Birth Day - International Childbirth Education Association

International Journal of
Childbirth Education
VOLUME 24 NUMBER 4 DECEMBER 2009
Features
Where Do We Go
From Here?
Are Unexpected
Outcomes in
Childbirth Normal?
Nurturing Laboring
Women Through
the Years
Poor Knowledge of
Causes and Prevention
of Stillbirths
Featured Educator
Chris Maricle
Book Review
Birth Day
Audio-Visual Review
Understanding Birth
Open Forum
The official publication of the International Childbirth Education Association

www.icea.org
Check out ICEA’s Newly
Revised Brochures!
Order from the ICEA Bookstore at www.icea.org
— Quantity Discounts Available! —

International Journal of
Childbirth Education
The official publication of the
International Childbirth Education Association
Managing Editor
Connie Livingston
Columnists
Donyale Abe
Heather Jeffcoat
Mary McCoy Wall
Elizabeth Smith
Reviewers
Susan Bash
Erica Konya
Erin Livingston
Candy Mueller
Graphic Designer
Laura Comer
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 International
Childbirth Education Association
(ICEA), Inc. Subscriptions are $60 a year.
The International Childbirth Education
Association, founded in 1960, unites
individ-uals 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 2009 by ICEA, Inc. Articles
may be reprinted only by written permission
of ICEA.
VOLUME 24 NUMBER 4 DECEMBER 2009
Indexed in the Cumulative Index to Nursing and Allied Health Literature (CINAHL)
Features
One Thing I learned at the 2009 Conference
By Jenney Rodriguez.............................................................................................................. 8
Where Do We Go from Here ?
By Connie Bach-Jeckell........................................................................................................11
Birth in Israel
By Lissa Szajnbrum..............................................................................................................13
Is Dad Getting What He Needs to Support Mom?...................................................................15
Are Unexpected Outcomes in Childbirth Normal?
By Sherokee Ilse.................................................................................................................. 16
Nurturing Laboring Women Through the Years
By Paulina Perez................................................................................................................. 19
Scenes from the 2009 Conference............................................................................................ 22
Many Thanks to Conference Supporters!..................................................................................24
Letters to the Editor..................................................................................................................24
Becoming a Birth Writer
By Elizabeth Merrell Gross................................................................................................... 25
Poor Knowledge of Causes and Prevention of Stillbirths.........................................................26
Columns
The Editor’s Perspective – Thanks and Farewell – By Connie Livingston.........................................4
Across the President’s Desk – Wisdom of the Sages – By Jeanette Schwartz.................................. 5
Executive Director’s Letter – ICEA’s Journal is Evolving – By David Feild.......................................6
Featured Educator – Chris Maricle................................................................................................. 8
Book Review – Birth Day – Reviewed by Jamilla Walker.............................................................. 12
Audio-Visual Review – Understanding Birth, 2nd Ed. – Reviewed by Connie Livingston............... 14
Announcements
ICEA Announces Doula Insurance Reimbursement................................................................. 10
Follow ICEA Online.................................................................................................................. 21
Journal Submissions...................................................................................................................31
ICEA.org
Calendar of Events.....................................................................................................................30
Cover Photo: Photo Contest winner, ICEA member Jan Mallak
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 3

The Editor’s Perspective
A New Year,
A New Decade
edi·tor (ed'it∂r) noun — (1) a person who edits; often,
specifically one whose work is procuring and editing
manuscripts (2) the head of a department of a newspaper,
magazine, etc.
As the year 2009 comes to a close, so does my
year as editor of the International Journal of Childbirth
Education. This has been a wonderful revisit to a position
I held in the early 1990s. I am deeply appreciative
to the ICEA Board for this opportunity to serve. I will,
however, remain active in ICEA as an ICEA Approved
Trainer.
I would also like to take this opportunity to thank
my Review Staff: Erica Konya, Erin Ross, Susan Bash and
Brief Writer’s Guides for the
ICEA Journal
Submitted (electronic is preferred) articles (minimum
500 words) should express an opinion, share a teaching
technique or research, or describe an experience.
References are usually not required because the writing
is solely from the author’s opinions or experience.
Accompanying photographs of the people and activities
involved will be published only with accompanying
Photo Permission Form.
The title page should include:
• Title and author’s name
• Academic and professional degrees, institutional
affiliations, and status
• Mailing address, phone and fax numbers, and
e-mail address
Writers are asked to include a photograph, a two- to
three-sentence biography, and a 50-100 word abstract
of the article. If bibliography is attached, please use
Chicago Manual of Style.
Candy Mueller for their
hard work and dedication
to the success of the
Journal during 2009. I
would also like to thank
all of the writers for their
contributions during
2009 as well as Laura
Comer at First Point Resources
for her innovative
design concepts that Connie Livingston
have made the Journal
easy to read with a contemporary spirit.
This final issue for 2009 has as the theme Open
Forum. With this issue is a wonderful centerfold of
photographic contributions from ICEA Convention
attendees. Congratulations to ICEA member Jan Mallak
for submitting the winning photograph for our Cover
Photo Contest! The featured educator for this issue
is Chris Maricle, a veteran childbirth educator with a
rich ICEA history! Another ICEA veteran, Polly Perez
offers a look at Nurturing Laboring Women Through
the Years. In keeping with the international aspect of
our organization, Lissa Szajnbrum gives us a glimpse
of Birth in Israel while ICEA Board member Connie
Bach-Jeckell continues to keep us informed about the
organizational outreach to Guatemala. Elizabeth Merrell
Gross discusses what it is like to be a birth journalist.
Last but not least, Sherokee Ilse, a featured speaker at
many birth conferences, shares about loss and childbirth
education.
As always, it is my intention as editor to inform, inspire
and engage the reader of the International Journal
of Childbirth Education.
Happy Holidays and New Year blessings to you and
your family.
– Connie Livingston
4 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Across the President’s Desk
Wisdom of the Sages
By Jeanette Schwartz, ICEA President
A recent birth I attended offered me an opportunity to
reflect on my path in the childbirth profession. I am grateful for
those who have shared their learning experiences with me as it
is this “Wisdom of the Sages” I use to support women in birth.
It was to be my day off. After the third phone call from
the maternity care unit asking me to come in and help, I
was compelled to say “yes”. As I was driving to the unit, I
thought about how the energy of the universe often calls us
for reasons we are unaware. I was called to be of assistance
to a mother to whom I had not originally been assigned. It is
ancient teachings that tell me “there is a purpose to everything
we are called to do and we need to offer our services
for the ‘higher good’.”
I thought of Celeste Phillips, RN, PhD and her work
around Family Centered Care that formed the philosophy
of the unit to which I was coming to work. The unit
was organized around the ICEA principles of “freedom of
choice based on knowledge of alternatives”. This means the
mother’s birth plan would be honored in an environment
where the mother would be respected in her choices.
I was assigned to a first time mother who had arrived at
the hospital an hour earlier in active labor. She was dilated
to three centimeters and was being supported by her mother
and husband. It is Penny Simkin’s teachings that come to
play now. Penny teaches the doula principles of continuous
support, positive statements (“you can do this, you
are strong, you are capable”) and the skills I would use to
help support this mother’s labor. Into the tub would be the
mother’s first choice for comfort measures—Barbara Harper’s,
Gentle Birth Choices, taught me about the benefits of hydrotherapy
and how safe it is to labor and birth in water.
Forty minutes later, this laboring woman was dilated to
six centimeters. She was “very loud” in her breathing…yes,
screaming. Again, I was able to calm her support people as we
listened to this mother’s “rhythm of screaming”. I was able to
reassure them that the mother was, indeed, in complete control
of her labor. It is Ida May Gaskin’s voice echoing in my
head “our birthing centers need to have more noise”. Today
that was going to be true.
It was Marilyn Hildreth’s
suggestion that I used next;
“Ask the mother, ‘What are
you thinking?’” to give clarity
to how the mother is coping
with labor. The mother’s
response: “I think I am going
to die.” In between contractions
I am able to explain
Suzanne Arm’s vision in her Jeanette Schwartz
film Giving Birth- Unveiling
Birth: The Wisdom, Science
and Heart of how for millions of years women have been
birthing and she is not alone in her thoughts. She explains to
me, “I don’t think I can do this.”
I stated, “This is as hard as it is going to be.”
“How can that be?” she says. “I’m not even in transition.”
I now need to draw on my 20+ years of experience
working with laboring women. Over the years, I have
observed women’s actions during active labor are about 20
minutes ahead of their cervix. For instance, in my experience,
if a mother is responding to labor as if she was nine
centimeters dilated, or in the transition phase of labor, a
cervical check might in reality show the mother to be only
six centimeters dilated. If the cervical check is delayed 20
minutes, in many instances the cervix would then be nine
centimeters dilated.
The way this mother was responding to her labor would
have led me to believe she was nine centimeters dilated even
though I knew her cervical check ten minutes ago revealed
her to be six centimeters dilated.
“You are in transition.” I stated. Again I ask, “Tell me
about your loud voice.”
“It makes me feel good.”
Enough said. It was truly inspiring to watch this mother
use all the wisdom of the ages to birth her baby. Dr. Sarah
continued on page 10
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 5

Executive Director’s Letter
ICEA’s Journal is Evolving
By David Feild, ICEA Executive Director
This issue of ICEA’s journal, the International Journal of
Childbirth Education, is the fourth one that has been published
electronically. No journals were printed and mailed in
2009. All issues were announced via e-mail to the membership
and posted in a special section of the ICEA website using
both special reading software from Virtual Paper and the
“PDF” file format. You have accessed one of these formats to
read this column.
Although a large factor in the decision to print the Journal
electronically was based on costs, it was hoped that the
new format might eventually bring some added value to the
publication (more on this below). As far as the cost savings
go, this has been a success. ICEA has saved approximately
$26,000 in 2009 in printing and mailing costs and we are
hoping to increase the savings in 2010 by achieving some
additional graphic design and editorial efficiencies.
After the March 2009 issue was published on line,
we asked members for their reaction. As you would guess,
the reaction was mixed. Fortunately, most members were
supportive of the new format and appreciated the money
savings. Not surprisingly, a generational gap was clear from
member responses. The “Veterans” and “Baby Boomers”
were the most vocal about missing the print format. Many
cherished their past issues and had actually archived on
bookshelves issues going back years and years. However,
most said they were trying hard to adapt to the change and
it did give them an excuse to visit the ICEA website more
often.
The younger generations (“Gens X & Y”) were generally
more accepting of the format change and expressed
interest in seeing how an on-line Journal might be expanded
to include additional features. There were, however, a few
exceptions. A couple of ICEA members live in remote areas
of the country where high-speed Internet connections are
not yet available. Reading the Journal with a dial-up connection
is tedious and off-putting. Another problem has been
lack of convenient access to a computer with an Internet
connection. And one member has some religious restrictions
on using modern electronic (computer) equipment.
Staff has produced a limited number of Xeroxed copies to
mail to these members, but undertaking this copying on a
wider scale proved economically prohibitive. A sampling of
members were asked if they would be willing to pay extra for
a print copy and the answer was “no”.
We are hoping in the coming year to take more advantage
of the electronic format. For example, there is no longer
a printing cost difference between black & white and color.
Having full color photos and artwork throughout the publication
is not an expense. As available, the editor and graphic
designer will use more and more color material throughout
the journal pages. Also, our advertisers are now able to run
full color ads for no extra ad cost (as an example, see the
InJoy ad near the back of this issue). We are hoping this will
help generate more ad revenue for ICEA. We are exploring
partnering with several sources of video material to embed
videos in Journal articles. An example are the types of videos
produced by Mindful Mama: http://www.mindful-mama.
com/media/p/26.aspx and, of course, by InJoy. The same
sorts of linkages can also be used for audio material that is
available on line. In addition, Journal authors will be increasingly
encouraged to site worthwhile links to other websites
in their articles. This will help expand credible sources of
information available to our members.
As an example, check out the new website promoting
ICEA’s 50th Anniversary Mega Conference, Celebrating Our
Pasts, Uniting for the Future of Birth celebration next year
with Lamaze in Milwaukee: http://www.futureofbirthconference.org/.
The support of the membership in switching the Journal
from print to on line has been greatly appreciated by the
ICEA Officers and Board. They know that adapting to this
change has been a struggle for many, but they remain committed
to not only maintaining the editorial excellence of the
Journal content but also increasing the Journal's use of Internet
“tools” to expand its content and keep it positioned to
take further advantage of enhancements in electronic communication
and publication. We hope that some of these
enhancements will start to become available in 2010. Keep
an eye out for them and be prepared to use your mouse to
click for added content.
6 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Featured Educator
Chris Maricle
What was it like to give birth in
1978? In Tulsa, Oklahoma, it meant
that only one hospital in the city allowed
fathers to be present for birth,
as long as it wasn’t a cesarean. It meant
that women were told to gain no more
than 25 pounds and to give up salt. It
meant that most women were routinely
given spinal block anesthesia just as
their babies crowned, and the babies
were delivered with forceps to “protect
their heads.” Twilight sleep, using scopolamine,
was still used. The episiotomy
rate was well over 90%. It meant
that rooming-in was allowed only with
a doctor’s permission. All babies were
routinely given sugar water or formula
and brought to the parent’s room every
four hours. Childbirth classes were usually
held in the instructor’s home, with
many physicians advising their patients
to stay away from them because, as one
doctor put it, “they just want you to
squat out in a field.”
This is the world of birth I entered
when I became a childbirth educator.
As a former teacher, I had taken
birth classes through an ICEA member
group, and those classes had made a
profound impression on me. What a
difference my training had made in
the birth of my son! I had managed to
have one of the earliest unmedicated
“Lamaze” births the hospital had seen,
despite the challenge of back labor.
Afterward, the ICEA group asked me
to become one of their instructors. I
remember thinking I would do this for
knew this was
a goal I wanted
to achieve.
With my
friends Cheryl
Coleman and
Denise Wheatley,
I spent
many hours
studying for the exam. I’ll never forget
my excitement at receiving my ICCE
designation! I have since earned my
certification as an ICEA doula (ICD)
and as an approved trainer (IAT.)
ICEA still means a great deal to
me because it provided me with research-based
information and support
when the medical community in my
area was unsupportive. ICEA has given
me a network of other birth professionals,
a means to verify my knowledge
and skills, and many friends.
During my years as a childbirth
educator, I have taught in many locations
including my home, my church,
physicians’ offices, medical clinics, and
a hospital. I have seen visual aids go
from homemade posters to16 millimeter
film to VCR tapes to DVD’s—and
now online learning. I have seen hospitals
change to a more family-centered
approach. I’ve even taught the second
generation—some of my “Lamaze
babies” have come to me for classes. I’m
fond of saying I will continue teaching
as long as I can still squat—and get back
up!
“a few months” to give me something
to do and to help out a few expectant
families. Several thousand families and
thirty-one years later, I still have a passion
for families, birth, and parenting!
By the time my second and third
sons were born during the 1980’s,
hospital policies were changing. I gave
birth in an alternate birthing center
which was located in a hospital (the
hospital where I still teach!) During
that time, home birth, water birth,
and “gentle birth” were being tried.
Once again the techniques which I had
taught to so many proved their worth
to me, as I had back labor and posterior
babies each time. I delivered using
a “birthing chair,” which was revolutionary
at the time—no one had ever
heard of a birth ball! ICEA’s support
of family-centered maternity care had
impacted the hospitals in Tulsa, and
all of them had adopted more familyfriendly
policies.
My first ICEA Convention was
in 1982 in Knoxville, Tennessee at the
ICEA Regional Conference. This contact
with other educators who shared
my passion for natural birth led to my
interest in working for ICEA. I became
the Oklahoma ICEA State Coordinator
and the first Photo Editor of the
International Journal of Childbirth
Education. Later on, I served two terms
on the ICEA Board as the US Midwestern
Director.
When ICEA developed a certification
program for childbirth educators, I continued on page 9
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 7

