Continuing Education Module: Persuasion: The Key to Changing Women's Ideas About Birth

Although standard maternity care is not evidence-based and, in many cases, increases risks for mothers and babies, few women make birth decisions that reflect this knowledge. This column discusses persuasion as a way to change women''s ideas about safe, healthy birth. The relationship between persuasion and choice is discussed, and the differences between presenting information and persuading women that natural birth is the safest and healthiest way to give birth are explored.     

Childbirth education for multiple pregnancy: part 1: prenatal considerations

Women with a multiple pregnancy have unique learning needs in preparing for birth. This paper explores the issues relevant to women with a multiple pregnancy to support a positive birth experience. One of the foundations of childbirth education and nursing care is to provide the individual woman and her family with knowledge regarding the birth process, what to expect, and how to cope with labor and birth. Education also focuses on caring for the newborns after birth and how to manage in the early days at home. However, traditional childbirth education classes, which meet in a series of evenings or Saturdays, may not meet the needs of women with a multiple pregnancy. In addition, because of the differences in care that exist for women with a multiple pregnancy, new paradigms for childbirth education are needed to meet the learning needs of these families. The purpose of this paper is to provide information to the childbirth educator on the differences in care women with a multiple pregnancy can expect and to suggest strategies to meet the childbirth education needs of these families.     

Position paper: promoting, supporting, and protecting normal birth

This updated position paper contrasts medical management of labor and birth with the normal physiology of birth and describes the care practices that support and facilitate the normal process. Lamaze International urges care providers to adopt these care practices as the standard of care, unless evidence-based medical reasons dictate otherwise. The roles of Lamaze-certified childbirth educators and the Lamaze Institute for Normal Birth in protecting, preserving, and promoting normal birth are described.     

Continuing education module-lamaze parents magazine: more than a giveaway

The Lamaze Parents magazine is an annual publication produced by Lamaze International to inform parents and childbirth educators on issues related to healthy birth preparation, normal birth, and parenting. The author of this column introduces teaching strategies for childbirth educators and doulas to use in tandem with the magazine's content in order to enhance their efforts in sharing current, evidence-based information with expectant parents.     

Step 5: has clearly defined policies, procedures for collaboration, consultation, links to community resources: the coalition for improving maternity services:

Step 5 of the Ten Steps of Mother-Friendly Care ensures that the hospital, birth center, or home birth service has clearly defined policies and procedures for collaborating and consulting with other maternity services and for linking the mother and baby to appropriate community services during both the prenatal and the postpartum periods. The rationales and evidence in support of this step are presented.     

Listening to mothers: take two

LISTENING TO MOTHERS II: Report of the Second National U.S. Survey of Women's Childbearing Experiences (Declercq, Sakala, Corry, & Applebaum, 2006) is essential reading for the childbirth educator. Birth continues to be "intervention intensive" in the United States, and less than 2% of women have births characterized by the six care practices that promote, protect, and support normal birth. Only a little more than half of the women surveyed attended childbirth education classes, and only 4% reported that childbirth classes were their most important source of information. Seventy-eight percent used the Internet as an information resource. As a result of childbirth classes, women report, they are more confident in their ability to give birth but also less fearful of medical intervention. The results of these and other findings have important implications for childbirth education.     

The power of numbers: transforming birth through collaborations

Collaborative efforts and coalitions have replaced exclusivity as birth organizations and individuals unite to humanize birth and provide women with transparency of information about maternity care providers and facilities and about access to the midwifery model of care. The Coalition for Improving Maternity Services and the upcoming 2010 "Mega Conference" to jointly celebrate the 50th anniversaries of Lamaze International and the International Childbirth Education Association serve as excellent examples of collaborative efforts to support natural, safe, and healthy birth practices as well as women's choices in childbirth. Childbirth educators are encouraged to learn from and support national coalitions devoted to improving maternity care and to use local resources to develop their own collaborative efforts on behalf of childbearing families.     

Advancing normal birth: organizations, goals, and research

In this column, the support for advancing normal birth is summarized, based on a comparison of the goals of Healthy People 2010, Lamaze International, the Coalition for Improving Maternity Services, and the midwifery model of care. Research abstracts are presented to provide evidence that the midwifery model of care safely and economically advances normal birth. Rates of intervention experienced, as reported in the Listening to Mothers survey, are compared to the forms of care recommended by the Cochrane Database of Systematic Reviews. Implications for perinatal education are addressed.     

New fathers' postbirth views of antenatal classes: satisfaction, benefits, and knowledge of family services

New fathers (men whose partners had recently given birth) were asked to indicate to what degree antenatal classes had prepared them for childbirth, for their role as support persons, and for lifestyle and relationship changes after the birth. These postbirth findings were compared with a previous exit survey of male attendants at antenatal classes in which fathers-to-be predicted that the antenatal classes had prepared them well on all fronts. The new fathers in this study, however, reported that the antenatal classes had prepared them for childbirth but not for lifestyle and relationship changes after the birth. Additionally, couples who attended antenatal classes were asked to what extent they were familiar with family-related services in the region and how often they had used these services since the birth of their baby. Fathers were less familiar than mothers with the family-related services.     

Infant Temperament: Stability by Age,Gender, Birth Order,Term Status,and Socioeconomic Status

Two complementary studies focused on stability of infant temperament across the 1st year and considered infant age, gender, birth order, term status, and socioeconomic status (SES) as moderators. Study 1 consisted of 73 mothers of firstborn term girls and boys queried at 2, 5, and 13 months of age. Study 2 consisted of 335 mothers of infants of different gender, birth order, term status, and SES queried at 6 and 12 months. Consistent positive and negative affectivity factors emerged at all time points across both studies. Infant temperament proved stable and robust across gender, birth order, term status, and SES. Stability coefficients for temperament factors and scales were medium to large for shorter (< 9 months) interassessment intervals and small to medium for longer (> 10 months) intervals.     

