JOURNAL - International Childbirth Education Association

I N T E R N A T I O N A L
JOURNAL
O F C H I L D B I R T H E D U C A T I O N
Volume 13
Number 4
Indexed in the Cumulative Index to Nursing and Allied Health Literature (CINAHL)
Postnatal Education
FEATURES
Reciprocal Interaction as the Foundation
for Parent-Infant Attachment
By Linda Todd .............................................................5
Focal Point on Breastfeeding: Questions to
Answer When Teaching a Breastfeeding Class
By Mary C. Gannon ...................................................28
ICEA Alternate Contact Hours Program #26 ............... 9
It Takes a Village to Raise a Child
By Cindy Butler .........................................................11
Parenting: Examining the Father
By Celestine West and Marcella A. Hart .......................18
Photo Feature: ICEA 1998 International
Convention in Atlanta ...........................................24
Focal Point on Labor Support: Attachment and Bonding:
The Doula’s Role
By Gillian Sippert .......................................................26
Managing Editor
Helen Young
1936 Garfield Avenue
Ottawa, Ontario K2C 0W8, Canada
Associate Editors
Caroline Brown
Marcella Hart
Columnists
Naomi Bromberg Bar-Yam
Mary Ann Ernzen
Dale King
Ana Lopez-Dawson
Debbie Madonna
Margery Simchak
Kathy Swift
Rebecca Ward
Cover Photo
Kelly Greene
Reviewers
Terry Algire
Cheryl Coleman
Debra Madonna
Pat Turner
This publication printed on
recycled
paper.
Next Issue:
OPEN FOCUS
Editor’s Notes .................................... 2
Letter to the Editor ............................. 2
Across the President’s Desk..................
3
Featured Staff Member ....................... 4
Healthy Lifestyles ............................. 12
Resources ........................................ 13
Statistics .......................................... 16
Focal Point on Childbirth Education:
Clearing Up the Myths
By Patricia Macko ......................................................32
Sample Pages from Postnatal
Curriculum Guide .................................................... 34, 35
Teaching Tips ............................................................... 36
Suggestions for a Doula’s Birth Bag:
ICEA Teaching Ideas Sheet #23
By Jan Mallak ............................................................ 39
COLUMNS
ANNOUNCEMENTS
Information Update .......................... 17
Certification Update .......................... 20
The Internet ..................................... 22
Political Issues .................................. 30
Educator’s Corner ............................. 33
For Your Information ........................ 37
Audio Visual Review ......................... 40
CIMS Feedback Request ...................................................................................... 3
Journal Deadlines ................................................................................................ 4
ICEA Virginia Larsen Research Grant Application Announcement .......................... 23
Web Page Photograph Request .......................................................................... 38
Newly Certified ICCEs, ICDs, ICPEs ...................................................................... 41
Journal Guidelines for Photography .................................................................... 42
ICEA International Convention 2000 — Call for Speaker Abstracts ........................ 42
Information for Journal Writers ........................................................................... 43
Change of Address Form ................................................................................... 43
Calendar of Events ............................................................................................ 45
Classified Ad .................................................................................................... 45
Photo Credit: Unless otherwise stated, all photos are
by Caroline Brown, IJCE Associate Editor: Photos.
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 (classifi ed, display, or calendar) information is available from ICEA. 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 offi cial publication
of the International Childbirth Education Association (ICEA), Inc. Subscriptions are $25 a year, $30 non-US ($20 additional for
airmail). Single copies are $5.
The International Childbirth Education Association, founded in 1960, unites individuals and groups who support family-centered
maternity care (FCMC) and believe in freedom of choice based on knowledge of alternatives. ICEA is a non-profi t, primarily
volunteer organization that has no ties to the health care delivery system. ICEA membership fees are $30 for individual
members (IM), $100 for supporting members (SM). For group rates write: ICEA, PO Box 20048, Minneapolis, Minnesota
55420-0048 USA.
© Copyright 1998 by ICEA, Inc. Articles may be reprinted only by written permission of the Managing Editor.
IJCE Vol. 13 No. 4 • 1

Editor’s Notes
by Helen Young
Recently, a woman called me requesting information
about the prenatal classes at the hospital where I teach.
She said, “I would like to know how much time you
spend on labor and delivery as compared to infant
care. I figure that the labor and birth are going to
happen no matter what I do. What I really want to
learn is how to best take care of my baby.” This type
of inquiry is occurring more and more often lately.
In the past, the main concern of many prospective
parents was how to cope with the pain of labor and
birth. Now with the knowledge that pain medications
are easily accessible at many centres for those who
choose the medicated option, class participants are
often more interested in infant care.
When I was pregnant with my first daughter,
Laura, my colleagues said that I would breeze through
the labor and birth because of my background as a
childbirth educator, but that I wouldn’t have a clue
about how to take care of my baby. Luckily, I was able
to breeze through my labor and birth due to a lot of
preparation, an uncomplicated labor, and excellent
support (my husband always says it was because I had
a great coach). After Laura was born, my husband
and I relied on our instincts and knowledge to deal
with the trials and tribulations of being new parents.
Laura is now a lovely seventeen-year-old, an excellent
student, and very involved in competitive sports and
school activities. I think we did all right.
Postnatal education topics can either be incorporated
into an existing prenatal class program or
offered as a separate series. Mae Shoemaker’s new
Postnatal Curriculum Guide is a timely resource available
through the ICEA Bookcenter. ICEA’s Postnatal
Educator Certification Program is offered for those
who wish to validate their expertise in this field.
This issue of the International Journal of Childbirth
Education focuses on postnatal education. Linda Todd,
in her article “Reciprocal Interaction as the Foundation
for Parent-Infant Attachment,” offers excellent information
regarding the attachment of infant and parent.
The special role of the father in parenting is discussed
in “Parenting: Examining the Father,” by Celestine
West and Marcella Hart. Gillian Sippert examines the
doula’s role in attachment and bonding in the “Focal
Point on Labor Support.” An excellent program
to support new parents is described by Cindy Butler
in her article “It Takes a Village to Raise a Child.” In
the returning Healthy Lifestyles Column, Ana Lopez-
Dawson addresses the issue of abuse in families.
As health care professionals, it is of the utmost
importance that we provide our clients with postnatal
education so that they can adapt well to becoming
parents. We must help them develop confidence in
their abilities to parent and encourage them to trust
in their own instincts. Hopefully, they will then be
able to instill a good sense of self-esteem in their
children — the children who are our future.
Dear Editor
As a childbirth educator certified by the Metropolitan
New York Childbirth Education Association
in 1983, I have been reading and benefitting from
the Journal for many years. I read your recent cover
story on labor support and your articles on “doulas.”
I want to clarify some potential confusion created
by your coverage of the topic. Whereas it is true
that DONA (Doulas of North America) began certifying
labor support doulas in the mid-1990s, NAPCS
(National Association of Postpartum Care Services), of
which I was a founding member in 1988, has been
certifying postpartum doulas for longer and actually
used the term “doula” for postpartum caregiver
earlier than DONA did for labor supporter. The word
was discovered in a book written by anthropologist
Dana Raphael called The Tender Gift: Breastfeeding and
subtitled Mothering the mother — the way to successful
breastfeeding (Schocken Books 1976). Ms. Raphael
Letter to the Edispoke
at one of NAPCS’ national conferences at a
time when the Klauses and Penny Simkin were developing
DONA.
We are not contesting who has claim to the name
“doula” because women have been helping women
since the beginning of time, and because both types
of doulas “mother the mother” and are honored to
share with her during these most special days of her
life. But I do know that in my own postpartum doula
service, which was incorporated in 1987, there is some
confusion among consumers as to what is meant by
“doula” if they hear that labor support coaches are
also calling themselves doulas. Therefore, I think it
behooves members of our health care professions to
specify “labor support doula” or “postpartum doula”
and not just “doula” as was done in your articles
on labor support. We cannot assume the reader or
consumer will know to which type of doula you are
referring unless you clarify in that way.
Best Wishes, Alice Gilgoff, CNM
Director of Public Relations, National
Association of Postpartum Care Services
2 • IJCE Vol. 13 No. 4

Across the President’s Desk
by Cheryl Coleman
“Light tomorrow with today!” says Elizabeth Barrett
Browning. So as the today of 1998 comes to a close, we
focus the light on the year ahead using the glow from a
successful 1998.
ICEA began this year with our biennial transition. The
new ICEA Board of Directors took office in February and
immediately got to work. Once again ICEA participated
in the annual Coalition for Improvement of Maternity
Services (CIMS) conference and shortly thereafter ratified
the Mother Friendly Hospital Initiative. ICEA has also been
quite visible in the professional community during 1998
by exhibiting at the Association for Women’s Health,
Obstetric, and Neonatal Nurses (AWHONN), American
College of Nurse Midwives (ACNM), and Lamaze International
conventions as well as the Birth, WIC, and National
Association of Childbearing Centers (NACC) conferences.
The ICEA International Convention was a success with over
five hundred educators gathering in Atlanta, Georgia. Six
Basic Teacher Training Workshops, one Challenges event,
and three Doula Training Workshops were held this past
year. The Doula Workshop and Certification Program
guidelines were broadened so that even more members
can join this growing, supportive profession. This year
was also a time of celebration and relief for well over two
hundred ICEA members who completed their certification
and now carry the titles of ICCE, CPE, or ICD. Congratulations
to each of you! In addition, ICEA volunteers and
staff have gathered resources, published new materials,
added many new quality books, videos, and teaching aids
to the Bookcenter, and added new columns to the Journal
to meet the needs of our members.
The ICEA Board of Directors and Central Office staff
continue to be busy working for you, the educator. As
we work, we always look at all we do with an eye to the
future. We have determined that we want to maintain
our mission of family-centered maternity care and be
the number one resource for education, certification,
and resources. You are our focus. You are what drives
the programs we offer, the events we exhibit at, and the
publications we develop. We continue to work for you,
but we also need to work with you. Many of you have
received surveys from us in the past year. We thank you
and appreciate your input. We have continued to refer to
the information you have provided as we take the light
of today and look toward a brightly glowing future.
——— We Welcome Your Feedback ———
The Coalition for Improving Maternity Services (CIMS) has developed
The Mother-Friendly Childbirth Initiative
and
The Ten Steps of The Mother-Friendly Childbirth Initiative
• Have you used the Initiative or Ten Steps as a model for
change in your community, hospital, birth center, or practice?
• How have you used this document?
• What responses have you received?
• Do you plan to use the documents and how?
Please share your responses with us by sending your comments to:
Pat Turner, ICEA President Elect and CIMS representative,
at ICEA, PO Box 20048, Minneapolis, Minnesota 55420 USA,
or her e-mail address: paturner@ctel.net
IJCE Vol. 13 No. 4 • 3

Featured Staff Member
Dale King, Statistics Columnist for the International Journal of Childbirth Education, received his doctorate in
Economics from the State University of New York at Albany in 1995. His dissertation was concerned with the
impact of socioeconomic, organizational, and professional liability factors on the odds of cesarean delivery.
Part of his research was published in the August 1994 issue of the Journal of the American Medical Association
and presented at an international conference on health policy and management. The central thesis
of his work was that women have begun to educate themselves so that they may have their desired birth
experience rather than let their physician make all the necessary decisions. For example, better educated
women were at the forefront of the increase in the vaginal birth after cesarean rate that occurred in the
late nineteen eighties.
Dale’s Statistics Column has appeared in the International Journal of Childbirth Education for the past two
years. He is currently employed as an analyst for the New York State Department of Health.
The International Journal of Childbirth Education welcomes your
articles and photos (authors and photographers must submit
a signed copy of the submission statement included in Information
for Journal Writers) for the next four issues.
They can be sent to Managing Editor Helen Young,
1936 Garfield Avenue, Ottawa, Ontario K2C 0W8 CANADA;
e-mail address: ag139@freenet.carleton.ca.
June 1999: “Infant Feeding”
February 1, 1999 Deadline
September 1999: “Your Practice”
May 1, 1999 Deadline
December 1999: “Turn of the Century”
August 1, 1999 Deadline
March 2000: “Open Focus”
October 1, 1999 Deadline
Writers are also encouraged to submit articles for Journal’s
Focal Points, as they relate to each particular issue focus.
Focal Point on Breastfeeding
Focal Point on Childbirth Education
Focal Point on Labor Support
Focal Point on Postnatal Education
4 • IJCE Vol. 13 No. 4

Reciprocal Interactions as the
Foundation for Parent-Infant Attachment
At a recent gathering of
new parents, a mother
admiring her four-week-old
baby said, “I talk to her all of
the time, but sometimes I feel
like
I must be crazy because, you
Where did the baby fit into this statement? This was
obviously a loving parent. The emergence of the social
smile in her baby would certainly awaken this mother
to the reciprocal nature of interactions that were already
going on. Still, her comment represents pervasive, cultural
messages that we are not fully human — not really
there — until we can speak for ourselves. Central to any
healthy relationship is the belief that we will be heard.
What can educators and health care professionals do to
support an awareness of reciprocity from the beginning
of this most central of human relationships?
Sensory development in the prenatal period allows the
baby to engage the environment socially at birth —and
before. The tactile sense is the first to develop prenatally
and the most refined sense at birth. Auditory development
is completed during the prenatal period. Once any remaining
amniotic fluid is absorbed, the newborn’s hearing is
as good as an older child’s. Auditory ability gives us the
A
by Linda Todd
clearest picture of prenatal learning. Newborn babies show
a marked preference for voices heard during the prenatal
period. DeCasper and Spence (1986) demonstrated that
babies recognize a story read to them twice a day in the
last six weeks of pregnancy when compared to an unfamiliar
story that was heard for the first time after birth.
Furthermore, the unborn baby often habituates to sounds
that might be considered disturbing, for example, barking
of a family dog or airplanes flying overhead, showing a
remarkable ability to filter these sounds out after birth.
At birth, the newborn’s sense of taste is acute. Babies
show a preference for sweet over sour tastes (Lipsitt 1977).
Rosenstein and Oster (1988) demonstrated that when
exposed to the taste of various substances, newborns
made facial expressions very much like adults exposed
to the same tastes, providing evidence that such facial
expressions are innate. Like the sense of taste, the sense of
smell is well developed at birth. In a time frame of thirty
to ninety minutes after birth, newborns exposed to the
odor of amniotic fluid cry significantly less than controls
or even those exposed to breastmilk (Varendi et al. 1998).
In the first days after birth, newborns distinguish between
the natural odor of the maternal breast and a breast that
has been washed, showing a preference for the natural
odor breast (Varendi, Porter, and Winberg 1997).
The least well-developed sense of the baby at birth
is vision. Newborns are remarkably nearsighted, creating
something of a visual cocoon for the first several weeks.
During that time, the human face captures attention. Stern
(1977) has speculated that in this world of limited vision,
the infant learns to read the nonverbal messages of the
human face in ways that might
not otherwise occur.
Nearly as impressive as
sensory development is motor
development in the prenatal
period. By twenty weeks of
pregnancy, the unborn baby is
capable of all the movements
that will be seen after birth
(Comparetti 1981). The early
development of the vestibular
system of the middle ear,
around four months, allows the
unborn baby to sense changes
in maternal posture as he floats
in the amniotic fluid (Patten
1968). Women frequently comment
on increased fetal move-
continued on page 6
Dan Hammond
IJCE Vol. 13 No. 4 • 5

RECIPROCAL INTERACTIONS AS FOUNDATION FOR ATTACHMENT from page 5
ment when lying down. After birth, women find great
pleasure in watching movements of their newborns and
relating them to sensations of pregnancy. Such observations
probably have an effect on integrating attachment
feelings for the fetus, the baby imagined in pregnancy,
and the real baby (Brazelton and Cramer 1990).
Much of the unborn and newborn baby’s movement
is reflexive in nature. These reflexes allow babies to respond
to and act on the world around them (Cole and
Cole 1993). For example, the crawling reflex may play a
role in the baby’s descent during labor. Bringing the hand
to the mouth and sucking can be observed frequently
throughout the prenatal period. After birth, this skill is an
important component of infant self-comforting. Movement
is, of course, a measure of fetal well-being. Introducing
the idea of fetal movement counts, as a way of spending
time with the baby to affirm wellness, supports a central
component of healthy parenting: paying attention. This is
more holistic than recommending fetal movement counts
solely as a way to identify a potential problem. It is hard
to engage in social discourse when all you are listening
for is bad news.
Just as before birth, the foundations of attachment
work between parent and baby after birth are largely
sensory. To the interaction, the baby brings all of the
sensory and motor skills developed during the prenatal
period. The quiet alert state into which babies are born
allows them to demonstrate not only that they can see,
hear, feel, and smell their parents, but that it is their parents’
voices, touch, faces, and odors that are preferred. A
newborn recognizes the sound of the mother’s or father’s
voice, turns towards it, scans the environment visually
to find that familiar person, and often orients the body
toward the parent. When in a parent’s arms, the baby
nestles in, clings with the grasp reflex, and roots to find
the comfort of suckling. New parents bring the same
sensory awareness to their babies. The very appearance
of the newborn draws out nurturing responses: head large
6 • IJCE Vol. 13 No. 4
B
in proportion to the rest of the body, rounded forehead,
large eyes, and round, full cheeks all make giving over
to the needs of the baby easier (Lorenz 1943). In the
first days after birth, mothers recognize their newborns
readily by odor (Porter, Cernoch, and McLaughlin 1983).
This primal sensitivity heightens awareness of the baby
in ways that baby books and parenting classes cannot.
Baby observation becomes a full-time job. The intensity of
this observation is reflected in the questions asked about
physical appearance, newborn behaviors, and caretaking
skills. As professionals, it is easy to overlook the meaning
of these questions. For the parents, the ability to distinguish
between normal and abnormal, what to expect, and
how to respond are literally issues of life and death. The
shadow side of the attachment work going on is fear of
loss. Taming the monsters of those fears is a large part
of the work of postpartum, learning to believe in one’s
ability to parent in such a way that both parent and baby
will survive and thrive.
Professionals can assist parents in beginning awareness
of the reciprocal nature of interactions with their
babies by talking with them, both before and after birth,
about their babies’ emerging sensory-motor skills. Even
well-educated parents who have seen the unborn baby
several times on sonogram, know the sex of the baby, or
have named the baby are often surprised to learn that
babies are born innately social — and that social interaction
begins before birth. Many parents have not brought
to conscious awareness the reality that their baby has
sensory competencies before as well as after birth.
Questions such as the following, asked during pregnancy,
invite parents to notice the reciprocal nature of
interactions occurring with their babies:
• When is the baby most active?
• D o c e r t a i n p o s i t i o n s y o u
are in change the baby’s activity?
• Does your baby move differently when it has been
a while since you have eaten
or right after a meal?
• Are you becoming more
aware of the baby’s sleep
and awake pattern? What is
that pattern like?
• Does the baby seem to respond
differently to different
voices. For example, what
happens when the baby is
moving and you call your
partner (or a sibling) closer
to watch?
• Are there any sounds your
baby seems to like, such as a
certain type of music? Have
you noticed the baby startle
or become almost overactive
in response to any sounds?
When the baby is active and
you (your continued partner, on a sibling)
page 7

