Open Arms Blog Has Moved!

The Open Arms blog has moved to:

http://www.openarmsps.org/blog

Please bookmark the new location and we'll see you over there!

"Where will Open Arms be this time?" Auction news!

Things just keep moving along at Open Arms this summer. It's hard for me to believe August is well underway and fall is coming. This year has been a busy one for us!

This week most of our staff was attending the 16th Annual DONA Conference in Albuquerque- reports back have been very positive. I've heard rumors that there are pictures and hopefully someone who went will send them to me and I'll post them!

But on to the news you've been waiting for ... the auction committee has also been working very hard on planning a great event for late fall. We'll have registration information for you soon, but our 3rd Annual Short & Sweet Auction, to be held Tuesday, November 30 in the evening, is going to live up to its name - it is less than two hours long, and it's sure to be sweeter than ever!

As you may remember, every year Open Arms finds someplace fun and exciting to hold our auction with an emphasis on neighborhood and community. We were at Tougo Coffee in the Central District in 2008 for our inaugural auction. In 2009, we wowed our guests with glass-blowing demonstrations at glassybaby's hot shop in Madrona.

And this year.... drumroll please... We're delighted to announce the 2010 auction location: Theo Chocolate in Fremont!

And yes, there will be chocolate samples and a tour of the chocolate factory! Who can resist?

In all seriousness, this auction is an essential way for Open Arms to raise funds toward the core program in our agency, Birth Doula Services, and we really hope you'll come and support us - bring your friends too, and get your holiday shopping done in one lovely evening. If you can't make it, we'll gratefully accept separate donations. Just specify "auction donation" and we'll take care of the rest.

The auction will have many interesting items (and as soon as I am given the go-ahead, I'll tell you about some of them), ideal for gift-giving or family fun, with an emphasis on community and local products and services. We think you'll love it! More details will be on this blog, on the Open Arms website, on our Facebook page and on Twitter soon.

Oh, and are you getting our electronic newsletter? We hope so, but if not, we'd love for you to join our mailing list! We promise we don't share our email list with anyone, and you can get off at any time.

Amazing Breast Milk

This New York Times article is a great way to close out World Breastfeeding Week -

Breast Milk Sugars Give Infants a Protective Coat

I love to hear all the marvelous ways natural foods are perfect for our bodies, with all sorts of benefits that can't be made in a laboratory. This article is great in showing that even the indigestible parts of human breast milk have a purpose and benefit a baby. Fascinating. Here's a teaser:

“We were astonished that milk had so much material that the infant couldn’t digest,” Dr. German said. “Finding that it selectively stimulates the growth of specific bacteria, which are in turn protective of the infant, let us see the genius of the strategy — mothers are recruiting another life-form to baby-sit their baby.”

Who knew?

milkmakers donates 10% of August profits to Open Arms!

Exciting news - milkmakers, makers of premium, all-natural and nutritious lactation cookies, has announced that in support of World Breastfeeding Week (August 1-7), milkmakers is donating 10% of August profits to Open Arms! Read all about it in their August newsletter.

milkmakers has had a lot of great press, and a Seattle lactation consultant, Renee Beebe tested cookies with her clients and found 100% had increased milk production in under a week.

But lacation cookies? I bet you're wondering what they're like. These are not cookies which are meant to be healthy but taste terrible - these are yummy yummy yummy on their own, with the added benefits of supporting nursing -- a great way to nurture your taste buds and take care of mama while also feeding your baby healthy breastmilk. Emily Kane, founder of milkmakers, brought some samples to a board meeting one day and let me tell you, they rival cookies I get at bakeries. Soft, sweet but not too sweet, yummy oatmeal-chocolate chip cookies ... oh so good. I ate more than a few (and no, didn't start lactating again after seven years, haha!).

Anyway - we're honored to receive this donation from milkmakers and I'd love to encourage you to try these in August and support Open Arms: order them for yourself, give them for baby showers, or if you work in the birth and parenting field, recommend them to your clients. She'll ship for you - just put them in the freezer to enjoy one at a time and do something good for body and soul.

Thanks again milkmakers for supporting Open Arms!

Two massage opportunities for pregnant women and those with infants

I'm posting these notices on behalf of the Simkin Center at Bastyr University. Sounds like fun! Feel free to pass along to people who might be interested.

Free Massage Therapy for Pregnant Women

Saturday, August 14, choose Noon or 2 PM
Kenmore, WA

Simkin Center seeks mothers-to-be to participate in a massage practicum during the Pre and Perinatal Massage Therapy Certification Course. Open to women beyond 12 weeks whose pregnancies are low risk and without complications. Contact Simkin Center simkincenter@bastyr.edu or 206.322.8834 x100 for more information, and to reserve a session time.

Free Infant Massage Training for Parents and Caregivers and their Infants

Friday, Aug 20 - 2-3 pm

Saturday, Aug 21 - 2-3 pm

Sunday, Aug 22 - 2-3 pm in Kenmore, WA

The Simkin Center seeks parents with babies, 3 weeks to 9 months old, to learn how to massage baby. You’ll provide important experience to students in the Infant Massage Educator Training. Older siblings or other family member are welcome. Join us for one day, two days or all three. Contact Simkin Center at simkincenter@bastyr.edu or 206.322.8834 x100 for more information, and to reserve a session time.

Skin-to-Skin Bonding after C-sections

I saw this blog entry today (it was posted a month ago) and thought that I must share it with you:


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

Go over there and read this and then take a look at her blog. This is a nurse who really understands how to make things happen and to get past all the objections and problems that we hear of that get in the way of women and their babies bonding and having a healthy start.

Check out the video on the blog - a great video on "Breast is Best" from Norway. WOW. I can't even imagine that happening here - breastfeeding during a c-section? Baby skin-to-skin on way back to a room? If a mother's not available, the father does skin-to-skin until the mother can be with the baby? Just listen to all the benefits of skin-to-skin. We in the US have a mighty backward system compared to Norway.

I'll be adding this blog to our blogroll.

Quote of the Day

People will forget what you said. People will forget what you did. But people will never forget how you make them feel. -Bonnie Wasmund

Surrender

Women have long fought for their rights: to vote, to own property, to education, equal pay, rights to hold certain jobs, marital rights, legal rights and others. More recently, the fight is around abortion. The latter controversy is still in lively discussion, as anyone reading the news can attest to. Elections are won and lost on that issue alone, and emotions run high. Few are without a passionate opinion on the matter, and the battles are still being fought.

Yet - where is the outcry from women and men - and from both the vocal pro-choice and pro-life movements - about what happens after a woman becomes pregnant? Both sides agree that a woman can get pregnant and keep her baby, but then neither seems to care what happens next.

What often happens is that the pregnant woman is thrust into a world where she has high stakes (the health and very life of her and her baby) and lots of conflicting information. Her mother, aunties, friends, work buddies and internet support groups weigh in with experiences and stories which either support her, pressure her or scare her, her partner suddenly urges her to be careful and will "protect" her, the natural birth crowd says how wonderful it is to have unmedicated labor or how important it is to do things the natural way implying all else will cause harm, and her doctor is usually friendly, caring and offers medical opinions based on experience, research, policy and litigation concerns.

Many women lean toward what their doctor says, which might make sense until they realize that it may or may not be something that is supported by the medical literature, might be based more on facility policy, insurance underwriters, or lawsuit exposure than on that particular woman's health or even on whether that doctor personally supports that option. Many practices today say they are low-intervention and don't do "unnecessary procedures," but how do you know whether that scheduled c-section for a "big baby" is unnecessary or necessary?

So how does a new family sort this all out? Underneath all of this is the underlying message: do what you're told or anything that does go wrong will be your fault. In the end, many women surrender and simply follow along - and deal with the consequences later. It's ironic that this happens right before she becomes fully responsible for her new baby. "Give up and follow along, we know best." How exactly does that help create an empowered, confident, strong parent?

