Archive for the ‘Healthy Birth Practices’ Category

Series: Brilliant Activities for Birth Educators – Events of Late Pregnancy and Premature Birth

November 19th, 2015 by avatar

PlaybillNovember is Prematurity Awareness Month and November 17th was World Prematurity Awareness Day. This month’s Brilliant Activities for Birth Educators post is about preventing prematurity, the events of late pregnancy and the importance of waiting for labor to begin on its own. As they do every year, the March of Dimes leads the way in recognizing the importance of preventing premature births. They have provided information and resources to bring this important problem to light.  The number one cause of death of young children worldwide is complications from being born too early, with estimates of 1.1 million deaths directly linked to being born too early.   In the United States, one in ten babies are born premature.  If you live in the USA, you can check out how your state has performed on the prematurity report card.  On the international level, you can find out how your country ranks here.  In the US, we also know that premature births and low birth weight babies are more likely to occur in families of color.

I cover premature birth in my childbirth classes in many ways, including recognizing the signs of premature labor, and facilitating a discussion around the Lamaze Healthy Birth Practice “Let Labor Begin On Its Own” as induction before a baby is ready and has started labor can unintentionally result in a premature birth if the gestational age is estimated incorrectly or even if the baby was not ready and needed some more time in utero.  Not every baby is ready to be born at the same time.

My favorite activity to do in class on this topic leaves families really understanding the benefits of letting baby start labor when they are ready (in the absence of medical complications).  In small groups – the families prepare and present a short skit on the events of late pregnancy.

When this is activity is done in class

I cover this information on week two of a seven week series, at the beginning of class.  The families are just beginning to gel and we have done quite a bit of interactive learning the week before, on class one, but this is definitely a leap of faith on their part to be doing such a “daring” activity at the start of the second class.  They have only been with me and their classmates for one 2.5 hour session.  I am asking a lot of them, but they always rise to the challenge.

© Penny Simkin

© Penny Simkin

How I introduce the topic and set up the activity

I hand out Penny Simkin’s “Events of Late Pregnancy” information sheet that is available for purchase as a tear pad from PennySimkin.com. I discuss how both pregnant person and baby are getting ready for birth in the last weeks of a pregnancy.  Many different processes are happening and systems are moving forward to have everything culminate and coordinate in the labor and birth.  Each and every process is critical to a healthy baby and a body that is ready for labor.  I divide the class into four groups and assign each group to be either a Pregnant Person, Uterus, Fetus, or the Placenta/Membranes.  I ask them to collaborate together and prepare a skit, activity, active presentation, interpretive dance, charade etc., that shares information on the changes their assigned role undergoes during the last weeks of pregnancy and through labor.  I give them around five minutes to prepare and offer to provide any props that they might need from my teaching supplies.  They gather their groups, take their tear sheet and head to four corners of the classroom to get to work.

The results of their creativity

After the small group work is completed, we gather back as a class and get ready for the “show.”  In turn, each group (and their chosen props) heads to the front of the room to do their presentation.  Everyone follows along with their info sheet.  The results are outstanding and usually quite comically.

Some of the most memorable presentations have included a newscaster holding a microphone and interviewing the fetus at different gestational ages.

Newscaster: “Hello 34 week old fetus, can you tell me what you are working on now?”

Fetus: “Well, this week, I am taking on iron and my mother’s antibodies. I need the iron to help me through my first six months and the antibodies protect me until I can make my own. ”


© Anne Geddes and March of Dimes

Other groups have created a giant pelvis with their bodies and had a “baby” assume the birth position and move through.  I recall a group ripped up red paper into confetti, and released it from up high to represent bloody show.  Just this week, one group did a hip hop dance and chanted along with the different events.  “Antibodies” have leapt through “placentas,” and fake breasts have leaked colostrum.  Giant uteri have contracted and pushed babies out.  One week, uncoordinated contractions representing Braxton-Hicks contractions “squeezed” out of sync and then got “organized” and worked in unison to represent labor contractions getting longer, stronger and closer together, flexing and squeezing like a well fabricated machine. I am continually amazed at the creativity and ingenuity of the results.  Everyone laughs and best of all, the events are memorable and easy to recall.


