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Some Tricks of the Trade For Your Classes.

I have, over the years, come up with some ideas on how to really get the information out there in the childbirth classes that I teach. But I also try to get the information out there in a way that may be more memorable than just a lecture in the front of the room.

First, I try to not only give accurate statistical information, but also to show and explain how I have seen these facts play out in real births that I have attended. Telling a story or recounting an experience (without names) seems to bring it close to home for couples.

I remember attending my hospital sponsored childbirth class fourteen years ago, but I don't remember learning much. I am committed to teaching the women and their partners what to expect, sights, sounds, smells, and all.

In the class I attended, no one told me what a mucous plug looked like or even what is was. When mine came out, I had no idea what it was and rushed to my husband to show him and ask him what he thought it was. "Gasp," he said, "I don't know what it is, but you shouldn't flush it." I make sure I teach women what to expect so they know it is not only normal, but a sign that their cervix is ripening.

No one told me that after you enjoy your first bit of sleep on your tummy after you give birth, you can expect a gush or even a clot to come out when you get up after laying flat for a period of time. I remember looking into the toilet after I heard something plop and being very concerned about what just came out of me.

I say these things with a sense of humor. I was upset when I realized that the classes I attended didn't include the soup to nuts information that I wanted and needed.

It has been suggested to me, by another labor assistant and childbirth educator, that childbirth classes give too much information to women--that all the particulars about episiotomy, true medical need for inductions, vacuum extractors, internal monitors, and so on, serve only to frighten women and make them mistrust the process and almost doom them to those interventions.

I disagree. I talk about all the possibilities so that women truly can make informed decisions about whether to accept a suggested intervention. I don't believe talking about them makes them happen.

My goal is to give women the knowledge of when interventions are truly needed and when they are being offered to merely speed up the process for convenience or to meet some standard of progress. I believe it is with this information that women can make their own best choices, so that in the event that a woman's birth veers away from her birth plan, she can feel good about her birth no matter what interventions end up being needed. Women can feel satisfied because they know the interventions were truly needed for their birth to be safe and healthy, and they can feel proud of their birth experience. Hopefully, they won't feel like they or their body failed or feel that things were out of their control--as many women do who weren't given the information needed. It is to that end that I use some of the following tips to explain some of the procedures.

Addressing Tough Topics

When I speak of episiotomies, I examine the beliefs and information that many women are given in support of episiotomies: that cuts heal better than tears; that they hurt less; and that they are needed.

I explain that if a woman is going to tear, she will surely only tear as much as is needed to accommodate the baby she has grown. It is difficult to determine how large a cut is needed and, therefore, it is not always a small cut.

I also talk about the fact that cuts usually prompt an additional tear. I use the example of trying to tear a towel. It is very hard to do. But, make a tiny cut in the material of the towel and see how easily it then tears. Once the tissue is injured it tears more easily.

When I have someone who tells of a sister or friend who had a tear that hurt or didn't heal as well as a previous cut, I ask the question, "Was it the same practitioner that sutured both wounds?" The response is always "no." I suggest that perhaps it was the skill of the practitioner doing the suturing that made the difference in the pain and healing process.

I always recommend that they speak to their healthcare providers about their wishes. We also discuss, of course, that in the event of fetal distress, an episiotomy could help with a swifter delivery in order to assist the infant.

I also make reference to the chances of delivering over an intact perineum. I don't know the size of their baby, the position they will be in when they are pushing their baby out, or the techniques their practitioner will utilize in helping to prevent a tear. What I do know is, if they don't make their concerns known, their chances of receiving an episiotomy are pretty great.

In some areas as many as 85 percent of first time mothers get one. I suggest they think of it like the lottery. I ask "What are your chances of winning big? I don't know, but if you don't buy a ticket you won't have any chance." So I advise them to read about and do prenatal perineal massage, to try squatting during the second stage of labor, to try panting instead of giving that one huge push when they feel that sting of the baby's head crowning, and to talk to their healthcare provider about this important issue.

The Cookie Trick

Another trick I use is to bring a large plate of cookies to one of my classes. I fill half the plate with large delicious homemade cookies and the other half with the cheapest cookies I can find at the grocery. At the end of the class when I notice that all or most of the homemade cookies are gone and the store bought cookies are still there, I suggest that it is interesting that, when given the choice, they chose homemade over store bought. I ask what they think their infant would choose--homemade milk or store bought. I suggest that they consider breastfeeding their infants. This is just a little blurb at the end of one of the classes. In another session I go into great detail about the benefits of breastmilk and teach them about successful nursing.

A Basic Demonstration

Another topic that gets a lot of attention is circumcision. I make a chart of the believed pros and cons. I explain that the studies that showed uncircumcised boys having many more urinary tract infections than circumcised boys were flawed. The mothers of the uncircumcised boys were instructed to forcibly retract the foreskin on a daily basis to remove the adhesions of the foreskin. This is now believed to be the cause of the increased rate of infections.

Basically, many of the reasons for performing the procedure, such as increased risk of penile cancer or infections in uncircumcised boys, are as uncommon as some complications of the procedure, such as removing too much of the skin, uncontrollable bleeding, or infection. The reasons for and against cancel each other out. A local doctor I spoke with said that, statistically, 10 out of 100 babies will have a medical condition that requires circumcision. Do we want to circumcise 90 babies "just in case"? Why not address each infant individually?

While I have a video tape of an infant being circumcised, I find it too horrible for me to watch, so I choose not to show it to expectant couples. In place of showing the graphic tape, I perform a mock circumcision. I purchase a muffin with the wrapper baked onto it. I suggest that the muffin is a penis and just as the muffin wrapper attached to the muffin is not able to slide back and forth, neither is the foreskin of an infant. I explain how a surgical instrument is inserted into the opening at the end of the penis and pushed up to separate the foreskin from the penis. I do this with the muffin and wrapper. I show how the instrument is then swept around the penis (muffin) to separate the skin. I show the dorsal slit and then, with my fingers, show how the clamp is pushed down and clamped against the penis to apply pressure and help stop bleeding once the skin is removed. I indicate how the skin is removed and remove the muffin wrapper. I explain that the clamp is left on until the practitioner believes it is safe to take off.

I work very hard to be basic. I try not to use scary words like cut, crush, tear, or shove, and try to use terms that don't invoke horror. My purpose is not to scare them into not circumcising their sons. My intent is to give the information that I didn't have when I had my sons circumcised. Had I known the studies and statistics and known the way in which the procedure was done, I would have chosen to leave my sons intact. As with all other decisions about labor, delivery, birth, and parenting, knowledge is power. I want to give parents the knowledge and power to make the decisions that are best for them.

These are just a few of the ways in which I try to give the best class possible so that parents don't say later, "If I had only known."

Janice D. Mello, CCE, CLA
COPYRIGHT 2000 Association of Labor Assistants & Childbirth Educators
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Author:Mello, Janice S.
Publication:Special Delivery
Date:Sep 22, 2000
Words:1644
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