The Personal Pain Plan

International Journal of
Childbirth Education
VOLUME 23 NUMBER 4 DECEMBER 2008
Healthy Lifestyles
Because I Said So!
Audio Visual Review

Giving Birth
Featured Educator
Brett Iimura
Perinatal Wellness
Postpartum Pelvic Pain
Photo Essay
A Babys Laughter
The Way I Teach

The official publication of the International Childbirth Education Association
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International Journal of
Childbirth Education
The official publication of the
International Childbirth Education Association
Managing Editor
Donyale Abe
Associate Editor
Deanna Broxton
Photo Editor
Caroline Brown
Columnists
Elizabeth Smith
Deanna Broxton
Heather Jeffcoat
Reviewers
Jeanette Schwartz
Meggin Finkeldei
Graphic Designer
Laura Comer
VOLUME 23 NUMBER 4 DECEMBER 2008

Indexed in the Cumulative Index to Nursing and Allied Health Literature (CINAHL)
Features
Mindful Yoga as a Vehicle for Childbirth Education
By Robin Sale........................................................................................................................ 7
Teaching the Facts: The Dilemma of Evidence-Based Care
By Donyale Abe..................................................................................................................... 9
Talk Less, Learn More: Evolving as an Educator
By Molly Remer, MSW, CCE (ALACE)...................................................................................15
The Way I Teach: Being an Entertainer
By Theresa Halvorsen, BA, ICCE.......................................................................................... 17
The Personal Pain Plan: A Strategy for Teaching Pain Medication Choices in Childbirth Class
By Loretta D. Bezold, RN, BSN, ICCE.................................................................................. 19
Divorce Prevention and Perinatal Education
By Viola Polomeno, RN, PhD.............................................................................................. 21
Columns
The Editors Perspective One on One By Donyale Abe.............................................................. 4
Letter From the President Highlights of 2008 By Jeanette Schwartz......................................... 5
Articles herein express the opinion of the

author. ICEA welcomes manuscripts, artwork,
and photographs which will be returned upon
request when accompanied by a self-addressed,
stamped envelope. Copy deadlines are February 1, May 1, August 1, and October 1. Articles, correspondence, and letters to the editor
should be addressed to the Managing Editor.
Advertising (classified, display, or calendar)
information is available at www.icea.org. Although advertising is subject to review, acceptance of an advertisement does not imply
ICEA endorsement of the product or the views
expressed.
The International Journal of Childbirth
Education (ISSN: 0887-8625) is published
quarterly and is the official publication of the
(ICEA), Inc. Subscriptions are $60 a year.
The International Childbirth Education Association, founded in 1960, unites
individuals and groups who support familycentered maternity care (FCMC) and believe
in freedom of choice based on knowledge of
alternatives in family-centered maternity and
newborn care. ICEA is a non-profit, primarily
volunteer organization that has no ties to the
health care delivery system. ICEA membership
fees are $75 for individual members (IM). Information available at www.icea.org, or write:
ICEA, 1500 Sunday Drive, Suite 102, Raleigh,
NC 27607 USA.
Copyright 2008 by ICEA, Inc. Articles
may be reprinted only by written permission
of ICEA.
Audio Visual Review Giving BirthUnveiling Birth: The Wisdom, Science and Heart
By Deanna Broxton............................................................................................................. 26
An Educators Moment Just Dance By Donyale Abe................................................................. 28
Featured Educator Brett Iimura................................................................................................. 29
Photo Essay A Babys Laughter By Caroline E. Brown............................................................ 30
Healthy Lifestyles Because I Said So! How You Teach Affects Outcomes in
Health Behavior Change By Elizabeth Smith...................................................................31
Perinatal Wellness Postpartum Pelvic Pain By Heather Jeffcoat, DPT.................................... 35
Executive Directors Letter The Evolution of ICEAs Bookcenter By David Feild..................... 37
Announcements
Journal Submissions................................................................................................................... 14
ICEA Upgrades Website..............................................................................................Back Cover
ICEA.org
Labor Note Cards....................................................................................................................... 38
Calendar of Events..................................................................................................................... 39
Photo Credit: Unless otherwise stated, all photos (excluding portraits) are by Caroline Brown, Photo Editor.
Cover photo by Benot Ferradini.
Volume 23 Number 4 December 2008 | International Journal of Childbirth Education |
The Editors Perspective
One on One
I attended Celebrate Childbirth Professionals, the 2008 ICEA Convention, and enjoyed every minute. I learned new yoga techniques to
include in my prenatal yoga classes, from the Positive Postures session. In
the general session, Preventing Late Preterm Birth as Every Week Counts, I
learned that I should take a multivitamin that includes folic acid everyday, and encourage other women to do the same.
At the Presidents Pajama Party, I relaxed, snacked, laughed, and connected with other birth professionals. Penny Simkins session, An Evening
Celebrating the Decades, was inspiring and renewing. I learned from Penny
Simkin that one womans birth experience could bring about change and
empowerment for other women.
The 2008 ICEA Convention was a time to celebrate birth professionals, who empower, serve,
and touch families everywhere that includes you.
You can download the B.E.S.T. certificate honoring the work that you do at www.icea.org.
In This Issue The Way I Teach

Robin Sale shares how to help women cope with the intensity of labor by connecting their
body and mind, in Mindful Yoga as a Vehicle for Childbirth Education. For seasoned educators, teaching the newer generations of parents can be challenging. In The Way I Teach: Being as Entertainer,
Theresa Halvorsen suggests how you can connect to Generation X and Y families. Molly Remers
Talk Less, Learn More: Evolving as an Educator, is an inspiring story about her growth process as a
childbirth educator, and she offers practical tips on how you can sharpen your teaching skills. A
review of the film, Giving Birth Unveiling Birth, by Deanna Broxton, will move and inspire you
to continue to teach childbearing families about all the birthing options and choices available to
them.
Take the time this holiday season to read the other articles in this issue. The information you
find will allow you to revive your teaching methods, and begin 2009 with a fresh perspective about
the way you teach.
Peace and Happy New Year!
Donyale Abe
Manageing Editor
iceaeditor@gmail.com
| International Journal of Childbirth Education | Volume 23 Number 4 December 2008
Letter From the President
Highlights
of 2008
By Jeanette Schwartz
At the end of the year, we tend to look back over the
past 12 months and reflect on our personal accomplishments and successes. The same is true for the International
Childbirth Education Associations Board of Directors. 2008
has been a very busy year.
During the first full year of the ICEA Approved Training
program (IAT), qualified ICEA members became approved
trainers who provide the Basic Childbirth Educator and
Doula Labor Support Training Workshops throughout the
United States and to the International Community. The
Educating the Educator program was put in place following
feedback from members who stated they wanted more opportunities to attend workshops in their local areas. What a
success this has been! Many workshops were held across the
U.S., in South Africa, and The State of Qatar this past year.
Please find a workshop near you at the ICEA website or
under the Calendar of Events listed in this journal. If you cannot attend a workshop listed, consider contacting one of the
approved trainers and bring the workshop to you. It is easier
than you think!
In June we saw the relocation of ICEA headquarters to
Raleigh, North Carolina. We formed a new partnership with
FirstPoint Management Resources to oversee membership,
website, certification, and bookcenter operations. With this
move, ICEA has leaped into the millennium, upgrading to
business practices and technology that enhance our day-today as well as long term service to members. In addition,
ICEA looks to a sound financial business plan to propel the
association into the future.
In September, we redesigned the International Journal
of Childbirth Education. Managing Editor Donyale Abe and
Graphic Designer Laura Comer, along with their editorial
team have created a publication of which we can all be
proud. Congratulations!
Also in September, ICEA supported the film, Orgasmic
Birth, along with an interview of the producer and film
director Debra Pascali-Bonaro. Have you listened to the
podcast Pleasurable Birth: Is It

Possible?, located on the ICEA
website? It is a great way to
learn more about orgasmic
birth and obtain contact
hours too!
As you well know, in
October, the ICEA 2008
International Convention Celebrate Childbirth
Professionals was held in
Jeanette Schwartz
Buffalo, New York. We will
long remember our celebration honoring Penny Simkins career and accomplishments
in the field of childbirth education. Penny Simkin was
presented with the ICEA Outstanding Childbirth Professional
Award. Noted speaker, Richard Obershaw taught us how to
better understand and utilize relaxation methods for our
own stress reduction, in addition to helping our clients and
patients. Ellen Hodnetts presentation on supportive care
during labor and birth validates ICEAs mission to provide
family-centered care and freedom of choice based on knowledge of alternatives.
We took a hard look at the truth concerning maternity
care in the U.S. by viewing the films The Business of Being
Born produced by Ricki Lake, and Pascala-Bonaros Orgasmic Birth. Donyale Abe inspired us to celebrate and honor
the hard work, accomplishments, and achievements that
Childbirth Professionals provide to childbearing families. Of
course, you may purchase the presentations of many other
noted speakers at the ICEA website. This is also a great way
to obtain more ICEA contact hours!
Have you visited the ICEA website lately? You can join
the ICEA forum to chat about ICEA issues with other members, sign up to be added to the ICEA e-mail list, download
the latest ICEA podcast, review journal articles, visit our
continued on next page
Highlights of 2008
continued from previous page
bookcenter, and more! Thank you Emily Fontes and FirstPoint staff for creating this valuable tool.
ICEA continues to partner with Impact Media to bring
you free subscriptions of an ICEA-friendly publication, New
Parent Magazine. I hope you are using this great resource
for your families. Another valuable partnership is a joint
ICEA task force with the organization First Candle. A new
educational brochure will soon be unveiled by First Candle
and ICEA. It is designed specifically for childbirth educators to help distribute information about safe infant sleeping practices. This collaboration is a great example of more
projects ICEA will become involved in to keep information
current and accessible.
This fall, ICEA joined the petition for Improving Maternity Care Services in the Czech Republic, attended the summit on homebirth in Chicago, and became an organizational
member of the Coalition to Improve Maternity Services
(CIMS).
In the 1986 premier issue of the International Journal of

Childbirth Education, President Jeanne Rose wrote the following thought: thinking of the strides we have made toward
humanized birth reminds me of how my father who, from
a generation of fathers less involved with childcare, used to
describe his efforts in putting children to bed as being like
stringing beads without a knot on the end. Each child once
tucked in for the night would get up for a drink of water, a
trip to the bathroom, a foray for a favorite stuffed animal, or
one last goodnight kiss. So too, the progress we have made
toward family-centered maternity care is not unlike stringing
beads without a knot on the end. No sooner have we made a
change on one front, then looked behind us to see that some
previous gain has slipped away.
ICEA made a lot of progress this year working on tying
yet another knot in the string!
Mindful Yoga as a Vehicle

for Childbirth Education
By Robin Sale
The practice of mindful yoga paired with

deep relaxation is an excellent body-centered preparation for labor and delivery.
By learning to focus with present-moment
awareness in the midst of discomfort,
women are pleased to find out that they
possess powerful resources to see them
through labor.
I didnt set out to teach childbirth education when I
began teaching prenatal yoga in 1986, a year after my son
was born. My intention was to teach women ways to help
themselves be more comfortable during pregnancy, and
maybe develop some inner calm and peace. I knew their babies would also benefit, and I viewed this as my small peace
on earth mission.
Soon it became clear that what the women were learning in prenatal yoga was helping them birth their babies.
They became enthusiastic promoters, telling their pregnant
friends this class was the only thing that helped them in
labor. When women return to class with their newborns for
what we call show and tell, Im always amazed at the creative
ways they use what theyve learned to help them through labor. While I still dont consider myself a childbirth educator,
Im continuously learning from my students whats been useful to them. I use their stories, which are sometimes pretty
funny, to inspire others.
For example, Diana was walking the halls of the hospital
with her husband Sean, to help move labor along. Walking
past the door to the classroom where I teach, and finding
it unlocked, she led him in. Between each contraction she
stood in the center of the room, and to Seans utter amazement, assumed the tree pose!
Heres how Diana tells the story: When I was in the
yoga room, I could feel the calm energy and the wonderful
support of all the women from my class. Standing in tree
pose I felt surrounded by their support. Later, when I was

in the midst of transition, I used the affirmation that we
learned for the tree pose - In the midst of lifes storms, I
stand serene. With each huge contraction, I repeated this in
my mind and thats what got me through.
Ive come to see that all childbirth preparation techniques are simply variations on ways to stay focused in the
present moment. Resistance to being present with what is,
because of fear or the expectation that it should be otherwise, is the source of much suffering in labor. Isnt the same
true for everyday living? The only way to stay in the present
moment is to literally come to our senses. We can only hear,
feel, smell, taste, and see in the present moment. Holding
any one, or combination of our senses in awareness can act
as an anchor to the here and now.
A deep, body-centered understanding occurs with the
repetition of yoga poses and incorporating pain-coping skills.
When a woman experiences holding a difficult pose for one
minute, which is about the length of the longest contraction,
without using a focus point, and then repeats the pose, the
second time using a focus point that really works for her, it
changes her whole perspective. She sees that a minute can
seem longer or shorter, depending on her ability to dwell
in the present moment. She learns that pain is more or less
tolerable, depending on her relationship to it. She embodies
a new confidence and feels new possibilities for her birth.
Often, this body-centered understanding arises quite spontaneously and in surprising ways in the midst of labor.
Through yoga, Im able to offer a full bag of tricks:
sounding, counting the breath, fixing the gaze, various
movements, imagery, and exploring sensation, to name a
few. I never know what will be useful to my students. But
one thing I do know is theres no one-size-fits-all approach
when it comes to labor coping skills. Ive also discovered that
when a woman finds what works for her, it really works. She
experiences the pain as a part of her whole experience and
not even the biggest part.
Mindful Yoga as a Vehicle for Childbirth Education

