FUNDAMENTALS OF COMMUNICATION Childbirth International
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Introduction to Childbirth Education
Introduction to Childbirth Education
In this unit we will explore the concept of childbirth education, and the role of the
childbirth educator. We will review the history of childbirth education and its benefits.
We will consider the different formats and styles suitable for antenatal classes.
Topics covered will include:
History of childbirth education
Role of the childbirth educator
Benefits of childbirth education
Types of childbirth class
At the end of this unit you will be able to:
Describe a brief history of childbirth education
Explain the role and responsibilities of a childbirth educator
List benefits of childbirth education
Describe different formats of childbirth classes
Nichols, F.H., & Humenick, S.S., 2000, Childbirth Education: Practice, Research and
Theory, W.B. Saunders Company, Pennsylvania.
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Introduction to Childbirth Education
When a woman is well-prepared for childbirth and effectively supported, her birth can
present a unique opportunity for growth as a woman and a mother. The childbirth
educator plays an important role in providing the information a woman needs to find her
way through the maze of options available. The complex physical and emotional needs
of a pregnant women and her supporters can be addressed through effective childbirth
education. The philosophy of the educator influences the style of their teaching. During
this unit we will explore the history of childbirth education and the styles of childbirth
education available to the educator today. We will consider the roles and responsibilities
of a childbirth educator and how these can be balanced with the role and responsibilities
of parents and other caregivers. Finally, we will address the benefits of childbirth
education that have been demonstrated through research.
In order to understand the history of childbirth education, it is helpful if we first explore
what was happening in the field of obstetrics at the beginning of the twentieth century.
Prior to the 1900’s, women predominately used midwives to care for them during
pregnancy and childbirth. And information was passed from woman to woman, with
very little written literature being available for women to read. As early as the 17th
century, the concept of birth being managed by obstetricians was beginning to be
adopted.
In 1843, Oliver Wendell Holmes (1809-1894), a Boston physician, published an essay
on the causes of puerperal, or childbed, fever. Following the death of a colleague after
performing an autopsy on a woman who had died of puerperal sepsis, and the
subsequent death of other women he cared for immediately afterwards, Holmes began to
investigate the role of hygiene in reducing the incidence of puerperal fever. Using case
studies, he was able to show definitively that lack of hand-washing was responsible for
passing puerperal fever from one woman to another.
In the United States during the early 1900’s, birth began to move from home to the
hospital environment. Midwifery became almost non-existent and childbirth began to be
seen as pathological. As this change took place, more and more interventions were
applied to birth routinely. At the same time women in the United Kingdom and the
United States were fighting to have equal rights. There was a widespread belief at the
time that those people who were better educated were more sensitive to pain due to a
change in their nervous system. As more people were now being educated there was also
an increased need for pain relief. It was thought that the pain of childbirth could cause
permanent damage to women and this justified their demands for pain-free childbirth. As
a result, the battle for anesthesia during childbirth became an important part of the
feminist movement.
In 1902, researchers in Germany developed the use Twilight Sleep. Using a combination
of morphine for pain relief and scopolamine for amnesia, these drugs were used to
prevent a woman having any memory of her birth. Whilst the woman had no memory of
the birth this was not the same as her not being able to feel anything. Scopolamine
caused her to lose her inhibitions and reports show women often screamed throughout
the labor and birth, but had no recollection of it afterwards. Two American reporters
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accompanied a pregnant friend to Germany. Following their friend’s birth, they reported
the success of Twilight Sleep in a popular US magazine and introduced the concept
there, where it became highly desirable. There were reports of children born to women
who experienced Twilight Sleep as being very intelligent. Doctors resisted the common
use of this anesthesia as they were concerned over the safety of using opiates during
labor. The National Twilight Sleep Association was formed by women who believed
anesthesia was a right for all, and a national campaign started. The Association
published numerous articles and held public talks, claiming that doctors were reluctant
to provide Twilight Sleep due to their jealousy over German doctors inventing it rather
than them. The campaign finally collapsed a year later when one of the leaders of the
Association, Frances X. Carmody, died during childbirth while using Twilight Sleep.
On the other side of the Atlantic, a similar war was being waged by suffragettes in
England. Using similar tactics, though this time against politicians rather than
obstetricians, the women fought for the rights of all women to have anesthesia available
for childbirth. The National Birthday Trust Fund was formed by upper-class women and
money was raised to research new techniques in anesthesia. They worked to develop
chloroform capsules, nitrous oxide delivery techniques, and funded the employment of
anesthetists in hospitals. Childbirth education was first offered by the American Red
Cross in 1908. In New York they began providing classes on hygiene, nutrition and
infant care. By 1930 they were running radio campaigns to encourage women to see
prenatal care early in their pregnancies.
In 1933, a young obstetrician in England named Grantley Dick-Read, published a book
called Introduction to Childbirth, which was later renamed to Childbirth Without Fear.
Dick-Read practiced as an obstetrician in London in the 1920’s, when the use of
chloroform was standard. He was called to attend a woman laboring at her home, living
in the slums of Whitechapel. The woman was living in a small worker’s hovel. When he
arrived he asked her if he could place the gas mask over her face to administer
chloroform – she refused. Dick-Read watched in amazement as she gently birthed her
own baby. He later asked her why she refused the pain relief. Her response was the
beginning of his exploration into the cycle of pain, fear and tension that underlies Dick-
Read’s philosophy: “It didn’t hurt. It wasn’t meant to was it doctor?” Dick-Read began
to explore the idea that childbirth was painful for some women and not for others. He
discovered that women who were relaxed and free of fear were able to approach their
labor differently than a woman who was afraid. He believed that a lack of understanding,
creating anxiety, could be overcome with education and relaxation exercises. Initially,
Dick-Read’s ideas were discounted by the general medical profession. In the 1950’s
Dick-Read proposed childbirth education as a way of eliminating fear by helping women
have a better understanding of the process of birth an opportunity to practice breathing
and relaxation methods. Together with a small group of other advocates for childbirth
education, he placed an advertisement in The Times for women to contact them if they
would like more information about childbirth. From these humble beginnings grew the
National Childbirth Trust – an organization that today flourishes, providing childbirth
education, breastfeeding counseling and support for pregnant and new mothers, across
the United Kingdom.
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Ferdinand Lamaze, a French physician, was another early pioneer in childbirth
education. Lamaze adapted his methods from Velvovsky, a Russian who developed
psychoprophylaxis. The concept of psychoprophylaxis came from experiements carried
out by Pavolv who observed that when a dog was offered food it began to salivate. Ivan
Pavlov noticed that each time he placed food on a tray in front of the dogs, they would
begin to salivate in anticipation of eating each time he entered the room. Pavlov decided
to investigate this further and began to ring a bell each and every time he was about to
feed the dogs. Eventually, simply ringing the bell was enough to cause the dogs to
salivate regardless of whether there was food present or not. This behavior became
known as a classical conditioning, or Pavlovian conditioning. Pavolov had proved that
all animals, including humans, can be conditioned, or trained, to to expect consequences
as a result of previous experiences. Velvovsky, using the concept of Pavlovian
conditioning, reasoned that women may be taught new responses to the pain of labor and
assist them in managing the pain with their minds.
Lamaze further adapted Velvovsky’s theories and developed relaxation and breathing
techniques to assist women in this goal. Lamaze returned to France in 1959 and began to
communicate his theory of psychoprophylaxis to women. He believed that in addition to
information and support, a woman must also alter the perception they had that birth was
about suffering. He would teach them strategies to change this perception so they
became more aware of the work their body was doing during labor. Marjorie Karmel,
author of “Thank You Dr Lamaze”, experienced an unmedicated birth in France. She
was later introduced to Elizabeth Bing, a physical therapist, in New York. Bing was
teaching childbirth classes using the Dick Read method at the time. The two women
established the American Society for Prophylaxis in Obstetrics (ASPO) together with ten
physicians and a small group of lay people. They promoted support and encouragement
for all women during labor and worked to ensure women were able to have their babies
without routine sedation but using the Lamaze techniques if they chose.
Robert Bradley, MD, (1917-1998) was another advocate for childbirth education who
was influenced by Dick-Read’s work. He wrote the book “Husband-Coached
Childbirth” in 1965, encouraging the active participation of the father as labor coach.
Bradley was important in influencing the presence of men in the delivery room
throughout the United States. The Bradley Method focuses on techniques that couples
can use to optimize their chances of having an unmedicated birth.
British social anthropologist, midwife and childbirth educator, Sheila Kitzinger,
developed a psychosexual approach to childbirth. Sheila refers to this psychosexual
approach as involving the whole person in every aspect of their lives, relationships and
birth. She believes that women can work with their bodies using visualization, touch
relaxation and guided imagery, developing greater sensitivity and control over the
descent of the baby through pelvic floor exercises. Her goal is to enable a woman to
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have a deeply satisfying childbirth experience where she has the confidence to believe
she can achieve the birth she wants.
Frederick Leboyer, MD, author of “Birth Without Violence” (1975), believed that
newborn babies were acutely aware of their surroundings at birth. He advocated for a
quiet, calm environment where mothers and babies could relax. One significant aspect of
his recommendations included the use of a warm bath immediately after the birth where
the baby could gently make the transition from the womb to the outside world. He
advocated for close contact between mother and baby immediately after the birth,
delayed clamping of the umbilical cord and immediate breastfeeding. Leboyer was an
advocate of painless birth.
Think about the concept of using a particular method, such as those above,
when teaching childbirth classes. List the pros and cons of adhering to a
method, from the viewpoint of the childbirth educator, and the parents.
Before defining your role as a childbirth educator, you would benefit from first defining
your own personal philosophy on childbirth and childbirth education, together with your
expectations for your clients. A philosophy is a set of ideas, beliefs or values related to a
particular field. Defining your own philosophy enables you to be clear about
determining the objectives you have for teaching childbirth classes.
Complete the following statements.
I believe the purpose of childbirth education is:
I believe birth should be:
Now that you have defined your own personal philosophy, you can begin to explore
your role, and subsequently your responsibilities as a childbirth educator. We believe
that the role of a childbirth educator is that of facilitator rather than teacher.
Teacher: a person who instructs, one who imparts knowledge
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Facilitator: a person who makes something easier, one who helps bring about
Facilitation is about the process rather than the content. A facilitator makes that process
easier, guiding a group or an individual towards a destination, yet allowing them to
discover their own answers. Teaching tends to focus more on rote learning, lectures and
presentations. Facilitation however is more active in its approach, dealing more with
discussions, role plays and exploration of ideas. With facilitation there is no right or
wrong since each individual will determine their own path. The role of the facilitator is
to make that journey a little easier, helping to open up doorways showing different ideas,
ways of being and ways of doing. It is up to the individual to determine which doorways
they will step through.
Before you can begin to be an effective facilitator of others, you must first be competent
at facilitating yourself. Facilitating yourself requires a degree of personal awareness,
leading to personal growth. In order to feel comfortable working with others, you first
need to be comfortable within yourself. This is about identifying how you feel about
yourself, rather than identifying what is wrong and trying to fix it. Accepting ourselves
for who we are is an enormous battle for many people. Consider the following questions.
Be really honest with yourself and think about any areas where you may have difficulty
with accepting who you are.
Are you comfortable with yourself the way you are right now?
Are you comfortable with your body?
Are you comfortable with your feelings?
Are you comfortable with your thoughts?
Are you comfortable with your sex and your sexual orientation?
Are you comfortable with your cultural and national affinities?
Are you okay with being you?
- source “The Facilitation of Groups”, Hunter, Bailey & Taylor
Being capable of self-facilitation means able to understand your level of responsibility in
regards to yourself. For example, how responsible do you feel for your own actions,
thoughts and feelings? If you react to a situation by being upset, who was responsible for
this reaction?
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Think of a difficult situation that you have experienced recently where you
had a strong emotional reaction. Answer the following questions:
How did you choose to respond? (e.g. sad, angry, frustrated, suffering, loved,
supported)
How did that reaction meet your needs?
How could you have chosen to respond differently?
What do you choose to learn from that experience?
Now think about others that you will be working with as a childbirth educator. Consider
that everything they do, say, feel and think is their choice. They choose to say, they
choose to feel, they choose to think. Recognizing this can be liberating. You are only
responsible for your choices, nobody elses. And each person you work with is also only
responsible for their choices. They are where they are because that is where they choose
to be. This enables you to focus on helping them find their own path, progress along
their own journey, however they choose for it to be.
Many research studies have shown both tangible and intangible benefits to childbirth
education. Below is a summary of some of the studies outlining the benefits to mothers,
their babies, and the fathers who attend classes.
In 1990, researchers compared two groups matched on race, patient type (private or
public), marital status, age, parity and socioeconomic status. One group attended
childbirth classes while the other did not. Those who attended classes were more likely
to give birth without pain-relief medication. They were also significantly more likely to
have spontaneous births (79% versus 51%).1
One study carried out in the UK in 1999 focused on the needs of fathers and how these
were addressed in childbirth classes. The researchers found that men found classes
beneficial when they acknowledged the role of the labor supporter (in this case the
father).2
Studies carried out over a three month period at one hospital found that women who did
not attend childbirth classes were significantly more likely to be admitted to hospital
when not in established labor than women who had attended 4-6 childbirth classes
during pregnancy. This had implications for caregiver workload but there were no
conclusions drawn on the effect on maternal or neonatal outcomes as a result of these
early admissions.3
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A more recent study conducted in Italy found that women who attended childbirth
classes had a significantly lower risk of cesarean section and were half as likely to
bottlefeed compared to those who did not attend classes. The women attending classes
were also more satisfied with their childbirth experience.4
A Chinese study found that the number of childbirth classes attended had an impact on
the rates of postpartum depression with a higher number of attendances decreasing the
rates of postpartum depression.5
There are an enormous variety of childbirth education classes available to choose from
when determining your own personal curriculum for teaching. As a childbirth educator
you may choose to run a traditional course format, or instead to focus on a specific style
of class or group of clients.
The most common format for a childbirth course is a series of classes for a group of first
time parents. The optimum number of clients to have in such a group is 8-12 women, or
6-8 couples. Many hospital run classes have significantly more clients in each class.
Larger groups are certainly feasible if the space is available but once the group size
exceeds 16 it becomes very difficult to employ active teaching skills and the classes tend
to become more like lecture sessions. The classes should cover a variety of topics related
to late pregnancy, labor and birth, breastfeeding and parenting. It is very difficult to
cover these topics thoroughly in less than 12 hours of teaching.
As more options become available to women in early pregnancy such as antenatal
testing and screening, there are more opportunities to provide early pregnancy classes.
The main topics covered would include antenatal testing and screening, diet, health,
exercise and choosing a caregiver and/or place of birth. They will focus on women
making informed choices about their health and that of their babies to ensure the most
optimum outcome for themselves. These classes can serve as an introduction to the
longer traditional format course covered in later pregnancy or be stand alone. They tend
to work well as a drop in session or a rolling class series where a different topic is
covered each week and women join at any point in the rolling cycle. Early pregnancy
classes are particularly helpful for teen groups and women deemed as having high risk
pregnancies such as multiples or pre-existing disease, since much can be covered on
illness prevention and health promotion at a stage where it is most beneficial to the
mother and baby.
Classes designed for women having second or subsequent babies can be more focused
on the issues that only affect these women. Topics usually include a debriefing session
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to look at what changes can be made from the last pregnancy and birth if the women do
not want to repeat that experience, preparing and managing older siblings, and coping
with more than one child. If the woman has never attended childbirth classes before or
had a lot of intervention with her last pregnancy and does not want to repeat that this
time, it is worthwhile for her to attend a full traditional course to learn the tools and
strategies to help her discover what she needs to do to get the birth she wants.
If you will be working with a large number of teens, you may choose to provide a class
specifically for them. The needs of a teen mother are very different from those of a
woman in her thirties. In addition, teens may feel very isolated in a class full of thirty-
somethings. They are also more likely to be single mothers and may not be comfortable
if everyone else in the course is in a couple. In addition to the usual topics of pregnancy,
birth and parenting, these classes can focus on the health and diet of a teen, and the
impact the baby will have on their particular lifestyle.
In some areas it is appropriate to teach some or all of your classes with only men or
women included. If you are working within a community where men rarely attend the
births of their children, you may want to offer a woman only course with perhaps one
couples or father’s only session. During the father’s session you can discuss the concerns
specific to men, their role and responsibilities, how they can most effectively help their
partner.
There are many other options for teaching childbirth classes. These include:
Sibling classes to prepare them for the new baby
Cesarean birth classes for women planning a caesarean
VBAC classes for women planning a vaginal birth after a previous cesarean
Breastfeeding classes
Parenting classes
How you decide to structure your classes will depend on many factors including
availability of the space where you are teaching, the age of your family, personal
commitments, the population you are teaching, the type of class you are teaching. For
example, siblings classes and refresher classes tend to be one or two sessions of a couple
of hours each.
A traditional course should be around 12 hours in length to effectively cover everything.
Each time you run a class it takes at least 15 minutes just to get into it at the beginning.
If you are going to be teaching in three classes of fours each you are going to get through
significantly more work than six 2 hour sessions. It would take about 8 two hour classes
to get through the same number of topics as you cover in three four hour classes.
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When deciding the timing of your classes, consider the audience you are teaching.
Children are probably best taught in the late morning – before they become sleepy and
bored. If most of your clients work you may have to teach evening classes but will have
to ensure there is lots of movement in the class content and little lecturing to ensure they
absorb as much as possible – trying to stay awake for a childbirth class after a long day
at work when you are 34 weeks pregnant is a pretty big challenge!
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This task summary is for your own records. It does not have to be submitted.
For this unit summary task, you will complete two activities.
Firstly, conduct research in your local area. You are to speak to women to find out what
class format works best for them – one day intensive classes, weekend classes, weekday
evening sessions of two hours a week for 8 weeks, weekday women only sessions etc
etc. Also, find out as much as you can about what is currently available to women in
your area. Identify as many different types of childbirth education as possible. This
information will all be helpful when you begin writing your marketing plan to determine
the market that you are going to serve and how best to promote your services to them.
If you live in an area where childbirth education is almost non-existent, think about
alternatives that women may use for childbirth education. It is unlikely that women get
no education at all. Do they access the internet at home? Read books? Attend a regular
pregnancy clinic where the clinic nurse provides education – albeit only individually to
each woman in a very informal way? Do you live in a village environment where
women talk together and pass on their education from one generation to the next?
The second part of this exercise is to determine which class formats currently on offer
appeal to you and which don’t. Then to consider formats that are not currently on offer
that you would like to provide. Speaking with women and asking them open questions
may surprise you in identifying class formats you had never considered before.
Use the space below to document your research findings and make notes on the sort of
classes you would like to offer.
Finally, identify any barriers to providing the classes that you would like to offer. Think
about internal and external barriers. Then consider steps you can take to eliminate those
barriers.
List the sorts of classes women say they would like to have – speak to at least 6 women
(they do not have to be currently pregnant or even have had a child):
Identify classes that are currently on offer in your area:
Identify the sort of class you would like to teach, i.e. your favorite format – you may like
to list more than one:
Finally, identify any barriers, either internally or externally, that you may have to
overcome to run classes in this format and what steps you can take to overcome these
barriers.
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1. Hetherington, S., 1990, ‘A Controlled Study of the Effect of Prepared Childbirth
Classes on Obstetric Outcomes’, Birth, Vol. 17, no. 2, pp. 86-91.
2. Smith, J., 1999, ‘Antenatal classes and the transition to fatherhood: A study of
some father’s views’, MIDIRS Midwifery Digest, vol. 9, no. 3, pp. 327-330.
3. Qureshi, N.S., Scholfield, G., Papaioannou, S. et al., 1996, ‘Parentcraft classes:
do they affect outcome in childbirth?’, Journal of Obstetrics and Gynaecology,
vol. 16, no. 5, pp. 358-361.
4. Spinelli, A., Baglio, G., Donati, S., Grandolfo, M.E., Osborn, J., 2003, ‘Do
antenatal classes benefit the mother and her baby?’, Journal of Maternal, Fetal
and Neonatal Medicine, vol. 13, no. 2, pp. 94-101.
5. Zhang, R., Chen, Q., Li, Y., 1999, ‘Study for the factors related to postpartum
depression’, Zhonghua Fu Chan, Ke Za ZhiI, vol. 34, no. 4, pp. 231-233.
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Learning Styles
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Learning Styles
Learning Styles
In this unit we will consider the different learning styles that people use and how you, as
a childbirth educator, can adapt your own personal style to be able to most effectively
teach your clients. We will discuss the problems associated with each style, the different
teaching techniques that appeal to the different styles and identify ways that you, as the
teacher, can recognize different learning styles in your clients.
Topics covered will include:
Meeting a clients’ learning needs
Understanding learning styles
Swassing-Barbe Modality Index
Kolb’s Learning Styles Model
Myer-Briggs Type Indicator
Multiple Intelligences
At the end of this unit you will be able to:
Describe the main learning styles
Recognize your own preferred style
Explain techniques appropriate for each style
Design an activity for one topic that can be taught in different ways to appeal to each
style
There are no recommended readings for this unit.
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Learning Styles
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Learning Styles
There are several different definitions of learning style. Booth and Brooks (1995) define
a learning style as:
…a compilation of patterns of behaviour that appear consistently in the
learning process of an individual from the initial stimulation to the final
recognizable product of learning. Simple stated, it is how we process out
information and work with the outcome.
Another definition comes from Dunn and Griggs (2000):
Learning style addresses the biological uniqueness and developmental
changes that make one person learn differently from another. Individuals do
change in the way they learn…Similarly, developmental aspects relate to
how we learn but, more predictable, follow a recognizable pattern.
Put more simply, a learning style is a preferred way of learning. There have been many
categories of learning styles developed. Having an understanding of learning styles
enables you, as a childbirth educator, to identify different teaching techniques that would
appeal to different people. As our clients have a preferred learning style, we also have a
preferred teaching style. If you do not take different styles into account when developing
the activities you will introduce in your classes, you will find that you lose the attention
of many of your class members. Those clients who have the same style as you will find
it easy to understand and retain the information you are covering. Those clients who
have a different style though will not gain as much from your classes and may even find
that they do not meet their needs at all.
In this unit we will explore several different ways of differentiating learning styles and
then will focus on one in particular that is very helpful to childbirth educators. At the
end of the unit we will look at some of techniques that appeal to each style.
As a childbirth educator you will be required to meet the needs of your clients. However,
many of your clients will not even be aware of what their needs are, particularly those
having their first baby. The content of your classes will be a combination of what your
clients want to know and what they need to know.
During a childbirth course you have a limited amount of time to communicate the
information and to provide opportunities for class members to practice the skills that will
help them during labor and afterwards. You will have to prioritize and many topics that
you would like to cover will have to be left out simply because there is not enough time.
In addition your groups will contain a diverse group of individuals. Each class member
comes to the group with their own set of experiences, knowledge and personalities. They
also have different expectations of the course and want to know different things.
One way that you can determine what your clients want to know is to begin the course
with agenda setting. This can be very helpful in ensuring that you provide them with the
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Learning Styles
information that they are looking for. Another advantage of doing this is that your clients
feel the classes are personally tailored for their needs and it ensures that your classes
never become dull for you to teach since every group is slightly different and unique in
the topics they want to cover. The disadvantage of agenda setting is that if you do it, you
then have to follow it. If you have a pre-prepared teaching plan you have to be
comfortable about not following it to the letter. When you first begin teaching this lack
of control can make you feel vulnerable.
Once you know what topics you are going to cover, you then have to determine how you
are going to teach them. This is key to meeting your client’s learning needs. Even if the
topics you are covering are of interest to your clients, if they do not appeal to their
particular learning style, much of what you cover will be lost.
We each have different factors that influence our learning style – the way we perceive
information, the way we acquire knowledge and the personality factors we each have to
affects our learning style. Understanding each of these factors enables us to identify the
method that we find most helpful in learning. There have been many tools developed to
evaluate or measure learning styles – these tools are referred to as Learning Style
Identifiers, or Learning Style Testing Instruments. A fancy way of saying, “figuring out
which learning style you prefer”. These testing instruments generally fall into one of
three categories: perceptual modalities, information processing, and personality patterns.
These are not as complex as they sound!
Perceptual modalities: How we perceive information, these are aspects of learning that
are physiological in nature. They include auditory (what we hear), visual (what we see),
and kinesthetic (what we do) learning styles.
Information processing: This is the cognitive, or thinking, component of learning – how
we acquire knowledge.
Personality factors: These are the affective aspects of each individual that influences the
way they learn, including their values, emotional behavior, motivation and decision-
making styles.
We will look at four of the commonly used testing instruments to illustrate the different
learning styles. During this section you will assess your own preferred learning style in
each of the areas of perception, information processing and personality. It is important to
remember that there is no right or wrong to learning styles – they are simply preferred
ways of learning.
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Learning Styles
Barbe and Swassing, developed a learning style assessment tool that looks at the way
people learn based on their perceptions. They categorized people into visual learners,
auditory learners or kinesthetic learners. Answer the following quiz to determine which
modality you learn best with.
Tick the answer that is closest to how you usually behave or respond.
When giving directions, I would usually:
A. tell someone how to get there
B. draw someone a map
C. show them the way myself
When I am talking to someone, the words that I am most likely to use are:
A. sounds good, rings true, talk me through it, I hear you
B. it’s black & white, looks good, it’s clear, I see, let me give you my view
C. I can handle that, let’s get in touch, sleep on it, a good fit, leaves me
cold
When buying a new piece of equipment I like to:
A. listen to the salesperson tell me how it works
B. read the instruction booklet
C. open the packaging and start using it, learning by trial and error
When studying for a test, I tend to:
A. Talk aloud while reading through notes
B. Write a summary of my notes
C. Use mind maps and diagrams
When planning my week ahead I tend to:
A. Talk about what I am planning to do with my partner or a friend
B. Write a “to do” list ad mark it off as I complete each task
C. Just keep it in my head, or write a list but I rarely check back on it
again and may forget where I placed it
If I am trying to remember how to spell a word I:
A. sound the word out, either aloud or in my head
B. picture the way it looks in my head
C. write down the different versions and decide which one seems right
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When I am being taught something new I prefer:
A. discussions, lectures and speeches
B. diagrams, charts and graphs
C. activities, role play and exercises
If I get lost while driving I will:
A. stop and ask for directions
B. stop and buy a map
C. keep driving around until I figure out where to go
When speaking to people I prefer:
A. to chat on the phone
B. to stand a little distance away or I feel crowded
C. to stand close to them and make physical contact with them
Now add the number of questions you answered for A, B & C
Total A answers:
Total B answers:
Total C answers:
If you answered mostly A’s, you are an auditory learner.
If you answered mostly B’s, you are a visual learner.
If you answered mostly C’s, you are a kinesthetic learner.
It is estimated that for every 10 people, 2 will be auditory, 4 visual and 4 kinesthetic.
However, the majority of teaching (90%) uses an auditory teaching style with lectures
and rote learning being the most common. This means that 80% of people have to learn
in an environment where the teaching style is not compatible with their learning style!
A visual learner learns best through seeing, or visual stimuli. They need to be able to see
the teacher’s facial expression and body language in order to have a good
comprehension of the course content. If they are seated in a formal classroom with rows
of people, they prefer to be at the front so they have an unobstructed view of the teacher
and any teaching materials being used. They tend to think in pictures and enjoy learning
from diagrams, illustrations and handouts. They will tend to take notes during
discussions. They have no difficulty following a map but struggle with spoken
directions.
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When reading a visual learner will often stop to imagine the scene they are reading
about. Their handwriting tends to be good, with size, spacing and visual appearance
being important to them. They remember faces rather than names, like to take notes and
write things down. They have a vivid imagination, thinking in pictures and able to
visualize with a lot of detail. A visual learner tends to be unaware of sounds around them
when concentrating but are distracted by movement. When solving problems they like to
create a list of the problems and possible solutions, organizing their thoughts by writing
them down.
When inactive or relaxing they like to watch something, doodle or stare into space. A
visual learner is not particularly expressive with their body when emotional, staring
when angry. Their facial expression is a good indicator of their feelings. They tend to be
quite quiet and become frustrated when they are required to listen for extended periods
of time. Language includes words such as look, see, map, view, clear. Appearance is
important to a visual learner as is neatness – they may choose not to vary their
appearance significantly. Tends to prefer the visual arts. Likes the individual
components and details of a piece of art rather than overall whole piece. They like to
listen to music quite loudly but will often get the words to a song wrong.
Visual learners are easy to cater to in childbirth classes. Use of appropriate visual aids
such as videos, charts and diagrams enhance their learning significantly. You can help
even more by writing key points on flip charts and putting them up on the wall after
discussions. If teaching decision making skills, consider providing reminder cards using
different colors and diagrams to your clients. When the group are brainstorming, provide
them with different colored pens to write the ideas down with. In any handouts that you
provide, accompany as much as possible with diagrams, charts and illustrations. Provide
notebooks and pens for visual learners to take notes during discussions and lecture
sessions.
Visual learners may have difficulty remembering the names of everybody in the group.
To help them achieve this, have an ice-breaker exercise at the beginning of each class
where everyone is reminded of names again. When listening to somebody talk they will
have difficulty absorbing what is being said unless they can see the speaker’s face –
always make sure you are facing all of the clients within a group to overcome this. Do
not be surprised if visual learners within a group answer questions with a yes or no
rather than a complete sentence. They may spend time during lectures doodling or
drawing on the edge of a piece of paper.
Auditory learners learn through hearing. A preference for auditory learning does not
usually develop until the age of 11 or 12, with more girls than boys having this style.
When in a classroom setting they enjoy listening to lectures and verbal presentations.
They prefer to be read aloud to rather than reading themselves. When they read they will
often say the words aloud or will move their lips as if speaking while they read. They
will use their finger to point to the words as they read. Enjoying dialogue in books, they
tend to ignore illustrations. They prefer to listen to the radio than read a newspaper.
They do not like looking at a computer screen, particularly when there is a lot of detail
or the background is fussy.
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Auditory learners enjoy talking to other people. They are often found chatting on the
pone for long periods of time. They find diagrams, maps and charts difficult to follow
and find it easier if someone else explains it to them. They enjoy participating in debates
and discussions. When trying to remember something they are likely to create
mnemonics to help with memory. Auditory learners enjoy the rhythm of words, often
using rhyme, puns and metaphors in their language.
They tend to remember names rather than faces. When trying to recall how to spell a
word they will say it aloud. They find it difficult to visualize in detail – visualization that
focuses on sounds is helpful to them. When relaxing they will often hum or talk to
themselves. Auditory learners do not enjoy making or reading notes, preferring to
discuss a problem and its possible solutions. When emotional they tend to use their voice
for expression. May shout or explode verbally but tends to calm down quite quickly.
Enjoys listening to others, but enjoys talking even more. Descriptions are long and
repetitive and uses words like listen, hear, sounds, rings true, talk.
Prefers listening to music rather than the visual arts, although happy to discuss them.
Sees an artistic piece as a whole and tends to miss the details. Spends more time talking
about art than observing it. When asked to respond or listening to others will tend to
have little eye contact, often looking from side to side.
Auditory learners gain more from listening to the spoken word than from watching. In
addition to birth videos, consider reading out birth stories on some occasions to enhance
the understanding of this group of learners. Untidy handwriting is common with auditory
learners and as a result they may be uncomfortable about being given the task of writing
down ideas in a brainstorming activity. Bear this is mind when you are looking for
volunteers for this task. When listening to somebody explain something, they will be
focused more on the words than on anything being shown with the hands. If explaining
something use your fingers to point with. For example, if discussing how the pelvis is
constructed, use your finger to point out the different parts as you say them aloud.
All children start out as kinesthetic learners – just watch a baby discover something new
and see how he or she explores it with their hands and then their mouth. When they
begin to attend school children start to develop a preference for their long-term learning
style. More boys than girls retain a kinesthetic style of learning.
Those who have a tendency to kinesthetic learning learn by doing or being. They are
hands on and like to learn through trial and error. They enjoy tactile activities, reaching
out to touch things. They will talk quickly and use their hands to communicate. They
find it difficult to sit still and often fidget.
A kinesthetic learner will take things to pieces and try to figure out how to put it back
together again by touch. They enjoy working with their hands and making things. When
working they have a preference for standing and need to take frequent breaks. They are
often good at sports.
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When learning they prefer to do an activity, role play or exercise, rather than listening to
or watching others. They are comfortable with others, standing close when talking and
enjoying touch. If reading a book they find it difficult to concentrate for long periods of
time and prefer stories where the action takes place early in the story. When trying to
spell a word they will look at the alternatives and then determine which spelling “feels
right”. Their handwriting is good when they first start writing but tends to deteriorate if
the space available to write in gets smaller. They remember events – what was done or
what happened – rather than names, faces, what was seen or heard.
If problem solving, a kinesthetic learner tends to be impulsive in choosing a solution,
often selecting the option that appears to be the most effort. They are very expressive
physically when displaying emotion, jumping for joy, stomping off when angry or
frustrated. They enjoy movement, dance and sculpture, often touching artistic pieces.
Their language is peppered with physical words such as handle, touch, connect, fit, get
and take.
When teaching kinesthetic types, include lots of movement breaks to prevent them from
becoming bored. Activities such as role play and physical activities like role play and
practicing positions for labor will be appreciated by kinesthetic learners. This group
learn more effectively when they are doing something else while they learn. For example
chewing gum while concentrating. Provide snacks that are in the center of the group so
they can help themselves throughout the class. They enjoy bright colors and pictures
around them – posters on the wall and bright colors on handouts, notes and teaching
materials will be helpful to them.
Log on to the following webpage. Registration is free and once registered
you simply click on the “Begin the Temperament Sorter” button to proceed.
Learning Styles
Three Rivers Community College
David Kolb created a learning styles model that combined both the perceptual modalities
and the information processing categories. Kolb based his model on work carried out by
three other theorists – Dewey, Lewin and Piaget. John Dewey emphasized that learning
had to be grounded in experience in order for it to be effective. Kurt Lewin observed that
the student must be active in the learning process to gain from it. Jean Piaget theorized
that our intelligence develops as a result of an interaction between ourselves and our
environment.
Kolb developed his model using two continuums – how we approach learning (doing it
or watching it), and our emotional response to the learning (a preference for thinking or
feeling). The first continuum – doing or watching – is information processing. The
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second continuum – the emotional response – is a perceptual modality. The diagram
below shows Kolb’s model clearly.
Learners who score highly on active experimentation prefer an active, experiential
approach to learning. If they do not get plenty of opportunities to experiment and take
part in learning they will become quickly frustrated. These learners tend to be
empathetic and "people-oriented." They do not find theoretical explanations helpful,
preferring to treat each situation as unique. They learn best when able to use specific
examples that they can become involved in. They benefit most when they are able to
participate in discussions with other high scoring AE types. They enjoy activities that
include readings, specific examples, role plays and simulations.
A person with a high AC score has an analytical approach relying on rational evaluation.
Theorists learn best when they are clearly directed. They quickly become frustrated with
unstructured exercises where the purpose is not immediately clear. They learn best when
teaching is focused on lectures and reading of papers or theories.
A high score on Active Experimentation shows the learner prefers an active, "doing"
approach to learning that relies heavily on experimentation. They learn best when they
can take part in discussions and projects, disliking passive learning situations such as
lectures. These people tend to be extroverts.
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A learner with a high Reflective Observation score indicates an impartial and reflective
approach to learning. They rely on careful observation, preferring learning situations that
allow them to take the role of impartial objective observers such as lectures. They also
enjoy questions that provoke thought. These people tend to be introverts.
The four learning styles defined by Kolb are determined by the combination of how a
person prefers to process new information as well as how they emotionally respond to
learning. Using the model, Kolb devised a way of categorizing people into one of the
four quadrants. These four categorizations are Accommodators, Divergers, Convergers
and Assimilators.
These people are hands-on in their learning (doing), relying on intuition rather than logic
(feeling). They are motivated by the question “What would happen if I did this?” The
Accommodator’s greatest strength lies in having the ability to carry out plans and
involving themselves in new experiences. They are more likely to be risk-takers than
people from the other three groups. They tend to solve problems in an intuitive way,
using trial and error, relying heavily on others for information rather than on their own
analytical ability. They are comfortable with people but are sometimes seen as impatient.
They will often choose "action-oriented" jobs such as marketing or sales. Honey &
Mumford called this style the “Activist”.
Divergers prefer to watch others in order to learn and gather information, using their
imagination to problem-solve. Their greatest strength is their imaginative ability. They
are able to view situations from many different perspectives. They are motivated by the
question “What is there to know?” They enjoy activities such as brainstorming and buzz
groups. Divergers are interested in people and tend to be rather emotional. They often
have a strong interest in the arts and the style is characteristic of people working in
humanities or the arts. Honey & Mumford referred to this style as the “Reflector”.
Convergers prefer hands-on learning, being concerned with people and interpersonal
relationships. The question that motivates a Converger is “How does that work/happen?”
Their greatest strength is their ability to practically apply ideas. They use hypothetical-
deductive reasoning to apply to specific problems. Convergers are generally
unemotional, preferring to deal with things rather than people. The Converger has
opposite learning strengths to the Diverger. Honey & Mumford called this style the
“Pragmatist”.
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These people use a logical approach to learning. Concepts and ideas are more important
than people. An Assimilator is fascinated with the question “Why does that happen?”
They require clear explanations rather than practical opportunity to experiment.
Assimilators will be uncomfortable if they are expected to figure things out for
themselves without detailed instructions or notes. This person’s greatest strength is their
ability to create theoretical models. They not as interested in people as they are in
abstract concepts and struggle when a situation or action is not logical. People with this
style enjoy research. The Assimilator has opposite learning strengths to the
Accommodator. Honey & Mumford referred to this learning style as the “Theorist”.
