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Labor rehearsal, birth options and unexpected outcomes all in one.

Labor rehearsals, birth options, and unexpected outcomes are all topics that can be a challenge to present in a childbirth class. Previous literature has discussed the importance of including these difficult topics in prenatal education, but strategies to accomplish these are not as clear for practitioners (Ilse, 2009). The activity presented in this article is a thorough and fun way to cover all three at once. The "yellow cards" are always mentioned on class evaluations as "the thing likes best" and "I really like the easy flow of the activity".

Materials needed for the class include:

* Birth Plan Game cards available from the ICEA Bookstore ("yellow cards")

* Newborn diapers with "unexpected outcome" cards inserted inside. Prepare these yourself. Suggestions for what to write on them are given below.

This activity is best done at the end of the class series. Begin by passing out the birth plan game cards, one set per couple. Ask the participants to review the cards and to work together with their partner. Place the cards that describe their dream birth experience face up. Inform the participants that this dream birth experience should not be what they think they can have, but should be what they think they would like the most. While the couples work together, walk around the classroom and answer any questions about the cards. This also gives the couples a chance to ask questions from the series and gives the instructor a great opportunity for one-on-one with each couple. As the couples complete the task, remind them to leave all the cards out, laying face up.

Now begin the labor rehearsal. The instructor might start with "You are at the mall when you think you might be having contractions." Ask questions of the group to review important highlights such as "How do you know that this is real labor and not just practice labor?", "What are you doing at home in labor?" and "When do you come to the hospital?" Go through early labor with prompts and questions until you arrive at the hospital and active labor. Now ask each couple to work together and remove two cards from their game card layout. They can remove any two, as timeline does not matter, but they must remove two and put them to the side. Give them a couple of minutes and then move on with the rehearsal.

Review active labor options with prompts and questions. It is good practice to ask questions about dilation, partner's support, pain coping and comfort measures. Good questions at this point are:

* "What are you doing once you get here to the hospital?

* What does it look like?

* How are you two working together?"

Moving into transition, ask the class questions such as: "What can partners do when they start to see mom shaking, vomiting and saying things like 'I can't, I can't'?", "What part of labor are you probably in?", "What are some specific things you can do to help moms at this phase?" Now is a great time to remind participants of direct eye contact, holding the laboring patient's hand, giving lots of encouragement, and to continue with comfort measures.. Direct the couples to choose two more cards. They may choose any two, but work together when selecting. It may be best to give them a little more time for part of the exercise, as it gets more difficult for them to choose each time.

Bring the couples back to the rehearsal again. Review pushing and birth options next. Engage the class in conversation about pushing, positions, options, partner's role, and ways they can help the perineum to stretch. They must now choose two more cards to discard from their set. After everyone has chosen their cards, the instructor could say, "After two hours of pushing and hard work, your new little baby girl or baby boy is born! This is probably the biggest moment of your life--certainly it is a physical event but it is also an emotional and spiritual event. What are your plans for celebration?" If needed, I give them hints on ways they can celebrate with songs, prayers, something from their culture or faith, pictures, websites, or 'it's a boy/girl' gifts. Bring them back to their cards. "The cards you still have facing up are the things that are probably the most important to you for this birth and the things you may want to discuss with your doctor and your support team now, before your due date. Take a few minutes to take notes or take out your camera phones and take pictures."

After cleaning up the game, ask them how it felt to give up things. Feed off their responses. Instructors might discuss how hard it is to give up things their hearts are really set on. Conclude with "It is important to remember that labor does its own thing and no matter how well you plan, it is going to go differently than expected." Following closely with the next game about unexpected outcomes emphasizes the need for flexibility and to expect the unexpected.

Pass out the little diapers, one per couple or two per couple if it is a small class. Jokes about little diapers and the surprises they contain set this next activity up nicely! Give them the instructions: "Inside is something that maybe you might not be expecting for this birth. Take a couple of minutes and work with your partner. If this happened to you, how would you cope with it, what would you do?" Now go around and have each couple tell the class their unexpected outcome and what they would do if it happened to them. Give them lots of affirmation and encouragement. There are no "wrong answers" in this game! Add unexpected outcome cards to some of the diapers to help break up the tension. This is a difficult topic and having some comic relief really helps the game run smoothly and it is more fun too.

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Some suggestions for the cards:

* your partner is stuck in traffic and you are at the hospital,

* twins!

* Cesarean birth

* breastfeeding is more difficult than you thought

* the baby goes to the NICU

* vacuum-assisted birth

* pain medication is not available for use

* long labor

* you are on the way to the hospital and you think the baby is coming

* different gender than expected

A good mix of serious and light hearted cards will stimulate conversation and some laughter too.

Wrap up the activity by collecting the diapers and cards and reminding the participants to go with the flow, work together, and expect the unexpected. Integrating a labor rehearsal with a birth option game allows for a good combination of discussion, review, individual and group work, brings the entire course into focus, and makes it personal for each couple. Everything the participants have learned and seen now pertains directly to them; they can see their choices laid out in front of them and can now choose and decide what works best for them. The prenatal educator is in a unique position to promote self-esteem and feeling of empowerment in new families (Nolan, 1995) and the activity suggested in this article provides a concrete tool for achieving this goal.

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References

Ilse, S. (2009). Are unexpected outcomes in childbirth normal and should they be presented in all classes? International Journal of Childbirth Education, 24(4), 16-8.

Nolan, M. L. (1995). Empowering women through prenatal education: Question asking skills and role play. International Journal of Childbirth Education, 10(3), 4-7.

by Paula Conriquez, BS, ICCE

Paula Conriquez is an ICEA certified childbirth educator. She teaches at two Houston hospitals. She teaches childbirth, breastfeeding, newborn care and infant CPR. She has been teaching for seven years, has recently joined the lactation staff at one hospital and has three children of her own. She can be reached at learnbirth@yahoo.com.
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Author:Conriquez, Paula
Publication:International Journal of Childbirth Education
Geographic Code:1USA
Date:Nov 1, 2011
Words:1315
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