Childbirth is rhythmic like the cycles of nature, like the
beating of the heart. You might think of contractions as the
yang, active part of the cycle, and the rest between the contractions as the yin, still part. You cant have one without the
other. Yet even though the strong yang work of the uterus
takes up less than one-fifth of a typical active labor, theres
virtually no attention paid to the much larger four-fifths portion in most childbirth education.
Try asking a woman to describe the sensations she felt
in between the contractions. Many women will tell you what
they were doing, thinking, or saying, but few can remember
what it felt like. Thats too bad, because if theyd been able to
pay attention in those moments and dwell upon their senses
they might have known the sweet relief of no pain and even
better the soft cloud of endorphins embracing them.
So I feel its essential to teach the importance of deeply
focused rest between the contractions. With practice we can
learn to drop into a very deep focused relaxation in seconds.
Even a minute of this kind of focus in between contractions
can be enough to restore the body and mind. Instead of wasting energy to brace for coming contractions or fretting over
how much time has passed, women should conserve energy.
The body will refresh itself and work more effectively. Im

convinced this helps bring about a smoother, shorter labor.
What I teach has evolved out of my own long-time
mindfulness practice and equally so, from the women in my
classes who have shared their stories over these many years.
Yoga is a powerful way to befriend our bodies in a time of
such rapid change as pregnancy, but yoga is just one part of
what makes these classes a refuge and a wonderful support
for women on their way to motherhood. Also essential is the
social support and collective resourcefulness that comes from
the wisdom circle part of class, but a discussion of that topic
will have to wait for another article. Im very grateful for the
opportunity to share my experience with other members of
the International Childbirth Education Association.
Resources
www.wholebirth.com/prenatal_yoga_national_directory.htm
www.mindfulbirthing.org/index.html
www.withawareness.com
Robin Sale, is the originator of the Whole Birth Yoga and
Support Classes. You can learn more about her Whole Birth
Prenatal Yoga Teacher Training, Expecting Couples Retreats, and
her prenatal counseling work at www.wholebirth.com. Robin
lives in Santa Cruz, California.
Present Moment Awareness

Labor Practice for Challenging Yoga Asanas
(These techniques can also be applied to the use of ice for labor practice)
Breath Awareness
Take a cleansing breath in through

the nose and out through the mouth.
Take deep, slow breaths.
Listen to the breath.
Feel the complete duration of the
inhalation, the exhalation, and any
pause in between.
Count breaths.
Sound
Make a sigh with the out breath

releasing the breath.
Create a blowing wind sound with
the out breath.
Open mouth and soften the jaw

making hahhhh sound
(like fogging a mirror).
Hum.
Work With Sensation
Be curious about it.

Name it burning, aching, stinging.
See it the color, texture, brightness,
or dullness.
Does it move, change, or pulsate?
Soften around sensation with your
breath, with your awareness.
Breath right into it as if to dissolve
or dilute it.
Breathe out let it go, flowing out
with the breath.
Expand awareness to include the

whole body.
Let awareness rest in a part of the body
that feels fine, the earlobe or big toe.
Soften where you can soften, isolate the
work to the muscles involved.
Focus in the Moment
Notice complaining mind wanting the

pain to go away or be over.
Waiting does not exist this moment is
all there is.
Be open to the possibility of finding a
sense of stillness or calm right within
the intensity. Like resting in the eye of
the storm.
Ask, Am I ok right now?
Teaching the Facts:

The Dilemma of
Evidence-Based Care
By Donyale Abe
With the release of a new report,

Evidence-Based Maternity Care, childbirth professionals have an additional
resource to teach and promote evidencebased care. Recent data shows a widening gap between current maternity
care practices and evidence-based care.
Hospital based childbirth educators are
often conflicted about how to teach
evidence-based care, when it is not the
standard of care used at the facilities
they teach.
One of the challenges of teaching childbirth classes is not
only presenting the information needed to prepare parents for
the labor process, but also giving them tools to feel empowered and confident about the experience. I am primarily a hospital based childbirth educator; and I have the delicate task of
balancing between the role of teacher and advocate, explaining hospital procedures and evidence-based care (ICEA, 1999).
This is a difficult task. The balance of duty can often weigh
upon my conscience, bringing my morale down.
A newly released report, (available for download at
childbirthconnection.org) Evidence-Based Maternity Care:
What It Is and What It Can Achieve, by Carol Sakala and
Maureen Corry, comprehensively examines the deficit
between actual maternity care and evidence-based maternity
care that should be the standard used everywhere.
Evidence-based maternity care uses the best available
research on the safety and effectiveness of specific practices
to help guide maternity care decisions and facilitate
optimal outcomes in mothers and newborns. (Sakala and
Corry, 2008.)
Teaching the facts, when I know that some prenatal care

requirements, hospital policies, medical care providers, and
labor room logistics limit a womans choices and options for
consent, is a dilemma that I struggle with. For example, I
teach women about the stripping of membranes. I explain
how the procedure is done, that it can be very uncomfortable, that they may have some spotting afterwards, and their
caregivers should ask for their consent before the procedure
is performed. Often, after taking the time to explain this, a
woman in class may approach me and disclose, now that she
knows what stripping the
membranes means, she
Empowerment:
thinks her care provider
did the procedure without
A womans confiasking for her permission.
dence and ability
I often ask myself
to give birth and
these questions:
to care for her
How can I best empower a mother?
Do I regret providing
her with the information about the procedure?
Should I encourage her
to discuss with her doctor what happened?
baby are enhanced

or diminished by
every person who
gives her care, and
by the environment in which she
gives birth.
Principle of:
The Mother-Friendly
Childbirth Initiative
As a childbirth educator, doula, representative, and patient of the hospital where

my families give birth, I strive to stay within the lines between these roles, yet for me to teach conscionably, conflict
within myself, and with other care providers sometimes must
occur.

When you know that evidence-based maternity care
practices are not widely used in birth facilities in your community, and especially the facilities where you teach, the dilemma and challenge is to teach the evidence, the research,
and the facts about the most effective and least harmful
perinatal care practices uncompromisingly, unswervingly, and
unapologetically.
These strategies can be used to effectively teach and
promote evidence-based care.
Discussion Groups
An interactive way to provide evidence-based information is to use benefit and risk discussion groups. For example,
when teaching about episiotomy, induction, amniotomy, and
other interventions, you can:
Divide class participants into small groups.
Have participants read current evidence-based information about the interventions found in their class booklet
or handouts.
Class members should write down and discuss the benefits, risks, and alternatives they discover.
Parents are often amazed by how many risks they
uncover in their discussion groups, and often conclude, as
in the case of episiotomy, that it should be performed only
when a medical need exists.
Class Booklet
The hospitals I have taught for have always provided
books, like The Family Way, for students to use to compliment the information learned in class. These books are
continually updated and contain evidence-based facts within
them. Through the years, I have learned to direct class members to the pages in their book, and let the book teach for
me. I always back up information presented by directing my
class to the specific page numbers in their books.
I encourage you to read from cover to cover, the class
booklet that your hospital provides to students. I underline
and highlight all the evidence-based information available in
the booklet to pass along to my students. It is against policy
for me to provide students with any other reference materials. The book does all the work for me, even listing valuable
websites for parents to access research articles.
I use the book to provide evidence-based information
about:
Benefits of changing positions and moving during labor.
Due dates and the normal length of pregnancy.
The value of labor support.
Methods to turn a breech baby.
Delayed pushing and pushing with natural urges.
Epidural risks.
Induction risks.
Myths about having a big baby.
Role Play
The most effective learning occurs when adults participate and apply what they have learned. Role plays are an
excellent tool for your students to teach themselves, reinforcing what they have learned. To use a role play:
Divide class members into groups.
Give them scenarios to discuss.
Have them act out a response to the scenario, with each
member playing a role.
Role Play Scenarios
Photo credit: flickr/Lab2112
You are five days past due. You are told you need pitocin for induction. What are your options? How would
you discuss this with your health care provider?
You are having twins. One twin is head down. You are
told you must have an epidural and be prepared for
a cesarean. What are your options? What concerns
would you have? How would you talk to your doctor
about your concerns?
10 | International Journal of Childbirth Education | Volume 23 Number 4 December 2008
Answer Questions
Sometimes the easiest way to teach is simply by answering questions. Take the time to build a rapport with your
students, tell jokes, make them feel at ease. Once they know
you are really willing to address their concerns, than an
entire class could be devoted to listening and responding to
them. You may be the only one they are comfortable with or
they feel has the time to assist them.
Patient Rights
Childbearing women frequently are not aware of their
legal right to make health care choices on behalf of
themselves and their babies, and do not exercise this right.
(Childbirth Connection, 2006.)
It is important that families know not only what their
rights are as they receive medical care, but also how to effectively exercise their rights. Take the time to explain what
informed consent is. (The Informed Consent Discussion
Sheet can be downloaded from icea.org)
A simple way to teach this is by using the acronym
B.R.A.I.N. When considering any procedure, families can
ask their health care providers:
Benefits What are the benefits to this procedure?

Risks What are the risks to this procedure?
Alternatives What are my other options besides this
procedure?
Intuition What does my gut tell me about this procedure?

Need Time I need time to consider this procedure.
Facts and Statistics

Some adult learners really focus in upon topics when
you present numbers, facts, or trivia.
I enjoy teaching about the benefits of squatting. I often
share that when women are able to squat they gain 28%
more space around the pelvic outlet for the baby to descend
(England and Horowitz, 1999). I then go on to teach six
different ways to squat. I also explain that a squatting bar
is available in the labor room for pushing and show them a
picture of the bar. I let them know that upon request it may
be possible for them to push in a squatting position.
After discussing this information, combined with practical things they can do, many women approach me later and
share that when class began they were sure they would need
medication to manage labor, but now they feel more confident because they have options.
Photo credit: flickr/daquellamanera
Examples of other statistics to discuss:

The United States cesarean rate in 1970 was 5.5%.

70% of first-time mothers go past their due dates.
Only 3% of babies are born on their due date.
In 2006, 31.1% of women in the U.S. had a cesarean
birth.
In the U. S., less than 25% of babies are still breastfed at
six months of age
Conversation with Care Provider

It is important that families are able to communicate
with their health care team members. Encourage those you
teach to bring up any concerns during their appointments. It
is also beneficial to practice with students how they can best
bring up topics and express their opinions to medical staff. I
remind students that no individual is all knowing and that it
is helpful to give evidence-based articles and information to
their health care providers for discussion.
Volume 23 Number 4 December 2008 | International Journal of Childbirth Education | 11

Write Letters
The maternity care industry is becoming increasingly
competitive. Hospitals closely located in one geographic area
have begun campaigns lauding the benefits of giving birth
at their facility. In this competitive environment they closely
monitor patient feedback and work to address concerns.
Families should be encouraged to write letters to health
care customer service departments, a health plan ombudsman, department heads, nurse managers, and independent
advocacy groups. Change can be brought about one letter
and one individual at a time.
The Birth Survey, at www.TheBirthSurvey.com, is a consumer driven website where families can rate their maternity
care experience and provide valuable information for other
consumers about intervention and their overall satisfaction
with the maternity care they received at their birthing facility. If I have the opportunity, I share with my students the
recent history of maternity care, reminding them that some
of their grandfathers were prevented by hospital policies from
witnessing the birth of their children.
It is only recently that all fathers in the U.S. are able to
be in the labor room for the birth of their children. It seems
laughable now, but in years past some fathers felt so strongly
that they handcuffed themselves to the mothers bed in
order to remain with her. If it were not for parents and birth
advocates writing letters, making their concerns known, and
questioning maternity care policies, we would not have many
of the changes present today, like family-centered maternity
care.
able to them, ask if I knew any home birth midwives in the

community. I gave them some referrals and they made the
decision in mid-pregnancy, to switch their prenatal care to a
midwife. They went on to have a successful homebirth.
Speak-up
My calling to be a childbirth educator, I do not take
lightly. I work hard and use many techniques to strengthen
and empower women. All women should be provided an
understanding of evidence-based maternity care and be
encouraged to make informed decisions.
Evidence-based care seems straight forward, and that
the right of a woman to decide for herself what is appropriate seems obvious. Yet many everyday maternity care practices negate low risk and low intervention birth techniques
that are as old as womankind. I dare to say that a woman
herself can be negated within her own birth experience. It
is imperative and urgent that WE birth professionals read
Evidence-Based Maternity Care, and act to bring change for
women as best we can. I know the challenges of this task.
Before I had children, I taught childbirth classes and
was a doula. I always took the time to explain informed
consent to my students and encourage them to discuss
any concerns they had with their care providers. Then, my
journey began to have children. It started at the infertility
clinic. I was over age 30, and had been trying for a year,
so my husband and I began all the needed tests. Once the
tests were completed we met with the nurse practitioner to
discuss the results. I was told during this appointment that
I was required to have a pap smear. I had recently had one
performed so I told the nurse practitioner that no, I did not
want a pap smear at this appointment. She proceeded to ask
Birth Place and Care Providers

