Becoming a Childbirth Educator in Three "Easy" Steps

I became a childbirth educator in 1980.  And to this day, I love what I do.  I have expanded my role from childbirth educator for expectant parents, to educating via social media, educating those new to the childbirth profession, and as a leader in childbirth educator organizations.  For three + decades, I have devoted my professional life to sharing and encouraging the embrace of the evidence and facilitating informed decision-making.

And it only took three “easy” steps.

Step one was to decide that this passion was also a career choice.  It is one thing to be excited about something shortly after the birth of one’s child.  It is quite another to take the proverbial bull by the horns and see it through the good times and the challenging times.  Some of my most fierce challenges included completing my certification through Lamaze (which included typing my six week curriculum on a portable typewriter with carbon paper), seeing the ramped used of epidurals in the late 1990s, and too-early elective induction/cesareans which necessitated the need for more NICU space.  Some of my peers quit during any one of these challenges.  I knew there was a proper way for birth – a physiologic way for birth to happen – and my passion kept me going.

“Cesarean surgery is the quintessential issue that distinguishes the medical and physiologic models of care.”¹

Stepping into social media and the “computerized age” seemed daunting however, I embraced Step Two - always educating.  Always loving gadgets and how things worked, everything from cell phones (remember the bricks?) to my first Apple IIc computer became a way to extend my passion.  Oddly, what seemed so

daunting back then has now become my most used educational tool.  Via my cell phone, I can log onto Facebook, Twitter, LinkedIn or be available for a client/peer with a question.  Via my computer or iPad, I can research new evidence, update my blog or website, or get answers to those with questions.  While books and magazines certainly do play a vital part of my research life, I cannot imagine how my research, educating or marketing would be without the internet, computers, cell phone, or other smart device.

Through all of the certifications, recertifications, continuing education, conferences,  organizational politicalness and perceived hiding of the evidence surrounding physiologic birth, I never lost the focus (Step Three) that physiologic birth is best for mother and baby.  Many authors have studied it, written about it and shown the evidence to be there – if we clean up our maternity care act, our maternal/infant morbidity and mortality rates with improve.  As we saw an increase in chemical pain relief, we also saw a decrease in breastfeeding rates. Anesthetics cross the placenta and reach the infant quickly and also target the mother’s sensory nerve tissue.  Early induction predicates cesarean sections, with associated risks. Yet knowing all of this, we still hesitate to do skin-to-skin during the immediate postpartum because it may interfere with continuing medical procedures; ignoring the fact that skin-to-skin supports normal thermal stability, stabilizes newborn blood sugars, releases milk to the newborn, and promotes gastrointestinal motility and digestion in the newborn (just to name a few of the benefits)².  

Clearly we do not focus on the evidence which leads to physiologic birth which leads to optimum labor/birth outcomes.

But I digress.

Yes, the three easy steps of becoming a childbirth educator: passionate career choice;  embracing technological change to find and promote research;  and staying focused on the evidence for positive outcomes.  To be called to this profession is a humble privilege.  To sustain in this profession, takes a passionate focus.

It is indeed my pleasure.

References:

1. Romano, A. and Goer, H. (2012) Optimal Care in Childbirth: The Case for a Physiological Approach. Classic Day Publishing.
2. Smith, L. (2010) Impact of Birthing Practices on Breastfeeding, 2^nd Edition.  Jones & Bartlett Publishing.

When a Professional Gets Burnt Out: Rediscovering What We Preach Part 1

Over the years, there have been numerous articles about professionals and burn out.  The general public is becoming aware of burn out.  And the one modality that can help both groups deal with stress is mindfulness-based stress reduction or MBSR.

Dr. Jon Kabat-Zinn first created MBSR in 1979 at the University of Massachusetts Medical Center. The National Institutes of Health's National Center for Complementary and Alternative Medicine has provided a number of grants to research the efficacy of the MBSR program in promoting healing. Completed studies have found that pain-related drug utilization was decreased, and activity levels and feelings of self-esteem increased, for a majority of participants.