After each group has a chance to present their section, we debrief and discuss any questions.  We bring things full circle by talking about what the impact might be for a premature birth or a birth that occurs before the baby or parent’s body is ready.  Everyone is clear that the process of birth and the transition that baby needs to make works best when baby chooses their birth day.  We admire everyone’s creativity and laugh about the mad skills that the class has!  As the series continues, I can refer back to these skits and remind them of the important steps as they come up again in class.  I am amazed that they have great recall of the progression.

What the families say about the activity

After we have finished, the feedback I receive on this activity is great!  Despite their initial hesitancy to get so far out of their comfort zone, families really remember the events, recognize how important the changes are that occur in the pregnant parent, the uterus, the baby and the placenta and membranes. They can clearly articulate why it is important to reduce the chance of a premature baby and wait for labor to start on its own.  The unique presentations really make things memorable and the families report back to me weeks later, or even at the class reunion after birth, how they often thought of this activity and it helped them to have patience to wait for baby to come.  They knew good (and important) things were happening in the last few weeks that would make for a healthy birth and baby.

How do you teach about preventing premature birth and the importance of waiting until baby starts labor?  What interactive teaching ideas do you use?  Do you think that you might try something like this in your childbirth classes?  How might you modify it.  Share your thoughts in the comments below.  I would love to hear from you.

Babies, Childbirth Education, Healthy Birth Practices, Lamaze International, Newborns, Pre-term Birth, Series: Brilliant Activities for Birth Educators , , , , ,

Meet Maria Brooks – New President of Lamaze International

November 17th, 2015 by avatar

“A Lamaze educator is able to anticipate a need that you may have before you experience it. She can tailor your class to help you navigate obstacles that are unique to your health and choice of birth location.”  – Maria Brooks, President, Lamaze International

maria brooks headshot 2015This fall, Maria Brooks, BSN, RNC-OB, LCCE, FACCE moved into the position of President of the Board of Directors and began serving her one year term leading our organization.  Maria (pronounced “Mah-rye-ah”) has been serving on the BoD since 2012 and also serves on the Lamaze ITS Steering Committee and Lamaze Membership Committee.  Maria is an L&D nurse at Pennsylvania Hospital in Philadelphia.  While I have known Maria for several years, I recently connected to ask some questions on behalf of Science & Sensibility readers.  I know that all of our Board works very hard on behalf of educators and parents.  Please join me in congratulating Maria and welcoming her into her new position. .

Sharon Muza: What are some of the opportunities and challenges that face our organization currently and what plan do you and the board have to meet these challenges?

Maria Brooks:  Exaggerated fears around pregnancy and childbirth have already taken hold in many women by the time they reach our educators. One of the ways Lamaze is trying to help make a difference is developing a para-professional community trainer/model for Lamaze education. A Lamaze peer educator program is an opportunity for Lamaze International to promote evidence-based healthy behaviors before, during, and after pregnancy among 18-25 year old young adult women.  The peer educator program will be designed to train college-aged women using a scripted toolkit to disseminate information on the Lamaze Six Healthy Birth Practices.  The purpose of the peer educator program will be to share information to help young adult women to formulate accurate and confidence-building ideals about pregnancy, birth, and breastfeeding. We plan to pilot the program in the coming year.

“Maria brings a depth of advocacy skills and passion for reaching women and their families in diverse communities with Lamaze education and resources. I look forward to working with Maria, the Board of Directors, and volunteer leadership as we continue the meaningful work of advancing Lamaze’s strategic imperatives in the coming year.” – Linda Harmon, Executive Director, Lamaze International

SM: When you think of the many recent accomplishments of Lamaze International, what are a few that you are most proud of? Why?

MB: In the last few years, Lamaze has made it a priority to “create demand for our brand.” We want to meet women where they are – online! We have seen a tremendous growth in our reach through our expanded presence on social media by hosting monthly Twitter chats and creating content-rich infographics and videos to share via Facebook, Pinterest, our blogs, Twitter, and so much more.  These efforts have raised our social media presence and profile. Both Science & Sensibility and Giving Birth with Confidence have been recognized for their high-value content and have seen significant growth in reach over the past few years reaching more expectant parents and professionals with evidence-based information. That alone is a big success. We are lucky to have these blogs represent the mission and vision of Lamaze. Lamaze also invested in development of a mobile app for expecting families, Pregnancy to Parenting, to make Lamaze education resources easily accessible on the go, and as a resource for our educators to use in class.  

