ICEA Study Guide 1 – ICEA & Family Centered Maternity Care

OBJECTIVES At the completion of Part 1 the learner will:

■ recall the ICEA motto, the ICEA mission & philosophy statements, and ICEA history

■ define the role and the scope of practice for the childbirth educator

■ recall a brief history of models for childbirth education

■ plan to complete the steps in becoming an ICEA certified childbirth educator

■ recall four levels of support for the ICEA professional childbirth educator

■ state ways in which ICEA supports the childbearing family

■ describe the ICEA Circle of Care and relate it to family-centered maternity care.

 

OUTLINE

  1. Understanding ICEA
  2. ICEA mission and philosophy statements and motto

Mission – The International Childbirth Education Association (ICEA) is a professional organization that supports educators and health care professionals who believe in freedom to make decisions based on knowledge of alternatives in family-centered maternity and newborn care.

ICEA supports the World Health Organization’s Code of Marketing Breastmilk Substitutes. ICEA’s goals are to provide:

  • Training and continuing education programs
  • Quality educational resources
  • Professional certification programs

Brief History: ICEA is a nonprofit organization. Since its formation in 1960, ICEA members and member groups have remained autonomous, establishing their own policies and creating their own programs. There are no membership requirements for individuals other than a commitment to family-centered maternity care and the philosophy of freedom to make decisions based on knowledge of alternatives in childbirth.

Philosophy– Family-centered maternity care is ICEA’s primary goal and the basis of ICEA philosophy. In 1986 ICEA adopted the McMaster University definition of FCMC:

Philosophy: The birth of a baby represents the birth of a family. The woman giving birth and the persons significant and close to her are forming a new relationship, with new responsibilities to each other, to the baby, and to society as a whole. Family-centered reproductive care may be defined as care which recognizes the importance of these new relationships and responsibilities, and which has as its goal the best possible health outcome for all members of the family, both as individuals and as a group.

Family-centered care consists of an attitude rather than a protocol. It recognizes a vital life event rather than a medical procedure. It appreciates the importance of that event to the woman and to the persons who are important to her. It respects the woman’s individuality and her sense of autonomy. It realizes that the decisions she may make are based on many influences of which the expertise of the professional is only one. It requires that all relevant information be made available to the woman to help her achieve her own goals, and that she be guided but not directed by professionals she has chosen to share the responsibility for her care.

Practice: The practice of family-centered maternity care is founded on this philosophy and encompasses birth practitioners, birth places, and maternity-newborn care, as determined by the needs and decisions of each woman and her family.

Motto in website header: Freedom to make decisions based on knowledge of alternatives in family-centered maternity and newborn care

ICEA Mission – a professional organization that supports educators and other health care providers who believe in freedom to make decision based on knowledge of alternatives in family-centered maternity and newborn care.

ICEA’s goals are to provide:

  • Training and continuing education programs
  • Quality educational resources
  • Professional certification programs

Philosophy: Family-centered maternity care is ICEA’s primary goal and the basis of ICEA philosophy. In 1986 UCEA adopted the McMaster University definition of FCMC:

Philosophy: The birth of a baby represents, as well, the birth of a family. The woman giving birth and the persons significant and close to her are forming a new relationship, with new responsibilities to each other, to the baby, and to society as a whole. Family-centered reproductive care may be defined as care which recognizes the importance of these new relationships and responsibilities, and which has as its goal the best possible health outcome for all members of the family, bot as individuals and as a group.

Family-centered care consists of an attitude rather than a protocol. It recognizes a vital life event rather than a medical procedure. It appreciates the importance of that event to the woman and to the persons who are important to her. It respects the woman’s individuality and her sense of autonomy. It realizes that the decisions she may make are based on many influences of which the expertise of the professional is only one. It requires that all relevant information be made available to the woman to help her achieve her own goals, and that she be guided but not directed by professionals she has chosen to share the responsibility for her care.

Practice: the practice of family-centered maternity care is founded on this philosophy and encompasses birth practitioners, birth places, and maternity-newborn care, as determined by the needs and choices of each woman and her family.

Brief History: ICEA Is a nonprofit organization. Since its formation in 1960, ICEA members and member groups have remained autonomous, establishing their own policies and creating their own programs. There are no membership requirements for individuals other than a commitment to family-centered maternity care and the philosophy of freedom to make decisions based on knowledge of alternatives in childbirth.

History of Childbirth Education – when birth took place in homes, the birthing woman was surrounded by women who provided advice, encouragement and support. When birth moved into the hospital in the 20th century, women lost the wisdom gained from being present at births throughout their lifetimes.