Be knowledgeable about free-standing birth centers,
home birth midwives, and care providers with low intervention rates. Also, learn about hospitals with low intervention
rates that allow doulas, water births, and provide midwifery
services in the communities where you teach.
You are sometimes the only one that is in a position to
direct families to health care providers and birth facilities
that use evidence-based maternity care. It is important to
have contacts available to give to families upon request.
I often have families ask me for doulas I can refer them
to. Once I had a family who attended my hospital class, who
after learning about the labor process and options avail-
Photo credit: flickr/manueb
me to undress, and place my feet in the stirrups so that she

could examine my ovaries and some other things. I agreed
to that part of the examination.
After the appointment was over, and my husband and I
got into the car to drive home, I realized that something did
not seem right. I told my husband that I thought she did the
pap smear when I told her clearly, that I did not want one.
Id also told the medical assistant, while waiting for the nurse
practitioner to come into the exam room that I did not want
a pap smear. I thought to myself that maybe a mistake had
been made. I called the nurse practitioners office the next
day to ask her what happened, and giving her the benefit
of the doubt, I thought maybe she did not hear me clearly,
when I said no.
Her response was, Yes, I did hear you clearly, when you
said no.
Id told two people clearly that I did not want a pap
smear, and, my husband was present the entire time, and yet
my request was disregarded. I was fully informed about the
benefits and risks, and the evidence. I tell you my story, not
for personal gain, not for healing or therapeutic purposes,
but because if this happened to me, an educated, informed,
and articulate person who did not give her consent, and I
had done everything I
could in that moment to
prevent it from happening, then what about
other women who are
not articulate and not
informed?
I speak with the hope of encouraging birth professionals
and women everywhere to continue striving for evidencebased maternity care. Work and advocate for the women
who never will be able to advocate for themselves.
Years later, I had two daughters, and was at the dentists
office discussing my nursing daughters tooth decay. She was
about six-months-old. I asked the dentist who was treating
her what I could do to prevent further decay. She told me
that I should wean my six-month-old. She then went into
her office and came back with a pamphlet for me entitled
Baby Bottle Tooth Caries.
I had written upon my daughters medical history form
that she was exclusively breastfed. So I was perplexed and
angry at the advice and pamphlet, which had nothing to
do with my situation. I took a moment to take some deep
breaths and proceeded to question the dentist about how
the pamphlet related to us.
Photo credit: flickr/joshschipper
She actually looked surprised at my question and asked

for the pamphlet back to glance at it, and then she admitted
that it was unrelated to us since we were exclusively breastfeeding. When I returned home, I looked up all the articles
that I had regarding tooth caries, and the evidence shows it
is not caused by breastfeeding, but a myriad of other things,
and I faxed this information to her. I had an appointment
with her two weeks later, and was nervous about her response to the articles, but to my surprise she had read them,
and agreed that she had been wrong in her information, and
that she was now going to
do further research.
Some years after
that as I was teaching a
Saturday class, and we
began going around the
circle with introductions, who should I notice there but my
daughters dentist and her husband. I was so surprised. I was
also glad that I had spoken up those years before. Now my
daughters dentist was pregnant, facing birth, and motherhood. I could only want for her what I want for all women
everywhere, evidence-based maternity care.
You may feel the

subliminal pressure not to teach
evidence-based classes.
Conclusion
I have had some childbirth professionals confide to me,
that they are discouraged with the status of todays maternity
care. Yes, the cesarean rate has reached an all-time high in
the U.S. The number of couples attending childbirth classes
has fallen. You may feel the subliminal pressure not to teach
evidence-based classes.

I implore you to H.O.P.E.
Hold On You must not stop teaching. How will it help if
you are not teaching?
Optimism Attitude is everything. Share the glass is half full
attitude.
Provide Information Share as much evidence-based maternity care information as you can.
Empower Women will be more confident. Families and
babies will be stronger.
ACOG Cesarean rates from 1970-Present:

www.acog.org/departments/dept_notice.cfm?recno=20&bu
lletin=264
Never give up teaching, providing labor support, doing

all you can, and really just your part to advance evidencebased maternity care.
Childbirth Connection. 2006. The rights of childbearing women. Available

at childbirthconnection.org. Accessed October 13, 2008.
ICEA. 1999. ICEA Position Paper: The role of the childbirth educator and the
scope of childbirth education.
Resources
England, P. and R. Horowitz. 1999. Birthing From Within. Albuquerque:

Partera Press.
The Family Way class book is available at thefamilyway.com
References
Sakala and Corry. 2008. Evidence-based maternity care: What it is and what
it can achieve. Available at childbirthconnection.org. Accessed October 13,
2008.
www.thebirthsurvey.com
Childbirth Connection, childbirthconnection.org:
What Every Pregnant Woman Needs to Know About
Cesarean Section
The Rights of Childbearing Women
Coalition for Improving Maternity Services,
motherfriendly.org:
Evidence Basis for the Ten Steps of Mother-Friendly Care
The Mother-Friendly Childbirth Initiative
Donyale Abe, ICCE-CD, IAT, a graduate of the University of

California, Berkeley is currently the managing editor of the ICEA
Journal and has taught private and hospital-based childbirth
classes since 1999. She serves as a mentor to childbirth professionals around the world, providing basic and advanced
childbirth educator training workshops. She is currently writing a
book about birth that will empower women everywhere.
Journal Submissions
The International Journal of Childbirth Education welcomes your articles, research papers, essays,
and photos for upcoming issues.
June 2009: Mothering

The deadline is February 1, 2009.
September 2009: Global Birth Circle

The deadline is May 1, 2009.
December 2009: Open Forum

The deadline is August 1, 2009.
Submissions can be made on the following topics:

Childbirth Education, Labor Support, Breastfeeding,
Birth Stories, Postnatal Education, and Perinatal Fitness.
The guidelines for submissions can be found at
http://icea.org/content/information-journal-writers
Please send all submissions electronically to
info@icea.org. A copy should also be sent to the
Managing Editor, Donyale Abe,
at iceaeditor@gmail.com.
Talk Less, Learn More:

Evolving as an Educator
By Molly Remer, MSW, CCE (ALACE)
Being an effective childbirth educator is an evolutionary process. This article details the realization that my
approach to childbirth education was in need of modification and how I let the idea of talk less, learn more
guide me in my efforts to truly meet the needs of childbearing women in my community.
Since late 2006, I have written
the following message at the top of
each of my teaching outlines: Talk less,
listen more. This simple reminder has
fundamental importance and has completely revolutionized how I structure
and guide my childbirth classes. During
each series that I teach, I realize how
listening to women and giving them a
space in which to share, is one of the
most important things I can offer. During my certification program, I studied
principles of adult learning and designing effective curriculums. I began my
journey as a childbirth educator with a
lecture and information-heavy approach that Ive since heard referred to
as, opening their heads and dumping
information in. As I have continued
to teach, Im continually discovering
ways to talk less, but hopefully, impart
more knowledge. By creating a guiding
philosophy of talking less, students
learn more as I plan and implement my
classes.
After my first year of teaching,
I realized couples who sign up for
my classes are not really looking for
pregnancy and prenatal care information, but for real birth preparation. The
women want to learn, Can I do this?
and How will I do this? The men ask,
How can I help her do this? It feels

almost insulting to meet this quest for
inner knowing with a discussion about
the benefits of prenatal vitamins. I had
to confront the fact that some of the
things I was teaching seemed irrelevant,
redundant, or obvious. It became clear
to me that I had to tackle the slightly
embarrassing reality that I was following a model of prenatal education that
was not in line with the true needs of
the women in my community.
I teach independent, natural
childbirth classes privately in peoples
homes. Maybe with a different population, my original approach would be
more successful, or I would take a different approach altogether. As students
have different learning styles, educators
naturally have preferred methods. I
have an information-heavy personal
style that spilled over into my teaching.
I continue to wrestle with this tendency
and struggle to rein in the information
overload approach I gravitate towards.
Over time, I began to drastically
cut my talk (lecture) and focus on
action instead. Though it felt nearly
sacrilegious to do so, I trimmed many
things out of my outlines that were
about nutrition and prenatal testing,
because many of the women I work
with are well read and familiar with

those topics. Ive come to realize that
I need to skip a great deal of the book
learning and get them actually moving,
practicing, and using skills. The book
learning naturally arises during the
course of the class, through questions
or explaining why specific techniques
are helpful during pregnancy and labor.
I have now restructured and re-
arranged my class outlines to include
an entire class about the mind-body
connection and psychological preparation for birth. This class replaced a
previous class about birth planning.
I found that many people already had
birth plans written, and the topic of
birth planning naturally came up during the six-week course without my
needing to spend excessive time lecturing on it. Ive also dedicated an entire
class to labor support, including plenty
of time to practice hands-on support
techniques. In addition, I created a
brand new class called Active Birth that
involves movement, positions, and
helpful ways to labor in a hospital bed
without lying down.
Pregnant women have information
overload. They are faced with more
information than they know what to do
with. They are bombarded by it. What
they really need is a sense of knowing.
What skills do I possess that
will help me greet my birth with
confidence?
What are my tools?
What are my resources?
Can I just let it happen?
Talk Less, Learn More: Evolving as an Educator

As an educator I ask myself:
What will help them feel
confident?
How can they be ready?
What will help them learn to
trust their bodies and their
capabilities?
I want people in my classes to
learn material that is dynamic, active,
exploratory, self-illuminating, supportive, positive, enriching, and affirming. I created a vision statement and
asked myself where my classes stood in
relationship to my vision. The answer
was, Not as close as I want them to!
My vision statement for my classes is
to focus on celebration, exploration,
motivation, education, inspiration,
validation, initiation, and dedication.
After I completed this self-inquiry and curriculum modification, I
discovered author and educator, Trish
Booths concept of The Evolutionary
Spiral of a Childbirth Educator. I quickly
recognized myself and my experiences
along the loops of the spiral. In the
Early Stage of the spiral, educators are
focused on content and presenting the
information. This perfectly matches
where I was when I started out with my
open heads and dump information in
approach. The Intermediate Stage is focused on the group as a whole and also
emphasizes learning rather than teaching.
Though I tend to teach one-to-one private classes and not groups, this seems
to clearly be the stage I was in when I
looked at my vision and realized that
I needed to talk less so people would
learn more. In the Advanced Stage, the
educator understands the meaning of the
childbearing experience and the focus
is on the individual learners. This feels
like the stage to which my teaching
has spiraled. Further along the spiral is
the Master Stage in which the educator
integrates the first three stages and moves
gracefully between them with a focus on

cognitive, emotional, and spiritual needs
of the group as well as the individual
learners (Booth, 1995).
Perhaps my insights are old news
to experienced educators, but they
have made a profound difference in
the quality of my classes. I am sure as
I continue to teach, I will continue to
deepen and refine my approach and
will continue to blossom as an effective
educator.
How to Talk Less

Birth Stories
Show two contrasting birth clips.
Use a birth from a popular TV show
(I often show Rachels birth from the
show Friends) paired with an empowering birth from a film like Birth as We
Know It, and then have students discuss
the differences.
Ice Cube Minute
Use the activity from Family-Centered Education: The Process of Teaching
Birth. In this exercise, couples hold an
ice cube in one hand for one minute
and see what coping measures spontaneously arise. I do this exercise fairly
early in my class series, before weve
done a lot of formal talking about
coping measures. It is very empowering
for couples to discover what tools and
resources come from within as they try
the ice cube minute.
Mind-Body-Connection
To illustrate the potency of the
mind-body-connection, practice two
pretend contractions while holding ice.
One contraction has a stressful paragraph read with it: Your body fills with
tensionit hurts! Oh no! The second
contraction has a soothing paragraph
read with it: You greet the waveit
is YOUR power This illustrates the
fear-tension-pain cycle viscerally.
Yoga Poses
Birth happens in our bodies, not
our heads. Use a five minute series of
birthing room yoga poses to begin the
class. Practicing the poses opens space
to simultaneously discuss and practice
squatting, pelvic rocks, optimal fetal
positioning ideas, healthy sitting, pelvic
floor exercises, leg cramp prevention,
back pain alleviation, and more.
Role Playing Cards
Talk through various birth scenarios. I have found that couples are
more receptive to talking through role
playing cards than actually getting into
a role and playing it through.
Values clarification exercise
Participants cut out values from a
list and arrange them in a grid to help
them figure out if they are in alignment with each other and with their
caregivers.
References
Booth, Trish. 1995. Family-centered education: The
process of teaching birth. Minneapolis: ICEA.
Learning Pyramid, www.birthsource.com/pdffiles/learning%20pyramid.pdf, accessed September, 2008.
Molly Remer, MSW, CCE is a certified

childbirth educator and activist who lives
with her husband and two young sons in
Rolla, Missouri. She is the editor of the
Friends of Missouri Midwives newsletter and is a La Leche League leader. She
blogs about birth, books, and midwifery,
respectively at talkbirth.wordpress.com,
mollyreads.blogspot.com, and cfmidwifery.
blogspot.com. She is enrolled in the ICEA
childbirth educator certification program.
The Way I Teach:
Being an Entertainer
By Theresa Halvorsen, BA, ICCE
As Generations X and Y replace previous

