Childbirth Education

Parent education programs have been developed in many countries to support parents as they prepare for birth and the care of their new baby. These programs are also an integral component of the maternity care system as they provide expectant parents with the basic information they will need to make appropriate informed choices about options for their care during pregnancy, labour and birth.

Developing and presenting programs that are accurate, involving, skills-based and enjoyable is a challenge for the childbirth educator who will be facilitating these courses. These articles offer insights into ways of presenting a number of key topics in a pregnancy program that will not only engage the participants in their own learning, but will meet individuals needs in a supportive social environment.

Making it real

Childbirth educators should be realistic about what might happen during labour. One of the reasons parents come to pre-natal education programmes is to find out 'what birth is all about'. They want us to tell them what to expect so that they can be prepared for the events that lie ahead. They assume that knowledge is the key to coping better with labour and the new baby and that if they just have the right information in advance, all will go well.

Read more: Making it real

   

Nitrous oxide - no laughing matter

by Andrea Robertson

Nitrous oxide (often called 'laughing gas'), in combination with oxygen (50% of each gas), has been in use for two centuries as a simple anaesthetic agent, and in obstetric care since the 1930s. It is the most popular form of anaesthesia in UK labour wards, where it is available in 99% of consultant units (Chamberlain et al, 1993), as well as in birth centres and for home births.

Read more: Nitrous oxide - no laughing matter

   

TENS - a marketing triumph

by Andrea Robertson

I am fascinated by the popularity of using transcutaneous electrical nerve stimulation (TENS) devices during labour. This handy little piece of technology arrived on the maternity scene many years ago, and is now particularly entrenched in Britain (it may have been introduced into other countries but has not taken hold there with the same enthusiasm). How has is become so popular, when there is no evidence of its efficacy, it promotes a reliance on technology and costs money? Clever marketing, for a start!

Read more: TENS - a marketing triumph

   

"Just listen to your body ..."

by Andrea Robertson

How many times have you heard this said (or said it yourself) to women during labour? We harbour this fond belief that women will know how to tune in to the rhythms and feelings within themselves during labour and birth and gently exhort them to "let yourself go" as the contractions build and the tempo increases. Do you think they know what we are talking about?

Read more: "Just listen to your body ..."

   

No Gain Without Pain!

by Nicky Leap

The pain of labour is a constant feature of the discussion in unstructured antenatal groups (Leap 1992) and women have highlighted the fact that the attitudes of midwives have a profound effect on their experience of giving birth (Kitzinger 1988; Oakley 1981; Philips et al 1984; Leap & Hunter 1993; McCrea et al 1998). This understanding motivated me to explore midwives' ideas and understandings regarding pain in labour. My personal interest was also fueled by fourteen years of practice specialising in home birth and working with women who consistently expressed views about their experience of pain in labour. Discussions with colleagues in the South East London Midwifery Group Practice (now the Albany Midwifery Group Practice, Kings Health Care, London) -- who prioritise reflective practice (Leap 1996b) often centred around justifying our actions when being accused of 'withholding pain relief' from labouring women. I was keen to explore how midwives can respond when confronted by accusations such as: "Why on earth would you not offer all women pain relief in the 1990s?".

Read more: No Gain Without Pain!

   

Get the fathers involved

by Andrea Robertson

Many midwives complain that fathers are "useless" in the labour ward - they sit and read the paper, hang about nervously getting in the way, or get agitated and upset and create anxiety for the labouring woman. Some hospitals still insist on antiquated rules such as "only one support person with the woman at a time" even though the research is clear that good social support makes labours faster and less painful for women. In these hospitals, the woman often has to rely on the father because she cannot have a female friend, and the poor father finds himself thrust into the role of having total responsibility for her comfort and welfare - enough to make even the strongest of men fearful and insecure.

Read more: Get the fathers involved

   

A new approach to pre-natal education

by Andrea Robertson

Do you know how the current "accepted" approach to prenatal programs was determined? No? Well no-one does - it seems to have evolved many years ago, and has never been seriously evaluated. This raises some interesting questions: how do we know that the typical model of 6 sessions per series of 2 hours each, starting at around 30 weeks gestation is the most effective format? Would some other format be more attractive or useful for clients? Would other approaches enable us to reach those people who normally avoid pre-natal education? There are a number of issues to consider.

Read more: A new approach to pre-natal education

   

The power of the group

by Andrea Robertson

For many couples today, having a baby can be a lonely experience. The trend towards smaller families and the isolation stemming from the lack of the extended family (or even a relative that lives nearby) means that many women and their partners find they know few people who are going through the same tumultuous period in their lives, otherwise known as pregnancy.

Read more: The power of the group

   

Obstetric Interventions Explained

by Andrea Robertson

One of the most important functions fulfilled by prenatal education programs is to offer parents information about the many options and choices available to them during pregnancy and birth. In an age when "informed choice" are current buzz words and litigation is rampant, someone must ensure that parents are fully aware of the benefits and effects of treatments they are being offered and that someone may well be the prenatal educator, given that she spends considerable time with parents in a designated learning setting.

Tackling the subject of obstetric interventions is a crucial part of this role.

Read more: Obstetric Interventions Explained

   

When you've got a problem ...

by Andrea Robertson

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?"

