Science & Sensibility

Creative Commons photo by Raphael Goetter

As the mother of two children, both who breastfed well into toddlerhood, and as a childbirth professional, I have spent a lot of time over the years 1) learning how to breastfeed or breastfeeding my children and 2) facilitating “how to breastfeed” conversations with pregnant women and their partners in my Lamaze classes, working as a birth doula with new mothers immediately after birth and in the first postpartum days at home with their newborn as well as regularly training new birth doulas and childbirth educators on how to prepare and work with their clients and students in the early days of the breastfeeding relationship.

I frequently find that new mothers often consider breastfeeding the next potential challenge after they have birthed, and getting it “right” includes avoiding pain, developing a good milk supply and making sure that their baby is getting all the nutrition they need in the vulnerable first days when things are so new and unfamiliar.  Breastfeeding challenges can increase the rockiness of an already emotionally and physically fragile time for the mother-baby dyad.

I have watched teaching methods, techniques and vocabulary change as more is learned about the newborn, their instinctive behaviors and the innate wisdom of the mothers of these new little ones.  Most of us have seen the widely viewed “Breast Crawl” video put out by UNICEF, WHO and WABA, and ooh-ed and ah-ed at the wisdom of the just born baby who self-latches when placed on its mother’s chest.   Suzanne Colson, Rebecca Glover, Christina Smillie and others have shared resources and information that has helped mothers and the professionals that support them get breastfeeding off to the best start possible, by introducing concepts such as baby led and laid back breastfeeding.

It was with great interest that I read Facilitating Autonomous Infant Hand Use During Breastfeeding and learned the important role the newborn’s hands play in helping to shape the breast, areola and nipple to facilitate breastfeeding.  I have always encouraged mothers to undress their newborn to allow for skin to skin when nursing, and sighed when I saw trained professionals encourage mothers to nurse a swaddled newborn.  But, I have to admit, I was guilty of encouraging mothers to “tuck” their baby’s hands out of the way when getting the baby to latch on, concerned that the baby’s hands would prevent a good latch as the baby seemed to want to suck on both the breast and their hand at the same time.

 In the past, the baby’s hand movements while at the breast where considered “uncoordinated,” “purposeless” and “random,” and were thought to interfere with the coordination of the breastfeeding process.  Current research shows that not to be the case at all.

Catherine Watson Genna, BS, IBCLC, RLC and Diklah Barak, BOT, the authors of Facilitating Autonomous Infant Hand Use During Breastfeeding share that babies that hug the breast with their hands are helping to stabilize their neck and shoulder girdle, by pulling together the shoulder blades. Hand movements, by the infant on the breast, increase maternal oxytocin.  It also causes the nipple tissue to become erect, which facilitates latch.  Babies are best able to use their hands “against gravity”, lifting them up, when their hands are in their field of vision.  The hands are used along with the lips and tongue to draw the nipple into the mouth, a behavior that disappears around 3-4 months of age.

The authors observed that infants use their hands to push and pull the breast to shape the breast and provide easier access to the nipple.  Newborns and young infants also use their hands to push the breast away, possibly to get a better visual sense of the location of the nipple.  Genna and Barak also state that an infant may feel the nipple with their hand, and use the hand as a guide to bring their mouth to the nipple.

 Wonderful black and white pictures accompany this article, and useful video clips are included for great visuals of the behaviors described by the authors.  The authors provide information on how to facilitate infant hand use during the breastfeeding session, including step-by-step instructions that can be shared with expectant and new mothers when you are teaching.

 Teaching new mothers that their newborn’s hands are a tool that the baby uses to find and latch on to the nipple, rather than something to be restrained and held out of the way, can help new mothers to appreciate the innate abilities of their newborn to self-latch and breastfeed successfully.  The materials in this article can be incorporated in the curriculum you cover when you discuss breastfeeding, and increase confidence and success for the new mother and encourage the breastfeeding relationship to have the best start possible.

 Please take a few minutes to follow the link and read the article, view the pictures and videos and let me know how you envision using this information in future classes?  Have you changed how you teach breastfeeding as new concepts and information have become available?  Share your tips and success stories with us, so that we all can become more skilled at providing new parents with effective teaching practices that support the breastfeeding relationship.  I look forward to hearing from you.

 Sources

Genna, C.W. & Barak, D.  Facilitating autonomous infant hand use during breastfeeding.  Clin Lact 2010; 1(1):15-20.

http://www.biologicalnurturing.com/

http://breastcrawl.org/index.shtml

http://www.breastfeedingresources.com/

http://www.rebeccaglover.com.au/

Sharon Muza Babies, Breastfeeding, Continuing Education, Doula Care, Evidence Based Medicine, Healthy Birth Practices, Infant Attachment, New Research, Newborns, Parenting an Infant, Practice Guidelines, Research Barak, breastfeeding, breastfeeding class topics, childbirth education teaching strategies, Colson, first weeks of breastfeeding, Genna, glover, how to breastfeeding, IBCLC, Lamaze Classes, newborns, postpartum, Smillie, teaching community breastfeeding classes, WHO breastfeeding recommendations

[Editor's note:  Have you ever wondered how to best compel your clients or would-be students into taking childbirth education seriously, and spending the time to research and seek out a solid, evidence-based childbirth preparation class?  The following is from yesterday's Lamaze International press release.  Share this with your colleagues and local birth networks.  Heck, you might even want to print some copies off and post them in some visible public spaces in your community.]

