Science & Sensibility

Continuing along in our occasional series on “Welcoming All Families” to our childbirth classes, this two part guest post is written by Pam Vireday,  creator of the Well-Rounded Mama blog.  Are your childbirth classes friendly to women of size?  What special accomodations and resources do larger-sized mothers-to-be need if any? In today’s post, Pam discusses a check list of items that you might consider when teaching childbirth classes and on Thursday, Pam shares how to promote in your classes optimum outcomes at the births of these mothers.- Sharon Muza, S&S Community Manager

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Although the exact numbers vary according to the source used, it is no secret that many women of childbearing age are “overweight” or “obese”* by government standards.  This means that, sooner or later, most doulas, childbirth educators and health care providers will have women of size as clients or patients.

Many birth professionals are unsure of how to address the unique needs of this group. At a time when the media messages around obesity and pregnancy are almost uniformly negative and scare-mongering, it is important that birth professionals create a place for women of size to discuss their unique concerns without judgment.

Terminology*

Research shows that many larger people find the terms “obese” and “overweight” stigmatizing. Although size-acceptance activists prefer the word “fat,” some people cannot hear this term neutrally, and euphemisms like “fluffy” can feel patronizing.

Birth professionals are encouraged to notice and adopt the terminology used by clients for themselves. Until then, use more neutral terms like “plus-sized” or “women of size.” (Further discussion of the relative merits of various terms can be found here.)

Create a Safe Space

Most larger women have been negatively judged by others for their weight, and the disapproval is never stronger than when they consider pregnancy. Women of size need a non-judgmental space where they can feel free to discuss their concerns for pregnancy without being shamed, lectured to, or made to feel like “bad mothers.”

Your job as a birth professional is to create this safe place. Examine your own biases about weight, eating, and health.  Question your assumptions and engage with each woman as an individual. Utilize reflective listening, assist them in researching special issues, and neutrally explore proactive behaviors that might help address their concerns.

Make Sure Facilities Are Size-Friendly

Ask yourself ─ are your facilities friendly to larger bodies?  Do you have armless chairs? Seating that is easy to get up from?  Restrooms that accommodate larger people?  Comfortable facilities set the tone for a space that is welcoming to all sizes.

Remember that getting up and down from the floor can be difficult for many women in pregnancy, not just heavier women.  Have a few low stools around that women can use to help boost themselves up.  Also be sure your birth balls are appropriate for heavier women; a little higher and a little more heavy-duty balls can be helpful.

Address Special Equipment Needs

The correct blood pressure cuff size is vital for larger people.  A too-small cuff can artificially inflate blood pressure readings and result in unnecessary intervention.

According to guidelines from the American Heart Association, people with upper arm circumferences above about 13.4 inches (34 cm) need a “large adult” cuff, while those with a circumference above about 17.3 inches (44 cm) need a “thigh” cuff.  If in doubt, measure the client’s arm and cross-check it against the reference range printed on the BP cuff.

Some care providers resist using larger cuffs, so women or their support people may need to be quite assertive about utilizing the correct cuff size.

Discuss Breastfeeding When Well-Endowed

Some high-BMI women are quite well-endowed. This can present special challenges in breastfeeding, yet many women receive no information on how to meet these challenges. Cover a variety of nursing positions and techniques, including the football hold, which may be more useful for well-endowed women.

Have Additional Resources Available for Women of Size

A consistent problem for women of size is the difficulty in finding resources for their specific needs. For example, finding maternity clothes or a nursing bra in a larger size can be a major problem. Many women appreciate having a list of companies that specialize in plus-size maternity products.

Address Potential Risks and Complications

While the possibility of complications must be acknowledged, remind women that having a risk factor for a complication does not inevitably mean developing that complication. An individual’s outcome cannot be predicted by risk factors alone. Treat women of size like any other pregnant woman by expecting normalcy as much as possible.

Share websites that examine weight-related research with a neutral, critical eye, which acknowledge that complications are possible and promote proactive prevention, but which also point out that larger women can and do have normal, healthy pregnancies and births.

Find Positive Images and Stories of Women of Size

Media images of heavy people in our society are highly stigmatizing.  Most pictures of fat people are headless (dehumanizing them), unflattering (focusing on bellies or behinds in tight clothes), or reinforce stereotypical behavior (eating junk food or being sedentary).

