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Series: Welcoming All Families: Supporting the Native American Family

November 18th, 2014 by avatar

By Melissa Harley, CD/BDT(DONA), LCCE

November is Native American Heritage Month and LCCE Melissa Harley shares some interesting facts about the rich culture included in some of the varied childbearing year traditions observed by some of the U.S. tribes.  There are many different tribal nations, and each one has their own ceremonies and practices around pregnancy and birth.  Beautiful and fascinating stories that are each unique in their own right.  This post is part of Science & Sensibility’s “Welcoming All Families” series, which shares information on how your childbirth class can be inclusive and welcoming to all. – Sharon Muza, Community Manager, Science & Sensibility.

© Bob Zellar http://bit.ly/1EVALCk

© Bob Zellar http://bit.ly/1EVALCk

As childbirth educators of today, we must strive to have a connection to childbirth of yesterday.   As educators, we should continually be looking for ways to be welcoming of all cultures, customs, and traditions in the classroom setting and when working individually with students.  In order to achieve these goals, it is helpful to better understand how such traditions played out in years gone by.  So often, we look at birth from a very telescopic lens of the past (singling out one or two cultures) rather than looking at history from a more wide panoramic view point.  As we strive to embrace cultural diversity, we should continue to explore populations that are perhaps a little less known.    Have you considered the culture of Native Americans in childbirth and how the past compares to childbirth in our society now? According to the Centers for Disease Control and Prevention (CDC), currently, there are roughly 5.2 million American Indians and Alaska natives spread throughout 565 federally recognized tribes in the US. (CDC, 2013)  Let’s take a look at some of the commonalities that we have with our Native American ancestors and learn a little together about being welcoming, helpful, and inclusive of Native Americans in our classes today!

Native Americans and Pregnancy

Although there are some differing opinions regarding historical pregnancy and birthing traditions of Native Americans, according to historian Ellen Holmes Pearson, PhD, Native Americans were known to take exceptional care of themselves during pregnancy.  Similar to today, maintaining good health throughout pregnancy often led to an uncomplicated labor and birth.  Much regard was taken to ensure that a Native American mother’s health needs were met in a way that would support the nutritional and physical needs of both mom and baby.  From the website teachinghistory.org, Dr. Pearson states   “During their pregnancies, women restricted their activities and took special care with their diet and behavior to protect the baby. The Cherokees, for example, believed that certain foods affected the fetus. Pregnant women avoided foods that they believed would harm the baby or cause unwanted physical characteristics. For example, they believed that eating raccoon or pheasant would make the baby sickly, or could cause death; consuming speckled trout could cause birthmarks; and eating black walnuts could give the baby a big nose. They thought that wearing neckerchiefs while pregnant caused umbilical strangulation, and lingering in doorways slowed delivery. Expectant mothers and fathers participated in rituals to guarantee a safe delivery, such as daily washing of hands and feet and employing medicine men to perform rites that would make deliveries easier.”

In addition to caring for the body in pregnancy, it was extremely important for Native Americans to care for their mind and spirit.   In the Navajo communities, pregnancy and childbirth were approached as a spiritual event.  Much time and effort was spent making sure that the mother had a positive pregnancy.  Ceremonies in the Navajo community in general were very important.  Some ceremonies could last for days and days.  It was only natural that the tribes would hold Blessing Ways for expectant mothers.   Unlike many other Navajo ceremonies, the Blessing Way was not held to cure a sickness, but rather to invoke positive blessings and avert misfortune. Contrary to current use of the Blessing Way, the traditional Navajo tribes used the Blessing Way for more than just pregnancy and birth.  The ceremony was also used for blessing of the home, and also to enhance good fortune through the kinaalda (girl’s puberty rites).  Native Americans today that wish to connect with their heritage during the childbearing time often do so by being very careful about their spiritual surroundings.  It is quite important for mothers to keep their thoughts positive, and to maintain a climate of peace with those around them.  It is also suggested that mothers should avoid arguing with others during pregnancy, or to allow bad thoughts to enter their minds.

Native Americans and Birth

Native Americans were known to give birth in a simple way, with only other women in attendance as men were never allowed to see a woman give birth.   In general, Indian women likely gave birth without much assistance at all.  A midwife would at times attend the birth, along with other female family members from the tribe.  In very simplistic style, the baby would be birthed directly onto the leaves below the mother who used upright posturing for birth.   The baby would be welcomed by the earth, rather than by man’s hands.

To hasten labor and reduce pain during the birth, tribes sometimes utilized herbal remedies.   Cherokees made a tea with Partridgeberry and started consuming it several weeks before the birth.  They were also known to use Blue Cohosh to promote rapid delivery and to speed delivery of the placenta. To relieve pain, the Cherokees turned to wild black cherry tea made with the inner bark from the tree. The Koasati tribes made a tea of the roots from the plant of cotton that reduced pain for birthing women.

In some tribes, rituals to “scare” the baby out were utilized.  An elder female would often yell “Listen! You little man, get up now at once. There comes an old woman. The horrible [old thing] is coming, only a little way off. Listen! Quick! Get your bed and let us run away. Yu.”

Another common tradition in birth was the use of the rope or Sash Belt thrown over tree limbs for the mother to hold.  The traditional Navajo sash belt is made of intricate-colored sheep wool that is woven upon a wooden loom.  Some hospitals today near Indian reservations have a Sash Belt installed in the ceiling for mothers to use.

Connecting the Past and the Present

While the mothers of today might not fear that eating speckled trout will cause birthmarks, most do still have concerns  and want to take steps to ensure a healthy baby.  We see mothers avoiding large amounts of caffeine and high mercury fishes. While we don’t often see our students choosing to give birth without much assistance onto the leaves of the trees, many do still choose upright posturing.  We also see a desire at times to hasten the labor, and some mothers turn to herbal or medicinal means to help that happen.   As childbirth educators, we can at times be of comfort to our students as they prepare for the healthiest birth possible. We can connect the past with the present, allowing parent’s space to explore the traditions within their cultures while also honoring current evidence and research based maternity care.  As I say in my classes, while pointing students to the evidence associated with Healthy Birth Practice #5, those mamas from long ago knew something intuitive: that using upright positions for labor and birth made a difference!

Health Services for Native Americans Today

If you live and work near an Indian reservation, you may be familiar with Indian Health Service (IHS).   IHS was established in 1955 with a goal to raise the health status to the highest possible level for Native Americans registered in a federally recognized tribe.   As childbirth educators, some of our students may seek medical attention at one of the nation’s 33 IHS hospitals or 59 IHS health centers.   Dr. Michael Trujillo, past director of IHS states in regard to IHS, “The values of human dignity, honesty, compassion, coupled with shared values of many different tribes and cultures, that have come to be spoken of as “Indian values, of listening, mutual respect, dignity, and harmony must always be at the forefront of what we do and how we do it. We must be professional in all our actions.”

