Thursday, April 22, 2010

Childbirth Education Course Development

My friend Rachel and I are in the process of developing some childbirth education courses to serve the English-speaking expat community here in Seoul. I believe that different programs work better or appeal to different women and we want to expand the range of options available.

Rachel and I are reading a lot of books and looking at programs to figure out how and what we want to teach. There are some philosophies of birth that say that women will find their own ways of coping in labor and technique-based classes are not necessary and even counter-productive. I know one thing for sure, I do not agree with this. (I do understand that there are women who this philosophy would really work for, though. I think they would have to be extremely committed to it and very well supported to get through if things did not go smoothly). This philosophy came about in response to the failure of the old Lamaze method on the part of many women who were told in the classes that they should be able to relax their way to avoid pain. When they felt pain, they grew anxious that they were "doing it wrong" and felt a lot of disappointment. I understand where the reaction against the method comes from, but I do not agree that method-free is the best way for most women to go. Since most women go into their births without prior experience of birth and very little body awareness or relaxation training, their natural ways of coping are often inefficient and counterproductive leading to longer, more painful labors and higher rates of intervention. If we were giving birth in a rural area without access to interventions, most women would eventually find their way through, but I think it would be rougher than it needs to be. I believe that birth can be enjoyable! I do think that the real point is not to be a slave to a particular method, to have a range of tools to use.

Currently, Lisa Fincaryk teaches a wonderful general childbirth education course that focuses on the differences you encounter in Korea such as the standard procedures in most Korean hospitals, how to negotiate with your Korean doctor and writing a birth plan. One of the strengths of this class is role-playing negotiating with the Korean doctors and staff. It is a great class with lots of good information, but it is not a method. While I think that the information in general childbirth education courses is essential preparation, I think that they give you enough information to HAVE birth preferences, but not enough to prepare you to carry out your preferences. Many women are prepared intellectually (through childbirth education classes), but not physically and emotionally. In the Passion for Birth Childbirth Education Lamaze seminar we learned lots of great and engaging ways to teach general childbirth information, but since most people lack time or resources to take both a childbirth education course and a labor preparation/method course, I would rather teach a method course.

Lisa also teaches Hypnobirthing classes here in Seoul as well. We are so fortunate to be able to have that option here as well. Hypnobirthing (I finally read the book) says that birth can be painless and enjoyable. The philosophy is that pain is caused by tension in response to fear. By eliminating the fear and training yourself to relax completely, you can work with your body instead of against it and have a pain-free, or very manageable birth. Having experienced a near pain-free and very manageable birth using Hypnobabies, I believe that it is possible. Where I disagree with Hypnobirthing is in their coverage of interventions and problems in labor. The coverage is minimal because the practitioners believe that covering undesirable topics will plant strong suggestions that will manifest themselves because they will override all the positive work you are doing by entertaining those thoughts.

I disagree. The culture through family horror stories, horror stories from strangers, fearful images from movies and television and lack of confidence in the body's ability to birth have already put the fear in us. Also, most women give birth in intervention-friendly hospitals and if you do not have a good understanding of when interventions are necessary or helpful and how to evaluate that, your whole plan can be derailed if you have something unexpected come up in your birthing. I think that by teaching women about the range of options between a zen, pain-free natural birth and an emergency c-section, you will actually reduce their fear and improve their satisfaction about their births because they will have a greater ability to make choices about their care. I believe that education, support and choice are keys to a women having satisfying birth experiences.

I do think also that Hypnobirthing kind of makes it seem like if you have a problem in your birthing time, it is your fault. Breeches are explained as being caused by fear. Having had two breech babies, this is really hard for me to hear. I did not feel afraid, but I had breeches. With Eva, I did fear release hypnosis sessions and the Hypnobabies breech track and nothing worked. An External Cephalic Version finally did work and I went on to have a very easy Hypnobabies birth, but I don't think that being told it is your fault is really helpful. I think I have the same reaction that Gayle Peterson and others had in response to the old Lamaze method. However, I do think that there is a lot of good information and technique in Hypnobirthing and for some people, it would be a very good fit.