Read more: When you've got a problem ...

   

Video Time!

by Andrea Robertson

When this article was written videos were still being widely used. These days, DVDs have taken over. The same principles for their use applies.

Using videos to enhance your prenatal education program is popular with parents. They are very comfortable with TV viewing and find it a familiar way to receive information. It is also a useful tool for the educator - it enables you to quickly illustrate points you are making, to include other speakers and viewpoints into your program in a brief yet effective way and it provides welcome variety and a break from other teaching strategies.

Using videos wisely and effectively takes careful consideration and presentation.

Read more: Video Time!

   

Education for Informed Choice

by Andrea Robertson

"Informed Choice" - the buzz words of the moment in maternity care circles! How often are women exhorted to make an "informed decision"? How many times do these words appear in policy documents and procedure manuals? The reality is that this concept, of parents making truly considered decisions about their care, is a mirage. Too many times parents lack the information they need, are asked to make a decision under duress, or are presented with options in such a way that they are gently led to make decisions that fit comfortably with caregiver's and hospital's protocols, rather than the parents expressed needs or desires.

The childbirth educator has a key role in preventing abuse of the concept of informed choice.

Read more: Education for Informed Choice

   

Pregnancy and birth are sexy? You bet!

by Andrea Robertson

Pregnancy and birth are very "sexy" topics. A pregnancy is a very obvious sign of a sexual activity but more than that, they demonstrate that a woman's sexual cycle is in full bloom and that she is fulfilling her biological destiny to reproduce. It's no wonder that sex and sexuality are integral themes of prenatal classes for expectant parents - all around them are signs of the sexual hormones at work. Incorporating these topics into your program will not only be relevant and interesting (everyone is interested in sex, after all) it is also easy and can be fun.

Read more: Pregnancy and birth are sexy? You bet!

   

Evaluating your pre-natal programs

by Andrea Robertson

Evaluation is an essential part of any educational program. It is important to know if your efforts are worthwhile and that your goals are being achieved, not only as a measure of your skills as an educator, but also to prevent burn-out. There is nothing more likely to produce frustration and boredom as a feeling that what you are doing is not valued or appreciated.

Checking for results can be done in lots of ways, each offering specific information and opportunities.

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Getting what YOU want from pre-natal education ...

by Andrea Robertson

Over the past six months, as you have been reading these columns about pre-natal education, I wonder how many times you have thought "I would love to try these teaching strategies in my classes, but I don't have the time"?  This is a constant complaint that I hear from educators -  there is never enough time in the program for discussion, full exploration of any topic, dealing with participant's questions, exploring individual needs. The list seems endless.

It is true that there will never be enough time to cover everything that parents want.

Read more: Getting what YOU want from pre-natal education ...

   

Working with the young and pregnant

by Andrea Robertson

Providing prenatal education programs for young women can be very rewarding. Many hospitals are now incorporating a program especially designed to appeal to this particular group and these can be successful and fun whilst providing a change in pace for the educators and a worthwhile community service.

Read more: Working with the young and pregnant

   

Prenatal education ... time to lift our game

by Andrea Robertson

The most effective education occurs when people take an active part in the learning process. The old-style "talk and chalk" presentations that many of us remember from our school days are now recognised as inappropriate, especially for educating adults. Most of us learn best through active participation and getting involved, especially when we have decided for ourselves what we need to know and are therefore motivated to find answers or learn the necessary skills.

Read more: Prenatal education ... time to lift our game

   

Unexpected outcomes - mentioning the unmentionable

by Andrea Robertson

One of the most fascinating aspects of birth is its total unpredictability. No-one knows what will happen and how those involved will fare, and no amount of preparation will ensure a given result. It's this uncertainty that makes giving birth both exciting and frightening!

Every pregnant woman has her moments of doubt about the health of her baby. Fears about death and handicap are common. These are the worst case scenarios and are often sources of great anxiety as the pregnancy rolls on. Talking about them can help and even though it is impossible to allay all fears, sharing concerns with others puts problems into perspective.

The whole issue of "expecting the unexpected" is an essential topic for pre-natal programs.

Read more: Unexpected outcomes - mentioning the unmentionable

   

Watch your language

by Andrea Robertson

Pregnant women are some of the most sensitive people you will ever meet. They are highly vulnerable and very suggestive, at a time when they are actively seeking information and support from a wide range of contacts. They listen to everyone and everything, read copiously, ask myriads of questions and are the recipients of mountains of advice.

Central to this communication is the language of birth. The words that are used and the manner in which they are spoken can be uplifting and inspiring or devastating and undermining. As caregivers, we often fail to appreciate the impact our words are having.

Read more: Watch your language

   

Help - it hurts! ... get me the complementary therapies!

by Andrea Robertson

Why does pain in labour scare us so much? Everywhere a pregnant woman turns she is confronted by messages that she will need "something" to help her get through the trials of labour. Trying to "suffer" the pain of contractions without assistance is being unnecessarily "brave" now that there are so many ways to ease or even stop the pain altogether. After all, there is no need to be a martyr is there?

There is no doubt that the majority of women giving birth today are offered drugs during labour.

Read more: Help - it hurts! ... get me the complementary therapies!