Strategies for impact in childbirth education Shari McBurney Certified Childbirth Educator (BACE) Certified Labor Doula (TOLABOR)
A proactive look at Change Current Agents Historic recommendations of Change role of and resources CBE ● Impetus to LTM ● ACOG update, refresh ● Penny and inspire Simkin ● Lamaze Strategies for impactful CBE
From whence we came... ● 1900 Most women gave birth at home until industrialization to ○ By 1938 - 50% gave birth in hospitals 1940s ○ By 1955 - 99% ● Twilight sleep ● 1950 Grantly Dick-Read blames fear for the pain of birth to ● BACE and other organizations are born 1960s ● Move away from scopolamine and to include partners in support ● Lamaze, Karmel, and Bing make waves ● CBE moves into hospitals 1970 To ○ Preparation for birth rather than natural childbirth methods 1980s ● Epidurals become ubiquitous ● Present Cesarean rates skyrocket to 33% in 2009 (32% in 2015) ● “Listening to Mothers” gives us insight ● ACOG publications ● Lamaze updates
Listening to Mothers Changes in need for education ● Who’s taking CBE? ○ 53% of mothers had taken a class either with this pregnancy or a prior one ○ Of those that took classes, 59% are new mothers ● What kind of class? ○ 49% weekly classes ○ 24% one-day ○ 26% two-day ○ 82% took hospital-based classes ○ 37% took class to learn about “natural birth” ● Main focus of class
Recent ACOG Publications ● 2014: Primary Cesarean Prevention ○ 6cm is the new active labor! Changes in need ○ Redefined: “abnormal” first stage labor ○ Labor induction >41w, unless medically indicated for education ○ Later Cesarean call for prolonged labor or pushing ○ Provide manipulation if possible for malposition ○ Continuous labor support ● 2017: Limit Labor & Birth Interventions CBE is absent as a ○ Stay at home until “active labor” method in both ○ Intermittent monitoring ○ Continuous support publications… because: ○ Stay hydrated ○ Avoid AROM “Insufficient evidence ○ Use various positions for labor and pushing exists as to whether ○ Use non-pharm methods for comfort antenatal education in ○ Await urge to push/passive descent small classes is effective in regard to obstetric and psychosocial outcomes.”
e d u c a t o r e i d u g O G C A a l t n a e p r o t Women o r f c e t i c r a p s e r d v i r o p r e d i support v o r P e r a C “Desired reforms will occur to a greater degree with active participation by educated expectant parents.” Collaborative Response to ACOG Committee Opinion #687
Dilemmas of Childbirth Educators We struggle We grapple They know too much of the wrong stuff... to build... with goals... ● ● ● Prenatal provider Community Is the objective... ● ○ ○ Over-exposure to Shorter classes Positive birth birth-related information, ○ Interpersonal connection experience? behavior and attitudes … ○ vs info to impart Advocacy for a much of it misinformation ○ Accessibility /inclusion particular type of ● Lack of access to ○ Availability birth? evidence-based information ● Credibility ● Cultural beliefs and ○ Lack of interprofessional direct/indirect childbirth education experiences ○ Curriculum out of date
Be the You Wish to See in the World “Reducing the childbirth experience to a series of stages, phases, or hormonal interactions will do nothing to empower a woman to trust her inner wisdom and find her own path.” A Paradigm of Normal Birth: Teaching Through the Healthy Birth Practices
Strategy #1: Change your Mind Challenge your status quo ● ● How you can help expectant parents to see themselves as ● Review your current objectives valued members of the maternity Include active participation as an ● care team overarching goal that guides ● How you can see yourself as your content part of this journey Use Healthy Birth Practices as ● framework for change
Strategy #1: Change your Mind ● A&P ● Shared ● Prenatal decision testing making ● Birth process ● Pain meds ● Pushing ● Early labor ● Birth ● Active labor ● ● Immediate Comfort postpartum measures ● ● Postpartum Birth team adjustment ● Partner ● Feeding preparation choices ● Resources
Strategy #2: Change your Curriculum What are the challenges for ● ● ACOG publications parents? ● Commentary What are the objectives in ● ○ Simkin’s response ○ teaching topics in the realm of Childbirth Connection care options? Recommendations
Brainstorm Selected evidence-based Challenges for parents (that might Childbirth education may equip parents to Suggested actions recommendations from be reduced with prior education) improve outcomes by teaching and objectives ACOG 2017 ● Delay hospital admission After hours of contractions at How to time contractions; identify until active labor home, many parents go to the progressing contractions ● hospital too soon . Function of prelabor in preparing cervix ● Constructive distracting activities ● On arrival, the cervix may not be How to deal with contractions ● dilated enough to merit admission; When to go to the hospital they may be sent home: worried, confused or angry Suggestions Actions Clinical Acknowledging challenges will objective help clarify your goal
Strategy #2: Change your Curriculum Incorporate suggestions on handout and from our activity ● Prioritize Skills and reasons , not solely information ● Increase your knowledge with continuing education and ● interprofessional collaboration
Shari McBurney Certified Childbirth Educator (BACE) Certified Birth Doula (TOLABOR)
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