Category Archives: Doulas

That’s me on the radio…

Adriana Lozada

Adriana Lozada

I just had the pleasure of discussing the advantages of delayed cord clamping with the wonderful Adriana Lozada over at birthful.com.

Here’s the link:

http://www.birthful.com/podcastdcc/.

Check out the rest of birthful.com, too–it’s a great resource–and read Adriana’s fascinating personal history. (Great photo here of Adriana with her 10-year old “mini-me,” Anika.) Adriana has a growing list of podcasts, including interviews with such well-known figures in the childbirth world as Gene Declercq, Rebecca Dekker and Sarah Buckley. I’m honored to be in their podcast presence. Thanks, Adriana!

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Filed under Cord clamping, Doulas, Iron deficiency, public appearances

Readers respond: Cord clamping around the U.S.

Unknown“Who even does early cord clamping anymore?”

This question was raised recently by a young doctor at the family medicine residency program where I teach. She and her residency colleagues had been taught in their OB rotation that delayed cord clamping is the childbirth standard of care. The benefits are proven, the resident said, and early clamping doesn’t do anything for anybody.

“So why would anyone do it?”

Good question. Yet judging from the emails I received after my last post, DCC is far from the standard of care around the country:

  • An East Coast doula wrote that her clients can have DCC performed at birth “if they request it.” (If they request it?? That’s a bit like saying, “There’s this thing called oxygen, and if it looks like your baby’s at risk of brain damage from a lack of it, we can give him some. If you ask us to, that is.”)

  • A California midwife wrote that the obstetricians at her hospital are adamant that DCC is “too risky” for newborns. Despite the evidence she presented to them, they’re sticking with ECC.

  • A Midwestern family physician reported that the DCC/ECC debate has split the medical staff where she practices. Although there’s some overlap, the family docs are largely pro-DCC, while the OB staff is in favor of ECC.

Clinging to interventions that have been shown to be useless and even harmful is, unfortunately, nothing new in the history of medicine.

Poor Ignaz...

Poor Ignaz…

Perhaps the most infamous example in the maternity care world is that of Dr. Ignaz Semmelweis (1818-1865), a Hungarian-Austrian obstetrician who clearly demonstrated that simple handwashing could greatly reduce maternal deaths from puerperal fever—a virulent infection that plagued crowded maternity wards in the 19th century. Everybody ignored him, his career crashed, and he died in an asylum…and a few decades later everyone was washing their hands. (A brief synopsis of his story is attached below, excerpted from my book, Birth Day: A Pediatrician Explores the Science, the History, and the Wonder of Childbirth.)*

I’m encouraged that the young doctors I work with see DCC as a no-brainer (or a pro-brainer, if you’ll pardon the pun.) But too many doctors don’t see the timing of cord clamping as the important issue it is. For them, it will probably take the Invisible Hand of the Market, in the form of pressure from pregnant clients, to change minds and practices, if not hearts.Adam Smith, Invisible Hand-8x6

So tell me, what’s the DCC/ECC environment where you live? Email me or (better still) add a comment on the blog!

 * * *

*(Shameless self-promotion: Birth Day—a ripping good yarn—is available in paperback or Kindle from Amazon, or you can order it from me directly at www.marksloanmd.com).

Excerpt from Birth Day: A Pediatrician Explores the Science, the History, and the Wonder of Childbirth (Copyright 2009, Mark Sloan M.D.)

“In 1844, Dr. Ignaz Semmelweis, an assistant lecturer in the First Obstetric Division of the Vienna Lying-in Hospital, began to make the same connection [as Dr. Oliver Wendell Holmes]. Semmelweis noticed that women who gave birth in his First Division, which was staffed by doctors and medical students, had eight times the risk of contracting puerperal fever than those who were delivered by midwives in a distant part of the hospital. Of the many differences in patient care between the two divisions, Semmelweis saw one that stood out. Doctors did autopsies on women who had died of puerperal fever. Midwives did not.

With no access to Holmes’s still obscure paper, it took three years and a number of failed hypotheses for Semmelweis to put it all together. The final piece of the puzzle fell into place when, like Holmes, he was struck by the similarities between puerperal fever and the death of a colleague from an infection incurred during an autopsy. “Suddenly a thought crossed my mind,” he wrote. “The fingers and hands of students and doctors, soiled by recent dissections, carry those death-dealing cadavers’ poisons into the genital organs of women in childbirth.”

Semmelweis immediately ordered all doctors and students in the First Division to wash their hands in a chlorinated lime solution before attending to patients. The results were startling: mortality rates from puerperal fever fell from 18 percent in the first half of 1847 to less than 3 percent by that November. But like Holmes’s in America, Semmelweis’s breakthrough was dismissed by his colleagues, including Friedrich Scanzoni, the most prominent obstetrician in Vienna.

Semmelweis’s discovery ultimately led to the ruin of his own career and health. He was dismissed from the Vienna Lying-in Hospital in 1849, in large part because of his increasingly strident arguments with colleagues. Despondent, he spent a few unproductive years at a hospital in his native Hungary before returning to Vienna. There he wrote articles and letters blasting his former colleagues. He even accused them of murder, calling them, among other things, “medical Neros” for ignoring his advice while women died. Disabled by severe depression, Semmelweis died in a mental hospital in 1865—ironically, from an infection that started in a cut on his finger.”

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Filed under Cord clamping, Doulas, History of Medicine, Iron deficiency

Shout-out #1: Enlightened Mama in the Twin Cities

Such a place!

Such a place!

I’ve given a couple of talks in the Midwest this month, and I want to give a shout-out to two very worthy organizations: Enlightened Mama in St. Paul, Minnesota (this post) and Southwest Tech in Fennimore, Wisconsin (coming soon).

I first met Liz Abbene, Enlightened Mama’s founder and “Alpha Mama,” a couple of years ago when I was speaking at the 2012 REACHE conference in Seattle. As we chatted about the conference I was impressed by Liz’s ability to carry on a coherent conversation while buried in children (she has four beautiful kids). Anyone who could keep that many balls in the air at one time, I figured, must run a pretty interesting business.

When the conference wound down, Liz extended me an invitation to speak at Enlightened Mama if I was ever in the Twin Cities. Sure, I said, figuring what are the chances of that ever happening? I’d never been to the Twin Cities and didn’t really have any plans to travel there.

Liz Abbene

Liz Abbene

Ah, but life has a way of changing one’s plans. Last year I enrolled in the University of Minnesota’s Masters in Public Health program, which requires online students to spend a couple of weeks on campus during the year. So I came to the Twin Cities for UMN’s Public Health Institute in early June and, as Liz had willed back in Seattle, I wound up at Enlightened Mama talking on the wonders of the newborn microbiome.

Space does not allow me to describe all that Liz does at Enlightened Mama. Suffice it to say that along with doula services she and her staff and partners provide lactation support and breastfeeding classes; massage, acupuncture and chiropractic care; family therapy and career counseling; and a number of other classes and services that promote wellness before, during, and after childbirth. Alas, there is no brewpub or nail salon at Enlightened Mama, but for all I know these are in the works.

Enlightened Mama is a great resource for families in the Minneapolis-St.Paul area. So if you live there and you’re pregnant, give Liz a call!

P.S: When I asked one St. Paul mother how her town differed from Minneapolis, she told me this:

“People from Minneapolis love to tell you how cool it is to live there. People from St. Paul already know we live in a cool town. No need to brag about it.”

I remain neutral in the matter…

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Filed under Breastfeeding, Doulas, Maternal-child health, Natural childbirth