In This Issue—Reminiscing About Birth and Motherhood

Abstract

In this column, the editor of The Journal of Perinatal Education reminisces about her births and those of her three daughters and how birth has had an impact on her personal and professional life. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

It is now 8 months into the COVID-19 pandemic that has changed many of our lives. I sit here in front of my computer in my home office where I now spend most of my time, teaching remote classes and participating in endless Zoom meetings. While putting the finishing touches on yet another issue of The Journal of Perinatal Issue (JPE), I struggle to think of what to write for my editorial. Being secluded for hours each day at home and while rereading several manuscripts selected for the current issue of the JPE, I began to reminisce about my personal involvement in birth. It is hard to believe I have been a Lamaze Childbirth Educator since 1974 and editor of the JPE since 2007!

In this issue's Celebrate Birth column, titled Amazing Grace: Remembering Pregnancy and Birth, Bonnie Sturm shares the story of her daughter and son's birth at the Maternity Center in NYC in 1986 and 1989, respectively. She eloquently reflects on the exceptional supportive care and freedom the nurse midwives were able to provide to her and her family. What follows is the expression of that deeply personal and profound experience, which will hopefully remind and inspire women of the truly individual and extraordinary gift of birth.

In this issue's feature article, The History of Lamaze Continues: The Legacy of Linda Harmon, Executive Director Emeritus Linda Harmon and JPE Associate Editor Judith Lothian reflect on the evolution of Lamaze International and the contributions the organization has made to advancing safe, healthy birth over the course of her 30 years as executive director. Shortly before Linda was hired, the organization (then American Society for Psychoprophylaxis in Obstetrics (ASPO)) moved to the association management firm, SmithBucklin. That move was a major step for the organization setting the stage for the dramatic growth of Lamaze that has taken place. Linda's leadership catapulted the organization into a new era. She devotedly guided the ship as Lamaze engaged in the important work of changing the culture of birth. In this feature article, Lothian asked Harmon questions about her work and life with Lamaze. It was a trip down memory lane for both Judy and Linda as well as for me.

I first became intrigued with everything about birth when I had my maternity rotation in my undergraduate nursing program. My maternity professor, who became my lifelong mentor, truly inspired my passion for childbirth. When I graduated from nursing school, my first job was as a labor and delivery nurse at a progressive hospital that practiced true family-centered care, allowing fathers in the delivery room, and rooming in for mothers and babies. I soon became an ASPO Certified Childbirth Educator and began teaching childbirth classes.

Unlike many women who learned about birth from their mothers, I knew little about my own birth because, sadly my mother died when I was in college before I had a chance to ask her questions about her experience. Things were very different for my own three daughters who grew up in a house surrounded by mother and baby statues and birth paraphernalia. In fact, some of their favorite early toys were a pelvis and a cloth fetus with placenta attached. When my oldest daughter was a sophomore in college, she interviewed me for class assignment about my experience being involved in childbirth education and my relations with my three daughters. She wrote an essay titled Motherhood Transcendence. When I read her essay, I asked if I could share it with Sharon Humenick, the editor of the JPE and it was subsequently published in the JPE, Volume 6, Number 2 (Budin, 2007).

I was extremely fortunate to personally experience three amazing unmedicated normal births. I always dreamed that my daughters would have similar positive empowering experiences and of course I had hoped and planned to share in their birth experiences. Fast forward 40+ years …

The first to become pregnant was our youngest daughter, Jill. She and her husband were planning for a midwife-attended home birth if all went well. When labor began uneventfully during the day of a full solar eclipse, everyone and everything was ready. Best laid plans. After laboring at home for over 24 hours with little progress, her midwife decided that a hospital transfer was appropriate. Despite implementing all strategies to facilitate labor progress nothing was effective and after many more hours she wound up giving birth by cesarean to a healthy baby girl. Unfortunately, I could not be present for the birth but in retrospect this was a wonderful example of a seamless hospital transfer demonstrating how the system worked as it was intended.

Almost 2 years later, in March 2020, just at the beginning of the COVID-19 pandemic, Jill went into preterm labor at 36 weeks and had a successful vaginal birth after cesarean (VBAC) to a healthy baby boy. Because of the COVID-19 restrictions, again, I was not permitted to be present for her birth, but her doula was allowed and provided me with hourly updates.

