Birth Day - International Childbirth Education Association

Are unexpected outcomes in childbirth normal and should they be presented in all classes?
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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.
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Volume 24 Number 4 December 2009 | International Journal of Childbirth Education | 17