Teaching Physical Skills

A common mistake I’ve seen in childbirth classes (and other types of classes) is that when an instructor teaches a physical skill, they spend several minutes talking about it, then run out of time for the students to actually DO the skill. I encourage you to flip it around. Talk as little as possible to give your students a sense of what you’ll be asking them to do and why, and then get them practicing as soon as possible. In my workshops, I teach that if you’ve got ten minutes, you spend one minute giving a very brief description of the activity. One minute demonstrating the activity. Then you have eight minutes for them to practice. As they’re practicing, you can walk / look around the room and give feedback, ask questions, and answer questions. But during 80% of the time you’ve got your students engaged and doing something with their bodies, rather than just sitting and listening to you. Here’s more details on each of the steps:

Step 1: Description

First, give a very brief overview of what you are going to do, describe when they would use this technique, and why – what the benefits of the technique would be. For example:

“I’m going to show you slow deep breathing. You can stay sitting and we’ll practice it together. Slow breathing is often the first comfort technique you’ll use in early labor. It helps you to relax, brings lots of oxygen to your baby and your muscles, and gives you something to focus on rather than just the pain.”

“I’m going to show you how to swaddle a baby – wrap it up tightly in a blanket. This is a great first step when you’re trying to calm a crying baby or when you’re trying to settle a drowsy baby to sleep.”

Keep this very brief. Provide just enough info so they know what to expect, and why it’s relevant to them, then quickly move on to them actually performing and practicing the skill.

Step 2: Demonstration

Next, demonstrate how the skill is done, with your body and/or AV’s, narrating each step as you do it. (It may also help to draw a diagram on the board, or point to a poster to illustrate a point.) Teach only the most basic version of the skill at this time. You’ll cover variations and adaptations during practice and feedback. Break the skill up into concrete, teachable steps, and illustrate each step clearly. Examples:

“Stand next to the chair, and place one foot up on it like this. You want your feet to be at a 90 degree angle from each other to open up your pelvis as much as possible to let that baby descend and.rotate. Then you’ll rock back and forth like this – see how much that changes the shape and position of my pelvis? OK, let’s all try.”

“You’ll hold the baby in your arms like this. See how my elbow is supporting his head and my hand is supporting the weight of his bottom? I hold him at the same height as the breast, with his tummy tucked tight against mine. OK, let’s all try.”

If there are several techniques you want to teach, teach them one at a time, with practice sessions between. So, don’t teach 6 positions, then have them practice all 6. Teach them one at a time.

Step 3: Practice

Next, have your students try the technique you have taught. This is where you should spend most of your time!

With hands-on experience of a technique, students will learn it better (and you’ll discover if you weren’t clear enough when you taught it!), remember it better, and adapt it to their use. This deeper learning means they are more likely to use this skill outside your class.

Practicing physical techniques in front of strangers can feel awkward to some people. Some things you can do to help with that: Turn on music during practice sessions so they can’t overhear each others’ conversations. Dimming the lights can also help, but don’t dim them too much, or it can feel strangely intimate. Acknowledge that it may seem silly, but tell them why you see value in teaching the skill. (“No, putting a diaper on a doll is really nothing like diapering your real squirmy baby. But it’s better to have practice some of the basic skills on a doll than it is to never have practiced.”) Be matter-of-fact about it when you demonstrate – if you’re embarrassed or awkward when you’re demo-ing, they’ll be embarrassed to practice it. Start with “easy” things that are generally socially acceptable, then move to things that might be more awkward. For example, teach ways to relieve leg cramps (calf stretches) first, then teach pelvic tilts standing up, then pelvic tilts on hands and knees, then squatting. Or teach hand massage, then upper back massage, then the lower back techniques like counter-pressure and double hip squeeze, which touch on more personal parts of the body.

Step 4: Feedback

The practice and feedback steps are often interwoven. Proper guidance results in quicker, more effective skill acquisition. Learning without guidance is learning by trial and error. It is slower, and less effective than learning with feedback.

As they practice a technique, they discover questions about it that they wouldn’t have ever discovered if you had just demonstrated it and not given them time to practice. During feedback, ask often if they have questions. Their questions will allow you to provide more details about the technique: the when, why, and how to do it get fleshed out in more detail during this process. All the things you may have been tempted to cover in lecture format will still get covered. However, because they come in response to questions and a state of inquiry amongst your students, they will pay more attention to your answer, and remember it better than they would have remembered lecture information you spoon fed to them.

As they practice, they may discover things that aren’t working for them, and you can provide suggestions for adaptation. Then they can experiment some more.

While observing them, you may notice that they misunderstood the demonstration. If so, find another way to show them, but point out that you are doing so. “Ok, let’s try doing this a little differently to see if that will work better for you.” Don’t criticize or blame them. Always find something to praise, and then mold that into success. Encourage them to problem-solve together.

For example, if during counter-pressure practice it looks to me like the partner’s hand is too high, instead of just telling him he’s doing it wrong, I might ask her, “how does that feel?” then I might say to him “your hand is a little higher than I typically place mine… try moving it down a couple inches.” Then I ask mom again, “How does that feel?” Then I encourage them to practice and experiment more with hand placement and pressure to find the spot that’s perfect for her.

