Robyn’s Birthing Story

This “Celebrate Birth!” column describes the experience of a long-time childbirth educator who attended the birth of her granddaughter Cora, her daughter Robyn’s second hospital birth. She discusses how Robyn’s instincts and confidence helped to overcome institutional issues to provide a good and safe birthing experience.     

Elisabeth Bing Is a Treasure: Personal Reflections on a Life in Birth

Celebrating Elisabeth Bing’s 100th birthday is an honor and a joy. Elisabeth’s life is an inspiration to all who continue her mission of birth and women’s advocacy. Dr. Mary Jo Podgurski strives to capture the indomitable spirit of the founder of American Society for Psychoprophylaxis in Obstetrics (ASPO)/Lamaze (now Lamaze International) through a personal reflection. Elisabeth Bing lived with valor. She is a role model to women everywhere, the mother of childbirth education, and a woman of great courage and wisdom. Thank you, Elisabeth, for the huge gift of your life.     

Jack Thomas,Our Third Baby,Enters the World!

Without the confidence and support of the medical team, this mother’s first birth was difficult and unsatisfying. She was able to give birth naturally, in the care of a midwife, with her second baby. With confidence in her ability to give birth and the wisdom that comes with experience, she is able to give birth naturally with her third baby in spite of being induced.     

Freebirth

This column is a literary, personal essay about the author’s spouse and her experience with unassisted birth.     

Julian’s Birth

A grandmother of seven and childbirth educator shares her daughter’s successful vaginal birth after cesarean (VBAC) birth story in Switzerland.     

Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary

Maternity care in the United States is intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy is far from restrictive. These interventions disturb the normal physiology of labor and birth and restrict women’s ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. This article is an updated evidence-based review of the “Lamaze International Care Practices That Promote Normal Birth, Care Practice #4: No Routine Interventions,” published in The Journal of Perinatal Education, 16(3), 2007.     

How Birth Doulas Help Clients Adapt to Changes in Circumstances,Clinical Care,and Client Preferences During Labor

This study examined how doulas adapt to challenges in client’s labors. There were 104 Canadian and 92 American doulas who responded to a survey distributed at a doula conference. We report results from open-ended questions in which doulas describe how they manage changes deviating from the mother’s birth plan and how they navigate differences of opinion between themselves and providers. Four themes emerged: giving nonjudgmental support, assisting informed decision making, acting as a facilitator, and issues with advocacy. Although 30% of doulas said that advocacy and information giving could result in conflict with providers, doulas reported working within their scope of practice and striving to be part of the team. Issues in doula responsibility and patient advocacy remain, and ongoing role clarification is needed.     

Influence of Culture and Community Perceptions on Birth and Perinatal Care of Immigrant Women: Doulas’ Perspective

A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women’s birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended.     

Giving Birth: “We Just Don’t Talk About It”

In this column, Alyson Grauer, a young woman recently embarking on her postuniversity career, shares her experiences with friends who do not talk about childbirth. She contrasts their fear and their unwillingness to talk and learn about birth with her own experience being the daughter of a Lamaze Certified Childbirth Educator and doula. Grauer’s experiences provide a backdrop for a deeper understanding of young adults’ beliefs about childbirth. Judith Lothian provides insight related to when and why women and men stopped talking about birth and the implications for childbirth education.     

Transitions: The Birth of Flora Arden

In this column, a young mother shares the story of her second home birth. Like the birth of her first baby, her daughter Flora’s birth was supported by the presence of a midwife and doula, the peace and quiet of her own home, and the love of her husband and family. Birth is described as transforming and a powerful transition for women. She describes the births of both her children as being “forever emblazoned on my heart as the sweetest and strongest days of my small life.” Paralleling this story of birth is the story of her mother-in-law as she faces brain cancer and seizes the power of that life transition.     

Exploring the Group Prenatal Care Model: A Critical Review of the Literature

Few studies have compared perinatal outcomes between individual prenatal care and group prenatal care. A critical review of research articles that were published between 1998 and 2009 and involved participants of individual and group prenatal care was conducted. Two middle range theories, Pender’s health promotion model and Swanson’s theory of caring, were blended to enhance conceptualization of the relationship between pregnant women and the group prenatal care model. Among the 17 research studies that met inclusion criteria for this critical review, five examined gestational age and birth weight with researchers reporting longer gestations and higher birth weights in infants born to mothers participating in group prenatal care, especially in the preterm birth population. Current evidence demonstrates that nurse educators and leaders should promote group prenatal care as a potential method of improving perinatal outcomes within the pregnant population.     

Vicarious Birth Experiences and Childbirth Fear: Does It Matter How Young Canadian Women Learn About Birth?

