Newsletter - September 2013

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What is a doula anyway?!?

Bianca Sprague

Bianca Sprague, CEO of bebo mia

For families that have recently discovered they are expecting, they find themselves in a whole new world of terms, books, products and services. Perineal massage, Chimparoo, placenta encapsulation, cord blood banking, attachment parenting, pee-pee-teepee, oh my! It is like learning a new language. They know they need a health care provider, but do not know the differences among their options. They hear such terms as doula and wonder, "What is that anyway, and do I need one? Is a doula like my doctor or midwife? If I have a midwife, why do I need a doula?" Breathe, we will clarify everything.

So, what is a doula? There are birth doulas and there are postnatal doulas. Birth doulas are with their clients during pregnancy, labour and delivery, they also typically do follow up care postnatally. Postnatal doulas come once you have the baby and do support (day and night) for you, your baby, and your family. In a nutshell, doula care is support: emotional, informational, and physical.

Your doula does not replace your Health Care Provider (Ob/Gyn, GP, or midwife). Your HCP is there to take care of your blood pressure, fetal heart rate, IVs, sutures, and other such procedures. Your doula is there to bridge the gap between you and your HCP. Most people in labour, find that too much is happening "to them" during their births. The doula's goal is to slow down that process and ensure that every step that happens during the labour, delivery, and immediate postnatal period is done by choice - i.e. informed consent. The doula should never be invested in your decision, but rather, support the choices that feel good for the parent(s).

Your birth doula is on call for you to answer questions during pregnancy, they are the first to arrive when you are in labour, and they are the last to leave. A good doula should be prepared to answer everything, from what sensations are normal and how to alleviate them, all the way to what kind of stroller should you get based on your budget and lifestyle.

People are surprised to learn that their doctor or midwife may not be the one attending their delivery, rather it will be one of the many other doctors or midwives in the practice. They are also not aware of the fact that for large chunks of the labour, the mother and her partner are alone in the room. The doula would be a constant care provider, offering suggestions to ease labour and ensuring everyone is well taken care of.

The doula is not there to replace the mother's partner (if she has one). Instead, she allows the partner to be as involved as they feel comfortable. This also allows for partners to sleep, take breaks, eat, and check in with family or friends.

Why have a doula? There are dozens of benefits to doula care. Studies have shown that when a doula is present, labours are shorter with less complications, babies are healthier and breastfeed more easily. The surgical birth rate declines dramatically, there is a decrease in postpartum depression, and mothers generally have a positive emotional connection to the birth, rather than the experience of trauma. Postnatal doulas will ease the transition that comes with the addition of a baby to a family, improve parental satisfaction and reduce the risk of mood disorders.

When selecting your doula, make sure it is someone you feel comfortable with. Interview a few doulas and consider these points while speaking with them:

1. TRUST YOUR GUT! You will know if you feel good with someone and when you feel off. They will be there during the most intimate time in your life, so you want to feel like you are in good hands.

2. The number of births they have attended doesn't always mean that they are better than someone less experienced. It can, but sometimes it is just a meaningless statistic. If you really like someone with less experience, go with them. Don't base it solely on the number of previous births they have attended. Among the bebo mia team, there are some doulas that have serviced 100s of families and some that have been with a dozen, yet they are all fabulous at what they do.

3. Find someone that is open to whatever you want in your delivery. You want to feel supported in your choices, WHATEVER THOSE ARE! We have clients hire us for elective c-sections and others hire us for home, water births. Our team has the same job for all clients - provide physical, emotional, and informational support. Period.

A doula should be on one's "Must Haves" list of their birthing day. They will be your friend, support and guide during one of the most exciting days of your lives!

To watch more about what a doula does, click here.

Bianca Sprague is the CEO for bebo mia and Baby & Me Fitness. She is a birth doula, childbirth educator, and lactation educator. She lives in Toronto, Canada with her daughter, Gray. bebo mia inc. is a full service boutique that specializes in guiding women safely through fertility, pregnancy and parenting. They offer a wide range of support, classes and services to reach the needs of any family. Always passionate about the health and well-being of families, bebo mia recently purchased Canada's first pre/postnatal fitness company, Baby & Me Fitness.

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Mason Shaffer Foundation

Mason Shaffer before

Sarah Shaffer, co-founder

Mason was first diagnosed with Osteopetrosis on August 21, 2009. Even though we would not receive the "official" diagnosis until conclusive genetic testing came back several weeks later, this is the date that will always stick in our family's mind. Everybody remembers where they were and what they were doing on significant dates in history, and August 21st, 2009, is a date in the Shaffer household that will never be forgotten.

Our doctors informed us that the only cure option for Mason was a stem cell transplant. The best possible donor for Mason would be his older brother Reilly. But after genetic testing, we learned that neither Reilly nor either of Mason's parents was a potential match for a stem cell transplant. Next, our doctor Anders Kolb at DuPont Hospital for Children initiated a search through the National Marrow Donor Program (Be The Match) to find a match for Mason as soon as possible. In early September, we learned that 3 different cord blood donations had been identified as perfect matches for Mason. On October 1, 2009, Mason received his transplant from DONATED cord blood stem cells. Today Mason is cured of Osteopetrosis. That's right... CURED!!!!

Mason Shaffer after

Through the inspiration from our son, we are highly motivated to take Mason's success story and pay it forward. It sounds very cliché, but what else can you do when a potentially tragic event strikes your family. We knew very early in Mason's journey that we were going to take our experiences and make a difference in other people's lives.