-Best Courses Teach Evidence-Based Practices to Improve Chances of Having Safe, Healthy Birth-

WASHINGTON–A recent report from the World Health Organization set off alarm bells for many expectant parents.  The report showed that newborns in 40 countries, including Cuba, South Korea and Poland, have a lower risk of death than newborns in the United States.

For expectant moms, one of the best, and often overlooked, ways of improving the odds of a safe and healthy birth is to take a good childbirth education class.  But how do moms know whether they are choosing a class that will make a difference?

“A good childbirth education class can make the difference between feeling out of control and overwhelmed, and being able to handle the expected and unexpected on the day of your baby’s birth,” said Marilyn Curl, President of Lamaze International.  “A really good class will also help moms-to-be avoid routine interventions like inductions and being confined to bed, which can actually increase the risks around birth.”

Here are some factors mothers-to-be should consider when selecting a childbirth education class:

1. Research the Class Curriculum

Ask to see the content covered in childbirth courses carefully before selecting one.  There are a variety of curriculums, and different approaches may work better for different people.  Some courses do little more than orient women to the procedures of the hospital, regardless of whether those protocols are backed by research findings.

Curl cautions that women should be wary of ‘patient obedience classes.’  “Any class that simply focuses on what women are or are not allowed to do according to the procedures of the institution is not going to equip them properly for labor and birth.” Curl said.

Expectant parents should consider what they want to gain from taking the class and make sure those points are part of the curriculum.  Lamaze classes focus on educating parents about six safe and healthy birth practices that are based on extensive clinical research.  “Women rarely receive all of the best care practices, so it is critical for parents to educate themselves about their options,” Curl said.

Typical topics covered in Lamaze childbirth education classes include:

• Normal labor, birth and early postpartum
• Positioning for labor and birth
• Pain management techniques
• Labor support
• Communication skills
• Comfort measures, including breathing strategies, relaxation and massage techniques
• Risks and benefits of medical procedures
• Breastfeeding
• Healthy lifestyles

If the instructor teaches the class in a hospital setting or in a doctor’s office, parents should ask whether the instructor feels she has the freedom to discuss controversial topics related to childbirth and whether the class will discuss strategies for broaching these subjects with their care providers.  This information can help parents evaluate whether the class will focus on teaching the safest birthing practices, rather than explaining hospital policies.

2. Consider the Instructor’s Training

Check what kind of experience and background the prospective teacher has and ask about the instructor’s certification.  Lamaze offers the only internationally recognized childbirth educator certification program that is accredited by the National Commission for Certifying Agencies (NCCA).  Lamaze Certified Childbirth Educators must pass a rigorous examination to show they meet the highest professional standards and have the necessary knowledge and skills to teach courses.  To find a local Lamaze Certified Childbirth Educator (LCCE), visit www.lamaze.org.

3. Invest Some Time

Between work schedules, family obligations and setting up the nursery, expectant parents may feel pressed for time.  But parents-to-be need to make certain they devote plenty of time and attention to preparing for labor and birth.  A one-day crash course might sound like the quickest way to get up to speed, but parents may not retain as much information from a course taught in this format.  Online forums and TV shows focusing on birth do not offer personalized or in-depth information that’s found in a class.

Lamaze classes typically provide 12 hours of instruction and discussion.  The classes are spread across six weeks to ensure parents have time to absorb the lessons and consider priorities as the big day draws closer.  “It may seem like a big time commitment, but nothing is more important than preparing for a safe and healthy birth and a good start for the baby,” Curl said.

4. Plan Ahead

Classes fill up quickly, so start researching courses early.  Try to sign up for a Lamaze class six to eight weeks ahead of time – around the first week of the second trimester.

5. Check Class Size

For first-time parents, in particular, having personalized attention from the instructor is an important part of a childbirth education class.  Ask about the size of the class.  Ideally, there should be a maximum of 12 couples enrolled to ensure each has a chance to interact with the instructor and ask questions.

Choosing a class with an informative curriculum, a knowledgeable instructor and personalized attention are crucial for ensuring expectant parents have their questions and concerns addressed before the baby’s birth.  More information on childbirth education courses is available at www.lamaze.org.
About Lamaze International
Lamaze International promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting practices.  Knowing that pregnancy and childbirth can be demanding on a woman’s body and mind, Lamaze serves as a resource for information about what to expect and what choices are available during the childbearing years.  Lamaze education and practices are based on the best and most current medical evidence available.  Working closely with their families, health care providers and Lamaze educators, millions of pregnant women have achieved their desired childbirth outcomes using Lamaze practices.  The best way to learn about Lamaze’s steps to a safe and healthy birth is to take a class with a Lamaze certified instructor.  To find classes in your area, or for more information visit www.lamaze.org.

Childbirth Education, Evidence Based Medicine, Lamaze Method, Lamaze News childbirth preparation classes, Do I need to take a Lamaze class?, how to choose a childbirth class?, Lamaze 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