About a year and a half earlier, our oldest daughter became pregnant with her first child at 42 years old. She was attended by a midwife and despite being diagnosed with gestational diabetes, she maintained good control of her blood sugar with diet and exercise and looked forward to a giving birth at a birth center within a New York City (NYC) hospital. One month before her due date the birth center closed. Fortunately, her midwife could still provide midwifery model of care in the hospital labor and delivery environment. The team of her midwife, husband, doula, and I were able to provide support at home and after admission to the hospital. After a long labor and pushing for almost 3 hours, I was able to witness my daughter gave birth to an 8-pound baby boy. My grandson will be two in February and is still a happily nursing toddler.

As I sit down to write this editorial for this issue of the JPE I am anxiously awaiting the arrival of our fourth grandchild. Our middle daughter is 39 weeks pregnant with her first child. Again, I will not be permitted to be with her for the birth due to COVID-19 restrictions. But she will have her husband, doula, and the amazing nurses at the hospital where I used to work, provide her with the support needed. I am confident she will be in good hands. Perhaps she will be able to share her birth story in a future issue of the JPE.

I will end here with an anonymous quote that is on a plaque in my office that has always inspired me …

It is refreshing to know that, for all the billions of times it has occurred, the birth of a baby, like the wonder inspired by a sunset, can never be tarnished by repetition.

IN THIS ISSUE

Following up on the theme of support in this issue of the JPE we share an article by DeSarro and Lanning about preparing doulas to support cesarean birth. Despite growing initiatives to support patient-centered labor and birth care, implementation of this care in the operating room is still limited. These authors discuss how doulas can be utilized in the operating room to facilitate evidence-based practices such as skin-to-skin contact for mothers and newborns during cesarean birth. This article evaluates a curriculum and training method that was developed to educate doulas to provide safe and effective care during the cesarean birth experience. This intervention was found to be effective at improving doulas' self-perceived confidence in skills essential to support cesarean births and may serve as a model for other institutions to address barriers to the implementation of patient-centered evidence-based care in the operating room.

The role of the doula in breastfeeding initiation and duration was explored in an integrative review by Diane Spatz and Stephanie Acquaye. The objective of this integrative review was to assess birth and postpartum doulas' roles in supporting breastfeeding initiation and duration. The electronic databases CINAHL, Embase, PubMed, and Scopus were searched using the key terms doula and breastfeeding. Fourteen manuscripts met inclusion criteria. Six key themes were identified. Doulas may acquire only modest amounts of lactation-specific education however doula care still enhances the breastfeeding care provided by health-care professionals. Doulas offer prenatal and intrapartum support that encourages breastfeeding initiation in the hospital, as well as provide breastfeeding support in the community and home setting. This reinforces the unique role of the doula in bolstering maternal–infant health. The effect of doulas on breastfeeding duration is less clear.

Webber, Wodwaski, and Courtney describe a project where they used simulation to teach breastfeeding management skills and improve breastfeeding self-efficacy. Breastfeeding rates in the United States continue to be variable and are not meeting benchmarks established by Healthy People 2020. Recognizing a lack of opportunities for nursing students to practice breastfeeding management during clinical rotations, a breastfeeding simulation program was implemented for students prior to beginning Maternal Child Health (MCH) clinicals. Students reported increased confidence in caring for breastfeeding dyads and enhanced comfort when providing care to a breastfeeding mother (breastfeeding self-efficacy). This hands-on educational approach can be utilized for any provider working with breastfeeding dyads.

Finally, in this issue we share another article by Spatz and coauthor Jodie Miller dealing with the sensitive topic of “When Your Breasts Might Not Work.” They discuss factors that can negatively impact a mother developing a copious milk supply and ability to exclusively breastfeed their infant. In this article, they present two case exemplars (glandular hypoplasia and breast reduction surgery) to illustrate that not all mothers may be able to develop a full milk supply. Families should receive appropriate prenatal anticipatory education and guidance from childbirth educators and all health-care providers. Important considerations include the value of every drop of milk that the mother is able to produce and treating the milk as an important medical intervention and developing a plan with the family for supplementation so that infant can receive adequate intake for growth.

Biography

WENDY C. BUDIN is the editor-in-chief of The Journal of Perinatal Education. She is also professor and associate dean for Entry to Baccalaureate Practice at Rutgers School of Nursing. She is a fellow in the American College of Childbirth Educators and member of the Lamaze International Certification Council.

DISCLOSURE

The author has no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.