RECIPROCAL INTERACTIONS AS FOUNDATION FOR ATTACHMENT from page 6
D
C
stroke the abdomen, what does the
baby do? Is the baby’s response different
depending on who strokes your
abdomen?
As professionals, our own awareness of
the sensory foundations of the parent-infant
relationship should serve as a basis for our
care of newly forming families after birth.
Parents and babies cannot benefit from the
innate skills and drives each brings to the
interaction if they are apart. While it is true
that parents and babies can look forward
to a lifetime together, what occurs between
parent and baby in the first minutes, hours,
and days after birth is not like any other time.
Complications requiring parents and babies
to be apart can be accepted and integrated,
but few parents would say such separation
makes things easier in taking on the parent-
ing role.
It is still common for newborns to be delivered into
the hands of a physician who gives the baby to a nurse
who assesses the baby, gives a Vitamin K injection, places
ointment in the newborn’s eyes, and occasionally even
bathes the baby before the baby is brought to the parents.
Nothing in our knowledge of what Stern (1977) calls
the biologically designed choreography between parent
and child would suggest this is the best course of care.
Postpartum care practices that result in babies going to a
nursery for initial care, lab work, pediatrician visits, and
to spend the night are not based on the best available
research on postpartum physiological or psychological
adaptation. It is common to hear postpartum staff say
that many parents don’t want their babies with them all
of the time. When new parents believe that having their
babies with them in the immediate postpartum means
they are solely responsible for newborn care, it is not
surprising that they ask to have their babies taken from
their sides.
Parents are often told that having their babies with
them throughout hospitalization allows them to learn how
to care for the baby. This really misses the point of keeping
parents and babies together, is an unlikely outcome
given the scope of the task of learning caretaking, and
overlooks the parents’ own needs to be cared for. Keeping
parents and babies together is important because for
the vast majority of families, being together best supports
physical, emotional, and social well-being of the new family
members. In truly family-centered environments, staff
believe that the safest place for babies is with parents.
They also believe that for new parents to benefit from
being with their infants, they need help — both in caring
for the babies and for themselves.
Birth facilities that get what is happening between
parent and baby keep them together by providing care
to the entire family unit in a single room. The nurse
providing care is an expert on all members of the new
family. Provision is made for fathers or other important
people to the mother to stay throughout the period of
hospitalization. Such important people are not simply
provided a bed but have their own needs acknowledged
and their significance to the baby affirmed in practical
ways. Newborn assessments, basic care, lab work,
and physician exams are done at the bedside or in the
arms of the parent. All staff recognize that being close
to parents makes these experiences less stressful for the
newborn and are teachable moments for the family. In
a family-centered environment, professionals are aware
that they are modeling interactions with the baby. They
introduce themselves to the baby, acknowledge infant
responses to interactions and cues, and help parents
translate infant behavior into infant language.
In this type of family-centered environment, a crying
baby is not viewed as someone to be banned to a nursery,
but as a distressed human who is telling us about a problem.
Finding ways to comfort the baby with the parents
provides a learning opportunity that is of great importance
continued on page 8
IJCE Vol. 13 No. 4 • 7

RECIPROCAL INTERACTIONS AS FOUNDATION FOR ATTACHMENT from page 7
to every new family. Frequently, newborn crying is due
to feeling alone. Swaddling and placing the baby in bed
with mother or father often results in everyone getting
some rest. For parents, the message is, “I am important
to this baby. I am what the baby needs.” This is both the
joy and burden of parenting. Realizing that parenting is
about presence is crucial in the development of healthy
families.
When caring for parents and babies together, skilled
staff can help parents see that crying is often a last step
in a baby’s communication process rather than the baby’s
sole way of communicating. Together, parent and professional
can watch for the subtler messages that every
newborn offers as a sign help is needed. Messages may
include a change in state of consciousness, averting visual
attention as a sign a break is needed, raising a hand in
front of the face as a way of showing that the interaction
is overwhelming, efforts to establish eye contact as a way
to initiate conversation, and rooting or batting the face
with the hands as evidence of hunger. In the old model
of rooming-in where parents assumed full responsibility
for the care of the baby, this kind of learning occurred by
chance — if at all — rather than by practice. When parents
and babies are cared for together, teaching flows naturally
from moments when the nurse is caring for the baby, the
parent, or both rather than being driven by checklists
that seem unrelated to competencies a parent actually
needs.
Finally, in a family-centered environment, visitors are
present at the wishes of the parents and are educated
about their role in getting this family off to a good start.
Staff recognize that the health care system has limited
resources and limited time with new parents, but know
families that thrive have quality social support. Built into
practice, then, is a valuing of those who come to celebrate
the addition of a new member of the community.
Basic to our hopes for babies and parents is that
they form relationships that sustain them throughout life.
Healthy relationships form when there is mutually satisfying
reciprocal interaction. That is true of parents and babies,
parents and the staff who care for them, and parents and
institutions in which every new family is treated as the
F
community’s greatest natural resource.
References
E
Brazelton, T. B. and B. G. Cramer. 1990. The earliest relationship: Parents,
infants and the drama of early attachment. Reading, MA: Addison-Wesley
Publishing Company, Inc.
Comparretti, M. 1981. The neurophysiologic and clinical implications
of studies on fetal motor behavior. Seminars in Perinatology May 5
(2): 183-189.
Cole, M. and S. R. Cole. 1993. The development of children. 2nd ed.
New York: Scientific American Books.
DeCasper, A. J. and M. J. Spence. 1986. Prenatal maternal speech inferences
newborns perception of speech sounds. Infant Behavior and
Development 9: 133-150.
Lipsitt, L. P. 1977. “Taste in human neonates: Its effects on sucking
and heart rate.” In Taste and development: The genesis of sweet preference,
edited by J. M. Eiffenbach. Washington, DC: U. S. Government
Printing Office.
Lorenz, K. 1943. Die Angebornen Formen mogicher Erfahrung. Zeitschrift
Fur Tierpsychologie 5: 233-409.
Patten, B. M. 1968. Human embryology. 3rd ed. New York: McGraw-
Hill.
Porter, R. H., J. M. Cernoch, and F. J. McLaughlin. 1983. Maternal
recognition of neonates through olfactory cues. Physiological Behavior
1: 151-154.
Rosenstein, D., and H. Oster. 1988. Differential facial responses to four
basic tastes in newborns. Child Development 59: 1555-1568.
Stern, D. 1977. The first relationship: Infant and mother. Cambridge:
Harvard University Press.
Varendi, V. H., K. Christensson, R. H. Porter, and J. Winberg. 1998.
Soothing effect of amniotic fluid smell in newborn infants. Early Hu-
man Development
51, no. 1: 47-55.
Varendi, V. H., R. H. Porter, and J. Winberg. 1997. Natural
odour preferences of newborn infants change over time.
Acta Paediatr 86, no. 9: 985-990.
■ Linda Todd, BA, MPH, ICCE, is the author of You and Your
Newborn Baby: A Guide to the First Months After Birth, as
well as ICEA’s publication, Labor and Birth: A Guide for You.
She is currently a Consultant and Coordinator of Educational
Services for Phillips+Fenwick, a California-based women’s health
services consulting firm.
8 • IJCE Vol. 13 No. 4

ICEA ALTERNATE CONTACT HOURS PROGRAM #26
Reciprocal Interaction as the Foundation for Parent-Infant Attachment
To receive one ICEA Contact Hour, read Reciprocal Interaction as the Foundation for Parent-Infant Attachment,
circle the correct answers on the self-test, submit completed self-test and application with payment. Contact Hours
purchased and earned from this program are valid for the current certifi cation period for TCP candidates, the current
recertifi cation period of ICCEs or ICPEs, as well as for any individual who is a member of an outside organization
that accepts ICEA Alternate Contact Hours. Send application with completed self-test and appropriate payment to:
ICEA Alternate Contact Hours, PO Box 20048, Minneapolis, Minnesota 55420 USA. Telephone 612/854-8660; Fax
612/854-8772. Applications and completed self-test may be faxed if using a Visa or MasterCard.
1. The pervasive cultural message is that we are not fully human — not really there — until:
a. birth
b. seven months of gestation
c. we understand what is being said
d. we can speak for ourselves
2. The most refi ned sense at birth is:
a. hearing
b. smell
c. touch
d. vision
3. Newborn babies show a marked preference for:
a. nursery rhymes
b. classical music
c. voices heard during the prenatal period
d. rock music
4. Women frequently comment on increased fetal movement:
a. after exercising
b. while laughing
c. while standing
d. when lying down
5. Frequently, newborn crying is due to:
a. pain
b. cold
c. feeling alone
d. being hungry
6. In the older model of rooming-in, learning occurred:
a. by regular instructions from the nurses
b. by chance
c. never
d. rarely
continued on page 10
IJCE Vol. 13 No. 4 • 9

7. In a family-centered environment, visitors are valued because:
a. families thrive on social support
b. nurses don’t have time to do all the care
c. visitors bring gifts
d. new parents need someone to keep them occupied
8. It is important that babies and parents form relationships that sustain them:
a. for the fi rst year
b. throughout life
c. for the fi rst fi ve years
d. until breastfeeding is well established
9. The unborn baby is capable of all movements that will be seen after birth, by _______ weeks.
a. 20
b. 16
c. 24
d. 12
10. Babies show a taste preference for:
a. sour over salty
b. salty over sweet
c. sweet over sour
d. sweet over salty
Date ___________________________________________________________________________________
Name __________________________________________________________________________________
Address ________________________________________________________________________________
City ______________________________________________ State/province _______________________
Postal/zip code _________________________ Country ________________________________________
Telephone ______ / _____________________
ICEA membership number (if you are a member) _________________________
(include expiration date)
Payment of $10 in US funds (ICEA members), $20 in US funds (non ICEA members), check and drafts drawn
on US banks only or Visa or MasterCard. You must include membership number if paying member rate.
Visa/MasterCard Number _____________________________________
Expiration Date _______________
Signature _______________________________________________________________________________
I am in the following ICEA certifi cation program(s):
_____ Teacher Certifi cation _____ Postnatal Educator Certifi cation ____ Doula Certifi cation
Contact hours earned from this program are valid only for the current certifi cation period for ICEA certifi cation
candidates or the current recertifi cation period for ICEA certifi ed educators and doulas.
Send application and completed self-test with payment to:
ICEA Alternate Contact Hours, PO Box 20048, Minneapolis, Minnesota 55420 USA.
Telephone 612/854-8660; Fax 612/854-8772.
12/98
10 • IJCE Vol. 13 No. 4

It Takes a Village to Raise a Child
by Cindy Butler
CIt is also an absorbing and sometimes taxing experience for
parents, child care providers, and other family members.
Parents and child care providers want to give their children
the best, so when they have questions and concerns, they
need resources to provide them with information, insight,
and reassurance. Family members play a role here as
do health and child care professionals, teachers, books,
and the internet. A telephone resource answered by a
well-informed, empathetic professional can be a helpful
adjunct and can provide on-the-spot, objective, and, if
desired, anonymous help to clarify a situation or increase
understanding of a child’s behavior.
“My eighteen-month-old boy hit and kicked me this
aring for children, for the most part, is a joy
and a source of great satisfaction.
morning when I tried to bring him inside from playing
at the park. He broke my glasses (sounds of sobbing).”
The Child Advice Warm Line in Ottawa, Ontario, Canada
is here to reassure this mother that her child was express-
ing frustration at having to end his fun playtime and did
not consciously intend to break her glasses or to hurt her.
Tips to try for next time might include preparing the child
ahead of time to go inside, focusing the child on a
pleasant task that needs to be done once inside, and
asking him to carry something. The mother could take
some deep cleansing breaths to help her maintain her
cool, and she could try to avoid having the toddler get
overly hungry or fatigued. Sometimes these suggestions
are a reminder, and other times this is the introduction
into life with a busy, independent toddler. Calls often
end with the Warm Line worker stating that “it sounds
like you are doing a very good job with this child” or
“you sound like a wise and sensitive parent.” At this, the
caller often sighs and says, “Thank you. I don’t hear that
very often.”
Parents of older babies and pre-schoolers make up
the majority of callers, followed by those with schoolage
children and teenagers. “Is this normal?” is a fairly
typical refrain. Dispensing information on resources in
the community and how to access them is an important
contribution of the professional.
Childbirth education focuses on postnatal support
of new families in the early hours, days, and weeks of
a baby’ s life. The Child Advice Warm Line (CAWL) can
and does address this period but extends support to the
first eighteen years of life. CAWL was developed in 1989
within the Children’s Village of Ottawa-Carleton, a licensed
home child care agency, to provide parents and child care
providers in the community with a resource that in kind
is like the “Home Visitor” who is available to home child
care providers and parents of children in the program.
The line operates seventeen hours a week — Monday 4:00
P.M. to 9:00 P.M. and Tuesday, Wednesday, and Thursday
12 noon to 4:00 P.M. The noon hour and evening hours
provide an opportunity to phone outside of regular working
hours. The Warm Line is funded and administered
through the Children’s Village of Ottawa-Carleton. Standing
independently from a health care agency and within the
framework of a child care agency broadens the scope of
concerns that can be addressed.
The choice of name was a difficult decision. Originally
it was hoped that the acronym CAWL would catch on, but
it often is more likely to be referred to as “the Warm Line.”
Other organizations seem to use the warm line concept and
name to refer to a source of support for every day con-
cerns that are not
emergencies. The
Child Advice Warm
Line recognizes
that raising children
is hard work
and caregivers of
children
need more help
with the “downs” than
with the “ups.”
“The first years last forever” (Canadian Institute of
Child Health 1998), and that is the compelling reason to
provide caregivers of children with information, reassurance,
encouragement, and resources. It is of the utmost
importance and the Child Advice Warm Line helps to
provide this service.
References
Reiner Foundation. 1998. The first years last forever. Pamphlet is part
of the “I AM YOUR CHILD” campaign. Ottawa: Canadian Institute of
Child Health.
■ Cindy Butler, RN, BSN, is a childbirth educator with the Ottawa Hospital
– Civic Campus Prenatal Program and coordinates and answers the Child Advice
Warm Line at the Children’s Village of Ottawa-Carleton, Canada. She has been
involved with prenatal and parenting education for many years as a teacher,
a nurse in a paediatrician’s office, and a La Leche League leader. Cindy is the
mother of two children and grandmother of seven-month-old Ansel who was
born (naturally) to her daughter and son-in-law in Tokyo, Japan.
IJCE Vol. 13 No. 4 • 11

HEALTHY LIFESTYLES
by Ana Lopez-Dawson
When Parenting Hurts
As an ICEA Certified Childbirth Educator and Licensed
Clinical Psychologist specializing in the area of abuse and
neglect, I have had the opportunity to meet with many
families and individuals before, as well as after, the birth of
their child. It is fascinating for me to observe how different
a parent might behave from their self- perception.
While an individual may consider themselves an
adequate parent, the interaction between parent and
child may suggest serious problems in their relationship.
Although in a single year more than 1,500,000 American
children may be neglected or abused, and many of
those children will die as a result of their maltreatment
(US Department of Health and Human Services 1988),
it is difficult for many parents to perceive themselves as
abusive or having the potential for being abusive. I believe
the reason stems from the fact that many abusive parents
have great difficulty recognizing their weaknesses, and
some refuse to take responsibility for their actions. Abusive
individuals come from all walks of life and backgrounds,
and thus, for professionals, it can be difficult to detect
an abusive parent if the abuse is subtle and not blatant.
Even very abusive parents can be observed to be loving
and affectionate with their children intermittently.
It is the general belief that there are several factors
which place a child at higher risk for being abused. Certain
vulnerabilities in the parent, such as psychopathology
and substance abuse, place that parent at higher risk to
abuse their child. Depression, for example, can be quite
debilitating, particularly during the postpartum period.
One might see a parent who is struggling unsuccessfully
to take care of their needs while also trying to meet those
of their infant. Symptoms such as sleep deprivation and
increased irritability are not unusual during a depressive
episode. This problem can be compounded further
during the postpartum period when sleep deprivation is
present by nature due to the infant’s feeding and sleep
patterns. These factors place the infant at increased risk
for abuse.
Alcohol and drug abuse (methamphetamine in particular)
seem to be a prevalent problem, particularly in
the families with whom I work. In a substantial amount
of cases, the baby is removed from the home at the time
of its birth due to prenatal drug exposure. As one can
imagine, the early separation and subsequent lack of quality
on-going contact with the infant substantially impact
the bonding and attachment process for the child and the
parents. Most of the time, these parents lack the coping
skills necessary to care for their child. Additionally, some
individuals may have secondary brain-related deficits, as
a direct result of their substance abuse, further limiting
their ability to parent. Early intervention is crucial in these
families.
Factors in the child which may increase their potential
for abuse include a strong temperament and certain vulnerabilities
such as mental retardation, physical disability,
low birth weight, or other factors which may present as
a special challenge to the parent in caring for that child.
Certain developmental stages such as the terrible twos or
adolescence can prove particularly challenging for parents.
Often, a lack of awareness on behalf of the parent
about what is normal behavior for a child at a certain
developmental stage causes much of the problem. For
example, I have worked with parents who perceived their
two-year-old as purposefully trying to push their buttons.
Teaching these parents that a normal two-year-old is supposed
to be oppositional can help to reduce the parents’
level of anger, their sense of helplessness, and possibly
reduce some of the risk for abuse.
Parents with handicapped children are often exhausted
physically and mentally from caring for their children. It is
not at all unusual for them to feel guilt-ridden over their
child’s disability (even if it was not a result of their own
prenatal neglect) or to have a sense of helplessness. Their
sense of failure as a parent may lead to abuse, which in
turn would increase their sense of helplessness. Finally,
many families experience a deep sense of loss over not
having had their expected outcome. Their child’s future
might be looked at with fear or worry.
The temperament of the child is also a crucial factor.
In my practice, I have worked with parents who were
well-equipped with parenting skills and social supports,
lacked a history of psychopathology, and were drug-free.
However, their child’s temperament was so challenging
that the parents would run out of stamina and patience.
Some of these children may struggle when they experience
a change in their environment. Transitioning from one
activity to the next may require much preparation and it
needs to be done in a gradual fashion. This requires the
parent to have adequate planning ability and an awareness
of environmental deviations. It is time-consuming
and extremely draining on one’s energy.
Finally, there are social factors which place families
at risk. These include those at or below the poverty level,
limited or the absence of social support, being a single
parent, having four or more children, younger parental
age, family violence, acculturation difficulties, and stressful
events (US Department of Health and Human Services
1988). One might see several families living in a small
apartment or cubicles because of lack of resources. There
are also many families who may not be of legal immigration
status who cannot tap into certain community financial
continued on page 13
12 • IJCE Vol. 13 No. 4

