The Technicalities of Teaching Childbirth Education Part 4

I have assembled 10 key principles of teaching effective childbirth education classes, and am briefly addressing them in this blog.  Part 3 in the Series is "Being Organized". Over the course of the next 10 blogs entries, I will address each one of these key principles so that you can enhance your own childbirth education classes!  Please read Part 1, Part 2 and Part 3!

Part 4 is Evidence-based Knowledge Base

From Milbank Report

"Evidence-based" is more than just the latest buzz word in maternity care.  On it is placed the foundation of policies, procedures and practice guidelines of hospitals, birthing centers and practitioners.  However, when this evidence was revealed has come into dispute lately as certain of these policies, procedures, and practice guidelines have been called into question.   

According to Evidence Based Maternity Care, also known as the Milbank Report, published in 2008 and written by Sakala and Corry, a wealth of evidence based information exists. " Although the field of pregnancy and childbirth pioneered evidence-based practice, resulting in a wealth of clear guidance for evidence-based maternity care, there remains a widespread and continuing underuse of beneficial practices, overuse of harmful or ineffective practices, and uncertainty about effects of inadequately assessed practices. …”


An outcry can be heard regarding the gap between actual practices and obvious lessons revealed by such sources as Childbirth Connection, the Cochrane Database, and even today's media.  Questions arise such as "why is the U.S. cesarean rate 32.9%?", "why are routine episiotomies still performed regardless of the need?", "why are there more inductions and/or cesareans on Monday through Thursday than on Friday, Saturday, Sunday or holidays?", "why is the national epidural rate over 65%? Do U.S. women tolerate pain less effectively than women in other industrialized counties?".  One only has to view the "Birth by the Numbers" excerpt below to see the true gravity of the situation.

Childbirth educators, both hospital-based and shockingly as well as independent educators, are feeling the pressure to NOT tell the truth during childbirth education classes.  Class curricula are scrutinized by groups of physicians, nurses and risk management staff.  Then areas in question are either softened or removed. Why would someone want the benefits/risks of epidural anesthesia or cesarean births or circumcisions removed from the curricula?


One hospital gleaned a good portion of their curriculum from both the Cochrane Review and Pub Med, the searchable database from the U.S. National Library of Medicine and National Institutes of Health.  From this foundation came a thorough and complete 4 week childbirth education series.  In addition to this great curriculum, a notebook was created with the dividers labeled with the controversial topics.  Inside each division, current studies supporting the evidence taught in class where inserted.  Anytime there was a question regarding the validity of the information taught in the class, the binder was presented.  Great idea, yet why must childbirth educators practice defensive teaching?


The pressure is one from many directions for the use of evidence-based maternity care - from childbirth educators, doulas, and organizations such as Childbirth Connection and Lamaze International.  Each have online infovideos about improving maternity care and empowering women to examine maternity care carefully.  Directly below, you will find the latest video from Childbirth Connections "Transforming Maternity Care" campaign.







And here is the new video from Lamaze International "Parents Pushing for Better"







Education must come from all angles: from the childbirth educator teaching the expectant parent, to changes in policies at the birth facility level AND from changes in the curriculum at our medical schools and nursing schools. Care should not be "the way we've always done it" or "that's the way we were taught 15 years ago".  The best practice is current and evidence-based!

The Technicalities of Teaching Childbirth Education Part 3

I have assembled 10 key principles of teaching effective childbirth education classes, and am briefly addressing them in this blog.  Part 3 in the Series is "Being Organized". Over the course of the next 10 blogs entries, I will address each one of these key principles so that you can enhance your own childbirth education classes!  Please read Part 1 and Part 2!


It is said, "Give a busy person something to do and it will get done".  So goes childbirth education.  I have never met a childbirth educator who doesn't have at least 1-5 other things going on in her life.  She is either balancing other professional jobs such as lactation consulting or doula work or nursing and/or also balancing family.  The professional juggler has nothing on THIS woman.


