A look back at one of our most popular blog posts of the past few years. Originally published May 18th, 2015. And still every bit as relevant!

A mother waits patiently on the small triage bed while the nurse concentrates on what her fingers are telling her about the progress of this labor. After a minute, she pulls her fingers out, and chirps brightly, “You are 5 centimeters dilated!” She flips her gloves into the trash can and turns to the computer to chart.

It’s a universal experience going into a hospital in labor. The progress of labor is reduced to a number between one and ten, and nothing else. An hour later, after being admitted to her room, the mother is told she is “still only a 5.” Once again, she isn’t a mother, she is a number. She is left alone to contemplate that, and to deal with it as she may.

Most of us tell our birth stories in terms of this number. “I was stuck at 5 forever!”

What if I told you that this number means very little when it stands alone? What if I told you that your cervix does a whole lot more than just dilate? What if I told you that there are more ways to measure progress in labor than that ubiquitous range of centimeters?

Well, it’s true.

My preceptor and mentor, Desirre Andrews says:

“There is a mystery surrounding cervical dilation and changes prior to and during labor. I like to think of it as the jobs of the cervix. The cervix does so much more than simply opening.”

So, the next time you have a baby, and you are facing a vaginal exam, make sure you ask about what else your cervix is doing!

1. Effacement
Hold up your pointer finger. Touch the second knuckle. From there to the tip of your finger is about the length of your cervix. In order for the cervix to dilate completely, your cervix has to shorten, or “efface,” completely. This is measured in percentages. If your cervix only reaches from the tip of the finger to the first knuckle, you are about 50% effaced. This process must happen before dilation can even occur. In many women, it occurs at the same time or it overlaps dilation. In first time moms, we often see effacement first, then dilation quickly follows. What if our mother was told that, while she was “still 5,” she went from 50% effaced to 90% effaced? That’s progress, people!

2. Ripening
Touch the tip of your nose. (You didn’t know this would be so interactive, did you?) That’s about the texture of a closed, uneffaced cervix. That’s no good for dilation, and it has to soften, or “ripen” in order to do its other jobs. This primarily happens before labor, but can also happen throughout labor. The texture of your cervix must work its way to the softness of your relaxed lips, and then softer still to match the texture of the inside of your cheek. We call cervixes at this stage “soft like butter.” Yet another measure of progress. If our mother were still at 5, but her cervix was much softer and more difficult to feel, that’s progress!

3. Position
To protect your baby, your cervix points towards your tailbone (posterior) during pregnancy, and sometimes even early labor. In order to open and allow the baby to move through it, your cervix must shift its position until it is pointing directly into your vagina (anterior). If our mother were told that though she were “still 5,” but that her cervix was easier to reach, this job has been done, and she has made progress!

4. Dilation
Last, but not least we have dilation. Your cervix must open up from a tightly closed position, all the way up to “10 centimeters.” Really, it’s not 10, though. At this point, nothing can be felt except baby’s head. It’s often now simply called “complete dilation.” The thing to realize about dilation is that it cannot happen unless the cervix is doing all of its other jobs already. They often happen seemingly in tandem, but sometimes a mother will be “stuck at 5” while her cervix is effacing, softening, and moving forward. Once those jobs happen, dilation is a downhill race to the finish (though it may not seem like it).

So, the next time you consent to a vaginal exam in labor, make sure you get more than a number. Ask about effacement, softness, and the position of your cervix. Your cervix is amazing and has a lot more to do than just open. Make sure it gets all the credit it deserves!

Were you informed of the various ways the cervix works before and during labor? How might this change the way you approach your future pregnancy care?

-Tiffany

A mother waits patiently on the small triage bed while the nurse concentrates on what her fingers are telling her about the progress of this labor. After a minute, she pulls her fingers out, and chirps brightly, “You are 5 centimeters dilated!” She flips her gloves into the trash can and turns to the computer to chart.

It’s a universal experience going into a hospital in labor. The progress of labor is reduced to a number between one and ten, and nothing else. An hour later, after being admitted to her room, the mother is told she is “still only a 5.” Once again, she isn’t a mother, she is a number. She is left alone to contemplate that, and to deal with it as she may.

Most of us tell our birth stories in terms of this number. “I was stuck at 5 forever!”

What if I told you that this number means very little when it stands alone? What if I told you that your cervix does a whole lot more than just dilate? What if I told you that there are more ways to measure progress in labor than that ubiquitous range of centimeters?

Well, it’s true.

My preceptor and mentor, Desirre Andrews says:

“There is a mystery surrounding cervical dilation and changes prior to and during labor. I like to think of it as the jobs of the cervix. The cervix does so much more than simply opening.”

