Tag Archive | childbirth classes

Three Hours into 1.5 Minutes??

I most often write blog posts directed at pregnant women, not birth professionals (though I hope the pros find my posts useful as well!). Via the excellent Passion for Birth blog this morning, I read this article that is very relevant to childbirth educators.

The article addresses how educators/presenters can attempt to cram three hours worth of information into 1 and half minutes and how that is NOT effective or helpful. They do so out of fear that this is their “only chance” to reach those learners (but the cramming style actually does not reach learners either).

Ugh. I found myself cringing a bit when reading because I think I have this tendency for sure. It was also relevant to me in my non-birthwork life. I am faculty at Columbia College and am teaching my first college class this session (final exam tonight!). All of the principles in the article are things I strive to keep in mind when teaching college students as well (and sometimes I succeed and sometimes I fail. The actual class is 5 hours a night—though now six, because I missed one week and made it up sequentially over the following 5 weeks of class—which makes it tricky to keep people engaged, though also gives me plenty of time not to be cramming information into people’s heads).

Anyway, so the summary of points from the article (OMG. I’m taking a metaphorical three hours to get to my point…;-) were as follows:

Learners want relevance
Learners don’t care about history
Learners want minimal detail
Learners want connections
Learners want focus
Learners want applications
Learners want practice

I remember reading somewhere else at some point (I think during my ICEA certification process), that most learners do NOT want the amount of information and level of detail that you can provide. The first three on my list above are things I find myself falling into in birth education—I tend to give lots of details and some end up being irrelvant (I don’t want anyone to miss anything!) and I do have a tendency to give lots of history, background, and overexplanation.

So, good things to keep in mind! I want to be effective, not inefficient or irrelevant. I have been thinking a lot lately about my classes and how I’d like to improve them and change them and “deepen” them. Reading this article made me think even further about my approach and what I hope to accomplish. I have this sense lately that something just isn’t “working” and I want to go beyond—stretch my boundaries and dig in further.

Can I really expect to have a great birth?

I received a comment via another blog asking “given my limited situation, can I really expect to have a great birth today?” (homebirth, midwife, and doula were all not options for the person asking the question). I think the answer is a qualified “yes.” The question really got me thinking about ways to help yourself have a great birth, when your overall choices are limited. I came up with a long list of ideas of things that may help contribute to a great birth:

