24h-payday

Elective Induction at 40 Weeks? “Decision-Based Evidence Making” Strikes Again

July 14th, 2015 by avatar

Today on Science & Sensibility, contributor Henci Goer takes a look at a systematic review released in spring that examined the impact of elective inductions on the cesarean rate.  Sound analysis or a house of cards?  Looking closer at the studies reviewed provides insight into how the conclusions reached by the investigators might need to be examined more closely.  Henci does that in this review.  Have you read this new systematic review?  Did you come to the same conclusions?  I invite you to share your thoughts in our comments section below. – Sharon Muza, Community Manager, Science & Sensibility.

flickr photo by catharticflux http://flickr.com/photos/catharticflux/2710057340  CC licensed.

flickr photo by catharticflux http://flickr.com/photos/catharticflux/2710057340 CC licensed.

Yet another systematic review has surfaced “Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials”  in which reviewers claim that electively inducing healthy women, this time at 40, not 41 weeks, offers benefits and doesn’t increase the cesarean surgery rate (Saccone 2015).

Let’s take a closer look.

Reviewers included five trials: three of them conducted in the 1970s (Cole 1975; Martin 1978; Tylleskar 1979), the fourth published in 2005 (Nielsen 2005), and the fifth in 2014 (Miller 2014). Already we have a problem. Induction management in the 1970s is sufficiently different from management today that results are unlikely to apply to contemporary care, but let’s get down to specifics. Two of the 1970s trials were deemed inadequate for inclusion in the Cochrane review of elective induction (Gulmezoglu 2012), and Miller 2014 is published only as an abstract. Quality systematic reviews exclude abstracts because they don’t provide enough information to evaluate the study. For these reasons, these three trials should be taken off the table..

That leaves us with the other two. Nielsen 2005 states in the title “Comparison of elective induction of labor with favorable Bishop scores versus expectant management: a randomized clinical trial” that it is confined to women with favorable Bishop scores. Anyone familiar with elective induction research should know that inducing when the cervix is ready to go won’t increase the cesarean rate compared with spontaneous onset, but inducing with an unripe cervix is a different story even when using cervical ripening agents (Dunne 2009; Jonsson 2013; Le Ray 2007; Macer 1992; Prysak 1998; Thorsell 2011; Vahratian 2005). As you move the induction date earlier and earlier, more and more women will have an unfavorable cervix, so including a trial limited to women with a ripe one will tilt the playing field in favor of induction. Furthermore, half the participants were multiparous women (113/226). Women with prior vaginal births will go on having vaginal births pretty much no matter what you do to them, which raises another point: inducing earlier means a higher percentage of the inductees will be first-time mothers because first time mothers tend to run longer pregnancies (Mittendorf 1990). Nulliparous women are much more vulnerable to anything that pushes them in the direction of a cesarean. That’s not all: The authors tell us that their hospital has a 7% cesarean rate for dystocia in women at term. If a hospital has a cesarean rate much higher than that—and many do—then results can’t be generalized to it, although, frankly, if the doctors are performing cesareans left and right, induction or spontaneous onset may not make much difference. In short, Nielsen (2005) doesn’t make a compelling argument for 40-week elective induction.

flickr photo by Selbe <3 http://flickr.com/photos/stacylynn/11944718954 shared under a Creative Commons (BY-NC-ND) license

flickr photo by Selbe < http://flickr.com/photos/stacylynn/11944718954 shared under a Creative Commons (BY-NC-ND) license

This brings us to the last trial, Cole (1975). Investigators allocated healthy women either to induction at 40 weeks (111 women) or 41 weeks (117 women). As with Nielsen, half the women had prior vaginal births. Despite being healthy, 22 women were induced for “obstetric complications” (undefined) in the 41-week induction group before reaching 41 weeks. If their doctors induced labor because they had concerns, then this would likely put the women at heightened risk for cesarean. Another 32 women were induced for exceeding 41 weeks. This means that overall, nearly half (46%) of the comparison group didn’t begin labor spontaneously, which would mask any association between induction and cesarean. Leaving the induction vs. spontaneous onset issue aside, the U.S. cesarean rate in the early 1970s was around 5%, which means it was a rare woman who would have one regardless of circumstances. Again, not exactly a strong case for inducing at 40 weeks.

