The Personal Pain Plan

8/18/2019 The Personal Pain Plan

1/44

International Journal of

Childbirth EducationVOLUME 23 NUMBER 4 DECEMBER 2008

The Way I Teach

The official publication of the International Childbirth Education Association

Healthy LifestylesBecause I Said So!

Audio Visual ReviewGiving Birth

Featured EducatorBrett Iimura

Perinatal WellnessPostpartum Pelvic Pain

Photo EssayA Baby’s Laughter


2/44

New ICEA PowerPoint PresentationsNow Available!

Newborn Appearance –$35

Pregnancy and Birth Series –$35

ICEA posters now available as PowerPoint slides!

Visit the ICEA bookstore at www.icea.org today!

International Childbirth Education Association • 1500 Sunday Drive, Suite 102, Raleigh, North Carolina 27607 • (919) 863-9487 • Email: [email protected] • www.icea.o

Breach Positions Engagement Cervical Effacement

Footling 0-cms dilated; 0% effaced

Vermix Jaundice Blue Hands


3/44

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education | 3

International Journal of

Childbirth EducationVOLUME 23 NUMBER 4 DECEMBER 2008

Indexed in the Cumulative Index to Nursing and Allied Health Literature (CINAHL)

FeaturesMindful Yoga as a Vehicle for Childbirth Education

By Robin Sale .......................................................................................................................7

Teaching the Facts: The Dilemma of Evidence-Based CareBy Donyale Abe ....................................................................................................................9

Talk Less, Learn More: Evolving as an EducatorBy Molly Remer, MSW, CCE (ALACE) ..................................................................................15

The Way I Teach: Being an EntertainerBy Theresa Halvorsen, BA, ICCE ......................................................................................... 17

The Personal Pain Plan: A Strategy for Teaching Pain Medication Choices in Childbirth ClassB y Loretta D. Bezold, RN, BSN, ICCE ................................................................................. 19

Divorce Prevention and Perinatal EducationBy Viola Polomeno, RN, PhD ............................................................................................. 21

ColumnsThe Editor’s Perspective – One on One – By Donyale Abe .............................................................4

Letter From the President – Highlights of 2008 – By Jeanette Schwartz ........................................5

Audio Visual Review – Giving Birth–Unveiling Birth: The Wisdom, Science and Heart –By Deanna Broxton ............................................................................................................26

An Educator’s Moment – Just Dance – By Donyale Abe ................................................................28

Featured Educator – Brett Iimura ................................................................................................29

Photo Essay – A Baby’s Laughter – By Caroline E. Brown ...........................................................30

Healthy Lifestyles – Because I Said So! How You Teach Affects Outcomes inHealth Behavior Change – By Elizabeth Smith ..................................................................31

Perinatal Wellness – Postpartum Pelvic Pain – By Heather Jeffcoat, DPT ................................... 35

Executive Director’s Letter – The Evolution of ICEA’s Bookcenter – By David Feild ....................37

AnnouncementsJournal Submissions .................................................................................................................. 14

ICEA Upgrades Website .............................................................................................Back Cover

ICEA.orgLabor Note Cards ...................................................................................................................... 38Calendar of Events ....................................................................................................................39

Photo Credit: Unless otherwise stated, all photos (excluding portraits) are by Caroline Brown, Photo Editor.

Cover photo by Benoît Ferradini.

Managing EditorDonyale Abe

Associate EditorDeanna Broxton

Photo EditorCaroline Brown

ColumnistsElizabeth Smith

Deanna BroxtonHeather Jeffcoat

ReviewersJeanette SchwartzMeggin Finkeldei

Graphic DesignerLaura Comer

Articles herein express the opinion of theauthor. ICEA welcomes manuscripts, artwork,and photographs which will be returned uponrequest when accompanied by a self-addressed,

stamped envelope. Copy deadlines are Febru-ary 1, May 1, August 1, and October 1. Arti-cles, correspondence, and letters to the editorshould be addressed to the Managing Editor.

Advertising (classified, display, or calendar)information is available at www.icea.org. Al-though advertising is subject to review, ac-ceptance of an advertisement does not implyICEA endorsement of the product or the viewsexpressed.

The International Journal of ChildbirthEducation (ISSN: 0887-8625) is publishedquarterly and is the official publication of theInternational Childbirth Education Association(ICEA), Inc. Subscriptions are $60 a year.

The International Childbirth Educa-tion Association, founded in 1960, unitesindividuals and groups who support family-

centered maternity care (FCMC) and believein freedom of choice based on knowledge ofalternatives in family-centered maternity andnewborn care. ICEA is a non-profit, primarilyvolunteer organization that has no ties to thehealth care delivery system. ICEA membershipfees are $75 for individual members (IM). In-formation available at www.icea.org, or write:ICEA, 1500 Sunday Drive, Suite 102, Raleigh,NC 27607 USA.

© Copyright 2008 by ICEA, Inc. Articlesmay be reprinted only by written permissionof ICEA.

The official publication of theInternational Childbirth Education Association


4/44

4 | International Journal of Childbirth Education | Volume 23 Number 4 December 2008

The Editor’s Perspective

One on One I attended Celebrate Childbirth Professionals , the 2008 ICEA Con-

vention, and enjoyed every minute. I learned new yoga techniques toinclude in my prenatal yoga classes, from the Positive Postures session. Inthe general session, Preventing Late Preterm Birth as Every Week Counts , Ilearned that I should take a multivitamin that includes folic acid every-day, and encourage other women to do the same.

At the President’s Pajama Party , I relaxed, snacked, laughed, and con-

nected with other birth professionals. Penny Simkin’s session, An EveningCelebrating the Decades , was inspiring and renewing. I learned from PennySimkin that one woman’s birth experience could bring about change andempowerment for other women.

The 2008 ICEA Convention was a time to celebrate birth professionals, who empower, serve,and touch families everywhere – that includes you.

You can download the B.E.S.T. certificate honoring the work that you do at www.icea.org.

In This Issue – The Way I Teach

Robin Sale shares how to help women cope with the intensity of labor by connecting theirbody and mind, in Mindful Yoga as a Vehicle for Childbirth Education. For seasoned educators, teach-ing the newer generations of parents can be challenging. In The Way I Teach: Being as Entertainer ,Theresa Halvorsen suggests how you can connect to Generation X and Y families. Molly Remer’sTalk Less, Learn More: Evolving as an Educator , is an inspiring story about her growth process as achildbirth educator, and she offers practical tips on how you can sharpen your teaching skills. Areview of the film, Giving Birth – Unveiling Birth, by Deanna Broxton, will move and inspire youto continue to teach childbearing families about all the birthing options and choices available tothem.

Take the time this holiday season to read the other articles in this issue. The information you

find will allow you to revive your teaching methods, and begin 2009 with a fresh perspective aboutthe way you teach.

Peace and Happy New Year!

Donyale AbeManageing [email protected]


5/44


Letter From the President

Jeanette Schwartz

Highlights

of 2008By Jeanette Schwartz

At the end of the year, we tend to look back over the

past 12 months and reflect on our personal accomplish-

ments and successes. The same is true for the International

Childbirth Education Association’s Board of Directors. 2008

has been a very busy year.

During the first full year of the ICEA Approved Training

program (IAT), qualified ICEA members became approved

trainers who provide the Basic Childbirth Educator andDoula Labor Support Training Workshops throughout the

United States and to the International Community. The

Educating the Educator program was put in place following

feedback from members who stated they wanted more op-

portunities to attend workshops in their local areas. What a

success this has been! Many workshops were held across the

U.S., in South Africa, and The State of Qatar this past year.

Please find a workshop near you at the ICEA website or

under the Calendar of Events listed in this journal. If you can-

not attend a workshop listed, consider contacting one of the

approved trainers and bring the workshop to you. It is easier

than you think!