For a history of the Center for Mindfulness at UMASS, click here

http://www.umassmed.edu/cfm/about/index.aspx

Studies of health care providers who use MBSR suggest that there is a decreased perception of stress and greater self-compassion. Job burnout and psychological stress were also decreased.

So just what is MBSR and how does it work?

MBSR is a behavioral program that uses the psychological concept of mindfulness to help with coping skills, reduce pain and increase mental focus.  Juliet Adams, founder of mindfulnet.org explains mindfulness through the ABC’s of Mindfulness:

A. is for awareness.  Becoming more aware of what you are thinking and doing – what’s going on in your mind and body.

B. is for “just being” with your experience.  Avoiding the tendency to respond on auto-pilot and feed problems by creating your own story.

And

C. is for seeing things and responding more wisely.  By creating a gap between the experience and our reaction, we can make wiser choices.

MBSR includes developing a sense of peace, heightened awareness,  and tranquility through regular meditation and relaxation.  MBSR helps to cope emotionally and physically with everyday stress, challenges and demands.  It is bringing awareness to the present moment – while trying to not allow your mind to wander onto other topics past or future.  In his Center, Kabat-Zinn has seen over 18,000 individuals who have reported a decrease in physical symptoms of stress, increased ability to relax, reduction in pain levels, greater energy and enthusiasm for life, and improved self-esteem.

Part of MBSR involves breathing - not unlike Lamaze!  Watch Dr. Kabat-Zin here: 

References and resources:

Davis, D.M. and Hayes, J.A. (2012)  What are the benefits of Mindfulness.  American Psychological Association. Vol 45, No 7.

Fjorback, L.O. (2012) Mindfulness and bodily distress.  Danish Medical Journal.

Goodman, J.H. et al. (2014) CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Archives of Womens Mental Health.

Mindfulnet.org

Shapiro, S. et al. (2005) Mindfulness-based Stress Reduction for Health Care Professionals: Results from a Randomized Trial.  International Journal of Stress Management Vol. 12, No 2. 164-176.

Fundamentals of Relaxation Part 5 - Breathing

In spite of the new technology associated with labor and birth, women are still fearful.  Fear may come from hearing stories, reading articles, or simply by not knowing the full truth about the events of the birthing process.  An important aspect of relaxation for fear is breathing.

Any source that addresses fear, stress or anxiety will also address breathing.  Breathing is an effective and easy way to reduce stress and fear by decreasing the body’s reaction to the stress.  Slow, rhythmic breathing has been shown to lower blood pressure, reduce heart rate, and reduce the secretion of stress hormones such as cortisol. Relaxed breathing also balances O₂ and CO₂ levels and decrease muscle tension.

Behaviors for coping with severe fear of childbirth or SFOC were related to six domains of childbirth education relaxation: concentration or focusing, support from family or doula, breathing, relaxation and perception of control.  Since breathing helps to maintain focus and relaxation and hence perception of control, breathing seems to be a foundational skill to learn.

For decades, Lamaze has taught patterned breathing to offset the intensity of the contractions. Since Lamaze has become as synonymous to breathing as Kleenex is to tissues, many expectant parents come to childbirth class, regardless of the method, to learning breathing.  While Lamaze still offers instruction on breathing, it is not so much how one breathes as that one does breathing effectively.

In a 2011 article in the Journal of Perinatal Education, author Judith Lothian gives these guidelines for using breathing in labor:

• Breathing is easily subject to conscious control. Therefore, controlled breathing is easy to learn.
• Slow, deep breathing is particularly effective. The “right” way to breathe is whatever feels right. There are no rules related to how many breaths per minute, whether to breathe through the mouth or nose, or whether to make sounds. The key here is that the breathing is conscious, not automatic.
• As labor contractions get stronger and the work of labor gets harder, speeding up the breathing and making it shallower is sometimes, but not always, more effective.
• Focusing on something, either with eyes closed \or open, can help maintain the rhythm of the breathing.
• Using conscious breathing in everyday life, either to relieve stress or to increase body awareness and mindfulness, is excellent practice for labor. It is an excellent life skill.
• Conscious breathing works best in combination with many other comfort strategies. In Lamaze classes, women no longer spend large amounts of time practicing breathing. Women move, change position, slow dance, sway on birth balls, learn massage, and identify the countless other ways they normally relax and find comfort. Each of these comfort strategies can be used in combination with breathing.
• In restrictive environments, breathing may be one of very few comfort strategies available for women in labor. It is one coping strategy that cannot be taken away.

