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Attention all Childbirth Educators! We Want to Hear from You!

Last week, we featured a post that garnered an on-going, dynamic debate over what information childbirth educators should, and should not address during prenatal classes.  Emotions ran high, discussion points were divisive: teach only that which you are an expert in, or be prepared to provide information on whatever expectant parents ask about (pertaining to pregnancy, birth and post-partum baby/parenting life).

And so, the dialog got me thinking.  Along with the issue of childhood vaccinations, many other topics exist out there which we childbirth educators may find ourselves faced with in class–perhaps lacking sufficient information with which to reply to our eagerly awaiting students.

And so, I pass the baton to you:

1. What student questions have you faced in class (or are most apprehensive about facing) that have provided the greatest challenge to you?

2. How did/do you address this question?

*Please forward this post to members of your own birth-related network(s).  The more discussion we can generate here, the greater learning opportunity for us all!

 

 

Posted by:  Kimmelin Hull, PA, LCCE

Childbirth Education, Different Methods for Different Questions , , , , , , , ,

  1. April 4th, 2011 at 04:41 | #1

    1. The trickiest question I’ve had yet was about cord blood banking: how they do it and “is it worth the money”.

    2. I provided a general answer as far as how it’s done, and referred the student back to their provider to discuss the second question. Then I read the recent JPE article about it three times to make sure I was equipped to handle questions about it in the future.

  2. April 4th, 2011 at 08:44 | #2

    Circumcision is a tough one for me both as an educator and as a doula. I have taught classes where I provide the evidence & show a video. Other times, I just provide some handouts. My biggest struggle last time was that I had two second-time parents, both of whom had circumcised their first sons. I really care about these people and don’t want to put them down, yet I do feel that ethically I have a responsibility to provide information that will keep their babies safe. When we teach about birth interventions, we try to do the same, but this is just such a heated topic.

  3. April 4th, 2011 at 15:14 | #3

    The trickiest questions for me are the ones tangled up in birth politics. A common example arises when discussing medical interventions. It’s often a dad who will say “Well, why can’t we just say no?”

    I try to gently point out the ways that saying no can be so much harder in the tired, vulnerable, unknown of birth. Of how providers can give you choices that are not complete or include the unhealthy-baby-card (“You can either have a nice relaxed c-section now, or an emergency one later when the baby suddenly gets stressed from this long labor”)

    I actually love, and encourage, questions I don’t know the answers to, because then I go research it for the following week and learn something in the process. Clearly only feasible for things like “how long is the average umbilical cord?” vs “should I vaccinate my child?”!!

    BTW, my favorite ever question was asked when I was waving an amnihook around. A rather quiet dad suddenly said (sounding just a tad inadequate!) “Why is that thing so darned long!”

  4. April 4th, 2011 at 15:32 | #4

    The biggest problem I have is in answering
    1. what contractions feel like
    2. how each woman’s labor will go
    3. how long labor will last
    4. what will it be like for me? types of questions.
    every woman is different and when we look at the “typical 12 hour labor” information, it is hard to communicate that “YOUR LABOR WILL BE NOTHING LIKE THIS”, yet also convey confidence that “this is what labor is like”
    You know what I’m saying?

    I always emphasise that every woman and baby is different, but I don’t think people think that. I think that they see the “typical labor” and compare it to the stories they have heard in labor and then do some sort of math equation to determine what their labor will be like…. and then expect that.

  5. April 4th, 2011 at 18:28 | #5

    I LOVE questions I have no answer for…as they compell me to step outside of my self as knowledge holder and really listen to what is being asked…what is the question offering an opportunity for group to consider?