One Thing I Learned at the
2009 Convention
By Jenney Rodriguez
I’m glad I went to the 2009
conference. Maybe I’m not the most
experienced person to talk about
childbirth education conferences; I’ve
only been to two or three. But I believe
that every encounter, even the seemingly
insignificant ones, are telling us
something that will ultimately help us
on our journey. The very visible lessons
learned at the 2009 conference had
to do with educating ourselves about
the present state of affairs of childbirth
education and how to stay motivated
and seek out higher standards, all of
which added to my sense of preparedness.
In my classes, I talk about “the invisibles”.
This refers to the many things
that are present in our lives (and in
the course and at the conference) that
aren’t easy to quantify or even define in
concrete terms; but are part of the big
picture that make us connect, accept
and grow. By ignoring their contribution
to our understanding of ourselves,
we dishonor our intuitive nature and
pretend to interact with life in a strictly
rational and mechanical way, which
leads to a sense of dissatisfaction and
imbalance. The feeling of belonging
and the broader perspective we acquire
from our fellow classmates or conference
goers is an important “invisible”;
as is a deeper sense of conviction about
those things we feel are worth striving
for. There are many things we pick up
at an event like this especially when we
are open to learning.
The most consistent understanding
that arose during the event was a
clear divide between older and younger
educators. At 51 with 25 years of teaching
under my belt, I may not be an
elder but I’m certainly not a young’un.
Different than other generational gaps
over history, this one feels bigger and I
suspect it has to do with the snowball
effect of an everyday wider technological
base. To understand this, I reflect on
working with traditional birth attendants
in India and my realizing what
illiterate meant. It wasn’t just that they
didn’t read and write, by not reading
and writing in their unique cultural
setting, they conceptualized everything
differently. Line drawings weren’t the
answer because a depiction of something
obvious to me such as water
signified something else to them. Well,
now I am equivalent to that traditional
birth attendant and the younger educators
are finding me unable to comprehend
their technological world. It’s
not just a matter of using a computer;
it’s the way that using technology
programs our brains to conceptualize
things differently that counts. I came
to the conference armed with all the
reasons why we shouldn’t let go of what
our generation of teaching childbirth
education stands for, believing these
lessons to be invaluable. I came of age
in the middle of my break-out session
when I realized it’s not about what I
believe; it’s about what our students
believe.
Both sides of the gap are looking
for validation. In a session about
the myths our couples believe to be
true that trigger a breakdown in the
postpartum period when they realize
they aren’t (for example that maternal
instinct exists said the speaker),
I felt the answer was not to classify,
empower by numbers and medicate
the new mother; but to create better
support systems, teach coping skills
and dedicate more time to properly
prepare for motherhood. But quality
preparation requires more class time,
something that younger couples, used
to instant gratification and superficial
styles of communicating, aren’t always
willing to do. I can stand on my soap
box and mourn the end of teaching as
we know it, or accept that convincing
our students to trust our wisdom when
they want to trust their own, is futile.
The real challenge is to project
what we hold to be sacred via methods
of learning that they can relate to. This
is no easy feat, but not impossible with
creative will power. Everything in the
conference that highlighted our need
to do this was met with interest. In
the panel discussion about possible
new venues for educators, having the
technological needs of the younger
educators mentioned was critical. A
session on teaching the “X” and “Y”
generations was right on. Suggestions
for broadening membership and makcontinued
on next page
8 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Featured Educator: Chris Maricle
continued from page 7
I now teach childbirth classes at
Hillcrest Medical Center, and I also
have my own private childbirth education
practice, entitled New Joy Christian
Childbirth Education. Although I
enjoy all my classes, I have found that
including a spiritual preparation along
with the typical birth curriculum provides
a more fulfilling preparation. I am
also a certified parent educator through
the Parents as Teachers program, so I
provide home visits, group meetings,
and screenings to families with children
under three. In some cases, I have been
childbirth educator, birth doula, and
parent educator to the same families.
My style of teaching has changed
too. Now I use PowerPoint and I have a
website, but my commitment to “freedom
of choice based on knowledge of
alternatives” remains strong. You won’t
find me teaching “what to do until you
get your epidural.” I continue to present
interventions from a risk/benefit
perspective, while realizing that the
decisions that my students make are
not necessarily a reflection of me.
I often tell my clients that giving
birth without medications was one of
the greatest challenges of my life, but it
also was one of the most empowering
experiences of my life. Whether expectant
women choose to use medical
interventions or not, my hope is that
through giving birth they will discover
something powerful and wonderful
about themselves and their partners;
and that they will be better parents
because of it. Parenting is a life-long
journey, while birth, although an unforgettable
and powerful experience, is
usually only one day in their lives. So,
as childbirth educators, we are building
families, and touching the future.
So much has changed since I
began my career, but one thing will
never change: the privilege we have as
birth professionals to walk alongside
families during a critical time in their
lives and to provide guidance for them
as they begin a fulfilling new chapter in
their lives. I can’t think of a better place
to be!
One Thing I Learned at the 2009 Convention
continued from previous page
ing conferences viable rallied around
being technologically savvy and offering
a new face of ICEA that reflected
this. Networking and promoting our
work can only be successful if we are on
board with how to do so in a modern
and global world and the openness to
learn how is the first step in honoring
our young students’ reality, albeit an
unfamiliar version compared with our
own.
Personally, I decided to stop
fighting my instincts that Power Point
presentations in class only deter the
student from connecting with the
educator. I am now incorporating them
into my curriculum. If that is what new
students need in order to relate to the
information, I’m there. All of us need
to connect with a sense of immediacy,
give part of our information digitally
and promote ourselves via all the techno
avenues available to new students
that exist today. It’s not about what we
know to be true, it’s about their coming
to their own conclusions because of the
choices they have made, available to
them in a time of unending options, in
a world that is changing faster than we
can imagine. The conference taught me
many things, both visible and invisible,
but this is one of the most important.
Jennifer Kozlow-Rodriguez, ICCE, CD
(DONA) is Director of Previda-Childbirth
and Family Life Preparation , Editor of
Padres de Hoy Magazine, President of
AMSEMA (The Alliance for the Betterment
of Maternity Services) for more than
25 years, in San Jose, Costa Rica.
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 9

ICEA Announces Doula Insurance Reimbursement
The President of the International Childbirth Education
Association (ICEA), Jeanette Schwartz, announced October
21, 2009 that the National Uniform Claim Committee
has approved a (new) billing code for doulas in the United
States. The code will enable certified birth and certified postpartum
doulas to obtain an NPI (National Provider Identification)
number to submit reimbursement claims to Medicaid
and third-party provider insurance companies.
Schwartz commented, “This is an important landmark
for ICEA birth doulas and great timing for our new ICEA
Postpartum Doula Program.”
“The birth or postpartum doula will need to provide her
certificate of certification as this is the evidence of certification
credentials necessary to apply for the NPI number,”
continued Schwartz. Only certified birth and postpartum
doulas will be able to use this code to apply for an NPI number
or for reimbursement. Application for an NPI number
can be made using the new taxonomy code at the National
Plan and Provider Enumerator Systems (NPPES) website.
Group practices are able to apply for a number, although the
application process is slightly different.
The new taxonomy code is 374J00000X and is called
“Doula” under the heading of “Nursing Service Related
Providers Type.” While the term Doula is listed under the
Nursing heading, RN or LPN licensure are not required to
obtain the NPI number. The description includes the services
of antepartum, labor doulas, and postpartum doulas. A
definition of doula work is included on the National Uniform
Claim Committee website: “Doulas work in a variety of settings
and have been trained to provide physical, emotional,
and information support to a mother before, during, and just
after birth and/or provide emotional and practical support to
a mother during the postpartum period.”
Schwartz went on to say that standard billing forms
are still being developed, with birth doula forms in the final
stages of development with postpartum forms coming at a
later date. Until forms are finalized, ICEA doulas are encouraged
to use the 1500 Universal Claims Form can be used to
bill for reimbursement. Forms and a free manual of instructions
are available online at websites such as the JustCMS-
1500Forms website. Software to automatically generate the
forms is available also. A sample of the 1500 Universal Claim
Form is available in PDF at the National Uniform Claim
Committee website. “For now,” Schwartz advised, “doulas
should bill clients directly as they have always done, file for
reimbursement, and then offer the clients reimbursement
when it is received from the insurance companies. We hope
to bring you even better news soon, that doulas can bill
insurance companies directly.”
Wisdom of the Sages
continued from page 5
Buckley’s talk on how hormones work in labor was very evident
in this woman between contractions. This mother was in
“near coma” as she completely shut out the outside world and
her endorphins provided the relief she needed. Ten minutes
later she was complete and another 40 minutes a bright, wideeyed
baby boy greeted his mother and father for the first time.
I know that if I had not joined ICEA many years ago,
had not attended the many sessions at international conventions,
and not listened to experts’ share their ideas around
non-medicated birth, this birth would have turned out
differently. I would have encouraged this mother to have
medication or an epidural (even though her birth plan was
very explicit she did not want medication). Her family could
have been in a state of fear—not being aware that rhythmin-breathing
is an important indicator of control, and this
mother may have perceived herself a “failure” because her
choices were not honored.
Of course the story does not end here. Doctors Marshall
Klaus and Nils Bergman have researched infant attachment
and have shared their work for many years. They tell us the
time after birth is a sensitive period for programming mother
and infant behavior. The baby was placed on the mother’s
chest, skin to skin, and remained there for several hours.
Nursing care was completed with baby in his mother’s arms.
Linda Smith’s book, “Impact of Birthing Practices
on Breastfeeding” examines the research and evidence in
detail on breastfeeding outcomes related to birth practices.
Because of this knowledge, I encourage the mother to let her
baby use his ability to latch and suckle on his own.
I am thankful for all who have shared their passion and
knowledge of birth. I encourage you to share your expertise
with others so everyone can benefit…the mother and her
family, the providers of care and the babies welcomed into
our world. We can change birth practices one birth at a time.
10 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