RESOURCES
by Rebecca Ward
This Resources Column will offer information on low-cost
resources for parents and professionals. The emphasis will
be on resources for the postpartum period, including
parenting and promoting healthy babies and mothers.
Expectant and new parents trust childbirth educators
and other health professionals for valid information.
When preparing parents for the fourth trimester of the
childbearing year, educators need to be knowledgeable
about current resources and help parents be discerning
consumers of information. New parents are inundated
with information, from the verbal advice of friends to
an avalanche of books. Now the global internet has
broadened access to information — both good and not
so good. Parents need to determine what sources are
reputable, reliable, and consistent with scientific knowledge
of health and child development. In keeping with these
goals, the ICEA Bookcenter offers the catalog Bookmarks,
which includes books, videotapes, and teaching aids
dealing with childbirth, family-centered maternity care,
breastfeeding, and early child care. Titles include Bonding
by Klaus, Kennell, and Klaus, Touchpoints — The Essential
Reference by Brazelton, and Your Baby and Child
by Leach.
Professionals and parents can contact the ICEA Bookcenter
by phone at 800/624-4934 or by fax at 612/854-8772.
AMERICAN ACADEMY OF PEDIATRICS (AAP) The AAP
issues policy statements on dozens of issues regarding
infants and children. Example: Breastfeeding and the Use
of Human Milk (RE9729). 1997. Pediatrics 100, no. 6:
1035-1039. The journal Pediatrics is published by the AAP.
Access to policy statements is free of charge at website:
http://www.aap.org/policy/pprgtoc.html#I. To request a
subscription or have articles faxed or mailed (at a charge),
contact AAP, 141 NW Point Boulevard, Elk Grove Village,
IL 60007 USA; phone 847/228-5005.
BABYCENTER.COM This is the most complete online
resource for pregnancy and baby information continued on you page can 14
HEALTHY LIFESTYLES: WHEN PARENTING HURTS from page 12
resources, and as a result, the families (and children in
particular) suffer substantially.
Parents who themselves have witnessed or have been
the recipients of abuse are at increased risk of abusing their
offspring. It has been estimated that approximately onethird
of individuals who have been physically or sexually
abused or severely neglected will mistreat their children
(Kaufman and Zigler 1987). Single parents in particular
are at high risk (Arbuthnot and Gordon 1996) due to the
combination of being overwhelmed with responsibility
and not having as much opportunity for regenerating
their battery as may otherwise be the case in a two-parent
household.
Social support is crucial for high-risk families. I become
particularly concerned when I observe a parent who is
abusive, has limited or no resources, and is isolated from
others. While some may agree (or disagree) that it takes
a village to raise a child, social support and community
unity truly have a positive role in helping families function
in a healthier manner. Some cultures are better equipped
at offering this support than others.
As childbirth educators, we are very fortunate in that
we have access to a woman during her pregnancy. We
often also have intermittent contact with the father as
well. This can allow us the opportunity to identify at-risk
families with whom we can intervene in order to help
deter future problems with abuse. Families who are in
crisis benefit significantly from having contact with caring
and sensitive educators and professionals who are
not judgmental. It is important to be in tune with the
fear that many parents have that if they disclose family
violence, they can risk losing their children. It is helpful
to be knowledgeable about the laws and procedures in
one’s geographic area with regards to how these cases
may be handled in order to better guide the parents with
whom we have contact.
Certainly, abuse of any kind is a tragedy and something
which should not occur. As advocates for families, I
challenge and encourage you to continue to take a proactive
stance in helping parents and their children. This will
allow families to empower themselves with information
and resources so that they can thrive both physically and
emotionally. There are numerous resources available in the
community which are geared to helping families function
at a higher level. Further information may be available
through your local human services office or other similar
facility.
References
Arbuthnot, J. and D. Gordon. 1996. What about the children: A guide for
divorced parents. Athens, Ohio: The Center for Divorce Education.
Kaufman, J. and Zigler E. 1987. Do abused children become abusive
parents? American Journal Of Orthopsychiatry 57: 187-192.
US Department of Health and Human Services. 1988. Study findings:
Study of the national incidence and prevalence of child abuse and neglect.
Washington, DC: US Department of Health and Human Services.
■ Ana M. Lopez-Dawson, PhD, PsyD, ICCE, works at Clinical Assessment &
Treatment Services located in West Des Moines, Iowa, USA.
IJCE Vol. 13 No. 4 • 13

RESOURCES from page 13
trust for the parents in your practice. Written by parenting
experts and reviewed by doctors and other health
professionals, the Resource Center offers an A-Z guide to
preconception, pregnancy, and baby’s first years. With
features such as bulletin boards, personal pages, and help
with naming baby, this website offers professional support
to a community of parents. A lot of fun and information
can be shared with your childbirth education classes.
Website: http://www.babycenter.com
BABYWISE BOOK CAUTION The book On Becoming Babywise
has raised concerns among pediatricians because it
outlines an infant-feeding program that has been associated
with failure to thrive, poor weight gain, dehydration, breast
milk supply failure, and involuntary weaning. A hospital
review committee in Winston-Salem, North Carolina has
listed eleven areas in which the program is inadequately
supported by conventional medical practices. Dr. Matthew
Aney states that “efforts should be made to inform parents
of the AAP recommended policies for breastfeeding and in
potentially harmful consequences of not following them”
(Aney, M. 1998. AAP News (the official news magazine
of the American Academy of Pediatrics) 14, no. 4). Colleen
Weeks, CCE, and member of ICEA, co-chaired a task
force of the Child Abuse Prevention Council of Orange
County, California which conducted a detailed investigation
of Growing Families International (GFI) materials. On
Becoming Babywise is a GFI publication. Colleen stated,
“We established six criteria for healthy parenting education
and our committee concluded that the GFI materials
meet none of those standards” (Christianity Today, February
9, 1998).
CENTERS FOR DISEASE CONTROL AND PREVENTION
(CDC) The CDC is an agency of the United States Department
of Health and Human Services. All public health
decisions are based on the highest quality scientific data,
openly and objectively derived. The CDC offers numerous
current publications and other resources.
National Immunization Program: National Immunization
Program Pregnancy Guidelines and numerous pamphlets,
including Why Does my Baby Need Hepatitis B Vaccine? and
Common Misconceptions about Vaccination (rebuts common
anti-vaccination arguments), are available through CDC.
National Immunization Hotline (USA): 800/950-0078, 8:30
A.M. to 5:30 P.M. EST Monday to Friday.
Group B Strep (GBS) Prevention Coordinator: The GBS
order form lists eleven different brochures, flyers, policies,
posters, a video, and a slide set on the prevention
of perinatal Group B Streptococcal disease. The Group
B Strep Association (GBSA), a community-based parents’
advocacy, educational, and support group for parents who
have lost infants to GBS disease, is listed as a link on the
CDC website: http://www.cdc.gov/publications.htm. Contact:
Publications Request (Specify department: National
Immunization Program, National Center for Infectious
Diseases, or GBS Prevention Coordinator), Centers for
Disease Control and Prevention, 1600 Clifton Road, NE,
Atlanta, GA 30333 USA.
CHILDBIRTH FORUM FOR THE PROFESSIONAL CHILD-
BIRTH EDUCATOR is brought to you by the Pampers
Parenting Institute. Classroom materials include flip-chart
material and tear-off pads which are sent to your home,
birth center, hospital, or office free of charge. Contact:
800/950-0078.
CPR AND FIRST AID INSTRUCTION In the United
States, the American Red Cross and American Heart Association
provide training in adult and infant-child CPR
and certification for instructors. For information on local
affiliates or chapters and instructor programs, contact
the American Heart Association at 800/242-8721; website
http://www.amhrt.org.
For locations and instructor training for the American
Red Cross, contact your local chapter. The American Red
Cross may offer Healthy Pregnancy/Healthy Baby, Infant-
Child CPR, First Aid, Child Care For Providers, Family Planning,
AIDS, and Substance Abuse Prevention Programs.
Not all services are available in all locations. Contact your
state, provincial, or local chapters of the Red Cross or Red
Crescent for information; website: http://www.ifrc.org/.
The American Safety & Health Institute also offers
courses and instructor certification. Contact: ASHI, 13202
Burnes Lake Dr., Tampa, FL 33612 USA; website: http://
www.ashinstitute.com.
DEPRESSION AFTER DELIVERY (DAD) is a national
self-help organization which provides support, education,
information, and referral for women and families
coping with blues, anxiety, depression, and psychosis
associated with the arrival of a baby. Depression After
Delivery promotes awareness of these issues to all sectors
of the community and advocates for changes affecting the
well-being of women and their families. PUBLICATIONS:
DAD offers its members a newsletter, Heart Strings, at no
charge with membership. DAD also has several information
packages available, such as General Information Packet
for Professionals ($15), General Information Packet for
New Mothers and Fathers ($5), and Information Packet
on Starting a Postpartum Depression Support Group ($5).
To obtain information, locate a support group in your
area, or obtain a list of medical professionals in your area
who are knowledgeable about PPD, contact Depression
After Delivery, PO Box 1282, Morrisville, PA 19067 USA;
phone 800/944-4PPD.
continued on page 15
14 • IJCE Vol. 13 No. 4

RESOURCES from page 14
MARCH OF DIMES BIRTH DEFECTS FOUNDATION “So
that more parents may know the joy of a healthy baby”
is what this organization is all about. A new video, Baby’s
First Months ($19.95 plus $4.50 shipping and handling),
and the pamphlet, Newborn Care, are available. Healthy
pregnancy brochures and videos are available in the Public
Health Education Materials Catalog. Contact hour information
is offered to professionals through the Nursing Module
Catalog. To order, call 800/367-6630; write March of Dimes
Birth Defects Foundation, PO Box 1657, Wilkes-Barre, PA
18703 USA; or e-mail at http://www.modimes.org.
RISK REDUCTION SUDDEN INFANT DEATH SYN-
DROME (SIDS) Although the cause or causes of sudden
infant death syndrome remain unknown, the incidence of
SIDS has declined from 1.3 per 1,000 in 1991 to 0.87
per 1,000 in 1996 in the United States and other countries.
This has been accomplished largely through public
education campaigns informing parents about several
important risk factors associated with an increased risk of
SIDS. Available scientific research supports having healthy
babies sleep in the supine position; not exposing babies
to cigarette smoke, either during pregnancy or after birth;
making the sleeping environment as safe as possible;
and breastfeeding rather than bottlefeeding. Contact the
SIDS Risk-Reduction Education Back to Sleep Campaign
at 800/505-CRIB (800/505-2742). English and Spanish
reminder cards, videotapes, and brochures for parents
or professionals are available. Website: http://www.sids.
org/news.htm. For SIDS reduction information in English,
Spanish, German, French, Vietnamese, Cambodian, Laotian,
Finnish, Japanese, Norwegian, Swedish, Chinese, and
Dutch, check website: http://sids-network.org/basic.htm.
POSTPARTUM SUPPORT INTERNATIONAL (PSI) This
membership-based international organization is dedicated
to increase awareness about the emotional reactions women
experience during pregnancy and throughout the first year
postpartum. Professional membership is $60. PSI brings
together research from diverse disciplines and international
journals. The website provides a resource guide,
bibliography, and support network. Search published
materials on postpartum mood and anxiety disorders,
post-traumatic stress syndrome, depression, or psychosis.
Need advice or assistance? Want to join a postpartum
support group? Listed individuals and organizations are
committed to offering assistance for mothers, fathers,
and families in need of social support, information,
and treatment. The list includes the United States and
various international locations. Website: http://www.iup.
edu/an/postpartum/. Contact: Jane Honikman, MS, Postpartum
Support International, 927 N. Kellogg Avenue,
Santa Barbara, CA 93111 USA; phone: 805/ 967-7636;
fax: 805/967-0608; e-mail: thonikman@compuserve.
com.
WORLD HEALTH ORGANIZATION (WHO) More than
forty publications related to maternal and child health
are listed in the WHO Publications Catalog of New Books
1991-1998. Look for scholarly reports of studies, training
manuals on midwifery, Care in Normal Birth: A Practical
Guide 1997, and policy statements on such compelling
topics as the International Code for Marketing of Breast-
Milk Substitutes and female genital mutilation. To quote
The World Health Report 1998, Life in the 21st Century: “The
world is poised to achieve unprecedented good health in
the next century — if lessons from the past are understood
and heeded.” Website: http://www.who.ch/. Contact: Distribution
and Sales (DSA), Division of Publishing, Language,
and Library Services, World Health Organization (WHO)
Headquarters, CH-1211 Geneva 27, Switzerland; phone
+41 22 791 2476/2477; fax +41 22 791 4857; e-mail
publications@who.ch.
If you are aware of a low-cost published or internet
resource or organization to be considered for this column,
please send the information to Rebecca Ward, ICEA Director
of Resources, 5351 Strasbourg Avenue, Irvine, CA 92604
USA. While the information available in this resource list is
believed to be accurate and up-to-date, the International
Childbirth Education Association, its Board of Directors,
and the International Journal of Childbirth Education staff do
not make any representations or warranties with respect to
content, accuracy, or use. The opinions and information
are presented for educational purposes only. This listing
is not presented as all-inclusive in nature.
■ Rebecca Ward, BS, is ICEA Director of Resources and Resources Columnist
for the International Journal of Childbirth Education. Rebecca is a Certified
Childbirth and Lactation Educator teaching at Mission Regional Hospital and
Irvine Medical Center in California. She and her husband Martin have raised
five children in Irvine, California.
IJCE Vol. 13 No. 4 • 15

STATIS-
by Dale King
Teenage Pregnancy
A recent report from the Center for Disease Control and
Prevention (1998) indicates that teenage pregnancy in
the United States has decreased since the beginning of
the 1990s. The 1996 birth rate among teenage mothers,
the number of births per 1,000 teenage women, fell 3
to 8% depending on the age specific subgroup. Among
teenage women 15 to 19 years of age, the 1996 birth rate
fell 4% from the previous year and 12% from 1991. The
decline in the American teenage birth rate was pervasive,
occurring in all of the fifty states, the Virgin Islands, and
the District of Columbia. In only three states, Delaware,
Rhode Island, and North Dakota, was the decline statistically
insignificant. This decline follows the sharp increase
in the birth rate that occurred from 1986 to 1991 when
the teenage birth rate increased 24%.
Between 1995 and 1996, teenage birth rates declined
for all racial and ethnic groups with the exception of the
Cuban teenage birth rate which increased from 29.2 to
34.0 births per 1,000 Cuban teenage women. The greatest
decline from 1991 occurred among non-Hispanic black,
Puerto Rican, and other Hispanic teens. These groups
experienced a decline in the birth rate of approximately
20%.
Despite recent declines in the teenage birth rate, it
is still true that more than one million teenagers in the
United States become pregnant each year. In recognition
of this fact, the American Academy of Pediatrics reiterated
their 1989 statement on Counselling the Adolescent About
Pregnancy Options (1998). The statement is intended to
serve as an objective guide to the pediatrician who must
diagnose and then counsel the pregnant adolescent.
Counselling must be comprehensive as to the adolescent’s
alternatives and throughout the counselling the pediatrician
must not impose his own beliefs and values. If the
pediatrician feels that he cannot objectively present an
alternative to the adolescent, he should refer the adolescent
to other experienced professionals. Adolescents have legal
rights protecting their privacy and the pediatrician must be
aware of and respect those rights. Confidentiality laws may
vary depending on the locality, and the pediatrician should
be informed of these laws. The law allows the pediatrician
to inform the appropriate government agency when he
suspects sexual abuse. Widom and Kuhns (1996) studied
the impact of early childhood victimization on teenage
pregnancy, subsequent prostitution, and promiscuity. Using
1967 through 1971 criminal court records from a Midwest
jurisdiction, the authors were able to identify 908 cases of
the abuse or neglect of a child 11 years old or younger.
The 908 cases of abuse or neglect were matched with a
control group based on race, gender, and age. Identification
of the members of the control group was achieved
by reviewing county birth records. The final stage of the
study, occurring as much as 20 years after the incident of
abuse or neglect, was to contact and interview members
of both groups to determine their subsequent sexual and
obstetric history. Contrary to other studies, the authors did
16 • IJCE Vol. 13 No. 4
not find early childhood victimization to be a precursor
to teenage pregnancy. In their concluding discussion, the
authors argue that teenage pregnancy may be the result
of other factors such as family size, income, and parental
education and employment status. Thus, determining the
factors that tend to cause teenage pregnancy depend
upon the design of the study. Secondly, the authors
caution that their study may underestimate the extent of
teenage pregnancy since it did not include pregnancies
that ended in abortion or miscarriages. The birth record
data and the final interviews may not have provided this
information.
Brown-Peterside and Laraque (1997) describe a New
York City hospital-based educational program designed
to increase teenage awareness of contraception and the
impact of pregnancy on the teenager’s life. The first step
was to build a coalition of community groups that would
serve as a working group to guide the program and
sponsor a series of workshops. The workshops featured
community speakers who provided neighborhood adolescents
information on health-related topics. Over 1,000
flyers were distributed to adolescents informing them of
services provided within the hospital. A centerpiece of
the program was a computer game designed to entertain
and instruct the players about the realities of teenage
pregnancy. Based on a questionnaire, the researchers were
able to determine that 91% of the adolescents participating
in the program demonstrated increased awareness of
the costs of having a child and were more likely to value
contraception. The working group was able to achieve
sufficient success that it received the Community Access
to Child Health grant to establish an adolescent health
center and increase its provision of services. The Center
for Disease Control and Prevention report indicates good
news — teenage pregnancy is on the decline after having
increased sharply. What caused the initial increase and
the subsequent decline may not be completely known
and will have to be left for further research. Perhaps, one
way of preventing an unwanted teenage pregnancy is to
educate the adolescent before she becomes sexually active.
In many cases, education is the key to guiding human
behavior and teenage sexuality and pregnancy may be
one of these behaviors.
References
American Academy of Pediatrics, Committee on Adolescence. 1998.
Counselling the adolescent on pregnancy options. Pediatrics 101,
no. 5: 938-940.
Brown-Peterside, P., and D. Laraque. 1997. Notes from the field. A
community research model: A challenge to public health. American
Journal Of Public Health 87, no. 9: 1563-1564.
Ventura, S., J. Martin, S. Curtin, and T. Matthews. 1998. Report of final
natality statistics, 1996. Monthly Vital Statistics Report 46, no. 11.
Hyattsville, Maryland. National Center For Health Statistics.
Widom, C., and J. Kuhn. 1996. Childhood victimization and subsequent
risk for promiscuity, prostitution, and teenage pregnancy;
a prospective study. American Journal Of Public Health 86, no. 11:
1607-1611.