Media discussions of pregnancy and obesity focus only on the risks for complications, tell apocryphal stories of worst possible outcomes as if they are commonplace, or compare fat pregnancy to child abuse.

Books that focus on obesity and pregnancy pay lip service to being size-friendly, but contain a preponderance of negative stories, highly-interventive births, and scare tactics about complications.  As one doula reviewer on Amazon wrote, “More time was spent telling me how much more likely I am to have a cesarean than to tell me how I can best avoid one.”

It’s very important to counteract these negative messages and images with positive ones.  Direct your client to websites which have plenty of positive images of women of size pregnant, giving birth, and breastfeeding (see list below).  Connect them with a community of like-minded women if they are interested.

Respect Patient Autonomy

Different people will look at the same information with differing values and make varying choices.  The same is true for women of size.  Some will respond to information about obesity-related risks by choosing a more-interventive childbirth model, and some will respond by choosing a less-interventive model.  Neither choice is right or wrong. Respect each person’s right to choose for themselves.

 

“All in all I think I just want to be treated the same as anyone else. Give me the information, not opinions, not value judgments. Let me decide what to do with it. Give me all the information, not what you perceive or decide I need. Treat me as thinking adult. Treat me with respect. Don’t belittle me, and do not treat me with kid gloves either.” Lexi Diaz, plus-sized mother of four.

Do you do anything different when women of size attend your classes?  Do you feel like your classes already accomodate any special needs they might bring? Do your visual aids and resource lists include pictures of women of size and resources designed for their needs?  Do you feel that any woman of size attending your class feels welcome or alone?  What have been your experiences with larger sized women taking your classes or being your client or patient.  Let us know your experiences in the comments section and share additional resources if you would like.  Read on Thursday, when Pam shares how CBEs can help women have optimum outcomes at their births.- SM

Plus-Sized Resources

Plus-Sized Pregnancy Information

• www.wellroundedmama.blogspot.com
• www.plus-size-pregnancy.org
• http://www.facebook.com/theamplemother
• www.plussizebirth.com
• www.facebook.com/plussizemommymemoirs
• http://pregnancy.about.com/od/plussizepregnanc/Plus_Size_Pregnancy.htm
• http://www.facebook.com/pages/Plus-Maternity-Australia/107067319323331
• www.fertilityplus.org
• http://community.babycenter.com/groups/a425315/plus_size_and_pregnant

Finding Maternity Clothing in Plus Sizes

• Plus-Size Maternity Clothing FAQ – help for finding maternity clothing, nursing clothing, nursing bras, and maternity-related products in plus sizes, both in the U.S. and abroad
• http://plus-size-pregnancy.org/BBWBabyCarriers.html – help for finding baby carriers and slings in plus sizes
• www.plusmaternity.com.au – resources on plus-sized maternity and nursing clothing in Australia
• http://plussizebirth.com/2012/04/babywearing-for-the-plus-size-mom.htm – info on finding baby carriers for plus sizes

Positive Images of Plus-Sized Pregnant Women

*Do not use any of these photos without asking permission first

• Plus-Sized Pregnancy Photo Gallery – series of blog posts with many pictures of plus-sized pregnancy and birth
• Plus-Sized Pregnancy Breastfeeding Gallery – pictures of women of size breastfeeding
• http://plussizebirth.com/gallery- gallery of plus-sized baby bumps, birth pictures, breastfeeding pictures, and babywearing pictures
• http://oneyawn.blogspot.com/2012/06/belly-pictures-baby-number-three.html – belly diary of a plus-sized mom, week to week in pregnancy
• http://www.facebook.com/theamplemother/photos_stream – plus-sized pregnancy photos
• http://birthislife.blogspot.com/2012/08/nursing-portrait-session.html – lovely breastfeeding photos of a woman of size
• http://www.yaleruddcenter.org/press/image_gallery.aspx – free for educational purposes with attribution to the Rudd Center for Food Policy and Obesity (no pregnancy images)

Birth Stories of Plus-Sized Women

• http://www.plus-size-pregnancy.org/BBWBirthStories/bbwstrindex.html – stories with a wide range of outcomes and experiences
• http://www.plus-size-pregnancy.org/BBWBirthStories/bbwvagnlstories.htm – stories of normal vaginal births in women of size
• http://www.plus-size-pregnancy.org/BBWBirthStories/bbwspecvagstories.htm – stories of normal vaginal births in women of size despite special circumstances

About Pam Vireday

Pamela Vireday is a childbirth educator, writer, woman of size, and mother to four children. She has been collecting the stories of women of size and writing about childbirth research for 17 years. She writes at www.wellroundedmama.blogspot.com and www.plus-size-pregnancy.org.

