Monday, August 20, 2012

The Technicalities of Teaching Childbirth Education Part 6: Critical Thinking

Somewhere in the deep recesses of the hospital, someone assumed that because a maternity nurse is a good maternity nurse, she’d also make a good childbirth educator.  As a maternity nurse who has been a Lamaze Certified Childbirth Educator for over 30 years as well as a childbirth educator trainer for CAPPAICEA and now Lamaze International, I can tell you unequivocally that assumption is untrue.  Not all childbirth educators are created equal.  I have known some great maternity nurses who have been less than good childbirth educators.  And I have known some lay persons who have studied and become tremendous certified childbirth educators.

I have assembled 10 key principles of teaching effective childbirth education classes, and am briefly addressing them in this blog.  In no particular order, they are:

  1. Know how to teach
  2. Preparation of a dynamic course lesson plan
  3. Being Organized
  4. Evidence-based knowledge base
  5. Learner Assessment
  6. Critical Thinking
  7. Robust teaching techniques
  8. Motivational skills for engaging students
  9. Compassionate listening 
  10. Problem solving

The definition of critical thinking is a way to determine if assumptions are true, sometimes true, partly true, or inaccurate.  To experienced childbirth educators, the synonym of critical thinking could be teaching about informed decision making or informed consent.

According to the American College of Obstetricians and Gynecologist's Committee on Ethics and Informed Consent, "The ethical concept of "informed consent" contains two major elements: 1) comprehension (or understanding) and 2) free consent. Both of these elements together constitute an important part of a patient's "self-determination" (the taking hold of her own life and action, determining the meaning and the possibility of what she undergoes as well as what she does). Both of these elements presuppose a patient's capacity to understand and to consent, a presupposition that will be examined later."

The ACOG report also states:

Consent is based on the disclosure of information and a sharing of interpretations of its meaning by a medical professional. The accuracy of disclosure, insofar as it is possible, is governed by the ethical requirement of truth-telling. The adequacy of disclosure has been judged by various criteria, which may include the following:
  1. The common practice of the profession
  2. The reasonable needs and expectations of the ordinary individual who might be making a particular decision
  3. The unique needs of an individual patient faced with a given choice

But research in US maternity care, as reported by Childbirth Connection, does show that informed consent "fails to meet legal standards for providing adequate information and choice of care."  Childbirth Connection also identifies what informed consent means to the maternity care clients and family, what are the legal rights to "informed consent" and "informed refusal", and tips to help clients explore issues with caregivers.

How can parents identify what best practice in maternity care is so that they can become more informed about their options?  The Milbank Report is a foundational document which identifies evidence-based maternity care in the US.  Both professionals and maternity clients must understand that the routine care provided in their communities may not be best practice.  The Milbank Report is a guide map for understanding and intensifying informed consent.

One job of childbirth education is to assist maternity clients in identifying foundational concepts for informed decision making.  Unfortunately, sometimes this goes against community routine practice.  Our country must look more carefully at best practice so as to reduce cesarean rates, maternal mortality/morbidity rates and infant mortality/morbidity rates.  And whereas the US spends significantly more money for maternity care than many other countries, our data does not reflect the use of best practice.

It is past time to step up education - choose today 5 ways to promote informed consent during the week of Labor Day - your website, blog, Facebook, Twitter or in your own classes.  Yes, YOU can make a difference!

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