Childbirth Education

Instructional Material

I. QUESTIONS FOR CHILDBIRTH INSTRUCTORS OR TRAINEES:

Teaching classes in preparation for childbirth can be extremely challenging as well as rewarding. The childbirth instructor must have a vast amount of technical knowledge at her fingertips. But more importantly, she must have a basic insight and understanding of the needs of expectant parents.

People enrolled in childbirth classes often ask their teacher an amazing variety of questions. (Some of these listed here may seem outlandish, but believe me, I have drawn heavily on personal experience in compiling this!) Some questions are merely requests for information. Other questions may reflect underlying confusions, conflicts, or difficulties that this individual or couple may be experiencing. The instructor needs to be sensitive to this, and perhaps, if necessary, devote extra time to them outside of class.

Additionally, many of these questions could easily launch a half-hour or more dissertation. But remember, while teaching classes, your time is limited and you do have other material that must be covered. It is very easy to “go off onto tangents” during class discussion. The experienced instructor soon learns to direct class discussion “back to the main track” so that essential class instruction will not be neglected. The challenge presented here is not simply knowing the “correct” answers to each of these questions (with some of these, there may be no one “correct” answer!), but in knowing how to respond to each question within one or two minutes while satisfying the needs of the person who asked the question.

Suggestions for use: The individual childbirth instructor or trainee may simply wish to go over privately each suggested question and think out for herself how she would respond. These questions could also be used as the basis for a role-playing, group discussion session during a teacher-training workshop. Feedback from other instructors, and varying opinions as to how to respond to certain concerns can greatly enhance the individual teacher or trainees learning both of information and of dealing with people. The temptation often is to “dictate” to students the way you would personally choose if you were in the same situation, i.e. “NO! You shouldn’t give the baby any bottles at all!!” The much greater challenge is to listen to their needs, ask them to respond with their own feelings, and lead them to doing their own thinking. Your own viewpoint is much less “threatening” when presented as “If it were me, I would…” Rather than, “You should…” However, sometimes when what they have in mind is actually medically dangerous, such as gaining hardly any weight during pregnancy, then it may be necessary to take a strong stand in that area.

Also it is important that the childbirth instructor be careful about answering questions of a medical nature, so that it does not become construed as giving medical advice, especially if you are not a medical professional or are not that person’s birth attendant. Know what types of questions you are not qualified to answer, and know when certain questions should be referred to that person’s doctor or birth attendant.

Sometimes questions will be asked to which you will simply not know the answer. Rather than “faking” an answer, you are better off honestly telling your students that you do not know, but will research the question for them in an attempt to find the answer as soon as possible.

Frequently in actual class situations, other students will “chime in” with their advice, experiences, opinions, etc. Sometimes their input can be extremely helpful. Also sometimes the instructor may feel somewhat restricted about saying what she thinks because in her official position she must be “professional” and tactful of others, and may not have the freedom to be outspoken on certain issues. Sometimes others, in their “unofficial” position may say things that you wish you could say. Other times, input from other students can be unhelpful, presenting true misinformation or intimidating the person asking the question. In situations like this the instructor is particularly challenged with intervening in an uncomfortable situation.

A few of these questions pertain directly to the use of the Lamaze method. If you are an instructor for another method, you probably will wish to skip these.

You may perhaps be able to think of other questions and concerns that you could add to this list and use in your own group discussions.

The following are questions and/or concerns that expectant parents may present in childbirth education classes:

1. What is a Braxton-Hicks contraction?

2. What is the difference between the Lamaze and Bradley techniques?

3. What is a placenta? What does it do? What is it like?

4. How will I know if I’m really in labor?

5. What do you mean “getting on top of the contraction?” (A common expression used to describe use of Lamaze techniques.)

6. What is the “big deal” about giving birth without medication? What’s wrong with taking medication during labor or delivery if you feel like it?