Dr. Grantly Dick-Read is credited with the birth of modern childbirth education. He offered a woman chloroform and she said no thank you, it doesn’t hurt and that changed his life. His book Childbirth Without Fear was published in 1942. He sought to reduce fear by educating women about what to expect during birth, and to reduce tension by teaching relaxation techniques. He helped countless women break the “Fear-Tension-Pain” cycle.

In 1950s, French Dr. Fernand Lamaze adapted Russian techniques of psychoprophylaxis. Early Lamaze strategies included focused breathing, relaxation techniques, and continuous support by a special nurse known as a monitrice. American women who gave birth with him returned to U.S. and wrote book Thank You, Dr. Lamaze which helped to spark natural childbirth in the U.S. in 1960, Lamaze and ICEA were formed. Both have continued to inform birthing women since that time. ICEA mission is to support educators and other health care providers who believe in freedom of choice based on knowledge of alternatives. Lamaze International works to promote, support and protect natural, safe and healthy birth through education and advocacy through the dedicated efforts of professional educators, providers and parents.

For more info see: Birth – The Surprising history of how we are born by T. Cassidy, Lying in- a history of childbirth in America by Wertz or Deliver me from pain – anesthesia & birth in America by Wolf. Also The timeless way video clips.

Significant Events in U.S. Childbirth History:

  • 1800s – physicians started attending normal births in mid 1800s. most babies born at home. 1847- Semmelweis instituted hand-washing in Vienna; Simpson introduced ether into obstetric practice in Scotland
  • 1900s- 50% of births attended by midwives; 50% by physicians
  • 1910s – American women marched in streets for right to have “twilight sleep”; 1915- low cervical cesarean significantly decreased infection/rupture (maternal mortality 600/100,000; infant mortality 124/1000)
  • 1920s – 1920 – DeLee published The Prophylactic Forceps Operation; 1925 – Frontier Nursing Service, staffed by nurse-midwives founded
  • 1930s – only 15% of births attended by midwives; births split 50/50 home/hospital. NY Academy of Medicine campaigned against unnecessary instrument and drug intervention. Sulfa drugs discovered; blood banks established (maternal mortality 620/100,000; infant mortality 65/1000; cesarean rate 2.5%)
  • 1940s – 1942 – Childbirth Without Fear by Dr. Grantly Dick-Read publishes; penicillin became widely available (maternal mortality 355/100,000; infant mortality 47/1000)
  • 1950s – 95% of all births in hospital; 1956 – La Leche League held 1st meeting; 1959 – Thank You, Dr. Lamaze published (maternal mortality 83.3/100,000; infant mortality 29.2/1000)
  • 1960s- natural childbirth movement underway, with formation of both ASPO/Lamaze and ICEA in 1960; fathers fought to enter delivery room (maternal mortality 32.1/100,000; infant mortality 26/1000; cesarean rate 4.9%)
  • 1970s- electronic fetal heart monitors introduced without randomized, controlled trials; EFM led to wider use of epidural anesthesia (maternal mortality 21.5/100,000; infant mortality 20/1000; cesarean rate 5.5%)
  • 1980s- first large scale, random studies of continuous EFM: showed no benefit (maternal mortality 9.4/100,000; infant mortality 12.6/1000; cesarean rate 16.5%)
  • 1990s- 1992 – DONA International formed (originally Doulas of North America); Lamaze Philosophy of Birth adopted; Childbirth Summit (Birth of CIMS); VBAC increased from 12.6% in 1988 to peak of 28.3% in 1996 (maternal mortality 8.2/100,000; infant mortality 9.2/1000; cesarean rate 22.7%)
  • 2000s – ‘00- WHO Code adopted by Lamaze International; ‘01- VBAC safety questioned, rate plummeted to 9.2% in ‘04; ‘03- ACOG states its ethical to do elective primary cesareans (maternal mortality 8.9/100,000; infant mortality 6.89/1000; cesarean rate 22.9%)
  • 2010s – ’10- NIH Consensus Development Conference on VBAC; ’10- Lamaze and ICEA celebrate 50th anniversaries with joint conference; ’14- Joint Commission Perinatal Quality Measures on elective births before 39 weeks; low-risk cesarean rates; and exclusive breastfeeding at discharge become mandatory for hospitals with >1100 births. ’14- ACOG recommends generally no inductions except for medical reasons and inductions for post-dates after 42 weeks (maternal mortality 21/100,000; infant mortality 6.5/1000; cesarean rate 32.7%)
  1. ICEA promotes informed decision-making, evidence-based teaching, and family-centered care to 
insure the best health for childbearing families.