In June we saw the relocation of ICEA headquarters to

Raleigh, North Carolina. We formed a new partnership with

FirstPoint Management Resources to oversee membership,

website, certification, and bookcenter operations. With this

move, ICEA has leaped into the millennium, upgrading to

business practices and technology that enhance our day-to-

day as well as long term service to members. In addition,

ICEA looks to a sound financial business plan to propel the

association into the future.

In September, we redesigned the International Journal

of Childbirth Education. Managing Editor Donyale Abe and

Graphic Designer Laura Comer, along with their editorial

team have created a publication of which we can all be

proud. Congratulations!

Also in September, ICEA supported the film, Orgasmic

Birth, along with an interview of the producer and film

director Debra Pascali-Bonaro. Have you listened to the

podcast Pleasurable Birth: Is It

Possible? , located on the ICEA

website? It is a great way to

learn more about orgasmic

birth and obtain contact

hours too!

As you well know, in

October, the ICEA 2008International Conven-

tion “Celebrate Childbirth

Professionals” was held in

Buffalo, New York. We will

long remember our celebra-

tion honoring Penny Simkin’s career and accomplishments

in the field of childbirth education. Penny Simkin was

presented with the ICEA Outstanding Childbirth Professional

Award . Noted speaker, Richard Obershaw taught us how to

better understand and utilize relaxation methods for our

own stress reduction, in addition to helping our clients and

patients. Ellen Hodnett’s presentation on supportive care

during labor and birth validates ICEA’s mission to provide

family-centered care and freedom of choice based on knowl-

edge of alternatives.

We took a hard look at the truth concerning maternity

care in the U.S. by viewing the films The Business of Being

Born produced by Ricki Lake, and Pascala-Bonaro’s Orgas-

mic Birth. Donyale Abe inspired us to celebrate and honor

the hard work, accomplishments, and achievements that

Childbirth Professionals provide to childbearing families. Of

course, you may purchase the presentations of many other

noted speakers at the ICEA website. This is also a great way

to obtain more ICEA contact hours!

Have you visited the ICEA website lately? You can join

the ICEA forum to chat about ICEA issues with other mem-

bers, sign up to be added to the ICEA e-mail list, download

the latest ICEA podcast, review journal articles, visit our

continued on next page


6/44


bookcenter, and more! Thank you Emily Fontes and First-

Point staff for creating this valuable tool.

ICEA continues to partner with Impact Media to bringyou free subscriptions of an ICEA-friendly publication, New

Parent Magazine . I hope you are using this great resource

for your families. Another valuable partnership is a joint

ICEA task force with the organization First Candle. A new

educational brochure will soon be unveiled by First Candle

and ICEA. It is designed specifically for childbirth educa-

tors to help distribute information about safe infant sleep-

ing practices. This collaboration is a great example of more

projects ICEA will become involved in to keep information

current and accessible.

This fall, ICEA joined the petition for Improving Mater-nity Care Services in the Czech Republic, attended the sum-

mit on homebirth in Chicago, and became an organizational

member of the Coalition to Improve Maternity Services

(CIMS).

In the 1986 premier issue of the International Journal of

Childbirth Education, President Jeanne Rose wrote the follow-

ing thought: “…thinking of the strides we have made towardhumanized birth reminds me of how my father who, from

a generation of fathers less involved with childcare, used to

describe his efforts in putting children to bed as being like

‘stringing beads without a knot on the end.’ Each child once

tucked in for the night would get up for a drink of water, a

trip to the bathroom, a foray for a favorite stuffed animal, or

one last goodnight kiss. So too, the progress we have made

toward family-centered maternity care is not unlike stringing

beads without a knot on the end. No sooner have we made a

change on one front, then looked behind us to see that some

previous gain has slipped away.”ICEA made a lot of progress this year working on tying

yet another knot in the string!

Highlights of 2008continued from previous page


7/44



Mindful Yoga as a Vehicle

for Childbirth EducationBy Robin Sale

The practice of mindful yoga paired withdeep relaxation is an excellent body-cen-tered preparation for labor and delivery.By learning to focus with present-momentawareness in the midst of discomfort,women are pleased to find out that they possess powerful resources to see themthrough labor.

I didn’t set out to teach childbirth education when I

began teaching prenatal yoga in 1986, a year after my son

was born. My intention was to teach women ways to help

themselves be more comfortable during pregnancy, and

maybe develop some inner calm and peace. I knew their ba-

bies would also benefit, and I viewed this as my small peace

on earth mission.

Soon it became clear that what the women were learn-ing in prenatal yoga was helping them birth their babies.

They became enthusiastic promoters, telling their pregnant

friends this class was the only thing that helped them in

labor. When women return to class with their newborns for

what we call show and tell , I’m always amazed at the creative

ways they use what they’ve learned to help them through la-

bor. While I still don’t consider myself a childbirth educator,

I’m continuously learning from my students what’s been use-

ful to them. I use their stories, which are sometimes pretty

funny, to inspire others.

For example, Diana was walking the halls of the hospitalwith her husband Sean, to help move labor along. Walking

past the door to the classroom where I teach, and finding

it unlocked, she led him in. Between each contraction she

stood in the center of the room, and to Sean’s utter amaze-

ment, assumed the tree pose!

Here’s how Diana tells the story: “When I was in the

yoga room, I could feel the calm energy and the wonderful

support of all the women from my class. Standing in tree

pose I felt surrounded by their support. Later, when I was

in the midst of transition, I used the affirmation that we

learned for the tree pose - ‘In the midst of life’s storms, I

stand serene.’ With each huge contraction, I repeated this in

my mind and that’s what got me through.”

I’ve come to see that all childbirth preparation tech-

niques are simply variations on ways to stay focused in the

present moment. Resistance to being present with what is,because of fear or the expectation that it should be other-

wise, is the source of much suffering in labor. Isn’t the same

true for everyday living? The only way to stay in the present

moment is to literally come to our senses . We can only hear,

feel, smell, taste, and see in the present moment. Holding

any one, or combination of our senses in awareness can act

as an anchor to the here and now.

A deep, body-centered understanding occurs with the

repetition of yoga poses and incorporating pain-coping skills.

When a woman experiences holding a difficult pose for one

minute, which is about the length of the longest contraction,without using a focus point, and then repeats the pose, the

second time using a focus point that really works for her, it

changes her whole perspective. She sees that a minute can

seem longer or shorter, depending on her ability to dwell

in the present moment. She learns that pain is more or less

tolerable, depending on her relationship to it. She embodies

a new confidence and feels new possibilities for her birth.

Often, this body-centered understanding arises quite sponta-

neously and in surprising ways in the midst of labor.

Through yoga, I’m able to offer a full bag of tricks:

sounding, counting the breath, fixing the gaze, various

movements, imagery, and exploring sensation, to name a

few. I never know what will be useful to my students. But

one thing I do know is there’s no one-size-fits-all approach

when it comes to labor coping skills. I’ve also discovered that

when a woman finds what works for her, it really works. She

experiences the pain as a part of her whole experience and

not even the biggest part.


8/44


Childbirth is rhythmic like the cycles of nature, like the

beating of the heart. You might think of contractions as the

yang, active part of the cycle, and the rest between the con-tractions as the yin, still part. You can’t have one without the

other. Yet even though the strong yang work of the uterus

takes up less than one-fifth of a typical active labor, there’s

virtually no attention paid to the much larger four-fifths por-

tion in most childbirth education.

Try asking a woman to describe the sensations she felt

in between the contractions. Many women will tell you what

they were doing, thinking, or saying, but few can remember

what it felt like. That’s too bad, because if they’d been able to

pay attention in those moments and dwell upon their senses

they might have known the sweet relief of no pain and evenbetter – the soft cloud of endorphins embracing them.

So I feel it’s essential to teach the importance of deeply

focused rest between the contractions. With practice we can

learn to drop into a very deep focused relaxation in seconds.

Even a minute of this kind of focus in between contractions

can be enough to restore the body and mind. Instead of wast-

ing energy to brace for coming contractions or fretting over

how much time has passed, women should conserve energy.

