Officially a Lamaze Certified Childbirth Educator

It is official - I passed my Lamaze exam and am now a certified childbirth educator!

I wrote a couple of months ago about why I did my training in Lamaze, before I had completed my requirements. Because I had to wait from my training course in October to my exam in April (the exam is only offered twice a year), the process took me exactly that length of time (plus waiting for exam results)! I was able to teach a childbirth education course to be "signed" off on and register and take the exam in the time in between. If you are interested in becoming an LCCE and are already in the birth world, I think you could also do it in this time frame. I will point out, however, that if you do not "keep up" with at least the last couple of years' worth of birth/breastfeeding research and recommendations, you might have trouble. 

The Exam

To prepare for the exam I read the enormous study guide, which I did not think was a very user-friendly review source. It spends much of the time referring you to outside sources. This is great as far as providing resources goes, but when I want to sit down and study for something, I don't want to have to go searching all around. I appreciated that each section had a "Review Questions" page, which I think actually helped me understand the Lamaze thought-process better than reading the study guide. I like the articles that were actually included in the study guide document, but skipped most of them unless they were Lamaze-specific and I wanted to get an idea for what their angle was. This turned out to be a good idea, because most of the questions on the exam asked extremely vague questions (e.g. "choose the best answer") rather than clear-cut fact-based questions. It is a good idea to get a feel for how Lamaze would like you to answer.

Teaching

One of the up-sides, or down-sides, of Lamaze is that I get to create my own curriculum. I do not have to follow a particular work book or a set of rules. I am encouraged to base the curriculum on the 6 healthy birth practices, which I would do anyway (because they are great!), but other than that, I can choose my own books, worksheets, posters, and other teaching tools/resources. This is a pro because I am not limited, but a con because that means I have to come up with what I want to use! I am still experimenting, and haven't fully decided on what tools I think most essential. I am doing it on the cheap, at the moment, before I decide to invest in expensive DVDs, posters, pelvises, dolls, etc. Any recommendations or product reviews would be greatly appreciated!

Lamaze does offer the purchase of a pre-made slide set, but I don't see myself teaching with slides, and I know that it is a product I could probably make on my own (minus some shiny photos). For someone who is starting from scratch, though, I bet this would be a really useful tool. 

I am excited to join the a community that I feel is respected, focused on evidence-based medicine, and well-known. 

I am a Lamaze Childbirth Educator

It's been 5 years since I did my doula training and attended my first birth, and I am finally officially adding a new service to my birth professional repertoire -- childbirth education!

I attended a Lamaze childbirth educator training a few months ago so that I can work toward becoming Lamaze certified. I have been wanting to become a childbirth educator for some time, but knew I wanted to do certify with Lamaze. Why Lamaze? Because I consider them the most in touch with birth-related research and evidence-based recommendations. I love their blog Science and Sensibility and that they have their own peer-reviewed Journal of Perinatal Education.

Lamaze isn't "all about the breathing," which is what many people who knew of Lamaze in the 20th century think of. It has come a long way to be a leading International professional organization.


Tonight I officially teach my first course as a childbirth educator (rather than "just" a doula)! The responsibility is almost greater, in a way, than my usual doula prenatal visits. At those visits we can talk about anything - what I think of, what the client thinks of - and I don't have the responsibility of being the font of all their knowledge. I can assume or hope that they have read books or been to a childbirth education class already and I can just fill in the gaps or reassure. But, as childbirth educator, I am presumably the first point of contact and information with the birth world. I have the responsibility to not forget to tell them something, and to tell them everything in the right way (don't want to freak anyone out)!

My favorite aspect of the Lamaze approach are the 6 Healthy Birth Practices. If you visit their website, you can watch easy-to-digest videos on each birth practice, or read each practice's paper, which includes the research-based for every recommendation. All of this is available here: http://www.lamazeinternational.org/HealthyBirthPractices

My scholarly heart rejoices at how evidence-based it all is!