    That being said, “do I have to breastfeed”? is a rare courageous and politically difficult question to answer. Some others in my area that come up:
    What if I have a panic attack in labor?
    What if I have a flashback during labor?
    What if my perpetrator shows up for birth?
    What if nurse tells me I am bad mom for taking meds(psychotropic medication)?
    How will nurse understand I don’t want to breastfeed because of my past abuse?
    I want to use the nursery…how can I without feeling like a bad mom?
    My partner wants to be at birth, but he/she doesn’t know my abuse issues….
    I can’t have an IV because needles trigger flashbacks…

  6. April 4th, 2011 at 18:34 | #6

    This is a great discussion question. First I’ll answer the “what should I know?” question. I feel responsible for having good answers to all questions an expecting couple might have. I am constantly reading articles and asking questions of doctors, midwives, and other doulas so I can know everything possible. After all, if I only answer questions I am expert in, where will the student go for answers? Their friends? Parenting Magazine? Weird internet sites? Dr. Amy? (God forbid!) Especially with breastfeeding I encourage parents to listen most to breastfeeding experts. I tell them the basics I know and strongly encourage LLL or a trusted LC.

    All of the above questions others listed are so good and relavant. I think my hardest answers are after birth when a couple might be asking “why did x happen?” Why did we end up with preeclampsia, pitocin, PROM, c-section, fetal distress, epidural, etc? My “method” – Bradley – stresses unmedicated births so strongly that women can feel like failures. I find it so hard to strike a balance between emphasizing evidence-based maternity care and accepting that our US maternity care is largely NOT evidence-based.

  7. avatar
    Bron NZCBE
    April 4th, 2011 at 18:40 | #7

    I teach classes in Rotorua NZ, our maternity system is midwifery focused with each woman having a Lead Maternity Carer, the vast majority of times this is a midwife. So as a Childbirth Educators we do not face some of the challenges of our international counterparts. Epidural rate at our local hospital is under 1% (for pain releif, does not include epidurals/spinals for C-section), C-section rates mid to high 20s, induction rates a little less, instrumental birth around 4-6%. So the people who attend our classes have a reasonably high expectation of a normal vaginal birth, however I still see a fairly high level of fear among pregnant women which is a mindset often difficult to shift. I have been teaching classes for 7+ years and when talking about labour always used to give approximate times for each stage and talk about cms dilated,length of contractions etc. For the last year (6 classes) I have not so much as mentioned a time or a centimetre, I talk about the opening up stage where your cervix goes from tightly closed to fully open,the pushing out stage where your baby travels from the opening of your uterus, through the birth canal and out into the world, and the welcoming stage where you welcome your baby and birth the placenta. In that time I have been asked exactly “ONE” questions about how long? It was a question about how long the pushing stage may last….may answer “was however long it takes to get baby out, maybe somewhere between 2 minutes and 2 hours, depending on how many babies you’ve had, what position you’re in, what has happened before that time. My question to the group was “how do you know how long is too long” and because we had been touching on it all throuhg the class prior to this the answer came back “when mum’s not coping or babe’s not coping” How will you know that? “mum will tell you or babe’s heart rate will tell you” I’m so glad to be teaching somewhere that has a good possibility of that being true in practice as well as in an ideal world!

  8. April 4th, 2011 at 18:42 | #8

    I think no matter what questions come at us we can always respond in the same way (something that I learned as a La Leche League leader): Give information and not advice. I always direct women to books and websites so they can gather their own information and make their own decisions.

  9. avatar
    Judith
    April 4th, 2011 at 18:57 | #9

    some of these questions point to the opportunity for a woman to look within herself and not just using “experts”. we also serve women when they are able to contribute and we direct questions back to them. how long were your mother’s labors? what is in your family history? one of the great things about pregnancy, labor and birth is that there are many great unknowables and we need to trust in ourselves and also give ourselves over, surrender.

  10. April 4th, 2011 at 20:44 | #10

    What I find disturbing at times is the questions people don’t ask. They seem rather oblivious to the whole process of childbirth and they seem okay with that. I have to be okay with their being okay with a lack of information and interest in understanding variables, options, procedures, differing approaches and philosophies,etc. Each couple, or woman, is in a different place regarding childbirth and I have to respect their journey without being too pushy or overly informative.

