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Looking Back (Fondly)

September 8th, 2010 by Debby

As I look forward to the upcoming Mega Conference in Milwaukee celebrating the 50th anniversaries of both Lamaze International and ICEA, I am also preparing for an unexpected, but happy move to Houston where my son, Brian, and his family live. For the past two days, I have been going through my library of childbirth books. I have been active in the field of childbirth education for over thirty years and clearly I have held on to every book I ever bought!  It doesn’t make sense to move all of them to our new home which will have much less bookshelf space. But how do I give up any of them? So many of the books bring back happy memories of the excitement I felt as I read them and of the passionate discussions I had with other childbirth educators about them. For fun, I decided to create a list of the “Top Ten” books that influenced me as a young childbirth educator. (The books have to be twenty years old.) For those of you who are also “very experienced,” how many of these books do you remember? How would your list compare to mine?

1. Spiritual Midwifery (1977) by Ina May Gaskin

2. The Rights of the Pregnant Parent (1976) by Valmai Elkins – This is easily my most tattered (used often!) book.

3. Immaculate Deception (1975) by Suzanne Arms

4. A Good Birth, A Safe Birth (1992, ok, only 18 years old) by Diana Korte and my dear friend, Roberta Scaer

5. Changing Childbirth (1982) by Diony Young

6. The Complete Book of Pregnancy and Childbirth (1980) and anything else by Sheila Kitzinger

7. Silent Knife (1983) by Nancy Cohen and Lois Estner

8. Birth Without Violence (1975) by Frederick Leboyer

9. Why Natural Childbirth? (1972) by Deborah Tanzer

10. A Child is Born (first edition published almost 40 years ago) by Lennart Nilsson

In another twenty (or thirty!) years, I wonder what books, filmmakers, and bloggers will be mentioned by today’s young childbirth educators as having been most influential in their early years? Birth has certainly changed since I taught my first childbirth class – in some ways for the better and in many ways for the worse. But I am proud to have been a part of the childbirth education movement and look forward to continuing to work with my “sisters” in birth to promote natural, safe, and healthy childbirth.

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How to Increase Attendance at Childbirth Classes

August 11th, 2010 by Debby

There can be no doubt that attendance is down at childbirth classes across the country. Prospective parents are relying on the Internet for information about pregnancy and birth and many feel that attending an in-person class will not be worth their time and money. I don’t believe that the Web and online learning can replace the magic that often occurs in high-quality childbirth classes. I am especially concerned about fathers – the likelihood that a pregnant woman and her partner will sit down in front of a computer at the same time so that they can process and discuss what they are learning is not high. Also, human nature is such that we seek out websites that confirm what we are already thinking. A woman who has been convinced by well-meaning friends that the best way to have a baby is by planning an induction and early epidural is not likely to spend a lot of time on a website or in an online class that touts the benefits of natural childbirth. However, in a good childbirth class with plenty of time for thoughtful discussions, this same woman may learn enough from both the instructor and the other parents in the class to open her eyes to all the options available to her. So how can we get her into class?

Here are a few suggestions:

1.  Hit the pavement – with food.

Jeanne and I used to run a community-based childbirth education program. Once a year, we’d visit each physician practice in our area at lunchtime. We’d bring lunch to the practices who referred the most women to us. Lunch was for the support staff as well as the physician. The in-person visit gave us the opportunity to discuss any problems or miscommunications as well as to inform the office about new classes we were offering. If the office nurse enthusiastically recommends your classes to all the pregnant women she sees, attendance at your classes will pick up. (We brought cookies to the other offices.)

2. Consider offering yoga, movement, and/or exercise classes.

Women are into fitness these days. If you schedule classes at times that fit into their busy schedules AND market your classes to health care providers, you will get women into class. We’ve heard about one childbirth educator who offers a “movement” class – a combination of yoga, belly dancing, and prenatal exercise. It sounds like fun. Once you have them in one class, you can often sell them on other classes.

3. Offer a wide variety of classes throughout pregnancy.

Rethink offering only a series of classes during the third trimester. Offer pre-conception classes and early pregnancy classes. Offer single classes on topics such as nutrition, what you need to buy for the baby, prenatal testing, baby-wearing. The possibilities are endless. Signing up for just one class isn’t as intimidating as committing to a series of classes. If the students find one class worthwhile, they may sign up for other classes. Weave information about safe and healthy birth into every class. If you have enough students, try to group students into classes by due dates so that they see familiar faces in their classes. In order to promote safe and healthy birth, you really want to get them into a class or classes that will help them plan for the birth practices that best promote safe and healthy birth. Attending a class like this will lead to a class on comfort measures. Get the point?

4. Supplement your classes with today’s technology.

Have a website with supplementary materials and links to reputable and trustworthy websites. (The Family Way ‘Web-It” feature on our website does this.) Text your students between classes in a series with teasers or questions to think about before the next class.