ICEA Position Paper: The Role and Scope of Practice for the Childbirth Educator 


http://icea.org/wp-content/uploads/2016/01/Role_Scope_CBE_PP.pdf

Childbirth Educators positively impact birth outcomes and parent satisfaction. Birth of baby represents birth of a family. ICEA- evidence-based family-centered maternity care and use of nonmedical and self-care techniques to encourage a normal, physiologic, pregnancy, labor and birth. ICEA endorses health care circle (team) and at center is pregnant woman.

Childbirth Educator:

  1. Upholds right of pregnant woman to care that is accessible, affordable and acceptable
  2. Does not discriminate in services or alternatives on basis of race, color, culture, age, language, marital status, or method of payment
  3. Recognizes that birth can safely take place in hospitals, birth centers and homes
  4. Functions as advocate who supports/protects natural process of birth
  5. Supports right of pregnant woman to be accompanied by person of her choice
  6. Supports right of woman to make informed decisions based on knowledge of benefits, risks and alternatives
  7. Encourages parental and family participation in childbirth
  8. Promotes mother, baby and family centered care as well as breastfeeding and parent-infant bonding
  9. Supports maternity care system based on needs of family, not provider
  10. Supports open communication and shared decision-making
  11. Cooperates w medical, midwifery and nursing communities, health and social service agencies and woman’s circle
  12. Views parents as capable of understanding healthcare technology and responsibility for own healthcare and that of their baby
  13. Recognizes education is only one of interrelated factors affecting process and outcome of birth
  14. Provides evidence-based info anchored in current research
  15. Identifies need for guidance and referral and offers them when appropriate
  16. Accepts parents point of view about what constitutes a good birth experience and does not set arbitrary standards or expectations and
  17. Helps parents develop realistic goals for pregnancy, birth and early parenthood.

Childbirth Educator is advocate for families, supporting family’s growth and development as they transition through pregnancy to parenthood and an advocate for women, promoting the health, autonomy, individuality and integrity of women as human beings.

Childbirth Educator maintains the role of CE is to act as:

  1. Teacher who provides info about physiology, psychology and sociology of pregnancy, childbirth, postpartum and early parenthood; demonstrates skills to assist women and their support persons to cope with pregnancy, childbirth, postpartum and early parenthood; and encourages communication between pregnant woman and other members of her health care circle.
  2. Facilitator who helps families better understand and value the experience of the transition to parenthood;
  3. Advocate for pregnant women, their partners, infants and families; and
  4. Spokesperson for development of maternal-child health care system that provides access for parents to safe, low-cost and family centered maternity care both within and outside the hospital.

All men and women have right of access to education about sexuality, reproduction, pregnancy, birth and parenthood. Educational programs should be financially and geographically accessible in all communities and be sensitive to individual differences of age, culture, race, health status, socioeconomic status and partner status. To ensure that CE programs are accessible to all women and their families ICEA encourages gov and other agencies to provide 3rd party reimbursement for CE services.

Childbirth Educator and parent education should be an integral part of the school health curriculum to encourage assumption of personal responsibility for reproductive health decisions by males and females ant to promote healthy attitudes and knowledge about sexuality, reproduction and parenthood.

Every woman should have the opportunity to give birth as she wishes in an environment that supports her physical and emotional needs.

  1. ICEA promotes informed decision-making, evidence-based care, and family- centered care to promote the best health for childbearing families
  2. Position Paper: The Role and Scope of Practice for the Childbirth Educator 
 see above
  3. Role and scope of practice for the childbirth educator

 

 

http://icea.org/about/icea-journal/

International Journal of Childbirth Education (IJCE) is the official journal of ICEA. It is a quarterly, peer-reviewed journal publishing original research, insights in practice and policy, commentaries, and book reviews relating to research and practice in family-centered maternity and newborn care

http://icea.org/wp-content/uploads/2015/12/CBEd-JUL-web-FINAL.pdf

 

www.ICEA.org: Membership-Certified Member’s Directory 


Search for childbirth educators, birth doula, postnatal educators, postpartum doula or prenatal fitness instructors by location, name etc.

 

ICEA Position Paper on Family Centered Maternity Care 


http://icea.org/wp-content/uploads/2016/01/Family_Centered_Maternity_Care_PP.pdf

Family centered maternity care may be carried out in any birth setting: home birth, birth center, hospital birth or emergent birth. FCMC respects family as a unit, the mind-body-spirit of the family and provides evidence-based care accordingly.