7. Can you know in advance whether or not you will need a Caesarian?

8. Why should I nurse my baby right away when the milk won’t be there for two or three days?

9. I want to nurse the baby, but I want my husband to give the baby a bottle too. Can’t I just do both?

10. How will I know when I need to push? What is second stage like?

11. My mother is going to take our child, age 2, when I go to the hospital, and keep her for the first two weeks, before bringing her home, so I can get lots of rest when I am first home with the new baby! (Comment on this and give your advice.)

12. My aunt told me that it’s a good idea to gain hardly any weight during pregnancy, and then you’ll have a small baby and therefore an easier labor! (Comment and give your advice.)

13. My doctor told me I might need a Caesarian. What’s the point of taking these classes then?

14. You mentioned “membranes rupturing.” What are these “membranes” that you’re talking about?

15. You told us we should feed the baby whenever it’s hungry, especially if you’re breastfeeding. My mother told me that you should make the baby stick to a schedule or you’ll spoil him. I don’t know which to believe.

16. What’s the big deal about having a Caesarian? Wouldn’t that just be an easier way to do it? Then you wouldn’t have to go through labor.

17. I don’t want an episiotomy. What can I do to keep from having one?

18. Some of these women are wanting to deliver in the hospital “birth room.” What’s the big deal about not going into the delivery room? What difference does it make at that point?

19. You said that it is dangerous for a pregnant woman to smoke. I smoke and my first baby is healthy and normal. I don’t think I believe what you say! (Comment and give your advice.)

20. Our first baby was stillborn. Now that I’m expecting again, I’m worried all the time that something might go wrong. I don’t feel good about this pregnancy. (How would you help her?)

21.1 don’t want any ‘traumatic’ procedures done to my baby I don’t want silver nitrate, circumcision, the baby taken away to the nursery, etc. What can I do to make sure they don’t do all these things to my baby?

22. I’m having a lot of heartburn. What causes that? What can I do about it?

23. I’m having a lot of backaches. What causes it? What can I do about it?

24. I’m having problems with insomnia. I just can’t find a comfortable sleeping position. What can I do?

25. I had a very bad led cramp last night. What causes that? Is it dangerous? What can I do to prevent it from happening again?

26. The last time I went to the bathroom there was some blood coming from my vagina. Is this anything to worry about?

27. I’ve decided that breastfeeding is not for me. What kind of formula do you recommend? What can you tell me about bottle feeding?

28. I have a problem with varicose veins. What can I do about it?

29. You told us that it’s important to eat plenty of nourishing food. But I’m hardly ever hungry any more. I eat a little bit and then I feel full. What should I do?

30. My feet and ankles have seemed a little bit puffy lately. Is this anything to worry about?

31. Why do you need this special breathing for labor? If you just relax and feel good about yourself when you’re in labor won’t everything go just fine? Doesn’t all this weird breathing seem kind of artificial?

32. Once in a while I feel little shooting twinges of pain in my lower abdomen area. What is this?

33. Is it dangerous to make love during the last few weeks of pregnancy?

34. How soon can you go back to having sex after the baby is born?

35. Is it true that you can’t get pregnant as long as you’re breastfeeding?

36. Don’t breasts full of milk make for a “turn off” during lovemaking?

37. How will I know when it is the right time to go to the hospital? (Or birth center, or call my home birth attendant?)

38. If you don’t have an episiotomy, won’t your vagina be all stretched out of shape from giving birth?

39. Whenever I practice “hee-hee” (or Lamaze “fast pant”) breathing, I feel like I just can’t get my breath. Am I doing it wrong? How can you help me with this?

40. I will have to go back to work when the baby is six weeks old. Is it worth it to even try to breastfeed, when I’ll just have to wean as soon as I go back to work?

41. If the baby doesn’t breathe or eat before it’s born, how does it get food or oxygen?

42. This is my first pregnancy. I don’t understand what you mean by labor contractions. What is a labor contraction really like?

43. I’ve heard that once your water breaks you shouldn’t get up and walk around. Why would this be dangerous?

44. My mother told me about the “labor pains” she had when she had her babies. I haven’t heard you mention this. What does labor “pains” mean?

