Open Arms Luncheon Keynote

By popular request, here's the link to Rachel Abramson's keynote speech, in its entirety, from the Open Arms Luncheon.

Open Arms Perinatal Services Spring Luncheon Keynote

Increasing bonding through biology

Oxytocin - of course we know that hormone as the one that's important during labor & childbirth and breastfeeding. It's also called the "tend and befriend" hormone because it helps bonding and creates good feelings and relaxation. The more of this hormone you have, the more good feelings you have about those around you and with babies, the stronger the bond. That's one of the reasons that mothers breastfeeding report increased bonding - all that oxytocin flowing helps with bonding.

This study that came out last month peaked my interest because it takes a look at the differences between mothers and fathers interacting with their infants and the impact on oxytocin.

Natural variations in maternal and paternal care are associated with systematic changes in oxytocin following parent-infant contact.

It seems men and women have increases in oxytocin at different times, and that these seem to match the typical interactions with babies according to the adult's gender. Women/mothers have a rise in oxytocin when they have high levels of affectionate contact with their babies - giving them lots of snuggly loving! Oxytocin doesn't rise with low levels of affection, it has to be that full-on affection and touch. Men, on the other hand, have their rise in oxytocin with high levels of stimulatory contact - physically engaging with their babies, lifting them in the air, or playing with them while highly engaged.

What's interesting to me is that both moms and dads naturally tend to do the kind of interaction that will increase oxytocin, with the moms snuggling up their babies and the dads being more physically active.

But it also has implications for parents who aren't bonding well or who feel separation from their infants due to depression or extended NICU hospital stays for premature babies - the study suggests that just doing the kinds of activities with your child that increase the parental oxytocin may be helpful in increasing their feelings of bonding with their babies. Allowing for more of these interactions will strengthen bonds of parenting naturally, enhancing the bond with biological responses.

So to strengthen the bonds of parenting, men and women can do different things.

So, men, play with those babies! Women, snuggle them up!

Let the bonding begin!

Community-based doula model

I wanted to share this from our luncheon.

Our speaker was Rachel Abramson, Executive Director of HealthConnect One in Chicago. She spoke about the kinds of results they have seen from community doula programs. The Open Arms Outreach Doula program is modeled after the program in Chicago.

Rachel said:

Let me tell you a bit about the community-based doula model, the foundation for Open Arms’ Outreach Doula program. This evidence-based model has been cited by the Center for American Progress as one of five important national evidence-based home visiting models. It began with a four-year pilot serving low-income African-American and Latina pregnant and parenting teens in Chicago from 1996 – 2000. With 254 mothers in the evaluation, we saw:

* 80% breastfeeding initiation rates, including 65% initiation rates at an agency with practically no breastfeeding in their home visiting program before the doula piece was integrated

* 8.1% c-section rates

* 11.3% epidural rates

* Increased pregnancy spacing for young teens

* Significantly enhanced maternal scores on the NCAST scale to rate videotapes of maternal-infant interaction

* Decrease in preterm births

* Cost savings including $750 per person in c-sections and epidurals not performed, approximately $500 per breastfed baby in savings on formula, and broader savings from shorter hospital stays and less illness among breastfeeding babies.

These outcomes have held up over time and with replication in a variety of underserved communities across the country. We have seen consistent high breastfeeding rates, consistently lower c-section and epidural rates, increased use of birth control, increased practice of skin-to-skin contact after birth, and lower preterm and low birth weight babies. There are now 40 community-based doula replication sites in 14 states, 6 of which are funded through the new HRSA Maternal and Child Health Bureau funding stream. We have rolled out this year a robust and user-friendly data collection system designed to continue the process of evaluating these programs and researching the outcomes and processes of community-based doula program.

These outcomes are so important. The birth outcomes that come from having a doula are outstanding - resulting in healthier moms and babies, lower health care costs and shorter hospital stays.

But the one that really caught my eye is the better parent-child interactions. That is the key - the lasting effect that will go on to improve lives for years to come. When a parent increases the quality of interaction with the child, all sorts of brain development happens, attachment happens, and the entire family is strengthened.

Tasering a pregnant woman?

OK this is related to Open Arms only in that the woman involved was pregnant, but boy oh boy, this story got my blood boiling!

Court: Seattle police OK to stun pregnant woman

Pregnant woman in front of an elementary school refuses to sign a ticket for doing 32 in a school zone (speed limit 20). She said the person speeding was the car ahead of her, not her, and refused to sign the ticket because she thought it would admit guilt if she signed it. She is tasered not once but three times when she refused to get out of the car and has permanent scars from it.

She argued that under Washington law, the officers had no authority to take Brooks into custody: Failure to sign a traffic infraction is not an arrestable offense, and it's not illegal to resist an unlawful arrest.

Berzon said the majority's notion that Brooks obstructed officers was so far-fetched that even the officers themselves didn't make that legal argument. To obstruct an officer, one must obstruct the officer's official duties, and the officers' only duties in this case were to detain Brooks long enough to identify her, check for warrants, write up the citation and give it to her. Brooks' failure to sign did not interfere with those duties, she said.

Furthermore, Brooks posed no apparent threat, and the officers could not have known how stunning her would affect the fetus, or whether it might prompt premature labor — another reason their actions were inexcusable, Berzon said.

On the heels of the shackling legislation, this really makes me wonder. What is it with people making sure that those pregnant women follow the law or they will be forced in such violent ways?