FCMC has been hallmark of ICEA since inception in 1960. At that time, that meant including father in classes and birth. Over time, more members welcomed but technology played increasingly significant role. 1996, Coalition for Maternity Services published Mother Friendly Childbirth Initiative.

Respect – mutual respect foundational to FCMC – respect for pregnancy as a normal, healthy event in a woman’s life, respect for parents as primary caregivers, respect of each member of circle of care

When pregnancy acknowledge as healthy life event rather than condition that must be treated, intervention will be minimal. Women choose whether or not to modify diet and other aspects of lifestyle.

Openness – open communication necessary to provide highest quality care. Relational competency also necessary to FCMC – extends beyond simple communication to include sensitivity and compassion. Communicating facts without sensitivity is not characteristic.

Confidence – imbuing woman and her family w confidence is central to FCMC. Birth more than just mechanical event of moving baby from inside to outside. It is one of the most significant developmental stages of life – emotionally and socially.

Goal of FCMC is to build confidence of new parents. Supporting and encouraging them as they care for their infant builds trust in their own abilities. When professionals perform tasks parents can do on their own, they undermine the parents’ sense of competence. In case of high-risk infants, parents should participate as much as possible in infants care.

Knowledge – necessary for women to be wise decision-maers. Make sure she is aware of evidence-based research and all options available to her.

Atmosphere – women will:

  • Choose caregiver/birthplace most beneficial for her
  • Work in collaboration w healthcare providers and other advisers she chooses
  • Have support people she desires present whenever she wishes
  • Move around and use whatever position she feels is beneficial during labor
  • Refuse routine procedures not evidence-base
  • Practice uninterrupted skin-to-skin and breastfeeding immediately after birth, keeping baby with her at all times (rooming in)
  • Have access to variety of support groups including those for breastfeeding, postpartum emotional health and parenting.

Facilities should provide education for staff and training in communication skills, labor support, non-pharmacologic forms of pain relief, breastfeeding support and perinatal mood disorders. Cultural preferences of mom should be honored.

In additional to specific classes for childbirth and breastfeeding, education should be part of each prenatal and postpartum visit. Info about support groups for breastfeeding, perinatal mood disorders and early childhood parenting should be readily available.

Outcomes – FCMC results in greater satisfaction for all involved.

“FCMC consists of an attitude rather than a protocol” – ICEA. Attitudes, as well as organizational structures, must change before maternity care will be truly family-centered.

 

Prerequisites, Training & Certification of the Childbirth Educator 


http://icea.org/wp-content/uploads/2016/01/PCBE_Prerequisities_Training_Cert_for_CBE.pdf

No single training or academic background is necessary. No single profession includes within it all the appropriate training, knowledge and skills necessary for competency. Combines aspects of the arts and sciences of many disciplines including teaching, sociology, social work, anthropology, physiology, psychology, midwifery, nursing, and medicine. May be female or male, parent or nonparent, married or single. Although giving birth is a valuable personal experience, one can be a competent educator without having done so. Sensitivity, empathy, compassion and knowledge are more important than educator’s gender or type of birth experienced.

Specialized training/prep facilitates competence and is considered mandatory for the profession. Training may be provided by childbirth ed groups, self-education, apprenticeship or combination. Should allow CE to demonstrate competency in following subject areas:

  1. Basic counseling, group leadership, adult learning theories, and communication skills;
    2. Anatomy (male and female) and physiology of reproduction (conception through postpartum);
    3. Physical, emotional, and social changes of pregnancy, birth, and postpartum;
    4. Emotional changes of the father at each phase of pregnancy, birth, and postpartum;
    5. Impact of pregnancy and parenthood on the couple relationship;
    6. Coping mechanisms for labor, including relaxation, breathing, visualization, comfort measures, and physiologic methods of labor and birth management;
    7. The benefits of labor support;
    8. The grief and mourning process that follows loss and/or unexpected outcome;
    9. Body conditioning exercises for pregnancy, birth, and postpartum;
    10. Perinatal screening and diagnostic procedures;
    11. Common physiological complications of pregnancy, birth, and postpartum;
    12. Obstetrical interventions, procedures, and medications, including their indications, benefits, risks, and alternatives (nonmedical and medical);
    13. Teratogenic and iatrogenic influences in pregnancy;
    14. Fetal development and newborn characteristics;
  2. Newborn assessment and procedures, including
    circumcision;
    16. Maternal and infant nutrition, including breastfeeding;
    17. Family development;
    18. Sexuality and family planning;
    19. Techniques to aid understanding and evaluation of research;
    20. The history, development, and philosophy of childbirth education;
    21. Elements of family-centered maternity care;
    22. Cultural diversities for pregnancy, labor, birth, postpartum, and parenting; as well as
    23. The doctrines of informed consent, and the rights and responsibilities of parents and newborns.

