I sit here and ponder Why childbirth education is important?. I am an educator because I think it can be a vital piece to the preparation puzzle prior to welcoming a baby.  I use the word “can” versus “is” due to the fact that all educational offerings are not created equally.

It is known that only a percentage of expecting mothers attend a childbirth class series. Perhaps they believe the staff will explain everything when they get to the hospital, they really have a deep trust in the process and are reading up on everything, or since they are having a home birth that additional education is unneeded. Whatever the reason, women are not getting the foundational information that can be incredibly helpful toward confidence, ability, decision making and mothering far beyond the birth itself.

A good childbirth class series (or rather perinatal class) is well worth the monetary and time investment for most first time mothers and can benefit those who have already birthed.  My post on choosing a childbirth class is a good jumping off point to figuring out what type of course suits the individual expecting mother (her partner or labor support).

A class series worth the time and effort will be comprehensive in nature, not just covering labor and birth. What does that look like? A class that covers midway third trimester pregnancy through 4-8 weeks postpartum. It is content that is deep and is applicable to real life.

A sample of course content:

• Pregnancy Basics
• Common Terminology
• Normal Physiologic Changes and “helps”
• Exercise
• Nutrition
• Prenatal Testing
• Birth Plans
• Informed Consent
• Communication and Self-Advocacy Skill Building
• Overview of spontaneous Labor and Birth
• Labor milestones with Comfort and Positioning Strategies
• Overview of all Options in Labor, Birth and Postpartum
• Labor Partner Role
• Immediate Postpartum
• Navigating first weeks Postpartum
• Overview of Infant Feeding and Norms
• Bonding
• Medications and Interventions
• Cesarean and VBAC
• Unexpected Events
• Role-playing Scenarios
• Relaxation and Visualization Practice
• Local/Online Resources

How the educator reaches her class is fundamental to the learning process and take away of participants.  I encourage women to interview the potential educator. Finding the right fit in a class is no different that in provider, doula or birth location.

Even if a woman knows she wants an epidural, TAKING A GOOD CLASS is vital because she will be having a natural birth the epidural is on board and her Plan B could very well be a natural birth. Being prepared will only serve her well in the fluid process known as labor and delivery.

Gaining knowledge that will help a woman to partner with her provider, address her own needs fully and help her to define her own birth philosophy gives her a leg up on being responsible and in charge in her own health care and even outcomes.

The vast scope of what a solid class series can offer an expecting mother (her partner or support person) is incredibly valuable and can not be understated. A class that provides for encouragement, comfort, safety, respect, connection, structure, evidence-based information and real life application can plant seeds and prosper skills that will carry a woman well into her mothering years. These skills are for life, not just for labor and birth. I am stunned often by how birthing knowledge carries me in daily ability with my own family.

Here’s to happy and deep learning!

Being a childbirth (perinatal) educator is a position that affords great opportunity to positively influence women in the childbearing year and far beyond.  It is also a great responsibility that ought include: self-assessment, continuing education, evidence-based curriculum, the ability inform with discernment and the willingness not to teach a good patient course.

With all of this in mind, it is important that pregnant women choose their childbirth class wisely. There is not any one-size-fits-all class.

How does one go about choosing a childbirth class? I encourage you to go about choosing a class series in the same way you would choose a provider or birth location. Do some investigating and even interview the educator.

Off to a good search:

• Get referrals from women who have had or wanted the type of birth you are desiring.
• Check out your local birth groups and get referrals.
• Ask your provider for a referral.
• Do a web search for classes in your area. You may be surprised that there are many offerings method and philosophy based outside and within the hospital setting.
• If thinking about a hospital sponsored course, find out if it is a comprehensive series or a what happens to women once they get to our hospital class? This is otherwise known as a good patient class.
• Check out the course website then call or email the instructor to get a feel for her style and philosophy. Even a hospital based educator should be able to call you back or email you.

Before registering for a class series:

• How long is the series? A minimum of 12 hours is needed to be a comprehensive series. At least 2 different class sessions over two different weeks, but  preferably a minimum of 4 class sessions. You may find classes up to 12 sessions. Be wary of condensed one or two day classes as there is not enough time to process information and retain it well. It IS worth the investment of time.
• When is the class? Day of week and time of day needs to fit into your lifestyle. Again, I encourage your investment over a period of time versus a one-day class.
• Where is the class held? Classes may be held in like-minded businesses, in home, care provider office or hospital.
• What organization is the instructor trained and certified with? Though certification is not required, it can be very important the training and background an educator has.  Check out the organization to make sure you agree with it.
• What does the instructor’s experience involve?
• What is the instructor’s philosophy and style?
  
