Friedman's Curve: An Outdated Standard?

This week's blog post explores the concept of "failure to progress" during labor and is based on a recent article at Evidence Based Birth. Please visit their website for more details and a full list of references.

C-Sections and Friedman's Curve

As most supporters of Lamaze childbirth preparation know, the C-section rate in the United States is among the highest in the world. About 30% of first time moms end up having C-sections, and about 35% of those C-sections were performed due to a diagnosis of "failure to progress."

Recent research, however, has shown that the standard measure of labor progress--Friedman's Curve--is outdated, and that following this standard may result in unnecessary interventions, including C-sections.  Friedman's Curve, published in 1955, describes the average length of time it took for women in Friedman's study to dilate each centimeter. Friedman found that the average time to get from 0-4cm dilation was 8.6 hours, the average length of time to get from 4-10 cm was 4.9 hours, and the average length of "pushing" was 1 hour. Friedman's data showed that labor sped up once women entered the active labor phase (about 4 cm) until they reached about 9cm dilation.Until recently, women whose labors did not follow Friedman's standards often had their labors induced or augmented (generally by use of pitocin).

Changes in Labor Since 1955

Although based on data from 500 first time mothers, labor conditions in 1955 were much different than today. In 1955 most women were moderately to heavily sedated during labor (Twilight Sleep was still common). Maternal demographics have changed greatly over the years as well, so today's moms are more likely to be older, overweight, etc .

In order to see whether Friedman's curve was still useful, a 2010 research study examined labor records from more than 62,000 women across the US. This study found that for women who go into labor on their own, labors tend to be much slower than in 1955. Most women do not start dilating rapidly at 3cm as Friedman had found, and many women went for long periods of time without any dilation. In and of themselves, today's longer labors have not been shown to generate increased risk of harm to baby or mother. However, if labor progress is measured by old standards, today's women are more at risk for medical interventions aimed at speeding up labor.

New Standards

In 2013 the definitions of normal labor and arrested labor were updated to reflect recent research. It is recognized that active labor may not begin until 6cm dilation, and the new definitions make it more difficult to diagnose arrested labor. It is hoped that these new definitions will decrease the rate of preventable C-sections.

The new standards make it more likely that families will be able to follow the Healthy Birth Practices promoted by Lamaze International, in particular Healthy Birth Practice 1: Let Labor Begin On Its Own and Healthy Birth Practice 4: Avoid Interventions that Are Not Medically Necessary. 
Most importantly, the new standards do a better job of recognizing that every woman is different, and that labor does not progress in the same way or at the same speed for everyone. Women's bodies are uniquely designed to undergo the process of pregnancy and labor, and in most cases can get the job done well without much intervention.

A Great Resource for New Families

This week on the blog I would like to give a shout out to our friends over at Mara's World.
Mara's World is a relatively new website run by 3 individuals who are dedicated to helping new parents navigate the world of pregnancy and infanthood.

The website contains a number of articles and planning guides covering a range of topics related to pregnancy and parenting. Some of the topics include:

• Pregnancy Nutrition
• How to Find a Childbirth Class
• How to Write a Birth Plan
• Relationship and Sex After Pregnancy
• How to Select a Pediatrician
• Top 10 Ways to Avoid Sleep Deprivation With a Baby

I have read a number of the articles and have found that they present useful, unbiased information that hits home. We particularly like their article Do I Really Need to Take a Childbirth Class? The short answer is: probably! Check out their website when you have a chance! 

Fall Partnership Classes for Babies and Toddlers

At Lamaze Family Center Ann Arbor we have several great partners who offer classes for babies and toddlers at our location. This week's blog will provide some information about the great classes offered by two of our partners, Kindermusik and Signing Smart. Both programs have free preview classes coming up in the next week so you can check them out!

Kindermusik offers two types of classes at Lamaze, Kindermusik Village for babies 0-18 months, and Kindermusik Our Time for toddlers 18 months-3.5 years.
At Kindermusik classes you will experience:

• Variety of music. Musical diversity builds strong neural networks in a baby’s forming mind, which is why each Kindermusik semester contains an array of styles, sounds, and genres.

 
• Instrument play. Age-appropriate experiences with child-safe instruments enhances a sense of rhythm and steady beat, develops a keen awareness of the distinguishing qualities of sound, and encourages spontaneity and creativity.