Learning from other people’s examples – both good and bad

One of the best ways to learn how to teach physical skills is to watch other people do it. Watch lots of other people! Each one will highlight slightly different information, each will have different analogies. By watching several, you collect a sampling of good ideas. (And sometimes you learn what not to do.

Today, with YouTube, it’s easy to observe a wide variety of teaching styles. If you look up something like “pelvic tilts for pregnancy” or “bathing a newborn”, you will find lots of videos. Some are professional and polished. Some are made with phones propped up on someone’s dining room table.(And sometimes those are the best teaching examples….)

Watch several videos, taking notes as you go along. What are the key points that they cover? Where did they give too much detail? Where were they not clear? How long did it take for them to get to the point of the exercise vs. did they spend a lot of time giving details you don’t really need to know? Did they make it look easy to do? (And I don’t just mean was it easy for them… I mean if I was a really uncoordinated feeling person and I watched them do it, would I think that I could do it?) How was their pacing? Could you practice along with them or were they too fast? Too slow?

Now you practice teaching it. Try out some of the things you saw in the videos. What works well for you? Are there things that you thought would work but you just can’t make it flow quite right?

When you’re teaching, try to pay attention to how much time you spend talking about something while your students sit still versus how much time they spend practicing. The more time they spend practicing and adapting something to their own abilities, the more likely they are to use it during labor or after birth.

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Group Process: Class Begins

tent

This is post #4 in my weekly series “Group Process in Childbirth Education: Building and Supporting a Community of Learners.” It’s about the first ten minutes of class – this is the most important time in terms of establishing effective group dynamics for the rest of the class series. People won’t connect unless they feel comfortable and feel like they belong.

Arrival and First impressions

Your students form an impression of you, their fellow students, and whether they belong in the first ten seconds after entering the room, so it’s important to get first impressions right.

Be early for the first class and have everything ready so you can focus on welcoming students. Pay attention to how you are dressed. Try to dress in a similar style to your students, but one step more formal, since you are the “authority.” Introduce yourself when they arrive, and begin a conversation (great topics: when are they due, what they’ll name the baby, traffic and weather.)

Have an attendance sheet or class folder with their name on it. This reassures them they’re in the right place.

Have them make nametags. Rather than little tags they wear on their chests, fold a piece of cardstock in half to make a little “tent”. Have them write first names and due date with a marker so it’s easily visible from across a room. They set it on the floor in front of them. Or, you can use the spiffy white board style nametags shown at the top of the page.

Have snacks available, or at least water and cups.

Play music to set a friendly, relaxed tone. Try to find music that’s fairly universally appealing, not something aimed at just one demographic.

Have an icebreaker activity available in case lots of students arrive early – it’s better to get them moving and talking, instead of sitting passively in their chairs. Choose one that helps people find commonality and appreciate the diversity of experience. Try Icebreaker Bingo – each student is given a sheet with 25 questions on it. Their job is to find someone in the room that can answer yes to the question and write their name down.

Class Begins

Your introduction: This partially serves to establish your credibility as the instructor for the class (what you know and how you learned it) but it also helps to establish you as a human being they can relate to – an approachable mentor on the parenting path.

Student Intros: If you’re teaching a one-time two-hour class with 12 couples, you may not do full introductions of all the students. But for smaller classes and multi-week classes, always make time for intros. Minimum intros are names and due dates. If you have time, try the 3 part intro:

  • Who Are You? (Name and Due Date)
  • What do you already know? (Could ask professional background, but that can set up social class distinctions. Could ask what they know about birth and baby care. Could say “In this class, we’ll be talking about some things that are new to you that you might worry whether or not you’ll be good at. I want you all to remember that you can learn new skills and get good at them. Share with us something new you’ve learned and gotten good at in the past few years.”)
  • What do you want to know? (What are you hoping to learn in this class? If you’re in a hurry, ask them to say in one word what they’re hoping to learn. If you have more time, you don’t need to limit it in this way.)

When they introduces themselves, show interest in them as an individual. But then also generalize what they said so it relates to everyone. “Yes, a lot of people worry about that. We will definitely be talking about that in week two.” “Thanks for that question on diaper wipes. We’ll be talking more about all things diaper related in the newborn care class.”

Housekeeping. Tell them how to get basic physical needs met: where the bathrooms are, where they can get food / drink, when you will be taking breaks. If you’re teaching a class that’s more than 3 hours, say that it’s OK to sit on the floor, or stand, or sit on the birth ball, or whatever they need to do to be comfortable for all that time. If people are comfortable, they can learn. But if they’re wondering when /how they’ll get to eat or pee, they’re not learning.

Go over the class outline so they know what to expect out of each session of class. Also define social norms and expectations for participation and interaction.

In next week’s post, we’ll look at more ways to build community as the class goes on.

Group Process: Room Set-Up

This is post #3 in my series “Group Process in Childbirth Education: Building and Supporting a Community of Learners.”

