Improving Birth: The Mother-Baby Friendly Movement

By: 
Dr. Ginger Garner

Every mother imagines the moment when she meets her baby to be one of, if not the most, joyous and beautiful day of her life.

As a mother of three, I know I did. And all three times, it was beautiful.

However, that is not the case for many mothers, especially in the United States, where our country occupies the shameful status of owning the highest maternal and infant mortality rate of any industrialized nation, including the highest first-day death rate for newborns, according to Save the Children’s annual State of the Worlds Mothers Report.

Womens’ willingness to give birth sustains our very existence. Their courage to give birth to the next generation should NOT be happening in the face of such high risk. It would seem logical that URGENT attention would have been given to reduce maternal and infant mortality. But it has not….

The Good News

The good news is the Mother-Baby Friendly movement was born out of that need to improve maternal and infant care. The 2015 guidelines for “Mother-Baby Friendly” standards of care were recently outlined by the International Federation of Gynecology and Obstetrics and published in the International Journal of Gynecology and Obstetrics.

In the 21st century prenatal care is still not universally mother and infant centered, or even safe. This should be surprising to us as both medical providers and healthcare consumers. Mothers and their babies deserve safe and compassionate care.

the-baby-friendly-hospital-initiativeThe Mother-Baby Friendly Movement

The “Mother-Baby Friendly” movement is an international effort that works toward improving birth, but it also creates a path for inclusion of a new health care provider and a new type of health care: the pelvic physical therapist who practices yoga as medicine.

Treating the pelvis is among the very nuts and bolts of what a pelvic PT does, and yet, they still aren’t a part of regular maternity and postpartum care.

Creating a system for certifying centers as mother-baby friendly rightfully acknowledges that we have a deep societal and cultural chasms which is producing poor mother-baby outcomes. Partnering with a pelvic PT can help reduce that chasm                                                       and vastly improve birth experience.

certified-baby-friendly

What Pelvic PT Can Do for Better Birth

Two important questions arise:

  1. What does a “Mother-Baby Friendly” facility look like?

  2. What can a pelvic PT could do for me?

To answer the first question:

According to the 2015 guidelines published by the International Federation of Gynecology and Obstetrics, a “Mother-Baby Friendly” facility MUST:   

  • Allow women to adopt preferred positions for labor AND provide food and beverages

  • Adopt a nondiscriminatory policy for HIV+ women, family planning, youth services, ethnic minorities, etc.  

  • Provide privacy in labor and delivery

  • Allow for choice of birthing partner

  • Provide culturally competent care

  • Have no physical, verbal, emotional, or financial abuse whatsoever, which includes coercing or scaring a woman into making a decision

  • Provide affordable or free maternity care

  • Have no “routine practice” (i.e. “standard” IV, fetal monitoring, etc.)

  • Provide nonpharmacological and pharmacological pain relief

  • Encourage and teach skin-to-skin mother-baby care and breastfeeding

To answer the second question:                                                                                                                                                                                                                                                                  

Medical Therapeutic Yoga Model of CareA pelvic PT can be an instrumental part of your birth experience by providing a biopsychosocial (BPS) model of care, something both the World Health Organization and the Institute of Medicine endorse and strongly encourage and something that I uniquely teach through a yogic-lens in all my pregnancy and birth education coursework. What is a BPS model of care – it’s one where YOUR needs are the priority and YOU are the center of care (not the electronic fetal monitor or your IV). In a BPS model, a pelvic practitioner would attend to not only your physical, but your emotional, energetic, psychoemotional, and spiritual concerns.

Pelvic PT’s can and should be involved in implementation of “Mother-Baby Friendly” criteria, which:
  • Physical Therapyimprove birth outcomes,

  • lower health care costs and for BOTH the birth facility and patient,

  • improve patient satisfaction,

  • improve birth experience and patient self-efficacy (which could affect postpartum depression and other common complications associated with postpartum), and

  • lower maternal and infant mortality.

 

Seven Reasons Yoga + Pelvic PT Can Make Birth Easier

The use of yoga and physical therapy together is a powerful combination. A practitioner that practices both is typically known as an Integrative Physical Therapist or a practitioner who offers integrated medicine. These practitioners not only help optimize prenatal care in a holistic way, they can also be a vital member of your birth team. Integrative Pelvic PT’s can:

  1. teach you about the range of birth positions you can adopt during labor and delivery,

  2. teach childbirth education classes for you and your birth partner,

  3. teach you about your birth options, what evidence-based means, and how to spot it,

  4. optimize your birth experience by providing bedside care, including soft tissue mobilization, manual therapies, and other physical therapy-specific skills,

  5. provide nonpharmacological pain management during labor and delivery (L&D), either through direct (therapies provided during L&D) and/or indirect (providion of TENS or other modalities or tools for use during L&D),

  6. follow-up with you in the postpartum ward to diminish postpartum complications such as pelvic pain, postpartum depression, incontinence, scarring, and other related issues, and

  7. practice all of these skills and interventions with cultural sensitivity, and (okay I threw in an extra one),

  8. work directly with your midwife or ob/gyn to optimize compassionate, biopsychosocial care.

Yoga can further enhance your pregnancy and birth experience. Contemplative science and practice is a burgeoning field whose evidence-base is fast growing and incredibly compelling.

Yoga can:
  • Evolve pelvic rehab with its systems-based biopsychosocial intervention, directly supported to improve maternal health outcomes.

  • affect genetic transcription from mother to baby, improving everything from HPA axis regulation to gut microbiome and colonization.

  • have a significant epigenetic effect that can also temper preexisting issues for mothers, like depression, inflammation, and weight management.

Pregnant women who practice yoga also:
  • improve their labor and delivery outcomes,

  • report decreased pain during pregnancy and labor,

  • report less fatigue

  • lessen their risk of premature birth, and

  • enjoy shorter labor duration.

The multi-system benefits of yoga, when combined with pelvic PT, can place it in a position of superior efficacy, to pelvic rehab alone. For that reason, and all the reasons listed above, adding a pelvic PT, especially an integrative PT trained in contemplative practices like yoga, can vastly improve the status of maternal and infant health worldwide and your personal birth experience.

Printed with permission from gingergarner.com

 

Dr. Ginger Garner PT, DPT, ATC, PYT    

Ginger is a longtime physical therapist, athletic trainer, and professional yoga therapist. She received her Doctor of Physical Therapy from The University of North Carolina at Chapel Hill and is the founder and executive director of Professional Yoga Therapy Institute, an international post-graduate program for licensed medical professionals, which celebrates its 16th anniversary in 2016. Ginger serves as a consultant to, and adjunct faculty for, medical schools in the US and Canada who use her yoga curriculum and methodology. She is a faculty instructor at Herman and Wallace Pelvic Rehabilitation Institute and Medbridge Education. Ginger maintains an international teaching and lecture schedule.

Ginger’s multimedia platform textbook, Medical Therapeutic Yoga, will be published in the summer of 2016. She is currently pursuing research at UNC on MTBI, PTSD, and yoga methodology. Ginger’s clinical practice, Crystal Coast Integrative Medicine, focuses on pelvic, orthopaedic, and women’s healthcare. Ginger is a mother of three, which drives her advocacy work for partnership-based education, integrated medical care, and egalitarian economics.