Author Archives: Janelle Durham

About Janelle Durham

I teach Discovery Science Lab and Family Inventors' Lab, STE(A)M enrichment classes in Bellevue, Washington for ages 3 - 9. I am also a parent educator for Bellevue College, a childbirth educator for Parent Trust for Washington Children, former program designer for PEPS - the Program for Early Parent Support, and a social worker.

AV Aids for Birth Classes – Videos

Videos are such a powerful tool in a childbirth and parenting preparation series. Seeing someone in labor can help to prepare them for what that might look like and feel like. Seeing a birth in a hospital setting (or at home if you’re teaching a home birth class) can help them start to imagine what their birth will be like and also gives them an opportunity to see maternity care procedures. Seeing a newborn baby squirming around helps them grasp what their baby might be like at birth. And seeing a baby and a breast come together is essential preparation for breastfeeding.

So, where can you find great videos? Here’s a collection of what I know about. PLEASE add comments with more details on these resources or with recommendations for other videos you would use in class.

Other than Injoy, almost all of the videos listed are free of charge. I put a $ sign at the end of the listing if you have to purchase them.


If you can afford them, I think that nothing beats Injoy videos. Learn about their videos, and preview clips at Consistently high quality, fairly diverse families featured. They intersperse clips from births with animated graphics of things such as the descent of the fetus during birth, and offer clear, easily understood narration about the birth process, breastfeeding, or newborn care. Childbirth educators who only work with clients planning out-of-hospital births may feel they are too medicalized, but if most of your population is planning a hospital birth, I think they appropriately balance working toward a lower intervention birth while also learning key information about interventions. $$

Other Options I have used:

Mothers’ Advocate. This series was jointly produced by Injoy and Lamaze and covers Lamaze’s 6 Healthy Birth Practices. All the benefits of an Injoy video, but free of charge. They are from 2010.

I made a video about newborn cues. You can learn more about it in this post.

Other Recommendations:

All the videos from here down were recommended by other birth educators for use in classes. If the person who recommended the video gave details about what they liked, I included those notes. I have not watched them all myself so please review in detail yourself before using in a class!

Birth Info

Evidence Based Birth by Rebecca Dekker, phD – her blog is great but I have not yet watched these videos, which include a full birth class series called “Birthing in the Time of COVID”.

Mandy Irby Birth Nurse – includes a multi-video series called Online Lamaze Class:

Alice Turner, doula and birth educator. Lots of videos with tips on comfort techniques and more.

Gentle Cesarean from Brigham and Women’s Hospital:

Beaumont Hospital has a full series of videos:

Hello Baby from the Childbirth Media Center: These are good, but they are really OLD – we had them when I started teaching 25 years ago. (To all the old educators out there… these are the Carl and Donna videos.)

For talking about pushing and a way to practice it more concretely when an urge is obviously not present.

Cesarean video – from Australia, so note any differences between what’s shown and your local practice:

Playdough Surgery – cesarean. There’s information here on using it in birth classes.

Birth Stories

Examples of what real labor looks like:

Alice Turner, Lamaze educator, recommends 5 birth videos with info on why she likes each video – find her recommendations and links to those videos at:

Birth of Easton:

Birth of Sloane – the person who recommended this said: “Home birth – Great partner support and example of different positions – no nudity – 6 mins 31 seconds – good sounds – baby born in water – interesting example of cord cutting by burning.”

Blake Andrew Isom. “Shows how the partner was right where the mother wanted him to be. He gave words of affirmation but you don’t hear them in the video. She had a doula at her birth so the husband was able to stay right with the mom holding her hands and comforting her.”

Denver Birth Videos. The person who recommended them said “I found this birth videographer from Colorado. She had so many beautiful videos on her website that demonstrated so many coping techniques and different things to try even in early labor like walking up stairs etc. Lots of great partner support and she has a huge range of types of births (home birth, water birth, land birth, hospital birth etc.). I personally messaged her and asked if I could use her videos in my classes and she gave me permission.”

Compilation of scenes from many births:


Great video with a Black dad talking about ways to support a postpartum parent:

For talking about helpers vs visitors. FUNNY! Some may not love it because it pokes fun at some worthwhile breastfeeding advice but I preface it and it lightens the mood as a good transition after talking about some of the hard stuff during postpartum.

Viral a couple years ago, but the Frida mom commercial is wonderful to open a discussion of postpartum.

