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.

Why is Natural Childbirth Taboo?

Natural Childbirth ~ according to Wikipedia, natural childbirth is a birthing philosophy that attempts to minimize medical intervention, particularly the use of medications and surgical interventions such as episiotomies, forceps, vacuum and cesareans.

A recent study (2007) revealed the rates of medical intervention in childbirth in the U.S.:
• Electronic fetal monitoring- 93%
• Epidural use- 63%
• Had their membranes ruptured- 55%
• Received oxytocin to progress labor- 53%
• Received episiotomies- 52%
and Cesarean Sections in the US are at an all time high of 31.1%

Even with the use of interventions over 50% of the time, the US infant mortality/morbidity and maternal mortality/morbidity is sluggish to say the least. Evidence mounts that despite the use of interventions, we are not a healthier birthing society.

While the US is generally ignoring evidence-based practices...wait! The evidence does not support the use of medications and interventions? That is correct! Infant and maternal outcomes are better where women are allowed to labor naturally. Well, is this new information? Could it be we just have not heard about it?

In 1985, the WHO Joint Interregional Conference on Appropriate Technology for Birth came up with general recommendations based on evidence including:

1. The psychological well being of the new mother must be ensured not only through free access to a relation of her choice during birth but also through easy visiting during the postnatal period.
2. The healthy newborn must remain with the mother, whenever both their conditions permit it. No process of observation of the healthy newborn justifies a separation from the mother.
3. Countries with some of the lowest mortality rates in the world have cesarean rates under 10%. Clearly there is no justification in any geographic region to have more than 10-15% cesarean rate.
4. There is no evidence that routine electronic fetal monitoring has a positive effect on the outcome of the pregnancy.
5. Pregnant women should not be in the lithotomy position during labour and delivery. They should be encouraged to walk about in labor and each woman must freely decide which position to adopt during delivery.
6. Birth should not be induced for convenience and the induction of labor should be reserved for medical indications.

...........and the list goes on.

What we have observed is that maternity care practices vary greatly based on many factors including how caregivers were trained, what the "we have always done it this way" practices are, how much caregivers embrace new research and how much pressure high level hospital directors dictate evidence-based care.

The concept to remember is that evidence-based care is generally mother-friendly care. The exact why of why we don't embrace it is complicated. But it shouldn't be.

If caregivers are truly in their profession to help women, to help babies be born and have the best interested of babies and mothers and families in their hearts, then evidence-based care should be the norm.

Therefore, natural childbirth should be the norm.

Perhaps it is time for all caregivers to reassess their definition of care to include "evidence-based".