INFORMATION UP-
by Mary Anne Ernzen
New parents have excellent instincts
about their own infant.
However, new parents are desperate for
parenting advice. Child care experts William and
Martha Sears believe that no one knows better than
the parents how to take care of a new baby. They
describe the development of mother’s intuition and
strongly encourage new parents to “do what comes
naturally.” They believe that new parents have a
“built-in response system that spurs them to act on
their baby’s cues.” The authors describe intuitionbuilding
strategies, referred to as the “Baby Bs,”
and they include breastfeeding, baby-weaning, bedsharing,
and believing in baby’s cries. The reader
is reminded that “answering baby’s cries teaches
him to trust you.” New parents are encouraged to
listen to their baby, and the baby will teach them
how to care for him by his actions, crying, and
cooing. Parents should listen to their inner voice
and pick up their baby when it cries. The authors caution
to beware of “baby trainers” who advocate schedules
and regimens for babies. When parents become confused
about advice on parenting, it is suggested that they “ask
their gut about it and follow their feelings, as they are
the experts on their baby.”
Sears, W., and M. Sears. 1998. Mother knows best. Baby
Talk 63, no. 3: 30-36.
Mothers of premature infants often
face unique parenting challenges.
The purpose of this study was to determine if
maternal concerns about the health and development of
prematurely born children continue into the preschool
years, resulting in parenting difficulties. Thirty mothers
and grandmothers were interviewed when the children
were three years old. The babies had been on average
28.2 weeks gestation and 1,104 grams at birth and spent
8.2 days on mechanical ventilation. Three major themes
emerged: behavioral management, feelings of protection,
and concerns about health and development. Mothers
reported difficulties related to behavioral management
with discipline and limit-setting. Mothers often attributed
these difficulties to the premature birth, describing how
their children were “spoiled rotten” or “treated special by
family members.” Discipline became problematic due to
the tendency of these mothers to be overprotective. One
mother confessed, “I think it has to do with the way he
was born. He’s just my little miracle baby. I’m always
going to have a sense of protection with him, more so
than with the other kids.” Health and development concerns
included worries over the sequelae of prematurity
such as cardiac, digestive, and vision problems, delayed
speech, small stature, and developmental delay. When
following up on a mother with a prematurely born child,
childbirth educators can encourage the mother to “tell her
A
story” about the experience. Help her explore her intense
feelings and discuss how these experiences might affect
her parenting practices. Stress the importance of treating
prematurely born infants like a full-term baby, exploring
any feelings of overprotection as well as the problems this
can create for the child as well as for the family.
Miles, M., D. Holditch-Davis, and H. Shepherd. 1998.
Maternal concerns about parenting prematurely born
children. Maternal Child Nursing 23, no. 2: 70-75.
Early lessons can help prevent spoiling.
You can’t spoil a baby under three months of age,
but it is important to begin to think about setting
limits in the following months. During the first three
months of life, infants have strong needs and communicate
these needs by crying. A prompt response by a caregiver
teaches the infant trust, which forms the foundation for
learning self-control and independence. Nathanson states
that age eight months to twelve months is a time of great
opportunity to counteract spoiling by setting limits. She
suggests saying “no” only to dangerous behaviors and using
distraction to handle aggressive or annoying behaviors.
Dr. Nathanson also advocates using “a firm, authoritative
tone of voice. Don’t elaborate or explain. A good rule is
one word per year of age. A two-year-old could be told
‘no biting.’” The author recommends ignoring tantrums
thrown in response to “no” and moving the child the first
time “no” is said. It is important that the baby knows
who is in charge and that cooperative behavior will be
rewarded. A calm, firm demeanor on the part of the
caregiver combined with consistency during this time will
begin the spoil-proofing process.
Nathanson, L. 1998. Can you spoil a baby? Parents 73,
no. 6: 80-82.
IJCE Vol. 13 No. 4 • 17

Parenting: Examining the Father
by Celestine West and Marcella A. Hart
P
(American Heritage Dictionary of English
Language 1992). Parenting is a dynamic
and learned process that involves not only
individuals but family units and society.
Parenting ranks as one of the most im-
portant functions in society and is the primary domain
of families. Paternal role attainment and father-infant attachment
have received less attention than maternal role
attainment and mother-infant attachment. The purpose
of this paper is to discuss parenting by examining fathers
in relation to parenting role attainment, attachment, and
style of parenting.
The father contains a man’s internalized conception of
his parenting role identity. This conceptualization includes
culturally defined behavior and individual variation of
that behavior. How fathers define their role influences
their behavior and thus the way they interact with their
children. Most fathers do not take as active a role in the
parenting process as most mothers, but the gap between
men’s and women’s participation in child rearing appears
to be shrinking. (Woodwork, Belsky, and Crnic 1996).
The divorce rate and the emergence of more and more
women in the work force contributes to this trend.
Harris and Morgan (1991) described what has been
termed the “new father” as one who has moved beyond
the traditional role of breadwinner and disciplinarian
and now shares more equally in all aspects of parenting.
The traditional role for the father is that of breadwinner.
This role identifies some of the paternal responsibilities
for training and discipline but does not stress the close
or compassionate side of the father-child relationship. An
alternative role includes a more nurturant and expressive
behavior. Minton and Pasley (1996) concluded that fathers
have the potential to be as significant to children and as
arenting is defined
as the rearing
of a child or children,
especially providing
the care, love, and
guidance by a parent,
the father, mother, or
person who stands in
“loco parentis” (when
not the natural parent)
A
competent in caregiving as mothers. However, they found
that fathers interacted less frequently, engaged in different
types of interaction, were less involved in caregiving,
were more involved in play, and displayed less affection
to their children. Harris and Morgan (1991) viewed behavior
as partially determined by group membership that
identified a set of norms and parallel sanctions. Within
a given society, the degree of conformity to norms can
vary. Contemporary American norms encourage paternal
involvement, but there is not a single model which fathers
should follow. The only formal training that fathers receive
is from the way that they were parented.
Attachment to the child and nurturance from the
parent are critical to successful parenting. The child with
a nurturant, accepting, and accessible father and mother
is likely to develop a strong sense of self-worth in conjunction
with solid intellectual social skills (Biller 1993).
Attachment according to Greenberg (1997) is one of
the century’s most enduring theories of human development.
Most young babies become attached to their
mothers because they are usually around. However, infants
are capable of forming multiple attachments, and it is
essential that parents respond sensitively to their child’s
needs to eat, play, feel safe, and be left alone. Parents who
are responsive to these needs are likely to build strong,
nurturing relationships. The sense that love is returned,
they are valued, and they can count on their mother and
father is secure attachment (Greenberg 1997).
continued on page 19
18 • IJCE Vol. 13 No. 4

PARENTING: EXAMINING THE FATHER from page 18
Parenting styles differ between mothers and fathers,
and this is a benefit for the children (Adler 1997). Three
styles of parenting were identified in the literature:
permissive or nonpunitive, non-controlling, and nondemanding;
authoritarian or dogmatic controlling and
obedience-oriented; and authoritative or firm but based on
reason and nondogmatic, and geared toward promoting
independence but encouraging adherence to standards
(Lafrancois 1990).
Researchers, according to Lafrancois (1990), tend to
favor an authoritative or democratic child-rearing style.
Observation showed that fathers play more, and mothers
provide more emotional support. The fathers’ interactions
are described as being more physical and less intimate,
with more of a reliance on humor and excitement. This
interactive style is critical in teaching a child emotional
self-control. Infants who stand the best chance of optimal
intellectual development are those whose parents provide
the greatest source of stimulation by speaking, holding,
touching, responding, and providing toys. Those who limit
the amount of stimulation to which the infant is exposed
to are likely to have an opposite effect.
Parenting is a learned process according to a number
of researchers (Horowitz 1990; Lefrancois 1990). They
state that preparation for parenthood is essential if effective
parenting is to occur. However, people receive little
or no formal preparation for becoming parents and lack
support for carrying out the job effectively. Preparation is
necessary to achieve cooperative and consistent parenting.
Parents learn to care for their children from a number
of sources. In many close knit societies, there are always
old ones (parents) around to show the young ones what
to do. But in more complex and impersonal societies,
there are many parents who have had little exposure to
parenting and do not have ready access
to the wisdom of old ones.
There are four important sources of
child care advice available — the medical
profession, books, media, and parenting
courses. Many traditional parent education
programs are geared to the mother, who
then instructs the father. Because mothers
and fathers often have different perceptions
about parenting, it is essential for
educators to incorporate fathers into their
programming (Lefrancois 1990).
Parenting is a dynamic and learned
process that changes with the addition
or loss of new members. Because many
of the social ills of society continue to be
attributed to parenting, support for parenting
should be available to all parents,
particularly fathers. Educators, researchers,
and clinicians have the responsibility to
help encourage and foster effective parenting
skills in individuals, families, and the
community. Childbirth educators are in a
unique position in the health care system to
become proactive in utilizing the available
resources and develop innovative classes to help fathers
develop the skills and knowledge needed for successful
parenting.
References
Adler, J. 1997. It’s a wise father who knows... his child. Newsweek 129:
73-129.
American heritage dictionary of English language. 3rd ed. 1992. New York:
Bison Houghton Mifflin Co.
Biller, H. 1993. Fathers and families: Paternal factors in child development.
Westport: Auburn House.
Greenberg, S. 1997. The loving ties that bond. Newsweek 129: 68-
69.
Harris, K., and S. Morgan. 1991. Fathers, sons, and daughters: Differential
paternal involvement in parenting. Journal of Marriage and
the Family 53: 531-544.
Horowitz, J. 1995. “A conceptualization of parenting: Examining the
single parent family.” In Single parent families: Diversity, myths, and
realities, edited by S. Hanson, M. Heims, D. Julian, and M. Sussman,
43-70. New York: The Haworth Press.
Lefrancois, G. 1990. The lifespan. 3rd ed. Belmont: Wadsworth.
Minton, C., and K. Pasley. 1996. Father’s parenting role identity and
father involvement: A comparison of nondivorced and divorced,
nonresident fathers. Journal of Family Issues 17, no. 1: 26-45.
Woodsworth, S., J. Belsky, and K. Crnic. 1996. The determinants of fathering
during the child’s second and third years of life: A developmental
analysis. Journal of Family and Marriage 58, no. 3: 679-692.
■ Celestine West, RN, BSN, is a 1993 BSN graduate from Armstrong Atlantic
State University, Savannah, Georgia, USA, where she is now in her final year
of graduate studies for her MSN degree. She has been working in maternal
child health nursing for twelve years. Celestine is a staff nurse in labor and
delivery within the St. Joseph/Candler Health System.
■ Marcella Hart, RNC, CCES, PhD, is Associate Editor: Education for the
International Journal of Childbirth Education. Marcella is an associate
professor at Armstrong Atlantic State University and does research in prenatal
care and childbirth education.
B
IJCE Vol. 13 No. 4 • 19

Postnatal Educator Certification
The ICEA Postnatal Educator Certification Program allows educators to expand the scope of their teaching to encompass the
postnatal period (birth to one year).
ICEA Membership
Maintaining continuous ICEA membership exposes the candidate to ICEA goals and philosophy through the quarterly publication
International Journal of Childbirth Education. Candidates must maintain membership in either the Individual Member or Supporting
Member categories. Loss of continuous membership for any reason will result in disruption of the certification process and possible
penalties or removal from this certification program.
If you are an ICEA Certified Childbirth Educator (ICCE)
Candidates enter the program (fee of $80) and receive the Study Guides. ICCEs who enter the program must provide verification
of twenty (20) hours teaching postnatal classes within twenty-four (24) months of applying to take the examination. Forms for this
verification are included in the Study Guides. Candidates must take the examination within one (1) year of entering the program.
Completed examination applications must be received by ICEA at least sixty (60) days prior to the requested examination date.
In the event of a fail grade, the candidate may retake the examination as many times as necessary within one year from the time
of the first fail date, providing examination repeat guidelines are followed.
If you are not currently certified by ICEA
Certification Update
Candidates enter the program (fee of $80) and receive the Study Guides. Candidates must verify twenty (20) hours teaching
postnatal classes within twenty-four (24) months of applying to take the examination. Candidates must have six hours of teaching
postnatal classes evaluated by another educator and must verify attendance for attending six (6) hours of an ICEA approved
contact hour program or complete six (6) ICEA approved Alternate Contact Hours. Forms for verification of prerequisites are
included in the Study Guides. Candidates must take the examination within one (1) year of entering the program. Completed
examination applications must be received by ICEA at least sixty (60) days prior to the requested examination date. In the event
of a fail grade, the candidate may retake the examination as many times as necessary within one year from the time of the first
fail date, providing examination repeat guidelines are followed.
ICEA Postnatal Educator Certification Program (PECP) Study Guides
The Study Guides include eight (8) study modules. Module titles are:
I Postpartum as a Process and the Role of the Postnatal Educator
II Physical Restoration
III Emotional Exploration of Pregnancy, Birth and Role Change
IV The Work of Attachment
V Assumption of the Care Taking Role
VI Parenting the Growing Baby: Development and Temperament
VII Redefinition of Relationships in the Family
VIII Childbearing Losses and the Developmental Work of Postpartum
Each module contains key concepts, overview of the module, learner objectives and content outline, references and suggested
reading.
All required readings for the PECP are available from the ICEA Bookcenter. Required readings for this program are:
Maternity and Women’s Health Care by Loudermilk, Perry and Bobak
Mothering the New Mother by Placksin
You and Your New Baby by Todd
The First Year After Childbirth by Kitzinger
The Earliest Relationship by Brazelton
Touchpoints by Brazelton
When a Baby Dies by Limbo and Wheeler
continued on page 21
20 • IJCE Vol. 13 No. 4

CERTIFICATION UPDATE from page 20
Certification Examination
The ICEA Postnatal Educator Certification Program Examination is a professionally prepared examination consisting of two hundred
(200) multiple choice questions. The certification examination questions are taken directly from the learning objectives and content
of the modules using the required reading materials. Four hours are allowed for the examination. It is a closed book, proctored
examination. If English is a second language for the candidate, permission may be given for use of a nonmedical English/primary
language dictionary and one additional hour to complete the examination. A passing score is 70% or 140 correctly answered
questions. There is no penalty for incorrect answers.
Candidates must take the examination within one (1) year of entering the program. Completed examination applications must
be received by ICEA at least sixty (60) days prior to the requested examination date. In the event of a fail grade, the candidate
may retake the examination as many times as necessary within one year from the time of the first fail date, providing examination
repeat guidelines are followed.
The fee for the CPEP examination is $200 US, discounted to $99 US if taken at the ICEA annual convention. Candidates must be
registered to attend the convention to receive this discounted rate.
Individuals who become certified as postnatal educators will use the initials ICPE. ICCEs who become certified as postnatal educators
will use the initials ICCE-CPE.
Recertification
ICEA encourages continual growth in childbirth and postnatal education by requiring its certified educators to recertify every
four years. During each four-year period of certification the educator is expected to work toward completion of the recertification
requirements. The recertification requirements are to:
1. Maintain continuous ICEA Individual or Supporting Membership
2. Obtain a minimum of twenty-four (24) ICEA Contact Hours within the four-year period of certification or attend an
entire ICEA Convention (convention core)
3. Complete one (1) of the following within the four (4) year period of certification
• Observe a minimum of three labors or births according to ICEA guidelines
• Have a class series evaluated
• Observe another educator’s class series
• Earn additional contact hours by attending an ICEA Challenges Workshop
4. Complete a self-evaluation of teaching.
5. Submit verification of recertification requirements with application and fee of $75 US.
Evaluation and Verification Forms required are supplied by ICEA.
Recertification dates and requirements will not change for those ICCEs who certify in the PECP.
Support Services
ICEA Certification Programs are independent study programs. The Teacher Certification Coordinator maintains all certification files
in the Central Office. Questions regarding the program or forms related to certification and recertification should be directed to
the ICEA Central Office, PO Box 20048, Minneapolis, Minnesota 55420 USA (612/854-8660) or call 800/TCP-ICEA. ICEA Central
Office staff handle the clerical aspects of administrating ICEA’s Teacher Certification Programs.
All ICEA Teacher Certification Program fees are nonrefundable. The ICEA Postnatal Educator Certification Program will allow no
exceptions to policies or procedures. Policy and procedures are subject to change; all changes will be published in the International
Journal of Childbirth Education.
See inside back cover of this IJCE for program application.
IJCE Vol. 13 No. 4 • 21

