Tag Archives: childbirth education

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.

 

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/]

Understanding Labor Pain

I discuss the physiology of pain and ways that people who have been through birth  describe how contractions feel. Given all of the physical changes and challenges of labor, it’s not surprising it is painful for many people. The acronym P.A.I.N. can remind us that labor pain is Purposeful, Anticipated, Intermittent, and Normal. However, understanding what factors make that pain worse than it has to be helps us learn how to reduce it. The Fear Tension Pain Triangle theory tells us that when we’re fearful, we tense up. As we tense, the pain increases, which frightens us more…. the fear increases, and so on. Instead, we want to explore ways to shift this to the Confidence Relaxation Comfort Triangle to make labor more manageable. [Transcript of podcast episode.]

Labor Pain Toolbox

Podcast Episode 1: The most common question from people preparing for labor is ‘how will we handle the pain’? This episode provides an overview of all the tools that we can stock in a Toolbox for Coping with Labor Pain. It introduces both non-drug comfort techniques and pain medications, explores how the choice of pain coping techniques influences the whole experience of labor, and discusses the Pain Medication Preference Scale, a helpful tool for clarifying and summarizing priorities related to pain medication. Knowing someone’s preference helps to guide the labor support team in how to support them through the challenges of labor. Learn about all these tools by listening to more episodes of this podcast, or by reading Pregnancy, Childbirth, and the Newborn.

[Transcript of this episode, with links to more info.]

Support and Sanity Savers Handout

I’ve created so many resources over the years that I sometimes forget about some. I got an email today reminding me about this one I wrote back in 2003, with two other educators (Tawnya Ostrer and Jamie Olson)… I looked back and, you know, it’s pretty good! So, I updated it, and will share it here.

This is a handout to be used in a childbirth education class or with doula clients, which encourages expectant parents to plan ahead for practical support, emotional support, and peer support. It also includes a letter that they can give to friends or family members who ask how they can help.

Postpartum Support and Sanity Savers – PDF

Postpartum Support and Sanity Savers – Word (you are welcome to edit the document to substitute your local resources for the Seattle area resources I list. Otherwise, please use as written, with copyright info intact.)

And here’s a related handout to help them plan for a division of labor after birth: Baby Care Plan

Labor Hormones in under 10 minutes

Note: this page is about how professionals can TEACH this concept to expectant parents. If you’re an expectant parent looking for info on labor hormones, their effect on labor pain, and what your partner can do to help you have a shorter and less painful labor, read Hormones and Labor Pain or listen to episode 5 of my podcast – Labor Support.

In my childbirth classes, and with doula clients, I want them to understand that our emotions, and the support we receive, absolutely affect labor on a physiological basis, by influencing our hormones. The big message is that fear and anxiety slow labor down and make it more painful. Support and feeling safe make labor faster and easier. I have simplified the complex details into a simple stick figure drawing that takes 5-10 minutes.

Before I talk about my teaching method, let’s start with…

A basic summary* of hormones

Oxytocin

  • What it does: Causes labor contractions that dilate cervix (i.e. helps labor progress)
  • What hinders oxytocin production: Anxiety, bright light, feeling observed or judged. Pitocin (if you’re given synthetic oxytocin, you make less hormonal oxytocin)
  • What increases oxytocin: Skin-to-skin contact. Nipple stimulation, making love.

Endorphins

  • What they do: Relieve pain, reduce stress (cause euphoria and feelings of interdependency)
  • What hinders endorphin production: Stress, lack of support. Narcotics (if you have an external opiate, your body will start producing less internal opiate… even after the narcotics wear off, you’ll have less endorphins)
  • What increases endorphins: social contact and support from loved ones.

Adrenaline

  • What does it do: In early / active labor: slow labor down(Imagine a rabbit in a field. If it doesn’t feel safe, it wants to keep baby inside to protect it)  In pushing stage: Make you and baby alert and ready for birth, give you energy to push quickly. (If the rabbit is about to have a baby, and something frightens it, it wants to get the baby out as quickly as possible so it can pick it up and run with it.)
  • What increases adrenaline: Stress / anxiety / fear; Lack of control; Feeling trapped; Hunger, cold
  • What increases oxytocin and endorphins and reduces adrenaline: creating an environment where the birthing parent feels private, safe, not judged, loved, respected, protected, free to move about.

Teaching about Hormones

So, in class how do I convey these ideas in just a few minutes, so it’s easy to understand and to remember?