The body will refresh itself and work more effectively. I’m

convinced this helps bring about a smoother, shorter labor.

What I teach has evolved out of my own long-time

mindfulness practice and equally so, from the women in my

classes who have shared their stories over these many years.

Yoga is a powerful way to befriend our bodies in a time of

such rapid change as pregnancy, but yoga is just one part of

what makes these classes a refuge and a wonderful support

for women on their way to motherhood. Also essential is the

social support and collective resourcefulness that comes from

the wisdom circle part of class, but a discussion of that topic

will have to wait for another article. I’m very grateful for the

opportunity to share my experience with other members of

the International Childbirth Education Association.

Resources

www.wholebirth.com/prenatal_yoga_national_directory.htmwww.mindfulbirthing.org/index.htmlwww.withawareness.com

Robin Sale, is the originator of the Whole Birth® Yoga and

Support Classes. You can learn more about her Whole Birth®

Prenatal Yoga Teacher Training, Expecting Couples Retreats, and

her prenatal counseling work at www.wholebirth.com. Robin

lives in Santa Cruz, California.

Present Moment AwarenessLabor Practice for Challenging Yoga Asanas

(These techniques can also be applied to the use of ice for labor practice)

Breath Awareness• Take a cleansing breath in through

the nose and out through the mouth.• Take deep, slow breaths.• Listen to the breath.• Feel the complete duration of the

inhalation, the exhalation, and anypause in between.

• Count breaths.

Sound• Make a sigh with the out breath

– releasing the breath.• Create a blowing wind sound with

the out breath.

• Open mouth and soften the jaw– making hahhhh sound(like fogging a mirror).

• Hum.

Work With Sensation• Be curious about it.

• Name it – burning, aching, stinging.• See it – the color, texture, brightness,

or dullness.• Does it move, change, or pulsate?• Soften around sensation – with your

breath, with your awareness.• Breath right into it – as if to dissolve

or dilute it.• Breathe out – let it go, flowing out

with the breath.

• Expand awareness to include the whole body.

• Let awareness rest in a part of the bodythat feels fine, the earlobe or big toe.

• Soften where you can soften, isolate thework to the muscles involved.

Focus in the Moment• Notice complaining mind – wanting the

pain to go away or be over.• Waiting does not exist – this moment is

all there is.• Be open to the possibility of finding a

sense of stillness or calm right withinthe intensity. Like resting in the eye ofthe storm.

• Ask, ‘Am I ok right now?’

Mindful Yoga as a Vehicle for Childbirth Educationcontinued from previous page


9/44



Teaching the Facts:

The Dilemma ofEvidence-Based CareBy Donyale Abe

With the release of a new report,Evidence-Based Maternity Care, child-birth professionals have an additional

resource to teach and promote evidence-based care. Recent data shows a widen-ing gap between current maternitycare practices and evidence-based care.Hospital based childbirth educators areoften conflicted about how to teachevidence-based care, when it is not thestandard of care used at the facilitiesthey teach.

One of the challenges of teaching childbirth classes is not

only presenting the information needed to prepare parents for

the labor process, but also giving them tools to feel empow-

ered and confident about the experience. I am primarily a hos-

pital based childbirth educator; and I have the delicate task of

balancing between the role of teacher and advocate, explain-

ing hospital procedures and evidence-based care (ICEA, 1999).

This is a difficult task. The balance of duty can often weigh

upon my conscience, bringing my morale down.

A newly released report, (available for download at

childbirthconnection.org) Evidence-Based Maternity Care:

What It Is and What It Can Achieve , by Carol Sakala and

Maureen Corry, comprehensively examines the deficit

between actual maternity care and evidence-based maternity

care that should be the standard used everywhere.

“Evidence-based maternity care uses the best available

research on the safety and effectiveness of specific practices

to help guide maternity care decisions and facilitate

optimal outcomes in mothers and newborns.” (Sakala and

Corry, 2008.)

Teaching the facts, when I know that some prenatal care

requirements, hospital policies, medical care providers, and

labor room logistics limit a woman’s choices and options for

consent, is a dilemma that I struggle with. For example, I

teach women about the stripping of membranes. I explainhow the procedure is done, that it can be very uncomfort-

able, that they may have some spotting afterwards, and their

caregivers should ask for their consent before the procedure

is performed. Often, after taking the time to explain this, a

woman in class may approach me and disclose, now that she

knows what stripping the

membranes means, she

thinks her care provider

did the procedure without

asking for her permission.

I often ask myselfthese questions:

• How can I best em-

power a mother?

• Do I regret providing

her with the informa-

tion about the proce-

dure?

• Should I encourage her

to discuss with her doc-

tor what happened?

As a childbirth educa-

tor, doula, representative, and patient of the hospital where

my families give birth, I strive to stay within the lines be-

tween these roles, yet for me to teach conscionably, conflict

within myself, and with other care providers sometimes must

occur.

Empowerment:

“A woman’s confi-dence and ability

to give birth andto care for herbaby are enhancedor diminished byevery person whogives her care, andby the environ-ment in which shegives birth.”

— Principle of:

The Mother-FriendlyChildbirth Initiative


10/44


When you know that evidence-based maternity care

practices are not widely used in birth facilities in your com-

munity, and especially the facilities where you teach, the di-lemma and challenge is to teach the evidence, the research,

and the facts about the most effective and least harmful

perinatal care practices uncompromisingly, unswervingly, and

unapologetically.

These strategies can be used to effectively teach and

promote evidence-based care.

Discussion GroupsAn interactive way to provide evidence-based informa-

tion is to use benefit and risk discussion groups. For example,

when teaching about episiotomy, induction, amniotomy, and

other interventions, you can:

• Divide class participants into small groups.

• Have participants read current evidence-based informa-

tion about the interventions found in their class booklet

or handouts.

• Class members should write down and discuss the ben-

efits, risks, and alternatives they discover.

Parents are often amazed by how many risks they

uncover in their discussion groups, and often conclude, as

in the case of episiotomy, that it should be performed onlywhen a medical need exists.

Class BookletThe hospitals I have taught for have always provided

books, like The Family Way , for students to use to compli-

ment the information learned in class. These books are

continually updated and contain evidence-based facts within

them. Through the years, I have learned to direct class mem-bers to the pages in their book, and let the book teach for

me. I always back up information presented by directing my

class to the specific page numbers in their books.

I encourage you to read from cover to cover, the class

booklet that your hospital provides to students. I underline

and highlight all the evidence-based information available in

the booklet to pass along to my students. It is against policy

for me to provide students with any other reference materi-

als. The book does all the work for me, even listing valuable

websites for parents to access research articles.

I use the book to provide evidence-based informationabout:

• Benefits of changing positions and moving during labor.

• Due dates and the normal length of pregnancy.

• The value of labor support.

• Methods to turn a breech baby.

• Delayed pushing and pushing with natural urges.

• Epidural risks.

• Induction risks.

• Myths about having a big baby.

Role PlayThe most effective learning occurs when adults partici-

pate and apply what they have learned. Role plays are an

excellent tool for your students to teach themselves, reinforc-

ing what they have learned. To use a role play:

• Divide class members into groups.

• Give them scenarios to discuss.

• Have them act out a response to the scenario, with each

member playing a role.

Role Play Scenarios• You are five days past due. You are told you need pito-

cin for induction. What are your options? How would

you discuss this with your health care provider?

• You are having twins. One twin is head down. You are

told you must have an epidural and be prepared for

a cesarean. What are your options? What concerns

would you have? How would you talk to your doctor

about your concerns?

Teaching the Facts: The Dilemma of Evidence-Based Carecontinued from previous page

Photo credit: flickr/Lab2112


11/44



Answer QuestionsSometimes the easiest way to teach is simply by answer-

ing questions. Take the time to build a rapport with your

students, tell jokes, make them feel at ease. Once they know

you are really willing to address their concerns, than an

entire class could be devoted to listening and responding tothem. You may be the only one they are comfortable with or

they feel has the time to assist them.