The following reading provides a quiz for you to print off and complete. At the end you
will be able to determine your preferred style according to Kolb’s Model. Having an
awareness of the different preferences of each style enables you to think about the most
appropriate activities and teaching techniques to use within each class.
Print the following webpage, linked from our website, and complete the quiz
Learning Style Quiz – Kolb’s model
Honey & Mumford
Imagine you are planning to teach a class about the different stages of labor.
You usually teach this in a lecture format. However, you know you have a
group where more than half the group are Accommodators and a lecture
style does not appeal to them. Think about three different ways you could
cover the subject so that these people will enjoy this section of the course.
The Myer-Briggs Type Indicator (MBTI) uses several different aspects of our
personalities to determine the preferred style of learning that we use. This instrument
was developed by two women – Isabel Briggs Myer and her mother, Katharine Briggs. It
is one of the most commonly used personality instruments used around the world.
The MBTI assesses how people prefer to take in and process information. This has been
further developed by David Mark Keirsey in his “Keirsey Temperament Sorter”. Keirsey
considers, based on personality type, what people can do well. We will look at both the
MBTI and the Keirsey temperament Sorter in this section.
The MBTI considers preferences based on four scales, or continuums.
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Isabel Briggs Myer, born in 1897, grew up in Washington, DC, USA, and
was home-schooled by her mother. Isabel married Clarence Myers, a
lawyer, in 1918. It was when she brought him home to meet her family
that the first seeds of the MBTI were sown. Katharine liked Clarence,
but recognized that he was very different in personality to anyone in
their family. She began to read biographies and developed her own
categorization of people based on the patterns she found – meditative
types, spontaneous and sociable types. She then found C.J. Jung’s
book, Psychological types, and shared her findings with her daughter.
The two become avid observers of personality types over the next 20
years.
The work of Katharine and Isabel took a huge step forward when, years
later, Isabel’s father mentioned it to the Dean of the George
Washington School of Medicine. The dean permitted Isabel to carry out
a study on freshmen at the school. This research eventually became
one of the largest longitudinal studies in medicine including 5,355
medical students. The data was obtained over four years and Isabel
analyzed dropouts, over- and under-achievers. She followed up the
students after twelve years to see if they whether or not they had
chosen specialties to fit their personality types and discovered they
generally had. A paper on her findings was presented in 1964 in Los
Angeles at the American Psychological Association but the research
was never formally published.
This measures how people prefer to focus their attention or derive their energy.
Extraverts focus on the world around them, consisting of people, things, and activity.
They derive energy by interacting with others. They enjoy talking, socializing and
participating. They tend to be people who are comfortable taking action and can become
impatient with tedious jobs or complex procedures. They tend to figure things out while
they are talking them through as this helps them clarify their thoughts. As students they
enjoy teaching situations where discussion is encouraged and with the opportunity for
physical activities. They struggle when they have to listen to others and concentrate.
Extroverts have a tendency to act first and think later and find it difficult not to become
easily distracted. They learn best when they are explaining something to others.
Introverts are energized by reflection, contemplation, and their own thoughts. They
focus their attention inwards. They enjoy being sociable but need plenty of opportunities
for solitude to recharge their energy. They prefer to figure things out in their own minds
before talking about them with others. Introverts learn most effectively when they have
the opportunity for quiet reflection. They enjoy reading, lectures and solitary written
work. They process information about a topic while listening to others talk about it. If
the teacher talks quickly and does not allow time to mentally process the information
they quickly become frustrated. Introverts may not enjoy discussion groups and they
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find it difficult remembering names of others in the group. The ideal teaching
environment for an introvert is one where they can work independently and where they
have sufficient time to think things through. They do not feel comfortable when they are
expected to speak in a classroom situation and prefer to be able to choose to speak
voluntarily.
The second continuum measured is the Sensing/Intuitive scale, looking at how people
take in information and become aware of people, events or ideas. Sensing people depend
on their senses to take in information – sight, hearing, taste, touch and smell. They
absorb information that is real and tangible – what is actually happening. They notice the
details of what is going on and are practical and realistic. They may focus so much on
the details that they do not see the bigger picture. This type likes facts, organization, and
structure. They have a good memory and tend to be conventional. They prefer to tackle
things step by step and are careful in their approach. They prefer to use existing skills
rather than learning new ones. They will read a question several times to ensure they
understand it before attempting to answer it. When being taught, Sensing types like
instructions that enable them to use their senses enjoying hands-on activities and audio-
visual materials that are relevant. If the teacher moves through classroom material too
quickly they may find it difficult to keep up, especially if the instructor jumps from one
concept to another. They find it easier to learn new information if they can find
relevance to their own lives and prefer teachers to be clear about their expectations of
students.
Intuitive types look for patterns and interrelationships between the facts they are given.
They look for the bigger picture and rely heavily on their intuition. They will often
ignore the finer details. They focus on future events and situations, constantly seeking
out new opportunities. An Intuitive person needs to know the theory before they can
determine which facts are relevant to them. They are creative and tend to work in bursts
of energy. Enjoying learning new things, they will clarify ideas before putting them into
practice. In exams, Intuitive students do not always read the questions thoroughly and
may miss key parts. Once they have mastered a skill, they become quickly bored with
repetition or practice. They become frustrated with teachers who move slowly through
material or repeat concepts several times. They have a tendency to anticipate what
somebody else is going to say, sometimes causing them to misinterpret meaning. The
ideal teaching environment for Intuitive types is one where they have endless
opportunities to be inventive and original, seeking new solutions to problems. They
prefer to determine their own way of tackling problems rather than following other
people’s instructions.
This continuum considers the ways people evaluate information and how they make
decisions. Thinking types look at the consequences of a choice or action taken and
decide using logic, analysis, and reasoning. Using analysis and critique, they identify
what the problem is and begin to find solutions. They work at finding principles that can
then be used in similar situations. They may appear uncaring and cold to others, with
their head tending to rule their heart. They generally have strongly held principles with a
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sense of fairness being more important than anything else. When learning new skills or
information they use analysis to being order out of chaos. If a teacher does not present
things in a logical sequence they tend to feel chaotic and uncomfortable. They enjoy it
when a teacher specifies clear objectives and presents an overview of the topics to be
covered before beginning on the detail. Accuracy and preciseness is very important to
Thinking people. The ideal teaching environment is one where topics are logical and
orderly. If a concept is an abstract one they need the logic pointed out to them.
Feeling people like to consider what is important to them and others when making
decisions. They like to create harmony and like to be liked. They find it difficult to say
no or disagree with others. Feeling types become distressed when there is any level of
interpersonal friction. Being able to help other people gives them personal satisfaction.
When in a classroom situation, they look for personal relevancy and a connection to
their own personal experiences in the material being studied. They may have difficulty
studying topics that do not appear to relate to people or relationships. They gain the most
when they feel they have developed a personal connection with the teacher and receive
feedback and encouragement. Teachers who are impersonal or detached are more
difficult for Feeling types to relate to. The ideal teaching environment for a Feeling type
is one where they build strong relationships with other class members.
This continuum considers people’s life styles and the type of work they prefer doing.
Judging people like to have a planned, organized life. They are structured and do not like
having loose ends. They are energized when they complete tasks. When studying they
tend to plan their work and then adhere closely to the plan. They cope well with clearly
defined tasks, meeting deadlines easily, and preferring to work on one thing at a time.
They do not work well when under pressure to finish something at the last minute.
Judging people dislike surprises. The ideal teaching environment for a Judging type is
one where there is clearly defined structure, specific guidelines and instructions, and
consistency. They like to know what they are going to be doing and when.
Perceiving types live by the moment – they are spontaneous and dislike being committed
to deadlines or plans. They enjoy being able to stay open to last minute changes and new
information that arises. They are flexible and good in emergencies when plans are
disrupted. When being taught, Perceiving types tend to start many tasks and often find it
difficult to complete any of them. They follow their impulses and are stimulated by
things that are new, becoming bored once they have already understood something.
Their biggest problem is procrastination! They may complete a calendar or make “to-do”
lists, but generally will never look at them again after they have been written. They work
best when under pressure to complete tasks quickly. If they have to complete a long task
they work best if they can break it down into smaller segments.
To determine what personality type someone is, according to the MBTI, a series of
questions are answered on preferences in different situations. This then determines
where the person is on each of the four scales or continuums. At the end of the test, a
four character acronym is given to the person. For example, if a person did the MBTI
assessment and was given the code ESTP they would be Extrovert, Sensing, Thinking
and Perceiving. There are a maximum of 16 different types.
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MBTI is a registered trademark and a full assessment can only be carried out by a
licensed assessor. Childbirth International staff have the license to carry out assessments
if any students are interested in having a full assessment done. There is fee for this
assessment. Please contact us if you would like to follow up on this.
Keirsey has taken these different types and categorized them together into four groups
depending on similar characteristics. While the MBTI cannot be taken online, the
Keirsey Temperament Sorter is available and is well worth doing to get an idea of how
the assessment works.
Log on to the following webpage. Registration is free and once registered
you simply click on the “Begin the Temperament Sorter” button to proceed.
Keirsey Temperament Sorter II
David Marc Keirsey
The Theory of Multiple Intelligences is perhaps one of the most exciting approaches to
education that exists. Howard Gardner proposed his theory in 1983 in his book “Frames
of Mind”. He suggested that intelligence was not a single quality that could be measured
and defined by one number as in the case of an IQ test. Rather, he believed that we each
have many kinds of different intelligences, or ways in which we analyze data and learn –
eight in total. He defined these as:
Verbal-Linguistic
Logical-Mathematical
Visual-Spatial
Bodily-Kinesthetic
Musical-Rhythmic
Interpersonal
Intrapersonal
Naturalist
When we are born we possess all eight intelligences but as we grow older we show a
preference for one or more of the different intelligences. Gardner surmised that if we
recognized which areas we were strong in and then focused on developing these, we
would perform in our work and our personal skills more successfully. Gardner is quoted
as assaying “It's not how smart you are that matters, what really counts is how you are
smart.”
As an educator, understanding the different intelligences is beneficial to you. In the same
way that you can develop your teaching materials to take into account the different
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learning styles of visual, auditory and kinesthetic, you can also adapt teaching activities
to account for the eight different intelligences.
Linguistic people think in words and learn through language. They enjoy reading,
writing, story-telling and word games. They tend to be precise when expressing
themselves verbally and become irritated when others are not. When learning, they are
able to absorb information most effectively if it is presented in written materials, audio
tape, discussion, debate, and stories. As a teacher, consider how you can integrate
activities that include reading, writing and speaking. Clients providing short
presentations on topics they have researched at home appeals to linguistic people. Poets,
writers and comedians have a strength in verbal-linguistic intelligence.
Logical people using reasoning in their thinking. They enjoy experimenting,
questioning, deductive problem-solving, and calculating. They tend to think in an
abstract way and will often see patterns and relationships that others miss. When
learning they like to experiment, problem-solve and analyzing behavior. When preparing
teaching activities, consider how you could integrate critical thinking activities to appeal
to these people. Mathematicians, lawyers, scientists and economists have a strong
logical-mathematical intelligence.
Visual people think in images and pictures. They enjoy drawing, designing and
visualizing. Visuals learn most effectively when they can use charts, pictures and
diagrams. Consider how you can integrate visual aids such as charts and videos into your
classes. Art exercises where clients are asked to draw how they see themselves during
labor for example can be effective activities. They also respond well to color – think
about how you can use color in your graphics rather than black and white pictures. The
appearance of environment is important to visual-spatial people – think about your use
of color, layout and aesthetics in the room where you teach. Artists, architects, surveyors
and decorators have strong visual-spatial intelligence.
These people think in terms of their body and what they can touch or feel physically.
They enjoy movement, touch and tend to use many hand gestures. They communicate
well through body language, enjoying role-play, activities that incorporate physical
movement, and activities where they have to “do it for themselves”. They find it difficult
to sit still for long periods of time so consider this when planning your classes, ensuring
you have plenty of activities for movement interspersed with periods of sitting. Dancers,
athletes, surgeons, sculptors and mechanics have strong bodily-kinesthetic intelligence.
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In this intelligence, learning is done through sound, vibration, melody and rhythm. They
enjoy listening to music while learning and will often tap their feet or a pencil as they
listen to people teaching or when concentrating. Including music in your childbirth
classes may be helpful, particularly having background music when people arrive, or
using sounds and rhythm during relaxation and visualization exercises. Videos with
musical backgrounds are likely to be appreciated. If carrying out a guided visualization
activity, include an awareness of the sounds that people can hear or imagine. Singers,
musicians and composers have strong musical-rhythmic intelligence.
These people learn best when working with others, in a team situation. They enjoy
bouncing ideas off other people and exploring issues in a group discussion. They tend to
be skilled at drawing others into a conversation or discussion. They are also very good at
mediating, conflict resolution and compromise. When learning they like to to be the
group leader, often taking this role naturally. As a teacher, consider activities where they
can cooperate, brainstorm and discuss at length. Politicians, salespeople, talk show hosts
and religious leaders have strong interpersonal intelligence.
Intrapersonal types tend to focus on self-reflection, meditation and having opportunities
to set goals and plan. They spend time thinking about their needs, their feelings and their
goals. They are more comfortable on their own than in large groups. They look for
meaning and purpose, having strongly held ethics and values. It is the Intrapersonal
types that others will often go to seeking advice or counsel. As a teacher, look at
including individual activities where clients can spend time reflecting and thinking on
their own. Philosophers, entrepreneurs and therapists have strong intrapersonal
intelligence.
This intelligence was added by Gardner after his original seven categories had been
defined. It involves our appreciation and understanding of the natural environment. They
are fascinated by changing weather patterns, the changing seasons, even the sound of an
insect in the room. They have a strong affinity and respect for all living things. If they
have a pet they may be concerned about how the pet will cope with the arrival of a new
baby. Or how as parents they will make choices that are environmentally respectful.
Botanists, farmers, zoologists and herbalists have a strong naturalist intelligence.
Print the following webpage, linked from our website, and complete the quiz
Multiple Intelligences: Seven Ways to Approach Curriculum
Thomas Armstrong PhD.
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This task summary is for your own records. It does not have to be submitted.
During this unit summary you will look at your own learning style and how it relates to
your studying this course through distance learning.
Using two learning assessment tools – the Swassing-Barbe Modality Index and the
Keirsey Temperament sorter – you will determine how your learning style has affected
your ease or difficulty with distance learning as a childbirth educator.
First, make sure you have identified your own learning style through the Swassing-
Barbe Modality Index on page 9 of this study guide.
Next, identify your preferred temperament using the online Keirsey Temperament Sorter
referred to on page 21.
Consider each of the following questions, taking into account your personal learning
style and temperament.
1. Which aspects of distance learning have you found difficult, challenging or not
enjoyable?
2. How does your learning style and your temperament relate to these areas that you
have found difficult?
3. What aspects of the course so far have you found easy and enjoyable?
4. How does your learning style and your temperament relate to these areas that you
have found enjoyable and easy?
5. Knowing your learning style and temperament, how can this change your
approach to distance learning now? Are there things you can do differently to
help yourself learn more effectively, with your learning style and temperament in
mind?
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Planning and Structuring a Course
During this unit we will be focusing on designing and writing a teaching plan for your
classes. A teaching plan provides you with the necessary documentation to provide
classes that are focused on the needs of the client and provide you with the tools
necessary to evaluate whether or not you are meeting those needs. We will identify
different class formats for different types of teaching and the environmental factors that
affect teaching. At the end of this unit you will be able to produce a teaching plan that
can be used in future teaching and forms part of the certification requirements for
students studying the Diploma of Childbirth Education with us.
Topics covered will include:
Using aims & learning outcomes
Identifying class activities
Alternative class formats
Choosing the right environment
At the end of this unit you will be able to:
Write aims and learning outcomes for your classes
Design and complete a teaching plan for a full antenatal course
List alternative class formats for teaching
Identify environmental factors for effective teaching
Schott, J., & Priest, J., Second ed., 2002, Leading Antenatal Classes: A practical guide,
Books for Midwives, Reed Elsevier Group, UK.
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If you have been teaching childbirth classes for some time, you may have a teaching
plan that you already use. If you have never taught classes, you may find the idea of
writing a formal teaching plan daunting.
We have chosen to use a structured format to writing a teaching plan. When childbirth
educators are determining how to teach their classes, they usually think about the
activities they will teach first. Perhaps you have heard of techniques and activities other
teachers use and think it would be great to include that in your own classes. Whilst this
style of preparation has merit, it tends to be more about what you would like to teach
rather than identifying the individual needs of your audience. It is also very difficult to
evaluate how effective your teaching is when you prepare in this way.
We have chosen to use a more formal method of preparation – a learning outcomes
based approach. This can seem overwhelming at first and many teachers find it
frustrating to do the nuts and bolts of the plan before being ready to actually teach. The
benefits of this approach though are many and we believe that in using a learning
outcomes approach you will be able to provide childbirth classes that are client focused
and focus on the principles of adult learning techniques. If you plan your classes well
you will help to build a climate for learning that will leave your clients feeling well-
informed and well-equipped to deal with whatever challenges lie ahead.
Read the following webpage, linked from our website
Building a climate for learning
Wilcox, S.
After you have completed this reading, write a short passage explaining, in
your own words, what empathy is and why it is an important skill to have as
a labor supporter or a childbirth educator.
When we are planning a childbirth course from the beginning we determine the aims and
learning outcomes, not only of the course, but of each session and of each individual
topic within that session. The learning outcomes for the topics are significantly more
specific than those for the overall course. For the purposes of your Childbirth
International teaching plan, you will be required to write aims for the course, the classes
within that course and for each topic that you are covering. However, you will only have
to develop learning outcomes for the topics, not for the overall course or the classes.
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First we must define aims and learning outcomes and identify the differences between
them. An aim is a brief and clear, overall purpose of the course, the session or the topic.
They identify what you are hoping to achieve – they are the teacher’s aims, or the
teacher’s purpose. When identifying aims you begin by asking questions such as:
What are you trying to achieve?
Why are you teaching this course? What is its purpose?
Why are teaching this class?
Why are you teaching this topic?
Examples of aims for these different aspects are:
The aim of this course is to enhance the knowledge and skills of clients to enable
them to have a positive birth experience.
The aim of this class is to provide a deeper understanding of birth and enhance
the physical skills a client has to cope with labor.
The aim of this topic is to increase awareness of the different pain relief options
available.
Determine the aims you have for the course. Think about why you are
teaching – what broad aims do you have for the course?
Learning outcomes are about the client and what you hope they have achieved by the
end of the topic, the class or the course. They are a set of detailed statements that specify
the different things a client will be expected to be able to do or know after they have
completed that section. The learning outcomes relate to specific skills and changes in
behavior that can be assessed and evaluated by the teacher. When written properly they
enhance clarity in a training program.
There are several advantages to using learning outcomes. Firstly, they provide both
teachers and learners with a clear picture of what is expected for that section of the
course. This gives a sense of direction and purpose. Without learning outcomes, there is
a more likely to be a tendency to do activities because they seem like fun but without
any clear purpose of what the activities are supposed to achieve. Secondly, having a
clear set of learning outcomes enables the teacher to identify when an activity is not
working as they thought it would or is not providing the outcome that was desired in the
client. This allows the teacher to try different activities for the same topic to determine
which one is most likely to achieve the desired outcome. It also allows the teacher to
identify when an outcome that they thought was important actually proves to be
worthless.
One of the most important advantages of this style of preparation is that when teaching,
a childbirth educator can easily evaluate effectiveness of a teaching method. If you do
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not determine learning outcomes it is more difficult to determine what you should be
evaluating and the risk is that you therefore do not assess effectiveness of teaching at all,
preventing the opportunity to improve and enhance your classes.
Sitting down to write the learning outcomes forces you to think hard about what you are
trying to achieve. It provides a formal approach to designing your course and the
ongoing monitoring of that course.
There is a danger with using this learning outcomes approach that your classes become
stilted. This technique discourages spontaneity and the ability to flow with the class
rather than applying stringent strict timetables to what you are teaching. Our experience
though is that all teachers when they first begin have a tendency to follow a plan rigidly
and feel uncomfortable with spontaneity. What we have seen is that as your confidence
as a teacher develops and grows you become more skilled at “winging it” with a class
and following the lead of the client rather than feeling the need to stick to a written plan.
This tendency when you first start stems from the safety that a plan gives you – while
following the plan the format of that class is controlled by you and your clients have less
opportunity to throw you off direction. At some point in the future you will begin to
welcome these curve balls though and will find there comes a time where you no longer
need to have a plan at all.
The biggest disadvantage to this approach is the time that it takes to put together. As a
result many teachers just don’t bother. Once you begin this process you will realize that
it is a dynamic process – not something that you do once and never change again. As
you develop new skills, gain more confidence and evaluate the activities that you are
doing in classes, you will find a need to change the activities, amend the learning
outcomes and tackle areas that initially you may be wary of.
As we mentioned earlier, aims are broad and non-specific. They cannot be measured. An
example of this would be “the aim is to develop confidence in the ability to birth”. How
do you measure someone’s confidence? How do you determine whether or not it has
increased or decreased as the result of your classes? Of course, this is not possible to be
done effectively. Learning outcomes however are more specific. They should:
be written in the future tense
identify learning
be achievable
be assessable
The reason the learning outcome must be written in the future tense is because it is what
you are hoping the client will achieve after completing the topic, class or course.
Learning outcomes are about how you will change knowledge, skills or behavior, rather
than what the client already knows when they begin the course.
Learning outcomes must identify what the client will learn. This way you are able to be
specific in terms of what you are hoping for them to achieve and it is then a simple task
of determining the most effective teaching tool to achieve that learning – more on that
later!
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There is little point in having learning outcomes that your clients are unlikely to achieve.
If you were expecting your clients to be able to identify all the available options for pain
relief after watching one video on birth this would be unachievable and unrealistic.
Unless you can determine the effectiveness of your teaching – that is, measure whether
or not your clients achieved the learning outcome, there is little point in defining them.
You may choose not to evaluate or assess all learning outcomes, but your teaching will
be most effective if you are able to develop activities that evaluates the learning
outcomes as you go through the course. For example, you may have a learning outcome
that states “the client will be able to state the three keys steps to correct positioning
while breastfeeding”. To evaluate whether this has been learned you could ask the group
at the end of the class what they remember of the three key steps. If they don’t remember
all of them it provides you with the opportunity to remind them again. If you are not able
to assess whether they achieved the learning outcome you have no idea whether or not
your classes are meeting your client’s needs. If you are teaching simply because you
enjoy sitting in front of a group of people and talking for two hours, that is probably not
a problem. If you want to help parents develop confidence, learn new skills and make
informed choices you will be frustrated in not knowing whether or not you are achieving
this.
The American educational psychologist, Robert F. Mager, has strongly influenced the
use of a learning outcomes approach in education. He believed that a learning outcome
should be clear and unambiguous, and should include three basic elements.
1. It should state what the client can do or achieve end of the activity
2. It should state the conditions under which this behaviour is to be shown.
3. It should identify the minimum standard of performance that is considered
acceptable.
An example of a learning outcome written in this way for somebody learning to drive
would be:
“The client is able to recall the rules for stop signs (what they can do) in a written
exam (the conditions under which they do it) scoring at least 8 out of 10 marks (the
minimum standard of performance).”
If we were to apply these three elements to every learning outcome, creating a teaching
plan would be an extremely time-consuming process. In most training programs now
where learning outcomes are used, the third element, the minimum standard of
performance, is generally left out.
Learning outcomes should link closely, and be consistent with, aims. If they are not
closely related you will find that your course lacks cohesiveness. Aims and learning
outcomes that are not closely related lead to you trying to achieve one thing but
expecting your clients to achieve something different. Remember, your job is to be a
facilitator in your client’s learning. If your aims are similar in tone to the client’s
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learning outcomes, you will both be on the same page, and are more likely to have a
course that feels consistent.
Learning outcomes are what you want the client to do or achieve. Since we are expecting
our clients to be able to do something as a result of the activity, verbs should always be
present in learning outcomes. We are able to identify the correct verb depending on what
it is we are expecting the client to be able to do. It can be difficult to identify the right
verb for each learning outcome. The list below is a set of verbs that you might find
helpful to use when writing your learning outcomes.
Verbs that can be used to construct learning outcomes
applies defends illustrates prepares
analyzes defines infers produces
breaks down demonstrates interprets recalls
categorizes differentiates knows recognizes
changes describes labels relates
chooses designs lists reproduces
compiles discovers locates rewrites
compares discriminates manipulates selects
composes discusses matches shows
comprehends distinguishes modifies solves
computes estimates names states
constructs explains operates summarizes
contrasts extends outlines tells
converts evaluates paraphrases translates
creates generalizes plans uses
criticizes gives examples predicts writes
deconstructs identifies prepares
What are the key things you would like the clients to have learnt by the
end of the course?
Before you write your teaching plan, you have to first determine who your target
audience and the format of your course. Some of you may be teaching to a specific
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target group such as teen mothers, or prefer to run women only classes. Childbirth
classes are generally run in a series of classes – perhaps 6-8 classes of two hours each.
There are many other alternatives, which we will cover later in this unit.
Once you know who your target audience is and the format of your course, you can
begin to determine the topics that you want to teach. It is easiest if you begin by
brainstorming some ideas. Ask yourself the following questions:
1. What do my clients need to know to help them during the rest of their pregnancy,
their labor and the early days of parenting?
2. What feelings, beliefs and ideas could we discuss that would help them?
3. How can they learn to use their bodies to help themselves and their babies?
Now take a large sheet of paper and divide it into three columns – information, attitudes
and feelings, and physical skills. Write down all the things you think your clients will
want to know for each column. You will use this list to begin planning your classes. You
may want to break down the bigger topics so they are more easily fitted into the different
classes. For example, rather than having a topic called “Stages of Labor”, it is more
manageable and easier to plan if you break it down into the following:
The signs of labor starting
Emotions during labor for women & their partners
What a partner can do to help during labor
Overview of labor
Early labor
Active labor
Second stage of labor
Third stage of labor
Now that you have identified all the topics that you could potentially teach, you will
need to determine the order in which you teach the topics. The likelihood is that you
have an enormous list of topics that all seem relevant and important. However, you have
a limited amount of time available to get through a wealth of information. This is where
you have to start being ruthless!
One of the easiest ways to plan the structure of each class is to use a technique from the
book “Leading Antenatal Classes” by Schott and Priest. They suggest taking a pile of
cards (about the size of a credit card) of different colors. We suggest you use white cards
for the class headings, then use green for Information, blue for Attitudes & Feelings, and
yellow cards for Physical Skills.
Write each topic you identified on the appropriate colored card, and write the class
numbers on the white cards (i.e. 1-6 if you are teaching six classes). Now lay the white
cards out on the floor (you will need a large floor space for this exercise) in a horizontal
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row. Underneath each class number, begin by placing the green information cards in the
class where you think they should go. Once you have finished, intersperse the green
cards with blue attitude cards in the most appropriate place. Finally, intersperse the cards
on the floor with yellow physical skills cards.
The next step is to start removing the cards that you could cover in a different way. Are
there topics that would be easy to cover in a handout? Subjects like “when to go to
hospital” or “what to pack in your labor bag” work well on handouts. Postnatal topics
such as “equipment for your newborn” and “newborn vaccinations” can also be covered
on a handout. This can save an enormous amount of class time. Remove the cards for
topics that could be covered in this way and put them to one side so you can prepare
appropriate handouts or find ready made handouts later.
Next, remove the topics that are not essential. This can be one of the hardest things to do
since most childbirth educators are keen to cover every single topic. It is more important
though to thoroughly cover a few topics rather than superficially cover many. Are there
any topics that are irrelevant? For example, if your clients are all going to be at least 30
weeks pregnant by the time your classes run, it is probably a waste of time talking about
antenatal testing in the first trimester. Equally, if you are running a class for first time
parents, discussing issues about siblings has little relevance to them – unless your aim is
to increase their enthusiasm for contraception after the birth!
You should now be left with a significantly smaller number of topics to cover. This is
now the most ruthless stage. How many topics overall are you teaching in each class?
We are only able to absorb a limited amount of information in one sitting. If your classes
are going to be about 2 hours in length, aim for no more than 4-5 topics in that time.
This may seem like very little but most childbirth educators are overly ambitious when
they first begin.
If you try to teach too much you will find that you constantly run over time and become
frustrated as you struggle to get through everything on your plan. You may also find you
panic if a client brings up a topic that was not on your agenda for that class as you
realize that discussing it now will mean not fitting everything else in. Not having enough
to cover is highly unlikely to be a problem in most classes, whereas trying to cover too
much often is. So, begin prioritizing from your topics. What is really essential and what
is just a nice to have? Anything that is not essential put in a pile at the bottom of the row
– you can always have these topics on hand to cover if you get a group that fly through
everything you are teaching. At the end, you should be left with something a little like
the diagram on the following page.
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Once you are happy with the topics you are covering, you can begin to look at the
overall feel of each class. Take a step back and look at the overall balance of each class.
There are probably more green cards than yellow or blue – this is to be expected since
the bulk of what you are doing in childbirth classes is imparting information. However,
is there a nice balance of blue and yellow in each class? Do you have the blue cards at
the end of the class? If so, think about how appropriate it might be to end a class on a
discussion about emotions or attitudes. During what part of the class are you teaching
the physical skills? Is it too late for pregnant women or clients who have been working
all day? Are there any information heavy sections, (i.e. lots of green cards together)? If
so, can you move a yellow card immediately after that section to allow the group to get
up and move around? You may find that you have to move cards from one class to
another to ensure balance. Play around with your class structure until you feel happy
with the layout.
If you have never taught before you may have no idea how long each activity will take.
You will just have to make a best guess. Most new teachers underestimate the time.
Remember that some activities such as videos take longer than you might think. It takes
5 minutes to introduce the video and get it running. Then about 15 minutes to watch it,
depending on how long it is. Finally, it will take another 15 minutes at least to discuss
the video, giving you a total of 35 minutes to watch a 15 minute video. You should
always allow time for discussion after videos since they often create powerful emotions
in expectant parents. Consider how much time you will allow for a coffee and bathroom
break, and for an ice-breaker at the beginning of each class. This is generally about 20
minutes overall.
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Write the estimated time for each activity on the card. Now look at the total time it
would take to teach all the topics you had planned for that class. You may still have
more topics than time available. This will require you to make another cull and remove
more topics. Sometimes you can add topics together if they are related – perhaps have
the men doing one topic and the women doing a related topic at the same time. Or
getting them to do something as “homework” so they are prepared for the class when
they arrive and you are not spending time covering basics. Bear in mind that most people
will do study topics you ask them to look at in their own time. It is just to easy to leave it
until the next class when people have very busy lives.
Go through the rows again. How is the time estimate now? If you are still over time,
have you allowed enough time to cover everything you want to? Perhaps you need to
add an extra class. Our experience is that it is unrealistic to get through all the topics
people want to learn in less than 12 hours of teaching time – that is not including the
time for ice-breakers and coffee breaks. If you are trying to do your classes in less time
you will either have to increase the number of classes or reduce the number of topics.
Perhaps you can make the parenting and breastfeeding classes separate from the prenatal
topics on the course. Think about topics that you could cover in one activity. A good
example of this is parenting issues. You might like to invite a couple with a newborn
baby to talk to the group about parenting. This will allow an enormous amount of
information to be passed throughout the group and only takes about one hour. You can
then finish that session answering questions on anything that was raised.
Finally, stand back again and take another look at the balance. Now that you have added
times to cards you may find that you have to move the cards again. If so, does the
balance still work? This exercise can take several hours and you may have to repeat
steps several times before you feel happy with it.
Once you are happy with the topics you can begin to write up your teaching plan. Pull
together the cards for each class. On the back of each card you can write the learning
outcomes for that topic. Refer back to the guidelines on how to write learning outcomes
and look at the learning outcomes verbs list. Make sure the outcomes meet the criteria of
being client focused, realistic and assessable.
For each topic you cover in a course, there should be between 3-6 learning outcomes. If
you have more than that you are trying to cover too much information and your course
will either feel rushed, or you will become frustrated when you are able to get through
all the material in the time available.
Once you have written learning outcomes you can begin to put together a written plan.
All that is left is to determine how you are going to teach each topic. We leave the how
until last since this part is completely adaptable. In theory, another teacher should be
able to pick up your teaching plan and teach exactly the same topics as you, with their
clients achieving the same outcomes, even if they used totally different activities in their
teaching. Planning your course in this way ensures that you are constantly client
focused. The tendency for many teachers is to hear about great sounding activities and
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adopting them without really thinking about whether or not the activity meets the needs
of their client or whether it fits in with your overall aims and philosophies.
By now you should be able to put together a skeleton teaching plan that looks something
like the following:
SAMPLE TEACHING PLAN
Course Title: Full course for couples
Course length: 8 sessions of 2 hours each
Overall course aims: To provide an environment where expectant parents can explore
issues relating to their pregnancy, birth and early parenthood, enabling them to make
informed choices related to their care.
Class One:
Aims: To understand fetal development from weeks 36-42 and the stages of labor
Topic: Stages of Labor
Aims: To understand the stages of labor
Learning Outcomes: At the end of this session, the client will be able to:
Name the three stages of labor
Describe the common emotional responses to each stage of labor
Explain the reasons why remaining upright during labor is beneficial
Demonstrate how a baby moves through the pelvis in second stage
Identify three positions that feel comfortable to them that could be used during
labor
And so on with each topic, for each class listed.
Once you have created the outline of your teaching plan you are ready to begin
considering the teaching and learning methods that you will use to present each topic. In
considering the most appropriate method or methods to use for each topic consider the
following:
What methods could I use to help clients achieve this learning outcome?
Which of these methods would be the most appropriate for the target audience,
environment I will be teaching in, and any constraints I have?
In answering the second question you will need to consider the actual audience you will
be teaching. Are there cultural or religious aspects that make certain teaching methods
inappropriate? Is the environment conducive to large groups, individual group work,
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videos or movement? Do you teach in a hospital where you have been told you are to
avoid certain styles of teaching? In the next section we will explore the different styles
of teaching, the benefits and disadvantages of each.
Whether or not an activity is effective will depend on a great extent on the learning style
of the clients you are teaching. Each of us have different styles in the way we learn –
visual, auditory, or kinesthetic. A visual person learns predominately by watching and
observing, while an auditory person learns by listening. A kinesthetic person learns best
by doing. You also have a preferred learning style and that also tends to be your
preferred teaching style. If you only ever teach activities that stimulate your own
teaching/learning style, you will lose two/thirds of your clients. For example, when
teaching about the pelvis, if you just lecture you miss the people in the group who are
visual and kinesthetic. If you show them what you are talking about by demonstrating on
a pelvis and then finish the activity by getting them to explore the pelvis themselves, you
address the learning styles of all clients and are likely to be a lot more effective in your
teaching. We cover learning styles in a lot more detail in unit ED2001, Learning Styles.
For the purposes of this unit, just bear in mind the importance of learning styles when
planning your course and remember that you may have to come back and adapt your
plan slightly when you have learnt more about them.
The size of your groups may be determined by many factors: demand for classes, the
size of the space available for you to teach in, requirements of the institution if you work
in a hospital, are just a few. The optimum size to teach childbirth classes to is about 8-12
people – either 4-6 couples or 8-12 pregnant women. Teaching smaller groups is
certainly possible but limits the activities that you can do with them. With a small group
you may find you tend to do more talking and have less interaction from the participants.
Groups larger than 12 make it extremely difficult to carry out active teaching. Mass
instruction becomes the dominant teaching style in large groups.
Teaching to a large group is primarily in the form of lectures or large group discussions.
It allows you to cover a lot of information in a relatively short time. The disadvantage of
this style is that it is largely passive and relies on what the group can get from the
teacher. The teacher tends to control the pace and the content. Large group teaching
restricts the amount of critical thinking that clients can do and reduces the opportunities
for discussing attitudes and feelings. People tend to be less comfortable discussing their
feelings and closely held values in large groups.
Lectures: A course where the teacher lectures for the entire time is not only dull, but
unlikely to have any real impact on the behavior or attitudes of the course participants.
Saying that, lectures certainly have their place in childbirth classes. Most people expect
some level of lecture, even when they don’t particularly enjoy them! Many clients,
especially men, will be initially reluctant about childbirth classes since they fear they
will be expected to “get in touch with their inner selves”. Starting a course off with a
lecture allows the men to begin to feel comfortable in a more formal environment
without threatening them with more emotional approaches to learning. Lectures can be a
good way of opening up a topic and imparting a lot of information in a short space of
time. For example, starting off the Stages of Labor topic can be achieved by giving an
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overview of labor, as a lecture, in about 15-20 minutes. You can then move into other
teaching styles once you know everybody in the group has the same base level of
knowledge.
The disadvantage with lecturing is that it requires little involvement from class members
and gives them relatively no sense of ownership of the learning taking place. If there is
too much lecturing the class becomes dull and drawn out. The average attention span is
no more than 20 minutes – lectures should not be longer than this. It is difficult to meet
the varied needs of a group when lecturing – if you have clients with special needs or
focused on different issues, you are unable to address these during a lecture as easily as
you can using other methods. In addition, lecturing does not cater to all learning styles.
This can lead to more than half of your group hearing the information but not being able
to retain it. It is worth integrating lectures with other teaching methods. For example,
talk about breathing through second stage, then get the group to watch a video of a
woman pushing her baby out. Finish this with women practicing breathing techniques
and positions for second stage.
Identify topics and situations where lecturing may be appropriate.
