheduling births prior to 39 weeks.

The negative connotation, ‘too posh to push’, according to the Urban Dictionary, refers to the growing number of prospective mothers who opt to have an elective cesarean section rather than a natural vaginal birth. Whether or not the label fits, many thousands of women across the globe are scheduling their births for reasons other than those medically indicated. In certain circumstances it may be necessary to schedule an elective cesarean due to complications of the pregnancy, but for the most part, these women are scheduling their births for the sake of convenience, to fit in with their busy lifestyles.

Numbers are sky-rocketing, with cesarean rates far surpassing the World Health Organization (WHO) recommendation that cesarean deliveries should make up less than 15% of all births, and less than 9.5% of births in the modern Westernized world. In the US, cesareans rates are at an all time high, with one in 3 women (32%) giving birth by cesarean. According to Dr. Samantha Collier, vice president of medical affairs at HealthGrades, a company that rates the quality of health care in the US, about 22% of those C-sections-or 63,000 births per year-are purely by patient choice, a 20% increase since 1999.

I find it sad to believe that vanity and the pressures of modern day life are standing in the way of normal physiological birth, and the health of many thousands of newborns. Only 25 percent of women know a full-term pregnancy should last at least 39 weeks, according to research published in the December 2009 issue of Obstetrics and Gynecology. Many people believe that all a baby is doing in the last few weeks of pregnancy is gaining weight, making for a more difficult and painful labor and birth. However this is not the case. Although babies do lay down the majority of their body fat in these last few weeks, they also undergo many other important developmental changes. The brain, lungs and eyes are all in the final stages of development in the final weeks of pregnancy, and imaging studies indicate that the brains of infants born after 39 weeks are notably larger than younger gestation babies. A baby’s brain at 35 weeks weighs only two thirds what it will weigh at 39 to 40 weeks. A recent study carried out by the March of Dimes, the National Institute of Health (NIH) and the Food and Drug Administration (FDA) highlighted that even though the occurrence is low, the risk of newborn death was 50% lower in babies born at 39 weeks or later.

Babies who are born prematurely will have more health problems not just at birth, but later in life too. Babies born early are at risk of breathing difficulties, hearing and vision problems, low birth weight, intestinal problems, difficulties maintaining their temperature leading to problems feeding, learning and development disabilities and even bleeding or fluid in the brain. These will not occur in all newborns that arrive early, but the risks remain.

Why scheduling an early birth can be a problem

(Taken from March of Dimes)

  • Your due date may not be exactly right. Sometimes it’s hard to know just when you got pregnant. Even with an ultrasound, your due date can be off by as much as 2 weeks. If you schedule to induce labor or a cesarean birth and your date is off by a week or two, your baby may be born too early.
  • Inducing labor may not work. If your labor is induced, the medicine your doctor or Certified Nurse-Midwife (CNM) gives you may not start your labor. When this happens, you may need to have a c-section.
  • A C-section can cause problems for your baby. As discussed above, babies born by C-section may have more breathing and other medical problems than babies born by vaginal birth.
  • C-sections can cause problems in future pregnancies. Once you have a C-section, you may be more likely in future pregnancies to have a C-section. The more C-sections you have, the more problems you and your baby may have, including problems with the placenta.
  • A C-section is major abdominal surgery for mom. It takes longer for you to recover from a C-section than from a vaginal birth. You can expect to spend 2-4 days in hospital after a C-section. Then you’ll need around 6 weeks (sometimes longer) after you go home to fully recover. You also could have complications from the surgery, including infections and bleeding. So it’s important to stay in touch with your health care provider even after you go home.

Babies need time to fully develop in order for them to be strong enough to survive ‘on the outside’.

Unless there are medical concerns, the safest and healthiest place for developing infants is in the womb.