Safe Infant Sleep for Grandparents:

Breastfeeding / Chestfeeding

First Droplets has a 15 minute overview of Breastfeeding in the First Hour: They also have great short videos on specific topics like latch:

Global Health Media has very helpful instructional videos on labor, breastfeeding and newborn care. (Like this one on latch: These were filmed in developing countries, so you would want to think about how to introduce them to families so that they see the information is also relevant in the U.S. since they may assume otherwise if they see the more primitive medical equipment.

International Breastfeeding Centre (aka Jack Newman’s site) has LOTS of great videos showing specific breastfeeding details, especially close-ups of latch:

Hug Your Baby has a breastfeeding overview and a newborn care overview: $

“Beautiful breast crawl by newborn baby.”

Important Considerations

When choosing videos, here are some things to think about or watch out for:


ALWAYS “set up” the video. Tell them

  • what they’re going to see
  • why you’re showing this video
  • what they should look out for

For example, here’s part of how I set up the Injoy Stages of Labor video: “I always show this video in the first week of class, because it provides a full overview of the labor and birth process from start to finish – sort of a preview of everything we will cover during this class series. You’ll see clips from three or four different families giving birth in a hospital, so you’ll see typical hospital procedures as well. I do want to give you a heads up: you will see a vaginal delivery of a baby – if you are uncomfortable with watching that, you can always close your eyes or turn away – but we find for many people it’s easier to see this for the first time when it’s not you or your partner giving birth… What I really like about this video is you’ll have a great opportunity to see what people in labor may look or sound like, what their partners can do to support them in labor, and how the care providers also support them. I want you all to look for some ideas on what each person does to help work with and manage labor pain.”


ALWAYS allow a few minutes to debrief the video. I kind of putter around a bit when turning off the video, turning the lights back on, sitting back down to give them just a moment to gather themselves. (It’s not unusual for someone to get a little weepy during a video.) Then I say “So, what did you see that surprised you? What do you have questions about?” Usually one of them will respond. If not, I may say something that addresses something that I think may worry someone, like “you may have noticed birthing people who weren’t wearing many clothes during labor… I want you to know that is because they chose to take them off, not because it’s typically required.” Then I’ll ask them to share things about whatever I asked them to look for in the video.

Diverse characters / settings:

Think about the students in your classes – age, race, socioeconomics, visions for ideal births, settings in which they will give birth. Make sure that there are people in the video who look like your students and/or have similar life experiences so they can relate, and they will feel like they belong in your classroom. If the people or settings shown are not like your students, give information about why this video was chosen. If you share a birth story video that focuses on one labor from start to finish, that may not feature a family who looks like theirs, so I introduce it by saying something like “this particular video has a single parent who is supported by her mother and doula – but all the support techniques can be done by any support person” or “this person does not speak English, so they have an interpreter at their birth. I like how the video shows all the stages of her labor from start to finish, so we can see how that process unfolds for one particular person. It shows how families might need to change and adapt their birth plan as things unfold differently than planned.”


I typically teach a 6 week series. I try to include some video in each session. I sometimes time it for right before a break so we can watch it, debrief it, then I send them off to break, where they might choose to talk it through with a partner or other students. Sometimes I show it right after break to get their brains back into class mode. I personally like videos that are about 8 – 13 minutes long… long enough to be worth settling in for, but not much longer than that because they eat too much into my class time. Some instructors take the flipped classroom approach and have students watch the videos between classes and discuss in class.

Be sure to also check out my posts on:

AV Aids for Birth Classes – 3-D Models (dolls, pelvises, breasts, and more…)

AV Aids for Birth Classes – Posters and Images (to put on the wall or into a PowerPoint

A New PMAD Handout

When we last revised Pregnancy, Childbirth and the Newborn, I struggled with including the list of all the risk factors for PMAD. It’s important information to have, and yet, I worry about someone who has a lot of those factors reading through it and getting more and more discouraged, and worried that there was no way they could avoid PMAD given their complex history. I wanted to find an approach that could empower rather than defeat.

Yesterday, I played around with a lot of metaphors…

  • a seesaw where the more risk factors you have, the more protective factors you need to balance them out
  • a budget metaphor
  • a fill the bucket metaphor where the risk factors drain the bucket
  • a floating object metaphor… if you have a lot weighing you down, you need a lot to buoy you up so you don’t feel like you’re drowning

Finally I found a metaphor I liked… I created a handout where I try out the baggage metaphor…. if you know you have a lot to carry, then you can plan ahead (pack it well), build your strength (by learning coping skills), get a luggage cart (learn about resources) and ask for help to carry it.