THE INTER-
by Debra Madonna
Parenting 101
I’ve always admired and respected Dr. T. Berry Brazelton
because this man knows babies. He has observed thousands
of babies and he understands and is enthusiastic
about infants, children, parents, and families. He has not
written the definitive prescription about how to raise a
baby. His appeal is that he is very interested in helping
families understand how babies develop and helping
parents learn to listen to their own babies. How he does
this through an understanding of touchpoints can be
accessed at webpage http://www.childrenshospital.org/
touchpoint/intro.html.
KEY WORDS
I was curious to see what information families in my
classes were reading on the Internet. I searched, using key
words like parenting, infant care, child safety, childbirth,
anesthesia, breastfeeding, mothering, fathering, and
organizations. And I found what I thought I would find:
the Internet is not an answer machine. It just has what
already exists in books and life, only more — more good
information and more junk.
Parents have always had to juggle information,
opinions, and unwanted advice from parents, in-laws,
brothers, sisters, friends, coworkers, strangers, authors, and
television shows. There has always been and will always
be people eager to tell new parents what to do and it’s
always been important to know the difference between
facts and opinions. The Internet is just a new source of
information.
WARNINGS AND DISCLAIMERS
Some sites are very good, others are like reading a magazine
that is more headlines than substance, and some are
just not very good. In general, caution your clients to be
skeptical, and encourage them to consider the source of
all information on the web, avoid a site that advertises
free online pediatric advice, and ignore a diagnosis from
anyone who has never seen their child.
HEALTH AND SAFETY INFORMATION
The Internet does offer one thing a mega-bookstore
doesn’t — direct access to research facilities such as the
National Institute of Health (http://www.nih.gov) and the
Food and Drug Administration (http://www.fda.gov). The
American Academy of Pediatrics (http://www.aap.org),
the Mayo Clinic (http://www.mayohealth.org), and other
medical organizations and institutions have opened their
libraries to the public. You can even register for e-mail
updates. This means that you have to consider that a
story is unfolding, and that is how we should always be
looking at all medical and scientific issues.
HARD TO FIND FACTS
I can remember those nights when I was sitting up with
a sick child, waiting for the morning to arrive so I could
call the doctor. Too worried or worn out to sleep, I’d recheck
all my baby books. Had it been available, I would
have used the Internet during those all-night vigils to get
more information or just make contact with the outside
world. And while I have never been in a chat room, I
might have then.
I recently had a woman in one of my classes whose
baby was diagnosed with an uncommon genetic condition.
I could only find a paragraph or two in most of my
textbooks. I ran a search on the web, moving from the
National Institute of Health into a national organization for
this condition. I discovered a bulletin board with messages
from parents. Some of these messages were posted months
apart from different parts of the country. No one was
diagnosing anything on these bulletin boards, but these
were notes from people looking for more information,
suggesting resources, or offering support. My girlfriends
and I used to call each other and share information on
ear infections and being home with two sick kids. But if
a child has a rare condition in 1998, sharing stories via
the Internet is a new version of a support group.
INTERNATIONAL MATERNAL
AND CHILD HEALTH
The Internet has given us the opportunity to step back
from our daily routine and to observe birthing and
breastfeeding practices around the world. It gives us a
telescopic look at the realities of maternal and child health
worldwide. Hopefully this view will act as a reminder to
appreciate what we have and reinforce our commitment
to the goal of health and safety for children and their
families internationally.
UNICEF’s 1998 State of the World’s Children report
includes The Convention on the Rights of the Child. The
following is a partial excerpt:
1. “Civil rights and freedoms: Every child has a right
to a name and nationality from birth, and States
have an obligation to preserve the child’s identity.
Children have the right to freedom of expression,
and the State shall respect their right to freedom
of thought, conscience and religion, subject to
appropriate parental guidance....Furthermore, no
child shall be subjected to torture, or other cruel,
inhuman or degrading treatment or punishment”
(http://www.unicef.org/crc/conven.htm#civil).
2. “Family environment and parental guidance: The
Convention stipulates that States must respect the
rights and responsibilities of parents and extended
continued on page 23
22 • IJCE Vol. 13 No. 4

THE INTERNET: PARENTING 101 from page 22
family members to provide guidance for children
that is appropriate to the child’s evolving capacities”
(http://www.unicef.org/crc/conven.htm#family).
3. “Basic health and welfare of children:... Parties shall
ensure to the maximum extent possible the survival
and development of the child, and the right to the
highest attainable standard of health. States shall
place special emphasis on the provision of primary
and preventive health care, public health education
and reduction of infant mortality. They shall
encourage international cooperation in this regard
and strive to see that no child is deprived of access
to effective health services....States Parties recognize
the right of every child to a standard of living
adequate for the child’s physical, mental, spiritual,
moral and social development” http://www.unicef.
org/crc/conven.htm#health.
SOURCES
Our clients can’t parent children by reading even the best
books... all day long. They can’t parent children by sitting
at a computer... all day long. They shouldn’t read any
parenting book or magazine from cover to cover. They
should turn to the index and start with what they need
first. And they shouldn’t forget to get down on the floor
and explore the world from their child’s perspective.
Would I have been a better parent if I could have
e-mailed Dr. Brazelton when my children were little? Would
I have figured out how to get them to do everything I
wanted them to do? I have no idea, but I keep trying.
“Don’t take too seriously all that the neighbors say.
Don’t be overawed by what the experts say. Don’t be
afraid to trust your own common sense” (Spock 1976).
REFERENCES
Spock, B. 1976. Baby and Child Care. New York: Simon & Schuster.
UNICEF. 1998. The Convention On The Rights Of The Child. State Of The
World’s Children Report. http://www.unicef.org/crc/conven.htm.
OTHER RESOURCES
Healthy Steps for Young Children Program; http://www.healthysteps.
org
National Center for Infants, Toddlers, and Families, Zero to Three;
http://www.zerotothree.org
Applications now being accepted
ICEA Virginia Larsen Research Grant
Application materials are now available for the 1999 ICEA Virginia Larsen
Research Grant. This $1000 (US) grant is awarded in the name of Virginia
Larsen, physician and ICEA pioneer who died in 1984. Contributions made to
ICEA in Dr. Larsen’s name and general organizational revenues support this
grant. The grant funds research which promotes the goals and mission of the
International Childbirth Education Association (ICEA).
Completed applications are due at the ICEA Central Office no later than
December 31, 1998. Applications will be screened by the ICEA Resource Advisory
Committee for research design and congruence with ICEA’s goals and mission.
The ICEA Board of Directors votes to determine the recipient. All applicants
will be notified of the Board’s decision no later than May 1999. The June 1999
issue of the International Journal of Childbirth Education will announce the
For an application and further details contact:
ICEA, , Attn: Resource Advisory Committee, PO Box 20048, Minneapolis, Minnesota 55420 USA
Phone 612/854-8660 • Fax 612/854-8772
IJCE Vol. 13 No. 4 • 23

ICEA 1998
A
B
Back: Collleen Weeks, Ann Corwin; Front: Ann Faust,
Jana McCarthy, Rebecca Ward
The California girls look forward to welcoming ICEA
to Los Angeles in 1999.
Pat Turner, ICEA President
Elect, taking a break
at Centennial Park
c
Role play at
the Doula Workshop
E
D
Jan Mallak demonstrating the “Doula Hula”
Practicing back massage
24 • IJCE Vol. 13 No. 4

F
G
A relaxation break at the Doula Workshop
Trish Booth “at work”
International Convenin
ATLANTA
H
I
The lap squat position
Practicing the double hip squeeze
Editor’s Note: Thanks to Jan Mallak, Pat Turner, and Rebecca Ward for sharing their photos after my camera malfunctioned at the convention.
IJCE Vol. 13 No. 4 • 25

FOCAL POINT ON LABOR SUPPORT
Attachment and Bonding: The Doula’s Role
by Gillian Sippert
We have known for some time the significant contribution
doulas make to the safe and healthy outcome of
childbirth. What we are beginning to see is evidence of
yet another positive correlation. Recent studies (Kennel
and Klaus 1995) have shown that continuous support by
an experienced woman during labour results in more affectionate
mother-infant contact after delivery and impacts
positively on maternal-infant bonding and infant-maternal
attachment.
Bonding refers to the emotional tie from parent to
infant, whereas attachment is generally used to describe
the tie from infant to parent. Past research (Kennell and
Klaus 1998) has led us to believe that the time a mother
spends with her infant immediately following birth is of
very great significance. The first hour seems to be an
especially valuable time in the bonding process. When
rooming-in and early contact began to be promoted in
maternity units worldwide, a significant drop in abandonment
was noticed (Lamb 1982). In Thailand, the
frequency of abandonment went from 33 per 10,000 to
1 per 10,000 births a year.
Kennell and Klaus (1998) note that women supported
throughout their labour take on average 2.9 days to feel
that the baby “is their own,” as opposed to those in the
non-doula-supported group who took an average of 9.8
days to feel the same way. The mothers who had continuous
labour support showed “more affectionate interaction
with their infants” in the first few hours after birth than
the women who were without doula support. They also
reported not leaving their babies as often, and they picked
up their crying babies faster than the women in the control
group. So what is it that makes doula-supported mothers
more likely to bond successfully with their infants? Why
is it that supported mothers feel that their babies are
more clever, more beautiful, and on average superior
to a “standard” baby? What specifically is lacking in the
birth experience of a non-doula-supported woman that
makes her more likely to think of her child as “almost as
good as” or “not quite as good as” a standard baby?
I believe the role that a doula plays in attachment
and bonding can be divided into a number of direct
and indirect contributions. Directly, the doula increases
a mother’s confidence in her parenting skills as well as
her ability to birth a child. This increased confidence
may lead to fewer requests for analgesia, fewer epidural
requests, and subsequently more natural births. The doula
may also relieve anxiety about the labour and increase
confidence, therefore relieving tension, which may impact
positively on the length of the labour. The doula also
provides positive images of the baby both before and
after birth. After the birth, the doula may encourage
A
early contact with the baby, reinforce the mother’s and
father’s emotional attachment by celebrating the birth as
a triumphant event, and comment positively about the
new arrival. After the birth, the doula may support breastfeeding
attempts and generally increase the new mother’s
confidence in her own nurturing and parenting skills.
Indirectly, recent studies (Kennell and Klaus 1998)
support that having a doula present tends to shorten
labour by 25%. Apart from its many direct benefits,
a shorter labour may result in a mother who is less
exhausted and may be more emotionally primed to accept
her baby and begin the bonding process. A mother
who has been in labour for an extended period and is
emotionally and physically drained may not be as eager
to greet her newborn, and she may even show signs of
resentment toward her child for being the source of her
physical anguish. According to Kennell and Klaus (1998),
having a doula present also reduces the requests for pain
medications and epidurals. Avoiding these interventions
may decrease fear and apprehension and may increase
a mother’s awareness of the labour and allow her to
continued on page 27
Submitted by Renee Turonis
26 • IJCE Vol. 13 No. 4

ATTACHMENT AND BONDING: THE DOULA’S ROLE from page 26
experience the full sensation of the birth of her child.
Reducing these interventions may also lead to a decrease
in maternal and infant fever, antibiotic use, and various
other complications such as resuscitation of the baby,
the use of IV antibiotics, and a septic work-up for the
baby, which may impact on the success of the motherinfant
bonding.
Kennell and Klaus (1998) also report that doula support
has been shown to reduce the cesarean rate by 50%. The
smaller the number of mothers having operative deliveries,
the smaller the number of mothers who will be faced
with the physical pain and recovery from surgery that
may interfere with successful bonding. Post-cesarean, the
ability to have skin-to-skin contact during that sensitive
period immediately following birth may not be possible.
The mother may have a decrease in self-esteem as she
feels the loss of a “normal” delivery, may feel a sense of
failure, and therefore may be more prone to postpartum
depression. Nursing may also be delayed for maternal or
infant health reasons, further delaying the initial bonding
opportunity.
Babies born to doula-supported mothers tend to be
healthier and require fewer medical interventions such
as septic work-ups (Kennell and Klaus 1998). This would
allow for more mothers in the doula-supported groups to
have initial bonding time with their babies immediately
after delivery.
Doula-supported mothers tend to choose breastfeeding
more often and continue for longer periods than
those who are not supported (Kennell and Klaus 1998).
This may be due to early contact and nursing, which
promotes the release of oxytocin in the mother’s brain.
Increased levels of oxytocin in the brain result in “sleepiness,
euphoria, a raised pain threshold, and feelings of
increased love for the infant” (Kennell and Klaus 1998).
This may explain why early breastfeeding tends to lead
to prolonged breastfeeding. A greater release of oxytocin
and perhaps the close physical contact, in and of itself,
promote bonding and attachment.
It is reasonable to believe that this early contact
reinforces emotional ties between parent and infant and
sets up a positive foundation on which to continue the
bonding process. It is also reasonable to believe that
the nurturing provided by a doula contributes to this
process.
Brazelton (1987) writes, “Bonding is like falling in
love, it is only the first step. Should that first step be
missed, it is not the end of the world for the mother-infant
relationship, and mothers who are separated early from
their babies for reasons beyond their control should not
feel guilty. Secure attachment takes months if not years
to accomplish.” The research of Kennell and Klaus (1998)
has shown that early contact and interaction between
mother and baby is preferable to delayed contact. They
make the following recommendations:
1. During the labour and delivery, every mother
should have the possibility of continuous physical
and emotional support by a knowledgeable, caring
woman (e.g., doula) in addition to her partner.
2. Whenever possible, analgesic medications and
epidural analgesia should be avoided so that there
will be no interference with the infant’s ability to
self-attach to the mother’s areola and to breastfeed
successfully.
3. Immediately after birth and a thorough drying, an
infant who has a good Apgar score and appears
normal should be offered to the mother for skin-toskin
contact, with warmth provided by her body and
a light blanket covering the baby. The baby should
not be removed for foot-printing, administration
of vitamin K, or eye medication until after the first
hour. The baby should be allowed to decide when
to start the first suckling.
4. The central nursery should be closed. All babies
should room in with their mothers throughout
the short hospital course unless this is prevented
by illness of the mother or infant. A small nursery
area should be available for infants of mothers
who are ill.
5. All mothers should begin breastfeeding in the
first hour, nurse frequently, and be encouraged to
breastfeed for at least the first two weeks of life,
even if the mothers plan to go back to work.
6. A most important component of assistance after a
perinatal death, stillbirth, or when a baby is given
up for adoption is for caregivers to show their real
feelings and take time to listen to the concerns and
the reactions of the parents. The parents should be
encouraged to hold their infant, because physical
contact allows further grieving. It is wise for the
physician to avoid defending every therapeutic
endeavor; doing this shortly after the death can
inhibit parents almost completely from beginning
to express their deepest feelings.
7. When the baby is small or preterm or has a malformation,
the parents need to go through the
process of mourning the loss of the perfect infant
they had expected before they can take on and
become attached to their infant.
Their research shows that doula support before, during,
and after delivery has a substantial positive impact on
maternal self-esteem and the bonding process.
References
Brazelton, T. B. 1987. What every baby knows. New York: Random
House.
Kennel, J. H, and M. H. Klaus. 1995, Building the foundations of secure
attachment and independence. Reading, Massachusetts: Addison-
Wesley.
Kennel, J. H, and M. H. Klaus. 1998. Bonding: Recent observations that
alter perinatal care. Pediatrics In Review 19: 4-12.
Lamb, M. E. 1982. Early contact and maternal-infant bonding: One
decade later. Pediatrics 70: 763-787
■ Gillian Sippert, BA, CD (DONA), became addicted to all things obstetrical
in nature in 1988 when she spent five months on a labour and delivery
ward in a hospital in northern India. Gillian is a volunteer with the Canadian
Mothercraft Birth Companions Program and she also provides professional
labour and postpartum support through her company, Ottawa Labour Support.
Gillian lives in Ottawa, Ontario, Canada, with her husband, Steven, and
sons, Matthew and David.
IJCE Vol. 13 No. 4 • 27

FOCAL POINT ON BREASTFEED-
Questions to Answer When
Teaching a Breastfeeding Class
by Mary C. Gannon
Breastfeeding education programs usually have three
purposes: to influence or to support prenatal decision-making
regarding infant feeding choice, to provide practical
information on management of lactation at the onset of
the breastfeeding experience, and to provide on-going
support after the initiation of breastfeeding (Riordan and
Auerbach 1993). Learning how to breastfeed must be
based on a good working knowledge of how the breasts
make and release milk and how the baby suckles and
receives the milk. Encouraging the mother to continue
to breastfeed for the minimum six to twelve months recommended
by the Canadian Paediatric Society and the
American Academy of Pediatrics means the mother must
have the knowledge of the superiority of breastmilk as
well as the risks of artificial feeding. If the mother values
what she is giving her child, she will be more likely to
continue to breastfeed through some of the early trials and
tribulations many new moms experience. To lessen these
trials means empowering the mother (and her partner)
by providing correct facts and information on how her
own body and her baby work together.
When teaching a breastfeeding class during a prenatal
series of classes, the teacher has already established a
relationship with the group members. This helps to create
an open atmosphere for reinforcing the superiority
of breastfeeding as well as empowering the moms to believe
that they will be able to breastfeed. The following is
a short series of questions to either use as group discussion
work or to keep in mind for yourself while teaching.
1. Why should a mother breastfeed? Why would a
mother choose to use artificial feeding and/or wean
at less then six months? These two topics used as a
group discussion serve not only as a motivational
enhancement but also help to dispel some of the
abundant myths of breastfeeding that people still
believe. These myths act as a barrier to learning.
continued on page 29
A
28 • IJCE Vol. 13 No. 4

