Wednesday, July 31, 2013

World Breastfeeding Week 2013 - Enhancing Peer Support for Breastfeeding Success

This year's World Breastfeeding Week is highlighting the importance of breastfeeding peer counselors in optimizing the breastfeeding success of new and experienced mothers. With little more than half of all mothers exclusively breastfeeding past one week (1), peer support is critical for increasing our population's health.

Breastfeeding is important for the health of both mothers and babies. Breastfeeding helps a baby stay healthy and research shows that increased length and exclusivity of breastfeeding can decrease a baby's risk of contracting a number of illnesses such as otitis media (ear infections) and gastroenteritis, or dying from SIDS. The benefits of breastfeeding extend into childhood and beyond by decreasing the risk of childhood obesity, diabetes (type 1 & 2), and leukemia. For the mother, breastfeeding helps to protect against breast cancer, ovarian cancer, and type 2 diabetes. (2)

"Compared with breastfed infants, formula-fed infants face higher risks of infectious morbidity in the first year of life. These differences in health outcomes can be explained, in part, by specific and innate immune factors present in human milk." (2)

Breastfeeding is encouraged by all major health organizations and it is recommended that breastfeeding occur exclusively, meaning no other liquids or solids (except medicine or vitamin supplements, if needed) until the baby reaches 6 months old. At 6 months, solid foods can be added to the baby's diet, in addition to breastfeeding, which should continue for as long as mother and baby desire.

"If 90% of U.S. families could comply with medical recommendations to breastfeed exclusively for 6 months, the U.S. would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be infants." (3)


The role of the peer counselor is to support mothers in the community. Peer counselors are trained to: provide emotional support to breastfeeding mothers, help with general and common breastfeeding issues/concerns, and to recognize signs of more severe lactation problems and connect the mother with a breastfeeding expert, such as an Internationally Board Certified Lactation Counselor (IBCLC).

A peer counselor is often a mother who has breastfed herself and receives additional training from the organization they are volunteering or working with (they may or may not be 'certified' with an organization, more below). Organizations such as the supplemental nutrition program Women, Infants, and Children (WIC) and La Leche League International (LLLI) provide trained peer counselors to provide group, on-call, or individualized breastfeeding support to moms.

A breastfeeding peer counselor may be certified with an organization, such as Healthy Children's Center for Breastfeeeding. A certification demonstrates that the counselor has completed a required number of hours in the classroom and passed an exam; it doesn't necessarily mean that they have ample direct experience with breastfeeding mothers. However, that being said, as a Certified Lactation Counselor myself, I can say that if you didn't know a thing about breastfeeding before going into the 40-hour course, you aren't going to pass the exam, at least a little knowledge and experience is needed.

Peer counselors, whether certified or not, are a crucial part of improving population health through encouraged, continued, and exclusive breastfeeding.

"The overwhelming majority of evidence from randomized controlled trails evaluating breastfeeding peer counseling indicates that peer counselors effectively improve rates of breastfeeding initiation, duration, and exclusivity." (4)

Their dedication improves maternal and infant health, saves hundreds of babies from preventable illness and death each year, and help to save countless amounts in healthcare cost (remember that $13 billion per year) and prevent tons of environmental waste.

If you are interested in becoming a peer counselor,  a certified lactation counselor, or even an IBCLC, I encourage you to research what is available in your area (such as existing breastfeeding support groups) and identify what credentials are required for the type of work you want to do. Then connect with a few people in those positions.

You can support breastfeeding mothers in many ways, you don't have to become a peer counselor or even receive any kind of training!  

You can simply thank a mother for breastfeeding her baby, or stand up for a mother that has been discriminated against for breastfeeding, such as in public. As a husband, wife, mother, father, sister, brother, boy/girlfriend, friend, coworker, or a bystander YOU can improve our breastfeeding rates by supporting and encouraging those women who are breastfeeding!

Thank you to all those who have breastfed their babies and to those who tried. Thank you to the counselors, health professionals, mothers, friends, and family members who have supported a breastfeeding mother.

Thank you to the BREASTFEEDING PEER COUNSELORS for your dedication to improving maternal and infant health, for everything you do!