Here’s the free printable handout, feel free to use it any time, anywhere.

I also updated two other handouts: One on what you really need to buy for babies, and one on planning with your parenting partners how you’ll divide up responsibilities after the baby is born.

Newborn Cues Video

The TL; DR: Expectant parents often wonder how they’ll know what their babies need, and new parents often wonder why their baby is crying and what they could do to figure out their needs before they cry. Newborn cues are instinctive behaviors that babies display which help us to figure out what they need. This YouTube video (which you are welcome to share in classes or in one-on-one appointments, or link to from your website) provides an overview of newborn cues. (Here’s a link you can share:

The Story Behind the Video

As a first-time parent back in 1993, I was clueless.. it seemed like my baby would go from 0 to 60 from happy to miserable in a moment. Years later, I watched videos of his early days, and saw that he was giving SO MANY cues about his needs that I missed until he escalated to screaming. So, when I started teaching newborn care classes in ’99, I always incorporated information about newborn cues.

Back in 2010, I put together some YouTube clips as a “Name that Cue” activity to use in my classes. I put it on YouTube for my ease, and in case anyone else would find it helpful. Now that video, and excerpts from it and updates of it have been viewed over 2 million times!

The video linked above is the newest version, where I’ve incorporated feedback I’ve gotten on previous versions and added a couple more clips. I’ve also set it up so it will be easy to create translations of it into other languages, and I’m currently recruiting educators whose native language is something other than English to help me create translations. (contact me at janelled at if you’re interested in helping!)

No Narration Option for Classes

For birth educators or others who are using this video in an educational setting: That video is designed to be watched independent of a class or educator. It’s 20 minutes, which is a lot of time for a class. If you prefer, I have a 13 minute version here with no narration that you can show and talk through it with your students.

Video Segments – Cue by Cue

In 2014, I created segments that covered only one set of cues at a time. Here’s links to those, if you prefer them.

Teaching about Cues

In my podcast episode on Caring for Your Newborn, you can see how I integrate teaching about cues into the information I give on newborn care and feeding.

Activities for Online Birth Classes

In the past year, so many of us have moved our classes online. We may continue to be online through coronavirus and beyond, as some instructors are considering continuing to offer online classes from now on, in addition to in-person. We’ve discovered that online classes can help make our classes more accessible to people from a broader geographic area, to people with limited transportation, folks who don’t want to deal with commuting to and parking at a class site, folks with disabilities, parents on bed rest, and more.

How do we make our online classes as engaging and memorable as possible? Here are lots of ideas for interactive birth class activities. My examples will go in order from pregnancy topics through the stages of labor and into postpartum and baby care. Most of the techniques can be adapted to many more topics than I address in my example.

Healthy Pregnancy

Due to my state’s Medicaid requirements, we have to cover several specific topics, including substances (alcohol, drugs, tobacco), healthy nutrition and food safety, exercise, sexuality and more. To address these topics, you could create an online Jeopardy game, or create a quiz in Kahoot to use in class, or use Zoom polls to quiz them during class. Or you could use Google Forms to create a quiz to send to the students as “homework.” You could use these wellness cards for ideas for questions and answers to include. You could adapt a grab bag activity by having a slide show with pictures of items and asking them to talk about them.

Anatomy Pictionary

Sharon Muza has a great icebreaker activity where she has students draw anatomy. You can easily adapt this to online classes by splitting students up into breakout rooms, have them use the Zoom whiteboard to create drawings, then screen capture those and return to the main room to share.

Jamboard Signs of Labor

This is an interactive bulletin board type activity, where there are post-its listing symptoms that labor may be starting. Students sort them into possible, probable, and positive signs of labor. Find it here, and make a copy for your use:

On a Zoom call, the way you would use this is: paste the link into chat. Everyone goes to the link and they can all manipulate it together, and you can talk them through it. (Learn more about using outside apps with Zoom.) If you’re meeting in-person, I’ve got an old school version of this activity where you print the cards and they sort them.

Comfort Techniques Chat Storm

Tell them “I’m going to ask you all to type some ideas into chat… First, I want you to think about when you’re sick – what helps you to feel better?” They start typing, then you can prompt them more… “It may help you to think – when you were a kid, what did your parent do to help you feel better? Or what did you wish they had done that you think would have helped.” As all the ideas pour in over chat, you can read some out loud, affirm them, comment on how these might be used in labor. Then do another storm for “what helps you to relax?” (more questions)

Comfort Tools Scavenger Hunt

Either during your presentation on comfort techniques for early labor, or in a discussion of “what to pack for the hospital”, send students off to find something in their house that helps when they’re in pain, or sick, or feeling worried. Have them do show and tell, and talk about how you could use those in labor.