References:

Lothian, J. (2011) Lamaze Breathing: What Every Pregnant Woman Needs to Know.  Journal of Perinatal Education.  20(2), 118-120.

Salomonsson, B.  (2013). Self-efficacy in pregnant women with severe fear of childbirth.  Journal of Obstetrics, Gynecologic and Neonatal Nursing. 42(2): 191-202.

Turankar, A. et al (2013) Effects of slow breathing exercise on cardiovascular functions, pulmonary functions and galvanic skin resistance in healthy human volunteers – a pilot study.  The Indian Journal of Medical Research.  May 137(5): 916-21. 

FEAR - contributing to labor interventions and PTSD

It is called tocophobia .  

It affects 1 in 10 women.

And it seems to be ignored by maternity care literature.

Yet, an amazing study done between 2006 and 2007 in Sweden's Karolinska Institutet, shows that psychoprophylaxis does help in some cases.

What is tocophobia?  From the Greek word tokos meaning childbirth and phobos, meaning fear, tocophobia is the fear (irrational) of childbirth.  Women and men can experience tocophobia and can experience a fear of dying, fear of pain, fear of lack of pain relief and fear of deformity of the newborn.  Occasionally tocophobia is culturally associated, such as when negative feelings toward childbirth are passed from mother to daughter or after seeing a film depicting childbirth early in life with no support or educational explanation.

In the medical literature, tocophobia or severe fear of childbirth (SFOC) is seen addressed more in

psychological journals or those from Europe than in the North American continent.  Maternal confidence and self efficacy are common threads in discussions of tocophobia or SFOC.  From the Nethersole School of Nursing in Hong Kong, the author writes that the efficacy-enhancing educational intervention should be further developed and integrated into childbirth education interventions for promoting women's copying ability during childbirth. Not only did the educational intervention promote a woman's self-efficacy but also reduced their perceived pain and anxiety in the first two stages of labour.

Further research in the literature demonstrates that prenatal anxiety was significantly related to self-efficacy for childbirth in late pregnancy, labor pain, number of hours at home in labor and admitting cervical dilation, and interventions used during the labor.


Kathy McGrath demonstrates that fear has its place in birth and new mothers can benefit from it:

Giving birth is meant to shake us right down to our roots so that we come out of it changed and ready to take on the daunting tasks of mothering a new baby. When birth goes well, from an emotional as well as a physical perspective, we come out of it empowered, awed, and humbled. When it does not go well, we can enter motherhood feeling disappointed, disillusioned, and disempowered. The stakes are high.

As childbirth educators and doulas, we need to approach this fear with caution and respect.  Not only does fear of childbirth result in extended length of labor, arrested labors, increased using of induction or augmentation, cesarean delivery, instrumental delivery but SFOC can affect mothers during the postpartum period as well with an increased risk of post-traumatic stress disorder (PTSD).  Fear and lack of control are elements contributing to PTSD.

SFOC is not addressed in the typical office visit.  Childbirth education classes are often discouraged.  Why are women's fears being ignored?  Why do we send new mothers, traumatized by a difficult birth that validated their prenatal feelings of fear, home alone with little or no support?

Give expectant mothers an atmosphere where they can feel safe in sharing their fear(s), where they feel they are heard and not judged.  Acknowledge the fear and share with them psychoprophylaxis!

What is psychoprophylaxis?  Based on a method of preparing women for childbirth with education, psychological and physical conditioning and breathing, psychoprophylaxis soon became synonymous with Lamaze, after Dr. Fernand Lamaze brought the Russian style of childbirth preparation to the West in the mid 1950s.  Quite simply, psychoprophylaxsis (psycho means mind and prophylaxsis means prevention) gives expectant mothers the educational and practical techniques to understand the careful hormonal orchestration of birth and be empowered to use simple techniques to produce effects that are not only healthy for both mother and baby but truly define self-efficacy for birth and the postpartum period.

