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!

Tuesday, September 18, 2012

The Technicalities of Teaching Childbirth Education Part 9: Compassion and Listening

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

One of the most important tools we use as childbirth educators is not something that can be touched, smelled, or watched.  This tool is compassion and listening.  For many women, pregnancy is an uncomplicated, normal, natural event.  However for some, it can be a time of memories being dredged up from long ago.

From continued pain from a previous epidural to other traumatic birth experiences, women appreciate the compassion and listening (or what we’ll call CAL) that an experienced childbirth educator can provide.  It does not take a course in active listening – just sitting quietly and hearing the woman share her experience is often enough.  CAL is something they may not be able to obtain from their family or friends without some feelings of judgment.  CAL is something that cannot be obtained from internet classes, videos, podcasts or websites.  CAL is something only a person can give to another person.  And in my humble opinion, something that is lacking in our culture as a whole.

To understand how listening is an important attribute to perfect, consider this TED talk!


As the active listener in a conversation, you may feel the need to slow the conversation in an attempt to more carefully listen and also reflect so that you can be compassionate.  You can slow the conversation by your body language (sit relaxed, have no or few reactions on your face, refrain from tapping or swinging your foot/leg), ask your questions slowly and with intention, and ask the speaker what her/his thoughts are about each topic she/he brings up.  This will help you to connect with the speaker on a more dynamic level.
Finally, do not think that you have to have an answer for the speaker's experience or problems.  The speaker may just need an ear to listen or a soft shoulder on which to shed some tears.  You should, on the other hand, be aware of those in your community to whom you can make referrals if the situation is very far away from your area of expertise.

Monday, September 17, 2012

The Technicalities of Teaching Childbirth Education Part 8: Motivational Skills

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
Consistency in attendance and desire to learn are the two most important considerations of any childbirth educator.  How do we keep them coming back for more AND how do we keep them engaged in learning?

Let’s be honest…people do not have to attend childbirth education classes.  These days, they can glean information from the internet and television and even from apps. As childbirth educators who are passionate about our profession, how can we keep people coming to the classes we love to teach?  What can offer in a live classroom setting that they cannot get from apps, TV or the internet?

Here are five principles we need to understand when developing classes:

  1. 1)    Adults need to develop and intrinsic motivation – an internal energy that emerges and connects the person with the need for this knowledge.
  2. 2)    Adults need to desire the information and insight and skills we can teach them.
  3. 3)    Adults’ attitude influence their behavior and their motivation.
  4. 4)    When adults find significant meaning, this will facilitate sustained involvement.
  5. 5)    Adults seek to be competent in a skill set and continued confidence building enhances competency.


To accomplish these principles and keep a motivated class, our childbirth education classes need to include activities for visual learners, auditory learners and kinesthetic (or tactile) learners.  This means we cannot rely 100% on PowerPoint presentations and videos.  Nor can we just lecture.  Our classes must be entertaining, surprising and fun.  If you must lecture for a long period of time, be sure to ask participants to think how it could relate to their birth plan (for example, medications).  Frequent feedback and reinforcing the positive, help build their confidence and create a great learning environment.

Practice and reinforcement are also important elements – when adults find they are competent in a particular skill set, they are more likely to use it not only for the birth experience but also for other situations (such as breathing for birth and for other stressful life experiences).

Potential Barriers
Just as an attitude can positively influence behavior and motivation, it can also have a negative impact as well.  If a participant feels that childbirth class is not going to be of help or has been told such, their attitude may not be one that will motivate them to complete the childbirth education class.

Other barriers to motivation include the childbirth educator’s attention to Maslow’s Hierarchy of Needs (especially safety and love needs, which can include both safety at going home at night/being in a parking lot with dim lighting to acceptance in the class with educator or other class participants) and clarity of roles, particularly those of the labor support person/partner/spouse.  By paying close attention to the various aspects of Maslow’s Needs and how they pertain to childbirth education classes AND making the role and skills of the labor support person clear, the childbirth educator can eliminate the beginning growth of these motivation barriers.

We can assume that we are not only “competing” for clients between ourselves as educators but also competing with the electronic media (TV, internet and apps).  In the marketing that we do for our classes, this should be addressed by mentioning the benefits of attending an in-person childbirth education class.  These benefits can include 1-1 interaction, immediate attention to questions, observation and confirmation of skill set accomplishment, and crafting the class curriculum to meet their specific needs.