First, I say: “In labor, our emotions and our environment effect our hormones. Our hormones have a huge effect on labor. Let’s look at a couple scenarios for labor.” [I draw two stick figures on the board.] “This one is awash in stress hormones which will make labor longer and more painful. Let’s label it adrenaline. This one is under the influence of oxytocin and endorphins. These help the laboring person shift into an altered state where labor pain is milder (less intense and less unpleasant) and also help labor progress more quickly.” [Add labels to drawings, add sad face and smiley face.]

Picture2

Then I say “So, you are all probably familiar with adrenaline. What do we call it? Yes, the fight or flight hormone. This is the idea that if an individual ran into a tiger in the woods, they would choose either to fight it or to run away. Do you know what we call oxytocin? Many call it “collect and protect” or “tend and befriend.” If a tiger is coming into our village, we gather everyone together, because we are safest together.” [I add these labels to my drawing.]  (I sometimes throw in the tidbit here that men who are not dads are more likely to release adrenaline during stressful situations; women and dads are more likely to release oxytocin – it’s the “gather the babies and protect them” response.)

Picture3

“So, what effect do these hormones have?”

“With adrenaline, all your muscles tighten. All your energy goes to your limbs in case you need to fight or run away. So, oxytocin production drops and labor slows down. (It’s hard for your cervix to open when you feel scared…)  You are also more sensitive to pain – this is useful if you’re at risk of injury – your body tells you what to move away from. But, in labor it’s not helpful – it just means labor hurts more!”

“With oxytocin and endorphins all your muscles relax. Energy is sent to the uterus and oxytocin increases. (Oxytocin is often called the love hormone, because it increases when we feel loved, and its peak levels are when we orgasm, when we birth, and when we breastfeed. It’s all about making babies, birthing babies, and feeding babies.) We also get an increased endorphin flow, which makes us less sensitive to pain, can cause euphoria, and can cause feelings of love and dependency in us… “I love you man….””

[As you talk, write the notes, and draw on the figures like this to show effects…]

Picture4

[If you teach the 3R’s method for coping with labor pain – relaxation, rhythm, and ritual, you can also add in here: If you’ve got oxytocin and endorphins flowing, you may also have more rhythm – you may rock, moan or sway rhythmically. If your partner helps to reinforce your ritual, it will help build your oxytocin and endorphins.]

“So, what causes adrenaline rushes? Fear, anxiety, feeling watched or judged, feeling like you have no control over your situation, being hungry or cold.”

“How can we tell a person in labor is rushing adrenaline? They act vigilant or panicky, have lots of muscle tension, and a high pitched voice.”

“What causes oxytocin and endorphins to flow? Feeling safe, loved, protected, having privacy, having support, eye contact, skin-to-skin contact, and love making.”

“How can we tell if someone is in an endorphin / oxytocin high? They seem open and trusting, their muscles are relaxed, and their voices are low-pitched and husky.”

[Add notes about causes and signs to your picture.]

Picture5

“So, partners, what’s the big picture summary?”

“If you remember nothing else from this class, remember this: If a person in labor feels safe, loved, and supported, her labor will be faster and less painful. If in doubt about what to do, always return to this! Anything that helps her relax, gain her rhythm and feel cared for will help her.”

More Info

* If you want a great overview of hormones in labor, read Pathways to Birth. If you want all the details on hormones in labor, read Hormonal Physiology of Childbearing. You can find them both at: http://transform.childbirthconnection.org/reports/physiology/.

Find more thoughts about teaching on my blog for childbirth educators. Check out ideas for interactive activities for childbirth  classes. To learn more about any topic related to the perinatal period, check out our book Pregnancy, Childbirth, and the Newborn: The Complete Guide

Pain Med Preferences

In classes, we talk about the Pain Medication Preference Scale from Pregnancy, Childbirth, and the Newborn. We have the expectant parents look at it together, and then encourage the pregnant parent to choose the number that best represents their preferences, and the support partner to choose what they WISH the pregnant parent would choose.

Then we have them discuss. Often they align, but not always. Sometimes there is a pregnant parent who is hoping for an un-medicated labor who has a partner who can’t bear the idea of seeing them in pain. Sometimes a pregnant parent wants medication, but the partner has concerns about side effects on them or the baby. I would much rather this issue come up during pregnancy when they can resolve it rather than arising without warning in labor.

I have designed a new worksheet that asks more questions about labor coping preferences that they can fill out separately, then discuss, to further illuminate these issues and enhance the discussion they can have about goals and preferences before labor begins. You can see the Pain Preferences Worksheet here – feel free to print and use in class.