generations in childbirth classes, its important for instructors to entertain their
classes, not just inform them.
Many things go through my mind during my childbirth
classes, but lately I have been hearing a line out of the movie
the Gladiator, Are you not entertained? Over the last few
months I have been focusing not only on the information I
provide, but also how it is presented. And yes, keeping my
students entertained is becoming a significantly larger part of
my classes, especially as my students become younger.
The latter part of Generation X and all of Generation
Y grew up with constant entertainment. Indeed, many of us
cant handle being bored. I know because Im a late Generation Xer. We text message, listen to music, and check
e-mails, all at the same time. On roller coasters, we listen to
our iPods because the roller coaster itself is not entertaining
enough. Our days consist of watching TV shows and movies,
listening to music, You Tube, concerts, and other live events.
So when members from Generations X and Y come to your
childbirth classes they are expecting to be entertained. How
do we make entertainment a priority while still giving our
students the information they need?
Humor
Humor is my number one weapon to keep my classes
entertained. Do not be afraid of jokes. While it has taken
months to develop my jokes, I receive great feedback about
them. One of my favorites when teaching patterned breathing is, Mix it up at little. You could do one he and one ho,
two hes and one ho. Heck, if it feels good, do three hes and
two hos. Say it out loud if you dont get the joke. Other
favorites include, Never tell a laboring woman to RELAX
because she will hit you. And when talking about APGARS,
I say, One of my sons scored a three. Hes fine now. Of
course he thought it was a good idea to swallow a quarter

last month, but other than that, hes fine.
In addition, do not be afraid to act like an idiot. One of
the instructors I work with paints her lips with lipstick and then
places her mouth on a balloon to show how important it is for
babies to open up WIDE when breastfeeding. Just do not force
your class to act like idiots themselves or they will shut down.
And do not be afraid to mess up. I was at a concert once
where the lead singer completely forgot the words to a song.
His band just kept playing hoping he would pick it back
up. He struggled for a good minute to remember the lyrics
until the audience started singing the song and he joined in.
While he was really embarrassed by his mistake, it was an
incredible moment for the crowd, one they will remember
forever, and in a positive light. The song was actually better
for the audience, because that singer blew it. So do not be
afraid to try new games, activities, or find a new way to explain things. Maybe you will mess up and create something
even better. And if you really blow it, chances are it will be
entertaining for your class.
Consider sharing stories and anecdotes in your classes.
Exaggerate freely, but dont lie, to make your points, and be
humorous. The funnier the story is, the more likely your class
will remember it, as well as the point of the story.
And finally, laugh at yourself. Did you make a joke that is
bombing? Laugh as you present it. It gives people permission
to laugh with you or at you. Ever notice how Jon Stewart on
the Daily Show cracks up when he is reading his screens? He
does this even when the audience is not participating.
More Ideas
Lets say you are just not good with jokes or making
your classes humorous. There are other things you can do
to make your classes more engaging. Make the switch to
teaching with PowerPoint. Younger generations are increasingly visual. They will learn best if they can see what you are
The Way I Teach: Being an Entertainer

talking about. If PowerPoint scares you, take a seminar in
PowerPoint presentations. You may also consider using overheads. However, one word of warning, I was forced to use
overheads in one of my classes and my students snickered
about how low tech I was.
You cannot teach without some lecturing, but you can
make it less boring. Learn how to lecture effectively. Do
not sit down to lecture; always be on the move. Be expressive, smile at your students, nod or frown at questions, and
tilt your head to the side when thinking. Watch your body
language when lecturing. Twisting your fingers and hunching
your shoulders makes
you seem unsure and
unprepared. If necessary, take a public
speaking class. However, try to cut back on
your lecturing whenever
possible. Its boring to
Generations X and Y.
Instead, play games,
watch movies, open up
discussions, and have
group activities.
If you use handPhoto credit: flickr/Hayden Simon
outs, make them
interesting. Use visuals, graphics, and charts to reinforce your
points if possible. Have someone you know who writes well,
look over your handouts, if you are uncomfortable with your
writing skills. When using PowerPoint, make sure you give
your students handouts of your presentation so they can take
notes. Taking notes keeps them engaged and entertained.
Advantages
When you make your classes entertaining, people actually want to come to them. I know I have done my job entertaining my classes when people tell me I was their favorite
instructor; that they enjoyed coming to the classes; that they
learned a lot without it being a chore; that they missed the
series when it was over; or that the time in class flew by.
Your class will also remember the information if it is presented well. You could be giving them the key to childbirth,
but if you give it in a boring way, they will not remember it.
When your classes are entertaining, participants are more
likely to remember the information.
If you need one more reason, by entertaining them,

your class will be less stodgy and formal. If you relay information in a casual way, your students become more casual.
They are more likely to ask embarrassing questions and
participate in class activities and discussions.
Disadvantages
Humor, my number one weapon, if not done carefully,
can be offensive. It is possible to make a joke about something that is funny to people in the birthing business, yet it is
in bad taste to others. For example, I heard another instructor compare a womans perineum after birth to hamburger.
The instructor thought she was being funny, but she ended
up scaring everyone in the class. In addition, use caution
when making jokes about nurses and doctors your participants will be placing a great deal of trust in these people
over the next few months.
Another disadvantage of utilizing humor in a class is
the possibility of losing control of the class. When you are a
little irreverent and unruly it encourages others to be so too.
While this is usually a good thing and opens the class up for
fun and games, it makes controlling them harder. If you have
an extremely unruly personality in your class they may get
the message that their behavior is acceptable.
Its hard to be funny all the time, especially when you
are sick or feeling a little down. Being an entertainer is exhausting, especially during long weekend classes.
Remember, if you do use humor in your classes, it is
easy for jokes to go flat after telling them many times. Be
careful about telling jokes too quickly or with the wrong inflections. If a joke was a hit last month, but now you are not
getting any response, try retiring it for a little while.
Conclusion
It is important as a childbirth educator to become aware
of what your students expect from you. Creating classes
that are entertaining will make you a better instructor and
your students will learn and remember the information you
are trying to present. While it can be time consuming and
exhausting, the effort will be well worth it for your students.
Theresa Halvorsen is a childbirth educator teaching more than
10 different classes for her local hospital. Her favorite is Prepared
Childbirth. Lately, she has been focusing on helping labor coaches learn how to support laboring women. Her blog on the subject
is at www.gentlebeginnings.blogspot.com. She lives in California
with her husband, twin boys, and too many pets to count.
The Personal Pain Plan:
A Strategy for Teaching Pain Medication

Choices in Childbirth Class
By Loretta D. Bezold, RN, BSN, ICCE
Teaching about pain medication options has been a central component of childbirth
classes. Prospective parents want the most up-to-date information as well as reassurances
that they will have options for pain relief available during labor. In some cases, only
medical choices are discussed while spending little, if any time presenting non-pharmacological methods to be used in labor. The development of a Personal Pain Plan assists
parents in their decision-making, based upon their current wishes and previous life
experiences. This approach is in direct accordance with ICEAs philosophy of freedom of
choice based on knowledge of alternatives.
As an educator with a few years under my belt, I have
been searching for the perfect way to teach clients about
pain medications and their available choices. With the following plan I believe I have come closer. I hope you find it
a useful addition to the bag of tricks that you use in your
childbirth classes.
When I was a new educator I would teach about pain
medications according to the curriculum. Eager to please my
superiors and maintain my position, I did not vary far from
what was in our teaching manual. As the years progressed, I
came to understand the subtle variations in each class topic
and what those variations required from me. Somewhere
along the way as the years passed, I threw out the manual
and began to write my own. I developed a Personal Pain
Plan that became very helpful to my students.
When I teach the Personal Pain Plan, I begin by first
paying homage to a childbirth educator of a previous generation, Grantly Dick-Read, and include a brief discussion of
the Fear-Tension-Pain cycle. This sets the stage for the next
activity.
I remind the class to participate at their own comfort
level. Some write down every answer and leave with their
form completed. Some write down a few answers but leave
others blank. Some students do not write anything down
and choose to consider what their answers will be outside of
class. The form they take home will be blank, but I can tell
by their expressions that every word I say is being considered. Although some students choose not to participate at
all, I always make sure there are colored pencils and other
drawing instruments available to them.
Class members receive the following handout, which is
folded to cover all but the first statement:
1. The worst pain I have ever felt
2. How I have handled pain in the past
3. My pain control options as I understand them
4. Comfort measures that sound good to me
5. My number on the Pain Medications Preference
Scale by Penny Simkin
1. The worst pain I have ever felt

The examples I use to illustrate the first statement
are a broken arm, a broken heart, migraine headache, etc.
After discussing these examples, people begin completing
their handout. If any participants look puzzled, I give
more examples such as the flu, surgery, or a painful prior
memory. I allow adequate time for answers to be written,
remembering that adults think slowly as they adjust to the
pace of the class.
contiued on next page
The Personal Pain Plan: A Strategy for Teaching Pain Medication Choices in Childbirth Class
2. How I have handled pain in the past

I introduce the second question by giving examples
like being with loved ones, comfort foods, a warm bath with
scented candles, medications (Tylenol, Ibuprofen), a dark
room with no light, or watching a soothing movie.
After they have considered the first two statements by
unfolding the paper to reveal them one at a time, I go on
to discuss the Gate Control Theory of Pain and Information
Transmission, using the examples previously discussed.
3. My pain control options as I understand

them
I follow up with an explanation of the use of small,
medium, and large pain control methods, with Phenergan
being small, Stadol being medium, and an Epidural being
large. This helps the students become comfortable enough to
ask questions.
4. Comfort measures that sound good to me

I always teach comfort measures appropriate to the
stages of labor and method of pain relief we are discussing
the small, medium, and large examples. This ensures that the
participants will have no trouble listing their comfort measures, what mom-to-be desires, and what the labor partner is
willing to do.
5. My number on the Pain Medications

Preference Scale by Penny Simkin
As the class is coming to an end, I distribute copies of
Penny Simkins Pain Medications Preference Scale and encourage the class to complete them individually before sharing their answers with their partners. As a learning exercise,
I often have class participants fill out forms separately, and
then compare answers. I then encourage them to attach the
Pain Medications Preference Scale to their birth plan, and
communicate their desires with their health care providers
both before and during labor. That concludes the development of their Personal Pain Plan.
This approach fills the need my conscience has to
present all the information about medications and comfort
measures, while encouraging class participants to consider all
of their options.
Freedom of choice based on knowledge of alternatives. Oh
yes, that is something I strive to teach in all of my classes.
Im sure you do, too!
Loretta Bezold has been involved in maternal child nursing for

25 years. She has been teaching childbirth classes for more than
20, a practicing doula for 17, and is currently a Public Health
Nurse working with families across the maternity cycle continuum. She has four children, two cats, a dog, and has been
married 28 years. She resides in Oak Harbor, Washington.
Divorce Prevention
and Perinatal Education
By Viola Polomeno, RN, Ph.D.
Divorce has become commonplace in Western society.

Many couples are choosing to end their marriages after a
few years, and after having children. Can perinatal education be helpful in preventing coupleship breakdown, or
even delay it? This article provides suggestions on how to
integrate divorce prevention within perinatal education.
What does divorce prevention
have to do with perinatal education?
More and more couples are separating and divorcing after just a few years
of being married and having had one
or more children. Some took marriage preparation courses to prepare
for marriage. They also took prenatal
classes to better cope with pregnancy,
and prepare for birth and early parenting. Their relationship went through
many changes, and a point was reached
where one partner, or the other, or
both wanted out of the marriage.
Can perinatal education be useful
in preventing coupleship breakdown,
perhaps even delaying it? Can perinatal
education be adjusted to include content on relationship changes and help
couples learn more relational skills? The
author of this article continues experimentation with her clinical practice in
perinatal education by integrating divorce prevention throughout her workshops. This article provides suggestions
on how divorce prevention content can
be interwoven into the curriculum of
perinatal education.
Educator Feelings
The perinatal educator must first
increase her or his level of awareness
concerning the topic of integrating
divorce prevention within perinatal
education. Certain perinatal educators
may not feel adequately prepared to
handle the topic without training, or
they may feel that it is not appropriate
within the context of perinatal education. Others may be intrigued by the
challenge presented for their practice
and are willing to experiment with the
topic. In fact, the perinatal educator
may ask herself or himself the following
questions in order to raise their level of
awareness:
How do I feel about divorce?
Is this topic to be avoided or to be
considered?
Was I a child of divorce?
How did this affect me later in life,
and within my own relationships?
Have I experienced divorce myself?
How was this experience for me?
If I have children, how was the
experience for them?
What impact did divorce have upon

my children?
What is the nature of the parenting
relationship that I have today with
my ex-spouse?
Has this had any impact for my
practice in perinatal education? If
so, how?
Is it appropriate to talk about this
within perinatal education classes or
workshops? If no, explore your reasons. If yes, how is it appropriate?
How can I adapt my practice
to integrate divorce prevention
information within my classes or my
workshops?
Change of Paradigm in
Perinatal Education
Once perinatal educators have
raised their level of awareness, they
must then decide which paradigm underlies their practice. Perinatal education that includes childbirth education
is undergoing a paradigmatic shift from
a traditional paradigm to an alternative
one. In the first paradigm of traditionalism, the emphasis is content-focused,
with information being provided on the
preparation of the couple for pregnancy, childbirth, early parenting, and
the skills to handle these events. In the
second paradigm of alternativism, the
emphasis is on the relationship (Polomeno 2007c). Budin (1998) wrote that:
contiued on next page