They recently created an infographic and accompanying infographic video that outlines the Healthy Birth Practices in a simple way. They are also slowly releasing infographics for each of the individual steps. Learn more below!

6 Simple Steps to a Safe and Healthy Birth

click to enlarge

Anyone else out there Lamaze certified? 

Turns out there is only one other Lamaze-certified childbirth educator (LCCE) in my area. ONE! I hope that I can fill a need. I wasn't able to attend a training as soon as I had wanted, because there are no Lamaze trainers in my state. I'm not sure why they aren't as popular here. 

Just as an aside, I actually thought that my Lamaze seminar was kind of a waste of time. I already knew all of the content, and was hoping to learn more about teaching methods than I dd (since I'm new to teaching). It was a requirement for those of us who haven't taught childbirth education before  and want to take the certification exam sooner than we can teach 60 hours of CBE. You can get around it if you are a CBE that has taught 60 hours in in the 3 years prior to taking the Lamaze exam. The seminar would be valuable for someone very new to birth stuff. I think it was valuable for the L&D nurses who were in the training with me, too. But I learned nothing new. (But I keep up with things more than most!)

Wish me luck! :)

Preconception Health Interviews

Dr. Michael Lu, associate professor of obstetrics & gynecology and public health at UCLA,was interviewed over several parts on Science and Sensibility: Preconception and Women’s Healthcare: An Interview with Dr. Michael Lu 

I've included some great segments of the posts below. If you are a maternal and child health scholar, I encourage you to read the posts in-depth!

Part One: Preconception Care

Allen Rosenfield probably 30 years ago asked the question, “Where is the ‘M’ in MCH?” Where’s the “mother” in maternal and child health programs–because much of MCH has focused on children’s health and much less on maternal health.  I think the question we’re asking today is where’s the ‘W’ in MCH—where’s the woman in maternal and children’s health?  If we really want to improve maternal and child health in this country, we really have to start by improving women’s health.

I think it’s pretty much in alignment with what you’re saying; it’s not just about childbirth.  If the natural childbirth movement is all about natural childbirth, it doesn’t have the kind of impact that it could have. The focus should really be on promoting women’s health over their life course continuum and how we would be a better society for doing that.

Part Two: Working Smarter - Prenatal Care 2.0

All of the things we’ve been learning about the fetal origins of health –the importance of nutrition, mental health, environmental exposures in developmental and fetal programming, how much of that counseling do you think is actually going on in OB’s office?  And remember most of these OB’s didn’t sign up to be a health educator, to be a nutritional counselor, to be a teratogen information specialist, to do all the things that we know are important in terms of really promoting maternal and infant health.

The public health response over the last couple of decades has been if the OB’s aren’t doing all those things, then let’s create these “wrap-around services”– some kind of the enhanced prenatal care model: I call it the prenatal care 2.0 system.

Part Three: Prenatal Preparedness and Childbirth Educators

Given the current constraints I think childbirth educators could try to really expand the content of their education into, not only the immediate postpartum, but also the inter-conception.  And if you think about it, for women that are going to have more babies, the postpartum care is really preconception [care] for the next.  I think it would be a good first step.  I think most health educators actually do a pretty good job in terms of talking about breast feeding.  I don’t think they do as good a job talking about family planning, at least I think its variable.  I don’t think they talk very much about postpartum weight retention, nutrition, physical activities.  So we know that both gestational weight gain as well as postpartum weight retention are main drivers of the obesity epidemic that’s going on in this country.  What are childbirth educators doing about that. 

We’re talking about baby-friendly hospitals.  What would a father-friendly hospital look like?  What would father-friendly prenatal care look like?   I think dads are changing.  There are a lot of dads that really want to be involved but aren’t very well supported to get involved.  What’s the role of the childbirth educator in terms of involving dads?  There are things both during childbirth as well as after the baby’s born in which dads can play a very important role.  But I think like most obstetricians, most childbirth education really doesn’t focus that much on dad’s role in all of this.

