When you've got a problem ...

Also by Andrea Robertson Book: The Midwife Companion Book: Preparing for Birth: Mothers Book: Preparing for Birth: Fathers Book: Your Childbirth Education Classes: Finding Clients Weblog: Andrea's Diary On the same subject Andrea's Papers Childbirth Education

by Andrea Robertson
		Andrea Robertson is a Consultant in Childbirth Education from Sydney, Australia. Her books include Preparing for Birth, Making Birth Easier, Empowering Women, and The Midwife Companion. As the Principal of Associates in Childbirth Education, an independent training organisation, she oversees the world's first Graduate Diploma in Childbirth Education, and presents highly acclaimed training workshops for midwives and educators on teaching and practical midwifery, within Australia, and in many overseas countries.

Many years ago (mid 1980s) a Ministerial Review of the Maternity Services in NSW set out to define appropriate care for mothers and babies in this State. Working groups were formed between consumers and all the various health professionals working in the field and hearings were set up all over the State to make sure that parents with different needs were heard.

The area of prenatal education ("Preparation for Parenthood") was extensively canvassed by one working party. They looked at what parents both needed and wanted to know and tried to decide what would be appropriate content for these programs, as a guide to the estimated 1000 educators who were working in this field at the time. They came up against the very real issue of "how can we predict what parents will need to know about birth and parenthood, so we know what to teach?" At that time, prenatal education programs concentrated on the provision of information and there never seemed to be enough time to cover all areas.

Further reflection on this issue revealed the obvious truth: no matter how well intentioned, experienced or insightful we are, we cannot predict what parents will need to know. Programs focusing on information alone were therefore likely to be of little value in the "real world" of life with the baby. An alternative was proposed: that the emphasis be placed on helping parents develop the skills they would need, in order to deal with whatever occurred, both in the pregnancy and labour and also postnatally.

All the training of prenatal educators through Associates in Childbirth Education (ACE) is now based on the Ministerial recommendations and the specific skills they identified. We use this approach in our training of students, and they in turn develop the skills of the parents in their groups.

The main skill that was identified by the Ministerial working party is that of problem solving. Parents will face all kinds of situations that will need to be dealt with and having a strategy to follow may make working through these new issues easier and less stressful. Most adults already have significant skills in solving problems because they have already tackled some of life's major upheavals: leaving home; getting a job; changing a job; getting married etc. The involvement of parents in their health care ("informed choice") also relies on the parent's ability to solve a problem, since making a decision is a key step in solving the problem at hand (e.g. "will I have the induction?", "do I want my baby to have a Vitamin K injection?", "do I want to have an injection of oxytocin to speed up 3rd stage?"). Learning how to tackle a complex problem, especially one that involves the safety and well-being of another person so directly (the baby) is well worthwhile, and there will be many ways you can introduce this concept and help parents refine their skills during your prenatal program. Here are some suggested activities:

• Defining the steps in solving a problem is a good way to start, as the result will provide a template that can be used when working on more difficult issues. The group can be asked what steps they use in other areas of their life, and they will quickly describe:
  
  
  • Identifying the problem
    
    
  • The outcome/goal to be achieved
    
    
  • Possible solutions for consideration (there are always several and as many as possible should be listed)
    
    
  • Analysing each solution: what are the risks/benefits? Are they feasible? How would I feel about doing it this way? How does this solution fit with my values/beliefs?
    
    
  • Choosing a solution
    
    
  • Trying it out
    
    
  • Evaluating its success - has the problem gone away?
    
    
  • Ask group members to think of a major problem they had to tackle in the past. Have them identify the steps they took in sorting out the issue and deciding what to do. By matching these to the steps in the template they can see they already have skills they can apply in this new situation. This can be a good way to build confidence.
    
    
  • Scenario cards can be used effectively as a medium for problem solving practice. The scenarios can describe a pregnancy, birth or parenting situation. They should be written in the third person, to avoid the potential for participants to personalise the problem, with can be threatening. Give just enough information on the card to describe the situation and leave it incomplete, to allow for various outcomes to be considered. Having selected a card, each couple are asked to think about the problem and to then share with the group (a) their assessment of what's happening and (b) possible solutions. Other ideas can be canvassed within the group to make sure many solutions are considered.
    
    
  • During the parenting session, give each person a baby doll to hold. This kind of "prop" can turn discussion on Asettling techniques@ into a fun session as each person tries to figure out how to handle and settle their Ababy@. Dolls can also be used to practice positioning at the breast and how to manage household tasks with baby in tow.
    
    
  • Practical sessions on comfort aids for labour can be set up as problem solving exercises. For example, rather than you demonstrating how to position a woman when her back is hurting badly during labour, ask the couples to work together to devise some way of easing the pain using their own resources (not the drugs!). This approach not only involves the men in the group but points out how important their role will be in the hospital, whilst giving them both practice in working things out for themselves.
    
    
  • Role plays that create "real life" situations can also be useful. Some possible scenes are: coming into hospital and dealing with the admission procedures; rehearsing ways of ensuring that her preferred birth position is respected; making sure that your baby is not given formula supplements by hospital staff. Scripts can be used to get the action rolling, then the players can experiment with changing some aspects of the conversation to see what happens when a different approach is used. Ask for volunteers for role plays (it's an ideal opportunity for the class extroverts) and ask the players to take on another person's role (e.g. have the man play the midwife, let the woman be the husband, have the support person be the labouring woman, for example). Make sure that you debrief the players afterwards, not only in their role, but also as themselves playing that role. Role plays or rehearsals are really a form of assertiveness training, yet they rely on problem solving as their basic mechanism.
    
    
  • Even the labour ward tour can be set up as a problem solving exercise. Ask the expectant parents to think about how they feel in the labour ward and invite them to think of ways of personalising it and making it more "user friendly". Compiling a list of items to take from home for use during the labour may become an extension of this activity and will involve the parents in thinking about what they might need for comfort during labour and birth.
    
    

  When you are planning each activity in your program, ask yourself "how can I set this up so that parents get some practise in problem solving as part of the exercise?" You'll discover that most class activities can be re-organised very easily to incorporate this important skill and in the process you'll have more participation and fun within the group. Don't forget to highlight what the parents are achieving - the more you show them how skilled they are becoming, the more confident they will be that they can, indeed, tackle anything that life throws at them!