SM: Do you feel that Lamaze is recognized as a serious player amongst maternal infant health organizations?  If yes, what accomplishments have helped us to earn this position and a seat at the table working with other well known organizations to improve maternal and neonatal mortality and morbidity?

MB: Yes, Lamaze has had a seat at the table with other maternity care players.  A recent example was being tapped this past year to work with National Institute of Child and Health Development (NICHD) and other key maternity care groups on the development of a new pregnancy registry.  We also have plans to host a Roundtable discussion on childbirth education with key stakeholders.  

Lamaze International offers the only childbirth educator certification program that has been accredited by an outside body, the National Commission for Certifying Agencies (NCCA),  which has reviewed and vetted the standards Lamaze employs in administering our certification exam.  Maintaining certification is equally important for ensuring LCCE educators stay up to date with the latest on evidence-based practices, adult education, teaching and advocacy strategies.

SM: What plans are in the works for the Lamaze International organization that will benefit families as they prepare to welcome a child?

MB: Quality childbirth education is still not available to many women. These are the very women who often have the poorest outcomes with the highest rates of unnecessary interventions. This has to change. If high-quality childbirth education was offered to all women no matter the social economic or educational background, this disparity will change. It is a priority to advocate for insurance coverage and reimbursement to pay for childbirth education. In March 2015 members of the board of directors met with legislators about the importance of all women receiving childbirth education. Currently the Affordable Healthcare Act allows enrollment at the time of birth.  We asked legislators to change the life event designation to pregnancy, to allow childbirth education to be a part of prenatal care and covered by health care insurance. We still have a lot of work to do but this initial step into policy advocacy is a positive move in the right direction.

Hear Maria talk about her birth experience in Lamaze International’s “Push for Your Baby” video.

SM: What about plans and programs for educators?  What can members expect to see from Lamaze during your term that will benefit LCCEs and offer opportunities for those that teach?

MB: Lamaze offers LCCE members a rich array of evidence-based resources to support their professional development, such as regular webinars on current hot topics, The Journal of Perinatal Education with home study modules, the new Business Toolkit and Social Media Guide.  The organization has also invested in developing teaching tools to support Lamaze educators, including the Lamaze Toolkit for Childbirth Educators, infographics, the new mobile app, online parenting classes to supplement in person classes.

SM: As both a Lamaze Certified Childbirth Educator and a L&D Nurse, do you find it necessary to keep both roles separate and wear two hats?  Is there any overlap?  What challenges do you face because of your dual roles?

MB: I love the opportunity to wear both hats, and I am very lucky to work in an environment that looks positively on the Lamaze Six Healthy Birth Practices. So no, the two roles do not conflict but each does sharpen the other. As a nurse, a large part of my job is to educate my patients and to help them make informed decisions about their health care. As a LCCE educator, I’m fortunate to have more time to build a relationship and rapport with my students before the actual birth day, but as a nurse, my “classroom” looks a bit different. It may be in triage when I have a mom begging to stay when she is in early labor or not in labor at all. I take that time to let her know the importance of waiting on labor and how every day counts for that little person growing inside her. Or it might be in the labor room with a family who for whatever reason did not take a childbirth preparation class and needs help knowing how to comfort their partner or friend. I spend time helping new mothers to see how powerful they are and how smart their babies are. I also find myself in a special place to help teach my fellow nurses non-pharmacological pain management, allowing them to also feel empowered to work with these families. And of course, I encourage my colleagues to become LCCE certified themselves. I’ve never felt more at home than when wearing both ”hats”.

SM: Why should families continue to attend in person classes when so many online options exist and the internet offers a multitude of learning opportunities and virtually unlimited information for the pregnant person and their family?

MB: The internet has a lot to offer and can be a great complement to a classroom, but nothing replaces a quality in-person class. A Lamaze educator is able to anticipate a need that you may have before you experience it. She can tailor your class to help you navigate obstacles that are unique to your health and choice of birth location. Being face to face with other families also gives an opportunity to  build relationships that grow deeper as your family evolves. Some of my best friends today I met in my Lamaze class. We shared a chuckle not long ago that the person in the class that asked the most questions is now the President of Lamaze!