  • Choose your doctor carefully—don’t wait for “the next birth” to find a compatible caregiver. Don’t dismiss uneasiness with your present care provider. As Pam England says, “ask questions before your chile is roasted.” A key point is to pick a provider whose words and actions match (i.e. You ask, “how often do you do episiotomies?” The response, “only when necessary”—if “necessary” actually means 90% of the time, it is time to find a different doctor!). Also, if you don’t want surgery, don’t go to a surgeon (that perhaps means finding a family physician who attends births, rather than an OB, or, an OB with a low cesarean rate).
  • If there are multiple hospitals in your area, choose the one with with the lowest cesarean rate (not the one with the nicest wallpaper or nicest postpartum meal). Hospitals—even those in the same town—vary widely on their policies and the things they “allow” (i.e. amount of separation of mother and baby following birth, guidelines on eating during labor, etc.)
  • When you get the hospital, ask to have a nurse who likes natural birth couples. My experience is that there are some nurses like this in every hospital—she’ll want you for a patient and you’ll want her, ask who she is! If possible, ask your doctor, hospital staff, or office staff who the nurses are who like natural birth—then you’ll have names to ask for in advance.
  • Put a sign at eye level on the outside of your door saying, “I would like a natural birth. Please do not offer pain medications.” (It is much easier to get on with your birth if you don’t have someone popping in to ask when you’re “ready for your epidural!” every 20 minutes.)
  • Work on clear and assertive communication with your doctor and reinforce your preferences often—don’t just mention something once and assume s/he will remember. If you create a birth plan, have the doctor sign it and put it in your chart (then it is more like “doctor’s orders” than “wishes”). Do be aware that needing to do this indicates a certain lack of trust that may mean you are birthing in the wrong setting for you! Birth is not a time in a woman’s life when she should have to fight for anything! You deserve quality care that is based on your unique needs, your unique birthing, and your unique baby! Do not let a birth plan be a substitute for good communication.
  • Cultivate a climate of confidence in your life.
  • Once in labor, stay home for a long time. Do not go to the hospital too early—the more labor you work through at home, the less interference you are likely to run into. When I say “a long time,” I mean that you’ve been having contractions for several hours, that they require your full attention, that you are no longer talking and laughing in between them, that you are using “coping measures” to work with them (like rocking, or swaying, or moaning, or humming), and that you feel like “it’s time” to go in.
  • Ask for the blanket consent forms in advance and modify/initial them as needed—this way you are truly giving “informed consent,” not hurriedly signing anything and everything that is put in front of you because you are focused on birthing instead of signing.
  • Have your partner read a book like The Birth Partner, or Fathers at Birth, and practice the things in the book together. I frequently remind couples in my classes that “coping skills work best when they are integrated into your daily lives, not ‘dusted off’ for use during labor.”
  • Practice prenatal yoga—I love the Lamaze “Yoga for Your Pregnancy” DVD—specifically the short, 5-minute, “birthing room yoga” segment. I teach it to all of my birth class participants.
  • Use the hospital bed as a tool, not as a place to lie down (see my How to Use a Hospital Bed without Lying Down handout)
  • If you feel like you “need a break” in the hospital, retreat to the bathroom. People tend to leave us alone in the bathroom and if you feel like you need some time to focus and regroup, you may find it there. Also, we know how to relax our muscles when sitting on the toilet, so spending some time there can actually help baby descend.
  • Use the “broken record” technique—if asked to lie down for monitoring, say “I prefer to remain sitting” and continue to reinforce that preference without elaborating or “arguing.”
  • During monitoring DO NOT lie down! Sit on the edge of the bed, sit on a birth ball near the bed, sit in a rocking chair or regular chair near the bed, kneel on the bed and rotate your hip during the monitoring—you can still be monitored while in an upright position (as long as you are located very close to the bed).
  • Bring a birth ball with you and use it—sit near the bed if you need to (can have an IV, be monitored, etc. while still sitting upright on the ball). Birth balls have many great uses for an active, comfortable birth!
  • Learn relaxation techniques that you can use no matter what. I have a preference for active birth and movement based coping strategies, but relaxation and breath-based strategies cannot be taken away from you no matters what happens. The book Birthing from Within has lots of great breath-awareness strategies. I also have several good relaxation handouts and practice exercises that I am happy to email to people who would like them.
  • Use affirmations to help cultivate a positive, joyful, welcoming attitude.
  • Read good books and cultivate confidence and trust in your body, your baby, your inherent birth wisdom.
  • Take a good independent birth class (not a hospital based class).
  • Before birth, research and ask questions when things are suggested to you (an example, having an NST [non-stress test] or gestational diabetes testing). A good place to review the evidence behind common forms of care during pregnancy, labor, and birth is at Childbirth Connection, where they have the full text of the book A Guide to Effective Care in Pregnancy and Childbirth available for free download (this contains a summary of all the research behind common forms of care during pregnancy, labor, and birth and whether the evidence supports or does not support those forms of care).
  • When any type of routine intervention is suggested (or assumed) during pregnancy or labor, remember to use your “BRAIN”—ask about the Benefits, the Risks, the Alternatives, check in with your Intuition, what would happen if you did Nothing/or Now Decide.
  • Along those same lines, if an intervention is aggressively promoted while in the birth room, but it is not an emergency (let’s say a “long labor” and augmentation with Pitocin is suggested, you and baby are fine and you feel okay with labor proceeding as it is, knowing that use of Pitocin raises your chances of having further interventions, more painful contractions, or a cesarean), you can ask “Can you guarantee that this will not harm my baby? Can I have in writing that this intervention will not hurt my baby? Please show me the evidence behind this recommendation.”
  • If all your friends have to share is horror stories about how terrible birth was, don’t do what they did.
  • Look at ways in which you might be sabotaging yourself—ask yourself hard and honest questions (i.e. if you greatest fear is having a cesarean, why are you going to a doctor with a 50% cesarean rate? “Can’t switch doctors, etc.” are often excuses or easy ways out if you start to dig below the surface of your own beliefs. A great book to help you explore these kinds of beliefs and questions is Mother’s Intention: How Belief Shapes Birth by Kim Wildner. You might not always want to hear the answers, but it is a good idea to ask yourself difficult questions!
  • Believe you can do it and believe that you and your baby both deserve a beautiful, empowering, positive birth!