Cheers to you!
~Wisdom and Birth

(1) Breastfeeding among U.S. children born 2000–2009, CDC National Immunization Survey
(2) Stuebe A. The risks of not breastfeeding for mothers and infants. Reviews in Obstetrics & Gynecology. 2009; 2(4):222-231.
(3) Bartick M and Reinhold A. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics 2010; 125;e1048; originally published online April 5, 2010. Retrieved from
(4) Chapman DJ, Morel K, Anderson AK, Damio G, Perez-Escamilla R. Breastfeeding peer counseling: from efficacy through scale-up. Journal of Human Lactation 2010; 26(3): 314-26.

Wednesday, July 24, 2013

They said WHAT!? Do you know what YOUR Doctor Believes about Birth?

What your pregnancy and birth care provider believes about birth WILL directly influence your birth experience.

Whether it is not feeling supported because your doctor doesn't believe women can give birth without intervention; having your trust in yourself, your body and your baby undermined because the doctor is constantly searching for a sign of something wrong with the pregnancy or labor; or, the unhelpful pressure to just accept the epidural, or schedule the induction, you've waited too long for that baby (and they have a vacation coming up).

An Obstetrician is trained as a surgeon. Trained to handle complications and emergencies during pregnancy and birth. ...but the majority of births will occur without complication.

So what good does it do to have the majority of women attended and cared for by a surgeon? Especially a surgeon who doesn't believe birth works, without their interventions, most of the time!?

It does us absolutely NO GOOD. In fact, it is the opposite... women and babies suffer unnecessary stress, procedures, medications, and interventions - and most of this is because they are seeking care from someone who isn't trained to truly care for healthy mothers and babies!

So, I have been around the "birth block" a few times and I've heard my fair share of bullshit, but a few phrases, uttered by (educated?) doctors, still take the cake! These come from my experiences as a research assistant in graduate school. Enjoy!

The first comes from a survey in which maternity care providers were asked questions about their beliefs and knowledge of maternity care practices.


I began with this comment because it helps to demonstrate that our current medical-maternity system IS NOT functioning in the best interest of the mother and baby... it is currently operating out of FEAR. This doctor's comment represents many responses on the surveys and is acknowledging that doctors choose to practice defensive medicine out of fear of litigation, lawsuits, and malpractice - they need to protect their job.

Defensive medicine entails interventions and constant monitoring for evidence of a problem, or evidence to show there was no evidence of a problem! This makes many doctors feel they have to confine a mother to the bed, with a continuous record of fetal monitoring, IV drips, and numerous ultrasounds so that they can prove they were doing everything they could to keep the baby "safe" by managing your labor... but, in reality, all this managing of healthy pregnancies puts the mother and baby at greater risk of complications. Mothers and babies can have adverse reactions to labor management and pain drugs, and then to the ensuing cascade of interventions that follow, possibly leading to a Cesarean to 'save' the baby - who likely wouldn't have been in distress had the birth been left alone in the first place. 

*          *          *

 This next one was a written response from a survey collected after the physician had participated in a presentation delivered by a well-qualified March of Dimes physician representative. This presentation is about the importance of healthy pregnancies continuing for at least 39 weeks - the data clearly demonstrate that healthy mothers and babies have better outcomes when pregnancy continues for at least 39 weeks...


First, this doctor may need to be reminded that they are not God. They do not decide when the "safe gestational age for elective delivery" should be - scientific researchers and professional medical organizations do. Currently, ALL of the medical-professional organizations agree that 39 Weeks is the EARLIEST a healthy baby should be induced or surgically delivered. The determination of 39 weeks is based of a massive amount of excellent research and scientific evidence. Would you want someone that is practicing in opinion rather than evidence caring for you and your baby? (more on 39 weeks)

In addition, the fact that this doctor refers to using "high quality multiple early and mid trimester reliable ultrasounds" demonstrates even further to me that they are strictly trained in a medical model of birth and that they are wholly unaware of the current evidence for medical practice. ULTRASOUNDS ARE NOT RELIABLE! Multiple ultrasounds (or even one) HAVE NOT been proven to be safe for developing babies... especially early and frequent ones! AND research has demonstrated that giving ultrasounds to women early and often may actually CAUSE intrauterine growth retardation... it is my strong opinion that this doctor is actually harming his patients in so many ways, rather than actually helping them. (more info on Ultrasound safety and use)

What about his comment on maternal health? Well, considering he is advocating for taking babies early (we are only talking about healthy ones here), he will be inducing and sectioning mothers MORE OFTEN, both of which, in a healthy pregnancy, increase maternal and fetal risk. Enough said.