Patient Rights

Childbearing women frequently are not aware of their

legal right to make health care choices on behalf of

themselves and their babies, and do not exercise this right.

(Childbirth Connection, 2006.)

It is important that families know not only what their

rights are as they receive medical care, but also how to ef-fectively exercise their rights. Take the time to explain what

informed consent is. (The Informed Consent Discussion

Sheet can be downloaded from icea.org)

A simple way to teach this is by using the acronym

B.R.A.I.N. When considering any procedure, families can

ask their health care providers:

Benefits – What are the benefits to this procedure?

R isks – What are the risks to this procedure?

Alternatives – What are my other options besides this

procedure?Intuition – What does my gut tell me about this procedure?

Need Time – I need time to consider this procedure.

Facts and StatisticsSome adult learners really focus in upon topics when

you present numbers, facts, or trivia.

I enjoy teaching about the benefits of squatting. I often

share that when women are able to squat they gain 28%

more space around the pelvic outlet for the baby to descend

(England and Horowitz, 1999). I then go on to teach sixdifferent ways to squat. I also explain that a squatting bar

is available in the labor room for pushing and show them a

picture of the bar. I let them know that upon request it may

be possible for them to push in a squatting position.

After discussing this information, combined with practi-

cal things they can do, many women approach me later and

share that when class began they were sure they would need

medication to manage labor, but now they feel more confi-

dent because they have options.

Examples of other statistics to discuss:

• The United States’ cesarean rate in 1970 was 5.5%.

• 70% of first-time mothers go past their due dates.• Only 3% of babies are born on their due date.

• In 2006, 31.1% of women in the U.S. had a cesarean

birth.

• In the U. S., less than 25% of babies are still breastfed at

six months of age

Conversation with Care Provider It is important that families are able to communicate

with their health care team members. Encourage those you

teach to bring up any concerns during their appointments. It

is also beneficial to practice with students how they can bestbring up topics and express their opinions to medical staff. I

remind students that no individual is all knowing and that it

is helpful to give evidence-based articles and information to

their health care providers for discussion.

Photo credit: flickr/daquellamanera


12/44


Write LettersThe maternity care industry is becoming increasingly

competitive. Hospitals closely located in one geographic area

have begun campaigns lauding the benefits of giving birth

at their facility. In this competitive environment they closely

monitor patient feedback and work to address concerns.

Families should be encouraged to write letters to health

care customer service departments, a health plan ombuds-

man, department heads, nurse managers, and independent

advocacy groups. Change can be brought about one letter

and one individual at a time.

The Birth Survey , at www.TheBirthSurvey.com, is a con-

sumer driven website where families can rate their maternity

care experience and provide valuable information for other

consumers about intervention and their overall satisfaction

with the maternity care they received at their birthing facil-

ity. If I have the opportunity, I share with my students the

recent history of maternity care, reminding them that some

of their grandfathers were prevented by hospital policies from

witnessing the birth of their children.

It is only recently that all fathers in the U.S. are able to

be in the labor room for the birth of their children. It seems

laughable now, but in years past some fathers felt so strongly

that they handcuffed themselves to the mother’s bed in

order to remain with her. If it were not for parents and birth

advocates writing letters, making their concerns known, and

questioning maternity care policies, we would not have many

of the changes present today, like family-centered maternity

care.

Birth Place and Care ProvidersBe knowledgeable about free-standing birth centers,

home birth midwives, and care providers with low interven-

tion rates. Also, learn about hospitals with low intervention

rates that allow doulas, water births, and provide midwiferyservices in the communities where you teach.

You are sometimes the only one that is in a position to

direct families to health care providers and birth facilities

that use evidence-based maternity care. It is important to

have contacts available to give to families upon request.

I often have families ask me for doulas I can refer them

to. Once I had a family who attended my hospital class, who

after learning about the labor process and options avail-

able to them, ask if I knew any home birth midwives in the

community. I gave them some referrals and they made the

decision in mid-pregnancy, to switch their prenatal care to a

midwife. They went on to have a successful homebirth.

Speak-upMy calling to be a childbirth educator, I do not takelightly. I work hard and use many techniques to strengthen

and empower women. All women should be provided an

understanding of evidence-based maternity care and be

encouraged to make informed decisions.

Evidence-based care seems straight forward, and that

the right of a woman to decide for herself what is appropri-

ate seems obvious. Yet many everyday maternity care prac-

tices negate low risk and low intervention birth techniques

that are as old as womankind. I dare to say that a woman

herself can be negated within her own birth experience. Itis imperative and urgent that WE birth professionals read

Evidence-Based Maternity Care , and act to bring change for

women as best we can. I know the challenges of this task.

Before I had children, I taught childbirth classes and

was a doula. I always took the time to explain informed

consent to my students and encourage them to discuss

any concerns they had with their care providers. Then, my

journey began to have children. It started at the inferti lity

clinic. I was over age 30, and had been trying for a year,

so my husband and I began all the needed tests. Once the

tests were completed we met with the nurse practitioner todiscuss the results. I was told during this appointment that

I was required to have a pap smear. I had recently had one

performed so I told the nurse practitioner that no, I did not

want a pap smear at this appointment. She proceeded to ask


Photo credit: flickr/manueb


13/44



me to undress, and place my feet in the stirrups so that she

could examine my ovaries and some other things. I agreed

to that part of the examination.

After the appointment was over, and my husband and I

got into the car to drive home, I realized that something did

not seem right. I told my husband that I thought she did the

pap smear when I told her clearly, that I did not want one.

I’d also told the medical assistant, while waiting for the nurse

practitioner to come into the exam room that I did not want

a pap smear. I thought to myself that maybe a mistake had

been made. I called the nurse practitioner’s office the next

day to ask her what happened, and giving her the benefit

of the doubt, I thought maybe she did not hear me clearly,

when I said no.

Her response was, “Yes, I did hear you clearly, when you

said no.”

I’d told two people clearly that I did not want a papsmear, and, my husband was present the entire time, and yet

my request was disregarded. I was fully informed about the

benefits and risks, and the evidence. I tell you my story, not

for personal gain, not for healing or therapeutic purposes,

but because if this happened to me, an educated, informed,

and articulate person who did not give her consent, and I

had done everything I

could in that moment to

prevent it from happen-

ing, then what about

other women who arenot articulate and not

informed?

I speak with the hope of encouraging birth professionals

and women everywhere to continue striving for evidence-

based maternity care. Work and advocate for the women

who never will be able to advocate for themselves.

Years later, I had two daughters, and was at the dentist’s

office discussing my nursing daughter’s tooth decay. She was

about six-months-old. I asked the dentist who was treating

her what I could do to prevent further decay. She told me

that I should wean my six-month-old. She then went intoher office and came back with a pamphlet for me entitled

Baby Bottle Tooth Caries .

I had written upon my daughters’ medical history form

that she was exclusively breastfed. So I was perplexed and

angry at the advice and pamphlet, which had nothing to

do with my situation. I took a moment to take some deep

breaths and proceeded to question the dentist about how

the pamphlet related to us.

She actually looked surprised at my question and asked

for the pamphlet back to glance at it, and then she admitted

that it was unrelated to us since we were exclusively breast-

feeding. When I returned home, I looked up all the articles

that I had regarding tooth caries, and the evidence shows it

is not caused by breastfeeding, but a myriad of other things,

and I faxed this information to her. I had an appointment

with her two weeks later, and was nervous about her re-

sponse to the articles, but to my surprise she had read them,

and agreed that she had been wrong in her information, and

that she was now going to

do further research.

Some years after

that as I was teaching a

Saturday class, and we

began going around the

circle with introductions, who should I notice there but my

daughter’s dentist and her husband. I was so surprised. I was

also glad that I had spoken up those years before. Now my

daughter’s dentist was pregnant, facing birth, and mother-

hood. I could only want for her what I want for all women

everywhere, evidence-based maternity care.

