Risk Assessment

Risk

At the end of one of my weekend classes, a healthy and fit-looking Momma came up to ask a question.

“I’m 35 years old,” she began, and I already knew where this was going.

“And yours is considered a “Geriatric Pregnancy,” am I right?”

She kind of laughed and said, “Yep – ‘Advanced Maternal Age!’ And my provider wants to induce me at 39 weeks. I just wanted to know what my chances are of having an induction that goes okay. One that won’t end up with me having a Cesarean.”

Now, I don’t know this woman’s health history, and I’m not a medical provider, so I’m not going to debate this plan of action with her. But I could tell she wanted to know if this induction at 39 weeks would be considered “medically necessary.” Again, without knowing her personal health history, I wasn’t going to comment on that – it’s not my place.

So here’s what I said instead: “If your provider ever had a Momma over the age of 35 who had a “negative outcome” during a birth that went past 39 weeks, it might change how they practice from that point forward. But many providers are only looking at the risk of increased complications that can happen to all women over the age of 35. Is your provider looking at you as an individual, considering any other risk factors that might increase your risk? And what’s the risk, anyway? What numbers are being considered? This information might help you understand ”increased risk” really means for you.”

For example, a provider might read a study that states a woman’s risk of stillbirth increases after the age of 35. The provider might then choose to focus solely on the age of the woman in their care, and encourage an induction at 39 weeks to prevent stillbirth.

Now, stillbirth is a terrible experience which most people would like to avoid at all costs. But women need full information to be able to assess if their risk of stillbirth in waiting for labor to occur on its own is high enough to agree that an induction at 39 weeks is the right decision for themselves.

The risk is real, it’s true – but there are many other factors to consider in assessing an individual woman’s risk for any complication, not just the risks associated with “Advanced Maternal Age.”

I might be a little bit touchy on this subject, if I’m being honest! I didn’t get married until I was 28. I had my first child at 31. Baby #2 came along when I was 33 1/2. My third was born when I was (gasp!) 37, and the last one came along at the ripe old age of 41.

And while it is true that my relative risk of stillbirth climbed with my age, my absolute risk as a multipara (woman who’s had a baby before) with Baby #4 was probably lower than that of a primipara (woman who’s not had a baby before) at a much younger age.

Part of that lowered risk has to do with my proven record of straight-forward, healthy pregnancies and deliveries. And part of that lowered risk can also be attributed to the fact that I was much healthier at 41 than I’d been when I started this whole baby-making enterprise a decade before!

The language – older mother, mature, advanced maternal age, elderly, and my personal favorite, geriatric pregnancy – coupled with the assumption that a woman is automatically high-risk because of her age really bothers me!

The power of words cannot be understated.

And when a woman is told that she’s high-risk, strictly because she’s over the age of 35, this absolutely affects how she experiences her pregnancy and can have negative implications for her birth!

So with all of this as a backdrop, I suggested that this Momma do some research and that she might find some good information online. Rarely, do I send anyone to the inter webs for information. First of all – there’s just so damn much of it! How are you supposed to sift through all of the mountains of information that now exist in the world on the subjects of pregnancy, birth and parenting? But in addition to that, there’s so much out there that’s opinion only and not evidence-based – and that’s really scary!

So there are only a few online resources I recommend and trust for this kind of research. One of those resources is Evidence Based Birth. Rebecca Dekker, a PhD-prepared nurse researcher and founder of EBB, is on a mission of “Putting current, evidence-based information into the hands of communities so they can make empowered choices.”

Her references list used to research any one issue can sometimes be pages long, and her articles are always reviewed by a panel of experts before she publishes them online. Plus, they’re written for the lay person, not a medical researcher, so they’re easy to understand. Here’s the article from the EBB website that speaks directly to this issue of Advanced Maternal Age.

After doing this important work of researching, I encouraged this Momma to have some more dialogue with her provider about her particular situation. In the end, she might come to the same conclusion that an induction at 39 weeks is reasonable for her and her pregnancy. Or, she might not. But what’s most important, is that she’ll be engaged with her provider in a shared-decision making model and her decision will be made using full information.

In this day and age, I think we should be encouraging women to know what their risk is so they can make truly informed decisions for themselves about their pregnancies, their births, and their babies.

In the meantime – can we please come up with another way of describing a woman who happens to be having a baby at the age of 35 or beyond? The terms we’re currently using are demoralizing. And I should know!

Thankfully, it’s not all bad. Based on this article, us “Geriatric Mommas” will have the last laugh: “Women who had their last child after 33 were twice as likely to live to 95 or older, compared with those who had their last child by 29.”

I’m not a math whiz by any account, but if my calculations are correct, this means I will live to be at least 125 years old seeing as I had my last baby eight years after the magical cut-off  of “33” as quoted in this article.