5. Work hard to make your classes the best they can be.

Don’t get lazy and keep doing the same things. If your classes are fun AND help women and their partners to have safe and healthy births, word will spread!

If you have found strategies that have helped to increase attendance at your classes , or if you have not experienced a drop-off in attendance, please share what you have done. I hope to hear from a lot of you.

Posted in Musings, Uncategorized | No Comments »

In Honor of World Breastfeeding Week

August 3rd, 2010 by Debby

I wanted to write something special to celebrate World Breastfeeding Week. But I really love my post from last year and decided that it is worth repeating (for at least one more year).

In honor of World Breastfeeding Week, I’d like to share one of my favorite personal breastfeeding stories. When my son Ben was a junior in high school, he took speech. One night he locked himself in my office to work on his “persuasive” talk. He wouldn’t tell me the topic. After he left the room, nosy mom that I am, I looked through the trash and pulled out his crumpled drafts. Breastfeeding. My son, who was captain of the defense on his high school football team, gave a speech about why all mothers should breastfeed their babies. It started out, “This year xxx (number) babies will die worldwide because they were not breastfed. This year, in the United States, xxx (number) of babies will die because they were not breastfed.” I don’t think I’ve ever been so proud of him. His speech teacher thought he was kidding when he told her his topic. Probably it’s good that he was a big, burly football player. In high school culture, I don’t know how many boys could get away with extolling the merits of breastfeeding in front of their peers. But no one made fun of Ben.

Wouldn’t it be nice if we lived in a society where breastfeeding is so much a part of normal culture that no one has to make persuasive speeches about it? Where hospitals are all baby-friendly? Where mothers are never asked to leave public places in order to nurse their babies? Where breasts are most appreciated for their ability to nourish and nurture rather than to titillate?

According to the World Health Organization, today we could save 1.3 million children’s lives by teaching women around the world how to breastfeed. This week, I hope that you will join with your co-workers to celebrate World Breastfeeding Week. Take an additional step and visit the website of the U.S. Breastfeeding Committee (or the organization that promotes breastfeeding in your country if you are outside the U.S.) to discover what you can do to promote, protect, and support breastfeeding. It can save lives.

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Disappointment with New ACOG Consumer Book

July 27th, 2010 by Debby

I like to quote ACOG (the American College of Obstetricians and Gynecologists) in both my childbirth education classes and in trainings that I do for both new and experienced childbirth educators. The new (2010) edition of ACOG’s book for consumers, Your Pregnancy and Childbirth, recently came out. While updating some teaching materials, I have been checking to make sure that information from the 2005 book, Your Pregnancy and Birth, is also included in the 2010 edition. (I like to make sure my quotes are up-to-date!) I am alarmed to find the new edition is even less supportive of pregnant women who may be interested in natural childbirth than the 2005 edition.

Monitoring

2005 edition: This edition had a nice section on auscultation and stated that “auscultation has no known risks.” The authors presented the pros and cons of the two types of electronic fetal monitoring (external versus internal), but did fail to mention the increased risk for surgery section with continuous electronic monitoring.

2010 edition: There is no mention of auscultation. All it says about fetal monitoring is, “Your baby’s heart rate and your contractions likely will be monitored with electronic fetal monitoring.”

Nonpharmacologic Pain Management Strategies

2005 edition: In the section on labor, delivery, and postpartum on page 120, there is a list of ways to ease discomfort during labor which includes breathing and relaxation, massage, changing positions often, showers or baths (if permitted), ice packs, resting between contractions, and cool, moist cloths. These strategies are presented after the information on hospital admission so that it is clear that these nonpharmacologic strategies can be used in the hospital. There is also a box on page 130 with ”Labor and Birth Options.” Included in the box are birthing bed, birthing stool, birthing ball, squatting bar, and birthing pool/tub.

2010 edition:  In contrast, in this edition, most of the nonpharmacologic pain strategies are included in the section on early labor when the pregnant woman is clearly still at home.  After the mother is admitted to the hospital, the list of nonpharmacologic strategies is much shorter. In a paragraph titled, “What You Can Do” [in active labor], it says, “ It may help to move around in the bed to find a position that is most comfortable for you.” (In the bed!) The book authors do finally allow a woman in active labor out of bed by stating, “If you feel like it and your health care provider says it’s ok, walk the halls.” I could not find any mention of a birthing ball or birthing tub in the 2010 edition.

In the 2010 section titled “Pain Relief During Labor,” there is this quote about natural childbirth:

“Despite the expected pain of labor, however, some women worry that receiving medication to relieve the pain will somehow make the experience less natural. But many women find that pain relief gives them better control over their labor and delivery. Don’t be afraid to ask for pain relief if you need it.”