I would like to become a Hypnobabiesinstructor because Hypnobabies does cover interventions and changes in labor. Unfortunately, they are not holding teacher training until 2011. So, I will continue to encourage women to look into Lisa's Hypnobirthing class or order the Hypnobabies Home Study Kit, but I realize that not all women find the hypnosis method appealing.

So, what are we going to teach? Well, Rachel used The Pink Kit for her birthing. The philosophy behind The Pink Kit is that women need to do the work to develop skills to use in their birthing time. Birth can be easy or difficult. If you follow your natural instincts, you may have a very quick and easy birthing time. However, sometimes our instincts lead us to positions and breathing that works against our bodies instead of with our bodies. By developing body awareness and an understanding of the potential impacts of our own anatomy, we can work with our bodies to get the baby out. The Pink Kit does talk about the impact of fear, but gives women (and partners) confidence by helping them build skills to use no matter how your labor progresses.

Yes! This philosophy really speaks to me. It is proactive and not fear-based. It is good preparation for the birth partner as well because there are things that the birth partner can practice. You can do The Pink Kit as a home study as Rachel did, but many people, especially first-time parents or those with previous birth trauma, prefer a live class. We know we want to use The Pink Kit as a basis for our class called Birth Skills. We want to include information on birth in Korea as well as the best elements of other books and philosophies to round out the class. We are in the early stages of trying to decide what to put in the class and how to present the information.

Here is where I need your help. If you can answer the following questions that would be great. If you don't want to answer in the comments, you can send me an e-mail mamaseoul at gmail dot com.

1. What childbirth education/ labor preparation classes did you take?

2. What other resources (books, films, groups, etc) did you use to prepare in addition to or instead of the classes?

3. What did you learn in your classes or other preparation that you feel helped you the most during your birthing time?

4. What did you feel unprepared for? What do you wish you would have known, but didn't?

5. If your partner attended classes, what did your partner learn in classes (or other preparation) that helped the most during your birthing time?

6. What do you think would have better prepared your partner to help you?

7. General impression of your classes/additional comments/anything else that you think will be helpful to us as we put together our classes:


Thanks!

14 comments:

Elita said...

1. What childbirth education/ labor preparation classes did you take?
We took a quick class at the hospital where I gave birth and a 6-week course at a birthing center.

2. What other resources (books, films, groups, etc) did you use to prepare in addition to or instead of the classes?
I read the Hypnobabies book and Ina May's book. I also read a ton of pregnancy books that also mentioned the process of labor and delivery.

3. What did you learn in your classes or other preparation that you feel helped you the most during your birthing time?

The class at the birthing center was really helpful. Tho things that helped me the most were #1, the idea of using a mantra, #2 picking a focal point when contractions were bad and #3 breathing techniques. We were taught how to breathe in order to "ride the wave" of a contraction instead of doing things like, squeezing your eyes or gritting your teeth, screaming, etc. We were told that contractions end up clamping down on the cord so you really need to take good, deep breaths because during a contraction you need to breathe for the baby. This was all I needed to hear to be mindful of my breathing. The mantra that worked for me was "There is no contraction stronger than me, and every contraction is bringing me closer to holding my baby."

4. What did you feel unprepared for? What do you wish you would have known, but didn't?

I was unprepared for how the doctor/nurse would try to talk to me into interventions I did not want (including a c-section) and how helpless I would feel. I thought for sure I was just going to refuse things like continuous fetal monitoring, an IV, etc., but when I got there and they used their scare tactics on me I gave in easily. I don't think you realize just how vulnerable you are going to feel in that moment.

5. If your partner attended classes, what did your partner learn in classes (or other preparation) that helped the most during your birthing time?
My partner did attend the classes with me, but I'm not sure that there was much he could do except hold my hand when I asked and stop touching me when I asked. I think he felt pretty helpless during the process, but that may be because the birth was in a hospital. Perhaps he would have felt more a part of the process and could have actually helped if we'd birthed at home or in a center.

6. What do you think would have better prepared your partner to help you?

Honestly just having him there was really enough for me, but I think having a doula would have been better for both of us. He was just as scared as I was when they said our baby was too big and would die if we didn't have a C-section, so having someone else there who was a professional to calm us down and help us negotiate with staff would have been great.