45. I want to breastfeed, but my friend tried to nurse her baby and she just didn’t have any milk. How will I know if I’m going to have enough milk?

46. What do the doctor or nurse feel when they do an internal pelvic exam? What are they checking? Why do they have to do this?

47. How can you tell what position your baby is in?

48. How did Lamaze childbirth (or Bradley, natural childbirth, or whatever you teach) get started?

49. My doctor said I had “good pelvic dimensions” when he first examined me. What does he mean by this? How can he tell?

50. Twins run in my family. How can you tell whether or not you’re having twins?

51. Can you still have a natural birth if you’re having twins?

52. Why is a twin pregnancy often more likely to be complicated?

53. Why is a breech birth more dangerous than a head down birth?

54. My friend had a Caesarian because her baby was too big for her pelvis. How can you know in advance whether or not your pelvis will be big enough?

55. How is a Caesarian different from a vaginal birth? What are some things to expect if you have a Caesarian birth?

56. Which kind of diaper is better—disposable or cloth?

57. Is it a good idea to give your baby a pacifier?

58. When should I start my baby on solid foods? Which foods first?

59. What kind of baby food should I buy for my baby?

60. My aunt wants to come and stay with us to help out after the baby is born. I don’t get along with her and would rather she not be here. What should I do?

61. What do you do if your baby needs to nurse and you’re out in public somewhere?

62. How do you pump your breasts so you can save your own milk for the baby in case you have to be gone?

63. I don’t see anything wrong with the hospital. Why do some people want to have their babies at the birth center or at home instead?

64. My friend had to go back to the hospital a few days after she was home because she started bleeding too much. What makes this happen? How can you prevent this?

65. I’m getting stretch marks!! What causes them? How can I get rid of them?

66. What kind of vitamins should I take when I’m pregnant?

67. Does it harm the baby if you smoke grass (marijuana) when you’re pregnant?

68. I’m a vegetarian and don’t eat any animal products. How can I be sure I’m getting enough protein during pregnancy?

69. I’ve heard it’s the law that your baby has to have the routine immunizations. It seems like such an unnatural thing to do. I’m not sure if I want this done to my baby. What should I do? What is your opinion?

70. I used to have a good figure and I’ve gained a lot of weight during pregnancy. How can I get my figure back after the baby is born?

71. What do they do when they circumcise a baby? What do they cut? Does it hurt them? Do you have to have it done?

72. If you don’t have your baby boy circumcised, won’t the other kids make fun of him? Won’t he feel ‘different’ from all his friends?

73. Why do they attach the heart monitor electrodes to the baby’s head during labor? Doesn’t that hurt the baby? What are the advantages and disadvantages of doing this?

74. I’m going to nurse my baby for nine months. Then we’re going to go on vacation for a month and leave her here with my mother. How do I wean her when it’s time to?

75. I’m scared to death! I’m just terrified of going through labor and having the baby! Can you help me?

76. What do you mean when you say “amniotic fluid?”

77. Why do they do a pubic shave? Is it a good idea?

78. Why do they give you an enema? Is this something I should ask not to have?

79. I’m delivering at the birth center, (at home, or in the hospital birth room). What is the best position to deliver in?

80. My friend had an I.V. when she was in labor. Why do they do this? What is it for? Should I have one too?

81. My mother told me I should stay in the hospital for four or five days so I could really get my rest. You mentioned going home right away. What’s the best thing to do?

82. What is the “Leboyer method” everyone is talking about?

83. My friend had to be X-rayed when she was in labor. Won’t X-rays harm the baby?

84. My doctor says I will have to have an ultra-sound test. What is that? What does it do? Is it dangerous?

85. What is the PKU test all about? When should it be done? Doesn’t it hurt the baby? Does it have to be done?

86. What is the doctor doing when he puts that “ice tongs” type device over your tummy?

87. I’ve had a baby before so I know it hurts. But I don’t understand how this breathing and relaxing is going to make any difference.

