IBCLC Detailed Content Outline: Psychology, Sociology, and Anthropology Focused CERPs - Section V

Families whose infants die in the Neonatal Intensive Care Unit (NICU) may be asked about autopsy, organ donation, and research tissue donation. Understanding how parents experience these often difficult but important conversations is crucial information for healthcare teams. This presentation provides the results of research that looked at the perspectives of parents who had experienced neonatal loss. Make a lasting difference to the families in your care by learning more about how to approach the conversation of autopsy, organ donation, and tissue donation for research in a way that is parent centered.

Developing secure bonds of attachment is a major developmental task for all human babies, a process that is considered to be foundational for future mental health and even physical wellbeing. The mechanism for doing so is called “nurturing,” and a growing body of evidence supports the impact of nurturing on physiologic stability, co-regulation and growth, as well as brain development and ongoing physical and emotional health. The first bond of attachment is between mother and baby and begins before birth. Separation of mothers and babies always causes stress and interrupts the bonding and attachment process. When temporary separation is necessary in the NICU, there are ways we can support mothers and babies to help minimize the detrimental effects of separation and to promote healing. This presentation will describe the neuroscience behind parent-infant bonding and attachment and the neurobiology of skin-to-skin contact as a modality for nurturing babies. We will describe ways to communicate with NICU babies in a manner that enhances bonding and attachment and promotes the development of trust as well as enhances brain and language development. We will discuss ways to support babies, mothers, families, and staff in promoting bonding and attachment in the NICU.

There is a growing awareness about the impact of Adverse Childhood Events or ACEs and the toxic stress they can create during a child’s formative years. So far much of the research and conversation has focused on identifying ACEs and the negative life-long consequences they can have. How can we reframe the conversation to shift from focusing on reacting to negative outcomes, to creating the caring connections that promote healthy brain development and stress regulation? To feel healthy, people of all ages look for a meaningful existence with loving and caring relationships. In the Salutogenic Model of Health this is called the Sense of Coherence (SoC). When the SoC is under strain, this can cause pain and trauma that both parent and child express in behaviours that are difficult to handle for themselves and others. As innately and intensely social beings, humans actively try to connect to others to build positive, contextualised relationships that support health and wellbeing and create social resources. Therefore, secure childhoods and nurturing social environments are likely to increase lifelong resilience. Looking at health from a salutogenic perspective can help us understand that health and wellbeing cannot simply be depoliticised and decontextualized as an individual responsibility. ACEs are not always preventable, but we have the power to help both parents and professionals create the positive childhood experiences (PCEs) that buffer the negative ones and create resilience.

Working in perinatal care can be deeply rewarding. It can also lead to job-related burnout, secondary traumatic stress, and moral injury. Secondary traumatic stress (compassion fatigue), or moral injury, can occur when witnessing traumatic events in the workplace. This can occur when witnessing infant death or traumatic births, or when there is too much work, or work that doesn’t seem to make a difference, and little institutional support. Unfortunately, this is remarkably common among caregivers for perinatal women. Burnout, compassion fatigue, and moral injury can lead to physical and mental health sequelae for care providers and have a negative effect on the care they provider. Self-care is essential for being able to provide care to others. In this presentation, participants will learn about the causes and consequences of burnout, compassion fatigue, and moral injury. Fortunately, there is hope for recovery. Participants will learn some specific strategies for integrating self-care into their care for others.

Indigenous practices around pregnancy, birth and postpartum have become wildly popular, and some even controversial, from rebozo belly sifting and Bengkung binding to herbal massage oils and vaginal steams. This presentation will dive deeper to explore the theories and assumptions behind certain lineages of indigenous postpartum care (Traditional Chinese Medicine, Mayan and Nigerian), their analysis of the postpartum body as in a “cold state,” and common warming foods and practices. We will also look at the theories behind functional medicine and compare the two perspectives – both ancient and emerging science - in their common view of the postpartum body as being in a depleted state in need of nourishment.

Given the lack of standard postpartum care and the high rates of postpartum depression and mood disorders, a family-oriented and public health approach is proposed here, at the intersection of both indigenous and functional medicine. Both early research and generational wisdom suggest that integrative postpartum care focusing on regular warm broths and baths, anti-inflammatory foods, and nourishing the hormonal, digestive and circulatory systems can relieve new parents’ swelling, joint pain, constipation, hot flashes, energy and mood, especially for those with health conditions, after a difficult pregnancy, or a long or traumatic birth.

Death is an extraordinary “thing” in our society. Since the invention of modern medicine, death has become the enemy, the unexcepted, the unacceptable, something to fight against, and a failure. Notwithstanding the fact that death is the only known certainty in life, we are shocked and overly distressed about it. There seems to be a hierarchy in death, that children shouldn’t die. It isn’t too many years ago that a mother expected with her large family that she would “lose” 2-3 children. That is still my experience in developing countries. I bring with me balance of modern medicine working together with educated mothers, and traditional expectations and practices, to try and find that balance in our work.