But before I get my hopes up, I think I’d like to know what my absolute advantage is, not just the relative advantage based on my age.

Know what I mean?

Becoming Mother – The Interview

stg-interview

I can’t remember how I found Sharon Tjaden-Glass and her book, Becoming Mother, but I’m very glad I did!

Becoming Mother is the book that Sharon wished had been written when she became pregnant for the first time: “I wanted the book that I eventually wrote. I wanted someone to be authentic with me. To talk about more than the physical. To go to the dark places. To show me what was hard and what was wonderful.” And Becoming Mother does all of this and more.

I recently sat down with Sharon via Skype and interviewed her about her book, pregnancy, birth and parenting experiences. The following are excerpts from that interview.

Barb: I found it interesting that you included your weight gain (and eventual loss) at the start of each mini-chapter of the book. It wasn’t focused on, or even called out – but why did you feel the need to include this as part of Becoming Mother?

Sharon: As women, I think we struggle a lot with body image and self-acceptance in American culture, and so this drives many of us to have that question in the forefront of our minds when we become pregnant: “What’s going to happen to my body? Will I gain a bunch of weight and never be able to lose it?”

The reason that I included the weight gain and loss in numbers was because I thought it would give pregnant readers realistic expectations for what that physical change is like. Of course, after having gone through the whole experience of having a baby, I understand at this point that the physical changes of pregnancy are not as monumental as the other changes. However, I wanted to meet pregnant women where they are when they first start reading this book.

B: That’s one of the things that I enjoyed most about your book – the focus on realistic expectations, the authenticity of it all. When you were newly pregnant, how realistic do you think your expectations were for after the baby arrived?

S: I wasn’t married to the idea that we had to take minimal time off, but I did know that it was important to me to keep the identity of my pre-mom self alive, even after the baby was born. Once she was born, we were more forgiving of ourselves in terms of going easy on not keeping up with the previous expectations. But we both held true to our commitment to “not totally lose” our previous selves.

B: In follow-up to this question, can you speak to that shift that occurs as a woman becomes a mother and her self-identity can become secondary to her new role as mother?

S: I sensed that it would be possible that I could “fall down this hole of parenthood” and lose my identity, not totally understanding that I’m a dynamic self and that I would always be changing, regardless of what happens in my life. Taking on this role as a mother has reorganized so many facets of my identity. It has also filtered how I see and experience the world. It’s impossible for me to tease apart “mother” from my other identities because it has affected all parts of my life. At the same time, I’m aware that I don’t want this role to “wipe out” my other roles, the other aspects of myself that make me who I am. Because I know that one day the all-encompassing role of “mother” will narrow and narrow as my child grows up. And soon they won’t need me in the same way that they need me now. So I want to make an investment in myself by cultivating those parts of me that will endure past this season of my life. Like with teaching and writing and maintaining friendships.

B: Early on in the book, you talk about  about “surrendering” as the first step in this journey. This is what I’m talking about! I’m not a fan of plans so much, but love the idea of surrendering to the process. Vulnerability during pregnancy is so intense – what do you think about this?

S: I think pregnancy is a constant reminder that you are not in control. And it serves a purpose. The further along you get in your pregnancy, the more control you lose: how much weight you gain, how sore and achy your body gets, your ability to stay asleep all night. Labor intensifies that message that you’re not in control. You’re in so much pain and there’s nothing you can really do about it. You can’t go backward. The only way is forward.

And then after the birth, it starts to click about how these physical limitations that reduce your control help your mental state. You’re much more pliable to giving in to what your baby needs. Whenever it needs you. Whatever you need to do, you’re open to it. It’s not so jarring after pregnancy and labor. Because you’ve been prepped for the past 10 months.

B: “On the hard days, I think – We have made a big mistake.” I so relate to this sentiment! In fact there’s been at least one day during all four of my pregnancies where I have not only thought this, I’ve said it out loud! It’s so important to normalize feelings of ambivalence toward pregnancy – even when it’s a wanted pregnancy. Did you ever talk about this with other pregnant Mommas? Or did you feel like you needed to stay quiet, not tell anyone how you were feeling?

S: I did, (talk to other Mommas) but always in a joking way. I think humor about these feelings helps bridge into those conversations about how tough motherhood can be. You hear it in conversations all the time—when mothers want to “complain” about something, they use two popular methods. 1) Use humor or 2) Use qualifiers: I love my son, but sometimes…

I’m really not the kind of woman to pretend that everything’s okay, especially to people that know me. People that know me and ask how I’m doing, they know I’m going to be honest about how I’m doing. So I didn’t feel like I had to keep up a positive face for everyone to reassure them that I was happy about being pregnant or becoming a mom. If I was having a hard time, I owned that hard time and shared it. The problem with this is that some people feel that your statement that you’re having a hard time is actually an inquiry, or a signal that you’re seeking advice. I’m not. I’m hardly ever seeking advice. And if I want advice, I preface my comments with, “I really want your advice.”