So, the next time you have a baby, and you are facing a vaginal exam, make sure you ask about what else your cervix is doing!

1. Effacement
Hold up your pointer finger. Touch the second knuckle. From there to the tip of your finger is about the length of your cervix. In order for the cervix to dilate completely, your cervix has to shorten, or “efface,” completely. This is measured in percentages. If your cervix only reaches from the tip of the finger to the first knuckle, you are about 50% effaced. This process must happen before dilation can even occur. In many women, it occurs at the same time or it overlaps dilation. In first time moms, we often see effacement first, then dilation quickly follows. What if our mother was told that, while she was “still 5,” she went from 50% effaced to 90% effaced? That’s progress, people!

2. Ripening
Touch the tip of your nose. (You didn’t know this would be so interactive, did you?) That’s about the texture of a closed, uneffaced cervix. That’s no good for dilation, and it has to soften, or “ripen” in order to do its other jobs. This primarily happens before labor, but can also happen throughout labor. The texture of your cervix must work its way to the softness of your relaxed lips, and then softer still to match the texture of the inside of your cheek. We call cervixes at this stage “soft like butter.” Yet another measure of progress. If our mother were still at 5, but her cervix was much softer and more difficult to feel, that’s progress!

3. Position
To protect your baby, your cervix points towards your tailbone (posterior) during pregnancy, and sometimes even early labor. In order to open and allow the baby to move through it, your cervix must shift its position until it is pointing directly into your vagina (anterior). If our mother were told that though she were “still 5,” but that her cervix was easier to reach, this job has been done, and she has made progress!

4. Dilation
Last, but not least we have dilation. Your cervix must open up from a tightly closed position, all the way up to “10 centimeters.” Really, it’s not 10, though. At this point, nothing can be felt except baby’s head. It’s often now simply called “complete dilation.” The thing to realize about dilation is that it cannot happen unless the cervix is doing all of its other jobs already. They often happen seemingly in tandem, but sometimes a mother will be “stuck at 5” while her cervix is effacing, softening, and moving forward. Once those jobs happen, dilation is a downhill race to the finish (though it may not seem like it).

So, the next time you consent to a vaginal exam in labor, make sure you get more than a number. Ask about effacement, softness, and the position of your cervix. Your cervix is amazing and has a lot more to do than just open. Make sure it gets all the credit it deserves!

Were you informed of the various ways the cervix works before and during labor? How might this change the way you approach your future pregnancy care?

-Tiffany

It has occurred to me through my time with doula clients and students,  that many care providers serving hospital birthing mothers do not ask any questions of their pregnant patients during the 7-10 minute prenatal visits that lead to a substantive working relationship.

I have also learned that too often the pregnant “patient” does not know to tell her provider anything about what is going on in her life or pregnancy since she is not queried first.

Thinking there must be a way to better bridge this very real separation to solid patient-provider relationship building, I am drawing from my work as a midwife assistant in the making of this tip list.

Pregnant mothers your provider needs to know so much more about you and your pregnancy than blood pressure, weight, fundal height and fetal heart tones. I encourage you to freely offer the below information at every appointment to grow personalized care, advisement and support.

1) Appetite/Diet/Supplements – tell your provider if your appetite has increased or decreased between visits. Do you have food aversions? Are you taking any supplements or want to take supplements?

2) Sleep habits – tell your provider how you are or are not sleeping.  For example, are you having trouble falling asleep, falling back to sleep or staying asleep.

3) Nausea – Do you continue to have nausea? When? How often? Does it correlate with anything in particular?

4) Hemorrhoids – if you have them or not. What you are doing for them.

5) Varicose veins –  Are there veins sticking out or causing issue anywhere in your body?

6) Bowel habits – Are you experiencing normal or abnormal bowel habits?

7) Exercise – What have you been doing? Do changes need to be made?

8) Stress – Is there anything in your life that is really stressing you? Stress can impact pregnancy health. Important to discuss.

9) Related Providers – Are you going to any pregnancy related providers (such as chiropractor, acupuncturist, yoga, etc.)?

10) General  – Are you feeling well or not. Do you need more information or referrals?

There is so much more to you than a pregnant uterus. You are a holistic person who needs to be treated as such. I would venture that something much more individualized can come out of your care with simple sharing!

Here’s to whole care!

A clean slate. A fresh start. Hope and dreams reactivated. Passions toward change are stirred. All of this by the calendar rolling over from one year to the next. It is not just  anew year though, it is a new DECADE to set precedent in. To make a mark. Oh the possibilities and opportunities that are ours to reach for and accomplish.