This year, in accordance with the Affordable Care Act, the Indian Health Care Improvement Act was permanently reauthorized.  This provision in the current law will increase access of quality health care to Native Americans near IHS facilities as well as those who do not live near an IHS facility.  The ACA includes some very specific benefits that will impact American Indians and Alaskan Natives.  Tribes across the country are encouraging members to become familiar with the new laws, and to evaluate how the provisions can increase access and affordability to quality healthcare for their members.

Connecting our Native American clientele with quality prenatal care is extremely important.   Consider the following statistics from the CDC:

  • American Indian/Alaska Natives have 1.6 times the infant mortality rate as non-Hispanic whites.
  • American Indian/Alaska Native babies are 2.2 times as likely as non-Hispanic white babies to die from sudden infant death syndrome (SIDS).
  • American Indian/Alaska Native infants were 2.5 times as likely as non-Hispanic white infants to have mothers who began prenatal care in the 3rd trimester or not receive prenatal care at all.

What’s a Childbirth Educator to Do?

As we strive to better serve the mothers of today, first and foremost, we should recognize the importance of the history that First Nations people bring to birth.   Many Native Americans today still practice customs and traditions from years gone by.  If you currently service a population that includes American Indians and Alaskan Natives, then you may already be aware of the customs in your area.

© Ursula Knoki-Wilson

© Ursula Knoki-Wilson

To help Native Americans feel welcomed in class, ensure that visuals of contemporary Native Americans are included in your curriculum.   You might also offer a segment in your comfort measures class that specifically addresses the customs from that population.  In general, keeping language inclusive of a variety of cultures can also lead to a sense of acknowledgement and acceptance. Simply recognizing that you are aware of different cultural traditions in class can lead to parents feeling more comfortable, thus opening a door for sharing and further education.

Regardless of your target clientele, it would be helpful for a childbirth educator to become familiar with the many different traditions surrounding childbirth in the cultures around us.  A quick internet search can lead to a wealth of information that might be helpful in class.  As with any tradition or culture that you are not familiar with, education is power!  If you are on or near a reservation, perhaps reaching out to the IHS facility nearby might be an option.  Some facilities have staff members that hold workshops and courses to help the people within their tribes stay connected with tradition. In addition, it might be helpful to inform area IHS facilities that there is a childbirth educator nearby who is sensitive to the mental, physical and spiritual needs of the tribe members. It would also be advisable for childbirth educators to become aware of the provisions in the ACA for American Indians, as to be prepared with resources, if you are asked any questions in regard to healthcare for American Indians.   As childbirth educators, we are in a unique position to encourage our clients to seek quality prenatal care.  Working together with the families in our classes, we can positively impact the infant mortality rates among these populations by educating the families about safe and healthy birth practices and the options available to them.

Ultimately, it is important to keep our space open for all cultures and honor the individual traditions of the parents that attend our classes.  By becoming more educated and sensitive to the cultures around us we can better serve our clientele as a whole.  And for our Native American students, I’ll leave you with this blessing:

Earth’s Prayer
From the heart of earth, by means of yellow pollen blessing is extended.
From the heart of Sky, by means of blue pollen blessing is extended.
On top of pollen floor may I there in blessing give birth!
On top of a floor of fabrics may I there in blessing give birth!
As collected water flows ahead of it [the child], whereby blessing moves along ahead of it, may I there in blessing give birth!
Thereby without hesitating, thereby with its mind straightened, hereby with its travel means straightened , thereby without its sting, may I there in blessing give birth!S.D. Gill, Sacred Words

Note: to read more information about the images of the cradleboard welcoming home two generations of families, please follow this link to the Turtle Track organization for the full story. – SM

References

American Indian & Alaska Native Populations. (2013, July 2). Retrieved November 15, 2014, from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html

Blessingway (Navajo ritual). (n.d.). Retrieved November 15, 2014, from http://www.britannica.com/EBchecked/topic/69323/Blessingway

Holmes Pearson, E. (n.d.). Teaching History.org, home of the National History Education Clearinghouse. Retrieved November 15, 2014, from http://teachinghistory.org/history-content/ask-a-historian/24097

Infant Mortality and American Indians/Alaska Natives. (2013, September 17). Retrieved November 15, 2014, from http://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=38

Knoki-Wilson, U.M. (2008). Keeping the sacred in childbirth practices: Integrating Navajo cultural aspects into obstetric care. [PowerPoint slides].  Retrieved from Naho.ca website http://www.naho.ca/documents/naho/english/IG_Presentations2008/009KnokiWilsonUrsula.pdf

About Melissa Harley

melissa harley head shotMelissa Harley, CD/BDT(DONA), LCCE has worked with birthing women since bearing witness to the vaginal birth of her twin nieces in early 2002. She is a Native American registered in the  Cherokee Nation Tribe (OK) and the owner of Capital City Doula Services in Tallahassee, Florida.   Melissa holds certifications as a Lamaze Certified Childbirth Educator, DONA International Certified Doula and an Approved Birth Doula Trainer(DONA). She currently holds leadership positions with DONA International as a Florida state representative, and she sits on both the DONA International Education and Certification Committees.Melissa is a contributor to several birthing publications including the Journal for Perinatal Education (JPE), the Bearing Witness Series: Childbirth Stories Told By Doulas, and the sequel book Joyful Birth: More Childbirth Stories Told By Doulas.Married for 16 years and the homeschool mother of two teenagers, Melissa, values education and a life-long pursuit of learning. Her teaching style is comfortable, fun, and interactive, with an emphasis on leading the learner to have their own “light bulb” moments. As a childbirth educator and doula, Melissa most enjoys watching women become empowered to listen to their inner voice and acknowledge their own strength to birth.  Mentorship and education are both her passions, and Melissa is dedicated to fulfilling those passions by actively facilitating childbirth education classes as well as training and mentoring new doulas regularly.  Melissa can be reached at Melissa@capitalcitydoulaservices.com

Babies, Childbirth Education, Newborns, Series: Welcoming All Families , , , , ,

Series: Welcoming All Families; Working with Women Pregnant after Infertility

September 9th, 2014 by avatar

Continuing the Science & Sensibility occasional  series: Welcoming All Families, Certified Nurse Midwife Emalee Danforth examines the research on perinatal and postpartum mental health on the family who arrives in your classroom or office with a history of infertility.  As the childbirth educator, you (and the rest of the class) most likely will not be aware of the families with this specific history, unless the family chooses to share privately or in the class group.  The educator needs to understand and recognize the increased risk of perinatal and postpartum mood disorders these families face.  Childbirth educators should evaluate their language and stories to be sure that they are providing sensitive and appropriate language and examples that welcome and apply to those whose path to parenthood might not be the same as other families in your class. – Sharon Muza, Community Manager, Science & Sensibility.

By Emalee Danforth, CNM

© Wikipedia

© Wikipedia

Infertility, defined as the inability to conceive after 12 months of timed intercourse or donor insemination (Practice Committee for the American Society of Reproductive Medicine, 2013), is a common experience. While estimates range, approximately 6-15% of the United States population will experience infertility (Chandra, Copen & Stephen, 2013) with higher rates possible when viewed from the global perspective (Mascarenhas, Flaxman, Boerma, Vanderpoel & Stevens, 2012).

