Wednesday, September 28, 2011

Top 10 Topics for Childbirth Education Classes ~ Part 2

As a veteran childbirth educator, I am always being asked by newer childbirth educators what are the most important topics in a childbirth education class!  That can be an easy yet difficult topic.  It can be easy because there are so many topics that should be covered to adequately inform expectant parents.  Yet, this question can also be difficult because of time constraints imposed on the educator.

Below are the “last” 5 top topics of 10 frequently requested by the expectant parents:

Where can I learn more – what are good resources?
Regardless of the length of the childbirth education class, clients can always learn more!  But where do you go for information…that is evidence-based and unbiased?  Many expectant parents today turn to the internet and that is ok, but use it with caution.  ANYONE can create a website or blog, make it look wonderful, but place on it incorrect information!  

However, some websites can be a great beginning place: has over 1200 articles for parents (as well as professionals) that are evidence-based and unbiased! is a website that features links that take the visitor directly to the research. is blog powered by Perinatal Education Associates, Inc. and has a lot of great info, mainly for birth professionals.  was created by a joining of Injoy Videos and Lamaze International.  Here your students can find free videos and professionally made handouts - free! is the website for CIMS ~ the Coalition For Improving Maternity Services.  This can point you in the direction of other great websites world wide. is powered by Lamaze International and is a blog with great research and articles. is a woman-centered, evidence based resource from author and researcher Nicette Jukelivics.  The information there is for both parents and professionals. is the mecca for evidence-based health care resources.

What can my partner do to help me during labor/birth?
Labor support, both emotional and physical, is essential during birth.  The partner may not be “wired” to know instinctually what to do at select times in labor.  A great solution is a childbirth class geared specifically to comfort measures and partners!  If this is not available, a great secondary solution is the book The Birth Partner – Revised 3rd Edition: A Complete Guide to Childbirth for Dads, Doulas and all Other Labor Companions.  It is currently available through Amazon for $11.55. A fantastic investment!

What about herbs during pregnancy and then herbs and placenta encapsulation after the birth?

If you as a childbirth educator are not qualified to speak to herbal remedies or placenta encapsulation, it is best to contact an expert in these two areas and invite them to either be a guest speaker or help you put together FAQ sheets.  Many health care professionals do not have backgrounds in herbal medicine and the FDA does not do research in this area. Contact a local midwife for their herbal contact – or it might be them! Likewise placenta encapsulation is a relatively new arena and thus you may have to send your clients to for more research and referrals.

What does labor/birth have to do with breastfeeding?

You may be the one to cover this information and what better resource to base your presentation on than Impact of Birthing Practices on Breastfeeding by Linda J. Smith (also available on Amazon).  Through this amazing research based book, you will find all of the links between labor/birth and breastfeeding that are available today, including location of the birth, medications, interventions and the power of labor support in breastfeeding.  Also in this book are the references for all of the statements made.  Some of the research may amaze and challenge you!

Childbirth education classes should never be “cookie cutter” in style…that is, they should not be repeated word for word during each series.  Childbirth education classes should be geared specifically to the educational needs of the students.  This can be simply accomplished as one hospital has done (Miami Valley Hospital, Dayton Ohio) – during the first class they give a handout that is to be completed and turned back in at the end of that first class.  This handout asks the students for their specific areas of interest and concern – both the expectant mother and the partner.  In this way, a hospital class can be interactive and personal.

Monday, September 19, 2011

Top 10 Topics for Childbirth Education Classes ~ Part 1

As a veteran childbirth educator, I am always being asked by newer childbirth educators what are the most important topics in a childbirth education class!  That can be an easy yet difficult topic.  It can be easy because there are so many topics that should be covered to adequately inform expectant parents.  Yet, this question can also be difficult because of time constraints imposed on the educator.

Below are the first 5 top topics of 10 frequently requested by the expectant parents:

Should I really go to childbirth education class?  If so, how do I choose which one?
Jamilla Walker RN
Author of
The Labor LadyGets Pregnant
Childbirth classes are designed to provide factual answers to questions. The classes should the parents a complete understanding of the process of birth and techniques that will help them through that process. Childbirth education is far more than learning to relax and breathe through contractions. When we understand the birthing process then we are better able to work with our bodies and not against them.

Choosing an Educator  It is important to take the time to inquire about the qualifications of a childbirth educator prior to attending their classes. Certified childbirth educators should go through an intensive training course and demonstrate competency in teaching and in childbirth. Parents should not be afraid to ask for references or to see past course evaluations.  Note: they don’t teach how to be a teacher in nursing school.  So because a childbirth educator is a nurse, doesn’t always mean she is a good educator.

