Wednesday, September 26, 2012

The Technicalities of Teaching Childbirth Education Part 10: Problem Solving

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
When expectant parents attend their childbirth education classes, they envision a class where they will learn some cute breathing, how to massage their partner’s hand and see a movie.  What they don’t expect is the depth and clarity with which subject matter is presented and how important informed consent actually is.

Informed consent is a very powerful tool.  On the American Medical Association website, I found this definition of informed consent:

In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:
·         The patient's diagnosis, if known;
·         The nature and purpose of a proposed treatment or procedure;
·         The risks and benefits of a proposed treatment or procedure;
·         Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);
·         The risks and benefits of the alternative treatment or procedure; and
·         The risks and benefits of not receiving or undergoing a treatment or procedure.

For some women, childbirth is a simple event that occurs with minimal complication and minimal intervention.  For others, many decision need to be made and these decisions can have a long lasting impact on many lives.  Problem solving in the form of informed consent, therefore, is a vital part of childbirth education class that shouldn’t be dismissed!

What sometimes seems very clear to the childbirth educator may be fraught with conflict for the expectant parents who are attending.  For example:

Problem: “I want to go natural but am afraid of the pain.”

Solution: Attend childbirth education classes and understand the source of the pain, why this is different pain than other types.

Problem: “I want to birth unmedicated but what if I can’t?”

Solution: Arm yourself with the knowledge base about medications and all of the nonpharmacologic alternatives.  Use informed consent and birth with flexibility.

Problem: “I want to use the doctor I’ve seen for years but he/she won’t go along with my birth plan.”

Solution: For many care providers, including nurses, birth plans are four letter words.  Just like in all walks of life, these care providers may have encountered birth plans from parents who are demanding, unyielding and just downright nasty.  This tends to spoil things for the rest of the group.  Find out if it is the birth plan itself, or just one part of the plan.  If it is just one section of the plan or one option, discuss the evidence based findings/research with the care provider.  Find out why they feel the way they do and perhaps either you or they may change their minds!  If it is still a reasonable sticking point, an expectant mother and her support team can always seek a second opinion and ultimately change providers if necessary.

Still parents may not be aware that they may need to give informed consent before, during and after the birth of their child.  The Childbirth Connection offers these tips to help parents explore issues with their careprovider:

Make a list of questions before each visit, and during the visit jot down the answers. You may wish to bring your partner or someone else who is close to you to listen to what is said. This is not the time to be shy; nothing is off limits. 

While talking with caregivers, you can say:

·         I don't understand.
·         Please explain this to me.
·         What could happen to me or my baby if I do that? Or if I don't?
·         What are my other options?
·         Please show me the research to support what you're recommending.
·         Where can I get more information?
·         I have some information I'd like to share with you.
·         I'm uncomfortable with what you are recommending.
·         I'm not ready to make a decision yet.
·         I'm thinking about getting a second opinion.
Any question that you have is worth asking. When answers are not clear, ask again until you understand.

Problem solving is not just a skill for the childbearing year, but for all of life – it is a life skill.  Take the time in childbirth class to clearly explain good problem-solving techniques by way of informed consent.  This will help parents become more empowered and even better parents!

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