By Connie Bach-Jeckell
Where Do We Go from Here ?
Motherhood…it’s a universal language.
It makes no difference of nation,
color, creed or race. Our blood types
are the same, our bodies go through
the same physical process…the hearts
of mothers are the same.
In our world right now, women
need information on family planning,
pregnancy and breastfeeding. They need
information on infant care. They have
no idea how to help a choking baby.
Birth is shrouded in mystery, experienced
alone and in fear. There are no
childbirth education classes available.
This age of technology enables us
to better reach out to developing countries.
ICEA was founded as an international
organization. We now have the
capability to easily provide education
to many nations and cultures. It’s time
for us to truly walk in our international
destiny; training and equipping
educators around the world…with the
goal of education and family-centered
maternity care for all women, regardless
of their nationality or ethnicity.
ICEA was founded to effect
change. We once fought for the rights
of fathers to be present at birth…
we pushed hard for family-centered
maternity care…we set a standard for
childbirth education. We still have the
same philosophy…freedom of choice
based on knowledge of alternatives. We
take for granted how much knowledge
we have…knowledge we could share
with someone else. There are other
families around the world who hope
for, and deserve, that same freedom to
choose. They need our help in moving
toward that goal.
It’s also time for some of us to step
out and walk in our individual destinies.
We’ve been brought to this place
in time for a purpose. It’s sad when a
graveyard is the prime place to discover
buried treasures…treasures that were
never delivered to their intended recipients.
Your destiny may be personal,
but it’s not private. Other peoples’
destinies may depend on how you
live out your own. (I am reminded…
if a woman hadn’t started a perinatal
exercise class at a community center
in Memphis thirty years ago; my life
would have been very different.)
Considering our resources, the
birth outcomes in this country are
humiliating, yet we continue to see a
general decline of participants in our
classes. In this “land of plenty,” a huge
selection of resources goes to waste. We
settle for sulfur water, while there’s an
undiscovered, miraculous healing well
flowing just below; but people don’t
seem to want to dig a little deeper.
This “low-priority” attitude,
wherever it comes from, sometimes
has a way of discouraging excellence in
educators, care providers, etc. Teaching
on an international level, although
challenging, can be a “healing experience”
for those of us who need a boost
in our original passion…or for those
who are looking for “what comes next.”
When we get back home we’re
excited about our experience, the
work we’re doing, etc. We’ve improved
ourselves, so our classes improve. In
this way, even the women we’re teaching
here at home benefit because we
stepped out of the box.
Give it some thought…decide if
teaching internationally is for you. If
you’re looking for the adventure of a
lifetime…a chance to grow into who
you’re becoming: step out. Take some
time to give your treasure to yourself,
ICEA and the world. Last August in
Guatemala I saw educators come alive
with an energy they hadn’t felt in a
long time. New destinies were revealed
and lives were forever changed. Even
though the ICEA team is no longer in
Guatemala, peoples’ lives are better
because we were there. (This includes
the team as well as those we served.)
Ours is a mission trip of a different
nature. It is so much more than putting
a small, temporary band-aid on a
gigantic, long-standing problem. It is
promoting the well being of families
around the world. We have a global
touch of influence. We speak that universal
language of motherhood.
I am reminded of a quote from
Suzanne Arms "If we hope to create a
non-violent world where respect and
kindness replace fear and hatred, we
must begin with how we treat each
other at the beginning of life. For that
is where our deepest patterns are set.
From these roots grow fear and alienation
- or love and trust."
Connie Bach-Jeckell, RN, IAT-CE-D-CPFE
is an ICEA Director and chair of the new
ICEA International Relations Advisory
Committee. She served as the Chair of the
2009 Convention Planning Committee.
She recently got married (June 2009) and
resides in Alcoa, Tennessee with husband
Charlie as well as with her children and
grandchildren.
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 11

Book Review
Birth Day by Dr. Mark Sloan
Book Review by Jamilla Walker
When I write book reviews, I generally try to do some
research on the author. I like to have some context (deeper
than that found on a book jacket) if I’m going to review
someone’s literary baby. However, when one enters “Mark
Sloan, MD” into the Google search engine, one better be
prepared for the abundance of information on Dr. McSteamy
from ABC’s Grey’s Anatomy. After trudging through tons of
interesting but useless information, I settled for his story that
is on the book jacket and cleverly woven through his memoir.
A memoir is exactly what Birth Day turned out to be.
While most of the books on my shelf are cleverly written
commentaries on the history and present day state of birth
in the United States, few are memoirs. These few are my
favorites. These memoirs are the reason I dream of catching
a baby one day, I read them when I need a little motivation.
Ina May Gaskin’s Spiritual Midwifery and Peggy Vincent’s
Baby Catcher are my all-time favorites. I have high standards
when it comes to professional memoirs; I was pleasantly
surprised both by Dr. Sloan’s storytelling abilities and his way
of introducing complicated material.
Birth Day is organized into a comfortable pattern. Dr.
Sloan picks apart every aspect of birth by telling the history,
describing the present and delving a bit into the possibilities
of the future. In this manner, he discusses everything from the
lithotomy position to the amazing role of relaxing to the beginning
of pain relief for childbirth. He admits that the lithotomy
position was first introduced by a fascinated King Louis XIV
who wanted a better view of his mistress giving birth, and is
now becoming an outdated position for pushing. He points
out that general pain relief was thrust into public discussion by
English Queen Victoria who oddly enough hated pregnancy,
childbirth, and child rearing. Pain relief became a major issue
for the feminists of the 1920s who demanded “better” pain relief
options (i.e. “twilight sleep” etc). Sprinkled through his history
of operative birth are all the legends and stories that make
mention to “alternate routes” – Greek mythology, Buddhist,
and Hindu legends. Most refreshing to me is that Dr. Sloan
learned his craft in an environment that treated Cesareans
as the saving grace they were supposed to be – for the cases
that would have resulted in death even 50 years ago, not for
women who’d prefer not to deal with the fear of childbirth. He
succinctly sums up the reasoning for our high Cesarean rates:
“Put them all together – the increase in dystocia, fetal
distress monitoring, repeat Cesareans, advancing maternal
age, and the expectation of a perfect outcome – and it’s
not surprising that the cesarean rates skyrocketed from
10.4%...to 22.7%.” (p.81)
This book is not an opinionated commentary on how
childbirth should be, but more an entertaining discourse on
our current cultural views and practices. Dr. Sloan presents
characters in ways many of us rarely see them. He was the
baffled, doe-eyed intern surrounded by sharp, stern nurses
who wrestled patients into stirrups and barked out orders.
His description of his own ineptitude during his internship
made me laugh out loud as few books can do. He uses analogies
to illustrate his explanations of hormones, the transition
between fetal and newborn oxygenation, etc. He points out
that most people think of the newborn transition as similar
to a scuba diver coming up for air (something I’d heard in
my obstetrics rotation), Dr. Sloan points out the problems
with this analogy in a hilarious way:
“If a diver really were like a fetus, his lungs would be filled
with seawater, his air tank would be connected to his belly
button, and half of his blood supply would be floating in a
sac outside his body. On his way up from the depths, he’d
squeeze the extra blood back into his body, force the water
out of his lungs, and permanently rearrange the flow of
blood through his heart. Then he’d pop to the surface,
naked and screaming, wide-eyed with amazement and
anxiety at the new world he’d been cast into. If diving
and childbirth were identical processes, Jacques Cousteau
might never have gotten into the water.”
Dr. Sloan makes no mention as to his target audience.
Other books are obviously written for new parents, neonatal
nurses, midwives, etc. There is so much discussion of medical
practices and procedures that I don’t think the general public
would be as amused as childbirth professionals. However, for
the new doula or educator who is still learning the background
of their craft, this book is fantastic. Birth Day is full
of great analogies and memory hooks that can be used in
childbirth teaching, as well as hundreds of fun little facts that
keep clients entertained.
12 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Birth in Israel
By Lissa Szajnbrum
I was incredibly lucky when I gave birth to my first child
22 years ago in Jerusalem. I was lucky that there was a hospital
that gave women freedom of choice and options when
giving birth. I was lucky that I had a wonderful midwife who,
by her expertise, helped me birth my son with no interventions
whatsoever. This empowering birthing experience
changed my life. While living in the United States for my
next two births, I chose a free-standing birth center and only
wanted a midwife to attend to me. Returning to Jerusalem
I gave birth to my subsequent three children in my “dream
hospital”. Now the hospital had a private birthing room on
the top floor; this was my obvious choice. Again, I had a caring
attentive midwife guide me through my births.
Alas, this hospital closed down 12 years ago. While the
many excellent hospitals in Israel claim to support “natural
birth”, the reality is far from this. The birth rate in Israel is
high, with an average of almost 3 births per woman, but there
are many women who give birth to 6 or more babies. Thus,
the maternity wards in Israel are almost always full and busy.
The health system in Israel provides free prenatal care to
every woman, free hospitalization for up to three days after
giving birth, a government supplement for every birth and
three months of paid maternity leave. Most hospitals give
childbirth education classes and there are many options for
pre- and post-natal exercise classes. Israel loves babies and
there are many social support systems in place to help women
before, during and after birth. All births are done by midwives,
unless a woman decides to pay privately for a doctor.
Despite all these options, many women arrive at the
hospital without having any childbirth education classes,
frightened at the prospect of having any pain, and immediately
choose the epidural. This can partially explain why
70-80% of women in Israel have an epidural. Even the staff,
while claiming to support a woman’s choice in childbirth and
“natural birth”, begins suggesting an epidural from the very
beginning of the labor. At a recent birth, I overheard a young
midwife speaking to the staff, exclaiming “Why shouldn’t
she have an epidural? Why should she have a trauma for her
first birth? She won’t want to have more kids!”
Many hospitals even have “natural birthing rooms”,
equipped with a birthing rope, chair, bathtub and a big bed
for labor. Unfortunately these rooms do not get a lot of use,
as the woman has to commit to not using any interventions
in her labor and it also depends on the availability of the
midwives to commit to this one birth, which is often in a
room not adjacent to the other labor and delivery rooms.
Homebirths constitute a small percentage of births in
Israel, approximately 500 a year. There is one free-standing
birth center in the center of Israel, run by a well-known and
experienced midwife. Actually they are little cottages alongside
her home in an agricultural community. These wellequipped
cottages offer a homebirth-like atmosphere; while
still close enough to a hospital. The midwife who began this
is considered a pioneer in Israel. She has authored a book on
homebirth in Israel and offers a postpartum convalescence,
also in cottages alongside her home. There are also a few
other home-based birth centers dispersed throughout Israel.
Doula-training is on the rise, at times the supply outweighing
the demand! There is heightened awareness here
of how helpful a doula can be, and is not just considered a
western-imported luxury. Most hospitals welcome doulas
into the delivery room; yet there are other hospitals who demand
that women use their own hospital-based doulas, often
at a higher cost than private doulas. Some hospitals have
volunteer doulas on call for women who may want them.
Unfortunately, birth in Israel is still highly interventionist.
The cesarean rate as of 2008 was 20%. Episiotomies are
used in 17% of the births and the epidural rate, as mentioned
above, stands at 70-80%. If a woman enters her labor
informed and educated with enough support, it is probable
she will have a positive birth experience. But many women
are passive in their births, depending on the medical staff
to decide for them how to birth their baby. There is a lot of
pressure “not to suffer” during the birth and even breastfeeding
is not always seen as essential.
Israel is a family-centered culture and society and the
government greatly encourages childbirth. Unfortunately
most medical staff still considers birth a “medical event”,
while paying lip service to “natural childbirth”. Many women
don’t know what to expect and depend on the medical staff
to guide them. Progress is slowly being made; there are many
programs available training childbirth educators, doulas,
alternative therapies, and postpartum support. Hopefully
theory and practice will soon meet and then Israel will truly
have a progressive model for childbirth.
Lissa Szajnbrum is originally from San Diego, CA but has called
Israel home for nearly 30 years. In Israel, she works as a doula.
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 13