Virtual Background for Hospital Routines

When you discuss arriving at the hospital, you can use a photo of triage room as your virtual background. (Learn how to use virtual backgrounds in Zoom.) When you discuss moving to the hospital room, change your background to reflect that.

Word Cloud – what will labor be like?

During in-person classes, I’ve used a worksheet where people can circle words that represent what they think birth will be like (words like: messy, excruciating, beautiful, long…). Then they discuss – if your birth is like that, what support will you need? (Or if you’re providing labor support, and the birth is like that, how will you best support the laboring person?) In a virtual class, you could do this as a word cloud, where all the students add their words, and you’d see common themes arise, as words that multiple people type are shown bigger than those only added by one. I have directions on how to do a word cloud in mentimeter here:…/use-other-apps-with-zoom/

Jigsaw Puzzle Stages of Labor

Take your favorite poster / infographic of the Stages of Labor, and convert it to a jigsaw puzzle, as Mallory Emerson describes here: For copyright purposes, you should only use images that you otherwise have the rights to use in your classroom. You can purchase a variety of images. I like the Road Map of Labor from Childbirth Graphics, but there’s also good stuff available through Plumtree, Better Birth, and Birthing with Guinever. (Find links to those products in my post on Where to Find AV Aids.)

You could either use this as homework – send students a link to do at home after class, or you could do it collaboratively during an online class – maybe as a warm-up before starting class or as a breaktime activity. It’s low key, interactive, and good for the visual and kinesthetic learners to review labor stages by interacting with the images.

Continuum Exercises

In a classroom, I have used a continuum exercise for something like: “If you have TONS of experience taking care of lots of newborn babies, go to that end of the room. If you’ve never held a baby under 6 months old, go to that end. The rest of you array yourself somewhere on that continuum.” It’s helpful to me to see the range of knowledge and helpful to them to see that they’re not the only ones… I have never done this for topics that I feel like people can be judgmental about… “oh, I knew she was one of those people.” But online you can do this anonymously. Have a slide showing a continuum like the pain medication preference scale, and you can have them annotate it to mark where they are. (You could also do this a poll or using another – rate on a scale of 1 – 10 type tool.)

Thumbs Up / Thumbs Down Reactions

They can use Zoom reactions to vote. Could be used for something like: “is this normal or is this a warning sign?” Or “is it time to go to the birthplace?” Or “True or False.”

Show and Tell

Sharon Muza suggests having students bring to class session: something they’ll want nearby when they’re nursing, or something they will use for newborn care. Learn more.

More Ideas / Training

For more general ideas you could adapt to perinatal topics, check out my Zoom Guide for more ideas on Demo Physical Activities on Zoom, Games and Interaction on Zoom, Use Other Apps with Zoom, Using Zoom on Facebook Portal, and more.

If you’d like to learn more about exactly how to use virtual teaching techniques in the birth class setting, I highly recommend the Creative and Confident classes offered by Sharon Muza, FACCE and Mallory Emerson, LCCE.

AV Aids for Birth Classes – 3-D Models

In separate posts, I cover where to find images (posters, PowerPoints, and illustrations) and videos. This post is focused on 3-D models: pelvis, breast, fetal dolls, placentas, and so on.

Note, all prices and links are current as of February 2021, and all may change (especially the Etsy items.)

Childbirth Graphics is the most comprehensive source. They’ve got all the basics: pelvises, fetal dolls, placentas, and breasts. And a whole lot more: cervix models, milk fat comparisons, pregnancy bellies… Durable and high quality. Sample prices: set of pelvis, doll, placenta, perineum is $256; pelvis $74 or $133; newborn doll $69; breast model $87.

Cascade Health Care Products has a number of products… they appear to all be Childbirth Graphics items that they are selling. Some of their prices are higher than Childbirth Graphics and some are lower, so it’s worth comparing. Set $279; doll $64; breast $97.

Birthing, Bonding, and Breastfeeding. Has rubber breast models ($20), crocheted breasts, and a breast model scarf. They say “The rubber silicone-filled breast forms a seal to allow for demonstration of flange fitting and nipple positioning. Breast reacts to pump and simulates what pumping should look like when the nipple placement is correct.”

