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.

Blending Childbirth Education and eLearning--> Dreams to Reality

Just a few short years ago, I took an impromptu "study" in my childbirth education class to see where parents went for their information.  In 2008, information resources ranked like this: (1) Friends; (2) Family; (3) Books; (4) Internet; and (5) Careprovider.  Now while this was very far from being a scientific study, educators are finding out today that the internet has moved up to #2 if not #1 in the rank of pregnancy/parenting information gathering resources.  I will be speaking on this topic at the 2013 Lamaze International Conference in New Orleans in October.  What remains important as the paradigm shifts more toward elearning is evidence based information.  Guest blogger Dianne Moran RN, LCCE, ICD from Customized Communications shares about blazing this very important new trail!

Have you ever seen the movie, The Field of Dreams? In the movie, the lead character is walking through a cornfield and he hears a voice telling him “If you build it, they will come.”

The premise was if he cleared this cornfield to build a baseball ball diamond, he’d be able to host baseball’s greatest players and people would flock from everywhere to pay for a seat to watch a game. Today, more people are familiar with this phrase because it is commonly used in the world of business. It implies that if you offer a product, the customer will magically appear and want to pay you for it.

Well, that is a dream.

Most of us know success isn’t simply attained because you’ve built something. You have to position it to attract an audience and then tell them that you have what they need and most importantly why they need it from you. That requires a bit more creative finesse.

With the latest developments in healthcare reform, our clients are faced with adapting to an ever-changing landscape in hospital healthcare. Hospitals and health systems realize now more than ever that it’s simply not enough to exist as a brick and mortar establishment. They have to strategize effectively to draw the community closer and market the most comprehensive procedure they have; the patient experience. This is a great challenge because this experience doesn’t simply begin the moment they see a nurse.

The patient experience begins at home. Right now a pregnant woman is online, searching for answers to her questions about childbirth and preparing to make a monumental decision; where to have her baby.

This is where cycle of influential healthcare starts and for hospitals, the prenatal period is a prime opportunity to reach that prospective patient. At CCI, we are consistently exploring ways to help our clients use patient education to position themselves within their communities to:

• ·         Keep the hospital’s brand of healthcare highly visible and distinguishable above all the rest
• ·         Engage and educate the expectant community
• ·         Use the momentum of a positive birth outcome as a catalyst for more growth and more success

In 2008, we began cultivating our own Field of Dreams when we set out to revolutionize the way patients and hospitals connect. We started by carefully calibrating each program within our Mother-Baby library into a resource hospitals could position on their website. The goal of our eLearning was to connect the expectant patient with the nurses and educators at her hospital by offering her access to educational programs 24/7.

It’s been five years now and our dream of building a dynamic pathway between the patient and the hospital has become a reality. eLearning has quickly become one of the most innovative tools we can offer a hospital.

So where that guy heard a voice in the middle of a cornfield, we hear that mama’s voice somewhere within your community saying “If you teach me, I will come” This is the voice of expectant parents in your community, and eLearning is just one of the many ways, you can reach her and her family now and in the years to come.

Dianne Moran, RN, LCCE, ICD

Customized Communications, Inc.

Did Childbirth Education Just Receive a Mandate?

A recent Bloomberg News Editorial came across my desk: Hospital Incentives Help Babies Determine Own Birth Dates.  In the editorial, a two year project in Washington State showed that hospitals could indeed reduce their elective induction/cesarean rates and subsequently the number of weak babies admitted to the NICU.  State health authorities studied health records and revealed that an astounding 15% of the 80,000 births were elective deliveries at 37 - 39 weeks; meaning that 12,000 elective early births took place in Washington State for no medical reason.

It is the assumption of many that health care providers are taught about physiologic birth during their years of training to become physicians or nurses.  Sadly, this is not the case.  Washington State legislature created a $10 million reward fund to be shared by hospitals that showed marked improvement on statistical data regarding early elective deliveries. Staff education was a part of the plan for many hospitals to reach the goal and partake in the reward.  Piggy backing the reward was a decrease in Medicaid payments that hospitals received for uncomplicated Cesareans. But why did it take money to be the incentive to respect human beings and facilitate health pregnancy outcomes?  

The evidence is clear and highly available.  Anyone now can access the CDC, Cochrane Database or National Institute of Health to find that the US infant and maternal mortality/morbidity rates are higher than ever before despite the fact that the US spends more on health care than many other countries whose statistics in this area are much better.  In a nearly 20 year period from 1990 to 2009, the number of near term babies (those born between 37-38 weeks) jumped 8% from 19% to 27% or more than 1/4 of the babies born.  Babies who are born at 37 weeks are more likely to die in their first year and are more likely to have health problems.

In the October issue of Seminars in Perinatology*, authors Chauhan and Ananth stated:

Approximately 1 in 4 women in the United States are induced, with up to 1 in 10-12 being induced for elective reasons. National guidelines by the American College of Obstetricians and Gynecologists, the Society of Obstetricians Gynaecologists of Canada, and the Royal College of Obstetricians and Gynaecologists list 21 indications for inductions; however, all 3 concur in only 14% women (3 of 21). An induction should be considered appropriate if it meets the following 4 criteria: (1) concordant with women's autonomous informed decisions and desideratum; (2) optimizes maternal-fetal outcomes, including psychological maternal well-being; (3) congruous with evidence-based medicine; and (4) cost-effective. A meta-analysis of 22 randomized trials noted that membrane sweeping reduces the likelihood of induction. Implementing policies to prevent elective induction at 37-38 weeks provides conflicting results about the rate of macrosomia and stillbirth at early term. We argue that a well-designed randomized controlled trial, with adequate power to demonstrate whether prohibiting elective induction increases the rate of stillbirth or complications such as macrosomia, is warranted. Patient education during their prenatal course is a promising strategy to decrease the rate of induction.

Were their efforts successful?  Yes!  Elective early deliveries were reduced 77%.This in conjunction with the statement that many hospitals in Washington reduced rates with patient and staff education demonstrates that education is the key to this entire dilemma.  

If this doesn't constitute a mandate for childbirth education involving both parents and professionals, I don't know what does. 

*Chauhan SP, Ananth CV.  Induction of labor in the United States: a critical appraisal of appropriateness and reducibility. Seminars in Perinatology. 2012 Oct;36(5):336-43. 

photo credit: SantaRosa OLD SKOOL via photopin cc

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!

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!

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.

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.