Now, research does demonstrate that in some hospitals, mothers and babies who birth during the day have better outcomes than those born at night. Is this the mother's problem? NO. This is a quality issue that HOSPITALS are responsible for, not laboring mothers. A mother and infant's health SHOULD NEVER be put at risk (by inducing or sectioning them early) just to avoid the mother possibly birthing her baby at night when hospitals are less 'well' staffed.

Remember in medicine, your first task is to "DO NO HARM".

*          *          *

And the last comment, which is by far the scariest!

When this Family Physician was asked if the increasing Cesarean section rate was concerning...


Oh boy. This isn't true, not at all. There is absolutely no evidence, anywhere, to suggest that the current female body is incapable of safely birthing a baby, especially in 1/3 of women! This doctor is practicing medicine in fear and ignorance and the mother/babies he cares for are likely suffering greater rates of medical intervention and Cesarean surgeries because of it.

Do you know what YOUR doctor believes about Birth?

Birth Works!!! We wouldn't have over 7 billion people on this planet if it didn't! If your doctor has made any comments like the one's above, please CHANGE DOCTORS!!!

Please feel free to leave a comment with the ridiculous things YOU have heard doctors (or other health professionals) say about birth!

I believe in your ability to give birth, make sure your doctor does too!
~Wisdom and Birth

Friday, July 19, 2013

Activity Restriction and Bed Rest in Pregnancy - Insufficient Evidence for Use and Potential Harms

It seems to make sense that "bed rest" during pregnancy, especially one that is threatening preterm labor or other complications, would be helpful. I mean, wouldn't staying in bed, rather than doing her normal activities, be a good thing for a mother and her baby?

The answer is NO. Bed rest actually increases risks for the mother and baby and causes a great emotional and financial toll on many families. Understand that this is only referring to complete activity restriction and strict bed rest, not to say that pregnant women should not rest. You should listen to your body and rest when you need to, always.

The Journal of Obstetrics and Gynecology published 3 articles in its recent June 2013 issue about bed rest and the unethical use of this practice. Let's take a look at the research and put this issue to rest!


Historically, bed rest was intended for orthopedic ailments, but quickly spread to all areas of medicine, without question of its benefit. Sounds familiar...

Overtime, evidence of the adverse effects from bed rest began to accumulate. Negative physical effects were recognized, such as muscle athrophy, bone de-mineralization, cardiovascular de-conditioning with loss of plasma volume, venous thrombosis, and alterations in the endocrine and immune systems. Subsequently, bed rest recommendations began to change for individuals recovering from myocardial infarction, pulmonary infections, and in postoperative recovery. Slowly, the recommendations for prolonged bed rest during or after an uncomplicated pregnancy began to dissipate...

"However, bed rest remains one of the most commonly prescribed treatments to improve reproductive outcomes in complicated pregnancies, despite a lack of evidence that it improves any obstetric or neonatal outcomes."(1) ...and as well see soon, can actually makes some outcomes worse!


McCall and Colleagues (2) published a summary of the literature concerning activity restriction and bed rest from the Cochrane Review. The review demonstrated that there is insufficient evidence to routinely recommend bed rest during pregnancy and due to some of the potential adverse side-effects, bed rest may even be harmful and unethical to prescribe.