Videos: Videos are often used in childbirth classes to show women giving birth, present
parenting topics or demonstrating breastfeeding. Video can be particularly helpful for
illustrating specific points but should be used in short episodes. A video of more than 15
minutes is difficult to absorb in a childbirth class. Video is particularly good for teaching
clients with visual or auditory learning styles, (we cover the specifics of adult learning
styles in unit ED2001 – Learning Styles).
Besides the obvious disadvantages of cost and the need to have access to equipment to
play the videos, caution should be used with video. They tend to encourage passive
rather than active learning, and discourage ownership of the learning. There is a
tendency for teachers to use video without having a focus – that is, just showing a birth
because the teacher thinks it is important for the clients to see one. One particularly
helpful technique for resolving this is to give each group member a role when watching
the video. One of the methods we use is to ask one third of the group to watch the video
from the mother’s perspective, one third with the partner’s perspective and one third
with the caregiver’s perspective. At the end of the video the group can then discuss what
it was like for that person in the video. Videos can also be used to contrast different
types of birth – for example, showing a highly intervened birth and compare it to a non-
intervened birth. Alternatively, show two similar births in terms of the way they are
progressing, but one where the mother is relatively passive and the other where the
mother is asking lots of questions and making informed choices.
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Identify topics and situations where using a video may be appropriate.
Class discussions: Class discussions usually involve a discussion where the teacher is in
control of the situation, allowing the group to ask questions, or guiding the class through
a structured discussion providing appropriate prompts. These may be in the form of a
follow-up to watching a video, a revision exercise, or a general discussion in its own
right. Discussion enables the teacher to receive feedback from each group member and
exploration of ideas while still controlling how the conversation flows and the topics
covered. The major disadvantage with class discussions is related to the dynamics of the
group and the individual personalities. If the group has a large number of quiet clients it
can be difficult to get them actively involved and limits the amount of discussion that
will take place. If there is an outspoken class member they have a tendency to dominate
the discussion, preventing others from interjecting.
Read the following webpage, linked from our website
Keeping teacher’s voices in balance
Brookfield, S., & Preskill, S.
After you have completed this reading, write a short passage explaining, in
your own words, what empathy is and why it is an important skill to have as
a labor supporter or a childbirth educator.
Read the following webpage, linked from our website
Encouraging student participation in discussion
Gross David, B.
After you have completed this reading, write a short passage explaining, in
your own words, what empathy is and why it is an important skill to have as
a labor supporter or a childbirth educator.
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Identify topics and situations where using class discussions may be
appropriate.
Carl Rogers, a humanistic psychologist like Abraham Maslow, developed a student-
centered learning approach. He believed the teacher was not an expert who handed down
knowledge to passive students, but rather a facilitator. The facilitator provides the
student with guidance on how to learn and then provides opportunities and experiences
through which learning can take place. A key part of this process was providing
opportunities for group learning, where the group dynamics and interpersonal
relationships within the group enhance the learning process.
Group learning techniques include brainstorming, small group discussions, group
projects, games and activities. This method can work well for client’s to get to know
each other better and open up more in discussions. Success relies on all group members
participating equally.
You can break the large group into several different configurations, depending on how
many group members you have. A group of 12 has the most variety of configurations: 2
groups of 6, 3 groups of 4, 4 groups of 3, 6 pairs, or gender specific groups with men
and women separate. If you have group members who are very outspoken you can give
them the role of writing notes or scribing – this tends to keep them quieter in the
discussions and allow the less confident members of the group to speak up.
When separating a large group into smaller ones you can use several different
techniques. Simply draw an imaginary line down the center of the group, or assign
everyone with a number. For example, go around the group pointing to each person
saying 1, 2, 1, 2, 1, 2, then ask all the 1’s and all the 2’s to get together into two separate
groups. It is best to repeat the counting once more to make sure everyone remembers
their group – it is surprising how often people don’t!
Buzz groups: These are short sessions built into a lecture or larger group exercise with
the purpose of stimulating discussion. Small groups of 2-4 people spend five minutes
intensively discussing a topic given by the teacher. Each group then feeds back to the
larger group on their findings and thoughts. This is an excellent way of providing variety
in a teaching session, which helps to maintain the attention of the clients. The technique
can be sued to cover a large variety of topics and encourages the clients to be actively
involved.
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Identify topics and situations where using buzz groups may be appropriate.
Games, activities and role plays: Games and role plays are now used in almost every
sphere of education. They can be used to achieve a wide variety of learning outcomes
and have a high level of client involvement. They are motivating and extremely
rewarding when carried out well. There is a tendency to used these activities,
particularly games, for the sake of it, without the teacher ensuring the activity is relevant
to the topic and addressing learning outcomes. It takes a certain level of confidence on
the part of the teacher to carry out these activities since the teacher has little or no
control over the way the exercise is going to progress. We have many suggestions for
different types of activities that you can try in your classes – these are covered in detail
in the units ED3001, ED3002 and ED3003, teaching different topics.
Role-play in particular has enormous benefit in childbirth classes. There is a tendency
for clients to avoid addressing difficult situations that may occur, believing that this will
never happen to them. Using role-play to get clients to face possible scenarios, and
develop communication skills and decision-making techniques to resolve them is of
enormous benefit. Teacher’s can also use role-play to demonstrate different aspects of
childbirth and parenting. As an example, a teacher role-playing the contractions in strong
active labor can be tremendously powerful, often with the client’s forgetting that the
teacher is only pretending! It provides the opportunity for client’s to hear how a woman
may sound during labor and the possible emotional responses she may have.
Identify topics and situations where using games and role-play may be
appropriate.
In this learning method clients are completely responsible for their own learning, the
pace with which they study, and the amount of depth they choose to study. The teacher
is responsible for producing the materials, or referring the client to sources of
information.
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Written materials: Handouts are often used in childbirth classes to reduce the amount of
class time spent on topics and to provide a written reminder of topics covered in classes.
Handouts can help clients to recall information at a later date when and if they need that
information. For example, a handout on the differing values of bilirubin and the
treatment options available can be helpful if the parents are faced with this problem if
their baby develops significant jaundice after it is born. Written materials are relatively
passive and rely on the skill of the teacher in writing them.
Identify topics and situations where using written materials may be
appropriate.
Individual assignments: When a client is actively involved in their learning, they are
significantly more likely to retain the information and skills they are learning. You can
use specific projects and assignments to enable clients to research more deeply into a
topic. For example, asking each student to research a specific pain relieving technique
and report back their findings to the group at the next childbirth class can be an excellent
way for the clients to retain the information.
This method of teaching relies on the involvement of the client. If they feel
overwhelmed, or are not motivated by the topic to be researched they may not
participate. It is worthwhile, if you plan on using this technique, that you have written
materials available to distribute to the group if one client does not do the work or leaves
it at home on the day of the class.
Identify topics and situations where using individual assignments may be
appropriate.
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Once you have addressed each of the components of the teaching plan you can run
through a checklist to ensure you have covered everything and it will be appropriate for
your setting.
Step 1:Are you clear about what your overall aims and learning outcomes are? If not,
clarify them.
Step 2: Have you got a list of topics for each class that provide a balance, and are
realistically going to be covered during the time available?
Step 3: Have you identified learning outcomes for each topic that are achievable,
realistic and assessable?
Step 4: Have you identified activities and teaching methods for each activity?
Step 5: Will your clients be comfortable with each activity planned?
Step 6: Will your chosen method be practical?
Step 7: Are the chosen methods going to be allowed in the environment where you
work?
Step 8: Do you feel comfortable with each chosen teaching method?
Now that you have identified different teaching methods for each topic, you can
complete the rest of your teaching plan. For each topic you should now be able to create
a list of activities. Draw up the activity list, determining the teaching method to be used
and document the estimated time to complete the activity. The full teaching plan should
look something like the layout on the following page. Once you are finished you will
have a teaching plan that identifies your overall course aims and learning outcomes, the
topics you are going to teach in the course, the activities (how you are going to teach) for
each topic, and the teaching style you are going to use, together with time estimates. All
that is left now is to determine how you are going to evaluate whether or not the learning
outcomes were achieved by the clients for each activity.
SAMPLE TEACHING PLAN
Course Title: Full course for couples
Course length: 8 sessions of 2 hours each
Overall course aims: To provide an environment where expectant parents can explore
issues relating to their pregnancy, birth and early parenthood, enabling them to make
informed choices related to their care.
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Class One:
Aims: To understand fetal development from weeks 36-42 and the stages of labor
Topic: Stages of Labor
Aims: To understand the stages of labor
Learning Outcomes: At the end of this session, the client will be able to:
Name the three stages of labor
Describe the common emotional responses to each stage of labor
Explain the reasons why remaining upright during labor is beneficial
Demonstrate how a baby moves through the pelvis in second stage
Identify three positions that feel comfortable to them that could be used during
labor
And so on with each topic, for each class listed. The following pages will then include
the activities, the length of time for each activity, and the teaching style that will be used
for the activities.
Activities: The following activities will be used during this topic:
Activity Style Time
Demonstrate the stages of labor using charts Lecture 30 mins
Separate into two groups Small groups 15 mins
(gender)
- men work out how baby moves through pelvis
- women explore pelvic floor
Discussion on how the baby moves through the Large group 10 mins
pelvis and its relationship with the pelvic floor
Watch video on a birth looking at it from Large group 20 mins
perspective of mother, father, & doctor
Discuss how it felt to watch video from each Large group 5 mins
perspective
Using orange & glass, show effect of upright Lecture 5 mins
position, baby’s head & the cervix
Using pelvis & grapefruit, show the effect of lying Lecture 5 mins
down versus being upright on pelvic outlet
Identify different upright positions Brainstorm 10 mins
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Practice positions for first & second stage Pairs 10 mins
Evaluation is imperative if you are to ensure that your classes meet the needs of your
clients. If you use aims and learning outcomes in each of your activities, this process is
relatively straightforward. There is no single right way to evaluate an exercise. You can
determine whether activities are successful through several different methods, including
feedback from:
classroom observation
client assessment
client feedback forms
your peer group
It is worthwhile to build in assessment or evaluation activities as you are teaching. We’ll
use the Stages of Labor topic we have been suing this unit as an illustration.
While teaching the activity on positioning you observe clients trying out
different positions and finding what works well for them and what is
uncomfortable.
In the discussion on how the baby moves through the pelvis you note that one of
the clients comments on the connection between the importance of pelvic floor
tone and the way the baby turns as it moves through the pelvis.
At the end of the discussion on how the upright pelvis creates more space for the
descent of the baby, the clients begin to question the horizontal position they
saw the mother birth her baby in the video they watched earlier.
In the last 5 minutes of the stages of labor lecture using charts, you place a chart
on the floor and ask client’s to label each body part using small card labels you
have prepared earlier – you are able to see that they all have a basic
understanding of the terminology.
The men return to the group and demonstrate how the baby most effectively
moves through the pelvis.
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You ask the group to complete a brief evaluation form at the end of a class, or at
the end of a course series, specifying the different sections of the course and
whether or not they found them helpful.
You ask a colleague to sit in and observe a class and provide you with feedback.
As part of your assessment for certification if you are completing the Diploma in
Childbirth Education training program, your tutor provides you with feedback
after reviewing your teaching plan and observing your teaching video.
Traditionally, childbirth classes are conducted in a series of 6-8 classes, each class being
2 hours in length. However, there are many different class formats to suit your own
personal needs, the needs of your clients and the environment where you are teaching.
A one day course is an excellent way of getting through a large amount of information in
a short period of time.
Advantages Disadvantages
Gets through a lot of information in Requires a large number of physical
a short period of time skills and group activities to keep
client’s motivated and alert
Reduces the time spent getting to
know each other at the beginning of Can be exhausting to teach on your
each class own
Can meet the needs of clients who Prevents the client’s from building
book their classes very late in up interpersonal relationships and
pregnancy creating their own support network
Refresher classes are designed to meet the needs of parents having a second or
subsequent baby.
Advantages Disadvantages
Parents do not have to go over the May not have enough clients to
basics of birth again justify a separate class
Can focus on issues specific to Despite having had a previous baby,
second timers such as siblings and clients may still need to go over the
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VBAC basics of labor and birth
Can use a shortened course format
Teen classes focus solely on the needs of adolescent parents.
Advantages Disadvantages
Focused on the very specific needs Unless the course is thought to
of teen parents address their needs very
specifically, you may have difficulty
Provides the opportunity for teen
with commitment from clients
mothers to establish a strong
support network amongst the group You may find it challenging to
before they have their babies identify the needs of teen parents
unless you have personal
This may be the only resource
experience or have researched the
available specifically to teen
subject thoroughly
mothers to address their fears and
concerns in a safe environment You may have a high proportion of
single mothers, which could lead to
the fathers present feeling isolated
There may not be enough clients in
your area to justify a course
The financial rewards may be less
Many childbirth educators run classes for older siblings when a baby is expected in the
family. They tend to be more focused on play activities, giving the children an
opportunity to understand the joys and challenges of a new baby in the family. They are
particularly beneficial to parents who are planning for their older children to be present
at the birth of the new baby.
Advantages Disadvantages
Can be a lot of fun to teach Can be challenging if you have no
experience of teaching children
Provides an opportunity for parents
and children to work together Addressing the needs of the parents
exploring the difference the new and the children at the same time,
baby will make in their family with learning methods appropriate
to both, can be difficult
Offers an opportunity to prepare
children for the arrival of a sibling Parents may find it difficult to afford
a class for themselves as well as
Can be integrated into a refresher
their older children
class
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Some childbirth educators will choose to teach gender specific classes. That is, classes
only for women, or only for men. You can choose either to have an entire course for one
gender, or integrate a gender specific class into a standard course.
Advantages Disadvantages
Opportunity to meet the specific Men may be reluctant to attend a
needs of each gender group class on their own
Can be helpful in cultures or Women may feel their partners are
religious groups where men are not being excluded
present at births
Do not provide the opportunity for
May encourage men to open up men and women to explore issues
more when their partners are not together such as parenting
present decisions
May have more flexibility on timing
if women are not working during the
day
It can be a lot of fun to teach your classes together with another childbirth educator.
Advantages Disadvantages
Less exhausting – particularly for If the teaching styles are very
the one day courses different is can be difficult for
clients to follow the course
Provide the clients with two
structure
different teaching approaches
If you and your colleague have very
Provides you with another person
different philosophies this will show
you can debrief with afterwards
through in the teaching, creating a
Opportunity to teach a larger different messages for the clients
number of clients at the same time
The financial rewards are not as
great as class fees have to be split
between the two of you
Rather than providing a course series, you may choose to run a rollover course format.
This entails having a set number of classes on different topics that clients can start at any
time. This course format works well for teen classes where it is more like a drop-in
group.
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Advantages Disadvantages
Provides greater flexibility for your No continuity of class members to
clients build a support network
Different clients attending each It may be difficult to stay on topic if
class provides more variety people have missed some classes.
You may choose to focus only on private classes rather than groups.
Advantages Disadvantages
Can be more flexible on timing and Provide no opportunity for parents
location of classes to establish a support network
Can work through a greater amount Limits the number of activities you
of work in a shorter period of time can try and the number of different
teaching methods available
Able to make the course content
very specific to the needs of the
clients
If you are working for an organization such as a hospital or a birthing center, your
teaching location and environment may already be pre-determined. If you are teaching
privately you will have more flexibility to adapt a room that is appropriate for teaching.
Think about the layout of the room, natural and artificial lighting, and noise from
internal and external factors.
Room layout: The room should be spacious enough to comfortably fit in 6-8 couples and
yourself. Remember to consider people moving around during physical skills activities.
How close is the bathroom? Is there an opportunity to put up posters on the walls? Is
there space for a television and video? Are there power points located nearby? Consider
the type of seating you will use. It must be comfortable enough for pregnant women to
sit for a relatively long period of time. Is there a variety of seating including low seats
and cushions? Is the floor carpeted and able to be cleaned before the class?
Lighting: Look at the types of lighting available. Is there lots of natural light if you will
be teaching during the day? Is the artificial lighting fluorescent? Can you add in floor
lamps to soften the lighting of the room?
Noise: If you are teaching outside your home, have you visited at the time of day you
would be teaching to determine any outside noise? Is it possible for other people, not
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taking part, to walk in and out of the room? If you are teaching at home, what will you
do when the telephone rings? Will your children be making noise in another part of the
house? Will this be a problem or not?
If you are teaching from home and need to furnish a room for teaching you can do so
very cheaply. Some large floor cushions make a good start. If you are focusing on active
learning techniques, your clients should not be sitting down for more than 20-30 minutes
at a time. There should be lots of physical activities and group exercises that have them
moving around frequently. Draw up a list of all the things you think you will need to buy
and budget for them. Identify what items are essential and what are optional. You may
be able to pick up second hand furniture through garage sales and the used ads in your
local newspaper or on bulletin boards. Don’t forget to include the simple items like a jug
for making coffee that is large enough for the number of clients you will be teaching,
cups and glasses to go around.
The types of rooms where childbirth educators teach are numerous. If you prefer not to
teach at home there may be other venues you can choose from including:
The local hospital or birthing center
A doctor’s clinic
Church halls
Community centers
Community space that is let out by complementary therapists
Rooms at the local school
Libraries
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Instructions for completing these two requirements can be found on the student website.
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Active Teaching Skills
Active Teaching Skills
During this unit, we will be discussing your clients needs and your own teaching goals.
We will explore ways that you can ensure your goals and your client's needs are in
alignment with each other. We will explore the role of creating agendas, benefits and
disadvantages of using them and different ways of creating them. Finally, we will
identify the differences between traditional teaching methods and a more active style of
teaching and will determine the expectations of your clients and how to ensure these are
realistic.
Topics covered will include:
Identifying your audience’s needs
Getting to know a group
Agendas
Active teaching vs. traditional teaching
Knowledge vs. skills
At the end of this unit you will be able to:
List the needs of your clients
Identify appropriate icebreakers
Describe the differences between traditional and active teaching methods
Explain the benefits of teaching skills and exploring feelings
There is no suggested reading for this unit.
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Active Teaching Skills
Most of us are familiar with traditional teaching methods as a result of our own
experience of education as a child and student. Most of us learnt at school using a rote
learning method. During this unit we will be exploring the practice of rote learning and
considering more effective ways of teaching adults in a childbirth education class
setting. Being aware of different teaching methods enables you to provide effective
classes that take your audience’s needs into account and provide your clients with real
tools that they can apply to their own situations.
Before beginning childbirth classes, it is imperative that you understand the needs of
your audience and do not make any assumptions about why they are coming to classes.
Common reasons for attending childbirth classes are:
I want to meet other pregnant women
I want to have a natural birth and so think I need to classes to help me achieve that
I want to understand what is going to happen
I am scared and think they will make me feel more comfortable
My wife told me I had to come!
All of these, and any other reasons, are perfectly valid. Having the group identify their
own agenda is a great way of determining their needs and what they want out of the
classes – more on agendas later. Another method is to have a booking or registration
form that asks the client the three most important things to them for this pregnancy. You
can also add a line that asks what is most important to them postpartum. If you spend
time on the telephone with your clients before classes begin you can also take the
opportunity to ask them what they want from classes. This can also be a good discussion
to include as the first activity in the first class – asking them in small groups to identify
what they want from classes. Alternatively, ask them to introduce themselves by name
and say why they have come to classes.
It is important to remember that it is your audience’s needs that are important rather than
your own needs. You may feel that birth should be natural in most cases and there is too
much intervention applied in the traditional hospital setting. However, that may not be
the focus of your clients. They may be experiencing high-risk pregnancies, perceive
themselves to be high-risk, or simply not interested in a natural birth. In these cases their
needs are still valid and important. If your classes focus totally on relaxation techniques
and the “evil” of intervention, you will lose your audience from the very beginning.
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It is helpful before planning a course to determine your own needs, being very honest
about what you think is important.
Identify the reasons why you have chosen to teach childbirth classes.
Now discuss whether or not these needs may be in conflict with your client’s
needs and what the most appropriate avenue may be to address your own
needs. Perhaps you want to be an advocate for change. Is a childbirth class
the place to do this? Are there more appropriate ways for you to meet this
need?
By far the most anxious time during a childbirth course for both the teacher and the
clients is the beginning of the first session. You have yet to meet and get to know each
other, nobody knows all the names of group members, and you have no idea how well
the group will gel with each other. There is much that you, as the teacher, can do to
make this process work more smoothly and help everybody quickly become
comfortable. The introduction section of the first class should take about 30 minutes –
by the time everyone has said their names and introduced themselves, you have stated
your objectives and the general group rules have been covered this should not be
difficult. It may seem like a waste of 30 minutes when time is so limited but will provide
an excellent foundation in order for the group to gel and for each group member to begin
feeling more relaxed.
Many teachers struggle to know how to manage the first 10 minutes of a childbirth
course. Clients are all arriving at different times, nobody is quite sure of what to expect,
and most are uncomfortable as they start to try and get to know each other. You might
find it helpful to have a video playing as people arrive to soften the atmosphere. There
are several excellent ones that simply have stills of women in labor and afterwards, set to
music. These can be inspiring and beautiful to watch, are relevant to the topics about to
be covered and for most people, are non-threatening as they don’t include any actual
birth video footage or labor “noises”. The two we would recommend are:
“Reach”
Edited by Stephanie Soderblom
You can purchase Stephanie’s video from http://www.birthdiaries.com/reach.htm and
contact Stephanie on elfanie@soderblom.net. The video costs US$20 and can be
provided in either VHS or DVD format.
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“In Union”
Edited by Vicki Chan, photography by Nic Edmonstone
You can purchase Vicki’s video from
http://www.capersbookstore.com.au/scripts/shop_item.asp?by=med&item=1164. The
video costs about US$48 (it is sold in Australian dollars) and can be provided in NTSC
or PAL format.
Some teachers find that providing a game or activity as people are arriving is a good way
to break the ice and help people become more comfortable. There are many different
games and activities that can be used at the beginning of a course. A search on the
internet will provide you with many wonderful examples.
One such game is “People Bingo”. Provide a sheet of paper that has been drawn up with
16 boxes, (draw up more boxes if you have a large group of more than 12 people). Each
box contains a different characteristic. You can use the following sheet or draw up your
own.
Got lost getting Wearing socks Owns a cat Is a vegetarian
here
Born in a different Works in an office Rides a bicycle Last holiday was
country overseas
Plays a sport Is an only child Plays an Has a hobby
instrument
Enjoys Doesn’t own a Buying their own Speaks another
photography computer house language
As people arrive, hand them a sheet and ask them to go around the room to talk to each
other. As they introduce themselves to each other, they ask the other person which box
they would like to have their name placed in. As they write the person’s name in the
relevant box, this prompts a discussion about the box they chose, and enables people to
start to get to know each other in reference to a topic other than childbirth.
You might find it helpful to have drinks and light snacks laid out for people to take as
they arrive. This is especially beneficial if you are teaching classes in the evening when
people are arriving straight from work and may not have had an opportunity to eat
dinner beforehand.
Once everyone has taken a seat they will be looking at you to begin the class. It is
important to do the housekeeping before anything else. Welcome the group members
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and thank them for coming, and then straight away let them know where the bathroom
is. This will be seen as critical information for the pregnant women in the group! You
can also take this opportunity to let them know what time you will be taking a break for
refreshments. At this point you can briefly introduce yourself, a little about your
background or your own family if you wish to share that, and your hopes and goals for
the course.
Unless you are teaching private classes, nobody knows the names of other participants at
the beginning of the first class. We have observed many childbirth classes where the
teacher either does not allow the group to introduce themselves at this point, or only
share their names at the beginning of the course and then provide no other reminders of
people’s names in subsequent classes. The outcome of this is that group members never
feel completely comfortable and do not interact as effectively. Learning names should
take place right at the beginning and should be followed up for at least the next two
classes.
There are many activities that help everyone to learn names. The following are some of
the activities we have used that we have found to be successful in everybody
remembering names quickly.
1. Picture introduction: Prepare a large sheet of paper before the class starts with your
name on the top. Include several pictures on the sheet that provide a little
information about you and your life. Go through each of the pictures explaining what
everything refers to. An example of this picture introduction can be found below.
The words have been included to give you an idea of what might be said – you
would not normally include them. Once you have completed your introduction, pass
a large sheet of paper to each couple, or woman if she is on her own, providing some
different colored marker pens for them to use. Ask them to draw the same sort of
picture introduction, emphasizing that drawing finesse is not essential! Once they
have finished – about five minutes – go around the group and ask them to introduce
themselves from their pictures. If in couples, the couples draw the pictures together
and do one introduction.
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2. Something about your name: This is an excellent way of remembering people’s
names. Introduce the activity, telling the group that you are going to ask
everyone to say something about their name to help them all remember each
other. You start off by saying something about your name – its origin, why your
parents chose it, whether or not you like it, something funny about it etc. I tend to
use this activity in the first session and, when introducing myself, usually say:
“My name is Nikki. It is short for Nicolette – which I do not like! My mother
obviously had high aspirations for me as she named me Nicolette Tania, after a
former Miss New Zealand and Miss Australia! When I was a kid my parents
called me Dick or Poo – not surprisingly I have reverted to using Nikki!” Go
around the room and ask everyone to do the same thing. Sometimes the answers
will surprise you. I recall one man in classes who said his name was Rupert.
Surprisingly though, he talked about his middle name – Peirs – rather than his
first name. He told us that all the first-born sons in his family had been given the
middle name of Piers for centuries. However, if they were born illegitimate, the
spelling was Peirs. I certainly never forgot his name!
3. Another way of remembering names is for everybody to add an adjective before
their name. For example “Silly Susie” or “Vibrant Vera”.
4. Nametags can be helpful to hand out before the class starts. Remember though
that many people do not like wearing nametags and feel self-conscious when
doing so.
5. Toilet Paper: As each person comes into the class, stand by the door with a roll
of toilet paper and ask each of them to take as many sheets as they need, not
explaining the reason for doing so. Once everyone has taken a seat, ask them to
write one thing about themselves on each sheet of paper they have then
introduced themselves afterwards.
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6. Wanting to learn: Going round the group, ask each person to state their name and
one thing that they hope to achieve from the course. This can provide a good
evaluation tool to enable you to ensure you meet the needs of all the group
members.
As you start each new class, it is helpful to have an icebreaker at the beginning to help
them feel settled and remind them of names from the previous class. Again, there are
many different techniques for icebreakers. We have written a few below that we have
found helpful. Always ask people to say their name and then the required information. It
is helpful to the group if you always start off. For example: “Lets just remind each other
of our names. I would like you to say your name and one thing you have done for
yourselves this week. I will start. My name is Nikki and this week I had a long soak in a
bubble bath with a magazine and a glass of wine!”
One thing you did for yourself this week
One character you hope your baby will have
A variation on the previous one is to state one character of your partner that you
hope your child will have – this is particularly good to do at the beginning of your
parenting class
One thing you are looking forward to about being a parent
One thing you would like your child to learn from you
One thing you have done you are proud of
There is an enormous amount of information on icebreakers available
on the internet. Do a search on www.google.com using the word
“icebreakers” and write a list of 12 different icebreakers that you think
might be able to be used, or adapted, for childbirth classes.
It is important from the outset of a course for you to state the course objectives so that
everybody is on the same page from the beginning. Explain what you hope to achieve
and provide during the course. This can be covered very briefly but provides some
goalposts for the group and enables them to see where the course is going.
Group rules are often ignored, sometimes causing enormous problems for the teacher
afterwards. You can choose to specify some of your own rules first, or ask the group to
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do this together as a group activity. The group rules should be written down on a large
sheet of paper and be on display on the wall for everyone to see throughout the course.
Remind the group that the rules apply to you as much as they do to them.
Confidentiality – emphasize the importance of confidentiality for everything that will
be discussed or shared during each class.
Respect – everybody is entitled to their own opinion, even if it differs from all other
group members.
Listening – each group member is expected to allow others to speak and express
their views uninterrupted.
Mobile phones – you may like to request everyone to switch off their mobile phones,
or at least turn them to silent, during classes. You may request people at the
beginning of the course to step outside the room if they need to take or make a call.
Stupid questions – you can emphasize that there is no such thing as a “stupid
question”. Every question is an opportunity for learning.
Many teachers include an activity at the beginning of the course where the group define
the agenda for the entire course, or alternatively share a preset agenda they have already
constructed. There are pros and cons to each of these methods, but we would
recommend that you do introduce the agenda in some way at the beginning of the first
class. People like to know what they are going to cover in classes and feel more secure
when they have a sequence they know they will be following.
Asking the group to determine the agenda themselves is a great way of finding out what
they are really interested in. There is little point spending 2 hours on hospital policies
and practices if all your clients are planning homebirths, although you would obviously
want to talk about what happens in hospital briefly for those that may end up
transferring. If you choose to have the group define the agenda you can give them a
large sheet of paper and draw it up themselves over 10 minutes, without your
involvement. This can then be put up on the wall throughout the course and can be
referred back to towards the end to ensure that you have covered everything. To save
time in the first class, you can also ask them in advance to let you know the three most
important topics to them before the first class and have the agenda already prepared
when they arrive.
If you are going to ask the group to define the agenda it is imperative that you then use
this when you are teaching. It is pointless, and in fact harmful to the rapport you have
with your clients, if you completely ignore their agenda and teach what you had already
planned beforehand! For this reason, some teachers prefer to define the agenda
themselves, providing them with more control over the topics. In this case, it is still a
good idea to have the agenda written up and on display so the clients can see at the
beginning of each class what they are expecting to cover.
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Draw up a list of the top 10 topics you think are important to include in a
childbirth course. Do not write more than 10 things.
Now ask three pregnant friends to tell you the top 3 things they would like to
have included in a childbirth course and write them down.
Look at your list and compare it with your friends. How many of their top
topics had you included? Think about anything you missed. Why do you think
they thought it was important but you had not included it?
Finally, ask three men to tell you the top three things they would like
included in a childbirth course. Again, look at your list and compare it with
the men. How many of their top topics had you included? Think about
anything you missed. Why do you think they thought it was important but you
had not included it?
As we mentioned in the introduction to this unit, most of us have learnt through
traditional teaching methods. The role of the teacher and the student differ depending on
whether a traditional teaching method or an active teaching method is being used.
TRADITIONAL TEACHING ACTIVE TEACHING
Teacher Students Teacher Students
Active Passive Active & passive, Active
depending on task
Directs thinking Is directed Evaluates, researches
Teaches content
Holds knowledge Absorbs knowledge Explores ideas
Poses problems
Experiments
Watches, models &
guides
There is a place for the use of traditional teaching methods in a childbirth class – the key
for the teacher is to recognize the most appropriate teaching method for a particular
situation or topic.
Rote learning is a method of teaching that requires no prior knowledge on the part of the
student. Information is provided and examples of that information being used are given.
If a new situation is encountered, it is matched with the learned examples, and the
appropriate response is given. This method of learning relies heavily on the ability to
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effectively memorize data so that it can be recalled in exactly the same way that it was
taught. Repetition is used with the premise that the more often something is done the
easier it is to remember.
Whilst rote learning does not encourage the student to understand the meaning behind
something, or analyze a situation in more depth, it can be a useful tool in education.
Sometimes it is the only effective way to learn something. Rote learning can be
described as retention - the ability to remember material at some later time in the same
way that it was presented by the educator. You may have used this method when you
were at school to remember your times tabels, or recall the elements of the periodic table
in science. Transfer is the ability to take what was learned to solve new problems,
explore new questions, or facilitate the learning of new information, or for a student to
make sense of what they have learned. In order for a client to be able to effectively
problem solve, transfer must take place, and to do this different teaching methods are
needed. This is where we can apply active teaching skills.
Topics that can use rote learning might include explanations of parts of the body, or the
names of drugs available for pain relief. In many cases, rote learning must take place
before active teaching methods can be employed. For example, there is little point in
discussing the strategies for coping with the first stage of labor if the clients do not
understand the terminology used. However, rote learning can be incorporated as part of
the class without it being boring – explaining the terminology as you work through
activities and discussions is more effective than giving clients a list of terms and
memorizing them in one sitting.
Many childbirth educators teach using a lecturing style – the educator stands at the front
of the class and explains everything while the clients sit passively and listen or take
notes. There are several disadvantages with this method of teaching. Firstly, think about
the profile of the clients you are working with. Many of them will attend your classes
after a long day at work. They are tired and may find it difficult to focus. If they are
pregnant they may be uncomfortable sitting for several hours in one chair. Secondly, a
class that consisted entirely of lectures would be boring for most people. Even if the
topic was one that they were interested in, listening to one person speak for the entire
class rapidly becomes tiring. A lecture session does not encourage the client to explore
their own feelings or discover their own solutions to problems. And finally, lectures
prevent clients from interacting with each other. An important component of childbirth
classes for many clients is to get to know other expectant parents and build relationships
with them. A lecture does not enable this process to take place leading to clients feeling
their needs were not met.
Although there are distinct disadvantages to a lecture approach, there are also
advantages.
Lecturing provides an effective way to pass on new information in the shortest
possible time.
Lecturing, when used with other methods of teaching, provides variety in a class
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Spending some time lecturing provides clients with some “down time”, where they
do not need to participate in the same way as active teaching methods. This may be
particularly beneficial for clients who feel anxious when they have to participate in
discussions and activities.
Lecturing appeals to auditory learners who learn best when they listen rather than see
or do.
The key then is to recognize when a topic is most effectively covered using lecturing.
Examples may include:
Explaining the stages of labor
Describing how breastfeeding works
Explaining what happens during an induction
Describing the role of hormones during labor
Introducing the concept of the pain-fear-tension cycle
Lecturing is most effective when the lecture session is kept short – preferably no longer
than 15-30 minutes at a time – and is followed immediately by more interactive
activities such as role-play, question and answer sessions or open discussion. To keep
lectures to the point and gain maximum effectiveness from them, it is best to keep them
to no more than five minutes. This surprises many childbirth educators, as they feel there
is so much to cover it would be impossible to achieve in only five minutes.
Whilst parents may sit and listen for more than five minutes, especially if they are in
classes to learn as much as possible, they are not learning and absorbing as much as you
would necessarily like them to after five minutes. Consider only giving clients three
things on each topic to remember. This can seem like an impossible challenge. Think
about something that you learned recently though – how many different things do you
remember really clearly? If can determine what the three most important points are and
focus on these, you are much more likely to help your clients to remember, recall and be
able to use the information than if you provide more detail.
Schott and Priest, in their book “Leading Antenatal Classes” use the analogy of making
a phone call at the airport to demonstrate the importance of this three things rule.
“One way to sort out the essential from the fascinating but optional is to imagine
this scene. You are at an airport and your transatlantic flight is about to be called.
You are making a long-distance telephone call from the airport to a close friend
who is eight and a half months pregnant. Just as your flight is announced, your
friend says, “Tell me about breastfeeding”. You only have time for three short
sentences. Imagine she will not have any other sources of information or support.
What do you say?
You could probably talk quite eloquently about the anatomy of the breast, the
physiology, the let-down reflex, colostrum, foremilk, hindmilk and so on. But
however interesting, this information is unlikely to enable a woman to establish
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breastfeeding. To breastfeed, she must know how to position the baby, how to
recognize a good latch, and the law of demand and supply. Without these three,
breastfeeding won’t work. Of course there is more to it – whole libraries of books
have been written on breastfeeding! But what does she have to know to get
started?” – Source: “Leading Antenatal Classes”, Schott & Priest
You might find it helpful to practice this “three things” rule with several topics to see
what you determine to be the most important three items to cover on any given topic.
Complete the critical thinking activity on the following pages and see what you decide
are the most important things to cover. Consider then how you would feel about leaving
out all the rest!
Write down 10-20 things you would like to cover on the topic of the onset of
labor. Once you have finished your list, circle the three most important things
that you should cover.
Write down 10-20 things you would like to cover on the topic of postpartum
depression. Once you have finished your list, circle the three most important
things that you should cover.
How did it feel to have to let go of many of the things you wanted to say?
What are your feelings on the three things rule?
In addition to only covering three things, if they are three most important things then
they are worth repeating. Much better that the clients really take on board three things,
than they are so swamped with information that they find it difficult to retain any of the
details. Using an introduction and a conclusion is common practice in training. Introduce
what you are going to talk about (“We are going to discuss xyz”), discuss it, then, cover
key points.
With active teaching methods, the childbirth educator takes on the role of facilitator
rather than teacher. The clients are actively involved in the class using discussions, role-
play, practicing physical activities and problem solving. Many childbirth educators avoid
active teaching methods, as they require more careful planning, imagination in creating
activities and are significantly less predictable in their outcomes. A teacher who does not
feel confident in their role may feel less threatened by traditional teaching methods as
the client is less participative and there is limited opportunity for the discussion to move
into areas that have not been planned or prepared for.
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Log on to the following webpage.
Active Learning
Center for Teaching Effectiveness
In “Seven principles of Good Practice in Undergraduate Education”, the authors
explain:
“Active Learning is not merely a set of activities, but rather an attitude on the part
of both students and faculty that makes learning effective The objective of Active
Learning is to stimulate lifetime habits of thinking to stimulate students to think
about HOW as well as WHAT they are learning and to increasingly take
responsibility for their own education.”1
Psychologist Mel Silberman defines the difference between active learning and
memorization:
“Real learning is not memorization. Most of what we memorize is lost in hours.
Learning can't be swallowed whole. To retain what has been taught, students must
chew on it.”
The two diagrams below help to show the effectiveness of active teaching methods.
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Source: Active Learning Online (http://www.acu.edu/cte/activelearning/whyuseal2.htm)
Dale's Cone illustrates the effectiveness of learning according to the materials involved
in teaching. Edgar dale conducted research in the 1960’s and found that the least
effective learning method, at the top of the cone, involved learning from information that
was presented in verbal symbols, in other words, listening to the spoken word. The most
effective method, at the base of the cone, was learning through direct, purposeful
experiences such as hands on learning.
