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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 , , , ,

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 , , , ,

American Obstetrician Takes Rational Position on Home Birth

June 16th, 2015 by avatar

Neel Shah, Harvard Medical School assistant professor and practicing obstetrician, commenting in the New England Journal of Medicine Perspectives section –  “A NICE Delivery – The Cross-Atlantic Divide over Treatment Intensity in Childbirth“, agrees with new United Kingdom National Institute for Health and Care Excellence (NICE) guidelines concluding that healthy, low-risk women are better off at home or in a midwife-led unit than in a hospital under the supervision of an obstetrician. Citing a table comparing outcomes in low-risk multiparous women from the Birthplace in England data, Shah writes:

The safety argument against physician-led hospital birth is simple and compelling: obstetricians, who are trained to use scalpels and are surrounded by operating rooms, are much more likely than midwives to pick up those scalpels and use them. For women giving birth, the many interventions that have become commonplace during childbirth are unpleasant and may lead to complications . . . .

He quite reasonably adds the caveat that the guidelines apply to low-risk women only and that even these women may develop labor complications without warning, but then, responsible home birth advocates acknowledge those same two points. That being said, I can’t resist adding a couple of caveats of my own.

© Families Upon ThamesFirst, one reason why women with risk factors plan home birth, women with prior cesareans being a common example, is that doctors and hospitals deny them the possibility of vaginal birth (Declercq 2013). With their only hospital alternative being unwanted and unneeded cesarean surgery, planned home birth becomes their least, worst option. This dilemma puts their choice squarely in the lap of the medical system. Another reason is that some women have been so emotionally traumatized by their treatment during a previous birth that they reject planned hospital birth and refuse intrapartum transfer even when this may be the safer option (Boucher 2009; Symon 2010). Again, the failure and its remedy lie with the system, not the woman.

Second, if the hospital lacks 24/7 obstetric, anesthesia, and pediatric coverage and at least a Level 2 nursery, which many do, then a woman is probably no better off in the hospital in an emergency than she would be at home or at a freestanding birth center. Furthermore, most urgent situations—a baby who doesn’t breathe, excessive bleeding, even umbilical cord prolapse—can be managed or stabilized by a properly trained and equipped home birth attendant. In fact, what would be done in the hospital is no different from what would be done at home: neonatal resuscitation, oxygen, medications to stop bleeding, maternal knee-chest position and manually holding the fetal head off the cord until cesarean.

Finally, with admirable frankness, Shah notes that unlike the U.K., and to the detriment of safety, “[A]ccess to obstetric care that is coordinated among homes, birthing centers, and hospitals is both unreliable and uncommon.” And while he doesn’t cast any blame, once more, the fault lies with the system. (Just as an FYI, a model guideline for transfer of care developed by a workgroup that included all stakeholders is publically available.)

Shah concludes: “The majority of women with straightforward pregnancies may truly be better off in the United Kingdom.” True that, but it doesn’t have to be that way. Dialing back the overuse of medical intervention and cesarean surgery; respecting the woman’s right to give informed consent and refusal; implementing a culture of care that is kind, compassionate, and respects a woman’s dignity; and ensuring that out-of-hospital birth attendants can consult, collaborate, and transfer care appropriately would have two benefits: it would reduce the number of women refusing hospital birth while minimizing the chance of adverse outcomes in those who continue to prefer to birth at home or in a freestanding birth center. Nonetheless, despite the generally positive responses accompanying Shah’s commentary, rather than inspiring a wave of reform, I would lay odds that the more common reaction to Shah’s piece within the medical community will be to shoot the messenger.

References

Boucher, D., Bennett, C., McFarlin, B., & Freeze, R. (2009). Staying home to give birth: why women in the United States choose home birth. J Midwifery Womens Health, 54(2), 119-126.

Declercq, E., Sakala, C., Corry, M. P., Applebaum, S., & Herrlich, Ariel. (2013). Listening to Mothers III. Pregnancy and Birth. New York: Childbirth Connection.

Symon, A., Winter, C., Donnan, P. T., & Kirkham, M. (2010). Examining autonomy’s boundaries: a follow-up review of perinatal mortality cases in UK independent midwifery. Birth, 37(4), 280-287.