 

 

 

Sharon Muza Breastfeeding, Cesarean Birth, Childbirth Education, Evidence Based Medicine, Guest Posts, Healthy Birth Practices, Healthy Care Practices, informed Consent, Maternal Obesity, Maternal Quality Improvement, Maternity Care, Series: Welcoming All Families breastfeeding, Childbirth Education, evidence-based care for women of size, guest post, maternal obesity, obesity, Pamela Vireday, pregnancy in women of size, series, welcoming all families

By Cara Terreri, BA, Community Manager for Lamaze International’s Giving Birth With Confidence blog

Today, an occasional series starts on Science & Sensibility, “Journey to LCCE Certification.”   We will follow Cara Terreri as she progresses on the path to become a Lamaze Certified Childbirth Educator.  Her journey starts with her Childbirth Education Seminar and will continue as she develops her own curriculum, teaches her first classes and sits for the exam.  I invite you to cheer her on and offer your support, suggestions and encouragement based on your own experiences on a similar journey.- SM

After having worked for the Lamaze International headquarters office for seven years now (marketing, writing, managing the Giving Birth with Confidence blog), it’s safe to say that I’ve drank the Kool-Aid. Slowly but surely, the words I pored over while editing became part of my own beliefs – even before I began my own birth journey. And until my last birth, I was happy to remain in my role of reaching women through writing. But my most recent, and most amazing birth (first unmedicated and truly empowering experience), ignited my desire to be more directly involved either as a doula or educator. But how? I already have a part-time job in marketing and writing (for clients in addition to Lamaze) on top of three children, a husband, and a dog – when would I find more time to devote to a budding career in birth?

While I still haven’t answered that last question, in the meantime, I attended the Passion for Birth Lamaze Childbirth Educator Seminar as the first step on the path to being a Lamaze Certified Childbirth Educator.  There was going to a workshop in my hometown, and the timing worked with my other obligations.  This workshop was going to be taught by Passion for Birth founder, Teri Shilling and  co-taught by Ann Tumblin.

At the end of day one, I was blown away. Walking into class, the first thing I noticed was how the tables and each seat were meticulously set up with loads of colorful, playful – and questionable (like, balloons and a ping pong ball?) – class materials. It was like walking into an art class! When class began, I was immediately engaged by the teaching techniques. Nearly every activity and exercise was meant to double as something that could be replicated in your own Lamaze class, including some techniques that should not be used. For example, class kicked off with the dreaded PowerPoint slide. Ann reviewed the slide, turned off the projector and asked everyone to write down the six bullet points reviewed. No one could. Why? Because PowerPoint is a horribly ineffective teaching tool! This was just one of countless “aha” moments for me over the next three days.

In spite of a nine-hour day, the instructors excelled at keeping me engaged and involved, and allowing me to learn – and successfully retain – the material. Beyond the teaching, I really enjoyed the community aspect of class. Participants (27 of them!) came from all walks of the maternal-child health arena, which allowed for interesting dialogue with differing but respectful perspectives.

The Lamaze Childbirth Educator Seminar was, in a word, inspiring. I truly believe that if I could mirror my classes using the Passion for Birth techniques I observed and learned, I would be one fantastic educator! Because Teri still actively teaches childbirth classes in her community, I also felt confident knowing that the information in her workshop is not only effective, but relevant to today’s families.

I believe that my biggest hurdles in completing certification and developing a birth business are making the time, given my other professional commitments; and overcoming my dislike of networking. In class, we discussed the need for aspiring educators to develop face-to-face relationships with individuals, groups, organizations, and businesses in the community. While I don’t think of myself as a wallflower, I’m also not a social butterfly and I’ve never liked being in a “sales-y” role. I’d love to hear from other educators who feel the same way – what did you do to overcome your aversion to marketing and promoting yourself and be able to successfully network with peers and potential students?