Audio-Visual Review
Understanding Birth
2nd Edition (2009)
Reviewed by Connie Livingston RN, BS, FACCE, LCCE, CD(DONA), ICCE, IAT
Always setting the bar high for
innovation in education, the new
Understanding Birth 2nd Edition does
not disappoint either the educator or
the viewer. Understanding Birth may be
the only DVD an educator will have to
purchase, with its powerful 3D computer-generated
graphics, 4D ultrasound
images showing fetal development,
new birth footage with a diverse mix of
families, and evidence-based information.
This new edition comes with two
discs. The first disc is divided into eight
chapters: (1) Understanding Pregnancy
(which covers the last trimester and
includes fetal development, discomforts
of pregnancy: both emotional
and physical; labor warning signs; and
prenatal exercise), (2) Understanding
Labor (includes signs of prelabor,
onset of labor, stages and phases of
labor with 3D computer animation,
importance of skin-to-skin contact
just after birth), (3) Christina’s Birth
(an unmedicated birth with mother
on hands/knees for the birth, with an
emphasis on natural coping techniques
and partner support during labor), (4)
Understanding Comfort Techniques
(discusses/reviews the use of breathing,
focusing, effleurage/massage, gravity
positive positioning, birth balls, specific
relief techniques for back labor, guided
imagery/visualization, hydrotherapy
and helpful suggestions for labor
partners), (5) Understanding Medical
Procedures (features the importance of
developing and using a birth plan while
discussing induction and augmentation;
fetal heart monitoring; IV fluids;
and pain medication options.), (6)
Understanding Cesarean Birth (explains
the reasons for a cesarean delivery,
shows the surgical procedure with 3D
animation, talks about the feelings and
procedures of an unplanned cesarean,
discusses the feelings and procedures
of a planned family-centered birth, and
describes recovery differences in contrast
to vaginal birth), (7) Understanding
Newborns (explores immediate
post-birth newborn procedures with an
emphasis on skin-to-skin mother-baby
contact, normal newborn appearance
and characteristics, first feedings and
some infant safety), and (8) Understanding
Postpartum (explains involution,
stages of lochia, peri care, rooming
in, postpartum emotions: blues and
postpartum depression, some breastfeeding
and the need for postpartum
emotional/physical support).
The 2nd Edition features all new
expectant parents, not recycled footage
from previous videos which is a plus.
The second bonus DVD is ideal
for more condensed class schedules,
such as weekend classes. Called Understanding
Birth Express, it features four
chapters (1) Pregnancy, (2) Labor, (3)
Medical Procedures, and (4) Cesarean
Birth.
Along with the two DVD set,
the educator can also make use of the
outstanding “See What You Read”
booklet available for Understanding
Birth. Expectant parents can use this
Injoy Birth and Parenting Education
7107 La Vista Place
Longmont CO 80503
1-800-326-2082 x2
www.injoyvideos.com
Ages: 13-Adult
135 mins.
Express Class DVD included
48 mins
Price: $449.95
Available in English and Spanish
innovative 70 page booklet to enhance
learning by reading and accessing
SeeWhatYouRead.com to review
missed or misunderstood information.
Each booklet comes with a personal
PIN number which gives the expectant
parent exclusive access to the website
for 6 months from the first log in. From
the website, parents can review topics
with more than 50 short video clips
from the comfort of their home, print
out checklists and other handouts, and
obtain additional information from the
web links to connect to other birth and
parenting websites.
The booklet also has photos from
the 3D animation in Understanding
Birth, charts and diagrams, partner tips
and a glossary/index section. With this
booklet, an educator may not need
another class manual.
If educators want one DVD to
cover all of the topics presented in
most childbirth education classes, OR
if doulas want one DVD to review
with clients, this is the ideal DVD to
purchase. And with all of the pluses
connected with Understanding Birth and
Injoy Videos, education just got a lot
easier!
14 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Is Dad Getting What He
Needs to Support Mom?
Who We Are — We have been helping men wrap their minds
around becoming dads since 1990. We built and now sponsor Boot
Camp for New Dads, the internationally acclaimed orientation workshops
for dads-to-be. More than 300 coaches conduct these “nursery
in a locker room” workshops across the U.S. and have helped
prepare over 250,000 men of all types to be fathers. We publish
Dads Adventure magazine and operate DadsAdventure.com so new
fathers have a place to get information they need and can trust.
A good father is great for babies and brings balance to
the lives of new moms. Mom then has more time and appreciation
for dad, which motivates him to do a better job for
her and their baby, which strengthens their relationship for
the long run. A great way to form a new family.
The alternative is much more prevalent as most relationships
suffer when a new baby arrives – often for the long run.
Mom focuses solely on her baby, has little energy for dad,
essentially pushes him away, and becomes angry that he is
not doing his share. A lousy (but very common) way to form
a family.
Our New Moms Hearts and Minds Project goal is to
strengthen the relationships of new parents. After spending
two decades educating dads-to-be about new moms, we
believe that educating moms-to-be about new dads will help
make this happen. Basically, by understanding and supporting
dad, a new mom will bring out the best in him.
We can only do this with the help of experienced moms
to both help us refine our message, and pass it on to momsto-be.
We also need to know of any advice you have for
new moms on getting the best out of dad. (This is how Boot
Camp for New Dads works – the veteran dads with their
baby on their laps tell the rookies what they have learned.)
Moms have always been our biggest supporters and
we know we can count on you to help us now. To start, we
ask that you review the ten things new moms need to know
about new dads, and tell us how to say it better. The way
we see it, this will help new dads keep mom’s heart (or get it
back after those first tough months), and he in turn will help
mom keep her mind.
We are on a mission to help strengthen fatherhood
across the U.S. (and world now). Mothers set a very high bar
for us fathers, you are fully networked, and are the only real
support a man has as he transforms into a dad. Nothing but
What New Moms Need To Know About New Dads
1. A new mom has a huge array of information and support, including
her mate, friends, family, the healthcare system and the
entire media and retail sectors. A new dad has a new mom.
2. Mothers are the most important factor in a father’s involvement with
his baby. You can facilitate it or hinder it, especially in the months
surrounding the birth when a new dad’s motivation peaks.
3. If you back off on doing everything with the baby and expect
him to do his part, he will. Encourage him to get out of the
house with his baby on his own, which is when they develop a
very special relationship.
4. Men thrive on respect, confidence and love and all are in
short supply as we become fathers. Focus on respect for what he
does right. It will build his confidence and show you love him.
5. Dads bring a unique set of strengths to raising kids and are the
best brain development toys possible. Don’t turn dad into an
assistant mom, encourage him to do it his way. Your baby will
thrive on the difference.
6. Having our babies get excited when they see us, and knowing we
are there for them when they need us, feeds our souls as men. With
experience, our confidence builds, our instincts kick in, and we
start feeling like real dads. It just takes longer than with moms.
7. It’s not about sex, it’s about love. New moms naturally and
dramatically shift their energy, attention, intimacy and love from
dad to their baby. If mom is not happy with dad, and a new baby
generates conflict, the loss in your relationship is more dramatic.
Even if you don’t feel like sex, he still needs to feel the love.
8. OK, it is partly about sex, but we don’t buy the notion that
more vacuuming would result in more sex. If so, we would have
an entire dad subculture built around supercharging vacuums.
Imagine a Dyson with 500 horse power. Focus on the love and
the sex will handle itself.
9. You are well ahead of him on the new parent learning curve, so
bring him along as your partner in caring for your baby. Once
things settle down, refocus on your relationship. This will
pay off in terms of the dad you want for your baby and the mate
you want for yourself.
10. The more he brings your child into his life, the more balance
you get in your life. Dad too. When mom gets more balance,
dad gets more of mom. Everybody lives more happily ever after.
good can come from this mom and dad collaboration.
Do you have comments on our Top Ten list? We’d love
to hear from you at feedback@DadsAdventure.com or (949)
754-9067.
Would you like an electronic copy of the DadsAdventure
magazine to put on your organization’s website? Please
email Alison@DadsAdventure.com.
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 15

Are unexpected outcomes
in childbirth normal and should
they be presented in all classes?
By Sherokee Ilse
The answer to both, I believe, is
‘yes.’ Allow me to explain.
“Just remember, at the end of
this pregnancy and labor, you will
have your prize, your joy, your baby.”
These words, spoken by the assistant
childbirth educator, still ring in my ears
decades later. Sadly, our ‘prize’ was a
baby boy who died a day or two before
birth. We named him Brennan William,
and from that day forward our
whole world changed. And we are by
far not the only ones.
Setting the Stage
In the US alone, close to 30,000
babies die prior to birth in what is
technically called stillbirth. If you add
in neonatal death and even Sudden
Infant Death Syndrome, the numbers
of families who will experience the
death of a baby is staggering in the
21st century in the United States. In
addition, there are so many unexpected
outcomes that occur during pregnancy
short of death. How are parents to
face the many common disappointments
and tragedies that occur in most
pregnancies or even their fears about
them if they are not even discussed by
childbirth educators?
Preparing for birth and parenting...
the dreams, the hopes, and the plans...
is something every parent does. The
hopes are high and the expectations
about the experience, while unique
for every person, are vivid to most. As
young children, most wannabe parents
planned their dream childbirth journey,
seeds planted as they played ‘mommy,
daddy, and baby.’ Over the years, the
dream grew as they watched adults
parent and prepared for their own
family. Pregnancy tests, ultrasounds,
books, videos, and meeting friends’
babies made it come alive. The picture
became more clear of what their
pregnancy would be like (easy, glowing)
how the birth would, or would not go
(short, natural, and pain-free labor) and
what the baby would look like ( Gerber
baby maybe?).
On top of that, today parents
often believe that if they follow the
rules and do everything right they
will control their destiny; they will get
and deserve to have only natural and
‘expected’ outcomes. In most people’s
minds the worst that can happen is a
Cesarean or a long labor.
Are these dreams helpful to cling
to? Does life really fulfill every dream?
Are things fair? Should childbirth
educators allow these parents to stay
naïve and uninformed? And what if all
does not go as planned? What if they
need more pain medication or medical
intervention than planned? What
if their boy turns out to be a girl? How
do people handle change, disappointment,
and yes, even the occasional
tragedy? If the unexpected does occur,
which it does probably close to 90% of
the time, will they wonder if they did
something wrong, blame their medical
caregiver or their childbirth educator,
and will they know what to do and how
to cope?
Until recently, few childbirth educator’s
or medical careproviders wanted
to challenge these perfect dreams or
openly discuss the unexpected. This
once taboo subject is rising from the
darkness. Those who make a commitment
to touch upon this in class and
who learn ways to do it well (it can be
done well, albeit challenging at first),
find much satisfaction and even positive
feedback, after the baby is born
in particular. They often find honest
discussions promote self-reliance in
families rather than a victim mentality.
Parents who have a sense they can
control and face their fears are more
confident and adaptable.
Unexpected outcomes don’t always
have to be negative experiences that
everyone must avoid. Though there
is always some loss when part of the
dream changes, with a good attitude,
support, coping skills, and resources,
losses can become a positive, growing
experience in time.
continued on next page
16 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Are unexpected outcomes in childbirth normal and should they be presented in all classes?
continued from previous page
It may be helpful to be reminded
that birth, babies, and indeed life, are
all gifts which people can only partially,
but not totally, control. This concept
is foreign to many prospective parents
who wish to control their lives, their labor,
and their baby’s birth. When something
goes wrong like a long stage three,
or uncontrollable emotions and expressions
of anger, a sick baby, a unexpected
deformity, or even death...guilt, fears,
and sense of personal responsibility can
be intense and long lasting.
Childbirth educators can help by
offering honesty, guidance, and hope
that no matter what happens they will
and can survive. By sharing coping
techniques, resources, and a small dose
of reality, parents can be affirmed in
their sadness and grief at the loss of
their dreams. They can also know who
to call to lean on or ask questions if
the childbirth educator has opened the
door of communication about even
such tough subjects as this.
The reality of childbirth classes in
today’s busy, electronic age puts even
more stress on childbirth educators to
include everything necessary in the limited
class hours. The mechanics of what
is to happen may take precedence, but
I would put forth that empowering
people to face any changes or challenges
that come their way ought to be
near the top, helping them to have a
‘can do,’ positive experience that may
even help them be a better parent.
Breathing techniques, stages of labor,
positions of the baby, physical and
emotional responses after birth, etc.
may seem of less importance to those
who have ‘unfaced’ fears or concerns.
The following experience offers support
for this perspective.
One Childbirth Educator’s
Story of Inspiration
Bobby K., a childbirth educator from
South Carolina, shared the following:
“I had one very memorable class
that taught me a valuable lesson in
‘priorities.’ This group was comprised
of professional people and the class
had met about three times. One night
they met in the parking lot before class,
came in and announced that all of this
‘breathing stuff’ just wasn’t relevant
and certainly wouldn’t do them any
good in labor. I was taken aback for
several minutes! Generally, when
people feel that way, they just stop
coming to class. But these people were
convinced labor was certain to be too
painful to be coped with by ‘breathing.’
Their preoccupation with pain was
unusually high. Somehow we managed
to change the discussion to fear. They
were terrified! Of everything! Instead
of the usual quiet nodding, as I or
others spoke, they blurted out fears
of deformed babies, dying of pain, of
not loving their babies, of fainting, and
even of being in an automobile accident.
The typical fears for health and
life had grown cancerous and invaded
everything. It came out sideways in
their fear of labor.
“So, I asked, “What is the worst,
most terrible thing that can happen to
you because of the pain?” and “What
are you really afraid of?”
“Each person wrote his/her answers
on a slip of paper, folded it, and
put it in a hat. In teams of two (I split
couples, put men with men, etc), they
drew out someone else’s fears and tried
some problem solving. Away from their
partners, they could more freely express
their fears. Each team then read aloud
what was on the paper and shared
their own ideas. Just having someone
else read them validated the fears and
everyone was appreciative and supportive
of someone else’s concerns. Not
surprisingly, many of the same anxieties
were expressed by several people, further
making them seem valid. Though
not verbally expressed initially, the
most frequent written fear was that the
baby would die.
“This class spent over two hours
working through these emotional
needs. It was very difficult for me to ‘allow’
them to direct their own learning.
I kept fingering my charts and glancing
at my watch. In the end, they finished
the series not knowing what a pudendal
was or how the baby turns during birth.
It took awhile for me to realize much
of that couldn’t have been learned until
the wall of fear came down anyway.
This group still wasn’t fond of the
‘breathing stuff.’ But at least their real
needs were met.”
Activities to introduce
unexpected outcomes
After the instructor has made a
willingness and commitment to cover
this topic in class, her comfort level and
positive, gentle, realistic presentation
will affect how it is actually done.
Laying the groundwork in class
can make all the difference in how this
is received. If participants know right
from the beginning that they will be
skirting no issues and that open sharing
is both modeled by the childbirth
educator and expected, the tone will be
set and likely followed.
continued on next page
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 17