In the spirit of all of this, I decided to make an #in2011 wish list on New Year’s Eve 2010 and with some help from a few friends here is what flowed out.

#in2011 breasts will be viewed as nurturing, comforting, and beautiful.

#in2011 the majority of women will be served under the midwife model of care for the majority are low-risk and will remain so.

#in2011 Childbearing women will be greeted with open arms by providers with their questions, needs and knowledge.

#in2011 pioneering social media women will gain even more ground in their work liberating childbearing women.

#in2011 delayed cord clamping and physiologic third stage will become the norm.

#in2011 doulas will be respected as educated, knowledgeable birth professionals by staff and care providers.

#in2011 childbearing women will be given opportunity not limited

#in2011 Those striving to improve the maternity system at the ground floor as educators will be mutually respectful and supportive.

#in2011 Doulas from all backgrounds and organizational affiliation will be open to one another, supportive, sharing.

#in2011 a woman with needs and opinions with not be marked for a cesarean because of it.

#in2011 Homebirth transports will be treated with dignity and respect.

#in2011 Stigma of mental illness and motherhood will be adsressed by every childbirth care provider. RT @WalkerKarra

#in2011 Childbearing women will not have to live in fear of their providers.

#in2011 We CAN change the world together for childbearing women. Put your words intro action.

#in2011 More birthing women will have low-intervention births that lead to healthier outcomes.

#in2011 Childbearing women will be seen, heard, respected and offered a variety of care options.

#in2011 there will be less imbalance of power between maternity patient and provider.

#in2011 childbearing women will rightfully claim their health records as their own -RT @midwifeamy

#in2011 we will wake up to and address the shameful disparities in access to and outcomes of maternity care RT @midwifeamy

#in2011 Less pointing fingers among insurance companies, providers & orgs that continues to feed this ever medicalized maternity system.

#in2011 I would like to see an equal playing field with accessibility to all to maternity research, guidelines, statistics…

#in2011 I would like see accountability for providers and institutions in their maternity care practices.

#in2011 I would like to see hospitals treat only the patients they serve the very best – high-risk or in-need mothers and babies.

#in2011 I would hope more women stop blindly trusting and do their own research for pregnancy, birth and postpartum.

#in2011 I would like to see arrogance leave the treatment room. It is not a personal affront for a patient to have an opinion and needs.

#in2011 I hope women are treated as holistic beings especially in pregnancy.

#in2011 I hope for care providers to be transformed into partners with their patients instead of authorities.

#in2011, I want to see care providers and family members taking postpartum mood disorders seriously. RT@smola04

#in2011 I hope women stop being treated with hostility and looked down upon for wanting something more in pregnancy, birth and postpartum.

#in2011 I would like to see more women receiving comprehensive postpartum care from their OBs and hospital based midwives.

#in2011 I hope that women will openly mentor those coming up after them to better understanding and expectations in birth.

#in2011 I hope social media efforts have even more impact on unveiling the hidden and progressing healthy birth practices.

#in2011 I hope less mamas are unnecessarily cut open in pursuit of delivering a baby.

#in2011 I hope to see midwives working together no matter the track they came up on. Being respectful and open.

#in2011 I hope to see women who have experienced amazing births be loud and proud sharing the good news without fear.

#in2011 I hope that midwives of all types will be fearless in their pursuit of their model of care for women.

#in2011I hope that hospitals and providers realize they need to offer individualized care to women and babies for the health of it.

#in2011 I would like to see women openly breastfeeding their children without shame or discrimination.

#in2011 A drop in the cesarean rate would be progress toward healthier practices.

#in2011 I want to see women in droves having their eyes opened and being fierce about the care they receive. About their maternity options.

#in2011 I would like to see less care providers offering up defensive and fear based medicine to their maternity patients.

#in2011 I hope for more accessibility to home and birth center births for women and babies.

#in2011 I would like care providers to view women as a sum of all parts, not a uterus growing a baby more valuable than she is.

#in2011 I would like to see more women taking charge of their care, taking personal responsibility and being powerful pregnant women.

#in2011 I desire more respect and autonomy for maternity patients.

#in2011 For women who want a VBAC to easily find an accommodating provider.

Is all this attainable in one year? Perhaps not, but pushing toward the positive and never taking the eye of the reason for all of this, the childbearing women and families, I do believe we can change the world and make the maternity care system as a whole a safer, healthier  and more respectful place.

What is on your 2011 wish list? If you would like to have it added here, leave a comment.

