The Uterus is NOT a Sterile Environment

May 22nd, 2014 Research

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No, researchers don’t have a way to test the uterus per se, but a group did find a way to test placentas.

That’s right…a group of researchers went searching for microorganisms in placentas. They found some.  The study is showcased in a story at the New York Times.

So what does this mean? We can’t be sure yet.  Like all good research, it answers one question and poses many more.

Do different microbial ecosystems lead to different pregnancy outcomes?  If so, what are the “bad” ecosystems and what can we do about them?

What affect does antibiotic administration have on the normal uterine flora? Can antibiotics in labor cause a lasting effect on the placental flora — and would this alter the baby’s flora?

Remember my previous questions about the microbiome and infertility? What role does uterine microbial ecosystem play in infertility?

Other than antibiotics, what things alter the uterine and placental microbiomes?

Sending much love to the microbiologists who are working to find answers to these, and many more questions.  I personally can’t wait to read more.


Encouraging Pregnant Women to Exercise

May 21st, 2014 Working With Clients

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When I was teaching childbirth education classes, a common question was “what type of exercise is the best?” I did my best to encourage women that ANY exercise was better than none – but the focus always seemed to come back to finding that one exercise that they SHOULD be doing. If they didn’t like the exercise or believed it took longer than the time they could devote to exercise, they didn’t do any exercise. I’m sure my experiences are not unique.

Here is a resource you can share with women that just might help them break out of the “this is the exercise pregnant women need to do” mindset. It is a podcast from Freckonomics – What’s the Best Exercise.  In fifteen minutes, the host and guests help listeners understand what they call the Three I’s for identifying the best exercise:

Intensity, Individualization, and “I Like to Do It.”




Tools for Improving Birth

May 20th, 2014 Labor Care, Raising Awareness

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Have you seen the new website from the American College of Nurse-Midwives?  It is a virtual toolbox for promoting physiologic birth. Inside you can find sample policies and protocols,  quality improvement resources, position statements and more. All the things you need to improve the rates of physiologic birth at your hospital.

Check it out and let me know what you think.


Childbirth Businesses and Facebook

May 19th, 2014 Marketing

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I’ve been a strong supporter of separation of personal and business on Facebook, and I still am.  Changes in Facebook algorithms have changed the way your business page works. So now I wonder, is Facebook still worth the trouble?

I go back and forth on this question.  I suppose the answer is going to be very individual for each business.  For me, I am starting to lean more toward the “not worth my time” side of the equation.  Here are my concerns, and why it may not make sense for me.

Continue reading


Advocating for Black Women’s Breastfeeding

The Black Mother’s Breastfeeding Association provides an local resource for families in the Detroit, MI area, and a great model for meeting the needs of a community of mothers.  Check out this great advocacy video they placed on YouTube: Knocking Down Barriers: Reclaiming a Breastfeeding Tradition.



US Healthcare Financing Changes and Pregnant Women

May 15th, 2014 Raising Awareness

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For readers interested in the changing US Healthcare Financing and its effects on pregnant women:  two resources for you this week.

First, the MACPAC (Federal group that reviews the state Medicaid and CHIP access) put out a report to congress in March.  You can view the report here: Report to the Congress on Medicaid and CHIP. The third chapter is about pregnancy coverage, and that starts on page 41 of the document.

Why do I think this is interesting?  Because the report highlights some of the challenges midwives have working with the Medicaid program – a program that pays for nearly half the births in the US (Here’s an article about it). What are these challenges?  The program receives federal and state funding, and states do have to meet minimum requirements.  But this leaves a system where women in different states received different types of coverage, and have different eligibility criteria.  This is why you may find the women in your state have such a different experience than the women another midwife works with in a different state.


Second, the National Association of Certified Professional Midwives (NACPM) is hosting a webinar this week all about the changes we can expect in women’s health due to the Affordable Care Act (ACA).  This is just one of a series of webinars about the ACA, so take a look at the offerings and sign up to get answers to common questions. You can access the webinar series here:  NACPM Resources


The Birth Worker Survey

May 11th, 2014 Statistics Summer

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To prepare for our summer of statistics, I’ve put together a short survey for you – the readers.  It is a simple survey asking a few questions about your beliefs about childbirth and your birth work.  We will use the results to talk about research statistics so we can become better readers of research.

So here is the link you need:  Birth Worker Survey

Feel free to share this link with your birth worker colleagues — more completed surveys mean more data to play with.