Part Four: Sacred Trust

It’s a system flaw.  It’s not just about asking the individual OB to work harder, but it’s asking the system to work smarter.  So this is where the teamwork approach actually comes into play.  I think doulas are much better trained in terms of providing support during labor than obstetricians are.  Most of us didn’t sign up to stay by the bed side.  We signed up for obstetrics.  You know that obstetrics is actually a surgical specialty? OBs are trained to screen for disease, to treat complications, etc.  They’re not really trained to provide nurture and support.

Part Five: Racial Gaps, Future Research

What’s the impact of the Medicaid Reform going to be on infant mortality and on the racial gap of infant and maternal mortality?  There’s very little discussion about that.  I’m all for Health Care Reform, but it’s really just health insurance reform.   Instead, let’s think through what are the components of care that really optimize women’s health, and make sure there is equal access to those components for African American women.

Excellent Links!

Circumcision and Nursing School

The Navelgazing Midwife responds to an inquiry encouraging open-mindedness. I particularly wanted to share this quote:
"I used to be quite the breastfeeding nazi, really believing ALL women could breastfeed and the ones that said they couldn't really weren't trying hard enough. When I had a client tell me she wasn't going to nurse about 20 times and I kept telling her how great it was and how if she just tried, she'd find out how much she'd like it. She finally leaned over and got in my face, telling me she'd been molested and the primary part of her body molested was her breasts and she was going to bottle feed. It was then I realized, not only is breastfeeding a woman's choice, but that sometimes, the most empowering thing a woman can do for herself is to schedule a cesarean/bottle feed/have general anesthesia/etc. Things I wouldn't remotely consider can be the most empowering to a mom."

Elevating The Natural Vs. Epidural Conversation: An Interview With Erica Lyon

Excellent interview with a childbirth educator with some really interesting answers to questions like, "What are some of the biggest misconceptions among your students about what will happen in childbirth?":
"That it will be short, that tearing is the worst thing ever, that husbands/partners will be grossed out or turned off or useless, that the epidural makes it totally a pain free experience, that providers who are dismissive and brief are the standard (and that they won’t be like that in labor), that this is the worst pain one will ever feel, that she will be in control during the labor."

Get a peek into the high-rollin' life of a WIC peer counselor

on Public Health Doula's Blog. I really liked the post that she sets up and links to on the Leaky Boob - take a look at what the life of a WIC breastfeeding peer counselor is like! 

A Look at the Research: The Link Between Epidural Analgesia and Breastfeeding

This post on Science and Sensibility blog takes a look at the research to help us figure out if there is a link between epidurals and breastfeeding and what it might be. I find it interesting because it takes other factors into account as well.

No Ingles? C-Section for You!

Sad, but true: Many Spanish speakers are not receiving appropriate maternity care. "Surely in the United States of America they are getting the best health care in the world, right?  Frankly, I believe they are taken advantage of by a system -- doctors, nurses, hospitals -- that don't want to deal with them.  They know that these women and families are often scared, and frankly, trust the doctors to take care of them to do what is best for them.  I think they are being scammed."

5 Reasons Not to Take Hospital Childbirth Classes (Or How to Find the Best Hospital Childbirth Class)

Many couples take their hospitals childbirth education course because it is short and convenient. There are a lot of downsides to taking a class through your hospital, though, and I frequently recommend that couples take one outside of their hospital. Here are some reasons why. 

Yale Researchers Pinpoint Reasons for Dramatic Rise in C-Sections

"In one of the first studies to examine the reasons for the rising number of women delivering their babies by cesarean section, Yale School of Medicine researchers found that while half of the increase was attributable to a rise in repeat cesarean delivery in women with a prior cesarean birth, an equal proportion was due to a rise in first time cesarean delivery."

How safe is your medication for breastfeeding? New LactMed app!

An app for your phone that tells you if a medication is safe with breastfeeding! This is really great, as many doctors just don't know if a medication should not be taken while breastfeeding, and therefore tell women to stop breastfeeding (when they might not have to!)