Here is what the evidence says for various pregnancy-related conditions:
  • Miscarriage (or spontaneous abortion) - There was no substantial difference in the risk of miscarriage between bed rest and no bed rest for two trials included in the review.
  • Hypertension - One small trial demonstrated a small significant difference in severe hypertension for women who were on bed rest compared to no bed rest, but there were only 218 patients and other randomized controlled trials do not support the routine recommendation of bed rest for hypertension in pregnancy. 
  • Healthy Women (with normal blood pressure) - there is insufficient evidence to support the use of bed rest for the prevention of pregnancy-induced hypertension. Two small trials (with 32 and 74 participants) have been conducted which demonstrated that some bed rest during the day (4-6 hours) decreases risk of preeclampsia, but not gestational hypertension. The authors recommend using caution when interpreting this data because of a small n (participants) and the fact that strict bed rest was not studied in either trial, just some bed rest. They end by saying, "whether women rest during pregnancy should therefore be a matter of personal choice." Rest if you feel like you need to!
  • Preterm birth - current evidence does not support (or refute) the use of bed rest. There was only one trial included in the review (and we'll look at another one below), but the authors conclude that, "Due to the potential adverse effects that bed rest could have on women and their families, and the increased costs for the healthcare system, clinicians should not routinely advise women to rest in bed to prevent preterm birth.
  • Preterm birth - A recent study (3) looked at women with a short cervix (defined as less than 30mm) to determine if bed rest would be appropriate for these women- who are at greater risk of preterm labor. In fact, women placed on activity restriction were 2.37 times more likely to deliver preterm (before 34 weeks of gestation) than women not placed on any activity restrictions. The bed rest recommendation actually appears to have been harmful for these babies.
  • Multiples - there were 7 trials included in this review and bed rest did not reduce the risk of preterm birth or perinatal death. One study demonstrated a small decrease in low-birth weight babies (less than 2,500g), but not in very low-birth-weight neonates (less than 1,500g). Dues to risks of strict bed rest, there is insufficient evidence to routinely recommend it for women carrying multiples. Just remember to rest when YOU feel like you need to!
  • Small for gestational age/suspected impaired fetal growth in singleton pregnancies - there was no difference in birth weight between groups; the evidence does not support bed rest for improved fetal growth.

Try prenatal yoga!
  • Increases the risk of preterm labor in women with a short cervix (less than 30mm) (Odds Ratio: 2.37; CI 95% 1.60-3.53). Meaning that you are 2.37 times more likely to experience a preterm labor if you have a short cervix and are placed on strict activity restriction. 
  • Increases the risk of venous thromboembolism (blood clots) (Relative Risk: 19; CI 95% 5-80). Meaning you are 19 times as likely to develop a blood clot if placed on bed rest than women who remain active.
  • Bone mineralization (bone loss) is increased in women on bed rest to a mean loss of 4.6% compared to ambulatory women (those not put on bed rest) of only 1.5% (bone loss is normal in pregnancy to a degree - which is why your body needs time in between babies to replenish nutrients! read about optimal pregnancy spacing here)
  • Increased muscle atrophy
  • Pulmonary atelectasis (a complete or partial lung collapse)
  • Psychological effects to the mother, father, and other children, including: anxiety, stress, and increased psychological suffering. Increased demands on the father may also lead to fatigue. 


The financial toll of bed rest on families and the economy is astounding, especially considering the routine practice may be contributing to even greater health risks and costs. In 1993 it was estimated that the annual cost of bed rest was as "little" as $1.03 billion and quite possibly as high as $5.7 billion. When this is adjusted for 2013 the cost ranges from $2 billion to $7 billion per year (1). All this cost would be acceptable IF bed rest improved health of mothers and babies... but it doesn't!

In addition, the family will likely suffer the loss of one (or some) of the mother's income and the mother is no longer able to contribute to the household in the many ways she did before - these tasks will fall to her partner and many things will have to be neglected. Other children may experience psychological distress due to their mother's inactivity and the emotional states of their parents. Paid parental leave is very rare and many families cannot afford the loss of any income.


So how big of a problem is this? Approximately 18% of pregnant women in the U.S. each year will be placed on bed rest at some point in their pregnancy. Unfortunately 71% of Maternal-Fetal Medicine Specialists would recommend bed rest for preterm labor and 87% would recommend it for premature rupture of membranes; over half of the specialists reported that they perceived little to no benefit to bed rest. (2)

The continued recommendation of activity restriction and bed rest may be because doctors fear being held liable for complications in pregnancy and birth, so they feel that prescribing something is better than nothing... but in this case, recommending nothing would be better than bed rest!

Walking is great for everyone!

Be sure to ask your doctor why they are recommending bed rest. Are they just recommending you find some more time to relax and rest? Do you just need to decrease your stress inducing activities? It is reasonable to request that a woman slows down to care for herself, her baby and her emotional/physical health.