So organization is key to being a successful childbirth educator.  The facets of organization include: class organization, teaching strategy organization, business organization and marketing organization.


Class organization

Do you have a curriculum for each class you want to teach?  That is a very good place to begin!  Put each in a binder with the evidence-based research behind all of the topics you teach per class.  Make the research in the last 3-5 years, as that is what the medical professional tends to listen to ~ update your research every 6 months or so.  Organize your handouts by class even if used for multiple classes.  Either make several copies and keep copies on hand, or file them in appropriate folders on your hard drive.  Use Post-It repositionable tabs to identify sections for class in manuals.  Use one color per class.  Use a highlight marker to help identify items you want to be sure and point out.  (Not sure what manuals to purchase?  There are currently 3 on the market and you can ask for samples so you can make a decision: Customized Communications, The Family Way and ICEA.)


Teaching Strategy Organization

When creating the curriculum, one of the concepts that deserves a great deal of attention is what type of teaching strategies will be used to cover a specific topic.  A beginning list of teaching strategies is listed here.  Remember there are all types of learners - some prefer to learn via video or web, some lecture, some by making lists or sitting in buzz groups.  Demonstration and return demonstration, especially when discussing the use of a birthing ball, ensures that proper use, positioning and comfort are achieved!  Sometimes, having charts and models as manipulatives can enhance learning.  Many educators prefer to have a baby and pelvis, a few charts and one to two movies per class.  These items, along with lecture, discussion and a few homework assignments can greatly enhance the confidence of the learner.


Business Organization

Whether you are teaching for a facility or as an independent educator, have a business sense will be invaluable.  Keep track of those who attend your classes and follow up with them after they birth their babies.  Assemble all of your receipts, mileage on your car and any other expenses so you can deduct them on your taxes - this also includes business lunches, conferences, and magazine subscriptions/new reference material! The costs do add up and you may be surprised at what you spend on your business during any given year. Even when you order business cards (as we'll talk about in the Marketing section below), these costs can be deducted.  Need a hand in keeping track of your expenses?  Check out Childbirth Educator Office!


Marketing Organization

The most fun, yet terrifying part of the Technicalities of Teaching Childbirth Education is marketing.  Getting the word out about your service is key to success, professionally and financially.  Your certifying organization should have a directory of members who perform the same services.  Listing there is a great first step.  Find other searchable databases that parents frequent, and list your services there.  Birthsource has two searchable databases that are free to list:  the US/Mexico and Canada, and the International Birth & Breastfeeding Center.  The newest searchable database is Childbirth Experts, developed by the owners of Birthsource and Websource LLC.  This database is for all of the US, and includes short descriptions of the various services along with contact information.  The American Pregnancy Association also has a database for listing your services.  Along with your website, consider a Facebook page, Twitter account and a blog.  While somewhat time consuming, web based marketing is THE way to reach expectant parents today!  You may also want to consider business cards for a more personal marketing technique:  great deals on business cards are at www.vistaprint.com and www.zazzle.com! 

The Technicalities of Teaching Childbirth Education Part 2

I have assembled 10 key principles of teaching effective childbirth education classes, and am briefly addressing them in this blog.  Part 2 in the Series is "Preparation of A Dynamic Course Lesson Plan.Over the course of the next 10 blogs entries, I will address each one of these key principles so that you can enhance your own childbirth education classes!

Developing a childbirth education class curriculum/lesson plan isn’t as easy as some might think!  You just can’t say, in class number 3, medications will be covered.  One has to dissect the material, get the evidence to back what is said, and estimate the timing of the discussion.  Additionally, and perhaps even more importantly, the teaching strategies must be effective and fun!