Think about the dizzying array of options that a birthing woman is unable to make. Perhaps the choice is simply denied due to policy (such as VBAC/vaginal birth after cesarean, water birth in a hospital or even something like eating or drinking during labor). Maybe there is strong pressure against it (such as homebirth, which requires strong commitment just to choose it and put up with all of the nay-saying - look at this homebirth post for some of the hot controversy.) Or, maybe a doctor doesn't allow the choice and once she finds out, she'd have to switch doctors to get what she wants, making it costly, inconvenient or downright impossible.

It starts right after that pregnancy test turns positive. Insurance companies get involved and decide what is and isn't covered. Maybe a woman finds insurance or Medicaid will cover an obstetrician at a particular hospital but not another one, or a midwife in the local university hospital but not a midwife in a birthing center - so that decision is made for her. Even the decision whether to receive prenatal care can be made based on things such as finances. The further a woman progresses in her pregnancy, more and more choices begin to disappear: Can I go into labor naturally? Can I avoid an IV? What do I do if my breech baby doesn't turn? How about electronic fetal monitoring? How about mobility during labor, or something as simple as the ability to eat or drink? How am I allowed to push this baby out? What am I allowed to do postpartum?

Different caregivers enable women to have more choice, or less choice, according to their own philosophy, experience, and policies. Yet when it's averaged out, over a third of normal, healthy women and babies in this country require major abdominal surgery to have their babies! There is something deeply wrong here.

The other day, the New York Times ran an article that has been making it around the birth circles: New Guidelines Seek to Reduce Repeat Caesareans. C-sections are a hot topic for sure. How is it that the medical literature says that vaginal birth after cesarean is safe in many circumstances (even with twins!), medical guidelines permit it and still a woman's right to choose it is in many cases outright denied?

The panel reaffirmed that vaginal birth was safe for many women with past Caesareans, and urged the obstetricians’ group to reassess its guidelines.

It is followed by things such as this:

Dr. Sandra B. Reed, an obstetrician at Archbold Memorial Hospital in Thomasville, Ga., which does not offer trials of labor after Caesarean, said, “I do not think this bulletin is strong enough to change the current policy in our facility.”

and this:

Dr. Waldman said he still hoped the new guidelines would encourage more hospitals to allow trials of labor after Caesarean, but, he added, “the big issue is liability.”

When it's liability - the legal system, not the medical system - that starts deciding what can happen to you and your baby over your objections (and if you don't believe it, read this about coerced and forced c-sections), then there's something vastly wrong. Women aren't stupid. Women make choices for good reasons, and they and their babies, not the doctors or lawyers, live with the consequences. I have to believe (want to believe) that the care providers don't like this either. It even isn't good from a cost-saving perspective - many of the unnecessary procedures add thousands to medical bills. If decisions are made to protect from lawsuits or for the financial benefit of hospitals and not for health reasons, then I really can't see this situation is tolerable for anyone but malpractice attorneys.

Women deserve the right to have a safe birth, free to respond to their bodies without interference, free from humiliation, shame and punishment, and to make informed choices for themselves and their babies.

I hope that more and more people see that reproductive rights are broader than simply contraception and abortion. Women must insist on being fully informed and then take responsibility for their decisions (and not then sue a doctor for not having forbidden the option) before anything is going to change. It is also going to require a change in the culture of fear around birth.

Personally, I am hoping that this is the generation of women that will take this on. What do you all think?

Visit to Washington, DC

Open Arms Executive Director Sheila Capestany traveled to Washington DC in June to participate in a meeting of Administration for Children and Families (ACF), for their Early Learning Communities Initiative. She was joined by John Bancroft from the Puget Sound Educational Service District and together represented the work currently underway in our Thrive by Five project community, White Center. Sheila spoke as a community partner in the White Center Early Learning Initiative (WCELI) on a panel discussion to pull out best practices across the country.

Just for a little background, ACF is developing a place-based framework drawn from successful community models of comprehensive and continuous early childhood services. The development of this framework is part of a project called The Early Learning Communities Initiative, which is designed to encourage dialogue between and within communities, and to spur local action. The outcome goals include healthy pregnancies and births, toddlers who are thriving, and young children who are prepared for success in school and well-being of families. Open Arms and WCELI fit perfectly into this and have a model which is working for many families here in the Puget Sound area.

Much of the initial discussion on the panel centered around Geoffrey Canada's place-based initiative in Harlem through the Harlem Children's Zone. This is a very interesting initiative for those of you who might not be familiar with it, and it's been very successful and held as a model. Check them out.

However, one of the most interesting things about the discussion was that the topic of doulas came up early - and continued to be the topic of conversation on the panel for quite a while. Why? Because it is becoming clear to many - and this is a new, radical idea in early learning circles - that birth work is foundational to early learning. Very, very few early learning initiatives in the country include services for families during pregnancy and through birth and most (if not all) of those that do, address only first-time parents. Open Arms' work in the White Center Early Learning Initiative was of great interest to many of the participating groups because we do serve our clients during the perinatal time and do not restrict our services to first-time parents. In fact, we do not place any limit at all on the number of children a woman might have had before receiving our services.

Birth is the foundational building block for a child. It is also a potentially transformative time in the lives of women and families - and we at Open Arms have found that it's true not only of a first birth in a family, but with subsequent births as well. Many participants were interested in this because the commonly held belief is that families are not open to services after a first birth. We have not found it to be limited in that way. Each birth is an opportunity for a family to connect, change, grow and achieve greater health and contribute to an enriched learning environment for all of the children in the family. Families must be healthy and empowered in order to take advantage of other policies and services later on. Otherwise, much of the effort put into these services is lost because families are not in a position to take full advantage of them.

Birth is the only time in a person's life when a person is admitted to the hospital healthy. There's nothing wrong with a woman during labor - she's just pregnant, and everything is normal. Yet our medical model of birth does not mirror that. Certainly medical events can occur during birth and hospitals and medical interventions are sometimes necessary, but some of the countries with lowest c-section and maternal - infant mortality rates are those with large numbers of women birthing out of the hospital in either birth centers or at home, and served by midwives rather than obstetricians. (Note it is also true that societies without birth support whatsoever have some of the highest maternal and infant mortality rates, so this obviously is a statement about planning and good support, not the absence of health care.) Many of the families we serve are from cultures where this medical model of birth is not familiar. When doulas are able to be cultural bridges between clients and the American way of birth, bias and misunderstanding can be minimized.

Open Arms is looking forward to more national discussion on issues around the importance of perinatal support to early learning, and we're proud to have a program which is being looked at as a model for others across the country.

KUOW Morning Edition: Story of Natural Birth

Thanks to board member Lisa Chin for pointing out this great piece by KUOW this morning:

There Will Always Be Three Now: A Story Of Natural Birth

You can listen online at their website.

When it comes to giving birth in America, there are choices. What doctor? What hospital? What medication? What kind of birth do you want? Less than 1 percent of couples choose a natural birth, a birth with no drugs and little to no intervention. Producer Katy Sewall brings an intimate look at one couple's decision to go that way. What is your birth story? How did you make the decisions you did? Are you satisfied with the choices that you made, or that were made for you? Call 1.800.289.KUOW (5869).

Special thanks to the midwives at the Puget Sound Birth Center and at Group Health Seattle.

The program is about choices in childbirth - in particular this is about the 1% who choose a "natural childbirth". I chuckled a bit because many in the birth field know "natural childbirth" can mean different things to different people and as such, is a very confusing, and sometimes loaded, term.

To some, natural childbirth simply means having a vaginal birth, regardless of the interventions - just not a cesarean birth. To others, natural childbirth means birth without pain medications, and sometimes without any interventions at all. This program, however, seems to refer to natural childbirth as out-of-hospital birth, including home birth and birth center birth, which is why they say only 1% of families choose it. A listener commented on the show about obstetric or nurse-midwife practices in-hospital, which have a high percentage (50% or more) of birthing moms who deliver without intervention or medication, but still in the hospital setting.