88. Why are premature babies in more danger than full term babies? Why are preemies kept in just a diaper when the full term babies are bundled up?

II. REVIEW QUESTIONS FOR STUDENTS TAKING PRENATAL CLASSES:

The following questions can be written on separate slips of paper and passed around to students, or the instructor may wish to simply read each question to one student at a time. This exercise should be done at about the 3rd or 4th class, after these basic concepts have been covered in class and/or handed out in written material.

The questions should not be intended to put anyone “on the spot.” They are simply to help insure that the basic facts have been learned. If the student who is given a specific question does not know the answer, ask anyone in the rest of the class to volunteer the correct answer. If no one knows it, then that information should be gone over and made clear for everyone.

As a childbirth instructor you may wish to add other questions of your own that specifically reflect your class material.

1. How often should you practice the exercises, relaxation, and breathing techniques learned in childbirth classes? (If possible every day. If not every day, as often as you can.)

2. How many times a day should you do the Kegel exercise? (Up to 250 times per day, – 10 times of 25 each – advice on this seems to vary.)

3. Name the three different ways that labor can begin. (Water breaking; loss of mucus plug with “bloody show”; or regular rhythmic contractions.)

4. Before labor does begin, what are several other signs that indicate that labor is about to begin? (Hyper- or hypo-activity, diarrhea, lack of appetite, backache, heaviness of lower pelvic area, frequency of urination, “menstrual” type feeling, insomnia, Braxton-Hicks contractions.)

5. Name several things you should do and not do during early labor. (You should eat lightly, rest, sleep if possible, bathe or shower, do little tasks, relaxation, slow deep breathing if needed. You should not do anything strenuous or tiring – vacuuming, shopping, etc.)

6. What should you do if your water breaks first? (Call your doctor or birth attendant immediately, put a large clean towel between your legs, stay off your feet as much as possible.)

7. When should you begin using your slow deep breathing and other techniques for prepared childbirth? (Probably once you get well into early labor or begin “established” labor. When you feel that you need it and when the contractions have become strong enough that you are not comfortable without using them.)

8. What is back labor? (The type of labor that involves a great deal of pressure and discomfort in the lower back region.)

9. What causes back labor? (Usually this is caused by the baby being in a position so that the back of its head is pressing against the mother’s tailbone, commonly called “posterior” presentation.)

10. Name several things to do for back labor. (Side relaxation position, counter pressure on lower back by labor coach, hands and knees position, walking around, sitting up on edge of bed and leaning over, hot and/or cold compresses.)

11. What is transition? (The final stage of active labor before the actual pushing stage begins. Usually involves dilation from around 7-8 to 10 cm.)

12. What are several signs of transition? (Nausea, vomiting, hot and/or cold flashes, discouragement, contractions very close together and longer than 60 seconds, contractions having more than one peak, “whirlpool” sensation, premature urge to push.)

13. What are some helpful techniques for dealing with transition? (Pant – or “Hee”‘ blowing, rapid pant, or rapid deep breathing — individual techniques vary considerably with different classes. Direct face to face labor coaching, reassuring her, taking one contraction at a time.)

14. What are the meanings of the terms “first stage”, “second stage”, and “third stage” of labor? (First stage – dilation from 0 – 10 cm; Second stage – pushing the baby out; Third stage – birth of the placenta.)

15. What should you do when you first feel the urge to push? (Call for the nurse, doctor, or birth attendant to examine you internally to see how far dilated you are. If you are on your own – overcome pushing for as long as possible.)

16. If you have the urge to push and are not yet fully dilated, what should you do? (Techniques vary widely in different childbirth classes: Light blowing, pant-blow, or “hee – blow”, rapid deep breathing, or whatever you’ve been trained in as a technique to overcome pushing.)

17. Why is it important not to push until you are fully dilated? (Premature pushing usually hurts, while pushing when you are ready usually feels “right.” Pushing against a cervix that is not quite fully dilated can cause it to swell and thus slow down the course of labor.)