You get the idea. I have had labor nurses tell me that if a woman really wants a natural birth that she shouldn’t go to a hospital. I am naive enough to disagree. Just as a woman who wants an epidural in labor should have that option available to her, I believe that a woman who wants a natural birth in the hospital should have the support, freedom to move and change positions, and access to nonpharmacologic pain measures that she needs in order to have the birth she wants. In their new book for consumers, ACOG clearly has moved backwards in their support of a woman’s right to choose the birth she wants.

Posted in Book Review | 2 Comments »

If You Need More Ammunition to Promote Spontaneous Pushing…

July 21st, 2010 by Debby

Those of us who have been teaching for a REALLY long time remember the research of Dr. Roberto Caldeyro Barcia in the early 1980s on the dangers to the baby of directed pushing. Since that time, many childbirth educators have been teaching their students about the benefits to both the baby and the mother of physiological or spontaneous pushing. Finally the “party line” has caught up to Caldeyro Barcia’s pioneering research, but practice has not. Researchers at the University of Texas Southwestern Medical School (home of Williams Obstetrics) have published several studies recommending spontaneous pushing, and AWHONN has taken a strong stand urging nurses to use physiological pushing with their labor patients. But as I travel across the country teaching workshops, I am told over and over again that the admonition to push hard to a count of 10 is still being heard in labor rooms today.

Several studies published in nursing journals in the last three years address the issue of physiological pushing:

1. A meta-analysis of studies comparing passive descent to early pushing in women with epidurals was published in JOGNN in early 2008. Researchers concluded that passive descent should be used to safely and significantly increase spontaneous vaginal births, decrease instrument-assisted deliveries and shorten pushing time.

2. In an article published in the January-March 2009 issue of the Journal of Perinatal & Neonatal Nursing, Dr. Lisa Hanson, PhD and CNM, provides nurses with evidence-based recommendations for using spontaneous maternal bearing down even in challenging labors with slow labor progress and fetal heart rate abnormalities.

3.In a small RCT (randomized controlled trial) published in the March/April 2010 edition of MCN (Maternal Child Nursing), researchers compared the length of pushing between an immediate pushing group and a delayed pushing group of mothers who had epidural analgesia. They found that delaying the onset of immediate pushing for up to 90 minutes or until the mother felt an uncontrollable urge to push resulted in an almost 50% reduction in the length of time that the mother spent pushing.

If you are a labor and birth nurse and/or childbirth educator in a hospital where directed pushing is still used routinely, you may want to obtain copies of these three articles to share and discuss with the decision-makers on your unit.

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Teaching Resources About Induction

July 13th, 2010 by Debby

Last weekend, a friend at a local hospital asked me about resources regarding labor induction. The hospital where she teaches is aware of the new Joint Commission perinatal quality measures, including the measure on reducing elective births before 39 weeks. She said that the hospital is concerned about balancing pressure from patients (especially) and from physicians to provide elective inductions and the new Joint Commission perinatal quality measure on induction. She asked me about research and resources for women on labor induction.

I just happened to have written the Healthy Birth Practice Paper #1 – Let Labor Begin on Its Own for Lamaze International. A PDF format of the paper is available on the Lamaze website so that the paper can be easily printed for distribution to colleagues at your hospital and/or for your childbirth education students. Even if you are not a member of Lamaze International, you are encouraged to distribute the paper. Because I wrote the paper (and updated it several times), I assume that “everyone” knows about it. I was surprised to learn that my friend from the local hospital did not. In addition to papers and one page summaries of each of the healthy birth practices on the Lamaze website, there are also very short video clips for each of the six healthy birth practices. You can also download these clips to your laptop to show in your childbirth class. Or you can order a DVD with all the video clips on it from InJoy Videos for only $12.95.

I have blogged in the past about the research study done at St. John’s Mercy Medical Center in St. Louis on labor induction. Childbirth educators added a detailed module on the risks of elective induction to their childbirth education curriculum. It made a difference – students who attended childbirth education classes had fewer inductions as compared to a control group during the same time period who did not attend classes. I am happy to report that this important study will be published in the next (fall) edition of The Journal of Perinatal Education.

Childbirth educators need to know that they CAN make an important contribution to their hospitals’ efforts to improve performance on the Joint Commission perinatal quality measures. I encourage childbirth educators to take advantage of the free resources provided by Lamaze International on the benefits of letting labor begin on its own and the other healthy birth practices.

PS: If you are a Lamaze member, there is an updated version of the one-page handout, Tips for Avoiding Labor Induction, available on the Lamaze website. From the home page, select the pull-down menu, “Member Center.” Under “Member Center,” select “Handouts and Classroom Tools. Tips for Avoiding Labor Induction 2010 is the handout second from the bottom.

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