The Learning Pyramid below shows the average retention rate, or how much we
remember, for various methods of teaching. This pyramid was developed following
research by the National Training Laboratories in Bethel, Maine, USA. The top of the
pyramid shows that we only retain 5% of what we learn from lectures whereas we retain
75% of knowledge and skills we learn through practicing or doing ourselves. Teaching
others and immediately using the knowledge is the most successful method of retaining
information.
The advantages of active teaching methods far outweigh the disadvantages. Firstly,
classes are much moiré interesting and varied, for both the teacher and the client. The
use of active teaching methods results in each class you teach being a little different,
creating an environment for the teacher that is much more interesting to teach within.
Active teaching also assumes that the clients will have some prior knowledge and
enables them to share that and apply that knowledge to new situations or problems. Both
the clients and the teacher receive more frequent and immediate feedback, enabling you
to know how effective your teaching is rapidly. Active teaching and learning instills
confidence in clients and encourages them to take responsibility for their own decisions.
The clients are more likely to interact with each other, which enables them to build
relationships within the group, providing support and friendship for them long after the
classes end.
Active teaching methods appeal to most people, in particular those who have kinesthetic
learning styles, or need to “do” in order to learn. They also enable clients to more
thoroughly explore their own feelings, values and ideas, reinforcing the message that
there is no right or wrong with parenting and parents need to find the way that works for
them.
Rather than simply lecture to a group, active teaching methods can be incorporated to
make the session more interesting and more valuable for the class members. During a
lecture you can encourage your clients to ask questions to clarify points. Once the
lecture is finished, clients can be asked to write down one question or issue they still
have unanswered. You can then go around the group and clarify all of these issues. This
exercise takes a few minutes but ensures that the clients have a deeper understanding of
the topic and helps you to evaluate how effective your teaching was, enabling you to
make adjustments to what you lecture on in your next course series.
Try to use questions during your lecture to check for learning and allow client
participation. Rather than simply telling your clients the various ways that labor can
start, ask the group what ways they know of already. This is particularly important for
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reinforcing that as adult learners they can indicate their current level of knowledge. Each
class attendee brings with them a lifetime of experience – recognize that, enable your
clients to be part of the group and let them do some of the work for you! When asking
questions, allow a pause for the group to consider the question and have time to
formulate their answer. Many group members may not be expecting to be asked
questions and will need time to think about your questions. More on pausing later!
If a client asks a question it is good practice to always repeat the question to the rest of
the group. This achieves several things. Firstly, it ensures that everybody has heard the
question properly. Some people talk so quietly or mumble, while other group members
may find it difficult to hear because of background noise or they were simply not
concentrating. Secondly, it ensures that you understand the question properly, giving the
group member the opportunity to correct you if you have misunderstood what they
asked.
At the beginning of a lecture session, it is a good idea to give a brief overview of the
topic about to be covered and an explanation that this is going to be a lecture. If you
launch straight into the topic some group members may quickly become lost or wonder
where this is all leading to. You can introduce the topic by first showing a video, or
asking the group to break into small groups to brainstorm, followed by the lecture that
clarifies the topic further. It is also a good idea to summarize what you have covered at
the end before moving on to the next topic. For example:
“So, lets just finish up by covering the key points. Labor can begin by regular
contractions, the waters breaking, or a bloody discharge or show. Lets talk now
about how you determine when it is the right time to call your caregiver or go to
the hospital.”
Many teachers are uncomfortable when there is a pause, or silence. If you have already
worked through the communication module, you will have read about using a pause or
silence to enhance active listening with your clients. The same rules apply to teaching a
group as communicating with one person.
Pausing after we have asked a question, or before we answer one, is extremely valuable.
If we ask a class a question and everyone is silent afterwards, we can become concerned
that the group does not want to interact. However, it is more likely that they are simply
taking time to think about the question and formulate their answers. Clearly, if you have
quiet or shy clients in the group they may be reluctant to answer, but this will be made
significantly worse if we always jump into the silences.
Research has been carried to determine the effect on retaining information when the
teacher pauses during a lecture. The lecturer paused for two minutes on three occasions
during lectures, while students worked discussed amongst themselves what they were
learning. At the end of the lecture the students were tested to determine how much
information they had retained and were tested again almost two weeks later to determine
long-term retention. A control group was used to be able to provide a comparison where
the same information and materials were used but not pauses were used. The difference
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between the two groups was amazing – as much as two letter grades between the two
groups. In this particular research, if the lecturer talked for six minutes less, the students
learnt more.2
When you have been asked a question it is also a good idea to take a pause before
answering. This allows you time to think about the question, formulate your answer, and
provide the answer in a clear, concise way. Many teachers worry about not having all the
answers or appearing blank when faced with a question. Pausing reduces the risk of
being blank and gives you an opportunity to see if you can recall the information or state
that you do not know the answer but can certainly find it out. Alternatively, you can
throw the question back to the group and ask if anyone else knows the answer, also
giving you a chance to take a pause and think about the answer.
Brainstorming provides clients with the opportunity to get all their ideas out before a
discussion takes place. You provide clients with a large sheet of paper and a pen, assign
someone to write, and then encourage the clients to begin throwing out ideas or answers.
It is important that while the ideas are being said nothing is questioned, criticized,
discussed or explained. Simply rapidly jot down everything said. This ensures
spontaneity and creativity, and encourages group members to contribute. A brainstorm
session should last between 5-10 minutes. If you are teaching a quiet group and the
group members are not forthcoming with ideas for a brainstorm session, it is helpful for
the teacher to get up and walk away from the group at the beginning of the exercise,
busying yourself with some other task like preparing the refreshments or getting some
handouts together for later. The group is significantly more likely to be participative if
the teacher is not sitting amongst them while brainstorming.
“Posting” is a variation on brainstorming where two or more columns are labeled on the
paper. These might be pros and cons of an issue or “causes” and “consequences” of an
event. As with brainstorming, discussion of ideas is left until the end of the session.
Discussions in groups are an invaluable tool for the childbirth educator. They help your
clients to think critically about what they are learning and apply abstracts ideas. A
discussion can take place amongst the whole group, smaller groups or pairs. In order to
have an effective discussion, you need to be very clear about the purpose and the
learning outcomes you have planned for the group. If the discussion is to take place in
smaller groups or pairs, tell the group beforehand how long they will have – 5-10
minutes is a good guideline. At the end of the discussion you can ask the smaller groups
to share their main findings or issues, or summarize yourself if discussing in a large
group.
Many teachers avoid discussions since they can be very unpredictable, with the teacher
having no idea how the conversation will flow or where it will lead. If there are quiet
individuals within the group you can pose questions to them directly, preventing one or
two individuals from dominating the rest of the group. You can redirect the discussion
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away from one person dominating by saying something like “thanks for that John, how
about everyone else? What do you think Susan?”
Think of your role as being the facilitator during a discussion, rather than a group
member. You can pose questions to keep the discussion flowing but allow your clients to
direct the discussion in a way they feel comfortable with. Questions should be open ones
where there are multiple answers, rather than a specific right or wrong answer. You can
emphasize at the beginning of the discussion that there is no right or wrong, simply
different view and perspectives. Closed questions are unlikely to promote real
discussion. For example, “can someone tell me the name of the diseases your baby can
be vaccinated for” is unlikely to elicit as much discussion as asking, “what are your
feelings about vaccination?”
One of the challenging aspects of discussion is when there is opposition or disagreement
amongst the group. Rather than seeing this as problematic, it is helpful to view it as
beneficial to your clients. Through hearing different viewpoints this helps the group to
clarify their own thoughts and feelings. Equally, if the discussion moves onto something
you had not anticipated, or gone “off track”; try not to feel an urgency to bring it back to
topic. It can be a learning opportunity for you to see the issues the group is really
interested in.
Discussions provide you with an excellent opportunity to enable your clients to use
critical thinking. Rather than always answering their questions, consider answering a
question with another question. If a client asks, for example, “what are the disadvantages
of an induction?” try responding with “what do you think the potential consequences
might be?” If a group member wants to know more about a controlled crying technique
you can follow the explanation of this method with a question like “what alternative
approaches can you think of?”
Many childbirth educators avoid role-play simply because they feel inexperienced in it.
However, this is one of the most valuable active teaching tools available to you. It
provides clients with the opportunity to try out their skills prior to labor and parenting in
a safe environment.
Log on to the following webpage.
Using role play to teach undergraduate business students: challenging the
teacher, supporting the learner
Mark Sutcliffe
The previous reading raised many issues about the benefits and disadvantages of using
role-play. The key points to achieving a successful role-play are:
Set clear guidelines
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Define roles and specify the situation or scenario that will take place
Provide an opportunity for the clients taking part in the role play to debrief and
reflect on what happened afterwards
Other important components of a successful role-play include:
The role-play scenario must be relevant to the clients – something they can truly
imagine happening to them in the real world
Don’t be afraid to stop the role-play if it has achieved its purpose before the end, or
is going nowhere
A particularly effective form of role-play is to create the scenario twice to enable clients
to see how certain skills can be effective. The following is a role-play that we have used
with great success in exploring the way that clients ask questions of their caregivers to
enable them to make informed choices.
Induction and Informed Choice Role-Play
Preparation: Choose one man and one woman from the group – preferably not a couple
– to play the role of a couple expecting their first baby. You, the teacher, plays the role
of the doctor. Ask the couple to sit in chairs facing you.
Scenario: The woman is 39 weeks pregnant and is in the doctor’s office with her
partner. The couple had planned to have a normal vaginal birth without any unnecessary
intervention. The woman has just had an ultrasound scan given by the doctor and they
are sitting discussing the results. [Explain this scenario to the couple so they understand
how the role-play will proceed.]
THE ROLE PLAY:
Doctor: “I am concerned about the levels of amniotic fluid around your baby. These
levels are becoming very low and this can be dangerous for your baby. I think we should
see you again in 3 days time to check them again. If they are getting lower at that point,
we will have to look at what we can do to ensure your baby is safe. OK?”
Allow the couple to comment or ask a question or two and respond to their answers,
providing the minimum amount of information that you can. Finish with:
Doctor: “So, we’ll see you in three days time then.”
Now ask the couple how they are both feeling. The following questions are helpful to
ask them at this point.
How are you feeling now?
What concerns do you have?
What do you think you will spend the next three days doing?
Now tell them that three days have passed and they are back in the doctor’s office. The
doctor has just done another scan.
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Doctor: “OK. I have just checked again and I am afraid the levels have got worse. I will
ring down to labor ward now and let them know you are coming down for an induction.
Let me explain what will happen – we will insert a pessary to help prepare your cervix
and will monitor you during that time to make sure the baby is doing ok. In a few hours
we will put up a drip to start contractions. Your baby is doing fine at the moment – you
should be meeting him or her sometime tonight!”
Again, allow them to ask one or two questions, but keep your responses minimal and to
the point. If necessary, stress that you are very concerned about the baby and want the
best for the baby and the mother. Reassure them of the safety of induction if they ask
about any risks, stating one or two brief risks but with little detail. For example,
“sometimes inductions can cause labor to be more painful but we can address that if it
happens at the time. Don’t worry.” If the mother states that she had wanted to avoid an
induction, you can respond with something like, “I know that was what you had planned,
but sometimes labor does not go to plan. At this point we have to consider the safety of
your baby.” At the end, ask the following questions:
How are you feeling now?
What concerns do you have?
In most cases, the couple will be feeling overwhelmed and afraid. However, they are
unable to ask many questions because they simply do not know what to ask. This is an
excellent role-play for doing again, having taught them how to ask effective questions.
Explain to the couple that you are going to do the role-play again, this time giving them
a list of questions they can ask. Provide the first list before doing the first discussion,
which can include the following:
What are the risks to our baby of low amniotic levels?
What is the level for normal amniotic fluid and what is the level for our baby at the
moment?
Besides there being a problem, what other things can cause low levels?
If the level is still low in three days, what would you recommend at that time?
What other options would we have if the levels are still low?
If the levels are still low at the next scan, how long would you be comfortable
waiting before intervening?
What can we do to increase the levels between now and the next scan?
Repeat the first discussion, saying exactly the same thing, but telling the parents to
choose questions from their list and answer them appropriately. Remember that you are
playing the role of a doctor so make it realistic – caring and concerned, but not
necessarily aware of all the different alternatives available. At the end of the scenario,
when the parents have asked all their questions, tell them again that you will see them in
three days time and ask them the following:
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How are you feeling now?
What concerns do you have?
What do you think you will spend the next three days doing?
Now, provide them with a second set of questions for the second part of the scenario.
These can include:
How have the levels changed from the last scan?
What other indications are there that our baby is compromised?
If we choose to wait a few more days, how would you feel?
What ways can we monitor the well-being of the baby to see how he or she is
doing rather than going straight for an induction?
What other options do we have for the induction rather than having the drip?
Finish with saying to the doctor, “we would like to go home and discuss all of this
first. We will call you this afternoon to let you know what we would like to do
next. What time would be best for us to call?”
Again, answer their questions honestly, as a doctor might. At the end, ask the couple the
following questions:
How are you feeling now?
What concerns do you have?
In most cases, the couple will feel more in control the second time they do the scenario
than the first time. They will feel that they were able to ask questions without
confronting or challenging the doctor and will feel a sense of empowerment. They may
still choose an induction but it will not seem overwhelming or that it was a decision
taken out of their hands.
Similar role-plays can be used to help parents identify options available to them for
many different situations either during pregnancy, labor or parenting. The role play
above requires about 40 minutes to work through which is a considerable amount of time
in a typical childbirth class. However, the benefits of the group understanding the
importance of asking questions that enable them to focus on what they want and
assertively communicate with their caregiver are enormous.
Traditionally, childbirth classes have focused on acquiring knowledge – explaining the
process of labor, the options available for pain relief, hospital procedures and policies,
and the benefits of breastfeeding. While there is certainly value in acquiring knowledge
as an expectant parent, we have found that there is enormous benefit in learning skills as
well. In addition, classes should spend a considerable amount of time focusing on
feelings and attitudes, which is often overlooked. Pregnancy and childbirth is a time
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where most people have conflicting or strong feelings on many issues as they find
themselves contemplating the responsibility of bringing up a child, dealing with
financial concerns and determining their roles as parents.
Acquiring skills is usually thought of as learning how to massage, developing relaxation
techniques and leaning how to change a diaper or bath a baby. Our focus of skills
acquisition though is more about developing communication skills, building
assertiveness and strengthening confidence. These are life skills that the parents can
apply in any given situation, whether it is facing an unplanned cesarean or determining
the best course of action for the treatment of a sick baby. They extend well beyond the
infant years into how best to choose an educational system or school, managing
discipline of a child, and deciding on the appropriate age for a son or daughter to begin
dating. Helping parents to learn these skills now provides them with the opportunity to
begin practicing them and becoming expert in managing any decisions they are faced
with in the coming years.
Communication skills are probably the most fundamental of these tools. Understanding
how to ask questions effectively of caregivers is paramount to feeling empowered and
making informed choices. In our unit ED3002 – Teaching Communication Skills we will
cover this subject in more depth.
At this point, consider the classes you have observed, taught or
attended yourself, and think about how much emphasis was placed
on communication skills. Did any of these classes teach about asking
questions assertively? Did they help the clients develop an
understanding of the perspective of the caregiver? In what ways did
they draw on the parent’s current knowledge and experience and
teach them how to build their understanding of their own
communication style? List any activities you can think of that focused
on communication skills.
Consider the advantages and disadvantages of teaching
communication skills in a childbirth class.
Decide on two different activities that you could teach that would
integrate communication skills as part of the activity.
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You may feel anxious about discussing feelings in a childbirth class, particularly if men
are going to be present. Pregnancy and birth though are such emotional times in people’s
lives; you would do them a disservice if this was not discussed. Many clients, especially
men, are also anxious about discussing feelings. We have all come across people who
talk about childbirth classes being a place where we get in touch with our feelings and
do all that “hippy stuff”. Discussing feelings need not be threatening or confrontational.
Asking clients how they feel about becoming parents, what their concerns or fears are,
and what they are most worried about are all relevant and pertinent questions to ask. It is
very easy to integrate discussions about feelings with the knowledge and skill based
information that you are presenting. A few pointers about introducing feelings based
topics:
Never introduce a discussion about feelings at the end of a class. These discussions
are unpredictable and will often lead parents to identify difficult topics. The last
thing you want is for a mother to say she is terrified of her baby dying five minutes
before a class is due to finish!
Integrate the feelings discussions with other more factual topics. This helps to break
up the class, preventing it from becoming too heavy or too deep.
Use techniques such as a safe pot to enable parents to share concerns without being
put on the spot. A safe pot can be used for example when asking parents to identify
their fears. Hand around pieces of paper and ask them to write their fears, without
their name, then place these in a central pot. You can choose to select them at
random, read out the fear and then discuss it as a group. The benefit of this is that
they remain anonymous, express their fears and have the opportunity to discuss
them, and also see that they are not alone in their concerns.
Resist the temptation to direct the conversations too much. This is a wonderful
opportunity for the clients to “direct the show” – they are unlikely to share very
much if you are constantly interrupting, sharing your own anecdotes or trying to steer
them in a particular direction.
Don’t be afraid of what might come out. If clients raise difficult topics and discuss
these fully, it is a sign that you are doing a great job of helping them to feel
comfortable and safe within your class.
Always have a box of tissues handy for the feelings topics!
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Active Teaching Skills
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Active Teaching Skills
In this activity you are going to design three activities for a childbirth class that adopt
active teaching techniques. Go to the following webpage:
http://ic.educ.indiana.edu/workshop2003/pdf/active_learning_techniques.pdf
Choose three different teaching strategies on this webpage. Using the topic of
“Breastfeeding”, design three activities that use these teaching strategiesWrite out the
aim of the activity, the learning outcomes and the process, or how the activity will take
place.
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Active Teaching Skills
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Active Teaching Skills
1. Hatfield, S.R., Brown, D.G., and Ellison, C.W., 1997, ‘Seven principles of Good
Practice in Undergraduate Education’, AAHE Bulletin, p. 40.
2. Ruhl, K.L., Hughes, C.A., and Scholss, P.J., 1987, ‘Using the pause procedure to
enhance lecture recall’, Teacher Education and Special Education, vol. 10, pp.
14-18.
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Teaching Adults
Childbirth International Page 96
Teaching Adults
Teaching Adults
Much of our experience of teaching will have come from being taught ourselves. During
this unit we will consider the differences in the needs of men and women in antenatal
classes and techniques to help groups work together effectively. You will be considering
your role as a facilitator of learning. Finally we will identify clients that can prove to be
problematic in an childbirth education course - the shy client, the talkative or
argumentative one, the class joker, and the medical client whose presence may lead the
teacher to feel a lack of confidence.
Topics covered will include:
Working with adult groups
Differences between men & women
Addressing men's needs
Teaching techniques for working with men
Difficult teaching situations
At the end of this unit you will be able to:
List common problems when working with adult groups
Identify strategies for making groups work effectively together
List differences between the needs of men & women in childbirth classes
Identify teaching situations that could be problematic
List strategies for working with clients who may be problematic
Rogers, J., 2001, Adults Learning, Open University Press, Buckingham.
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Teaching Adults
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Teaching Adults
When working with adults as a teacher, or facilitator, it is worth recognizing the unique
characteristics of this group. Providing an environment that is conducive to adult
education means that not only will this particular class gain the maximum from what you
are teaching, but they are significantly more likely to recommend your classes to others.
Those who have had experience in the field of childbirth education will know that word
of mouth and a good reputation as a childbirth educator are important factors in building
your classes and the number of clients you are serving.
Log on to the following webpage. Registration is free and once registered
you simply click on the “Begin the Temperament Sorter” button to proceed.
30 things we know for sure about adult learning
Ron and Susan Zemke
There are many differences between teaching adults and teaching children. The teaching
of children is referred to as “pedagogy”. The word is derived from the Greek words paid
meaning “child”, and agogus meaning “leader of”. Pedagogy refers to the art and science
of teaching children and may be used as a synonym for teaching. In a pedagogic model
the teacher assumes the responsibility for making decisions regarding what is learned,
how it is learned, and when it will be learned. Teachers direct the learning. Androgogy
on the other hand is the art and science of helping adults to learn. Five basic issues must
be addressed using this model:
1. Learners must know why something is important to learn
2. The learners are shown how to direct themselves through information
3. The learners are shown how to relate the topic to their own experiences
4. It is assumed that people will not learn until they are ready and motivated to learn
5. The teacher may need to help the learner overcome inhibitions, behaviors, and
beliefs about learning.
In order to effectively teach adults there are several key points that should be kept in
mind by the teacher.
Adult students may offer greater diversity
Your clients will have a vast array of life experiences, previous education and
current life circumstances. They may also come from a rich diversity of cultural
backgrounds, ages, beliefs and value systems.
The environment will affect willingness to take risks
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Adult learners are more prepared to take risks with exploring difficult topics
when they feel safe within their environment. The environment needs to be one
where they will not feel judged and where it is ok to make mistakes without
being embarrassed.
Your clients will respond best when you are enthusiastic and confident
Before teaching a subject, you must first feel comfortable about it. If you are
embarrassed by discussing the topic your clients will not respond well. Equally,
your level of confidence in the subject matter must be high. Whilst your clients
will expect you to be knowledgable on the topic, they will not expect you to have
all the answers. It is better to say you are unsure of the answer and that you will
find out, rather than fumbling through a question and appearing unsure.
Your clients are refining their knowledge rather than forming it
Unlike learning in childhood, which is formative, adult learning is
transformative. Children build new neurological pathways in the brain as they
learn whereas adults improve those pathways and develop them. Your clients are
building on their knowledge and may be transformed by what you teach them.
Problem solving is a particularly effective learning strategy for adult
learners
Problem solving requires mature thought processes before it can take place. In
adults, this form of learning stimulates and motivates them.
Adults need to practice new skills and apply them to real life situations
Your clients will learn best when they are given ample opportunities to practice
the skills and application of knowledge you are teaching them. They also will be
more motivated to continue that learning if the practice comes int eh form of real
life situations that they can relate to.
Think about your own learning experiences. See if you can answer the following
questions to determine learning strategies that have worked for you in the past and
those that have not been as effective.
Compare how you learned as a child to how you learn now. What is
different?
If you have ever done any previous adult education, what was your
favorite and your least favorite?
What subject did you know nothing about 5 years ago but know feel
very knowledgable?
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Author Dorothy Billington conducted a four year study that looked at the environments
necessary to enable adults to learn most effectively. The following reading looks at the
findings of this study.
Log on to the following webpage. Registration is free and once registered
you simply click on the “Begin the Temperament Sorter” button to proceed.
Seven characteristics of highly effective adult learning programs
Dorothy Billington
Males and females have learning strengths in different areas. Clearly there are
generalizations and not all people will follow the patterns of their own gender. However,
it is helpful to understand the different ways that our brains work to see the impact this
would then have on our teaching.
Abstract versus concrete thinking: Males tend to be better at being able to determine
something without being able to see or touch it as they are more skilled in an abstract
world. They tend to prefer moral debates about principles. Females however are more
concrete in their thinking.
Language: Women use more words on average than men. There are countless jokes
about this difference in our communication styles. The words they choose also differs
with men preferring jargon and technical language. In their book “Why Men Don’t
Listen and Women Can’t read Maps”, authors Allan and Barbara Pease emphasize this
difference.
A woman can effortlessly speak an average of 6,000-8,000 words a day. She uses
an additional 2,000-3,000 vocal sounds to communicate, as well as 8,000-10,000
gestures, facial expressions, head movements and other body language signals.
This gives her a daily average of more than 20,000 communication ‘words’ to
relate her message.
Contrast a woman’s daily ‘chatter’ to that of a man. He utters just 2,000-4,000
words and 1,000-2,000 vocal sounds and makes a mere 2,000-3,000 body language
signals. His daily average adds up to around 7,000 communication ‘words’ – just
over a third the output of a woman.
When women learn they tend to use language to express that learning throughout the
process, whereas mean are more likely to learn silently. Don’t take the men’s silence in
your classes for boredom – they may just be doing a lot of learning!
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Listening: One of the fundamental differences between men and women is the different
ways that we communicate. Because of the different ways our brains are wired, women
tend to be able to take in varying sensory input more effectively than men. Women tend
to hear more of what is said in a conversation and are more receptive to the details. This
helps them to follow a conversation more effectively and they have less need to control
the discussion with rules. For this reason, women in your classes will tend to hear things
better than the men. This can be an issue if you are very softly spoken. Sitting the group
in a circle rather than in rows helps as the men are always then sitting at the front of the
group. Increasing the volume of your voice is also beneficial.
Use of Space: Men tend to need more space than women when learning. Not only will
they spread themselves out more, but they have a tendency to move around during the
learning process. Men have lower serotonin levels and higher metabolism than women
and the movement helps to reduce them fidgeting as well as stimulate their brains. Think
about this when preparing class activities and topics. If all of your class time requires the
group to be sitting in one place the men are going to quickly become uncomfortable and
will begin to shut down. If doing group work, have some space set aside for men when
they are working in men-only groups to spread themselves out.
Group Work: When working in single sex groups, men will tend to quickly identify a
group leader and focus immediately on achieving the goals of the group. Women,
meanwhile, will form less structured groups and may focus on general discussion
without ever reaching conclusions.
Vision: Our differences even extend to how we see. Men tend to see better in a well lit
bright room, while women see better in dimmed lighting. Think about how this affects
your clients in the environment you will be teaching in – perhaps having dimmed
lighting with bright lights placed around the room men can sit near when they are doing
group work.
Memory: The short and long-term memory of men and women differs as well. Women
can store seemingly random information more effectively for short periods of time.
However, if the information is placed into a logical sequence, or several pieces of
information are related to each other in a logical way, men are able to store it better for
long periods of time. This is significant in teaching childbirth classes as it may be that
the men in your group are the ones that will remember what you teach them when it is
needed for labor or parenting while the women are unable to.
All too often in childbirth classes the specific needs of the men within the group are
ignored. Childbirth educators are usually women and therefore may find it easier to
address the needs of women than those of men. Unfortunately, some childbirth educators
see the men’s needs as superfluous since childbirth is “women’s work” and may
discount or ignore men’s concerns, fears and problems.
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If you are teaching mixed gender classes, the woman’s partner is as much your client as
she herself is. His expectations, fears and needs are legitimate and important. A fearful
father is not as much help to the mother and their baby. In addition, he is also facing a
life-changing event and may have very real concerns about finances, responsibilities and
future parenting roles, as well as concern over the health and safety of his partner and
child.
When men are asked why they attend childbirth classes, their responses are varied. Some
come because they want to learn more and participate to a greater degree in the
pregnancy and birth. Others attend only because the mother has insisted upon it and may
be apprehensive or ambivalent towards the content and nature of the classes. Many are
anxious that they will be expected to be “touchy-feely” in childbirth classes and have an
image in their mind of various yoga poses and deep breathing. As the teacher your role
is important in helping men to gain as much as they want to and are able to from your
classes, while also ensuring they feel comfortable within that environment.
The first step to addressing the needs of men in your classes is to identify your own
feelings about men and their role during pregnancy, childbirth and parenting. There are
many pros and cons related to including men in a childbirth class.
Write a list of the advantages of having men involved in childbirth classes.
Now write a list of the disadvantages of having men involved in childbirth
classes.
Consider whether or not for you, the advantages outweigh the
disadvantages.
One of the challenges when working with mixed gender groups is being able to really
hear what the men’s concerns actually are. They tend to censor what they say in front of
their partners in order not to worry the women or because they want the women to feel
that they are protected and supported by their men. As the teacher though, it is important
that you understand and really hear their concerns. There are several different ways of
tackling this.
Take opportunities to divide the larger group up into single sex groups of men and
women. The groups can have the same task or a different one. You can take the
opportunity to cover topics with the women that they would be uncomfortable doing in
front of the men, while the men can go off to have a discussion about a subject that they
would not want to address in front of their partners.
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In many cultures today, men are now expected to be present at the birth of their child. In
Western culture this is a relatively new phenomenon with men only being welcomed
into the delivery room in the last 30-40 years. This can be a real challenge for men as
they are expected to remember everything that was covered in their childbirth classes,
focus on their partner’s needs, watch the woman they love in pain, make decisions and
possibly see their partner or their child in danger. Even if their birth is normal and
uncomplicated, these things all concern them before the birth as they worry about how
they will deal with this. If asked to discuss these concerns in front of the women, they
are unlikely to be completely open and honest about it. Alternatively, you can split the
group into two groups of men and women, asking the men to talk about how they feel
about being present at the birth while the women discuss what they are looking for from
their partners. It is important to reinforce to the men that when they share their
discussion afterwards with the women, comments that were made are to be anonymous.
Rather, they are to share the groups findings as a whole. Acknowledging that some men
may not actually want to be present at the birth of their child can be a relief for many
men. This can be an excellent opportunity to identify other sources of support for the
women such as family members, friends or the presence of a doula. When the women
share their findings the men often see that all the women want is their presence and little
else. Providing a hand to hold is something that most of them can do comfortably and
removes any sense of performance anxiety.
Another alternative to single sex groups is to hold a men only class as part of your
course curriculum. This provides men with the opportunity to get to know each other
better as well as discuss issues that relate to them and their concerns.
Think about your language when teaching to a mixed male and female group. We
covered this topic in the Communications module but it worth reiterating again.
Consider how a male client would feel if a teacher made the following statement:
“When your uterus contracts, the baby moves down towards your vagina. As the
bay is being born you will feel a burning sensation as the baby’s head stretches
your perineum.”
Many men would feel excluded in this type of discussion. Obviously the man is not
going to feel the sensations the woman is experiencing during labor. However, you can
still work at not excluding him directly as the following example shows:
“When the mother’s uterus contracts, the baby moves down towards her vagina. As
the bay is being born she may feel a burning sensation as the baby’s head stretches
her perineum.”
You might want to think about the language that you use to refer to the men within the
groups you are teaching. Do you tend to use husband, partner or father? Which term are
you more comfortable with? Depending on your own comfort levels and the mix of
clients that you are working with, there may be one phrase that is more appropriate than
another. For example, if many of the couples you worked with were unmarried, partners
may be more appropriate. On the other hand, if your clients were predominantly from a
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similar strongly religious background, they may feel more comfortable with the term
husbands. Some teachers prefer to use other phrases that are less formal and structured.
Think about the list below and consider how you feel about each term.
Look at the following list and write down some of your feelings for each term.
Men
Guys
Boys
Daddies
Males
Now lets think about situations where the partner of a woman in classes is not the father
of the baby or her husband/boyfriend/partner. There may be times when you are teaching
women who are single mothers, whose partners are unable or prefer not to attend classes,
or whose partner is another woman. Consider how it might feel for the supporters of
those women if the language you use includes only men and excludes them. The
following paragraph for example would exclude women acting as the primary supporter
of the laboring mother:
“So, we are going to practice some massage that you men can use for your wives
during labor. Guys can really help here as they tend to be stronger and can use
more strength in back massage than women can.”
The whole area of appropriate language for mixed gender groups is a minefield!
It is not enough to simply invite men to a group and expect them simply to fit into a
curriculum designed for women. If men are welcome in your classes, consider
emphasizing that from the very first contact all the way through to the last time you will
see them. You may send a welcome and introduction letter to your clients before classes
begin. This can be a good way to set their expectations for the first class, provide
directions or a map on where to find the classes and let them know if there is anything
they have to bring. Do you address it to the women only, or to both her and her partner?
Some childbirth educators provide a father’s or partner’s only session at some point
during a course. This can provide the men with an opportunity to discuss issues that
specifically relate to them.
When you are writing your teaching plan, consider every single topic from the
perspective of the men in your groups. Is there anything you can add or any activities
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you can use that would help the men to have a deeper understanding or sense of
involvement? Remember when you are describing events such as how labor progresses
to not only describe what is happening from the mother’s and caregiver’s perspectives.
What can the man see, feel or hear? Think about the topics you could include that are
more significant to partners than they are to the mother’s. For example, you could
discuss how it feels to be left outside in the corridor when a woman is wheeled into
theatre for a cesarean, how it feels to watch someone you love in pain, trying to meet
work commitments as well as be there for his partner, or how to manage to get up each
day to go to work when you have had no sleep the previous night.
It can be helpful when watching birth videos to consider how the man in the video is
feeling – often the group will identify that the men in birth videos appear lost and see to
be feeling helpless and vulnerable. This can be a great opportunity for exploring the
things men can do to avoid these feelings or at least minimize them and practical things
they can do to help themselves and their partners.
Many men find that the role models they have for fatherhood are few and far between.
You can help this in childbirth classes by providing positive, loving images of men with
their partners and their children. Critically review all of your teaching materials and see
whether or not the images they contain of men are positive ones. How many photos,
diagrams or videos do you show that display fathers as being active participants in their
baby’s care?
One helpful thing you can do is invite a couple who have recently had a baby to join in
your classes for half an hour or so. You can split the group into men and women and
provide each group the opportunity to talk to the new parents and discover what the
reality of parenting is like – both good and bad.
In this section we are going to look at some of the more common situations that
childbirth educators find especially challenging. Each class you teach will be a little
different as the individuals attending will be different. They will come with their own
knowledge base, previous experiences and personality traits. You can run a course where
the whole groups gels beautifully together, they are relaxed and everybody has a lot of
fun. Then you can run the next course and it can be flat and uninspiring. That can simply
be a factor of differing group dynamics and will happen from time to time. However,
there are some personality “types” that can be particularly challenging to teach with.
In most groups there is usually one quiet person. This may be because they are naturally
shy, or they may feel ill at ease in a group setting. It is not unusual for people to be
quieter when they feel intimidated or are concerned about asking a “stupid” question.
One way to resolve this is to encourage questions from the group throughout a course.
Asking the group to set class rules at the beginning of the first session enables you, as
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the teacher, to set a few rules as well. In Unit ED2002, Active Teaching Skills, we talked
about setting class rules and mentioned that one of these can specifically state there is no
such thing as a stupid question. Remind the group that all questions are valid, no matter
how basic they seem, and that with questions the group as a whole will gain more from
their classes.
Remember that just because someone is quieter than the rest of the group does not mean
that they are not benefiting from the sessions. They may simply be more comfortable
taking a back seat and letting others lead. Breaking into smaller groups sometimes helps
them to feel more comfortable and may encourage more participation from these group
members. If you sit opposite the quietest person in a group this will also encourage them
to speak up more.
A situation can arise where one group member is overbearing in some way – either they
have very strongly held fixed views, tend to dominate the class with questions and
comments, or interrupt others when they are talking. If this causes others to then be less
participative you will need to resolve the problems. We will cover the issue of dominant
group members in the next section.
One of the most difficult teaching situations is when you have a whole class that are
quiet and reserved. The classes never really seem to take off and the teacher often feels
flat afterwards. One of the first courses I ever taught was like this and it was a terrible
knock to my confidence as a teacher. In the fourth class I tried a completely different
strategy to bring the group out more. As soon as they arrived, I asked the men in the
group to stand up and gave them directions to head off to the closest bar (the class was
being held in the evening). I instructed them to go to the bar and spend one and a half
hours discussing their role at the upcoming birth of their baby and talk about how they
felt being there. They were obviously surprised but did as requested and all left together.
The women meanwhile spent that time covering the pelvic floor, some relaxation
exercises and talked about the role they wanted their partners to have. Without the men
around the women became very talkative and interacted well. The men returned at the
specified time and walked in laughing and chatting. Having the time apart to get to know
each other as a single gender group removed many of their initial reservations and really
helped this group to get on with each other. From that point on the classes were much
easier to teach and more enjoyable for all.
Obviously this technique is not going to work for everyone, nor will it solve every
problem. Other ways of tackling quiet groups is to encourage the group to set up a
meeting together where they can chat over coffee, for example, outside of class time.
Alternatively, you could host a coffee morning for the women where they can come and
get to know each other better. Another solution is to have a separate single class for the
women and the men – again, with single gender groups they tend to get to know each
other much more quickly.
The class member who constantly sees the funny side and drops quick one-liners can be
a gift to a childbirth educator. They are able to lighten the mood when the topics are
serious and create a relaxed atmosphere. If you have a class member though who is
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constantly joking about serious issues it may be a sign that they have some level of
discomfort. You can tackle this by laughing at their comment and then turning to them
and asking how they think they might really feel in these circumstances.
If the jokes are at the expense of other group members these need to be dealt with
swiftly. It is most effective to talk to the person directly and individually. The aim is not
to belittle the joker and embarrass them, but to put an end to the comments. Ask them
what they are hoping to get from the classes and explain to them the potential
consequences of their comments. It is your job as the teacher to ensure that everybody in
the group is respected – even if that means confronting one person and dealing with a
difficult issue. As the teacher you have the right to ask the joker to refrain from the
comments that are upsetting any one group member.
This person is common in childbirth classes. In our experience it is usually women who
tend to tell horror stories – “oh, my friend had that happen to her – she had an infection
and then her baby caught it and nearly died. It was awful!”
If horror stories come out, you can address them immediately by asking how the rest of
the group feel when they hear stories like that. It can be a good idea to ask why they
think people need to share stories about their births and other peoples and why the bad
ones are so readily shared. If they are pregnant you can pretty much guarantee that they
are hearing these stories from all around them – even if it is only in the check out queue
at the supermarket!
If one class member is constantly telling horror stories it is likely that they have some
fear about a specific issue that they need to deal with. Make time for them individually
and provide them with the opportunity to share all their fears – either directly or in the
form of stories – then help them reflect on their fears and concerns. If you try to ignore
the problem it is more likely to get worse rather than disappear.
Opposite to the mouse, the chatterbox is the class member who has to comment on
everything, contributes confidently and loudly, and tends to dominate all conversations.