What about the benefits? The best reviewers can come up with are a clinically meaningless reduction in mean blood loss (-58 ml); a lower rate of meconium-stained amniotic fluid (4% vs. 14%), not, mind you, a reduction in meconium aspiration, and therefore clinically meaningless as well; and an equally meaningless reduction in mean birth weight of -136 g (5 oz). If they had found something more impressive, surely they would have reported it.

Really? This merited a pre-publication media blast? Because it amounts to a textbook example of “garbage in, garbage out.” I can see only three possibilities to explain it: either 1) the authors and peer reviewers at the American Journal of Obstetrics and Gynecology (AJOG) don’t know as much as they should about what constitutes a quality systematic review, 2) they are so steeped in medical model thinking—“How early can we get the baby out of that treacherous maternal environment?”—that their judgment is compromised, or 3) we have a “pay no attention to what’s behind the curtain” effort to promote elective induction. I don’t know which is the more troubling, but if it’s the last one, the sad thing is that because it’s got the magic words “systematic review,” “meta-analysis,” and “randomized controlled trials” in the title, it’s likely to succeed.

References

Cole, R. A., Howie, P. W., & Macnaughton, M. C. (1975). Elective induction of labour. A randomised prospective trial. Lancet, 1(7910), 767-770.

Dunne, C., Da Silva, O., Schmidt, G., & Natale, R. (2009). Outcomes of elective labour induction and elective caesarean section in low-risk pregnancies between 37 and 41 weeks’ gestation. J Obstet Gynaecol Can, 31(12), 1124-1130.

Gulmezoglu, A. M., Crowther, C. A., Middleton, P., & Heatley, E. (2012). Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev, 6, CD004945.

Jonsson, M., Cnattingius, S., & Wikstrom, A. K. (2013). Elective induction of labor and the risk of cesarean section in low-risk parous women: a cohort study. Acta Obstet Gynecol Scand, 92(2), 198-203. doi: 10.1111/aogs.12043

Le Ray, C., Carayol, M., Breart, G., & Goffinet, F. (2007). Elective induction of labor: failure to follow guidelines and risk of cesarean delivery. Acta Obstet Gynecol Scand, 86(6), 657-665.

Macer, J. A., Macer, C. L., & Chan, L. S. (1992). Elective induction versus spontaneous labor: a retrospective study of complications and outcome. Am J Obstet Gynecol, 166(6 Pt 1), 1690-1696; discussion 1696-1697.

Martin, D. H., Thompson, W., Pinkerton, J. H., & Watson, J. D. (1978). A randomized controlled trial of selective planned delivery. Br J Obstet Gynaecol, 85(2), 109-113.

Miller, N., Cypher, R., Pates, J., & Nielsen, P. E. (2014). Elective induction of nulliparous labor at 39 weeks of gestation: a randomized clinical trial. Obstet Gynecol,132(Suppl 1):72S.

Mittendorf, R., Williams, M. A., Berkey, C. S., & Cotter, P. F. (1990). The length of uncomplicated human gestation. Obstet Gynecol, 75(6), 929-932.

Nielsen, P. E., Howard, B. C., Hill, C. C., Larson, P. L., Holland, R. H., & Smith, P. N. (2005). Comparison of elective induction of labor with favorable Bishop scores versus expectant management: a randomized clinical trial. J Matern Fetal Neontal Med, 18:59-64.

Prysak, M., & Castronova, F. C. (1998). Elective induction versus spontaneous labor: a case-control analysis of safety and efficacy. Obstet Gynecol, 92(1), 47-52.

Saccone, G., & Berghella, V. (2015). Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials. American journal of obstetrics and gynecology.

Thorsell, M., Lyrenas, S., Andolf, E., & Kaijser, M. (2011). Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women. Acta Obstet Gynecol Scand, 90(10), 1094-1099. doi: 10.1111/j.1600-0412.2011.01213.x

Tylleskar, J., Finnstrom, O., Leijon, I, et al. (1979). Spontaneous labor and elective induction – a prospective randomized study. Effects on mother and fetus. Acta Obstet Gynaecol Scand, 58:513-518.

Vahratian, A., Zhang, J., Troendle, J. F., Sciscione, A. C., & Hoffman, M. K. (2005). Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstet Gynecol, 105(4), 698-704.out

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.