18. Why are the exercises such as deep knee bends, pulling knees apart, squatting, etc. important? (In order to push the baby out more effectively, it is important to strengthen and stretch the pelvic area and perineum, and be able to pull the legs as far apart as possible.)

19. Why is relaxation important during labor? (To deal with the contractions most effectively, because fear can slow down the course of labor. Also conservation of oxygen: When muscles are tensed, this requires oxygen, and can draw oxygen away from the contracting uterus, thus making labor longer, more uncomfortable and less efficient.)

20. When you finish pushing during a contraction, you should exhale and ease yourself back down slowly, rather than falling back suddenly. Why? (If you fall back suddenly, the baby will slide back up the birth canal, while if you ease down slowly the baby is more likely to stay down where you have pushed it. Thus the progress of second stage will be somewhat faster.)

21. What are the symptoms of hyperventilation, and what should you do if this happens? (One’s hands and feet feel “tingly.” If hyperventilation is continued it may result in unconsciousness. To remedy, breathe into cupped hands or paper bag to re-breathe one’s own carbon dioxide and restore oxygen-carbon dioxide balance.)

III. HYPOTHETICAL SITUATIONS — TO BE GIVEN TO STUDENTS DURING PRENATAL CLASSES:

The following are a number of possible situations that can occur either during very late pregnancy, during actual labor and birth, or during the first few days after the baby is born. Some are designed for mothers. Others are designed for the husband or labor coach.

The childbirth instructor may wish to type or write out each situation on separate slips of paper and then pass them out to students, or she may wish to simply read a posed situation to each student at a time. This exercise should be done during one of the later classes in a prenatal class series, after the couples have learned and discussed several areas of late pregnancy, birth, and the new baby.

There are no “right or wrong” responses to each situation. Each student must simply tell how he or she would handle each event. Some of these will produce a lot of laughs! Often other students in class will contribute their own ideas. If the student is “way off base” in their answer the teacher should attempt to steer them towards other possibilities, perhaps by saying “Another thing you might consider doing is . . .”

As a childbirth instructor you may wish to think up other situations, perhaps that apply more directly to your own class and/or local birthing practices:

FOR HUSBANDS OR LABOR COACHES:

1. She is having the urge to push. She is not quite fully dilated yet and has been instructed not to push. She is trying to use her breathing techniques that she has learned to keep from pushing but is still pushing some anyway.

2. The baby was born two days ago and now she and the baby are home. The doctor or birth attendant has advised that she do no housework or other strenuous activity for at least two weeks. She decides that the floor is a mess and starts running the vacuum cleaner.

3. She is having regular contractions. She has not yet reached the point that she needs to use any breathing or other prepared childbirth techniques that she learned in class. You both suspect that she is in early labor. Since there are few groceries in the house, she wants to go grocery shopping.

4. You both decide that it is time to leave for the hospital or birth center since her contractions are 5 minutes apart. After getting everything ready and leaving, the contractions stop.

5. She is in labor and things are going rather slowly. The doctor comes in, checks her, and says she might need a Caesarian. She panics!

6. She has made an agreement with her doctor that the fetal heart monitor will not be used unless it is absolutely necessary. Upon arriving at the hospital, a nurse is trying to attach the fetal heart monitor, insisting that it is always used on all mothers in labor. Your wife/partner is getting very upset!

7. The baby was born just a few days ago and all has been going well. Suddenly your wife/partner starts crying uncontrollably because she cannot get back into her regular clothes!

8. She is well into labor and has been doing well with breathing, relaxing, and handling the contractions. The last time she was examined she was dilated to 7 cm. Suddenly she becomes very discouraged, says that she cannot take it any more, and is telling you to go away and leave her alone!

9. She has been in labor for many hours and things have gone very slowly. She has done a good job with breathing, relaxing, and dealing with the contractions, but by now she is becoming very tired and discouraged. You are in the hospital now and the doctor starts a Pitocin-drip I.V. to induce labor. The induced labor contractions are very hard and fast and she is having a great deal of difficulty dealing with them.