One of the most important rules with the chatterbox – NEVER SIT OPPOSITE THEM!
If the teacher sits in a position where a very talkative group member can maintain eye
contact with them, they will be encouraged to continue talking at every opportunity. If
you sit yourself beside them they are much more likely to be quiet. Another technique
for dealing with class members who talk excessively is to give them a job to do – note
taker for example. If you were doing a brainstorm activity you can explain that they have
to write down everyone’s ideas and nobody is to interrupt or discuss them until the
whole list is completed.
A variation on the chatterbox is the class member who whispers and chats to people
around them, without actually contributing to the discussion. This is not only distracting
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to you, but also to other group members. And frankly, it is simply rude. If you try and
ignore the problem it is unlikely to improve. And in doing so you validate their
behaviour, giving them the impression that it does not bother you. The best way to tackle
this is to take it on directly. If you are the one talking, stop in the middle of a sentence
and glance at the person whispering, waiting until they stop before you continue. If
another group member is talking while someone else whispers, gently interrupt them
speaker by raising one hand, “One moment Harriet”, and again, glance at the whisperer
until they have stopped. They will very quickly look up at you as they feel all the group
looking in their direction. Once they are quiet, smile and thank them, then turn back to
the original speaker and ask them to go on.
This is another variation on the chatterbox. The interrupter appears to have so much to
say that they have no problem with preventing others from speaking in order to share
their views. This is a relatively simple problem to resolve as the following example
shows:
Mary: “I am worried about how I will know when it is the right time to go to
hospital. The last thing I want…”
Alison: “Oh, I feel like that as well. What happens if the baby comes so quickly
we don’t get there?”
Teacher: “Just a minute Alison. Lets wait for Mary to finish and then we will come
back to you. Mary? Would you like to go on?”
Without doubt, one of the most frustrating class members is the one who is perpetually
late. You, as the teacher, are torn between waiting for them to arrive to ensure they don’t
miss anything and to reduce disruption to the group, and starting the class without them
so everyone else is not kept waiting.
When they arrive it will inevitably cause disruption. However, the alternative, waiting
for them to get there, is irritating for all the other class members who made the effort to
arrive on time. One of the concerns is that the latecomers will ask questions about things
that you covered when they were not there and this will cause you to repeat it. A simple
strategy for dealing with this problem is to explain that you covered that topic earlier in
the session and would love to explain it to them during the coffee break or at the end if
they can stay behind for a few minutes.
If a client is constantly late you could take them to one side and ask them about it.
Explain that it is difficult for you to know if they are coming or not but you do not want
to keep the rest of the group waiting. Ask if they have other commitments that prevent
them from arriving on time – it may be that their babysitter is unable to come any earlier,
or they work a shift that prevents them making it on time. If they say they just find it
tough to get to things on time, gently explain that you are ok with that but hope they
could understand that you would be unable to cover the material that they missed until
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the classes are finished each time. You could also request that they are as quiet as
possible when they come in to limit disruption.
This is not a problem as such but a class member that many childbirth educators worry
about, especially when they are just starting out. The medico is a nurse, midwife, doctor
or other health professional. Many childbirth educators worry that they will look foolish
in front of a person with such vast medical knowledge, will be unable to answer
questions, or will have their credibility questioned by these class members.
It is very rare that they actually cause a problem at all. Remember that they are there as
expectant parents, not to assess your performance. As such, they have the same fears,
concerns and issues as every other class member. Nurses, even though they may have
excellent nursing skills, may have little knowledge about childbirth and the female
reproductive system unless they have specifically worked in the labor ward. Even when
the class member does have a high level of knowledge, they have not come to classes to
share that. They are there for the same reasons as everyone else – to meet other parents
and build their support network, to answer their own very specific questions, to
understand their feelings and discuss expectations etc etc.
It is important when teaching medical professionals that you do not constantly turn to
them to validate anything you are saying. Many health professionals do not want the rest
of the group to know what they do for a job since it is then common for other group
members to begin directing their questions to them. Think about the ice breaker
exercises you choose for the beginning of the course and whether or not you provide an
opportunity for people to keep their occupations to themselves if they choose to. If the
client tells you they are a health professional before the classes start, you could ask them
whether they want the rest of the group to know or not.
Do not confuse the behavior of the person with the person themselves. We all have
times when we behave unreasonably or inappropriately but this does not mean that
this behavior defines who we really are. If you remember it is the behavior that you
are tacking, rather than judging the whole person, it is easier to address.
Look for the underlying cause of the behavior. In most cases it is anxiety or fear. If
you can address this the problem will often resolve itself.
Never tolerate behavior that you feel is wrong. If it irritates you, it is more than
likely irritating the whole group and they may be looking to you to take control.
Sometimes, whatever you try does not work. This is more likely to be related to the
tenacity of the person causing the problem, rather than your own effectiveness.
Use small group work to stop behavior that is a problem and to give you a chance to
take a breather and think of strategies you can try for the rest of the class to tackle it.
If working in small groups, make sure the groups vary so the same disruptive person
does not always end up with the same group of people!
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Don’t panic! As you become more experienced you will develop your own strategies
for dealing with these issues and they will be less of a concern to you.
Read the following webpage, linked from our website
Dealing with difficult students
Queens University
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Teaching Adults
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Teaching Adults
During this unit summary you will work on your teaching plan.
Choose from one of the following topics that you intend to cover in your childbirth
classes.
Prenatal testing and screening
Health and diet in pregnancy
Communicating with caregivers
The emotions during labor
Postpartum depression
Breastfeeding problems
Now answer the following questions.
1. List the three key points you want to communicate to the women in the group.
2. List the three key points you want to communicate to the men in the group
3. Identify the type of session you would like to conduct this session in, e.g. a lecture,
large group discussion, small group discussion, exercise or activity.
4. Identify specific language issues you need to be aware of in relation to the men in the
group.
5. List the learning outcomes you would like the group members to have at the end of
this session.
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Using Visual Aids Effectively
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Using Visual Aids Effectively
Using Visual Aids Effectively
Visual aids can be used in childbirth classes to help clients grasp a concept visually that
otherwise would be very difficult to understand. However, they can also be fraught with
difficulties. Videos can frighten clients if they are inappropriate or too graphic and charts
or pictures may not be clear enough to understand. Using a pelvis or doll inappropriately
can affect the messages you are sending to your clients. During this unit we will explore
the benefits and disadvantages of visual aids and consider ways that you can use them
for maximum impact and effectiveness. We will also consider how you can use real
people, for example parents of a young baby or other health professionals, to add an
extra dimension to your classes and help create a more realistic picture for clients.
Finally we will explore ways that you can use visual aids cheaply without necessarily
having to purchase a large number of expensive items.
Topics covered will include:
Benefits & disadvantages of visual aids
Using videos & audio recordings
Charts & pictures
Using the pelvis & dolls
Real people, real situations
Homemade visual aids
At the end of this unit you will be able to:
Identify situations where visual aids are appropriate and effective
Explain the birth of a baby using a pelvis and doll
Select appropriate videos for demonstrating different types of births
Recognize concerns clients may have when watching videos
Describe how to manage a class with visitors or guests
There is no suggested reading for this unit.
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Using Visual Aids Effectively
Visual aids are frequently used in childbirth classes to enhance the content of the class
and provide ways of learning that can appeal to various learning styles. However, too
often they are included simply because teachers think they should, without determining
the purpose of the visual aid and whether it is actually meeting the learning outcomes.
Throughout this unit we will explore the different types of visual aids available to you
and how to utilize them most effectively in your classes. Because most childbirth
educators are on a tight budget, we will also consider all the different things you can use
at low cost.
A study carried out by the University of California Los Angeles (UCLA) found that,
during presentations, more than 90% of an audience’s understanding comes from visual
and audio messages. The Wharton Research Centre at the University of Pennsylvania
studied effectiveness of communication in 1981 and found that audiences hearing only
verbal presentations retained only 10% of the information. By comparison, a
combination of verbal and visual messages meant retention was 50% - an increase in
effectiveness of 400%! Clearly there is a strong argument for the appropriate use of
visual aids.
Visual aids include all of the following:
Videos
Charts
Audio recordings
Slides and overheads
Powerpoint and other computer generated presentations
Flip charts
Photographs
Diagrams, charts and graphs
Models such as pelvis and doll
Live models such as parents and babies
Posters
By far the most effective visual aid though is yourself. You can use your own body to
demonstrate many skills and tools. Modeling upright positions, good posture and
demonstrating behavior that is assertive is all a part of using effective visual aids.
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Benefits of visual aids Disadvantages of visual aids
Can enhance the message you are sending Teachers can hide behind them
Appeal to different learning styles Must be looked after and kept in good
condition
Can break up the monotony of a lecture Can distract from what the teacher is saying
Can use everyday items to reduce cost Can be expensive
Can provide a better insight into a subject Can be shocking or make clients feel
uncomfortable
Can help parents to relate to a topic if May not be effective for large groups due to
culturally relevant lack of visibility
Can provide an opportunity for clients to Written aids such as flip charts must be
experience something themselves and neatly written to be read properly
practice before they have their baby,
increasing confidence
Can get clients involved more in getting Can alienate clients if the aids are not
them to scribe for the whole group during culturally relevant
brainstorming for example
May rely on the availability and operation of
equipment such as video players and
overhead projectors
Can make the teacher seem disorganized if
not prepared in advance
If writing, as in flip charts or whiteboards, the
teacher may have their back turned to the
audience
Videos and audio recordings are a powerful tool in childbirth classes. Enabling parents
to see a woman giving birth or a baby being breastfed, or hear the noises typical of a
woman in labor or a crying baby, all help to enhance their understanding and raise issues
that might not otherwise be discussed. It is important though to consider the downside of
videos and audio recordings.
Some clients will be shocked and uncomfortable with videos of women giving birth.
Remember that if you have watched many birth videos you are somewhat jaded and less
likely to find scenes shocking or confrontational. A mother or father who has never
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before seen these images may be horrified by a woman in strong labor. Women may feel
frightened and overwhelmed by seeing another woman laboring, wondering how they
are ever going to manage that. Scenes of crowning may scare them as they wonder how
the baby is ever coming out of such a small space. Men may find the video shocking as
they wonder how they will cope with seeing their own partner so exposed and vulnerable
or in pain. When reviewing whether a video is appropriate to show in classes, think
about how it might look to someone who has never before seen a woman birthing.
Make sure that the video is culturally relevant. If the women you are working with are
all going to be having their babies in active management hospitals, there is little benefit
in showing them home waterbirths in Russia for example. If you are going to be teaching
teen parents, it is better to have videos that show teen mothers giving birth so they are
able to relate to what they are seeing.
Also consider the culture of the audience who will be viewing the video. In some
cultures, the nudity shown in some birth videos may be seen as offensive and
inappropriate. Even when teaching within a culture where nudity is acceptable, full
crowning shots may be too much for first time parents to watch.
Think about how the use of interventions are shown in the videos you choose. Are you
trying to show them how interventions can be used appropriately or inappropriately, or
are you to trying to get across a message of birth usually being a natural process? When
selecting a video for classes think about the messages it is sending and whether it is
reinforcing the topic you are teaching. It is important that the video has a purpose. All
too often, childbirth educators show videos of birth for the sake of it, thinking that it is
one of the things they have to include. Your clients will not be worse off if they do not
see a video. Make sure you are clear on the purpose of the video. Is it reinforcing
something you have already been discussing? Are you going to use it to launch a
discussion on a specific topic? Make sure the video is relevant and not just included for
the sake of it.
We find it helpful to have clients watch a video with a purpose. For example, divide the
group up before the video starts, assigning the role of mother, father, caregiver and baby
evenly amongst the group. Ask them to vide the video from the perspective of the person
you have assigned to them. At the end of the video, ask them how they felt being that
person. This launches an excellent and worthwhile discussion on different perspectives
and needs.
It is not essential to show a whole video. You might like to just view one part of it to
reinforce a particular message. Alternatively, you can use two or more births for clients
to compare and contrast different types of births or different decision making strategies
that woman might use.
In preparing a video, ensure that it is set up in advance of the class at the appropriate
starting place. Check that the equipment you are planning to use is all working and
requires no setting up during the class. Have the volume set correctly and check in
advance where everyone needs to sit to ensure they can view it clearly. Remind people
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before you start the video that they may leave and go to another part of the room at any
time if they are uncomfortable.
Many birth videos are available to purchase. The difficulty can be in selecting the most
appropriate one for the lowest cost. Check out e-bay for videos that are being sold
second-hand. This can save an enormous amount of money. Ask other students and
doulas or childbirth educators on email discussion lists what videos they like and why.
Some good videos include:
Birth
A video showing eight women giving birth in a variety of settings, including a hospital
waterbirth, a homebirth and a twin cesarean birth. This video was produced by the birth
photographer Nancy Durrell McKenna and shows many normal births without routine
interventions. You can purchase it through the Birth Intgernational website at:
http://www.acegraphics.com.au/product/video/vt048.html
Birth Day
A beautiful short video of home birth. This video is available in English, Spanish and
English with German subtitles. You can view the first 30 seconds of the video online at:
http://www.homebirthvideos.com/birthday.asp
Born in Water
A video produced by the Andaluz Waterbirth Center, showing seven waterbirths
attended by a midwife in Guatemala and Oregon. You can purchase the video through
their website at: http://www.waterbirth.net/pages/Video.html
In a Simple way, A Child is Born
This video is inspirational in showing the normality of birth. A short video of only eight
minutes, the cost may be an issue for some. You can purchase the video through the
Birth International website at:
http://www.acegraphics.com.au/product/video/vt115n.html
Inner Strength
A video showing three women giving birth in their own unique way, all naturally with
the support of family and a midwife. You can purchase the video at the Birth
International website at: http://www.birthinternational.com/product/video/vt114.html
Sophie’s Birth
A home birth after two previous hospital births, this video can be purchased from the
ICAN wewbsite at: http://www.ican-online.org/shop/video_sophie.htm
The Art of Birth
An Australian video showing two waterbirths in a birthing center and two at home. You
can purchase the video through the Birth International website at:
http://www.acegraphics.com.au/product/video/vt102.html
The Birth of Neko Pilara
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A 43 minute video from New Zealand of a natural birth, showing good pictures of
techniques for managing labor such as breathing and various positions. A brief clip from
the video can be seen on the website. You can purchase the video online at:
http://www.goldenbayindex.co.nz/birth/
With Both Feet on the Ground
An active birth in a home setting in the Netherlands, this video shows the long labor and
birth, supported by a midwife. You can purchase the video from the Birth International
website at: http://www.acegraphics.com.au/product/video/vt006.html
Rather than having video footage of the birth you can also choose videos that have a
montage of photographs showing women giving birth in different ways. The video we
would recommend is:
In Union
A beautiful compilation of photographs put together by Australian midwife Vicki Chan.
This video makes an excellent tool to use at the beginning of classes when clients are
first arriving or to use during a coffee break. It can be purchased through Capers
Bookstore at:
http://www.capersbookstore.com.au/scripts/shop_item.asp?by=med&item=1164
There are hundreds of birth videos available for purchase. Getting feedback from others
who have purchased them can help you in deciding the most appropriate one for your
classes.
Audio recordings can be as powerful as videos in getting a message across. They are
particularly useful in hearing the normal sounds a woman may make during labor and
birth, as well as the sounds of a newborn when crying. There is no need to specially
purchase an audio recording – simply record sounds (with the mother’s permission) at a
birth that you attend as a supporter, or ask a friend who is a doula to do this for you.
Alternatively, play a video with the picture turned off to give your clients a feel for the
noises that can be perfectly normal for a woman to make while she is laboring. The same
can be done for a parenting class and recording a baby’s cry. This recording can then be
used in conjunction with an activity where the clients identify ways to calm a crying
baby and generates a discussion about how difficult it is to ignore the noise a newborn
baby makes and why that is.
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Consider the purpose of your video or audio recording. What is your objective in using it?
Does it address your learning outcomes?
What message does the video send to clients?
Is it culturally sensitive?
Are the people on the video relevant to the clients you are teaching?
Do you need to stop the video at different points to provide explanations or to open a
discussion?
Make sure the recording is set up in the right place before you start the class.
Can everyone in the room see and hear it clearly?
Charts can be useful in demonstrating the progress through labor. Used in conjunction
with a discussion on stages of labor, they help to provide a visual cue to what you are
describing. Charts showing the different stages of labor can be placed on the floor and
used for a labor line type activity or can be held up in front of your own body to visually
demonstrate the progress through labor.
Charts are also available to show the development of a baby throughout pregnancy.
These can be helpful for clients to identify how the woman’s body accommodates the
growing baby and explaining the reasons why she may experience some of the more
common pregnancy discomforts such as heartburn and constipation, as the charts show
clearly the need for organs to take up less space and become cramped as the baby
becomes bigger. When suing charts such as these, hold them up against yourself to
ensure the mother is always upright and to give visual clues as to the perspective of the
chart.
If using charts, ensure they are laminated to protect them. Charts that are spiral bound
together can be good to keep them clean and tidy, but are less flexible than individual
charts.
One of the best set of charts that we have come across are a series of photographs taken
of various stages of labor and birth. These pictures show an excellent variety of different
types of birth, interventions and natural births, and many different cultural groups. The
pictures are produced by Lina Clerke, an Australian doula, and are available through her
website at: http://www.wonderfulbirth.com/default.asp?url=2955&Type=3
Pregnancy development and stages of labor charts can be purchased from a variety of
sources. These include:
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Anatomy and Physiology Charts
OUR FAVORITE: National Childbirth Trust, UK:
http://www.nctms.co.uk/res_prodshow.asp?cat=22&scat=114&id=116&v=&pg=1
Birth International, UK & Australia:
http://www.birthinternational.com/product/chart/ch005.html
Birthsource, USA:
http://www.birthsource.com/Scripts/prodView.asp?idproduct=123
Giving Birth Charts
OUR FAVORITE: National Childbirth Trust, UK:
http://www.nctms.co.uk/res_prodshow.asp?cat=22&scat=114&id=138&v=&pg=1
Birth International, UK & Australia:
http://www.birthinternational.com/product/chart/ch023.html
Birthsource, USA:
http://www.birthsource.com/Scripts/prodView.asp?idproduct=135
Poster of Positions for an Active Birth
National Childbirth Trust, UK:
http://www.nctms.co.uk/res_prodshow.asp?cat=22&scat=114&id=588&v=&pg=1
Birth International, UK & Australia:
http://www.birthinternational.com/product/chart/ch002.html
Cards and tear off pads of Positions for an Active Birth
National Childbirth Trust, UK:
http://www.nctms.co.uk/res_prodshow.asp?cat=22&scat=114&id=614&v=&pg=1
http://www.nctms.co.uk/res_prodshow.asp?cat=22&scat=114&id=704&v=&pg=1
Rather than using prepared charts, you can use a variety of photographs to illustrate
women in labor. One of the most successful activities we have done is to have a number
of photographs, laminated, of women giving birth, the immediate postpartum period, and
newborn babies. The newborn pictures included healthy newborns in their parent’s arms
as well as those in intensive care settings. We also included pictures of fathers giving
support, looking exhilarated and looking exhausted. These pictures were taken from
parenting and motherhood magazines. At the beginning of a class, the pictures are all
scattered onto the floor. Clients are asked to choose a picture of how they would like
their birth to be, and another of how they would not like it to be. As a group, they then
take turns discussing why they chose the pictures they did. This can be a very powerful
exercise in identifying what the parents are looking for in their birth as well as what they
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are afraid of. You can use similar pictures for many different situations such as coping
with a newborn baby after the birth.
Arranging for previous clients to visit your classes can invaluable in your parenting
class. It provides the opportunity for expectant parents to find out what it really is like.
It also gives them the opportunity to see a young baby being handled and cared for by
new parents. This can help the whole thing seem more real – of course, this can
sometimes be a bit of a shock to the clients when they realize this will soon be them with
a new baby in their arms! We cover the topic of inviting clients to classes with their
baby in more detail in the teaching About Parenting unit (Unit ED3003).
Another way to integrate reality into your classes is to have visitors. A lactation
consultant, physiotherapist, chiropractor or obstetrician can all be beneficial for parents
to hear their point of view. Think about other health care professionals that might be
helpful to include in class sessions. As an alternative to having these visitors in classes,
you could also organize regular monthly sessions where expectant parents can drop in
and talk to health care professionals.
Your own body is by far and away your most effective visual aid. When using other
visual aids such as the doll or charts, hold them up against your body to give perspective.
You can place your cupped hands around the baby’s head to show how forceps are
applied. Hold the doll away from you and cross your arms over. Place a cupped hand
either side of the baby’s head to demonstrate this (see Figure 1). Using your hands over
your head and moving them gradually down towards your ears shows the progress of
dilatation in relation to the baby’s head (see Figure 2).
Extending your hand you can demonstrate the stretch of the perineum during the birth.
You can also use this to demonstrate the difference between a tear and an episiotomy.
Stretch the hand tightly to show the perineal stretch. Then ask the group to feel the soft
skin between your thumb and forefinger with their other hand and notice how it is only
skin, not muscle, in this area. Now get them all to take a red pen and draw the position of
the anus and the line of a small first degree tear. Ask them to extend the tear into the
muscle area slightly. Then again to extend it and curve it as happens with an episiotomy.
This very clearly demonstrates the differences between tears and episiotomies and serves
as a good reminder to them throughout the class as they can see it on their own hand (see
Figures 3-5).
The most effective way to demonstrate a contraction is for you to do one. Either model
the behavior of a woman during different stages of labor or simply the make the noises
that are common. We have made an audio recording of a woman in labor – this is a
demonstration rather than a real woman laboring but if you listen you can hear just how
effective your own voice can be.
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Listen to the following audio recording, linked from the Childbirth
International website.
Woman in Labor
Childbirth International
When discussing positions of the baby and aches and pains in pregnancy, you can use a
shawl and the doll to show how the baby is supported and why women may experience
back pain. Place the baby in a shawl or wrap that has been folded into a triangle. Wrap
the bottom corner of the shawl over the doll to hold it securely. When you bring the
shawl up close to your body you can position the doll as if it was in the womb. Tie the
ends of the shawl around your back. Explain how this shows the ligaments that support
the uterus and how they attach to the lower back – leading to an increase in back
problems during pregnancy as the baby gets heavier. You can then spend some time
discussing posture and positioning while the group can see what is happening as you
adopt different postures (see Figures 6 and 7).
After your body, the doll and pelvis are the things you will probably use the most.
Whilst they are quite a large investment, they will last for many years and will be used
often in your classes. We would suggest the resin style pelvis with a movable sacrum,
and a doll that is designed to fit into the pelvis. You can purchase different dolls
showing different racial groups if you are not teaching only Caucasian clients.
The pelvis and doll can be used to demonstrate the stages of labor, used as a prop during
an induction role play, to demonstrate the space available within the pelvis, different
positions the mother can adopt during labor and how these affect the pelvis, posterior
positioning of the baby, or breastfeeding positions.
You can sometimes purchase second hand dolls and pelvis on auction sites such as ebay.
Try www.ebay.com and type in pelvis into the search field to see if there is anything
available.
There are specific teaching dolls available but they may be out of your price range. We
would suggest that if finances are an issue, purchase a teaching pelvis but consider a doll
from a toy shop. One with a fabric body is easiest to manipulate. Take the pelvis with
you into the shop to make sure the doll passes through it easily – it should not be so easy
that the doll simply falls through but you also don’t want it to be so tight that the doll
can get stuck – not a good visual to give to pregnant women!
Treat your doll as if it was a real baby. Gently move it around, supporting its head.
When you are not using it place it gently beside you making sure you do not pile other
things on top of it. If you do not do this you will find some of your clients become
uncomfortable when you are being rough with the doll.
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Many of the commercial teaching dolls come with a placenta and umbilical cord
attached. You can however make your own version. Use thick sponge rubber, cut into
the shape of a placenta and cut it about 8cm in diameter. Take some dark red fabric that
and cover the sponge rubber. To make the umbilical cord, use three pieces of curtain
tieback or dressing gown (bath robe) cord. Each piece should be about 1 meter (3 foot)
in length and you use two pieces that are dark red and one piece that is purple. Twist the
lengths together and hold them in place at one end with stitching. Untwist some of the
threads at the other end and attach these all to the center of the placenta. You can put a
layer of pale grey tights (pantyhose) over the cord to show the protective Wharton’s
jelly. Attach a press stud to the end of the umbilical cord and another to the dolls’ belly
so it can be attached.
Sizes: Everyday items can be used to illustrate relative size. A walnut is the size of a
baby’s stomach. An egg cup holds about the same amount of fluid as a newborn’s
stomach can hold. Alternatively, you could cut a natural sponge to the size that can hold
about the same amount of water and then squeeze it out to show just how little the baby
needs to have. Different sizes of the baby at different gestational stages can be shown
with everyday items as well.
We have left this section until last because it is the largest area of this unit. There are so
many tools and models that you can create yourself for use during classes. This helps
keep the cost down but also makes it all seem more familiar to clients as you can use
everyday items.
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Using the measurements below, look around your home and see what you
could use to demonstrate this stage of gestation.
Gestation Length Items to use
4 weeks ¼ inch
8 weeks 1 ¼ inches
12 weeks 2 ½ - 3 inches
20 weeks 10 inches
25 weeks 12 inches
33 weeks 18 inches
40 weeks 20 inches
Fruit: It may seem odd to suggest that fruit can be used to demonstrate birth! A
grapefruit can be used to show the baby’s head in moving through the pelvis. A bunch of
grapes demonstrates the anatomy of the breast in discussing how milk is produced. A
banana is the perfect shape for showing the curve of the pelvis and the direction the baby
has to take as it moves through. A pear that has been cut in half can be used to show the
shape of a non-pregnant uterus in a woman who has never had a baby. An apple shows
the shape of a non-pregnant uterus after the woman has had a baby.
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This task summary is for your own records. It does not have to be submitted.
Go through the following list and identify those visual aids that you would feel
comfortable using and those that simply do not feel right for you. Identify also the
different uses or applications for each of the aids, considering the different places in a
course that you could use them. Think broadly on this rather than just using what has
been written in this study guide. Use the empty space at the end of this table to think of
your own visual aids.
Item Comfortable? Uses/Applications
Birth Videos
Parenting Videos
Photographs
Charts
Doll
Pelvis
Audio Recordings
Visiting parents
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Item Comfortable? Uses/Applications
Visiting Health
Professionals
Flip charts
Whiteboard
Your body
Everyday Items
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Evaluating your Teaching
Evaluating Your Teaching
In order to determine whether or not our classes are meeting the needs of our clients, the
most effective way is to ask the clients. In this unit we will explore different methods
for evaluating the effectiveness of our classes and explore ways that we could enhance
the classes if they are not. We will discuss different evaluation form design and
determine the most appropriate time and method for getting evaluations from clients.
Finally, we will consider how to manage the situation when a client is disappointed with
the classes.
Topics covered will include:
Designing and using evaluation forms
Gaining benefit from evaluation
Managing disappointment in your classes
Responsibility for outcomes
At the end of this unit you will be able to:
Create an evaluation form for use in antenatal classes
Explain the reasons for using evaluation forms
Identify areas that could be improved in your antenatal classes
There is no suggested reading for this unit.
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Evaluating your Teaching
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Evaluating your Teaching
Evaluation is an important part of teaching. If you have no idea what your clients think
of your classes, you have no way of knowing if anything needs changing. Evaluation is
not about receiving lots of compliments. While it is nice to hear that people enjoyed
your classes, the real benefit is in receiving feedback that helps you to improve them
and giving you the ability to identify your areas of strength and weakness.
Evaluation should be an ongoing process through each course, rather than something
you just do at the end of the last class. If you have prepared a good teaching plan you
will have identified a method of evaluating the effectiveness of every single topic you
teach. You can, for example, do a brainstorm at the end of an activity to see how much
the group remembers. Or ask them how they are feeling about watching a video. You
could start or finish each class by asking them to say one thing they are enjoying and
one thing they are finding difficult. This does not have to be formal evaluation but it is
an effective way of identifying what is working and what you need to improve on.
In this unit we will consider more formal methods of evaluation, how you can
incorporate them into your classes and how to manage negative feedback.
Most teachers who use evaluation forms have a written form that they pass around for
the class to fill out. Decide before hand how you are going to handle the following:
The timing of giving out the forms
Whether they are filled in anonymously or with names
Whether each client fills on in or each couple do it together
Whether they give the form to you straight away or take it home with them to
complete
Timing: You may decide to just give out the one evaluation form at the end of the last
class. Alternatively, you could hand out an evaluation form midway through the course
to see if you are on track and how your clients are finding the classes. If you host a
reunion class this can also be a good time to have the evaluations completed. A reunion
involves getting the parents together several weeks after the last baby of the group has
been born. You can schedule the reunion at the last class. The benefit with having
evaluations done then is that you can ask questions about how helpful the information
was for their labor and the early days of parenting. Again, remember to use open
questions such as “What did you learn in classes that was most helpful to you during
labor/as a parent?” or “What is the one thing you wish you had known before you had
your baby?” It can be a good idea to start accumulating these comments and have them
available as a handout for future classes. Another trick is to have a guestbook that
parents write in at the reunion, writing one thing they wish they had known and one
thing that was the most helpful to them. Put this guestbook out for the coffee break in
future classes for expectant parents to read. It is a great way of making labor and
parenting seem more real.
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Names or anonymously: There are pros and cons to each of these options. Clients may
be more honest and provide more constructive feedback without their name on the form.
Having their names means that you can address any issues they raise with them directly.
Couple or individually: Within a couple they may have very different things that they
liked and did not like. Filling in the form together though can be more relaxed and
social.
When to hand the form in: If you ask them to complete the form and give it to you
before they leave, you know you will get them all back. However, your clients may feel
rushed and prefer to spend some time pondering over what they liked and did not like. If
they take it away with them you may get more comprehensive answers. Inevitably
though some of these forms will not be returned to you so the amount of feedback you
get overall may be considerably less than if you do them in class. Also, once they have
returned home and life takes over, they may forget some of the things you covered in
classes. If you do give your clients evaluation forms to complete later on at home,
remember to include a self-addressed stamped envelope to increase the chances of them
being returned.
In terms of form design you need to think about what your objectives of handing out the
form are. Do you want to know how they felt about the course overall, or are you more
interested in how they felt about each topic covered? Do you want to know more about
the information they have gained or more about their feelings and emotions?
The form should, if possible, be on one single sheet of A4 paper. Remember to use open
rather than closed questions. For example, rather than asking “Did you enjoy the
classes?” you could phrase it as “What did you most enjoy about the classes?” Another
way of asking this would be to say “Name three things you most enjoyed about the
classes.” Make the questions simple and straightforward and provide space at the end
for them to add any additional comments.
You can ask questions that require a sentence or two for the answer. Another way of
getting the information is to ask the question and then have tick boxes where they can
rate the answer. You can use this technique to get information about effectiveness on
the information that you gave in classes, how comfortable the group felt with each
other, whether you spent enough time on each topic, or a whole host of other areas. This
method makes it very easy and fast for clients to complete the form. The downside is
that you limit the amount of information that they can pass on to you. It is a good ideas
to use a combination of tick boxes and sentences to get a better understanding of what is
working and what is not. The following page has some examples of how you might set
out tick box questions.
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How did you feel about the different areas we Not enough Too much
Just right
covered? info info
Stages of labor
Relaxation skills
Breastfeeding
Parenting information
Coping strategies for labor
Difficult topics (interventions, grief,
depression)
Relationships
Some common questions to include on your evaluation form can be found below.
1. What did you most enjoy about the classes?
2. What did you least enjoy about the classes?
3. How comfortable were you in the class environment? (e.g. lighting, noise, seating)
4. What could the teacher have done differently to improve the classes?
5. What topics do you wish had been covered?
6. What topics do you wish we had not covered?
7. What was the best thing the teacher did?
8. What was the worst thing the teacher did?
9. How do you think the classes will help you during labor?
10. How do you think the classes will help you with a new baby?
11. What improvements could you suggest to the teacher to make the classes more
effective?
You could also ask about the more administrative issues. For example, the timing of the
class, the cost and the quality of the handouts and materials used.
Remember to also use self evaluation. What did you think about the classes and how
they went? Reflect on what you felt worked well and what you felt was not as effective.
Were there activities you tried that seemed to really work or some that were a flop?
Could you adjust these so they are more successful? What did you enjoy most about
teaching this set of classes and what did you enjoy least? Is the environment working
for you? Were there any clients that you found very difficult to teach? Why? What
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could you do to avoid further situations like this? Would it be beneficial to do some
continuing education to help improve this area?
As mentioned earlier, the true value of evaluations is in being able to identify areas in
your classes that are not as effective as they could be. If positive and complementary
comments are made that is a bonus, but it is the constructive criticism that you want to
really hear.
The way in which you word your questions will be the greatest determinant of how
helpful the feedback is to you. If you only ask what you have done well you will miss
the opportunity to hear what could be improved. Using open questions that focus on
things you could improve or differently always work well. You could ask the clients to
complete sentences like the following:
I would like you do more of …
I would like you to do less of …
It would be unrealistic to expect that you will change your classes after every piece of
feedback. Having the occasional comment for example that the client would prefer the
classes at an earlier time of day is worth acknowledging but not worth taking action. If
however, many of the clients are saying they would like the classes earlier then it may
be time to consider a change to the timing.
Sometimes you will read feedback in your evaluations where you can see how the
suggestion would improve classes, but you are unable to carry these changes out
because of other factors or restrictions. For example, if many clients said they would
prefer an earlier time, but the room you are using is only available for a limited time,
you may not be able to implement this change. Equally, if you have young children who
cannot be cared for by anybody else until 7.30pm you are unlikely to be able to change
the start time of the class.
Once you implement a change in a class you might like to watch carefully for any
feedback on that area for the next few classes. Lets say you receive feedback that there
is too much sitting down in your classes. You decide to include some more activities for
the next class that gets the clients up and moving around. Watch the feedback forms for
the next few sessions you do and see whether or not you are still having this comment
made or if the opposite is now true. Implementing changes are ongoing – you will
always be tweaking your courses a little as you learn more, receive feedback and
become more confident and proficient in your teaching skills.
It is a good idea to tackle changes slowly rather than implementing lots of changes all at
once. You will find it easier to monitor the effectiveness of one or two changes rather
than 20!You could also be really up front with your clients and tell them when you start
an activity that this is something new you are trying because of previous feedback and
would like to hear from them how they found it. For example, if you decide to try out
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some different videos because previous clients have told you that the ones you were
using were too graphic, explain this to the next class when you are showing the new
ones. Ask them to tell you afterwards what they thought – were they acceptable, too
tame, or still too graphic?
First and foremost, try not to take negative comments too personally. There are always
going to be some people who do not like certain activities or topics, or even who do not
like any of the course. It may be that they had thought the classes would be different
than they were or that they were not comfortable discussing some of the things you did.
If you teach with the hope that every single person will enjoy every single thing you do
you are setting completely unrealistic expectations and will, without doubt, be
disappointed.
If a client does have a particularly negative comment or something they were really
unhappy with, it is important that you acknowledge this. You can do so afterwards in a
letter or email to the client. Saying something simple like “Mary, I wanted to thank you
for your feedback on your evaluation form. I am sorry you did not like the such and
such aspect of the classes but thank you for your honesty.” If the feedback was
something that the client was very unhappy with you can always offer for them to speak
to you to discuss it. For example, if a client felt the classes did not provide them with
the social networking they were hoping for you can listen to them express this. It does
not mean you have to change what you do or even apologize to the client. Simply
acknowledging their issue and listening is what is most important. Afterwards you can
reflect on what they said and perhaps identify areas where you could make
improvements. You might decide to take a look at your promotional materials such as
your brochures and website and analyze whether or not they give the impression there is
more socializing and building of networks than there really is.
Sometimes an evaluation form will comment on how a particular topic was not covered
that the client would have liked included. This is very common if the client is asked to
complete the evaluation after the course has finished. It is not unusual for example for
clients to say that there was nothing, or not enough, covered about parenting and getting
a feeling of what it is really like to care for a new baby. You may hear this and think
“But we did cover that!” Because we tend to hear best when it is something that seems
relevant to us, and many parents cannot get beyond the reality of labor and truly
picturing life with a baby, they don’t always hear or retain this information as well as
the details about the birth itself. It can almost seem that there is a wall in front of them
that represents labor and birth and they simply are unable to see beyond it. If you know
you have definitely covered a topic that a client is saying they didn’t hear, bear this in
mind and don’t worry too much about it. If you truly didn’t cover the topic think about
how you can rectify this in future classes. It is impossible to cover every single thing.
However, many topics can be touched on in handouts and given to the parents to read at
their leisure afterwards.
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It can be difficult to admit that a client might right and you could be doing something
better. Just because you finish your training though does not mean that you need to stop
learning and growing. This is a lifelong process. Each of us at CBI have adapted our
classes over the years as we have learnt more and become more adventurous in trying
new things. Some things have worked, others have been disasters. But it is the client
feedback that drives these changes. Remember that your client is the customer. If you
want your classes to be popular and your business successful you need to meet their
needs, not yours. There is little point in running classes that you love but everyone else
finds boring and dull, or threatening and confrontational!
You are not responsible for the sorts of births your clients have. This is worth repeating.
YOU ARE NOT RESPONSIBLE FOR THE SORTS OF BIRTHS YOUR CLIENTS
HAVE. Your responsibilities involve providing an environment that is conducive to
learning, being supportive and encouraging, providing the information the clients want,
and ensuring that everyone feels safe and respected within the class. That is where it
ends. What the mother or father choose to do with the information you provide is up to
them. Each client will interpret things slightly differently, each will have different
attitudes and approaches with their caregivers, each will make different choices. These
things will have afar greater impact on how their birth turns out than anything you can
teach them.