Reader Additions:

Kay Miller:

I hope that we (doulas/educators) can stop alienating the providers, instead partnering with them to provide the best care possible for the mamas and babies that we work with.
I hope that doulas/educators and providers can have mutual respect for one another, and realize the value of the care and support that each provides.
I hope that while we work to change the negatives of health care for pregnancy, birth, and postpartum, that we can remember to openly recognize and affirm the positives.
I hope that families will make decisions based on education and research, not on fear.
I hope that both “sides” stop using fear tactics to persuade families to make certain choices. A decision to home birth due to fear of hospital birth is still a decision based on fear.

I am so thankful to all of the submissions I received for this Why I am Grateful for my Birth(s) blog carnival. I have found no matter what a woman can learn something and be grateful for something in every birth experience no matter how difficult or wonderful. Enjoy these quips and please go to their blogs to read in completeness.

Tiffany Miller of Birth In Joy says in an excerpt from her post The Most Important Piece, “I am thankful that Mom believed in my ability to breastfeed my new baby, even though it hurt at first. She never told me that I had so severely damaged her nipples, as she tried to learn with no support whatsoever during my own newborn days. Nary an ounce of bitterness did she carry from that time. She knew and accepted that my path was my own, and supported me completely.” She goes on to further outline how the mentoring and support of her mother paved her way.

How grateful she is for all four natural births and her mother’s unwavering assistance. Assistance and presence she could never imagine doing without.  Just beautiful and shows how important in our lives are the ones who came before.

Kristen Oganowski of Birthing Beautiful Ideas in her post Your Births Brought Me Here writes this gorgeous, tear inspiring letter to her two children about what amazing changes they spurned in her own life, in the very life that they would come to know. Without one birth, would the other have come along the way it did?

Here is an excerpt: “When you both were born, I called myself: Graduate student (unhappily).  Teacher (happily).  Feminist (always).  Mother (timidly). Today I call myself: Doula (happily).  Birth and breastfeeding advocate (unflinchingly).  Blogger (smirkingly).  Writer (finally).  Feminist (permanently).  Mother (confidently).  Graduate student (temporarily). Your births brought me here, to this place where I am (finally) content and impassioned. All wrapped up  with a Love, Mom.

Our next post is by Sheridan Ripley of Enjoy Birth. She writes very plainly about how grateful she is for varied experiences that give her insight to what other women experience and that she is better able to support them.

Here is a peek.

• If I had only amazing natural birth experiences would I have judged those moms who choose epidurals?
• If I had only vaginal births would I have understood and fought so hard for VBAC moms?
• If I only had easy times creating that nursing relationship with my boys, would I have been as supportive of my moms struggling with nursing?

Very poignant and open…..

We come to Bess Bedell of MommasMakeMilk.Com came to a place of self-awareness, peace and a fierceness to help others in her experiences. Like others her heart grew and expanded with her own knowledge and walk. A strength and confidence awoke in her to the benefit of so many coming after.

My two births birthed a new women. A mature women who has opinions, knowledge, experience and a passion in life. If I had not had my c-section I may never had given VBAC a second though. The lack of VBAC support and availability would probably never have entered my radar. My second birth showed me that success and perfection are not the same but both are wonderful and I can be happy for and embrace a mother and her experience even if it wasn’t a completely natural, completely med-free birth. Both of my experience have prepared me for the future. My future of birthing, and next time I plan on birthing at home, and my future of educating and supporting pregnant and birthing mothers.

And lastly my own blog post entry. I know I rarely speak of my own births in any detail unless it is one on one. As a community member, advocate, doula, educator, I strive NEVER to be an intervention on a woman. Today I decided to give a small window into my own experiences and why I am grateful. Please read and comment freely – Grateful For My Births.

Thank you so much to those who submitted posts. The openness of other women allow all of us to learn, grow and share as we are meant to within a healthy society. We are not there yet, but I have a hope that through this sort of connection, we are healing some brokenness.

In reading all these posts, not one is the same, not in tone or style, but every woman was changed positively in the end.

Focusing on Thanksgiving, I asked others to submit a “Why I am Grateful For My Birth(s)” blog post.  In the spirit of that, here is my own blog posting. Stay tuned for the Carnival of posts to be up by Thanksgiving morning.

I myself have had four varied labors and births, one of which could be considered a “normal” and natural birth experience.

From my first labor and birth, I learned that maternal ignorance no matter the intention can get you into the OR  I had to travel 45 minutes to my birth location, was only a 2 cm but nurse admitted me because she did not want me to go all the way home (she of course did not tell me that or we would have rented a hotel room nearby to labor in), I then allowed the same nurse to perform AROM at 3 cm’s because she figured it could speed things up because early labor you know is slow often for first time mothers.Walked stairs for hours but….. Now came the pitocin because my waters were broken and I was not moving fast enough. Then came horrid, blinding back labor. At some point I got a partial dose of fentanyl. Then another. Finally in transition about 20 hours in, I thought I wanted the epidural. I did not get one as I was complete and pushed for nearly four hours. Then finally after a failed vacuum assist to rotate his head and help me I ended up in a cesarean for deep transverse arrest for an acynclitic, deflexed baby head.