SM: Tell us something unusual about you that we might never know!

MB: I am a classically trained actor and dancer and worked as a stage actor in New York City for over ten years.

Childbirth Education, Healthy Birth Practices, Lamaze International, Lamaze News, Push for Your Baby , , , , , ,

Series: Brilliant Activities for Birth Educators: Trick or Treat – Halloween Spoils Make Great Teaching Aids

October 29th, 2015 by avatar

By Stacie Bingham, LCCE, CD(DONA)

pelvis title BABEOctober’s Brilliant Activities for Birth Educators honors the Halloween holiday as educator Stacie Bingham takes us down the Halloween aisle for items you can use to make props for teaching families about baby’s movement through the pelvis.  Stacie is a creative educator who is always coming up with new ways to introduce families to concepts that help them to have safe and healthy births.  I would also like to take a moment to congratulate Stacie on passing the recent Lamaze exam and earning the credentials Lamaze Certified Childbirth Educator.  Way to go Stacie!  Enjoy this month’s Brilliant Activities for Birth Educators post and consider checking out past posts as well for other great ideas.  Happy Halloween! – Sharon Muza, Community Manager, Science & Sensibility

I am crafty and cheap frugal; finding alternatives to traditional (costly!) childbirth education supplies is one of my favorite pastimes. I wander thrift stores, clearance aisles, even the market where I buy groceries, always thinking: what could I do with this? It has enabled me to build up a collection of props to support my classes at very little cost, while also giving me more wiggle room in my budget for items that must be purchased, such as media and print resources.

skeletonMake your own mini pelvis, placenta, umbilical cord and amniotic sac

Last October, I had the idea of creating a miniature baby/pelvis model from a Halloween skeleton. I made a trip to my local superstore and purchased a skeleton, and then my labor began. I had a tiny baby doll, I believe it is a Barbie baby from sometime in the past 20 years (it was my little sister’s, swiped acquired by me on a visit to my mom’s house). I started digging around my house to see what else would work. My supply list ended up as follows:

  • Skeleton (I used a 10 inch one in this example)
  • Doll that fits through skeleton’s pelvis
  • Embroidery floss, blue and red
  • 1 Orthodontic rubber band
  • Needle and thread
  • Reddish fabric for placenta
  • Plastic baggy (amniotic sac)
  • Washi tape
  • Tiny baby sock (uterus)

How to assemble the pelvis

I started by separating the pelvis from the torso with scissors. I boiled some water on the stove and submerged the pelvis in while holding on to the legs. Every so often I would pull it out and work to widen the pelvis. I used scissors, although other tools would work as well. After repeating this a few times, re-submerging and working again, the pelvis shape was to my liking. Then I used a utility knife to further excise the remaining segments of the spine.

Stacie BABE3How to assemble the umbilical cord and placenta

For the umbilical cord, I used three strands of embroidery floss, which I braided together. To make the placenta, I took two small squares of fabric (leftover from a quilting project), and cut a circle shape. I turned the fabric prints to face each other, and then I began to sew. I left a small opening so I could turn the fabric right-side out (I found a straw handy to help poke out all the places I couldn’t reach with my fingers), and then I closed the hole with a couple of small stitches. At this point, I took the “cord” and threaded it through the needle (did I mention I used a very large needle?). Carefully inserting the needle through the side of the placenta between stitches, so it would disappear into the placenta, I poked the needle out through the middle of one layer of the placenta, anchoring it into place and allowing the cord to attach from that spot. I wasn’t sure how I would link the baby to the cord, which is where the orthodontic band came into place. It is clear and fit snugly around the baby’s belly. Since there was a tiny knot in the end of the cord, I simply tucked it under the band.

Stacie BABE2How to assemble the amniotic sac

For the amniotic sac, I turned to a clear plastic baggy. I cut it into a u-shape and used Washi tape to seal the edges. It is a bit disconcerting to see a baby in a plastic bag, and there are so many other things you could use – one item that comes to mind is an organza bag you might get candies or favors in at a wedding or shower. The final touch was, using one of my baby’s socks for the uterus, and, voila!

How I use it

I love the idea of table-top props, those designed to be used as you sit across the kitchen table from a couple during a private class. The tiny pelvis and baby fits easily into my bag with the curriculum, handouts, and other supplies I may need, saving me from dragging my big set along.  If you are talented enough, consider making many sets of them, and providing each family a set to use in your group classes.