Or, has your doctor recommended that you completely restrict your activity? Be sure to find out the reasons for the recommendation and determine if you need to seek a second opinion. Remember, there is insufficient evidence to routinely recommend strict bed rest for complications in pregnancy and even some evidence of potential harm. 

Remember the Hippocratic oath, "First, Do No Harm"... well strict bed rest is more harmful than beneficial and it is time we ended its practice!

Be active, healthy, and rest when you need to!
~Wisdom and Birth

Please remember that this is not medical advice, just a summary of current research literature. Talk to your midwife, doctor, or other health provider if you have questions or concerns. 

(1). Biggio JR. Bed rest in pregnancy: time to put the issue to rest. Obstetrics and Gynecology 2013; 121(6): 1158-1160.
(2) McCall CA, Grimes DA, Lyerly DA. "Therapeutic" bed rest in pregnancy: unethical and unsupported by data. Obstetrics and Gynecology 2013; 121: 1305-1308.
(3) Grobman WA, Gilbert SA, Iams JD, Spong CY, Saade G, Mercer BM, et al. Activity restriction among women with a short cervix. Obstetrics and Gynecology 2013; 212: 1181-86.

Monday, July 8, 2013

It's Not the Babies that are Expensive...

I was reading through all the comments on the Reddit post "what was marriage like in the first year?" and one of the most maddening (or saddening) recurrent themes was that of newly-wed couples who had had a baby together in their first year of marriage and felt the financial toll of having the baby was SO GREAT - it sometimes ended up causing major rifts in their relationships.

Without fail, every post in which the Redditor described how children were the trigger of their financial downfall, they mentioned how expensive FORMULA AND DIAPERS were... *head smack*

Babies aren't expensive... the crap we buy for them is! The choices we make about what we feed our baby, what we diaper and clothe them with, etc. Major corporations are making a huge profit off of American families, off of people like you and me, because their advertising works. We pass up the free, cheap, and often healthier options for the products we see advertised - in our face - everyday.
Babies do not need formula and disposable diapers, in fact, the vast majority of babies, families, and countries would be MUCH BETTER if formula and disposable diapers were never advertised again. It may sound like a little much, but we would all survive just fine like we did before Pampers and Similac were around making millions, excuse me billions, in profits off our struggling American families - not to mention those even less fortunate families around the world that are suffering from these unnecessary expenses!

Feeding Your Infant

The cost of infant formula for one year is approximately $2,366

Breastfeeding - $0. Absolutely free.

The vast majority of babies need nothing but breast milk for the first 6 months of life, with the addition of appropriate family foods after that time. Save the money!!! You can introduce family foods and save even more on the unnecessary infant foods... fresh fruits, vegetables, and whole foods are cheaper and healthier! In addition, breast milk is chock full of nutrients, minerals, and living cells for immunity - none of which can be found in costly formula.

Formula manufacturing companies do not have your babies best interest in mind. They only seek to run a business and make a profit. In the United States, the formula advertising is so successful that it has almost completely undermined breastfeeding as the normal and best way to feed your baby and now many believe that babies may actually need formula at some point. WRONG!

The vast majority of babies will never need formula and in reality, they should never receive formula. If 90% of babies were fed nothing but breast milk for the first six months and continued breastfeeding through one year, then we could save over 900 babies per year.

Let me say that again, we have the power to save over 900 babies a YEAR by breastfeeding!! There are so many benefits to breastfeeding, including a healthier baby who needs to visit the doctor less often and parents who will miss work less often too! Breastfeeding is natural and normal, but not always easy. There are many professionals who can help you with breastfeeding, be sure to find one that works well for you!

So what about diapers? 

Disposable diapers cost approximately $2,400 per child AND they contain toxic chemicals. They are PACKED with toxic chemicals in order to be "absorbent" - the little crystals or tiny white beads you see after a diaper explodes, disintegrates, or has been worn for awhile... these are composed of hazardous and toxic chemicals. Diapers bathe a baby's most sensitive organs in heat and chemicals everyday, for years. Truly, studies have found Dioxins in diapers, were are very hazardous to everyone's health, but especially a tiny developing baby. Manufacturing companies are allowed to do this because the toxic chemicals are "separated" from the babies skin by some papery and plastic fabrics - remember, these companies DO NOT have your baby's best interest in mind... just to profit off those who will fall victim to their expensive lies.