7. General impression of your classes/additional comments/anything else that you think will be helpful to us as we put together our classes:

I think too many women go into birth (and breastfeeding for that matter) thinking it's natural and that if something goes wrong the doctors will be there to fix it. But there are things that happen commonly in labor that are normal and don't need intervention. I think it's important for women to understand things like fetal heart tones, what's a normal window for progression, etc. Some of the things you mentioned in the post. It's not enough to go into labor thinking positive thoughts, you've really got to understand the process and the way the thinking goes in the hospital so you know what interventions may be necessary and what are CYA (cover your ass).

Good for you for offering these classes! Awesome.

Mama Seoul said...

Thanks for the comments, Elita! I knew you would have some good stuff. I think that even the strongest women feel vulnerable when giving birth especially when they are throwing scare tactics at you. I'm so glad you were able to avoid a c-section with all that pressure!

One of the highlights of Lisa's general childbirth class is role-playing negotiating with the Korean doctors and staff.

Right now we are thinking of offering a 1-session class called Birth Choices that exposes people to the idea ideas/philosophies of birth, what is available in Korea and how to make choices to determine what the really want with a lot of links and references.

Our Birth Skills class would be 3-6 sessions and cover childbirth education, but mostly skills for labor. People would need to do some reading outside of class and practicing to get the most out of the class so it will definitely appeal to a certain personality type just as Hypnobirthing does.

Janeen said...

Will you be offering any information regarding the birth situation for women of size? I feel that this is very important too because there are certain things that need to be addressed for women who are overweight/obese, ESPECIALLY here in Korea where they may run into problems finding a size friendly provider. There is a TON of information here:
http://www.plus-size-pregnancy.org/
and she also has a blog you can find here:
http://wellroundedmama.blogspot.com/

One HUGE consideration (especially when it comes to making sure that a woman who is plus sized is NOT pushed into needless interventions) is making sure that the blood pressure cuffs are large enough. A too small cuff will cause problems and the machines that you find in most OB offices in Korea are VERY inaccurate.

The author of the blog and the website is in the ICAN group I've been frequently and I discussed this a bit with her because it was one of my big concerns with my appointments and whether it was even worth going when I did not wish to get an ultrasound each time and they didn't really do much else at the appointments.

Epidurals are also a big concern as not all of the hospitals in Korea have epidurals that have needles long enough for an overweight/obese woman and this is something that REALLY needs to be addressed so that an overweight/obese woman can make the best choice in how she wants her birth to go since that right there takes away a measure of pain control and can make a cesarean birth harder to recover from if one is needed.

Unfortunately, I can't really answer much in the way of the questions. I don't think the birthing classes really helped me out at all, especially since I ended up with back labor. To be honest, when it was all said and done, my instincts were kicking in more than what I remembered in class. And as for support, I didn't really have any because my husband was working two jobs and even when he lost the one job 9 days before our daughter was born, he was still working overnight so he never was very supportive. He barely stayed awake through the classes and he slept through most of the labor.

What I really didn't know enough and understand enough was the interventions and how those tend to lead to a cesarean birth instead of a vaginal birth. And that, I never would have learned in my birthing class. I had to learn that in the years since I had my daughter from various people who found themselves in the same boat. I also was totally unprepared for how badly I would react to the IV drugs. NEVER AGAIN!

Mama Seoul said...

Rachel is a woman of size and she had a good experience with a Korean doctor here. That stuff will definitely be covered in the Korea section.

Most childbirth education courses usually do cover interventions and the fact that they increase your risk for a cesarean, but like Elita said, it is hard to resist the medical staff when they are using fear tactics. They often use false statistic as well so it is good to know the real ones, but most people don't memorize that stuff until they really need it, like when going for a VBAC.

Janeen said...

One doctor really does not give many women very many options. Considering there are at least two moms who have left/are leaving the country due to the difficulty in finding a weight friendly provider, I do think that this should be looked at more.

I haven't seen my OB since I was 15 weeks pregnant due to how he reacted towards me regarding my weight. Most of this pregnancy has been without much in the way of prenatal care AT ALL. The last time I saw anyone was when I saw another OB for the ultrasound. That was almost 7 weeks ago.