Conclusion

I have had some childbirth professionals confide to me,that they are discouraged with the status of today’s maternity

care. Yes, the cesarean rate has reached an all-time high in

the U.S. The number of couples attending childbirth classes

has fallen. You may feel the subliminal pressure not to teach

evidence-based classes.

You may feel thesubliminal pressure not to teach

evidence-based classes.

Photo credit: flickr/joshschipper


14/44


I implore you to H.O.P.E.

Hold On – You must not stop teaching. How will it help if

you are not teaching?Optimism – Attitude is everything. Share the glass is half full

attitude.

Provide Information – Share as much evidence-based ma-

ternity care information as you can.

Empower – Women will be more confident. Families and

babies will be stronger.

Never give up teaching, providing labor support, doing

all you can, and really just your part to advance evidence-

based maternity care.

Resourceswww.thebirthsurvey.com

Childbirth Connection, childbirthconnection.org: What Every Pregnant Woman Needs to Know AboutCesarean SectionThe Rights of Childbearing Women

Coalition for Improving Maternity Services,motherfriendly.org:Evidence Basis for the Ten Steps of Mother-Friendly CareThe Mother-Friendly Childbirth Initiative

ACOG Cesarean rates from 1970-Present: www.acog.org/departments/dept_notice.cfm?recno=20&bu

lletin=264The Family Way class book is available at thefamilyway.com

ReferencesSakala and Corry. 2008. Evidence-based maternity care: What it is and whatit can achieve. Available at childbirthconnection.org. Accessed October 13,2008.

Childbirth Connection. 2006. The rights of childbearing women. Availableat childbirthconnection.org. Accessed October 13, 2008.

ICEA. 1999. ICEA Position Paper: The role of the childbirth educator and thescope of childbirth education.

England, P. and R. Horowitz. 1999. Birthing From Within. Albuquerque:Partera Press.

Donyale Abe, ICCE-CD, IAT, a graduate of the University of

California, Berkeley is currently the managing editor of the ICEA

Journal and has taught private and hospital-based childbirth

classes since 1999. She serves as a mentor to childbirth pro-

fessionals around the world, providing basic and advanced

childbirth educator training workshops. She is currently writing a

book about birth that will empower women everywhere.

Journal SubmissionsThe International Journal of Childbirth Education welcomes your articles, research papers, essays,

and photos for upcoming issues.

June 2009: MotheringThe deadline is February 1, 2009.

September 2009: Global Birth CircleThe deadline is May 1, 2009.

December 2009: Open ForumThe deadline is August 1, 2009.

Submissions can be made on the following topics:

Childbirth Education, Labor Support, Breastfeeding,

Birth Stories, Postnatal Education, and Perinatal Fitness.

The guidelines for submissions can be found at

http://icea.org/content/information-journal-writers

Please send all submissions electronically to

[email protected]. A copy should also be sent to the

Managing Editor, Donyale Abe,

at [email protected].



15/44



Talk Less, Learn More :

Evolving as an EducatorBy Molly Remer, MSW, CCE (ALACE)

Being an effective childbirth educator is an evolution-ary process. This article details the realization that myapproach to childbirth education was in need of modification and how I let the idea of “talk less, learn more” guide me in my efforts to truly meet the needs of child-bearing women in my community.

Since late 2006, I have written

the following message at the top of

each of my teaching outlines: Talk less,

listen more . This simple reminder has

fundamental importance and has com-

pletely revolutionized how I structure

and guide my childbirth classes. During

each series that I teach, I realize how

listening to women and giving them a

space in which to share, is one of the

most important things I can offer. Dur-

ing my certification program, I studiedprinciples of adult learning and design-

ing effective curriculums. I began my

journey as a childbirth educator with a

lecture and information-heavy ap-

proach that I’ve since heard referred to

as, “opening their heads and dumping

information in.” As I have continued

to teach, I’m continually discovering

ways to talk less, but hopefully, impart

more knowledge. By creating a guiding

philosophy of talking less , students

learn more as I plan and implement my

classes.

After my first year of teaching,

I realized couples who sign up for

my classes are not really looking for

pregnancy and prenatal care informa-

tion, but for real birth preparation. The

women want to learn, “Can I do this?”

and “How will I do this?” The men ask,

“How can I help her do this?” It feels

almost insulting to meet this quest for

inner knowing with a discussion about

the benefits of prenatal vitamins. I had

to confront the fact that some of the

things I was teaching seemed irrelevant,

redundant, or obvious. It became clear

to me that I had to tackle the slightly

embarrassing reality that I was follow-

ing a model of prenatal education that

was not in line with the true needs of

the women in my community.I teach independent, natural

childbirth classes privately in people’s

homes. Maybe with a different popula-

tion, my original approach would be

more successful, or I would take a dif-

ferent approach altogether. As students

have different learning styles, educators

naturally have preferred methods. I

have an information-heavy personal

style that spilled over into my teaching.

I continue to wrestle with this tendency

and struggle to rein in the information

overload approach I gravitate towards.

Over time, I began to drastically

cut my talk (lecture) and focus on

action instead. Though it felt nearly

sacrilegious to do so, I trimmed many

things out of my outlines that were

about nutrition and prenatal testing,

because many of the women I work

with are well read and familiar with

those topics. I’ve come to realize that

I need to skip a great deal of the book

learning and get them actually moving,

practicing, and using skills. The book

learning naturally arises during the

course of the class, through questions

or explaining why specific techniques

are helpful during pregnancy and labor.

I have now restructured and re-

arranged my class outlines to include

an entire class about the mind-body

connection and psychological prepa-

ration for birth. This class replaced a

previous class about birth planning.

I found that many people already had

birth plans written, and the topic of

birth planning naturally came up dur-

ing the six-week course without my

needing to spend excessive time lectur-ing on it. I’ve also dedicated an entire

class to labor support, including plenty

of time to practice hands-on support

techniques. In addition, I created a

brand new class called Active Birth that

involves movement, positions, and

helpful ways to labor in a hospital bed

without lying down.

Pregnant women have information

overload. They are faced with more

information than they know what to do

with. They are bombarded by it. Whatthey really need is a sense of knowing .

• What skills do I possess that

will help me greet my birth with

confidence?

• What are my tools?

• What are my resources?

• Can I just let it happen?


16/44


As an educator I ask myself:

• What will help them feel

confident?• How can they be ready?

• What will help them learn to

trust their bodies and their

capabilities?

I want people in my classes to

learn material that is dynamic, active,

exploratory, self-illuminating, support-

ive, positive, enriching, and affirm-

ing. I created a vision statement and

asked myself where my classes stood in

relationship to my vision. The answer

was, “Not as close as I want them to!”

My vision statement for my classes is

to focus on celebration, exploration,

motivation, education, inspiration,

validation, initiation, and dedication.

After I completed this self-in-

quiry and curriculum modification, I

discovered author and educator, Trish

Booth’s concept of The Evolutionary

Spiral of a Childbirth Educator . I quickly

recognized myself and my experiences

along the loops of the spiral. In theEarly Stage of the spiral, educators are

focused on content and presenting the

information. This perfectly matches

where I was when I started out with my

“open heads and dump information in”

approach. The Intermediate Stage is fo-

cused on the group as a whole and also

emphasizes learning rather than teaching .

Though I tend to teach one-to-one pri-

vate classes and not groups, this seems

to clearly be the stage I was in when I

looked at my vision and realized thatI needed to talk less so people would

learn more. In the Advanced Stage, the

educator understands the meaning of the

childbearing experience and the focus

is on the individual learners . This feels

like the stage to which my teaching

has spiraled. Further along the spiral is

the Master Stage in which the educator

integrates the first three stages and moves

gracefully between them with a focus on

cognitive, emotional, and spiritual needs

of the group as well as the individuallearners (Booth, 1995).

Perhaps my insights are old news

to experienced educators, but they

have made a profound difference in

the quality of my classes. I am sure as

I continue to teach, I will continue to

deepen and refine my approach and

will continue to blossom as an effective

educator.