Anatomy Warehouse. They have multiple pelvis styles and a placenta. They also have lots of anatomical training models that are not items you would use in a class. Pelvises range from $41 – $70.

Brilliant Activities for Birth Educators. This is not a site that sells AV aids… it’s a blog that tells you how to make your own! Lots of fun ideas for interactive activities.

Crochet or Knit Your AV’s: this post has links to patterns.

DIY Pelvis. How to make a pelvis model from 2 file folders!


You can buy models on Amazon. They sell the Childbirth Graphics set, but it’s $275, and you can get it for $256 direct from CG. They have multiple inexpensive pelvises that claim to be life-size and flexible, but the reviews often say they are not life-size, not flexible and not that well-made. (But, they do have one that’s just $39, so maybe that’s a fair compromise?) They have this mini doll and pelvis for $39 or the doll, pelvis and placenta for $69, but the quality looks poor. (And they also have identical products that are sold under many brand names for a wide variety of prices, which is typical of low quality imports.) I think you would be better served by saving up money for one of the professional quality models from Childbirth Graphics (which last for decades!) or picking one of the Etsy items below.

(Note: the Amazon links are affiliate links – if you purchase anything on Amazon after clicking on one, I do get a small referral fee.)

Etsy Shops

Edy’s Wonderland. Set of pelvis, uterus, baby, placenta $167 (can buy pieces separately.) Miniature set of baby, placenta, uterus, beanie, diaper $56. Breast $17.

Wicked Stitches. The full set shown of sperm, uterus, placenta, baby, breast, belly balls, and baby poop / diaper is $131. All sold separately. Sample cost – breast $18.

Mother Hen Doula – Felt Pelvis for $6. Knitted breast $8, placenta $9, uterus $17.

Viva Doula. Non-pregnant uterus with detachable vagina and vulva; full-term uterus, placenta and sac; breast $234 for set; pieces sold separately. Sample cost breast $53. Also has miniature sets, dolls, knit penis, weighted doll $197.

Birth Matters NW. Weighted Dolls. $50

Mam Amour Dolls. Breast model and breastfeeding baby doll, $221. VBAC Mama Doll $234.

Namsis Craft. Breast and latch $25; placenta $110; doll $80, pelvis $60, uterus.

Milk Mama Milk. Placenta, baby, uterus $119; breast and latch puppet $34, diaper with poop $13, belly balls $12.

Your Birth. Doll $20. Cesarean birth apron $65.

Bebek liked ishop. Placenta, non-pregnant uterus, 4 breasts for $170. Placenta $48.

Soul Mama Crochet. Breast $22, breast and placenta $44

Hazel Creates Threads. Cloth pelvis, uterus and amniotic sac, crochet placenta and breast $133

Clover Care Doula Services. Uterus, placenta and membranes $108.

More ideas?

If you know of other great sources, add them in the comments!

Free Illustrations for Birth Professionals

Years ago, I created LOTS of simple line drawings for use in birth education materials. I’m putting them here for anyone who wants to use them for any perinatal education or birth support purpose, whether that’s for class handouts, PowerPoints, to show to a client over a video call, or whatever. Everything on this page is free for you to use, no need to credit me as the source. For any of them, just right click on it, and choose copy or save as.

Positions for Labor

Sitting or Resting

Standing / Moving

Forward Leaning

Pushing Positions


Maternity Care




Fourth Stage / Skin to Skin




Breastmilk Expression

Birthplace Options


Rebozo Techniques

AV Aids for Birth Classes – Posters and Images

I’m gathering links to resources, and will continue to add more, but here’s some to get you started. I cover posters, handouts, and illustrations in this post. I have separate posts on where to find videos and 3-D models.

Childbirth Graphics is sort of the grande-dame of AV Aids. They’ve got pelvises, fetal dolls, placentas, posters, and handouts galore. Primarily physical products you can order and have shipped to you. They have digital versions of posters you could use in an online class. Durable and high quality.

Plumtree Baby. Handouts, posters, and PowerPoints. Like Childbirth Graphics, all good stuff, with a really great look.

Transition to Parenthood. I have around 100 free-to-use illustrations depicting labor and birth positions, maternity care interventions, breastfeeding, and more. All .jpgs you can copy and use wherever you want free of charge.

I also have lots of free printable handouts for birth classes. The Guide to Labor Support is a 2 page cheat sheet that covers the theories of fear-tension-pain and gate control, covers counter-irritants and hormones, and more. I have three wallet cards: questions for informed consent and two versions of a comfort techniques reminder.