As Barbara Hotelling so brilliantly put it: 
We once lost touch with a caring model of birth, and we are fortunate to have that knowledge and the availability of that model again. Childbirth education must evolve from the technological curriculum to a physiologic study of how well women's bodies are created, not for being delivered, but for giving birth.

With physiologic birth as our guide, we can reduce or eliminate tocophobia.


References:

Bergstrom M. et al.  Fear of childbirth in expectant fathers, subsequent childbirth experience and impact of antenatal education: subanalysis of results from a RCT.  Acta Obstetricia et Gynecologia Scandinavica 2013 Apr 16.

Harris, R., Ayers S. What makes labour and birth traumatic? A survey of intrapartum 'Hotspots'. Psychology and Health 2012; 27(10): 1166-77.

Hotelling, B. Considerations when using videos in Lamaze Classes.  Journal of Perinatal Education 2012 Summer; 21(3): 189-92.

Hotelling, B.  From Psychoprophylactic to Orgasmic Birth.  Journal of Perinatal Education 2009 Fall; 18(4): 45-48.

Ip, W et al. An educational intervention to improve women's ability to cope with childbirth.  Journal of Clinical Nursing 2009 Aug; 18(15): 2125-35.

McGrath, K. The Courage to Birth.  Journal of Perinatal Education 2012 Spring; 21(2): 72-79.

Rouhe H. et al. Obstetric outcome after intervention for severe fear of childbirth in nulliparous women, a randomized trial.  British Journal of Obstetrics and Gynecology.  2013 Jan; 120(1): 75-84. 

Saisto T., Halmesmäki E. Fear of childbirth: A neglected dilemma. Acta Obstetricia et Gynecologica Scandinavica, 2003 82(3), 201–208 

Planning for Your Birth!

I want to apologize to Julie Olson and Katie Immel.  They submitted this great guest blog for the 2013 Blog Carnival honoring the International Week for Respecting Childbirth (last week) and I just now found it in my spam box.  Please welcome Julie and Katie.....

Planning for your Birth

by Julie Olson and Katie Immel

The day your child is born is a day you’ll remember forever, so it makes sense to put some thought and planning into how you would like it to go. It is important to keep an open mind during pregnancy, labor and birth, because things can happen that are outside of anyone’s control. However, your preparation, planning and goals will affect your experience and may alter the decisions that you make along the way. If you understand and give thoughtful consideration to your options ahead of time and communicate your desires to your care provider (and to the people who will be supporting you), you are more likely to have a happier and more satisfying experience.

Books, websites and discussions with friends can provide helpful information and serve as a valuable starting point, but a childbirth class offers you and your partner a dedicated time to focus on your upcoming birth, discuss information you have learned and put more concentrated effort into identifying and clarifying your desires and goals. 

Sometimes, parents believe they do not need to take a childbirth course because they are planning an epidural, but childbirth education is about more than pain management. Classes provide education on all kinds of topics, such as pregnancy wellness, the typical course of events in labor, your choices, what to expect after the birth and possibly newborn care and breastfeeding. This information can relieve fears and help you enjoy your pregnancy, birth or postpartum time more than if you go through it blindly. You also have a chance to connect with other expectant parents, learn you are not alone in this journey and maybe even meet couples who turn into lifelong friends.

Occasionally, parents believe they do not need to be educated because their care provider will be there to handle things. While in some ways it might seem easier to turn over decision-making to another person and be free from responsibility, there is no one else as invested in your birth experience or its outcome as you are. No one else will be taking your child home and raising him/her and no one else will feel the emotional impacts of the birth like you and your partner. Some decisions made for you by your care provider may not make a difference to you or may be beneficial, while others may leave you with doubt, regret or even trauma. You may look back at your experience and wonder if that intervention or medication was necessary or ask yourself “what if...” questions. Important future decisions might be affected by your birth experience, such as limiting how many children you have or resigning yourself to a similar birth with your next child. Your involvement in the decision-making, regardless of the birth experience or outcome, can have huge benefits to you for years to come.

