Thursday, July 26, 2012

The Technicalities of Teaching Childbirth Education Part 4

I have assembled 10 key principles of teaching effective childbirth education classes, and am briefly addressing them in this blog.  Part 3 in the Series is "Being Organized". Over the course of the next 10 blogs entries, I will address each one of these key principles so that you can enhance your own childbirth education classes!  Please read Part 1Part 2 and Part 3!

Part 4 is Evidence-based Knowledge Base

From Milbank Report
"Evidence-based" is more than just the latest buzz word in maternity care.  On it is placed the foundation of policies, procedures and practice guidelines of hospitals, birthing centers and practitioners.  However, when this evidence was revealed has come into dispute lately as certain of these policies, procedures, and practice guidelines have been called into question.   

According to Evidence Based Maternity Care, also known as the Milbank Report, published in 2008 and written by Sakala and Corry, a wealth of evidence based information exists. " Although the field of pregnancy and childbirth pioneered evidence-based practice, resulting in a wealth of clear guidance for evidence-based maternity care, there remains a widespread and continuing underuse of beneficial practices, overuse of harmful or ineffective practices, and uncertainty about effects of inadequately assessed practices. …”

An outcry can be heard regarding the gap between actual practices and obvious lessons revealed by such sources as Childbirth Connection, the Cochrane Database, and even today's media.  Questions arise such as "why is the U.S. cesarean rate 32.9%?", "why are routine episiotomies still performed regardless of the need?", "why are there more inductions and/or cesareans on Monday through Thursday than on Friday, Saturday, Sunday or holidays?", "why is the national epidural rate over 65%? Do U.S. women tolerate pain less effectively than women in other industrialized counties?".  One only has to view the "Birth by the Numbers" excerpt below to see the true gravity of the situation.

Childbirth educators, both hospital-based and shockingly as well as independent educators, are feeling the pressure to NOT tell the truth during childbirth education classes.  Class curricula are scrutinized by groups of physicians, nurses and risk management staff.  Then areas in question are either softened or removed. Why would someone want the benefits/risks of epidural anesthesia or cesarean births or circumcisions removed from the curricula?

One hospital gleaned a good portion of their curriculum from both the Cochrane Review and Pub Med, the searchable database from the U.S. National Library of Medicine and National Institutes of Health.  From this foundation came a thorough and complete 4 week childbirth education series.  In addition to this great curriculum, a notebook was created with the dividers labeled with the controversial topics.  Inside each division, current studies supporting the evidence taught in class where inserted.  Anytime there was a question regarding the validity of the information taught in the class, the binder was presented.  Great idea, yet why must childbirth educators practice defensive teaching?

The pressure is one from many directions for the use of evidence-based maternity care - from childbirth educators, doulas, and organizations such as Childbirth Connection and Lamaze International.  Each have online infovideos about improving maternity care and empowering women to examine maternity care carefully.  Directly below, you will find the latest video from Childbirth Connections "Transforming Maternity Care" campaign.

And here is the new video from Lamaze International "Parents Pushing for Better"

Education must come from all angles: from the childbirth educator teaching the expectant parent, to changes in policies at the birth facility level AND from changes in the curriculum at our medical schools and nursing schools. Care should not be "the way we've always done it" or "that's the way we were taught 15 years ago".  The best practice is current and evidence-based!

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