Click here to read more-Elective Delivery Before 39 Weeks: Reasons for CautionAmerican Journal of Obstetrics and Gynaecology, March 2010

Booby Traps

How refreshing! I just finished reading the following article, ‘Talk breastfeeding with your OB’, that I came across online, written by an MD, who is not afraid to put up his hands and admit that his knowledge surrounding lactation is limited. Good for him, I say. In my book, there is no shame in admitting your own limitations. I believe it only makes you a stronger person. If only more people were able to do this. This only came to light when his wife decided she wanted to obtain her IBCLC (International Board Certified Lactation Consultant) certification. He admitted that he only remembers 2 lectures from medical school on lactation physiology, which he completed 27 YEARS AGO, in 1984!!

How much does your OB know about the physiology of breastfeeding or the best way to support nursing mamas? Who will you turn to if you need support?

Breastfeeding isn’t as easy as those glossy pictures on the cover of mothering magazines would have us believe. Breastfeeding is natural, but it is a skill that takes time to develop for both mom and baby. It takes a lot of dedication and determination, but however bumpy the journey, it is well worth the ride. It’s well documented that in addition to containing all the vitamins and nutrients your baby needs in the first 6 months of life, breast milk helps protect your baby from a long list of chronic and acute illnesses, including ear infections, diarrhea, pneumonia, diabetes, and sudden infant death syndrome (SIDS). Every day really does count, in terms of the benefits of breastfeeding, not just for the baby, but for mom too.

With breastfeeding promotion and awareness on the rise, I can’t help but feel our mamas are being set up for a fall. Many women start out breastfeeding, but give up sooner than they had planned, even though breastfeeding is medically, nutritionally, and emotionally the absolute best thing you can do for your baby. ‘Many women struggle to breastfeed for as long as they might otherwise like, and many don’t receive the support that might make a difference‘ (Maria Quigley, National Perinatal Epidemiology Unit, Oxford University). According to the CDC (Centers for Disease Control & Prevention) statistics, 3 out of 4 women initiate breastfeeding, suggesting that most women want to breastfeed. However rates at 3, 6 and 12 months remain stagnant and low. The CDC reports that just 43% of infants are still breastfeeding at 6 months of age, and only 13% are breastfeeding exclusively, nowhere near the recommendations from the World Health Organization (the WHO also recommend breastfeeding continues in addition to solids foods for at least the first year of life). These figures illustrate the struggle mothers continue to face with breastfeeding and that our support systems are failing our moms. Breastfeeding is an important public health issue and should be given a higher priority within our society. Parents of today are raising the future generation. How can we expect them to succeed when postpartum support within our maternity system is so poor? 50+ years ago, families stayed in the same towns they grew up in, extended family members all lived under one roof, and the women of the village supported each other when it came to childbirth, but in today’s world where family members are spread across different countries and continents, who do moms turn too? I think that women today are lacking a very important network of women in their lives.

We know that a mother’s decision whether or not to breastfeed, can be hugely influenced by her care provider, and hospitals and maternity units set a powerful example to new moms and families. The Baby Friendly Initiative (BFI) is a global program sponsored by UNICEF and the World Health Organization (WHO), to ensure that all maternity units become centers for breastfeeding support. The BFI Initiative awards, encourages and supports birthing facilities that offer optimal levels of care for lactation, based on the UNICEF ‘10 Steps to Successful Breastfeeding’. Any birthing facility, no matter how big or small, or how many births it supports, can apply for BFI status. The facility has to undergo external evaluation to demonstrate that the facility meets all of the ‘10 Steps’ requirements. However, in America today, only 4% of all babies are born in a BFI accredited facility.

If women in America were given the support they deserve, or even the same amount of postpartum support other women around the world receive, we would see a dramatic change in our breastfeeding rates, not only at birth, but rates at 3, 6 and 12 months would be significantly higher.

As the MD of the above article writes,

‘the best situation is one which all care providers are familiar with one another and are willing to work together on the patient’s behalf’.

One World Birth: The Revolution