B: If only people understood this! “When I want your advice, I will ask for it. Thank you very much!” I always say that unsolicited advice is usually not very good advice, anyway…

You do a great job writing your birth story.  And while I’ll encourage people to read Becoming Mother for all sorts of reasons, in particular, reading your well-written account of one woman’s journey – emotional and physical – through giving birth is intense, profound and not without challenges. I know you’re pregnant again and want to know how you might be handling things differently this time? What has changed for you?

S: It (self-advocacy) was extremely challenging (the first time). Robbie Davis-Floyd talks about this very thing—the authority of knowledge in childbirth. That doctors possess more scientific knowledge about childbirth and so we often defer to their judgement. But on the other side of this, women often don’t give any weight to their own bodily knowledge, their own intuition about what’s going on. It cannot be trusted. And I definitely felt like this. That if I pushed my own bodily intuition too far that the doctor would lash out at me. I felt like there was a drive for the doctors to have “birth be this one way.”

We have changed providers and place of birth because of this tension with the doctors. I wanted to have a provider who would allow my birth to be what it will be, rather than forcing it to be something that it’s not.

B: Which would you say was harder for you: birth or breastfeeding?

S: Breastfeeding by far—because my body was not responding in the way that it should have. Some women have labors in which their bodies cannot get the baby to descend or dilate enough or fit through the hips. That’s how it was with me and breastfeeding. Always like trying to thread the frayed end of a thread through a tiny needle.

B: I love that image. It conveys so well the level of frustration you feel about something that ends up being so challenging when you think you “should” be able to do it no problem…

How about your relationship with your husband, Doug? How was the first year post baby on your couple relationship? Is there anything that you wish you’d known before that you found out the hard way?

S: I wrote about this in detail on my blog in my post, “When I Became Real to My Husband.” I think this demonstrated to me that loving someone did not depend on what you have to offer the other person. (This is a great read for an authentic, real look at the postpartum couple relationship – Barb)

I wish I would have known that it would take close to a whole year for sex to be really enjoyable again.

B: Right? All the books say “Six weeks! Six weeks!” Well, not my book…

Last question: What do you think about the great American myth of being Superwoman on the other side of becoming a mother?

S: Do you know Brené Brown? (Do I ever! She’s my future BFF – she just doesn’t know it yet…Barb) She talks about shame triggers, body image and motherhood. I feel like the myth of Superwoman in motherhood is just one more way to control and shame women. “Women are judged by their willingness to follow the rules and men are judged by their ability to break them.”

Well, Sharon Tjaden-Glass broke a few rules herself in that she wrote her book, Becoming Mother, even as she was going through her own pregnancy, birth and early parenting journey.

For Sharon, “Being creative isn’t something that I have to work at. It’s something that I am. I just have to make time for it. If I don’t make time for it, I feel blocked and unfulfilled.” And we are all the better for her commitment to staying creative and sharing her account of what it was like for her as she was Becoming Mother.

I want to thank Sharon for taking the time to talk with me about her experience and encourage readers who are pregnant now or know of someone who is, to consider this book as part of their overall preparation. It’s a well-written, honest account which provides realistic expectations (of which I am always a fan!) of what it’s like to move through pregnancy, birth and new parenting. You can purchase a copy of Becoming Mother here. And you can follow Sharon Tjaden-Glass on her blog here.

ICEA Conference 2016

icea

I just got back from the annual ICEA (International Childbirth Educator’s Association) Conference in Denver, Colorado. I don’t get to go every year, but I’d like to! These educational conferences are invaluable in keeping me current. Plus I love networking with other passionate-about-all-things-pregnancy-birth-and-parenting professionals! And snagging a boatload of my required continuing education credits for recertification is a nice perk.

This year, I was not just an attendee, but also a presenter. My breakout session, “Birth Plans: Helpful or Harmful?” went really well and the preliminary evaluations look good. I exchanged lots of business cards for what I hope will yield future collaborations. The other sessions that I attended were excellent and at the end of this post there’s a shout-out to some of the amazing women behind the presentations I was lucky enough to attend. They are doing great work in the field of maternal-fetal health and wellness.

But for this post, I want to highlight something that I saw as a really wonderful, positive, and hopefully continuing trend: a small but enthusiastic group of young, energetic Millennials attended this conference. These are young women, choosing to become Childbirth Educators in the digital age, who understand the importance of face-to-face, community building, peer-to-peer education that can really only happen in person. It’s just not the same via the Almighty Internet.