List the responsibilities of the childbirth educator, the caregiver and the
parents. Think about each one and then review your list of the childbirth
educator’s responsibilities. Do you think you are being realistic? Are you
setting your standards for responsibility too high? Too low?
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This task summary is for your own records. It does not have to be submitted.
For this task you are going to create an evaluation form and ask a friend or family
member to evaluate your effectiveness. Choose something that you do everyday – it can
be making dinner, handing out discipline, managing people at work – any area of your
life at all that is not related to pregnancy, birth or parenting. Design an evaluation form
that uses a variety of questions to determine your effectiveness at this task. Ask a friend,
colleague or family member to complete the form. Ask them to be as honest as they can
be, providing constructive criticism.
Once they return the form to you completed, read through their answers and reflect on
them.
What did you learn in designing the evaluation form?
What did it feel like to read their comments?
Which comments surprised you?
How effective do you think your evaluation form was?
How do you think you could improve the evaluation form?
What have you learnt about creating evaluation forms and working positively with the
feedback given on them?
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Teaching Knowledge Based Topics
Teaching knowledge based topics
During this unit we will be exploring different activities that provide information on
knowledge-based topics such as breastfeeding, labor, pain and interventions. We will be
covering games and activities that have worked for many teachers, assisting you in
building up a repertoire of teaching ideas.
Topics covered will include:
Icebreakers and introductions
Teaching labor topics
Teaching pain topics
Teaching interventions
Teaching breastfeeding
At the end of this unit you will be able to:
Plan teaching activities for knowledge based topics
Determine the learning outcomes that the activities address
Determine the learning styles that the activities meet the needs of
Identify ways that the activities can be evaluated for effectiveness
There is no suggested reading for this unit.
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In this study guide we are going to introduce a multitude of ideas for teaching topics
that are designed to acquire knowledge. This is by no means a comprehensive list as
many teachers have developed other ways of covering these subjects. Nor is it designed
to be prescriptive. Take the ideas, play with them, find ways that they fit with your
particular style and personality, and adapt them accordingly.
Remember that before you begin drawing up the activities and exercises you are going
to cover you should first be very clear on the topics and the learning outcomes you want
your clients to have. Once you have determined this, you can then find activities that are
appropriate and likely to achieve those learning outcomes. Many teachers start by
choosing activities without being clear on outcomes. This results in a class that may
have many fun things to do but without clear objectives. Consequently, the class
participants may feel the activity was pointless or do not understand what the point of it
was. It is also much more difficult to evaluate the effectiveness of each activity if you
have no idea of your proposed learning outcomes in advance. Our unit ED2004 –
Planning and Structuring a Course covers aims and learning outcomes in detail.
In each section we will provide a list of ideas. Ideas will be explained in detail and will
explore potential learning outcomes, learning styles that are suited to that activity and
strategies for evaluating effectiveness.
Whilst not specifically knowledge-based, the activities you use at the beginning of a
class, and specifically at the beginning of a course, can determine how effectively the
group interacts and communicates with each other. We know from previously covering
Teaching Adults (ED2003) that adults learn best when they are motivated and feel
supported. A group of adult learners that are comfortable with each other are much
more likely to want to work together and subsequently will retain more knowledge than
those that are stiff and ill at ease.
Many teachers are anxious just before the first class. You have no idea what your clients
are going to be like or how they are going to react to what you are teaching them. They
are also likely to be nervous and unsure of what to expect. How you open this class can
make a significant difference to how the whole course progresses. It is important in the
first class that you first introduce yourself and provide some basic information. For
example, tell the group what time you will break for refreshments, explain that they are
welcome to ask questions at any time, tell them if you are going to provide handouts,
and importantly, explain where the bathroom is! You can also give a little information
about your background and how you came to this work although this should be brief.
Once you have done the initial introduction of yourself and the classes it is time for the
group to introduce themselves. Many childbirth educators do not provide this
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opportunity and as a result the group can have great difficulty in really becoming
cohesive.
General Questions: You might like to start their introductions by giving them some
guided questions. For example, ask each of them to introduce themselves, saying their
name and then the main reason they have come to classes or the one topic they really
hope is going to be covered in the course. Try and steer away from questions that are
very personal in nature such as their occupation as some people may not want to share
this. Also, questions like “when is your baby due” can become tedious in medium-large
groups.
Small discussions: Another alternative for the first session is to get them to break into
smaller groups and get to know each other on a more personal basis. This can be less
threatening for the quieter members of the group. Give them 5-10 minutes to Class 1
get into pairs (not with your partner) and find out 3 things about
them. Then pair up with another couple and do the same. Then come back
to the whole group and the original pairings introduce each other.
Obviously it is important that each group member has the opportunity to introduce
themselves at the first class so everybody can get to know each other’s names. It is also
important to provide other opportunities throughout the rest of the course for names to
be refreshed. If you run your classes once a week the group are unlikely to remember all
the names the first few sessions. We would encourage you to cover a quick refresher of
names at the beginning of each class. Not only does it help with remembering names,
but it also provides a definitive start to the beginning of the class. The following are a
variety of things you can get the group to cover as the first activity to help with
remembering names. For each activity, describe the activity then ask the group to carry
it out, saying their name first before they feed back their answers to the group.
1. Say their name and tell everyone what they would have been called if they had been
born the opposite gender.
2. Using a large piece of paper, draw pairs of overlapping circles. As each couple
arrives, ask them to write their names in each of the pair of circles and something
about their baby in the section that overlaps. Once everyone has arrived, discuss as a
group what has been written about the baby. This is particularly good at the
beginning of a parenting class.
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3. At the beginning of the class, divide the class into smaller groups. Give them a piece
of paper that has a doughnut shape on it – a circle with a smaller circle inside it. Ask
everyone in the groups to write one unique thing about each group member in the
outer circle, and then one thing they all have in common in the central circle. You
can make it a bit tougher by saying they cannot use “we are expecting a baby”.
4. Ask everybody to introduce themselves by using a descriptive word that shares the
same first letter as their own name. For example, “Hi, I am talkative Toby”, or “I am
luscious Linda”. Not related to babies but a great way of remembering names.
5. Hand out cards to everybody. They have to draw a quick picture (in just a few
minutes) of how they are feeling. On the back of each card is a symbol or letter.
Once they have finished their picture they have to find the person with the matching
symbol or letter and then share with each other what they drew.
6. Explain to the group that they are about to be taken to a desert island. They are
allowed to take one thing with them. They each have to describe what that thing
would be and why they would choose it. You can make this activity related to birth
by saying they are going to be having their baby on the island and have to choose
one thing they would take with them to help with the birth.
7. Start a sentence with “the scariest thing I have ever done was…” and ask each
person in the group to complete the sentence.
8. Scatter a large number of pictures on the floor that have been cut from magazines or
books, or printed off the internet. The pictures can depict images of labor, or
emotions. Ask everybody to select a picture and then share why they selected it.
This is a great introduction to the topic of labor. If the pictures are all images of
women in labor you can include different types of labor. In this case you can ask
them to pick one picture of what they would like and one of what they would not
like. You can include cartoons and funny pictures to lighten the atmosphere. It is
helpful to laminate these pictures or mount them on card to protect them and ensure
they last for a lot longer. This is an excellent activity to begin the labor class. You
can get pictures from parenting magazines. Including images of babies in intensive
care, women with high levels of interventions as well as natural births, and even
pictures that just show facial expressions like exhaustion or joy, can provide some
excellent discussions.
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9. Break into pairs (no partners together) and find out three things about the other
person. Once this is done, pair up with another couple and share your discoveries.
10. Each group member say their name and something about it. It can be the origin of
the name, whether or not they like it, whether they had a nickname when they were
younger or how their name was chosen. This is one of the most effective activities
for remembering names.
11. Say their name and one thing they did for themselves this week.
12. Say their name and one thing they did for their baby this week.
13. Say their name and one characteristic they would like the baby to inherit from their
partner. This is a lovely exercise to start or finish the parenting talk.
14. Say one thing your parents did when you were a child that you either would repeat
or would avoid doing with your child. This can be a challenging activity as some
clients have not had happy childhoods and may bring up difficult feelings.
15. Say the first thing they will say to their baby when he or she is born.
16. One thing they are looking forward to once their baby has been born.
17. One thing they hope they never hear themselves saying to their child.
The purpose of icebreakers is to enable the group to get to know each other and feel
more comfortable with each other. Once the group has completed the first class, the aim
of these exercises is to remind each other of group names as well as to provide a
definitive start to each class.
Learning outcomes for these exercises include:
The group will learn each others names
The group will establish a support network amongst themselves
These activities all appeal to different learning styles. Activities where the class breaks
into groups and do a physical activity or write things down are more likely to appeal to
visual and kinesthetic learners. Listening to others in a circle will appeal to auditory
learners. The key with icebreakers is to ensure they are relevant and not too “gamesy”
and to try and make them as relevant as possible to childbirth and parenting.
You will know if the activities are successful simply by observing the group interacting
with each other. If you find there is little discussion going on and relatively poor
interaction, try icebreakers at the beginning fo the next class that means they have to
work in smaller groups. People are generally more chatty and open when they are in a
smaller group as it seems less threatening.
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Log on to the following webpage. There are a number of suggestions for
different icebreaker activities.
Icebreaker Activities – some suggestions
Janelle Durham
Materials can be copied and used by educators but no profit is allowed to
be made from her resources.
We feel it is an important part of any course to agree and set ground rules right at the
beginning of each course. This ensures that everybody has similar expectations of group
behavior and prevents any misunderstandings later in the course. To go through the
ground rules you can introduce the concept after initial introductions. Explain to the
group that you have a few ground rules you would like to cover and share with
everyone. You can either do this exercise as one large group or break into smaller
groups and then join together after completing your own lists. Topics you might like to
ensure are included are:
Confidentiality
Non-judgmental
Punctuality
Handphones (mobile phones)
An alternative way of tackling ground rules is to categorize it more specifically. Draw
up, on a large sheet of paper, with four boxes drawn on the sheet. In each box do the
headings gives, gains, groundrules and ghastlies. Ask them to brainstorm what to put
into each box.
Gives: what would you give to the group? For example, friendship, knowledge,
experience, questions.
Gains: what do you hope to get from the group? For example, knowledge, friendship,
support.
Groundrules: what groundrules should we set?
Ghastlies: what are you dreading? For example, watching videos, role play, relaxation,
touchy-feely stuff.
If you draw the paper up as a list rather than boxes, you can include a 5th “G” – GOT
TO COVER. Ask them to include the one topic that they really want to cover in the
course. This is a great way of defining the agenda.
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A note on agendas: It is important that if you include an agenda setting exercise that
you are going to take it into account when designing the classes. There is little point in
asking the class to set an agenda if you have already planned out all the topics for the
whole course and have no intention of acknowledging what they say they want to cover.
Newer teachers often feel daunted by the prospect of being able to adapt their class plan
if clients want topics they had not planned for. This comes with experience and
confidence. The benefit of agenda setting is that you know you are covering the topics
that are really important to them. One way of adapting your classes to accommodate
class set agendas when you are first starting out and want more control over the class
content is to always leave 15 minutes free in each class when designing your teaching
plan to cover those topics the class have identified on their agenda.
If you have a preplanned agenda before the classes start, you might like to provide this
information to your clients. Clients tend to prefer to have some idea of what they are
going to cover in each class rather than it all being a surprise. Take care with this
approach though. If, for example, you say that the sixth class will be covering
breastfeeding, you may find the men do not show up, or the women who are unsure
about breastfeeding decide to skip that session. Rather, define the class topic as “feeding
your baby” to be clear that the class is appropriate for all, regardless of the choices they
will make once their baby is born.
There are times during your classes where you need to take a break and re-energize
everyone. Particularly after heavy topics like coping with the unexpected, interventions
or watching birth videos. An energizer givers everybody, including you as the teacher,
the opportunity to stretch, clear their head and get rid of any negativity or
uncomfortable feelings.
"Stroking and smoothing"
Everyone stands up with their partner. One person stands behind the
other and strokes them from the top of the head and over the
shoulders. They stroke again, this time down the arms all the way to
the finger tips. The third time they stroke over the lower back, over
the bottom, down the thighs and then stroke their hands around to the
front of the legs and over the feet and toes. The stroking should be
firm but gentle. They repeat the exercise this time swapping roles.
“All the S’s”
This is a good energizer for people that are uncomfortable with touch,
especially in the first class where they may not want to be physically
demonstrative, even with their partner, in front of a group of
strangers. Stand everybody up and ask them all to shout things that
begin with S that they can do to relieve tension. Everybody in the
group tries the things that are shouted out. Ideas include smile,
shake, stretch, swing, sway, sigh and sing.
Labor is the one topic that most clients are keen to be getting on with when they start
childbirth classes. There is an enormous amount to understand and it can seem daunting
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for both the educator and the client when they realize just how much could be covered.
When considering what to include remember the reasons why your clients are coming to
your classes. Do not try and impress them with your knowledge – they will gain so
much more by understanding feelings and having coping strategies rather than simply
absorbing facts about what happens during labor like a sponge.
The following are some ideas to begin building on when you are covering the topic of
labor. As with all other topics, first identify what your aims and learning outcomes are
before deciding on which activities to include. Feel free to adapt these ideas in ways that
will suit your particular teaching style and the needs of your clients.
Before you start talking about labor, it is helpful to make sure that the terminology for
parts of the body are clear for all class members. A good exercise to do to ensure this is
to place a chart on the floor of a pregnant woman. You can use a professionally
prepared chart or one that you draw yourself. Pass around small labels to all class
members with names for parts of the body and baby on them. Ask all group members to
get up and place their labels where they think they should go. At the end of the exercise,
correct any labels in the wrong place. Examples of labels include:
Uterus/womb
Placenta
Cervix
Vagina
Perineum
Bowel
Bladder
Baby
Umbilical cord
Epidural space
Fundus
Amniotic sac
This is a good exercise for visual and kinesthetic learners. The aim of the exercise is to
ensure a base level of understanding together with providing an opportunity for the
group to get up and move around. If you start your first class with something that
requires them to move around they will be much more likely to continue with this
throughout the course rather than expecting to be passively taught through lectures.
The learning outcomes for the exercise might be:
All group members understand the basic terminology used in classes
The group will get up and moving
Evaluation of this exercise is easy – you can see as they place the labels what their
current knowledge level is and also can correct any inconsistencies as they are working
through the exercise.
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There are two good exercises for covering this topic. In the first you prepare three cards
for each group saying “stay at home”, “call my caregiver”, and “go to hospital”. Prepare
another set of cards with possible scenarios such as:
Waters break with a gush
Waters break with a trickle
Bloody show (vaginal discharge)
Contractions every 10 minutes, lasting 30 seconds
Contractions every 3 minutes, lasting 30 seconds
Contractions every 3 minutes, lasting 70 seconds
Backache
Vomiting and/or diarrhea
There are many other scenarios you can include. The group places the three main cards
on the floor in a row. They then begin to place the scenario cards under the relevant
heading, depending on what they think they would do. This is a group exercise so they
have to all discuss each scenario and agree on the best course of action.
The alternative to this exercise is the “stop/go” game. Using similar scenarios, each
group member takes a turn going through the scenario cards. One group member places
the cards down one at a time in a pile. Another person says whether they would stop at
home or go to hospital. Once they get to a GO the cards are all picked up, shuffled and
passed to another group member for someone else to have a turn.
The benefits of this exercise is that begin to develop that each labor will begin and
progress differently. They can also see very clearly that each woman will make different
decisions about when to go to hospital. If they are planning on having a homebirth with
a midwife they can vary the exercise by saying when they would call their midwife to
come rather than when they would go to hospital.
If you want to, this is also an opportunity to include some of the symptoms of more
serious problems such as preeclampsia. Include cards that say “pad soaked with bright
red blood” or “sharp pain in your ribs and dizziness”. Remember that when you
introduce topics that cover complications the discussion can become very detailed and
longer than expected. Also, some clients may be upset at these discussions so be aware
of how the group is responding.
These two exercises work well for visual and kinesthetic learners. To evaluate the
exercise you could have a general discussion at the end asking them what they learnt
and how they now feel about when to go to hospital. Many women are worried about
leaving it too late and having the baby unplanned at home or in the car on the way to the
hospital. This is a good opportunity to bring the topic up while you are having the
general discussion.
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Many teachers like to provide the opportunity to practice contractions to give an overall
idea of the length of a contraction and the class to practice positions for labor. One way
of achieving this is to prepare a recording in advance with 3 minutes of relaxing music,
followed by 1 ½ minutes of white noise (recorded off the untuned radio), followed by 3
mins of relaxing music, followed by another 1 ½ minutes of white noise and finishing
with more relaxing music. The white noise starts quietly, builds up and then quietens
down again. You can talk the group through the relaxations and the contraction periods.
This exercise helps them to understand the waves and pattern of labor, enabling them to
determine how they can stay relaxed in between contractions and then focus during
them. You can combine the exercise with labor positions. Have “stations” positioned
around the room with tools like massage equipment, a birth ball, a stool or step, a
bucket etc. For each contraction they move to one of the tools and practice a position.
Once the contraction is over they move to another station. You can also include cards
with pictures of labor positions such as supported squatting, resting on the side or
standing and swaying, rather than only having physical tools they can use at each
station.
Log on to the following webpage. There are a variety of illustrations of
different positions for labor that you can print and pass out to clients for
ideas on positions.
Artwork showing positions for labor and birth
Janelle Durham
Artwork can be copied and used by educators but no profit is allowed to be
made from her resources.
It is a difficult concept for many to understand that the pelvis has the ability to open
during labor to allow the baby the maximum amount of room to move through. Visual
exercises and activities can help get this concept across.
One of our favorites is the simple glass and orange or ball exercise that we
demonstrated in the physiology in labor and birth unit. Using an empty glass as the
cervix and an orange or ball as the baby’s head, you can show the class how the baby’s
head applies more effectively to the cervix when the mother is upright. Hold the glass in
one hand, and the orange in the other. Position the glass horizontally, as if a mother was
lying down. Show how the orange is unable to provide even, constant pressure on the
cervix. Now move the glass to an angle of 45°, as if the mother was in a semi-sitting
position. Again, the orange can apply some pressure but not even and constant. Now
move the glass vertically as if the mother was upright. It is easy for the group to see
how the orange can now fit the glass perfectly and applies constant, even pressure.
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It is also important to demonstrate how the pelvis moves in the second stage to
accommodate the baby. Take one pelvis, add a grapefruit. Hold the pelvis in the supine
position (as if the mother was lying down), and place the grapefruit inside it as if it were
the baby’s head. This is easiest to do if you rest the pelvis on the floor. You can see
how the grapefruit nestles into the sacrum and coccyx. Try to pass the baby (grapefruit)
through the pelvis as if it were being born. Now move the pelvis to an upright position
and carry out the same exercise. It is very clear to see how much easier the grapefruit
can come through the same pelvis.
This is an excellent exercise for visual learners. To enhance the activity and allow it to
appeal to kinesthetic learners as well, pass the pelvis and grapefruit around the group
and let them try it out for themselves. At the end of both these activities you would
expect to see clients understanding the benefits and importance of being upright and
mobile in terms of optimizing labor progress. To evaluate the exercises you might ask
them to practice some positions that they brainstorm together that would allow for the
pelvis to expand to its full capability.
It is helpful for parents to understand that the baby makes a number of movements in
order to be born as it progresses through the pelvis during labor. This enables them to
make the connection more easily between the baby’s birth and the mother’s position
during labor. One exercise that helps them see this connection is to pas the pelvis and a
doll to the men in the group. Ask them to move to a different area of the room, and
together figure out how the baby will go into, and come out of, the pelvis. Tell them to
think specifically about the diameters of the baby’s head compared to the diameters of
the pelvic inlet and pelvic outlet. Most groups of men will quickly figure out that in
order to come through the pelvis in the most efficient way, the head must enter with its
widest diameter in line with the widest diameter of the pelvic inlet. And then, in order to
move through it must rotate so the widest diameter of the head in line with the widest
diameter of the pelvic outlet. This activity appeals to many men as it gives them a
problem to solve. After the activity they come back to the main group and share their
findings. You can then combine this with an activity for the women on the pelvic floor.
Women often prefer to have a discussion about the pelvic floor without men present so
this is a great activity to do at the same time as the men are doing the work with the doll
and the pelvis. You can spend the time with the women getting them to practice pelvic
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floor exercises and show them the link between the pelvic floor and the ability of the
jaw to relax. Practice a few pelvic floor exercises such as pretending their pelvic floor is
a lift, drawing it up gradually one level at a time. Remind them to keep breathing! At
the end, relax the pelvic floor and then finish the exercise by releasing and bulging the
pelvic floor outwards as they would do when they are pushing in the second stage of
labor. You can then ask them to tighten their jaw muscles strongly. Ask them again to
do the pelvic floor exercises and try to release and relax the pelvic floor completely
while their jaw is still tight. They can easily feel for themselves how important it is to
keep the jaw relaxed in order to properly relax the pelvic floor. Following this it can be
a good idea to talk about ways of relaxing the jaw such as focusing on the outbreath and
vocalization.
Once the men return to the group you can compare the different things the two groups
discovered and then go on to talk about positions in labor that would help the baby
negotiate the pelvis in the most effective way together with keeping the mother relaxed
and comfortable.
Role-play is a very effective way of communicating the realities of labor and the
intensity of contractions. We find two useful ways of achieving this.
Firstly, the easiest way is to prerecord a woman in labor when she is making noise and
play that back in classes. This provides clients with a sense of normal labor sounds and
can make the whole process seem less frightening. Some people find it easier to listen to
a woman in labor than to watch a video, especially those who are auditory learners.
Others however find it is more difficult to listen and prefer the visual impact of a video.
For this reason we would suggest that using both methods at different times in classes is
helpful. This can be a good exercise to precede a discussion about vocalization and
feeling comfortable about “losing it” during labor.
An alternative way to understanding vocalization and the intensity of labor is to role-
play it yourself. This is particularly effective if you are co-teaching with another
childbirth educator so one of you can play the mother and the other a doula or support
partner. While it can seem scary at first to pretend that you re in labor in front of a room
full of people, it is amazing how quickly you adapt to the role and start to really feel the
part of the laboring woman. The class usually find this activity very helpful in terms of
understanding the feelings and impact of labor and often comment on how they felt they
were really watching someone in labor in the room with them.
The aim of both of these exercises is to help create an understanding of labor and make
labor more real – a difficult concept for many women and their partners to understand
before they have given birth to their first baby. You can also use a variety of videos to
provide an insight into different types of labor. We will cover the use of videos in detail
in the teaching unit ED1002 – Using Visual Aids Effectively.
As mentioned earlier, these exercises are very helpful for an auditory learning style. The
role-play is also helpful for visual learning styles.
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The learning outcomes for these exercises might include:
Explain the normal range of responses to labor and contractions
Recognize our own feelings about vocalization
Identify coping strategies for labor and ways of supporting a laboring woman
To evaluate the effectiveness of this exercise, you can have a discussion afterwards to
discuss how the group felt and whether they could see themselves using vocalization as
a technique for coping with contractions. We would suggest that a discussion such as
this is important after listening to or seeing a woman in labor, even if it is simply a role-
play, since many people have strong emotions after watching such an exercise.
One of the techniques we have used in the past with great success as an alternative to
birth videos is to use stories and poetry. It is a nice way of breaking up a class and
changing the pace, also gives people a chance to sit back, relax and be in a slightly
passive role for a few moments. This can be helpful if the class is a heavy one, or busy
with lots of questions, as it provides the chance for class members to catch their breath.
You can choose a birthstory from a book, or one you read off the internet (make sure
you do not use any identifying names unless you have permission from the author).
Choose stories that reflect the issues you are covering at the time whether it is talking
about coping with a long back labor, or an unexpected rapid birth. It can also be nice to
include poetry that reflects some of the issues covered in your classes. One of my
favorites is the following poem written by Barbara Kozlowski.
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Birth Story
by Barbara Kozlowski, CNM
(I'm drowning)
And the midwife holds me in her arms and says “Yes it's hard isn't it you're doing so
well”
(And I am surfacing)
And she says “you're doing it exactly right”
(And I'm drowning)
And she says “you're taking such good care of your baby”
(And I am surfacing)
And she says “yes this is how it is you'll live you're good and strong”
(And I am drowning)
And she says “good good that's good”
(And I am surfacing)
And part of me says “f--- you I'm dying here”
(And I'm drowning)
And part of me says “oh my god I AM doing this aren't I”
(And I am surfacing)
And part of me says “LEAVE ME ALONE SAVE ME HELP ME”
(And I am drowning)
And part of me says “this is the most incredible thing I've ever done, I can't believe I'm
actually doing this yes yes YES”
(And I am surfacing)
And the baby comes in a long sea salt waterfall flood ocean of sweat and tears and birth
waters and blood
And I take her slippery warm wide-eyed amazed and knowing little self against my
EarthMother created-and-moved-the-universe warm and billowy belly and tell her she's
wonderful and safe
And I follow her with a red and glorious afterbirth
And I think I DID IT! I AM TOTALLY INCREDIBLE! WE WANT SOME PRIZES
AND NEWS COVERAGE IN HERE! DID YOU SEE THAT? WAS THAT GREAT
OR WHAT?
And the doctor writes:
32-year-old gravida II para I presents in active labor. Normal spontaneous vaginal
delivery of a viable female LOA over intact perineum. Apgars 9 & 10. Uneventful
delivery.
Written by Barbara Kozlowski, from the book Labor Day: Shared Experiences from the
Delivery Room, by Ann-Marie Giglio (Editor), Workman Publishing Company, 1999.
For many women, transition is the most challenging time during labor, where
contractions are coming almost one on top of the other and they are at their most
intense. It can be helpful to talk about this stage specifically to help women and their
partners develop an understanding of the challenges and emotions possible at this time.
One activity that might help them to understand the feelings is to produce a mnemonic –
this is where you choose another word for each letter in the word TRANSITION that is
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related to the initial word. You could combine this activity with a birth video. For
example, you could show the group your mnemonic first, then watch a video that shows
a good example of typical transition, asking the group to identify when they think
transition is taking place. Finally, they could then brainstorm their own mnemonic for
you to evaluate their learning. A suggestion of the mnemonic that you use is:
T iredness
R est and be thankful
A nger
N ausea
S haky/sweaty/shouting (which ever you prefer)
I rritable
T ense/ toilet
I rrational
O ut of control/ out of the door!
N early there!
A card exercise is an effective way of identifying things that partners can do during
labor to support their partners. In this exercise you provide the women with a set of
cards saying things like “I can’t do this anymore”, “get me my epidural NOW!”, “why
is this taking so long?”, “please, help me”, and “you pig, I am never doing this ever
again!” The partners also have a set of cards providing techniques for dealing with these
comments. They could include ideas such as “ask the nurse for help”, “offer
encouragement”, “suggest a shower” and “just hold her hand and smile”. The women
take turns in reading out their card and the partners offer ideas by using the strategies
provided on their cards.
This exercise appeals to many men since it provides them with useful solutions to what
they may perceive as a problem. Many men find it difficult to sit by and hear these
comments from women without having useful solutions to offer to fix the “problem”.
The exercise also helps the class to realize that while a woman is saying she wants help
she may be simply asking for reassurance. To get this point across, you can ask the
woman, after the men have made suggestions, what she thinks she is really asking if she
made such a comment.
This exercise is effective for auditory learning styles and also for partners of all learning
styles to build a repertoire of how they can cope with their partner laboring.
The learning outcomes for such an excise may include:
Provide coping strategies for partners during strong labor
Recognize common comments made by laboring women
You will be able to evaluate the effectiveness of the exercise by the comments made
during the activity itself.
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Another activity for identifying support strategies for partners is to do the 5 T’s of
labour support. You can choose to structure this in a way that works for your own
teaching style. One way is to provide 5 large cards with images on them – this makes
the activity particularly helpful for visual learners. The 5 T’s are:
Touch (touch and massage) – use a picture of a hand
Time (recognize ways that labor is intensifying over time) – a picture of a clock
Talk (ask her what she is wanting or keep talking to a minimum) – a picture of a mouth
Turn (change positions or take turns to support with someone else) – a picture of a
spinning top or a carousel
Tinkle (regular trips to bathroom) – a picture of a toilet or a tap
The time component in particular is a great one for extending a discussion about. How
long do women and their partners think each stage of labor lasts? This helps to identify
expectations and adjust any that are completely unrealistic. You can also talk about how
the length between contractions is not as significant as how long the contractions
themselves are lasting. Many women are told by their caregivers to come into hospital
when their contractions are 5-10 minutes apart without realizing that if the contractions
are lasting less than 45 seconds they are most likely to still be in very early labor, or
perhaps labor is going to stop for several days before becoming well established.
Finally, you can discuss the clock picture and how time limits can lead to a restriction of
choices and how the support partners can manage this effectively.
We would encourage all educators to focus on tools and skills that clients can develop
to help them cope with whatever challenges labor and parenting provide. However, it is
worthwhile to cover the basics of what to expect during labor so that you clients have
some clear understanding of the stages of labor and the progress.
There are many different ways that you can cover the basics of labor. This section of the
course generally needs to be started as a lecture – there is so much information to be
covered in a limited period of time and it is important to ensure that everyone in the
group has the same basic understanding before you go any further. Some teachers use
charts of labor to illustrate while they are lecturing, others use the pelvis model and a
doll to demonstrate for example the second stage progress of the baby. Adding visual
data to your lecture is going to help the visual learners while the lecture will be taken on
board by auditory learners. What is more difficult is to capture the attention of
kinesthetic learners during lectures. One thing you can do is use your hands to
demonstrate things like the shape of the uterus and the hands at the end being the cervix.
If you ask the group to do the same thing with their hands while you are talking, the
kinesthetic learners are more likely to be interested. This technique is helpful since you
can then use your fingers to show effacement as the uterus muscles pull up from the top
of the uterus, thinning out the cervix, and then dilatation as the muscles continue to
contract. We have created a technique example video for you in the readings for this
unit.
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Log on to the following webpage. Registration is free and once registered
you simply click on the “Begin the Temperament Sorter” button to
proceed.
Video of visual demonstration showing labor
Childbirth International
In order to help clients understand the continuum of labor you can use a labor line.
Please a string on the floor, representing the length of any given labor. Place cards with
dilatation on them along the line at regular intervals from 0cm through to 10cm, and
then a further card with Birth written on it at the end. Split the group into two – one
group of men and one of women works well with this exercise. Give the women a set of
cards – say green cards – with things that might be happening. Give the men a set of
cards – say blue cards – with comfort strategies for different stages of labor. Ask the
two groups to place their cards along the line based on where they think these things
might be appropriate. The women can place their cards under the string while the men
place theirs above the string. The following tables show some of the things you could
write on the cards.
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Green cards – What is happening?
Contractions every 5 Contractions every 10 Contractions every 2
minutes, lasting 45 seconds minutes, lasting 30 seconds minutes lasting 90 seconds
Contractions every 3
Bloody show or discharge Backache continual
minutes, lasting 60 seconds
Backache every 8 minutes Mother teary Mother distressed
Shaking legs Vomiting or nausea Cold feet
Urge to open bowels No urge to push Grunting during contractions
Mother dozing between Mother making lots of noise
Waters break with a gush
contractions during contractions
Hyperventilating Mother looking spaced out Loose bowel motions
Mother exhausted Contractions stop Actively pushing
Stinging or burning feeling
Bloody show or discharge Leaking amniotic fluid
on perineum
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Blue Cards – What can you do?
Have a bath Have a shower Take a walk
Get eye contact with mother Massage Heat packs on back
Give lots of encouragement Go to the toilet Put on some socks
Take clothes off Massage legs firmly Seek some privacy
Breathe into cupped hands
Try a different position Focus on breathing out
or paper bag
Stroke down arms Stroke over jaw Change music
Reach down to feel baby’s Sleep or rest between
Turn lights down low
head contractions
Squeeze mother’s hips
Apply heat pack to perineum Cold packs on back
together
Have something to eat and
Try a different position Take a walk
drink
Have something to eat and Sleep or rest between
Use the toilet
drink contractions
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It can also be helpful to demonstrate the different pushing techniques to provide a
greater understanding of what happens during the second stage of labor. Many women
will be expected to use Valsalva pushing techniques during this stage. Helping them to
understand the differences between this form of breathing and pushing, compared to
pushing with their body’s signals, is beneficial.
One of the first things you can do is to open up a discussion about how the body copes
with exertion in normal circumstances. For example, how do they breathe when they are
about to hit the ball during tennis? What happens to their breathing when pushing a
heavy piece of furniture? What about weight lifters? Ask someone to role play a weight
lifter and then talk about the forms of breathing and holding the breath that are used. By
the end of the discussion the group will usually conclude that when exerting ourselves
we may hold our breath for a few seconds but we usually exhale strongly and possibly
vocalize as our muscles are doing the greatest amount of work. You can then compare
this to labor and ask the group how they think this type of breathing contrasts with
Valsalva pushing. You can explain at the end of the conversation that if women are left
to follow their own instincts they will usually breathe throughout a contraction and then
hold their breathe for no more than 5-6 seconds while they push several times
throughout a contraction.
Another exercise you can try is one that demonstrates how much more strength we have
during labor if we continue to breathe while we are exerting through pushing. Ask one
of the men in the group to stand up in front of you. Stand facing him and place your
hands against each others, palms touching, in front of your chests. Ask him to take a
breathe and then hold his breath and push against you, trying to push you over. You do
the same, but take deep breaths and continue breathing throughout. In most cases you
will be able to push him more easily and may find that you are significantly stronger
than he is during that time. Some teachers try this with two men instead of being the one
involved however some men can become very competitive during this exercise so it is
less likely to effectively demonstrate the differences.
Many clients will focus completely on the labor and birth itself and think little about the
time afterwards. Childbirth classes are a great time to introduce the issues related to the
third stage where the placenta is born as a large number of clients may not have even
considered there being any options available at this time. Once they understand the
issues related to an actively managed third stage as compared to an expectantly
managed one they may develop strong preferences about how they would like this stage
to proceed.
The first thing is to ensure that each client understands what is happening through the
third stage. A great way to demonstrate the way the uterus contracts, causing a smaller
surface area to be available to the placenta and therefore it begins to naturally detach, is
to use a balloon. You have to first explain that obviously the placenta would be on the
inside of the balloon (or uterus) if this was really labor, but the exercise is simply to
give an idea of what is happening visually. Stick a large postage stamp to the outside of
the balloon after you have already inflated it. Allow the air to slowly come out of the
balloon and watch the stamp gradually begin to detach until there is not surface area left
for it to adhere to and completely fall off.
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The important issues to address with the third stage are mostly related to whether or not
the parents choose a natural or expectant third stage, or an actively managed routine
third stage. You can use a variety of exercises to provide this information. One way is to
use two paper plates. Draw lines on the plates to break them up into identical sections.
In each section write statements, or use graphics to represent, about the two types of
third stage management. Then cut the plates up into jigsaw pieces using the lines as
guides. Pass the pieces to the group and ask them to put the jigsaws together correctly.
By the end they will have identified all the components of the two different approaches
– possibly with a little guidance from you as they go – and you can answer any
questions as they are working through it.
A similar exercise can be done using cards with statements. Have three green cards
saying “Expectant Third Stage”, “Managed Third Stage” and “Could Be Either”. The
remaining cards – all white for example – have statements about the two different
approaches. The statements you use for this exercise, or the one above, can be found in
the table below. You can add some more of your own if you think there important topics
to cover.
Expectant Third Stage Managed Third Stage Could Be Either
Wait and watch Cord traction Placenta born
Mother upright Oxytocic drugs given Baby/mother skin to skin
Could take up to 2 hours Fundal massage
Cord clamped after
Cord clamped & cut
pulsation or once placenta
immediately
born
Should take no longer than
10 minutes
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Log on to the following webpage. There are a number of suggestions for
different games and activities you can use in classes on labor.
Ideas for labor class
Janelle Durham
Materials can be copied and used by educators but no profit is allowed to
be made from her resources.
When women are asked why they are attending childbirth classes, the most common
answer will be to learn about pain relief options and how to cope with pain. This is
particularly the case for first time mothers who have no real concept of what to expect
during labor.
There are many different approaches to teaching about the topic of pain and you have to
find the one that works for you specifically. There are a couple of “rules” that we would
suggest are important to remember when covering pain though.
1. Do not lead women to a particular expectation about pain. For some women the pain
will be described as excruciating, while for others they will say it never really hurt at
all but describe it as intense. Prior to labor there is no way of knowing how each
individual woman will respond.
2. Use your classes to provide information that is difficult to find elsewhere. Most
pregnancy books will tell women about the pain relief options available to them, but
do little to explain the physiology of pain, the factors that affect pain tolerance and
perception, or explore personal attitudes to pain. You can always provide a handout
on pain relief options available in your area rather than covering this topic
specifically in classes.
3. Remember to keep your own personal views on pain relief out of the discussion.
Women who labor without pain relief are no more heroes than they are martyrs.
Equally, women who choose pain relief are not weak, nor are they wiser than
women who do not.
4. Help women to remain open minded about their options and the path they will
choose once labor starts. They may be planning to have an epidural and then find
they labor so quickly that this option is no longer a viable one for them.
Alternatively, they may be intending to labor without medication and then become
so tired after a long labor that an epidural becomes more appealing to them.
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5. Watch your language. If describing the administration, for example, of an epidural
being placed, ensure you use the third person. It is much better to say “the woman
will be asked to lie still while the catheter is inserted” rather than “you will be asked
to lie still”. In this way you do not create a preconceived image for the mother of
how she will see herself during labor.