One of the people interviewed in this piece is Penny Simkin, a doula and childbirth educator here in Seattle and one of the founding board members of Open Arms. Penny provides some fabulous information about doulas in this program as well as reiterating some of the statistics about c-sections - the shocking rising rate of c-sections, for example - up 50% since 1996! She says this is due to the inflated sense of dangers of vaginal birth and unrealistic appraisal on the part of parents of dangers of cesarean. She also talks about the variation in the "cesarean epidemic" across the country, where different states and areas are apt to have widely differing c-section rates. For example, you're far more likely to get c-section in New Jersey than Utah. One of the reasons? Malpractice fear. Another reason for the rise was breech birth. Penny explains there was one very widely study finding bad outcomes in breech births that since has been completely discredited, but now 7-8 years later, medical schools are no longer teaching new physicians how to vaginally deliver a breech baby. So, with no training, few doctors can do them now.

All in all, this was a lovely program. For those of you doulas listening in, it's so nice to hear a peaceful birth on a radio show - you'll appreciate it. My husband rolls his eyes every time there's a birth on television. All that drama and huffing and puffing - he knows I'll make some sort of comment about that initial contraction and boom! she's in labor and boom! out pops the baby with screaming and hollering. It's nice to hear a birth happen in calm and peace.

On another note, this program has a caller that talked about the hard fight women had to gain their birthing choices - in her case, admitting the father to the birthing room. That work isn't done. Have you all seen the recent controversy about the Ohio medical practice that bans doulas? It's pretty interesting - read the comments on that blog. Those of us in Seattle are used to having quite a few more birth choices than in other areas of the country, or even other areas of the state. The fight for birth choices isn't over.

Building a Community-Based Doula Program in Your Area

Occasionally, people visit our blog who have read about the effectiveness of community-based doula models and are researching how to create a program in their area.

If this describes you, please contact us for information or just to talk about what you're considering. Open Arms has had a community-based doula program for years now and have learned a few things along the way, especially as we've built our Outreach Doula program with the White Center Early Learning Initiative, and we are happy to share that expertise with you to help your program get off the ground.

The Open Arms program is based on the Chicago HealthConnect One community-based doula model. To follow that model, there are several key steps that a program must adhere to:

• Employ women who are trusted members of the target community
• Extend and intensify the role of doula with families from early pregnancy through the first months postpartum.
• Collaborate with community stakeholders/institutions and use a diverse team approach
• Facilitate experiential learning using popular education techniques and the HealthConnect One training curriculum
• Value the doulas' work with salary, supervision and support

Although there are other web pages and programs out there that describe how to start a community-based doula program, we strongly feel that this model provides an excellent foundation for this kind of program. There are reasons for each of these steps, and they have been proven to increase the effectiveness of the program. They also help a community-based program to be truly community-based ... if you skip any of these steps, it's easy to veer off course and provide a program that isn't actually from the community it serves and therefore will have reduced effectiveness and simply won't be as valuable to your clients.

Contact us by email or phone at 206-723-6868 and we'd be happy to talk with you.

Open Arms featured today on KONG TV's Learning for Life series

Today's Learning for Life show on KONG featured an interview with Open Arms Executive Director Sheila Capestany, speaking about our Outreach Doula program.



Here's the description from the website:

Giving birth and raising children should be among the most natural things in life.

But for women going through the process without the support of family and friends, the experience can be intimidating and lonely. This is especially true for women who come from a different country and culture and speak a different language.

The Outreach Doula program, started by Open Arms Perinatal Services last year as part of the larger White Center Early Learning Initiative, supports both immigrant Latina women and Somali refugees in their own languages by women of and from their own communities.

Outreach Doulas work with families from early pregnancy through a child's second birthday.

Sheila Capestany, executive director of Open Arms, talks about the Outreach Doula program and the difference it's making in the community

Happy Father's Day from Open Arms!

Father's Day - a day to celebrate the dads in our lives ... our own, our spouses or partners, our children who themselves might have become fathers, and father figures who step in at important times in our lives and our children's lives to give support and encouragement. If you're a father yourself, know that your role is very much appreciated. A lot of people think these holidays are just another opportunity to sell cards and presents, but I do think there's huge value in remembering to say thank you to those we love and appreciate. Hope your day was an enjoyable one.

As a doula, one of my biggest joys was supporting fathers in their transition to parenthood. I know that a lot of the focus in pregnancy is about the mother and baby. She goes through pregnancy, the baby grows, the labor and birth are joint efforts between mom and baby - but dads, I can only imagine what goes through your mind as the woman you love gives birth. What a joy to watch a dad relax into his own knowledge that he can be of help, that he doesn't have to know everything or be in control in order to give a huge positive influence to his partner or his child.

I've been on vacation recently (therefore no posts to this blog!) and I've loved watching my husband be around for our kids. I see how much more easily they go to him to make themselves feel better when he's been around more, and the confidence he exudes around them. I see the way he interacts with our children - different from me, and so very valuable.

To all the dads out there: thank you for everything you do for your families.

Contagious Positive Impact: An Interview with Yen Baynes, Open Arms Outreach Doula

This is an interview that Open Arms did for our latest newsletter. Hope you enjoy it!

In our first interview, we introduce Yen Baynes, Latina Outreach Doula. Outreach doula services begin in early pregnancy and continue up to two years after delivery. You can read more about the Outreach Doula Program here.

In the photo, Yen Baynes is on the right.

What's your name, job position, and how long have you been at Open Arms?

My name is Yen Baynes. I'm a Latina Outreach Doula for the White Center Early Learning Initiative (WCELI) Outreach Doula Program. I've worked as a full-time staff person since June 2009, but I've been an Open Arms Volunteer Doula since 2006.

Why did you become a doula?

I became a doula because I had a doula at my birth who spoke my language and helped me during my perinatal period. Because she spoke my language, she could relate to my family, and that helped hold the emotional space I needed in order to have a positively transformative birth experience. It was amazing -- I had an amazing birth!

What is the most meaningful thing about being a doula?

It's an honor to be with women during a transformative time - pregnancy and birth. I especially love that I have a long term relationship with my clients and I'm with families from pregnancy to age two. It gives me a lot of comfort that I'll know these babies and families for a long time. I also love experiencing birth with my clients - it's my favorite! I call it my journeys to "birth land," because it's a kind of time warp when everything else falls away and you're just in the present with the birthing woman as they go through the passage that is their birth experience. I love holding the space for women in birth. Despite the exhaustion, it brings me a kind of energy boost that informs my whole way of being in the world.

Is there an instance you remember where having you as an Open Arms doula made a big difference for a family?

I always feel like it's really important to be there - families are often on a track that is already very biased against them. They tend to get more interventions and a more disempowering experience. But one client does come into mind - she has a medical condition that requires that she be induced. Because it's somewhat uncommon, it is hard to understand, even with an interpreter, the intricacies of the condition and why an induction is the best course of action.

As we've worked together for a few months, she's been writing down what questions she has for her doctor so she can get all the information she needs to make an informed decision about her care. This practice has turned out to be very useful now that there are health concerns. She is now able to go into her birth feeling she's choosing the induction rather it be something that is being done to her. I think emotionally, going in with that mindset, her birth will be more empowered and more manageable.

People often see doulas as supporting only idyllic, natural births with no interventions. In reality, it does happen quite often that clients are actually facing births where interventions are appropriate. At its core, what we doulas can do well has more to do with holding space for choice and empowerment. It's about building a relationship in which the model is to trust the woman's strengths in decision making when it comes to what is happening with her pregnancy and her baby.

What would you like to tell people about Open Arms that they might not already know?

I think something that is very powerful but hard to describe from an outsider's perspective is our reflective practice. Often people say they see us as this pack of super powerful women - we've had comments at restaurants about this powerful aura that we have - and that's how it manifests, but what's happening is that we're very interconnected through a deeply reflective way of being with each other and with our clients. It's been a very intentional (and sometimes arduous!) approach that is both from the top-down - from board to executive director to staff to doulas to clients to babies, and from the bottom up. Our interactions are imbued with honoring each other's strengths as we move forward.