Sometimes I wonder how much longer I’ll remain relevant in this field, or even, how much longer the field of childbirth education will exist. It’s sad and scary to think about a time when I’ll be “too old” to teach classes, or worse – a time when expectant parents will just stop coming altogether:

“We can read about it on the Internet!”

“There’s so many YouTube births out there, we don’t need to take a class…”

“I’ve written my Birth Plan – what else do I need?”

Today’s expectant parents need connection – it’s a hunger that they might not even be fully conscious of, a product of this time when a sense of community is linked to how many friends “like” their posts, or how many “followers” they have. In the months and weeks prior to becoming a family, expectant parents need real connection:

Real connection with their childbirth educator who can provide evidence-based, unbiased information and encourage them to become truly informed consumers and advocates for themselves, their babies and their births.

Real connection with a group of people who are experiencing the same emotions and feelings of vulnerability. These are people who will not trivialize or sensationalize those feelings. They get it.

Real connection with one another as a couple, devoting time and energy to focus on each other and their baby and to learn as much as they can about the powerful transformation that the birth experience can offer.

It fills me with hope to realize that there are women who represent the age demographic of the Mommas in my classes, just entering into this field. That there are women who still get the importance of continuing to teach these classes to their peers.

I’m considered the Lead Educator at the places where I work – which means I do the mentoring of new educators. And I love it! I’m always trying to recruit potential newbies from my classes. If I see a Momma that has a certain twinkle in her eye, I try to connect with her so I can plant the seed of becoming a Childbirth Educator someday.

But as Lead Educator, I know that the classes we offer have to be nothing short of amazing. They can’t be fine. They can’t be good. They have to be classes that are an incredible value to today’s parents – not just in terms of money, but in terms of our most precious commodity – time.

When half of the class is wishing they were in their PJs, eating ice cream and binging on Netflix, and the other half of the class comes kicking and screaming because they think it’s going to be “All about HER!” – that’s a tough crowd. We have been charged with making our classes engaging, fun and entertaining. Oh, yeah, and don’t forget –  they need to learn a ton, as well!

It’s not an easy job. But none of the really important jobs ever are. Those of us working in this field know the potential that birth has to either positively or negatively affect the laboring woman’s self-identity, self-confidence, relationship with her baby, her partner and herself – for the rest of her life. We get it. But does this generation get it?

Well, this past week I got to see a sample of women from this generation taking notes, asking questions, learning from those who’ve gone before them, soaking it all up – showing me in words and actions, that yes indeed, they do get it.

And that’s good news for us all.

*I’m always, always trying to recruit younger women to do this work. If you’ve ever thought, “I wonder what’s involved in becoming a Childbirth Educator…” please, contact me – I’d love to talk with you about next steps.

And as promised, here are some amazing women doing some incredible things in the world of birth. Please check them out!

Jennie Joseph – is working to change what happens in materno-toxic zones to help reduce pre-term birth, low birth weight babies, and other complications that women of color experience at higher rates than their white counterparts.

Barbara Harper – travels the globe with the mission of making waterbirth an available option for all women.

Amy Rebekah Chavez – I’ll let you read all about who she is and what she does, but this woman is rad and she’s got the science and education to back up her work around trauma and healing.

Elizabeth Petrucelli – recognizes the importance of discussing unexpected outcomes with the families that attend her classes and this is a message that resonates with me for sure.

Aynsley Babinski & Pam Barnes-Palty – understand the need for birth workers to take part in self-care so that they can better address the needs and concerns of the families that they work with.

Colleen Weeks – shares from her personal experience in the field for 35+ years, how to continue to grow as an educator over the arc of your career and how to support our families when they’re hurting.

Amy Haderer-Swagman – I have to highlight this Momma-artist who was one of many great vendors from the conference, who made such gorgeous mandala birth art necklaces that I bought two of them!

This is not meant to be an exclusionary list – I was unable to attend all of the sessions that were available and I didn’t get to attend the last day at all, so my apologies to all of the other fantastic presenters who I know put as much care and attention into their presentations as I did. If you check out this ICEA Conference page, you can read more about these other wonderful women and find out more about the goodness they’re bringing into the world of birth.

PREMADs – Do You Know About These?

premads

I read this article by Juli Fraga from the Washington Post: “Prenatal Depression May Be The Most Severe Form of Maternal Depression” and it got me thinking… There are probably lots of pregnant women out there who don’t even know that PREMADs exist. What are PREMADs? PRE-natal Mood and Anxiety Disorders. It’s a word I came up with to describe what happens when a woman experiences a mood or anxiety disorder prenatally, during pregnancy.

