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.
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: https://www.youtube.com/watch?v=RiV_uXOg6Bg)
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 live.com 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. https://youtu.be/-rpVYSfuknU
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.
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.
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.
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.
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: https://janelledurham.com/guide…/use-other-apps-with-zoom/
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.
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.”
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.
In a separate post, I cover where to find: posters, PowerPoints, illustrations, and handouts. 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.
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.)
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
Many childbirth educators are now teaching their classes online. For those who are using Zoom, I wrote up a guide that has several tutorials, from the basic “how to join your first meeting” to becoming a more skilled participant, to hosting meetings, sharing video, playing live music, and more. It also includes lots of ideas for interactive games and learning tools you can use. Find it at: https://janelledurham.com/guide-to-zoom/.