As an Open Arms employee, I get a lot of support and space-holding from my supervisors, and that's the model I use for how to hold space and provide support for clients. In turn, my clients model their relationships with their babies and their community in this way, as well. It's contagious positive impact! Women can have multiple children and still have this new infant and new relationship be completely different, because their way of being with their new baby has been based on a reflective model since pregnancy.

Can you describe reflective practice?

Reflective practice honors what the person already knows. It is based on wondering and being curious about what a person has already mastered in order to get to where they are today. As a provider, my wanting to understand what a woman already knows about herself and her situation strengthens her ability to learn new information. For example, with my client - after hearing she needed an induction, my first question was "do you have enough information?" And, once we figured out what she needed to know about the condition, I was able to ask "what do you know about induction?" I don't mean facts, although it turns out she knows a whole lot -- she was a nurse in her home country and she has a lot of factual knowledge. But what did it mean for her to have an induction next week when she was planning to give birth next month? What were the implications for herself and her baby? It wasn't for me to tell her - she had that information herself. It was in feeling heard that she could hash out a good plan for what should happen next. In being heard, she is able to go into the experience trusting that her personal, embodied way of knowing is not only valid, but crucial when it comes to making decisions in her health and in her life.

This was the same way I was trained here at Open Arms back before we even started taking Outreach clients. And, it is the same way we speak to each other in the office day in and day out. This kind of honoring and the effect it can have is not specific to any one population or situation. As humans, we all do better when we can trust our powerful ways of knowing. We do better when we know better. The exact same skills will prove useful when my client's child is in school and she has to talk with a teacher or principal. By using reflective practice, she will understand and advocate for her child. People first see it modeled, and then can practice it. At its core, reflective practice makes for an important building block toward becoming better parents.

Seattle Human Services Coalition Award Ceremony

Last week on June 3rd, Open Arms was deeply honored to receive the Human Services Coalition award for Innovative Program.

The following is a transcript from the awards ceremony. We are pleased - and humbled - to receive this award, and know that it is the result of deep commitment to serving our clients and our community.

If you are interested in seeing some of the other award winners for this year, please visit the Seattle Human Services Coalition Awards web page.

Here's the transcript of the award.

Innovative Program Award

Germaine Covington – MC, Introduction of Innovative Program Award:

Our next award celebrates creativity through unique programs and services developed by agencies and community based organizations to respond to emerging or existing needs. The Innovative Program award is presented to an organization that has implemented a new program, or substantially re-designed program within the past 5 years and has creatively used resources and has demonstrated a commitment to providing culturally relevant resources.

Now, please join me in welcoming Seattle City Councilmember Sally Clark who will be presenting the Innovative Program Award to Open Arms Perinatal Services.

Councilmember Sally Clark:

Open Arms Perinatal Services provides birth doula services to low-income women, women of color, refugee and immigrant women and teens which help support, educate, respect, honor and empower women and their families throughout the childbearing year and beyond. The programs’ goals are to decrease infant mortality rates, especially for Latina and African American women who are disproportionally affected and to provide the opportunity for more women with empowering birth experiences that usher them into motherhood feeling prepared and successful in advocating for themselves and their children.

Often, new parents are unaware of what constitutes normal newborn growth and development and normal postpartum recovery for the mother. Moreover, immigrant and refugee women often face additional challenges because they are in an unfamiliar land, with unfamiliar customs and environments, and might not understand the language. The risks for teens are even greater. In addition to the challenge of birthing and raising a child, teen mothers face severe challenges in completing their education and are at higher risk of severe health problems, all of which make them more likely to be reduced or confined to poverty.

Through Open Arms, certified bi-lingual birth doulas receive cultural competence and anti-racism training provide high quality care in 6 languages and emotional support while removing barriers that exist for many women needing health care.

Recently, Open Arms launched a Doula Outreach and Training Project which offers a career path and professional certification to the mothers they serve while at the same time enabling and empowering women to work in their own communities. Outreach doulas provide services to women and their families who need more intensive support during pregnancy and early parenting. They begin outreach in early in pregnancy and continue up to 2 years after delivery. In addition to doula training, outreach doulas receive training in assessment, case management, and other social service skills.

By helping families from the very beginning, they set the stage for the long-term health and the well being of each family they serve. By removing barriers to service, increasing awareness and personal advocacy, providing education about pregnancy, birth options, breastfeeding and positive early parenting and reducing medical interventions and the costs of perinatal care, Open Arms is able to fill in the gaps left in our customary perinatal practices and give families a healthy start.

Sheila Capestany, Open Arms Executive Director walks forward, accepts award, shakes hand and poses for picture, brief remarks

Resources and information

I have a number of blog posts half-composed in my head, but have not had a spare moment to write them down, what with summer vacation coming up and so many things to do in the meantime. Soon, soon - stay tuned!

Today though I saw the HealthConnect One Facebook page, and wow, is it ever full of great resources, information and workshops.

If community doula programs are your thing, or if you're researching creating one in your area, or if you're in the birth field, or if you're just interested in these issues, go check them out.

Pumping in the workplace

Just after I posted on the topic of supporting breastfeeding in the workplace, I see this article:

The mother of all office dramas: New law changing the perception of workplace lactation

It does a good job of talking about some of the challenges of workplace breastfeeding.

On the other side of the debate is this discussion - is breastfeeding really that much better to warrant all of this pressure on women to breastfeed? Take a look at this video where Hanna Rosin, who wrote the article “The Case Against Breast-Feeding,” and NBC chief medical editor Dr. Nancy Snyderman discuss whether breast-feeding is best for your baby. I think the evidence does say that breastfeeding gives many benefits - but, as they say in the video, it's not medicine, and it's not child abuse if you don't do it. More important is that women find a way that works for them - whether it's breastfeeding initially, doing a mix of breastfeeding and formula, or extended breastfeeding. But as we see in both articles here, breastfeeding and the workplace are not a combination that mixes well all the time. I'm glad groups like the Breastfeeding Coalition of Washington are helping businesses to find ways to move forward in this area.

Visit msnbc.com for Breaking News, World News, and News about the Economy

Improving maternal-child health & infant mortality

This video was recently posted to the Bill & Melinda Gates Foundation about the improvements in maternal, newborn and child health in Malawi. Through education and community support, Malawi has greatly reduced the number of deaths in mothers and babies. Improving maternal-child health is one of the World Health Organization Millenium Development Goals.



A recent New York Times article Global Death Rates Drop for Children 5 or Younger describes some of the progress made in this area in more detail.

One thing to note from the article as well as other surveys: The United States has one of the highest infant mortality rates in the developed world! I did however find it interesting that Washington state has one of the lowest rates within the United States - ranked 49th with a 5.1 infant deaths per 1,000 live births - but that would still be around 26-27th in the world rankings, falling far short of countries such as Singapore (2.30 deaths/1000 live births), Sweden (2.76), or Japan (2.80).

So what can we do about this? Among the causes of infant mortality in the United States, a leading cause is prematurity and low birth weight. Many premature babies die. Of the premature babies who survive, despite the advanced care they receive, many face a lifetime of learning and medical problems, including increased risk for hypertension, diabetes, and coronary artery disease. The March of Dimes Prematurity Campaign is working hard to increase awareness and funding to help reduce prematurity and its risks. Through March of Dimes funding, a number of risk factors have been identified, but one of the most interesting - and easy to reduce - factors is c-sections. From the March of Dimes website:

The Relationship Between Cesarean Delivery and Gestational Age Among U.S. Singleton Births, Clinics in Perinatology: This study found that cesarean sections account for nearly all of the increase in U.S. singleton preterm births between 1996 and 2004.

The c-section research suggests that more scrutiny is needed to ensure that cesarean sections are medically indicated. C-sections performed before 39 weeks for the convenience of the mother or the physician do not comply with guidance from the American College of Obstetricians and Gynecologists (ACOG); they may significantly contribute to the growth of premature birth in the United States.

Based on the study’s findings, the March of Dimes has called for hospitals and providers to voluntarily assess c-sections performed before 39 weeks to ensure that professional guidelines are being followed. This message supports the quality improvement initiatives now under way in many hospitals and has the potential to reduce the prematurity rate within those institutions.