The majority of research on the experience of pregnancy and parenting following infertility examines only those who have conceived using IVF (in vitro fertilization, also referred to as ART, assisted reproductive technology). This group of patients is easy to identify and therefore study, but represents only a portion of those who have experienced infertility. Additionally, study designs have often excluded those with multiple gestations, those with same sex partners, and those who have utilized donor gametes. In everyday life, all of these types of clients will cross the path of a care provider or childbirth educator and each has a unique experience. The available research can outline some of the known characteristics of persons who have conceived via IVF after infertility but caution should be applied to generalizations.

The Psychology of Pregnancy after Infertility

There is a particular psychology of infertility that can transfer to pregnancy, childbirth and postpartum. The emotional hallmark of infertility is anxiety (Bell, 2013). Once pregnant, this worry does tend to persist through the pregnancy and heighten as the due date approaches. The level of general anxiety appears similar to those who have conceived spontaneously, but pregnancy-focused anxieties are heightened in previously infertile women, especially those who experienced prolonged treatment failure and high infertility-related distress (Hammarberg, Fisher & Wynter, 2008). McMahon et al. (2011) points out that “the relatively low correlation between pregnancy-focused anxiety and state anxiety…confirms that pregnancy-focused anxiety needs to be considered as a separate construct from more generalized anxiety” (p. 1394) and that this phenomena may be due to a particular reproductive history rather than individual personality factors.

Infertility is also known to be associated with elevated rates of depression (Cousineau & Domar, 2007). However, evidence is consistent that once pregnant, ART women and men experience lower levels of depressive symptoms than those that have spontaneously conceived (Hammarberg et al., 2008). This may be related to higher rates of psychosocial factors that are protective for perinatal mood disturbance in ART expecting women and men including higher socioeconomic status, higher education, higher quality and longer lasting intimate relationships, being older than average and having a planned conception (Fisher, Hammarberg & Baker, 2008). This same study posits that “it is possible that this low rate of distress is reflecting an almost elated mood, in which the pregnant state and family formation achieved after a long period of anticipation and via intrusive and disruptive interventions are somewhat idealized”(p.1110). Indeed, Hjelmstedt, Widstrom, Wramsby & Collins (2003) found that ART women experienced pregnancy in a less negative way and were also less worried about possible “loss of freedom” in their future lives as parent compared to the spontaneous conception control group.

It is therefore surprising that after birth, ART women experience postpartum depression at similar rates to the rest of the childbearing population (Hammarberg et al., 2008). Fisher et al. (2008) found significantly higher rates of admission for ART women in Australia for postpartum mood disturbances despite their more elevated mental state antepartum. This may be because after a long struggle with infertility and undergoing invasive and costly procedures, ART women feel “a low sense of entitlement to complain or to express any doubts, uncertainty, or mixed feelings about the realities of motherhood (Fisher et al., 2008, p. 1111).” However, once the baby or babies are born, ART women must adjust to motherhood and cope with the demands of a newborn just as any other mother. The combination of idealization of motherhood and lack of preparation for the experience of ambivalence can cause mental distress postpartum. In addition, the higher frequency of birth complications among ART women including preterm birth, cesarean section, low birth weight and multiple gestation (Hammarberg et al., 2008) all can have an additive effect on the stresses of motherhood.

There is evidence that ART women experience the process of emotional attachment to the fetus differently from those with spontaneous conception. Fisher et al. (2008) found that ART women thought about their fetus as much in early pregnancy as the general population of mothers did in advanced pregnancy. In late pregnancy, ART women had significantly more intense and protective emotional attachments to the fetus than women who spontaneously conceived. McMahon et al. (2011) found that with age taken into account, there was a strong association between ART conception and more intense maternal-fetal attachment. This is likely the result of extended anticipation of parenthood, investment in the process of conception and intimate awareness of the biology and timing of conception.

© infertile.com

© infertile.com

There remains a dearth of information on the experiences of ART women during childbirth. There exists one recent prospective multicenter study out of Finland on this topic (Poikkeus et al., 2014) which finds that dissatisfaction with childbirth was similar between ART women and controls with singleton pregnancies. The factors that have been previously found to be related to risk for a negative childbirth experience still remained true for both groups: low educational level, inadequate social support, dissatisfaction with her partner or spouse, untreated fear of childbirth and antenatal depression. Also recalled intolerable pain in birth and giving birth by emergency cesarean section increased dissatisfaction with birth. The authors’ conclusion was that dissatisfaction with childbirth was not related to mode of conception but rather lay with the underlying individual psychosocial and obstetric factors of each patient.

Recommendations for Care

While the body of research on the experience of women pregnant after infertility remains emergent, we can use what we know to help guide the most optimal and sensitive care for this population. Firstly, it is important to remember that this group is often invisible, particularly in the childbirth education classroom. The question “how many months did it take you to conceive?” or the unwitting quote from Ina May Gaskin “What got the baby in is what will get the baby out” will land quite differently on the ears of a woman who has gone through ART. In the clinical setting most if not all patients will share their mode of conception, but in the setting of CBE it may be kept private and language usage should be sensitive to this.

The within-group differences in an ART population can also be significant. A woman who needed help getting pregnant due to a very low sperm count in her male partner and conceived on her first round of IVF will likely have a different experience and outlook than a woman who has gone through multiple rounds of failed IVF for unexplained infertility and a miscarriage before having a term pregnancy with an egg donor. Each woman will be having her own unique experience.

The combination of early and intense attachment to the fetus as well as increased levels of pregnancy specific anxiety for ART women points to the need for frequent reassurance and quite possibly increased frequency of care, particularly in the first trimester and prior to quickening. Sensitive care during pregnancy can help transition a client, if appropriate, from a sense of herself as “high risk” and under specialty care to generalist obstetric or “low risk” midwifery care. Bell (2013) suggests that this reassurance will help women “slowly grow to trust in the process which is pregnancy, and … gain a sense of accomplishment and fulfillment as they continue to gestate” (p.51).

Promoting physiologic birth is the goal for all women including ART women. ART women are more likely to have protective social factors such as greater age, income, education and more stable relationships that can help increase satisfaction with childbirth but concurrently more likely to have characteristics such as older age, multiple gestation and preterm birth that lead to higher rates of obstetric intervention, which leads to a decreased satisfaction with childbirth. Working with each client’s individual strengths and limitations will help best prepare her for birth. For many women, feeling like they are active participants in their childbirth care and decision making is critical to their feeling of satisfaction. Involvement in this process may help a client regain a sense of control that may have been eroded during invasive and intensive infertility treatments.

While baby blues and postpartum depression and anxiety should be discussed with every client, understanding more about the psychology of ART women can help guide a practitioner to have a nuanced and sensitive discussion with these clients. A skilled provider or childbirth educator will be able to recognize and honor the joy and gratefulness that an expecting woman or couple feels after conceiving through ART, but also understand that this is likely layered with pregnancy-specific anxiety, a desire to regain some sense of control over one’s body or birth, and a vulnerability to postpartum mood disturbances. Anticipatory counseling including statements such as “some women who give birth after successful IVF treatments are surprised by the many ups and downs of caring for a newborn and may not have anticipated any negative feelings” or “no matter how glad you are to become a mother, it is normal to experience fatigue and feelings of ambivalence.” can help new parents allow their full range of feelings to surface. When mothers feel safe to share their feelings, more prompt identification and treatment of depression and anxiety is possible.