When choosing a class, determine whether the class is consumer oriented or provider oriented. Consumer oriented classes tend to encourage expectant parents, the consumer, to take an active role in choosing the options desired for the birth. Provider oriented classes tend to inform parents as to the care and procedures they can expect from the hospital and your doctor during childbirth, sometimes with little emphasis on alternatives.

Private or Group Class   Once they have choosen the childbirth educator, then they should determine whether to have private instruction or be part of a group class. Private instruction allows for more flexibility and individualization. Classes are arranged around their schedule and greatly benefit those who are not able to attend the weekly group classes. Moreover, private classes can benefit those who may have apprehensions about being involved in group activities. Also, private classes allow personal questions to be asked that otherwise may not ask in a group setting. Some private classes are taught in the comfort of their home. This especially benefits those women on bed rest. Private classes will cost a little more, but it may be worth the difference.

Group classes greatly benefit those who prefer to meet other women or couples who are also pregnant. Group discussions on issues related to childbirth are common and oftentimes invigorating. Many hospitals offer group classes so parents can become familiar with the policies and procedures of the hospital in which they plan to give birth. This affords  them opportunity to know what options are available and what they can expect during their hospital stay. Since the class members have similar due dates, they may even see them in the hospital during or after the birth. These friendships can last long after the birth of the baby.

Types of Classes   There are a variety of childbirth classes available to you. The most common is the basic childbirth preparation course consisting of at least 12 hours of instruction. There are also weekend courses that can help those on a busy schedule. The refresher course benefits those who've previously given birth and the teen course is especially designed to address the needs of pregnant teenagers. Some childbirth educators also offer hourly consultation for those who have questions to ask but don't necessarily want a structured course. This, however, is not advised for first-time moms or teenagers. Take the time to review the contents of each course to determine which course is best suited for you.

Bottom line:   Know who all of the childbirth educators are in your community and what method they teach.  Be able to give referrals freely to Lamaze childbirth educators,  independent educators, hypnobirthing educators, Bradley teaching couples, hospital classes, etc.

Pregnancy wellness and the impact on labor/birth
Length of childbirth education classes often dictate what topics and to what extent topics are covered.  Unfortunately today, expectant parents feel like they cannot afford the time to take childbirth education classes – they are just too busy.  In answer to this feeling, hospitals have shortened and shortened childbirth classes to where some classes are only 4 – 8 hours long: one day.  Some educators call these brief experiences “drive through” classes, because the exposure to information is so incredibly brief.
Topics usually on the chopping block first are those of pregnancy wellness, nutrition, exercise and stress reduction – and their impact on labor and birth.  Wait….if all of these topics impact labor and birth and are left out of a curriculum …..are educators short changing parents?  This is a bold statement, but the answer is YES.

How to teach this topic?  Explore the new My Plate information on nutrition ( ,  exercise (, and stress relief during pregnancy  Evaluate what you can actually teaching within the time boundaries of your class and what you can afford to put into handout format.  Be a good resource for community based referrals also such as pregnancy exercise or pregnancy yoga classes!

What will labor really be like?
This topic can include the Stages and Phases of labor, cervical dilation and effacement, pelvic station, cardinal movements, intensity of labor contractions, time variations within the stages and phases, emotional and spiritual changes in the laboring mother, physical changes in the laboring mother….this can be a really inclusive topic!  Be certain to include the topics of fear and pain.  These are two elephants in the room that are fed healthy diets by many cable TV shows about pregnancy and birth.  The pain of labor must be differentiated from, for example, the pain of a headache or muscle strain.

How to teach this topic?  You can use a variety of teaching strategies including lecture, interactive discussion, handouts and visuals such as charts, models and videos.

What are my options?
For many women, childbirth is their first experience in a hospital.  It might also be their first healthy experience with a hospital – if family or friends have been previously admitted into a hospital when sick or injured.  It is vital to address the fact, prior to exploring options, that pregnancy is an experience of health.  It is not like other events of hospitalization where one is ill.  Therefore, a laboring mother and her partners’ options are greater.  Options include choice in physical comfort (such as positions, labor apparel worn, massage/touch etc), support (including partner support, doula support, family support and genuine emotional support from hospital staff), coping strategies (including breathing, relaxing, guided imagery, focusing, touch/effleurage, aromatherapy, water therapy, music, spiritual support), educational support (proactive reading and attendance at childbirth education classes).

How to teach this topic?  A firm foundation of comfort measures meshed with an equally firm foundation in anatomy and physiology of labor/birth leads to a conversation of informed consent.  This powerful topic, informed consent, lays the ground work for patient satisfaction in the entire birth experience.  Research shows that the degree to which a laboring woman feels that she is a vital role in the decision making process of labor/birth, increases her satisfaction with the process and positively impacts her parenting.  Lecture, guest speakers (other parents), videos, group discussion/brainstorming, and handouts may all be utilized.

