Science & Sensibility

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Injoy Birth and Parenting Education is offering a free webinar titled “Secrets of a Postpartum Doula: Newborn Care and Soothing Techniques” taught by  Kimberly Bepler, IBCLC.

This webinar is scheduled for December 6, 2012, 1:30 pm (EST).  Some of the objectives of this webinar are to present:

• The latest evidence in newborn care
• Tips on teaching parents how to keep their babies happy and fulfill their innate needs
• Ways educators can become more baby-friendly and promote breastfeeding, while still supporting parents and giving them the competence (and confidence) to do their best
• New options for the care of infants

If you are a professional who works with expecting and new parents and their newborns in the classroom, or one on one, you may want to consider registering for this webinar event.  Learning effective methods of presenting evidence based information and interesting learning techniques is something that we all can brush oup on, no matter how long we have been working with new families.

Please consider joining the webinar and hearing what Kimberly will be sharing.

Click to to register and for more information. Please contact Injoy for all questions about this webinar.  Thank you.

Sharon Muza Babies, Childbirth Education, Continuing Education, Infant Attachment, Newborns, Parenting an Infant, Webinars Childbirth Education, Continuing Education, Injoy, newborns, Parenting an Infant, Webinars

A Guest Post by Anna Deligio, MSW, LCCE, CD(DONA)

Today’s post is the second in an occasional series on welcoming all families to your childbirth class and honoring the diversity that different family models bring to pregnancy, birth and parenting.  You can read the first part in this series here, to learn about the non-biological mom’s experience in a childbirth class from Anna’s partner, Cathy Busha.  Look for more on this topic of diversity in future months. – SM

____________

“The real voyage of discovery consists not in seeking new landscapes but in having new eyes.” Marcel Proust

There have been variations on the definition of family for as long as there has been a definition of family. It is not news that there are women creating families without partners – either by choice or because the male involved is not involved. Nor is it news that lesbians, gay men, bisexual and transgendered folk have been quietly having and raising children for generations.

What is news is the increase in the number of women choosing to parent without partners and the increase in LGBT (lesbian, gay bisexual, transgendered) families in the last couple of decades. According to the New York Times article, “For Women Under 30, Most Births Occur Outside Marriage” from February of 2012, now more than half of births to American women under 30 occur outside of marriage[i]. Studies done by the Family Equality Council, a non-profit that works to connect, support and represent LGBT families, show that there are currently an estimated 1 million LGBT parents in the United States raising an estimated 2 million children[ii].

Are these increases evident in the students and clients you serve as a birth professional? Do you see more women choosing friends or family members as their labor support people rather than the male who supplied the sperm? Have you worked with any LGBT couples as they prepared for and experienced the birth of their child?

If your answer to the above questions is “no”, there might be an opportunity for you to examine how welcoming and affirming of diverse family structures your materials and teachings are. We know these families are out there, so why aren’t they in our classes (if they are not)?

My partner Cathy and I recently had the opportunity to attend a two-part childbirth preparation class offered through our insurance. We are pregnant (I am carrying) for the first time and expect a birth sometime around the end of July. Like many pregnant people, we chose the class that was offered through our insurance and attached to the hospital where we will be birthing.

As a Lamaze Certified Childbirth Educator in a hospital setting, I came to the class open to learning strategies I could take back to my classes. As a pregnant lesbian, I came curious if the materials would reflect our family and wondering how inclusive the language would be.

© Marco Santi Amantini - Fotolia.com

As expected, the materials lacked diversity because diverse materials don’t exist. I have searched for posters and videos that include diverse families and have come up with a few that involve young, single mothers but none that show LGBT families or more mature women who chose from the start to parent without a partner. This is a real problem to me. You can be as inclusive as possible in your use of language, but if the materials you use show only female-male dyads, you continue to give the message that they are really your intended audience.

Lack of materials would be an insurmountable challenge if birth professionals weren’t such a crafty and persistent lot. Make your own. Search online for images of diverse family structures and use them (with permission) on your websites and in your handouts. (See notes below.) Make your own posters with these images. Use your persistence and advocacy skills to lobby InJoy and other video manufacturers to include diverse families. Let them know you want films with diverse families – LGBT families, families of women who choose to parent without partners (not just pregnant adolescents who are forced into single parenting). If you’re super-crafty, create your own birth films with these families (and then please link them far and wide so we all can benefit from your wild talents).