Are unexpected outcomes in childbirth normal and should they be presented in all classes?
continued from previous page
While there are many, many ways
to present and discuss unexpected
outcomes, one of my favorite activities
is the Card A, B, and C activity.
A quick summary:
Give each person a card. Ask them
to label one A, one B, and one C.
Ask them to write out words or
phrases to express their ‘dream come
true’ plans/hopes for this pregnancy
and this baby on Card A.
On Card B ask them to write out
a “What if scenario of anything they
have been concerned that might happen...minor
types of issues (partner out
of town when they go in labor, labor
starts before they are ready, longer than
expected...).
On Card C ask them to put down
their biggest fear. You might point out
that everyone has fears and find them
not always easy to express. If they can’t
go to their worst, how about a biggie.
It may not be wise to push someone
too hard who wants to keep their worst
fears buried.
Gather the cards -- Card A’s
together, B together, etc. Then take a
quick break.
During this time you can look
through Cards B and C to see if some
of the tougher fears have come up...if
not, you may want to add in a few.
Upon return, speak about your
hope and wishes that Card A comes
true for everyone, however, it rarely
does. Often little things happen that
deviate from the hope and plan.
When/if Card A comes to pass, consider
it a miracle.
Now pass out a few Card B’s and
more Card C’s to each couple. Make
sure they don’t have their own. Then
ask them to discuss what they might
feel, need, and do if this were to happen.
It’s easier to be less emotionally affected
by someone else’s fear, although
this may also be a very emotional experience,
so do prepare them for that.
A wrap-up discussion of this activity
is vital. This can be a very powerful
and enlightening exercise, so plan for
plenty of time for discussion. Some
parents have even said, “If my baby
dies, I want to take pictures, spend
time with her, invite my other children
to hold her, etc.” This certainly won’t
happen every time, but do keep in
mind that for many people when they
are encouraged to face a concern and
given support and guidance, they can
and do handle it.
Share a few resources (books,
websites, suggestions) for a few of the
fears and let them know that if they
remember nothing else if this happens
to them, or someone they know,
CALL YOU. And also tell them that all
these things have happened to various
people who do survive and have happiness
again...if they understand the
importance of doing their grief work
over what has been lost. Offer them
hope and a belief that they can handle
anything and you will be there to help.
In summary
I am quite convinced that if our
childbirth educators had suggested
some of the following, our experience
would have been substantially different:
• that no matter what happens during
the birth process we would be able
to handle it.
• that if anything unusual or unexpected
occurred we were to call
one of them for help, support, and
advice
• to face our fears rather than avoid
them, thus gaining a bit more control,
• and know that even if our dreams
changed, even dramatically, after
we had weathered the disappointment
and grief, we would find new
dreams.
After a number of months and
even more so years later, I came to see
that our sweet Brennan had a mission
in life; he was and still is our ‘prize.’
Sadly, he didn’t live outside the womb,
but he lives in our hearts forever. And
he motivates me to continue a three
decade crusade to make it better for
other moms, dads, and families one at
a time. I reach out to each of you and
ask you to go beyond your comfort
level. Gently and carefully help prepare
families to know that unexpected
outcomes are normal and they can be
faced and handled, no matter how bad
they are. Empower them to believe
they can survive and to know who to
call (you or other community resources)
for help while making some of the
most important decisions in their lives.
The above article was adapted from a
small portion of the book, Presenting
Unexpected Outcomes: A Childbirth
Educator’s Guide, by Sherokee Ilse.
Available from ICEA or www.wintergreenpress.com
online store. Sherokee teaches
childbirth educators practical methods of
how to Present Unexpected Outcomes and
is presently writing a CEU home study
unit on this topic.
18 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Nurturing Laboring
Women Through the Years
By Paulina Perez, RN, BSN, FACCE, LCCE, CD
As I write this article, a breeze
blows through my memories of the
last 44 years I have been working in
maternity care. I have cared for many
laboring woman but it was not until
late 1981 that I began to work professionally
as a “monitrice”/doula even
though I had been working in obstetrics
since 1965. As with most other
things in my perinatal career, I began
this work because of the need of a patient.
Someone asked me to help them.
Two fathers in a refresher childbirth
class asked to hire me for labor support
for their wives. Word of mouth spread
fast and I have been doing professional
labor support since then. Being a monitrice/doula
means that you are asked
to drive miles to get to your clients’
homes. You are there late at night when
others aren’t around. You often work
both night and day. Your work takes
you to many different hospitals.
When I began my labor support
practice in 1981, I agreed to accept any
client whose hospital and physician/
midwife OK’d my presence. I had to
find myself in three impossible situations
before I changed my policy. One
of those impossible situations involved
a physician who had originally agreed
to my presence but began to punish my
client during labor. The abuse began
with sarcastic, demeaning comments to
the mother while looking directly at me
and continued with “extremely rough”
vaginal exams. His gestures were abrupt
and fierce. The situation escalated as
I stepped out of the labor room to go
the bathroom. The physician literally
cornered me in the break room
where I stopped to get a cup of coffee
before returning to my patient’s room.
He began to directly verbally accost
and abuse me with implied and direct
threats. His threats ranged from his assurance
that he would see that I could
no longer attend births at this hospital
to a more direct “I will get you.” He
also mentioned that I should watch out
for myself from now on. Boy, this was
a very direct threat to my well-being.
He went on saying that he also would
have someone come to my childbirth
classes and report to him every thing
I said. Any attempts to reason with
him proved useless and just seemed
to escalate his bizarre behavior. It was
after this episode with him that the
extremely “rough” vaginal exams of my
client began.
I feared for not only myself but for
my client. I decided to excuse myself
from this labor. At that time I simply
told my client that I had a emergency
at home. I felt that nothing would be
gained by open confrontation and potentially
much could have been lost by
the mother. I felt that for me to remain
at this labor would put the mother in
danger of receiving less than adequate
care, simply due to my presence. For
that reason, I chose not to tell the
family at that time my real reason for
leaving. I felt strongly that birth should
not ever be a battleground. Before I left
I arranged with
an L&D nurse
friend to come
in immediately
and provide
labor support
to my client.
I did report
the incident
to the chief of obstetrics and as well to
the obstetrical nurse manager at the
hospital. It did not surprise me that no
action was taken against the physician.
The substitute labor supporter I
hired to attend my client did report
that after I left the “rough” treatment
ceased, although the physician
did comment several times about my
absence. He kept saying to the mother,
“Where is Polly? I thought she was so
important to you and your birth.”
I learned this after that birth when
I talked with my client and her husband
honestly about what happened
and my real reason for leaving. They
were very understanding of my reasoning
and felt that I had made the appropriate
decision. They did not discuss
this incident with their doctor as they
felt openly confronting him with this
information would make my position
as a monitrice/doula at that hospital in
even more peril.
I was devastated emotionally
and had nightmares for six months
about this incident. This affected me
continued on next page
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 19

Nurturing Laboring Women Through the Years
continued from previous page
so deeply because I felt responsible in
some way for the abominable way this
woman was treated. I have always tried
via all of my professional actions to
help others; so to see someone treated
in a very inappropriate manner simply
due to my presence was and is hard to
live with. Many nights after this incident
I “relived” this obstetrician making
his remarks to this mother as he
did on that fateful day- remarks such as
“If you think you hurt now wait until
later- didn’t anyone tell you this would
hurt?”, while flashing a huge smile and
looking directly at me. Those words
didn’t pierce the surface of my body,
but the memory of them continued
long after the incident. Many discussions
with therapist colleagues of mine
helped me deal with this incident and
helped me make the decisions about
how I would continue to give care.
Within the next six months I had
two clients who had totally unnecessary
cesareans. I did a lot of soul searching
and decided that due to differences
in philosophy about the way labor
and birth should be handled that I
would not attend births at certain area
hospitals and with certain physicians.
I felt, and still feel that I was doing my
potential clients a favor by the strong
statement I was making. By hiring me,
parents felt that they could get what
they wanted from the birth; but the
reality in certain birth settings was that
even with my presence a “good” birth
experience would be very unlikely. I felt
my new policy would make parents become
aware of what they could realistically
expect from the hospital system. I
felt that this has helped many families
realize that they needed to seek a different
hospital or caregiver. I referred
them to physicians and midwives that
I’ve worked with who have the same
philosophy of birth as the client and
also mine. My clients simply wanted to
labor and birth in their own way and
have medical interventions only when
they were medically necessary. This
should have been a simple goal. Most
of my clients seek what I call “basic
birth”: nonintervention unless intervention
is really medically necessary.
After my change in practice policy
about where I would work was made,
I found that the cesarean rate in my
practice lowered considerably. I also
started working with many women that
wanted a VBAC. After my change in
practice policy, the vaginal delivery rate
for the women I cared for who wanted
VBAC also increased to 85.77%. The
largest VBAC baby delivered vaginally
in my practice weighed 10 pounds and
11 ounces. The longest VBAC labor
with which I assisted was four days.
This particular woman had two previous
cesareans with no vaginal births
and one of the cesareans was a twin
pregnancy. She labored at home until
the last four hours. Her obstetrician
was aware of the labor throughout all
of the prodromal time. We had kept in
close phone contact and the obstetrician
even saw the woman once in her
office during the labor. This doctor was
most reassuring to the mother about
continuing her very slow prodromal
stage at home. This woman actually
dilated at a rate of 1 centimeter per
day and went into the hospital on the
fourth day at 6 centimeters of dilation.
I was there with her continuously. I was
there with each position change. I was
there when she was rocking back and
forth on the hospital bed while swinging
her head from side to side as she
coped with her labor. I was honored to
be there when she birthed her VBAC
baby- the one some told her would
never be able to be birthed vaginally.
Labor support has always been important
to me as I see it as integral to
perinatal care. I have always wanted the
women I cared for to know that “I am
continued on next page
20 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Nurturing Laboring Women Through the Years
continued from previous page
here and you are not alone”. I wanted
to be there with them when they were
in the deep water of the sea of labor. I
was there with each contraction watching
the birth come closer and closer. I
saw the strength and courage in their
eyes as they knew that I believed in
their ability to birth their baby.
The pressure and harassment
continues for all of us who support a
change in maternity care and believe
in protecting normal birth. Riding
out the bad times takes courage and a
plan. We must take responsibility for
our time with the clients we much care
about. We must decide what we truly
care about. We must have complete
faith in birth and birthing women. We
must think positive. We must weave a
lifetime blanket of trust for the women
who come after us. We must help
renew their spirit and engage their
heart! We must support each other so
that we can continue to help, support,
nurture, and attend laboring women.
We must lift up others and help them
pull through the difficult times.
After giving a speech on labor
support at an area meeting, I received a
letter stating, “Sitting there listening to
you talk, I suddenly realized how much
I truly admire you for your energy and
your spunk, but also for your consistency.
I can see how it must be awfully
distressing for you sometimes, to seemingly
be banging your head on the
walls of hospital rules and regulations.
So when you are on the downswing,
think about how many women you
have helped to give birth positively and
perhaps they, like me, will find maturity
and peace through your influence.”
We fight for such a vital cause
that effect only how we birth, but
how our daughters will birth in ages
to come. Our care makes a difference
in the world of mothers and babies.
Our hopeful and helpful words can
positively change the course of a labor.
We must all remember this and try to
keep the faith!
I have learned how you face the
turns in the road will show how you
face life. I learned that I had the ability
to take things in stride. I have learned
to really know and feel compassion
and empathy for the pain of another
human being. I appreciated the emotional
complexity of perinatal nursing. I
learned that taking the time to listen to
my client’s stories helped me give them
better care. I learned that the quality of
care is what counts. And to this day, I
continue dancing under the rainbow of
perinatal maternity care.
Polly is an internationally known nurse
and public speaker. Polly is President of
C.F.E., Inc of Johnson, Vermont. She is a
consultant to hospitals, universities and
corporations on health care related issues.
Polly has always campaigned for patient
rights and for family-centered care. She
is the author of numerous articles and
books which include Special Women:
The Role of the Professional Labor Assistant,
The Nurturing Touch at Birth:
A Labor Support Handbook, Doula
Programs: How to Start and Run a
Private or Hospital-Based Program with
Success!, Special Women: The Role of
the Professional Labor Assistant - the
video, Birth Balls: The Use of Physical
Therapy Balls in Maternity Care and
Brain Attack: Danger, Chaos, Opportunity
and Empowerment. Polly can be
reached at pollyp@pwshift.com, www.
childbirthfamilyeducation.org or www.
cuttingedgepress.net
Follow ICEA Online
Now you can follow ICEA closer online than ever before!
ICEA is on Facebook: participate in discussions, link with members worldwide,
find out about ICEA events sooner!
ICEA is on Twitter: send us a Tweet, get our Tweets, reTweet to your colleagues.
Join us today! Get connected!
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 21

