Interventions – the Role Playing Game

Years ago, I created a Dice Game for Exploring Variations in Labor which I used when I taught a two hour class on interventions. I divide the class into three groups, and have them create three characters with different motivations, and at various points during the class, I have them roll dice and/or flip coins to see how the labors are playing out, then ask them to role-play how they think their character would respond to those circumstances.

I used the activity a few times, then my teaching schedule shifted to where I was mostly teaching refresher classes, breastfeeding and newborn care, so I shifted out of the habit of using it.

This weekend, I was scheduled for a 5 hour class which covered pain meds, interventions, cesarean, and postpartum. I decided this game would be a fun way to structure the majority of the class. I decided to start it by having them flip one coin and roll one die to determine where their character is on the pain medication preference scale. Then I asked them to create a character, decide WHY that was her pain med preference, and what support team and birth plan she’d have based on that. (Note: you could also include the medical mindset tool here.) Then we went from there, walking through:

  • what week in pregnancy labor started (and talking about preterm labor, induction, and decision making about induction)
  • how early labor started, how long it was, and how they’d cope and when they’d go to the hospital (to review that info from previous week)
  • how long their active labor would be, what they could do to move it along, augmentation, and whether they would choose pain meds based on the combination of their initial preferences and how labor was unfolding for them
  • how long pushing would take, what they could do to help, whether interventions would be offered, and what decisions they would make

The class went VERY well, with all the students really engaged, and really getting moments of insight into decision making and the need to be flexible about the details of the birth plan while still honoring the general intent. I also think it felt very non-judgmental, honoring the variety of reasons why people might make the decisions they do.

For example, our character with the -5 PMPS, who was a naturopath and planned a home birth ended up rolling on her first roll that induction was needed. So, we saw how that played out through the rest of the labor. Our character with the +6 requested induction and was counseled out of it, but then went into labor naturally at week 38, and had a fast early labor, and the epidural she chose, but then rolled a slower active labor, so we got to think through what that would be like.

Note: Although there’s lots of randomizing rolls and coin flips, I do sometimes adjust or nudge the results a bit. I want it to turn out that each character faces some challenges, but each ends with a vaginal birth and a positive experience. I cover cesarean after the role play is over.

There are so many ways you can adapt this idea, from a 10 minute review of the stages of labor, to a 30 minute labor rehearsal, or 2 hours on variation, or this ~4 hours class which includes stages review, practice of coping techniques, pain meds, and cesarean. Here’s a lesson plan for this class.


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