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BABE Series: “Should I Stay or Should I Go Now?” or When To Go To The Hospital or Birth Center

June 30th, 2015 by avatar

Today I am sharing our Brilliant Activities for Birth Educators (“BABE”) idea for June!  “Should I Stay or Should I Go Now?”- submitted by Lamaze Certified Childbirth Educator Mindy Cockeram. The BABE series contain fun and interesting ideas that childbirth educators can use in their Lamaze classes to make them engaging and memorable for the families in attendance.  Today’s idea covers when families in labor should move to the birth location. Do you have a fun teaching idea that you would like to share in a future BABE article.  Please pop me an email and we can connect. – Sharon Muza, Community Manager, Science & Sensibility.

By Mindy Cockeram, LCCE

© Mindy Cockeram

© Mindy Cockeram

Introduction

The topic of ‘when to go’ to the hospital or birth location, when a woman is in labor is one subject I’m sure most childbirth educators discuss early on in the childbirth class series, – possibly even on the first night – because it is one of the most perplexing and often worrying topics on which families want clarification. I find that most people have received many different pieces of advice about ‘when to go’ from a whole host of friends, family and care providers.

When we start discussing contraction timing, I suggest families use the ‘3 in 10’ guideline (3 contractions in ten minutes OR five minutes apart for a whole hour). But of course active, well-established contractions are not the only reason to turn up at Labor & Delivery and so we use this deck of cards to introduce different situations and their possible ramifications.

How It’s Used

To add some humor into the activity, I call the decision of when to go to the hospital ‘The Clash Moment’ – from the song ‘Should I Stay or Should I Go’ sung by the great British rock band The Clash. In my opinion, this song was written for the laboring couple. The lyrics ring out:

“Should I stay or should I go now?
If I stay there will be trouble.
If I go there will be double?
So come on and let me know,
Should I stay or should I go?”

I shuffle the “Clash Deck” and then hand the deck to a partner. The partner then takes the top card off the deck and reads it out. I shout out to the class ‘Stay or Go?’ and they decide and answer back. Often the reactions are mixed, so I usually facilitate a discussion if necessary and introduce the evidence based arguments. If the situation on the card would send the pregnant person to the hospital, the deck is handed over to the next family. If the situation on the card is not a reason to go, the same family draws the next card. Often a family will draw a card signaling early labor, then draw the loss of the mucus plug (‘showtime’), then ‘feel shaky’ before finally drawing ‘want to push now’. It’s fun watching the pregnant person’s face and the partner’s reaction as they read the next card if they are ‘still at home’.

Depending on the number of cards in your deck, the activity normally takes about 20-30 minutes to do well.

Takeaways

It is interesting to see how often the partners disagree with the pregnant people about whether to stay or go. The statements that usually create the most conversation are ‘Gush of water’ (termPROM), ‘Feel something small protruding inside’ (rare cord prolapse), ‘Instinct says it’s time’ and ‘Backache comes and goes’ (possible posterior labor).

clash babe 2

© Mindy Cockeram

I always present the evidence for staying at home with term PROM vs going in and the difference between guidelines for PROM in the USA (baby out within 24 hrs from PROM) vs the UK (if PROM within 24, baby out within 48) where I trained. PROM usually also leads into a light discussion on warding off Group B Strep and other bacteria by evening out the ‘bad’ bacteria with the ‘good’ bacteria (lactobacillus).

In the first class I also show a hypnobirth video clip and the pregnant person is totally silent. When a family reads out ‘ouch with a contraction’ and all yell ‘stay’, I remind them that the hypnobirthing person we watched never once murmured ‘ouch’ and a baby popped out. Then we discuss how people will have different ‘ouch tolerances’ based on their length of labor and the position in which the baby is in. So eventually they realize they should time the ‘ouch’ instead of trying to guess dilation based on the sounds that are being made.

Modifications

You can add any situation or symptom to a card that you like. I’m in California and am thinking of adding ‘Feel an earthquake’ to my “Clash Deck” to see what they think. I also want to add some pre-eclampsia symptoms like ‘have a persistent headache with flashing aura’ while Pre-Eclampsia Month is still fresh in my mind.