Brilliant Activities for Birth Educators. This is not a site that sells AV aids… it’s a blog that tells you how to make your own! Lots of fun ideas for interactive activities.

Better Birth Blog – Lauren McClain, birth educator, has created lots of great visually appealing handouts on a wide variety of perinatal topics. They’re primarily digital files you can print or share with clients.

There are free handouts for childbirth ed students and doula clients at these sites, but I haven’t had a chance to review them in detail: Birth Arts and Childbirth Professionals International. (Best Doulas has created handouts from articles published elsewhere, but I would think about copyright issues for sharing those.)

HolmCreative. Shawna Holm has an Etsy shop with printed cards, a positions poster, printable PDF handouts, and vector illustrations.

Educated Birth. Cheyenne Varner creates fabulously inclusive infographics and illustrations that reproductive health workers can purchase to use as teaching tools. You receive digital files – .pdf, .jpg, .png. The basic use pricing is for people with one income stream (e.g. doula), extra use pricing is for professionals with multiple income streams (e.g. doula, CBE). Can then use with unlimited number of clients.

Queen City Birth Work has another great set of inclusive digital illustrations of birthing positions. All proceeds are donated.

Praeclarus Press has free PDF posters of breastfeeding and also labor support by doulas. Inclusive illustrations.

Student Midwife Studygram. Jess is a NHS midwife in England. When she was in midwifery school, she began doing anatomy illustrations to help herself learn, understand and remember what she was studying. Now she makes those illustrations available for others to use. Flashcards or PDF’s.

It Starts with Birth on Etsy has printable handouts, and printable posters

Stanford Medicine Photo Gallery: Images of normal newborn appearance (milia, lanugo, etc.)

Birthing with Guinever. Has two versions of a stages of labor poster.

Cost Comparisons

There are many considerations in choosing AV Aids for your class. First, I encourage you to only choose images that show diverse people – diversity in race, orientation / gender / family structure, ability, etc. I think each of the providers listed on this page does a fair job at that, but some place this as a top priority.

Second, look for the ones which best meet your teaching needs and style.

I know that cost is a consideration for many birth professionals, so low cost is always a nice option, but I also balance that with the fact that the people who create these products are working hard to provide great professional images that support working people and deserve decent pay for that work.

I just wanted to give some sense of the cost of items, so tried my best to compare apples to apples. I looked for a Stages of Labor poster on each of these sites (images above). Childbirth Graphics: 22 x 28 stages poster $25. Plumtree Baby 18×24 stages poster $24; Better Birth stages poster 11×17 (I think) $25. Educated Birth – Labor positions poster with comfort techniques – 24×36 $52. HolmCreative has a 12×36 poster of positions for labor for $50. Student Midwife fetal station and mechanics of labor poster, 11.7×16.5, £8 = $12. Birthing with Guinever – .jpg image, free download.

More ideas?

For more links, check out the Pinterest pages for Foothills Birth Services and Tina Gibbs’ Antenatal Teacher board.

If you know of other great sources, add them in the comments!

Setting Expectations for Parenthood

In a journal article on “Mother’s Expectations of Parenthood“, authors Lazarus and Rossouw address the influence of unreasonable prenatal expectations of parenthood on the development of postpartum mood disorders. They make recommendations for antenatal classes that I think are worth consideration for childbirth educators:

“Current antenatal classes focus mainly on the birthing process; however… it is the transition that occurs once the mother is at home that is pivotal in the development of depression, anxiety, stress, and low-self esteem… An education program focusing on compromised infant, support, and self-expectations during the first year post birth should be created and incorporated into existing antenatal classes… This type of education program should perhaps emphasize the potential realities of having a child (such as a difficult and painful birthing experience or a baby with a more difficult temperament) but, most importantly, it should normalize the ambivalence and doubt that a mother may experience post birth, and stress the importance of reaching out for help and talking to others if she experiences even the smallest difficulty during the transition to becoming a new mother.

“This education program could also highlight how current social norms for new mothers as “super mums” is… not merely unattainable but rather it creates an environment that promotes the development of depression in new mothers, given that women feel strongly obliged to isolate themselves and conceal their true feelings when they are experiencing difficulties and/or depression post birth. These behaviors only succeed in further feeding the symptoms of depression by avoiding the issues at hand… If a healthy shift to new motherhood is to transpire, it is the rule rather than the exception that this transition may be accompanied by some degree of grief and loss and changes in mood.”

As a childbirth educator, or doula, do you encourage your clients to think about their expectations and be certain that they are realistic?