I realize that some of these strategies may seem unnecessarily “defensive” and even possibly antagonistic—I wanted to offer a “buffet” of possibilities. Take what works for you and leave the rest!

Great births are definitely possible, in any setting, and there are lots of things you can do to help make a great birth a reality.

Births & Marathons

A parallel is often drawn between giving birth and running a marathon. There was a great article called “The Gift of Leaping” in the most recent issue of the International Journal of Childbirth Education (available to download as a pdf here) that was based on this theme.

In it, the author discusses how in both experiences your mind’s strength can be called upon to surpass your physical strength and she notes, “The pain of accomplishment is so much easier than pain endured.” I loved that!

She goes on to share: “I want that feeling of going beyond what you think is possible for laboring women. If you let go of control and allow the process to unfold, you are so proud of yourself. Then pride morphs into self-confidence and trust. What a perfect combination for parenting. When it comes down to it, you have to do this by yourself, be it labor or running. You might hear other laboring women around you or have the support of crowds in a race, but it’s still up to you. there’s a start and a finish and only you can see it through. Fortitude brings a new self-awareness and strength that feels overwhelming…I know one of my greatest challenges in the vocation of perinatal education is getting women to trust the process and her own capabilities before labor. My practice runs helped prepare me for the marathon, but there is no practice run for labor. Women must rely on their confidence and the legacy of the many women who have birthed before them…”

I share her feelings about her greatest challenge. The whole point of my birth classes is for the participants to develop confidence and trust in their ability to give birth naturally. It is difficult to share what birth is really like–it is a singular experience (each birth is different too, so even if you’ve done it before, there are still surprises ahead!) I also feel like it is irreplaceable to start off the parenting journey with a overwhelming sense of power, pride, and capability–a sense that often comes with the “I did it!” of giving birth!

Perceptions of Pain

Some time ago I wrote several posts about pain in labor, one of which addressed needing more words for pain. In the book Birthwork, there is an interesting list of possible perceptions of pain in labor:

‘Satisfying painenjoyable labour

–‘Positive pain’–it is birthing the baby

‘Constructive pain’–it is doing a good job

‘Functional pain’–acceptance of the process

‘Okay pain’–it hurts but everything is on track

‘Intense pain’–it is a lot!

–‘Abnormal pain’–something is not right

‘Overwhelming pain’–unable to manage alone (exacerbated by isolation, fear, exhaustion, and tension).

‘Off the wall pain’–utterly unbearable (usually associated with intense nerve or spinal pressure).

Even though these aren’t new words for pain, I think they add to our vocabulary for describing what is going on with our birthings. Additionally, keep in mind that you can transform the language and perception of the sensations of labor even further, by not using the word pain or contractions at all–you can refer to “sensations” or “tightenings” or “pressure” or “waves” or “surges” or “intensity” and so forth.

What Does Coping Well Mean?

“I believe with all my heart that women’s birth noises are often the seat of their power. It’s like a primal birth song, meeting the pain with sound, singing their babies forth. I’ve had my eardrums roared out on occasions, but I love it. Every time. Never let anyone tell you not to make noise in labor. Roar your babies out, Mamas. Roar.” –Louisa Wales

Occasionally, I hear people telling birth stories and emphasizing not making noise as an indicator, or “proof,” of how well they coped with birthing–“I didn’t make any noise at all,” or “she did really well, she only made noise towards the end…” Women also come to classes looking for ways to stay “in control” and to “relaxed.”