Study Finds that Women Show a Shocking Lack of Knowledge about Childbirth

I was going to simply share this article on my facebook page, like I do a lot, but I couldn't think of what to write in the description as a good summary of the article to compel readers to click on it. I realized, as I scanned for a good quote, that so much information in the article was worth sharing, that I should just share the whole article here on my blog. Please read!

Pregnant women show an amazing lack of knowledge about childbirth options, study shows

By Shari Roan, Los Angeles Times

Fewer pregnant women and their partners are attending prenatal education classes these days and appear to be quietly following whatever advice the doctor or midwife recommends, researchers said Monday.

Doctors, led by Dr. Michael Klein of the Child & Family Research Institute and University of British Columbia, surveyed 1,318 healthy pregnant women. They found many seemingly unprepared to make their own decisions regarding childbirth options, such as whether to have natural childbirth or a Cesarean section.

Fewer than 30% of the women, all first-time mothers, said they had attended prenatal childbirth classes. Many said they used the Internet or books to become informed about childbirth. Still, a shockingly high number could not answer basic questions regarding the pros, cons or safety issues associated with epidurals, episiotomies, Cesareans and other childbirth options. The women who were receiving obstetrical care from midwives tended to be more informed about their options compared with women receiving care from a medical doctor.

"[E]ven late in pregnancy, many women reported uncertainty about benefits and risks of common procedures used in childbirth," Klein said in a news release. "This is worrisome because a lack of knowledge affects their ability to engage in informed discussions with their caregivers."

The study was published in the June issue of Journal of Obstetrics and Gynaecology Canada.

The type of provider mattered greatly in terms of what kind of care women received. The researchers published a related study in May in the journal Birth that showed younger obstetricians were much more likely to favor the routine use of epidurals and expressed more concerns about the safety of vaginal birth compared with older obstetricians. The younger obstetricians seemed to view C-sections as the preferred option for childbirth, the authors noted. In the United States, efforts have begun to reduce C-section rates. About one-third of all U.S. women have a surgical birth.

This is shocking and yet seems accurate. Women turn their decisions over to their doctor, but don't realize that their doctor is not explaining all their options and providing informed consent/refusal information. DON'T BE PASSIVE! Take charge of your health care!

Don't just rely on the internet, or assume you'll have time to read all those books. There is no substitute for a prenatal childbirth education class, or any in-person education, for that matter, such as breastfeeding. 

And this was a subtle point that I hope you noticed - if you want more information about your pregnancy and childbirth options, hire a midwife!

(the study abstract, in case you are interested, can be found here: http://www.sogc.org/jogc/abstracts/201106_Obstetrics_5.pdf)

Informed Choice and the BRAIN Acronym

I vary my prenatal visit topics depending on my client's experience and knowledge, but one of the things I talk about with every doula client is Informed Choice and Informed Consent. Specifically, we discuss what it will be like to exercise their right to informed choice during the sometimes highly emotional experience of pregnancy and childbirth in a medicalized setting where informed consent is not always practiced (sad, but true).  An excellent tool to use to talk about this topic and help clients see what this looks like, especially during labor, is the BRAIN acronym. 

Use Your BRAIN! 

In most instances, there is time to discuss every treatment or procedure with the care provider. This includes the nurses, too, not just the doctor or midwife. The reason this is a great tool is because everything that happens to a patient should include an informed choice, which includes both the option of informed consent and informed refusal. Yes, the doctor has been to medical school, but that doesn't mean that everything she says or proscribes is based on scientific evidence, or that it is your only option.

Benefits - What are the benefits of this procedure? How will this help me/my baby/my labor?

Risks - What are the risks of this procedure? How might this negatively affect me/baby/labor?

Alternatives - Are there alternatives to this procedure? Are there other options?

Intuition - What is my gut feeling about this?

Need Time, or Nothing - Can I delay this procedure and take some time to think about it/Discuss it with my partner? What will happen if I choose to do nothing for now?