What the families say

Families enjoy getting to manipulate the baby through the pelvis as you take them through the class content. Often parents are delighted to see such a small little baby and pelvis, and they want to touch and try, passing the baby through the bones. The benefit of seeing and navigating the baby through the pelvis with these teaching aides supports two of the Lamaze International Healthy Birth Practices, #2: “Walk, move around and change positions throughout labor”  and #5 “Avoid giving birth on your back and follow your body’s urges to push.” For some parents, this is the first time this idea has been not only explained, but more importantly, demonstrated.  The little kit is always well received.


I am sure this design could be improved upon, and I would love to hear your ideas! It took me less than an hour and about $5 to complete this project — I was only limited by my imagination and what was lying around my house (as a personal challenge). This Halloween season, I also purchased three boxes in the shape of (haunted) houses that nest inside each other, and a candy mold of tiny brains. I recovered the houses with scrapbook paper and am creating an activity about making hospital birth more like home, and the candy molds will be tiny soap-reminders for families to use their “BRAIN”s when making birth choices. (Benefits, Risks, Alternatives, Intuition and Not Now.) With Halloween fast approaching, get out there and see what you can find in the seasonal sale bins to make your classes interesting and exciting, and keep your supply budget down.  Remember, making your own supplies doesn’t have to be scary!  It can be economical and a lot of fun.

For complete instructions with pictures, and more DIYs for CBEs, visit me at www.staciebingham.com.

About Stacie Bingham

© Stacie Bingham

© Stacie Bingham

Stacie Bingham, LCCE, CD(DONA), embraces the lighter side of the often weighty subject of birth. Her style feels more like a comedy-show experience than a traditional class. She has been a La Leche League Leader for 13 year, attended 150 births as a doula, and logged 1000 hours as a childbirth educator. An experienced writer and editor, she was a columnist for the Journal of Perinatal Education’s media reviews, has been published in LLLI’s New Beginnings and DONA International’s International Doula, and keeps up with her blog (where she frequently shares her teaching ideas).

She is the current Chair for Visalia Birth Network, and a founding member of Chico Doula Circle, and Advocates for Tongue Tie Education. Stacie has presented at conferences on the topic of tongue tie, as her 4th baby came with strings attached. Stacie and her four sons, husband, and two dogs reside in California’s Central Valley. For more information or teaching tips, visit her at staciebingham.com.

Childbirth Education, Guest Posts, Healthy Birth Practices, Lamaze International, Series: Brilliant Activities for Birth Educators , , , , , , , ,

Time for ACOG and ASA to Change Their Guidelines! Eating and Drinking in Labor Should Not Be Restricted

October 27th, 2015 by avatar

“…The problem for anesthesiologists is that our practice guidelines on obstetric anesthesia are strongly worded, and state that women can not eat during labor. We can’t ethically design a large enough study to answer this question, so we will have to wait for expert opinion to change.” – Paloma Toledo, MD

Screenshot 2015-10-26 17.04.39Social media was all abuzz yesterday about information coming out of the American Society of Anesthesiologists (ASA) conference currently being held in San Diego, CA. Headlines everywhere screamed “Eating During Labor May Not Be So Bad, Study Suggests,” “Light Meal During Labor May Be Safe for Most Women,” and “Eating During Labor Is Actually Fine For Most Women.”  People chortled over the good news and bumped virtual fists over the internet celebrating this information.

The ASA released a press release highlighting a poster being presented at the ASA conference by two Memorial University medical students, Christopher Harty and Erin Sprout. Memorial University is located in St. Johns, Newfoundland, Canada. When a professional conference is being held, several press releases are published every day to advise both professionals and the public about news and information related to the conference. This was one of many released yesterday.

The student researchers suggested in their poster presentation that it may be time for a policy change. Their research indicated that, according to the ASA database, there has only been one case of aspiration during labor and delivery in the period between 2005 and 2013. That aspiration situation occurred in a woman with several other obstetrical complications. “…aspiration today is almost nonexistent, especially in healthy patients,” the researchers stated. The research was extensive – examining 385 studies published since 1990. Much of the research available supported the findings in the poster presentation/study.