Understanding the prevalence of infertility and its psychological effects can help the childbirth educator, nurse, clinician or other birth professional provide sensitive and optimal care to the often invisible population of women or couples who are pregnant following infertility treatment.

Have you had families with a history of infertility in your childbirth classes?  As clients? What if anything did you do different to be sure to meet the needs of these families?  Can you share how you have handled this in your classroom environment?  Did your families choose to let you know?  Your thoughts and comments are valued in our discussion section below. – SM

References

Bell, K.M. (2013). Supporting childbearing families through infertility. International Journal of Childbirth Education, 28(3), 48-53.

Cousineau, T.M. & Domar, A.D. (2007). Psychological impact of infertility. Best Practice & Research Clinical Obstetrics and Gynaecology, 21(2), 293-308. doi: 10.1016/j.bpobgyn.2006.12.003

Chandra, A., Copen, E.E. & Stephen, E.H (2013). Infertility and impaired fecundity in the United States, 1982-2010: Data from the National Survey of Family Growth. National Health Statistics Report, 67, 1-18.

Fisher, J., Hammarberg, K. & Baker, G.(2008). Antenatal mood and fetal attachment after assisted conception. Fertility and Sterility, 89(5), 1103-1112. doi: 10.1016/j.fertnstert.2007.05.022

Hammarberg, K., Fisher, J. & Wynter, K. (2008). Psychological and social aspects of pregnancy, childbirth and early parenting after assisted conception: A systematic review. Human Reproduction Update, 14(5), 395-414. doi: 10.1093/humupd/dmn030

Hjelmstedt, A., Widstrom, A-M., Wramsby, H. & Collins, A. (2003). Patterns of emotional responses to pregnancy, experience of pregnancy and attitudes to parenthood among IVF couples: A longitudinal study. J Psychosom Obstet Gynecol, 24, 153-162.

Mascarenhas, M.N., Flaxman, S.R., Boerma, T., Vanderpoel, S. & Stevens, G.A. (2012). National, regional, and global trends in infertility prevalence since 1990: A systematic analysis of 277 health surveys. PLOS Medicine, 9(12), 1-12. doi: 10.1371/journal.pmed.1001356

McMahon, C.A., Boivin, J., Gibson, F.L., Hammarberg, K., Wynter, K., Saunders, D. & Fisher, J. (2011). Age at first birth, mode of conception and psychological wellbeing in pregnancy: Findings from the parental age and transition to parenthood Australia (PAPTA) study. Human Reproduction, 25(6), 1389-1398. doi: 10.1093/humrep/der076

Poikkeus, P., Saisto, T., Punamaki, R., Unkila-Kallio, L., Flykt, M., Vilska, S., Repokari, L. … (2014). Birth experience of women conceiving with assisted reproduction: A prospective multicenter study. Acta Obstet Gynecol Scand 2014; doi: 10.1111/aogs.12440
Practice Committee for the American Society of Reproductive Medicine (2013). Definitions of infertility and recurrent pregnancy loss: A committee opinion. Fertility and Sterility, 99(1), 63. doi: 10.1016/j.fertnstert.2012.09.023

Toscano, S.E. & Montgomery R.M. (2009). The lived experience of women pregnant (including preconception) post in vitro fertilization through the lens of virtual communities. Health Care for Women International, 30:11, 1014-1036. doi:10.1080/07399330903159700

About Emalee Danforth

Danforth Emalee head shotEmalee Danforth is a Certified Nurse-Midwife working in Seattle, WA. She practices at University Reproductive Care, the University of Washington’s infertility and reproductive endocrinology clinic. Previously she spent 5 busy years practicing full-scope midwifery in the hospital setting. She holds a BSN from the University of Michigan and an MSN from the University of Washington. She is also a co-facilitator of Maybe Baby, a resource and support group for LGBT persons on the path to parenthood.

Childbirth Education, Guest Posts, Perinatal Mood Disorders, Postpartum Depression, Series: Welcoming All Families , , , , , , ,

Series: Welcoming All Families – The Need for LGBTQ- Specific Childbirth Classes

June 24th, 2014 by avatar

By Kristin Kali, LM, CPM

© Kendra Quinn

© Kendra Quinn

Today on Science & Sensibility, as part of the occasional series, Welcoming All Families, midwife and educator Kristin Kali, LM, CPM shares information on holding a childbirth class that is designed specifically for LGBTQ families.  Kristin discusses the benefits of holding an LGBTQ class, provides some resources and offers additional information on content designed to meet the specific needs of LGBTQ families.  - Sharon Muza, Community Manager, Science & Sensibility

Take off your childbirth educator hat for a moment, and consider your own personal experience. If you are a member of a culturally marginalized group, (and if you do not identify as a member of a marginalized group – imagine) you know the difference between being in a space where you are welcomed and respected, versus being in a space with others who share a similar cultural experience, who speak a common language, and who have aspects of everyday life in common. In a space that is welcoming yet mixed, you may only discuss things you hold in common with those around you, unless you are willing to teach others around you in order for them to understand you and your experience. But if you are in a position of vulnerability, such as being pregnant, or in a class to prepare you for giving birth, you are not likely to discuss things that the people around you simply do not understand or do not have a context for.

Imagine being a lesbian, gay, bisexual, transgender or queer person who is going through pregnancy, with many of the same physiological concerns as any pregnant person, and with many of the same needs and desires, including the desire for a healthy baby, a positive birth experience, and a childbirth class to help assist in attaining that goal. Yet, although you have much in common, if you are in a class of primarily heterosexual couples, or even a class with many different types of families, some of the primary aspects of your experience of bringing this baby into the world and becoming a parent will not be shared.

© Firestone-Kahn 2013

© Firestone-Kahn 2013

Now put your childbirth educator hat back on again. As a childbirth educator, you might be thinking, “Well, there are many unique circumstances that people have when they come to a childbirth class – people may be coming from having dealt with infertility, military wives whose husbands are away at war, women who are giving birth as single moms. We are together to learn about giving birth, so that’s mostly what we talk about when the group comes together.” I invite childbirth educators to imagine any one of those unique scenarios, and envision if the class was full of people who had that scenario in common. How powerful would that be? What might be discussed in the safety of others who truly understand this experience? How might that affect the empowerment, strength and resolve of someone who is preparing for the prospect of giving birth and becoming a parent?

I can tell you, after 9 years of teaching specialized childbirth classes for LGBTQ families, that it is very powerful. When people live in a culture where their relationship may not be honored with the right to marry, when a child is born and a parent is not legally recognized as a parent and they have to prove themselves worthy to a social worker just to gain legal parentage (or perhaps legal parentage is not allowed in their state at all), when they didn’t simply have sex with their partner, rather they used all of their savings and maxed their credit cards just to get the funds for sperm so that they could conceive, it is such a relief to be in a group that has the same common denominator. More than that, it allows for camaraderie, and issues that are unique to families like theirs to be discussed.