The BRAIN acronym and Informed Consent exercise may seem obvious, but for many people, especially pregnant and laboring women, it doesn't always occur. Many people don't realize that they have the right to ask these questions or even to refuse certain procedures when they are being told they "have" to by a physician with authoritative knowledge. There is a social power play going on, and it is going on while a woman is nervous for her and her baby's health.

I recently had a client use the BRAIN acronym for informed consent/refusal that I had taught her and her partner! Her doctor started talking about induction at her 40 week prenatal visit, and then scheduled some dates for her at the hospital, even though he told her at 2 check-ups that she and baby were doing well. She felt very nervous about it, but also nervous because of the way the doctor talked about "what could happen" to the baby. So she went home and talked to her partner about the Benefits, Risks, Alternatives, Intuition, and Need Time aspects of the decision to induce. Then she called me and told me that the only benefit they could think of was seeing the baby sooner! Which wasn't enough to make them feel comfortable with inducing, so they decided to tell the doctor they'd like to wait until 42 weeks. So awesome!

• No person should give you a pelvic exam or manipulate your cervix without your prior consent.
• No person should pressure you into attempting induction unless it is medically necessary.
• No person should pressure you to dilate faster for his or her own convenience.
• No person should break your water or cut your perineum without consulting with you first and gaining your permission.
• You have the right to refuse a course of treatment that you feel is not in your or your baby’s best interest.
• No person should rush you to make a decision.

These things are true, and childbirth educators and doulas say these sort of things all the time, but they still happen. I see them happen. So it is an important thing to pass on to our clients -  YOU HAVE A RIGHT TO CONSENT TO AND REFUSE ANYTHING THAT INTERFERES WITH YOUR BODY OR THE BODY OF YOUR CHILD.

There are some great informed consent role plays out there, where mom and partner can practice asserting their rights. I really like these (via Prep for Birth), because these are very difficult situations that almost every woman birthing in a hospital will find herself in:

You are laboring along slow but sure. Early labor is taking awhile. Your contractions change and seem stronger. You go to the hospital and are 5 centimeters. Baby looks good on the monitoring in triage, so you are assigned a room. The labor and delivery nurse would like you to stay in bed and not move around or get into the shower/tub. That is ALL you want to do.

What would you do?

 Hopefully, you would use your BRAIN! Let's practice:

B: What are the Benefits of staying in the bed? Well, your labor has been normal and the baby looked healthy on the monitor. Your body is telling you that you would be more comfortable moving around. So why would the nurse ask that of you? There are benefits for the nurse - he/she can keep you securely hooked up to the electronic fetal monitor, the blood pressure cuff, possibly an IV, and all the other gadgets being used to record your vitals. That way she can leave the room to do other things but you are still being "monitored" by the equipment. The nurse has also been told in training that birth must occur in the bed and that the monitor is the best and only way to detect fetal stress, which in her experience happens all the time.

R: What are the Risks associated with staying in bed? Well, you would be extremely uncomfortable the whole time, especially if getting out is all you want to do. Another risk is that staying in bed may make your labor more painful and possibly slower. Moving in response to labor contractions and change of positions makes use of gravity and changes the shape of your pelvis, helping baby make his/her way down. The freedom to move and to use pain coping techniques like the shower gives you an increased sense of control and lessens your anxiety. (For more about the proven benefits of movement during labor, click here).

A: Are there alternatives to this procedure? Can we get more information about why the nurse wants you to stay in bed? If its to keep the baby on the monitor, you can request intermittent monitoring (every 45 minutes or so)? Or maybe something that is portable, like a fetoscope or a telemetry unit, and that way you can even get into the shower. If you have done your research, or if the nurse/doctor does theirs, you will know that routine continuous EFM provides no benefit for babies and increases the risk of cesarean for mothers.

I: What is my Intuition telling me? Well, that's easy - its I WANT TO MOVE! 

N: Its ok to Need some time to think about it. You might choose to stay on the monitor for a bit and see if you can get comfortable with that. Or, after you gathered all the information you can from your nurse and or doctor on the benefits, risks, and possible alternatives, you just want a few minutes to talk to your partner and your doula about what you're thinking and feeling. There is no rush to decide.