The current policy of the ASA on oral intake in labor is that laboring women should avoid solid food in labor. You can read the ASA’s most current guidelines, published in 2007: Practice Guidelines for Obstetric Anesthesia An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia.  The American College of Nurse Midwives recommends “that women at low risk for pulmonary aspiration be permitted self-determined intake according to guidelines established by the practice setting.” They also conclude “drinking and eating during labor can provide women with the energy they need and should not be routinely restricted.”  American College of Obstetricians and Gynecologists recommends no solid food for laboring women and refers to the ASA guidelines.

I connected with Paloma Toledo, MD, an obstetrical anesthesiologist who is attending the ASA conference in San Diego to ask her what her thoughts were on this new research. “General anesthesia is becoming increasingly rare, so fewer women are at risk for aspiration, since most women will have neuraxial anesthesia for unplanned cesarean deliveries. The question is, is eating in labor unsafe? They do allow a light meal in the UK, studies have shown that eating does not adversely affect labor outcomes, and in the CEMACE data, despite allowing women to eat in the UK, there have not been deaths related to aspiration. I think a lot of women want to move away from the medicalized childbirth and have a more natural experience. Women want to eat, and I believe the midwife community has been encouraging eating in labor. The problem for anesthesiologists is that our practice guidelines on obstetric anesthesia are strongly worded, and state that women can not eat during labor. We can’t ethically design a large enough study to answer this question, so we will have to wait for expert opinion to change.”

Lamaze International released an infographic in July, 2014 covering this very topic. “No Food, No Drink During Labor? No Way!” and I covered this in a Science & Sensibility post sharing more details.  You can find all the useful infographics available for downloading, sharing and printing here.  Additionally, the fourth Healthy Birth Practice speaks to avoiding routine interventions that are not medically necessary, and it has long been clear that restricting food and drink in labor is certainly an intervention that should not be imposed.

It is important for birth professionals to recognize what the American Society for Anesthesiologists’ press release is and what it is not. We must not overstate the information that they have shared. Please be aware that this is not a policy change.

Hopefully, this will be a call to action by the ASA to examine the contemporary research and determine that that their existing guidelines are outdated and do not serve laboring and birthing people well, nor reflect current research.

Childbirth educators and others can continue to share what the evidence says about the safety and benefit of oral nutrition during labor and encourage families to request best practice from their healthcare providers and if that is not possible, to consider changing to a provider who can support evidence based care.


American College of Nurse-Midwives, (2008). Providing Oral Nutrition to Women in Labor.Journal of Midwifery & Women’s Health53(3), 276-283.

American Society of Anesthesiologists Task Force on Obstetric Anesthesia. (2007). Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia.Anesthesiology106(4), 843.

Committee on Obstetric Practice. (2009). ACOG Committee Opinion No. 441: Oral intake during labor. Obstetrics and gynecology114(3), 714.

Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub3.

Childbirth Education, Do No Harm, Evidence Based Medicine, Healthy Birth Practices, Lamaze International, Medical Interventions, Research , , , , , , , ,

Series: Brilliant Activities for Birth Educators – The Six Ways to Progress in Labor – Making It Memorable!

July 30th, 2015 by avatar
© Sharon Muza

© Sharon Muza

Time for another post in the “Brilliant Activities for Birth Educators” series.  The purpose of this monthly series is to share engaging, interactive and effective teaching ideas that childbirth educators can use in their classes.  We know that when families are participatory, engaged and interacting with their partners, other class members and the instructor, real learning (and retention) happens!  Today, I share an idea I modified from an activity that I originally saw Michele Deck, former Lamaze International President and exceptional trainer, share at a the REACHE conference in Tacoma, WA several years ago.


In my childbirth classes, I like to have parents understand that there are many ways that their bodies are preparing for birth. Changes happen in the weeks, days and hours leading up to the moment of birth.  I feel that if parents understand the six ways to progress in labor, they can appreciate that at times, cervical dilation (the most “well-known” of the six ways to progress) may not be changing, but other changes may continue to show that their body and baby are working towards the big moment of birth. Parents leave class understanding that labor progress is a coordinated effort by the parent’s body and the baby that incorporates many different changes.