6. Be sure to include opportunities for the men in the group to explore how they will
deal with seeing their partners in pain, if that is how the labor progresses. The
emotions of supporters have a significant impact on the support they are bale to
provide and the choices the woman will make.
We would suggest starting any discussion on pain relief first with a discussion on pain
itself. What causes labor pain? Why does it hurt some women? What is pain threshold?
What factors affect pain perception?
Many childbirth educators spent much of the time on the pain discussion working
through all the different pain relief options available, together with the pros and cons of
each one. It is very difficult to do this in an unbiased way. It is also something that can
be just as effectively covered in a handout. Whilst it is important that women
understand epidurals, for example, do have side effects, this takes up an enormous
amount of time in classes – time which we feel is better spent on feelings about pain and
making choices rather than the specific options available.
One of the first activities we cover in this area when teaching our own classes is to
determine how the group members see themselves as dealing with pain. Ask all the men
to stand on one side of the room, and the women on the other. Place a piece of paper
with the number “0” at one end of the room, and another paper with the number “10” at
the opposite end. Ask the two groups to stand with their backs to each other so the
group of men cannot see the group of women. Now, ask the women to stand somewhere
between the numbers 0 and 10, based on how they see themselves coping with pain in
labor. 0 is “will not cope at all” while 10 is “will cope brilliantly”. Ask the men to do
the same for how they believe their partners will cope. Once everyone has chosen their
own place, get them to turn around and see where their own partner has selected to
stand. This exercise is not designed for a great deal of discussion to take place
afterwards. It is aimed rather to enable the group members to understand that people
have different ideas about their own tolerance for pain, as well as letting them see if
there are any major discrepancies between how they feel and how their partner feels. If
there are any group members standing below the halfway point between 0 and 10, it can
be worth getting them to explore why they chose to stand where they did. Ask them
open questions about how they think pain will be, and whether past experiences have
led them to this belief. Many people believe that since they do not like pain usually they
are not going to cope with pain in labor. Almost as if the only women who cope well
with labor pain are those that have a sadist streak or those that just do not experience
highly painful births.
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Once you have explored the concept of pain it is a good idea to open discussion on pain
tolerance and pain perception. It is often a new concept to clients that pain is something
that is in our heads – it is our brains response to a stimulus. Therefore, if we are able to
alter the way the brain interprets the stimulus we can also alter the response that is given
to that stimulus. This can be a good time to talk about positive and negative pain, as
well as factors that influence our responses. For example, ask the group to identify times
where they have deliberately chosen to do something that they know will be painful.
Examples might include running a marathon or exercising hard, plucking eyebrows or
waxing the bikini line. Ask them what they did to prepare themselves for the pain and
how they coped with it whilst they were experiencing it. Most will explain that focusing
on how it feels and breathing are helpful.
Next you can explore factors that make pain better or worse. You can explain that our
recognition for pain is pretty much the same across the world. What changes is our
willingness to tolerate it. When a group of people were all asked to hold onto a rod that
was progressively heated up, they all felt discomfort at the same point. However, some
were able to continue holding the rod for longer than others. You might remember the
research we discussed in Unit AP2003 – Pain in Labor where two groups – one Jewish
and one Protestant were exposed to painful stimuli. After the exercise the groups were
told that the other group had shown a greater tolerance to the pain and upon retesting the
Jewish group had a significantly increased pain tolerance level. This indicates that just
our mental attitude alone can affect our pain tolerance levels.
At this point you could ask the group to brainstorm – either as one large group or as
smaller groups – factors that might increase or decrease our tolerance for pain. Even if
there are women in the group who are planning to have an epidural or a planned
cesarean birth, it is beneficial to discuss what they can do to reduce pain. For women
planning a cesarean they may find this helpful for any anxiety prior to the operation
while for women planning an epidural this may help them cope before the epidural is
administered or if it is not as effective as they are hoping for it to be. If you do an
exercise such as this remember to finish it up by getting the group to determine what
they can personally do to enhance the factors that increase our tolerance and to reduce
or eliminate those factors that decrease our tolerance. This helps them to see how the
activity is specifically relevant to them and helps them identify how they can take
responsibility for decisions and influencing their labor themselves. For example, if they
identify that an environment where they feel safe, with low lighting, warmth and loving
supporters is helpful, they can discuss how they can make this happen in the place of
birth they have chosen. If the group is struggling to identify factors you can help them
by getting them to think about a time where they have been in pain and what has helped
or hindered. Suggest that they are currently in bed with stomach cramps – what could
they do that would help? How would they feel if they were alone in a room that was
cold with nobody next to them? Can they think of situations where they have been in
pain before where it was unbearable and why do they think it was so bad? You could
also introduce the concept of the Pain-Fear-Tension cycle at this point to help the group
see that as we experience pain we become more frightened, which leads us to become
more tense, and subsequently increases the pain we are experiencing.
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Focusing on pain is an effective way for many people to cope with the pain. This is
contrary to what many believe where they think that distraction is more effective. While
for some it is, the vast majority seem to find pain is easier to cope with if focusing
rather than distracting. The ice cube exercise we discussed in Unit AP2003 – Pain in
Labor is a useful one to cover at this point in a class.
Another issue that is often not covered in childbirth classes is developing realistic
expectations of pain and the relief options offered. Many clients believe that an epidural
is a risk free option for example that is 100% effective in eliminating all pain. On the
other hand, there are some clients who believe that if you simply focus on breathing
techniques you can get through labor without a hitch. Having realistic expectations is
important for all of their labor, but especially in relation to pain management.
The “Perfect Drug” exercise is a helpful one for establishing realistic expectations. Split
the class into smaller groups of 4-5 individuals in each group. You tell the group that
they are each a group of scientists with the ability to design the perfect drug for labor.
They can choose any characteristics that they want their drug to have. They write each
characteristic on a sheet of paper. Once they have all finished and come up with half a
dozen or so characteristics, move back to one large group again. Prepare a large sheet of
paper drawn up with a list of the options available in your area for pain relief, including
both pharmaceutical as well as non-pharmaceutical options. Below each option are a
series of checkboxes. Ask the groups to read out their chosen characteristics one at a
time. As they read them out you write them on your large sheet, one below the other
(see diagram example below). Once all the characteristics have been read out, as a
group you can then start ticking or crossing, indicating which pain relief options address
that characteristic. By the end of the exercise the group will have an excellent visual
example of the ways in which each option addresses their different needs. They can also
see how there is no single perfect option and each has pros and cons attached to it.
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Characteristics Epidural Narcotics Water Breathing
No side effects for
baby
No side effects for mother
Can still move around /
Mother can control dosage / /
Can still feel contractions /
No pain at all /
Doesn’t affect mental state
Can use at any time /
Can help to sleep /
Can use after the birth
Can use if need a cesarean /
Doesn’t affect breastfeeding
Makes a calm happy baby / /
Helps mother to bond / /
Working through the chart in this way helps the clients to understand all the pros and
cons in a non-confrontational and unbiased way. It also provides the opportunity as you
are working through the exercise to explain the side effects and clarify any
misconceptions about the options available. For example, if one of the characteristics is
for the option not to affect the baby you can briefly explain how the baby might be
affected by narcotics that he/she has been exposed to during labor.
The boxes where we have placed both a tick and a cross represent where the answer is
unclear. For example, if one characteristic was to feel no pain at all, you can explain
that in most cases the epidural will meet this objective, but that it is not always
completely effective. Equally, we have placed both a tick and a cross for helping the
mother to move around when using water. When in the shower or bath the mother will
have more ability to move than if on the bed attached to monitors, but her movement is
still restricted by the space available within the bath or shower itself.
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In any given childbirth class that includes first time parents having their baby in
hospital, up to 50% of them will have interventions such as assisted delivery,
episiotomy, induction or a cesarean birth. Because of this the discussion of interventions
is a critical one in childbirth classes. When deciding whether or not to teach
interventions many teachers struggle to find ways to explore the topic without
overwhelming and frightening clients, but also to teach them in a balanced and unbiased
way. You could approach interventions as many teachers do – by explaining each
intervention and clarifying any common myths surrounding them. Some teachers
discuss ways that you can ask informed choice questions when faced with intervention.
The reality for most parents that eventually have any level of intervention though is that
when faced with the prospect of them, the focus of the baby’s well-being overrides their
ability to question effectively and they are inclined to follow their caregivers advice
regardless of their own feelings or instincts.
There are clearly medical situations where interventions are warranted and life-saving.
However, we are all aware that many interventions are routinely applied without
consideration of evidence-based care. If you have been teaching for a while you might
like to focus more on the informed decision making with less discussion of the
interventions themselves. We cover many different techniques and activities for doing
this in our advanced training workshops and on our advanced training videos that will
be available in 2005/2006.
1. A paper chase is an effective way of determining current knowledge levels and
filling in the gaps. Split everybody into three groups. Provide each group with a
piece of paper.
One paper is headed FORCEPS, another VENTOUSE/VACUUM and the final one
is headed EPISIOTOMY. On each piece of paper, draw a grid of four boxes titled
WHAT, WHY/HOW/WHEN, ADVANTAGES and DISADVANTAGES.
Each group writes down as much as they know about the intervention in each of the
grid boxes. Give them 4-5 minutes to complete the grids and then ask them to pass
the paper on to one of the other groups. They complete each sheet so they all have
an opportunity to share their knowledge of the different interventions.
At the end of the exercise, one person from each group reads out what has been
written by everyone. If you provide a pregnancy or childbirth book to each group
they can also quickly look up the topic – you can mark the appropriate section in
advance so they are not wasting time searching for the information.
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Forceps Ventouse/Vacuum
WHAT IS IT? WHEN IS IT WHAT IS IT? WHEN IS IT
USED? HOW? USED? HOW?
ADVANTAGES DISADVANTAGES ADVANTAGES DISADVANTAGES
Episiotomy
WHAT IS IT? WHEN IS IT
USED? HOW?
ADVANTAGES DISADVANTAGES
2. A good exercise that can easily be covered during a coffee break is to split the group
into 3 and give each of them different activities. The first group discusses why an
assisted delivery might be necessary. The second group describes the procedure of
forceps and ventouse/vacuum. The third group answers a set of true and false
questions relating to assisted deliveries. At the end of this (about 5-10 minutes) each
group reports back to share what they covered.
3. If you would like to use a more visual approach to interventions, you can draw a
map. In the center of the map is a highway, or straight road, labeled a “normal birth
with no interventions.” Off that you draw smaller roads that indicate other things
that can happen – an induction using different methods, labor slowing down or a
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long, tiring back labor for example. You can draw the picture in advance and work
through it in the class or draw it as you work through the discussion, involving the
group in identifying forks that might have to be taken. You can further extend the
exercise by getting the group to identify ways that they could “get back on track” if
they have to take a fork. At the end of the exercise you could bring the discussion
around to talking about how they might feel if their “perfect birth” does not happen.
This will then integrate some feelings and emotions work together with the
knowledge gained from the exercise.
4. A general group discussion on the differences between “normal” labor and an
induction can be useful in identifying the many interventions that often accompany
inductions and picturing how the cascade of intervention can occur.
5. A true/false exercise can help to dispel some of the myths about interventions. Put
each statement onto a card and ask the group to put the cards onto the floor into two
columns of true and false. Examples of statements are:
A mother does not have to push while forceps are used (false)
An episiotomy must be done before forceps or ventouse are used (false)
If ventouse is not successful, forceps will always work (false)
Forceps can sometimes cause small indentations on the baby's head (true)
Ventouse/vacuum can cause caput on a baby's head – this is a good opportunity
to show a picture and explain caput (true)
Instrumental deliveries can sometimes injury the mother (true)
A mother must be in stirrups to have forceps or ventouse/vacuum (false)
Forceps and ventouse/vacuum are not available at home births (true)
Forceps are commonly used to life a baby out during a cesarean birth (true)
You can do the same thing for episiotomies and cesareans. In smaller groups, each
group can take one pile for a specific topic and decide on the truth or falsehood of each
statement. This will generate a good discussion without the need to lecture and avoids
the teacher as coming across as anti-intervention
In our experience, discussing the interventions themselves though is limited in its
effectiveness. While it will allow clients to understand the procedures and the
terminology, it does not help them to identify strategies that will avoid the interventions
themselves. Nor will it help them to make choices during labor. The reality is that if
their caregiver tells them there is a concern about the baby and a particular intervention
needs to be used, they are unlikely to begin a discussion on the necessity of the
intervention as they are only concerned about their baby at that point in time, and rightly
so. As an alternative, you can focus on teaching decision making skills and sharing tools
that help them to identify a caregiver who is in line with their own philosophies, and to
learn how to communicate more effectively with their chosen caregiver. The beauty of
this approach is that you enable them to see that there is no right or wrong, good or bad,
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in terms of care during labor as such. Rather it is about finding the right fit of caregiver
based on whatever they as individuals want from the experience.
Many clients will be worrying about having to have a cesarean and others will be
planning one for various reasons. Removing some of the fear can be achieved by
ensuring you cover this topic in your classes. You can integrate cesarean births with
vaginal births in the videos you show in classes and can also tackle a few different
exercises to enable the group to discuss the subject.
1. Provide a contrast between vaginal birth and cesarean birth by helping the group to
visualize the room itself where their baby might be born. First, provide a set of small
square and oblong shaped cards, paper and pens. Ask them to draw on the paper the
room if they are having a “normal” birth. Each of the square cards represents a
person who will be in the room – the mother, father, other supporters, caregiver,
nurse or midwife. Each of the oblong cards represents a piece of equipment – the
shower, the delivery bed, a chair, the baby cot etc. They place the cards on the paper
where they see everyone standing and the items positioned. Next, provide another
sheet of paper and ask them to do the same for a theatre where a baby is being born
by cesarean. You will need additional square, or people, cards to represent the
pediatrician, the anesthetist and additional nursing staff. This provides an
opportunity to discuss all the different people and their roles. At the end of the
exercise you can take the father card and remove him from the room. Finish by
discussing reasons why this might happen and how they would feel if it did.
2. Like the interventions activities, a true and false exercise can be helpful in dispelling
myths about cesareans. Ideas for true and false statements include:
Once a cesarean, always a cesarean (false)
Forceps might be used to help deliver the baby from the abdomen (true)
An epidural must be removed immediately after the cesarean has been
completed (false)
Ankle exercises after the birth help to reduce the risk of an embolism developing
(true)
A mother must not eat for 24 hours after a cesarean (false)
Waiting for labor to start on its own significantly reduces the risks to the baby if
born by cesarean (true)
An emergency cesarean is carried out only when the baby is at risk of dying or
being harmed (false)
Remember to have some discussion on the differences in recovery and breastfeeding
following a cesarean. It can be helpful to have a mother join the class who has had a
cesarean to discuss with the group how she found the experience. This helps to provide
some realism to the experience.
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It is also important to discuss the range of emotions that might surround a cesarean
birth. To do this you could use pieces of paper with a range of physical and emotional
feelings written on them. Scatter the pieces of paper on the floor and ask each group
member to choose two of the feelings that they might feel immediately after the baby is
born. Then ask them to choose another one or two to identify how they might feel 6
months later. If there are a couple that you feel are important to discuss and these are
not chosen you can select these ones. Go around the group and discuss the feelings they
chose, then identify what they might do to help with some of the more negative
emotions or physical feelings. Identifying support and sources of further information
can help the parents identify strategies for dealing with their feelings afterwards.
Suggestions for feelings include:
PHYSICAL - pain, hunger, immobile, thirsty, ravenous, cold, flabby, exhausted,
shaky, tired, itchy, uncomfortable, starving, well, sick, in pain, numb, comfortable
or fatigue.
EMOTIONAL - concerned, excited, concerned, delighted, love, deflated, flat,
relaxed, relieved, numb, grateful, traumatized, proud, failure, like crying,
overwhelmed, helpless, guilty, thrilled, high, euphoric, full of joy, elated,
mesmerized, emotional, overjoyed, tearful, low, incredulous, contentment, anti-
climax, detached, complete, disbelieving, disappointed, enthralled, concerned,
cheated, happiness, demoralized, overawed, wonderful, calm, stunned and dazed.
There is so much to teach on breastfeeding that you might feel overwhelmed in covering
this effectively. Go back to the basics and identify the three key points you want to get
across in a breastfeeding class. These might be:
1. Positioning
2. Support
3. Expectations
Many teachers use a grab bag for a breastfeeding class. This involves putting items into
a bag that relate to breastfeeding. The bag is then passed around and each person in the
group selects one item. The group then discuss each item in turn, identifying its
relevance to breastfeeding. Suggestions for items in the bag include:
Clock – feeding routines, expectations about how often newborn babies feed,
feeding through the night, not having enough time to do anything else
Cabbage – engorgement
Condoms – contraception and the return of sexual feelings
Water – eating and drinking for the mother, feeding a baby in a hot climate, the need
for additional fluids for the baby
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Walnut – the size of a newborn baby’s stomach
Breast pump – returning to work, going out and leaving the baby with a carer, is
pumping necessary in the first few weeks?
Nipple cream – taking care of the breast
Telephone – who to call if you have problems
Sexy lingerie – body image, sex
Nursing bra – where to find them, choices available
You can teach positioning by using dolls that the mothers hold combined with a video
that shows a good latch. Ask the mothers first to hold the baby doll as if they were
breastfeeding. Most will hold the doll in a bottle feeding position. Demonstrate how to
move the baby onto its side and line the baby’s nose up with the mother’s nipple. An
easy way for them to remember is:
Tummy to tummy
Baby to breast
Nose to nipple
You can also use the dolls to practice and demonstrate several different breastfeeding
positions.
Some teachers will go into great detail about common problems experienced by
breastfeeding mothers. Take care to keep the topic of breastfeeding a positive one. By
all means, discuss problems such as engorgement, thrush and mastitis briefly but ensure
that you do not focus only on the problems or give the impression that breastfeeding is
such hard work that their chance of success is limited. If you have not breastfed
yourself, or have had a negative experience of breastfeeding, deal with this before
teaching this class! This is a great opportunity for you to debrief your breastfeeding
experience in a reflective story or journal. If you do not do this your feelings about
breastfeeding in relation to your own experiences or limited experience will come
across in your teaching.
One way of making the topic of breastfeeding problems a positive one is to focus on the
possible solutions rather than just explaining the problems themselves. You can use a
set of “Problems” cards together with a set of “Solutions” cards and ask the group to
determine possible solutions for each of the problems. If you make more than one set of
the cards you can then break them into several smaller groups to work together. This
enables shyer members of the group to contribute equally.
The cards on the following page can be used as examples of this exercise. This activity
works well for visual and kinesthetic learners. You can evaluate its effectiveness by
having a discussion at the end where you ask each group member to say one thing they
learned from this exercise.
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PROBLEMS
Seems to fall asleep after
Cracked or bleeding nipples Baby fussy at breast
only a few minutes
Sharp pain in shoulder
Breasts hard and hot Lumps in breasts
blades
Baby suddenly has nappy
rash or white spots in Mother depressed and Baby feeding every 1-2
mouth that cannot be crying all the time hours
rubbed off
Baby feeding more than an Baby wakes every hour
Baby’s poo is green
hour at a time during the night
No wet nappies for more Mother feeling achy and Baby does not seem to be
than 6 hours breasts hot getting enough milk
Baby only feeding every 4
Baby not gaining weight Mother exhausted
hours
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SOLUTIONS
Check breastfeeding Try a different
Give the baby formula
position breastfeeding position
Ring breastfeeding
Give the baby water Go and see pediatrician
counselor
Place warm compress on
Rest more often Eat and drink more
breast
Place cold compress on Express a little milk before
Feed more often
breast feeding
Go to bed with baby for 24-
Feed less often Stop breastfeeding
48 hours
Possibly thrush – try Baby only feeding every 4
Try relaxation techniques
measures to eradicate hours
Feed for longer on each
Take a break from the baby Contact doctor
side
Go without a bra for a few
Try a different nursing bra Readjust expectations
days
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Log on to the following webpage.
Breastfeeding benefits
Breastfeeding handouts
Janelle Durham
Materials can be copied and used by educators but no profit is allowed to
be made from her resources.
Log on to the following webpage.
Breastfeeding curriculum
Medela
Log on to the following webpage.
Outlines for a varity of class formats
Janelle Durham
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This task summary is for your own records. It does not have to be submitted.
All too often we teach topics in an obvious way. This is particularly an issue if you have
been teaching for a long time and have got into a rut. During this exercise you will
select a topic and come up with a radically different and innovative way to teach it.
You can be as way out and as inventive as you want to be. It does not matter that the
practicalities of teaching this topic in the way you design is impossible to implement.
The purpose of the exercise is to think outside the box. Sometimes you will then be
inspired to have a different approach to the way you teach and this encourages you to
experiment with new ideas.
Choose one of the following topics:
Pain
Cesarean
Interventions in general
Stages of labor
Spend some time thinking about a different and experimental way of covering this topic
in classes. You might like to write a poem or song, have an activity that involves
drawing or other artwork, a role play that you design yourself, or a physical activity that
involves all the group.
Once you have designed the activity, determine the practicality of it in applying it to a
childbirth class. Could it work? What sort of people would it appeal to? How could you
adjust it to make it more practical and applicable?
If you would like to share the activity you have designed with the other students, that
would be great. Write the activity out in an email and post it on the cbistudents list at
cbistudents@yahoogroups.com . Make notes about your activity and the answers to the
above questions on the following pages.
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Teaching Communication Skills
Teaching Communication Skills
During this unit we will be exploring different activities that provide information on
communication skills such as communicating with caregivers, birth plans and decision
making. We will be covering games and activities that have worked for many teachers,
assisting you in building up a repertoire of teaching ideas.
Topics covered will include:
Teaching assertiveness
Cascade of intervention
Choices – who makes them?
Sharing beliefs
Models for communicating
Communicating with each other
At the end of this unit you will be able to:
Plan teaching activities for communication topics
Determine the learning outcomes that the activities address
Determine the learning styles that the activities meet the needs of clients
Identify ways that the activities can be evaluated for effectiveness
There is no suggested reading for this unit.
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Teaching Communication Skills
In this study guide we are going to introduce a multitude of ideas for teaching topics
that are designed to improve communication skills and help your clients to achieve the
birth that they want, as defined in their terms. As with our other teaching topics, the
different activities covered here are not designed to be prescriptive. Take the ideas, play
with them, find ways that they fit with your particular style and personality, and adapt
them accordingly.
Teaching communication may seem like an odd topic to cover in childbirth classes. For
those of you who have already completed our Communications module though you will
know how important communication is in terms of developing our skills in dealing with
others and helping us to determine our own perspective. This is also true of our clients.
The more effectively they can communicate with their caregivers, the better chance they
have of having the birth they want, regardless of what that is.
In each section we will provide a list of ideas. Ideas will be explained in detail and will
explore potential learning outcomes, learning styles that are suited to that activity and
strategies for evaluating effectiveness.
Many couples find that whilst they can be assertive in an environment where they are
comfortable such as their own home or workplace, they cease being so when they are in
front of a doctor. This is not surprising since many of us were brought up listening to
comments like “listen to the doctor”, “be a good girl for the doctor” and “the doctor will
know what to do.” We tend to put doctors on a pedestal. This is partly due to our
upbringing and the place of respect that doctors hold in all societies. It is also due to our
previous experiences with doctors. We are usually ill when we are consulting with one
and therefore look to him or her who can make us feel better. For many women, they
are in awe of the education and perceived intelligence of doctors as well. On top of all
this is the mysticism that the human body holds and the reluctance of many to take
responsibility for their own health.
So, why is assertiveness important in pregnancy and childbirth? Our view is that it is
important in all terms of healthcare. Regardless of how involved people want to be in
the decisions surrounding their health, the alternatives to assertiveness are simply
ineffective at creating positive relationships with caregivers. Aggression clearly is not
an effective approach when trying to communicate with a caregiver or hospital staff
member. And passivity, while it may avoid confrontation, is not a positive way to
communicate with others.
How then, do you as a childbirth educator, help others to be more assertive? The first
step is to become more assertive yourself. As a teacher you model behavior to your
clients – walk your talk so to speak. To become more assertive, you first need to
identify situations where you are clearly not assertive and recognize the reasons for this.
You cannot fix a problem without understanding what it is caused by.
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Think about a situation recently where you have responded aggressively.
Describe your response and then identify the factors that led you to behave
this way. For example, it was the end of a bad day, you were hungry or tired,
you were feeling defensive or you simply did not like the other person.
Now identify a situation where you have responded in a passive way. Again,
think about the factors that led you to behave this way – the position of the
other person (e.g. an authority figure), tiredness, discomfort with
confrontation etc.
Finally, think about any situation in the past where you believe you
responded assertively. How did you feel about yourself afterwards? What
factors were different in this situation than in the situations where you felt
aggressive or passive? How did the outcome compare to the previous two
situations?
As you can see from the previous exercise, there are many factors that affect our ability
to be assertive. Imagine a woman in labor for the first time arriving in hospital. This
may be her first ever trip to the hospital as a “patient”. She is in labor, may be afraid of
how she is going to cope, and may be in pain. She is going to be concerned about the
well-being of her baby. The noises and smells are ones that she is unfamiliar with. She
is probably meeting her nurses and midwives for the first time. If she has a desire to be
liked by the hospital staff, as most people do, she is unlikely to walk in there wanting to
tackle any difficult issues. As labor becomes more intense these issues will all become
more significant. The staff are all busy and she is concerned about “bothering them”.
The staff themselves may reinforce this feeling if they behave as if her questions or
concerns are foolish or silly. How likely, given these factors, is it that the mother is
going to be assertive without any previous education in this area or previous
knowledge?
Alternatively, she may be a woman having her third baby. In her previous two labors
she feels she was treated badly by the staff at the hospital. This time she is determined
she is doing it her way. She walks into that environment in a challenging way – “just see
if you can control me!” Before she has even stepped through the door she is being
aggressive. Hardly a situation that is conducive to support and encouragement!
Many women, when you speak to them about being more assertive during pregnancy
and labor, worry that to do so will mean upsetting their caregiver. Assertiveness though
does not involve arguments. It is about stating your point of view and being heard.
Women deserve to know their rights in terms of health care.
Women have:
The right to be treated as an individual
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The right to be fully informed choices being offered
The right to ask questions and receive accurate answers from her caregiver
The right to be treated with respect
The right to refuse
The right to confidentiality
The right to make informed choices without undue pressure from others
The right to a safe environment with supportive caregivers
It is also important to remember that the caregiver also has rights.
Caregivers have:
The right to be treated as an individual
The right to be treated with respect
The right to refuse treatment
The right to dismiss a client
The right to practice in an environment where they feel safe and that their practice is
safe
It is important to remember that some clients do not want to make choices or participate
in decision making. Choosing not to be involved and hand the responsibility for the
decision over to their caregiver is a valid choice and one that also should be respected.
Before you begin to explore assertiveness in decision making and asking questions, it is
helpful to talk to the group about body language and assertiveness. It is very difficult to
be assertive when you are lying down with your knickers off! Try this exercise. Lie in
the middle of the group, propping yourself up by the elbows and spread your legs wide
apart with everyone looking down on you. Ask if anyone can see why normally
assertive people suddenly are less likely to be this way when in hospital. Ask the group
to move you around so that you are in a more physically assertive position.
Simply practicing different possible scenarios or situations help to build your clients
confidence in dealing with issues in an effective and assertive way. You can provide
several different scenarios and ask couples to consider it. How would they feel if this
happened to hem? What choices would they have? Where could they get more
information? Write the situations on cards and hand them out. If you laminate the cards
they can then be used as one of your class resources. In addition to the issue, provide a
variety of handouts, printouts from the internet and books for them to find the
information. When we do this activity we give each couple ten minutes to work through
their scenario. They are told that they can come and ask the teacher questions at any
time during the ten minutes to clarify or explain anything. At the end of the activity,
they share the activity with the rest of the group by reading out their situation. They
then identify to the group what they found out and what they think they would do in this
situation. One of the most bizarre outcomes of this activity is the number of times the
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couples actually end up having the scenario they were given in their own labor!
Examples of possible scenarios include the following.
1. You have been having regular contractions for the past 48 hours. You have been
unable to sleep and are now exhausted. You are starting to feel some pressure in
your bottom at the peak of contractions and having intermittent backache. You
are wondering whether you should be making your way to the hospital. This is
your first baby. What do you do?
In this situation, the likelihood is that the mother is experiencing a baby that is
trying to rotate to a good position and is now moving to posterior. This is an
excellent opportunity to talk about strategies for dealing with early labor and
resting. It is also a chance for you to recap with your clients over signs for
active labor and transition.
2. You have been having some intermittent contractions for the past few days. You
know your baby is in a good position with its head down and you are 40 weeks
and 3 days pregnant. This is your first baby. As you stand up to go to the kitchen
you feel a gush of warm fluid and think your waters might have broken. What do
you do?
This scenario enables you to discuss the caregiver’s policy on ruptured
membranes, the differences between hind and forewater leaks and the risks of
prolonged rupture of membranes. If the couple have chosen an active
management caregiver this discussion helps them to see how they may be led
down the cascade of intervention even if there were no problems with themselves
or the baby.
3. You have just seen your doctor and he has said your blood pressure is higher
than normal. He is concerned that this, together with some swelling in your
ankles, is an indication that you are developing pre-eclampsia. He would like to
schedule an induction for the following Monday morning. You are 39 weeks
pregnant with your second baby. What do you do?
This scenario allows clients to explore management policies for routine
induction together with identifying the potential risk factors of illnesses such as
pre-eclampsia.
4. Your baby was born two days ago. The nurse came to see you an hour ago to
take the baby for a jaundice test that you were told was routine. She has just
returned and informed you the baby has a very high bilirubin count and is
seriously jaundiced. She wants to take the baby to the nursery to go under lights
for treatment. The baby has been feeding well every 2-3 hours and appears well
to you. What do you do?
This scenario introduces the idea that assertiveness does not end with the birth
of the baby but will continue on throughout their lives as parents. You can
explore the merits of routine tests, consider the jaundice treatment guidelines
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and discuss alternatives to jaundice light treatment. You can also take the
opportunity to discuss breastfeeding a jaundiced baby.
5. Your baby is two weeks old. You have gone to the doctor because you woke up
this morning feeling very unwell. You have flu-like symptoms and are aching all
over. Your breasts are hot and red and feel very lumpy. Your doctor has told you
that you have mastitis. He has prescribed antibiotics and said you must stop
breastfeeding for 48 hours. What do you do?
Another scenario that focuses on postpartum issues, this gives your clients the
opportunity to explore alternative treatments for breastfeeding problems. It also
enables them to grasp some understanding of the degree of understanding
medical caregivers may have of breastfeeding problems and to identify
alternative sources of support.
You can create your own scenarios depending on whatever issues your clients
commonly face. The idea is to think about creating a scenario where they can consider
alternatives and possible outcomes. Draw up your learning outcomes first and ensure
that each scenario can meet these.
Evaluation of this exercise is pretty straight forward. There are no right or wrong
answers as each couple might choose something completely different depending on
their own beliefs and situations. Look for understanding of the fact that options are
available and ways in which they can find their own answers. Remember to emphasize
that this exercise is valuable because it is the research and decision making skills that
they can apply to any given situation.
When interventions are being suggested, decisions need to be made. Parents often feel
overwhelmed by the way that interventions seem to cascade from one to another and
often will say after their birth that nothing went to plan. “I got nothing in my birth plan”
is a common refrain amongst new mothers. One way of covering intervention is to focus
on the cascade of intervention itself. This is a very visual approach and particularly
effective with kinesthetic learners. Ask for a male volunteer to pretend he is a pregnant
woman about to have an induction. The rest of the group are medical students who will
be part of the team. You will play the primary caregiver. You write down all the
possible interventions in advance on sticky notes, making sure there are several copies
of the more commonly used ones such as vaginal examinations and electronic
monitoring. Ask the man to lie down on the floor, providing a mat and pillow. You then
play the role of the caregiver, talking through each procedure as you do it. You can ask
one person to write down on a large sheet all the interventions as they occur, which you
will use at the end of the exercise.
Hand out the sticky notes to the group of “medical students” so each one has several
interventions in their hands. Ask the team of medical students what they think they
should do at each stage. They will automatically look at their notes and use those as
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prompters. As you, as a group (not involving the father) determine the best strategy, you
place that note on the father’s leg. You can have additional props to show the lack of
mobility during a typical induction. For example, a piece of tubing that is attached to his
wrist for a drip, two lengths of elastic around his waist for the monitor, a length of
tubing for a catheter and a cuff and wire for a blood pressure monitor.
As you work through the exercise you regularly ask the father how he is doing but avoid
asking what he would like to do at any time. You talk him through how his labor is
progressing, explaining things like the labor is slowing down and you think you need to
use some medicine to speed it up, you are concerned about the baby’s heart rate and he
is finding the contractions very difficult to cope with now, offering pain medication to
make him more comfortable.
At the end of the exercise, you finish with the baby’s birth, however that was
determined to happen. You can then turn to the sheet of paper where all the
interventions were written down. The interventions are all written in a list down the left
side of the page. It is a good idea if you have these written in red marker pen. Using a
green or blue pen, you then work through each one, asking the group what other
alternatives there were at each step of the way. This helps the group to identify
alternative strategies and to see that even if the cascade starts, there are things they can
do to slow them down or stop them altogether.
Finally, ask the group why they only chose the interventions that were in their hands
and never or rarely suggested non-medical alternatives, as is usually the case. This will
help them realize that a doctors toolkit includes the medical options but rarely includes
the non-medical ones and that if parents do not ask questions and explore options, the
doctor probably will not either. This reinforces the importance of them taking
responsibility for their own births and the decision making.
After this exercise you can continue with exploring tools that help them in making
decisions. One of these is to use the decision making chart that you can find on our
student website here:
http://www.childbirthinternational.com/Student/Downloads/Decisions.pdf
Another tool is to use BRAIN. On a large sheet of paper draw up:
B Benefits
R Risks
A Alternatives
I Instinct
N Nothing
You then work through each one.
Benefits: What are the benefits of this intervention that you are suggesting?
Risks: What are the risks of this intervention that you are suggesting?
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Alternatives: What are the alternatives to the intervention – remind them they can use
other resources besides their caregiver such as books, the internet, you, other parents
etc.
Instinct: What does your instinct tell you? What feels right?
Nothing: What might happen if we do nothing or take a wait and see approach?
Remember to emphasize the importance of asking one question first – have we got time
to discuss this? This ensures they understand from the outset whether this is a true
emergency or something that can be delayed for minutes, hours, days or even weeks.
One way for parents to begin to acknowledge their responsibility for decision making
during pregnancy and childbirth, and subsequently for parenting, is to examine the
different choices available and who is responsible for making them. In this activity you
provide a sheet of paper with a grid drawn up on it, showing examples of some of the
choices available. In pairs, usually couples works best, the clients tick the box
depending on who they feel is responsible for each choice. See the example on the
following page.
At the end of the exercise you can talk about any areas where they had problems
answering. At the end of this exercise you can explain the differences between active
and expectant management. This then follows with an explanation of how the
management option is not the most relevant thing. More importantly is that the parents
feel the caregiver has the same style as they have. Some parents will be more
comfortable with an active management approach, while others prefer an expectant
management caregiver.
It can be helpful to provide an additional two sheets – one showing where the ticks
would be for an active management approach while the other shows a more expectant
management approach. They can then easily see where their expectations lie and which
sort of caregiver is going to most closely match their needs. We will talk in more detail
in the Teaching Communication unit about how parents can select a different caregiver
or work more effectively with the one they have chosen.
The following pages show the charts for both active and expectant management care in
most circumstances. These are generalities and there are obviously exceptions to all of
these issues. The point of the charts is to give a general feel as to the roles and
responsibilities of the parents and the caregiver in different management styles.
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Decisions – who makes them?
Mother Father Caregiver
What mother wears during labor
Positions mother labors in
Positions mother gives birth in
Choice of supporters present
Pain relief methods used
Rupturing the membranes (breaking the waters)
Choice of music during labor
When to go to hospital
When to have a vaginal examination
Lighting in the room
Use of electronic monitoring
Whether to have a cesarean
Whether to have an episiotomy
Whether to have an induction at 41 weeks
Videos or photographs taken
Which medical staff present in room
Announcing the sex of the baby
Who catches the baby
Where to give birth – home, hospital or birth
center
How the mother breathes while pushing
Cutting the umbilical cord
How the placenta should be birthed
Whether the baby should be routinely suctioned
Giving vaccinations to the baby
Breast or formula feeding
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Decisions – who makes them in Active Management?
Mother Father Caregiver
What mother wears during labor
Positions mother labors in
Positions mother gives birth in limited
Choice of supporters present
Pain relief methods used
Rupturing the membranes (breaking the waters)
Choice of music during labor
When to go to hospital
When to have a vaginal examination limited
Lighting in the room
Use of electronic monitoring
Whether to have a cesarean
Whether to have an episiotomy
Whether to have an induction at 41 weeks
Videos or photographs taken
Which medical staff present in room limited
Announcing the sex of the baby
Who catches the baby
Where to give birth – home, hospital or birth
center
How the mother breathes while pushing
Cutting the umbilical cord
How the placenta should be birthed
Whether the baby should be routinely suctioned
Giving vaccinations to the baby
Breast or formula feeding
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Decisions – who makes them in Expectant Management?