 

ACOG, Cesarean Birth, Childbirth Education, Do No Harm, Evidence Based Medicine, Guest Posts, Medical Interventions, New Research, Research , , , , , ,

Access Safe Sleep Photos for Your Use – Help Families Reduce Unsafe Sleep Environments

July 9th, 2015 by avatar

 Lamaze Certified Childbirth Educators and other professionals that work with expectant and new families often share information and resources on the topic of newborn and infant sleep.  This subject always elicits lots of questions and discussion in my childbirth classes from the families.  I always make sure to provide resources that clearly demonstrate what constitutes a safe sleep environment, some helpful strategies on getting “enough” sleep with a newborn and how families can reduce the risk of SUID/SID for their infant.

Lamaze International President Robin Elise Weiss, Ph.D recently participated in a Federal SUID/SID Workgroup forum and one of the outcomes of this forum was a Safe Infant Sleep Photo Repository.  This collection of images reinforces the American Academy of Pediatrics safe sleep recommendations.  All of the images are in the public domain, which means that you are free to use them for your blog posts, teaching presentations, classroom posters, websites and other needs as you like.  There are plans to increase the diversity of families represented in the images in the near future, to include Native Americans and Native Alaskans.

First Candle’s Safe Sleep Image Guidelines is a useful resource if you are a photographer who takes your own images or you are looking to better understand what type of safe sleep image to use in your work with families.  Additionally, if you see images in the media (magazines, websites, commercials, marketing materials, ads, etc.) that are using unsafe sleep images, you can contact First Candle and let them know, so they can contact the appropriate organization and have them replaced with images showing safe sleep environments.

Some of my favorite safe sleep resources include:

Take a moment to review your teaching materials and resources on the topic of safe sleep for new families.  Make sure your images model safe sleep practices. Check out the images in the Safe Sleep Image Repository and use them as you like in your classroom, your practice and as you work with families.  What families learn from you about safe sleep can help to reduce the tragic death of an infant as a result of being placed in an unsafe sleep environment.  How do you talk about safe sleep to your clients and students?  Share your favorite resources and teaching ideas on the topic of safe sleep in the comments section below.  Would you consider using some of the images available in the Safe Sleep Image Repository?  Let us know.

 

 

 

Childbirth Education, Newborns , , , , , , , ,

Series: On the Independent Track to Becoming a Lamaze Trainer – The Curriculum Gets Written (Almost)!

July 7th, 2015 by avatar

By Jessica English, LCCE, FACCE, CD/BDT(DONA)

Late last year, LCCE Jessica English began the path to become an independent trainer with Lamaze International, as part of the just opened “Independent Track”  trainer program.  This new program helps qualified individuals become Lamaze trainers – able to offer Lamaze childbirth educator trainings which is one step on the path for LCCE certification.  She’s agreed to share her trainer journey with us in a series of blog posts; “On the Independent Track to Becoming a Lamaze Trainer”, offering insights at key milestones in the process.  You can read the first part of Jessica’s journey here.  Today, Jessica updates readers on her progress as she tackles the curriculum. If you are interested in becoming a trainer of Lamaze Childbirth Educators, you can find information on applying for the November 2015 Independent Track Program on the website now, and applications are due August 31, 2015.   –  Sharon Muza, Science & Sensibility Community Manager.

JEnglish retreat 1I am so ready to start training childbirth educators!

Unfortunately, my curriculum is not so ready. But I’m getting there — and building lots of empathy for the process my future students will be going through as well.

After finishing my trainer workshop in November, I spent some time processing everything I’d learned. I felt excited about becoming a Lamaze trainer, but I wasn’t ready to jump into writing my curriculum. This is a pretty typical pattern for me, so I was patient with what I know to be a healthy process for myself. I think and process and mull… And then when I’m ready I leap.

As winter turned to spring in the U.S., I watched a few of my classmates finish their curricula and start promoting their trainings. Awesome! Birth workers I had connections with from around the country started asking me when I’d be teaching my first workshop. Wonderful! I started a list of future Lamaze educators so I can update them when I am fully approved to train. I started to feel ready to leap, but the days, weeks and months flew by without much of a dent in my curriculum. I run a busy doula agency and I’m a birth doula trainer and business coach. Not to mention teaching my own childbirth classes and taking care of my own doula clients! And did I mention that I organize a major baby and family expo each February? The phone was always ringing, the email never stopped, meetings dotted each day. I’d jot down ideas or bookmark a resource that I wanted to use with my students. I tried reserving an hour a day to work on the curriculum, but it was challenging to really hold that time sacred. I also found it hard to clear out other distractions. It felt like just as I’d really dig in to a topic, time was up and I needed to move on to another (wildly different) task.

english independent - jpgYears ago in my corporate life, I learned the Eisenhower Decision Matrix for categorizing tasks (popularized by Stephen Covey). I sometimes use this matrix with my business coaching clients. Tasks are divided into categories of urgent, important, both or neither. Using this tool, I could see that I was stuck mostly in the urgent column, but not getting to the Lamaze trainer curriculum because although it was extremely important, it was in no way urgent. It was time to prioritize the important.

