Variations in Labor – A Dice Game

Five_dice_02

This is a dice game which can be used to structure a labor rehearsal, or to structure a presentation on variations, or could be the framework for a two hour long class where you are both teaching about variations and interventions AND want to practice / review comfort techniques. (I also have a ten minute dice game to review stages of labor.)

I will guide the students through creating three different birth stories. We will roll dice, flip coins, and just make things up as we go along. I divide the white board up into three columns, and we write the stories on the board as we go. By the end of the exercise, we’ve walked through three possible ways labor could unfold, and how someone might respond to that. This is a good way for students to imagine what birth might be like and reflect on how that might feel, and consider the ways in which their initial birth plan shapes their decisions and how they might have to adapt their birth plan in response to circumstances.

If I’m using this to structure my labor variations presentation, then each time we get to a situation where an intervention might be recommended, we leave our stories behind for a moment, and I do the presentation on that intervention, then we move on. If I’m using it for a labor rehearsal, we take a break at each section where it talks about “coping with” that stage,and we discuss and practice techniques.

Here is a Sample Dice Game that is an example of what the white board might look like at the end of this exercise. (I wrote that sample before I started beginning with pain medication preferences.)

Here are the steps in the game. A * indicates that I ask the group  for this answer, a # indicates they roll dice or ¢ flip a coin, a + means they do the math.

If needed, cheat the math or have them re-roll so you end up with three diverse stories, shift things around as needed to make sure you cover the content you need to cover and so that each of them may face some challenging situations, but in the end everyone has a positive birth experience and a positive outcome.

Pain Medication Preferences. # ¢ Have them flip one coin and roll one die to determine where their character is on the pain medication preference scale. If they flip heads, it’s + and if they flip tails, it’s -. So, heads and 6 would be +6, a strong desire for pain meds. Tails and 3 would be -3, prefer to avoid pain medications. (Note: if needed, have one re-roll so you have a diverse set of preferences.)

Birth Plan Prior to Labor? *

Ask them each to create a character. What’s their birthing parent’s name? Why do they have that pain med preference? Who are their support people? What is their birth plan? (If they’re making up crazy birth plans, let them have fun with it and laugh along for a bit, but then suggest that the rest of the game may go better if their character has more typical preferences.) After a few minutes, ask them to tell the other groups about their character. Write the character’s name on the board.

What week does labor begin? #

Have them roll one die. If it’s a 1, labor begins at week 38. 2 = week 39. 3 and 4 = week 40. 5 = week 41. 6 = week 42. Write the answers on the board.

In a variations presentation, 1 = before 38 weeks; 2 = 38 weeks, 3 = 39 weeks, 4 = 40 weeks, 5 = 41 weeks, 6 = Induction. Write results on board. Then take a break to discuss preterm labor (whether or not any of them are having it), and then to cover induction (whether or not any rolled a 6.)

What time of day does labor begin? # # ¢ 

Roll two dice to get time of day. Flip coin – heads = am, tails = pm

How does labor begin? *

This is a chance for them to review what they’ve learned about signs of labor.

Length of early labor? # # #

Roll 3 dice to see how long early labor lasts. If they roll 18, roll one more die to see how much longer than 18 it is.

In variations presentation, here’s where you cover prodromal labor and precipitous labor (even in none of the women in our stories are having it)

What do she and partner do?* 

Encourage them to imagine the scenario – where would their character be at 2 am? Where might the partner be? How should they respond? What coping techniques would be helpful and possible at this time and place. This is a chance for them to practice problem-solving and imagine how to adapt the techniques they’ve learned in class.

If using this as labor rehearsal, you could stop and practice early labor techniques now.

When will they move from early labor to active labor? +

They do the math – take what time labor started, add the number of hours early labor lasted – what time would that be?

How will they know it’s time to go to the birthplace (or call the midwife)? What is that trip like?*

Review the decision-making process. Discuss what it might be like to arrive at the birthplace at that time of day. Remind them how triage works. (Option – I’ve never done this, but you could have them roll two dice # # to see how dilated they are… If they roll an 11 or 12, they need to re-roll.)

Coping with Active Labor *

Discuss how they would cope, based on her birth plan, her pain medication preferences, and how her early labor went.

In labor rehearsal, could spend time practicing here. 

Length of active labor and transition #

Roll two dice. If someone is having a really long active labor (5 or more), ask them if they might change their coping techniques and how. If they roll a 7 or more, tell them that augmentation would probably be recommended.

Variations: cover prolonged labor and augmentation here.   Can talk about all the things that might cause prolonged labor (dehydration, immobility, full bladder, fear, tension, uterine inertia) and have them think about how to prevent / treat. Talk about Pitocin and decision-making. 

Labor Rehearsal: Could practice back labor techniques – position and massage.

Considering pain meds *

Variations: could cover pain medications here, if not covered elsewhere in series. This dice game gives a great opportunity to explore with the group what effects our pain med choices: prenatal preference, PLUS how our labor progresses and what other things happen, PLUS what kind of support we receive, and care provider’s influence (e.g. since Marge has been in hospital for hours, the nurse may have hinted several times that pain meds would be good option for her)

Pushing Begins +

Look at what time active labor begins – add the length of active labor and transition. What time does she begin pushing?

Coping with Pushing *

Labor Rehearsal – what positions and techniques would help with pushing?

Length of pushing #

Roll one die, divide by 2. Could choose to add 30 minutes or an hour to dice results for those who have epidural.

Cover second stage variations here (again, even if none of the moms in the stories have one.) Cover episiotomies, vacuum, forceps, and possibility of cesarean. I have “offered” cesarean to the moms in these stories, but I always end the stories with all three having successful vaginal births. I cover cesarean in detail later on in the class, not as part of this exercise.

Time of Birth +

Time pushing began plus length of pushing.

Total Length of Labor +

Add together early labor duration, active and transition, and pushing stage.

Discuss what it would be like to have labor that long.

Then allow time to de-brief that whole exercise. What was it like to go through that process? What parts felt most challenging for their character? What would have helped that character have the best possible birth?

Sample Dice Game