I will be discussing a baby as meaning from the moment of conception through to first year of life. We will explore the concept that as health professionals how our own thoughts, feelings, fears and beliefs influence how we respond to a mother and her family. The behaviours and expectations of the people around her influence her grief path, therefore we need to be clear and conscious in our communication. Examine rituals and behaviours that can alleviate some of her devastation, relief or pain.

Women with physical, sensory, and intellectual/developmental disabilities experience significant social, health, and health care disparities. Recent data show that their pregnancy rates are increasing. However, little is known about the perinatal health outcomes and care experiences of women with disabilities. In this presentation, I will provide an overview of research concerning the perinatal health outcomes and care experiences of women with disabilities, specifically highlighting findings from a National Institutes of Health-funded study conducted in Ontario, Canada.

From population-based health records data, we found that women with disabilities experience higher rates of perinatal health complications than women without disabilities. From interviews with women with disabilities and health and social service providers, including midwives, we identified barriers to optimal perinatal care for women with disabilities, including failures to meet accessibility and communication needs, with particular gaps in care identified in the postpartum period. This presentation will conclude with a discussion of implications for midwifery practice, identifying ways in which the midwifery model of care may best address the challenges experienced by women with disabilities during pregnancy, delivery, and the postpartum period; these include longer appointment times, the ongoing process of informed consent, home visits, and extended support in the postpartum period.

Trauma-Informed Care (TIC) foundations establish that qualities such as trust, respect, compassion, and self-regulation on the part of the practitioner are essential to creating the conditions that would translate into ‘safety,’ ‘trustworthiness,’ ‘mutuality,’ and ‘choice.’

But how do we develop these qualities?

In many ways, we have an ideal in our imagination for this quality of personhood that ‘delivers’ trauma sensitive care, but we often fail to explore how exactly one cultivates and maintains an approach that is not just ‘informed’ but embodied.

By briefly reviewing the history and limitations of trauma-informed care and exploring the emerging themes at the intersection of trauma-healing, social justice, and somatic studies, we will define Healing Informed Care (HIC) and what the framework asks of us in our care roles.

As we learn the ‘what’ of healing-informed approaches, we will uncover the ‘why’ and the ‘how.’ Participants will emerge with a practice map for building skills that not only make Healing Informed Care possible, but skills that support meaningful self-monitoring and self-care, critically important to buffer against stress and burnout in these professions. By building an intimate and compassionate awareness of our own patterned responses, we unleash the potential to better understand and to attend to the bodies that we are in, and to naturally build ‘beloved community’ where safety, dignity and care are more readily available in service of healing.

We deepen understanding of false conceptual assumptions that define racial equity by critiquing standards of organizational operations. Strengthening awareness to lactation providers by defining and determining key terms which identifies structural racism and reduces superficial outcomes. By alternating racial equity from a “hot topic” to systemic revolution to deconstruct barriers by challenging these assumptions by concepts. Identifying standards that ensure transformation and shift gears from idealist views on racial equity to strategies to promote impactful solutions. Reevaluating promises to actions which Increases understanding of racial equity through policies, practices and procedures. Empowering audience to determine their baseline and understanding of racial equity to build compacity to their ability to morph from ally to accomplice. Giving guidelines, theories and concepts to build an organizational framework to develop and implement plans to incorporate into practices. Despite a growing interest to being sympathetic to racial equity efforts, this learning environment will improve understanding of systems of racism which impact health outcomes. Giving the learners the ability to examining concrete approaches to advancing racial equity.

“Incomplete, inaccurate, biased or unavailable patient education, resources and lack of opportunity for pregnant patients to have meaningful conversations with their healthcare providers about their individual care” (Stirling, Vanbeisien & McDougall, 2018, p. 13) is a major setback when women are being facilitated with childbirth-choices. Initiating the facilitation of childbirth-choices early in pregnancy gives the woman some time to weigh the options and for the healthcare provider to clear any misconceptions relating to childbirth types, yet this is a largely un-investigated area of concern in Namibia.

Improving the outcomes for women to have a positive childbirth experience and ensure that the SDG 3 of health for all is achieved exploring the experiences of women and that of midwives was important to ensure the former. Taking into consideration the Universal Rights of Childbearing women and Respectful maternity care (RMC) with a special focus on two of the rights which are “right to information, informed consent and refusal and respect of her choices and preferences, including the right to her choice of companionship during maternity care &” and “right to liberty, autonomy and self-determination and freedom from coercion”. This presentation will contextualize the experiences of women and midwives alike in the facilitation of childbirth-choices. A developed model that will help midwives in the facilitation of childbirth-choices for a positive childbirth experience for women and their families.