A Photo Essay
Scenes from the 2009 Conference
Doulas demonstrate labor
techniques and exhibitors
interact with attendees.
Photos by Connie Livinston and
Vonda Gates
22 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 23

Many Thanks to Conference Supporters!
ICEA would like to thank the
following individuals and businesses
for the success of the 2009 ICEA
Convention in Oklahoma City:
SPONSORS: March of Dimes -
Sponsor for General Session speaker
Jan Figart.
SPEAKERS: Donyale Abe,
Diana Barnes, Donna Beger, Loretta
Bezold, Alison Bishop, Greg Bishop,
Cindy Carter, Christine Cleary, Deana
Dumaoal, Jan Figart, Vonda Gates,
Barbara Harper, Lisa Hayes, Marilyn
Hildreth, Katrina Hubbard, Sandy
Jones, Val Lincoln, Chris Maricle,
Connie Livingston, Patricia Predmore,
Jenny Kozlow Rodriguez, Jeanette
Schwartz, Terriann Shell, Elizabeth
Smith, Linda Smith, Jan Tedder,
Sharon Ward, Denise Wheatley, Kim
Wilschek.
EXHIBITORS: Awaken Your
Birth Power, Booth Camp for New
Dads, Childbirth Graphics, Cord
Blood Registry, Customized Communications,
Inc., DONA International,
Frontier School of Midwifery and
Family Nursing, Howbility, InJoy Birth
& Parenting Education, Inc., Lamaze
International, Lansinoh Laboratories,
March of Dimes, Perinatal Education
Associates, The Family Way Publications,
The Gideons International.
CONTRIBUTORS FOR
WELCOME BAGS & THE SILENT
AUCTION: Because of your very
generous spirit, we were able to raise
over $1700 at the 2009 Silent Auction
which benefits the Scholarship
Fund. Thank you for all that you do to
educate, empower, and advocate for
pregnant mothers and new families.
Wishing you and your business continued
success.
Awaken Your Birth Power, Barbara
Hotelling, “Birth Day” by Mark
Sloan, MD, “Birthing in the Spirit” by
Cathy Daub - Birthworks International,
Bummis, Britax Car Seats, books
from Perinatal Education Associates,
Calomseptine Ointment, Childbirth
Graphics, “Comfort Measures” DVD
by Penny Simkin, Expressiva, “Fathers-
To-Be” by Patrick Houser, “Family-
Centered Maternity Care” by Celeste
Phillips, InJoy Birth & Parenting
Education, Inc., Lansinoh”Laugh and
Learn” DVD - Sheri Bayles, RN, Linda
Smith, Mamalates Nicette Jukelevics,
Pepsi, Pumpin Pal, The Family Way,
“The No-Cry Parenting Guide” - Elizabeth
Pantley, Sandy Jones.
…And our many individual
members and supporters that generously
contributed personal and homemade
items to our Silent Auction!
Letters to the Editor
Thank you for publishing the article Broken Maternity
by Kathryn L. Berkowitz. I received a link to the article and I
was very pleased to hear the insider’s point of view regarding
this subject. It was refreshing (though sad) to hear Kathryn’s
story, but I appreciate the fact that you published it, because
it’s a story that needs to be told over and over again until
people know (in advance) that there is emotional sequelae
that may be expected following an abortion. I am a new grad
CNM and I feel this will help me to have greater insight and
ability to help my clients when I begin to attend laboring
women again.
—Kathy Mercer, CNM
• • •
Thank you so much for publishing Kathryn Berkowitz’
poignant story of her experience of abortion and its
aftermath. My heart ached, as it has so many times as I’ve
listened to women pour out similar stories. Her detailed
description of the pain and subsequent healing gives voice
to the hundreds of women who have stayed silent except
to share behind the closed door of my counseling office.
Abortion is almost always shrouded in secrecy and shame,
sometimes sustained by years of denial until those protections
break down, intensifying the personal devastation.
For two decades now, I have observed these women to
often go on and experience complex layers of further grief.
Because of the physical intrusiveness of the procedures
themselves, it isn’t unusual that subsequent pregnancy and
birth may include a myriad of problems. And then there is
the psychological component so articulately outlined by Ms.
Berkowitz. I was also appreciative of her sharing how she
has found help. Care Net Pregnancy Centers all over North
American offer counseling for women who find themselves
experiencing difficulties after an abortion experience. Additionally,
some houses of worship and private therapists have
become knowledgeable in offering help to these women.
Unfortunately, the scared silence of so many women has
been complicit in our inability to gather hard evidence of the
true nature of abortion aftermath, especially in the face of
the political stridence that accompanies this issue. I long for
the day when we can really dissect these sequelae that I so
frequently see and hear. Meanwhile I think Ms. Berkwotiz’
article should be required reading for all those involved in
assisting families during the perinatal experience.
—Nancy Williams, MA
Certified Childbirth Educator, International
Board Certified Lactation Consultant
Licensed Marriage and Family Therapist
24 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Becoming a Birth Writer
By Elizabeth Merrell Gross
A few months ago I received a Facebook message from
a friend urging me to check out a great blog about birth. I
clicked on the link and found myself laughing out loud one
moment and tearing up the next. The author’s description of
her own journey into a world where natural childbirth rather
than the standard “medicalized” birth was the norm was
both hilarious and touching. Heather Armstrong, writing as
“Dooce” turned her successful blogs about her first pregnancy
into a full-length book endearingly titled, It Sucked
and Then I Cried: How I Had a Baby, a Breakdown, and a Much
Needed Margarita. Her breezy style and spot-on depiction of
pregnancy, labor, and birth strikes an empathetic chord with
women who can immediately identify with her experiences.
Heather Armstrong is one of the lucky ones. Blogging,
although immensely popular, carries no guarantee
of success. It is, however, one way to get started as a birth
writer. Blogs usually catch on through word of mouth and
by being forwarded through email and social networks such
as MySpace and Facebook. To be a successful blogger, one
must blog fairly consistently. Readers rarely tolerate sporadic
postings. If you plan on having a successful blog, write often
and encourage faithful friends and family members to spread
the word.
Another way to get started as a birth writer is to submit
articles to magazines that focus on pregnancy and parenting.
The plethora of publications offers terrific opportunities to
share what you know with a select readership. Some magazines
recycle articles and that makes getting published with
them a bit like jumping onto a spinning merry-go-round. Do
you have a fresh perspective on a pertinent topic? What is it
that sets your article apart from the others? Is the publication
looking for anecdotal information or do the editors prefer
research-based articles? Know your audience and take the
time to read a few copies of the magazine to determine if it
is the best venue for what you have to offer.
Giuditta Tornetta, author of Painless Childbirth: An
Empowering Journey Through Pregnancy and Birth (Cumberland
House Publishing 2008) began her writing career as a
performance artist writing one-woman shows. Her advice
for women interested in writing about birth professionally is
to “just do it.” She also urges writers to check their sources
and make sure information is backed up by research. She
says, “This industry is very careful to [use] evidence based
statements.” Writers who publicly publish articles have a
responsibility to present information fairly and accurately. It
may feel good to discharge some emotional rhetoric, but too
many have worked too hard as childbirth educators, doulas,
and midwives to be seen as unrealistic, ignorant, or just plain
crazy. Certainly everyone has a right to express an opinion,
but care should be exercised so that an entire network of
doulas does not find themselves out of work because one
wrote a defamatory article about a particular obstetrician or
hospital policy.
Trends in birth writing have stressed the need to incorporate
a great deal of research and supportive data when discussing
labor, birth, and parenting. Our society has become
more fact-based and there are no shortages of arguments on
either side of an issue. It is no longer enough to simply decry
the overuse of epidural anesthesia or internal electronic fetal
monitoring. New parents and birth professionals need factual
information. Providing women with thoughtful, specific,
concrete data during their pregnancies can definitely help
prepare them for the birth experience. Birth plans (another
form of birth writing) offer women and couples a chance to
articulate their desires and preferences for labor and delivery.
It is comforting to have a plan written down and to know
that it provides a starting framework for handling the challenges
of birth.
As a doula for the last fifteen years, I feel strongly
some of the most important birth writing is encompassed
in the birth story. Penny Simkin stressed the importance of
“preserving the birth memory in a positive light” at my very
first doula conference in Gainesville, Florida. I am dismayed
when I meet other doulas who discount the importance or
necessity of writing a birth story for their clients. Some laugh
at my anxious expression and tell me, shrugging, that writing
is just not their thing. I understand. If Penny had said we
needed to draw a picture of the birth, I may have balked
knowing that any birth drawing I might attempt would look
more like a Rorschach test. But this is where the argument
is made: It is words – spoken or written- where we have
continued on page 33
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 25

Poor Knowledge of Causes and
Prevention of Stillbirths
Among Health Care Providers
An Implication for Regular In-Service Training in Developing Countries
AUTHORS: E.O Ojofeitimi, Ph.D+, E.O Orji, MB BS,
FWACS++, E.O Asekun-Olarinmoye, B. Sc.(Hons), MD,
FWACP+, J.O Bamidele, MD, FMCPH+, O.O Owolabi B.Sc.++,
E.A Oladele, MB BS, M. Sc.+, + Department of Community
Medicine, College of Health Sciences, Ladoke Akintola University
of Technology, Osogbo, ++College of Health Sciences, Obafemi
Awolowo University, lle-Ife, Osun State, Nigeria.
CORRESPONDING AUTHOR: Professor E.O Ojofeitimi, +
Department of Community Medicine, College of Health Sciences,
Ladoke Akintola University of Technology, Osogbo, Osun State,
Nigeria. Email: eojofeit@yahoo.com
Abstract
Introduction: Stillbirths contribute significantly to
perinatal mortality in developing countries where infection,
malnutrition and poor obstetric care are still perennial health
problems. Among the health care providers in developing
countries,there is a dearth of information on the knowledge
of causes and prevention of stillbirths
Objective: To assess the level of knowledge of health
care providers on the causes and prevention of stillbirths.
Materials and Methods: A Semi-structured questionnaire
containing open and close ended questions was
employed to collect data from 201 health workers including
medical students, nursing officers and community health
officers. The two colleges of medicine students who participated
in the study have had full posting in Obstetrics and
Pediatrics while the nursing officers and community officers
in training have had more than eight years experience in
health care delivery at antenatal clinics.
Points were awarded for each correct question and the
maximum possible score was 21. The level of knowledge was
determined by using a scale ranging from less than 5 as very
poor, 5-8 as poor, 9-12 as fair and above 13 as good. Data
were analyzed and Chi-square test of statistics was used to
test for level of significance, P- value was placed at p0.05). Only 36 (17.9%) of the
respondents were able to distinguish between stillbirth and
miscarriage.
Conclusion and Recommendation: There is a poor
level of knowledge on the causes and prevention of stillbirths
among all the cadres of health workers. This is a pointer to
the need for (i) regular in-service training among all the cadres,
(ii) review of curricula of all health cadres to lay emphasis
on stillbirths and (iii) increased efforts to improve practical
activities during obstetrics and pediatrics’ postings.
Keywords: stillbirth, miscarriage, knowledge, causes and
prevention, health care providers
Introduction
Stillbirth either before or during labour is a difficult
experience that occurs in one out of 200 pregnant women
[Onadeko and Lawoyin 2003; Olusanya et al 2006; Kuti
continued on next page
26 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Poor Knowledge of Causes and Prevention of Stillbirths Among Health Care Providers
continued from previous page
et al 2003; Njokanma et al 1994; Orji et al 2006]. In fact,
stillbirths contribute significantly to perinatal mortality in
developing countries where infection, malnutrition and
poor obstetric care are still perennial problems [Kuti et al
2003; Njokanma et al 1994]. The perinatal mortality rate
(PMR) in advanced countries where adequate nutrition
health and obstetric care exist, is put at 10 to 20 per 1000
births as compared to 60 to 120 per 1000 births in developing
countries [Kuti et al 2003; Njokanma et al 1994; Orji
et al 2006; Orji 2002; Fasubaa et al 2003; Kuti et al 2003;
Ojofeitimi et al 2008]. The PMR in Nigeria, for example, has
been reported to be very high and it ranges from 30 to 120
[Onadeko and Lawoyin 2003; Olusanya et al 2006; Kuti et al
2003; Njokanma et al 1994].
While several studies have substantiated the common
causes of stillbirths in developing countries to include
teenage and advanced maternal age pregnancy, high parity,
prolonged obstructed labour, high level of caesarean section
refusal, type 2 diabetes, malnutrition, infection, inadequate
prenatal care and lack of emergency obstetric care [Onadeko
and Lawoyin 2003; Olusanya et al 2006; Kuti et al 2003;
Njokanma et al 1994; Orji et al 2006; Orji 2002; Fasubaa et
al 2003; Kuti et al 2003; Ojofeitimi et al 2008; Fretts 2005;
Lawoyin 2007; Adimora and Odetunde 2007; Onwuhafua
and Oguntayo 2006; Sule and Onayade 2006], none of the
studies cited in the literature has ever assessed the level of
knowledge of causes and prevention of stillbirths among the
health care providers let alone among the nursing mothers
and pregnant women. It is therefore pertinent to periodically
assess the level of knowledge of health care providers on the
causes and prevention of stillbirths, especially, in developing
countries such as Nigeria where the PMR, under age
five and infant mortality rates are still very high [Onadeko
and Lawoyin 2003; Olusanya et al 2006; Kuti et al 2003;
Njokanma et al 1994; Orji et al 2006; Orji 2002; Fasubaa et
al 2003; Kuti et al 2003]. After all, stillbirths are preventable
and the health care providers are the custodians of health
information that is required to reduce PMR.
Materials and Methods
Subjects: A total of 201 workers including medical
students, nursing officers and Community Health Officers
were interviewed. The respondents comprised of 134 medical
students, 35 Community Health Officers and 32 practicing
nursing officers. The subjects were purposefully selected from
two health institutions in Osun state, Nigeria. The medical
students have had full posting in obstetrics and pediatrics,
while the Community Health Officers in training and nursing
officers have had more than eight years in health care
delivery at antenatal clinics.
Data collection on assessment of knowledge of
causes and prevention of stillbirths: A semi-structured
questionnaire containing open and close ended questions
was employed to solicit the respondent’s knowledge on
the most common known causes of stillbirths; difference
between miscarriage and stillbirth; some factors that can
increase a mother’s risk of having stillbirth; and steps to be
taken to prevent stillbirth.
Scoring Technique: This was based on the review of
literature as to the commonly known causes of stillbirths,
definition of stillbirth and miscarriage, factors that increase
a mother’s risk of stillbirth and steps to be taken on prevention
of stillbirth. The correct responses were scored a point
each. The total maximum possible score was 21. A total score
less than 5 was interpreted as very poor. A total score from
5-8 was graded as poor. A total score from 9-12 was rated
as fair and a total score of above 13 was interpreted as good
knowledge of the subject matter.
Statistical Analysis: After the levels of knowledge
among the health care providers were scored, coded and
grouped, the following null hypothesis was used: that there
was no statistical difference between educational status,
cadre, marital status, age and level of knowledge on cause
and prevention of stillbirth. The null hypothesis was tested
using Fisher’s Chi-square table. A probability, P