Our focus in the field of maternal mental health has primarily been on raising awareness of PMADs – Postpartum Mood and Anxiety Disorders. And rightly so! According to PSI International, 1 in 7 women suffer from postpartum depression, and 1 in 10 men do as well.

A recent search I did for information about the rates of prenatal depression yielded this information from a 2009 ACOG report that states somewhere between “14-23% of women will experience depressive symptoms while pregnant.” I would guess that now that we’ve expanded the umbrella of postpartum depression to include anxiety, OCD, PTSD, bipolar and psychosis, that the percentage of women who might be experiencing one of these anxiety or mood disorders during pregnancy has expanded as well.

In the past several years, I’ve witnessed an increased awareness across the board from OBGYNs, midwives and nurses for the need to screen women postpartum for mood or anxiety disorders. And I can speak directly to how much more time Childbirth Educators spend talking about this issue in the classroom.

But I’m beginning to think that there’s a hole in that education and screening, as the focus continues to be on a mood disorder waiting to happen to a women until after her baby is born. What if she’s experiencing anxiety or depression right now – while she’s pregnant? PREMADs might be getting overlooked entirely (seeing as I just made up the word today!) and women end up suffering in silence during their pregnancies hoping that they’ll eventually feel better. I’m afraid this might be leading to higher rates and more intense mood disorders in the postpartum period.

This doesn’t need to happen.

The symptoms of PREMADs might get overlooked during pregnancy because they’re chalked up to just being a part of the hormonal ups and downs of pregnancy. These will all even out in the 2nd trimester, or after childbirth classes begin, or whatever. But they don’t.

We all have days during pregnancy that are really stressful – we may even question whether this pregnancy was a great idea! (Personal confession: In each of my four pregnancies I had a day where not only did I question whether it was a good idea, I actually said it – out loud, to other people. “This was a bad idea. A very, very bad idea.” All four times. No lie.)

But if you’ve been experiencing any of the following symptoms pretty consistently over a two week period, you should really be touching base with your provider – or someone else you trust who can get you the professional support you need.

Signs and Symptoms

  • Being sad most of the time and not being able to “shake it off”
  • Feeling anxious or worried about the pregnancy, the baby, the birth, your relationship… the list goes on and on
  • No enjoyment in the stuff you usually like to do
  • Sleeping a lot – or not being able to sleep very much at all
  • Not being able to focus for very long periods of time
  • Feeling guilty or worthless
  • Thinking about harming yourself
  • Feeling hopeless

Again, after a stressful day at work or following a recent fight with your partner, you might be able to say yes to a few of these symptoms – but they go away after some time has passed. It’s when any of these symptoms are persistent or nearly continuous over a two week period that you need to be checking in with someone.

You don’t have to have all of these symptoms to seek help. Even one of these would be an indication to be talking to your provider so they can screen you further and then create a treatment plan that might include lots of different things that have been shown to help: exercise, diet, support groups, acupuncture, getting more sleep, herbal remedies and Omega 3s, individual psychotherapy and medications.

Please take note of these symptoms and ask your provider to screen you during your pregnancy for your risk of PREMADs.

There’s no reason to not get help as soon as you can. Because if you seek and receive support now, you might not be so overwhelmed in the first few days, weeks and months of postpartum with your newborn.

My biggest concern is that women who are experiencing an undiagnosed PREMAD now, are at a greater risk for a PMAD after the baby is born. Add in a challenging birth experience and the normal – but huge – adjustments involved with new parenting and these women may end up experiencing a PMAD that’s much more severe than it would’ve been if it had been addressed prenatally.

I’d love to see screening for PREMADs become part of the routine care for women as they prepare for birth and parenting. Help me spread the word by sharing this post far and wide so that awareness of PREMADs can be something we’re all on the lookout for when we, or our friends and family become pregnant.

Find the support and care that are available to address anxiety, depression or other mood disorders experienced during pregnancy. Learning how to lessen feelings of anxiety, sadness and fear, might increase feelings of enjoyment of the pregnancy experience. This can lead to feelings of anticipation and joy for the upcoming birth which might translate into an easier postpartum transition. It’s a win-win-win-win-win situation. (That’s a lot of winning!)

Thanks for spreading the word. And I hope that this mini-PSA of mine finds a few of those women who might be wondering if their feelings of anxiety or sadness are beyond the usual hormonal changes brought on by becoming pregnant. Even if only one woman reads this post and seeks support, I’ll feel like raising awareness for PREMADs made an important difference.

Do you know any women who you think might be suffering from something beyond the usual hormonal fluctuations that happen during pregnancy? And now that I’ve named it PREMADs, do you, or someone you know, recognize that this is what was happening at the time? How would seeking help during pregnancy have helped you in the postpartum period? I’d love to hear your thoughts on this. Please leave a comment here.