In my post on “Failing to Meet Your Own Expectations“, I offer some questions parents can ask themselves about their expectations for their parenting, and some ways to re-frame them to be sure they are attainable goals.

Key Research and Guidelines 2015-19

At the 2019 Lamaze Conference, Deborah Amis presented a Research Update. I watched it today – it is available at that link for $20. It is an excellent review of the most important research and research-based guidelines issued between 2015 and 2019. I will list here some of the items she covered, with links and a few notes, but I’d encourage you to watch the recording for all the details.

Here are the key research and guidelines you should be aware of – just listed in the order she covered them in her presentation.

WHO Statement on Cesarean Section Rates (2015) – “at a population level, caesarean section rates higher than 10% are not associated with reductions in maternal newborn mortality rates.” Here is a companion FAQ.

California Maternal Quality Care Collaborative (CMQCC) Toolkits. Each includes best practice tools and articles, care guidelines, and implementation guides. Toolkits include: Substance Exposure; Maternal Sepsis; Venous Thromboembolism, Cardiovascular Disease in Pregnancy, Obstetric Hemorrhage, Preeclampsia, Reducing Elective Deliveries before 39 weeks, and Toolkit to Support Vaginal Birth and Reduce Primary Cesareans and Implementation Guide, 2016

AJOG April 2019 – Safety Assessment of a Large Scale Improvement collaborative to reduce nulliparous cesarean delivery rates. Study of CMQCC efforts to reduce primary cesareans. Data from 119,000 births. NTSV cesarean rate fell 29.3 to 25% between 2015 and 2017, with no increase in poor maternal or neonatal outcomes.

AIM – Alliance for Innovation on Maternal Health – Patient Safety Bundles – “… a small, straightforward set of evidence-based practices … proven to improve patient outcomes.” Not new ideas, but a standardized approach for delivering well-established, evidence-based practices to be implemented for every patient, every time. Topics include: Safe Reduction of Primary Cesarean; Reduction of racial disparities; Obstetric Hemorrhage, Severe Hypertension in Pregnancy, Obstetric Care for Women with Opioid Use Disorder, Cardiac Conditions; Postpartum Discharge Transition, and more.

Lancet: Optimizing Caesarean Section Use – 2018 series. Reviews the global epidemiology and disparities in caesarean section use, as well as the health effects for women and children, and lays out evidence-based interventions and actions to reduce unnecessary caesarean sections.

AWHONN Save your life: get care for these POST BIRTH warning signs. Patient handout.

ARRIVE Trial. Study with 6000+ participants showed elective induction at 39 weeks yielded a cesarean rate of18.6% vs. expectant management rate of 22.2%, a 16% reduction in relative risk. Leads to ACOG Guidelines that “it is reasonable… to offer elective induction of labor to low-risk nulliparous women at 39 weeks gestation.” Also read Rebekka Dekker’s article on this in Evidence Based Birth, which includes a link to a one-page patient handout, which includes other ways to reduce c-s risk: midwifery care, continuous labor support, intermittent auscultation, etc. Dekker also links to responses to the ARRIVE trial and ACOG guidelines from ACNM and CMQCC. Summaries of the AWHONN response and SOGC response are on this Talking Points handout from Amis’ The Family Way.

JAMA 2018 – Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia. Shows no difference in perineal lacerations, endometritis, severe hemorrhage, transfusion, NICU, neonatal morbidity. Immediate pushing group had shorter second stage (mean 102 minutes vs. 134 minutes), decreased chorioamnionitis, decreased hemorrhage, decreased neonatal acidemia, decrease suspected sepsis. Delayed pushing had less 3rd and 4th degree tears; active pushing was 75 minutes vs 84. ACOG Committee Feb 2019 – “data support pushing at the start of the second stage of labor for nulliparous women receiving neuraxial analgesia”.

AWHONN’s Second-Stage Labor Practices Reduce Cesarean Births and Newborn Harm (2019) has 13 evidence-based, second-stage labor practices. (Article on Implementing Guidelines.) Provide info about both immediate and delayed, but a key guideline is respecting spontaneous urge to push.

ACOG – Approaches to Limit Intervention During Labor and Birth – 2017 and 2019. Also read Sharon Muza’s follow-up articles on these guidelines: Sharing ACOG’s Guidelines with Clients and her Research Update – ACOG Advises No Longer Laboring Down and Support of Family-Centered Cesareans. Guidelines include: laboring at home till active labor; doulas, intermittent monitoring, reducing AROM, using coping techniques and positions; oral hydration; pushing with urge to push, immediate pushing at 10 cm with epidural, and family-centered cesareans.

