This month’s Brilliant Activities for Birth Educators is less a structured activity and more of a technique that creates many benefits. It provides the educator with opportunities to reinforce best practices, creates community in the class, positions expectant people as the expert in their own care and helps exercise their “self-advocacy muscles” which are critical for a positive birth experience. To find all the Brilliant Activities for Birth Educators activities for free on Connecting the Dots, follow this link.

Introduction

Instructors often start each class in a series with a brief check in - giving families an opportunity to share news and ask questions about content previously covered. Frequently, a pregnant person will mention that they had a recent appointment with their health care provider, and inquired about the likelihood/possibility of an evidence based practice they hope to have at their labor and birth. In a recent class I held, someone shared that they asked if they can push and birth in a position that is not on their back, after we had previously covered physiological second stage, including birthing in an upright position - the Fifth Healthy Birth Practice. The response they received was no, they cannot, with a vague explanation of why it is not possible at that facility.

Open Discussion

Rather than using this experience to restate the research on spontaneous pushing and upright birthing positions, the educator can use this as a teaching moment to pull other families into the discussion. Ask the person who originally shared their experience how this made them feel. Validate the benefits of talking to their provider and integrating what they heard with what they are learning in class. 

Next, inquire if other families discussed a similar question with their providers and how that discussion went.  Inevitably, another family or two has had a similar discussion. Some responses they received might have been the same and others had different responses, more in line with best practice. Childbirth educators can offer a prompt to the entire class at this point. Ask all the families why they think some providers offered information in line with evidence while other providers seemed hesitant or even resistant to offering evidence based care. Then take a step back and let the entire group discuss and share with each other.

Discussion Takeaways

After the discussion has run its course, there are several takeaways that everyone is left with:

1. Every doctor or midwife does not practice the same way.
2. Providers at other locations may have different protocols that align with best practice. 
3. There may be other providers in the same facility who practice more in line with the research.
4. Changing providers and/or birth locations may be an option.

Educator Steps

Make available information from professional organizations (ACOG, ACNM, AAFP are common ones in the United States) that support best practice protocols along with links to resources from Lamaze International to the entire group. If one family is facing this situation, others may be too. Offer to help people prepare to have conversations with their providers, where they can ask for care that aligns with current research and provide support on exploring a change of providers or facilities if desired. It is important to recognize that there is privilege involved in having the ability to make changes.

Conclusion

It is very valuable to provide class families with opportunities to talk with each other about how they all navigate shared decision making as they prepare for labor and birth and to find differences and commonalities in their care and options. Making space for these discussions is an important use of class time. Families learn from each other, hear about new options and receive support from their peers in a safe and non-judgemental space.

Published: November 30, 2022

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