Mother Father Caregiver
What mother wears during labor
Positions mother labors in
Positions mother gives birth in
Choice of supporters present
Pain relief methods used
Rupturing the membranes (breaking the waters)
Choice of music during labor
When to go to hospital
When to have a vaginal examination
Lighting in the room
Use of electronic monitoring
Whether to have a cesarean
Whether to have an episiotomy
Whether to have an induction at 41 weeks
Videos or photographs taken
Which medical staff present in room
Announcing the sex of the baby
Who catches the baby
Where to give birth – home, hospital or birth
center
How the mother breathes while pushing
Cutting the umbilical cord
How the placenta should be birthed
Whether the baby should be routinely suctioned
Giving vaccinations to the baby
Breast or formula feeding
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Childbirth International has designed a tool to help clients identify whether or not their
caregivers have the same approach to pregnancy and birth as they have. One of the key
elements we have found to be significant in whether women feel they get the birth they
want is the degree to which the mother’s beliefs match her chosen caregiver’s beliefs.
What is difficult for the mother is to accurately determine this without some sort of
model or structure to work from.
The BLIEFs model enables a mother to ask her caregiver a series of open questions that
will provide an insight into the caregivers belief system in relation to pregnancy and
birth.
View the powerpoint presentation on this model through the Childbirth
International website.
BLIEFS Model
Childbirth International
We have previously covered BRAIN, a technique for asking questions in a structured
way. There are two other models that Childbirth International has developed that may
be helpful for your clients to learn. Different strategies will work for different people so
explaining several methods to achieve the same outcome may be helpful.
Perhaps more than any other time in our lives, pregnancy is a time in which we are
faced with a multitude of choices to be made which affect not only our own lives but
potentially the lives of our unborn children:
Which caregiver to choose?
Where to give birth?
Whether to have antenatal testing and if so, which tests?
What kind of birth do we want?
Should we vaccinate?
Do we get our baby boy circumcised?
The range of choices and options can be overwhelming and many parents approach the
task fearfully, perhaps even avoiding the issue altogether and simply following the
advice of their doctors, friends or relatives. This approach may work just fine when
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everything goes according to plan, but as soon as there is a crisis or unexpected
situation, it can leave parents feeling vulnerable and out of control.
As a Childbirth Educator your clients will look to you as a source of information and
advice on the choices facing them. They will perceive you as an expert and may expect
you to help guide them through the maze of choices ahead of them. That is quite a
responsibility! What is your role in all of this and how can you help them make good
decisions?
What is a smart choice?
First, consider what you mean when you use words like "she made a good choice", "that
was the right decision", "smart move" or "good decision"? Are you talking about the
outcome, the actual decision made (whether to induce a post-term pregnancy or not) or
the process - how the decision was made and what factors were taken into account?
Our definition of a good decision is one that works for the person taking the decision at
the time the decision was made. It may be made in a very scientific way weighing up all
the pros and cons, or it may be made in a very instinctual way based on emotion and gut
feel. Either could be considered a good decision, provided the person making it has
taken responsibility for their decision and understands the basis on which they have
made it. Opting NOT to explore options and alternatives is a choice just as much as
opting to seek a second opinion.
Informed choice and responsibility
The terms informed choice and informed consent are commonly used in the context of
healthcare decisions. Indeed, many hospitals and medical institutions now have
"informed choice for patients" enshrined in their mission statements or patient's
charters. But what does it mean to make an informed choice?
An informed choice is one that is freely made by an individual on the basis of options,
information, and understanding. In other words, informed choice refers to the process of
decision making. Informed consent, on the other hand, is the communication of that
decision to the caregiver - for example, agreeing to an induction or other procedure.
Sadly, many of you will have come across situations where what appears to be an
informed choice is actually a choice made on the basis of limited information. For
example, the client has a caregiver who recommends an induction without offering them
a full picture of the potential risks.
As a Childbirth Educator you may have access to a much broader range of information
than that being offered to your clients. You may feel responsible for offering them that
information or even for helping them see that their caregiver is being less than open
with them. However - the first question to ask yourself is - do they want that
information? Will it empower them or leave them feeling more confused than ever?
Remember that your role is never to give advice or make recommendations.
It can be tempting to see your role as information gatherer or information provider.
Doing research and being able to apply your carefully-acquired knowledge to a situation
can be very rewarding. However, it is perhaps more appropriate to focus more on your
role as that of a facilitator. In this role your primary focus is on asking exploratory
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questions and using your listening and communication skills to help your client discover
the situation from different perspectives.
The DECIDE model gives you a simple framework in which to do this:
Discover
Explore
Compare
Inform
Decide
Evaluate
The following scenario shows how this framework may be applied to a real-life
situation.
Step One - Is there actually a problem? (Discover)
The first step is always to check that the client wants the information and that there is, in
fact, a decision to be made. Imagine the following scenario:
Client: "My doctor has told me that this is going to be a big baby. I need to have an
induction on Monday if I have not gone into labor over the weekend."
Doula: "And how do you feel about that?"
Client: "Oh fine, to be honest I'm fed up with being pregnant and just want to get the
show on the road."
Doula: "Do you have any concerns or questions?"
Client: "Not really, he explained it all to me and it sounds just fine. I'll let you know the
date when it is scheduled and you can meet me at the hospital."
In this scenario the client is totally willing to go along with her doctors
recommendations. She has not expressed any interest in considering alternatives nor any
desire to explore the decision further. In this case it would not be appropriate to try and
"talk her out of it" or share what you know about the risks of induction.
However, for the purposes of working through the DECIDE model, let's imagine that
the client instead responds:
"I'm feeling a bit worried - I really wanted a natural birth and now it looks as if that
won't be possible".
Where do you go from here?
Step Two - What exactly is the problem? (Explore)
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Define the problem - frame the decision correctly. If you begin from the wrong place,
you won't be able to make a good decision.
Let's imagine the client starts by saying she is thinking of using castor oil over the
weekend to "get things going" as a way of helping her avoid the hospital induction. She
wants to know if you have any other suggestions. What is the problem here? Your client
is seeing it in terms of her not having gone into labor yet. For her the choices to be made
are about which method of induction to choose.
However, as you explore the problem further with her and help her reflect on her
feelings she starts to realize that in fact the problem is that she is not truly comfortable
with her doctor's approach. She wants as natural a birth as possible and yet is with a
doctor who clearly practices active management. This puts a whole different
complexion on the decisions to be made.
Step Three - Create imaginative alternatives (Create)
This is a phase for creative thinking. In the example above, by simply considering
different methods of induction as alternatives from which to make a choice you might
inadvertently miss other options such as refusing the induction, switching doctors, and
so on.
The first step is to ask the client what she perceives as her choices. She may, for
example, only be thinking in terms of induction or not, she may not yet be able to see
that there may be other options such as seeking a second opinion or monitoring the
baby's wellbeing more closely.
Step Four - Gather information about your choices (Inform)
This step may be the stage where you are finally able to use your data gathering skills
after all! It is also the stage for your client to do her own information gathering -
perhaps calling other caregivers to make an appointment to see them. On your part it
may now be appropriate for you to do some research. This may be something as simple
as researching the risks and benefits of castor oil or it may be more complex such as
examining the latest evidence based guidelines on induction at term.
Step Five - Weigh up your choices and make a selection (Decide)
In this phase you help your client to evaluate her choices. The simplest way of doing
this is simply to list each option and write down the advantages and disadvantages of
each.
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Example : "Try natural induction over the weekend"
Advantages Disadvantages
May help avoid medical induction May not work
Mother can select a method she prefers May be unwanted side effects (e.g.
uterine hyperstimulation)
May carry less risk than medical May be in conflict with caregiver
induction
May help mother feel more empowered
This approach can be used for each of the options generated.
The second step in this phase is to help your client balance each of these options against
what they are hoping to achieve and reach a decision about what they plan to do.
Step Six - Reflect on the decision and clarify next steps (Evaluate)
The final step in the DECIDE framework is to evaluate the choice made.
How does it feel? Having gone through a fairly structured decision making process it
might be a good time to take a step back and consider how they really feel about the
option they have chosen - are they truly comfortable with it?
Considering how the decision they have made fits with their individual tolerance for
risk can also be a useful step - for some clients, safety will be the overwhelming
concern, while others may be much more concerned about issues such as freedom to
choose, or achieving a drug-free birth.
Sometimes choices involve trade offs and it can be useful to understand and explore
what these are. For example, trading off the desire for a natural delivery against the
comfort of staying with the caregiver who has supported them through 5 years of
infertility treatment.
It can be helpful at this stage to help your client look into the future and determine how
she thinks she might feel afterwards about her decision. How would you feel if you go
ahead with the castor oil and subsequently go into labor on your own? If you think
about a month down the track, how do you think you might feel if you decide not to
have the induction and end up with a cesarean for "failure to progress"? Alternatively,
what about if you have the induction and have a cesarean after many other
interventions? Explore all the possibilities and help your client to determine what
outcome would fit right with her and which one is going to lead to her having a sense
that she made a "good" choice for herself with no regrets.
What are the consequences of this choice - what else needs to be done? The final step,
once the decision has been made, is to identify exactly what the client needs to do to
make it a reality - communicating it to the caregiver, for example.
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Finally, as a Childbirth Educator it is important to remember that only your client can
determine what is the right choice for them and their individual circumstances. Enabling
them to make a choice on their own is empowering and teaches them a skill that they
can use in the future on many occasions.
MPOWER is a tool designed for women to ask questions when they are feeling
overwhelmed by the problem they are faced with.
View the powerpoint presentation on this model through the Childbirth
International website.
MPOWER Model
Childbirth International
One of the things that parents often find is how little they knew about their partners
parenting style before they became parents. Of course, this is obvious. How could you
possibly know what someone would be like as a parent or whether your styles were
compatible, if you have never done it before. It often surprises them though and is often
the source of conflict.
In the parenting sections of your classes, it is helpful to cover some activities that will
explore different styles and viewpoints. Be prepared that there may be some conflict
over this as couples realize for the first time that they do not agree on everything.
Usually this takes the form of stony silences between couples which can affect the
dynamics and momentum of the class. It is a good idea to schedule a coffee break after
these activities or something very lighthearted to give them time to cool off.
One of the biggest changes for new parents is the way the baby takes over their lives. A
priority setting exercise can help to determine what each person feels is important to
them once the baby arrives. Of course, this is all supposition and it may change
dramatically after the birth, but it is a good stepping stone.
Give each couple a sheet similar to the one on the following page. Ask them,
individually, to identify what is important to them. Once they have completed this, ask
them to compare their sheets with their partners and discuss any discrepancies. Give
them 5 minutes for the discussion and suggest that they come up with one thing they
could each do to compromise or resolve the discrepancy.
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At the end of the exercise, ask if anyone would like to discuss their findings. This is a
topic that is best not to put people on the spot. They may find they have some serious
conflicts with their partner and they may be very uncomfortable discussing it in front of
the whole class.
It is a good idea to follow this activity with one on building support networks.
Understanding that even when you and your partner are in disagreement there are others
that can provide support and friendship is a useful exercise. They can brainstorm this as
one large group, or you can have the men and the women brainstorm separately since
they may have very different and distinct support networks.
Another activity that is similar and can help to identify any issues relating to different
expectations between a couple is the following one on identifying responsibilities. Ask
the individuals to complete the table on their own, then compare with their partners. As
with the last exercise, follow with something light and easy and avoid a group
discussion where clients feel they have to share what they covered as their may be some
discomfort. To help them finish the exercise on a high note, ask them to discuss
strategies as a group for dealing with conflict in a relationship.
Log on to the following webpage. This handout provides a questionnaire for
couples to complete to gain an understanding of each other’s beliefs and
perspectives.
Beliefs About Birth
Janelle Durham
Materials can be copied and used by educators but no profit is allowed to
be made from her resources.
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Priorities – mark the importance of each (V-very, M-moderate, N-not important at all)
Immediately
6 weeks 3 months
after the birth
Just spending time with the baby as a couple
Spending time together without the baby
Spending time on your own
Spending time with other family members
Spending time together with friends
Spending time with friends without your partner
Sex and intimacy
Grocery shopping
Cleaning the house
Washing and ironing
Cooking meals
Gardening
Sports and hobbies
Work
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Responsibilities – who does what?
Mother Father Other
Feeding the baby during the day
Feeding the baby during the night
Changing wet diapers/nappies
Changing dirty diapers/nappies
Bathing the baby
Cleaning the house
Grocery shopping
Washing
Ironing
Cooking mother and father’s meals
Preparing baby’s meals
Gardening
Being at home when the baby is unwell
Arranging childcare
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This task summary is for your own records. It does not have to be submitted.
In this exercise you will work together with a friend to practice the DECIDE decision
making technique described earlier in this unit.
Ask a friend to describe a problem they currently have. It does not have to be related to
birth or parenting and can be as complex or as mudane as they like. In the sections
below, work through the DECIDE tool with them. Your role is one of guidance. Do
NOT give suggestions or answer the sections for them. Simply ask the questions and
guide them through the answers. Take care not to share your own personal opinions or
experiences.
At the end of the exercise ask them to rate the effectiveness of the tool for you. We will
assume, for the purposes of this exercise, that step one has already been covered and in
fact a problem does exist.
Step One – Describe the situation? (Describe)
Step Two - What exactly is the problem? (Explore)
Define the problem - frame the decision correctly. If you begin from the wrong place,
you won't be able to make a good decision.
Step Three - Create imaginative alternatives (Create)
This is a phase for creative thinking. Ask your friend what they perceive their choices to
be.
Step Four - Gather information about your choices (Inform)
Identify areas where research may need to be done to find out more. Carry out the
research together.
Step Five - Weigh up your choices and make a selection (Decide)
Ask your friend to weigh up the pros and cons of each available option.
Step Six - Reflect on the decision and clarify next steps (Evaluate)
The final step in the DECIDE framework is to evaluate the choice made. How does it
feel? Are they comfortable with it? Does it match their individual tolerance for risk?
Can they imagine how they might feel about this decision in a week? Or a month? Or a
year? Do they need to do anything to put the decision into place?
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Rate the effectiveness of this form of decision making:
Completely ineffective
Somewhat effective
Quite effective
Very effective
Rate the performance of the student.
How well did they explain the steps of the tool?
They didn’t explain it at all, I didn’t really understand it
They gave some explanation, I understood some of it
Their explanation was quite good, I understood most of it
They explained it very well, I had a good understanding of it
For the student, rate how easy you found the tool to use:
Very difficult
Somewhat difficult
Quite easy
Very easy
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Teaching About Parenting
Teaching About Parenting
During this unit we will be exploring different activities that provide information on the
postnatal period such as parenting, relationships and unexpected outcomes. We will
identify ways to make parenting real to expectant parents through the activities chosen in
prenatal classes. We will discuss activities that can be used to explore relationships in
the postpartum period and how to address difficult topics such as unexpected outcomes,
grief and loss. We will be covering games and activities that have worked for many
teachers, assisting you in building up a repertoire of teaching ideas.
Topics covered will include:
Making parenting real
Relationships
Postpartum depression
Grief & loss
Dealing with postpartum life
At the end of this unit you will be able to:
Plan teaching activities for parenting and postpartum related topics
Determine the learning outcomes that the activities address
Determine the learning styles that the activities meet the needs of clients
Identify ways that the activities can be evaluated for effectiveness
There is no suggested reading for this unit.
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Teaching About Parenting
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Teaching About Parenting
In this study guide we are going to introduce a number of different activities that can be
used in the parenting section of your course. Feel free to amend and adapt them to suit
your own personal learning style, comfort zone and the types of clients you will be
teaching.
You can choose to have one or two specific classes that cover parenting. You may prefer
to integrate the parenting sections of the course with other classes. If you are running
early pregnancy classes some of these activities may be able to be adapted to begin
thinking about parenting or alternatively, use them in an adapted way to cover loss
topics relevant to early pregnancy.
Clients in childbirth classes will often say they felt unprepared for the reality of
parenting. Communicating the joys and challenges of parenting is incredibly difficult, no
matter how talented the teacher. Part of the problem is that the birth is like an invisible
wall that many clients cannot realistically see over. There is also a tendency to believe
that they will be the one couple who have the perfect baby. Honestly, before they have
children it is almost impossible to accurately picture how life is going to change.
That said, there are many activities that you can cover in your classes that will help them
to begin to imagine it. More importantly, you can enable them to explore some of the
more difficult issues, address their concerns and fears, and identify any differences in the
approaches between each couple.
We have looked at using grab bags before in the breastfeeding section of this module.
This activity can also be used to explore parenting issues. Prepare a bag with several
different items in it. Pass the bag around and each group member takes one item. As a
group, you then all discuss what the relevance of the item might be and how you feel
about that topic. This exercise enables you to cover many issues in one session. It
ensures that everybody participates and has a turn in voicing their opinions. Suggestions
for the grab bag include:
Nursery thermometer
Congratulations card written by a relative who wants to "pop in" to see the baby,
brings up discussion on visitors and rest time
Sanitary towel – can discuss lochia, expectations and reality
Picture of a mother sleeping with baby in bed with her
Cleaning polish - who is responsible for housework?
Mobile phone - the importance of communication
Cinema film schedule or restaurant menu – taking time together as a couple
Condom – contraception and sex
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Tissues – baby blues and support
Pacifier – breastfeeding and using a pacifier
Scratch mitt or baby hat
Swimming ring - stitches, episiotomy, healing
Candle burnt at both ends – trying to do too much, “superwoman”
Check book or cash – the cost of having a baby, returning to work
Camera
Picture of weighing scales
Bottle of wine – relaxing together at home
Sling
In brainstorm groups, identify what a mother, a father and a baby need. You could have
each group cover all three things together, or break into three groups and each one
identifies important things for either the mother, the father or the baby.
Changing diapers seems like a pretty basic thing to cover. It is a good opportunity
though to lighten the class, get people moving and cover expectations. Ask three people
in the group who have never changed a diaper before to volunteer. Give each of them a
plastic doll wearing a diaper. In advance, you prepare the diapers to show what normal
newborn feces are like. For one baby, use mustard to represent breastfed poo, another
uses pesto to show the change from meconium to normal poo, and the third uses
marmite, vegemite or black treacle to represent meconium. Provide cotton wool and
water, towels to lie the dolls on and a clean diaper to put the baby in. While working
through the exercise you can explain how to lift a newborns legs to remove the diaper,
use the top part of the diaper wiping down to remove most of the feces, and tell them
that if they leave the baby uncovered and it is a boy it will probably have peed on them
by now! You can also use a variety of diapers including cloth or terry ones and
preformed ones to have a discussion about buying diapers. This is a fun exercise where
everybody gets a surprise as the volunteers remove the nappy to reveal what is inside!
The learning outcomes for these exercises are about helping the parents to explore issues
that may arise and understanding the realities of parenthood. So they may include being
able to describe problems new parents might face, listing feelings that are normal to a
new parent, describing the normal pattern for a newborn baby. These activities are all
great for kinesthetic learners but also are beneficial to other learning styles as they tend
to involve lots of discussion, and movement. Evaluation of whether the activities are
successful or not can be very informal here – simply listening to the discussions as they
unfold, or watching the clients tackling the changing of a diaper or nappy.
Many expectant parents are unsure of the many variations of “normal” appearance in
newborns. This activity helps them to see the sorts of things that a newborn baby can
have and learn what these things mean. You can prepare pictures printed from the
internet, cut out of magazines, or purchase special charts that have photos of newborn
babies on them. Include things like:
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Vernix
Birthmarks (stork bites, mongolian spots)
Learning to focus
Milia (the small white spots many babies have)
Newborn acne
Mottling
Molding
Caput
Lanugo (the soft hair found on the body of newborn babies)
Milk Blisters
Swollen genitals
Facial swelling or bruising
Physiological jaundice
Enlarged breasts
Umbilical stump
Reddened skin
Log on to the following webpage. There are a series of photographs linked
from our readings pages showing you pictures of these different things.
Newborn Appearance Photos
Having a realistic expectation of what is considered normal in the way a newborn looks
is helpful in classes. The learning outcomes for an activity such as this might be to be
able to list common normal differences in newborn babies, visual characteristics of
physiological jaundice, or being able to describe a timeline of when different things
appear on a newborn baby such as when the cord stump falls off, when milia or jaundice
might appear, when molding might go down etc.
This activity really works well for visual and auditory learners. The visual messages are
excellent if you use pictures for the clients to really see what these things look like. The
discussion that follows each picture is great for auditory learners. To evaluate the
effectiveness of the exercise all you really need to do is observe the clients and follow
their discussion. How comfortable do they seem with the idea that their baby might have
some of these things? Are their expectations realistic in terms of the baby’s appearance?
Do they seem to have any fears about this that might be addressed? Did the xercisae help
them raise these issues?
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Amongst the monumental changes that having a baby brings, one of the most significant
is the changes in relationships. This affects not just the relationship between a couple,
but also their relationships with friends and other family members, particularly their own
parents. It is worth discussing relationships as a specific topic in childbirth classes and to
encourage clients to continue this discussion after the class.
There are almost as many ways to parent as there are parents themselves. Every couple
bringing up a baby together have themselves been parented by at least two other people.
If a parent grew up in a nuclear or extended family, the number of styles that have
influenced them is even larger. It is no surprise that there will be differences and
sometimes disagreements over how to handle different issues and decisions.
A good activity to start with is to get everyone to move into couples. Ask them to
identify one thing they liked about the way they were parented and one thing they did
not like. There is no need to share their discussion with the whole group – this is simply
something they share together.
One of the most worthwhile activities in the parenting class is to invite previous class
members to return with their baby to talk to the new group. It is a good idea to ask the
parents visiting to specifically talk about parenting issues and not about their birth,
otherwise this tends to take over the discussion! If you plan for them to arrive before the
coffee break and spend about an hour, this gives your clients the chance to hear what it is
really like to have a new baby from someone who is still experiencing life with a
newborn.
When choosing a couple to ask to visit, select someone who has a very young baby. All
too quickly the memory of newborn life fades and they cannot give such an accurate
picture – a baby that is about 4-6 weeks old seems to work best. If you ask them to talk
about what they thought life would be like and how it is different from their expectations
this provides lots of opportunity for discussion. If it is a couple visiting you can also split
them into groups of men and women to enable them to discuss issues more relevant to
the two groups. Your role in this is really to sit back and listen as well – you do not need
to guide or direct them, unless the topics discussed are becoming inappropriate or the
group needs some encouragement to start talking.
Once the visitors leave during the coffee break you can then round the session off by
asking if the group want to discuss anything that came up during their visit and then
asking them what they learned from the visitors.
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Log on to the following webpage. This handout is something that can be
given to expectant parents to remind them of the importance of
appreciating each other in the day to day grind of caring for a new baby.
Appreciation
Janelle Durham
Materials can be copied and used by educators but no profit is allowed to
be made from her resources.
Log on to the following webpage. This handout is something that can be
given to expectant parents to give them ideas on how to carve out time for
each other.
Finding the time and space to be together
Janelle Durham
Materials can be copied and used by educators but no profit is allowed to
be made from her resources.
Log on to the following webpage. This handout provides information on how
we most appreciate others.
Love Languages
Janelle Durham
Materials can be copied and used by educators but no profit is allowed to
be made from her resources.
Discussing relationships is an incredibly important part of the parenting section.
Knowing that there may be, and probably will be, strains on their relationship over the
next year or so because they have had a child, and things they can do to address this,
helps to provide them with realistic expectations of parenthood. It would be unrealistic
of the teacher to expect to be in some sort of marriage counseling role, and in fact, this
certainly is not her role. However, raising the issues and emphasizing the importance of
communication and making time for each other’s needs and your own needs, reminds
them to address these issues with each other if they arise.
All learning styles find these activities helpful – discussions where they can ask their
own questions and explore in a way that is comfortable to them are going to benefit
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clients regardless of their most comfortable style. The learning outcomes are focused on
the clients identifying issues that may cause conflict, listing why it is important to spend
time together and focused on themselves, and ways they can do this.
To evaluate the relationship topics you might like to have a brainstorm at the end of
couple or small group discussions for the group to draw together all the things they have
learned or identified.
Covering the symptoms of postpartum depression and where to find support are
important, especially for the fathers and other supporters in your classes. You can begin
this session by asking if they have any experience of postpartum, or other forms of,
depression. Be aware though that if you ask this question there may be class members
who have had experience of depression that has ended tragically. In one class I
remember observing the teacher asked if anybody knew any women who had had
depression after the birth of their baby. One client said yes, her sister had experienced
severe depression for a year. When asked how she managed to come through it the client
said she didn’t, she had committed suicide. The teacher was very skillful and managed to
support the client and also help the whole class deal with this shock. Not an easy task for
a new teacher though!
If you have little time available for covering postpartum depression, you can cover it
simply by having a brief discussion to clarify the groups understanding, read a short
story written by a mother who has experienced depression and how she has survived it,
and finish by providing a handout on resources available for help and support if anybody
experiences any form of depression. One thing that is important to remind the group of is
that in the vast majority of cases it is the mother and not the baby who is at risk. Unless
the mother has postpartum psychosis, which is very rare, her baby is much more likely
to well cared for than neglected or hurt. Unfortunately it is the cases of psychosis where
mother’s do harm their babies that are publicized and this is all that most people hear
about this very tragic illness.
A brainstorm session on things parents can do to reduce the risk of developing
postpartum depression is a particularly positive way of approaching the topic. You can
also integrate discussions on depression in other parenting activities where you cover
scenarios and discussions on difficult topics related to parenting. We will cover these
scenarios later in this unit.
Grief and loss are the topics that most childbirth educators dread covering. Nobody
wants to raise issues that generate fear and sadness. It is important to remember that
while this is a really tough subject, most parents are worrying about it so you are not
raising anything they are not already considering. Discussing it in classes will not
prepare the parents if something happens to them and their baby. This is an unrealistic
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goal. However, it will give them the opportunity to highlight and share their concerns,
and brings the topic out into the open.
It is worth remembering that grief and loss are not just about the death of a child. Grief
and a sense of loss will be experienced if a child is born with a disability or abnormality
of some kind. It will also occur if the child has any life-threatening illness. Other forms
of grief and loss are more commonly experienced. For example, the loss of freedom, the
loss of a relationship between two individuals,
loss of career opportunities that may occur, even the grief that may be experienced if the
baby is a boy and a girl was hoped for. Clearly not on the same scale as death but all
losses none the least that may lead to grieving and very mixed emotions.
When choosing topics that discuss loss, try and focus on how you can conclude the
exercises or activities you use so they finish on a positive note and consider ways of
coping and seeking support rather than just finishing with the black topic of loss. Also
worth noting is the timing of when you cover this topic. If you are running a series of
classes, the first class is probably much too early as the group has not yet become
comfortable enough to discuss such a highly emotive topic easily. When you do decide
to cover it, try and have it as early in that session as possible. You do not want to leave
clients leaving the class having just discussed grief!
A good way of introducing the subject is to create a “safe pot”. This involves asking
everyone to individually write down their greatest fears and concerns. Assure them this
is anonymous and they can feel safe to write anything they like. It is a good idea to hand
out the same color and style of pens or pencils to everyone so it is not clear who has
written what. Once they have written their list they fold the paper and place it in a “safe
pot” on the floor in the center of the group.
Once the fears and concerns have been written done and placed in the pot, you can
approach the next step in two ways. The first is to leave them in there, not discussing
them at all. Reassure everyone that their greatest fears are safely in the pot for the next
week and they can leave them there. You then discuss several grief and loss related
topics that are commonly given as fears such as stillbirth and disability. Alternatively,
take the papers out and read out what the fear was. This can be slightly more confronting
and if you do approach it in this way you must let them know beforehand that this is
what you intend to do.
When discussing stillbirth or disability, remind parents of how rarely these things
happen while also reassuring them that everybody worries about this at some point
during pregnancy. You can also remind them that as your children grow up the fear that
something might happen to them is always there – that is simply part of parenting.
Finish the safe pot exercise by asking them to identify sources of support if they
experienced loss. You can also get them to focus on what they could do to support
friends who experienced loss. This helps to draw away the focus from their own fears
and look at what might be helpful in supporting others – often difficult if people have no
idea what is helpful and what is not.
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Finally, when discussing stillbirth, think carefully about your language. Saying “if your
baby dies” is a lot harder to hear than “when a baby dies”. This is one of the topics
where it is very important to stay impersonal!
You can also cover other less obvious forms of loss – loss of body shape, loss of sleep,
lack of control, loss of being just the two of you, loss of freedom etc. You can also
explore what you gain when you have a baby – family, love, respect and admiration
from others, weight, or larger breasts! You can have them brainstorm their list of losses
and gains and from there go on to explore how they have coped with each of these. The
parallels between coping strategies for this form of loss and more significant forms are
then very clear. It enables them to acknowledge that we have the capacity and resources
to deal with many different emotions.
There is an excellent poem called “Holland”, written by Emily Pearl Kingsley. It
reinforces the losses faced by parents with a disabled or ill child, comparing parenting
under these circumstances with taking a holiday and ending up somewhere different than
you expected to be. It is a beautiful and inspiring way to finish a discussion on loss –
make sure you have tissues handy!
In addition to loss, prematurity is an important topic to cover. If you are going to cover
this, make sure it is done towards the beginning of the course. If you wait until most of
the clients are 36 weeks pregnant it is no longer relevant for this particular pregnancy.
Rather than cover prematurity as a separate topic, it is an easy one to integrate into a
discussion on labor itself. One activity that works well is to place a series of pictures –
just photographs taken from books and magazines. Have a range of photos showing
women having normal, active labors, those having a cesarean pictures of the parents
immediately afterwards with the baby looking positive, and then include a few pictures
of babies in special care or intensive care nurseries. Ask everybody to choose one
picture of how they would like their labor and birth to be, and one they would like it not
to be like. Make sure there are lots to choose from – we use about 80 pictures on the
floor to select from with a group of around 12-15 clients.
Every time you do this at least one parent will choose the baby in intensive care. You
can then open a discussion on prematurity, sick babies and identify sources of support
and information.
If you include a hospital visit as part of your classes, you can ask the hospital staff if a
walk past the special care nursery is possible. This helps to remove some of the fear and
anxiety simply in being able to see where it is.
Another way of integrating the topic of illness or prematurity into your classes is to
cover it when discussing another aspect of labor. For example, if you discuss labor and
use an exercise where clients draw who is going to be in the room when the baby is
born, you can use small plastic models – like those in children’s games – as they are
describing who will be there and where they will be. Once they have finished, remove
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the baby from the room and ask how they would be feeling if this happened and the baby
was taken to intensive care. Always follow this activity with something very upbeat
rather than another heavy topic or a relaxation exercise. Relaxation sessions that
immediately follow a difficult topic are often heavy and subdued as the parents may
spend the relaxation time thinking about all that could go wrong!
Generating scenarios for parents to consider is as helpful in the parenting class as it is in
classes on labor and birth. Scenarios get them to explore the possibilities and begin to
discuss the options they have available to them. If you have previously covered decision
making tools such as BRAIN, DECIDE and MPOWER, you can remind them of these
tools to use when working through their scenarios. With scenarios they can either break
into smaller groups or couples and discuss them, or simply hand out one to each person
and ask them to read them aloud to the whole group. If you are covering parenting at the
end of the course they are usually pretty comfortable with each other by this stage and
are less likely to be uncomfortable with discussing it this way. The following ideas for
scenarios are designed for the first part to be given to the mother, and the second part to
her partner.
Scenario 1:
I am feeling really unwell. How on earth am I going to look after my baby when I can’t
even drag myself out of bed? My parents are not around, I don’t know my neighbors
well enough, and my sister is busy today. My partner is going to have to take the day off
work!
I have 3 important meetings today and have to visit a client this afternoon. My boss is
restructuring the business at the moment and I know I am in line for a promotion. We
really need the extra money – I can’t jeopardize my chances by letting him down today!
She is going to have to manage on her own. I can tryc and come home early.
Scenario 2:
My mother-in-law is so excited about this baby. I am really worried though as she just
seems to be taking over and it hasn’t even arrived yet! I am really looking forward to
being able to have some time together with just me, my partner and the new baby once it
arrives. I hope she understands our need for privacy.
My mother is so excited about this baby. Once the baby arrives, she is going to come
and stay for a few weeks which will be great. She can really lend a hand, help us learn
how to take care of it and spend some time together. It will be great having her here –
just like being back at home again!
Scenario 3:
If this baby wakes me up one more time tonight I am going to throw it out the window ...
or kill myself … or both!!! I don’t really care which, as long as I don’t have to get up
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one more time. I just need to sleep! Why does everybody elses baby sleep except mine? I
don’t think I can go on like this for much longer. And when he just snores all night long
it is even worse. How can he ignore that screaming? I wish it was just the two of us
again!
I hope I can get some sleep tonight. I don’t know how I am going to face a full day of
work tomorrow when I feel this tired. Every time the baby wakes she also starts stressing
– and then I feel so awful for her as well. She says I should be helping her but what is
the point in us both being tired every day? I could at least be more helpful in the
evenings if I didn’t feel so tired and then she could rest then. Anyway, she gets to rest
during the day when the baby sleeps while I have to keep working. My mother thinks we
should leave him to cry it out but every time I suggest it I am told I have no idea what I
am talking about. I wish it was just the two of us again!
Scenario 4:
I am dreading going to bed tonight. I know he wants to start making love again but I am
just so tired. As soon as I get into bed I just want to sleep, not have sex! I would love a
hug or cuddle, and a kiss, but if I do that he will think I am giving him the go ahead to
sex. I feel awful saying no all the time but I just don’t have any energy left for sex.
Looking after a baby all day, I have never felt so unsexy.
I wish she would come to bed with me. I would love to be making love again, but she is
so disinterested. I feel like the baby has taken over our lives so much. She won’t even
give me a cuddle – every time I try she pulls away from me. It is ridiculous – I am
starting to feel envious of the baby!
You can create your own scenarios based on what issues you think commonly arise after
a baby is born. There are no right or wrong answers to this, simply issues to explore.
Rather than using written scenarios, some teachers find pictures or drawings, or create
their own, that show the sorts of things in these scenarios. For example, a frazzled
looking woman surrounded by dishes and washing with a picture of an impeccably
dressed man. You can add a few words as explanation to the pictures and ask them to
explore and discuss the issues raised. This activity can either be done in pairs, small
groups, or one large group, depending on the type of discussion you want to take place.
Another activity for helping to get across of realism in how challenging it is to care for a
new baby is to prepare in advance for one class as if you were a new mother. Have the
room look like nothing has been done for days – piles of washing on the floor, ironing in
a basket, you still dressed in a dressing gown and slippers. Don’t prepare any drinks or
refreshments and answer the door to clients with a “baby” in your arms. Once they all
arrive, ask them how they think they would feel if this is how their house looked. Ask
the woman to discuss how they would feel if they did not achieve anything in the house
all day and identify what they have actually achieved despite the state of their home. Ask
the partners to discuss how it would feel to come home to a house like this. Ask them to
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identify things they could do to either reduce the work that needs to be done, change
their expectations, or seek extra support and help to do the work.
It can be helpful to discuss the topics that often generate heated disagreements between
couples or between them and their family or friends. To get them to explore some of
these issues you can create “Take a Stand” cards, each containing a statement that is
controversial. Ask the clients to choose a card and then discuss with someone else, or
discuss in a small group. Alternatively, you read the statement out and everyone stands
on a line on the floor showing where they stand in relation to the issue. At one end of the
line you have a card that says “COMPLETELY AGREE” and one at the other end that
says “COMPLETELY DISAGREE”. Take a Stand issues could include:
My baby will never have a pacifier/dummy
My baby will not be sleeping in our bed – it is a terrible habit to get into
All babies should be immunized
Babies should sleep through the night by six weeks
Men should have to change at least 50% of the dirty diapers/nappies
Women should be at home with their baby until they are at least 5 years old
Young babies need a good routine to help them to settle into life
Having a baby will not change my life
Toddlers should be potty trained by the time they are two years old
Babies need to cry to exercise their lungs
Many parents worry about how they will cope with a baby that is crying. They may
secretly dream that their baby is going to gaze up at them lovingly from the moment it is
born and never shed a tear until it leaves home! In the crying baby activity, you pass a
doll around the class telling the group the baby is crying. Ask them all to identify a
possible cause for the crying and one thing they could try to resolve it.
One excellent activity to get parents thinking about how their priorities and available
time will change after the baby is born is 24 hour clocks. In advance, prepare a 24 hour
clock for several different babies at a variety of ages from one week old through to six
weeks old. Place a name for the baby on the top of the clock and then hand each one out
to the couples. You can pretend that this is their baby – this is the one they will get. Ask
them to look at the clocks and discuss together as a couple how they feel about this
particular baby’s pattern or routine. Provide each of them with a blank clock and ask
them to complete it, based on what their baby is doing at the time, and taking into
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account their other tasks, responsibilities, and activities. Once they have completed their
own 24 hour each couple can compare what they drew up and discuss any issues that
may have arisen. A blank 24 clock and an example of one for a baby, together with some
sample baby patterns, can be found on the following pages.
To generate as much discussion as possible in the 24 hour clock activity, you can create
specific patterns for the baby’s clock that you hand out. For example, having a baby that
cries almost non-stop from 5pm through to 11pm can then be used to discuss colic and
the stress of a crying baby.
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Log on to the following webpage. Janelle’s class outline shows the
suggested topics for a 6 ½ hour newborn care class.
Newborn Care Class Outline
Janelle Durham
Materials can be copied and used by educators but no profit is allowed to
be made from her resources.
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This task summary is for your own records. It does not have to be submitted.
If you have had a child of your own, list the 20 things you wish you had known before
you became a parent. If you have not had a child, talk to several friends who have to
come up with a list.
List ways that this list could be used in a parenting class. Think about activities or
exercises that could use it. Choose one of the activities or exercises and describe how it
might work.
Discuss what else you might need to do in order to prepare for an activity that used this
list. Do you need any specific materials to make this session work well? Do you need
more information? Describe how you feel using activities like this. Do you think they
are helpful to the parents in your classes?
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