You asked for suggestions and asked questions on what we had experienced in our own childbirth preparation classes. And in my case, no, they really did not go very much into how the various interventions tend to add up and lead to a cesarean. They don't really go into the fact that if you're getting back labor, the WORST thing to do is anything that will have you on your back including getting the waters broken or an epidural though they did talk about counter pressure to help with back labor. They sort of glossed over all of the intervention stuff especially since the childbirth class was in the same hospital we all delivered in.

Mama Seoul said...

Janeen,

I know that there are limited options for women of size and VBACs, but 1 provider is better than nothing. In my case, I went back to the US, though now I would stay for VBAC #2 if I get pregnant again over here.

I think for you, the best option is to go back home.

Your experience is the reason I want to teach classes so people have more skills to deal with difficult circumstances and also how to interact with the medical staff.

I hope you have a quick and easy VBAC at home. Let me know how it turns out,

Janeen said...

Rachel was having her first though, wasn't she? It seems that a VBAC is even more difficult, especially since big babies are such a concern here.

I had asked way back about size friendly providers on the forum and never really got an answer. I did send a message to Rachel through the forum, sent it back when I first saw Dr. Lee due to how he reacted towards me. I got HUGE red flags back then. Never heard back.

I leave May 6th. I finally got the ticket last night. I have to leave both my husband and daughter because air fare went up so much and I needed to make sure I had money to live on when I got back, especially since I'm going to be looking for a place to stay. I'm hoping he'll be able to get her back to the US by September but a lot of it is going to depend on the payment situation through the school.

I'm glad to be going back to where I will at least feel a little more comfortable with my surroundings and I know that the hospitals are equipped to deal with larger women. Just not too thrilled about having to go back alone and facing at least a month or so alone with a newborn baby until the air fares go down enough for my husband to him and our daughter back home.

Mama Seoul said...

She was having her first. She was in the States when you first started posting on the forum.
But, again, I think that going home is the best for you.

Crystal said...

What childbirth education/ labor preparation classes did you take?

I did not take any formal classes due to lots of travel in the 2nd and 3rd trimester.

2. What other resources (books, films, groups, etc) did you use to prepare in addition to or instead of the classes?

I read "What to expect when expecting" and a couple other books at Borders (can't recall the names). I also read part of the girlfriend's guide to childbirth. I also read the hypnobabies book. I read/saw many medical, wikipedia, and youtube articles/videos.

I spoke with friends and family about their experiences. I recalled seeing my sister's births.

3. What did you learn in your classes or other preparation that you feel helped you the most during your birthing time?

I have not given birth yet but will answer this question in several days or within 2 weeks! :)

4. What did you feel unprepared for? What do you wish you would have known, but didn't?

same as above

5. If your partner attended classes, what did your partner learn in classes (or other preparation) that helped the most during your birthing time?

same as above

6. What do you think would have better prepared your partner to help you?

same as above

7. General impression of your classes/additional comments/anything else that you think will be helpful to us as we put together our classes:

I think this is an excellent idea and I am glad you are taking action on it. I would have definitely taken your class! :) It seems very well-rounded in terms of content and viewpoint. I also like your emphasis on labor coping techniques.

Mama Seoul said...

Crystal,

Report back after you have your baby and also let me know how you feel about have a doula at your birth.

mommymichael said...

1. What childbirth education/ labor preparation classes did you take?

With my first pregnancy, I started out with Hypnobirthing, but found by the end of my pregnancy incredibly unprepared. There was no information about interventions, or how to avoid them. I felt it was mostly "pain free birth is possible, and if it doesn't happen for you then you did something wrong." I was frantically searching the internet for more scripts (I had 3 from them that were mostly guided imagery at best) and came across Hypnobabies. I was way late in my pregnancy, way passed the recommended start time. But Kerry (the founder) sent it to me anyway, with no guarantees.

I learned more about childbirth and hypnosis in just the first few pages than I ever did with Hypnobirthing. (IMO)

If you've already looked up Hypnobabies, than I'm sure you're familiar with what they teach. It's a LOAD of information.
I went on to use it with all 3 of my babies births.