In my childbirth classes, the families introduce themselves to each other with the “usual” information, such as name, due date and place of birth. However, before we get started with introductions, I briefly talk about the transformation of self that happens when a person becomes a parent, and as a person’s gender is so central to who they are, of course gender is central to that experience. I invite the introductions to include stating the pronoun that they prefer people to use in reference to them, and also what they plan for their baby to call them – maybe Mom or Dad, but perhaps a different word that more closely matches their gender such as Baba or Dadmom or anything else.

The second thing we do is share conception stories – I’ll bet this is not something discussed in heterosexual or mixed groups! But for the LGBTQ families in my class, the pregnancy experience started way before that little one was growing inside, and sharing these stories candidly establishes normalcy when the situation is not viewed as “the usual way” by society. Furthermore, families may be still be carrying emotional aspects of their conception process in a way that can impact the birth itself, or the partnership during the transition to new parenthood. Sharing conception stories brings me, as the instructor, up to date. It lets me know what happened for each family in the process of getting to this class, and anything important that I need to watch out for or hold space for with each parent-to-be.

Throughout the class, after setting the stage for open discussion and creating such a sense of safety, participants are likely to ask the important questions that they may not otherwise have asked. People feel free to be exactly who they are, not a guarded sense of “how much can I share about myself and not have the other parents look at me weird or be a spectacle”. We cover all the aspects of labor and birth that would be covered in any childbirth class. In fact, my class is based on a popular curriculum. I just bring together LGBTQ families and specifically discuss topics that are unique to this group within the context of the curriculum.

What makes an LGBTQ childbirth ed class so special? I will let the parents speak for themselves by sharing some of the feedback and comments I have received after class:

“There is something wonderfully supportive about being surrounded by other queer families. It created a truly safe and inclusive space where our LGBT experience was at the center, and not just touched on as an aside or an exception to the norm.”

“I am so grateful for this class. Going in as a queer family, not having to translate from everyone else’s ‘normal,’ not needing to explain our family was great.”

“As a gender variant pregnant woman, this class provided support and community that is often lacking in society at large.”

“I needed to voice fears and have time to ask questions in a non-judgmental space.”

“It’s not just about using neutral pronouns and terms (like “birth parent” instead of “mom”). It’s  great to be in a room full of queer folks who understand my experience, so I feel like my queer specific questions are adding to the group’s experience rather than distracting or pulling the class off on a tangent.”

As an educator, it is important to be able to inform people about what to expect, and to be able to hold people as they explore their thoughts and feelings in relation to the class material. While LGBTQ families may have a lot in common, each family is unique. There is a broad range of family structures, conception histories, gender issues, co-parenting strategies, and interpersonal dynamics to explore, all in relation to giving birth and caring for a newborn.

For those who are interested in teaching childbirth classes for LGBTQ families, there are a number of considerations. Are there enough families in your community to support an exclusive class? Even if you are an LGBTQ person, do you have experience working with a variety of LGBTQ people in the process of becoming parents? Are you able to name common birth and postpartum dynamics that come up in lesbian partnerships, for transgender parents, and extended co-parent families?

You can educate yourself by reading books about LGBTQ family- building:

The New Essential Guide to Lesbian Conception, Pregnancy and Birth
And Baby Makes More
Confessions of the Other Mother

Attend an LGBTQ cultural sensitivity training that is specific to birth and family-building:

MAIA Midwifery LGBTQ Cultural Sensitivity Trainings

Check out websites and blogs about LGBTQ parenting:

http://www.mombian.com/
http://www.lesbiandad.net/
http://itsconceivablenow.com/
http://www.milkjunkies.net/

I do not recommend that non-LGBTQ allies teach this specialized class. Instead, enthusiastically refer LGBTQ families to a specialized class if there is one in your area, explaining the value that so many families have found in attending a childbirth class with other queer families. (Read about ways to make your mixed class supportive for LGBTQ families here and a lesbian couple’s CBE class experience  here.)  The sense of safety that is created when a marginalized group gathers exclusively allows something to happen that would not happen in a mixed group. Being in “safe space” provides a sense of common understanding that goes way beyond welcome and acceptance. It allows for dialogue regarding a common lived experience and a shared cultural identity. There is a sense of knowing – not needing to explain the things that to an outsider could be explained, but would not truly be understood without direct, lived experience. Kind of like becoming a parent.

If you are interested in teaching childbirth classes for LGBTQ families in your community, please don’t hesitate to contact me.

Are there educators in your community who teach LGBTQ childbirth classes?  Maybe you are one of those educators?  Do you see the need for such classes in your community?  Share your experiences and observations with our readers on specialized classes such as this. – SM

About Kristin Kali

© Kristin Kali

© Kristin Kali

Kristin Kali, LM CPM is the owner of MAIA Midwifery and Fertility Services, a fertility-focused midwifery practice that provides holistic, individualized care. MAIA serves all families, with specific expertise in serving LGBTQ families, single parents by choice, transgender parents and those conceiving over 40. Fertility consultations, classes and support groups are available in Seattle, Oakland, and online.

Kristin is a Certified Professional Midwife through the North American Registry of Midwives. She is a Licensed Midwife in California and Washington. Kristin is a graduate of Seattle Midwifery School and a member of the Midwives Association of North America, National Association of Certified Professional Midwives, American Society for Reproductive Medicine, Gay and Lesbian Medical Association, California Association of Midwives, and Midwives Association of Washington State.

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Series: Welcoming All Families; Working with Women of Color – Educator Information

February 27th, 2014 by avatar

By Tamara Hawkins, RN, MSN, FNP, IBCLC, CHHC, LCCE

Today, contributor Tamara Hawkins, RN, MSN, FNP, IBCLC, CHHC, LCCE finishes her two part post series “Welcoming All Families; Working With Families of Color” with a fantastic post on evaluating how well your classes are meeting the needs of Women of Color and tips and information to create a space that welcomes and celebrates WOC and their families.  While, February is Black History Month, educators have a responsibility to offer classes that are inviting and appropriate for WOC all year long. Find Tamara’s first post here. – Sharon Muza, Community Manager, Science & Sensibility. 

black mother and newborn

© David Blumenkrantz

Are your classes inviting and supportive for Women of Color? Or are WOC not your “target market”? I received a comment after sharing my post about Tuesday’s Welcoming All Families; Working with Women of Color blog post; “Sadly many of my (as you say) ‘women of color’ friends, associates and even just casual acquaintances have told me straight up ‘you don’t need to do all that!’,” referring to the belief that taking a childbirth class is not really a valuable or important part of preparing to have a baby for African American women. I believe that it will take more than a few focus groups to get to the bottom of why some WOC do not feel the need to take childbirth education. In today’s post, I would like to focus on childbirth educators! How can childbirth educators be sure their classes are appropriate and inviting to Women of Color?