[we] as childbirth educators have
always put so much emphasis on an
event that occurs in a few hours (labor
and birth) and we have not focused on
issues that affect these couples for a
lifetime.
The author has previously written
the following:
The challenge in perinatal
programs is not only to prepare
couples for childbirth but also to
sensitize them to the transition to
parenthood and all that it entails.
Preparation for the transition to the
couple partnership within the parent role requires that the educator
devote time to the couples relationship and help them to reconnect as
needed. This includes teaching the
couple how to be more in tune with
each other, increase their sense of
intimacy, improve conjugal support
and communication, and enhance
their sexual relationship
(Polomeno 2000a).
Anticipatory Guidance
The modality that is used throughout the integration of divorce prevention is anticipatory guidance. Its aim
is to strengthen the conjugal system,
promote family health, and prepare
couples for pregnancy, birthing and
parenting (Polomeno 2006; Polomeno
2007c). In the present context, the
partners focus on their relationship, by
assessing their happiness and satisfaction with it. They work together
to discover each others reactions to

different issues. They also learn how to
keep tuned in to each other, keeping
harmony between themselves, and
supporting each other emotionally.
Part of anticipatory guidance is helping
a couple discover their strengths and
qualities, both individually and as a
couple, in order to better attend to
the positive aspects of the transition to
parenthood and learn how to deal with
the negative ones. The couple learns
how to deal with any stress that may
arise, instead of blaming each other for
something that has occurred. Then the
relationship becomes a safe haven for
the partners.
The educators role is to raise
each participants awareness, create
a safe environment for the exploration of issues, and provide emotional
support and reassurance through the
normalization of feelings and thoughts.
As a result, the couples become more
aware of their relationship and of their
partnership. The educator develops an
environment within the workshop or
class whereby each partner and each
couple derives great comfort from experiencing the sharing of thoughts and
feelings, the sensation that they are all
in the same boat experiencing similar things regarding the transition to
parenthood. Support is created within
the coupleship, but also at the collective level. The educator needs to have
knowledge and skills in advanced group
dynamics for this type of anticipatory
guidance to function.
Suggestions on How to
Transform Your Practice
The author is still experimenting
with this part of her practice in perinatal education, but the feedback from
her clientele has been both positive
and supportive.
Introducing the Topic

When a perinatal educator has
decided to integrate divorce prevention
within their classes, they must choose
the where, the when, and the how. Couples should be told upfront about this
content. The author first mentions the
subject of divorce prevention during
the introduction of a workshop, and
before beginning a discussion about
the subject. The couples are invited to
choose between staying for that part
of the workshop, or if they are uncomfortable, they are free to leave. She is
respectful of their choice. She explains
why she wants to discuss divorce prevention. In all of the workshops couples
have had a similar response. They are
curious and willing to stay and explore
the topic. The tone the educator uses
to invite couples to participate is critical. Here is an example of a script that
the author uses:
I would like to talk about
relationships and how to keep
them intact as you are becoming
parents. For some time now, I have
been discussing divorce prevention
with couples, believing that the
best time to talk about divorce is
the best time to talk about divorce

is when the couple is in love.
when the couple is in love. Divorce

is a reality today. It can be scary;
I can acknowledge that. However,
when children are involved, its a
different story. I would like to help
couples establish their co-parenting
relationship from the beginning,
despite what happens to them and
their relationship. I believe in two
things: A child has the right to be
loved by both parents, and each
parent can support each other in
their parenting roles as they are going through the process of divorce.
Divorce Content
Divorce prevention involves not
only talking about divorce, but also
how to keep the relationship intact.
Information may be given in a block
of time or interwoven throughout the
curriculum. The following information about divorce is given in a block
of time and usually at the end of a
workshop. The duration is about 20
minutes.
Invite the participants to react to
the word divorce. What comes to
mind when they first hear the word?
Write down their answers on a flipchart or on a blackboard. Analyze
the words chosen by regrouping
them into trends or tendencies.
Invite the couples to share stories
about those who have been through
a divorce.
Discuss the question: What is the
current divorce rate? Provide national divorce statistics and how the
divorce rate is calculated. For example, in Canada, the divorce rate
for a first-time marriage is 30%, the
average duration of marriage is 14.2
years, and it is in the fourth year of
marriage that most divorces occur.
Invite the couples to react to these
statistics.
Discuss the question: Why do couples divorce? What are the reasons
that couples give for divorcing?
Explain the effects of divorce on the
parents and on the children.
Explain the current divorce laws,
both nationally and provincially
(Canada) or nationally and statewide (United States of America).
Explain the different ways to divorce
which include: the couple doing it
themselves, going through a mediator, using divorce lawyers, mediation
in court in front of a judge, collaborative divorce, and going to trial. Explain the general laws about splitting
property and money, child support,
and child custody. The author spends
some time on this last point and explains joint custody, shared custody,
and full custody by one parent with
parental visitation for the other.
How to co-parent: explain co-parenthood, how to establish it and
how to renegotiate when issues
arise. There are agencies that exist
that provide workshops on co-parenthood and how to negotiate this
while divorcing. The role of the
parent facilitator is briefly described
at this point.
The Couple Connection

A major content area in divorce
prevention concerns how the couple
keeps connected throughout the transition to parenthood. Part of a curriculum can be transformed to interweave
this information. Some of the following
content can be presented in segments.
It is up to the educator to decide when
and where to incorporate the content.
Transition to Parenthood
Explain the transition and its various stages. At this time, the concept of
vulnerability is also presented, as well

as the great moments of vulnerability,
the cumulative effects of vulnerability,
and how these can lead to an emotional schism at any point in time. It
is inevitable that a new baby will force
the parents to reorganize their lives
and their love. This is all natural and
normal. The partners will experience
a range of feelings from the positive
to the negative. Looking out for each
other is always helpful in these circumstances.
Marriage and Love Facts

Couples need some information
about marriage and love and how these
change with parenthood. An educator can first ask couples about their
observations regarding friends and
family members relationships while
parenting, what appears to be working
and not working for them, and what
couples are actively doing to keep their
relationship intact.
Stages of Marriage
A person may experience several types of marriage with the same
partner. People do and will change, so
there must be some flexibility in the
relationship to accommodate these
changes and to integrate them.
Difficulties
Conjugal strain and conjugal
discord may occur at any moment.
Learn to recognize it and deal with it.
If not, it will affect how partners feel
love for each other and be willing to
express it. Understanding and empathy
are two qualities that partners can learn
and nurture within their relationship.
Seek professional help if this is what
is required to deal with any difficult
situation.

Trust
Trust is built slowly over time. It is
fragile. One wrong word or action can
destroy it or set the couple back. To regain trust involves much work for both
partners. Building trust and keeping it
alive require daily efforts.
Intimacy
Intimacy must be renewed on a
daily basis. The parenting couple must
make their relationship a top priority
along with all the other ones. When
partners slip into their role as parents,
and forget about being friends and
lovers, a shift occurs in the relationship.
It is important to remember, love must
be felt, heard, and expressed everyday.
Couples need to find different ways
of continuing romance, dating, and
lovemaking to keep the flames of love
kindled and bright.
Distance
Sometimes distance may creep
into the relationship. This may be
healthy or harmful. Distance may be
healthy if a partner is dealing with
issues outside of the relationship, but is
still in it. It becomes problematic when
the partner is physically and psychologically absent. Love may dwindle with
time, if no attention is given to the relationship, as the other person may feel
rejected, abandoned, unappreciated,
and unloved. There are two opposing
forces that co-exist in the relationship.
On the one hand, the partners want
space, freedom, and individuality. On
the other hand, there is a drive to be
close and intimate with the partner,
sharing moments and feelings.
The Meaning of Connection
Gender differences
The couple built their relationship one layer at a time, evolving into
a team and building a partnership.
The feeling of partnership is described
as how the partners feel in sync with
each other, how they feel on the same
wavelength, or on the same page.
The feeling of disconnect is then
explained. The person will feel a
discomfort that is felt either physically,
psychologically, or both. Sometimes it
may come out as an emotion such as
anger, frustration, being upset, feeling
depressed or down. It could also be
physical such as aches and pains in the
shoulder region, the abdomen, lower
back pain, and headaches.
Most of the authors practice is

with heterosexual couples. The transition to parenthood evokes biological
differences. There is no other time in
the couples lives that they become
so aware of these differences. Reactions based upon gender become more
evident so the potential for conflict is
greater. Stereotypical male and female
reactions are presented according to
the latest research in the domains of
marriage, family, and sex therapy.
Getting Reconnected
Each partner becomes aware of his
or her physical and psychological state
and then shares it with the other. This
may take time as each partner struggles
with awareness, then communicates,
allowing the issues that underlie the
disconnect can be brought out into the
open. It is at this time that the conflict
resolution process is presented.
Emotional support is then explained what it means and how it is
done. Needs are discussed, rather than
expectations. Finally, love as a concept
is discussed, as well as how intimacy
lays the foundation for the relationship,
which counters the effects of vulnerability. The couples intimacy leads to
family intimacy the sense that each
partner is the others soft place and that
home is a safe haven.
The Stress Management Plan

Each partner writes down how he
or she reacts to stress and then shares
this information with the other. They
also share how they react to each other
when stressed and how the reactions
affect them. The couple is encouraged
to develop a stress management plan
outlining their individual responses to
stress, how they may feel and react to
each other, and then create a list of
strategies to deal with stress. The idea
behind the stress management plan is
to help the couple work together and
support each other to get their relationship back on track.
The Intimacy Plan

Couples are invited to participate
in writing a couples intimacy plan.
Each partner first defines intimacy, then
they discuss their definitions. They
determine what they have in common
and what aspects are different. From
this, the couple is encouraged to write
down how they would like to experience intimacy together through words
and actions. Sexual intimacy often
emerges from this discussion.
Beyond the Educators Scope
Conclusion
Couples who attend perinatal

education workshops or classes, are
occasionally in couples, family, or sex
therapy at the same time. The couple is
seeking help to deal with issues that are
having an impact on their relationship.
Perinatal education is often perceived
as an outlet for them. Its a time-out for
the couple to focus on their baby project. Where it can become a problem is
when the couple openly fights in front
of the other couples (this has previously
happened to the author in the past).
How does a perinatal educator deal
with such a situation? The educator
can invite the couple to step outside
the room where the workshop is being
conducted. She may ask the couple
if they need help of any kind. The
educator has to decide the extent to
which she or he wants to get involved.
Depending on the situation, sometimes
the partners just need a cooling down
period. One partner may decide to stay
while the other decides to leave. Maintaining an attitude of neutrality and of
non-judgment is best for the partners
and for the rest of the group. Getting
the group back on track will depend on
the educators calm manner. If abuse or
any form of violence becomes present,
then a security guard or the police may
need to be called. The workshop may
need to be stopped and continued at
the next session.
Perinatal education is undergoing a major paradigmatic shift from

content to relationship focus. More
and more educators are furthering
their training, knowledge, and skills in
domains such as couple, family, and
sex intervention. Increased training will
benefit the quality of future childbirth
classes and workshops. Perinatal education is in need of research on these
modifications and their impact on the
families, relationships, and their birthing and parenting experiences. The
greatest gift that parents can give to
their unborn and born children is the
security of their love.
References
Budin, W 1998. Commentary of exemplary
service article: Health promotion for expectant
fathers: Part II. Practical considerations. Journal
of Perinatal Education 7(2):37-39.
Polomeno, V. 2007a. Marriage, parenthood, and
divorce: Understanding the past as we move
into the future. International Journal of Childbirth
Education 22(2): 13-19.
Polomeno, V. 2007b. Marriage in the transition
to parenthood: How can perinatal education
help? Or can it? International Journal of Childbirth
Education 22(2): 20-29.
Polomeno, V. 2007c. Content or relationship?