What can I expect when laboring/birthing in the hospital?
The reality of nurses carrying multiple patient loads is a topic that needs to be covered in any childbirth education class.  This is a reality that may not be on every expectant parents’ radar.  Likewise, typical/routine interventions such as electronic external or internal fetal monitoring, medication for induction/pain management, mechanical induction methods, and the latest evidence-based information regarding routine birth/newborn procedures.  It is quite possible for a rousing discussion of “why do they still do that if it is not evidence-based” might follow any lecture situation on routine birth/newborn procedures.  Keep your objective teacher hat ready and avoid letting your personal/professional biases show.  Let the evidence speak for itself.

How to teach this topic?  Not only do you need a great objective teacher hat but also a great poker face for this group of topics.  Here, more than anywhere else, your biases will show.  The separation between a childbirth educator and a great childbirth educator is the great childbirth educator presents the topics with the current, up-to-date evidence-based research and the class members have no idea of any bias.  Borrowing from the Fox News Channel motto “we report, you decide”, would be a good way of keeping professionally focused on this topic.  If you have a strong bias and poker faces are not your strong suit, use videos (such as Healthy Birth Your Way – free download at, handouts (see same website for excellent handouts) plus group discussions….as long as you feel comfortable coping with hot topics and charged personalities.

Tuesday, September 13, 2011

More on Delay Cord Clamping ~ Got Evidence? Parts 3 & 4

(if you are viewing this blog on Facebook, please go to www.childbirth to view the video)

Need evidence about delay cord clamping? This is from Dr. Nick Fogelson, the Academic OBGYN on delay cord clamping - he talks the evidence. This is Part 3 & 4 of grand rounds.

More on Delay Cord Clamping ~ Got Evidence? Part 2

(if you are viewing this blog on Facebook, please go to www.childbirth to view the video)

Need evidence about delay cord clamping? This is from Dr. Nick Fogelson, the Academic OBGYN on delay cord clamping - he talks the evidence.  This is Part 2 of grand rounds.

More on Delay Cord Clamping ~ Got Evidence? Part 1

(if you are viewing this blog on Facebook, please go to www.childbirth to view the video)

Need evidence about delay cord clamping? This is from Dr. Nick Fogelson, the Academic OBGYN on delay cord clamping - he talks the evidence.

Delayed Cord Clamping ~ Not just a fad

(if you are viewing this blog on Facebook, please go to www.childbirth to view the video)

A review of current medical literature (2005-2010) finds overwhelming recommendations that late cord clamping can be advantageous for newborns by improving iron status and does not increase the risk of postpartum hemorrhage (Cochrane Database Syst Review. 2008 Apr 16;(2):CD004074.). A 2007 article in the Journal of the American Medical Association found that delay clamping in full term babies is beneficial to the newborn and the increase in polycythemia was benign. (Journal of the American Medical Association 2007 Mar 21;297(11):1241-52. Hutton EK, Hassan ES “Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials”.)

When looking at the effect of placentofetal transfusion on cerebral oxygenation in preterm infants, delayed clamping of the umbilical cord actually improved cerebral oxygenation in these infants in the first 24 hours. (Pediatrics. 2007 Mar;119(3):455-9).

Finally, an article in the British Medical Journal addressed concerns that delayed cord clamping could not only increase polycythemia but also cause hyperbilirubinaemia (abnormally high levels of red blood cells and bile pigments in the bloodstream, often leading to jaundice). However, trials show this is not the case. (British Medical Journal 2007, August 17 18;335(7615):312-3. Weeks, A. “Umbilical Cord Clamping After Birth”).

If you want to show your clients this same video, download it to your laptop or notebook by using Real Player.  Or if you do not wish to do that, use your fetal doll model with cord and placenta to show them a live demonstration of the same.  What a tremendous learning opportunity!

Monday, September 05, 2011

Maternity Care vs. the way a woman's body labors

For years, perhaps decades, I have been saying and in some instances SCREAMING that the US Maternity Care system does not practice evidence-based care.  That's right, it doesn't.  Look at the CDC statistics, the 34% cesarean rate or the fact that nearly 45 other countries have better statistical data than the US when it comes to maternal and infant morbidity and mortality.

However, and this was a HUGE aha moment, when I was watching the live webcast of the play BIRTH on 9/5/11.....I discovered that there is a GIGANTIC disconnect not only between US maternity care and the evidence  BUT  US maternity care and the way women are built to labor and birth their babies!