Prior education experiences

The first thing childbirth educators have to be aware of is that people are more likely to connect with people of their own culture. An example of this; a vegan may be more likely to seek out health care from a provider who blogs about a vegan lifestyle. WOC and other ethnic communities will seek out education from a provider they can relate to culturally. At the least, the educator will have proven to be sensitive to their needs whether those needs are cultural, ethnic or economic. Vontress writes in the Journal of Multicultural Counseling and Development, “Members of minority groups bring an experience of consciously having to negotiate and even survive educational treatment of invisibility or negative ultra-visibility,[ultra-visibility; being singled out or made to be the “token” Black person], lower expectations, stereotyping, hostility and even abuse.” If an expectant mother or her partner has ever had this type of experience, why would they want to sit in yet another class and perhaps have those same feelings brought up all over again? What if they are presently feeling dismissed, their concerns ignored and rushed with their health care provider? Childbirth educators have the responsibility to understand this and make our classes welcoming by using language and images that subconsciously allude to our support and equal treatment and understanding of families of color.

I am guilty of saying “the baby’s mouth and lips should look pink to indicate great oxygenation.” A WOC in class raised her hand and said, “Even brown babies?” I responded “Well, yes, especially a newborn.” Be mindful that WOC have babies of all color hues. Some babies may be dark when born and others may be very light. Darker hued mothers who have not been around newborns may not know to expect their newborn to look light skinned.  A culturally sensitive childbirth educator should mention this fact, so that all families can be prepared. During early pregnancy class, talk about how WOC may experience expansion of the areola and that yes even though they may have dark areolas to start, the areolas can get darker. In discussions about nutrition, talk about soul food cooked in a healthy flair. Remember that the standard American diet is not a one size fit all solution. The Physician Committee for Responsible Medicine mentions 70 percent of African Americans are lactose intolerant (compared with only 25 percent of whites) and may suffer from cramping, diarrhea, and bloating after eating dairy products. Encouraging a WOC to have cheese and yogurt to get calcium and added protein may not be the best advice. Offer alternatives that are appropriate for everyone.

Marketing and teaching materials

Next, evaluate your marketing materials. Have you placed images of women of color on your website, brochures, and social media pages? Do you keep up with the health disparities and concerns for women of color? Do the images on your classroom walls or your teaching posters represent a wide variety of ethnicities?

Review your teaching materials. Do you show birth and breastfeeding images of WOC? Are there images of WOC exercising, eating well, and asking questions of their care providers? In order to effect behaviorial change, one has to be able to envision oneself doing something similar. A great example is a commercial from fatherhood.gov. This videos features an African American dad learning cheerleading moves with his daughter with the grandmother listening and approving of the interaction in the background. AA women love this commercial because we remember performing the same type of cheers when we were young. This type of imaging will promote interest in fatherhood and also plant a seed in the minds of some men that it’s okay to spend daddy-daughter time, maybe even doing something fun or a little silly. The commercial would not be as effective if it showed a Caucasian father doing the same thing. There would be no connection. And if there is no connection, there is no assimilation, and therefore no change in behavior. When expecting parents can see themselves in the “role models” then they can see themselves emulating this behavior with their own children, or their own birth or breastfeeding experience.

Be ready to make change

Once your evaluation is complete, make some changes. There are not many sources to purchase ready made childbirth class images of women and families of color. Don’t hesitate to create your own. Look for images of AA couples on sites such as Shutterstock, Corbis Images , iStockphoto, or Fotosearch. Then use some creativity to create posters and images you can use! Or better yet, have a contest in your classes, asking them to create a poster. Invest in videos that show women of color birthing and breastfeeding. I use Injoy’s products in my classes as I find their videos do a good job representing multicultural families.

In Injoy’s “Miracle of Birth 4″ video, Natasha’s birth shows a biracial couple experiencing a birth supported with analgesia. In “Understanding Labor 2″ and the “Miracle of Birth 3,” Chelsea’s birth follows a young African American couple as they have an epidural birth with augmentation. Daniela’s birth follows a bi-lingual Spanish speaking couple as they have a cesarean birth. Injoy offers an option to purchase these videos individually which is great for a limited budget. The Baby Center has a video of Samiyyah‘s birth center birth which can be imbedded in PowerPoint presentations or played on a monitor. Unlike the well edited and discreet videos Injoy offers, this Baby Center video feels raw and uncut. Be prepared with Kleenex. This birth is a great lead in into discussing orgasmic birth, normal birth emotions, vocalization for pain relief and the fetal ejection reflex during pushing.

Language used when addressing health concerns of African American women is important. As an instructor, you don’t want to talk about pre-eclampsia and preterm birth in a manner that assumes that AA women should already know they are at higher risk for these diseases, but rather frame it as health care workers and researchers are uncovering higher rates of pre-term birth, diabetes, cesareans and lower rates of breastfeeding in the AA community. Presenting these subjects in this fashion, as an awareness among health care providers, may remove any feelings of guilt or negative self-consciousness for those who may not know the information ahead of attending class. Sources to find information related to women of color include Office of Minority Health, March of Dimes, Womenshealth.gov and Women’s Health Guide to Breastfeeding.

Create an event

Consider bringing in guest speakers to your class. Is there a WOC birth advocate in your area that has a large following? Collaborate with her to spread the word. Can you host a Twitter chat or Facebook party discussing your intent to serve the needs of WOC and clarifying the wants and needs of your birth community. Have WHO code compliant corporations donate products for a baby shower or a baby fair. Ideas for a fair may include a pediatric dentist who discusses the important of infant oral care. Bring in a safety expert who will discuss and demonstrate car seat safety and installation. Have a prenatal fitness expert and/or nutritional counselor to discuss food and the connection to gestational diabetes. A community midwife or OB can discuss the impact of lifestyle choices on the risks of developing pre-eclampsia, diabetes related to induction and cesarean births and low birth weight babies. Conclude the event with a game show set up like Family Feud with topics covering medical options, comfort techniques and support strategies for breastfeeding families. Having a fun event always draw crowds.

Offer tiered pricing

Are your classes accessible on an economic level? Do you accept insurance or have a sliding scale for families. The National Health Service Corp has a great resource on how to set-up a discount fee schedule. Is your practice set up to accept social service coupons or Medicaid for childbirth class subsidies such as what Washington State offers? The Kaiser Family Foundation reports 27 states out of 44 that responded to their Medicaid Coverage of Prenatal Services Survey offer coverage for childbirth education. Independent instructors will have to research their own state Medicaid offices for specific information on provider eligibility and reimbursement rates. When receiving reduced fees or subsidies, it may be tempted to schedule classes during the day. Please remember even people on Medicaid or WIC have jobs. Let’s respect that and offer flexible schedules for classes in the evening and on weekends.

Can you set up scholarships? Human Resources and Services Administration has several large grants available to serve the maternal child health community. The March of Dimes has scholarships available for grants reducing disparities in birth outcomes. The What to Expect Foundation has a new program to teach practices that build a healthy pregnancy. The wonderful Kellogg Foundation is another resource to tap into for help building a program to be inclusive and inviting to women of color.