This has caused me to do some thinking. Though relaxation is very important and helpful, to me, the goal of “laboring well” is not necessarily “staying in control” or “staying relaxed” or “not making any noises.” Instead, I view “laboring well” as involving: listening to yourself; respecting your own needs and acting on them; working with your body; finding your rhythm; trusting your instincts; following your body’s urges/signals; accessing your inner wisdom; finding your unique way along the path; journeying with openness, curiosity, acceptance, excitement and joy; and responding to coping strategies that spontaneously arise from within.

I have been reading Penny Simkin’s The Labor Progress Handbook and she addresses this subject as well:

“Childbirth education programs first emerged in the 1940s, when much less was known about the powerful, multisensory ways in which women spontaneously cope with labor. Much has been learned since then, but older ideas have left their stamp on Western culture…Many people still think that ‘coping well’ means that the woman remains silent and does not move during contractions. Often, caregivers, partners, and the women themselves believe that women who are physically active and vocal are coping poorly, and may strive to help these women to be quiet. However, we now know that women with kinesthetic and vocal coping styles often find much more effective relief from pain and stress when they move and make sounds, than when they try to use the quiet, still techniques of early childbirth methods.”

During my own births I found movement and sound to be of tremendous importance. With my first baby, I felt more inhibited and primarily coped by humming. I spent a lot of time kneeling on the ground with my head on the bed. With my second, I was alone with my husband for most of the time and was much more vocal–“talking” myself through contractions. I also moved around a great deal and found it very important. Talking (well, really rhythmic word repetition) and moving, for me, are parts of “surrendering” to the power, process, and intensity of giving birth. This fits with my personality as well as in “normal” life I talk a lot (talk-to-think) and I also have a lot of physical energy that leads to my “buzzing” around the room a lot or stepping back-and-forth as I speak.

Edited to add that the Feminist Childbirth Studies blog linked to this post with an interesting and insightful further development/exploration of this subject in the post characteristics of a ‘good’ labor and birth experience?

I revisited this topic in a later post: The Power of Noise in Labor

Birth art sculpture depicting pushing the baby out. Roar, mama, roar!

A Father’s Role

I recently finished reading the new book Labor of Love by Cara Muhlhahn and I was struck by this quote:

“Anyone would cry to see the way families interact around a homebirth. In a home environment, the intimacy and integrity of the family, especially the father or partner, often have pivotal roles to play. In the hospital, these key players are mostly cast aside except to hold the woman’s hand and cheer her on: ‘Push!” At home, they can support the mother in any number of invaluable ways, from regulating the temperature of the water in the pool to preparing food or choosing her favorite music.”

I have noticed this as well–I recently watched the new documentary Orgasmic Birth and was struck by the glaring differences in how fathers behaved at home compared to in hospitals. At home, they embraced their wives. They danced, they murmured, they stroked, they kissed, they held. At the hospital, they held her hand or tentatively stroked her back (with body at a distance–just a hand reaching out to lightly touch her). I’ve seen this in real life as well. I tell men in my classes not to be “scared” of their wives in labor, but to walk through the waves (of discomfort, anxiety, whatever) and just hold and love her. I tell them that they do not need to be “trained” to be more “special” or different than they are. They don’t need to be doulas. What they need to do is love her the way they love her and reach out to her to show her that. I tell them that hospitals can be intimidating and it can be awkward to show physical affection in that setting, but to do reach past that and do it anyway. I’ve read a number of posts and emails recently about whether fathers belong at birth–I think they do, but I also think that the hospital climate too often discourages them from having a real role or being valuable. I think they can be stripped of their position as “lover” and “father” and left feeling helpless and useless.

Which Pelvis Model to Buy?

The content in the post was originally made in response to a question on a message board regarding what type of pelvis model do childbirth educators suggest for use in birth classes. I’m posting similar content here for any fellow childbirth educators who may come to this blog looking for pelvis feedback 🙂 Some people had expressed disappointment with a very tiny pelvis model that is out there for sale (and looks deceptively larger in photos) and others were concerned about whether the pelvis was flexible or not and also whether it had “bolts” at the joints for flexibility. Here is my response:

  • I have a non-mobile pelvis I bought from ebay (around $50) and like it quite a lot. It doesn’t have the flexibility elements, but I point to each joint and describe how it can flex, and that seems to be enough for most people. (The seller was “vanscience” when my husband got it for me for Christmas, not sure what is on there now.)