In an earlier post, I discussed the success that Swedish Medical Center is having in reducing inductions before 39 weeks. This kind of work is essential if we're to improve the health of moms and infants in the United States.

Of course, another cause of prematurity is premature labor - something that we at Open Arms are helping mothers to address. By teaching the signs and symptoms of premature labor, doulas are able to help moms to identify premature labor early, before it progresses to a point that is difficult to stop, and to seek help from care providers. This education around premature labor is now a regular part of our prenatal visits and since January has already helped several moms to avoid early births.

But is the infant mortality rate constant, meaning is it distributed evenly in our population? One might think so, but it's not - African Americans in particular have a shockingly higher infant mortality rate, and overall the non-white rate of infant mortality is higher than that of non-Hispanic whites even when adjusting for socioeconomic, income, and education levels. Why is that?

If the health of a society is measured by its infant mortality rates, then the United States is not a particularly healthy population. Compared to the rest of the industrialized world, the United States is vastly underachieving in this very important area - certainly nothing to be proud of, despite touting its excellent health care. It would benefit us to really understand why this inequity exists and do something about it.

If you want to explore this problem in greater depth, this report Racial Differences in the Relationship Between Infant Mortality and Socioeconomic Status is a good summary of the problem. This report finds that over time, even when factoring in socioeconomic status and income, these differences persist.

There have been many reasons put forth on why these differences exist: health care disparities including prenatal care, cumulative and chronic stress from racism and discrimination, nutritional differences not only currently but in past generations, and behavioral differences.

We at Open Arms are deeply concerned with the question of infant mortality. We believe social factors play a part in the discrepancies in infant mortality as well and are working to reduce them. For example, providing bilingual and bicultural doulas can help reduce communication barriers between care provider and mother to improve health outcomes, and connection to lactation services that fit within a cultural context can promote breastfeeding when before it might have been dropped. Information on health care and healthy parenting and nutrition must be available in a way that can be understood and followed - one way does not fit all communities.

Just in Melinda Gates' video, volunteers from the community were trained and went back the community to support women and give them the information they needed. When you have support coming from within communities rather than externally, it suddenly works.

If that model can drastically improve maternal-child health in countries such as Malawi, it can work here in the United States. For evidence of this, see some of the research from Chicago HealthConnect One on their community-based doula model, which is the basis for the Open Arms programs.

A few community organizations of interest

I was at the Within Reach luncheon last week and was inspired by their work. If you haven't heard about this organization, they are right there on the front lines connecting families to the programs and services they need: health care, nutrition and food resources, childcare, and immunizations. Many of their families have been hit hard by the downturn in the economy, and are needing support for the very first time and have no idea where to turn. Within Reach is doing great, necessary work to promote maternal, child and family health - check them out.

While I was at the luncheon, I sat next to Michele McGraw from the Breastfeeding Coalition of Washington. We had a wonderful talk about breastfeeding in the workplace. There's no denying the benefits of breastfeeding, but there are many obstacles to it, and one of the top obstacles is when mom goes back to work. Many workplaces are not set up for pumping breastmilk at work or if a process is in place, it is often for one or two specific mothers who have asked for it. Then when those moms are no longer pumping at work, the policy and procedures go away. There's no organizational support for it, and it seems to be too much work for employers.

To respond to this, the Breastfeeding Coalition of Washington is creating information packets for employers to not only accomodate breastfeeding moms, but to see the benefits to themselves for supporting it. A baby who is fed breastmilk is less likely to be sick, which means that mother will be at work rather than at home caring for a sick baby. Also women who are committed to breastfeeding but find that the workplace doesn't accommodate that might find that it's easier to take a different job or quit altogether, requiring that employer to hire and train a new employee. By presenting the benefits to employers as well as tried-and-true methods for making it work and sample policies to adopt with minimal expense or disruption to the workplace, the Breastfeeding Coalition is supporting more employers to make the transition to breastfeeding-friendly workplaces, and in the end, that benefits everyone.

I was so excited about the work of both of these terrific organizations and wanted to share them with you!

On another note, Michele works at Birth and Beyond in Seattle, and she told me about their Sunday Socials gatherings for birth professionals to meet and greet on a bimonthly basis. Any of you birth professionals who are interested in meeting others of like mind, we hope to see you there at the next Sunday Social on Sunday, June 13 from 3-5pm. Open Arms will be a "featured business" on that day, and our board treasurer Sarah Pulliam will do a brief introduction about Open Arms. Hope to see you there.

Birth To Thrive Online - Profile of New Mothers Changing

Go check out the latest blog post on the Birth To Thrive Online Blog:

The U.S. Mom Is Increasingly Older, Born in Another Country and Better Educated: What Does This Mean for Early Learning?

The Pew Research Center published their New Demography of Motherhood earlier this month. It states that births from foreign-born mothers are increasing and are up 60% from 1990. The Thrive blog calls out the Open Arms outreach doula program for Somali and Latina communities in White Center, one of the two Thrive by Five Washington Demonstration Communities, as an excellent example of outreach efforts to immigrant communities.

Also take a look at the MomsRising blog post that prompted Thrive's post:

Who is Giving Birth in the US?

I will add the MomsRising blog to our blogroll.

Dads can get postpartum depression too

Here's a new article on dads and postpartum depression. It says a father's depression often appears different from a mother's: Dads are more likely to be irritable and angry. And about half as many dads as moms have postpartum depression: one in ten, as opposed to one in five for moms.

New dads get baby blues, too

When studied, a father's postpartum depression has an effect on a family as profound as a mother's postpartum depression. Quoting from the article:

According to one large study, following more than 10,000 families for seven years, a father's depression during his child's infancy made the kid more likely to have emotional and behavioral problems by 3.5 years old and more likely to have a psychiatric disorder by the age of 7. This remained true even if dad's depression disappeared after infancy and even after accounting for mom's depression, explained Paulson, who was not involved with this 2008 study published in The Journal of the American Academy of Child and Adolescent Psychiatry.

Pushed Birth Blog

My friend Walker told me about this website a while ago and I'm not sure why I haven't posted it yet - it must have fallen off my to-do list. This is a great website -- strong (in a good way) on how it talks with women about obstetric care and birthing in the United States.

Pushed Birth

It's the sister site to the book Pushed: The Painful Truth About Childbirth and Modern Maternity Care (Da Capo, 2007).

Check out their blog and their links. Good reading there. I haven't seen their blog updated recently (the last I see is March 2010) but in hopes they continue writing, I'm going to add them to our blogroll.

Has anyone read the book? Care to do a book review? Contact me!

The Pros and Cons of Induction

Sometimes it's medically necessary to induce labor - but many times, it's a gray area and women have some say about whether they choose to wait or induce their labor.

I saw this video today from King 5 News in which Julie Ogata from Parentmap speaks on the topic of pros and cons of labor induction.



The video cites some very interesting statistics from Swedish Medical Center here in Seattle. By paying attention to who is able to get an elective induction - with particular attention to moms below 39 weeks and first time mothers - Swedish has brought the induction rate down for first time moms from 25% to 1%! That is a amazing. Doctors at Swedish also studied their patients and found that for inductions, the c-section rate was 3x higher than for women who weren't induced! These are certainly statistics that catch one's attention.

You can read more of the ParentMap discussion on induction on the ParentMap website.

Dr. David A. Luthy, medical director of the department of OB/GYN at Swedish Medical Center in Seattle, speaks in the article about the increased risks for women who choose elective (note that word) induction. He does a very good job of stating the increased risks when induced over naturally/spontaneously starting labor. I'm excited to hear our Seattle physicians speaking about this common practice, so women can be informed about what we're choosing.

If we don't know what we're choosing, it's not truly a choice, right?

The end of the article talks about a different viewpoint - seeking control during the labor and delivery process. With an induction, you "know," right? Though is that true?