Creating Your Own

It is really simple to make the card deck. Just type or write out situations or symptoms like I have and attach each one to each card from an old deck. Then laminate the cards between two sheets of plastic laminate, cool and trim with scissors.   Leave a bit of a plastic edge when you trim them otherwise they might peel if cut too close to the card. I’ve been using the same deck for almost ten years and they’ve held up very well.

The class seems to love this activity and I hope you do to. Let me know if you have any questions or feedback on its use in your classes.

Note/Disclaimer: The use of the acronym “BABE” (Brilliant Activities for Birth Educators) is not affiliated with, aligned with or associated with any particular childbirth program or organization.

About Mindy Cockeram

Mindy Cockeram head shotMindy Cockeram is a recently recertified Lamaze Educator working with a large hospital chain in Southern California where she’s been teaching for four years. She trained initially through the UK’s National Childbirth Trust in Wimbledon, England in 2006 after a career in the financial markets industry in London. She graduated from Villanova University in 1986 with a bachelor’s degree in Communications and a minor in Business Studies. Currently working on a book, she resides in Redlands, California with her British husband and two children.

Childbirth Education, Guest Posts, Series: BABE - Brilliant Activities for Birth Educators , , , ,

Webinar – “Childbirth Class for Students Who Want An Epidural” – Today! Register Now.

June 25th, 2015 by avatar
Photo by Patti Ramos Photography

Photo by Patti Ramos Photography

Robin Weiss, PhD, MPH, CPH, ICCE-CPE, ICPFE, CLC, CD(DONA), BDT(DONA), LCCE, FACCE, President of Lamaze International, has an absolutely great webinar scheduled for later today that you definitely don’t want to miss. This 60 minute live webinar, titled “Childbirth Class for Students Who Want an Epidural” will be valuable for both new educators and experienced educators alike at 1 PM EST.

When families enroll in Lamaze classes, some people may be planning to birth without pain medications while others may already have made a different decision and are intending to get an epidural.  Then of course, there are those people who prefer to “see how it goes” and make a decision at during labor.

As a childbirth educator, we won’t necessarily know who falls into which category, and honestly, it simply doesn’t matter.  Our role is to present information that is unbiased, based on evidence and best practice and helps families to make the best decision for themselves. Everyone who takes a childbirth class needs to receive quality information and deserves to have the facts presented in a nonjudgmental manner.

Teaching about epidurals in a Lamaze class allows families to gain knowledge in a safe and welcoming environment.  Whether this topic is covered extensively during your regular classes (which it should be) or you decide to offer a module for those who are positive they want medication, families should have the opportunity to learn what they need to know.

Robin Weiss is the perfect facilitator to lead us through this potentially tricky topic. She has been a childbirth educator, author and trainer of Lamaze educators for many years. She recently completed her Ph.D in Maternal Infant Health at the University of Louisville in KY.

This will be a great check-in to help you evaluate how you are presenting this topic to your students, give you some new ideas and perspective for approaching the subject and possibly even provide the impetus to offer a specialized class.

© Robin Elise Weiss

© Robin Elise Weiss

If you participate in this webinar, you have the option of receiving contact hours for a small additional fee upon completion of a post-webinar evaluation.

Won’t you consider registering now for this webinar that happens today, at 1 PM EST.  After you participate in the webinar, I invite you to come back and share your thoughts, ideas and any learning moments that you have taken away on this topic.

 

Childbirth Education, Epidural Analgesia, Medical Interventions, Webinars , , , , ,

Looking Back in Time: What Women’s Bodies are Telling Us about Modern Maternity Care

June 18th, 2015 by avatar

By Christina Gebel, MPH, LCCE, Birth Doula

Christina Gebel, MPH, LCCE, Doula writes a reflective post examining current birthing conditions to see how today’s practices might be interfering with the the normal hormonal physiology and consequently impacting women’s ability to give birth.  Times have certainly changed and birth has moved from the home to the hospital.  A slow but steady increase in out of hospital births is examined and Christina asks us to consider why women are increasingly choosing to birth outside the hospital – and what do hormones have to do with it? – Sharon Muza, Science & Sensibility Community Manager

“Pregnancy is not a disease, but a beautiful office of nature.” These are the words of Victoria Woodhull, the first female candidate for President of the United States in 1872.