About Henci Goer

© Henci Goer

Henci Goer, award-winning medical writer and internationally known speaker, is the author of The Thinking Woman’s Guide to a Better Birth and Optimal Care in Childbirth: The Case for a Physiologic Approach She is the winner of the American College of Nurse-Midwives “Best Book of the Year” award. An independent scholar, she is an acknowledged expert on evidence-based maternity care.

Evidence Based Medicine, Guest Posts, Home Birth, Maternal Quality Improvement, Maternity Care, Medical Interventions, Midwifery , , , , , ,

Applying the Health Belief Model in Your Role as a Birth Professional

June 4th, 2015 by avatar

HealthBeliefModelPart2Last Tuesday, in part one of this two part post series, Andrea Lythgoe explained the Health Belief Model in her blog post Understanding the Health Belief Model.  Andrea discussed the different components that make up this model.  As we learned, perception is key and there are several different ways that a family’s perception of their circumstances can influence their decision making.  Today on Science & Sensibility, Andrea discusses how the childbirth educator or other birth professional can use this knowledge about the Health Belief Model to structure conversations and activities that assist families in making important decisions about their maternity care. – Sharon Muza, Science & Sensibility Community Manager

So how does this Health Belief Model come into play with childbirth education? It is important to remember that as childbirth educators, our role is not to be manipulative and push families towards certain goals.  Our responsibility is to present evidence based information so that families can make decisions that feel right for them.Here are some approaches we can use that make use of this model when fostering decision making skills in the families that attend our classes:

Perceived Benefits

Childbirth educators can provide families with information about the benefits and risks of the choices they are considering, and introduce other options they might not have considered. For example, I frequently have families in my classes who are unhappy with their care provider. I can help the family understand the benefits of more clearly communicating their birth preferences with their care provider to make sure that the HCP is on board. I can point out that they may find switching to a different care provider or birth place potentially more compatible with their own preferences, and give them tools to explore, evaluate, and choose the option that feels right to them.

Perceived Barriers

Childbirth educators can carefully listen for and identify the barriers that families perceive exist. You may be able to correct misinformation that a family believes prevents them from making a change they wanted to make. Be a MythBuster! Proactively address and correct myths that might be perceived barriers for your students and clients.ApplyingHBM2

Perceived Seriousness

Childbirth educators can help families to recognize, investigate and  accurately understand the risks of choices they may encounter.  We can give them tools to discuss and understand the “culture of risk” so that they have an idea of the severity of potential interventions and side effects. This goes both ways, as we need to be careful to be honest and realistic about the information we present. Always provide evidence based information and steer clear of exaggeration, minimization and scare tactics.

Perceived Susceptibility

Susceptibility is the hardest one to address. As I mentioned in my earlier blog post, once a person has experienced a loss or complication – in themselves or a loved one – there is a loss of innocence, and it is difficult to get past the previous experience. They don’t need to be “talked out” of feeling susceptible, but childbirth educators can often help families navigate the fear they may feel. Validation of their fears, suggestions for coping with fears, and potentially referring to counseling are ways to assist families who may be paralyzed by fear. It is important to be aware of how your own experiences affect your approach to providing unbiased information to your students and clients.

Self-efficacy

Childbirth educators can do wonders for helping class members build their self-efficacy. One simple activity that I have found builds self-efficacy is to ask pregnant people to list two times in their life when they have achieved something that did not come easily, and two times they saw their partner do the same. They then share their lists with each other or even with the class. I ask them to describe to each other or write down the personal traits that helped them accomplish this difficult task.CaregiversMotto

Another way to build self-efficacy in your classes is to provide lots of opportunity for families to practice the skills and coping tools they may find helpful in labor, multiple times during their childbirth class, in a variety of situations. This repetition helps to build confidence in their ability to remember and use the techniques when they are in labor. You can build on techniques you’ve previously taught. If you taught a slow deep breathing technique last week, encourage pregnant people to practice it during later parts of their class when you teach massage or positions.

Cues to Action

As childbirth educators, we may be able to provide some cues to action. Giving families the assignment to prepare a birth plan before your next class can be one such cue to action. You can also help partners to learn to provide these cues to action as well. Reminders in labor to ask for time to make decisions can be a cue to review all their options and use the “BRAIN” tool to make decisions. As a childbirth educator, it is key to remember that you cannot force them take action, you can only provide the pregnant person and their partner with cues they can choose to act on – or not.