My second son's birth is found here http://www.youtube.com/watch?v=hLYNaJPjcTU&eurl

and my third (i opted for an epidural after 36 hours on pitocin but was very proud of myself! I felt it was a decision well made. But I feel this is a good example of "breathing baby down" that Hypnobabies teaches. I've noticed that it seems a lot of moms don't know how to control their pushing. Granted sometimes the body just takes over and the baby barrells out. However, I feel that easing baby's head out can help prevent tears, and I'm so grateful that I was able to learn that with Hypnobabies.
birth story: http://mommymichael.blogspot.com/2010/01/trillian-finn-caoilfhionn-has-arrived.html

video: http://www.youtube.com/watch?v=hLYNaJPjcTU&eurl


2. What other resources (books, films, groups, etc) did you use to prepare in addition to or instead of the classes?

my complete list of books that i've gathered can be found at my website
http://comfortbirth.com/do-your-research/

3. What did you learn in your classes or other preparation that you feel helped you the most during your birthing time?

a doula!!
knowing that i can change positions without "permission" and it's perfectly fine. a lot of moms feel trapped by "can i? is it okay?"
asking questions if I feel pushed to do an intervention..
why? are myself and baby okay? what if we don't do this? what happens if we do? we'd like time to discuss our options by ourselves.

4. What did you feel unprepared for? What do you wish you would have known, but didn't?
with my first, I missed out on learning the belly lift technique to aid in back labor.
otherwise I didn't feel unprepared.

5. If your partner attended classes, what did your partner learn in classes (or other preparation) that helped the most during your birthing time?
i did the homestudy, my partner wasn't very active in participation.
However, I know for a fact that Hypnobabies does teach willing partners ways to help mom deepen her hypnosis, positions to aid in a comfortable active birthing, things to help mom if she's tired and needing a rest, and positive things to say to mom. (among a whole SLEW of others) my husband is in the navy, so he was gone more than he was home.
like i said - a doula is wonderful.

6. What do you think would have better prepared your partner to help you?
see above.

mommymichael said...

to continue since i'm typing too much

7. General impression of your classes/additional comments/anything else that you think will be helpful to us as we put together our classes:

I enjoy knowing the risk/benefits of common interventions. sometimes they're unavoidable.. but I LIKE knowing what to expect. it also aids in the confidence to say no because I know what I'm talking about and why I don't want it.
such as the use of cytotec, popping my membranes at the start of labor.

the deep breaths and low moaning, i found beneficial to know I didn't sound "silly" and to just go with the sounds. they're "working" sounds.

bowel movements during pushing. You'd be surprised how many women didn't know it would happen or were embarrassed when it did.
I say get it out of the way and talk about it. show pictures of the side cut view of a birthing woman, to show the rectum being smooshed. there's no way that something wouldn't come out. "and that's okay. it's normal."

Crystal said...

Doing a quick check back in, gotta get ready to nurse Evan at 8pm. :) (Yonsei policies!)

I wanted to add something that I thought I would NEVER add or think. I think doulas can be very useful at csection births.

In the last days of my pregnancy plans changed and a csection was scheduled. I naturally assumed a doula would be unneccessary since I wouldn't need help coping with labor and so on.

There was one thing that went wrong during my csection, my hubbie was so bust with the baby and me that he forgot to send out a placenta pcr kit we had for Lyme disease. It was really important that this kit was sent out and if we had a support person there, they could have given emotional support and helped to ensure things were done that we wanted done, from big to small things.

I suggest that maybe doulas offer a discounted price for csection mommies since they don't require much, but could still benefit greatly from a doula or someone interested/educated in childbirth, etc. Maybe even a friend could fulfil this role but I think someone who is trained in issues related to childbirth, csection, pregnancy, etc would be better equipped.

Mama Seoul said...

Congratulations on the birth of Evan!
I do think a doula can be helpful at a c-section birth. I had a doula at my c-section birth. She took pictures of the baby and there is a cool shot of me seeing him for the first time. She also stayed with me when my husband went with the baby (as I wanted him to). She calmed my parents down before the birth and was there afterwards as well.