Chair Set-Up

The arrangement of chairs makes a big difference in group dynamics – in how well the students connect to you and to each other, and in how much attention they pay in class.

Here are options:

Semi-circle or U shape with instructor at front

  • Advantages: students can see each other and can see instructor well (helpful for demos of positions, audiovisual aids etc.) Sets up instructor as authority, but in a friendlier way than seminar seating. Instructor can move into the center of the room, walk toward people when they ask questions; this dynamic motion helps to engage students.
  • Disadvantages: Takes up a lot of space. Some students are uncomfortable looking at each other rather than looking straight ahead at white board. (Having tables in front of them reduces this discomfort, but makes the class much more formal than just chaUirs.)
  • Things to be aware of: Make sure all the chairs are angled to face more forward to the front of the room rather than facing into the center of the room… otherwise students spend lots of the class turned sideways in their chairs. Very uncomfortable!
  • Best compromise for a class with a mix of lecture, group discussion, small groups, etc.

Circle of chairscircle

  • Advantages: Everyone can see everyone. Equalizer. Best for group discussions. There’s plenty of floor space for practicing comfort techniques.
  • Disadvantages: Takes lots of space. Some people may be uncomfortable facing each other – feel like they’re on display with nowhere to hide. Circles don’t wok well with tables unless there’s one really big table everyone is seating around. Not good for videos or visual aids as some people won’t have a good view.
  • How I use this: I don’t use circles when I teach, simply because I write and draw on the board a lot and that works better with U shaped seating than with circles. I do use circles for class reunions because I want everyone there to be an equal participant, and acknowledge that everyone has valuable knowledge to share.

Seminar seating (rows of tables with chairs on one side, all facing the board) or theater seating (rows of chairs facing forward, no tables). seminar

  • Advantages: sets up a formal learning structure, focuses attention forward.  Good view of visuals for those in the front of the room. Best for lectures. Theater seating is the most compact seating – you can fit more people in the room with this option than any other, which may be important in a small space. theaterStudents with a professional or academic background may feel quite comfortable in this arrangement.
  • Disadvantages: may be too formal, and discourage interaction amongst students, and even interaction between students and teachers. Those in the back of the room may have a harder time seeing and hearing. This set-up also puts students in their academic brain. This is not where I want my childbirth class students because in labor you’re not in your academic brain. I want people moving, feeling, connecting, and exploring so they learn in a way they’re more likely to remember during labor. Also, this feels like a “class room”. If you have students who were “never good at school”, this will not feel comforting and welcoming to them.
  • How I use this: I try to avoid this arrangement, but sometimes when I’m running late to a class, I discover that this is how the facility staff set up the room, so I live with it, but make an extra effort to encourage group participation.

Banquet style seating (students gathered around tables, facing inward)banquet

  • Advantages: best for small group activities. Good for encouraging interaction and getting students to teach each other.
  • Disadvantages: For any lecture, half the people have to turn around in their chairs to see the front of the room. Could encourage people to only interact with the people at their table, and not with the full class.
  • How I use this: I occasionally use this set-up on week four or five of my series. After the group has already built a rapport, doing small group discussions can work well for values clarification and problem-solving exercises.

However the room is set up, make sure it’s clear and obvious to the students where they are supposed to sit. For example, if you have a room with far more chairs than you need for class, putting handouts on the chairs you want them to use helps make it clear. If you need all the chairs to be used, and don’t want couples to leave space between them and the next couple, make it obvious that there are “pairs” of chairs and put the handouts for a couple so they straddle over two chairs.

Decor, artwork and visual aids

If you’re teaching in a shared or borrowed space, you have to live with whatever décor comes with the room. Occasionally you may have something you need to cover up. For example, if you’re teaching a secular class in a church building, some of your students may be more comfortable if you can subtly cover up very religious images or words. If you’re in a medical clinic waiting room, you may want to set aside some of the educational materials and magazines that are normally there.

You can also decide whether to bring any of your own décor into the space – a table cloth maybe? Or flowers? I personally like to travel light, and I don’t like a lot of visual clutter, so I try to make the space as plain and neutrally welcoming as possible.

I have some slides I use in my childbirth educator training that illustrate a variety of classrooms, display of visual aids, and instructor appearance. Check them out, and then imagine that you are a “typical expectant parent” from the population you serve. What would you think about each of these settings? What would make you comfortable? Uncomfortable?

Pay attention to artwork and to visual aids. Medical illustrations of anatomy and pelvis models and such may be uncomfortable to some people, either because they don’t understand what they’re seeing (which makes them feel ignorant) or because they think bodily details are “icky.” I keep most of my medical AV’s out of sight at the beginning of the first class. “Earth mother” style artwork may also be a turn-off to some who already feared that birth class would be too “woo-woo” for them. Pictures of babies are almost always a winner, especially if they show diverse families.

Assess your current classroom

The next time you’re in your classroom, take a good critical look at it. Imagine you were a new student coming it, not knowing what a childbirth class would be, and wondering whether it was a good fit for them. What would they see? How would they interpret it? What could you do to make them more comfortable?