Status of the International Code

Aug 8th, 2014 Breastfeeding

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This past week we’ve been talking about international initiatives for breastfeeding, and I wanted to be sure I shared some information about the first one, the International Code of Marketing Breast-milk Substitutes published in 1981.

By its very existence, this document demonstrates the widespread popularity of infant formula.  In fact, the popularity was so widespread, health policy-makers felt action needed to be taken to stop unethical practices which added to the growing popularity.

What did the International Code do?
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An important document you’ve never read

Aug 6th, 2014 Breastfeeding

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I’d like to introduce you to the Innocenti Declaration.

The full name of this document is the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding, and it was jointly released by  the World Health Organization and UNICEF in 1990. It was this document that spurred WHO and UNICEF to launch The Baby-Friendly Hospital Initiative in 1991.

Notice as you read, that this is primarily a document about ensuring adequate and appropriate infant nutrition. Notice also, in the declaration section, the writers tied infant nutritional outcomes to overall maternal health — including adequate nourishment for the mother, access to family planning to allow longer inter-pregnancy intervals, and attention to the social environments in which women work and live. Continue reading

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Ten Things about The Ten Steps

Aug 4th, 2014 Breastfeeding

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You are probably familiar with The Ten Steps to Successful Breastfeeding.  Here are ten things you might not have known about the Ten Steps.

  1. The ten steps were first published by WHO/UNICEF in 1989 in a document titled Protecting, promoting and supporting breastfeeding.
  2. The Baby-Friendly Hospital Initiative was launched in 1991 to ensure every maternity facility in the world would follow these then steps.
  3. Avoidance of marketing breastmilk substitutes is not included in the ten steps. For a hospital to be accredited as Baby-Friendly they must also follow the International Code of Marketing of Breast-Milk Substitutes. Continue reading

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It’s Breastfeeding Month!

Aug 1st, 2014 Best of the Web, Breastfeeding

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August 1-7 is World Breastfeeding Week, and August is breastfeeding month.  Birthing Naturally is celebrating all month with blog posts all about breastfeeding.

We are kicking off the month with five great links to help you celebrate.

  1. The World Alliance for Breastfeeding Action hosted a photo contest in honor of World Breastfeeding Week.  Check out the winners of the contest here.
  2. The United States Breastfeeding Committee is a coalition of over 50 independent organizations to support, promote, and protect breastfeeding.  Take a look at the legislation and policy information to find how you can advocate for breastfeeding. If you are not from the United States, do a quick search to find your country’s committee and learn how you can join the advocacy.
  3.  The World Health Organization has publications and statistics about breastfeeding around the world.  Educational materials are provided in many languages. Check out their publications to educate yourself or use in educating others.
  4. UNICEF has published 264 posts about breastfeeding around the world in 2014!  Read some of the stories and be inspired, or find solutions from global neighbors that might help in your corner of the world.
  5. Breastfeeding advocates around the world have put together public service announcements to promote breastfeeding.  Check out the collection we’ve made for you at Birthing Naturally’s YouTube Channel and let us know which one is your favorite.



Statistics Summer Wrap-Up

Jul 30th, 2014 Research, Statistics Summer

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I wanted to take a moment to thank you for spending the summer learning how to read the statistics in research with me.  I hope you found the series helpful, and maybe it inspired you to read more research.  If so, I have a few resources you might like to know about.

The Birthing Naturally Twitter Feed posts a different study about pregnancy, childbirth and the post-postpartum every day.  Follow the feed for daily links to relevant abstracts.

The Cochrane Collaboration has a Pregnancy and Childbirth Group.  Their page provides easy access to the research summaries from their systematic reviews.

When you search in PubMed, a box in the upper right corner will provide you with information about how to purchase an article, or if there is a free version of the article available.

If you are a member of a midwifery or nursing organization check their website to see if they provide access to published studies.  You might also ask at your University libraries if they have public access library cards you can purchase.

Some journals provide key articles for free.  If you find a journal that frequently publishes articles of interest to you, sign up to receive the RSS feed or emails of the table of contents.  This can remind you to check into new research regularly.

Think you might be interested in conducting research?  Contact your local nursing or midwifery college to partner with researchers who can help you.

Thanks again for joining me this summer.  Let me know what you thought of the series and any ideas you have for future series.


Qualitative Research

Jul 28th, 2014 Research, Statistics Summer

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StatisticsSummerYou may have been wondering why I had not discussed qualitative research in this series.  The un-glamorous answer is that while qualitative research helps to inform practice, it doesn’t actually use statistics as we think about them.

Statistics lives in the world of numbers, and is used in research that is called quantitative — basically because it counts things.  But qualitative research isn’t about counting things.  It is about openly exploring an area to gain perspective rather than statistical significance.

So while quantitative studies as people to complete surveys and provide blood samples for testing, qualitative studies ask people open ended questions or observe how they perform a task. This type of information is useful in a few different contexts. Continue reading



Jul 25th, 2014 Research, Statistics Summer

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Last time we talked about the unique contributions of a systematic review.  Today we will talk about how meta-analysis informs our practice. Remember, these are both techniques that synthesize existing data. This means just like a systematic review, a meta-analysis must be performed with rigor.  A very specific question should be asked, and inclusion and exclusion criteria defined before collecting available studies.  Multiple databases must be searched, and counts of excluded studies and the reasons should be kept.

Where a meta-analysis differs is in the actual analysis. Remember when we talked about the importance of sample size to obtaining accurate estimates? Meta-analysis uses statistical techniques to pool the data from multiple studies providing us with better estimates. Here is an example: Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. Continue reading


Systematic Review

Jul 23rd, 2014 Research, Statistics Summer

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For today’s post, you might want to open a second window at the Cochrane Collaboration Website so you can scroll through what is available while we talk. One thing I have been trying to communicate (over and over and over) is that each study is only one small piece of the puzzle researchers use to help figure out what is going on.  Today we are going to talk about one tool researchers use to synthesize the available data, the Systematic Review.

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Time to Event Techniques

Jul 21st, 2014 Research, Statistics Summer

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Sometimes you want to understand the odds of an event that everyone in the group will not experience.  The best example in pregnancy and birth is the length of labor.  When you try to get an average length of labor you need to decide how to handle the labors that end in a cesarean birth.

You see, some women will have zero labor because they will have a planned cesarean.  Other women will labor for a time and then have a cesarean.  Most of the women will labor and give birth vaginally.  If you include the cesarean births you may have falsely low estimates of the length of labor.  But if you exclude the cesarean births you lose data that helps you understand the trajectory of labor.  What should you do?

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Assessing Study Quality

Jul 18th, 2014 Research, Statistics Summer

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We are nearly done with our discussion of statistics, so I wanted to take a day to discuss study quality. When researchers talk about the quality of a study they are considering the quality of the total package, not only the statistical significance of the findings. In fact, the quality of the study will affect the value the findings.

There are two documents you should be familiar with before you begin to assess the quality of a study.  The first is the CONSORT Statement and the second is the STROBE statement.  Continue reading


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