Every woman is different, every baby is different and every labor is different. There are no absolutes and no hard and fast rules that apply one hundred percent of the time. Education can’t guarantee a particular outcome or ensure that your birth is all that you desire, but it can help you feel respected and empowered - and all families benefit from that.

Julie Olson is a mother of two, a DONA International Birth Doula, a Lamaze Certified Childbirth Educator and the owner of Plumtree Baby, LLC, which provides printed materials and visual aids for childbirth education. Katie Immel is a mother of three, a DONA International Birth Doula and an ICEA Certified Childbirth Educator. She is an author and graphic designer for Plumtree Baby, LLC.

International Week for Respecting Childbirth May 20-27

The International Week for Respecting Childbirth (SMAR = Semaine Mondiale Pour L’Accouchement Respecte) is an opportunity to express a common commitment through an international campaign for the respect of the birth. It takes place every year in May. Each Global Week focuses on a specific theme. The theme for 2013 is "Please do not disturb, Birth in progress". (To get more information on this global even, go to www.smar.info.)

Imagine what we could accomplish if we all worked together!

So let’s try it!

International Week for
Respecting Childbirth
May 20-27, 2013

First, friend me on Facebook and encourage all of your peers and colleagues to do the same – then, look for the Facebook Event “International Week for Respecting Childbirth” – join it!

Second, begin now to write blogs, update your Facebook page and Tweet about the importance of attending childbirth education classes.  While this is not quite the Global Theme, you would learn about undisturbed birth and laboring the way the mother wants to labor if you attended childbirth classes!

As birth professionals, regardless of the smaller segment we represent (childbirth educators, doulas, nurses, physicians, midwives, massage therapists, lactation consultants and others), if we band together toward one common goal, we CAN and WILL make a difference.

Are you with me?

More Top Pregnancy and Childbirth Apps

Last time we looked at The Pregnancy Wheel, Safe Pregnancy and Birth, iDoula, Ilithyia, and Partogram.  Now, we explore four different apps for pregnancy and birth.  

Next time, we will focus on breastfeeding apps for the parent as well as the professional!

*Do you like an app we’ve not featured?  Let us know your thoughts…info@birthsource.com

I am very excited about this particular app!  

iBirth is an app made by childbirth educators and is truly impressive!  Co-founder Judith Nowlin is a birth doula and Bradley childbirth educator and mother and co-founder Amanda Hanson is also a Bradley childbirth educator and mother plus is a Doctor of Psychology.  Together, they have brought great videos of positions to use in labor, with suggestions for back labor and pushing, dynamic information about prenatal nutrition (complete with grocery lists!), and Tips & Lists.  Tips and Lists include tried and true birth secrets, food to eat in labor, and more evidence-based tips.  They’ve even included vocalization in labor and birth. 

I was so excited about this app, I emailed Judith and Amanda.  In the phone interview with Judith, she told me of the "conception" of this tremendous idea (or their "4th baby" as they both have 3 children)  and how the app was birthed in 2009.  Using the client-dads and their tech knowledge together with Judith and Amanda's strong backgrounds, they worked to create the ultimate pocket guide for both parents and professionals.  "We saw the value of how what we do face to face with our clients impacts their lives. We put care into the language we used in this app and didn't want to replicate other apps," said Judith.  They wanted to have an impact on maternity care - and so they have!

An updated version of the app is in the planning stages - it will make the app more interactive, and have more content and increased functionality.

There is also a 22 minute DVD + 3 extra segments for vocalization from iBirth available at Amazon or their website (www.ibirthapp.com)  for only $29.95.  You will be able to read a review about this DVD soon on this blog.

$3.99
Our rating: *****(5 stars++) ~ in other words, you need this app!

Also from iBirth is the free Simple Contraction Timer.  Data history is preserved even if the app is closed or the phone is turned off.  A great asset for dads/partners during labor.


Be sure to "like" the iBirth Facebook page too!