What is more important for perinatal education?
International Journal of Childbirth Education 22(1):
4-11.
Polomeno, V. 2006. Why is love so important
in childbirth education? International Journal of
Childbirth Education 21(1): 35-44.
Polomeno, V. 2000a. The Polomeno family
intervention framework for perinatal education:
Preparing couples for the transition to parenthood. Journal of Perinatal Education 9(1): 31-48.
Polomeno, V. 2000b. Sex and pregnancy: A
perinatal educators guide. Journal of Perinatal
Education 9(4): 25-34.
Viola Polomeno, R.N., Ph.D., known as

The Love Nurse, is an assistant professor
at the School of Nursing at the University
of Ottawa, in Ottawa, Canada, where she
also conducts research in perinatal sexuality. She maintains a clinical practice in
perinatal education through the Polomeno Intimacy Center (www.violapolomeno.
com). She is a member of the Canadian
Sex Research Forum, a research collaborator with the Laboratory of Human
Sexuality at University of Ottawa, and a
member of the Social and Sexual Issues
Committee of the Society of Obstetricians
and Gynecologists of Canada.
Audio Visual Review
Giving BirthUnveiling Birth:

The Wisdom, Science and Heart
Reviewed by Deanna Broxton
Giving Birth is a magnificent film
that challenges the belief that birth is
something to be feared, rather than a
natural rite of passage, and a deeply
powerful event that shapes and changes
a woman forever.
Created by childbirth author
Suzanne Arms, and produced by Amy
Gilliland, this 36-minute film is an
excellent teaching tool packed full of
compelling facts and insightful commentaries from a variety of childbirth
experts, and age-old wisdom about
the transformative power of birth. It
is the perfect film to show to expectant parents, many of whom may have
deeply ingrained fears, doubts, and
shame surrounding childbirth. Giving
Birth addresses those fears head-on and
explores how those deeply held beliefs
influence labor and birth.
In this film, viewers will see how
a baby experiences birth and bonding;
watch a natural, normal pregnancy,
labor, and birth; and hear from obstetricians and nurses who believe in the
ability of women and babies to birth.
We also discover a mans experience of
birth, and learn that scientific research
has proven that medical interventions
are actually more harmful than beneficial, except in rare situations involving
complications.
Giving Birth also includes one hour
of bonus material that features reflections on birth from Certified Nurse
Midwife Roxanne Cummings. It also
contains post-birth footage of a mother
named Molly whose family, labor, and

delivery are featured in this film.
An accompanying teaching guide
entitled Giving Birth: Challenges and
Choices includes resources and references, bios of the films professional
experts, and provides useful tips on
how to use the DVD in class. The guide
also explains important birth issues and
facts including the history of childbirth,
labor, positioning, risks and hazards of
interventions, safety of home birth and
midwifery care, birth trauma, and the
role of women and men in the birthing
process.
Arms, who narrates most of the

film, shares a profound discovery. Her
research revealed two approaches to
birth: one is the medical management
approach that perceives and treats every birth as a crisis waiting to happen;
Executive Producer: Amy Gilliland

Created By: Suzanne Arms and
Suzanne Berthiaume
SuzanneArmsPresents.com
Film Length: 36 minutes
Format: DVD
and the second is the midwifery model,
which views birth as a normal, natural
process that needs patience, watchful
attendants, and support.
Arms effectively uses scrolling text,
soothing music, photos, and interviews
with childbirth experts to communicate
a number of compelling points, one of
which is that 95% of healthy women
can give birth naturally at home and
in birth centers with the help of a supportive partner, doula, or midwife. We
also learn that part of being supportive
includes speaking encouraging words to
the laboring mother and having faith in
her ability to give birth.
And so, as the film progresses, we
learn that there is a need to redefine
what a normal, natural birth is. The
films assertion is that seeing what is
normal allows women to be really free
to make choices that will best serve
themselves and their children.
Giving Birth drives home the point
that when it comes to birth, there is
a wide range of what is considered
normal, yet unfortunately, many
obstetricians have never seen one.
Instead, Arms explains that particularly
in North America, much of what we
have come to think of as a normal part

of the birthing process, such as artificial
induction, vacuum extraction, the use
of epidurals and sedation drugs, fetal
monitoring, cutting the umbilical cord
early, and separating mothers from
their babies after birth, is in fact, not
normal at all.
With that in mind, Giving Birth
may help women who have already
birthed their babies, make peace with
the birth that they had, and for those
waiting to give birth, this new knowledge may empower them to know that
their birth experience, does not have to
follow the medical model to be normal
and magnificent.
This film refutes the idea that
the way birth is done in the United
States of America is based on scientific
evidence. It instead reveals that medical
management of birth is the result of a
series of historical circumstances that
moved birth into the hospital. Arms
says women are strongly influenced
by a legacy of fear, pain, fear of pain,
and shame about their bodies. She
adds that women operate under the
mistaken belief that somehow their
bodies dont work well enough in birth,
and they therefore need to be rescued
by modern technology.
Cummings also explains that it is
the job of a midwife to treat that legacy
of fear with respect. For couples in
your classes who know very little about
midwifery, this film will show them that
traditional midwives are skilled at helping women feel unafraid of birth.
Throughout the film, we are repeatedly reminded that birth is a family
affair, and that supported, natural
births are good for parents and babies.
Giving Birth discusses how various
cultures approach childbirth. For many,
children grow up around it, and know
their own birth stories a fact that
Arms believes is critical to the physical,

spiritual, and emotional wholeness of
a child. It is for this reason, and all of
the others previously mentioned that
Cummings, in her soft-spoken, yet determined way, challenges us to consider
doing birth differently.
And because Molly chose to do
birth differently, the birth stories of her
two children may very well be known
and special to them. We are fortunate
to be allowed to witness her labor and
the birth of her son, in all its power and
beauty.
Couples who have never journeyed
through the birth process should find
that watching Molly and her partner
Jim go through labor together, under
the watchful care of Cummings, is
awe-inspiring. We see the couple in
nearly every stage of Mollys labor. One
minute they are dancing together and
laughing, then the next minute, Molly
is hanging on to Jim tightly, gripping
his shoulders, head down, resting
on his chest, as she works through a
contraction. We see Jim physically and
verbally encouraging her when the
contractions get difficult. He stands like
a strong tree in a fierce storm pliable, yet unbreakable. Molly is allowed
her moments of vulnerability without
it leading to intervention, and without
her needing to be rescued.
Cummings tells us that the power
a woman feels during her labor is one
that she can work with and not against.
She can merge with it and own it.
The body has its own ability to deal
with the pain of labor, and given the
right amount of support and privacy,
a woman can do it, and it is a major
achievement of her own strength and
capacity that no one can ever take away
from her for the rest of her life. That
leads her to be a fiercely protective,
strong, and confident mother.
Molly did just that. It was that

power that gave her the strength to sit
on a birthing stool and push her son
out into the world; and into her hands,
then into her arms that drew him to
her breast in triumph and joy.
Giving Birth will most certainly
challenge our most deeply held beliefs
about birth. You may even begin to see
it as Dr. Christiane Northrup did while
attending her first birth as a medical
student. In the film, Northrup says she
cried and thought, This is the holiest,
most sacred moment Ive ever experienced. I was brought to my knees by it.
As the film ended, I wanted to
remember the blessing ceremony for
Molly and her unborn baby. I listened
to the voices of women from many
generations past and presentI am
Cory, granddaughter of Evadaughter
of Esther, mother of Erin I listened
to these voices as I watched ocean
waves roll, rise, and fall much like
the contractions of labor. I watched
as words of wisdom scrolled down the
screen. I believe those words are the
essence of Giving Birth. They inspired
me, and I hope they inspire you and
the students you teach:
Childbirth is an experience in a
womans life, which if entered into
fully holds the power to transform
her forever. Passing through these
powerful gates, in her own way,
remembering all of the generations
of mothers who walk with her, she
is alone, yet not alone
Deanna Broxton is Associate Editor for the
IJCE and the owner of D. Broxton Designs
an editorial services company. She has
been a professional writer and editor for
15 years, and her work has appeared in
regional and national publications. She
resides in Northern California with her
husband and young son.
An Educators Moment
Just Dance
By Donyale Abe
Balancing a career, family, finances, and self is tricky
and often seems unattainable.
You just have to believe in the illusion that there are
more than 24 hours in a day, more than 365 days in a
year, and that it is possible to function on less than a full
nights sleep.
You day dream about the perfect life: keeping the
equity in your home, living with an uncomplaining
spouse, winning the lottery, having pets that walk themselves, and perfect children.
Dreams nourish the soul. Reality can be distressing.
Living healthy, centered, and sane, perhaps, is ones lifelong journey. You may do well to heed this advice from
Dr. Christina Yang on the television drama, Greys Anatomy:
Cristina: Youre not dancing.
Meredith: Im too tense to dance.
Cristina: Which is why were dancing.
(Meredith complains about her life)
Cristina: Shut up! Dance it out.
(Meredith makes big decision about her life)
Cristina: Dancing makes ya brave.
Why not take out 3-5 minutes a day to just dance?

Thats one song. It will get your blood going, swing your
mood in the up direction, and forget about having a
partner, let it be a chance to connect with, you.
Reflection
How do I feel when I am dancing?
Why dont I dance more?
Action
Create a playlist of songs that make you want to dance.
Turn on the radio and dance right now!
Yes, you can dance.
Starter Playlist
1. Dancing Queen, ABBA
2. Shout, The Isley Brothers
3. Cha Cha Slide, DJ Casper
4. I Will Survive, Gloria Gaynor
Dance first. Think later. Its the natural order.

~Samuel Beckett
Anyone who says sunshine brings happiness
has never danced in the rain.
~Author Unknown
To watch us dance is to hear our hearts speak.
~Hopi Indian Saying
Featured Educator
Brett Iimura
My career in childbirth education dates back about 22
years when a friend, whod had a beautiful home birth in
Massachusetts, gave me a book she no longer needed Spiritual Midwifery by Ina May Gaskin. Then I fast forward a few
years to the birth of a friend who lived in New York. She
was pregnant with her second child and I was asked to be
with her at the birth if her husband couldnt make it. Well,
he couldnt and I did. It was my first up close and intimate
childbirth experience. I remember the strength my friend
showed, and the marks she left in my hand! I recall feeling
rather impotent in the face of her power, yet I was trying to
be there for her however she needed me. I remember the
young doctor excitedly asking me if I wanted to come down
to that end to see the baby whose head had just popped out.
I was taking it all in rather matter-of-factly, feeling as if this
was just an ordinary, everyday event. The enormity of it all
gradually dawned on me during the next few hours. I was
mesmerized by the fact that my friend now had a beautiful,
new, living creature in her arms, whereas only minutes before
we were talking about the baby in the abstract. I was in awe
thinking about the thousands of years of herstory and the
striking contrast between the potential for disaster and the
overwhelming miraculousness of what I had just witnessed.
Several years later I was married, living in Japan, and
pregnant with my first child. While, as my husband likes to
say, I was studying for my Ph.D. in birth, I was simultaneously trying to figure out what my birthing options were. It
didnt look promising until I visited a Japanese friend who
had just given birth in a midwifery clinic, which was somewhat similar to a birth center in the United States. I learned
about options Id previously thought were unavailable in Japan. As a result, I went on to have both of my babies in our
tiny, Tokyo apartment with an independent midwife present.
In March 1997, a year and a half after my first child was
born, I teamed up with another American woman married to a Japanese man, and together we created Childbirth
Education Center (CEC). Having been through birth in
Japan ourselves, we recognized the tremendous need that
existed, especially in the foreign community, for information
on birthing options. We developed a curriculum and course
materials, and began teaching. We drew on our own birth
experiences and relied on our Japanese language ability to
learn all we could about the myriad of choices available to
pregnant women. We became certified by the International
Childbirth Education Association, which established us as
professionals in the eyes of

other medical professionals as
well as our clients.
At the time, even Japanese women had to purposefully search for information,
since birth options were not
discussed in the media, found
in books, or even womens
magazines. Although there
were a few pockets of
progressive midwives or
educators, without the ease of information exchange that the
Internet now provides, it was difficult to discover them. During the past 10 years that situation has changed radically and
increasing numbers of Japanese women have easier access to
a variety of resources.
However, because of the language barrier, the foreign
community in Japan is still often very much in the dark. Our
mission with CEC has always been to empower women by
not only relating information about physiologic, intuitive
birth, and breastfeeding, but also by facilitating their search
for practitioners who can provide care that is compatible
with their own personal philosophies. Despite my partners
return to the U.S. several years ago, I have been able to continue to expand my network to caregivers all over Japan.
In the 12 years of CECs existence, more than 1,400
couples from more than 50 countries have participated in
our classes, which adds a highly multi-cultural dimension
to all of our discussions. One of the pleasant side-effects of
this dynamic is that I learn how birth is approached all over
the world, which is part of what keeps me coming back for
more! Acting as a doula/interpreter for some of my clients
is another. Because of the multi-cultural aspect of CECs
classes, I have been asked to write articles for both American
and Japanese birth-related journals, and have given several
presentations in Japan, hopefully adding to international
understanding about childbirth related issues.
Furthermore, Ive recently begun to analyze and publish
some of the data I have collected over the years regarding
rates of various interventions among different groups of
women in my classes, as well as their satisfaction with the
care they receive. I hope to continue to do this in greater
detail and contribute to the discussion of birth issues on a
global scale.
A Photo Essay
A Babys Laughter
By Caroline E. Brown
A babys laughter brings smiles to all those
around. Researchers have found an association
between humor, laughter, and positive health
outcomes (Martin & Lefcourt, 2004; McCreddie
& Wiggins, 2008). Laughter triggers physiological
responses that yield positive influences on health
(Martin & Lefcourt, 2004). Laughter may act to
mediate stressful events that facilitate a persons
ability to cope with stressful events (Nelzlek &
Derks, 2001). As educators involved with new families, we are uniquely positioned to help new parents
understand the importance of laughter as a means
of mediating the stressors of being new parents.
References
Martin, R. & Lefcourt, H. (2004). Sense of humor and physical health:
theoretical issues, recent findings and future directions. Humor 17 (1),
1-20.
McCreddie, M. & Wiggins, S. (2008). The purpose and function of
humor in health, health care and nursing: a narrative review. Journal of
Advanced Nursing 61 (6), 584-595.
Nelzlek, J. & Derks, P. (2001). Use of humor as a coping mechanism,
psychological adjustment, and social interaction. Humor 14 (4), 395-413.
Caroline E. Brown is Evidence-based Practice/Research

