As a Lamaze Certified Childbirth Educator, I am constantly on the lookout for videos to share with my childbirth class families. I would like the birth stories I show in class to reflect what families can expect if they are hoping and planning for a low intervention labor and birth. It is often hard to find stories that meet my needs. It is easy to find the "sensationalist reality show" versions of birth, but not so simple to find the uncomplicated, grounded labors that require a lot of hard work and support the family's preferences for as few interventions as possible and evidence based care. Enter The Healthy Children Project and the video series "Happy Birth Day." This video series is a collection of six birth stories that you can share with families to give them a peek into what birth is really like and to reinforce what they have learned in their childbirth class.
If you attended the 2016 Lamaze International Annual Conference (either in person or virtually), you may recall plenary speaker Kajsa Brimdyr, PhD, CLC, sharing ' "Reality" Versus Reality: The Nocebo Effect on Birth and Breastfeeding' with attendees. Maybe you also attended her concurrent session "Birth Consequences: The Impact of Epidurals"? Did you read my interview with Kajsa before the conference, here on Science & Sensibility? After hearing Dr. Brimdyr speak, I was delighted to learn more about the Happy Birth Day videos and consider if I might want to use them in my classes.
There are a total of six videos, telling a different birth story and running between 10 and 15 minutes. Each video opens with the viewer meeting the family towards the very end of their pregnancy. In these scenes, the families share how the pregnancy has gone and their hopes and expectations for their upcoming birth. All the families are choosing to birth in a hospital with the same certified nurse midwife, Louise. Most of the families are having their second child. Some talk about changing to this midwife after originally seeing other health care providers, when they realized that their needs were not being met.
While watching all the videos, I tried to view them through the lens of Lamaze International's Six Healthy Birth Practices which are evidence based and best practice. All the videos highlight a man and woman as the couple, and women of color are profiled in two of the six videos.
Let labor start on its own
The labors seem to start spontaneously, with the exception of one woman who is induced after her water breaks and labor does not start after some time passes. She is induced with pitocin.
Walk, move around and change positions throughout labor
This healthy birth practice is well represented in all six videos. Laboring people are seen on birth balls, in the bath, walking the halls, rocking back and forth, slow dancing, resting in bed, in bed on all fours, and leaning over the back of the bed. Lots of position changes and movement that support the progression of labor. I liked the variety of positions a lot.
Bring a loved one, friend or doula for continuous support
While all the laboring people have very supporting partners, no family has a doula with them. In one story, there is a mention of doula intending to be there, but unable to come. All the women birth without a doula. One couple seems to have an older woman there too, who I assumed was a mother or mother-in-law. Partners are very engaged and supportive and are seen providing physical and emotional support. Nurses also are very supportive and helpful in coaching the mother through labor and coping with contractions as well. The midwife also steps into this role from time to time.
Avoid interventions that are not medically necessary
Most of the women seem to avoid medical interventions. The woman undergoing a pitocin induction has continuous fetal monitoring and an IV of course, as would be expected and routine under those circumstances. There are a couple other videos that have electronic fetal monitoring and at least two women have what sounds like internal fetal monitors (that "ping" sound rather than than the normal external electronic fetal monitors I am used to hearing) but I could be mistaken. Lots of women are seen eating food and all are drinking. Two seem to be given ice chips at times.
There are IVs/saline locks. Most women choose to wear a hospital gown. One woman seems to wear her own robe. Some of the women are admitted in what would still be considered early labor, less than 5-6 cm. In one scenario, it appears that baby is coming rather fast, and the mother voices her disappointment in not being able to get in the tub, which she also missed in her first birth. The baby seems to not be all that tolerant of the speed of labor and the midwife has inserted her hand in the mother's vagina for some reason. The mother asks the midwife "can you stop doing that? I don't want to be touched" and the midwife replies, "no, I am sorry, I can't." It seemed that the midwife's actions were meant to help the baby tolerate labor (holding back a lip? rotating the baby?) but I was disturbed that the mother asked her to stop touching her and the midwife said no and kept her hand inserted in her vagina.
One baby was a face presentation, and that mother completely dilated and tried to push her baby out on her hands and knees. The baby shows signs of distress and is ultimately born by cesarean. I loved that she was given the chance to push her baby out. I have been at face presentation births as a doula and trying to push was not an option.
After birth, there were times where the bulb syringe was used routinely on the baby, before passing the baby up to the mother. It is my understanding that current best practice is not to do suctioning on healthy, responsive babies. Delayed cord clamping was the norm in all the situations.
Avoid giving birth on your back and follow your body's urge to push
This one was the healthy birth practice that seemed to have gone by the wayside across the board. All of the women birthed on their back, though we see some women pushing in the side-lying position and the hands and knees position. All the babies born vaginally were born with their mother's on their backs. Some women push spontaneously and in some cases, we hear directed pushing, asking the mother to curl around her baby and not let her breath escape. Partners seem to be helping to hold legs back and out to the sides by grasping the womens' legs. I would have loved to see a birth in an upright or hands and knees position.
Keep mother and baby together - It's best for mother, baby and breastfeeding
This healthy birth practice hit a home run in all the videos. Even the mother who gave birth by cesarean was seen skin to skin with her baby in the operating room while the surgery was being finished. All the babies born vaginally were placed skin to skin on the mother's chest within 30 seconds of birth and we see them remain there. There are no scenes where baby is not on the mother or taken to a warmer. Lots of licking and sucking and resting after birth right on the chest in all the mother baby dyads.
Overall, I thought that the six videos did a good job demonstrating supportive, mostly low intervention hospital births with a midwife. Women are seen coping with labor in a large variety of positions, with a supportive partner and birth team, and having immediate contact with their newborns on their chests. Lots of opportunity for the childbirth educator to show that while labor can and often is very difficult, people can do a lot of coping techniques and position changes to help them deal with the pain. We get to hear both the birthing person and the support person sharing their expectations pre-birth, their thoughts about their labor, explaining what helped and what was going through their minds as they worked to birth their babies.
I think that childbirth educators, doulas and other professionals who work with birthing families might enjoy sharing some or all of these birth stories. Happy Birth Day is a collection of videos. Each story can be rented for 24 hours, ($0.99), 48 hours ($1.99) or purchasd and downloaded for $9.99 - which includes one burn. You may choose to rent or purchase all six or select them individually.
The Healthy Children Project has a lovely three minute trailer accompanied by a sweet song that is available free on YouTube and would be a lovely little film to share. You can find it on the Healthy Children Project website or here. It is also included above in this post.
Would you like to receive all six videos on a DVD for your use with birthing families? Leave a comment on the blog here by December 20th and you will be entered into a drawing to win one of two copies of these great videos. Be sure to include your email address or login to comment so we can reach you.