Cloth diapers cost approximately $480 per child and can be used for more than one baby, saving even more money on future babies, too! Compared to babies who use disposable diapers, babies wearing cloth diapers learn to use the toilet earlier - meaning that you are done with diaper changing sooner! Cloth diapering is WAY better for the environment, your baby's health, your sanity, and your wallet. Contrary to what the big diaper industry wants you to believe, cloth diapering is NOT disgusting and horrible to deal with and their are more options in cloth diapering than ever before! There are companies to clean your diapers, or simple ways to clean them at home. No big deal. Plus, there are so many cute designs and choices, building your collection could be fun!

SO, by simply using cloth diapers and breastfeeding your baby for at least the first year, you could save a minimum of $4,300! 
Take a vacation or make a special purchase with the money you saved!

There are many other ways to save money, such as purchasing used baby furniture, instead of new. A few simple products make the first months with a baby easier, but you truly don't need much! If you are on a tight budget, all you may really need is a bassinet for sleeping baby next to your bed, a wrap to hold and carry your baby, some onesies, blankets, and cloth diapers! You could probably ask for many of these as gifts at your baby shower :)

So no more blaming babies, they are not responsible for the expensive and unnecessary purchases we make. Keep your money where it belongs, with your family, and forgo the disposables and the formula!

You deserve your money more than those CEO's!
~Wisdom and Birth

Approximate cost information above comes from The Business of Baby by Jennifer Margulis (2013).

Wednesday, July 3, 2013

Wisdom and Birth is turning 1!!!

 Happy One Year to Wisdom and Birth!

WOW! I can't believe my birth blog is already One Year Old!

I had wanted to start a birth blog for many years, but just never got around to learning how to conquer the IT nightmare that technology can be for me. Finally, with a little inspiration from a friend, I conquered the web and created Wisdom and Birth in July of 2012!

My blog began simply, with a few posts of things I had created in the past, such as my DONA position paper and a book review, but I was lost with where to start and how to write to my new (and at the time non-existent) audience. Now, I have over 30 published posts and I am reaching out of the comfortable and safe topics (such as natural nipple creams) and into the controversial ones like Ultrasounds and Pitocin!

When I began blogging as Wisdom and Birth I wasn't sure how much of my "voice" I wanted to put into my blog and how much of it I wanted to leave as "professional". You see, with my Bachelor's degree in Science and (almost) a Master's in Public Health, I have been heavily trained into writing with very little soul - just the facts. I have so much Passion for all things birth and baby related and it is my goal to slowly recover the "soul" in my writing and to get this passionate voice across to my growing audience!

So, for this next year of blogging, one of my goals is to write more posts that have 'soul'... and this is one of my first attempts to do so!

As I reflect on this past year I am reminded of how busy I have been. I began my graduate education in January of 2012 and I am in the last stretch of the program. I have been attending school full-time and I even had two semesters (out of six) with an extra class in order to get the degree done in just two years... in December I will graduate with a Master's degree in Public Health!

In May of last year I was elected as President of the Maternal and Child Health Student Organization and in April of 2013 I hosted the 4th Annual MCHSO Spring Symposium, which focused on International MCH Topics. This was a fantastic event which drew a crowd of over 100 people spanning two days... and one of the Keynote Speakers was my dad!

Last summer I received a great honor when I was awarded the Maternal and Child Health Leadership Trainee Scholarship from my school and enjoyed a year of free-tuition, mentorships, professional trainings, conferences, and some extra money from a stipend!

In August of 2012 I took a position with the Florida Perinatal Quality Collaborative working as a Graduate Research Assistant. I am still working diligently on this project, which aims to decrease the number of early elective and non-medically indicated deliveries before 39 weeks of gestation throughout Florida's hospitals.
In addition to all this, I have also doula'ed for a couple of families and I facilitated two breastfeeding support groups, one on campus and one in the community for REACHUP, INC.

Wow! I can hardly believe how much I accomplished this past year and I am amazed that I still found time to spend with my amazing and supportive boyfriend and our 4 adorable pets :)

Here's to another year of improving Maternal and Child Health and blogging as Wisdom and Birth! Please share my blog with others and help encourage a birth revolution!

~Wisdom and Birth