Hypno 4 Birth was nuilt by British certified hypnobirthing educator Dany Griffiths.  As an introduction to hypnobirthing and a pipeline to the www.tums2mums.com website.  Griffiths has included an overview of hypnobirthing, what can be learned in a class (in person, home study or Skype), samples of birth stories, fundamentals of birth affirmations, a lovely Mp3 segment with music and birth affirmations and information on how to contact her. If you are interested in learning more about hypnobirthing or know someone who is interested, this is a great way to get some preliminary questions answered.

FREE

Our rating: *** (3 stars)

My 9 Months comes from the March of Dimes Foundation but is currently an iPad only app.  This great app tells you what is happening during prenatal appointments, discusses fetal development week by week, helps you make your birth plan, suggests how to reduce stress and how to get started breastfeeding and even includes a glossary of terms. Extremely interactive.
Free
Our rating: *****(5 stars+)

Stage 1 is a fantastic free app from Arboretum Software.  Helps tell you where you are in labor so you don’t end up at the hospital too soon.  Follows Lamaze-style by providing a focal point, soothing timing ring and background picture that you choose to facilitate breathing techniques.  Great overall reviews.
Free
Our rating: *****(5 stars)

What Parents Need and What They Want in Childbirth Classes: Is there a disconnect?

My experience as a Lamaze Certified Childbirth Educator has given me the opportunity to teach in a variety of venues.  I began teaching at an adult school affiliated with a high school in a rural California, to a community college on the Atlantic coast of Florida, to private classes in Los Angeles, to volunteer teaching on an Air Force Base, to teaching for three hospitals, and finally back to private teaching now in Ohio.  From my Lamaze Seminar Trainer, Harriet Palmer, I learned that being able to empower women and families through research based information (or the truth) was the most valuable teaching tool.  And even though I had to leave one of the hospitals because I wanted to teach the truth and resisted censorship, I can still look myself in the mirror and be proud of the educator that I am.  I personally and professionally have fought against co-optation.

Birth professionals who have been active since the 60s and 70s will no doubt remember the writings of Eugene Declercq in the Birth & Family Journal (now the BIRTH journal) and Polly Perez and myself in Lamaze's Genesis, pointing out the side effects of co-optation....when former community based childbirth education classes become part of the hospital revenue stream.  The fear then was that childbirth education classes would be censored, restricted, condensed and basically not resemble anything close to childbirth education.  They would be, in a sense, what to expect from THE HOSPITAL while you are in labor.

The time arrived and co-optation did occur as predicted and in most (yes, I say most because there are still a few hospitals who value evidence-based uncensored childbirth education classes) cases, there have been censorship, restrictions, and condensed versions.  In most situations, labor and delivery nurses are asked to teach childbirth education classes and I must tell you that nursing school does not prepare you to teach childbirth classes.  While it does prepare you to do snippets of education at the bedside, childbirth education is another animal altogether.  And in many cases, these labor and delivery nurses are not required to become certified childbirth educators in order to teach classes.

Why does this all of this matter?  It matters for several reasons:

• Co-opted childbirth classes are not in the best interest of the expectant parents.
• Certification DOES matter.
• Teaching informed decision-making and evidence-based information impacts everyone.
• Birth matters to the baby.
• Birth matters to the mother/parents.

Midwives are particularly suited to add childbirth education to their repertoire of services as they have had the emergent and normal/physiologic side of childbirth in their education....nurses typically do not receive the normal/physiologic information in their classroom studies.  Midwives can take the time to teach and explain thus empowering their clients to achieve and enjoy this once in a lifetime birthing opportunity; to not be rushed through a process which can leave a lasting imprint on a woman's heart and soul.

Educating expectant parents of today takes more skill and cleverness, resourcefulness and constant marketing.  Today's parent needs to be exposed to something nearly 10 times before acting on it, as opposed to the 3-4 exposures for parents in the 1980s.  Educators must make their classes timely, evidence-based and truly innovative to meet the ever changing learning needs of parents.  Parents still need the information, the evidence and the facts, but they need all of this in a concise package with minimal fluff and tricks ~ otherwise they get very bored very fast.