How to Talk Less

Birth Stories

Show two contrasting birth clips.

Use a birth from a popular TV show

(I often show Rachel’s birth from the

show Friends ) paired with an empower-

ing birth from a film like Birth as We

Know It , and then have students discuss

the differences.

Ice Cube Minute

Use the activity from Family-Cen-

tered Education: The Process of TeachingBirth. In this exercise, couples hold an

ice cube in one hand for one minute

and see what coping measures spon-

taneously arise. I do this exercise fairly

early in my class series, before we’ve

done a lot of formal talking about

coping measures. It is very empowering

for couples to discover what tools and

resources come from within as they try

the ice cube minute.

Mind-Body-Connection

To illustrate the potency of themind-body-connection, practice two

pretend contractions while holding ice.

One contraction has a stressful para-

graph read with it: “Your body fills with

tension…it hurts! Oh no!” The second

contraction has a soothing paragraph

read with it: “You greet the wave…it

is YOUR power…” This illustrates the

fear-tension-pain cycle viscerally.

Yoga Poses

Birth happens in our bodies, not

our heads. Use a five minute series ofbirthing room yoga poses to begin the

class. Practicing the poses opens space

to simultaneously discuss and practice

squatting, pelvic rocks, optimal fetal

positioning ideas, healthy sitting, pelvic

floor exercises, leg cramp prevention,

back pain alleviation, and more.

Role Playing Cards

Talk through various birth sce-

narios. I have found that couples are

more receptive to talking through role

playing cards than actually getting into

a role and playing it through.

Values clarification exercise

Participants cut out values from a

list and arrange them in a grid to help

them figure out if they are in align-

ment with each other and with their

caregivers.

References

Booth, Trish. 1995. Family-centered education: The process of teaching birth. Minneapolis: ICEA.

Learning Pyramid, www.birthsource.com/pdf-files/learning%20pyramid.pdf, accessed Septem-ber, 2008.

Molly Remer, MSW, CCE is a certified

childbirth educator and activist who lives

with her husband and two young sons in

Rolla, Missouri. She is the editor of the

Friends of Missouri Midwives newslet-

ter and is a La Leche League leader. Sheblogs about birth, books, and midwifery,

respectively at talkbirth.wordpress.com,

mollyreads.blogspot.com, and cfmidwifery.

blogspot.com. She is enrolled in the ICEA

childbirth educator certification program.

Talk Less, Learn More: Evolving as an Educatorcontinued from previous page


17/44



The Way I Teach:

Being an Entertainer By Theresa Halvorsen, BA, ICCE

As Generations X and Y replace previous generations in childbirth classes, it’s important for instructors to entertain theirclasses, not just inform them.

Many things go through my mind during my childbirth

classes, but lately I have been hearing a line out of the movie

the Gladiator, “Are you not entertained?” Over the last few

months I have been focusing not only on the information I

provide, but also how it is presented. And yes, keeping my

students entertained is becoming a significantly larger part of

my classes, especially as my students become younger.

The latter part of Generation X and all of Generation

Y grew up with constant entertainment. Indeed, many of us

can’t handle being bored. I know because I’m a late Gen-

eration Xer. We text message, listen to music, and check

e-mails, all at the same time. On roller coasters, we listen to

our iPods because the roller coaster itself is not entertaining

enough. Our days consist of watching TV shows and movies,

listening to music, You Tube, concerts, and other live events.

So when members from Generations X and Y come to your

childbirth classes they are expecting to be entertained. How

do we make entertainment a priority while still giving our

students the information they need?

Humor Humor is my number one weapon to keep my classes

entertained. Do not be afraid of jokes. While it has takenmonths to develop my jokes, I receive great feedback about

them. One of my favorites when teaching patterned breath-

ing is, “Mix it up at little. You could do one he and one ho,

two hes and one ho. Heck, if it feels good, do three hes and

two hos.” Say it out loud if you don’t get the joke. Other

favorites include, “Never tell a laboring woman to RELAX

because she will hit you.” And when talking about APGARS,

I say, “One of my sons scored a three. He’s fine now. Of

course he thought it was a good idea to swallow a quarter

last month, but other than that, he’s fine.”

In addition, do not be afraid to act like an idiot. One of

the instructors I work with paints her lips with lipstick and then

places her mouth on a balloon to show how important it is for

babies to open up WIDE when breastfeeding. Just do not force

your class to act like idiots themselves or they will shut down.

And do not be afraid to mess up. I was at a concert once

where the lead singer completely forgot the words to a song.

His band just kept playing hoping he would pick it back

up. He struggled for a good minute to remember the lyrics

until the audience started singing the song and he joined in.

While he was really embarrassed by his mistake, it was an

incredible moment for the crowd, one they will remember

forever, and in a positive light. The song was actually better

for the audience, because that singer blew it. So do not be

afraid to try new games, activities, or find a new way to ex-

plain things. Maybe you will mess up and create somethingeven better. And if you really blow it, chances are it will be

entertaining for your class.

Consider sharing stories and anecdotes in your classes.

Exaggerate freely, but don’t lie, to make your points, and be

humorous. The funnier the story is, the more likely your class

will remember it, as well as the point of the story.

And finally, laugh at yourself. Did you make a joke that is

bombing? Laugh as you present it. It gives people permission

to laugh with you or at you. Ever notice how Jon Stewart on

the Daily Show cracks up when he is reading his screens? He

does this even when the audience is not participating.

More IdeasLet’s say you are just not good with jokes or making

your classes humorous. There are other things you can do

to make your classes more engaging. Make the switch to

teaching with PowerPoint. Younger generations are increas-

ingly visual. They will learn best if they can see what you are


18/44


talking about. If PowerPoint scares you, take a seminar in

PowerPoint presentations. You may also consider using over-

heads. However, one word of warning, I was forced to useoverheads in one of my classes and my students snickered

about how low tech I was.

You cannot teach without some lecturing, but you can

make it less boring. Learn how to lecture effectively. Do

not sit down to lecture; always be on the move. Be expres-

sive, smile at your students, nod or frown at questions, and

tilt your head to the side when thinking. Watch your body

language when lecturing. Twisting your fingers and hunching

your shoulders makes

you seem unsure and

unprepared. If neces-sary, take a public

speaking class. How-

ever, try to cut back on

your lecturing whenever

possible. It’s boring to

Generations X and Y.

Instead, play games,

watch movies, open up

discussions, and have

group activities.

If you use hand-outs, make them

interesting. Use visuals, graphics, and charts to reinforce your

points if possible. Have someone you know who writes well,

look over your handouts, if you are uncomfortable with your

writing skills. When using PowerPoint, make sure you give

your students handouts of your presentation so they can take

notes. Taking notes keeps them engaged and entertained.

AdvantagesWhen you make your classes entertaining, people actu-

ally want to come to them. I know I have done my job en-tertaining my classes when people tell me I was their favorite

instructor; that they enjoyed coming to the classes; that they

learned a lot without it being a chore; that they missed the

series when it was over; or that the time in class flew by.

Your class will also remember the information if it is pre-

sented well. You could be giving them the key to childbirth,

but if you give it in a boring way, they will not remember it.

When your classes are entertaining, participants are more

likely to remember the information.

If you need one more reason, by entertaining them,

your class will be less stodgy and formal. If you relay infor-

mation in a casual way, your students become more casual.

They are more likely to ask embarrassing questions and

participate in class activities and discussions.

DisadvantagesHumor, my number one weapon, if not done carefully,

can be offensive. It is possible to make a joke about some-

thing that is funny to people in the birthing business, yet it is

in bad taste to others. For example, I heard another instruc-

tor compare a woman’s perineum after birth to hamburger.

The instructor thought she was being funny, but she ended

up scaring everyone in the class. In addition, use caution

when making jokes about nurses and doctors —your par-

ticipants will be placing a great deal of trust in these people

over the next few months.Another disadvantage of utilizing humor in a class is

the possibility of losing control of the class. When you are a

little irreverent and unruly it encourages others to be so too.