Coordinator at UCSD Medical Center and a faculty member
at San Diego State University. Shes uses photography to facilitate research, learning, and practice. Her photography has
been exhibited at the Carnegie Museum of Natural History,
the State Museum of Pennsylvania, the Whyte Museum of
the Canadian Rockies, and published in the field of nursing
and photography.
Healthy Lifestyles
Because I Said So!
How You Teach Affects Outcomes

in Health Behavior Change
By Elizabeth Smith
First Born
Getting The Message Out
In October of 1992 my first daughter was born. It was

around that time that the preliminary studies were being
conducted on sleep safety and SIDS. And although they really werent sure about the outcomes, the nursing staff shared
information with me that explained that putting a baby to
sleep on its back may reduce SIDS. They also explained that
some babies sleep better on their stomachs and that was
the way they and their mothers had done it. So it was up
to my husband and I to decide. Being new, young parents,
we relied on what we knew, and our daughter slept on her
stomach. She did sleep better both longer and deeper in
that position. We were very careful not to use big blankets or
pillows in her bed, and she never slept in our waterbed. Like
the majority of babies, she was fine.
What is the difference in the two scenarios? It was more

than just someone telling us what was best for the baby. It
was hearing the same, consistent message over and over. The
message was backed by evidence that was valid, replicated,
and significant. However, that was not the most critical part
of the lesson. At the time I didnt think about it, but 12 years
and a masters degree later, I know that it was the attitude
and body language in each message that really sealed the
decision for us. Numerous studies have shown that what is
said is only 5-7% of the message. The other 93-95% of the
message comes from body language. As couriers of health
care messages, we need to be very aware of not just the
information, but of how we deliver the message.
Active Listening
Parenting Advice Changes

Three years later, our son was born. The advice we were
given at the time was that studies had proven that there
was a 50-75% reduction in SIDS if babies were always put
to sleep on their back. We were reassured that babies dont
choke on their spit-up in that position. Diapers, t-shirts,
and handouts all carried the same message: Back to Sleep.
We were told that babies dont always sleep as deep in that
position, which was good because then they are able to wake
themselves and are less likely to stop breathing. The nursing
staff showed us how to bundle our son tightly to avoid his
being awakened by the morrow reflex. Our son was placed
on his back to sleep and we never even considered putting
him on his tummy.
As educators, one of the first things that we have to

remind ourselves of is to actively listen to the person we are
teaching or counseling. Classes in both my undergraduate
and graduate programs put a lot of emphasis on the listening
component of teaching health topics (Kleinschmidt, 1993
and White, 2000). Health care workers have a tendency to
enjoy having the answers, and as a result, we are very quick
to respond without thinking about what the person is really
asking.
Take the example of a new mom who asks her pediatrician if it hurts more to give five vaccinations in one visit
rather than to give the five shots in two visits. She may be
asking several questions. She could be concerned about
things people have told her about autism. She may have to
go to work early the next morning and is afraid of being kept
awake all night. Or she may be very sensitive to pain herself,
Because I Said So! How You Teach Affects Outcomes in Health Behavior Change
and is worried about how her baby will respond to the shots.
The simple open-ended question; What have you heard?,
will encourage a dialogue, making it easier to find out what
she really wants to know rather than going off on a tangent
about a view point she hadnt even considered.
In addition to not necessarily understanding the question being asked, a quick answer could possibly be a hostile
answer. The body language may signal that I as a health
care worker know all the answers and you as a patient should
just listen to me (White, 2000). We inadvertently put the
patient/client in the space where they dont feel like they
have any expertise in the area. It is critical to remember that
the patient is the expert on who they are. No two people are
alike, therefore, no two problems are exactly the same. We
need to remember to consider the background of the person
asking the question.
Language
Lactation Consultant Dianne Wiessinger writes about
how our wording profoundly affects the messages we are
giving (Wiessinger, 1996). For years, formula companies and
lactation consultants alike have used the message, Breast is
Best! We communicated the identical and consistent message; yet we were still unable to meet the Healthy People
2000 goals for initiating and maintaining breastfeeding. As
we approach 2010 we are still behind on reaching the new
goals. Why?
Wiessinger challenges us to look at what we are saying.
By saying that breastmilk is best, or the optimal choice for
feeding a baby, we are saying that breastmilk is superior.
Superior is a great goal, but how many of us are superior
in other areas of our lives. I personally am not the ultimate
housekeeper, and in fact, have a sign on my front door that
reads, Martha Stewart Doesnt Live Here, Adjust! Most
people who come to my house and see that sign comment
on how it fits their lives as well. They cant be superior,
so adequate will have to do. This is the message that gets
communicated not only with breastfeeding, but with other
health issues as well. When we say that breast is best, we are
saying that it is the optimal choice, but if you have to use it,
formula is adequate. By rephrasing that message and saying
that breastfeeding is the normal way to feed a baby, it turns
the table on the formula issue. Now formula has become the
abnormal or substandard way to feed a baby. Wiessinger says
Photo credit: flickr/shawnotron
that while most people are fine with being adequate, they
are not fine with being abnormal or substandard. Thus they
will think more about the health decision they are making.
This same use of language can be applied to other topics of childbirth education. Vaginal delivery is the normal
way a baby is born. Therefore, cesarean birth becomes
abnormal. Stretching of the perineal body during birth is
normal, thus making episiotomy abnormal. Balancing normal
with the occasional need for medical intervention then
becomes less of an opinion and more fact-based.
The language of statistics is also important when giving health messages. There is a big difference between the
following two statements. The first way to teach benefits
and risks is to say, The risk of major complications from
vaccinations is less than 1/10,000. Another way to approach
the topic would be to state that, A person is 20 times more
likely to suffer from ill affects from getting the measles than
they would from getting the vaccination. This addresses
both the risk of getting the vaccination and the risk of not
getting the vaccination.
Another example of how to utilize statistics in the
language of teaching is to state, The risk of maternal
morbidity is four times higher with a cesarean birth than a

vaginal birth. Because we naturally relate back to our own
experience, the rephrasing of statistics helps identify the
reality. The vast majority of people know someone who has
had a cesarean section and generally everything was fine.
Additionally, the same majority also know women who have
had a less than optimal outcome with a vaginal delivery. By
putting the statistic at four times more likely we are giving
a better perspective of how often that bad outcome occurs,
thereby helping the patient realize the risk associated with
the procedure.
In The Art of Teaching without Preaching, Amy Spangler
gives tips for use of language when teaching about health
behaviors. She states that you should never use the word
but in any of your messages. The use of that word negates
everything you have said up to that point. The following
example illustrates how the message changes when using the
word but.
Babies who are breastfed are less likely to develop illnesses.
When they are sick they tend to be less sick than formula
fed babies, but, if you do feed formula make sure to follow the instructions for mixing.
The use of the word but takes away the message that
was intended. Yes, we do need to make sure that patients
know the importance of correctly mixing formula. However,
it needs to be in a different conversation to avoid the contradiction of the message.
Other suggestions from Spangler include being aware of
your body language. You should be sure to smile, and look
at the person. Think of them as an equal who will validate
their concerns, and if possible try to match their learning
style. Matching the message to learning styles takes practice.
However, the payback is well worth the effort.
Alternatives
When you are helping someone adopt a new behavior it
is very important that you provide the skills to make it possible. Educators must consider how change can be facilitated
so that it will be a continual behavior. When we were told
to put our son to sleep on his back, we were also given skills
to make it possible. We were taught how to keep him tightly
bundled so he wouldnt startle and wake up.
A woman who has just been diagnosed with gestational
diabetes, needs to have the information to comply with dietary changes. She must be given the skills to make it work.
Evidence-Based Research
Evidence-based information is critical when working
with patients. There are so many theories, practices, and
beliefs associated with pregnancy, birth, and parenting. Consistency and validity cannot be emphasized enough. From an
educators perspective, having the evidence makes it much
easier to deliver the message. We all go for the easier road if
we dont have the correct information.
Going back to the subject of my first daughter, the
nursing staff had preliminary information but no hard data
to back up the new practice of Back to Sleep. Because of their
lack of confidence in the new message, we too were skeptical. It was easier to go with the old standby of putting the
baby on her belly. She slept longer and so did we. Had we
known that putting her on her belly put her at a 25% greater
chance of dying from SIDS, we never would have made that
choice. Three years later, having evidence to back up the
information shared with us made everyone more confident
How do we know the evidence is accurate? As educators we need to get our information from reliable sources.
Peer-reviewed journals and prospective studies with high
sample sizes are some good indicators of accurate evidence.
Replication is also something to look for. If the same results
occur over and over even with different experimental design,
then it is more likely to be accurate.
As we teach changing practices, it is important to
acknowledge cultural and family traditions. Remind patients/
clients that their mother may have done it a certain way,
and at the time that was considered correct. Then go on to
explain how things have changed and evidence gives rise to
another way of doing things.
Does it work?
We dont always know if the way we teach is right on
an individual basis. We might not always have the opportunity to see the patient or client over time. We then need to
build our own skills to have multiple ways to teach a topic.
Increasing our own skill, knowledge, and approach builds
confidence in how the message is delivered.
At the University of Utah Hospital, we had the opportunity to see how our teaching affected some of our patients
through a postpartum outcome monitor. As part of the Baby
Friendly Hospital Initiative, the research team looked at
long-term breastfeeding rates both at the beginning of our
journey to become a Baby Friendly Hospital, and now as we
Because I Said So! How You Teach Affects Outcomes in Health Behavior Change
await designation (Lucas, et al. 2008). The aim statement for
this project was: 2 North Breastfeeding Mothers with Term, Well
Babies will Meet or Exceed the Healthy People 2010 Goal for
Breastfeeding Mothers of 75% Still Breastfeeding at 6 Weeks.
We surveyed moms with healthy, full term babies both
in 2005 and in 2006. Of the mothers surveyed in 2005, 97%
had a vaginal delivery compared to 86% in the 2006 survey.
This is significant because although we had a decrease in
vaginal births we still had an increase in babies breastfeeding
in the first hour of life.
The teaching done in the first part of this outcome was
both to patients and to nursing staff. The patients who went
to childbirth, parenting, or breastfeeding classes were told
about the importance of skin-to-skin contact for long-term
breastfeeding success. The nursing staff was also educated
on the evidence of skin-to-skin care for all moms and babies
once they were both medically stable. The result was an
increase in the number of babies placed skin-to-skin in the
first hour of life or medical stability.
Another area to consider was how we taught about
pacifier use. Pacifiers are tricky because they are so common in our culture in the United States. Everything from
blankets to t-shirts to diaper bags have pictures of pacifiers.
When we tell parents not to use pacifiers, we are sending a
message that conflicts with the norm. Through coaching of
our nursing staff we were able to give a consistent message
that although a lot of babies can take a pacifier and not have
a problem with breastfeeding, some babies do experience
confusion. Since we cant look at a baby and know if he or
she will be the baby who has a problem, we no longer give
pacifiers for non-medical use at our hospital. Instead, we

teach alternate ways to soothe babies, making other options
available. It is also critical to teach the American Academy
of Pediatrics guideline for pacifier use after the third week of
life.
The results from our revised teaching had significant results. Pacifier use during hospital stays decreased among the
two groups. In 2005, 74% of the babies received a pacifier
compared to 65% in 2006. In the 2006 survey, the mothers
or charts indicated three were for medical use, 33 were used
per mothers request and 14 were unknown. Since that time
our pacifier use has decreased again.
Changing the way we taught skin-to-skin contact and
pacifier use resulted in babies who were breastfed longer, and
there was more maternal satisfaction with the breastfeeding
experience.
Whether the teaching you do is to patients, families, or
hospital staff, considering how to effectively teach will result
in better outcomes.
References
Kleinschmidt, J. 1993. Facilitating Health Behaviors. University of Utah
Department of Health Promotion and Education.
Lucas, E., Epperson, S., Nye, V., Dority, T., Erickson, M. and Gulliver, B.
2008. 2North Clinical Outcome Project.
Spangler, Amy. 2007. The Art of Teaching without Preaching.
Wiessinger, D. 1996. Watch Your Language! Journal of Human Lactation.
12(1):1-4.
White, G. 2000. Public Health Practicum. University of Utah School of
Medicine.
Perinatal Wellness
Postpartum
Pelvic Pain
By Heather Jeffcoat, DPT

You had the perfect pregnancy. Your delivery could not
have been any better. At your six-week checkup, everything
looked great. So, whats with all the pain?
Pelvic pain is an often neglected problem that many
women experience after childbirth. However, when pain
persists beyond the first few weeks, patients are often hesitant to mention it to their healthcare providers. Oftentimes
when they do, they are told It will get better with time.
And no further support is provided. But how much time? I
have had patients who are still experiencing some degree of
pain one year after childbirth, and longer. This is too long to
wait for treatment, especially if the pain is preventing them
from exercising, playing with their children, or even enjoying
intimacy with their spouse.
Postpartum pelvic pain can occur for several reasons.
After delivery, estrogen levels drop and progesterone levels
stay high. This is especially the case if your
client is breastfeeding.
This hormonal influence
causes dryness of the
vaginal tissues. In this
case, the solution might
be as simple as recommending a water-based
lubricant for your client
and providing general
advice to increase their
water intake. Immediate
muscle and skin pain
2006. Sean Dreilinger
or discomfort is also
expected, especially if
tearing occurs during the delivery. This can be managed in
part, with frequent ice packs to the perineum. Performing
kegel exercises will also promote healing by increasing local
circulation. Keeping the area clean with the use of a perineal
irrigation bottle and sitz baths will reduce infection and
further assist in the healing process. The use of a doughnut

cushion provides relief for perineal discomfort in some patients. Finally, keeping bowel movements soft, will minimize
stress on any sutured and healing sites, thereby minimizing
pain.
Women may experience immediate central pubic pain
during their vaginal delivery. This could be due to a sprain
or separation of the pubic symphysis joint, leading to pain
over the sacroiliac joints, buttocks, or thighs. The client may
report extreme difficulty and pain with turning in bed, transitioning from a seated to standing position, getting in and
out of a car, or with weight-bearing activities.
Later sequelae may include bladder dysfunction (Snow
and Neubert, 2001). Early intervention includes providing
the client with a pelvic brace for external support. Oftentimes, these patients require advanced manual techniques to
restore normal alignment, reduce muscle
spasm, and the need to
perform stabilization exercises that will strengthen the area without
causing further pain.
Coccydynia is
another commonly
reported pain after delivery. These women will
primarily complain of
pain with sitting. Instruction of proper posture
and use of a specialized
wedge cushion are important first steps. Pelvic floor muscle spasm can be associated with this diagnosis and may require further intervention
by a physical therapist trained in manual therapy of the area.
Postpartum Pelvic Pain