• Dance. A classroom full of baby and adult pairs dancing together helps a little body develop the muscle strength needed to crawl and walk and helps a little heart to fall in love with the sheer joy of responding to music.

 
• Together time. A Kindermusik class is truly the essence of “quality time,”offering you a place to create special memories with your child, gain new insights into your child’s development, and nurture your child’s natural love of music.

 
• Expert advice. A Kindermusik educator explains “what-to-watch-for” every step of the way and how each activity enhances your child’s complete development
• Learning continues at home. With the home materials, the learning continues at home with your child’s best teacher—you! 

Kindermusik is offering two free preview classes at the Lamaze Family Center Ann Arbor on Wednesday September 11th. The Kindermusik Village (babies 0-18 months) preview will be held at 9:30am and the Kindermusik Our Time (toddlers 18 months-3.5 years) preview will be held at 10:30am. Registration is not required, but it gives us an idea of how many people to expect. You can register here.

Regular Kindermusik classes at Lamaze Family Center start on Wednesday September 18th.

Signing Smart is another valued Lamaze Family Center partner offering fall classes.

By participating in a Signing Smart class, you can learn songs, signs, and activities to help your child communicate frustration-free. 

Signing with your hearing infant or toddler (6 months to 2 years) is an intimate experience that enriches your bond with your child while promoting speech, conceptual development and long-term learning. 

With Signing Smart your child can express his needs and interests, which results in less frustration and fewer tantrums. Your child can finally "tell" you what's on her mind-long before she can speak!

Signing Smart is offering a free preview class on Saturday September 7th from 11:00-11:45am at Malletts Creek Library. Registration is not required, but it gives us an idea of how many people to expect. You can register here.

Regular Signing Smart classes at Lamaze Family Center start on Tuesday September 17th.

Come check out the free preview classes and open up a whole new world of learning for your baby or toddler. We hope to see you there!

Healthy Babies: Worth the Wait

There is a nice blog post on the Lamaze International Science and Sensibility Blog this week by Dr. Richard Waldman, the past president of the American Congress of Obstetricians and Gynecologists.  In the blog post, Dr. Waldman discusses the importance of conversation and collaboration between doctors, nurses, midwives, doulas, and pregnant women to ensure that babies get the best start in life.

Dr. Waldman focuses specifically on the recent trend towards elective labor induction and elective C-sections before 39 weeks of gestation. This is also a focus of the March of Dimes "Healthy Babies are Worth the Wait" Campaign. As both Dr. Waldman and the March of Dimes point out, there is a growing trend over the past two decades of late preterm births. Dr. Waldman argues that the excellent care provided by NICU and neonatal nurseries has made both health professionals and women complacent about giving birth early.

Recent research, however, has shown that babies born after 39 weeks are generally healthier and do better in the long run, than babies born before 39 weeks. Of course, in some cases health risks to mom or baby make early labor induction/C-section a necessity. For most of us though, it makes sense to wait until 39 weeks or later to give birth, in order to allow the brain and other organs to fully develop. As someone who gave birth to my daughter at 41 weeks 1 day, I know how hard it can be to wait patiently for a baby to come. As the March of Dimes campaign states though, her good health has definitely made it worth the wait!

To read Dr. Waldman's original blog post, click here. To read about the March of Dimes campaign, click here.

Time to Think About Fall Classes

It's still hot and humid, but fall will be here before you know it! Have you registered yet for fall classes for your baby or toddler?

Lamaze Family Center and our partners offer a variety of classes for babies and toddlers 6 months and up including:

• Parent-Toddler Playgroup
• Creative Movement for Toddlers and Tykes
• Signing Smart
• Kindermusik

Click here to read descriptions of the classes and to register before they fill up!

Breastfeeding Facts

In honor of World Breastfeeding Week, here are some fun facts about breastfeeding:

How Many Women Breastfeed?

