Tag Archives: birth classes

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.

 

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/

Labor Support

Continuous labor support, which can be provided by a partner or spouse, other family or friends, a professional doula or by medical caregivers has been shown to reduce interventions, improve outcomes, and improve satisfaction with the birth. This episode is all about how to provide effective labor support: by learning about childbirth, learning about what best comforts the person you will support in labor, creating an environment where she is comfortable and feels able to do what she needs to do to cope without being judged, watching for Relaxation, Rhythm, and Ritual and reinforcing those, and – most importantly – helping her to feel safe, loved and protected. When someone feels safe, loved and protected, oxytocin and endorphins flow, and labor progresses faster and hurts less. [Transcript of episode.]

Comfort Techniques for Labor

Learn comfort techniques and learn why they work. Cognitive strategies include education, visualization, affirmations, and choosing to view pain as a positive sign of labor progress. Gate Control techniques work by focusing  your attention on something pleasant (like music, a beautiful view or aromatherapy) instead of focusing on the labor pain – this blocks pain signals from reaching the brain, so you’ll experience less pain. Counter-irritants include things like biting your lip – a pain you control – to help make the pain you can’t control feel more manageable. And body mechanics involves using position, movement and massage to encourage baby to move into the best position to help labor to progress and be less painful. Here’s a printable handout that summarizes comfort techniques for labor.

[Transcription of episode and checklist of comfort measures available at https://transitiontoparenthood.wordpress.com/for-parents/labor-and-birth/comfort-techniques-for-labor/]