Lajja_gauri ancient birth art

© “Lajja gauri

The world in which pregnant women find themselves today looks a lot different than the time of Woodhull’s campaign run. For instance, hospitals didn’t become the mainstream setting for labor and delivery until the 1930s and 40s. While modern medicine has undoubtedly helped millions of women who may have otherwise died in childbirth, mothers and birth advocates across the nation are beginning to ask if we are paying a price for today’s standard maternity care. With increasing protocols and interventions, pregnancy is viewed less like the office of nature Woodhull spoke of and more like a pathological condition.

The Hormonal Physiology of Childbearing, a recent report by Sarah Buckley, systematically reviews existing research about the impact that common maternity practices may have on innate hormonal physiology in women and fetuses/newborns. The report finds strong evidence to suggest that our maternity care interventions may disturb these processes, reduce their benefits, or even create new challenges. To find out more, read an interview that Science & Sensibility did with Dr. Buckley when her groundbreaking report was released.

Let’s examine something as simple as the environment that a woman gives birth in. In prehistoric times, laboring women faced immediate threats and dangers. They possessed the typical mammalian “fight-or-flight” reaction to these stressors. The hormones epinephrine and norepinephrine caused blood to be diverted away from the baby and uterus to the heart, lungs, and muscles of the mother so that she could flee. This elevation in stress hormones also stalled labor, to give the mother more time to escape. Essentially, she told her body ‘this place is not safe,’ and her body responded appropriately by stopping the labor to protect the mother and her child during a very vulnerable time.

Today, mothers are not fleeing wild animals but rather giving birth in hospitals, the setting for nearly 99% of today’s births, where this innate response may cause their labor to stall. The sometimes frenetic environment or numerous brief encounters with unfamiliar faces may trigger a sense of unease and, consequently, the fight-or-flight response, stalling the mother’s labor. Prolonged labor in a hospital invariably leads to concern and a need to intervene, often by the administration of Pitocin, synthetic oxytocin, to facilitate regular contractions. Arrested labor could lead to further interventions up to and including a cesarean section. The fight-or-flight response may be further reinforced by these interventions, as they potentially come one after the other, in what is often referred to as the “cascade of interventions.”

This is just one example of how a woman’s body’s natural physiology can go from purposeful to working against the labor, the mother and the baby. Epinephrine and norepinephrine are both necessary in labor and delivery. In fact, at appropriate levels, these hormones support vital processes protecting the infant from hypoxia and facilitating neonatal transitions such as optimal breathing, temperature, and glucose regulation, all markers for a healthy infant at birth.

Recent data show that mothers themselves may already think what the Hormonal Physiology of Childbearing report suggests. The series of Listening to Mothers (LtM) studies, a nationally-representative survey of childbearing women, shows a shift in mothers’ attitudes towards normal physiologic birth: In 2012, 58% of mothers agreed somewhat or strongly that giving birth is a process that should not be interfered with unless medically necessary, up from 45% in 2000. According to 2013 national birth data, out-of-hospital (home and birth center) births have increased 55% since 2004, but the overall percentage is still only 1.35% of all births nationwide. While low, this shows that a small core of mothers are voting with their feet and choosing to give birth out of the hospital. Though their choice may seem extreme, they’re not alone. In the LtM data, which only surveys women who have given birth in a US hospital, 29% of mothers said they would definitely want or would consider giving birth at home for a future birth, and 64% said the same of a birth center. All this raises the question: What’s happening in a hospital that is leading mothers to consider other settings for their next birth?

One answer to upholding women’s preferences, autonomy, and the value of normal physiologic birth is a mother’s involvement in shared decision making with her provider, along with increasing access to models of care that support innate physiologic childbearing, like midwives in birth centers. Increasing access to these options may present a challenge, as demand seems to outweigh availability.

Leslie Ludka (MSN, CNM) has been the Director of the Cambridge Health Alliance Birth Center (Cambridge, Mass.) as well as the Director of Midwifery since 2008. Like other birth centers, the center has seen a steady increase in demand each year, with patients coming from all over New England. Ludka sees many barriers to having more birth centers available including finances (the reimbursement for birth not being comparable to an in-hospital birth), “vacuums in institutional comprehension” of the advantages of the birth center model for low-risk women, and the rigorous process to be nationally certified by the Commission for the Accreditation of Birth Centers (CABC), requiring “a great commitment and a lot of support by all involved.” In order to overcome these barriers, Ludka suggests marketing the safety of birth centers to the general public, sharing outcome statistics for women and infants cared for in birth centers, and educating insurers and providers about the overall benefits and financial savings of midwifery and the birth center model. With supportive policy and better understanding on the part of insurers, the public, and healthcare institutions, models like the birth center could become more plentiful, more easily meeting the demand.