So what next? As a new/inexperienced educator on the pathway to certification, the next official step is to be observed in teaching. But before I can do that, I need to create my curriculum and develop a plan for connecting with my local prenatal community. After a group curriculum-building exercise on day one, I gained new respect for the work that educators put into writing, preparing, and refining a class curriculum. That being said, my strongest skills are in writing, researching, and organizing. And with the multitude of tools I acquired through the workshop, I now have the resources create a comprehensive curriculum. Stay tuned for my next update, when I share how that is going.

If you are interested in becoming a Lamaze Certified Childbirth Educator and taking a seminar, please refer to Lamaze International for more information on seminars and the pathways to certification.

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I would like to ask experienced LCCEs and Doulas;

• How did you get started on this path?  
• What led you to become a childbirth educator?  
• What things did you find useful?  
• How do you enjoy what you do?  
• What are some of the challenges?  
• Why did you choose Lamaze as the organization to certify with?
• Can you share your tips from the trenches with Cara and other people who are interested in working as a childbirth educator or other birth professional?

In the next installment of the Journey to LCCE Certification Series, Cara will share how things are going as she works to develop her own curriculum.  Look for that post in the next few months. In the meantime, share your own experiences so that Cara and others on the same path can benefit – SM

Addendum

In the interest of full disclosure, I want to share that I am a trainer for the PfB organization that presented the workshop Cara attended.  I want to take a moment to share that Lamaze International has many vibrant, creative and well established programs that offer workshops all around the country, and internationally as well,  for men and women interested in becoming childbirth educators.  I encourage each individual to reach out and explore the different programs, talk to the program representatives and select the program that meets their professional needs.  Links to all the programs can be found on the Lamaze International Childbirth Education Training page -SM

About Cara Terreri

Cara began working with Lamaze two years before she became a mother. Somewhere in the process of poring over marketing copy in a Lamaze brochure and birthing her first child, she became an advocate for childbirth education. Three kids later (and a whole lot more work for Lamaze), Cara is the Site Administrator for Giving Birth with Confidence, the Lamaze blog for and by women and expectant families. Cara continues to have a strong passion for the awesome power and beauty in pregnancy and birth, and for helping women to discover their own power and ability through birth. It is her hope that through the GBWC site, women will have a place to find and offer positive support to other women who are going through the amazing journey to motherhood.

 

 

 

 

Sharon Muza Childbirth Education, Giving Birth with Confidence, Guest Posts, Lamaze Method, Series: Journey to LCCE Certification, Uncategorized Ann Tumblin, Cara Terreri, Childbirth Education, Giving Birth With Confidence, guest posts, lamaze, Lamaze Certification, LCCE, Passion for Birth, series, Series: Journey to LCCE Certification, Teri Shilling

Guest post by Cathy Busha, MSW

This post is the first in an occasional series on CBE teaching strategies that embrace the diverse populations that take childbirth classes.  Childbirth educators that want to welcome all families to their classes will find information and resources in the series for making their classes a positive place for all.  The second post in the series, to be posted on Thursday, will offer insights on specific things that educators can do, from a LCCE and lesbian mom.  Please welcome this guest post by Cathy Busha, MSW. – SM

My partner and I are expecting our first baby in July; she is carrying.  To prepare, like many first-time expecting parents, we signed up for a birth class offered through our insurance. Rather than seek a private class, it felt important to us to attend this class because 1) it’s free and our budget is tight 2) it’s at the hospital where we are having the baby and 3) from a social change place, I believe in integration not segregation; the birth class that is offered for everyone should be welcoming and have information inclusive of us, too.

While I have not experienced overt homophobia during our pregnancy, as the non-biological mom, I have experienced moments of invisibility. For example, when we found out we were pregnant, a well-meaning friend said, “Congrats! Anna is going to be a mom!” I didn’t know if the educator or our classmates would have judgment or visible discomfort about two women having a baby. While the advertisements for the class talked about partners, all the images were of heterosexual couples. As a genderqueer lesbian, I had some nervousness about attending the class.

My partner is a Lamaze certified childbirth educator, so I have learned a lot about the birth process through conversations about her work. That said, it felt important to me that we take a class together – to make sure I had a strong foundation of understanding of the birth process and how to support her. While we had been watching videos together at home, I wanted to take a class with her so we could learn, talk about the information and create our birth plan together, as a couple.