QUESTIONS TO ANSWER WHEN TEACHING BREASTFEEDING CLASS from
Some of the more common myths I’ve heard are:
breastfeeding is painful, many women don’t have
enough milk, the mom’s diet is very restrictive while
breastfeeding, most babies need supplements, not
every woman can breastfeed, and it’s very hard to
learn. By dealing realistically with the myths that
your class has about breastfeeding, you will help
to make the moms (and partners) more open to
the truth about breastfeeding.
2. Why should a baby be breastfed as soon after birth
as possible? There’s a fabulous short video that shows
a newborn baby crawling up her mom’s tummy
to latch on to the breast perfectly. The importance
of colostrum, the readiness of the mother’s body,
and the baby’s awake alert state can be discussed
as you reinforce this wonderful first meeting with
the newborn. The baby’s many reflexes, including
rooting, latching, sucking, and swallowing, are created
to make the baby a partner in the business of
breastfeeding.
3. Why is rooming-in so important? Learning about
the baby and recognizing her cues helps the mother
get the best start to breastfeeding. In order to feed
every two to three hours, the mother needs her baby
close by. The importance of night feeds to enhance
prolactin release can be reinforced. The use of dolls
and extra pillows lets moms-to-be get some practical
experience with the baby rooting, latching on, and
taking the baby off. Different feeding positions as
well as when to change breasts can be practised.
The importance of baby-led feeding can be reinforced.
A good breastfeeding video that shows a
baby latching on and being taken off the breast
enhances this very practical learning experience.
4. What is your partner’s role? There is a lot of care to
an infant other then feeding. It’s interesting to see
the different suggestions that the class comes up
with. Providing nutritional support and household
assistance, burping and consoling the baby, monitoring
the mother’s fatigue level, limiting visitors, and
most importantly, continuing to support and value
the decision to breastfeed are all good examples.
5. Where can you receive breastfeeding support
and/or advice? Community breastfeeding clinics,
lactation consultants, baby advice phone lines, La
Leche League, breastfeeding-friendly physicians,
and friends who have had a positive breastfeeding
experience are all wonderful supports for sustaining
breastfeeding. The earlier that a problem is brought
to the attention of an expert, the sooner it can be
brought under control. It is imperative to be familiar
with the community resources for breastfeeding. A
pamphlet with a list of resources that the mom can
keep is a good way of making sure that she can
find the follow-up care that she needs.
6. What about special circumstances such as prematurity,
multiple births, congenital anomalies, or infant
neurologic impairment? Each of these circumstances
would benefit most from individualized teaching
and assistance as well as educational materials and
on-going group support specific to the family’s
needs. In the case of prematurity, since it is more
commonly seen, it is worthwhile discussing the
specific advantages of breastmilk for the preterm
baby. With cesarean sections, it is important to
reinforce that the mother is more than capable
of breastfeeding as soon as possible, immediately
following the surgery in most cases. You can also
demonstrate breastfeeding positions that don’t put
pressure over incision lines.
As a prenatal teacher, I’ve sometimes wondered just
how effective teaching is without the baby to practice with.
Can you really teach breastfeeding techniques without
the baby? According to a study by Duffy, Percival, and
Kershaw (1997), teaching breastfeeding skills prenatally
does have a positive effect on breastfeeding rates and
skills. This study is a strong affirmation for all the prenatal
teachers working hard at promoting breast -feeding.
References
Riordan, J., and K. Auerbach. 1993. Breastfeeding and human lactation.
England: Jones and Bartlett.
Duffy, E, P. Percival, and E. Kershaw. 1997. Positive effects of an antenatal
group teaching session on postnatal nipple pain, nipple trauma and
breastfeeding rates. Midwifery 13, no. 4: 189-196.
■ Mary C. Gannon has been teaching prenatal classes in the Ottawa,
Ontario, Canada area for the last nine years. All four of her children were
joyfully breastfed.
IJCE Vol. 13 No. 4 • 29

POLITICAL ISSUES
by Naomi Bromberg Bar-Yam
Parenting and the Law:
New Mothers’ Breastfeeding
Promotion and Protection Act
It is difficult to talk about parenting in the 1990s without
addressing issues of work and family. Government and
private organizations and agencies have addressed the
complex issues of parenting and working in many different
ways. Work/life benefit programs are becoming
more common in many large corporations, and legislators
have enacted laws providing various levels of protection
to pregnant women and parents and incentives to companies
to support their workers’ family obligations. Laws
in the United States that have impacted on maternal and
child health issues include the Pregnancy Discrimination
Act (PDA) of 1978 (Title VII of the Civil Rights Act) and
the Family and Medical Leave Act (FMLA) of 1993. The
New Mothers’ Breastfeeding Promotion and Protection
Act of 1998 (H.R. 3531) was introduced this year by
Representative Carolyn Maloney (NY) and is currently
being discussed in various Congressional committees.
It amends the PDA and the FMLA and is an important
protection for breastfeeding working mothers. This article
will review the elements of the legislation and its current
status and suggest action strategies for childbirth educators,
other maternal and child health professionals, and
community members to help publicize the bill and see
that it passes.
PROVISIONS OF THE MALONEY BILL
The New Mothers’ Breastfeeding Promotion and Protection
Act includes six provisions:
1. Protect a woman’s right to breastfeed or express
breastmilk. The Pregnancy Discrimination Act, an
amendment to the Civil Rights Act of 1964, was
enacted in 1978. It prohibited workplace discrimination
based on pregnancy, childbirth, or related
medical conditions. While the intent of this bill was
to include breastfeeding, the courts have chosen not
to include it. This bill includes an amendment to
the Pregnancy Discrimination Act explicitly making
breastfeeding part of the Pregnancy Discrimination
Act.
2. Encourage employers to support lactation. This
bill would encourage employers to offer workplace
lactation support by providing a tax credit for setting
up a nursing mother’s room, purchasing or renting
lactation equipment, hiring a lactation consultant,
or otherwise creating a lactation-friendly work environment.
3. Offer mothers’ milk breaks to new working
mothers. The Maloney Bill amends the FMLA, allowing
new mothers eligible for Family and Medical
Leave Act benefits also to take one hour per eighthour
working day to nurse or express breastmilk.
This can be taken in two thirty-minute breaks or
three twenty-minute breaks. The time is not to be
taken from the employees’ leave entitlement (i.e.,
nursing break time does not count against maternity
leave time); however, like the other FMLA benefits,
employers are not required to pay employees for
nursing break time.
4. Develop standards for breast pumps. While
numerous breast-pumping products are on the
market, they are not all effective, efficient, or even
safe. This bill requires the FDA to develop minimum
quality standards for breast pumps, to ensure that
the pumps on the market meet those standards, and
to issue a compliance policy guild to assure that
nursing mothers have access to full and complete
information about breast pumps.
5. Promote a breastfeeding awareness campaign.
The Departments of Agriculture and Health and
Human Services are charged with developing a campaign
“aimed at health professionals and the general
public to promote the benefits of breastfeeding for
infants, mothers, and families” (H.R. 3531).
It is interesting to note that this legislation focuses
on promoting the benefits of breastfeeding
without including the risks of formula feeding. In
order to make breastfeeding a social norm in the
United States, it is important to include the risks
of breastmilk substitutes. While it is not essential
that this be included in the language of the bill,
it should be part of the breastfeeding promotion
campaign.
6. Expand WIC breastfeeding programs. WIC
(Women, Infants, and Children) is a food subsidy and
nutrition education program for low-income pregnant
women, nursing mothers, and young children
at risk for malnutrition. It is funded through the
American government’s Department of Agriculture
and is administered by each state. Over the last
several years, WIC has increased its promotion of
breastfeeding through education programs, lactation
consultant services, and availability of breast
pumps. H.R. 3531 encourages states to provide
further breastfeeding support by allowing them
to use food benefit funds “including savings from
infant formula cost containment” (H.R. 3531) for
“breastfeeding promotion and support activities”
(H.R. 3531). This includes using these funds for
breastfeeding promotion and the purchase of breast
continued on page 31
30 • IJCE Vol. 13 No. 4

POLITICAL ISSUES: PARENTING AND THE LAW from page 30
pumps.
These are the provisions of the New Mothers’ Breastfeeding
Promotion and Protection Act. It is a comprehensive
bill covering a broad range of breastfeeding promotion
and support issues in several sectors of society, including
education of health professionals, the public, people in the
workplace, and low-income mothers. It places breastfeeding
among America’s basic civil rights prohibiting employers
from discriminating based on a woman’s breastfeeding
status.
The bill also assures that women will be given the
time necessary to breastfeed at work; however, like the
other provisions of the Family and Medical Leave Act,
the time is unpaid. This limits the usefulness of the bill
to those who can afford to take unpaid time to nurse
their babies. Many American women will still be forced
to choose between breastfeeding their babies at work and
paying their electric or gas bill. While this is an issue of
broader concern than just the Maloney bill, it is important
to be aware of it in this context.
CURRENT STATUS OF THE BILL
Currently H.R. 3531 has thirty-three co-sponsors in the
House of Representatives and is gathering other co-sponsors.
It is being considered by various committees of the
House, including the Education and the Workforce, Ways
and Means, Government Reform and Oversight, Commerce,
and House Oversight committees. The WIC provision has
passed the Education and the Workforce Committee and
the WIC bill is expected to be presented to the House
floor soon.
The bill has been endorsed by the American Academy
of Pediatrics (AAP), the American Public Health
Association (APHA), the Association of Women’s Health,
Obstetric, and Neonatal Nurses (AWHONN), the Academy
of Breastfeeding Medicine, the International Childbirth
Education Association (ICEA), the International Lactation
Consultant Association (ILCA), the National Association
for Breastfeeding Advocacy (NABA), and the National
Association of WIC Directors.
This bill is being considered in the House of Representatives.
A parallel bill has not yet been introduced in
the Senate.
STATE BREASTFEEDING BILLS
Minnesota, Florida, and Texas have passed bills regarding
breastfeeding in the workplace. A similar bill is currently
being considered in California, and the New York State
Senate is in the process of introducing such a bill. These
cannot be discussed in detail here but may be covered
in a future Political Issues column.
ACTION STRATEGIES
As childbirth educators and perinatal health providers,
it is important to support H.R. 3531 strongly. There are
several action strategies that have been recommended by
the office of Representative Maloney, the bill’s author.
1. Find out if your Representative is a sponsor of the
bill. This can be done by calling his or her office
(locally or in Washington) or on the Web at http://
thomas.loc.gov.
2. If your representative is a sponsor, contact him or
her by letter, phone, or e-mail to add your support
of this bill. If he or she is not (yet) a co-sponsor,
contact the office and encourage them to do so.
3. Encourage colleagues, clients, patients, and students
as well as local childbirth and breastfeeding groups
to do the same. Once you have the information about
the Congressperson in your district and surrounding
districts, it is easier to pass full information on to
others.
4. Representative Maloney’s office is looking for new
mothers who have had difficult experiences nursing
at work and/or with breast pumps to provide
written or verbal testimony to emphasize the importance
of this bill. If you know of such a person,
have them contact Gail Ravnitzky in Representative
Maloney’s office at 202/ 225-7944 or by e-mail:
gail.ravnitzky@mail.house.gov.
5. Encourage groups with which you are affiliated to
endorse this bill.
USEFUL INTERNET RESOURCES
http://www.house.gov.maloney: information about the
bill (summary, general information, and the bill itself)
This is Representative Maloney’s home page and has
information about all of her bills by category. This bill is
listed under “special issues” and then is cross listed under
children and under women’s issues.
http://thomas.loc.gov: to find out who has endorsed
this bill
http://house.gov: to contact your representative
www.lalecheleague.org: Elizabeth Baldwin and Kenneth
Friedman’s article, “A Current Summary of Breastfeeding
Legislation in the U.S.” is available on line at the La Leche
League web site.
e-mail to: intern4.ny14@mail.house.gov: to be added
to a mailing list to receive updates on H.R. 3531
THE POLITICAL ISSUES COLUMN
The Political Issues column is a new feature of the International
Journal of Childbirth Education and will appear in
each issue. The purpose of the column is to inform readers
about legislation, policy initiatives, position papers, and
national and international trends in maternal and child
health. It is my goal to include information on policy
and legislative initiatives in individual countries and international
bodies such as the World Health Organization
and International Labor Organization. However, there are
many such initiatives and papers of which I am not aware.
If you, as an IJCE reader, learn of a law, policy initiative,
or organization position paper that you think should be
addressed in this column, or if you have feedback about
the Political Issues columns that appear, please contact me:
Naomi Bromberg Bar-Yam, 17 Cedar Street, Newton, MA
02459 USA; phone 617/964-6676; e-mail naomi@necsi.
org. Thank you and I hope these columns help to further
your knowledge of national and international trends in
maternal child health.
■ Naomi Bromberg Bar-Yam, ICCE, PhD, is a childbirth educator and social
worker who has recently earned her PhD in social policy. She teaches and
writes about a wide range of perinatal health issues. Naomi lives with her
husband and four children in Boston, Massachusetts, USA.
IJCE Vol. 13 No. 4 • 31

FOCAL POINT ON CHILDBIRTH EDUCA-
Clearing Up the Myths
by Patricia Macko
Currently I teach childbirth classes for a local hospital.
We offer a six-week series which allows me the time to
cover a variety of topics the expectant mother might need
to know. I had a clear set of goals and lecture outlines
when I started teaching, but it took me awhile to let
my creative ideas loose. I was comfortable lecturing. By
nature, I’m a list maker and love to check something off.
But as I taught, I began to tire of having thirty people
stare at me. And I was not satisfied with the interaction
in the class. No one talked to each other. I pondered
my safe options and finally came up with the following
breakout session.
The areas I wanted to target on the first night were
nutrition (a sure dozer), exercise, and fetal movement. I
decided to call the session “Clearing Up the Myths,” since
I always answer a barrage of questions regarding topics
such as heartburn and determining the sex of the baby.
I hoped to loosen up the class a bit.
About halfway through the night, I have the class
divide into two to four groups according to their due
dates. I sometimes adjust the size of the groups depending
on the number of class members. The participants
first introduce themselves to each other. Then I select a
willing volunteer in each group to read one of several
questions I have printed on index cards, a different topic
on each card. I tell them I want to clear up any myths
regarding pregnancy. The volunteer reads the card to the
group and the members discuss it and come up with an
answer. This takes about five minutes.
My nutrition question is, “You need to eat for two —
true or false?” The group usually comes up with several
ideas for a good diet. We review the food groups and I
mention that they are eating for two. I remind the women
to think about nutrition choices for themselves and their
babies, stressing that this does not mean they need two
complete meals at one sitting. I explain that their kidneys
are doing the work for the baby as well, and the pregnant
woman should try to drink six to eight glasses of water a
day. The use of over-the-counter drugs, alcohol, tobacco,
and caffeine is discussed, their short and long-term health
risks being mentioned.
My next card is on fetal well-being. Prior to starting
these breakout sessions, I had a sad experience with a
young couple. The expectant mother came into class one
night saying she knew the baby settled down before delivery,
but her usually active baby had not moved since
the early morning. It was a long night at the hospital
after class. Her baby died from a cord accident. I felt as
if I was in part responsible for her lack of knowledge. I
now make certain that the topic of fetal well-being is wellunderstood
by the class. My card regarding this subject
reads: “A pregnant woman should not lift her arms above
her head — true or false?” We talk at length about how
often a baby moves and the importance of knowing the
activity level of the baby. Most of the class participants
know how to do a kick count but I give a quick review.
Some participants say that their grandmothers still think
a pregnant woman should not raise her arms above her
head. I tell the class that cord accidents are just that,
tragic accidents.
My card to introduce exercise and posture is: “A
pregnant woman should not lift heavy objects — true or
false?” We discuss proper body mechanics and the mental
and physical benefits of exercise. Walking, cycling, and
swimming are encouraged.
Another card reads: “If you have lots of heartburn
while you are pregnant, your baby will have lots of hair
— true or false? “ The class members have plenty to say
on this one. I add that the cause of heartburn is the relaxation
of the sphincter muscle of the stomach. Various
comfort measures are suggested which include drinking
water with meals, avoiding highly seasoned foods, and
eating frequent, smaller meals.
The card about how to determine the sex of the unborn
child really opens the class up. Everyone has something
to share. I’ve heard about a swinging string, Draino and
urine, and using the mother’s age and the due date. The
list is endless and it’s fun to hear all the ideas. I caution
the class to remember that ultrasound has improved but
it is not 100% accurate and to not paint the baby’s room
based on it.
Other questions or concerns which come up during
this session include weird dreams, pets, and litter boxes.
Most people volunteer something they have heard and
it always works well for my class. In my class summary,
I cover the warning signs of pregnancy problems. We
discuss contractions, bleeding, increase in temperature,
decrease in fetal movement, early rupture of membranes,
unrelieved pain, and headaches accompanied by spots
before the eyes.
When class is over, I check my outline to see if I have
left out something and I make a note for next week. The
class members have usually interacted well with each other
and my goals have been met. Most importantly, I don’t
feel as if I’ve done all the teaching. They have!
■ Patricia Macko is a certified educator who has taught childbirth classes in
Stockton, California, USA for nine years.
32 • IJCE Vol. 13 No. 4

EDUCATOR’S COR-
by Kathy Swift
Childbirth educators, as a whole, love to share their
opinions with each other about various aspects covered
during classes. The International Journal of Childbirth Education
staff wanted to give you the opportunity to share
your thoughts, insights, and opinions on specific topics...
so a new column has been born! It is entitled “Educator’s
Corner” and it will allow your responses to be printed
concerning a question asked.
Each edition of the Journal will feature a particular
question that will try to evoke your opinion on an issue
of concern to the childbirth educator. The question may
be stated in such a way to illicit your response if a mother
or father were to ask it in class. What a wonderful way
for novice as well as experienced educators to learn!
Responses should be sent to:
Kathy Swift, MSN, RNC, ICCE
5633 Penelope Street
Alexandria, LA 71303
[318] 442-2892 (home)
[318] 442-7498 (fax)
kswift@linknet.net
I would recommend emailing your answer to me but
if this is not possible, mailing or faxing would be great.
I would also be willing to discuss your response via the
telephone. Let’s share our thoughts with one another!
Remember, there are no right or wrong answers here...
just different opinions.
For this first issue, we asked the question “Do parents
have ANY idea of the amount of time babies need for
nurturing? How can we assist them with this issue?”
Debra Madonna, ICEA Secretary, wanted to share
her point of view on the subject. She writes.... “We’ve
all heard: Enjoy your children; they grow up quickly. It’s
wonderful advice, but we don’t understand it until we blink
our eyes and our own children are grown. Our challenge
is to teach parents to appreciate this ‘baby time.’ Parents
have to believe this time is important if they are going
to use our great advice. Good habits start in the heart.
1. Look into your baby’s eyes for ten seconds each
day.
2. Sniff the baby in the morning and at night.
3. Hug the baby until they ask to be put down.
Parents’ Quiz:
1. How many loads of laundry did you do today? How
many stories did you read to the baby?
2. When you go to sleep: Can you see and smell your
baby? What color are her eyes?
3. Did you kiss your little baby’s cheeks and fingers
and toes today?
Baby Quiz:
1. Did you have a nice time today or do you wish
your parents spent more time at work?
If I was a brave mother, I’d ask my children to take the
Baby Quiz!”
The question for the June issue of the IJCE focuses on
infant feeding. We would love to receive your answer to
this question: “What is your opinion regarding material
printed by formula companies on breastfeeding? Should
this material be distributed in childbirth classes? Why or
why not?”
All responses should be submitted no later then January
15, 1999. Please submit your opinion and share your
ideas with other childbirth educators.
■ Kathy Swift, MSN, RNC, IBCLC, ICCE, is the Educator’s Corner columnist
for the International Journal of Childbirth Education. Kathy is an assistant
professor in maternal and child nursing at Louisiana State University in
Alexandria, Louisiana, USA.
Parents’ Assignments:
N E W F R O M I C E A
✦ Postnatal Curriculum Guide ✦
The Postnatal Curriculum Guide
is divided into individual topics that can be combined to form any
number of classes in a series. Each individual lesson contains the following: Learner Objectives,
Outline, Teaching Strategies and Questions for Discussion and Resources.
POSTNATAL CURRICULUM GUIDE $13.00 US (includes shipping and handling)
To order, call ICEA Bookcenter, 800/624-4934 or 612/854-8660. Fax 612/854-8772,
e-mail icea@info.org or mail to ICEA, PO Box 20048, Minneapolis, Minnesota 55420 USA.
IJCE Vol. 13 No. 4 • 33