10. The baby is due two weeks after Thanksgiving, although the doctor/birth attendant has said that it might come early. Your wife/partner wants to put on a big Thanksgiving dinner in your homes inviting all the relatives.

11. She has reached second stage and it is taking quite a bit of pushing to get the baby born. After pushing for more than a half an hour, she says that she is just too exhausted and simply cannot do any more pushing!

12. Your wife/partner is well into labor and has been having strong contractions for several hours. She has been doing very well with natural childbirth techniques, but now she says that she just can’t do it any more. She says that she does not believe that natural childbirth works and she wants to take medication.

13. The baby is one week old. Your wife/partner is breastfeeding, so you feel that there is little that you can do for the baby. All the excitement of giving birth has started to die off. You feel tired because the baby cries a lot during the night. Your wife/partner’s attention all seems to be focused on the baby. You are feeling resentment because no one has given you any attention or concern through all this and you feel guilty because you resent having the baby at all.

FOR MOTHERS:

1. It is getting close to your due date. you wake up at 3 a m to use the bathroom and pass some bloody mucus. You feel very heavy in the lower pelvic area but are having no contractions. You are unable to get back to sleep.

2. You are in the labor room in the hospital, or in one of the rooms at the birth center. Another mother in labor is admitted into the room next to yours. She is screaming, groaning, and being very noisy and complainy with her contractions. This is interfering with your ability to concentrate, relax, and deal with your labor.

3. You are in the middle of the grocery store when your water suddenly breaks!

4. You have made plans to have the baby at home and will be giving birth any day now. Your neighbor who had all of her babies in the hospital cannot understand why anyone would have her baby at home She starts telling you about all the dangerous things that can happen during birth, and is filling you with a lot of fear and guilt.

5. Your labor has progressed more quickly than you had expected Your husband or partner is on his way home and you are in transition and are having to push. It is inevitable that the baby will be born before you can get to the hospital or birth center, or get your home birth attendant to come to you.

6. You have been in early labor since 4 a.m. The contractions are regular, but not very strong yet. It is now 8 a.m. and the rest of the family is eating breakfast. You do not feel very hungry.

7. You have done well throughout labor at home, but by the time you reach the hospital or birth center you are in transition. The contractions are coming very fast and you are having a very challenging time staying in control. People are asking you questions and insisting on admittance procedures (blood pressure, prep, etc.). You are finding it extremely difficult to deal with all this and stay in control of your contractions.

8. The baby is brought to you for the first time to nurse (or take the bottle). The baby is awake, but not interested in eating.

9. The baby was born two weeks ago. you are still adjusting to breastfeeding. The baby is not on a schedule and is waking during the night. Your neighbor who bottle fed her baby is trying to get you to give up this “nonsense” because formula and schedules are “easier.?’

10. The baby was born just a few days ago. You are still very tired from giving birth and adjusting to the new baby. Your aunt calls and wants to bring several relatives over to see the baby and visit.

11. You have decided that breastfeeding is not for you and you are more comfortable with bottle-feeding. The baby is a few days old. Your neighbor who breastfed her baby comes over and is acting very disdainful. She tells you that “Any mother who really loves her baby would breastfeed!”

12. The baby is one week old. you are very happy about giving birth and are enjoying the baby, but are still feeling tired and sore. Your husband/partner is feeling depressed, complaining that he feels left out, no one is paying attention to his needs.

13. You are in the hospital in labor. One of the nurses is being very critical of your choice of natural childbirth, contradicting things that you are saying, and being generally unhelpful.

14. You are in labor and will be having a home birth. One of your friends that you’ve invited is being complainy, disturbing you, and saying things that you don’t like. You are wishing that you hadn’t invited her.

By Rosemary Romberg

c. February 1982 (Updated for website – 2000)

(Revised – 2013)

Baby with rattle


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