Women’s bodies are sending subtle messages that our current healthcare system is, at times, not serving their needs. It’s time to respond to these messages, beginning by viewing childbirth foundationally as a life event and not first as pathology, and adapting our models of care to speak to this viewpoint. If we fail to do so, we run the risk of creating excess risk for women and newborns.

It’s been 143 years since Woodhull ran for president. We’ve made progress in getting much closer to seeing our first woman president, but with childbirth, perhaps our progress now starts with looking back in time.

About Christina Gebel

© Christina Gebel

© Christina Gebel

Christina Gebel holds a Master of Public Health in Maternal and Child Health from the Boston University School of Public Health. She is a birth doula and Certified Lamaze Childbirth Educator as well as a freelance writer, editor, and photographer. She currently resides in Boston working in public health research. You can follow her on Twitter: @ChristinaGebel and contact her through her website duallovedoula.com

Childbirth Education, Guest Posts, Home Birth, Maternity Care, Medical Interventions, Midwifery , , , ,

Customizing Your Lamaze International Directory Profile – A Quick and Easy How To Guide

June 11th, 2015 by avatar

jim croceOn Monday, I shared the news that Lamaze International has just released a new mobile app “Pregnancy to Parenting” that families can download from the Google Play or Apple App store for their smart phones. With this app, they can receive valuable tips and tools, and useful evidence based information that will take them from pregnancy, through labor and birth, and well into the first weeks of parenting. Families can also search for a local Lamaze class in order to receive the gold standard in childbirth education. You can get all the details on the mobile app by reviewing the blog post “Lamaze International Launches Free Pregnancy to Parenting Mobile App to Support Families” and then clicking over to the mobile app information page on our website where you can find a mobile app resource kit for your use.

As more and more families continue to download and access the app, Lamaze Certified Childbirth Educators can expect that more families will utilize the “find a local class” feature and contact you to register for your Lamaze childbirth program.  You will want to be sure that your profile information is current and up to date on the Lamaze International website.

When you set up your profile, there is some information that is required and other information that is optional.  Additionally, you can set the parameters for the information that parents see when searching the Lamaze directory.  The more information that you complete, the more information will display in your directory listing.  Today on Science & Sensibility, I will walk you through the steps on how to control what is listed and visible in the “find a local class” feature and the overall directory.

Modifying your Lamaze International directory profile

1. Log in to your lamazeinternational.org account by using this link.

2. Select edit profile on the right.

3. Please note that the following profile fields are optional:

  • Designations
  • Job Title
  • Company
  • Personal Website
  • Fax
  • Languages you teach

A full profile in the directory will look like this:

directory 1 4. If you fill out the Languages you teach and add a picture to your profile, they will appear when hovering over the “i” (information) box.

directory 2

5. You can add your picture by clicking on the ‘My Picture’ link on the right side bar of your profile page, and uploading an image.

directory 3

6. When editing your profile, you can also use the following checkboxes to control certain aspects of your directory listing:

  • You can exclude yourself from the directory entirely by checking either the ‘Exclude from LCCE Directory’ or ‘Not Currently Teaching’ checkboxes.
  • You can hide your street address from the directory by checking the ‘Hide Street Address from LCCE Directory’ checkbox.

directory 4

Here is an example of a directory listing with the street address “hidden.”

directory 5

Consider how you would like your profile to appear in the Lamaze Directory and in the “find a local class” feature on the parents’ Lamaze.org website, the professional LamazeInternational.org website or in the “Pregnancy to Parenting” mobile app.  Go ahead and make any changes using the directions above and save by selecting “hit ok” at the bottom left of the webpage.  When the database is refreshed, your information should appear as you have selected.  Check it out for yourself.  Should you have any questions about these instructions or need additional information, please do not hesitate to email info@lamaze.org with “directory assistance” in the subject line and your email will be directed to a staff member who will be happy to help.  Alternately, you can contact the Lamaze office by phone at 202-367-1128 or Toll-free: 800-368-4404.

