Re-organising childbirth education in Iran
As mentioned in my previous entry, childbirth education in Iran is in its infancy. The first classes only began about 2 years ago, and were modelled on a program an Iranian midwife had used in France. This is fine as far as it goes, but it has huge gaps, especially in the area of labour and birth.
Given that birth in Iran is totally interventionist, it is surprising that the obstetricians have been able to continue on this path without any questioning or opposition, especially from women. If the whole subject of labour and birth management is omitted from even the few classes that now exist, then this state of affairs will continue.
Women need information about a whole array of topics, from hospital routines, to the drugs, obstetric procedures, complications and caesareans that are so prevalent. At present, the prenatal program contains a short lecture on the stages of labour, but nothing about how the birth will be managed.
The training program that had been developed to provide educators with the necessary skills to facilitate prenatal programs is also very sketchy. I have now sent them copies of the training course program and curriculum that we used with our Graduate Diploma in Childbirth Education. There are elements within it that may be useful as a starting point for developing an appropriate course in Iran. I am hoping that they will set up a distance education package, adminstered centrally, because with such a large country, this would provide the best access for student educators. It would also help maintain consistency and quality, something that is difficult to manage when the training is decentralised through many universities as now happens.
During the workshop, we again tried out a number of teaching stragtegies and activities that can be used in parent education programs. Although these were enjoyed by the midwives at the workshop, I suspect that they didn’t really “get it” in terms of using these in an actual class with pregnant women - they seemed to focus more on their traditional teaching methods which are all didactic in the style of most university education. This is another reason why I believe a centrally orgnaised training program will be more effective and innovative - if the key trainers do “get it” (and there are some switched on women in Iran) they will ensure that they train educators to provide classes that are fun and interactive and not a series of lectures or school-like lessons.
“What’s labour like” (above and below) always generates lively discussion. I was particualrly interested to see how this activity was interpreted as most of the group only have a theoretical knowledge of normal physiological birth.
We also had fun with “graffiti sheets” on changes in pregnancy (below).
We also had some very interesting disucssion about “the breathing” and the “relaxation”, as they have been using ideas that are rather out of date, and frankly useless in the Iranian context. As I pointed out, it is waste of time teaching women in how to “breathe” and “relax” in labour when they will be lying on a bed trying to cope with an array of humiliating obstetric procedures. No amount of training or practise will work in the face of ongoing physical abuse resulting from serial vaginal examinations from a parade of unkown junior doctors and registrars. To lead women to believe that the training will make the birth less painful is also dishonest. A solid course in how to say “NO!” might be of better value.
I will be interested to get some feedback from the team in Iran and to hear their thoughts on the training course I am suggesting. Women in Iran deserve a better deal during pregnancy and labour and I believe that better education will be an important component in bringing about the necessary changes.