In our secondary analysis of a cross-sectional survey, we explored predictors of childbirth fear for young women (n = 2,676). Young women whose attitudes toward pregnancy and birth were shaped by the media were 1.5 times more likely to report childbirth fear. Three factors that were associated with reduced fear of birth were women’s confidence in reproductive knowledge, witnessing a birth, and learning about pregnancy and birth through friends. Offering age-appropriate birth education during primary and secondary education, as an alternative to mass-mediated information about birth, can be evaluated as an approach to reduce young women’s childbirth fear.     

Choice? Factors That Influence Women’s Decision Making for Childbirth

This article reports the findings from a mixed-methods study on factors that influence women’s decisions about birth, with the view that women’s decision making about birth can affect the use of cesarean surgery. Data was collected from focus groups and structured postpartum interviews and was analyzed using the Consensual Qualitative Research method. The findings relate specifically to the factors reported as influential in making decisions about birth including how the women categorized, prioritized, and/or favored certain types of knowledge about modes of birth. Four major information categories were identified but only stories about birth and/or attending a birth appeared to have a lasting effect on birth choices. These findings have implications for prenatal and perinatal education and nursing practice.     

Men’s Perceptions of Pregnancy-Related Weight Gain: A Psychosocial Firestorm (Upheaval) Intertwined With Supportive Intentions

In-depth interviews were conducted with 16 men who had a significant other who had given birth within the last 5 years. Men were asked about their perceptions of pregnancy-related weight gain, and content analysis was used to identify themes from the interviews. Men described nine themes related to perinatal weight gain: (a) negative perceptions, (b) eating behaviors, (c) exercise habits, (d) health impact, (e) body changes, (f) weight-loss success, (g) “it bothered her more than me,” (h) “the weight gain wasn’t a problem,” and (i) intimacy. Together, these themes offer a glimpse into men’s experiences and highlight the discord and balance between experiencing negative feelings/perceptions and being a supportive partner. This information on how men perceive pregnancy-related weight gain can be used to develop interventions to assist men to support their significant others in meeting weight loss goals following pregnancy.     

Childbirth Education and Obstetric Interventions Among Low-Risk Canadian Women: Is There a Connection?

The objective of this study was to examine the associations between attendance at childbirth education classes and maternal characteristics (age, income, educational level, single parent status), maternal psychological states (fear of birth, anxiety), rates of obstetric interventions, and breastfeeding initiation. Between women’s 35th and 39th weeks of gestation, we collected survey data about their childbirth fear, anxiety, attendance at childbirth education classes, choice of health-care provider, and expectations for interventions; we then linked women’s responses (n = 624) to their intrapartum records obtained through Perinatal Services British Columbia. Older, more educated, and nulliparous women were more likely to attend childbirth education classes than younger, less educated, and multiparous women. Attending prenatal education classes was associated with higher rates of vaginal births among women in the study sample. Rates of labor induction and augmentation and use of epidural anesthesia were not significantly associated with attendance at childbirth education classes. Future studies might explore the effect of specialized education programs on rates of interventions during labor and mode of birth.     

Envisioning outcomes from choosing the midwifery model of perinatal care

This birth story illustrates one woman's view of the importance of the type of birthing care she received and the involvement of her existing child in a second birth. The value of the mother's vision and her ability to participate in fully informed choices are emphasized.     

Student performance–university preference model: a framework for helping students choose the right A‐level subjects

Every year, many students in the UK fail to achieve a place at their preferred university because they take the wrong A‐level subjects. This study aims to suggest a framework for helping students choose the right subjects. Data on student achievement in A‐level examinations were obtained from a UK sixth form college over a four‐year period. Statistical techniques were employed to support our hypothesis that a student’s choice of A‐level subjects should be based on both the student’s ability and a university’s preference for particular subjects and grades. Despite the limitation of small sample size, a model has been created that will maximise a student’s chance of achieving a place at his/her university of choice. The model presented could easily be extended in future to incorporate more levels in each of the attributes considered, and in this way it could provide the optimal choice of subjects for each individual student given his/her particular aspirations.     

铁凝:直面人性的探寻

铁凝在作品中将直面人生、审视人性作为创作的主题 ,具体表现为五个方面 :对于情绪记忆的自审与忏悔 ;逃遁窥视、渴望交流的期待 ;自足与他足的抉择 ;角色意识与反角色意识的束缚与解脱 ;失语小人物的脆弱人性等 ,从而营构了其独特的小说世界。     

Continuing Education Module Styles Vary When Teaching Expectant Parents About Medications

In this column, the author presents information from prominent Lamaze childbirth educators and from the literature to describe various options that educators can share with expectant parents regarding the use of pain relief medications during labor and birth. Ann Tumblin teaches about epidurals in a hospital class without losing sight of evidence-based practices that support normal birth. Jessica English focuses her classes on the natural processes of giving birth and spends only a little time presenting information about pain medications. Judith Lothian encourages educators to consider a new framework for Lamaze classes that involves letting go of the details and incorporating Lamaze’s six Healthy Birth Practices and storytelling.