While this is usually a good thing and opens the class up for

fun and games, it makes controlling them harder. If you have

an extremely unruly personality in your class they may get

the message that their behavior is acceptable.

It’s hard to be funny all the time, especially when you

are sick or feeling a little down. Being an entertainer is ex-

hausting, especially during long weekend classes.

Remember, if you do use humor in your classes, it iseasy for jokes to go flat after telling them many times. Be

careful about telling jokes too quickly or with the wrong in-

flections. If a joke was a hit last month, but now you are not

getting any response, try retiring it for a little while.

ConclusionIt is important as a childbirth educator to become aware

of what your students expect from you. Creating classes

that are entertaining will make you a better instructor and

your students will learn and remember the information you

are trying to present. While it can be time consuming and

exhausting, the effort will be well worth it for your students.

Theresa Halvorsen is a childbirth educator teaching more than

10 different classes for her local hospital. Her favorite is Prepared

Childbirth. Lately, she has been focusing on helping labor coach-

es learn how to support laboring women. Her blog on the subject

is at www.gentlebeginnings.blogspot.com. She lives in California

with her husband, twin boys, and too many pets to count.

The Way I Teach: Being an Entertainercontinued from previous page

Photo credit: flickr/Hayden Simon


19/44


contiued on next page

The Personal Pain Plan:

A Strategy for Teaching Pain MedicationChoices in Childbirth ClassBy Loretta D. Bezold, RN, BSN, ICCE

Teaching about pain medication options has been a central component of childbirthclasses. Prospective parents want the most up-to-date information as well as reassurancesthat they will have options for pain relief available during labor. In some cases, onlymedical choices are discussed while spending little, if any time presenting non-pharma-

cological methods to be used in labor. The development of a Personal Pain Plan© assists parents in their decision-making, based upon their current wishes and previous lifeexperiences. This approach is in direct accordance with ICEA’s philosophy of ‘freedom ofchoice based on knowledge of alternatives.’

As an educator with a few years under my belt, I have

been searching for the perfect way to teach clients about

pain medications and their available choices. With the fol-

lowing plan I believe I have come closer. I hope you find it

a useful addition to the bag of tricks that you use in your

childbirth classes.When I was a new educator I would teach about pain

medications according to the curriculum. Eager to please my

superiors and maintain my position, I did not vary far from

what was in our teaching manual. As the years progressed, I

came to understand the subtle variations in each class topic

and what those variations required from me. Somewhere

along the way as the years passed, I threw out the manual

and began to write my own. I developed a Personal Pain

Plan © that became very helpful to my students.

When I teach the Personal Pain Plan©, I begin by first

paying homage to a childbirth educator of a previous genera-tion, Grantly Dick-Read, and include a brief discussion of

the Fear-Tension-Pain cycle. This sets the stage for the next

activity.

I remind the class to participate at their own comfort

level. Some write down every answer and leave with their

form completed. Some write down a few answers but leave

others blank. Some students do not write anything down

and choose to consider what their answers will be outside of

class. The form they take home will be blank, but I can tell

by their expressions that every word I say is being consid-

ered. Although some students choose not to participate at

all, I always make sure there are colored pencils and other

drawing instruments available to them.

Class members receive the following handout, which isfolded to cover all but the first statement:

1. The worst pain I have ever felt…

2. How I have handled pain in the past…

3. My pain control options as I understand them…

4. Comfort measures that sound good to me…

5. My number on the Pain Medications Preference

Scale© by Penny Simkin

1. The worst pain I have ever felt…

The examples I use to illustrate the first statementare a broken arm, a broken heart, migraine headache, etc.

After discussing these examples, people begin completing

their handout. If any participants look puzzled, I give

more examples such as the flu, surgery, or a painful prior

memory. I allow adequate time for answers to be written,

remembering that adults think slowly as they adjust to the

pace of the class.


20/44


2. How I have handled pain in the past…I introduce the second question by giving examples

like being with loved ones, comfort foods, a warm bath with

scented candles, medications (Tylenol, Ibuprofen), a dark

room with no light, or watching a soothing movie.

After they have considered the first two statements by

unfolding the paper to reveal them one at a time, I go on

to discuss the Gate Control Theory of Pain and Information

Transmission, using the examples previously discussed.

3. My pain control options as I understand

them…

I follow up with an explanation of the use of small,medium, and large pain control methods, with Phenergan

being small, Stadol being medium, and an Epidural being

large. This helps the students become comfortable enough to

ask questions.

4. Comfort measures that sound good to me…I always teach comfort measures appropriate to the

stages of labor and method of pain relief we are discussing—

the small, medium, and large examples. This ensures that the

participants will have no trouble listing their comfort mea-

sures, what mom-to-be desires, and what the labor partner is

willing to do.

5. My number on the Pain Medications

Preference Scale

©

by Penny SimkinAs the class is coming to an end, I distribute copies ofPenny Simkin’s Pain Medications Preference Scale© and en-

courage the class to complete them individually before shar-

ing their answers with their partners. As a learning exercise,

I often have class participants fill out forms separately, and

then compare answers. I then encourage them to attach the

Pain Medications Preference Scale© to their birth plan, and

communicate their desires with their health care providers

both before and during labor. That concludes the develop-

ment of their Personal Pain Plan©.

This approach fills the need my conscience has topresent all the information about medications and comfort

measures, while encouraging class participants to consider all

of their options.

‘Freedom of choice based on knowledge of alternatives.’ Oh

yes, that is something I strive to teach in all of my classes.

I’m sure you do, too!

Loretta Bezold has been involved in maternal child nursing for

25 years. She has been teaching childbirth classes for more than

20, a practicing doula for 17, and is currently a Public Health

Nurse working with families across the maternity cycle con-

tinuum. She has four children, two cats, a dog, and has been

married 28 years. She resides in Oak Harbor, Washington.

The Personal Pain Plan: A Strategy for Teaching Pain Medication Choices in Childbirth Classcontinued from previous page


21/44


Divorce Prevention

and Perinatal EducationBy Viola Polomeno, RN, Ph.D.

Divorce has become commonplace in Western society.Many couples are choosing to end their marriages after a few years, and after having children. Can perinatal edu-cation be helpful in preventing coupleship breakdown, oreven delay it? This article provides suggestions on how to

integrate divorce prevention within perinatal education.

What does divorce prevention

have to do with perinatal education?

More and more couples are separat-

ing and divorcing after just a few years

of being married and having had one

or more children. Some took mar-

riage preparation courses to prepare

for marriage. They also took prenatal

classes to better cope with pregnancy,

and prepare for birth and early parent-ing. Their relationship went through

many changes, and a point was reached

where one partner, or the other, or

both wanted out of the marriage.

Can perinatal education be useful

in preventing coupleship breakdown,

perhaps even delaying it? Can perinatal

education be adjusted to include con-

tent on relationship changes and help

couples learn more relational skills? The

author of this article continues experi-mentation with her clinical practice in

perinatal education by integrating di-

vorce prevention throughout her work-

shops. This article provides suggestions

on how divorce prevention content can

be interwoven into the curriculum of

perinatal education.

contiued on next page

Educator FeelingsThe perinatal educator must first

increase her or his level of awareness

concerning the topic of integrating

divorce prevention within perinatal

education. Certain perinatal educators

may not feel adequately prepared to

handle the topic without training, or

they may feel that it is not appropriate

within the context of perinatal educa-

tion. Others may be intrigued by the

challenge presented for their practice

and are willing to experiment with the

topic. In fact, the perinatal educator

may ask herself or himself the following

questions in order to raise their level of

awareness:

• How do I feel about divorce?

• Is this topic to be avoided or to be

considered?

• Was I a child of divorce?

• How did this affect me later in life,

and within my own relationships?

• Have I experienced divorce myself?

How was this experience for me?

• If I have children, how was the

experience for them?

• What impact did divorce have upon

my children?

• What is the nature of the parenting

relationship that I have today with

my ex-spouse?