• What is the cost of the course? Classes can cost anywhere from free through a hospital to a few hundred dollars. It really can be a wide range. Find your comfort level. Though expect to invest in a good class. Free or low cost for everyone is often not comprehensive in nature.
• What is the course content? A comprehensive class should include a variety of topics, such as, pregnancy basics,  common terminology, normal physiologic changes, exercise, nutrition, prenatal testing, birth plans, informed consent, communication skill building, overview of spontaneous labor and birth, labor milestones with comfort and position strategies, overview of all options in labor and birth, labor partner role,  immediate postpartum, navigating first weeks postpartum, overview of infant feeding, infant norms, medications and interventions, cesarean, unexpected events, role-playing scenarios, relaxation practice and local/online resources. It is usual to expect homework on top of class time as well.
• What are the birth outcome statistics for class participants? It may be difficult though to get true data whether a philosophy-based or method-based class.
• What is expected of me as a class participant?
• What do I need to bring?
• Who may come with me?
• Is there a lending library?

I hope you find this list helpful and are able to find the just right fit. I look forward to your feedback.

I am very excited to announce the addition of  Lori Welch, BS, CCCE to the Preparing For Birth teaching team. She is a CAPPA Certified Childbirth Educator and also Lamaze trained. She has experienced both hospital and home births herself.  She has a deep calling for assisting others in their pregnancy, birth and early parenting journeys.

Beginning in May 2010, she will begin teaching and overseeing the bulk of  PFB group classes.

Class registration will remain the same. Her contact information will be lori@prepforbirth.com.

I look forward to working alongside her and expanding the available offerings for birthing families.

Though most hospitals have “birth centers”, they are really nothing more than the labor and delivery floor where births take place. The only freestanding birth center in Colorado is the Mountain Midwifery Center.  MMC is owned and run by Tracy Ryan, CNM  along with 4 other main midwives along with supporting staff.

What is a birth center? From the MMC site: “A Birth Center is designed to be a “Maxi-Home” not a “Mini-Hospital.” Here we strive to allow women to labor and birth in a true home-like environment while providing one-on-one care that helps ensure superior mom and baby outcomes. The Birth Center is not just pretty birth rooms, it is an education-intensive program of care. From your first visit through the birth of your baby and beyond, the Birth Center is designed to facilitate healthy choices for families.”

Located about an hour from Colorado Springs in Englewood, the birth center is a fantastic location to birth.  Check it out!

Today the cesarean rate is an alarming 31.8% (CDC 2007 preliminary data).  Only a maximum of 15%  of birthing women should be having cesarean deliveries in order to keep mortality (death) and morbidity (poor outcomes) to the healthiest levels according to the World Health Organization. With the staggering discrepancy in what should be and what is, you NEED to care about this topic.  You could have a questionable cesarean like so many others.

It is important that you the childbearing woman understand how to have the healthiest birth for you and your baby which is most often a no-to-low intervention vaginal birth.

When a cesarean occurs for a truly medical and/or life saving reason it is necessary and the benefits far outweigh the consequences for mom and baby.  The cesareans that occur for other than truly medical and/or life saving reasons are often not necessary or became necessary due to external influence that skewed the labor and delivery outcome (routine induction, epidural,  impatience by provider, mal-position of baby, staying in bed during labor, routine continuous monitoring, pushing in one position, lack of food and water during labor, routine augmentation of labor, lack of support, etc.)

Below is a list of ways to promote having a vaginal birth even if you have already had a baby this information needs to be known.