I checked in with a couple of folks in my brain trust, sharing my frustration about finding the time to write. (I’ll bet you have a brain trust too! This is my inner circle of trusted advisors that I turn to for support. Some of them are paid, others are mentors or friends with whom I’ve developed a circle of reciprocity — “you help me engineer my life, I’ll help you figure out yours too.”)

My business advisor suggested a retreat.  I talked with another brain trustee, looking for ideas on an affordable retreat. She mentioned Gilchrist, a local retreat center where I could rent a simple cabin and spend a couple of days in the woods. Yes! Perfect! My brain trust had come through for me again.

I reserved three days and two nights in the woods, packed up my food, teaching supplies and laptop. My goal was to leave the retreat center with a fully written curriculum ready to submit to Lamaze International for review. Gilchrist is a 45-minute drive from my home, so I tried to use the drive time to clear out all of the “urgent” from my system. The cabin and the grounds were beautiful. There was no wifi in my cabin and even phone service is spotty, which made it easier to focus in on the curriculum. Each day I walked the trails, cooked, wrote and meditated on everything new childbirth educators would need to make a real difference for families.

I felt connected and focused. It’s always easier for me to tackle big tasks in one large chunk than to piecemeal it, and the retreat was just what I needed. As I think ahead to helping new educators find time to finish their curricula and plan for their classes, I’ll offer the options of reserving small chunks of time over a long period (this works well for some people, even though it’s not a great match for my personal style) or maybe booking their very own Lamaze retreat.JEnglish retreat 2

Unfortunately, I didn’t quite reach my goal to finish the trainer curriculum on retreat. I’m close, though. Another full day of writing should be enough to wrap up what I need to submit to Lamaze International’s lead nurse planner, Susan Givens. An interesting sidelight of the trainer process is that I’m getting laser focused on my own childbirth classes. What are the strongest pieces of my curriculum? Where are the weak links? If I’m training new educators, I want to be sure I’m modeling the best teaching techniques in my own classes. So tucked into the calendar this summer, I have another full day reserved for finishing my trainer curriculum, and also a full day to re-examine and revitalize a few topic areas in my own eight-week Lamaze series.

I’m still puzzling through a few technical issues with the curriculum. I’m working toward enough structure that I can make sure attendees get everything they need, but also some flexibility to let them take the reins at times. I want to model the same innovative teaching techniques I hope they will use in their own classes. I’m grateful for my experience not only as a childbirth educator for the past decade but also as an approved birth doula trainer for DONA International. I have a great sense of both the research and the reality of adult learning. Also on the docket: figuring out how my business curriculum will be incorporated into my Lamaze workshop. Should it be part of the core training, or an extra day or half day that new educators can opt into if they’re planning to teach independently? Business building is a big part of my focus in the birth world, so this piece of the curriculum is really important to me! Some of this will come clear as I finish writing, but experience also tells me that things will shift and adjust as I start to train and get a sense for what works best in action.

To use a birth analogy (because Lamaze educators can turn everything into a birth analogy!), my trainer curriculum feels like it’s in transition. Intense. A little overwhelming. But transition! What a fantastic place to be! Almost there. Keep going. Almost there.

About Jessica English

jenglish-headshot-2015-2Jessica English, LCCE, FACCE, CD/BDT(DONA), is the founder of Heart | Soul | Business. A former marketing and PR executive, she owns Birth Kalamazoo, a thriving doula and childbirth education agency in Southwest Michigan. Jessica trains birth doulas and (soon!) Lamaze childbirth educators, as well as offering heart-centered business-building workshops for all birth professionals.