Really, all you know when you induce is that you're starting the process. I've attended enough births as a doula to know that the idea of control in labor is an oxymoron. You can't control it despite all the careful reading, classes, doula, care provider, birth site and a 10-page birth plan! Actually, I'll go so far as to say you can't plan especially if you have a 10-page birth plan. Even a scheduled c-section can have unexpected outcomes or complications. And even if you, through some strange twist of fate, get the birth exactly as you plan, just wait for parenthood! All it takes is that first night when your infant is inconsolable and there's nothing you can do about it to take the idea of control and throw it out the window!

Anyway I did like this video and article, and hope you do too.

Early quality of care affects children for years

I saw this article today on MSNBC:

Low-quality child care can have lasting impact
Behavior, academic problems persist through age 15, major study finds

It was a major study and therefore is news (and it includes Washington State data), but what I don't get is why we are surprised by this and why we as a society don't put care during the earliest years as a higher priority. I loved how the end of the article said that this isn't a low-income problem - this is a problem for all of us.

We as a society need to prioritize our babies and toddlers and say that it is important for us all to enable parents, all parents, to have access to high quality child care (and by that I mean caring for a child, not the process of dropping a child off at "childcare" because child care can be low quality when given at home as well.) However what also comes from this is that often when you have less money, you're not able to afford a higher quality of childcare. Also childcare providers themselves can actively hide what is going on to parents so although the parents think it's a quality childcare, it's not. I don't know how the finances of this will ever be able to be worked out, but I do hope that more attention on this will help get our children what they need because investing in those first four years of a child's life has to be a top priority.

I wonder where all this comes from. Is it that old thinking that babies are basically lumps that just need tending to physical needs, but they really blossom when they begin to talk or go to school? This study indicates that by then, much of the damage of an unstimulating, harsh or neglectful environment has been done and it persists through at least adolescence. Or is it that we don't value what is traditionally women's work - caring for children? Or is it that we figure kids grow up anyway and survive and because they are resilient, as long as they are alive and appear unhurt, we are OK?

I am relieved that the popular media has begun to say over and over again - take care of our moms, take care of our children, value the early prenatal / birth through preschool years and a lot of the problems of society will be lessened not only in this generation but in future ones.

What do you want to know?

I'm happily blogging away here but it's time for me to ask you, what do you want to know from Open Arms? Do you have any topics you'd like for me to address about our organization, our mission, or why we do what we do? What interests you?

Reply in the comments or email me at blog@openarmsps.org and let me know!

Open Arms wins Seattle Human Services Coalition Award

We at Open Arms are thrilled to have received the Seattle Human Services Coalition award for Innovative Program!

The winners were announced today:

18th Annual Human Services Awards

The award recognizes Open Arms for its "response to an existing need in a new way, its ability to build upon an outstanding program model, its creativity in leveraging resources, and its positive program results."

I'm thrilled about this award. Today I had a wonderfully stimulating and energizing conversation with one of our current board members and a potential board member and left that conversation feeling so excited about the work we do at Open Arms, as I often do when I have a chance to step back and really look at Open Arms with fresh eyes. Our programs are innovative - and I'm pleased to see that recognized through this award.

Open Arms is a community-based organization, and all of our programs are deeply committed to working within the cultures and communities we serve - not imposing structure from the outside. Open Arms Programs - our regional birth doula services program and our White Center Early Learning Initiative (WCELI) birth doula and outreach doula programs - show results and are cost-effective.

Our clients - low-income women, refugees, immigrants and others - struggle in many ways, but one of the ways that is most apparent is in the area of health disparities. Issues such as postpartum depression, preterm birth and infant mortality disproportionally affect our clients. By removing barriers to service, increasing awareness and personal advocacy, providing education about pregnancy, birth options, breastfeeding and positive early parenting, and reducing medical interventions and the costs of perinatal care, Open Arms programs are able to fill in the gaps that are left in perinatal care and give families a healthier start - which has a great impact in terms of health care costs, early learning and future success of families.... and that affects us all.

Seattle Woman Magazine Mentions Open Arms

You can read the article here:

The Doula Business
by Cheryl Murfin

Nonprofit provides birth kits to refugee camps and sub-Saharan Africa

I just received news (thanks Audrey!) about this interesting new nonprofit World Birth Aid. I thought Open Arms blog readers might be interested.

Their opening sentence on their website says so much:

All it takes to save two lives is a clean pad, soap, razor blade, a length of string and a set of illustrated instructions.

I think that is amazing - that these items are so absent that a woman has to birth without them. We take so much for granted.

Here's an email from Yvonne Røskeland, one of the World Birth Aid team:

Hello my friends,

Good Spring to you all. As many of you know I have had an interesting year. Due to circumstances beyond my control I was unable to work as a midwife this past year, which has provided me with a wonderful opportunity to spend time with my two year old son Lukas. I hope to introduce you soon to those he has yet to meet. The time I have had away from work has also allowed me to reflect on my personal and professional life.

I spent formative years of my youth in Africa with my family and shortly after receiving my midwifery education I spent two months in Afghanistan delivering babies in a devastatingly dire environment. These experiences have helped encourage me to create a non-profit organization to aid pregnant women and newborn babies in desperate circumstances in sub-Saharan Africa. My organization is called World Birth Aid. The goal of World Birth Aid is to provide a simple clean birth kit which consists of soap, a clean pad on which to deliver, clean string to tie the umbilical cord, a clean razor blade to cut the umbilical cord and illustrated instructions on how to carry out a hygienic delivery outside of a hospital environment.

It is a small organization with a simple charter but I know that if we can provide clean birth kits to women who would otherwise be forced to deliver in squalid conditions we will save lives.

I have recently finished our website. If you wish, you can learn more at www.worldbirthaid.org. If you feel inclined, please forward this email to any and all friends as the larger community we can create the more birth kits we can deliver.

Warm wishes to you all,

Yvonne

Quote of the Day

Another quote... I liked this. It made me think of Open Arms for sure!

“Although the popularly desired outcome is ‘Healthy mother, healthy baby,’ I think there is room in that equation for ‘Happy, non-traumatized, empowered and elated mother and baby.’” –Midwifery Today, Winter 2008

Quote of the Day

"You're braver than you believe, stronger than you seem and smarter than you think." - A. A. Milne

More on Shaken Baby Syndrome

There seems to be a lot of relevant news today - as I scanned the news one last time before going to bed tonight, this caught my eye, which is relevant to my post earlier today about postpartum depression and shaken baby syndrome. This article takes it wider, stressing that many parents are under extreme stress with the economy just as county and state funding has been decreased to programs who aim to help prevent such abuse. The children pay the price.

Shaken baby injuries rose in recession: Grim child abuse spiked; a third of kids older than 1

Seattle Children's was one of the medical centers citing a rise in numbers of babies and children (some up to age 6) presenting with shaken baby syndrome, or abusive head trauma.

The number of babies and young children suffering abusive head trauma climbed by 55 percent in the months after the recession began in December 2007, according to a review of 511 cases at four children’s hospitals across the U.S.

The spike came during a period of rising unemployment, falling home prices and cuts to state and county budgets, including those that fund safety net programs to prevent child abuse.

Crying it out harms babies' brains

Here's a link on crying it out, and why leaving your baby to cry isn't a great idea:


BBC News: Crying-it-out 'harms baby brains'

I really hesitated to post this because honestly, parents can be blamed for a lot. There are times when it feels the entire weight of the world rests on our shoulders... oh and speaking of rest, we aren't getting any. There's certainly the temptation to let a baby cry it out a little if that means that we'll get some sleep - and our baby will get some sleep! I had triplets, and believe me, I couldn't physically answer each baby's cry immediately - there were two others to attend to. So news like this can honestly wear me down and make me think no matter what I did, it wasn't going to be good enough.

But the reason I'm posting this isn't just about that sleep technique of crying it out. I do believe that babies cry for a reason and that babies become emotionally and physically healthy when we respond to them in a timely way and with loving, nurturing care. And when we leave our babies to cry - not once or twice, but regularly, and hard, and for long periods of time, it isn't good for the baby.