It all became clear.  Suddenly.  Like a bolt out of the blue.  A woman's body is wanting to labor and birth the baby one way, and we/US maternity care is demanding that the labor and birth happen in a different way.  As if to say that a woman's body is wrong and maternity care is right.  That the woman's body should accommodate the maternity care and NOT THE OTHER WAY AROUND.

Once I actually said it outloud and then put it on paper, it seemed so simple.  Such a simple concept.

So while it is horrific that our maternity care is not evidence based, it is even more horrific that we do not honor and respect the work that a woman's body is trying to do, albeit as individual as we all are.  That our maternity care system is not flexible enough or educated enough to learn about all of the possible variables of normal.

 But that our maternity care system is at odds with a woman's body during labor.

Thursday, September 01, 2011

One World Birth ~ the next great birth film

We have come to a pivotal point in US maternity care. A revolution has been brewing for some time now and the actual beginnings started as a buzz at the various midwifery, birth and breastfeeding conferences and to some degree online, for example on blogs. Now, just as this newborn bird incrementally tears open the restrictive interventionist shell of the maternity care egg, we see that there is a light of truth being shown on this US maternity care….a care system that exudes mediocrity.

With staggering statistics of 34% cesarean rate and humiliating maternal/infant morbidity and mortality rates as the costars of this tumultuous reality show, today’s birth celebrities (Ina May Gaskin, Michel Odent, Sheila Kitzinger, Elizabeth Davis, to name a few) venture into view to call the plays like they see them ~ "if we get birth right, we get the world right". (

The marriage of evidence-based maternity care with modern medicine is dismal at this moment. With uncomplicated pregnancies turning into complicated births, one only has to look at the factors surrounding the birth to see a path of interventionism and iatrogenic dystocia. These women then take their experiences back into the community and in trying to validate their non-informed decision making, instill fear into future laboring women. Compounding this is the impact of the media, who sensationalizes childbirth to the extreme so that the lines are truly blurred between fact and fiction.

In the 1970s, those of us who were in the birth professional spoke louder than now, literally and figuratively, regarding the policies and routines that interfered with the birth process, including the cooptation of childbirth education classes into the hospital setting. Parents must once again realize that all childbirth education classes are NOT created equally and they will not receive cookie-cutter classes regardless of where they attend classes. While it would be very unfair of me to say that all hospital childbirth education classes were guilty of the sin of omission in many details of information (mainly because I have worked for at least one hospital who didn’t have such stringent ties on their childbirth educators), I can say that for the vast majority of childbirth educators who teach in a hospital setting, an evidence-based curriculum is challenged by obstetricians and anesthesiologist who have little if any training in physiologic birth. And basically because the childbirth education department in such a hospital is NOT the huge money maker department, sins of omission occur. The whole truth is not told. Parents essentially do not get the full story.

When identified as a “patient”, a human begins to feel a certain vulnerability, a need to be cared for and a need to trust. And so an expectant mother and her partner begins to put their trust into care providers that may or may not fully understand the emotional, hormonal or spiritual piece that the expectant parents assume they know. Let’s be clear, how many women have either thought this scenario or verbalized it:

When I am ready to give birth to my child, I want the baby to come early so it can be admitted into the NICU and out of my touch for hours or days. To obtain this end, I want to have my membranes stripped in that painful procedure, be given a synthetic hormone to speed my labor and shuts down my body to make its own natural hormone. I definitely want to lay as still as I can on my back, so labor slows, the baby does not complete the cardinal movements easily and the weight of the baby and the uterine contents puts tremendous strain on the vena cava. In the presence of the resulting fetal distress, I will push and hold my breath and deprive my uterus and baby of more oxygen, thus making the fetal distress worse. At this point, my care provider will perform abdominal surgery on me to deliver my child so I can have a recovery period so much longer than with a vaginal birth and thus, my baby will go to the NICU.

Absurd? Yes. But this same scenario happens every hour of every day of every week of every month of every year. And our species is not thriving. One only has to look at the CDC statistics to see that the US is behind such countries as Qatar. It is not supposed to be that way. We are the leaders of the world. We are more innovative and smarter than that. We must do better. We must consider the expectant mother as whole being not a uterus and vagina. We need to make the scenario of the “patient” in a hospital less frightening as the power of fear and the impact of fear and the hormones surrounding fear are revealed. If that interaction was honored for what it is, and respected, and if women were supported by educated care providers who knew how to care for women regardless of their choices, AND if expectant parents were fully educated about all of the options and possible scenarios, birth would be a better beginning.

If you have not viewed the video clips available from, I urge you to do so. See what is being said and take part in the conversation/ revolution. 

It is right time; the right place.

September is BOLD and BIRTHY

I have been waiting for September.  Why you may ask?  Because of the One World Birth videos today and the BOLD play on Monday.  To give you a taste of OWB, here is one of the videos that are FREE!