Community connections

Do you have local resources so you can connect AA women to WOC birth workers that share their ethnicity and culture? Sista Midwife Productions has a resource list by state of birth workers of color. If we have to refer out to help a mother feel more comfortable and get what she needs rather than what we have to offer, that’s a win-win situation.

Educators need to learn from the clients they serve. We have to ask the community what information is important to WOC. The Black Mothers Breastfeeding Association can serve as a template to build networks that educate and support pregnant WOC. Invite mothers and fathers of color to lead groups for expectant parents. Groups can cover topics such as how to have conversations about birth options, cultural expectations of birthing mothers and parenting styles and ethnic cooking with a healthy spin and specific topics related to controlling or preventing gestational diabetes and pre-eclampsia, reducing cesarean birth and increasing breastfeeding success.

In order to attract WOC to our classes, educators need to become culturally sensitive and appropriate. Evaluations of our marketing and teaching materials are in order to ensure inclusion of AA women. Educators have to be up to date on the statistics and health facts and challenges facing AA families. Our hospitals, birthing centers, birth support groups and networks should brainstorm ways to fund and provide scholarships and/or grants to make classes economically feasible. Lastly, if we are serious about supporting all mothers and helping them to have a safe and healthy birth, let’s build and support local birth support groups.

Change can be challenging. Start with small goals. The first step is self-evaluation. What had been working and what can be improved? Share your resources? Where do you find images and videos that are welcoming to women of color and all ethnicities? After you have evaluated your program, come back and let me know what worked and did not work. If you need some help, please contact me. I’m excited to try some of these resources myself. I’ll keep you posted on my Facebook page.

References

Vontress, C. “A Personal Retrospective on Cross Cultural Counseling.” Journal of Multicultural Counseling and Development, 1996, 24, 156-166

About Tamara Hawkins

tamara hawkins head shotTamara Hawkins, RN, MSN, FNP, IBCLC, CHHC, LCCE is the director of Stork and Cradle, Inc offering Prenatal Education and Breastfeeding Support. She graduated with a BSN from New York University and a MSN from SUNY Downstate Medical Center. She is a Family Nurse Practitioner and has worked with mothers and babies for the past 16 years at various NYC medical centers and the Elizabeth Seton Childbearing Center. Tamara has been certified to teach childbirth classes since 1999 and in 2004 became a Lamaze Certified Childbirth Educator and an International Board Certified Lactation Consultant.  Follow Tamara on Twitter: @TamaraFNP_IBCLC

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Series: Welcoming All Families; Working with Women of Color

February 25th, 2014 by avatar

By Tamara Hawkins, RN, MSN, FNP, IBCLC, CHHC, LCCE

In honor of Black History Month, and as part of Science & Sensibility’s occasional series on welcoming all families to our classrooms and practices, Tamara Hawkins, RN, MSN, FNP, IBCLC, CHHC, LCCE writes a two part post for the series speaking to meeting the needs of families of color.  Today, Tamara shares some insights into the experiences of women of color and their families in childbirth classes and on Thursday, Tamara will discuss how educators can make their classes friendly to women of color and their partners, with information and resources for the educator as well as other birth professionals. – Sharon Muza, Community Manager, Science & Sensibility

© Williams Family

© Williams Family

In my second year of nursing school, I gave birth to my daughter. When pregnant with her, I faced the choice of taking a Lamaze class or completing my Biochemistry course. Both classes were on the same night.  I wanted to become a midwife and knew the benefits of birthing with the least amount of interventions. I also knew the stigma I would face as a single young Black mother so I prioritized and choose Biochemistry. I had to complete my semester before giving birth. I did not even think of taking a class other than what was offered at the hospital. I was not offered any alternatives either.  I thought to myself, “How difficult could labor be? It all seemed so simple.” In preparation, I read the book, Preparation for Birth: The Complete Guide to the Lamaze Method by Beverly Savage and Diana Simkin.  I was ready with the electric massager and my birth plan.

I never second thought the benefits of Lamaze class or thought it wasn’t something Black women did, however I clearly remembered people saying, “Why do you want to take that class?” “You don’t need that,” or just laughing because somehow I should’ve just known what to do and didn’t. Women in my neighborhood started having babies as teenagers.  In the prenatal clinic, there was limited information about birthing options and childbirth education other than the public education programs that played endlessly on a loop in the waiting room. Grandmothers, who were mostly the primary caretakers, would expect the girls to tough it out without pain relief as this could be seen as punishment for getting pregnant so early. Some mothers hoped it would serve as a deterrent to getting pregnant again. Childbirth education was not an expectation as past generations just knew to go to the hospital when the pain got too bad. I was just expected to know to move and breath and squat and groan with the contractions and to just deal with the pain. The baby would eventually come out.

A few months after the birth, I wished I had taken a class. I had a horrible birth and breastfeeding experience.  The book and “barely there” labor support was not enough to get me through the emotional challenges of labor. I needed more. I needed practice. I needed discussion. I needed to know the real deal and how to navigate the system. From my birth experience, I knew childbirth education was an essential path to have a beautiful normal birth experience.  I felt so passionate about this that I became a Lamaze certified childbirth educator.

The women I get to mentor in my childbirth classes come from different cultures and backgrounds than I do. They have different fears and concerns. What troubles me is the low attendance of women of color (WOC) in childbirth classes. Lamaze class is about learning healthy habits, building confidence and facing fears. Techniques shared in class help women create solutions for potential labor scenarios and manage labor pain while partners learn skills to comfort and protect moms in labor and to communicate effectively with care providers. This is especially important for African American (AA) women.

The Office of Minority Health reports AA women have 2.3 times the infant mortality rate as non-Hispanic whites.  AA women have twice the rate of sudden infant death syndrome and are 2.3 times more likely to begin prenatal care in the 3rd trimester than non-Hispanic white women. (Mathews, et al, 2013)  The cesarean birth rate amongst AA women is no better.  The rate of cesarean delivery declined among non-Hispanic white women for the third straight year to 32.3% in 2012. The 2012 cesarean rates rose, however, among non-Hispanic black (35.8%) and Hispanic (32.2%) women.  (Hamilton, et al, 2013)  Amnesty International 2010 report, Deadly Delivery: The Maternal Health Care Crisis in the USA revealed AA women are nearly four times more likely to die of pregnancy-related complications than white women. These rates and disparities have not improved in more than 20 years. (Amnesty International, 2010)

Attending childbirth class is a path, and some people may say, a Rite of Passage to achieve better health, better birth outcomes and better breastfeeding for African American Women.  For the past two years, R.O.S.E., Women E-News and MomsRising have hosted a twitter chat (#blkbfing) encouraging women of color to breastfeed. These organizations also have to emphasize breastfeeding success starts with a normal birth, minimal interventions and a healthy mother.  Skills and techniques learned in Lamaze classes support these outcomes.

So, if we know the health disparities that affect WOC during pregnancy and birth and the government knows, how can I and other educators reach and encourage more attendance in Lamaze class. Does the instructor need to look a certain way? Are childbirth classes just for white women?  I sat down with Domineque and her husband Davon who delivered in New York City, NY and Reese McGillie, who birthed in Seattle, WA to talk about their experience attending a childbirth classes as women of color.