Poor Knowledge of Causes and Prevention of Stillbirths Among Health Care Providers
continued from previous page
Table 1
Socio-demographic characteristics of respondents
N=201
Variable Frequency Percent
Professional status
Community health Officers 35 17.4
Medical students 134 66.7
Nurses 32 15.9
Age (years)
21 - 25 59 29.4
26 - 30 84 41.8
31-35 18 9.0
>35 40 19.9
Marital Status
Single 113 56.2
Married 70 34.8
Divorced 17 8.5
Widows 1 5.0
Educational Status
Secondary 10 5.0
Tertiary 191 95.0
Ethnicity
Yoruba 176 87.6
Ibo 18 9.0
Hausa 7 3.5
Table 2
Key Variables on Awareness of stillbirths among health care
providers
Knowledge About Stillbirth
Variable Frequency Percentage
Ever heard of Stillbirth
Yes 158 78.6
No 43 21.4
Person who has had Stillbirth
Relative 87 33.3
Nobody 91 40.0
Friends 42 20.9
Self 11 5.5
Can Stillbirth be prevented?
Yes 190 94.5
No 11 5.5
Need more Information on Stillbirth
Yes 145 72.1
No 58 27.9
Level of Knowledge on causes
and prevention of Stillbirths
< 5 (Very poor) 126 62.7
5 - 8 (Poor) 64 31.8
9 - 12 (Fair) 11 5.5
13 + (Good) 0 0.0
As shown in Table 2, about 60% of the respondents
have been exposed directly or indirectly to stillbirth and
practically (94.5%) of them believed that stillbirth can be
prevented. Only thirty six (17.9%) of the respondents were
able to distinguish between stillbirth and miscarriage. About
28% indicated that there was no need for more information
on stillbirth because they were knowledgeable on the subject.
However, 94.5% of the respondents were rated as very
poor or poor on level of knowledge on stillbirths.
Table 3 depicts that level of education, age cadre and
marital status of the respondents were not significantly
related to the level of knowledge of causes and prevention of
stillbirths (P>0.05)
Table 3
Relationship between level of knowledge of causes and prevention
of stillbirths and socio-demographic characteristics of
respondents
Socio-demographic Level of Knowledge
Characteristics
Age: (years) Very Poor Poor Fair P- value
21-25 34 21 4 0.235
26 - 30 54 24 8 not significant
31-35 15 3 -
>35 23 16 1
Marital Status
Single 71 34 8 0.557
Married 41 27 2 not significant
Divorced 13 3 1
Widow 1 - -
Educational Status
Secondary 7 3 - 0.713
Tertiary 119 64 11 not significant
Cadre
Community
Health officers 22 13 - 0.3 77
Medical Students 81 44 9 not significant
Nurses 23 7 2
Ethnicity
Yoruba 106 60 10 0.135
Ibo 16 1 1 not significant
Hausa 4 3 -
continued on next page
28 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Poor Knowledge of Causes and Prevention of Stillbirths
continued from previous page
Discussion
Pregnancy is a time of joy for most parents, filled with
hope, excitement and expectations for the future. But
pregnancy can also be a time of worry and fear, particularly
when a stillbirth occurs. Sometimes, the fetus develops
health problems in the womb and as a result, cannot survive
to term. Known as still birth, these deaths can be traumatic
and difficult for any parent to have to deal with [Fretts 2005;
Lawoyin 2007; Adimora and Odetunde 2007; Onwuhafua
and Oguntayo 2006; Sule and Onayade 2006].
The healthcare workers are strategically positioned to
counsel parents on the possible causes and prevention of
stillbirth [Fretts 2005]. However, as our study showed, there
is a general poor level of knowledge on the causes and prevention
of stillbirths among all cadres of respondents. This
is appalling. The implications are numerous. On one hand,
this implies that pregnant woman may not be counseled on
what to do to avoid having stillbirth which implies that the
level of stillbirths would continue to rise. On the other hand,
when the risk factors are present, appropriate timely intervention
would not be instituted because the health worker is
ignorant of the practical implication of such risk factor.
Unfortunately, stillbirth is a fairly common occurrence
in all countries in the world. Though any woman can experience
a stillbirth, there are certain factors that increase their
risks. These risk factors include: having a multiple pregnancy,
having pre-existing health conditions (such as high
blood pressure, diabetes), smoking during pregnancy, using
street drugs during pregnancy and being over the age of 35
[Onadeko and Lawoyin 2003; Olusanya et al 2006; Kuti et
al 2003; Njokanma et al 1994; Orji et al 2006; Orji 2002;
Fasubaa et al 2003; Kuti et al 2003; Ojofeitimi et al 2008;
Fretts 2005; Lawoyin 2007; Adimora and Odetunde 2007;
Onwuhafua and Oguntayo 2006; Sule and Onayade 2006].
Adequate knowledge of these by the health care providers
would assist in counseling clients appropriately.
Due to increased knowledge and better treatment of
maternal conditions, the numbers of stillbirths occurring every
year in developed countries have reduced [Fretts 2005],
clients are counseled to attend all prenatal appointment
where the welfare of mother and baby are regularly assessed
to identify the above malfactors. The baby’s movement is
also noted and infections such as Syphilis, Gonorrhoea,
Chlamydia, Toxoplasmosis, etc are detected and treated early
in pregnancy. Any pain or vaginal bleeding is reported early.
However, in developing countries like ours, the level of PMR
is likely to be on the increase since the health care providers
are ignorant of the causes and what to do to prevent
stillbirth or even detect early warning signs.
In conclusion, this study has shown a poor level of
knowledge on the causes and prevention of stillbirths among
all the cadres of health workers interviewed.
We therefore recommend that medical schools and
School of Nursing/Midwifery should review their curricula to
lay emphasis on practical knowledge of causes and prevention
of stillbirths. Furthermore, regular update and refresher
courses should be organized for the workers rendering
maternity services at all level of health care delivery.
References
Adimora GN, Odetunde IO 2007. Perinatal Mortality in University of Nigeria
Teaching Hospital (UNTH) Enugu at the End of the Last Millennium.
Niger J Clin Pract. 10(1):19-23.
Fasubaa OB, Orji EO, Ogunlola IO, Kuti O, Shittu SA 2003. Outcome of
Singleton Breech Delivery in Wesley Guild Hospital, Ilesa, Nigeria. Tropical
Journal of Obstetrics & Gynaecology 20(1):59-62.
Fretts RC 2005. Etiology and Prevention of Stillbirth. Am J Obst Gynae
193(6): 1923-1935
Lawoyin TO 2007. Infant and Maternal Deaths in Rural South West Nigeria:
A Prospective Study. Afr J Med Med Sci. 36(3):235-41.
Kuti O, Owolabi AT, Orji EO, Ogunlola IO 2003. Ante-partum Fetal Death
in a Nigerian Teaching Hospital: Aetiology and Risk Factors. Tropical Journal
of Obstetrics and Gynaecology 20(2): 134-136.
Kuti O, Orji EO, Ogunleye IO 2003. Analsyis of Perinatal Mortality in a
Nigerian Teaching Hospital. J. Obstet. Gynaecol 23 (5): 512-4.
Njokanma OF, Sule-Odu AO, Akesede FA 1994. Perinatal Mortality at the
Ogun State University Teaching Hospital, Sagamu, Nigeria. J Trop. Pediatr 40
(2): 78-81.
Ojofeitimi EO, Ogunjuyigbe PO, Sanusi RA, Orji EO, Akinlo A , Laisu
SA, Owolabi OO 2008. Poor Dietary Intake of Energy and Retinol among
Pregnant Women: Implications for Pregnancy Outcome Southwest, Nigeria.
Pakistan Journal of Nutrition 7(3):480-484.
Olusanya BO, Surulere OA, Okolo AA 2006. Still Births in Sub-Saharan
Africa. Lancet 8, 368 (9530): 17.
Onadeko MO, Lawoyin TO 2003. The Pattern of Stillbirth in a Secondary
and a Tertiary Hospital in Ibadan Nigeria. Afr. J Med Sci. 32 (4): 349-52.
Onwuhafua PI, Oguntayo A 2006. Perinatal Mortality Associated with
Eclampsia in Kaduna, Northern Nigeria. Niger J Med. 15(4):397-400.
Orji EO 2002. Analysis of Obstructed Labour at Ife State Hospital, Ile-Ife,
Nigeria. Sahel Medical Journal 5(3): 143-146.
Orji EO, Ojofeitimi EO, Esimai AO, Adejuyigbe E, Adeyemi AB, Owolabi
OO 2006. Assessment of Delays in Receiving Delivery Care at a Tertiary
Healthcare Delivery Centre in Nigeria. J Obstet Gynaecol 26(7):643-4.
Sule SS, Onayade AA 2006. Community-based Antenatal and Perinatal
Interventions and Newborn Survival. Niger J Med. 15(2):108-14.
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 29