34 = A Spring Chicken, But 35 = An Old Bird?! I Cry Fowl!

Chickens

I was busy all weekend doing what I love: teaching expectant families all about how to get a baby out (Saturday – Express Class) and where to go when the baby is actually coming out (Sunday – Maternity Tour). It was a gorgeous, sunny, not-too-hot weekend and I was stuck inside both days catching glimpses of the sun when and where I could. AND I WASN’T EVEN MAD.

I mean, I saw how nice the weather was the night before, and I may have even mumbled, “Ohhhhhh, I don’t want to go to work tomorrow!” before going to bed, but some sort of alchemic transformation happens when a class or tour begins. And then I know I’m exactly where I need to be, doing exactly what I’m supposed to be doing. I’m not sure if anyone else can truly understand this, unless they too, are lucky enough to have a job that they love.

At the end of class on Saturday, a healthy and fit-looking young couple came up to me to ask a question about their particular situation. “I’m 35 years old,” she began and I already knew where this was going… “And yours is considered a “Geriatric Pregnancy,” am I right?” She kind of laughed and then said, “Yep – ‘Advanced Maternal Age!’ And my provider wants to induce me at 39 weeks. I just wanted to know what my chances are of having an induction that goes okay. One that won’t end with a Cesarean.”

Now, I don’t know the particulars of this woman’s health history, and I’m not a medical provider, so I’m not going to debate this plan of action. But I could tell that she wanted to know if this induction at 39 weeks would be considered “medically necessary.” Again, without knowing her personal health history, I’m not going there with her.

Here’s what I told her instead: “If your provider had a Momma over the age of 35 who had a “negative outcome” during their birth, it might change how they practice from that point forward. But many providers are only looking at the relative risk of increased complications that can happen to women over the age of 35. Is your provider looking at your absolute risk?”

This is not something that many providers consider. They read a study that says a woman’s risk of stillbirth increases after the age of 35, but their focus remains solely on the age of the woman in their care, and this can translate into only discussing her relative risk. If they were looking at the woman’s age as just one of several other risk factors that might contribute to or lessen their overall risk, this would mean that they were considering the absolute risk. Too many women don’t even know to ask about relative vs absolute risk, and too many providers are not forthcoming with this information.

Pregnant women and their partners should be able to determine their individual, personal absolute risk of complications and what those complications are if they wait to deliver spontaneously at term, as opposed to being encouraged to deliver early via induction at 39 weeks, because their is a relative risk of increased stillbirth for women over the age of 35.

The risk is real, it’s true – but there are many, many other factors to consider in assessing an individual woman’s absolute risk of any complications, not just the risks associated with “Advanced Maternal Age.”

I might be a little bit touchy on this subject, if I’m being completely honest. I mean, I didn’t get married until I was 28. I had my first child at 31. Baby #2 came along when I was 33 1/2. My third was born when I was (gasp!) 37, and the last one came along at the ripe old age of 41.

And while it is true that my relative risk of stillbirth climbed with my age, my absolute risk as a multipara with Baby #4 was probably lower than that of a primipara at a much younger age. Part of that lowered absolute risk has to do with my proven record of straight-forward, healthy pregnancies and deliveries. And part can be attributed to the fact that I was in much better health at 41 than I’d been when I began this whole baby-making enterprise ten years earlier!

The language – older mother, mature, advanced maternal age, elderly, and my personal favorite, geriatric pregnancy – coupled with the assumption that a woman is automatically high-risk because of her age really bothers me! The power of words cannot be understated. And when a woman is told that she is high-risk, strictly because she is over the age of 35, with no other known risk factors, this absolutely affects how she experiences her pregnancy and can have negative implications for her birth! 

So with all of this as a backdrop, I suggested that this Momma do some research and that she might find some good information online. Rarely, do I send anyone to the inter webs for information. First of all – there’s just so damn much of it! How are you supposed to sift through all of the mountains of information that now exist in the world on the subjects of pregnancy, birth and parenting? But in addition to that, there’s just so much out there not evidence-based and that’s really scary!

That’s why I was so excited when I “met” Rebecca Dekker a few years back as she was just starting up her website, Evidence Based Birth. Rebecca wanted to create a resource for expectant families (and professionals!) that would review the latest research on a particular topic in obstetrics and translate the findings into something that someone who wasn’t a clinician or a researcher could actually understand.

She takes her time with each article and reviews everything, making sure to use “good” studies – meaning studies that are unbiased, that used the proper technique, assessment and validation tools, and that have statistically significant results. After she’s written her article, she submits it to her advisory Board to insure that the information that goes “live” on the website is exactly what she claims it to be: evidence-based. I know that if I send any of my families to her website, I can feel comfortable that the information they’ll find there is something I can trust.