It is generally accepted that lesson plans include the topic, behavioral objectives, an outline to fit the objectives, timing of the presentation and teaching strategies.  When more than one presenter is involved, an extra column could be inserted to prompt when each presenter is teaching.  A form would look something like the one below:

Behavioral objectives, learning objectives, instructional objectives, and performance objectives are terms that refer to descriptions of observable student behavior or performance that are used to make judgments about learning. Whether you are a childbirth educator, doula, nurse, lactation educator or trainer, at some point you will be asked to write behavioral objectives.

While some feel that writing behavioral objectives is a waste of time, it is generally felt that using behavioral objectives allows the educator to actually see what will be covered during a specific time period and not to overwhelm the student. Using objectives help to clarify what details to include under what generalized topic area, plus allows for examination of the order in which topics and details will fall. Further, using behavioral objectives promotes creativity with the educator when developing teaching strategies for use with all learner types.  For more about writing behavioral objectives for childbirth education, click here.  

Included also in the lesson plan are any materials needed by either the presenter or the students.  This could be anything from a pencil, to videos to teaching tools.  A plan for “homework” to maintain continuity from session to session may be desired as well as an opportunity for review from previous session and an informal evaluation of understanding at the end of each session.

Many childbirth educators also find it helpful to write an overall objective before each class.  This will help them stay on topic when writing the lesson plan and also allow for deeper consideration of why a topic needs to be presented during that class.  Often, educators find they want to present much more material than there is time for.  Historically, childbirth education classes are shorter now than in the late 60’s and 70’s.  Less information is being presented and the incidence of fear, interventions and disillusionment with birth is on the rise.  I see a correlation.

If you need assistance in formulating your childbirth education curriculum/lesson plan, regardless of the method of childbirth you are teaching, please contact me at clivingston@birthsource.com.  I’d be happy to help!

The Technicalities of Teaching Childbirth Education Classes: Part 1

Somewhere in the deep recesses of the hospital, someone assumed that because a maternity nurse is a good maternity nurse, she’d also make a good childbirth educator.  As a maternity nurse who has been a Lamaze Certified Childbirth Educator for over 30 years as well as a childbirth educator trainer for CAPPA, ICEA and now Lamaze International, I can tell you unequivocally that assumption is untrue.  Not all childbirth educators are created equal.  I have known some great maternity nurses who have been less than good childbirth educators.  And I have known some lay persons who have studied and become tremendous certified childbirth educators.

I have assembled 10 key principles of teaching effective childbirth education classes, and am briefly addressing them in this blog.  In no particular order, they are:

1. Know how to teach
2. Preparation of a dynamic course lesson plan
3. Being Organized
4. Evidence-based knowledge base
5. Learner Assessment
6. Critical Thinking
7. Robust teaching techniques
8. Motivational skills for engaging students
9. Compassionate listening 
10. Problem solving

Over the course of the next 10 blogs entries, I will address each one of these key principles so that you can enhance your own childbirth education classes!

Know How To Teach

A good childbirth educator has a good curriculum (either self-created or created by someone else) and can effectively deliver the information.  A great childbirth educator blends pedagogy and andragogy to make the class/curriculum engaging, exciting and worth coming back each time!

What is pedagogy and andragogy?  Pedagogy is the science of instructional learning.  Much like the first day of third grade, the learner comes to the experience with little previous learning on a topic and the instructor becomes the most influential learning tool.  With Andragogy, the learner brings experience and prior knowledge and is self-directed by the instructor.  Learners would like to perform a certain task (birth their baby),  solve a problem (overcome fear of labor) ~ and better quality of life becomes a motivator.

When blending pedagogy and andragogy for childbirth education classes, the instructor intimately examines course curriculum for content, usefulness of objectives, appropriate timing of subject matter and teaching strategies.   For example, a discussion about cesarean sections cannot and should not be limited to just viewing a video.  Nor should cesarean sections be the first topic in a traditional childbirth education series.  Logical flow of topics becomes important to the learner as well as the instructor.