• Take the ICAN webinar on cesarean prevention.
• Interview before choosing your care provider – you are doing the hiring! Know his or her statistics.  If you do not get a clear answer, that is a RED flag.  You need individualized care. ou and your baby deserve no less.
• Interview both midwives and OB’s.
• Research your chosen birth location well.  There are other options outside of the hospital – home and birth center.
• Hire a doula who shares your philosophy and is comfortable with the type of birth you desire. Some searchable places for a doula are: www.cappa.net, www.dona.org, and www.alldoulas.com.
• Without medical reason standing in the way, labor at home into active labor if traveling to a hospital or birth center.  Well established labor upon arrival to the hospital or birth center decreases the opportunity for interventions, medications, and cesareans.
• Get educated! Take a childbirth class that promotes confidence, consumer awareness (knowing rights and responsibilities), and evidence-based practices. A “good patient” class is not what you want to take.  READ books that share positive stories and good information.  A few of the searchable sites are: www.cappa.net, www.independentchildbirth.com, www.lamaze.org, and www.ican-online.org.
• Turn off your TV – stop watching the dramatic birth shows.  They are not real.
• Use mobility in labor.
• Drink and snack in labor.
• Say NO to routine interventions – meaning interventions or medications without a true medical reason. These can include, IV with fluid running, artificial rupture of membranes, continuous monitoring, wearing of hospital gown, and vaginal exams.
• Say no the the epidural completely or at the earliest at 6 cm’s dilated.
• Push and deliver in positions other than the reclined or “C” position unless that feels good and baby is coming well that way.
• Only have those around you who will support what you need and desire in labor and birth. When you close your eyes who is there with you in your labor “cave”? Who doesn’t fit well there?
• Study yourself for what comforts, assures, and adds to your feeling of safety.
• Eat healthy and exercise during pregnancy.
• Read What Every Woman Needs to Know About Cesarean Section – http://www.childbirthconnection.org/article.asp?ck=10164
• For more information on Cesarean recovery and support, VBAC education and support, and Cesarean prevention go to www.ican-online.org.
• Bottom line – take your money and walk if you are not being listened to and treated as a partner in your care.

Putting effort into the initial postpartum period is in my opinion equally as important as preparing for pregnancy and birth.  Sometimes it is even more important due to circumstance or birth outcome.  Too many focus solely on the labor, delivery and perhaps the “stuff” that goes with having a baby while completely forgetting to look at all incredible change that occurs with having a new baby 24 hours a day, 7 days per week.

Below is a listing of important information to think about, investigate, understand and/or plan for.  Make a note of people in your immediate life that can be a resource as you go through the list.

Look carefully at class descriptions you may take in your local area, some are very thorough and others do not go into information you need in detail.

Here’s to postpartum preparedness!

Common Physical Changes for the Mother

Uterine Change and Bleeding

Breast Expectations and Breastfeeding Norms

Hormones and Symptoms

Recovery Requiring Attention

Vaginal Tearing, Episiotomy, Cesarean, Extreme Soreness or Swelling, Hemorrhoids

Nutrition

Common Psychological Changes

Mother and Father/Partner Changes

Processing the Birth Experience

Processing Becoming a Family

Postpartum Mood Disorders

Peer and Professional Support Resources

Understanding Your New Baby

Babymoon

How Baby’s Feed

Attachment

Infant Development

New Family Dynamic

Coping with Sleep Deprivation and Exhaustion

Managing Stress

Grieving the Changes

Siblings and Pets

Knowing How to Get the Right Support

Postpartum Doulas and Practical Support

Making Your Best Decisions

Defining Parental Roles – Financial, Baby Care, Changing the Status Quo

Choosing a Health Care Provider for your Baby

Early Infant Health Care Decisions – Vaccinations, Circumcision, etc.

Parenting Philosophies

Developing Your Parenting Style

Where Baby Will Sleep

Boundaries with Family and Friends

When to Seek Professional Help

Relationship Care

Realistic Expectations

Sexual Intimacy

Practicalities of Life

“Dating”

Priorities

Single Parenting

Arranging Practical Support

Making a Community

Parenting Needs

Unexpected Outcomes

Processing a Difficult Birth

Babies with Medical Needs, Coping and Advocating

Dealing with Loss, Grief, and Trauma

I offer a Postpartum Strategies class privately in the Colorado Springs area that goes into more detail on many of these topics.  My Bookstore lists several helpful books as well.

Normal, natural birth is spoken of all the time in the birth world.  It is discussed on many levels from the evidence of being overwhelmingly the safest and healthiest way to birth, to the emotional aspects of privacy, safety and support,  to following the money trail of interventive birth versus natural birth and so much more in between.

I ponder and sometimes struggle with what to share with expecting families and  how to share it.  Why the struggle?  This normal, natural birth viewpoint is counter-cultural.  I, along with many peers believe in the inherent design of women and babies to work as intended.  There is lack of belief in routine intervention, non-evidence based protocols or practice style that is created around pregnancy and birth being a tragedy in waiting.

