This weekend, Jeanne and I will be attending a meeting to revise the Lamaze International Childbirth Educator Program Study Guide. If you are a Lamaze educator and enrolled in a Lamaze program in the last two years, you will be asked to complete a survey. We hope you will take the time to complete the survey. Even if you are not a Lamaze childbirth educator, we would love your input. What helped you the most to become a childbirth educator? Was it reading books and articles? Watching DVDs or videos? Observing another educator teaching her class? Attending births? Student or practice teaching?  We would really appreciate it if you would share the references, books, DVDs, and experiences that have helped you the most to feel confident in teaching your classes. Please feel free to respond by adding a comment to this post or emailing us at info@thefamilyway.com. Thank you!

In advance of the upcoming MegaConference celebrating the 50th anniversaries of both Lamaze International and ICEA, I purchased on eBay a copy of the May 1958 edition of Ladies Home Journal, which many credit with birthing the modern childbirth education movement. In November of 1957, editors published a letter from a registered nurse who asked for an investigation of “the tortures that go on in modern delivery rooms.” In response, the magazine received a flood of letters, some of which they published in the May 1958 edition along with their own investigative report. The editors were shocked to learn of women who were left strapped in the lithotomy position on the delivery room table for as long as eight hours until delivery occurred. Other women told of having their legs tied together to prevent birth until the doctor arrived and of being cut and sutured without any anesthetic. Almost universally, women complained of being separated from their husbands and left alone with no support. The editors concluded that most doctors and nurses were kind and practiced appropriately, “but the response from nurses and mothers indicates inescapably that this is not always the case, and that instances of callousness toward suffering, or unethical measures that actually increase suffering are not so rare as our editors hoped they’d be.” Later , the editors wrote, “Until a generation ago, a normal childbirth was a natural, essentially happy event, attended by a husband and a kindly neighbor or two. Even in hospitals, friends might cheer the mother in the labor room; her husband or some other person close to her, could stay with her until the baby was born. Now, childbirth has been turned into a medical mystery, conducted in secret.”

Editors urged that hospital rules be changed to allow the husband to stay his his wife throughout labor and birth. “This one change in present hospital rules would abolish practically all the nightmare features of which mothers have complained. With a husband present, there is little likelihood that a women will be slapped or yelled at subjected to uncalled-for tortures. It will give the mother the support and reassurance of a loving presence.”

In addition, editors urged:

1. Mothers should “shop around” a bit before selecting an obstetrician. An Independence, MO, mother remarks, sensibly, “When buying a new home, a car, or even appliances you check several before buying. You should check a doctor as well.”

2. There should be more explaining of childbirth to mothers in advance.

3. There should be freer communication between doctors and their patients. Mothers should feel at liberty to express their fears to their doctors; to tell the doctors what they would like them to do.

4. If a mother is subjected to treatment that she considers cruel or unethical, it is her duty to report it to the local board of health, or hospital head, or some other person in authority.

In conclusion, editors quoted a Frankfort, Kentucky woman who said, “Every woman should be treated like a queen, even with her tenth! Not with excessive attention (yes, I know we’re short of nurses) but with good humor and joy in the occasion.”

Some things have changed; and some things have stayed the same.

One of the most important lessons from last week’s NIH meeting on VBAC is that, if we reduce the primary cesarean surgery rate,  fewer women and babies will be at increased risk in future pregnancies because of a uterine scar. So, what can we, as childbirth educators, do to bring down our sky-rocketing cesarean rate? Ideally, we can reach expectant parents in early pregnancy and help them to plan for a healthy pregnancy and birth. If your students are primarily planning to birth at home or in birth centers, you will not have to spend much time on avoiding unnecessary cesareans. However, if like many of us, you teach in a hospital and meet your students in traditional, third-trimester childbirth classes, encourage them to do the following (printable pdf):

1. Let labor begin on its own. Medical studies have clearly shown that induction almost doubles the likelihood of cesarean surgery for a first-time mom.

2. Hire a doula or arrange for a woman experienced with childbirth to stay with you and your partner throughout labor. A good doula will not interfere in the relationship between you and your partner. Instead, she will provide reassuring support for both of you and recommend comfort measures.

3. Stay at home in early labor. Labor takes much longer than most people think. Recent studies suggest that the average labor for a first birth is somewhere between 12 and 17 hours. At home, you can move around freely, take a walk in a nearby park, relax in your tub, and eat lightly according to your appetite. Once you get to the hospital, there may be a focus on getting birth “done” in a certain time period.

4. Ask that your baby be monitored intermittently (at regular intervals) rather than continuously. The American Congress of Obstetricians and Gynecologists (ACOG) states that intermittent monitoring is just as safe for low-risk women as continuous monitoring and that continuous monitoring is associated with an increased risk for cesarean surgery.

5. And ask for a “hep lock” or “saline lock” rather than IV fluids. Being “hooked up” to an IV restricts your ability to move freely and to use comfort measures such as the bath and shower. ACOG says that it is safe for women with uncomplicated labors to drink clear fluids during labor.

6.Move around! Bring your birth ball and use it. Ask for a room with a rocking chair. Staying upright, walking, and changing positions frequently may shorten your labor by about an hour. When labor progresses at a good pace, it is less likely that your health care provider will recommend a cesarean for “failure to progress.”

7. Try natural methods of pain relief to delay/avoid epidural analgesia. Although it is controversial as to whether epidurals increase the risk for cesarean surgery, there is no question that the interventions required when you have an epidural (for sure, continuous monitoring and IV fluids; and often, medications to speed up labor, a catheter in your bladder, and a forceps or vacuum delivery) change the ways in which you labor. Many women find that a warm bath substantially reduces the pain of labor. A shower, walking or slow dancing, bouncing or swaying on a birth ball, massage, and reassurance from your partner, your doula, and your health care team all will help you to cope with contractions. Remember that the hardest part of labor is also the shortest part.

8. Ask for more time. As long as you and your baby are doing well, it is okay for labor to last a long time. If the average labor for a first-time mom is 12 to 17 hours, then some “normal” labors will take much longer than that. Plateaus, when labor slows or even stops for a while, are also considered normal.

9.Do not begin pushing until you feel the urge to do so. Some health care providers want your baby to be born within a specified time limit after you begin pushing. Whether you have an epidural or not, waiting to push until you feel the urge to will decrease the time you spend pushing. Pushing in response to your body’s urges, rather than being “coached” to push, is safer for you and for your baby.

10. Believe in birth and in yourself. Most women (at least 85 to 90% according to the World Health Organization) can and should give birth naturally (vaginally). Do all that you can to make birth as safe as possible for you and for your baby.

In addition to encouraging the ten strategies listed above, you also may want to distribute in your classes the new handout by the Coalition for Improving Maternity Services (CIMS), The Risks of Cesarean Surgery. The six healthy birth practices identified by Lamaze International promote safe and healthy birth. Visit the Lamaze website at www.lamaze.org to download free video clips and pamphlets for each healthy birth practice. In our handbook, Prepared Childbirth – The Family Way, we discuss strategies to reduce unnecessary cesareans on page 53, “Are All Cesareans Necessary?”

As of April 1, the Joint Commission has identified the “low-risk cesarean rate” as one of the new Perinatal Quality Measures. In addition to promoting cesarean-reducing strategies in your classes, work within your hospital to develop protocols and policies that promote natural, safe, and healthy birth.The time has come for all of us: childbirth educators, nurses, providers, and administrators (as well as legislators, insurers, attorneys) to work together to decrease our alarming and dangerous cesarean rate.

If you’d like the references to any of the “Top Ten” points, please email me at amis@thefamilyway.com.