As I’ve explored books and blogs and birth websites, it seems the birth world, like the rest of the world, is hyper-heterosexist with rigid gender roles. Heterosexism assumes that everyone is straight: there are no pictures or stories of lesbian births on mainstream birth websites. At best, the word ‘partner’ is used, but all images, examples and stories are of straight couples.  I have grown weary of having to translate my role (non-biological mom) from mainstream books, videos and materials that assume all families are one man, one woman.

As for gender roles, on birth websites, women are portrayed with long hair, flowy white dresses, surrounded by flowers, brimming with nurturing instincts. Men, on the other hand, are described as bumbling, strong, masculine providers who may or may not know how to hold a baby or change a diaper, but patiently suffer through their wives’ crazy cravings and mood swings. I don’t identify with either of these paradigms and wondered how I would fit into the birth class we had chosen to take.

I fully anticipated that we’d be the ‘token’ lesbians in the birth class and I was right; however, there was also a single woman in our class who attended with her best friend.

Our childbirth class was two Saturdays with two different and wonderful educators.  As they taught us about the “stages and phases,” I felt affirmed and included when the educators said statements like:

• “…partners are continuous labor support for the mom…”
• “…a doula helps the woman and her partner through the birthing process…”
• “…research shows that just holding your partner’s hand during contractions has strong emotional and physical results…”
• “…it is important to start talking to your baby now – the baby can also hear the partner’s voice…”

Then I realized that while both childbirth educators went out of their way to talk about the birth mom and partner, I felt empathy for the single mom — the word partner rendered her and her friend invisible.  I wondered how can educators honor and include everyone in the room?

While our educators clearly tried to use inclusive language like partner there were still comments such as:

• “…you fathers will also produce high levels of oxytocin during birth…”
• During hand massage training, “…most of you guys in here have bigger hands then your partners…”
• and “…when the baby is born, everyone wants to look at it and figure out – does the baby look like mom or dad?”

We also did a break-out session,  where the pregnant women made a list of what would be helpful from their support person during labor; we support people left the room and were asked to also make a list of what we thought would be helpful for us to do. When we returned to the room to share our lists, the educator said, “Dads – let’s hear your list,” which made the best friend and me invisible again. It felt hurtful and dis-empowering for the educator to use the word “dads,” particularly after working in our small group – where I felt very included and acknowledged by the other support people. It’s no surprise to me, but in working through this exercise in our small groups, it became clear that as support people, our hopes and fears for the birth process were exactly the same.

In the class, we practiced massage, counter-pressure and other comfort measures. My partner and I are very comfortable in public with our sexual orientation/gender identities. As I rubbed her back, I wondered how comfortable this activity might be for a lesbian couple who was less ‘out’ or if someone in the room was openly homophobic.

Overall in the class, I felt we were acknowledged and accepted by the educators and classmates; however, all the videos, print material and photos were of straight couples. It would have been validating to see even one same-sex couple depicted. While childbirth educators should check out the Family Equality Council or Gay Parent Magazine to learn more about the LGBTQ (lesbian, gay, bisexual, transgender, queer/questioning) community, the assumption that pregnant women “must be in relationship with a man” is what needs to change. Queer families are not the only non-traditional family structures that have been increasing; the solo parent (aka Single Mothers by Choice) community is a growing and vibrant one, too.

Overall, the class was a positive experience for my partner and me. I feel more knowledgeable and prepared to support my partner through childbirth. It may have been easier for us to take a private class, but it was more important for us to connect with other families and develop a sense of community. In meeting our needs, we believe we also helped break down stereotypes and increased awareness. I am eagerly counting down the weeks until I can put into practice everything I learned in class and help my partner birth our baby.

A native of Lancaster, Pennsylvania, Cathy Busha is a Human Services/Social Work Faculty member at a community college in Salem, Oregon. A former middle school English teacher and high school basketball and track and field coach, Cathy has a Master’s of Social Work degree from Arizona State University.  The focus of her work includes diversity/inclusion, organizational development and multi-issue community organizing, particularly LGBT (lesbian, gay, bisexual, transgender) people of color, youth and immigrants. Cathy and her partner moved to Oregon from the Boulder, Colorado area this past August and are expecting their first child in July. She welcomes all parenting advice. She can be reached at cbusha@hotmail.com.

 

Sharon Muza Childbirth Education, Guest Posts, Series: Welcoming All Families, Uncategorized Cathy Busha, Childbirth Education, childbirth education class, lamaze, lesbian, series, welcoming classes