Common Questions:

1.  Is this anonymous?  I can’t tell who you are when you fill it out, but I think Google can and probably keeps track of it.  So it is anonymous to me, but not to the entire world.

2. Can I fill out the survey if I plan to become a birth worker? Yes, you can.

3. Can I fill out the survey if I don’t work anymore? Yes, you can.

4. What if I don’t like the questions, or the answers?  You don’t have to answer any question that makes you uncomfortable.  But it is a survey, and that means lines have to be drawn about what can be asked, how it can be asked, and how responses can be coded.  Don’t worry too much about getting the “right” answer, this is just for fun and is in no way a “valid” survey.  We’ll talk about what that means in June.

I look forward to completing this project with you.  Enjoy!




Does Prenatal Obesity Matter?

Apr 30th, 2014 Prenatal Topics

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I gave a talk last month about obesity and pregnancy. I had an inkling it wouldn’t be a well accepted topic.  I have this image in my head that very few people are as interested in obesity as I am; and that probably for the most part American’s are sick of hearing that they should maintain a healthy weight.

I didn’t get booed off the podium.  I actually had a few women ask questions when I was done, and a few who felt inspired that they really needed to take their own health more seriously.

I had three main points:

1. If at least 1 in 5 women will enter pregnancy obese, it is not an issue midwives can ignore.

2. We think about obesity as just having extra weight?  As if the problem is that there is the extra stuff hanging on your body that slows you down because you have to go through the day essentially wearing a full backpack. And if you could just drop that backpack your life would go back to “normal.” The problem with this type of thinking is that it ignores the fact that adipose tissue is active tissue with a metabolic function – and that function is not to just store and release extra fat based on how many slices of pie I ate this week.

3. When I read popular literature about obesity and pregnancy, I read about a very limited set of problems.  These problems begin with the labeling of obesity as a risk category for pregnancy, which allows the mother fewer options and results in unnecessarily high cesarean rate for obese women. My concern with this line of reasoning is not that it is necessarily wrong, but that it is dreadfully incomplete and gives the false impression that obesity adds no REAL risks to the health of mother or baby.

I have to rush off this morning – Statistics exam tomorrow and I’m having a dreadful time trying to stay focused and review.  Over the next couple weeks I’ll fill you in on the details of the main points, and we can explore some ways to help women achieve their optimum health.


The bonus of semesters

Apr 28th, 2014 Training

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I have less than a week remaining in my first year as a doctoral student. That means this is a busier than normal week, but a wonderful break is ahead.  It occurred to me this morning how helpful the semester system is, so I wanted to share a few thoughts with those of you whose learning doesn’t follow this structure.

Yes, semesters have their problems. They interfere with regularly scheduled life, I have to reorder things and I rarely feel as if I can relax or that I am “done.” When you live by semesters you are not finished until the semester is over.

But, think of these bonuses….

A semester forces me to make my learning a priority — something that doesn’t often happen when I don’t have the outside structure to motivate me.

A semester pushes me to expand further in a very short time, broadening my understanding of a subject and then letting me move on an apply that new understanding to the things I do.

Between semesters I get breaks, giving me a time to work hard and then a time to back off and let the new things I’ve learned change the way I think or act.

Semesters help me balance my life because the work gets done, and then I have a rest.  I’m a rather organized and self-motivated person, but it still is not the same when I try to “just learn something” as I go along.

The deadlines of a semester require that I move ahead, even when I wade into uncomfortable territory.

What about you?

For me, the concept of a semester works great.  I like it so much that I tend to plan other things in terms of a specific time period.  For example every year I give myself that one year to learn a new cooking technique – and I’m not allowed to give it up in that year even if it is hard. When I have  a “to do list” of the little things I want to do, but never seem to find time for, I can get them done by scheduling a few hours every week for a month or so. Even my exercise is partitioned into time categories – the next three months are all about being ready to run a 10K.

If you are learning midwifery through self-study without a semester structure, would creating a “semester” for yourself improve your learning?



A Fun New Project

Apr 25th, 2014 Statistics Summer

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I’m contemplating a new project for the summer.  I want to help you, my audience, become better consumers of research.  This isn’t a new idea, I have actually been thinking about it for over a year.  But the reality of being in a PhD program by day and mom by night is not really a place to try new things.

But this summer seems like the perfect time.  We could talk about a topic each week, and I can pull in examples from PubMed so you can learn to look deeper into an article.

If we do this, I want to have some fun and interesting examples.  So I am putting together a little internet survey to give us data to use.  Be on the lookout for a link to the survey in May, participate, and enjoy a summer of learning statistics.



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