As for language, our instructors, like a lot of professionals, used the term “partner” rather than “husband” or “father”. Partner creates a little more space for diversity, but maintains with a couple of problems: if the subsequent pronouns are all male, it suggests that partner doesn’t include females, but just men who aren’t legally married to the pregnant woman; partner continues to exclude women who are not parenting with an intimate partner, regardless of that partner’s gender.

To that end, I believe that “support person” is the most inclusive term available. Some might think that it diminishes the role of the father. Fathers have a lot of privilege in the birth world, so the impact on them is minimal. More than that, their role during the labor and birth is about being a support person. It does not matter if they supplied the sperm or if they will be parenting the child – those actions address their past and future relationships with the baby, not their relationship to the birthing person during labor.

During labor, their relationship is as support person to the birthing person. This applies to any who will be supporting – female partners, mothers, best friends, husbands, etc. Once the baby is born, they can go on to be mother, father, grandmother, aunt, etc., but during the labor their role is support to the birthing person. (Their potential inability to separate those roles during labor speaks, always, to the value of having a Labor Doula).

Just as with any language that challenges the mainstream, it is important to be explicit. Take a moment at the start of your class and in your materials to explain why you are using the term “support person” rather than “father” or “partner”. Demonstrate your dedication to inclusivity and create a space that is affirming to all the stories in the room. Spread your educating beyond the stages and phases of labor to teachings on the importance of honoring all families. Do this whether or not you think you have any diverse families in your class – it’s dangerous to assume another’s story and, at the very least, you’re educating a new batch of allies to diverse families.

Top 10 Ways to Create an Inclusive Childbirth Education Practice 

1. Remember that Pictures Say A 1,000 Words – make sure that your website, flyers, handouts, posters, and other promotional materials show diverse family structures. Include images of LGBT families and women who chose to parent without partners. If you don’t have these images from your own client interactions, utilize stock photos and magazine images to create these materials until you can use your own client images, with permission, of course. (See Copyright Information.)
2. Use Inclusive Language – change all of the places that say “father” or “partner” to “support person.” Explicitly explain that, while you honor all of the other roles in your clients’ lives that their loved one (husband, female partner, mother, sister, best friend, etc.) plays, you will focus on their role during labor – that of support person. Explain that you use this term to make sure that all families feel welcome in your work.
3. Advocate and Advocate Some More – regularly contact manufacturers of childbirth educational materials and videos and tell them that you want materials that include all families, and celebrate diversity.  Use your purchasing power to create change.
4. Use the Power of Stories – make sure that the stories you share in class include the stories of diverse families. If you don’t personally have any of these stories yet, change the pronouns in some of your stock stories to make the families more diverse. Change the fathers to lesbian partners. Omit the partners altogether and make the story about a professional woman who chose to parent without a partner.
5. Put Yourself in a Place to Learn – find where these diverse families are in your neighborhoods. Join their groups, attend their meetings, show up with the intent to listen and learn. Build bridges with these communities and learn how to be an ally to them. Join the email list of the Family Equality Council and learn from the work they do with LGBT families.
6. Don’t Guess the Stories of Your Students – take the time at the start of class to learn the stories of your students. Don’t assume because everyone there is in a male-female pair that the male provided the sperm and is planning on co-parenting. Even if everyone in your class falls under that model, use your inclusive language and materials. Explain why you do. Spread your educating past the stages and phases of labor to the importance of honoring all family structures, whether or not they are currently reflected in that cohort of students.
7. Stop Assuming Everyone Has Access to Sperm – when talking about ways to naturally bring on labor, avoid the saying, “What got the baby in will get the baby out”, as some women have become pregnant in a very clinical way, and clearly that does not apply in this situation. When talking about sex as an induction tool, talk about orgasm (achieved with or without a partner) and the release of oxytocin.
8. Blow Up the Gender Boxes – when talking about parenting, leave out stories and examples that are overly reliant on limiting gender roles.  Keep your information to the tasks at hand and assume that everyone in the room is fully capable of equal parenting. Make sure you also speak to women who will parent without a partner and emphasize the need for everyone – regardless of relationship status – to have a community of supporters willing to help out with the raising of the child.
9. Be a Good Ally – interrupt limiting language when you hear it from colleagues. Teach them the phrase “support person” and explain why you choose to use it instead of “father” or “partner”. Challenge speakers at conferences to be more inclusive in their presentations. Thank those who are.
10. Give Yourself Some Grace – unlearning unhelpful paradigms takes a lot of energy and work. Give yourself some grace as you do the work of unlearning limiting language. Like all good things, it’s a process and takes time to truly integrate.