• According to the CDC's 2013 Breastfeeding Report Card, 76% of US women start out breastfeeding their children. By 6 months, 49% of moms are breastfeeding, and by 12 months only 27% are still breastfeeding. 
• In Michigan 75% of moms start out breastfeeding, but only 22.8% are doing so at 12 months. data from cdc.gov
• Nationwide, 7% of babies are born in a "Baby-Friendly Facility" ( an accreditation program based on recommendations from WHO and UNICEF, that was designed to encourage and recognize hospitals and birthing center that offer an optimal level of care for infant care and mother/baby bonding). data from cdc.gov
• In Michigan, only .55% of births occur at a "Baby-Friendly Facility." data from cdc.gov

The Health Benefits of Breastfeeding data from surgeongeneral.gov:

• Breastfeeding protects babies from infections and illnesses, including diarrhea, ear infections, and pneumonia.
• Breastfed babies are less likely to develop asthma.
• Children who are breastfed for 6 months or longer are less likely to become obese.
• Breastfeeding reduces the risk of SIDS.
• Mothers who breastfeed have a decreased risk of breast and ovarian cancers.

The Economic Benefits of Breastfeeding data from surgeongeneral.gov:

• Families who breastfeed can save between $1,200 and $1, 500 in expenditures on infant formula in one year.
• It is estimated that if 90% of US households followed guidelines to breastfeed exclusively for 6 months, the US would save $13 billion annually from reduced medical and other costs.
• Breastfeeding leads to better infant health, which means fewer health insurance claims, less employee time off to care for sick kids, and higher productivity.

How Long Should a Mother Breastfeed?:

• The American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least 12 months, and thereafter for as long as mother and baby desire. The World Health Organization (WHO) recommends continued breastfeeding up to 2 years of age and beyond. data from cdc.gov

Although breastfeeding is natural, it is not always easy, and many women quit breastfeeding because they are frustrated, or don't have good support. At the Lamaze Family Center Ann Arbor, we offer two main breastfeeding classes: Breastfeeding 101 and the Breastfeeding Obstacle Course. The first is meant to be taken before birth and covers breastfeeding basics. The Breastfeeding Obstacle Course builds upon information in Breastfeeding 101 is a guide to the common pitfalls and challenges of breastfeeding. You can learn more about our courses here.

Thanks to all the moms out there who breastfeed, and have a great World Breastfeeding Week!

Postpartum Depression-The Most Common Complication of Childbirth

Did you know that between 10 to 20% of all women experience perinatal mood and anxiety disorders, often referred to as "postpartum depression?" That's about 1 in 8 women, which is why postpartum depression is sometimes cited as being the most common complication of childbirth.

The general term "postpartum depression" is used to describe a range of disorders, including postpartum depression, postpartum anxiety, postpartum obsessive-compulsive disorder, postpartum post-traumatic stress disorder, and postpartum psychosis. The symptoms associated with these disorders are more serious than the "baby blues" experienced by up to 80% of mothers. Unlike the "baby blues," which often go away after the first month or so postpartum, these more serious symptoms can last for months if left untreated.

A woman with postpartum depression might experience feelings of sadness, anger, guilt, irritability, changes in eating and sleeping habits, and lack of interest in her baby. Those with postpartum anxiety often experience extreme worries and fears, often over the health and safety of their baby. Women with postpartum obsessive-compulsive disorder have repetitive unwanted thoughts or feel the need to do certain things over and over to reduce their anxiety. Postpartum PTSD is generally caused by a traumatic childbirth experience and often includes strong feelings of anxiety and flashbacks to the trauma. Postpartum psychosis is very rare, but extremely serious, and those experiencing it may have hallucinations or delusions that lead them to consider harming themselves or their baby. The symptoms associated with any of these disorders can appear anytime during the first year after giving birth.

Although postpartum depression and anxiety disorders are relatively common, many OB-GYN's don't discuss the symptoms or warning signs with their patients, so women experiencing the symptoms may feel isolated or alone. The good news is that there are effective and well-researched treatment options that help women to recover. Treatment may include increased self-care, social support, therapy, and sometimes medications.

The Lamaze Family Center Ann Arbor is proud to partner with the Postpartum Depression Support Group of the Greater Ann Arbor Area to offer a free support group for women experiencing symptoms of postpartum depression and anxiety. The group meets on the 1st and 3rd Mondays of each month from 10:30 am to noon at the Lamaze Family Center (2885 Boardwalk). Women, their partners, babies, and other supports are welcome.

If you or sometime you know are experiencing symptoms of postpartum depression or anxiety, know that support is out there. For more information about the Postpartum Depression Support Group of Greater Ann Arbor, you can call 734-418-2683.