  • Then, I have the very tiny one as well (purchased from ebay, not from the Doula Shop). It is only about two inches probably. This is the one I actually prefer to use to show some of the cardinal movements and posterior/anterior positioning of the baby. I have a tiny fetus that I picked up from Birthright. It is a “12 weeks fetus,” but in an odd twist of providence, it fits PERFECTLY through that tiny, cheap pelvis that I regretting having for a long time. Now, I love it and find it really useful. My mom knitted me a tiny uterus with dilating cervix that exactly fits the tiny baby as well! The tiny baby even gets “stuck” on the back of the pelvis when it posterior and then when it rotates to anterior, it slides right through with a little “push.” It is like they were made to go together. The baby is hard plastic, so I can’t flex it to show all the movements, but they get the idea. I just share that babies go through a series of cardinal movements, but I don’t go through a big demo of exactly each one, I just show the baby rotating and slipping through.

  • I find the tiny set really easy to manipulate and convenient to demo with. The large one works well for tipping back and forth to show how different positions might compress or open and to point out the parts that are flexible in real life. But, I actually find that people seemed more interested in the positioning of the baby when I started to use the tiny set to show that part. I generally teach private, one-on-one classes, so that might be why it works so well for me. It would not work well in an up-in-front-of-a-class setting.

  • So, I use the big pelvis and big uterus and big baby each as separate teaching tools and then the little pelvis and baby as a “unit.”

  • Just wanted to share that that tiny pelvis isn’t all horrible! (though, man, was I disappointed when I got it and saw its microscopic nature. I was like, “this is a rat pelvis!”)

    Movement and pain

    A brief quote from Biance Lepori an Italian architect who specializes in the design of birth rooms:

    “Even pain dissolves with movement; pain killers are a consequence of stillness.” (emphasis mine)

    This architect specifically designs rooms that support physiological birth–birth that unfolds accords to the natural biological processes of the woman, on her own timeline, and under her own power.

    I emphasize active, normal (physiological) birth in my classes. I feel like the use of movement is one of the single most important ways we have to embrace labor and its rhythms and also to support healthy, physiological birth. Though I teach a variety of positions for labor and birth, “birthing room” yoga poses, and encourage practicing them, I believe that the movements you need during labor come from within and arise spontaneously during labor, not from specific training and practice. The key is the FREEDOM to use movement in the way you need to (many women end up being denied the right to free movement during labor 😦 ). The benefit to practicing different positions and movements prior to birth is that you gain a “body memory” of how to move your body in labor supporting ways.

    Healthy Birth Guides

    I recently received a shipment of The 2008/2009 Guide to a Healthy Birth published and distributed free of charge by Choices in Childbirth in NYC. I ordered a stack of these nice little booklets for only the cost of shipping ($11 for 50 booklets). I really like the content and plan to distribute these in my birth classes and encourage other educators to do the same. The emphasis of the booklet is on being an informed consumer and it also touches on the politics of birth and the business of birth, which I really liked. The end of the booklet has an article by Dr. Harvey Karp about the 5 S’s. I particularly enjoyed the chapter called “The Purpose and Power of Pain in Labor.”

    All in all, this is a fantastic and nearly free resource and I’m pleased to have them available! Check them out yourself! (You can also download the booklet for free as a pdf.)

    I first learned of these booklets from the wonderful Passion for Birth blog.

    How to Use a Hospital Bed Without Lying Down

    In classes, I often suggest that when couples enter their hospital room in labor they pile all of their belongings onto the bed rather than the laboring woman hopping into it. I encourage people to start seeing the bed as a tool they can actively use during labor, rather than a place for labor and birth to passively happen to you. To that end, I’ve made a little handout called “helpful ways to use a hospital bed without lying down.” I’m uploading it here in hopes that others may find it useful as well.

    Kneeling & leaning on back of hospital bedFor more about the importance of freedom of movement during labor, make sure to check out Lamaze’s Healthy Birth Practice paper: Walk, Move Around, and Change Positions Throughout Labor or this video clip from Mother’s Advocate.