With the new mobile app roll-out, now is a great time to verify that your directory information is:

  • current,
  • accurate, and
  • as you wish it to appear

Go ahead and take a few minutes to take care of this small detail and you will be helping families to be able to find and contact you for your Lamaze class offerings.

Childbirth Education, Lamaze International , , , ,

Lamaze International Launches Free Pregnancy to Parenting Mobile App to Support Families

June 8th, 2015 by avatar

Free new app!Lamaze International is delighted to announce the launch of their new “Pregnancy to Parenting” mobile app for families.  This just released app is meant to be a comprehensive evidence based resource for people to use during the childbearing year and is free to anyone who downloads it.  In addition to sharing customized information about their pregnancies, the app also provides tips and information for labor and birth and then continues to support families after birth as they feed and care for their new baby.  85% of millennials are heavily reliant on their smartphones for both information as well as entertainment throughout the day.  Lamaze International, well-recognized as the leader in childbirth education, meets today’s parents where they are at (on their smart phones) with this well designed, well thought-out app that takes families from conception all the way into their first weeks and months of parenting!

After downloading the app from either the Apple App store or from Google Play, parents can get weekly information about their pregnancy, updates on what baby development looks like that week and even access fun lighthearted facts that are entertaining as well as interesting. Daily tips, relevant articles, and Q&As are also included.

The “Pregnancy to Parenting” app lets pregnant families find a Lamaze class near them (make sure your information is up to date in your membership profile!  We will discuss how to access and update your profile in a post here on Thursday), maintain a calendar that tracks their CBE classes, doctor or midwife appointments, and even create a pregnancy journal with notes, videos and pictures.LI_MobileAppScreenshots5

As labor begins, there is a handy contraction timer and parents can access evidence based information about what to expect during labor and birth as well as useful tips, for example – information on the importance of moving around and changing positions as labor continues to progress.

After birth, parents can use the useful breastfeeding and diaper tracker as they head into the wonderful but exhausting first days and weeks with their newborn.  There is also information on postpartum mood and anxiety disorders, what to look for and how to get help.

The content in the “Pregnancy to Parenting” mobile app was prepared and approved by Lamaze Certified Childbirth Educators just like you, and delivered in a thorough and easy to navigate app that looks great and functions well on today’s mobile devices.

As the “Pregnancy to Parenting” mobile app gets introduced to expectant and new parents, Lamaze International is offering educators and other birth professionals an opportunity to participate in a 60 minute webinar: Utilizing the New Lamaze Mobile App – Pregnancy to Parenting, facilitated by former Lamaze President Michelle Deck, RN, MEd, BSN, LCCE, FACCE on Tuesday, June 9th at 1:00 PM EDT.  The purpose of this webinar is to share information with childbirth educators on the app’s content and functionality as well as suggest how educators can introduce the mobile app to families and incorporate the app in their classrooms.  You can register now for this informative session.

LI_MobileAppScreenshots3Lamaze International has prepared an educator resource kit to help you spread the word about the new “Pregnancy to Parenting” mobile app that includes flyers for your classroom and workplace, a friendly email that you can use to introduce the app to your students and community and even PowerPoint slides that can be integrated into your classroom curriculum.  Learn more about the mobile app and these resources here on the resource kit page of the Lamaze International website.

Lamaze International wants to offer the families you work with (and all families) access to additional information that supports what they are already learning in their Lamaze class.  Having access to resources that provide evidence based information in a format that today’s families are used to accessing helps families to have a safe and healthy birth and make decisions that support healthy mothers, healthy babies and healthy families.  Making it easy for families to find a Lamaze class in their area, when they have not yet signed up for childbirth classes, helps educators to reach more families and benefits educators by directing those families right to you! The new “Pregnancy to Parenting” mobile app is a great tool for families and educators a like.  Head over to the app store of your choice and download the app, so you can become familiar with it and will be ready to share with the families that you work with.  See you in the webinar!

Babies, Breastfeeding, Childbirth Education, Lamaze International, Lamaze News, News about Pregnancy, Pregnancy to Parenting Mobile App , , , ,

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