• The New Essential Guide to Lesbian Conception, Pregnancy, and Birth
• The Ultimate Guide to Pregnancy for Lesbians: How to Stay Sane and Care for Yourself from Pre-conception through Birth, 2nd Edition
• Confessions of the Other Mother: Nonbiological Lesbian Moms Tell All

Sharon Muza Childbirth Education, Guest Posts, Series: Welcoming All Families

What with all the posting we did last week in the run-up to Mother’s Day, I got a little behind in my updates about attending a local childbirth education class.  (Actually, with so many great organizations to report on there simply wasn’t room for me to fit this post in!  Luckily, I’ve been taking extensive notes.

During the second week of class, the instructor started with a discussion about pain—using the familiar Pain-Fear-Tension diagram:

A give-and-take conversation ensued about traumatic pain versus labor pain and how the characteristics differ greatly.  The class participants seemed to get it—that labor does not represent pathology.

I was heartened to hear the instructor take time out to address the culturally-driven practice of ‘working up until the baby is born,’ for a large percentage of American women.  She linked this practice to the sustained fatigue women enter their birth experiences with, and how oxytocin production falters when a term pregnant woman’s body is and has been in hyper-adrenaline-secreting mode for the previous weeks/months.  Her point, about our human inability to cope well with pain, when physically and mentally exhausted, seemed to resonate with her students.  Disappointingly, however, she warned the class: “It’s not going to change—society’s unfavorable nature toward pregnant women and new moms.  I’m not telling you to go out there with your picket signs [and try to make a change].”

Why shouldn’t we be telling (suggesting) our students to “go out there with their picket signs?”  Why shouldn’t we entice the people for whom the pregnancy, labor and birth experience constitutes a here-and-now situation, that unless pregnant women and their partners demand better maternity leave plans…that, indeed, nothing will change?

***

The second half of class consisted of watching an InJoy video on the stages of labor.  I seem to continually find myself engaged in a love-hate relationship with childbirth education videos. I LOVE the computer animations used to show expectant parents what’s going on inside of mom’s body during the labor and birth process.  I LOVE that, over time, they have begun to include more and more representations of normal birth practices (in the video we viewed, we see laboring women using birth balls, bathtubs, doula support and various first and second stage positions).  I LOVE the fact that each birth vignette ends with images of mother and baby breastfeeding.  But there are also mishaps along the way—perhaps subtle enough that the expectant parent might not notice, but glaring enough that I continually find myself asking, ‘why?’  Here’s what I mean:

While the video (in this class, there is a heavy reliance on information delivery via video with a breezy, summarized follow-up by the instructor) made mention of the importance of staying home in early labor, several subsequent scenes demonstrated women in the hospital who were clearly in early labor.  Despite a few images of women in their homes (I guess, in early-early labor) the majority of the film demonstrated laboring women in the hospital setting—no birth center settings seem to have been represented.  And, while I know many hospital L&D units have invested gazillions of dollars in revamping maternity wards such that they feel less clinical (with pretty cupboards hiding medical equipment, nice wall paper, jetted tubs…), many childbirth education videos still show rooms full of crash carts, infant warmers, IV pole stands and the like.  I’m not arguing the existence of these things—one would and should expect their presence in a hospital setting, for those small-percentage-of-the-time incidences in which they are needed.  But their inclusion in childbirth education videos has the subtle effect of further convincing already media-influenced expectant parents that pregnancy and birth is a medical condition to be treated.

I’m not a film maker, so I suppose my criticism must be taken with a grain of salt.  There may be pressures placed upon the companies that make childbirth education films beyond that which I can imagine.  All I know is, when teaching my own classes, I constantly find myself dissecting the film with my students afterward, and discussing which parts of the film helped or hurt their image of birth.

As this second class was coming to an end, questions from the students arose in response to the film. While pushing positions were reviewed in the video, a woman asked one of those time-honored questions.  “How will we know how to push?”  The instructor responded to the question by assuring the class, “we’ll teach you that when you come in to deliver.”  Being an L&D nurse at the same facility in which a childbirth educator is teaching may have its benefits here:  the potential to follow-up with students and assist them during their labor and births provides a continuity of care different than that which an independent teacher can likely offer (unless she also practices as a doula).  Still, I wondered how satisfied the student felt about this response.