The childbirth educator should demonstrate professional responsibility by:
1. Developing constructive relationships with other members of the health care circle who have
contact with class participants;
2. Acquiring knowledge of national, regional, and local laws and regulations pertaining to the rights and responsibilities of expectant and new parents and the legal responsibilities of the child birth educator;
3. Acquiring knowledge of professional organizations relating to prenatal education and early parenthood; and
4. Demonstrating knowledge of community health and social service agencies to which parents
may be referred.

The art is learned through practice and application of skills. Acquisition of knowledge and teaching skills best accomplished through ongoing certification program that includes: seminars, workshops and/or conferences; directed readings; observations of classes; directed practice teaching; observation of labors and births in a variety of settings; evaluated teaching; evaluations from both parents and peers; and periodic renewal or recertification that mandates continuing education, birth observations, peer evaluation, and membership in profession CE associations.

Practice Settings for the Childbirth Educator 


http://icea.org/wp-content/uploads/2016/01/PCBE_Practice_Settings_for_CBE.pdf

Place that:

  • Freedom to teach wide variety of options, including full range of alternatives
  • Promotes freedom of choice by parents in terms of where, how and with whom care takes place
  • Class size limited to 6-10 moms and support persons
  • Adequate physical surroundings

No inappropriate place except one that limits freedom of choice and knowledge of alternatives. Restrictions prevent fully informed decision making and may contribute to increasing medicalization of childbirth and a dehumanization of birth for woman and family.

Need to be aware of impact on setting on views of classes as related to professionalism, privacy, comfort, continuity, convenience and credibility.

ICEA Position Paper on Physiologic Birth 


http://icea.org/wp-content/uploads/2016/01/Physiologic_Birth_PP.pdf

While technology increases, maternal/infant morbidity/mortality rates have not shown significant improvements. ICEA defines physiologic birth as birth where baby is birthed vaginally following a labor, which has not been modified by medical interventions.

Normal Physiologic Childbirth

  • is characterized by spontaneous onset and progression of labor;
  • includes biological and psychological conditions that promote effective labor;
  • results in the vaginal birth of the infant and placenta;
  • results in physiological blood loss;
  • facilitates optimal newborn transition through skinto- skin contact and keeping the mother and infant together during the postpartum period; and
    supports early initiation of breastfeeding.

One that is without interference, complications and in line with normal body functions

Factors Influencing Physiologic Birth

The mother’s health status and education are two of the most important factors. A mother’s complicated health history and/or pregnancy may warrant interference.

Benefits of Physiologic Birth

Birth without medical intervention may have many benefits:

  • less postpartum pain;
  • quicker physical recovery from the birth;
  • increase in self-esteem as a result of the birth;
  • enhanced bonding with the baby;
  • reduced likelihood of post-natal depression;
  • a calmer, more settled baby;
  • an easier breastfeeding experience;
  • effective respiratory transition for the baby; and
  • more effective gut colonization that prevents allergies in the baby.

Additional benefits of physiologic birth include a reduction in genital tract trauma/need for suturing as well as triggering the production of certain proteins in a newborns’ brain that may improve brain development.

Intervening in a normal physiologic birth process, where there are no complications, increases the risk of complications for the mother and her baby.

Six evidence- based care practices that promote physiologic birth were created by Lamaze International and outline changes in labor care: avoiding medically unnecessary induction of labor, allowing freedom of movement for the laboring woman, providing continuous labor support, avoiding routine interventions and restrictions, encouraging spontaneous pushing in non-supine positions, and keeping mothers and babies together after birth without restrictions on breastfeeding

Expectant parents can optimize their chances for a physiologic birth by becoming educated in childbirth education classes with the latest research. Informed decision making must be at the forefront of our presentation of physiologic childbirth. The goals of prenatal (childbirth) education are to build women’s confidence in their own ability to give birth, to provide knowledge about normal birth, and to help women develop individualized birth plans that provide a road map for keeping birth as normal as possible even if complications occur.

Providing positive sources of media information, such as television shows or web information, can assist expectant parents in their quest for knowledge. Referrals to such out-of-classroom materials become necessary especially when limitations are placed on the dissemination of class information.

About The Author

Jessica