It says in the article:

Recent scientific tests show high levels of the stress hormone cortisol develop in babies when no one answers their cries... Dr Leach suggested unattended extreme crying bouts of 30 minutes or more could be damaging to babies... Dr Leach told the BBC News website: "We are talking about the release of stress chemicals. The best known of them is cortisol, which is produced under extreme stress."

"One is not talking about a wakeful baby lying there gurgling, one is talking about a baby that is crying hard and nobody is responding. When that happens, and particularly if it happens over a long period, the brain chemical system releases cortisol and that is very bad for brain development. Some neuroscientists describe it as toxic."

I am interested in this news because again there is scientific evidence that we must nurture our babies and respond to them. If a parent regularly chooses not to respond to a baby's cries, a baby's brain chemistry changes from the neglect and there are well-documented, lifelong effects.

Why would parents not respond to their baby? Some parents don't know it's important, some are emotionally unable to respond because of depression or other factors, some are too self-absorbed to attend to someone else's needs, some are purposefully abusive/neglectful and some are unable due to factors such as alcohol or drug abuse. One can see how such patterns can repeat through generations, however - with each generation leaving the next with additional challenges caused by early neglect and abuse.

In closing on this last day of April, I'd like to share this article with you: Blue Ribbon Campaign Means April is Child Abuse Awareness Month. We've seen this information before, but it's a really good write-up of the issues, and again says home visiting programs (such as Open Arms) work at reducing childhood abuse and neglect.

Postpartum Depression and Shaken Baby Syndrome

Thanks to Sarah Pulliam, LICSW, MPH, social worker at Seattle Children's Hospital and Open Arms Board Treasurer, for sending much of the information that appears in this blog post.

In this post, I'm again talking about postpartum depression. There has been increasing discussion about postpartum depression in the news, and I'm glad that this is coming up more to help build awareness.

As a mother who had undiagnosed (or perhaps unaddressed is a better term) postpartum depression during much of the first year of my own children's lives, I can say from personal experience that it is something that has a big impact on mothers' lives and abilities to care for their children. We as women often rationalize why we feel the way we do and don't address it, especially since it's something that we see reflecting on our abilities to parent. Women might think, "I'm not blissfully happy like a mom should be - in fact, I'm a wreck - but I can't let anyone see I don't have it all together so I'll hide it." Even partners, friends, family members and physicians can think, of course you're irritable, you're postpartum and don't have enough sleep - that's normal. But postpartum depression should not be dismissed - if "baby blues" last more than two or three weeks, there could be a problem. No one should feel the need to suffer in silence because postpartum depression is treatable.

I'm glad to see this issue coming to the forefront more, so physicians can address it and can help women and their families receive help in whatever form is needed.

Heidi Koss-Nobel, Executive Director of Postpartum Support International of Washington, was just interviewed on King 5's Learning for Life program on the topic of Postpartum Mood Disorders. She stressed that postpartum depression affects one out of eight women after pregnancy and is the most common complication of childbirth. In this video, she discusses ways to distinguish postpartum depression from baby blues and regular sleep deprivation during postpartum and how to get help.



Heidi Koss-Nobel also talked about the factors that increase the likelihood of postpartum depression: women with lots of stressors in their life, women with a history of infertility, teen moms, women with a history of depression or family history of depression, military families, low income women, even those who moved recently.

Related to this topic, Sarah also went to a presentation recently on Child Abuse prevention by Dr. Jenny Radesky at Seattle Children's Hospital. Dr. Redesky said that paternal postpartum depression is now becoming more accepted as a real problem as well. She said that environmental stressors such as poverty and unstable living conditions contribute to higher rates of postpartum depression in both parents, not just mothers.

We certainly can see why this can be a problem within a family, but the reason why this is so important is that the consequences of having parents with untreated postpartum depression are so high. There are real lasting effects. As Heidi Koss-Nobel says in the video, postpartum depression can eventually lead to long-term health problems for both parents & baby. As a result of depression, parents can interact less with the baby, be less responsive to their babies, and babies can later develop their own depression and anxiety as well. On the extreme side, postpartum depression can lead to more serious problems of neglect, abuse, psychosis or suicidal thoughts or actions on the part of the parent. These kind of grave consequences cannot be ignored.

A review of the literature suggests that a baby is more likely to be physically abused (also known as Shaken Baby Syndrome, or Abusive Head Trauma or AHT in the medical literature) by parents who are depressed in the postpartum, usually 2-3 months after birth. One of the main reasons is that these parents are having difficulty attaching to the baby in the first place. They may have trouble reading infant cues or responding to them appropriately. They may be sleeping and eating irregularly, and feeling ineffective and overwhelmed, and ambivalent about parenthood. This cumulative stress understandably tends to lower the threshold of self-control. But another important reason is that babies of depressed mothers are at higher risk for abuse is that the babies are often more irritable and resist soothing (stemming from attachment difficulty or even possibly inadequate care).

Taken together, it is not surprising that depression is a strong risk factor for trauma in infants — and the outcomes are grave. About 30% of babies who suffer abusive head trauma will die. The remaining infants who survive often have life-long disability and health care problems. The cost of one intensive care stay is on average $80,000. That is not including all of the chronic care a child may need the rest of their life, a cost borne by society. The real tragedy? These outcomes are entirely preventable.

A link to local support groups and other resources for parents is the Shaken Baby Coalition.

I'm pleased to say that Open Arms is now including postpartum screening as part of our program with all our clients. We believe that postpartum depression can occur for any woman regardless of her education, socioeconomic status, or any other measure. We strongly believe that all parents and their babies deserve to be as healthy as possible, and this means mental health as well.

No woman is immune to postpartum depression. I'm delighted that this issue is receiving the widespread attention it deserves.

For more information, visit the Postpartum Support International of Washington website.

Newsletter archive

Update: Our newsletter archive is now up and running!

It's not beautiful - see my previous post about being a bit busy right now. All right, let's be honest, at the moment the archive page is downright ugly. But ugly or not, it is functional and you can see the past two newsletters for Open Arms, including the one that we published today.

I'll put a link to this on our website in the next few days as well.

Managing resources

It's been a while since I've posted - life gets complicated and busy, and so I prune my to-do list down to the bare essentials so I can get it all done. It's a theme that runs through life - so many things to get done but we have limited resources.

The Open Arms Board had a board retreat yesterday - we had another great meeting. Have I mentioned how much I love being with these people? One of our many areas of discussion was being fiscally conservative while being open to opportunity.

Open Arms has always been a fiscally conservative agency. We don't go off and do things without having a deep understanding of how we'll pay for what we do, not only immediately but also into the future. Like many of us in our personal lives - we may have a lot of wants, but that doesn't mean the world is our oyster. Sure - we cover our essentials as a matter of daily business - no crisis. But sometimes we see something that really catches our eye and we think ..... oooooooh, THAT would be nice! ... and then reality hits and we add it to our wish list for more research and consideration.

We at Open Arms have a long wish list. There is so much need out there, and we could do so much more to help women and their babies in our region. But we are thoughtful about how we grow and what new programs we take on. As an organization, we've met most of our goals from our strategic plan five years ago (and changed direction where it was appropriate as well) and our strategy has worked well for us. Now we're back planning for our future for the next few years. It's an exciting time and quite frankly, I think we're an extraordinary organization with great staff doing great work. It's easy to want to reach far in our goals. But we are sticking with what works: careful growth, thoughtful and intentional decision-making, and fiscally responsible management of programs and agency. I think it's a great balance of high goals and caution, and with this process, we're excited to think about where the agency can be in five years.

Oh - and we had our newsletter come out today. We're working on a website where we can archive these and when it's up and running, I'll post a link to our past newsletters. Do you want to be on our mailing list? Send us your email address and we'll add you (don't worry, you can remove yourself at any time)! info@openarmsps.org

A novel approach to lowering c-sections

Thanks Emily for bringing this New York Times article to my attention - what a startling idea. Use c-sections when they're needed...