Vaginal scar pain is another common postpartum pelvic
pain, either from an episiotomy or natural tearing. The severity of the pain can range from pain with tampon insertion
to pain with intercourse. For some women, the pain is so
intense that they avoid these activities all together. Teaching
perineal massage over the scar is a helpful initial intervention. With persistent postpartum vaginal pain, scar tissue
hypersensitivity, peripheral nerve injury or entrapment, joint
injury, or pelvic floor muscle spasm could be the cause, and
referral to a womens health physical therapist would be
indicated.
Pelvic pain caused by nerve injury or entrapment occurs
in 0.92% of live vaginal births (Wong et al, 2003), but is
generally thought to be much higher. The positioning of the
mother may create nerve compression or ischemia. It has
been reported that the semi-Fowler-lithotomy position or
excessive hip abduction and external rotation are common
positions linked to nerve injury. These positions may contribute to femoral mononeuropathy during uncomplicated,
vaginal deliveries (Al Hakim, 1994).
The tailor position with prolonged epidural anesthesia
has also been suspected in femoral and sciatic nerve traction injuries (Ley et al, 2007). The position of the fetus or
prolonged pushing can put adverse tension on nerves. A
common site for compression is the obturator nerve (Massey
and Cefalo, 1979). Injury to the pudendal nerve is associated with occiput posterior presentation at birth, and with
forceps or vacuum-assisted deliveries (Tetzschner et al, 1995;
Tetzschner et al 1997). Also, surgical lacerations have the
potential of creating peripheral nerve injury as well. All nerve
injury or disruption to nerve input can lead to incontinence
or pelvic pain.
Womens Health physical therapists are trained to evaluate and treat pelvic pain before, during, and after pregnancy.
To locate one in your area, contact the American Physical
Therapy Association Section of Womens Health at sowh@

apta.org or call (800) 999-APTA, extension 3229. Interventions such as scar desensitization and mobilization techniques, manual therapy to the pelvic floor and associated
muscles, specific therapeutic exercises, modalities to decrease
pain and inflammation, pelvic floor muscle biofeedback, and
patient education are essential components of postpartum
recovery.
References
ACOG, 2005. Your pregnancy and birth. Washington, DC: Meredith Books.
Al Hakim M,. Katirji B. 1994. Femoral mononeuropathy induced by the
lithotomy position: a report of five cases with a review of literature. Muscle
Nerve 17(4): 466.
Babayev M., Bodack M.P., Creatura C. 1998. Common peroneal neuropathy
secondary to squatting during childbirth. Obstet Gynecol 91(5): 830-832.
Haslam, J., Laycock, J. 2002. Therapeutic management of incontinence and
pelvic pain. 2nd edition. London:Springer-Verlag.
Ley L., Ikhouane M., et al. 2007. Neurological complication after the tailor
posture during labour with epidural analgesia. J Gynecol Obstet Biol Reprod
36(5): 496-499.
Massey E.W., Cefalo R.C. 1979. Neuropathies of pregnancy. Obstet Gynecol
Surv. 34(7): 489-492.
Ronchetti I., Vleeming A., et al. 2008. Physical characteristics of women
with severe pelvic girdle pain after pregnancy: a descriptive cohort study.
Spine 33(5): 145-151.
Snow R.E., Neubert A.G. 1997. Peripartum pubic symphysis separation: a
case series and review of the literature. Obstet Gynecol Surv 52(7): 438-443.
Stephenson, R., OConnor, L. 2000. Obstetric and gynecologic care in physical
therapy. New Jersey: Slack, Inc.
Tetzschner T., Sorensen M., et al. 1995. Pudendal nerve damage increases
the risk of fecal incontinence in women with anal sphincter rupture after
childbirth. Acta Obstet Gynecol Scand 74(6): 434-440.
Tetzschner T., Sorensen M., et al. 1997. Delivery and pudendal nerve function. Acta Obstet Gynecol Scand 76(4): 324-331.
Wong C.A., Scavone B.M., et al. 2003. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol 101(2):
279-288.
Executive Directors Letter
The Evolution of ICEAs
Bookcenter
By David Feild
For many years the bookcenter has been at the heart of
the International Childbirth Educaton Associations operations, providing a valued service to members. The store has
been a source of information, provided teaching materials,
and study materials to members seeking certification. The
book center has also provided parents and the international
birth community with books and literature about childbirth,
parenting, and related topics.
Most importantly, Id like to acknowledge the numerous authors who have copyrighted their work under ICEAs
name. These publications are always bestsellers because of
the superior qualifications of the authors and the very relevant content aimed at our members. ICEA also carries books
published by commercial publishers and other well-known
authors. A somewhat unique feature of the bookcenter is
the wide variety of teaching tools and aids that have been
assembled for sale everything from posters to hot sox.
In tracking sales and analyzing how members and others
are utilizing the bookcenter, the ICEA Board of Directors is
actively reviewing the business model for the bookcenter and
several changes are underway.
The first priority is a major improvement to how the
ICEA website, www.icea.org, supports bookcenter operations. The website has been redesigned to include a more
user-friendly catalog and an improved ordering and creditcard processing system. We believe this enhancement will
save members time and make it easier to place online orders.
It is still possible to place orders by fax, e-mail, and telephone, but the most cost-effective system will be ordering
from the ICEA website. The ICEA Board hopes that the improved website functionality will be a welcome convenience
for members.
In connection with the website enhancements, the ICEA
Bookcenter Coordinator, Heidi Sorensen, is working with a
small member committee to consider increasing the number
and variety of publications and other educational materials

that are available for download online, in addition to being
available by mail.
An example is the ICEA Position Papers and Statements
that members often use to obtain alternate contact hours for
certification. Making these papers available as downloadable
files, including the quiz, will make it easier and quicker for
members to obtain these alternate contact hours. Another
new addition is the availability of various ICEA posters compiled into a PowerPoint presentation available for sale.
In addition, Board Member Emily Fontes is heading a
member group that reviews new publications for possible inclusion in ICEAs bookcenter. This will enable ICEA to make
quick decisions regarding whether or not to offer a new book
or brochure. A similar mechanism will be used for reviewing
new teaching tools, movies, and CDs. An increasing amount
of time and attention is being given to keeping the inventory
up-to-date and competitively priced.
In terms of an evolving business model for the bookcenter, the board of directors is looking to build partnerships with other online sellers, particularly Amazon.com.
A company like Amazon has resources far beyond those of
ICEA. Its buying power is large, allowing them to discount
prices and offer benefits such as free shipping that would be
difficult for ICEA to provide. Rather than compete head-tohead with other online sellers, it may benefit ICEA and its
members to use other sellers to help with marketing and/or
fulfillment efforts. These options will be thoroughly explored
in the coming months.
When you get a chance, please go to www.icea.org and
check out the revamped ICEA bookcenter operations. And,
keep your eyes open for new online products that will be
available shortly.
ICEA
Labor Note Cards
Review the information you have learned in class by answering the following questions.
Remember to use these note cards during your labor.
!
What positive statements encourage the mother?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
!
What are good things to do during labor?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
!
What labor tools can be used?
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Permission granted for reproduction and use in teaching childbirth education classes.
2008 International Childbirth Education Association, Inc. (ICEA)
Calendar of Events
January 17, 2009
Washington, D.C. Reaching Them,

Advanced Childbirth Educator Workshop.
Childbirth Professional Development
Group, 916/525-7596,
Website: birtheducators.googlepages.com,
Email: birtheducators@gmail.com.
January 31-February 1, 2009
May 2-3, 2009
Los Angeles, California. Basic Training for

the Childbirth Educator. Babytime Birth
Services, 818/693-1513,
Website: www.lababytime.com,
Email: babytime2001@hotmail.com.
June 19, 2009
Sacramento, California. Basic Training for

the Childbirth Educator. Childbirth Professional Development Group, 916/525-7596,
San Francisco Bay Area (Oakland, CA).

Reaching Them, Advanced Childbirth
Educator Workshop. Childbirth Professional Development Group, 916/525-7596,
February 28, 2009
June 20-21, 2009
Sacramento, California. Reaching Them,

Group, 916/525-7596,
April 24, 2009
Portland,Oregon. Reaching Them,

Group, 916/525-7596,
April 25-26, 2009
Portland, Oregon. Basic Training for the

Childbirth Educator. Childbirth Professional Development Group, 916/525-7596,
San Francisco Bay Area (Oakland, CA).

Basic Training for the Childbirth
Educator. Childbirth Professional
Development Group, 916/525-7596,
August 29-30, 2009
Los Angeles, California. Basic Training for

the Childbirth Educator. Babytime Birth
Services, 818/693-1513,
Website: www.lababytime.com,
Email: babytime2001@hotmail.com.
*October 15-17, 2009
Oklahoma City, Oklahoma. ICEA Perinatal

Fitness Educator Training. International
Childbirth Education Association,
919/863-9487,
Website: www.icea.org,
Email: info@icea.org.
Stay in Touch Send Us Your Email Address!

Do we have your email address? Email is the quickest way for ICEA to
deliver membership news and updates to you. Send your email address to us
at info@icea.org.
*October 15-17, 2009
Oklahoma City, Oklahoma. ICEA International Convention. 919/863-9487,

*October 15-17, 2009
Oklahoma City, Oklahoma. ICEA Postnatal

Educator Training. 919/863-9487,
*October 15-17, 2009
Oklahoma City, Oklahoma. ICEA Doula and

Labor Support Training. 919/863-9487,
*October 15-17, 2009
Oklahoma City, Oklahoma. ICEA Basic

Training for the Childbirth Educator.
919/863-9487,
*October 15-17, 2009
Oklahoma City, Oklahoma. ICEA Educating

the Educator Training.
ICEA Calendar listings are free of charge

for events that have been approved for
ICEA contact hours. There is a charge for
listing non-approved events. To be listed
in this calendar, contact hour applications
must have been approved two months
prior to the publishing of the IJCE and be
scheduled to take place during the three
months following publication. Events
scheduled for later months will appear in
the next issue of IJCE.
E
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FR ER
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Are you Teaching Safe Sleep Practices?

SIDS is the leading cause of death in the post-neonatal period, more
than all other causes combined.
As a childbirth educator, you play an important role in not only teaching
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International Journal of

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Postpartum Pelvic Pain

The Way I Teach

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VOLUME 23 NUMBER 4 DECEMBER 2008

Articles herein express the opinion of the

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education | 

The Editors Perspective

In This Issue The Way I Teach

 | International Journal of Childbirth Education | Volume 23 Number 4 December 2008

Letter From the President

podcast Pleasurable Birth: Is It

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education | 

In the 1986 premier issue of the International Journal of

 | International Journal of Childbirth Education | Volume 23 Number 4 December 2008

Mindful Yoga as a Vehicle

The practice of mindful yoga paired with

pose I felt surrounded by their support. Later, when I was

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education | 

Mindful Yoga as a Vehicle for Childbirth Education

The body will refresh itself and work more effectively. Im

Present Moment Awareness

Take a cleansing breath in through

Make a sigh with the out breath

Open mouth and soften the jaw

Work With Sensation

Be curious about it.

 | International Journal of Childbirth Education | Volume 23 Number 4 December 2008

Expand awareness to include the

Focus in the Moment

Notice complaining mind wanting the

Teaching the Facts:

With the release of a new report,

Teaching the facts, when I know that some prenatal care

baby are enhanced

As a childbirth educator, doula, representative, and patient of the hospital where

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education | 

Teaching the Facts: The Dilemma of Evidence-Based Care

Role Play Scenarios

Photo credit: flickr/Lab2112

10 | International Journal of Childbirth Education | Volume 23 Number 4 December 2008

Benefits What are the benefits to this procedure?

Intuition What does my gut tell me about this procedure?

Facts and Statistics

Photo credit: flickr/daquellamanera

Examples of other statistics to discuss:

The United States cesarean rate in 1970 was 5.5%.

Conversation with Care Provider

continued on next page

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education | 11

Teaching the Facts: The Dilemma of Evidence-Based Care

able to them, ask if I knew any home birth midwives in the

Birth Place and Care Providers

Photo credit: flickr/manueb

12 | International Journal of Childbirth Education | Volume 23 Number 4 December 2008

me to undress, and place my feet in the stirrups so that she

Photo credit: flickr/joshschipper

She actually looked surprised at my question and asked

You may feel the

continued on next page

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education |

| International Journal of Childbirth Education | Volume 23 Number 4 December 2008

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education |

| International Journal of Childbirth Education | Volume 23 Number 4 December 2008

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education |

| International Journal of Childbirth Education | Volume 23 Number 4 December 2008

Volume 23 Number 4 December 2008 | International Journal of Childbirth Education |