Summary

Having a good understanding of the perceptions and factors influencing families’ decision making can help us as childbirth educators and birth professionals to create effective classroom activities.  We can also use this information to improve communication and personal interactions with the families we work with. When childbirth educators can provide their students with tools for making the decisions that are best for them, families can move confidently through any decisions that they may face throughout the childbearing year and beyond.

In closing, it is always good to remember the Caregiver’s Motto taught by Penny Simkin:

 “A person  has a very good reason for…

…Feeling this way
…Behaving this way
…Saying these things
…Believing these things…”

How do you help the families that you work with to make decisions?  What activities do you find build self-efficacy and confidence in your classes?  How do you best apply the Health Belief model to your interactions with students and clients? Please share your experiences in the comments section. – SM

About Andrea Lythgoe

Andrea Lythgoe

Andrea Lythgoe

Andrea Lythgoe is a doula, hospital-based Lamaze childbirth educator, birth photographer, and former instructor at the Midwives College of Utah. She is the author of the website UnderstandingResearch.com where she aims to help those just beginning to read research to understand the language of research. Her interest in research started while attending the University of Utah, where she made ends meet by working on a large randomized controlled trial and earned a degree in community health. Andrea served on the Board of Directors for the Utah Doula Association for over 10 years. She lives and practices in the Salt Lake City, Utah area. Andrea can be reached through her website.

 

 

 

Childbirth Education, Guest Posts, Maternity Care , , , ,

Perception is Everything – Understanding the Health Belief Model

June 2nd, 2015 by avatar

HealthBeliefModelPart1Today, regular contributor Andrea Lythgoe explains what the “Health Belief Model” is and how it may influence the decisions that your students and clients make.  As childbirth educators and other birth professionals, we sometimes scratch our head at the choices that some of the families we work with make.  When you examine the Health Belief Model – you can get a better understanding of how those decisions might have been reached.  On Thursday, Andrea will discuss how you can apply this decision making model in your role as a childbirth educator. – Sharon Muza, Community Manager, Science & Sensibility.

Ever wonder why people make the decisions they do about their pregnancy or birth? Why they stick with an health care provider they clearly don’t like? Or why they choose to feed a baby the way they do? Do you, at times, see people make decisions in ways that make no sense to you or are the complete opposite of what you might have decided?

The Health Belief Model was developed over 50 years ago, and it can provide some insight into the way that people make decisions about their health. The Health Belief Model starts with recognizing four factors that can play a role in decision making: perceived benefits, perceived barriers, perceived seriousness, and perceived susceptibility.

Let’s look at each of these factors individually:

Perceived Benefits

This one is pretty easy to understand. This is the “why”. We all know we should eat healthy and exercise, but we don’t always do that. Sometimes it is because we don’t understand or can’t clearly grasp the benefits, or the benefits are not important to us.  Also keep in mind that a benefit that you place a high value on might be of low importance to the families you serve. Remember that this birth is about the benefits the families you work with value, not the benefits you feel are important. For example, you may place a high value on mobility in labor, while a class member may place higher value on pain relief. The family has to feel that the benefits outweigh the costs and inconvenience of the action.

Perceived Barriers

“Perceived barriers” may be keeping people from whatever they “should” do or want to do. Maybe they feel like they can’t improve their diet because of limited money. They might feel that they cannot birth at home because of insurance coverage.  As a childbirth educator, you may – or may not – be able to help families identify the barriers they face and help them navigate around them. You can preach the benefits all you want, but if a perceived barrier is keeping families from making a change they say they want to make, all your efforts to demonstrate the benefits won’t make any difference. Remember that class members will not always feel comfortable disclosing to you the barriers they perceive, and they are not required to disclose them. But specifically asking a family –  “Is there anything you feel is holding you back from changing care providers?” or “What I hear you saying is that you want a home birth but have planned a hospital birth. How did you come to that decision?” may help them – and you – to better understand the barriers they perceive.

© Andrea Lythgoe

© Andrea Lythgoe

Perceived Severity

How much importance people place on the potential or real consequences of an action is “perceived severity.” Do people think it is a “big deal?” With the recent push to avoid inductions, especially before 39 weeks, I am hearing a lot of people state “It can’t be THAT risky for the baby. I know lots of people who were induced at 37 weeks and their babies are just fine!” Another common statement is “I formula fed all my kids and they turned out to be a lawyer and a doctor!”