We developed the Mason Shaffer Foundation to expand the network of qualified cord blood donation facilities, fund cord stem cell research, provide education on the cord blood donation process, and develop an informational support network for families affected by Osteopetrosis.

Mason Shaffer at age 4

The Mason Shaffer Foundation launched a cord blood donation program in May 2011. We work with the New Jersey Cord Blood Bank and Main Line Health to offer the first cord blood donation program in the Philadelphia area. The Mason Shaffer Public Cord Blood Program provides expectant families with the educational guidance necessary to make an informed decision on cord blood donation. This joint effort means that all women giving birth at the Lankenau Medical Center have the opportunity to donate their baby's lifesaving umbilical cord blood for FREE. Donated cord blood is listed on the NMDP's Be The Match registry for use by any patient in need of a stem cell transplant.

When Mason was diagnosed with Malignant Infantile Osteopetrosis (MIOP), we found it very difficult to find current, accurate, and reliable information about this extremely rare disease that only strikes 1 in 250,000 live births. It was difficult for our family to find other families with the diagnosis. Therefore, the Mason Shaffer Foundation also provides an information and support network for families called M.A.S.ON. (Mason's Awareness & Support for Osteopetrosis Network). We will hold our 1st Annual Patient/Family Support Meeting this October 20 in Philadelphia.

As we are approaching Mason's 4th anniversary of his life saving transplant, we sit in true humility, joining with ALL of the MIOP families... those of us with our angels still here with us, and those of us who have angels in heaven... some of us have other children who carry both genes, or babies that carry one gene, and some of us do not know our children's status... this disease has changed us as parents, challenged us, scared us, made us stronger, more humble... made us more human... the Mason Shaffer Foundation helps us remember every day that there is only one reason that allowed Mason to still be with us: that one mother donated one umbilical cord. We will NEVER forget that and will work to ensure that this miracle is available to all who need it!

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Collector Training Improves Cord Blood Collections

Deborah Liney, MBA CHTC

Deborah J. Liney, MBA CHTC, Dana Farber Cancer Institute

Parents anxiously expecting the arrival of their baby have a multitude of decisions to make. From "What color do I paint the nursery?" to "Do I try natural childbirth?". While parents have been grappling with these questions for decades, a relatively new question has arisen: "Do I donate or save my baby’s cord blood?"

Private cord blood banks inundate expectant parents with marketing literature and advertisements concerning the benefits of privately banking a baby's cord blood. Public cord blood banks that seek donations to help patients tend to have more modest marketing budgets, if any budget at all. Whereas private banking costs parents over a thousand dollars in the first year, public donation is free.

Approximately 70% of patients who need a stem cell transplant do not have a match within their family, so that registries of adult donors and cord blood donations are their only hope for a cure. Because the matching requirements are not as stringent for cord blood transplants as they are for transplants from adult donors, cord blood plays a vital role in offering access to a cure to all patients. Public cord blood banks currently make cord blood units available for use in stem cell transplants to cure a range of diseases from leukemia to lymphoma and a host of 60+ other genetic diseases found in children.

Public and private banks also differ in how they collect cord blood. Private banks rely solely on the mother's caregivers to collect the cord blood after the baby is born. Private collections may be performed by a medical doctor, a nurse, or a midwife. Public banks rely on a mix of doctors who received extra training in cord blood collection and dedicated cord blood collection specialists who work at the delivery hospital.

Our hospital, Brigham & Women's, is the largest birthing center in the state of Massachusetts, with nearly 8000 births a year. However, we cannot afford to employ cord blood collection specialists on a 24/7 basis, so we began training doctors to collect cord blood at those times when the staff are not available.

We compared the size of the cord blood collections performed by doctors versus those collected by the dedicated collection staff. The basic volume threshold for storage in a public bank is 80 mls. While ultimately cell dose is the deciding factor as to whether a collection is "bankable", volume is used as a surrogate marker. Cell dose refers to the number of stem cells in the cord blood prior to cryopreservation. There must be enough stem cells to engraft and create a new immune system for an adult-sized patient.

no. CBU collected, meeting threshold, banked: MD vs staff

During 2012, a total of 998 mothers consented to donate. But 99 collections were not attempted because there was no trained staff available to perform the collection. A total of 899 collections were attempted. From those attempts, 573 total cord blood units were collected, but 151 of the collected units were too low in volume to ship for processing (26.3%). Among the remaining 422 cord blood units that were shipped to the bank, 56 were collected by doctors or midwives (13.3%) and 366 were collected by the Collection Specialist staff (86.7%). Ultimately, 48% of the 366 cord blood units collected by dedicated collection staff were banked, while only 20.5% of the 56 collections by medical staff were banked.

Our study shows that dedicated collection staff outperform medical staff in both the number of cord blood collections that exceed the volume threshold by a factor of 6.5, and in obtaining collections that pass all banking criteria by a factor of 15.3. These results should not reflect poorly on the doctors and other medical staff who take the time to participate in this process, but rather on the fact that the medical staff are there to take care of mom and baby and cord blood collection is a secondary thought. In addition, we can comment from our experience that your music teacher was right, "practice makes perfect". The more collections you perform, the better you are at collecting.

Deborah Liney is the Administrative Director of the Brigham & Women's Hospital Cord Blood Donation Program that contributes cord blood units to the National Marrow Donor Program in partnership with Carolina's Cord Blood Bank. She is also the Associate Director of Quality Assurance for Donor Services at Dana Farber Cancer Institute. She has worked in the field of stem cell transplantation for over 20 years.