A Sample from Postnatal Curriculum Guide by Mae Shoemaker
Difficult Situations — What Should You Do?
“I don’t have enough information on
that topic or I am not feeling confident
with the material.”
“I’m spending all my time thinking
about and planning for this class.”
“I don't approve of the way that class
member is dealing with her problems.”
“I don't like that mom.”
“A baby in the class that cries stantly and is disruptive to my teach-
coning
and the rest of the group”
• Begin collecting information now. Go through magazines,
texts, books, newspaper articles, tape TV shows
• Talk to colleagues
• Invite an “expert”
• Co-teach a topic
• Keep the information basic
• Design the class so the parents help you teach
• Don't be afraid to admit you don't know an answer. You can’t
be expected to know everything. Let them know you will
try to get answers to their questions by the next class.
• Take care of yourself — it can be emotionally exhausting
• Work on your class preparation at designated times only
• Understand your own personal attitudes and biases
• Try to talk to your parents from a risk-benefi t point of view
• Do not dictate solutions to problems
• Try to fi nd one trait or quality that is acceptable and focus on
that
• Provide an area away from, but within the confi nes of your
room for comforting the child
• Ask others for suggestions about how to soothe the baby
• Talk to the mom outside class time about possible problems
• Suggest she see her caregiver if there seems to be a problem
“A baby in the class with a • Talk to your moms ahead of time
physical problem”
• Ask the mom if there is any particular way she would like the
situation handled
“The person who monopolizes
the discussion or interrupts”
“The person who makes
unrelated comments”
“The person who is overly critical”
“The ‘perfect mom with the
perfect baby’”
“The class expert”
“The parent who is ‘different’ in
some way from the rest of the group”
“The shy and reserved parent”
• Impose fi rm limits
• Step in often and refocus the discussion
• Talk to her after class
• Try to use “That’s interesting, but let’s keep to the subject.”
• Try to build this person’s self-confi dence
• Handle this person gently
• Point out reality whenever possible
• Remind this person about ground rules
• Give her specifi c tasks to do
• Work to point out her value to the group
• Make sure she feels comfortable
• Compliment this parent often
• Make an effort to draw her into the discussion
34 • IJCE Vol. 13 No. 4

A Sample from Postnatal Curriculum Guide by Mae Shoemaker
Teaching Techniques for Success
Off to a Good Start —
Learn each other’s names. Do oral introductions and use name tags.
Introduce the babies: share names and something special about the baby.
• Using birth stories can break the ice — but be careful not to make it the focus of the
class.
Journals: Use them to focus on mom, baby and family.
Use fi rst names when talking to your moms and refer to the baby by name.
•
Establish ground rules:
mutual respect
keeping to topics
listen to one another
Mini-Lectures —
Keep any lecture you have to 5 minutes.
• Use for topics that are clearly defi ned.
Begin your discussions —
• “ Many families have experienced....” This works well when introducing those feeling
oriented topics.
Have the group formulate the questions —
• You suggest the topic, and let the group brainstorm questions.
Theoretical situations —
• Present a scenario and allow parents to try and fi gure out what is going on or how
they might handle a situation.
Use Your Moms as Resources —
Get to know your moms and fi nd out what they might be able to offer the group.
• Ask them bring toys, games, music, etc. to the class to share.
Postnatal Curriculum Guide
by Mae Shoemaker is published by ICEA. See page 33 for order information or call 612/854-8660.
IJCE Vol. 13 No. 4 • 35

TEACHING TIPS
These are some of my favorite teaching aids and the ways I use them. I hope they will be useful to you!
When discussing the physiology of labor and birth, I use the pocket-size pelvis and doll to demonstrate the widest
diameter of the baby’s head negotiating the widest diameter of the pelvic inlet and outlet, and how the ischial spines
infl uence rotation and are used for measuring descent. After demonstrating this, I pass the objects around the class
to be handled and played with.
I use a ribbed sock and cupie doll to demonstrate uterine effacement and dilatation; I then pass them around the
class.
Next, I fi ll a ziplock bag with warm water and place a cupie doll in, head down. As I squeeze the bag (over a dish
basin) to demonstrate the pressure of contractions, the water begins to bulge in front of the doll’s head and the bag
invariably breaks or leaks—surprising the class. This is a good way to illustrate the surprise of spontaneous rupture
of the membranes! As I continue to squeeze contractions, the class observes the doll’s head seals off the water flow
between squeezes but water leaks out with the squeezes. In a later demonstration, I use an amniohook on the water
bag to illustrate artifi cial rupture of the membranes.
When teaching about hospital routines/interventions, I use the following props: as I discuss hospital admittance,
I put on a hospital gown over my clothes and ask the class to tell me how they would feel dressed this way while
having intense contractions and trying to dialogue with professionals who are not only fully dressed but uniformed
and wearing nametags. This prepares us to discuss the woman’s vulnerability, the coach’s role in advocacy, and to
brainstorm ways of reducing the disadvantage mom may feel. Usually, I place a second gown over the first, wearing
it backwards like a robe as they are making suggestions.
As I bring up various interventions, I begin putting them on myself; i. e., I hang an IV bag from a coat rack and tape
the tube to my wrist or secure it with my watchband; as I move about asking for info on the disadvantages of a
routine IV, it is easy to see the limitations of my movements. I then ask for the reasons why an IV is used and when
it is considered an advantage. We then discuss alternatives. I follow the same procedure for EFM, external and
internal, using elastic belts and jar lids and extension cords and objects to be tethered to, such as the TV, and the
graph readout of a sample monitoring. The blood pressure cuff is added, tubing that imitates continuous epidural, a
construction worker’s dust mask for an oxygen mask, etc. By the time we have discussed the pros and cons of the
interventions, it is apparent that I am quite warm and cumbersome! Everyone can see the difficulty I am having just
reaching for my teaching props, gesturing, etc. This makes a great springboard from which to problem-solve how to
cope as positively as possible if events/choices of labor lead to such an array of equipment! However, I believe one
of the great advantages of using these props is to help people think through the choices they may make that lead to
such a tangled web! Of course, I augment all these props with the usual charts and pamphlets, some fill-out forms
for prioritizing options, and video clips. Thanks to ICEA’s excellent conventions and Journal
articles over the years,
I have tried to compensate for all types of learning styles on any given topic!
When teaching infant care and breastfeeding, I give each couple a fully dressed doll and have them mimic various
positions for holding babies in feeding, burping, etc. They undress the dolls and mimic bathing (with all the props) and
sometimes even infant massage with a video demonstration. At one point, while the moms watch the breastfeeding
positions video, the guys are in another room dressing the naked dolls from diapers to booties, onesies, dresses, bibs,
jackets, blankets, etc. This is to give them a chance to figure out all those snaps before trying it on wiggling babies!
When they return successful in spite of no advice from the women (but lots from each other), it leads to discussing
the differences in men’s and women’s styles of care, and the importance of building confidence in each partner—if
they want each other’s participation in baby care!
Micki Johnson, ICCE, CD (DONA)
Reprinted from Teaching Tips from ICEA Certifi ed Childbirth Educators (ICCEs), ICEA 1998 International Convention.
36 • IJCE Vol. 13 No. 4

For Your Information
ICEA member, Chris Maricle, recently forwarded a message
that she had received from a friend in Russia to
Cheryl Coleman, ICEA President. Chris and her husband,
Ken, have made at least one mission trip to Russia with
the Methodist Church, and they would like to share the
following message with you.
Dear Brothers and Sisters!
Greetings and love from Voronezh Evangelical
United Methodist Church! This is the second attempt
to transfer a request from Anna Stefanova, my former
classmate, a doctor, and the leader of a nonprofit
social organization, Healthy Mother. We will be very
grateful for any help or advice. Thank you for your
interest and care!
Irina Mitina
This is Anna Stefanova’s letter:
Sisters and brothers!
I am Anna Stefanova, the leader of a social
women’s nonprofit organization called Healthy Mother.
Recently, I met Irina Mitina, my classmate, and it was
a pleasant surprise for me to learn that now she is a
pastor of the Evangelical United Methodist Church in
Voronezh. Irina told me that the main motto of the
church is the words of James, “Faith that does nothing
is dead.” So I am writing this letter in despair and in
HOPE to get into contact with you, and I would be
very thankful for your answer.
The main aim of our organization is motherhood
and childhood rights defence in the Central Black
Soil Region. This region is south of Moscow, and its
population is about ten million people.
In the cruel economical crisis we are having now
in Russia, we have to look for help and support from
different organizations. The crisis we are facing now
has influenced all classes of our society. The income
of people has been decreasing dramatically (for
example, the average salary in our region is about
twenty dollars per month) and savings have depreciated
several times due to the unprecedented rouble
devaluation. The most unprotected people, such as
newborns, suffer from all these changes more than
others.
The morbidity of pregnant women has increased.
For example, every other pregnant woman suffers from
anemia and the number of cardiovascular and renal
diseases is disastrously great. That is often caused by
the lack of proteins, vitamins, and minerals in their
nutrition. When doctors prescribe a corrective diet,
many patients can’t afford keeping to it because of
the reduced circumstances. There are pregnant women
who can afford eating only macaroni or potatoes.
Many pregnant women suffering from iron deficiency
anemia can’t buy the prescribed medicine because
of its unaccessible price.
As a result of their pathological state, these
pregnant women lose their hair, teeth, and nails
and they also have such complications as premature
birth, insufficiency of labor pains, birth trauma, and
uterine hemorrhage. These women are even not able
to nurse their children because during nursing, their
condition becomes progressively worse.
The babies suffer from oxygen starvation during
pregnancy. After delivery, the babies are weak, nonadapted,
and most of them have encephalopathy.
The perinatal mortality and pathology of newborns
are constantly increasing.
Medical insurance doesn’t cover pregnancy.
Pregnant women are provided with medicine by the
State health care system which is out of resources due
to the financial crisis. Gynecological and obstetrical
clinics don’t have many important supplies and some
planned surgical operations have been cancelled.
Doctors are unable to care for the pregnant woman
and her baby.
We appeal to your feeling of humanity and compassion!
We know that you can’t help everybody, and
you can’t change the economic situation in Russia.
But we would be VERY GRATEFUL for ANY help. We
will also appreciate any ideas and advice that could
help our pregnant women, young mothers, and their
babies.
Yours faithfully,
Anna Stefanova
Chris writes, “I know that childbirth educators will respond
from their hearts because they truly care about
pregnant women and babies. I can assure you that,
although I don’t know Dr. Stefanova, I am very good
friends with Irina Mitina. Irina is a very dedicated
woman who is completely trustworthy. Right now the
United Methodist Church’s Russia Initiative Task Force
is working on a way to make sure that any money
contributed to Healthy Mother can reach them and
be wisely used.”
* * * * *
If you would like to contact Chris about this situation
in Russia, you can reach her at 5120 E. 75th St., Tulsa,
Oklahoma 74136 USA; phone: 918/496-3284; email:
sonsinger@worldnet.att.net.
IJCE Vol. 13 No. 4 • 37

ICEA would like to add your
photographs on our web pages.
Visit the ICEA web pages (www.icea.org), match one or more of your color
photographs with an ICEA service or program. Send the photograph(s) to
ICEA with your credit line and the following signed submission statement:
All submitted photographs are for single use only on the ICEA web pages, and the
photographer has obtained permission from the subjects to publish the photos.
Become a part of our internet service.
Send your photograph(s) to:
ICEA, Attn: Doris Olson, PO Box 20048,
Minneapolis, Minnesota 55420 USA.
38 • IJCE Vol. 13 No. 4

Suggestions for a Doula’s Birth Bag
ICEA Teaching Ideas Sheet #23
Just a few years ago, a doula’s birth bag often consisted of some audiotapes, a tennis ball,
powder, lotion, and a hot water bottle. Today, a “suitcase on wheels” may be needed so the
doula can bring a variety of tools for her clients to try according to their own particular comfort
needs. Not all of these are necessary, but many of the items can be found around the house
or purchased at a reasonable price.
Camera, 2-3 rolls of fi lm (200–400 ASA), extra battery (or a disposable camera with fl ash—can
give to client immediately after birth)
Audio tape player and tapes
Aromatherapy (lavender is often recommended)
Candles/matches (check with facility regarding use)
Disposable gloves (for universal precautions and/or to fi ll with warm water to place on
breasts to provide nipple stimulation and/or perineum to provide pushing guidance and
possibly more tissue elasticity—check with facility regarding “orders” being required for
either of these uses)
Change of clothes or own scrub suit
Plastic spoons and straws (for ice chips and clear fl uids)
Snacks (for self and mother’s partner)
Chapstick/vaseline/lip gloss
Sour lollipops/candy sticks
Mouthwash or breath freshener
Hand-held fan (paper, straw, or battery-operated)
Ice Wrap (bring frozen) or instant cold pack
Rice Sock (microwave on high for 3 mins.—can add drops of aromatherapy—good for upper
or lower back, abdomen, neck, cold feet, trembling legs, etc.) or instant hot pack
Hot water bottle(s)—can use for hot water or ice chips
Washcloths
Small spritzer bottle fi lled with cool water (to refresh face/body)
Socks (red ones so bodily fl uids aren’t so noticeable)
Lubricating oil for perineum (extra virgin olive oil, for example)
Powder/lotion for massage
Wooden/textured massager(s)
2 “stress balls” (to squeeze rather than the partner’s hands)
Vibrator (quiet one with variable speeds is best—check with facility regarding use during
monitoring)
18-inch piece of swimming pool foam “ring” (for lumbar support)
2 small pocket combs (use on refl exology points across middle of palm for labor pain)
Sea bands (use on acupressure points on inside of each wrist for nausea)
Hand-held mirror and small fl ashlight (to see baby better as it’s “peekabooing” during pushing)
Variety of focal points
Client’s Birth Plan
Notebook/pens
Breastfeeding information
Brochures/business cards
Parking/meal money
Written by Jan S. Mallak, 2LAS, ICCE, CD (DONA), ICD
© International Childbirth Education Association, Inc.,
PO Box 20048, Minneapolis, Minnesota 55420 USA.
IJCE Vol. 13 No. 4 • 39

AUDIO VISUAL REVIEW by Margery Simchak
“The Timeless Way”:
History of Birth from Ancient to Modern Times
VHS Color
Time: 30 minutes
Price: $79.95 US
Available from:
ICEA Bookcenter
PO Box 20048
Minneapolis, Minnesota 55420-0048 USA
800/624-4934
Every professional should be aware of the history of her
chosen profession. Childbirth educators especially should
be aware of how birth has been experienced and viewed
throughout time. It gives us a sense of purpose and accomplishment
and even a challenge in promoting childbirth
as a natural process of life and family growth. Since little
is written in ancient history about birth, our best way to
review birth is through art, either drawn or sculptured.
Carole Summer, the producer, has done an excellent job of
reviewing birth art globally in this fascinating video about
woman’s most important work — childbirth.
Birth art from all over the world is shown in chronological
order, beginning with a sculpture from the Aztecs
created 20,000 years ago and familiar to many seasoned
childbirth educators. The birth art is described by a pleasant
female narrator. She describes the birthing woman as
a goddess portraying great strength and power. The art
shown and well-described is from Greece, France, Italy, the
Roman Empire, Columbia, the Amazon, Africa, Mexico, and
Japan. Several pictures of Native Americans, including the
Blackfoot and Sioux, are also shown.
The video seems to have the objective of promoting
and validating birth in the upright position as most old art
shows the birthing woman either standing, kneeling, or
squatting. She is usually not alone but has at least a support
person and a receiver. Sometimes, the scene includes
many people and seems to represent a social event rather
than a private medical event.
Some of the birth art shows the laboring woman larger
in proportion to the other people in attendance. The art also
portrays the woman with the innate ability to give birth,
and birth seems to be respected. Early American birth art
shows women using birthing chairs. Blackfoot women are
shown using stakes, ropes, or bars to grasp onto as they
push the baby down the birth canal. For comparison, the
video switches to a modern woman using a birthing bar. A
modern graphic of many different labor positions is shown
again to compare the old birthing methods to those most
childbirth educators recommend and encourage.
The video reflects on midwifery. Written history of
more than a hundred years ago describes the midwife as
mature, a mother past her childbearing years, and having
a sympathetic heart and good moral character. Another
history book states that a midwife should have a lady’s
hand, a hawk’s eye, and a lion’s heart. The video describes
how in the past midwifery was the only aid to the laboring
mother. Then midwives were replaced by male doctors,
who originally attended only complicated cases and then
eventually monopolized obstetrics while moving women
into a sterile hospital environment to give birth.
When birth moved to the hospital, women were then
forced to deliver flat on their backs with feet elevated in
the classic lithotomy position. The narrator mentions that
this position lowers maternal blood pressure, decreases
oxygen to the baby, and creates a longer labor and more
complications.
Clips from a 1930 black-and-white birth film show only
the shaved perineum. The sterile table is shown, with the
1930 narrator explaining about how sterile everything must
be surrounding the birth. Another clip shows a visiting nurse
in a home of a low-income family, teaching correct breastfeeding
positioning. The video leads the viewer to assume
that the wealthier women went to the hospital while poorer
women birthed at home with only nurse visitation.
The video then switches to modern obstetrics, describing
the introduction of childbirth education beginning in
the 1960s. Because of the improved consumer education,
women were more awake and alert during the birthing
process. However, cesarean birth and epidural rates rose
sharply. In the 1980s, the cesarean birth rate peaked at
above twenty-five percent. Even with concentrated efforts
to lower that rate, present cesarean birth rates still hover
at twenty percent. Epidurals, although excellent pain relief
for labor, do increase cesareans and have side effects.
Modern obstetrics does include a return of the midwife.
The video explains the difference between a certified nursemidwife
and a licensed midwife. Professional birth assistants
are also a present-day option that provides valuable support
to the laboring women.
The video then overviews the history of obstetrics,
with a split screen showing a modern woman in a similar
position or gesture to that of an ancient sculpture. The
summary states that traditional birth is not just universal
but emotionally fulfilling and medically sound.
Not every childbirth class would appreciate this video,
but some would. Certainly it convinces the viewer to get
off her back when giving birth and surround herself with
support people. This video could be a test for a childbirth
educator. If the educator does not see the value of the
historical knowledge, perhaps her class content is too narrow.
40 • IJCE Vol. 13 No. 4