How crazy is it that I took a look at the EBB website this afternoon and did a search for “Advanced Maternal Age” and found out that Rebecca was doing a free webinar on that exact topic in exactly three minutes! I know, right? Cue up the woo-woo music!

I quickly registered for the webinar and was happy to hear that the discussion I had with the Momma from my class about relative risk vs absolute risk was exactly what Rebecca would be covering in both the webinar and the written materials that accompany it on the website. I really hope that the Momma from class took me up on my suggestion and checked it out.

After doing this important work of researching, I encouraged her to have some more dialogue with her provider about her particular situation. In the end, she might come to the conclusion that an induction at 39 weeks is reasonable for her and her pregnancy. Or, she might not. But what is most important, is that she will be making a decision with her provider based on full information.

In this day and age, I think we should be encouraging women to know what their absolute risk vs their relative risk is so they can make truly informed decisions for themselves about their pregnancies, their births, and their babies.

In the meantime – can we please come up with another way of describing a woman who happens to be having a baby at the age of 35 or beyond? The terms we’re currently using are demoralizing. And I should know!

Thankfully, it’s not all bad. Based on this article, us “Geriatric Mommas” will have the last laugh: “Women who had their last child after 33 were twice as likely to live to 95 or older, compared with those who had their last child by 29.”

I’m not a math whiz by any account, but if my calculations are correct, this means I will live to be at least 125 seeing as I had my last baby eight years after the magical cut-off  of “33” as quoted in this article.

But before I get my hopes up, I think I’d like to know what my absolute advantage is, not just the relative advantage based on my age.

Know what I mean?

To Clone or Not to Clone?

Dolly

That is the question… Well, not really.

I’ve often wished that I could clone myself – not for any weird reasons, I think there really should only be one unique version of us in the world. It’s just that there’s an awful lot I’d like to accomplish in this one, wild life I’ve been given and sometimes it feels like too much for just one of me to try and get it all done.

One thing I really wish I had time for is helping more Mommas process their birth stories.

On a small scale, I’m already doing this. My families know how much I love birth stories. When my classes gather for reunions, I spend time listening to the birth stories of everyone gathered. I’m on the lookout for key information to help them reframe their births, if needed. I want them to know where they were strong. I want them to acknowledge who supported them and how, specifically.  And I want them to be proud of their level of participation in this life-changing event.

In short, I want all women to have a birth story they can look back on as a positive experience. One that informs who they are now as a woman, mother, partner, friend, and professional. I want all women to recognize what they’ve gone through in the ultimate Hero’s Journey that they’ve traveled in a matter of hours or days, that marks their lives as forever different, forever changed in ways both obvious and hidden – even to themselves.

So… nothing too important!

I’m happy to say that most of the women I’ve had the honor of working with over the years have a positive birth story to tell – despite it looking anything like that on the surface. The majority of this has to do with her individual attitude, flexibility and openness to responding to birth as it unfolds in real time. But, I’d like to think that they learned a little bit about this from being in my classes. I’d like to think that the preparation I offered around expanding expectations, and embracing vulnerability before birth helped them process the reality of their birth experience.

But what about the women who haven’t had a positive birth experience and haven’t been in one of my classes? Maybe their birth happened just last week, or maybe 20 years ago. All too often, these women are told that a “healthy Momma, healthy baby” is all that matters and they don’t get to finish processing this event in a way that allows them to move forward in their parenting journey. It’s my theory that these women continue to process their birth stories (as I feel they must, until they can come to some form of closure) with unsuspecting and extremely vulnerable pregnant women.

I hear about it all the time in my classes. Mommas will complain how all they hear are the “horror stories” that other women, many of them complete strangers, tell them about their own birth experiences. I think this is happening on a subconscious level. I don’t believe for a second that a woman processing her birth is intentionally trying to scare pregnant women with a negative birth story. I just think it’s the loop that they find themselves in as they try to make meaning from this experience that was life-changing, but not in a positive way.

Oh, how I wish I could meet all of these women! I’d love to be able to sit with them and listen deeply to their stories. I’d let them process as much or as little as they felt comfortable with sharing. And maybe in the retelling of their story, I could try to help them reframe and then reclaim their birth story as their own. I’d love for them to see, maybe for the first time, where they were strong, who supported them and how. Maybe they could finally begin to integrate this experience into the woman they are now. Maybe, in the process of this reclaiming, they could finally stop that negative birth experience processing loop with younger, vulnerable pregnant women.

To that end, about six months ago, I created a document that I’m calling: “Retelling and Reclaiming Your Birth Story: An Exercise to Give Meaning to Your Experience.”