Becoming a certified childbirth educator is a key piece to becoming a great educator.  While there are a myriad of childbirth education training programs in existence, when “shopping” for certification, it is not always wise to go with the “easy route” or less expensive route.  Thoroughly examine the course objectives, outside learning expectations and other requirements.  Additionally, delve into the history of the organization and how much weight a certain certification has in your community.  Rome wasn’t built in a day and neither are childbirth educators.

For adult learners, no one type of teaching strategy works all of the time.  A wise childbirth educator can assess her class and identify how each person learns.  By the next class meeting, she can alter the way in which certain topics are presented to effectively meet the learning needs.  For example, during one series, she may cover medical interventions by lecture, Power Point, or fictitious demonstration with certain tools such as amnihook or forceps.  In the next series, she may assign interventions to class members and then have them report their findings at a later date.

Additionally a wise educator realizes that when she is teaching she is part educator and part entertainer.  The use of humor, surprise, and application of previous accomplishments to the maternity situation enables learners to better grasp as well as remember fundamental elements.  The use of humor, surprise and application of previous accomplishment as applied to any situation is called creating memory hooks.

For more information:

Knowles Theory http://www.infed.org/thinkers/et-knowl.htm

http://www.floridatechnet.org/inservice/abe/abestudent/andravsped.pdf

Perspectives on Learning for Childbirth Educators  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595026/

Teaching Normal Birth Interactively 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595200/

Childbirth Education: Practice, Research & Theory 2^nd Edition by Nichols/Hummenick

Inside Birth: Through the Eyes of an MRI

Why Fear Mongering is Costing Maternity Care $$

Just counting the articles about fear in childbirth and the increase in time in labor and increase in complications of labor, one would think this is a new concept.  However, it is not.

In a recent Time Magazine article, WhyWomen Who Fear Childbirth Spend More Time in Labor, author Alexandra Sifferlin points out “Women who fear childbirth just got something else to worry about: a recent Norwegian study found that women who were scared of giving birth ended up spending more time in labor, about 8 hours versus 6.5 for women who weren’t afraid.

According to the study’s authors, 5% to 20% of pregnant women fear giving birth. The reasons vary, from the mothers being young or never having given birth before to their having pre-existing psychological problems, a lack social support or a history of abuse or bad obstetric experiences.

The study also found that mothers who feared childbirth were also more likely than unafraid women to need an emergency C-section (11% versus 7%) or assistance with instruments such as forceps for vaginal delivery (17.0% versus 11%). Overall, about a quarter of women who feared childbirth delivered without any obstetric interventions, compared with nearly 45% of women who were not afraid.”

“There are a number of reasons why women may develop a fear of childbirth,” said John Thorp, editor-in-chief of BJOG: An International Journal of Obstetrics and Gynaecology, the journal in which the new study is published, in a statement. “This research shows that women with fear of childbirth are more likely to need obstetric intervention and this needs to be explored further so that obstetricians and midwives can provide the appropriate support and advice.”

Let me first be very clear, as a nurse of 36 years and a Lamaze Certified Childbirth Educator of 32 years, I believe there is a time and place for obstetrical intervention.  We are blessed and fortunate to have the technology to save lives.  However, when fear is the catalyst for an increase in medical intervention including major abdominal surgery (yes, a cesarean is major abdominal surgery), then we need to stop bantering back and forth about how tragic this all is and DO something.

From all over this country (US), I am hearing stories of how obstetricans and medwives are discouraging expectant mothers from attending childbirth education classes.  While childbirth education is not the panacea for an epidemic of fear/intervention, I have been practicing long enough to know that when comprehensive, evidence-based childbirth education is incorporated into prenatal care, intervention rates go down and women’s satisfaction with care providers/hospitals as well as their birth experiences go up.

Remembering too that hospitals are a business.  A company.  And businesses and companies exist to make money.  This unfortunately is where the water gets very, very murky. 

And it begs the question.  “If comprehensive, evidence-based childbirth education would decrease fear, interventions and revenue for a hospital, is it any wonder why this education is discouraged?”