• Has this had any impact for my

practice in perinatal education? If

so, how?

• Is it appropriate to talk about this

within perinatal education classes or

workshops? If no, explore your rea-

sons. If yes, how is it appropriate?

• How can I adapt my practice

to integrate divorce prevention

information within my classes or my

workshops?

Change of Paradigm inPerinatal Education

Once perinatal educators have

raised their level of awareness, they

must then decide which paradigm un-

derlies their practice. Perinatal educa-

tion that includes childbirth education

is undergoing a paradigmatic shift from

a traditional paradigm to an alternative

one. In the first paradigm of traditional-

ism, the emphasis is content-focused,

with information being provided on thepreparation of the couple for preg-

nancy, childbirth, early parenting, and

the skills to handle these events. In the

second paradigm of alternativism, the

emphasis is on the relationship (Polo-

meno 2007c). Budin (1998) wrote that:


22/44


23/44



when the couple is in love. Divorce

is a reality today. It can be scary;

I can acknowledge that. However,

when children are involved, it’s a

different story. I would like to help

couples establish their co-parenting

relationship from the beginning,

despite what happens to them and

their relationship. I believe in two

things: A child has the right to be

loved by both parents, and each

parent can support each other in

their parenting roles as they are go-

ing through the process of divorce.”

Divorce Content

Divorce prevention involves not

only talking about divorce, but also

how to keep the relationship intact.

Information may be given in a block

of time or interwoven throughout the

curriculum. The following informa-

tion about divorce is given in a block

of time and usually at the end of a

workshop. The duration is about 20

minutes.

• Invite the participants to react to

the word divorce. What comes tomind when they first hear the word?

Write down their answers on a flip-

chart or on a blackboard. Analyze

the words chosen by regrouping

them into trends or tendencies.

• Invite the couples to share stories

about those who have been through

a divorce.

• Discuss the question: “What is the

current divorce rate?” Provide na-

tional divorce statistics and how thedivorce rate is calculated. For ex-

ample, in Canada, the divorce rate

for a first-time marriage is 30%, the

average duration of marriage is 14.2

years, and it is in the fourth year of

marriage that most divorces occur.

Invite the couples to react to these

statistics.

• Discuss the question: “Why do cou-

ples divorce? What are the reasons

that couples give for divorcing?”

• Explain the effects of divorce on the

parents and on the children.

• Explain the current divorce laws,

both nationally and provincially

(Canada) or nationally and state-

wide (United States of America).

Explain the different ways to divorce

which include: the couple doing it

themselves, going through a media-

tor, using divorce lawyers, mediation

in court in front of a judge, collabor-

ative divorce, and going to trial. Ex-

plain the general laws about splitting

property and money, child support,and child custody. The author spends

some time on this last point and ex-

plains joint custody, shared custody,

and full custody by one parent with

parental visitation for the other.

• How to co-parent: explain co-par-

enthood, how to establish it and

how to renegotiate when issues

arise. There are agencies that exist

that provide workshops on co-par-

enthood and how to negotiate thiswhile divorcing. The role of the

parent facilitator is briefly described

at this point.

The Couple ConnectionA major content area in divorce

prevention concerns how the couple

keeps connected throughout the transi-

tion to parenthood. Part of a curricu-

lum can be transformed to interweave

this information. Some of the followingcontent can be presented in segments.

It is up to the educator to decide when

and where to incorporate the content.

Transition to Parenthood

Explain the transition and its vari-

ous stages. At this time, the concept of

vulnerability is also presented, as well

as the great moments of vulnerability,

the cumulative effects of vulnerability,

and how these can lead to an emo-

tional schism at any point in time. It

is inevitable that a new baby will force

the parents to reorganize their lives

and their love. This is all natural and

normal. The partners will experience

a range of feelings from the positive

to the negative. Looking out for each

other is always helpful in these circum-

stances.

Marriage and Love Facts

Couples need some information

about marriage and love and how these

change with parenthood. An educa-tor can first ask couples about their

observations regarding friends’ and

family members’ relationships while

parenting, what appears to be working

and not working for them, and what

couples are actively doing to keep their

relationship intact.

Stages of Marriage

A person may experience sev-

eral types of marriage with the samepartner. People do and will change, so

there must be some flexibility in the

relationship to accommodate these

changes and to integrate them.

Difficulties

Conjugal strain and conjugal

discord may occur at any moment.

Learn to recognize it and deal with it.

If not, it will affect how partners feel

love for each other and be willing to

express it. Understanding and empathyare two qualities that partners can learn

and nurture within their relationship.

Seek professional help if this is what

is required to deal with any difficult

situation.


24/44


Trust

Trust is built slowly over time. It is

fragile. One wrong word or action candestroy it or set the couple back. To re-

gain trust involves much work for both

partners. Building trust and keeping it

alive require daily efforts.

Intimacy

Intimacy must be renewed on a

daily basis. The parenting couple must

make their relationship a top priority

along with all the other ones. When

partners slip into their role as parents,

and forget about being friends and

lovers, a shift occurs in the relationship.

It is important to remember, love must

be felt, heard, and expressed everyday.

Couples need to find different ways

of continuing romance, dating, and

lovemaking to keep the flames of love

kindled and bright.

Distance

Sometimes distance may creep

into the relationship. This may behealthy or harmful. Distance may be

healthy if a partner is dealing with

issues outside of the relationship, but is

still in it . It becomes problematic when

the partner is physically and psycholog-

ically absent. Love may dwindle with

time, if no attention is given to the re-

lationship, as the other person may feel

rejected, abandoned, unappreciated,

and unloved. There are two opposing

forces that co-exist in the relationship.On the one hand, the partners want

space, freedom, and individuality. On

the other hand, there is a drive to be

close and intimate with the partner,

sharing moments and feelings.

The Meaning of ConnectionThe couple built their relation-

ship one layer at a time, evolving into

a team and building a partnership.

The feeling of partnership is described

as how the partners feel in sync with

each other, how they feel on the same

wavelength, or on the same page .

The feeling of disconnect is then

explained. The person will feel a

discomfort that is felt either physically,

psychologically, or both. Sometimes it

may come out as an emotion such as

anger, frustration, being upset, feeling

depressed or down. It could also be

physical such as aches and pains in the

shoulder region, the abdomen, lower

back pain, and headaches.

Getting ReconnectedEach partner becomes aware of his

or her physical and psychological state

and then shares it with the other. This

may take time as each partner struggleswith awareness, then communicates,

allowing the issues that underlie the

disconnect can be brought out into the

open. It is at this time that the conflict

resolution process is presented.

Emotional support is then ex-

plained — what it means and how it is

done. Needs are discussed, rather than

expectations. Finally, love as a concept

is discussed, as well as how intimacy

lays the foundation for the relationship,which counters the effects of vulner-

ability. The couple’s intimacy leads to

family intimacy — the sense that each

partner is the other’s soft place and that

home is a safe haven.

Gender differencesMost of the author’s practice is

with heterosexual couples. The transi-

tion to parenthood evokes biological

differences. There is no other time in

the couple’s lives that they become

so aware of these differences. Reac-

tions based upon gender become more

evident so the potential for conflict is

greater. Stereotypical male and female

reactions are presented according to

the latest research in the domains of

marriage, family, and sex therapy.

The Stress Management PlanEach partner writes down how he

or she reacts to stress and then shares

this information with the other. They

also share how they react to each other

when stressed and how the reactions

affect them. The couple is encouraged

to develop a stress management plan

outlining their individual responses to

stress, how they may feel and react toeach other, and then create a list of

strategies to deal with stress. The idea

behind the stress management plan is

to help the couple work together and

support each other to get their relation-

ship back on track.

The Intimacy PlanCouples are invited to participate

in writing a couple’s intimacy plan.

Each partner first defines intimacy, thenthey discuss their definitions. They

determine what they have in common

and what aspects are different. From

this, the couple is encouraged to write

down how they would like to experi-

ence

Documents

The Personal Pain Plan