I’ve had a few Mommas from my classes go through the five step process and a few have agreed to share the results here as future posts. It’s been a desire of mine to share some birth stories on my blog. Real birth stories from real women but with an eye on being able to acknowledge birth as a positive experience, even if it didn’t go according to plan.

I think my invitation to retell and reclaim your birth story can be helpful as a tool to get the details of your birth down in a way that has structure. This can be a beautiful gift to your child. You can remember and reflect on their birth-day every year, and they’ll have something to refer to in preparation for the time when they’re ready to have children of their own.

I’d also like to extend this offer to any woman who’s had a negative birth experience that they’re still trying to process. I believe it can be a tool for healing and integration. I’m not a professional counselor, I make no claims about this. But in the busy-ness of our daily lives, we have forgotten the power of story and how it can transform us.

I think every woman deserves that opportunity for transformation.

If you, or anyone you know, might benefit from taking part in this exercise, please take this short four-question survey and I will send a pdf file of the “Retelling and Reclaiming Your Birth Story: An Exercise to Give Meaning to Your Experience” out to you as soon as possible. Please feel free to share this offering far and wide – I’d love to help as many women as possible!

Thanks for your support. And thanks for allowing me to try and accomplish even more with my one, wild life (this way I don’t have to clone myself!)

Educating Educators!

TTR

Here, I’m making an important point about increasing student engagement…

I had the pleasure of working with a room full of Health Educators a few days ago for a training session I’d developed to help these professionals increase the level of engagement they have with their students.

No pressure, or anything, but when the title of your presentation is: “Teach to Reach: Six Rules of Engagement,” you’d better be able to bring it! Thankfully, I think I did. The evaluations were really positive: most attendees were wishing that the training had been longer, and I’ve already been asked to come back. So, that’s good.

I love doing presentations and trainings. There’s a reason why this is such a good fit for me. I’ve said it many times before, but it bears repeating – I am the most extroverted person I’ve ever known. So, getting up in front of a group of people doesn’t rattle me at all. I have no nerves in this situation.

In fact, the bigger the crowd, the more excited I get. The original number of people attending this training was supposed to be about 20. The day before, I found out it would be closer to 35. For some presenters, that might make them freak out. But not me – I was psyched! The energy from the audience totally feeds me.

The idea of being an “efficient communicator,” intrigues me. The larger the group, the more people receive the message I’m trying to convey at one time. Getting the most “bang for your buck” is a personal credo of mine!

And I really enjoy working with other educators, too. There’s a shared understanding of what it is to do group facilitation and to do it well. We communicate in the same “language” and can dive right in and get to work.

I’m especially interested in encouraging health educators to work harder at their craft because so much of our message we want or need to convey has the potential to be truly life-changing for the students in our classes. But not if they’re bored or checked out!

I started the training by asking participants to identify their greatest challenge as an educator. But I also asked them to claim ownership of their greatest strength. I think it matters as an educator, presenter, or human being, really –  that we take stock of what we’re really good at and then capitalize on that skill because it comes relatively easy to us and it also authentically represents who we are.

Participants shared that they were great listeners. That they had a lot of knowledge and expertise. They shared that they were able to connect well with their students. And my personal favorite, some felt they were able to make good use of their sense of humor while teaching. It’s a great feeling to be among such a strong group of professionals.

But there’s a little bit of extra pressure when you’ve been asked to train members of your own tribe. What if they already know everything? How can I make this information new and something they’ll actually be able to use? How do I keep them engaged and with me for two solid hours?

Turns out, these are the same questions we, as educators, should be asking about every class of students we teach, members of our tribe, or not. But, still – I knew that this particular group of people would be able to tell where the holes (if any!) were in my presentation and would be ready to point them out to me on the class evaluations. Which is why it matters even more that they were really positive.

My hope is that in some small (or potentially big) ways, what I offered this group of fantastic educators will help them get their messages out into the world with even greater impact!

If you’re an educator or work with educators who might benefit from having me present on this or other topics to increase student engagement and the impact of their message, please contact me here for more information.

Educating educators is just one more thing I love to do – it’s usually a lot of prep-work, but always a lot of fun!

PS – I’ve been asked to present at the ICEA Conference in Denver in the middle of October. My presentation there will be very Childbirth Educator focused and is titled: “Birth Plans: Helpful or Harmful?” I love getting the opportunity to be in front of my peers, create new presentations and content, and be a part of the conversation about topics that matter.

Lucky me!

Whether you’re an educator or not, take stock of your greatest challenges, but also remember to take stock of your greatest strengths! These are the ways in which you shine – let others see your light and bask in its warmth and glow! Claim your gifts TODAY!