Wallet Cards for Birth Classes

Long ago, I made small cards of the Key Questions for Informed Choice that I gave to students to keep in their wallets as a reminder. Recently, someone asked me for a copy of the file so they could print their own, and I discovered I had mis-placed it.

So, today, I created some new wallet cards, that you are welcome to use with doula clients, childbirth education students, or whoever would find them helpful.

Key Questions for Informed Choice

card listing key questions - benefits, risks, alternatives, timing

This file contains two versions of the key questions. Refer your clients to podcast episode 8 (or its transcript) to learn more about maternity care choices.

To learn more about how I teach clients the questions and how to weigh those against their personal goals and values, read about Teaching Decision Making.

Labor Comfort Techniques Reminder Card

labor comfort techniques card

I already had a two-page cheat sheet Guide to Labor Support. I created a comfort techniques wallet card to accompany it. Your clients can find the full Guide on the transcript of podcast episode 1 on Your Toolbox for Coping with Labor Pain.

There is more on the 3R’s in my episode on the Stages of Labor.

Visual Reminder of Comfort Techniques

comfort technique reminder card

If you feel like that first card is too wordy, and want something more visual, check out my visual comfort cards. These are not intended to stand alone. They would be best as reminders of concepts and techniques that you taught them, or that they can find in episode 4 – comfort techniques for labor. (The transcript for the episode includes a printable 2 page handout on these techniques.)

Printing the Cards

You could easily print these on paper or cardstock and cut them apart by hand.

I print my own nametags, so I always have “Name Badge Insert Refills” on hand, so I designed them to print on those. (They would also print on any of these products: 74461, 74549 or these Amazon brand cards. Note, those links are affiliate links, and I get a small referral fee from Amazon if you purchase after clicking on those links.)  These can easily be broken apart to create nice professional looking wallet size cards you can share.

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.

 

Life with Your New Baby

Adapting to life with a new baby presents many joys and challenges. Learn about the importance of self-care, relationship skills, tips for managing daily tasks and returning to work.

[A transcript of this episode with links to resources is available at https://transitiontoparenthood.wordpress.com/for-parents/life-with-baby/.]\

Caring for Your Newborn

Offers a brief overview of key information about caring for a newborn – how to figure out what baby needs by observing their cues, how to meet those needs with feeding, diapering, dressing, and bathing, calming crying, and helping your baby to sleep well.

[A transcript of this episode with additional information and links to resources is available at https://transitiontoparenthood.wordpress.com/for-parents/newborn_care/.]

Choices in Maternity Care

We’ll talk about all the choices you make in your maternity care, from choosing a care provider and birthplace and developing a birth plan to what happens if unexpected complications arise and you have to make choices about interventions you were hoping to avoid. [A transcript of the episode is available at https://transitiontoparenthood.wordpress.com/for-parents/options-for-maternity-care/choices-in-maternity-care/]

Birth and Baby’s First Hour

This episode covers second stage labor – the birth of a baby, third stage – the delivery of the placenta, and the first hour of baby’s life. Addresses when to push, how to push, and positions to aid labor progress. Talks about “the Golden Hour” of bonding with a new baby. [A full transcription of this episode is available at: https://transitiontoparenthood.wordpress.com/for-parents/labor-and-birth/birth-and-babys-first-hour/]

Teaching about Birth Plans

Here are the steps I teach for how to develop a birth plan. I do a brief walk-through of a birth planning process. For each, describe how to do the step, who participates, and the primary goal.

  • Birth Plan Checklist – Pregnant Parent and Partner
    • Find a checklist such as http://www.pcnguide.com/wp-content/uploads/2016/03/2-Preparing-Your-Birth-Plan.pdf. The pregnant parent and the primary support person walk through this together, making sure they understand what each of the options are (and if not, learning more), and making sure the support person knows her preferences for each. There is no need to share this detailed checklist with their care providers, it’s just for their own reference – it’s worth tucking it in the bag they’ll take to the hospital in case they would like to refer back to it in labor.
  • Top 3 – 5 Priorities – Discuss with Care Provider.
    • While completing the checklist, they can determine what their top priorities are. They should discuss these with their care provider at a prenatal appointment. Will these choices be options for them during their birth process? What can they do to increase the likelihood of reaching those goals? This discussion allows them to develop realistic expectations and increase the chance the expectations will be met. (Note, sometimes this can lead a parent to re-examine whether the caregiver and birthplace choices they have made are the best fit for their goals.)
  • Written Birth Plan – To Share with Nurses at the Hospital
    • A birth plan is the primary tool for communicating with nurses about the family’s goals and priorities, and what kind of support from caregivers would be most helpful to them.
    • It should never be more than one page long (in a easily readable format.)
    • One format is to have three sections. The first describes who they are as a family and who will be at the birth and what they have done to prepare for this birth. The second gives the big picture of their preferences for labor support, pain medication, and interventions. The third is optional, and explains any special information that “if the nurse only knew this about me, they could better support me.” This is a good place to address religious or cultural preferences, history of sexual abuse or other personal history that may affect them during the birth process, any particular worries they have about the birth.
    • If parents are planning a home birth, they may not need a written birth plan for their midwife if they’ve been in deep discussion for the whole pregnancy. However, they absolutely should have a written birth plan in case of transfer. In a survey of birth satisfaction, some of the lowest rates were for people who had planned an out-of-hospital birth and transferred. They could increase the chance of a satisfying birth experience by taking time to articulate their wishes.
    • Sample birth plans are available at http://www.pcnguide.com/wp-content/uploads/2016/03/2-Preparing-Your-Birth-Plan.pdf. Feel free to print several examples to share in class to show there’s no one right way to write a birth plan.

Childbirth Educators can support students with figuring out their top 3 – 5 priorities using the Birth Plan Card Sort exercise: https://transitiontoparenthood.files.wordpress.com/2018/10/birth-plan-card-sort.pdf. Instructions are on the last page.

Learn more about the steps of teaching about Informed Decision Making, including Values Clarification, and how to make the decision after gathering information.

Pain Medications for Labor

This episode offers an overview of medications for labor pain and childbirth – nitrous oxide, IV opioids, and epidural analgesia. For each it covers how it’s administered, the benefits – how it helps with labor pain, and the possible side effects. There is also a detailed discussion of labor support for a person using epidural analgesia.

A full transcription with links to more information is available at https://transitiontoparenthood.wordpress.com/for-parents/labor-and-birth/pain-medication-for-labor/