Childbirth Education, Guest Posts, Lamaze International, Lamaze News, Series: On the Independent Track to Becoming a Lamaze Trainer , , , , ,

Report Finds Widespread Global Mistreatment of Women during Childbirth

July 2nd, 2015 by avatar
© Pawan Kumar

© Pawan Kumar

The journal PLOS Medicine published a research review yesterday, “The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Method Systematic Review” (Bohren, et al, 2015).  Reading this report was both disturbing and extremely sad to me. Respectful care is a part of the United Nations Millennium Development Goal Target 5A: Improve Maternal Health. – which set a goal of reducing the maternal mortality ratio (the number of deaths among women caused by pregnancy- or childbirth-related complications (maternal deaths) per 100,000 live births) by 75% from 1990 to 2015.  The target rate had been 95 pregnancy or childbirth related deaths per 100,000 women but the current rate is sitting at 210/100,000, which is just a 45% drop.  99% of all maternal deaths occur in low-income and middle-income countries, where resources are limited and access to safe, acceptable, good quality sexual and reproductive health care, including maternity care, is not available to many women during their childbearing year. The most common cause of these maternal deaths are postpartum hemorrhage, postpartum infection, obstructed labors and blood pressure issues – all conditions considered very preventable or treatable with access to quality care and trained birth attendants.

Analysis of reports examined in this paper indicate that “many women globally experience poor treatment during childbirth, including abusive, neglectful, or disrespectful care.” This treatment can further complicate the situation downstream, by creating a disincentive for women to seek care from these facilities and providers in future pregnancies.

The reports and studies that were reviewed to create this report obtained their information from direct observation, interviews with women under care,  and were self-reported by the mothers.  Follow-up surveys were also conducted.

From the qualitative research, investigators were able to classify the mistreatment  into seven categories:

  1. physical abuse
  2. sexual abuse
  3. verbal abuse
  4. stigma and discrimination
  5. failure to meet professional standards of care
  6. poor rapport between women and providers
  7. health system conditions and constraints

The quantitative research revealed two themes: sexual abuse and the performance of unconsented surgical operations.

World Bank Photo Collection http://flickr.com/photos/worldbank/7556637184 shared under a Creative Commons (BY-NC-ND) license

It is no surprise that women’s experiences were negatively impacted by the mistreatment they received during their maternity care treatment period.  Some of the treatment was one on one – from the care provider to the mother, while other inappropriate treatment was on a facility level.

Investigation of the treatment of women during pregnancy and childbirth was conducted because it is known that care by a qualified attendant can significantly impact maternal mortality, but if women are disinclined to seek out appropriate care due to a fear of mistreatment, help is not available or utilized and mortality rates rise.  Removing this obstacle is key to reducing maternal deaths.

Prior experiences and perceptions of mistreatment, low expectations of the care provided at facilities, and poor reputations of facilities in the community have eroded many women’s trust in the health system and have impacted their decision to deliver in health facilities in the future, particularly in low- and middle-income countries Some women may consider childbirth in facilities as a last resort, prioritizing the culturally appropriate and supportive care received from traditional providers in their homes over medical intervention. These women may desire home births where they can deliver in a preferred position, are able to cry out without fear of punishment, receive no surgical intervention, and are not physically restrained. – Bohren, et al.

Women who are mistreated during childbirth obviously reflects a quality of care issue, but also a larger scale- a fundamental human rights issue.  International standards are clear that this is not acceptable.  The researchers encourage the use of their finding to assist in the development of measurement tools that can be used to inform policies, standards and improvement programs.

We must seek to find a process by which women and health care providers engage to promote and protect women’s participation in safe and positive childbirth experiences. A woman’s autonomy and dignity during childbirth must be respected, and her health care providers should promote positive birth experiences through respectful, dignified, supportive care, as well as by ensuring high-quality clinical care. – Bohren, et al.

I encourage you to read the study for a thorough review of the research findings.  The information is difficult to fully take in. Additionally, a companion paper  – “Mistreatment of Women in Childbith: Time for Action on this Important Dimension of Violence against Women” provides further information.  The New York Times covered this topic in their June 30th Health Section. The World Health Organization also covered this report and has a statement on this issue, endorsed by over 80 organizations, including Lamaze International.  The WHO also has a list of videos on the topic of abuse and mistreatment of women during pregnancy and childbirth that can be found here.

References

Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. (2015) The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med 12(6): e1001847. doi:10.1371/journal.pmed.1001847

Jewkes R, Penn-Kekana L (2015) Mistreatment of Women in Childbirth: Time for Action on This Important Dimension of Violence against Women. PLoS Med 12(6): e1001849. doi:10.1371/journal.pmed.1001849

Do No Harm, Maternal Mortality, Maternal Mortality Rate, Maternal Quality Improvement, Maternity Care, New Research, News about Pregnancy, Research , , , , , ,

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 , , , ,

cheap oakleys fake oakleys cheap jerseys cheap nfl jerseys wholesale jerseys wholesale nfl jerseys