Physiologic basis of pain in labour and birth – Bonapace… Buckley. (SOGC) “…scientific literature supports the use of nonpharmacological approaches to pain management … due to benefits for the mother and child, including a reduction in the need for obstetrical interventions, labour augmentation, or Caesarean section.” Addresses Gate Control, Diffuse Noxious Inhibitory Control (counter-irritants), Central Nervous System control, continuous labor support, and the hormones of labor.

International Childbirth Initiative – 12 steps to safe and respectful motherbaby- family maternity care. Includes: affordable care, midwifery model, continuous support, non-pharmacological first option, benefit/risk considerations, and baby-friendly practices. (It’s similar to the Ten Steps of the Mother Friendly Childbirth Initiative from CIMS, from 1996.)

WHO update 2015 – Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice. Includes 56 recommendations for labor and birth. Many are same as 1996 – midwifery, intermittent, food and fluid; mobility & upright positions, following urge to push, skin-to-skin. New: active labor begins at 5 cm; during active, may progress more slowly than 1 cm/hr; no interventions to speed up labor before 5 cm; delay cord clamping at least one minute; delay bath 24 hours.

AIMM study – Vedam et al 2018 – Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. States with a better integration of midwives into the health care system had more spontaneous births, VBACs, breastfeeding and at 6 months; less interventions; less preterm birth, LBW, neonatal deaths.

Consortium for Safe Labor? I didn’t get the full citation on this… but Amis summarized that hospitals with physicians AND midwives had lower rates of induction, augmentation, c-s; had birth at a later gestational age, more NICU admissions; no differences in adverse neonatal outcomes or Apgars.

Midwifery Care for Low Income Women – fewer small for gestational age; fewer preterm, fewer LBW – “women who are more vulnerable benefit from the care of a midwife.” Study.

Listening to Mothers in California 2018 – survey of 2539 participants. Summarizes survey result data, but also includes quotes from parents who describe their maternity care experiences. Asked about choice of care provider and birthplace, maternity care preferences vs. care received, respectful and disrespectful treatment, and racial disparities. Here are a couple of interesting visuals from Listening to Mothers.

Teaching Birth Prep on a Portal

I recently wrote a review of Facebook Portal for those who are considering a purchase. On this page, I’ll just give you a quick overview, and then comment specifically on how well I think it would work for online childbirth preparation classes.


The Facebook Portal is a video-chatting device. You can also use it for streaming or surfing the web, but it was primarily designed as a device for teleconferencing software such as Facebook Messenger, What’s App, and now Zoom. (Not for Teams or Skype)

Zoom works fairly well on the Portal, although it does not have a few of the features you’ll find on your app on your computer – you don’t appear to be able to run breakout rooms or do polls from it. You also don’t seem to be able to share directly from the Portal, but you can easily share from another device without having to log it in to Zoom. See the full review for more details.

Audio Video Quality

It’s got really good speakers, multiple microphones and a camera with good video quality. The camera has movement tracking software, which follows you if you move around the room. I was hopeful that this would be good for birth classes, providing a better view of comfort techniques than I can manage with my laptop.

It turned out, as you can see in the second video, that the motion tracking did not work well for this purpose. The camera focuses around your face, so when you’re trying to demo foot placement for a lunge, the camera will show you from the waist up or even shoulders up.

You can do manual control of the camera, where you can zoom in or out, and aim it where you want it, so you can create just a nice wide angle that shows most of your body. It looks better and sounds better than it does when I use my laptop’s webcam. You’ll see this in the second video.

Using for Birth Classes

So, here’s how a few techniques for birth classes look on my laptop with its external mic.

Here’s how things look on the Portal – the first part of the video has the camera using motion tracking – the second part is manual control. You’ll notice even in the still images here that the color and picture quality is much better on the Portal than on my Lenovo laptop.


The Portal experience is not a game changer, and I wouldn’t necessarily run out to purchase one. However, if the price ($129 – 179 in November 2020) is manageable, I think the improved audio / video quality and the ability to get the wide-angled shot offer some appealing benefits for me.

For more info on using Zoom

I have LOTS of tutorials about how to use Zoom – for brand new beginners, experienced hosts, musicians, preschool teachers and more. Check out:

Note: the links to products in this post are affiliate links. If you click through to Amazon and purchase anything, I will get a percentage of the revenue. That helps support my work writing this blog and others.