Even in trepidation, the truths must be shared and not hidden simply because most of what is seen and heard in our culture is the opposite (think as an example of the media and the dramatic voice over person on those birthing shows).  The longer I am in this field and calling of work, I believe that protecting women from the truth for whatever reason is harmful.  I participated in a Henci Goer session several years ago at a conference that set this ideal permanently within me.  She asked many questions for the participants to answer.  One question was regarding telling options to expecting families even if they are not available locally – should you or shouldn’t you?  I stood for quite a time in front of the large paper on the wall while holding the marker in my hand.  There were many NO’s on the paper in front of me and it took some courage for me to write a commanding YES! next to their responses. I had bucked the trend.  Not easy, not a bit. When all the sheets were gathered and Henci peered at them to discuss all of the responses, she overwhelmingly said we have an ethical obligation to tell it all.  Phew I was not wrong in my group of peers, but sadly most of them said no probably out of the same fear as I had in answering the questions.  That moment gave me great strength and clarity not because Henci said so, rather because I stood in my conviction and faced the fear of being apart from others in the truth.

Why is it of the utmost importance to share all?  Because no one else goes home or remains home with that baby.  The care provider, staff, doula, educator….they all go home to their own lives.  Each expecting family must be able to live with the decisions made during pregnancy, labor, and birth.  Natural birth has many benefits but it isn’t consequence or risk free, so that too must be spoken of.  Each woman must decide what she needs and can best live with as a mother, wife, partner, even as a woman in her community who will go out and share her experiences with others.

I will often tell expecting families who contact me about childbirth education classes that they will receive much more than the anatomy, physiology, comfort measures, etc. from my course.  That very likely it will challenge to the core their beliefs and value systems surrounding what they know in their own birth culture of family, friends and personal history.

I love this work.  I hope someday to be replaced by the community based education women ought get back to. If not, I along with many others will be here to keep the conversation and education moving forward.

Today pregnant women need to be consumers and self-advocates. Many childbirth classes are teaching strategies to better these skills. This is not by chance, but rather by the often one-size-fits all packaging and management from pregnancy onset to labor through immediate postpartum in the care provider offices and hospitals of today.

Many routine tests are done prenatally. Though prenatal care and these tests can help further healthy outcomes for moms and babies, too often women can be funnelled into a cycle of unnecessary fear, stress and choice limitation while in reality still healthy and maintaining normal pregnancy.

Below is a listing of common prenatal tests and practices for you to question (what is it for, what does it improve upon, what can it lead to in other tests or interventions, is it for low-risk moms and babies, what will I do with the information), research and decide on are:

• pregnancy test by urine dip or blood work
• ultrasound to date the pregnancy
• blood pressure reading each visit
• weight measure each visit
• urine test – check for protein in the urine
• fundal height measurement as pregnancy furthers
• gestational diabetes testing
• triple screen testing (AFP)
• just because ultrasounds
• ultrasound for fetal size
• routine ultrasound for fluid level as “due date” approaches
• biophysical profile(s) as “due date” approaches or passes
• membrane sweeping

It is vitally important that you are equipped and aware of your care provider’s philosophy and usual practices.

What are you willing to do? What are you willing to bypass? How responsible for your pregnancy and birth are you willing to assume? At the end of the day you are ultimately the one who has to live with the choices you or your provider make.

Be a driver – you are more likely to arrive at the destination you desire.

Visit http://www.birthingtouch.com/ for upcoming childbirth classes serving the Colorado Springs area and for CAPPA childbirth educator trainings in Colorado, Missouri, and Utah.

• Proper support is important for childbirth – builds confidence in mom, builds safety in mom, lowers complications, interventions, medications and cesareans.
• Induction is only for medical reasons – big baby, past “due date”, tired of being pregnant, care provider preference, upcoming holidays… all put mom and baby at risk for complications, interventions and cesarean.
• Cesarean only for medical reasons – cord prolapse, placenta previa, pre-eclampsia or HELLP syndrome where induction fails, true fetal distress, some breech positions, placental abruption, uterine rupture (there are other less common reasons as well – notice previous cesarean, non-medical reason, large baby, gestational diabetes, obesity, convenience are not on the list)
• Unrestricted movement in labor –
• Pushing in gravity prone positions – only use reclined or lithotomy of mom desires it.
• No separation of mom and baby unless there is a complication.
• Drinking and eating in labor – the uterus is a muscle it needs to be watered and fed.
• Intermittent monitoring of mom and baby – only high risk moms and babies need continuous monitoring.
• No routine medications or interventions – pain management should not be pushed on a mother, episiotomies should not be routine, augmentation of labor should only be done AFTER non-medical methods are tried and patience is used, naturally occurring rupture of membranes, etc.
• Unrestricted breastfeeding access.
• Informed consent and refusal need to be utilized.

Check out http://www.cappa.net/, http://www.independentchildbirth.com/, http://www.lamaze.org/ for resources outside of Colorado Springs, CO (classes, doulas, other related professionals).