The six different ways that progress is assessed include:

  1. The cervix is moving forward
  2. The cervix is ripening
  3. The cervix is shortening/thinning (effacement)
  4. The cervix is opening (dilating)
  5. The baby is descending (station)
  6. The baby is rotating


At the end of the activity, class members will be able to describe the six ways that labor progress can be measured and explain why the focus should not just be on dilation, but rather on the synchronized way that change is happening throughout the pre-labor and labor period.  My hope is families will recall this information during labor, if the cervix is measured and the cervix has not dilated significantly since the last exam.

© Sharon Muza

© Sharon Muza

Supplies I use

The supplies for this activity are very simple.  I tape a large piece of newsprint at the front of the room, which has a rectangle drawn on it, divided up into a “table” of 2 squares x 3 squares with a colorful marker. I give each class participant a similar table, on a regular 8 1/2 x 11 sheet of paper, and make sure they have a pen.  I have several different color markers for them to use in front of the class. I also use the standard childbirth class teaching tools – the fetal model, a knitted uterus, and a pelvis.

How I teach it

I cover the six ways to progress after we have discussed the events of late pregnancy and before the stages of labor. When I start the activity, I share that we will be discussing the six ways to progress in labor and that many people, parents and health care providers alike, focus on dilation, but there are many ways to assess progress and it is important to understand all of them.  After I cover the first way to measure progress, the cervix moving from posterior to anterior (which you can teach using your favorite technique), I ask them to draw a simple symbol (“like a kindergarten student might draw, quick, simple and without words”) in the first square.  The symbol that they draw will help them to remember what happens first.

After they have drawn their first symbol on their own paper, I ask for a volunteer to come up and draw it on the class sheet up front.  Everyone “oohs and aahs” at the class drawing and then all share what they drew.  We move on to the cervix ripening.  Again, I teach this in my typical way and ask them to draw another drawing on their own paper to represent ripening in the second square. Another volunteer comes up to draw for the class and we all share what everyone drew. I repeat this process for all six ways to progress.

Maximum Retention

So that they can really solidify and remember each of the six ways to progress, after we discuss and draw a new square, I go back, and while pointing at the specific square, ask – “what happens first? and second?  and next…?”  The class repeats back what is happening.  After all six ways are completed, I ask them to turn their papers over, and ask randomly – “what happens fourth?”  “and sixth?” “first?” without looking at anything but pointing on the wall, where the squares were located before I took it down.  Every single class member is able to a) identify what happens in each step and b) what that means for the labor, even after I have removed the newsprint.

I let them know that I will randomly ask them this information sometime later on in the series and the person who can answer all six correctly, gets a prize.  A week or so later, in class, I ask for someone to recall the six ways to progress and award a prize to the first person who correctly names them all again! Class members enthusiastically compete with each other to be the first to recall all six ways to progress.

© Sharon Muza

© Sharon Muza


This method of using the squares, both at their seats and in the front of the class, really helps the families to remember the six ways to progress in labor.  There is lots of laughter and admiration for everyone’s clever ideas on how to represent each method, they really remember what the symbols stand for (and the actual action that happens in labor) and they are still remembering it several weeks later.  This activity is always a lot of fun to do in my childbirth classes and appreciated and enjoyed by the participants.

How you can modify this activity?

This activity reinforces retention and can be modified for many purposes in your childbirth classes.  You could do a similar activity for talking about safe sleep, how to tell if baby has a good latch during breastfeeding, or even apply it to Lamaze International’s Six Healthy Birth Practices.  By using the idea of drawing a simple symbol to represent a fact, and being asked to recall it several times, people really find that the information worms its way into their memories, and they can recall it later when it is needed.  After all, several weeks or months can pass from childbirth class to the big event, and anything we can do as childbirth educators to help families retain information for their recall when they need it down the road is a big win!

An invitation

I invite you to draw your ideas for the six ways to progress in labor, or conduct the same process for another childbirth class topic and share it with all of us. What topic ideas do you in mind to try with this method? Send me a picture of what you or your families have drawn, along with your contact information and website, and I can put them all up in another post.  We can even try to guess the topic being discussed from the drawings – and you can see how effective this technique is. I am excited to see what you all come up with.  Send them to me using this email address.


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.


Childbirth Education, Healthy Birth Practices, Push for Your Baby, Series: Brilliant Activities for Birth Educators , , , ,

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