Newly Certified ICCEs
Cheryl Andres, ICCE, Summerfield, North Carolina USA
Jennifer Ayers-Gould, ICCE, Bay City, Michigan USA
Jennifer Bardell, ICCE, Oklahoma City, Oklahoma USA
Christina Bishop, ICCE, Leesburg, Virginia USA
Candice C. Boucher, ICCE, Provo, Utah USA
Donna Canton-Russ, ICCE, Stouffville, Ontario CANADA
Gail Carchietta, ICCE, Lake George, New York USA
Susan R. Cole, ICCE, Findlay, Ohio USA
Patter I. Cross, ICCE, Round Rock, Texas USA
Karla Ennis, ICCE, Locust, North Carolina USA
Caroline Escobar, ICCE, Raleigh, North Carolina USA
Marcia R. Farmer, ICCE, Seffner, Florida USA
J. Constance Frey, ICCE, Olympia, Washington USA
Holly Glennon, ICCE, Anchorage, Alaska USA
Kathy Graalfs, ICCE, Sacramento, California USA
Linda Gray, ICCE, Munson Township, Ohio USA
Ellen Haynes, ICCE, Jacksonville, Florida USA
Debra Hazel, ICCE, Millington, Michigan USA
Jennifer Hemberger, ICCE, Milwaukee, Wisconsin USA
Karen Henderson, ICCE, Kingsport, Tennessee USA
Lori Holland, ICCE, Oxford, Georgia USA
Robin Horn, ICCE, Milpitas, California USA
Sarah Howe, ICCE, Lakeland, Florida USA
Sheryl Hurley, ICCE, Brunswick, Ohio USA
Julie King, ICCE, Colorado Springs, Colorado USA
Karon Kujawa, ICCE, Findlay, Ohio USA
Dorothy Lewis-Brooks, ICCE, Warner Robins, Georgia USA
Irma Luciani de Fernandez, ICCE, Santo Domingo,
DOMINICAN REPUBLIC
Amy Maddox, ICCE, Fort Collins, Colorado USA
Amy Martin, ICCE, Indianapolis, Indiana USA
June McLean Vida, ICCE, Kitchener, Ontario CANADA
Cindy McLeod, ICCE, Ringgold, Georgia USA
Lisa Melvin, ICCE, Albany, Georgia USA
Debra Merritt, ICCE, Santa Rosa, California USA
Janet Miller, ICCE, Rowlett, Texas USA
Lisa O’Cull, ICCE, Ewing, Kentucky USA
Kristen Palmer, ICCE, Norman, Oklahoma USA
Edith Paquette, ICCE, Regina, Saskatchewan CANADA
Tracy Peters, ICCE, Flowery Branch, Georgia USA
Karen M. Petyak, ICCE, Fayetteville, North Carolina USA
Sharon Recknagel, ICCE, Mustang, Oklahoma USA
Traci Rhode, ICCE, Maryville, Tennessee USA
Doreen Schutte, ICCE, Portland, Oregon USA
Ada Seidemann, ICCE, Tel Aviv ISRAEL
Monna Shank, ICCE, Elkins, West Virginia USA
Carol Shattuck-Rice, ICCE, Berkeley, California USA
Dana Shibley, ICCE, Estacada, Oregon USA
Patricia Solano, ICCE, Lakeland, Florida USA
Rita Spinney, ICCE, Ellsworth, Maine USA
Heather Stroh, ICCE, Tallahassee, Florida USA
Jennifer Tehaney, ICCE, El Dorado Hills, California USA
Lizabeth T. Thomas, ICCE, Augusta, Kentucky USA
Sheila Vance, ICCE-CD, Huntsville, Alabama USA
Susie Wacker, ICCE, Universal City, Texas USA
Donna Webb, ICCE, Huntsville, Alabama USA
Newly Certified ICDs
Maria Bosch, ICD, Tifton, Georgia USA
Jodi Bubenzer, ICD, Madison, Wisconsin USA
Kim Burkinshaw, ICD, Trenton, Ohio USA
Marcia Christian, ICD, Boca Raton, Florida USA
Karin Cooper, ICD, San Antonio, Texas USA
Christine DePoyster, ICD, Arvada, Colorado USA
Colleen Duewel, ICD, Murray, Vermont USA
Kimberly Johnson, ICD, Duarte, California USA
Ruth Kemp, ICD, Sarina, Ontario CANADA
Linda LeMon, ICD, Cold Spring, New York USA
Machelle McLaughlin, ICD, Murphysboro, Illinois USA
Rosalie Moore, ICD, Sherman, Connecticut USA
Janet Newall, ICD, Amherst, New York USA
Danielle Pelletier, ICD, Virginia Beach, Virginia USA
Eunez Shird, ICD, Oklahoma City, Oklahoma USA
Sherry Stafanoff, ICD, Granite City, Illinois USA
Adrian Steinbach, ICD, Orlando, Florida USA
Newly Certified ICPEs
Sheryll Brimley, ICPE, Mississauga, Ontario CANADA
Debie Little, ICPE, Morganton, North Carolina USA
Catherine McSorley, ICPE, Keswick, Ontario CANADA
Anne Roberts, ICPE, Clarksville, Georgia USA
Linda Uhrich, ICPE, Winnipeg, Manitoba CANADA
Stephany White, ICPE, Augusta, Georgia USA
IJCE Vol. 13 No. 4 • 41

International Journal of Childbirth Education
Guidelines for Photography
IJCE is seeking photographs depicting all aspects of childbearing and childrearing consistent with ICEA’s philosophies.
COVER AND INSIDE PHOTOS
* Photographs can be submitted as either color or black-and-white prints.
* Black-and-white is preferable due to enhanced reproduction qualities.
* Photos must be clear and sharply focused.
* Candid shots of subjects are preferable to posed ones.
* There is a special need for photos representing the international nature of the IJCE.
SUBMISSION GUIDELINES
Please submit photographs that can be placed in a stock file and used as needed. All photos should be sent to
Caroline Brown, 201 West South Street, Carmichael, Pennsylvania 15320, USA. Please include the signed Submission
Statement: “All submitted photographs are for single use only and the photographer has obtained permission from
the subjects to publish the photos.” Photos will be returned after use.
MODEL RELEASES
It is the responsibility of the photographer to obtain signed releases from the models.
RECOGNITION
A credit line will be given to the photographer. Financial compensation is not possible due to the volunteer nature
of the publication and organization.
ICEA International Convention 2000
CALL FOR SPEAKER ABSTRACTS
St. Louis, Missouri USA
August 10-14, 2000
Adam’s Mark Hotel
GUIDELINES FOR SUBMISSION
* Abstracts should be postmarked by June 1, 1999
* Abstracts should be submitted to: ICEA, Attn: Director of Conventions, Abstract Submission 2000,
PO Box 20048, Minneapolis, Minnesota 55420 USA
* Abstracts must be word-processed
* Abstracts will be considered for 60-90 minute general sessions or 90-minute breakout sessions
* All abstracts must contain the following: Title of presentation, Presenter/co-presenter, Current CV
for each presenter, Objectives for the presentation, Brief presentation outline, Brief bibliography
GENERAL INFORMATION
Session enrollment is based on meeting room space. Presenters are notified one month prior to the
convention of the number of participants in the session. Presenters may enclose a stamped, self-addressed
postcard for notification of receipt. Notification of acceptance can be expected by September
1999. Abstracts not chosen by the Convention Committee will be held on file for one year from date
of submission.
All presenters receive an honoraria for presenting at an ICEA International Convention. Individual honoraria
amount is determined by length of presentation and is presented to the speaker upon registration
at the convention.
42 • IJCE Vol. 13 No. 4

Information for Journal Writers
The International Childbirth Education Association (ICEA) as a professional organization supports educators and other
health care providers who believe in “freedom of choice based on knowledge of alternatives in family-centered maternity
and newborn care.” ICEA’s goals are to provide: support for childbirth and postnatal educators, professional
certification programs, training and continuing education programs, and quality educational resources.
ICEA promotes these goals by publishing the International Journal of Childbirth Education, sponsoring international
conventions and workshops, publishing booklets and pamphlets concerning the childbearing year, providing a wide
selection of books and resources through the ICEA Bookcenter, and offering the ICEA Teacher Certification, Postnatal
Educator, and Doula Certification programs.
TYPES OF ARTICLES
Informal articles: “In my opinion,” “The way I teach,” “Birth story”
These articles between 500 and 1000 words express an opinion, share a teaching technique or describe a birth 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 are welcomed.
Research articles should be four to eight pages in length and either 1) report on scientific advances related to
the childbearing year, 2) discuss recent developments or newly designed programs which deal with alternatives to
medically-based childbirth systems, or 3) review programs, methodologies, or studies which are analytic in nature,
rather than descriptive. Placement of tables and charts should be identified in the contents. In keeping with ICEA
Advertising Guidelines, any mention of purchase information for books and publications carried by the ICEA Bookcenter
must list the Bookcenter as the source.
Regular columns are written by Journal staff members.
SUBMISSION STATEMENT
In accordance with the Copyright Revision Act of 1976, the following statement must be submitted in the cover
letter and signed by all authors and coauthors before a manuscript will be accepted:
In consideration of the International Childbirth Education Association taking action in reviewing and editing my submission,
the author(s) undersigned hereby transfer, assign, or otherwise convey all copyright ownership to the International
Journal of Childbirth Education in the event such work is published in the Journal. This manuscript or its essence has not
been accepted or published previously and is not under simultaneous consideration for publication elsewhere. All submitted
photographs are for single use only and the photographer has obtained permission from the subjects to publish the photos.
continued on page 44
CHANGE OF ADDRESS FORM
IF YOU MOVE... The post offi ce will not forward bulk mail even if you give them your new address. ICEA must make the
changes, so please let us know. This is the only notice you need to send for uninterrupted service. Allow six weeks.
1. Please print clearly your address as we now have it.
Name ________________________________________________
Address ______________________________________________
Cit ________________________ Province/State ___________
Postal/Zip Code ______________ Country ________________
2. My current membership(s) number is:
(top line of address label)
3. Print your new address here:
Name ________________________________________________
Address ______________________________________________
Cit ________________________ Province/State ___________
Postal/Zip Code ______________ Country ________________
4. Date new address is effective:
All letters and numerals
(Additional membership number)
Are you in the ICEA Teacher Certifi cation Program? _________
Do you have more than one ICEA Membership? _________
If yes, please indicate the membership categories: _______________________________________________________________________
(i.e., Individual, Member/Member Group, Contributing Professional)
IJCE Vol. 13 No. 4 • 43

INFORMATION FOR JOURNAL WRITERS from page 43
SUBMITTING MATERIAL
Papers will be considered for publication only if they are contributed solely to the International Journal of Childbirth
Education. Submissions should be typed on white paper and double-spaced with a one-inch margin on all four sides.
A running head (with article title and author’s name) at the top of each page should identify the manuscript. Writers
are asked to submit a diskette (PC-formatted, with files in Microsoft Word, if possible) in addition to a paper copy
of the material. Diskettes labeled with a name and mailing address can be returned.
A 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 encouraged to include a photograph and two to three sentence biography.
Review
All submissions are reviewed by the International Journal of Childbirth Education editorial board and, if necessary, additional
expert reviewers.
References
The Chicago Manual of Style is used for references. Authors must attribute all quotations and borrowed materials
to the author and source and are responsible for the accuracy of references. The following citation style examples
should be followed:
Book
Author’s last name, first initial, year of publication, title of book in italics (with first word and proper nouns
capitalized), publication location, publisher
Example:
Young, D. 1982. Changing childbirth: Family birth in the hospital.
New York: Childbirth Graphics.
Magazine
Author’s last name, first initial, year of publication, title of magazine article (with first word and proper nouns
capitalized), name of magazine in italics (with all words capitalized), volume, number (if given), page numbers
Example:
Haller, K. 1996. Drive-through deliveries. JOGNN 25, no. 1 : 289-294.
REPRINTS AND EDITORIAL ADDRESS
Authors receive one complimentary copy of the International Journal of Childbirth Education in which their article appears.
Additional copies can be purchased from the ICEA Central Office, PO Box 20048, Minneapolis, Minnesota
55420 USA.
Articles, letters, and other editorial correspondence should be addressed to: Helen Young, 1936 Garfield Avenue,
Ottawa, Ontario, K2C 0W8, Canada. Messages can also be left at e-mail address: ag139@freenet.carleton.ca or
phone 613/225-9401.
All photos that do not accompany articles should be sent to Caroline Brown, 201 West South Street, Carmichael,
Pennsylvania 15320 USA. Please include the signed Submission Statement: “All submitted photographs are for single
use only and the photographer has obtained permission from the subjects to publish the photos.”
44 • IJCE Vol. 13 No. 4

CALENDAR OF EVENTS
* January 8-9. Phoenix, Arizona. Labor Support Course: Basic Doula
Training Workshop. Sponsor 3.
* January 9-10. Lincoln, Nebraska. Labor Support/Doula Workshop.
Sponsor: Birthcare–Nebraska. Contact: Ann Seacrest, 2309 Lake
Street, Lincoln, Nebraska 68502. 402/477-9600.
* January 12-13. Santa Monica, California. Lamaze Breastfeeding Support
Specialist Training Program. Sponsor: Lamaze International.
Contact: Christal Huegle, 1200 - 19th Street NW, #300, Washington,
DC 20036. 202/857-1128.
* January 15-17. Tampa, Florida. Mother Massage During Pregnancy.
Sponsor 2.
* January 21, 22, 25, 26. Seattle, Washington. Basic Teacher Training
Workshop for Childbirth Educators. Sponsor: Childbirth Education
Association of Seattle. Contact: Barbara Orcutt, 10021 Holman Road
NW, Seattle, Washington 98177. 206/789-9883.
* February 12-13. Phoenix, Arizona. Labor Support Course: Basic Doula
Training Workshop. Sponsor 3.
* February 27-28. Strongsville, Ohio. Doula Training Workshop. Sponsor:
Great Expectations Labor Support Services. Contact: Sunday Tortelli,
19006 Stoney Point Drive, Strongsville, Ohio 44136. 440/572-
2574.
* March 12-13. Phoenix, Arizona. Labor Support Course: Basic Doula
Training Workshop. Sponsor 3.
* March 19-21. Tampa, Florida. Mother Massage During Pregnancy.
Sponsor 2.
* March 20-21. Tucson, Arizona. Sponsor/Contact: Penny Stansfield,
6910 N. Skyway Drive, Tucson, Arizona 85718. 520/297-3684.
* June 23, 24, 25, 1999. Baltimore, Maryland. ICEA Basic Teacher
Training Workshop. Sponsor 1.
* August 5-8, 1999. Los Angeles, California. ICEA 1999 International
Convention. Sponsor 1.
* September 27, 28, 29, 1999. Chicago, Illinois. ICEA Doula and
Labor Support Workshop. Sponsor 1.
* September 28, 29, 30, 1999. Baltimore, Maryland. ICEA Basic
Teacher Training Workshop. Sponsor 1.
CLASSIFIED AD
MORNING SICKNESS RESOURCES
“Take Two Crackers and Call Me in the Morning! a real-life
guide for surviving morning sickness.” Miriam Erick, MSRD.
72 pg. commonsense cartoon guide. English: $11.00
ppd.; Spanish: $13.00 ppd. Grinnen-Barrett Publishing,
Box 779-C, Brookline, Massachusetts 02146.
* ICEA Contact Hours applied for.
Sponsors
1. International Childbirth
Education Association (ICEA)
PO Box 20048
Minneapolis, Minnesota 55420 USA
612/854-8660 612/854-8772 (FAX)
2. Elaine Stillerman
108 East 16th Street
New York, New York 10003
212/533-3188
3. Birth Matters
Terry Emrick
2962 W. Port Royal Lane
Phoenix, Arizona 85053
602/938-3002
ICEA Calendar listings are free of charge for events that have
applied for ICEA Contact Hour approval. There is a charge
for listing non-contact hour events. To be listed in this calendar,
contact hour applications must have been submitted
two months prior to the publishing of the Journal and be
scheduled to take place during the three months following
publication. Events scheduled for later months will appear
in the next issue of Journal. For additional information or to
request a submission form, contact: ICEA, PO Box 20048,
Minneapolis, Minnesota 55420 USA. 612/854-8660.
Plan to attend the
1999 ICEA
International Convention
August 5-8, 1999
The Biltmore Hotel
Los Angeles, California USA
Registration materials will be mailed
by April 1, 1999. ICEA members
outside of North America must request
convention registration materials.
International Childbirth Education Association
PO Box 20048
Minneapolis, Minnesota 55420 USA
612/854-8660 • 612/854-8772 (FAX)
IJCE Vol. 13 No. 4 • 45

46 • IJCE Vol. 13 No. 4
BABYCENTERS WEBSITE
AD

EMPATHY BELLY
AD
IJCE Vol. 13 No. 4 • 47

48 • IJCE Vol. 13 No. 4
MEDELA
AD