Here's another scenario:

You have been assured that after your push out your baby, he will be placed right on your belly or chest for assessments even if he needs oxygen without separating you two. After you birth your baby, he is making good effort to breathe, is vocalizing, and his color is just right. The baby nurse wants to take him right away. You ask her to do all his assessments on you and she says no and without your consent takes him off to the warmer.

What would you do?

(Some may recognize this in a different form - BRAND. I like BRAIN better because it includes Intuition, and also because the "Nothing" and the "Delay" of BRAND seem too similar to me, and are encompassed well under "Need time.)

Thinking about Becoming a Childbirth Educator

Lately I've been contemplating becoming a childbirth educator more and more. As a doula, I encounter families kind of late in pregnancy. Some have had childbirth education classes, some haven't. Some take a several week series of classes from an independent educator, and some take a one day hospital staff-led course. They have varying levels of knowledge, which means I do varying levels of childbirth education in my prenatal visits. And sometimes it is not enough time to inform them of everything they should know, or its too late to help them or change minds, etc, for the better.

As a childbirth educator, I would be able to reach families when they are earlier in their childbirth planning, most willing to be filled with childbirth-related knowledge and open to new ideas. My work would have a large effect on their having a positive birth experience, fully informed of all their options. Knowledge is power is a very important concept for me.

Furthermore, childbirth education is a lot more flexible than doula work. I would be able to make my own schedule, teach as much or as little as I'd like, still doula, and not have to worry about being on call for a month at a time and unable to go out of town. The benefit of also being a doula means I can still be with mothers and couples during their actual births and can bring extra knowledge to my childbirth classes.

I've been honored to be able to attend one Bradley childbirth education class in a series with one of my past clients. The class seemed so much fun - surrounded by other couples who are also pregnant with whom to chat and share experiences with, learning everything one step at a time with your partner present, having videos, charts and models to assist in visual learning. Also, getting to physically practice childbirth coping techniques and labor contractions, and being able to ask questions of the instructor as they came into your mind. I loved it!

I am also honored to be able to be currently attending a Lamaze class with a client. I've only been to one so far, and it was very different from the Bradley class. This one took place in the instructors home, and there were no other couples present. It was excellent one-on-one time and the couple was able to feel completely relaxed and ask as many questions as they wanted. The instructor was also really happy to have me there, and included me in all question answering and solicited my opinion and experiences. I had a fabulous time hearing/learning/thinking birth for 2 hours, and I can't wait for the next class! I also learned a lot from the instructor, a more seasoned doula. And the clients benefited from both of us discussing our knowledge and experiences with them (more than they would have gotten if I hadn't been there!)

All in all, I get really jazzed when I think about teaching childbirth education. I feel like its a logical step to take in the world of birth work, and it would feed my hunger for birth conversations all the time! And helping new moms!

The next step is to choose which organization I would like to certify with! Many doulas go through CAPPA to add on CBE (childbirth education), I think because it is quick and easy. Another option is Bradley, which I really enjoyed attending and I like their natural birth philosophy, but I'm not sure about because the tag line is "husband coached childbirth." I'm just not sure that's how I want to "sell" my CBE. Another option is Hypnobirthing, which I think is cool, but not something I think I want to be an instructor of. Lamaze is, of course, the big one that everyone has heard of. The process looks a little bit harder and longer, and I do worry that when people think Lamaze they think of an old type of childbirth ed with all the funny breathing. But Lamaze has recently gotten really big on doing some great research and evidence work on childbirth, and I really like their healthy birth practices concept. There are others, like ICEA and so forth, that I don't know much about, and some new ones like Brio birth, but I feel like they all start to sound the same at some point.

The names that keep popping up on pregnancy sites that talk about childbirth education are Bradley and Lamaze, so those seem like the big ones to consider.

Does anyone have any insights on the varying childbirth educator certifying organizations and philosophies?  Or on being a childbirth educator in general? Does anyone know if some of these (like Bradley) require you to have given birth yourself? Thanks!