What do you readers think of this story?

What a luncheon - thank you!

Thank you to everyone who came to today's Open Arms Luncheon! Together we raised over $35,000 for mothers, babies and families. I can't think of a better investment, and I'm thrilled that so many came out and supported us. I hope you learned something as well.

In a few days, I'll post the remarks from our keynote speaker, Rachel Abramson. She was inspirational and talked about the statistics and studies in support of the work of community doulas like Open Arms doulas.

If you missed us and still would like to make a donation, you can still donate through our website.

Thank you!

Home visiting and Open Arms: an overview

I just wanted to post a few words about home visiting. OK, maybe more than a few! Open Arms deeply believes in the efficacy of the home visiting model, and our programs reflect this.

First - some background. Home visiting is, of course, when services are delivered in the client's home as opposed to in an office or service center. Services are very often related to family services and prevention.

It turns out that home visiting programs are quite effective. One can see why, especially for the demographic that Open Arms serves. If a client can receive information at home, it does not require transportation or childcare in order to attend, and it's a comfortable place in which the client can relax and be able to take in the information. Additionally, the home visiting service provider can proactively observe and respond to the home environment and day-to-day activities that otherwise might not be brought up in an office visit, making the services provided more relevant for the client. Everyone wins.

Our program at Open Arms is based on the home visiting and community outreach work of HealthConnect One in Chicago. If you are attending our luncheon this week Wednesday (there is still room!), you will hear more about the work they do from our keynote speaker, HealthConnect One Executive Director Rachel Abramson. You'll also hear the larger context of the effectiveness of this work and why what we're doing at Open Arms is on the forefront of a national movement for preventative healthcare.

Regardless of what your opinions are about the proposed healthcare reform, it is interesting to note that home visiting services are a key part of the healthcare proposal. For some context and research on this, see Home Visiting for At Risk Families: A Primer On a Major Obama Administration Initiative. This article, and others, uses as an example one very successful home visiting model called the Nurse-Family Parnership (NFP).

The NFP described in the link above is apart of Thrive By Five, just as Open Arms is. By funding Open Arms in addition to NFP, Thrive By Five will be able to show that that a) paraprofessionals such as doulas can be effective, b) even women who have already had babies can benefit greatly from home visiting support (NFP is geared towards first-time mothers), and c) serving older women is effective too (NFP is geared towards young moms).

And is it true that paraprofessionals such as doulas are effective in home visiting services? Yes. Our own statistics show positive outcomes, but for those of you who are interested in research, this summary Effectiveness of Home Visiting will be very useful in digging down and getting some answers.

I mentioned in a previous blog post that Open Arms is unique in the way that we combine three kinds of services - we are a home visiting organization, but unlike most if not all home visiting services we also will be there for the client's birth as well. And through all of our work, a community focus is essential. So now you know a little more about the home visiting piece. We very much hope that our own work will contribute to the research around home visiting and show that it's an effective model for long-term change and growth. We'll be working on that piece in the next few years.

To close, here's another very interesting article on the variety of home visiting service models out there.

What is multiculturalism and how does it work?

I had a wonderful conversation with our Executive Director, Sheila Capestany today. It was about multiculturalism and the workplace.

Open Arms is a highly multicultural organization and strives to keep that foremost in the minds of staff, doulas and board as we do our work. I learn something every day when I am in the office in terms of what that means, and the impact it has on not only how we serve our clients, but how our organization functions internally as well. I realize that as much as I might think I know about multiculturalism, I still have much to learn.

Our staff primarily comes from the Latina, Somali and American cultures. First and foremost, our staff speak different languages with varying degrees of fluency in English - some have English as a first language, and others learned it later in life. So when one is speaking about deep issues, some - but not all - are communicating in a second language. This gives uneven communication skills at the most fundamental level and offers lots of opportunity for misunderstanding. Additionally, we face issues of religions - sometimes with conflicting values and cultural traditions that must be worked through.

Then communication styles and protocol must be bridged. Consider if every day you must examine - and articulate your answers to - questions such as these: How do I look when I disagree? What is an appropriate response if someone disagrees with me? Are questions appropriate and how do I ask them? How do I show respect? How do I give direction? How do I say no? How do I recognize that you have a problem? What do I do if I don't understand what my manager has told me? As a manager, how can I tell if I've effectively communicated to this person on my team? How do I differentiate a suggestion from a directive? These questions go both ways, so regardless of whether one is staff or manager, all must be equally responsible for communication. No one way trumps any other. Even something as seemingly simple as what is served for a staff lunch or whether you choose to partake in the food and how much can inadvertently give offense or carry messages.

Our staff must keep an inquiring mind and welcoming spirit to be able to face and embrace these challenges every day. I hesitate to use this word because it's so overused, but to truly celebrate the differences and respect each other and our core philosophy of multiculturalism, we must be mindful at every turn of the impact of culture on the issues and tasks to be done.

Not only does everyone have to continually learn about each other, each has a responsibility to share. And by sharing, we must first identify what our culture is and what we really feel - and then express it to others. Talk about risk! And the process of self-examination and subsequent change of something so fundamental as culture, bias, prejudice and tradition can be painful. Our staff must trust each other to continue the conversation, to turn towards communication and resolution instead of shutting down or ignoring it. It takes a staff who trusts each other enough to stick with the inevitable conflicts that arise.

I am proud to work for an organization that so consciously and deliberately practices their values, not only externally but internally as well.