  11. April 4th, 2011 at 21:00 | #11

    Judith,

    You bring up an important point–one especially applicable when interacting with women/couples approaching birth for the first time. The big unknown of ‘how will it go for me?’ is agonizing for so many women and is, of course, a question that is (specifically) unanswerable. I suppose the general response I have tended to use with couples in the past, when faced with this question is, “how it goes for you depends a lot on how much you prepare for your birth” (plus, “how nimble you can remain with the labor and birth process, once it begins”–the art of surrendering, as you aptly point out.) And yes, genetics, chance, environment…all those things have a HUGE impact as well.

    Thanks to ALL so far for sharing!

  12. avatar
    Rachel
    April 5th, 2011 at 10:22 | #12

    I try to present information in a way that will lead parents to make an informed decision – what the risks are, what the benefits are, address what they have “heard” about it, and dispel the rumors as much as possible. This is particularly true when talking about pain meds – and wanting to respect that every person feels pain in a unique way, and trying to be sensitive to not creating any feeling of guilt after the birth, I find the hardest question to be “what should we do?” to solicit my opinion. My answer usually starts with, “it depends…” but I get in into tricky territory here, as I go into “risks” again and “tolerance for pain” which feels like an answer and not just “information.” I have similar difficulty in talking about episiotomy, as I don’t want to them to question the judgment of their doctor, since their faith in him/her is important to their retrospective perception of the birth experience, too. I guess overall I feel that the most important thing in my education is to protect the woman’s perception of the birth after the fact – allow room for lots of situations to occur without risking that she feel guilty afterwards, or wonder if she somehow failed or made bad decisions.

  13. April 5th, 2011 at 22:12 | #13

    Other comments sent in by Science & Sensibility readers:

    “…I think the issue of circumcision for boy babies is certainly a hot topic…I provide information and try to give them most knowledge possible with which to make an educated decision. If they ask me what we did (I have 2 boys), I share our decision with them and why we chose to do what we did, but always within the context of the available research.”–Lisa B.

    “In answer to your questions, probably the most challenging question that I have ever had in 36 years of teaching childbirth classes came very early in my teaching career. I had just returned to teaching about 12 weeks after having had my second child. We were going to do a few prenatal exercises just before our evening break. I was explaining the exercise and the benefits when a father said he had a question for me. He said “You just had a baby recently right?” to which I replied yes. “I want to know then when my wife is going to look like you and not a fat cow.” Needless-to-say I was absolutely speechless and so embarrassed for his wife. After a few deep breaths I told him “Pregnancy is a beautiful time in a woman’s life and weight gain is an essential part of having a healthy baby and your wife looks wonderful,” and then we promptly took our break. During the course of the class I was able to spend a little time with them and learned the pregnancy was not planned and I eventually suggested they might benefit from speaking to someone about the stress of another baby. Fortunately another situation like that has never occurred.” –Linda H.

  14. avatar
    Caroline W
    April 6th, 2011 at 11:27 | #14

    I taught childbirth classes for almost 30 years in a variety of settings including hospital, clinics, birth centers, and home birth practices. In the beginning of a series I gave out a list of commonly covered material and frequently asked questions and asked the class on a scale of 1-10 to let me know what they were interested in learning. I also provided a space to list what they would want to know about even if it wasn’t covered on my list. I would get an idea how to gear my classes and custom tailor what I taught to the interest of the class. This was more effective than a 1 size fits all program that I started out with . interests could vary widely, when clients had a sense of being in the driver seat about some of the content they tended to complete the entire series

    There was a vast difference in information requests from the homebirthers compared to hospital classes. The last hospital class I taught, the entire class most important question was when can I get an epidural. I realized that childbirth classes had evolved into something I did not want to support. It was just a thing to do, part of the ritual of an American tehno-birth. Although I attempted to be gentle about the possible impacts of epidurals on breastfeeding I realized that the desire for non medicated births had decreased exponentially and that my influence towards natural birth was over as soon as an unsuspecting couple walked through the hospital doors.

    The hospital I taught for pushed epidurals so hard that my sessions made little difference. Doula’s were the only way one would avoid a cascade of awful interventions. Ultimately I decided that I was too philosophically at odds with American birth to continue teaching for the “system”. I would now only teach homebirthers.

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