In Effort to Limit C-Sections, Two Methods Yield Different Results on Staten Island

Doctors at Staten Island University Hospital are drawing lines around when to use c-sections - just because you want one isn't a good enough reason. They also don't induce before 41 weeks (induction can raise the risk of complications and c-section) and they encourage VBAC. Compare their 23% c-section rate with that of comparable hospital Richmond University Medical Center at 48.3% c-section rate. Read the article for rationals for the higher rate.

Good read.

Reducing violence and crime

I was in a discussion with someone recently. The gist of the other person's position went something like this:

Why should I, who have spent my life becoming educated and working hard to support my family, spend my money to help someone who is poor and unable to support their family to go and have more kids?

You all have heard the argument, or yourself feel this way.

Then you hear about costs of all sorts: Medicaid, government support, education, crime.... I have worked hard and gone without to support my family, and "they" keep having children and expect me and my tax dollars to support them. Usually the solution proposed is stop having babies, but since you're having one and I don't think you should, I'm not going to "support" you in this and my denial of resources or disapproval of funding for you to receive help will not reward the behavior.

(I am going to address the latter part of this some other day.)

Or people simply say, I think this is a private concern and not something for which we as a society should be responsible.

I've posted a lot recently about why Open Arms does the work we do and the importance of investing in children and parents from the very earliest time - prenatal through birth to postpartum. There are many ways I can come at this (and I have some more coming!), and I've been touching on many different perspectives in previous posts.

Every way I come at this, the evidence is inescapable. It is the RIGHT THING TO DO for ALL of us, and the cost to society of NOT doing it is so sky-high that we cannot afford to stand back. We must support mothers and babies from the very beginning.

If you want a world where we can actually have children succeed in school, have lower health care costs, create healthier children and parents, create stable families, lower domestic abuse and have less crime, then you come to the conclusion (and well-respected scientific evidence agrees) that programs that are involved very early, such as the birth doula and outreach doula programs at Open Arms, are worth the small investment for very large gains. And, I will stress that it is not only within poverty that all these issues come up. These issues and the need for support for families cross socioeconomic lines. It is not only "they" who need support, it is "we" who need support. It's our sisters, daughters, friends, aunts. It's just that if you have money, it's a little easier to get it.

So it's long term change, and it's powerful. If you are a parent yourself, you know that everything changes when you have a baby - it's a time when you're receptive to change, and you have a reason to do it. When one starts parenting feeling competent and strong, one can make healthy choices and continue that way, making good decisions and facing difficulties with confidence. But when one feels out of control, inadequate, unhealthy, and hopeless, nothing changes and cycles of poverty and violence repeat.

Evidence shows again and again (and I'm providing some of it in this blog) that is so much less expensive in terms of time and money and so much more effective to provide support from the beginning - and then not need so much support later! Early intervention works!

In this post, I'm going to talk about crime. The worst stereotype is of course that of the young mother (usually minority, or immigrant, or what have you), having child after child who will be neglected, be a drain on the educational system and society, and eventually all the kids will turn to crime. You know how that stereotype goes.

Here's a video from yesterday's King5 Learning for Life called Investing in Kids Now Fights Crime Later.



I'll quote from the program (my emphasis):

The other program areas for which we advocate are intensive voluntary home visiting programs to help young families develop the skills and have the information they need to get their kids off to a good start, to not engage in inappropriate discipline or at worst, child abuse, and to really promote bonding. Again the research shows that when children get off to that kind of a start they are far less likely to be abused or neglected and far less likely to be involved in crime when they grow up.

The officer goes on to talk about a recent case where a 17-year-old mother had killed her child. He says this mom was alone, with absolutely no support at all. She just didn’t have the skills to raise a child, and it was so overwhelming. He says, "To me, there were two victims." Yes, an infant murdered, and a 17-year-old whose life is ruined. What if she had a trained outreach doula that she trusted and could relate to, who knew her, who could teach her, support her and connect her to her community, other mothers and role models - even crisis centers - to help? This young girl would not be incarcerated, her life ruined, and her beautiful baby would be alive.

All of us who turn away and say "not our problem" carry some of the burden for this type of story. It is not the baby's fault. They come into the world just as innocent and open to experiences and love as your children did, your nieces and nephews, all the children that you know and love, and you yourself when you were born. I'd argue that in cases such as the above, it really isn't even that young mother's fault, ultimately - she did not act in a vacuum. She had no way to change and grow into a new way of mothering because no one stepped forward to help, and so ultimately two lives were broken. When we as a society fail to be there for our most vulnerable members, our infants and children, then we fail as a society.

Open Arms does not track crime statistics. That's not our focus.

This is the Open Arms mission statement:

Open Arms embraces a world that cherishes birthing women, their babies, families and communities.

Our mission is to provide services that support, educate, respect, honor and empower women and their families throughout the childbearing year.

And we believe by doing this, so many good things happen.

Visit us on our website to learn more about our programs and the work we do.

Things have gotten a little heavy lately - I'm looking forward to posting on some lighter topics over the next few days!

Another article on the maternal deaths declining

This article is from the New York Times:

Maternal Deaths Decline Sharply Across the Globe

It is about the same study that I referenced yesterday on the politics of public health funding.

It's a good article - again, it lists the same things we've been talking about that make the difference.

The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of “skilled attendants” — people with some medical training — to help women give birth. Improvements in large countries like India and China helped to drive down the overall death rates.

I can understand the fuss over funding - in today's short-attention span world, people worry that if numbers improve, it implies that it no longer needs funding and focus moves on to the next crisis - as if the problem is solved. It isn't solved. But the good news is, women's (and babies') health can be affected positively with funding and worldwide attention toward maternal health.

Dr. Horton contended that the new data should encourage politicians to spend more on pregnancy-related health matters. The data dispelled the belief that the statistics had been stuck in one dismal place for decades, he said. So money allocated to women’s health is actually accomplishing something, he said, and governments are not throwing good money after bad.

Reducing Infant Mortality - watch this video!

This is, hands-down, the best video I have ever seen on the topic of maternal and neonatal health. Settle in - it's about 17 minutes long. If you are interested in these issues, you will love this.

If you are unsure of the critical importance of having full term babies and avoiding prematurity, you will get your answers. If you wonder why we keep talking about lowering the birth intervention rate (epidurals, c-sections, inductions etc.), supporting women in receiving their perinatal care and promoting breastfeeding, you will have to ask no longer.

If you wonder why we as a society need to support all mothers in having healthy pregnancies, births and babies, just listen to the cost of NOT supporting them.

In the end, the video talks about the midwifery model of care - it mentions doulas once or twice in passing, but it is not a doula promotion. It is a HEALTH promotion.

I think I'm going to revisit this topic again later. But for now - put away anything else you're doing - watch. And pass it on.

Reducing Infant Mortality from Debby Takikawa on Vimeo.

If you want to share this video, go to the Reducing Infant Mortality website for instructions to link, share, embed, download or order CDs.

Politics of public health funding

News article today:

Fewer women dying in childbirth: Report finds 35 percent decline over 28 years

Remember, this is worldwide, not in the US.

On the one hand:

The British medical journal Lancet rushed out a paper on Sunday that found the number of women who die in pregnancy or childbirth has dropped by more than 35 percent over 28 years.

On the other hand:

But on Tuesday, another report by the Partnership for Maternal, Newborn and Child Health, a global alliance hosted by the World Health Organization, claimed progress in maternal health has "lagged." According to their "detailed analysis," from 350,000 to 500,000 women still die in childbirth every year. The authors did not explain where their data came from or what kind of analysis was used to obtain that wide range of figures.

Enter politics and funding:

"Experts say public health figures need to be taken with a huge grain of salt, particularly when they come from people who are also soliciting funds for the campaign.

The U.N. has a track record of inflating disease figures to keep the aid money flowing, so I'd probably place more faith in the figures which show a lower disease burden," said Philip Stevens, of International Policy Network, a London think tank. "This is yet more confirmation that whoever paints the most apocalyptic picture gets the most cash, even if they have to manipulate and spin the data."