Get certified.

Become well-versed in social media marketing to reach the parents of today.

Write your own curriculum - tedious, yes but more valuable than you can ever imagine!

Evaluate your curriculum including the dates of the evidence for topics as well as the teaching strategies.  

Remember we aren't in Kansas anymore Dorothy and the bottom line is we can't teach like we are!

Taking A Look At Mindfulness Guided Imagery as an Add-on to Relaxation

Research shows that relaxation during labor and birth allows for a dramatic reduction in the stress reaction.  When subjected to stress (of any kind) or fear, be it real or anticipated, body changes take place that trigger a defense mechanism and institutes the fight or flight mechanism.  The fight or flight mechanism is started by the autonomic (or involuntary) nervous system and includes body changes such as an increase in respirations and mild/moderate rapid heart rate.  With this stress response, females have a strong tendency to take flight or flee.  Obviously this is not practical during labor/birth.

Most of us teach about the Fear-Tension-Pain Cycle as first described by Dr. Grantly Dick-Read in the late 1950s.  Fear (due to lack of education and practical knowledge), leads to tension in the body – tension in the muscles of the body uses oxygen that would have normally been made available to the fetus and the uterus.  This, in turn, decreases the efficiency of the uterine contractions and thus slows or in some cases, stops the labor process.  Tense striated muscles contribute to an increased in lactic acid build up that impinges on pain receptors, magnifies pain perception and increases fatigue. Fatigue decreases the pain threshold, further increasing pain perception and reduces the laboring mother’s ability to conserve energy for the expulsive efforts needed during the second stage of labor.

Conscious relaxation and practicing coping techniques may be some of the first items removed from childbirth education curricula when timing in the class becomes an issue.  However, initiating a relaxation response to contractions or pain stimuli can decrease metabolism, slow down the heart rate, calm breathing, reduce blood pressure and relax muscles – all of which has a positive effect on the baby, mother and labor.   Click here to read entire article 

Building a Curriculum: Top 10 Things to Consider

Are you inspired to create a presentation?  Do you want to speak on a topic that you are passionate about but don't know where to begin?  This is the first of several basic tutorials on curriculum development adapted from the Birthsource Lamaze Childbirth Education Seminars that I teach.  

First, read through the Top 10 Things to Consider below.  If you would like a practice worksheet for this, please email me at info@birthsource.com.  

******************************************************************************

In maternity care, there may be many opportunities to create courses for continuing education.  How does one begin to put together a curriculum and what are the first common steps?

Decide on Basic Topic ~ this may not take a lot of brainwork especially if you are passionate about something to begin with!

Name the Presentation ~ you may have to brainstorm on this one to get a catchy, trendy title!  Avoid sarcasm, off color remarks or inappropriate jabs at individuals/organizations.

Include speakers and their CVs/resumes ~ if more than one person is speaking, you will need to include copies of the curriculum vitae or resume.  Need more info?  Click here.

General time allotment for presentation ~ basically, how long do you have for this presentation?  Minutes? Hours? Days?

Topic list in logical order of presentation ~ first write down all of the topics you want to include in this course and then put them into a logical order.  “Logical” order may be chronological, alphabetical, or in order of appearance (as when each one builds on the previous ones).

List of teaching strategies ~ what types of strategies will be employed to get your point across to the various types of learners in your course? Make a general list.  Read about adult learners!

Define basic objectives ~ what are the basics outcomes that you would like to see students achieve?  Need more help?  Click here.

Will the students do any pre-attendance work? Any advanced reading or forms to fill out?

Required or recommended reading lists? Will there be books, magazines, or web-based information that will enhance their attendance at the course?

List of references used in creating the course.  Be sure to write these references in the proper format.  The proper professional format is the American Psychological Association Style.  Purdue University has a wonderful APA Formatting and Style Guide at owl.english.purdue.edu/owl/resource/560/01/

Once you have completed the above, you are ready for the next step -

 that will be writing the curriculum!  That will be our next blog installment!

Lamaze Push for Your Baby --> Parents Share

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!