Calendar of Events
January 14-15, 2010
Cincinnati, OH. Professional Childbirth
Educator Workshop. Connie Livingston RN,
BS, LCCE, FACCE, ICCE, IAT. Location:
Bowen Center for Womens Health. 11317
Springfield Pike Springdale, OH 45246.
Website: www.birthsource.com.
Email: clivingston@birthsource.com.
Phone: (937)312-0544 or 1-866-88-BIRTH
January 15-16, 2010
Tifton, GA. Professional Childbirth Educator
Workshop. 8-5:30PM Both Days
(Friday&Saturday). St. Anne’s Episcopal
Church. Vonda Gates, IAT-CE-D.
Phone: (605)343-3203 or (605)209-7115.
Email: vonda@birthbasics.org
January 16-17, 2010
Sacramento, CA. Professional Childbirth
Educator Workshop. Donyale Abe, IAT-CE.
Website: Childbirth Professional Development
Group
Email: birtheducators@gmail.com
Phone: (707) 742-3830
January 22-23, 2010
Midland, MI. Professional Childbirth Educator
Workshop. idney Mueller, IAT-CE-D.
Phone: (269)388-4670
Email: rhythm-motion@sbcglobal.net
January 23-24, 2010
San Antonio, TX. Professional Childbirth
Educator Workshop. Donyale Abe, IAT-CE
Website: Childbirth Professional Development
Group
Email: birtheducators@gmail.com
Phone: (707) 742-3830
February 5-6, 2010
Cape Girardeau, MO vicinity. Doula and Labor
Support Training Workshop. Exact Location
Coming Soon. Jean McHenry, IAT-CE-D
Email: doulajean611@sbcglobal.net
Phone: (630)877-7482
February 6-7, 2010
Oakland, CA (San Francisco Bay Area).
Professional Childbirth Educator Workshop.
Donyale Abe, IAT-CE
Website: Childbirth Professional Development
Group
Email: birtheducators@gmail.com
Phone: (707) 742-3830
February 7-8, 2010
Cape Girardeau, MO vicinity. Professional
Childbirth Educator Workshop. Exact Location
Coming Soon. Jean McHenry, IAT-CE-D
Email: doulajean611@sbcglobal.net
Phone: (630)877-7482
February 13-14, 2010
Naples, FL. Professional Childbirth Educator
Workshop. JM Birth Consultants. Marilyn
Hildreth RN, IBCLC, LCCE, FACCE, ICCE,
IAT-CE-D, CD(DONA)
Email: michele@jmbirthconsultants.com
Phone: (703)350-2056
February 20-21, 2010
St. Louis, MO (Airport Location).
Professional Childbirth Educator Workshop.
Donyale Abe, IAT-CE
Website: Childbirth Professional Development
Group
Email: birtheducators@gmail.com
Phone: (707) 742-3830
February 27-28, 2010
Las Vegas, NV. Professional Childbirth Educator
Workshop. Babytime Birth Services.
Diana Peterson, IAT-CE
Email: LABabytime@me.com
Phone: (818)693-1513
March 4-5, 2010
Columbus, OH. Professional Childbirth Educator
Workshop. Connie Livingston RN, BS,
LCCE, FACCE, ICCE, IAT. Location: The Inn
at Darby Glen. 14515 Robinson Road Plain
City, Ohio 43064
Website: www.birthsource.com
Email: clivingston@birthsource.com
Phone: (937)312-0544 or 1-866-88-BIRTH
March 6-7, 2010
Portland, OR. Professional Childbirth Educator
Workshop. Donyale Abe, IAT-CE
Website: Childbirth Professional Development
Group
Email: birtheducators@gmail.com
Phone: (707) 742-3830
March 6-7, 2010
Springfield, IL. Doula and Labor Support
Training Workshop. Exact Location Coming
Soon. Jean McHenry, IAT-CE-D
Email: doulajean611@sbcglobal.net
Phone: (630)877-7482
March 8-9, 2010
Springfield, IL. Professional Childbirth Educator
Workshop. Exact Location Coming Soon.
Jean McHenry, IAT-CE-D
Email: doulajean611@sbcglobal.net
Phone: (630)877-7482
March 18-19, 2010
Schaumberg, IL. Professional Childbirth Educator
Workshop. Connie Livingston RN, BS,
LCCE, FACCE, ICCE, IAT
Location: Coming Soon!
Website: www.birthsource.com
Email: clivingston@birthsource.com
Phone: (937)312-0544 or 1-866-88-BIRTH
March 20-21, 2010
Baltimore, MD. Professional Childbirth Educator
Workshop. Donyale Abe, IAT-CE
Website: Childbirth Professional Development
Group
Email: birtheducators@gmail.com
Phone: (707) 742-3830
April 8-9, 2010
Dayton, OH. Professional Childbirth Educator
Workshop. Connie Livingston RN, BS, LCCE,
FACCE, ICCE, IAT. Location: Miami Valley
Hospital, Berry Womens Pavilion. One Wyoming
Street, Dayton, Ohio 45409
Website: www.birthsource.com
Email: clivingston@birthsource.com
Phone: (937)312-0544 or 1-866-88-BIRTH
April 16-17, 2010
Bass Lake, CA (near Yosemite National Park).
Professional Childbirth Educator Workshop
(Discount if registered and paid 60 days in
advance). Contact: Sandy Williamson ICCE,
ICD, IAT, CLC
Email: mamadoula@sti.net
Phone: (559)641-7295
April, 19-20, 2010
Fort Wayne, IN. Professional Childbirth Educator
Workshop. Sidney Mueller, IAT-CE-D
Phone: 269/388-4670
Email: rhythm-motion@sbcglobal.net
April 23-24, 2010
Toronto, Ontario, Canada. Professional
Childbirth Educator Workshop. Location TBA.
Vonda Gates, IAT-CE-D
Website: jmbirthconsultants.com
Phone: (703)350-2056
Email: michele@jmbirthconsultants.com
continued on next page
30 | International Journal of Childbirth Education | Volume 24 Number 4 December 2009

Calendar of Events
continued from previous page
May 6-7, 2010
Minneapolis/Saint Paul, MN. Professional
Childbirth Educator Workshop. JM Birth Consultants.
Lori Frane-Lake, RNC, WHNP, MSN,
LCCE, ICCE, IAT. Vonda Gates, IAT-CE-D
Email: michele@jmbirthconsultants.com
Phone: (703)350-2056
May 11-12, 2010
Worchester, MA. Doula and Labor Support
Training Workshop. Sidney Mueller, IAT-CE-D
Phone: (269)388-4670
Email: rhythm-motion@sbcglobal.net
May 13-14, 2010
Worchester, MA. Professional Childbirth Educator
Workshop. Sidney Mueller, IAT-CE-D
Phone: (269)388-4670
Email: rhythm-motion@sbcglobal.net
May 13-14, 2010
Pittsburgh, PA. Professional Childbirth Educator
Workshop. Connie Livingston RN, BS,
LCCE, FACCE, ICCE, IAT.
Location: Coming Soon!
Website: www.birthsource.com
Email: clivingston@birthsource.com
Phone: (937)312-0544 or 1-866-88-BIRTH
May 14-15, 2010
Bass Lake, CA (near Yosemite National Park).
Doula and Labor Support Training Workshop
(Discount if registered and paid 60 days in
advance). Contact: Sandy Williamson ICCE,
ICD, IAT, CLC
Email: mamadoula@sti.net
Phone: (559)641-7295
May 15-16, 2010
Phoenix, AZ. Professional Childbirth Educator
Workshop. Babytime Birth Services. Diana
Peterson, IAT-CE.
Email: LABabytime@me.com
Phone: (818)693-1513
June 4-5, 2010
Bass Lake, CA (near Yosemite National Park).
Professional Childbirth Educator Workshop
(Discount if registered and paid 60 days in
advance). Contact: Sandy Williamson ICCE,
ICD, IAT, CLC
Email: mamadoula@sti.net
Phone: (559)641-7295
June 12-13, 2010
Nashville, TN. Professional Childbirth Educator
Workshop. Donyale Abe, IAT-CE
Website: Childbirth Professional Development
Group
Email: birtheducators@gmail.com
Phone: (707) 742-3830
June 17-18, 2010
Kalamazoo, MI. Doula and Labor Support
Training Workshop. Sidney Mueller, IAT-CE-D
Phone: (269)388-4670
Email: rhythm-motion@sbcglobal.net
June 26-27, 2010
Ventura, CA. Professional Childbirth Educator
Workshop. Babytime Birth Services. Diana
Peterson, IAT-CE
Email: LABabytime@me.com
Phone: (818)693-1513
July 5-6, 2010
Salt Lake City, UT. Professional Childbirth
Educator Workshop. Donyale Abe, IAT-CE
Website: Childbirth Professional Development
Group
Email: birtheducators@gmail.com
Phone: (707) 742-3830
July 9-10, 2010
Bass Lake, CA (near Yosemite National Park).
Doula and Labor Support Training Workshop
(Discount if registered and paid 60 days in
advance). Contact: Sandy Williamson ICCE,
ICD, IAT, CLC
Email: mamadoula@sti.net
Phone: (559)641-7295
July 23-24, 2010
Petoskey, MI. Professional Childbirth Educator
Workshop. Sidney Mueller, IAT-CE-D
Phone: (269)388-4670
Email: rhythm-motion@sbcglobal.net
August 6-7, 2010
Bass Lake, CA (near Yosemite National Park)
Professional Childbirth Educator Workshop
(Discount if registered and paid 60 days in
advance). Contact: Sandy Williamson ICCE,
ICD, IAT, CLC
Email: mamadoula@sti.net
Phone: (559)641-7295
August 19-20, 2010
Minneapolis/Saint Paul, MN. Professional
Childbirth Educator Workshop. JM Birth
Consultants. Marilyn Hildreth RN, IBCLC,
LCCE, FACCE, ICCE, IAT-CE-D, CD(DONA)
Email: michele@jmbirthconsultants.com
Phone: (703)350-2056
September 17-18, 2010
Bass Lake, CA (near Yosemite National Park)
Doula and Labor Support Training Workshop
(Discount if registered and paid 60 days in
advance). Contact: Sandy Williamson ICCE,
ICD, IAT, CLC
Email: mamadoula@sti.net
Phone: (559)641-7295
ICEA Calendar listings are free of charge for
events that have been approved for ICEA
contact hours. There is a charge for listing nonapproved
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.
Journal Submissions
The International Journal of Childbirth Education welcomes your
articles, research papers, essays, and photos for upcoming issues.
June 2010: Celebrating 50 Years
The deadline is February 1, 2010.
September 2010: Evidence
Based Practice
The deadline is May 1, 2010.
December 2010: Breastfeeding
The deadline is August 1, 2010.
March 2011: Open Forum
The deadline is November 1, 2010.
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.
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 31

Save the Date!
Celebrate the 50-year anniversaries of Lamaze International
and ICEA in 2010 and rejuvenate your passion for safe, healthy
births. We are unifying the birth community by sharing our
ideas and learning from each other to provide committed,
evidence-based care for mothers and their families.
Abstract submissions are being accepted until
January 8, 2010. View all Mega Conference
details at www.futureofbirthconference.org
www.futureofbirthconference.org

Becoming a Birth Writer
continued from page 25
great power. At the very least, we can offer a new mother a
timeline of the events of her birth. We can recreate the joy
she felt when her own mother arrived, the laughter when
her husband told a joke, and the love that filled the room as
her support people circled around her and held her during
contractions.
As birth professionals we cannot change every circumstance,
but we can find the good. In 2003, one of my
doula clients died after an emergency cesarean. I wrote her
husband a birth story and in it I shared the conversation I
had with his wife a few weeks earlier when she told me how
much she loved her husband and how excited he was to be
having a son. I told him that it was a very good thing that he
insisted his wife get to see the baby and touch him before
they took him to the NICU. To this day, I believe it was the
most important writing I have ever done.
Do you have the desire to see your writing published?
There are many ways to accomplish that goal. As Giuditta
said, “Just do it.” You have nothing to lose. For those of you
who have put off writing birth stories, maybe now is the
time to begin. Birth memories fade, but the written words of
encouragement and praise will bring joy for a lifetime.
Elizabeth Merrell Gross lives in the beautiful Florida Panhandle
and has taught childbirth classes and worked as a doula for 15
years. She is the mother of five children and brand new grandma
to two precious grandsons. She also teaches College Success and
composition classes at Northwest Florida State College.
Got Babies_halfpg_IJCE 2009:Got Babies_1/2_IJCE 2009 ICEA 9/1/09 2:01 PM Page 1
Got Babies?
We Got Answers!
PROGRAMS ON
Prenatal Care • Labor & Delivery • Breastfeeding
Postpartum • Parenting & Child Abuse Prevention
Teen Pregnancy & Health • Staff Training
ICEA Attendees Visit InJoy Booth #12
and SAVE 15% on Your Order!
THE MOST TRUSTED NAME IN BIRTH AND PARENTING EDUCATION
InJoyVideos.com
p h o n e 8 0 0 - 3 2 6 -2 0 8 2 x 2 • fa x 3 0 3 - 4 4 9 - 878 8 • I n J oy V i d e o s . c o m
Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 33

www.howbility.com/icea
info@howbility.com
www.howbility.com

Moms are looking for answers . . .
You have a new solution
Medela and 2-Phase Expression are registered trademarks and Freestyle is a trademark of Medela, Inc.
Weighs less than 1lb
(Shown actual size)
Freedom is born
Hands-Free Accessories • Rechargeable Battery
H A N D S - F R E E B R E A S T P U M P
A small, lightweight breastpump that’s powerful
and 2-Phase Expression smart, Freestyle comes with
hands-free accessories for true pumping mobility
that busy pumping moms will love.
More milk, less time
2-Phase Expression ® technology
Discover more at www.medelafreestyle.com

FREE
OFFER
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 new
parents how to achieve a successful birthing experience, but also shaping
their behaviors when they take their new baby home. Modeling safe sleep
practices should be an important part of your curriculum.
New “Sudden Infant Death Syndrome Risk Reduction Guidelines: The new American Academy of
Pediatrics guidelines warn against the use of loose blankets in a crib because of the risk they pose
for SIDS. They also suggest the use of a wearable blanket as a better, safer way to keep babies warm
and comfortable.
HALO is the choice of leading birthing centers and NICU’s concerned with modeling safe sleep practices
and offers special pricing for educator, gift shop and lactation center resellers.
The only wearable blanket with the First Candle/SIDS Alliance Gold Seal. No one puts more care
and testing into producing a safe and effective product than HALO. It is our mission to help you
educate parents on how they can reduce their precious new baby’s risk of SIDS.
Visit on-line today for more information
and to order your
FREE “Safe Sleep Resource Kit”
www.halosleep.com/icea
Kit Includes:
A HALO ® SleepSack Swaddle for
classroom demonstrations, First
Candle/SIDS Alliance “Safe Sleep
Guidelines” door hangers (refills are
FREE) and “Safe Sleeping Tips”
brochures (refills are also FREE) to hand
out in class.
© 2008 HALO Innovations, Inc. 111 Cheshire Lane, Suite 700, Minnetonka, MN 55305 * 888-999-HALO (4256) Ext. 113
T H E S A F E R W AY T O S L E E P ®