A subsequent question about the quality of breastfeeding support in the hospital garnered a similar answer—affirming the presence of 25 nursing staff members who have undergone lactation support training, the instructor responded to the question with a sweeping, “We’ve got you covered.”

If this post feels like a breezed-through version of the class, then it replicates the experience of the class well.  Under pressure to present a ton of material in what may be a limited amount of time on the facility’s Community Education calendar, the list of topics being covered seems fairly complete, but the depth of discussion feels thin.

Stay tuned later today for a review of Childbirth Education Class # Three:  Comfort Measures and Medical Interventions.

Posted by:  Kimmelin Hull, PA, LCCE

Kimmelin Hull Series: Teacher Turned Student, Uncategorized childbirth education teaching strategies, childbirth preparation class, Lamaze childbirth education, teaching childbirth education classes

Wednesday night, I attended my first childbirth education class as a student, in nine years.  My goal: experience childbirth education as a student again.  What’s not to learn by revisiting the classroom as a consumer?

Upon arriving at the community lecture room in our local hospital, each class participant was met with a copy of InJoy Birth & Parenting Education’s Understanding Birth workbook—a series which is accompanied by the website, SeeWhatYouRead.com.  This website is a great resource, acting as a supplement to the workbook and in-class discussions and video observations.  Many of InJoy’s video segments on birth and the perinatal period are available for student/teacher viewing.  Being a Log In protected site, each workbook has a PIN printed on the back—granting access to paid programs/students, only.

The instructor began with a 20 minute introduction to the class, including herself and her background as a labor and delivery nurse at the same facility where the classes take place, as well as a Lamaze Certified Childbirth Educator for the past three years. When it was the rest of the group’s turn, we went around the room in typical opening class format, introducing ourselves, and sharing the particulars of why we were there—including the three of us who are observing:  myself, a doula and a nursing student—and details about pregnancies, maternity care providers and sex of the expectant babies (if known).  All six couples had already found out the sex of their baby: 4 girls and 2 boys.  It seems the art of waiting for the surprise at the end of the journey is becoming a lost one.

The remainder of the class consisted of a body mechanics demonstration by a staff physical therapist, discussion on the head-to-toe physical (and mental!) changes that accompany pregnancy, and highlights on important elements of nutrition for the third trimester.

Some folks will caution against the milieu induced by bringing hospital staffers into childbirth ed. class.  By locating the classes at the same  facility  in which a woman will subsequently give birth (any facility, for that matter), you risk sending her the message, “This is how we ‘do’ birth here.”  Add to that environment, medical providers talking about (shall we say, “promoting”?) their services, and a skeptical class participant might leave the experience feeling coerced.

In the compilation of cross-cultural essays, Childbirth and Authoritative Knowledge (R. Davis-Floyd, C. Sargent, ed., 1997), the issue of authoritative knowledge as a means of altering the birth process and experience itself is addressed—looking at birth and its preceding preparations from sixteen different societies and cultures around the world.  From Ellen Lazarus’ essay, What Do Women Want?  Issues of Choice, Control and Class in American Pregnancy and Childbirth:

“In a study looking at childbirth education and childbirth models, Carolyn Sargent and Nancy Stark (1989) found that their informants, mainly middle class, received “ideological messages” from both health professionals and relatives but that patients “bought” the medical model…Margaret Nelson makes the point that the reason a middle-class model of childbirth has dominated much of the literature is that much feminist writing focused on the natural as a contrast to medicalized birth (Oakley 1986; Romalis 1981).  She writes, however, that the middle-class model is coming closer to a hospital birth, catering to a clientele for which the hospitals compete.”

In her June, 2000 Medical Anthropology Quarterly article, (Volume 14, Issue 2, pages 138–158) Preparing for Motherhood: Authoritative Knowledge and the Undercurrents of Shared Experience in Two Childbirth Education Courses in Cagliari, Italy, Suzanne Kelter discusses authoritative knowledge in terms of the childbirth education setting.  She argues that, while institutionalized childbirth education courses have the potential to be singularly authoritative, the encouraged interaction, and sharing of experiential knowledge between class participants can de-medicalize the overall take-home  message. “When so [legitimized], women’s experiential knowledge can provide an alternative to the biomedical knowledge that sometimes compromises their subjective agency and personhood as they become mothers.”