When I was in labor with my second baby, a nurse told me: “Your baby will DIE if we don’t have you on the monitor all the time!” Luckily, I knew enough to just laugh and ask her exactly what the monitor did that sustained life. This was the nurse’s way of raising the perceived severity in an attempt to get me to stay in bed and stay connected. Sadly, it’s not the only time I have heard this strategy used, and I’ve even heard childbirth educators use a variation of this technique: “If you choose to be induced, your baby will pay the price!” Some people will recognize the hyperbole, but others will only perceive the negative and move into complying solely out of fear, even if that is not what they wanted to do.

Perceived Susceptibility

“Perceived susceptibility” essentially refers to the question “Could this happen to me?” Every person is going to have a different view of what are the chances this could happen to them. Teenagers are pretty notorious for thinking that something won’t happen to them. (There’s a saying that “all teenagers think they are immortal, invincible, and infertile.”) Adults can have a similar attitude, or alternately, they can have an Eeyore-like attitude that “If something bad will happen, surely it will happen to ME.”

Sometimes people’s feelings of being at risk are heightened by past experiences. A person who needed fertility treatments to become pregnant may feel like their pregnancy is high-risk even if all is well. This is another area where fear plays a big role. It can be a tricky thing to try to help someone adjust their perceptions of risk. Past life experiences can also play a role here. I personally am never going to be completely comfortable with a family’s choice not to use antibiotics for GBS, because I lost a niece to GBS over 20 years ago. Your family’s experience, or the experiences of those close to them, may all play a role, as can the personal and clinical experiences of your family’s health care providers.  You could provide statistic after statistic about how rare a birth defect is, and you could explain until you are blue in the face that it is not genetic, but if they or a loved one has experienced a heartbreaking loss, it is natural that they will perceive a greater susceptibility.

Notice the one word connected to all of these factors: PERCEIVED.  Perception is key – and your perception may well be different from the perception of the families you serve.

Cue to Action

After considering these factors, remember that something has to motivate them to put that decision into action. In the Health Belief Model, this is called a “Cue to Action.” For many people, the pregnancy itself triggers them to start eating healthier, exercise, or quit smoking. For others, different experiences may be their “cue to action”. I remember a coworker several years ago who quit smoking cold turkey the first time she felt her baby move, though she had no issues with smoking in pregnancy up until that point.

Self-efficacy

One last factor that can influence decision making is self-efficacy. Self efficacy is how a person feels about their ability to successfully accomplish something. If you have ever heard a pregnant person say “I’d love to do natural childbirth, but I am a wimp. I know I couldn’t do it.”, then you have observed a classic example of low-self efficacy.  Boosting confidence and giving concrete tools to work with can help increase self-efficacy.  This is something that you can help with in your role as a childbirth educator

Summary

Childbirth educators can have an effect on all of these factors in the course of their work with childbearing families. It is important for us to be aware, as we communicate childbirth information, that people often make decisions based on how they feel about the information presented, rather than on the facts themselves. In my next post, I’ll talk about how this model can be applied to childbirth education and even doula work.

Can you think of decisions that your students or clients make that seem to defy logic?  Why do you think they have made those specific choices?  Share your observations and experiences in the comments section of this blog. – SM

Sources:

Green, L.W. & Kreuter, M.W. (1991) Health Promotion Planning: An Educational and Environmental Approach Mayfield Publishing Company, Mountain View, CA

Health Belief Model Definition

About Andrea Lythgoe

Andrea Lythgoe

Andrea Lythgoe is a doula, hospital-based Lamaze childbirth educator, birth photographer, and former instructor at the Midwives College of Utah. She is the author of the website UnderstandingResearch.com where she aims to help those just beginning to read research to understand the language of research. Her interest in research started while attending the University of Utah, where she made ends meet by working on a large randomized controlled trial and earned a degree in community health. Andrea served on the Board of Directors for the Utah Doula Association for over 10 years. She lives and practices in the Salt Lake City, Utah area. Andrea can be reached through her website.

 

 

Childbirth Education, Guest Posts, Maternity Care , , ,

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