Childbirth education for multiple pregnancy: part 2: intrapartum and postpartum considerations

Women with a multiple pregnancy can expect a different labor and birth course than those with a singleton pregnancy. While the postpartum period is similar to that of families with a singleton, it is likely to be more hectic in families with multiple infants. In addition, a multiple pregnancy increases both maternal and neonatal risks; therefore, women with a multiple pregnancy may experience slight differences in care due to these potential risks, including additional monitoring and treatment. This article discusses the intrapartum and postpartum considerations families with a multiple pregnancy/birth may experience. This information is provided so that the childbirth educator can incorporate this content into courses, as appropriate, and assist families with a multiple pregnancy to anticipate a realistic birth and postpartum experience.     

Listening to Mothers II: Knowledge, Decision-Making, and Attendance at Childbirth Education Classes

In this column, a woman describes her concern that her childbirth classes did not provide the information she needed to make informed decisions during labor and birth. The results of the Listening to Mothers II survey suggest that this experience is not unusual. Although most women (97%) who participated in the survey wanted to know all or most of the potential risks of epidural, induction, and cesarean before consenting to have the intervention, the majority-including mothers who had experienced the intervention, women who were experienced mothers, and women who had attended childbirth classes-did not know the complications of induction or cesarean. These findings raise important questions about the outcomes of childbirth education. The factors that may contribute to these findings are discussed, and suggestions are made for insuring that women have the knowledge they need to make informed decisions about their maternity care.     

Fathers' birth attendance, early contact, and extended contact with their newborns: a critical review

Research concerning fathers' birth attendance, early contact, and extended contact with newborn infants is reviewed in this paper. Relationships between fathers' early history with infants and subsequent patterns of involvement are discussed. The methodological challenges of studying the effects of fathers' birth attendance and early contact with infants are considered. In contrast to popular belief, no conclusive statements can be made at this time concerning the effects of paternal birth attendance, early contact, and extended contact on father involvement in infancy. Implications for future research and policy-making are discussed.     

Prenatal and Postnatal Diagnosis of Infant Disability: Breaking the News to Mothers

The birth of an infant with a disability is often perceived as the loss of a “perfect” baby and is typically an unanticipated event for the mother and family. Mothers may experience self-blame for the disability; therefore, sensitive communication is crucial. A private setting is recommended, with a minimum of health-care professionals in attendance when the diagnosis is revealed. The perinatal educator can guide the mother through the early emotional phases of processing and accepting the new information by offering support and incorporating timely information and interventions. The perinatal educator can also inform and prepare other expectant couples in the childbirth class and encourage them to support the mother and father in celebrating the forthcoming birth. The objective of nursing care for a mother whose infant is newly diagnosed with a disability is to facilitate a positive outcome for her and to promote optimal infant bonding. In all communication and information, replacing the term “disabled infant” with “infant with a disability” is emphasized in order to recognize the infant first and the disability second.     

A call to action and a challenge to use a standard to measure mother-friendly birth classes

In spite of the efforts of numerous organizations and individuals to offer mother-friendly birth information and care in the United States, the nation remains a highly technical, low-touch birth culture with a decline in positive maternal-fetal outcomes. A number of organizations and individuals came together to form the Coalition for Improving Maternity Services and to create the Mother-Friendly Childbirth Initiative (MFCI). The MFCI is a wellness model of maternity care that offers 10 evidence-based steps of care that will improve birth outcomes and reduce costs. Birth educators can use this self-assessment tool to provide the same evidence-based information.     

Birth,Bath, and Beyond: The Science and Safety of Water Immersion During Labor and Birth

The 2014 objection to birth in water voiced by both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) in ACOG Bulletin #594 on immersion in water during labor and birth is nothing new. The Committee on Fetus and Newborn published the very same opinion in 2005, based on a case report that was published in 2002 in the journal Pediatrics. What has changed since 2002 is a growing body of evidence that reports on the safety and efficacy of labor and birth in water. This article reviews the retrospective literature on water birth and explains newborn physiology and the protective mechanisms that prevent babies from breathing during a birth in water.     

Promoting, protecting, and supporting normal birth

In this professional paper, published by Lamaze International and reprinted here with permission, Lamaze International identifies six care practices-adapted from the work of the World Health Organization-that promote, protect, and support normal birth. The six care practices are: labor begins on its own; freedom of movement throughout labor; continuous labor support; no routine interventions; non-supine (e.g., upright or side-lying) positions for birth; and no separation of mother and baby with unlimited opportunity for breastfeeding. Evidence to support each care practice is presented. Health-care providers and places of birth are encouraged to adopt these care practices as standards of care. Additionally, women are encouraged to choose health-care providers and places of birth whose care practices promote, protect, and support normal birth.     

Transparency in Maternity Care: Empowering Women to Make Educated Choices

The author of this guest editorial calls for a higher level of transparency in maternity care. The public should have access to information about hospital and provider policies and practices so that women and their families can determine where and with whom to birth. Currently, many grassroots-level projects, including The Birth Survey, are addressing this need.     

出生性别比偏高的原因、后果及治理对策研究——以南京市为例

20世纪80年代初以来,南京市人口的出生性别比持续攀升,导致的原因既与传统观念相关,又与经济、政治、社会与文化环境密切相关。出生性别比失调可能引发一系列严重的社会问题,从而对社会经济发展带来某些不利的影响。综合治理出生性别比偏高成为必然。