Tag Archives: teaching technique

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.

 

Grab Bags

Grab bags are a fun and interactive teaching technique that is easily adapted to a wide variety of topics. Basically, you gather up a collection of small items that symbolize each topic you want to cover – you may find these things around your house, in your kid’s toybox, at a Goodwill or a dollar store. Put them in a bag. At class, pass the bag around, and each student takes one (or each couple, depending on how many items there are). They then hold it up to show the other students, and they talk about how they think it relates to the topic, and you follow up with any additional information or discussion to add some more “meat” to the conversation.

What kinds of topics it works well for:

I use it for places where I have lots of little things I want to talk about that don’t need to come out in any special order… basically, whenever I find myself with a  lecture with 7 or more bullet points, I know that will seem like just an endless jumble of info to my students, so I start thinking about other techniques to use, and this is a great one.

I also find it works well for introducing the awkward topics. During the prenatal wellness section, when discussing all the things students “shouldn’t do”, it’s easy to turn into a nag. Here, when the candy cigarette appears, I “have to” talk about smoking but it  feels less judgmental. During postpartum, when the condom appears, it introduces the topic of sexuality after baby in a gentler way than me announcing “Sex” or writing it on the board.

However, don’t overuse it! I think it would feel gimmicky and tired if you used it multiple times in one series.

Here are examples of topics I have used it for:

Prenatal Wellness Lunchbox: I use one of my daughter’s old lunchboxes to contain this – I think it’s nice for our students to see signs that we are parents – it helps them connect. I fill  it with items that symbolize healthy choices for pregnancy, and not-so-healthy choices.

Sample items: calcium tablets, iron supplements, raisins, protein bar, tuna, caffeinated soda, a prenatal appointment reminder card, flyer for prenatal exercise class, cigarette, alcohol, Tylenol, condom, plastic baggies with “substances” in them. I label them so they know what it’s supposed to represent, and what it really is: “cocaine (baking powder)”, “marijuana (parsley)”, and so on.

Comfort items for labor: When I introduce it, I talk about how every pregnancy book has a list of items you should take to the hospital. But you often don’t need them all. For example, if it says “eye drops” and you don’t own any eye drops, you don’t need to go out and buy them! They’re not one of the comfort items you use in your life. But they are a good reminder to people who wear contacts to consider bringing contact supplies or a pair of glasses if needed. Then I say “So, this bag is just a collection of ideas about what kinds of things people find helpful for comfort in labor. Hold up your item, say how you think it would be useful in labor, and then say whether you think you would find it helpful.”

Sample items: heating pad, ice pack, massage tool, tennis ball, snack (clif bar, peanut butter crackers…), water bottle, CD (note that many students will use their smart-phone for music… the CD is a little dated, but I’m not putting my phone in the bag…), reflexology combs, toothbrush, mints, shorts, sweater, etc.

Postpartum adjustment: items that address physical, emotional, and lifestyle adjustment. Sample items: Maxi pad, peri bottle, tucks pads, stool softeners, condoms, breastmilk pads, kleenex (to symbolize baby blues), phone number for PPMD hotline, alarm clock (to represent sleep / frequent wake-ups), easy-to-eat food, phone to represent reaching out for support, red silk rose to talk about romance / relationship after baby.

A grab bag alternative… If you feel like you’re over-using the grab bag technique, but want some of the same effect, Teri Shilling from Passion for Birth has a postpartum bathrobe, where she fastens all these symbols all over a bathrobe that she wears when she presents this topic. It’s a very entertaining visual aid!

Try some experiments with grab bags. They’re always entertaining!

A note on number of items: My class size can vary from 6 couples to 14 couples. I may have 14 items in a bag. If I have 14 couples, they draw one item per couple. If I have 7 couples, they draw one item per person. But if I have ten couples, then I have two options for how to handle it. Pass the bag around once and have them take one item per couple, then pass it again, asking those who are willing to take a second so we can cover them all. Or, I can edit the bag before passing it around and only include the 10 most important items and put four others away.