Baby number 2 27 months later and I was for sure in no way going to get to the hospital before I was in very well established labor. VBAC, whatever, I knew if things were okay. I would never have pitocin in labor again or have my waters broken. So I labored beautifully, with no fear, hey there was some ivory tower mama left in me still. After having contractions work up to 2 minutes apart and 90 seconds long, I decided it was time to leave. My husband ran back in the house and put a water proof pad on my seat (what a very intuitive man). On the way during the 15 minutes ride to the hospital, my water broke, I mean BROKE – kaplooey. Yep water proof crib pad saved the passenger seat if our minivan. In triage I was checked and behold I was a stretchy 9 cm’s. Everyone was so happy. A VBAC good for you mama. No saline lock. Some monitoring. Then the trouble started.  The on-call doc came in and was impatient. I pushed for about an hour (mind you I was a VBAC) and when he was low enough she cut an episiotomy and used forceps on him.  Very little conversation, my husband just said she insisted and there he was. So a natural labor and almost natural birth. I still felt great. Episiotomy was far less painful than surgery…. I got my VBAC. Though  my baby ended up in NICU overnight because of forceps. That was awful. We were both very mad after we could process it. He nursed well nonetheless. Took him home the next day.

Labor and birth number 3 is told in detail on my blog post A Woman’s Voice Birthed Into Fullness so I will not report on it here.

My 4th labor and birth had me in the place of I am arriving at the hospital very late in labor even though this time I was a 1VBA2C mama. Funky contractions of a few hours each over three nights including one trip to the hospital thinking it MUST be labor, had me sitting at 7 cm’s dilated WITHOUT being in labor. How did I know that? I asked my midwife to check me every day after the short bout of contractions. I just laughed and laughed about being in “transition” dilation wise but not being in labor. On the fourth night of when the contractions started, I said OKAY I am having this baby. I did some nipple stimulation and acupressure over an hour, next thing I know 3 minutes apart contractions then closer. We got to the hospital I was 8 cm’s, walked for a half hour. Then I was 9 cm’s and pattern was back strong. Midwife came. After some odd and funny asides. I allowed AROM baby was +1 and in good position. She promised me. PROMISED me as I glared her down that this would not cause another cesarean. Baby was in perfect position. Gulp. OK. I trusted her and knew she did have our best interest at heart. No baby did not fall out. Have I mentioned I have an android pelvis? I was completely shortly after that and pushed. He was born about 45 minutes later. That for me was such a short amount of time to push. He was in my hands and on my chest with the exception of maybe two minutes for FIVE hours post birth. FIVE. He had about a 14.5″ head and came out over an intact perineum.  I was, well, normal, everyday, usual. Yep. I basked in the no nonsense aspects of it.

I learned so much through all my labors and births. Through #1 that though I made many excellent choices in my care provider and birth location, heck we even took out of hospital independent birthing classes, that maternal ignorance and a willingness to believe no nurse would do something that could cause harm was really am ivory tower point of view that women can just have babies. I knew I could birth, but knew I needed to know even more.

Through #2 that on-call providers can be dangerous people and that I COULD birth.

With #3 my voice came into being. I turned into who I am now. Like a butterfly with the roar of a lioness.

And #4 oh my baby. I became normal, just like every other woman who had a natural labor and birth. Just another birthing woman. Not special. I really liked that title.

Yes I am grateful or I would not be the advocate, doula, educator, flag waving proponent of informed consent AND refusal, strive to help and support women in their childbearing years…. oh so much more. I am grateful because in all of this I have found my calling.

Thank you to K, L, J and D for being my sons.  Thank you to bad on-call doc, well meaning but harmful nurse, horrid nursery staff, and C.E. the midwife who believed in me and my body as much as I did.

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 invite you to participate in Preparing For Birth’s upcoming Blog Carnival set to appear on Thanksgiving morning.

Topic: “Why I am grateful for my birth experiences.” This is your point of view. I encourage you to be open about expectations, what it was really like and how it impacted you as a woman, mother, etc.

When Due: Entries need to be received by November 23, 2010 to email desirre@prepforbirth.com

What to include: Blog copy and link to your blog along with name, website, and contact information for attribution.

I look forward to hearing from many of you.