In this week’s class I attended, I think the presence of “authorities” (L&D nurse who also happens to be a mother of four young children and a physical therapist—mom to three) proved beneficial, particularly due to a large emphasis on student participation.  The P.T. spoke emphatically about exercises pregnant women can and should be doing in their last trimester to prepare for birth (squatting, lunges, Kegels, hip abductor stretches, abdominal strengthening) and measures she and her partner can do both now and after the baby’s arrival to protect the low back from injury (such as when improperly lifting a baby-containing car seat).   She guided the willing group through cat/cow pose on all fours, the aforementioned stretches and strengthening techniques, and even taught moms and partners how to assess for the presence of a diastasis recti.

The focus on nutrition was well-delivered, garnered a decent amount of group participation via question/answer format, and seemed to maintain the eager students’ attention.  Basing a justification for attention to nutrition “this late in your pregnancy” on the still-developing needs of the fetus (building iron stores for first six months of baby’s life; taking in adequate amounts of calcium so baby doesn’t leach calcium stores from mom’s skeletal structure; adequate water consumption to prevent dehydration-related uterine hyper-irritability…) seemed to hit home with the audience.

Of concern, no less than 10 minutes into the class, the instructor explained the primary motivation for developing the hospital’s program, now five years old.

“There were lots of childbirth education programs in the community that were basically teaching people to be afraid of what happens here in the hospital.”

Having been one of those private childbirth educators, I sat back quietly—not sure if I should be offended at the broad statement, or congratulatory of her correctness.   I know several local CEs (and doulas) who would respond, “You’re darned right we’re teaching them to be afraid.”  Others, like me, would prefer the party line, “We’re teaching them to be fully informed.”  Either way I looked at it, I still wondered if the underlying message was the same:  In an “us” versus “them” system, we are competing for the same clientele, rather than working together to reach them, hoping to be the first to share our knowledge—delivered authoritatively, or not.

I’m hoping to do some bridge building while participating in this class.  After all, the class instructor and I:  we’re both LCCEs.  We’ve got a great thing in common.

Posted by:  Kimmelin Hull, PA, LCCE

Kimmelin Hull Authoritative Knowledge, Childbirth Education, Continuing Education, Films about Childbirth, Uncategorized authoritative knowledge, exercises for pregnancy, hospital childbirth ed classes, Kimmelin Hull, Lamaze Certified Childbirth Educator, Lamaze Classes, nutrition in late pregnancy, physical therapy in pregnancy, private childbirth ed classes

Keeping birth healthy and safe doesn’t end when the baby is out. Skin-to-skin contact, the beginnings of emotional attachment, the mother’s physical recovery, and the initiation of breastfeeding are the continuum of biological processes that began in pregnancy and labor. We’ve reached number six in our six-part series of Blog Carnivals. And this one is about keeping moms and babies together after birth.

That’s right – this is the last Healthy Birth Blog Carnival! The Carnivals, to me, represent the huge amount of information, support, and woman-to-woman collaboration the internet now offers to support safe and healthy birth. I’ve loved reading all of your stories, hearing diverse perspectives, and working together to generate a new understanding of the type of care that moms and babies deserve. I know I am in for some delightful and insightful reading – and some heartbreaking stories, too.

You can submit anything that relates to the care and support of mothers and babies after birth. Here are some resources from Lamaze International to get you started:

• The Healthy Birth Practice Paper, written by Jeannette Crenshaw, MSN, RN, NEA-BC, IBCLC, LCCE, FACCE
• The Healthy Birth Your Way handout on keeping your baby with you in the hospital, produced by InJoy Birth & Parenting Videos in partnership with Lamaze International
• Our Healthy Birth Your Way video

Participation in the Healthy Birth Blog Carnival is easy:

1. If you are a blogger, write a blog post on the Carnival theme. Post it on your blog by Friday, June 11. Make sure the post links back to this blog post, to the Healthy Birth Practice Paper, or to the video above. You may also submit a previously written post, as long as the information is still current.

2. Send an email with a link to your post to amyromano [at] lamaze dot org.

3. If you do not have a blog but would like to participate, you may submit a guest post for consideration by emailing it to me.

4. I will compile and post the Blog Carnival at Lamaze’s brand new web community for women: Giving Birth with Confidence.

Amy Romano Uncategorized Healthy Birth Blog Carnivals, Healthy Birth Practices, newborns, no separation, postpartum