Tamara: Tell me about your experience in childbirth class? Were you the only African American in class?

Domineque: Well to start off as a new mom and WOC, I was really unsure what to expect at a Lamaze class.  However, after discussing things with my husband and talking to others, we decided to give it a try.  I wanted to know what others thought of Lamaze class. No one I knew ever attended one. As a school teacher, I am always into learning new things. I was nervous and afraid as this was a surprised pregnancy. I wanted everything to go right. I searched websites constantly and read tons of books. I must say I had a great experience. I felt a warm welcome and was very comfortable there. I don’t remember now if we were the only AA couple. (chuckles) I think we were, but I wasn’t bothered by that.

© McGillie Family

© McGillie Family

Reese: I had a familiar feeling of being the only AA woman in the class. It did not bother me during class. I might call it being complacent. Typically, I expect to be the only AA woman in classes, conferences and trainings. I had a great learning experience in my childbirth class. In hindsight, it would have been nice to have other AA women in attendance to not feel alone even though I was in a class full of people. You know, sort of having the ability to meet and join up with some Sista friends. Perhaps it was a combination of my security as a AA woman but sitting in that room, I knew no matter what, my experience would be different. I’m sure the other mothers did not worry about arriving at the hospital and having someone question them about their level of education, adequate prenatal care, whether they were married or even had a partner or even their competency level to parent their child.

TH: Do you feel the class touched upon topics specific to African American women such as higher rates of preterm labor, pre-eclampsia and lower rates of breastfeeding?

Reese: No. I wish it did. Twice I faced pre-term labor.  My first baby was born at 34 weeks. I was sad and afraid especially because I could not get a clear answer as to why I was having pre-term labor. It would have been nice to know sometimes preterm births happen more in AA women and that the exact reasons why are unknown in most cases.

TH: Do you think learning about the risks associated with birthing and being AA would make a mother more or less anxious about the process?

Domineque: I believe it would make anyone more anxious when the topic is introduced.  Giving strategies to reduce preterm birth such as recognizing labor contractions, how to time contractions, how to rest and hydrate oneself was discussed in class but not in the context of this only happens or happens more to AA women. We discussed pre-eclampsia in class but again not geared towards AA women. If it was just discussed as something that AA women experience more than other ethnicities, I might have felt singled out and self conscious. I did not know AA women experienced higher rates of pre-term births and pre-eclampsia. I am not sure if learning that specifically in class would have changed my learning experience.

TH: Did friends or family try to talk you out of the class? If so, what were their reasons for suggesting you not to take a class?

Domineque:  I didn’t get persuaded or dissuaded from others. No one in my circle attended a childbirth class and really had no input into the decision. My husband and I talked about our fears of being young parents, newlyweds and my desire to have an unmedicated birth. We agreed to do it. Thank goodness no one tried to dissuade us.

Reese: I was encouraged to attend childbirth classes by my midwife. It was an expectation. I was excited to take a class with Penny Simkin.

TH: Did it make a difference to you whether your instructor  was African American?

Domineque: No. I wanted someone who was experienced and fun. My biggest concern about attending a Lamaze class is  whether or not it was going to be boring and just filled with breathing exercises.

Reese: No. I was already reading a book Penny Simkin authored and was excited to attend her class

TH: What were two skills you learned in class that you were able to apply in labor and/or after giving birth?

Domineque:  Lamaze classes prepared me for a safe, healthy birth. I also learned about breathing and relaxation. Most importantly, I learned coping strategies and movement techniques. The class also gave me practical advice on how to start breastfeeding such as holding the baby skin to skin. I was able to breastfeed Dyllan for a long time. I was even surprised how easy it was to nurse in public. During our childbirth class there was a video clip of an AA woman breastfeeding her baby immediately after birth and I thought “Wow, I want to do that.”

TH: Did seeing images of AA women in birth and breastfeeding change your feelings or make you more confident about what you would be able to do in your birth?

© McGillie Family

© McGillie Family

Reese: Yes. Absolutely. I remember clearly the AA couple’s birth story in class. She seemed powerful. She was not in a hospital and it influenced my belief that even AA women could have beautiful experiences. That having great births were not just reserved for Caucasian women or those with money.

TH: What would you tell another African American mother about taking a childbirth class?

Domineque: I would tell them that after leaving the Lamaze class, I felt comfortable with breathing strategies and more at ease and confident. It was definitely worth it. The class prepared me to have conservations with my care providers.  One of the best parts of class was practicing the use of the acronym B.R.A.I.N. I was learning how to assert myself in situations where I was taught the doctors knew everything and I shouldn’t question what was happening.

TH: Davon, what would you tell AA men about taking a childbirth class?

Davon: As a husband, I would tell all partners, not just AA men, to weigh out options on pain medication vs. no pain medication and be there to support your spouse every step of the way. I believe a lot couples choose not to attend a Lamaze class because they think all that’s needed is an epidural. I learned there is so much more to birth than just the physical pain of the contractions. A woman needs the most support during vulnerable times like deciding when to go to the hospital and help her to advocate for walking and changing positions in labor.  My wife and I worked hard together to get through labor.  Support is key.  My wife was able to have an unmedicated birth using the techniques we learned and practiced in class.

TH: I have a few questions for the readers:

Is the Millennial generation of AA woman easier to reach and educate through social media instead of traditional classes?  Are you an AA mother who attended a childbirth class? What was your experience? Were your needs met in class? If you did not take a class, how did you prepare for birth? Did friends and family support your decision or turn their nose up at you?

I am grateful these two women shared their experiences with me. They even gave me insight as an AA woman and instructor to become more sensitive to how I run my classes. I find myself wanting to be more inclusive and not make race an issue, at least not in birth. Is there any situation in life that race does not play a role? Stay tuned for my post on Thursday that will include resources on how to make classes culturally sensitive and welcoming to AA families.

References

Amnesty International. (2010). Deadly Delivery: The Maternal Health Care Crisis in the USA.

Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2012. National vital statistics reports; vol 62, no 3. Hyattsville, MD: National Center for Health Statistics. 2013.

Mathews TJ, MacDorman MF. Infant mortality statistics from the 2009 period linked birth/infant death data set. National vital statistics reports; vol 61 no 8. Hyattsville, MD: National Centers for Health Statistics. 2013.

About Tamara Hawkins

tamara hawkins head shotTamara Hawkins, RN, MSN, FNP, IBCLC, CHHC, LCCE is the director of Stork and Cradle, Inc offering Prenatal Education and Breastfeeding Support. She graduated with a BSN from New York University and a MSN from SUNY Downstate Medical Center. She is a Family Nurse Practitioner and has worked with mothers and babies for the past 16 years at various NYC medical centers and the Elizabeth Seton Childbearing Center. Tamara has been certified to teach childbirth classes since 1999 and in 2004 became a Lamaze Certified Childbirth Educator and an International Board Certified Lactation Consultant.  Follow Tamara on Twitter: @TamaraFNP_IBCLC

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